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50
Method of Inspection.—Inspection took place in the doctor's or teacher's room
as was convenient. A table with a basin of weak disinfectant and a plentiful supply
of towels were provided. The oculist sat at the table in a position for good daylight;
inspection and the children entered in single file, each child being seated opposite the
oculist during examination. The eyelids were everted sufficiently to obtain a
satisfactory view. The school nurse made notes on each case as directed. Advice
was given regarding individual treatment and it is to be noted that these suggestions
were accepted and carefully carried out in every case.
Conditions found on Examination.—Except for the two Swanley cases in which
there were definite signs of trachomatous infection, the majority of the cases were
of the so-called " follicular " type of conjunctivitis. In some the condition was
typically follicular, the lower lids alone being affected. In some the conjunctiva of
the lower lid and also of the fornix and bulb were studded with vesicular-like enlargements
which often had a brownish or blood-stained tinge. It was noticed that these
enlargements became more engorged and obvious the longer the lid was kept everted,
thereby suggesting a vaso-motor irritability. Other cases, and it was in these the
question of infectivity became more urgent, exhibited varying degrees of granulation
from a mere roughness apparent in the lower lids and at the extremities of the upper
lids to a more widespread granulation which suggested the possibility of trachoma,
latent or otherwise.
It is difficult from the administrative point of view to make hard and fast rules
concerning these cases of conjunctivitis. Definite cases of trachoma and of acute
conjunctival diseases present no difficulty as in these cases exclusion from school or
isolation is imperative. But in a large number of borderline cases in which there is
a certain degree of granulation in the conjunctiva without pronounced symptoms
(corneal affection, photophobia, etc.), would complete or partial isolation be justified ?
Are these children to be cut off from swimming for example ? A child with a lid
condition that is faintly suggestive of contagious disease must not be allowed to run
the risk of spreading the contagion to others. Most lid conditions are chronic and
until they have cleared up the child may have to be cut off from much of its normal
daily activities and amusements. This to a child without any declared
" disability " seems inexplicable and may lead to untoward results mental and
physical.
On the other hand, if it be decided to legislate merely for those on whom definite
suspicion can rest there is a risk that the condition may be spread. In practice it has
been assumed that all the cases in the list are potentially infective and require local
treatment. No case which required treatment was allowed to take up swimming
until specially permitted. That a course of inspection and treatment is of benefit
in these cases can be seen from the results obtained.
The specific causation of conjunctival disease in an institution such as the one
inspected cannot be explained from the facts available and the idea of a bacteriological
examination had to be abandoned on account of practical difficulties. That some
external irritant (dust) or internal excitant (diet, e.g.) acts as a common factor is
not unlikely.
Anerley
Residential
School.
As in the case of the orphanage above reported, the inquiry at this residential
school was carried out in close co-operation with the medical officer in charge
and treatment was assiduously applied by the school nurse although much extra
work on her part was involved.
The numbers on the roll at the time of the first inspection (28th May, 1930) were
564, of whom 531 were actually in attendance. Thirty-one children were absent at
Broadstairs, but were inspected on their return to Anerley. The first inspection of
children in attendance extended over three visits, viz., 28th May, 4th and 5th June.
A list of 190 children (88 boys, 102 girls) affected with any form of conjunctival
disease was drawn up. Of these, in the case of 7 boys and 3 girls trachoma was
suspected and the children were referred to the County Hall where Mr. Bishop
Harman recommended them for admission to Swanley. Four of them, 3 boys and
1 girl, were seen again on 19th September on their return. They were advised