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"The school is built to accommodate 130 children. On the opening day 48 children were
admitted; the number on the roll at present being 110. The regularity of attendance is very
good, having regard to the fact that these are delicate children, and that this winter has been a
particularly foggy and damp one. The average attendance is 90 per cent.
"On the whole, the children show definite improvement in general health, and are noticeably
bright and happy. Of the 110 children in the school 50 are girls and 60 boys. Eight children
have been transferred to Downham from other open-air schools, and many others were formerly
in open air classes in the elementary schools at Downham. Twenty-two boys and 11 girls have
extra milk, ½ pint daily in the middle of the morning, and eight boys and four girls have cod liver
oil and malt, two teaspoonfuls daily, in school.
"The children may be classified as suffering from: malnutrition, 46; anaemia, 40; enlarged
cervical glands, 43; chronic bronchitis, 22; tuberculosis, 15; general debility, 15; unhealthy
tonsils or adenoids or both, 14; chronic blepharitis, 6; chronic otorrhœa, 5; old rickets, 5;
children with recent chorea, 4; fibrosis of lungs, 3; chronic nasal catarrh, 2; asthma, 2; tendency
to corneal ulcers, 2; rheumatism, 1. One child had undergone an operation for empyema and
six children had a family history of tuberculosis.
"1. Malnutrition.—As regards nutrition, all the children have gained in weight whilst
attending the school, the average increase for the boys being 1.7 kgs. and for the girls 2.3 kgs.
All the children have increased in height, the average increase for the boys being 2.4 cms. and for
the girls 2.5 cms. Other evidence of improved nutrition, e.g., elasticity of skin, firmness of
muscles, is shown by 19 boys and 18 girls.
"2. Anaemia.—17 boys and 14 girls show improvement in this respect.
"3. Enlarged cervical glands.—Of seven children who have at some time been under treatment
for tubercular glands, five are improved. One boy had to be referred to the Tuberculosis
Officer on account of enlarged axillary glands and is now in Highwood Hospital. In twentythree
cases the children have unhealthy tonsils or adenoids or have been operated on for tonsils
and adenoids, and ten show improvement. Of four children subject to bronchial catarrh, three
have improved. One child who attends hospital with chronic otorrhœa following an operation
for mastoid abscess, and one who has chronic blepharitis, show no change.
"4. Chronic Bronchitis.—Of these cases, eleven show all round improvement, two show
improvement of general health, the chest condition remaining unchanged, three improved during
the summer months, but had recurrences of bronchial catarrh and became anaemic during the
winter, and in four cases the condition remains as before.
"5. Tuberculosis.—Of three children who have had treatment for tubercular cervical glands,
two have improved in general health, the glands remaining quiescent. Of three children who
have been under treatment for abdominal tuberculosis, none has local symptoms now, two show
general improvement, one child is still anaemic. Of three cases of old abdominal tuberculosis and
enlarged bronchial glands, one is improved, one is anaemic although gaining in weight, and one
is now off the roll of the school. Of three children who have formerly had treatment for
tubercular chests, two are making good progress, one keeps thin and anaemic. One boy with
enlarged cervical glands developed enlarged axillary glands and is now at Highwood.
"6. General Debility.—Seven of these children show improvement.
"7. Unhealthy Tonsils or Adenoids.—Four children have had an operation, and all are
improved. In five cases an operation has been recommended. Three children remain
unchanged.
"8. Chronic Blepharitis.—In two cases the condition has improved, the other four remaining
unchanged.
"9. Chronic Otorrhoea.—-Two children have had ionisation and are cured of otorrhœa,
one showing considerable improvement in general health. The others remain unchanged.
"10. Old Rickets.—Three cases show general improvement in health.
"11. Choreic Children.—Four children have formerly had chorea and now are keeping
well. One had another mild attack of chorea during this winter. He is thin and anæmic and his
heart is not affected. One child still shows slight involuntary movements. He is of poor
nutrition and his heart has an apical systolic murmur. He does no drill, or games or school
bathing.
"12. Fibrosis of Lungs.—The general condition of these children is better.
"13. Chronic Nasal Catarrh.—The local condition is unchanged.
"14. Asthma.—One child has had no attack for some time and is making good progress.
"The other was a moderately severe case of asthma and chronic bronchitis with eczema.
I admitted him with some reluctance, on the recommendation of the hospital physician who
was treating him, the child's mother also being anxious for him to attend the school. He had
an attack of pneumonia in June, but since then has improved very much as regards general
health and attends school fairly regularly.
"15. Corneal Ulcers.—There has been no recurrence of ulcers, but one child still has chronic
blepharitis and conjunctivitis.
"16. Rheumatism.—One child with a history of an attack of acute rheumatism is doing well.
"17. Empyema.—This child remains thin and pale. The chest expansion is fair on the
affected side."