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28
(b) The decline in the number of children in the schools.
(c) Fewer children found by the school doctors, which may partly
be accounted for by the overtaking of arrears already considered, but
also probably on account of the children being generally healthier.
(d) The increased charge for operation (from 2s. to 5s.).
(e) The alteration in attitude of the profession, which is adopting
a more cautious procedure before recommending operation under the
influence of the Board of Education's medical department and other
authorities.
With regard to (a) it may be mentioned that, up to 1929, it was not
possible to deal with more than about 15,000 operation cases a year. With the
help of the appropriated hospitals this number was increased during 1930
and 1931 to over 16,000 a year, with the result that the accumulation of
cases was overtaken. The following statement shows the number of
operations performed during the years 1928—1933 inclusive.
Year.
No. of
Operations.
Year.
No. of
Operations.
1928 15,036 1931 16,243
1929 14,904 1932 13,765
1930 16,215 1933 10,008
It is quite impossible to assess the relative effect of these various causes,
but it would appear that causes (a) and (c) are most preponderant, in London
at any rate.
(iii) Minor Ailments.—Two slighter influences have already been discussed,
namely:—
(a) The influence of the block grant.
(b) The reduction of the numbers of children in the schools. This
latter influence is independent of medical inspections, as the vast bulk of
children suffering from minor ailments is not discovered by the
doctors at routine inspections. A fall in school population should
therefore mean a fall in the number of minor ailments suffered by the
children. This, however, is masked by the considerable fluctuation in
the incidence of these complaints from year to year. The chief influence
in the decline of minor ailments this year is
(c) the healthier condition of the children. This may be either
temporary or permanent. The past year has been exceptionally fine
and sunny, and in former dry and sunny years a similar improvement
has been recorded; it must therefore be feared that the improvement
is mostly climatic and may not be lasting. In a year like 1933 natural
ultra-violet radiation must have had a powerful effect upon these conditions
which are mainly external. There is, however, some hope that
part of the improvement is permanent and due to better care and
improved housing conditions—it is noticed that the fall in numbers is
greater where housing conditions have improved, but even this may be
only secondary to the climatic influences, which with better housing
conditions would be able to operate to a greater extent. Even if the
improvement is only temporary it is gratifying to know that the fall in
numbers treated is due to the healthier state of the children.
The continued decline in ringworm tells the same tale, and is to be
ascribed to a permanent increase in the standard of care and the continued
exercise of efficient following-up by the nursing staff.
(iv) Dental Conditions.—The decline in the number of children treated
for dental disease is not a matter for congratulation as it is known that
there is a large percentage of children (about 40 per cent.) requiring treatment
in the schools who do not get it. Year by year things have been
improving, and better numbers have been secured. This improvement
ought to continue. It is therefore not a question only of a drop compared