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the children in school escaped coming under the eye of the doctor in some way or
another during the course of the year.
Parents are invited to be present at all routine inspections, and attended in
77.6 per cent. of the examinations in the three statutory age groups compared with
74.1 per cent. in 1933 and 68.5 per cent. in 1932. At the inspection of entrants, the
proportion was 91 per cent., and in the "leaver" group 42 per cent. It is most
satisfactory to be able to note each year a very distinct advance in the interest of
the parents in the inspections. The presence of the parent has a very considerable
effect, and relieves very greatly the task of following-up, as it eliminates the necessity
for home visiting and correspondence.
Refusals.
Refusals of parents to submit children for medical inspection are so few in
number as to be almost negligible. During the year 1934, the parents of 65 children
(31 boys, 34 girls), compared with 89 in 1933, refused to allow them to be examined
by one of the Council's assistant medical officers. Nine objections were subsequently
withdrawn, and in 10 instances either medical record cards were completed by a
private medical practitioner or medical certificates as to physical fitness were produced.
The cases were distributed amongst the divisions as follows: N., 4; N.E.,
9; N.W., 17; S.E., 11; S.W., 24.
Thus not only do parents attend the inspections in greater numbers each year,
but refusals to allow inspection dwindle each year.
The number of children subjected to routine inspection in the three statutory
age groups who were referred for treatment was 58,521, 42.3 per cent. of the number
examined. This figure includes cases noted by the school doctors for dental treatment,
and, if these cases be excluded, the percentage is reduced to 15.5, compared with 16.7
in the previous year, and 17.5 in 1932. This quite considerable drop shows the
healthy conditions which prevailed in 1934.
Each age group has its own peculiar constitution, by which liability to different
ills varies from age to age. The change in age groups inspected makes less certain
the comparisons hitherto possible from year to year over the whole length of time,
now twenty-four years, during which inspections have been carried out in the three
groups—entrants, children aged 8 and children aged 12.
The smaller number of children in the 7-year group submitted to inspection also
makes less valid the combined figures for all the age groups, as they are underweighted
in respect to this age group, which normally is specially productive of certain
tvDes of defect.
The state of
nutrition of
the children.
Unremitting attention has been given to the state of nutrition of the children
in school. Acute anxiety lest the children should suffer has been the key note of the
past three years. In the words of The Lancet, "the fear of underfeeding its children
is haunting the conscience of the nation." By precept and instruction the question
has been kept continually before the school doctors. It is therefore satisfactory to
note that there has been no decline in the nutritional state of the children attending
elementary schools in London.
The Board of Education syllabus provides for every child to be marked during
routine inspection as "1," "2," "3" or "4"; 1 being exceedingly good nutrition,
2 normal, 3 subnormal, and 4 definite pathological malnutrition. Complete surveys
by the school doctors exist for about a quarter of a million children examined each
year since 1912. In that year the number returned in classes 3 and 4 taken together
formed 12.8 per cent. of the total examined. This proportion was gradually reduced
until in 1930 the proportion was 4.8 per cent., and in 1931 this proportion remained
unchanged. In 1932 there was a very slight setback to 4.9 per cent., the result
mainly of an increase in ill-nourishment in the entrants who had just been through
a very severe epidemic of measles. In 1933 the proportion of poorly nourished
children was 4.7 per cent and in 1934 the proportion is 4.6 per cent., which is the
lowest figure ever attained in London.