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may, under the circumstances, reasonably be expected in investigating
the physical condition of the children attending public
elementary schools.
It would at the same time be incorrect not to notice that
while the averaged results may as a whole be thus regarded, there
are in some few instances wide departures from the general standard
in the observation, or lack of observation, of particular
officers.
It is difficult to believe, for instance, that while for all the
children examined affections of the heart and circulatory system
amount to only 4.7 per cent., this same class of affections should
in the boys' department of an otherwise healthy school rise to
38 per cent, of all the boys examined, or that affections of the
nervous system chiefly of one form should in the same department
of boys amount to 10 per cent, of all the boys examined, when
the combined observations of all the Medical Officers have succeeded
in discovering something less than one and a half per
cent, of all the children exhibiting evidence of this class of disease.
This is by far the most marked aberrance I have been able to
discover in the comparative results of the different Medical
Officers on what I may call the positive side, but on the side of
omission there are instances quite as marked.
These occur chiefly in respect of affections of the nose and
throat, the presence or suspected presence of adenoids, and the
existence of enlarged cervical or submaxillary glands. They
are obviously instances of failure to record abnormalities which
careful observation could scarcely fail to have discovered. In a
few cases enlargement of the lymphatic glands have in no instance
been recorded, in others no mouth breathers have been detected
and adenoids have remained wholly unsuspected.
It is clear from what I have said that the standardisation of
what by consensus of opinion is the normal state, and of the
degree of departure from this which is to be accepted as pathological,
and so to be recorded, still leaves much to be desired.