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financial and physical. The only extravagance in the
School Medical Service is inefficiency. It is the uninitiated
who are loudest in their criticism of the service; they
ignore the fact that beyond all wealth is mental and physical
fitness of the individual.
The great changes that have occurred in the physical
welfare of the school child since the Education Act, 1907,
are obvious. No longer do we see gross crippling; wilful
malnutrition has disappeared, and the brightness and
cleanliness must be the first thing that would strike a
visitor from a previous generation.
In the years 1910/1914, the yearly average showed 23
per cent. of the children anaemic, 16 per cent. rickets,
15 per cent. defective vision, 27 per cent. enlarged tonsils
and adenoids, and 5 per cent. ringworm of the scalp.
In 1911, 71 per cent. of children examined showed evidence
of vermin. Compare these figures with the present day
school children, who show a total of 23 per cent. as suffering
from early stages of defects—defective vision has fallen
to 7 per cent.; anaemia has disappeared; defects of nose
and throat have fallen to 12 per cent.; ringworm of the
scalp is a rarity, and only 3.4 per cent. of children show
evidence of vermin.
It is in the investigation of these discovered defects
that the field of prevention widens. They can in many
cases be traced back to the infant stage, to the parents,
or to the environmental conditions of the home or school,
and so it is that we must have the closest possible coordination
of all Public Health Services; the bad feeding of
the infant may not make its effects obvious until the child
reaches school age, or ideal school hygiene may be counteracted
by the bad home conditions. I would repeat that
there is still much to be done before we can realise even
our most modest of aims, viz., a healthy child in a healthy
environment.
Children to-day live at a greater nervous tension than
did their parents before them, and this, with the cheaper
means of indoor amusements, not always of a desirable
mental or moral stimulus, must have a detrimental effect
on the health of the child of to-day. In spite of these
detrimental factors in present day school life, there is