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respiratory disease of any sort was carefully recorded in all cases examined, and
a special look-out was kept for intercurrent conditions of disease, e.g., tonsils and
adenoids, naso-pharygeal catarrh, or bronchitis, etc., since a high rate of mortality
would appear to indicate the likelihood of an even higher rate of disability amongst
children below school age.
Amongst the cases examined, 25 per cent. gave a history of respiratory disease,
chiefly bronchitis, and signs of bronchitis were found in 4 per cent. Tonsils and
adenoids or catarrhs or otorrhoea associated with enlarged tonsils, were found,
however, in 49.5 per cent. of the total cases examined. Only 2.5 per cent. of the
total cases were referred for operative treatment, a figure comparable with 7 per
cent. of the total number of children so referred from L.C.C. Schools, and the much
higher percentage of those examined at the school entrants' age, namely, 10 per
cent.
Fifteen otorrhoea cases were referred to the minor ailments clinic of the
London County Council for treatment.
Nervous Conditions.—Another type of defect was sufficiently evident to call
for some remark. Signs of undue nervousness, such as screaming, fighting, negativism,
enuresis, night terrors, stammer, thumb-sucking, masturbation, cyclic
vomiting and acidosis attacks, were observed in 20 per cent. of all cases between
the age of 2 and 4 years. No less than two-thirds of this amount occurred at the
earliest age examined, namely, between 2 and 3 years.
In a majority of the cases in which the symptoms occurred, the child was
an only child or appeared after a long interval, say five, seven, or more years after
the rest of the family were born, and the nervousness seemed to be definitely
related to these particular circumstances.
Nervous symptoms were noted in 46 per cent. of only children, and in 68
per cert. of "big space" children (children separated from the last child by an
interval of more than 4 years were considered as belonging to this group) compared
with the figure of 20 per cent. for the total cases already quoted.
On the other hand, there was evidence that a good deal of the difficulty
was associated with tiredness, over-excitement and lack of sleep. For that reason
the figures that follow for the hours of sleep are of great interest.
Hours of Sleep.—The variation in regard to sleep management was marked.
There was a good deal of too late going to bed, spending too many hours in bed
during the day, and very late getting up. The two latter were often found in conjunction,
so that some children seemed to be spending as little as a couple of hours
of the total daylight period out of bed. The fault of too long mid-day lying in bed
was, curiously enough, noted chiefly in the case of children over 2 years, and very
often in cases where management was otherwise good. If the habit had once been