The health of the school child

Public Health THE JOURNAL OF

The Society of Medical Officers of Health. "No. 4.

JANUARY,

1925.

VOL.

XXXVIII. L

Subscription ¢)riee, 31s. 6d. per annum, post free i n advance.

Single copies, 2s. 6d., post free.

CONTENT3. PAGE

EDITORIAL-The Health of the School Child . . . . . . . . . 101 Smallpox and Vaccination in Canada . . . . . . 109, The Vital Statistics of Sweden and England and; Wales .... ........... 103 ,PUblic Health Services in Germany . . . . . . 104 World's Dairy Congress . . . . . . . . . : 106 Atmospheric Pollution ............ 107 The, Late D r . J . F. W. Tatham ...... 108 Retirement of Dr. E. W. Hope . . . . . . . . . . 108

13!otes ,on th-e School Medical Service (By Algernon Wear, C.M.G., M.D. , B.S., D.P.H., School Medical Officer, Leeds C.B.) .........

109

A Visit to tim Anti Tuberculosis Clinics and Sanatoria of Switzerland (By P. Heffernan, B.A., M.B., Major, 4.M.S. Ret., Tuberculosis Officer, Det:byshire County Council) ..... , ...

1!2

The Prevention of Mental Disease as a Practical Proposition (By G. C. F. Roe, L.R.C.P. and S.I., D.P.H., D.P.M., Assistant Medical Officer of Health, Wakefield C.B.) ......

116

SOCIETY OF MEDICAL OFFICERS OF HEALTH-Ordinary Meeting . . . . . . . . . . . . . . . North Western Branch ............ Home C0untle~' B r a n c h " ......... Northern Branch . . . . . . . . . . . . . . . Midland Bx;aneh ...' ... ... Tuberculosis Group ... '.: . . . . . . . . . .

...

119 119 121 122 124 125

REVIEWS-The Diagnosls and Treatment of the Infectious Diseases . . . . . . . . . . . . . ... Modern Methods in the Diagnosis and Treatment of Pulmona~Ty Tuberculosis . . . . . .

125

126

CORRESPONDENCE - , The Superyision of Mentalty Defective Children-. Assistant Medical Officers. . . . . . . . . . . .

£ditorial. THE

HEALTH

OF

THE

SCHOOL

T h e p u b l i c a t i o n of t h e a n n u a l r e p o r t * of Sir G e o r g e N e w m a n , C h i e f M e d i c a l Officer of t h e B o a r d of E d u c a t i o n , is o n e of t h e m o s t i m p o r t a n t e v e n t s of t h e S c h o o l M e d i c a l S e r v i c e ' y e a r , n o t only b e c a u s e of t h e c o l l e c t e d i n f o r m a t i o n w h i c h it c o n t a i n s b u t also f o r t h e ideals it sets up, s o m e of t h e m s o h i g h , t h a t at p r e s e n t t h e y a p p e a r to be u n a t t a i n a b l e , y e t if t h e a d v a n c e s detailed in the r e p o r t a r e c o n t i n u e d in the c o m i n g years, t h e y m a y be f o u n d to c o m e w i t h i n reach. E n c o u r a g e m e n t in this d i r e c t i o n is to be f o u n d in the s t a t e m e n t t h a t " t h e r e s t r a i n i n g c o n d i t i o n s u n d e r w h i c h tlm S c h o o l M e d i c a l S e r v i c e suffered in 1922 o w i n g to the n e e d s of n a t i o n a l e c o n o m y b e g a n r o b e less o p p r e s s i v e in 1923,".and if this i m p r o v e m e n t c o n t i n u e s S c h o o l M e d i c a l Officers, all of w h o m h a v e a s t r a i n of O l i v e r T w i s t in t h e i r c o m p o s i t i o n , will feel t h a t t h e y m a y a s k for m o r e clinics, m o r e o p e n - a i r s c h o o l s , m o r e special schools w i t h s o m e h o p e of t h e i r r e q u e s t s b e i n g success.ful. The information scattered through the report is s t a t e d in f i g u r e s o f Such m a g n i t u d e t h a t e v e n m e m b e r s of t h e s e r v i c e a r e i m p r e s s e d , w h i l e t h e g e n e r a l p u b l i c m a y w e l l be a s t o u n d e d at t h e a m o u n t of q u i e t w o r k g o i n g on a n d of vehieh t h e y h e a r b u t little in detail, T h a t !,754,9.19 school c h i l d r e n w e r e s u b j e c t e d to r o u t i n e m e d i c a ! i n s p e c t i o n in 1923 and t h a t 739,390 special i n s p e c t i o n s w e r e a l s o m a d e is in i t s e l f a sufficiently r e m a r k a b l e fact, b u t it m u s t a l s o b e n o t e d .tha~ ,about h a l f a million o r one fifth of t h e t o t a l n u m b e r were. f o u n d to r e q u i r e m e d i c a l t r e a t m e n t of s o m e s o r t or another. T h i s h u g e n u m b e r d o e s n o t include moreover those children who required dental t r e a t m e n t , o v e r 600,000, o r t h o s e dealt w i t h for dirty or verminous conditions, Of the 500¢000 c h i l d r e n m a n y .suffered f r o m m o v e -than o n e •

197. i9'8

CHILD.

•

.,

"L

• Tile Hdalth of the School Child. Annual Repor~t of the Chief Medlcat .Officei" of th'e 'Board of Ed:ucatlpn. for thd year 1923. H.M. Stationery Office. Price 2s. net.

102

PUBLIC HEALTH.

defect, for 880,000 defects we,'e treated during the year. The great bulk of the treatment was provided at the 1,076 school clinics established by local authorities or at the 390 hospitals with which the authorities had made arrangements for treatment. Under one or other of these two schemes 473,000 minor ailments were treated and 63,000 by other means, 170,000 cases of defective vision came under treatment and 134,000 pairs of spectacles were prescribed by ophthalmic surgeons acting for the authorities. Figures of similar magnitude are given in the report referring to other defects and the attendances of children at the clinics reached enormous numbers, as many as 1,400,000 in London, nearly 300,000 in Manchester and nearly 200,000 in Leeds. Such figures as these show that the 1,751 school medical officers, the 469 school dentists and the 4,277 school nurses cannot have been idle during the year. Sir George N e w m a n ' s comments on the results of all this activity are encouraging. The attendance of parents at the inspections, he tells us, is increasing year by year, while their desire for advice and willingness to carry it out is very noticeable. The number of cases of heart disease, of anaemia and of nose and throat diseases is decreasing. Although the general cleanliness of school children is improving the number found to be in a dirty or verminous condition continues to be appallingly high. The ideal of an entirely clean school population is still as much out of reach as that of a school population with healthy mouths free from all decay of the teeth. If the dental scheme detailed on page 182 of the report could be carried out in its entirety it would mean that in a few years every school child would have its teeth examined once a year and would receive any necessary treatment. Assuming that there are 6,000,000 school children and that a full-time dentist can deal with 5,000-6,000 children yearly, about 1,000 school dentists would be required, or more than two-thirds of the number at present on the Dental Register. In the combined education and treatment of crippled children the ideal is again far ahead of the achievement. It ought to be possible, as Sir George N e w m a n states, to get the crippled child under treatment as soon as the crippled condition is known even by the maternity and child welfare departments and long before school age, then it would be practicable to carry out treatment in a hospital school and return the child to an ordinary elementary school, keeping it under the observation of an orthopoedic clinic as long as might be

JANUARY,

necessary. If, as Sir Robert Jones is stated to have said, 80 per cent. of cripples are curable provided treatment is begun early enough, it should be possible to return to ordinary school life and afterwards to profitable everyday work, a large proportion of children whose prospects ,apart from the hospital school and orthopoedic clinic are g l o o m y in the extreme. In the matter also of outdoor education achievement again lags far behind the ideal. There are :forty day and twenty residential openair schools in the whole country with accommodation for t,690 children, but from information given in the report there must be over ten times that number of children who would benefit by a period of instruction in such schools. The report deals with many branches of the service in which increased action is required, and in this connection the sections on the organisation of the treatment of crippled children, on the day open-air school and the appendix in the nature and cost of equipments of the various types of clinics, are invaluable to the School Medical Officer, who has to guide and inform his authority. In the section on the Provision of meals it is satisfactory to find that the number of children fed and of meals provided is only about onesixth of what it was in 1921-2, showing that, despite commercial depression, there is an improvement in the financial circumstances of the parents. Sir George N e w m a n lays great stress on the necessity for continual research and we can assure him that all School Medical Officers feel that necessity and would be only too glad to devote themselves to it had they the time to spare, but the figures as to inspection and treatment given above show that available time is fully occupied. If by an increase in their staffs senior Medical Officers could be released from routine work or could release some specially qualified member of the staff, there are many promising lines of investigation which might be followed. S M A L L P O X A N D V A C C I N A T I O N IN CANADA. The Canadian Department of Health has recently issued " a popular treatise" on smallpox and vaccination, written by Dr. J. J. Heagerty, of that department. A short clinical description of smallpox is given and also its history, more particularly in Canada, is interestingly dealt with. Vaednation is carefully considered and the tragedy mentioned