The health of the school child in 1934

PUBLIC HEALTH THE JOURNAL OF

T H E SOCIETY OF M E D I C A L OFFICERS OF H E A L T H . No. 4. Vol. XLIX. ~[ANUARY, 1986. Subscription price 31s. 6d. per annum, post free, in advance.

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Contents. PAGE

EDITORIAL--The Health of the School Child in 1934

... Meals for Children Attending Public Elementary Schools ...... ......... Tuberculosis in Lancashire ... ...... Health S e r v i c e s - - A n n u a l R e t u r n s ... ... Hmmolytic Streptococci and Puerperal Fever... T h e L o n d o n Waters in 1934 . . . . . . ... Maternal M o r t a l i t y : A Question of N o m e n clature ... ... T h e American "'Public"Heaitta Association Annual M e e t i n g . . . . . . . . . . . . T h e Actinomyces G r o u p ...... ... T h e League of Nations Nutrition Commission Medical Uses of R a d i u m ...... ... T h e Fever G r o u p Presidential Badge ...

1O9 111 113 114 115 116 116

117 117 ll8 118 119

PAGE

Health, Cardiff; and H. R. TmHE, M.D., F.mC.S.L, D.P.H., D e p u t y Medical Officer of" Health, Swansea . . . . . . . . . . . . . . .

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SOCIETY OF MEDICAL OFFICERS OF HEALTH-Notices ......... 140 Ordinary Meeting ... ......... T h e N o r t h - W e s t e r n Branch ......... T h e Yorkshire Branch . . . . . . . . . . . . T h e W e l s h Branch ... ... T h e M a t e r n i t y and Child'Welfare G r o u p ... T h e Fever Hospital Medical Service G r o u p T h e Joint Tuberculosis Council

140 141 142 142 143 143

......

144

T h e Central Council for Health Education . . . . . .

145

SPECIAL ARTICLES-Fever Hospital Practice in Retrospect and Prospect.

THE LITERATURE OF PREVENTIVE MEDICINE-Practical Suggestions for Spiritual, Mental and

By E. H. R. HAemms, M.D., D.PH., Medical Superintendent, North-Eastern Hospital, L o n d o n C o u n t y Council ......... Co-ordination in Preventive Medicine. By W. E. HAmH, F.R.C.S., D.P.H., Assistant Medical Officer of Health, C o u n t y B o r o u g h of D e r b y . . . . . . Ut Ira Dicarn. (Being C o m m e n t s , apropos and otherwise, on S u n d r y Matters) . . . . . . . . . Food Poisoning. By C. W. ANDERSON, M.B., CH.B., D.P.H, T.D.D., Assistant Medical Officer of Health, Cardiff ; W. POWELLPmLLIPS, M.R.C.S., L.R.C.P., D.P.H., D e p u t y Medical Officer of

Physical Health . . . . . . .__ . . . I n s o m n i a and other Disturbances of Sleep ... H o w are y o u r Kidneys? Bladder ...... T h e T r e a t m e n t of R h e u m a t i s m in General Practice ... . . . . . . . . . . . . Individual Health ... ......... T h e Medical Cookery Book ......... Unfit H o u s e s . . . . . . Triple Challenge or War, Whirligigs and W i n d mills . . . . . . . . . . . . . . . . . .

120 125 130

I n the A n n u a l Reports

. . . . . . . . . . . .

157 157 157 157 157 158 158 158 159

Editorial. The Health of the School Child in 1934. O U G H naturally it is not limited to,a T Hdiscussion of these subjects, Dr. MacNalty s report on the Health of the School Child* shows a very definite and distinct tendency to enlarge upon nutrition, health education in the school and the work of the school medical service in the direction of improving physical and health conditions of the children. In his introduction, which is both learned and interesting, he makes perfectly clear that the place he gives to physical culture in the scheme of education is a very prominent one and indicates the reasons that lead him to that conclusion. Inevitably, there *Annual Report of the the B o a r d o f E d u c a t i o n . 1935. Price 2s) 6d. n e t .

C h i e f M e d i c a l Officer o f H . M . S t a t i o n e r y Office,

is much said about Greece and the Greek conception of education. More important still, there is evidence in support of the belief he very strongly holds that here in this country there is a marked desire to re-establish a harmony between training of the mind and training of the body for which the school medical service is very largely responsible. Discussing nutrition and school feeding, Dr, MacNalty submits, in proof of the great expansion which has taken place in schemes for the provision of meals, the fact that between November, 1931, and March, 1935, the number of children receiving free meals has doubled, and the number receiving free milk increased five times. Under the milk in schools scheme, which troduced on October 1st, 1934, the of children receiving milk on payment

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leapt in one bound from 900,000 to 2,650,000. Curiously, in view of these startling changes, the figures for the incidence of malnutrition revealed by routine inspection show a slight increase over those of 1933. Some of the increase no doubt, however, is apparent rather than real and associated with the increased facility for treating cases of malnutrition which has resulted from the Milk Marketing Board's scheme and the emphasis which the Board's circular 1437 lays upon the defect b y directing that the slightest symptoms of subnormal nutrition should be taken into account. Reports from a number of school medical officers quoted by Dr. MacNalty are on the whole also reassuring, though there are, of course, some exceptions. The case of Leeds is one of the most interesting, weight charts given in the report going to show that 12-year-old girls now average nearly 6 lbs. and 12-year-old boys nearly 4 lbs. more than in 1923. Since it is a matter of importance, some space is given in the report to a discussion of the assessment of nutrition, the choice of a clinical standard rather than any method based upon a weight-measure-age ratio, being explained. There is a reminder also that in every collection of children, however well fed and circumstanced, so many as 4 per cent., may appear of subnormal nutrition. Some such proportion may be found in preparatory schools for the well-todo, where their subnormality is clearly due neither to lack of food or sleep or fresh air. The fact that such children will ahvays be found does not, however, invalidate the statement that the main factor in the production of subnormal nutrition in children is poverty. Discussing the experiment now in progress under the auspices of the Milk Marketing Board to study the effect of giving different amounts of raw or pasteurised milk to children in elementary schools, opportunity is taken to make reference to a number of points connected with milk generally, making clear particularly that though there never was any intention in circular 1437 or anywhere else to preclude the use of raw milk in favour of the efficiently pasteurised article, there is a very strong belief that the latter possesses many advantages. On physical education a most encouraging account of the physical training in elementary schools is given, though the need for suitable rooms and equipment for the physical exercises and properly laid out playing fields for games is stressed. Further, and very rightly, disappointment is expressed that only 122 local education

JANUARY,

authorities employ organisers of physical training since they are needed not only in schools and by the teachers but as leaders in the organisation of all local physical training activities, whether voluntary or provided by the authority. The magnitude of the work of the school medical service in directions other than those mentioned is shown by figures relating to the routine of inspection and treatment, and by facts regarding such activities as those connected with dental work; eye, ear and speech conditions; open-air and nursery schools; maladjusted children, and so on. The number of children inspected in the specified age-groups during 1934 was 1,794,963, or 35.5 per cent. of those in average attendance. In addition, 1,231,663 children were referred for some special reason by parents, nurses, school teachers or attendance officers. The total number of 3,026,626 children thus passed under medical review represents 59.8 per cent. of the average attendance. The number of re-inspections carried out was 2,006,9~6. For the treatment of those found to be suffering from defects it is interesting to learn additional provision was made during.the year, the total number of school clinics going up to 1,916 from 1,880 in 1933. For the treatment of children with defective vision and eye disease all local education authorities, with one exception, it is noted, have established schemes. The importance of making provision for early detection in these schemes is emphasised, and a plea is made that the ophthalmic service should stretch backwards to cover children below school age and forward, as far as legislation allows, to include young persons above the age of 14 years. In this connection the desirability of co-operation between various health services is stressed. The subjects of ear disease and deafness, as they well deserve, are given a chapter to themselves. Here there is an interesting note on the causation of chronic middle ear disease, and it is shown that there can be no doubt that although the incidence of this condition in elementary school children has diminished, there is good reason for believing that many cases escape detection by the ordinary methods of medical inspection. A note on the treatment of the disease is given, and the concluding section with regard to some special investigations on defective hearing is deserving of attention. The account of the activities of the school dental service contains naturally much reference to dental caries, a disease which affects some 95 per cent. of the school population. The need

1936.

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for fuller provision for dealing with this very formidable problem is again stressed, attention being drawn to the note on " Conditions of a satisfactory dental scheme " which has appeared in previous reports. Special interest attaches to what is contained in the report with regard to stammering and other speech defects, and effort is made to have it generally realised that failure to acquire reasonable facility in speech is just as serious as failure to acquire ability to read and write. The success of modern methods of speech training in curing or improving cases of defective speech is so encouraging that, more particularly since the cost of making provision is not great, local education authorities in increasing numbers may be expected to adopt the suggestions offered by Dr. MacNalty. That there is a growing realisation of the value attaching to open-air schools and nursery schools is clear, and in addition to the references to the good work done and capable of being done by these institutions there is a hint as to the willingness of the Board of Education to consider applications from local education authorities as to their establishment. The problem of the maladjusted child receives consideration in a special chapter, and reference is made to the work of the child guidance clinics set up in different parts of the country for the study and treatment of such children. At present two clinics maintained by local education authorities have been approved by the Board, and seeing that reference is made to the fact that it is as yet too early to express detailed views as to what constitutes a well-organised clinic of this description, the Board would appear to be not unwilling to consider and discuss proposals. The staff, it is suggested, should include a medical man with experience in psychological medicine, a psychologist and a trained social worker. The premises should provide rooms in which the members of the staff can interview children, a:play room and a waiting room~ Very properly the need for avoiding any association in the public mind of the child guidance clinic with mental disorder or mental defect is impressed. In the final chapter Dr. MacNalty makes reference to the chief epidemiological happenings of 1934 in so far as they affect school children. Measles, it is shown, was prevalent and caused 3,719 deaths in children under 15 years of age. The fact that diphtheria caused a greater mor:talky among children than measles, even in a :year of epidemic prevalence of measles, was an

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unusual feature of 1934. The reasons for this increased diphtheria mortality and the question of artificial immunisation are discussed. The need for the provision of immunising facilities is indicated as is also the willingness of the Board of Education to encourage and assist in every way possible. The increased prevalence of scarlet fever, to which a reference was made in 1933, was even more marked in 1934, and there was a rise in death~ from rheumatic fever and heart disease probably epidemiologically associated with it. In this connection attention is drawn to the fact that institutional provision for the treatment of children suffering from after-effects of acute rheumatism is still inadequate, particularly in the north and midlands. This is the first report by Dr. MacNalty since he assumed office as Chief Medical Officer of the Board of Education. On it he is offered sincere congratulation, and it is noted that both at the beginning and the end he has generous tribute to offer to others : in the former position to his colleagues, and in the latter to Sir George Newman, who became the first Chief Medical Officer of the Board in 1907 and retired on March 31st, 1935, and throughout the whole of that period rendered service to the nation of inestimable value.

Meals for Children Attending Public Elementary Schools. H A N the eve of Christmas no more opportune moment could have been chosen by the Board for the issue of their circular 1443 (December 16th, 1935). In this, in consequence of the many communications received from, very prominently amongst others, the Society of Medical Officers of Health in criticism of circular 1437 and as to the methods to be adopted in the selection of children for provision of meals having regard to the provisions of sections 82 to 84 of the Education Act, 1921, and also to those of the Board's Special Services Grant Regulations, a restatement of the Board's attitude is made and, notably, the announcement that " provision may properly be made for any child who shows any symptoms (of malnutrition) whether educational or physical, however slight." What the reasons for the limitations imposed by circular 1437 in regard to milk distribution may have been it is not easy to say. It cannot be doubted, however, that, as this present circular states, the Board are concerned to secure that all children who are unable by reason of lack of food to take full

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