The Health of the British School Child

Correspondence from Dr. J. Menzies Campbell

The annual report of the Chief Medical Officer for the Board of Education for 1934 is issued by Dr. Arthur MacNalty, but refers to the work done under the direction and supervision of Sir George Newman. In his introduction Dr. MacNalty utters a warning against that education which is overbalanced on either the mental or the physical side, or is unfitted to the age, sex, habits, circumstances, and state of health of the child.

Nutrition and School Feeding

The report repeats the emphasis of former reports on the necessity for satisfactory nutrition. The total number of school meals provided in the year was 68,100,000, and the milk meals provided free of payment increased to 42,200,000. During the routine medical examination 12 children per 1,0000 were found to be malnourished and 14 per 1,000 undernourished. This is a slight increase on the figure of 11.1 for 1933. On the whole the reports received from the districts were reassuring. Special attention has been paid to the nutrition of the pre-school child and of adolescents attending the junior instruction centers. An investigation into the nutritive value of milk, made by a committee of the Milk Marketing Board, is expected to confirm results published by Dr. Corry Mann; and the Minister or Health has now definitely decided that pasteurized milk is better than raw milk, the changes of quality being too small to outweigh the great advantage of protection from disease.

Inspection and Treatment

The report stresses again the desirability of cooperation between school medical officer, teacher, and parent, and gives figures illustrating the importance of the detailed medical examination as well as the general review. The number of children inspected during 1934 was 1,794,963, or 35.4 per cent of those in average attendance. In addition, 1,231,663 were referred for special reasons, the total representing 59.7 per cent of the average attendance. The table of physical defects revealed by examination remains much the same as in previous years, except for a rise in the incidence of skin diseases.

The physical fitness of secondary school children is on the whole better than that of the elementary school children, but they suffer from the problem of overstrain, on which varying opinions are expressed by different medical officers. Defective visions is also a problem of importance for these older children, and postural defects tend to be commoner among them than among their juniors. There are now 1,916 school clinics, an increase of thirty-six on last year; those for throat conditions and ringworm have diminished in number. Where possible school medical and maternity and child welfare services use the same health centre, as this promotes both economy and co-ordination. School medical officers continue to report good progress in cleanliness. The use of elastic plaster dressing for impetigo is proving successful, and also obviates the necessity for exclusion from school.

Eyes, Ears, and Teeth

Although health visitors play their part, the most important method of ascertainment of eye defects is the routine medical inspection. The school nurse is also a valuable factor, but none of these methods is successful without the co-operation of the teacher. Unfortunately, children are not tested for visual acuity until the age of 8, but an additional routine eye inspection of the six-year-olds is made by some medical officers and is very valuable. The most satisfactory system for the supply of spectacles is a contract between the local education authority and the local optician, and in some clinics a representative of the firm attends during refraction sessions. The follow-up by school nurses is of the utmost importance. No ophthalmic scheme is complete without special arrangements for the treatment of squint and fusion training. Hitherto the testing of colour vision has not been included in eye examination, but its ascertainment is of great importance to the individual, and in certain areas investigations have been made.

The prevention of acute otorrhoea is mainly a problem of specific diseases such as measles, scarlet fever, and diphtheria, and of the common cold. Early treatment in the acute stage is of great importance to prevent the intractable chronic ear discharge. The report recommends the use of an electric auriscope which would detect slight and potential cases in which there is no frank ear discharge. Figures from Essex show that when a special examination is made a large proportion of children are found to suffer from it or to have suffered from it. Of 2,074 children examined. 100 had only intermittent discharge and 54 percent had the disease on one side only. Diastolization continues to give promising results for rhinitis. A possibility that must be borne in an open-air school, for improvement in general hygiene reacts on the local disease. The treatment of the ear itself is often protracted and disappointing. It must be carried out by a specialist at an aural clinic, and it demands the co-operation of many officers under various sections of the public medical service.

There are now the equivalent of 604 full-time dentists, an increase of 25 percent during the last five years. During 1934 the amount of work done for each hundred children treated included sixty-seven fillings in permanent teeth, thirty-three extractions of permanent teeth, and 155 extractions of temporary teeth. The report declares that the school dental service is still comparatively young, and that its development must be unhampered by fixed ideas. Local education authorities are increasingly appreciative of the help of the dental Board in propaganda. A recent interesting development is a scheme for the dental treatment for adolescents in Brentford and Chiswick. This is sponsored by the education authority, and is an attempt to fill the gap between school and dental benefit under the national health insurance. An inquiry into children naturally free from dental caries has revealed one safe generalization only: that the regular use of the toothbrush is not essential for freedom from caries. Of 560 children with sound teeth recorded, 104 brushed their teeth irregularly and 132 never. The dietetic habits of these children gave results that can only be described as bewildering. All sorts of dietetic errors had been committed by those showing perfect teeth.

–The British Medical Journal