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Public Health.REPORTS OF SCHOOL MEDICAL OFFICERS.

The City of Liverpool.-The health conditions of the scholchildren of Liverpool present a special interest by virtue <

the fact that in certain parts of the city numerous racielements are commingled, the Jewish and Polish quarters beinboth large and increasing. The question of race is beininquired into in the case fof each inspection, and it is n(

unlikely that when sufficient data have been acquired son:interesting facts may be revealed, although, of course, tt

foreigners who settle in Liverpool may be either the fit (the unfit representatives of their respective nations. It :somewhat difficult to determine which, because no doutdifferent forces are at work inducing emigration in differercountries. It is difficult, for instance, in the case (

England to determine whether it is the fit or unfit whicleave the country. As regards Ireland, it is thought bmany that it is the fit which depart, thus leaving behind thunfit to alter what might be regarded as the normal relationbetween the healthy and the unhealthy. In the case o

Liverpool it is obviously necessary to determine the nationality of the children in order to establish a sound basis upowhich to build up inquiries as regards national deteriorationThe first report to the Liverpool education authority imade by Dr. E. W. Hope, the medical officer of healthand we are glad to see that the general supervision o

the procedure has been left in his hands. The actuawork of inspection is carried out by three medicaomoers, and with the consent of the health committeethe services of its female sanitary inspectors have beei

placed at the disposal of the school medical officers. TherEare at the present time 14 of these inspectors, who have defi.nite districts of the city assigned to them, and whose service:are made use of when the schools in their districts are beininspected. These female inspectors also visit at their homessuch children as the medical officers deem desirable, and ait is the duty of these inspectors to put into force Section 122of the Children Act, 1908, which deals with verminouschildren, there is an obvious advantage in this arrangement.With regard to clothing, the inspections brought out the factthat 12 per cent. of the children possessed no underwear atall, and it was found that in the poorer neighbourhoods thechildren wear practically the same number of garments bothin summer and winter. About 60 per cent. of the children werewearing watertight boots, 10 per cent. had boots with mereapologies for soles, another 25 per cent. boots which althoughsatisfactory in dry weather were not watertight, while theremainder came barefooted to school. As to nutrition, 20per cent. of the new admissions were good, 55 per cent. fair,23’ 5 per cent. poor, and 1’ 5 per cent. bad, and in each case thecondition of the girls was rather better than that of the boys.But it must be borne in mind that it was children from the

poorer parts of the city that were here under examination.During the autumn of 1908 an inquiry was made by themedical officer of health as to the extent to which under or

improper feeding prevailed in Liverpool, and on considerationof the reports made the city council decided not to put inforce during the winter the Education (Provision of Meals)Act, 1906, but to rely upon voluntary contributions whichwere administered by a special subcommittee of the educa-tion committee. Coupons available at cocoa-rooms and a fewspecial depots were given to the children who required food,and a marked improvement in the physical and mental con-dition of the children was noted by the teachers. Largenumbers of children appear to have been fed by the committeeduring the winter months, and, in addition, some 2000 werereceiving meals every day at the day industrial schools andat special schools. The result of the investigations at thehomes of the children was to show that amongst a greatnumber of the very poor the diet consisted of bread andbutter and tea for each meal, occasionally, in some cases,varied by fish or ’’ hot-pot," but in many instances the familyhad nothing but bread and tea. In the case of the childrenfrom some schools it was found that although the parentscould afford to provide them with good food their ignorancewas responsible for the insufficiency of nourishment. Theabove facts bring out very clearly the enormous import-ance of the inspection of school children and of the visits of

educated persons to the homes. If those people who, withinsufficient food, drink tea in excess could only be inducedto procure milk instead, this act in itself would constitutean enormous advance. Enlarged cervical glands were

noticed in as many as 22 per cent. of the new admissions,and in 12’ 5 per cent. of those finally leaving school, but in

1 only two cases altogether could such glands be definitelyf called tuberculous. Similarly, there were but six cases of1 pulmonary tuberculosis amongst all the children examined.

With respect generally to the question of treatment no

arrangements have as yet been made with any of the generaltor special hospitals or the dispensaries, but a special sub-3 committee has been formed to consider the question, at least; so far as defective eyesight is concerned.’ The West Riding of Yorkshire.-The inspection of the! children in this important county is carried out by teni whole-time medical inspectors acting under the supervisionj of the county medical officer of health, Dr. J. R. Kaye.! The question of employing as inspectors all the 111 localmedical officers of health (mostly in private practice) was inthe first instance considered, and it was only after holding ageneral conference of such medical officers of health thatthe arrangement already referred to was decided upon. There

are ten districts, for each of which a resident medical in-spector, who devotes the whole of his time to the work, hasbeen appointed, and the number of children on the registerof each district varies from 10,000 to 31,604. Up to thepresent no school nurses have been appointed, but it is antici-pated that such appointments may be desirable in the future.The parents do not as yet appear to have taken a very activeinterest in the process of inspection, as although notificationswere sent to all in the usual fashion only 14’ 05 per cent.were present at the inspection of their children. But it isnecessary to point out that, owing to unavoidable delays, thefigures given only relate to the last three months of 1908;in other words, the current report must be regarded as rathera preliminary and preparative one than an annual report.Moreover, the figures here furnished should not be used asthe basis for any general inferences. Of the children exa-mined only 0’57 per cent. were regarded as "poorlynourished "-a term which, it is pointed out, is not synony-mous with "poorly fed"; but as there were no weighingmachines available it was difficult to arrive at veryaccurate results. Some apparent anomalies as regardsnutrition were found in different districts. For example,Dr. Elizabeth M. McVail, one of the medical inspectors,found in her district that the nutrition of the childrenseemed better in the valley schools than on the hill-

sides, but she thinks that the explanation may be foundin the fact that the average wage of the valley residentsis higher than that of those living on the hill-sides. As

regards the Huddersfield area, Mr. G. H. Pearce states thathe found no children who could be properly regarded aspoorly nourished, in explanation of which he points to theabsence of real poverty in the villages visited by him, andin his view the children are much better nourished than isthe case in the urban districts. Dr. Eva McCall, writing asto the Barnsley district, finds the economic conditions thereprevailing largely responsible for the high standard ofnutrition which obtains. The miners are well paid andthere is no demand for female labour. Consequently thewoman attends to her home and to her children. As thestatistics in this report refer to such a brief period it willbe better to defer detailed consideration of this side of theWest Riding report until next year. In the matter of treat-ment it has been decided in the first instance, in addition tothe usual advice to parents, to form what are known as local" care of children " committees. So far as we are able to

gather, it is proposed that these committees should be com-posed partly of co-opted ladies and that such committeesshould endeavour, somewhat on the lines of the Elberfeldrelief system, to take a personal interest in certain cases andbring them in touch with philanthropic and other institutions.We look forward to next year’s report to hear what successhas attended the work of these committees.Borocgh of Bootle.-The first annual report to the education

committee of this borough is made by Mr. W. Daley, who isthe medical officer of health and who receives an additionalE25 per annum in consideration of his work in connexionwith school inspection. His specific duties are (a) to super-vise such medical assistance as may be necessary; (b) topresent an annual report; (e) to take steps as regards

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infectious disease; (d) to report as required on the sanitary t

condition of schools; and (e) to attend meetings of the 1:education committee. The actual work of inspection vdevolves upon the additional medical officer, who receives iS150 per annum for such work and who, for additional iremuneration, acts as surgeon to the police and the fire a

brigade. During the year 1908 there were 1565 children c

examined, and in 60 per cent. of the examinations the fparents accepted the invitation to be present. As regards c

treatment it is stated that, speaking generally, the parents of tthe poorer children do not carry out the advice of the school E

medical officer in cases where any financial outlay would be (

involved, but parents better circumstanced have to an (

appreciable extent either consulted their own medical 1adviser or taken the children to a hospital. But the 1figures relative to certain diseased conditions are far Ifrom satisfactory. Of 406 cases of enlarged tonsils and iadenoids only 11 cases received treatment. Enlarged Jcervical or submaxillary glands were detected in 181 cases,a large proportion being due to verminous conditions or Idecayed teeth. As regards dental conditions 20 per cent. of jthe children were found to present some defects, while in thematter of clothing 16 per cent. were found to be badlyclothed or badly shod. Of the total number of childrenexamined eight were found to be suffering from pulmonarytuberculosis. In the matter of general nutrition many of thechildren were found below the normal standards of heightand weight, but the report states that the majority of thesewere simply undersized children well nourished and cared for. :

No open-air camps have as yet been arranged for, but in thesummer, in fine weather, classes are held in the playgrounds.Of the children attending school there had suffered beforethe commencement of school life 58 per cent. from measles,36 per cent. from whooping-cough, 18 per cent. fromchicken-pox, 7 per cent. from scarlet fever, and It percent. from diphtheria.

County Borough of Devonport.-Mr. O. Hall, the medicalofficer of health, has been appointed school medical officerfor this district. Out of 2078 children examined 44’6 percent. had good teeth, 24’6 6 per cent. indifferent, and 30’ 7per cent. bad, and Mr. Hall suggests that a tooth-brush drillshould be introduced into the school curriculum. Pulmonarytuberculosis was found in only eight cases, although predis-posing conditions were frequent. Nutrition was on the whole

satisfactory. The subject of treatment is not discussed inany detail; probably the experience of the first year is beingawaited.

Borough of Cambridge.-The work of the medical in-

spection of school children was commenced in voluntaryfashion in Cambridge in 1907, but the advent of the com-

pulsory regime has necessitated rearrangement of the wholeprocedure. The school medical officer is Dr. A. J. Laird,the present medical officer of health, who has himself carriedout the medical inspection, and a school nurse, who wasappointed in the autumn of 1906 at a salary of B95, assistsat the inspection by weighing and measuring the children andby testing their hearing and vision. She also follows up cases attheir homes and reports in writing to the school medical officer.A dentist has also been provisionally appointed at a salary of300 per annum, but it appears that at the date of makingthe report the appointment had not received the sanction ofthe Board of Education. Assistance at the routine inspectionis also afforded by three lady health visitors, who in additionfollow up cases at their homes. As regards routine inspectionit is not the practice at Cambridge to invite the attendanceof the parents, although they are informed by the teachersthat their presence will be welcomed. Notices are, however,sent to the parents whose children present defects requiringattention, and this notice is followed by visits from the schoolnurse or health visitors. The figures as regards nutrition wereas follows : above average, 15 per cent.; average, 68 percent.; below average, 17 per cent.

County Borough of Boitrneiizoiit7t.-Dr. A. D. Edwards, whois the school medical officer of the borough, reports that as thework of inspection was not commenced until October, 1908,the report deals mainly with local conditions of schoolhygiene upon which sufficient information for trustworthydeductions has been obtained. We gather that Dr. Edwardsis not altogether satisfied with the present arrangement, bywhich he as school medical officer does not form part of thepublic health service of the town, and he thinks that under

,he system which at present obtains there is always the possi-)ility of the existence of an undesirable gap between thevork of the departments. It is not clear why the town counciln the first instance decided to keep the work of medica}nspection outside that of the medical officer of health. Thetttendances of parents at the medical inspections of thechildren vary widely. Sometimes it is as high as 60 per cent.Hid at other times it is as low as 6 per cent. In the matter)f treatment Bournemouth seems somewhat badly provided,jhere being’no provision for the treatment of defective vision,enlarged tonsils or adenoids, diseases of the throat, ear, or nose)r carious teeth, and Dr. Edwards states that in none of theseconditions is it possible for the parent to obtain adequatetreatment for the child at a small charge from a medicalpractitioner. This is an unfortunate state of affairs,s,nd in the interest of the public health it oughtsomehow to be remedied. The past incidence of in-fectious diseases upon children leaving school beforeAugust, 1909, was as follows : measles, 86’ 56 ; whooping-cough, 37’5 per cent.; chicken-pox, 20 per cent. ; and scarletfever, 2’5 per cent. In cases of the suspected occurrence ofinfectious disease amongst the scholars swabs from the throatare taken for bacteriological examination and by this meanssymptomless "carriers" have been excluded. Childrenare always excluded from school when the true Klebs-Loffier bacillus is detected, but the presence of Hoffman’sbacillus is not regarded as warranting such exclusions.But where this bacillus is found the children harbouringit are regarded with suspicion. In one instance where

typical Klebs-Loflier bacilli had been found in the throatswabs the pencils which had been used in common by thechildren in the affected class were examined and the typicalorganisms found. Dr. Edwards urges the reinstatement ofthe epidemic grant which was withdrawn in 1903.

VITAL STATISTICS.

HEALTH OF ENGLISH TOWNS.

IN 76 of the largest English towns 8004 births and 3974deaths were registered during the week ending Sept. 25th.The annual rate of mortality in these towns, which hadbeen equal to 12’ 8 and 13. 0 per 1000 in the two precedingweeks, declined to 12-6 6 in the week under notice, and waslower than in any week since the middle of August. Duringthe first 12 weeks of the third quarter of the year the annualdeath-rate in these towns averaged only 11 9 9 per 1000,and in London during the same period the rate didnot exceed 11’ 4 per 1000. The lowest annual rates ofmortality recorded in the 76 towns last week were 4’ 0 inLeyton, 4’ 5 in King’s Norton, 4 9 in Hornsey, and 5 9 inWest Hartlepool ; the rates in the other towns rangedupwards, however, to 16’7 in Hull, 17 - 4 in Rochdale,17 - 5 in Oldham, and 17’ 8 in Middlesbrough. In Londonthe recorded death-rate last week was equal to 12 - 2 per1000. The 3974 deaths in the 76 towns last week showed adecline of 127 from the number in the previous week, andincluded 509 which were referred to the principal epidemicdiseases, against numbers declining steadily from 849 to 63Zin the four preceding weeks; of these 509 deaths, 348resulted from diarrhoea, 51 from whooping-cough, 37 fromdiphtheria, 30 from measles, 26 from scarlet fever, and 17from fever " (principally enteric), but not one from small-pox. The 509 deaths from these epidemic diseases lastweek were equal to an annual rate of 1’6 6 per 1000,a lower rate than in any week since the middle of August.No death from any of these epidemic diseases was registeredlast week in Cardiff, Leyton, Halifax, Hornsey, or in fiveother smaller towns ; the annual death-rates therefrom rangedupwards, however, to 3 5 in Rhondda and in Middlesbrough,3 . 8 in Hanley, 4’0 0 in Brighton, and 4’9 in Stockton-on-Tees. The deaths attributed to diarrhoea in the76 towns, which had declined in the four precedingweeks from 676 to 461, further fell last week to 348, butcaused annual death-rates ranging upwards to 2.8 8 in Hull,2 - 9 in Stockton-on-Tees, 3 - 0 in Middlesbrough, 3-1 inRhondda, and 3’ 2 in Brighton. The fatal cases of whooping-cough, which had been 73 and 59 in the two previousweeks, further declined to 51 last week ; the highest annualrates from this disease being 1-2 in Derby and 2-0 in GreatYarmouth. The 30 deaths from measles also showed a.