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1023 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 v devolves upon the additional medical officer, who receives i S150 per annum for such work and who, for additional i remuneration, 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 f parents accepted the invitation to be present. As regards c treatment it is stated that, speaking generally, the parents of t the 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 1 adviser or taken the children to a hospital. But the 1 figures relative to certain diseased conditions are far I from satisfactory. Of 406 cases of enlarged tonsils and i adenoids only 11 cases received treatment. Enlarged J cervical or submaxillary glands were detected in 181 cases, a large proportion being due to verminous conditions or I decayed teeth. As regards dental conditions 20 per cent. of j the children were found to present some defects, while in the matter of clothing 16 per cent. were found to be badly clothed or badly shod. Of the total number of children examined eight were found to be suffering from pulmonary tuberculosis. In the matter of general nutrition many of the children were found below the normal standards of height and weight, but the report states that the majority of these were simply undersized children well nourished and cared for. : No open-air camps have as yet been arranged for, but in the summer, in fine weather, classes are held in the playgrounds. Of the children attending school there had suffered before the commencement of school life 58 per cent. from measles, 36 per cent. from whooping-cough, 18 per cent. from chicken-pox, 7 per cent. from scarlet fever, and It per cent. from diphtheria. County Borough of Devonport.-Mr. O. Hall, the medical officer of health, has been appointed school medical officer for this district. Out of 2078 children examined 44’6 per cent. had good teeth, 24’6 6 per cent. indifferent, and 30’ 7 per cent. bad, and Mr. Hall suggests that a tooth-brush drill should be introduced into the school curriculum. Pulmonary tuberculosis 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 in any detail; probably the experience of the first year is being awaited. Borough of Cambridge.-The work of the medical in- spection of school children was commenced in voluntary fashion in Cambridge in 1907, but the advent of the com- pulsory regime has necessitated rearrangement of the whole procedure. The school medical officer is Dr. A. J. Laird, the present medical officer of health, who has himself carried out the medical inspection, and a school nurse, who was appointed in the autumn of 1906 at a salary of B95, assists at the inspection by weighing and measuring the children and by testing their hearing and vision. She also follows up cases at their homes and reports in writing to the school medical officer. A dentist has also been provisionally appointed at a salary of 300 per annum, but it appears that at the date of making the report the appointment had not received the sanction of the Board of Education. Assistance at the routine inspection is also afforded by three lady health visitors, who in addition follow up cases at their homes. As regards routine inspection it is not the practice at Cambridge to invite the attendance of the parents, although they are informed by the teachers that their presence will be welcomed. Notices are, however, sent to the parents whose children present defects requiring attention, and this notice is followed by visits from the school nurse or health visitors. The figures as regards nutrition were as follows : above average, 15 per cent.; average, 68 per cent.; below average, 17 per cent. County Borough of Boitrneiizoiit7t.-Dr. A. D. Edwards, who is the school medical officer of the borough, reports that as the work of inspection was not commenced until October, 1908, the report deals mainly with local conditions of school hygiene upon which sufficient information for trustworthy deductions has been obtained. We gather that Dr. Edwards is not altogether satisfied with the present arrangement, by which he as school medical officer does not form part of the public 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 the vork of the departments. It is not clear why the town council n the first instance decided to keep the work of medica} nspection outside that of the medical officer of health. The tttendances of parents at the medical inspections of the children 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 these conditions is it possible for the parent to obtain adequate treatment for the child at a small charge from a medical practitioner. This is an unfortunate state of affairs, s,nd in the interest of the public health it ought somehow to be remedied. The past incidence of in- fectious diseases upon children leaving school before August, 1909, was as follows : measles, 86’ 56 ; whooping- cough, 37’5 per cent.; chicken-pox, 20 per cent. ; and scarlet fever, 2’5 per cent. In cases of the suspected occurrence of infectious disease amongst the scholars swabs from the throat are taken for bacteriological examination and by this means symptomless "carriers" have been excluded. Children are always excluded from school when the true Klebs- Loffier bacillus is detected, but the presence of Hoffman’s bacillus is not regarded as warranting such exclusions. But where this bacillus is found the children harbouring it are regarded with suspicion. In one instance where typical Klebs-Loflier bacilli had been found in the throat swabs the pencils which had been used in common by the children in the affected class were examined and the typical organisms found. Dr. Edwards urges the reinstatement of the epidemic grant which was withdrawn in 1903. VITAL STATISTICS. HEALTH OF ENGLISH TOWNS. IN 76 of the largest English towns 8004 births and 3974 deaths were registered during the week ending Sept. 25th. The annual rate of mortality in these towns, which had been equal to 12’ 8 and 13. 0 per 1000 in the two preceding weeks, declined to 12-6 6 in the week under notice, and was lower than in any week since the middle of August. During the first 12 weeks of the third quarter of the year the annual death-rate in these towns averaged only 11 9 9 per 1000, and in London during the same period the rate did not exceed 11’ 4 per 1000. The lowest annual rates of mortality recorded in the 76 towns last week were 4’ 0 in Leyton, 4’ 5 in King’s Norton, 4 9 in Hornsey, and 5 9 in West Hartlepool ; the rates in the other towns ranged upwards, however, to 16’7 in Hull, 17 - 4 in Rochdale, 17 - 5 in Oldham, and 17’ 8 in Middlesbrough. In London the recorded death-rate last week was equal to 12 - 2 per 1000. The 3974 deaths in the 76 towns last week showed a decline of 127 from the number in the previous week, and included 509 which were referred to the principal epidemic diseases, against numbers declining steadily from 849 to 63Z in the four preceding weeks; of these 509 deaths, 348 resulted from diarrhoea, 51 from whooping-cough, 37 from diphtheria, 30 from measles, 26 from scarlet fever, and 17 from fever " (principally enteric), but not one from small- pox. The 509 deaths from these epidemic diseases last week 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 registered last week in Cardiff, Leyton, Halifax, Hornsey, or in five other smaller towns ; the annual death-rates therefrom ranged upwards, 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 the 76 towns, which had declined in the four preceding weeks from 676 to 461, further fell last week to 348, but caused annual death-rates ranging upwards to 2.8 8 in Hull, 2 - 9 in Stockton-on-Tees, 3 - 0 in Middlesbrough, 3-1 in Rhondda, and 3’ 2 in Brighton. The fatal cases of whooping- cough, which had been 73 and 59 in the two previous weeks, further declined to 51 last week ; the highest annual rates from this disease being 1-2 in Derby and 2-0 in Great Yarmouth. The 30 deaths from measles also showed a.
