H.—3l.

" This compares with Mecredy's figures for 1932 as follows : — Total Number Palpable. Visible. enlarged. Per Cent. Per Cent. Per Cent. "Dr. Mecredy .. .. .. .. 29-2 65-0 76-8 " Dr, Champtaloup .. .. ..35-8 42-0 77-8 " It is to be noted that Mecredy's figure, 76-8 per cent., is not so quoted himself, as he gives figures separately for three terms in 1932 in an ascending order from 59 per cent, to 94 per cent. Taking his figures over the whole year, as my own were, the average is 76-8 per cent. " It is also to be noted that though the total showing enlargement is approximately equal, my own findings place a larger proportion in the palpable group. This may possibly be due to a variation in standard between two observers. " My observations have confirmed my opinion that not only is thyroid enlargement more common in girls than in boys, but also that it is present to a more marked degree. " Boys — Per Per Cent. Cent. "* .. .. .. 39-0 39-0 palpable ;; ;; ;; j«'° " Girls— "* .. .. .. 33-0 33-0 palpable^ " t .. . . .. 45-o'\ . 0 .., , J>Bl-8 per cent. | 48-8 visible J r " The tendency appears to be towards progressive enlargement. Of these previously examined and recorded in this respect, — "23-1 per cent, had the same degree of enlargement. " 4-9 per cent, had decreased to a lower grade. " 72-0 per cent, had increased to a higher grade. " Thus the great majority had shown an increase in size since the previous examination." Treatment Keturns. All School Medical Officers and nurses have devoted considerable time to the special problems arising out of the depression, and especially to measures for the prevention of malnutrition. Much advice has been given to parents, and a larger number of minor treatments for school-children carried out by nurses or by the parent under supervision of the nurse. School Medical Officers refer to the difficulty of obtaining adequate dental attention for children in need of it. Economy measures have made dental treatment, especially conservative dentistry, less available at public hospitals, and an increasing number of parents are unable to pay dental fees. Dr. Turbott, East Cape, reports : " Eye, ear, nose, and throat clinics were held twice during the year, in May and in November, during which fifty-eight children of poor parents were referred to Dr. Scoullar, of Napier, who attended by arrangement with the Cook Hospital Board. These children at ordinary school examinations were found with defects requiring specialist treatment. The Hospital Board aids the acquirement of any glasses ordered in necessitous cases." The problem of securing expert examination and treatment for many children, especially country children, is still great, though many Hospital Boards co-operate more than before in arranging special examinations, and subsequently carrying out any special recommendations —e.g., the supplying of spectacles. Infectious Disease. School attendance has been largely affected by an epidemic of measles which in the early part of the year appeared in the Auckland District, progressing slowly and comprehensively to the limits of the South Island, where it was active in December. There have been extensive outbreaks of influenza in certain areas, of which Palmerston North was one ; several hundreds of school-children were affected with violent sickness and high temperature, the onset being so sudden and so general as to suggest possible food poisoning. Further clinical history and general features of the illness, however, established the diagnosis of influenza. As seven cases of encephalitis were reported last year from North Auckland and ten from New Plymouth, the situation was closely watched. Dr. Cook (North Auckland) reported as follows :— " Influenza and Encephalitis.—: Schools were closed for the last week in the middle term in the Bay of Islands and Hokianga districts on account of the encephalitis cases which had been notified. The number of children exhibiting encephalitic symptoms were not numerous, but few appeared to escape the influenzal-like condition associated with this outbreak. I feel that the catarrhal conditions following the measles epidemic had left many children with lowered defences, so that they fell easy victims to another similar disease." Epidemics of diphtheria, whooping-cough, and mumps, of lesser magnitude have also been experienced.

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