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149
School Medical Officer. This following up extends to the age of eighteen years or,
in many instances, for a longer period. In the case of tuberculosis, the care committees
may continue supervision for any period required. It has been found, however,
with the increasing efficiency and early age of treatment that numbers of children
are enabled to return to the ordinary schools, when any subsequent after care would
follow the ordinary channels, or may be deemed no longer certifiable before passing
the age of sixteen, and so are eligible to leave school for employment. The details
are given on page 158. In the case of each leaver, a form is filled for the guidance
of the after care workers, showing what occupations would be less desirable and
what attitudes and movements impossible.
(4) With a view to the prevention of crippling every effort is made to ascertain
the existence of cases of tuberculosis, poliomyelitis, rheumatism, and the like, at
the earliest moment, in order that offers may be made of residential treatment;
and it may be well to emphasize here the fact that there is no limit placed by the
Council upon the duration of such residential treatment, except the opinion of the
medical officer in charge of the patient. These facilities for residential treatment
under the Council's various schemes have, as already explained, been frequently
brought to the notice of all hospitals and other agencies. In those cases where the
diseases are notifiable, steps are taken in co-operation with the borough medical
officers of health, to follow up the patient from the date of notification in order to
ensure at least the offer of appropriate treatment under the best conditions
possible.
The general arrangements for medical inspection and treatment; the provision
of meals ; open air schools ; artificial light treatment, and the general rise in standard
of living, have checked many deficiency diseases ; while the causes of infection are
reduced both by early treatment and the greater cleanliness of food, dwellings and
persons. As was clearly shown by the photographs published in last year's annual
report, the physical condition of the London school children has enormously improved
in recent years, while the reduction of crippling must be evident to all
who can recall the streets of the poorer parts of London some thirty to forty
years ago.
Details of
scheme.
Tuberculosis of Bones and Joints.—In London it is found in most cases that the
affected child has attended first as an out-patient in the surgical or the special orthopaedic
departments of the various general or special hospitals, and that it may subsequently
have been admitted as an in-patient. Very few cases of tuberculosis of
bones or joints attend, in the first instance, at the tuberculosis dispensaries. Consequently,
applications for residential treatment are mostly received by the Council
from the voluntary general or special hospitals. In the case particularly of the
out-patients, hospitals have been urged to apply to the Council for residential treatment
at the earliest possible moment, and many applications are made nowadays
by telephone message, the necessary papers being forwarded later.
All applications must be made on the prescribed forms, Form A (the clinical
record), and Form B (the environmental record). Subsequently, a home enquiry
form is obtained, giving the economic circumstances, and all cases are considered
for assessment.
Procedure by the Council on receipt of applications.—On receipt of the Forms
A and B, or on receipt of a telephone message in urgent cases, arrangements are
made by the Council for the immediate admission of the patient to a residential
orthopaedic institution. All urgent cases, i.e., cases of tuberculosis of spine, hip or
major joints are admitted within a few hours of application to an orthopædic hospital,
such as Queen Mary's, Carshalton, or Princess Mary's at Margate. Less urgent cases
are transterred within a few days. No cases are kept waiting for admission more
than a few days.