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CHAPTER XXIV
RETORT OF THE COUNTY MEDICAL OFFICER OF HEALTH AND SCHOOL
MEDICAL OFFICER (DR. W. H. HAMER) FOR THE YEAR 1914.
Part II.—Education.
Introductory Note.
The year 1914 is the third completed year since effect was given to the Council's resolution of
25th July, 1911, reorganising the London school medical service. In the report relating to the year 1913
special reference was made to the question of the medical staff, its numerical strength, permanency
and duties. During that year the Board of Education had caused inquiry to be made by its medical
inspectors into the working of the Council's inspection and treatment schemes, and arising out of this
inquiry certain criticisms of detail were made by the Board and embodied in a letter sent to the Council
on 24th June, 1913. This letter was set out in full in last year's annual report and suggestions were
made with a view to meeting the points raised. These suggestions had not, however, at the time of
preparation of that report been in their entirety considered by the Council and it was not until the
2nd July, 1914, that the Council was in a position to reply fully to the Board's letter. The reply is
reproduced in full on pages 83-85.
Staff considerations
As mentioned in last year's annual report, the question of the medical staff was already receiving
attention at the time of the receipt of the Board's letter, the outcome of this consideration being the
re-arrangement of the duties of the medical assistants engaged in inspection in the schools, so that their
services are now utilised in connection with the whole field of school work in the Council's public health
department. The other changes summarised in the Council's letter of the 2nd July last, involved more
prolonged consideration, many conflicting interests had to be reconciled, and the importance of the questions
precluded hasty decisions. The results, however, briefly stated, were as follows—the organising
staff was increased and a definite proportion of its members (54 organisers and 12 women clerks) was
allocated to the public health department; arrangements were made for the treating doctor at the
centre or hospital to be furnished with full information as to the defects of the children referred to
him; the facilities for nursing treatment were increased; and several minor matters arising out of
inspection, re-inspection and treatment, were dealt with.
Owing to conditions arising out of the war, serious hindrance has been felt in carrying into practical
effect some of the decisions communicated to the Board. In several of the districts owing to absence
of the permanent school doctor, it has been necessary to carry on his work with the aid of temporary
assistance. In the treatment centres and hospitals many changes have occurred in personnel, thus
causing interference as regards continuity of method. Difficulty has also been experienced owing to
the changes in the nursing staff in consequence of the war. It is evident that it would be premature
at the present time to express any final opinion on the new methods.
Other
changes made
during the
year.
During the year 294,026 children were examined by the assistant medical officers, and of these
101,432 were found to require treatment for one or more defects. The parents were present in 68 per
cent. of the cases examined. Dr. C. J. Thomas has examined the results, and it has been possible for
him to make comparison between the figures for three years of medical inspection, 1912, 1913 and 1914.
The comparison thus made indicates a gratifying improvement in many directions. The percentage
of children found suffering from enlarged tonsils and adenoid growths requiring operation continues to
be lower than was formerly the case. There appears, moreover, to be a steady improvement in neatness
and cleanliness of all children which reflects great credit upon the unremitting efforts for amelioration
made by school nurses, head teachers and care committee workers.
In comparing the incidence of defect upon age and sex it is found that although starting school
life on an equality with boys, the girls at the leaving age show an excessive incidence compared with
boys in respect to visual defect, deformities, heart defect, anaemia and nervous disease. This excessive
incidence suggests that girls as a whole spend a less healthy and hygienic life than boys, and one of
the problems of hygiene remaining to be solved is how to give the girls an equal place in the sun with
the boys.
Medical
Inspection.
In the Council's letter to the Board of Education reference has been made to the increase of
facilities for nursing treatment, but it may be emphasised that at the end of the year provision had
been made for the treatment of nearly 20,000 cases as against 12,320 at the end of 1913. Experience
moreover shows in the case of nursing treatment that better attendances have been secured as the
number of centres has been increased. The average numbers under the agreements during 1913 were
12,082, while the attendances numbered 10,159, a deficiency of nearly 2,000. During 1914, the numbers
were respectively 15,183 and 14,634, a shortage of less than 600 upon considerably higher numbers.
Except as regards dental treatment, little alteration has been found to be necessary in the
arrangements for treatment, though throat and aural defects show a further decrease, 12,961
cases being treated, as against 13,618 in 1913; eye cases, however, show an increase of some 3,000.
The most important sphere of usefulness in a treatment scheme is undoubtedly to be found
in dental defect. The demand for dental treatment in London is increasing so rapidly that the provision
authorised for the year beginning on the 1st April, 1915, is for more than 63,000 cases, or,
roughly, three and a half times as many as two years earlier. For all classes of ailments treated under
the Council's scheme, the centres, including hospitals, at the end of the year numbered 42, providing
for 98,976 children, as against 34 centres providing for 84,359 children at the end of 1913.
Medical and
Dental
Treatment.
It must not be forgotten that every material extension in the development of a treatment scheme
involves a corresponding increase in the work of "following up." The Council, has fortunately been
able to avail itself of the help of a large body of voluntary workers, inasmuch as each school or group
27715 m
"Followingup."