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84
Annual Report of the London County Council, 1914.
The final reply of the Council was sent on 2nd July, 1914, and in conjunction with the previous
letter covered all the points raised by the Board. This letter is here reproduced:—
1. London. 2nd July, 1914.
2. School Medical Service.
Sir,—The Council has given further consideration to the points raised in paragraphs
5, 8 and 9 of Mr. Davies' letter of 24th June last (M.3303/13), relating to "following-up,"
to the arrangements for medical treatment, and to the extension of the functions of the assistant
medical officers.
With regard to the point raised in paragraph 5, as to the arrangements for "following-up
and to the suggestion that a proportion of the staff of organisers of Care Committee work
should be allocated to the School Medical Officer, I am to state that it has now been decided
to place the organising staff on a permanent basis, to enlarge its numbers, and to allocate to
the School Medical Officer a certain proportion of the staff based upon the amount of work
involved in connection with the school medical service.
For the proper organisation of the work of medical inspection and treatment the Council
has decided that London shall be divided into five divisions, and that the medical work in
each of these divisions shall be placed in charge of a divisional medical officer. In the five
divisional offices the administration of the treatment centre work will be focussed, and officers
allocated to the public health service will be employed to deal more particularly with the
voucher and "following-up" work connected with the treatment centres. Under the reorganisation
the staff of organisers is being increased from 74 to 82, and, in addition, 29 women
clerks are to be appointed. Fifty-four of the organisers and twelve of the women clerks are
being allocated to the public health department, the work of the whole of the organising staff
being co-ordinated by the Education Officer and the School Medical Officer through a principal
organiser who is an officer attached to both the education service and the school medical service.
Certain criticisms of the Board in connection with medical treatment, referred to in paragraph
8, have been given very careful consideration, and in connection therewith, I am directed
to state that arrangements have been made for the medical officers of the treatment centres
to be furnished with full information as to the nature of the defects of the children referred to
them. With regard to the restriction of dental treatment to the 6-8 age group, I am to
point out that it is the practice to make appointments for older children only in cases of those
urgently needing assistance, and to furnish facilities for treatment at such times as the accommodation
at the centre permits.
In connection with the statement of the Board that the arrangements in respect of nursing
treatment are not considered to be satisfactory, the Board will remember that, since the receipt
of their letter, additional facilities have been provided and further schemes will be submitted
for the Board's approval as opportunity arises. It is proposed that arrangements shall be
made whereby the school doctor shall inspect at the centre children requiring nursing treatment
referred by care committee workers, school nurses, teachers and attendance officers with a
view to referring immediately to the proper department those cases found to be suitable for
treatment under the Council 's arrangements. The organiser of care committee work at the
centre will communicate with the care committee in order that the necessary investigation
and assessment may be made.
With regard to the suggestion of the Board as to the treatment of the cases of discharging
ears, I am to point out that the Council's otologist has given careful consideration to this
question and has visited many of the centres at which the treatment of discharging ears is
carried out. The other duties which it is necessary for him to perform do not admit of the
extension of his work in this direction, but in the arrangements now being made provision is
included for certain of the school doctors, who have had special experience, to pay special
attention to this side of the work.
With regard to the extension of the functions of the school doctors, I am to state that
the Council has recently approved a scheme whereby it will be possible to introduce into the
duties sufficient variety to obviate the danger indicated by the Board. The scheme involves, as
before-mentioned, the division of London for the purposes of medical administration into five
districts,each placed in charge of a divisional medical officer and, in order to meet the new requirements
of the Board, it has been found necessary considerably to augment the medical staff.
In each division the staff under the control of the divisional medical officer consists of a nucleus
of permanent medical assistants, the remainder of the staff consisting partly of full time temporary
medical assistants appointed for a period of three years only, and partly of temporary
quarter time school doctors appointed for a period not exceeding two years. With the recently
appointed staff, and with the re-distribution of the work, the numbers of the medical staff
now engaged in school medical inspection comprise, in addition to the central staff and the
five divisional medical officers, 17 permanent full time medical assistants, 20 temporary
full time medical assistants and 20 part time school doctors. The work of the last
named class of doctors will be practically confined to inspection, and there will thus be
additional opportunity to vary the duties of the permanent officers by utilising their services
in connection with special schools, secondary schools and higher education institutions, inspections
at treatment centres, special investigations and general public health work. It has