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98
Annual Report of the London County Council, 1914.
Hospital treatment was arranged for 24 children, 23 attended tuberculosis dispensaries or infirmaries
and 8 were placed under the care of their private doctor; 10 children were recommended for
open-air schools, 9 secured admission to convalescent homes or cottage hospitals, and a country holiday
was arranged for 16 under the auspices of the Children's Country Holiday Fund, while in certain other
cases the assistance of the Invalid Children's Aid Association was secured.
In addition to the treatment of the ill nourishment or its cause, the Care Committee were also
able to ensure that other defects noted by the doctor received attention and this operated to a certain
extent in the direction of improving the nutrition.
Four cases died during the period they were under notice.
(1) Boy, 55/12 Height 96 c.m., weight, 14 kilograms. Premature child (mother dying
at his birth). Fair home conditions. Suffered from ear discharge. After 11 months, height,
100 c.m., weight, 16 kilograms. Died from abscesses in throat.
(2.) Girl, 10. Height, 118 c.m. Weight, 17'8 kilograms. Father dead. Home clean.
Suffered from anaemia. Became an in-patient of a hospital, where she died.
(3) Girl, 9. Noted at inspection to present symptoms of tubercular peritonitis. Died
in hospital from tuberculosis.
(4.) Girl. Noted to be malnourished and tubercular. Died from phthisis before
re-inspection.
At the re-inspection the doctor classified the nutrition of the children formerly noted as illnourished,
as follows:—good 1, average 27, sub-normal 133 and bad, 113. In the remaining cases no
classification was made, so that it would appear that in spite of the cure bestowed upon them, about 40
per cent, remain cases of malnutrition.
Medical and dental treatment.
In the introduction to this report some mention has already been made of the great increase in
the facilities provided for the medical treatment of school children during the last three years. At
the end of the year 1914 the scheme included 12 hospitals and 30 medical treatment centres, providing
in the aggregate for 98,976 cases. This figure may be contrasted with the 12,000 children for whom
provision was made in January, 1910, the first year in which the Council's treatment scheme actually
came into operation. Owing chiefly to the great demand for dental treatment, the London treatment
scheme has grown to proportions unforeseen five years ago. Thus, for the year beginning 1st April,
1915, provision has been made for the treatment of 125,486 defects, including 63,140 dental cases.
Three-fifths of the provided schools and one-half the non-provided schools are included in the dental
scheme at present in operation.
As regards the treatment scheme as a whole, the attendance of the children has been very good,
although, as might be expected, difficulty has been experienced in maintaining an even flow of cases
throughout the year owing to the somewhat considerable variation in the number of applications made.
To meet this difficulty it was suggested that hospitals and centres should, as far as possible, treat a
definite minimum number of cases to be supplied regularly and should deal with any accumulation
of cases by means of additional sessions. This suggestion was carried into effect in the arrangements
for treatment for the period beginning 1st August, 1914, and a maximum number of additional sessions
was allowed in respect of each hospital and centre, to be used when required during the period of the
agreement at the discretion of the school medical officer. Special arrangements made with regard to
the various classes of ailment treated under the Council's scheme are set out in the following paragraphs.
Eye defects.—In last year's annual report it was pointed out that as the result of inquiry into
the visual acuity of children in the " middle age " group, it was deemed desirable to refer for further
inspection all children whose visual acuity was 6/12 or worse. In view of the lower standard previously
adopted, the existing provision at the hospitals and centres was found to be insufficient; indeed, in some
instances considerable increase has be made to to cope with the altered conditions. Even with this
increased provision, congestion has occurred and in eight months the number of eye cases dealt with was
1,058 in excess of the numbers for which agreement had been made. To meet this difficulty additional
sessions were allowed as mentioned in the preceding paragraph.
Ear, nose and throat defects.—It has been pointed out in previous reports that the effect of the
facilities provided by the Council since 1910, is now being realised in the material reduction in the number
of school children suffering from defect of the ear, nose and throat. This reduction has been maintained
during the year 1914 and it has thus been possible to effect a corresponding reduction in the provision
proposed for 1915. This type of ailment is especially adapted for the exercise of the method of meeting
sudden increases in numbers by arranging for additional sessions. During the year question arose
as to the steps to be taken in the event of haemorrhage occurring at home after operation at the centre.
It was agreed with the centre authorities that the district nurse who visits the home after the operation
should be informed of the name of the surgeon conducting the operation, and that, should
bleeding occur, the operating surgeon should visit the patient. In some cases, however, the surgeon
who operated may not be accessible, and if the services of a local doctor are requisitioned, question arises
as to the responsibility for payment of his fee. The centre authorities took the view that they were
responsible for treatment at the centre only, and that the Council should be liable for any after treatment.
The Council felt, however, that the entire responsibility for treatment should rest with the centre committees.
Finally, it was arranged that the local practitioner's fee should be paid by the centre committee,
the Council reimbursing the committee the amount of the fee. It was understood that the arrangement