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112
own age in the elementary school, due to enforced absence through
sickness. In the elementary school he is often at the bottom of his
class, with the result that a sensitive child develops a sense of
inferiority, becomes miserable and unhappy, and his general health
suffers in consequence. I gathered that in the majority of cases the
children disliked going to school, and on the slightest pretext appealed
to their parents to be allowed to stay away, with the result
that they still further lost ground and a vicious circle was set up.
At the open-air school a child meets others in the same backward
state as himself, and so less attention is drawn to him in this
respect. He soon begins to regain confidence in himself, the result
being that he becomes happy and contented and his general health
improves accordingly.
The arrangement of institutional treatment by the London
County Council has shown some improvement, 150 of our cases
being admitted to hospital or sanatorium. The period of waiting is
shorter, and the number of our cases which have failed to gain
admission is less. The problem of the advanced case, however, is
still unsolved. The accommodation for this class of case is totally
inadequate, while the institutions that are available are too far removed
from the patient's home. I would again urge the need of a
local home for advanced cases. In the Borough of Hackney, however,
this problem is to a large extent solved, as when the home
conditions are unsatisfactory the Borough Council will accept
responsibility for the cases turned down by the L.C.C. and arrange
for their admission to a local institution. Moreover, by a special
Act, patients in an advanced and infectious state, when the home
conditions are such that they are a danger to others, can be compulsorily
removed.
Although the L.C.C. do not appear to appreciate the urgent
need for the provision of institutional treatment for all advanced
cases to prevent the spread of infection, yet they introduced a
scheme whereby the children of these patients should be removed
from their homes and boarded out elsewhere. It has not been a
success, as it is difficult to persuade parents to surrender their
children to strangers in a home which they have never seen, and
and which they are discouraged from visiting. It would appear to
be a more reasonable and economical method of securing the same
end, to remove the source of infection—the patient himself.
The problem of securing suitable work for patients on their
discharge from sanatorium is at last receiving the attention of the
authorities, but whether it will result in a solution of the difficulty
remains to be seen. A lengthy report by the Medical Officer of
Health of the L.C.C. in November last was considered by their
Public Health Committee, and the Council later defined its present
position in the matter. Briefly it may be summarized as follows:—