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skill are unable to emulate. Very much depends upon the influence of the head teacher of the school.
The vast majority of the teachers appreciate the impartance of the work and leave no stone unturned
which can aid in its success, and it is impossible to over-estimate the share of the credit for ultimate
success which is due to the enthusiasm of the teachers. A few head teachers remain, however, still
indifferent or even hostile and in schools, fortunately very rare, where these conditions exist, the
results are poor in the extreme. Especially do the numbers of parents who attend the inspections
appear to be affected by the sympathies of the head teachers and the presence of the parent at the
inspection is found to be a most important element in obtaining speedy treatment for the child.
The process of bringing the necessity of treatment home to the parent is often a very slow one.
The school doctor at the inspection finds a chi'd has one unsound tooth. This is recorded as a defect
and failure to get it remedied brings discredit. The parent is busy or apathetic and does not attend
the inspection. The school nurse visits the home and gives the mother, if she can find her, an advice
card telling her what is wrong and advising her to get treatment The voluntary visitor follows her
after a little time and endeavours to persuade the mother to take the child for treatment. There
may be no difficulty and an appointment is made forthwith at a treatment centre. On the other
hand several visits may be made before the mother can be found. She is harassed possibly by domestic
worries, makes difficulties, the father must be consulted and he does not hold with tampering with the
teeth, there is money to be paid for having it done, she will lose a day's work over it, which she cannot
afford, it has never given the child any pain so why should she bother and so forth. The date of the
first re-inspection comes round. The care committee representative is present when the doctor sees the
child again, nothing has been done, the tooth has now gone too far to be saved. Is it any use bothering
any more ? No, the case is given up. It has been a failure. Or perhaps the doctor says there are
signs of decay now in the adjoining teeth. It is decided to persevere with the case. A strongly
worded advice card is sent. The visitor resumes her visits of persuasion. She may now be successful
or on the other hand the parent may have become more like adamant. The doctor down the street
has seen the child and says it is only a first tooth and will drop out. The second re-inspection comes
round. Nothing has been done ! Some conclusion must be come to. Further persuasion seems to be
useless. Can the case be sent to the N.S.P.C.C. for prosecution ? No, it is not of sufficient importance,
a prosecution would probably be unsuccessful, especially as the mother has taken the child to a doctor.
Or else, now there is an abscess and the case is rather serious. The special officer is asked to visit and as
the child is now complaining of pain the mother may consent; if she does not the N.S.P.C.C. must intervene.
Many of the cases run such a course as the above ; there is nothing for it but to keep these
cases under observation until they pass from the early beginnings of disease into a more serious
condition when, as a rule, treatment can be insisted upon and indeed the obstinate opposition dies down
of itself. The very nature of the work is thus essentially educative and ultimate success will depend
on bringing home to the people the importance of attendance to the beginnings of disease and the
truth of the adage " a stitch in time saves nine."
Re inspections
As will be gathered re-inspection of children found with defects is an important part of followingup.
It is no use pulling plants up to see how they are growing, and to serve any useful result the
re-inspection should not follow too close upon the original discovery of a defect. A clear term is, therefore,
allowed to elapse between the primary inspection and the re-inspection and another clear term
between the first re-inspection and the second re-inspection, if the latter is found necessary. The total
number of re-inspections carried out in 1920 was 158,641. 93,985 of these were first re-inspections and
64,656 were second re-inspections.
The tables in the appendix show that a larger number of children are now treated in the year
than are referred for treatment in the year. During the war many causes combined to reduce the
efficiency of following-up and it is now clear that not many cases are final y unaccounted for. Reinspection,
however, shows that the process, though in the iong run nearly complete, is a very slow
one. At first re-inspection it was found that 38.9 per cent. of the children referred for treatment had not
received it and still required it. Including these with the children who were undergoing treatment
which was still however, incomplete, 56.1 per cent. were referred lor second re-inspections. At second
re-inspections the percentage of children not under treatment and still requiring treatment was 41.1.
The children seen at second re-inspections are not all identical with those seen at first re-inspections
in the year, some of them having been referred for further re-inspection from the previous year, but,
if it is assumed that a similar proportion will obtain for the cases that have not yet undergone second
re-inspection, the combined result gives a figure of 76.9 per cent. of chi dren satisfactorily dealt with
after the lapse of fifteen months from primary inspection, as compared with a similar figure of 73.5
per cent. in 1919.
The figure of 76.9 per cent. of children found satisfactorily dealt with by the time the second
re-inspection was carried out is the highest yet obtained since the Council undertook the provision of
treatment for ailirui children.
Dental cases
Were it not for the inclusion of figures of dental cases referred by the school doctors for treatment
the results would be still better. As is well known the scheme of the Board of Education for dental
treatment aims at beginning with the younger children and, as yet, full fac lities do not exist in any
case for the treatment of the mass of dental defect. There is also more reluctance on the part of patients
to face the dentist's chair than to undergo any other form of treatment. It is not surprising therefore
that the "leakage" in the case o. children referred for dental treatment by the school doctors is
higher than in the case of any other class of defect.
The percentage of children suffering from dental defect found still requiring treatment at first
re-inspections is 49.8 and at second re-inspections is 53.6.