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It will be seen from Table IV. in the Appendix that while during 1920, 16,883 children were
referred for treatment for defects of nose and throat, no fewer than 17,383 received treatment during
the year; it is clear, therefore, that arrears are being now overtaken; 9,976 children were operated
upon for tonsils and adenoids under the Council's scheme alone.
At first re-inspections during the year 41.7 per cent. of the children needing it were found to
be untreated and at second re-inspections 40.7 per cent. of the remainder were still untreated. Of the
children treated 27 per cent. were treated at hospitals (institutions not included in the Council's scheme)
as compared with 25 per cent. in 1919. Rather more than one-fourth of the work of performing operations
upon the throats of school children still falls therefore upon the general hospitals.
The "leakage" in the case of visual defect is much less than in the conditions already discussed.
At first re-inspections only 39.3 per cent. of children were found to be still untreated and in need of
treatment and at second re-inspections 39.8 percent. The vast number of 32,013 children was treated
during the year, of whom 29,887 were submitted for refraction under the Council's scheme. The numbers
treated were greatly in excess of those referred during the year, showing that arrears are rapidly being
overhauled.
Spectacles were prescribed at the Council's centres for 22,827 children and obtained in 19,882
cases. Only 14 per cent. of children obtain spectacles apart from the Council's scheme. The general
hospitals show considerable reluctance to undertake much refraction work and children are thrown
back by them to a large and increasing extent upon the Council's scheme. No part of the cost of
providing spectacles falls upon the rates; in the majority of cases the parents find no difficulty in
buying them at the wholesale prices charged at the centres. Provision is made by the care committee
visitors for payment by instalments, in some cases this has in the past delayed the supply of the spectacles
a little. In cases of necessity help is forthcoming from voluntary funds managed by the local
associations of care committees.
Re-inspection shows that "other complaints" are attended to with less difficulty by the care
committees than in the case of the defects for which provision has been made by the authority. At
first re-inspections 17.9 per cent. only of these conditions remain in statu quo ante, and at second
re-inspections 17 6 per cent. In other parts of the report glimpses will be seen of the agencies at work.
The general hospitals and infirmaries make little trouble in providing for serious conditions of heart
and lung. Stammering classes have been established. Tuberculosis dispensaries are now within reach
of all children for diagnosis, observation and treatment of all tuberculous conditions, and sanatorium
treatment for children can be obtained without difficulty by the Council.
The ever-widening provision of open-air treatment for the anaemic and debilitated is also
described and the good offices of such bodies as the Invalid Children's Aid Association are much drawn
upon. The Children's Country Holiday Fund, too, now concentrates upon the anaemic and debilitated
child and makes up for loss of numbers by more discriminating incidence of benefit.
In view of the great importance of the condition of discharging ears both as regards the peril to
the individual, and the offensiveness of the condition to others, special methods of following-up have been
adopted. Dr. Chaikin reports as follows:—I would like to point out the great importance of the school
nurses' supervision in the schools. They have brought to my notice many cases of otorrhœa. Some
were under no treatment at all. Others were not attending treatment centres regularly. The
notification to me was followed by a communication to the Care Organisation and, in the term following
notification, the children were seen by the school doctor. In cases of otorrhoea there is need for constant
supervision. Children fail to continue regular attendance at centres because parents think they
are better ; then there comes an exacerbation ; the discharge becomes profuse or there is pain and the
child reappears. The work of the nurses in discovering quiet cases constitutes a great preventive
service. There were 333 cases of otorrhoea notified by school nurses and 5 by head teachers, in the
Eastern Division, in 1920. More boys than girls were affected. My own view is that it is easier to
notice ear discharge in a boy than a girl owing to the latter's hair.
During the past year the total number of examinations made by Dr. Wells of chronic cases,
which do not clear up after treatment at a centre was 2,476. This number represented 939 cases, of
which 502 were new cases during the year. Of the cases under observation, the number discharged as
" cured " was 230, representing a percentage for the whole of London of 28.2 per cent. during the
year. The total number of purely deaf cases was 114 and the number discharged as " cured " was 53,
giving a percentage of 46 per cent.
The work of the School Attendance Branch in connection with Medical Supervision of Children.
The points of contact of the School Attendance branch with the school medical service are
innumerable and extend along the whole line of operations. So much is this the case that very substantial
allocations are made to the school medical vote in the estimates on account of services of the school
attendance officers. Not only are the local officers of the two services in constant touch regarding
children absent from school on account of alleged ill-health, but important services are rendered by the
attendance officers in connection with the following-up of difficult cases where treatment has been
recommended, in connection with the service upon neglectful parents of statutory notices under the
Children Act and with the recovery of charges for medical treatment. The departments are in close
touch upon questions involving juvenile employment particularly, at present, in regard to children
employed in entertainments.
In addition to the constant interchange of information and assistance in regard to children
absent from school, a special register is compiled from information supplied by the attendance branch, of
children who have been absent from school for a period of three months and upwards. The names
Nose and
throat cases
Visual defect
Other
complaints
The follow
ing up of
cases of discharging
ears