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Much discussion has taken place both in medical and lay circles upon the question of after
treatment of children operated upon for enlarged tonsils and adenoid growths. The practice of
performing operations in out-patient departments and handing over the child directly after the recovery
from the effects of the anaesthetic, to the mother, to find her way home by crowded public conveyances
has been felt to be unsatisfactory. The presentation to the Council by Lady Henry of a building in
Woolwich which had been erected during the war for the purpose of a day nursery, has provided a most
suitable hospital wherein operations upon the throat can be carried out In addition to residential
staff quarters, operating theatre and other accessory rooms, two wards each receiving twelve children
have been provided. The establishment was opened in June, 1920 under the name of the "Cyril
Henry" treatment centre, so called in memory of the son of the donatrix. Twelve boys and twelve girls
are operated upon each alternate day and each child is detained in the hospital for two nights after the
operation. It has thus been found possible to deal with all the children formerly treated at the
Woolwich, Greenwich, Deptford and Peckham centres.
The children are seen by the surgeons at their local centres in the first place and those referred
for operation are dealt with at the Cyril Henry centre, each surgeon visiting the centre in turn to carry
out the operations upon his own cases. After discharge from the Cyril Henry centre each child returns
to the local centre for breathing exercises under the supervision of his own surgeon until finally discharged
as cured. The arrangement has proved highly successful and less difficulty is now being experienced
in the South-Eastern division in persuading parents to have the necessary attention to nose
and throat defects as they are relieved from the ordeal of the care and transport of the chil d immediately
after the operation. The question of providing an ambulance for the conveyance of children from
other centres to their homes after operation has been discussed but no decision on this point has yet
been arrived at.
The arrangements for medical treatment generally have continued to be developed according
to the scheme outlined in the annual report of the school medical officer for the year, 1912. At the end
of the year 1920, the scheme included 14 hospitals, and 46 treatment centres, the latter managed by
voluntary local committees of medical practitioners, nursing associations, and dispensary and other
committees. The agreements with these 60 centres provided for the treatment of 194,100 children, the
numbers of the particular ailments treated being as follows:—eyes (refraction, 30,490; eye diseases,
2,050); ear, nose and throat, 15,800; ringworm, 2,100; minor ailments, 44,440; teeth, 99,220.
The facilities thus provided for treatment are available for elementary school children and
scholarship holders in secondary schools at a nominal charge of Is. for each ailment treated except
that in the case of minor ailments the charge of 3d. has been made. Fee paying pupils at secondary
schools are also treated, in default of available private means, subject to the actual average cost of
treatment being refunded to the Council. The average cost for the year 1920, was fixed at 6s. 6d. per
case. The question of revising the charges made for medical and dental treatment is at the present
time (March, 1921), under consideration.
Under the Council's arrangements for treatment for the year 1921-22, it has been necessary to
ncrease the allowances to treatment centres in several respects. For instance, to meet the high cost
of adaptation of new centres a grant of £100 is now made. The allowances for equipment are, moreover,
higher than in former years, and now stand at £75 in respect of eye or aural treatment; £100
for dental work ; and £150 for X-ray treatment of ringworm. The salaries of treating doctors have
been raised from £70 to £80 per annum for work on one session a week; dentists as from 1st April,
1921, will receive £65 per annum instead of £50 or £55; and £175 per annum will be paid for the whole
time services of a nurse.
The capitation payments hitherto made have proved insufficient to meet the current expenditure
on maintenance of the hospitals and centres, and a separate grant is now paid, based on the total number
of cases for which agreement is made for treatment, in order to meet the difficulties encountered at
the present time.
The number of children actually treated shows a further increase on the comparison of successive
years, the total for the year 1920 being 197,700, as against 169,200 for the year 1919. More detailed
particulars of the treatment of the separate ailments are here summarised.
(a) Minor ailments.—The year has been one of acute pressure upon all the minor ailment departments.
Simultaneously with the increase in epidemic prevalence of scarlet fever, there appears to have
been a corresponding increase in septic conditions of the skin, and the Consequence has been that children
have required treatment in larger numbers than usual. During the year four new minor ailment centres
were established, and the accommodation at existing centres was increased so that the total provision
at the end of the year was for 44,440 cases. Notwithstanding this provision, larger by more than 10,000
than the figure for 1919, many centres were still overcrowded. Altogether 61,771 cases were treated
—a number greatly in excess of the accommodation nominally provided—and the number of attendances
made reached 1,121,026, a number which has never been approached in former years, and representing
a 32.4 per cent. increase on the numbers for 1919. In considering the provision for minor ailments in
London, and in comparing the work done with that in other areas, it must be remembered that the
Council deals with a large number of children at the cleansing stations for parasitic conditions which
in other areas are dealt with at minor ailments centres. In addition to cases of infestation by lice, all
cases of scabies are treated at the cleansing stations, and on account of scabies alone 9,675 cases must
be added to the 61,771 cases referred to, making a total of 71,446.
(b) Aural defects (including enlarged tonsils and adenoid growths).—Under this heading, 18,615
appointments were made for treatment under the Council's scheme. 14,746 children attended for
examination, and 9,976 underwent operative treatment. 10,351 children were discharged as " treatment
completed."
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