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21
MEDICAL TREATMENT.
In the introduction to the Report for 1906 it was stated that "the question of rigid adhesion
to the policy of completely excluding any medical treatment from the work of the Educational Branch
of the Public Health Department may have to be very carefully considered," and various examples were
given later of types of cases where a public medical service would be of the greatest utility. In the
introduction to the Report of the following year it was stated "a point has now been reached as to
whether the greater part of the medical inspection shall remain fruitless, or whether the Council shall
take steps which will justify its later interference to see that its younger dependents have a fair
chance of properly benefiting by the education offered. Treatment as a public duty will have to
be considered in respect to certain educational matters, such as visual troubles, discharging ears, ringworm
and the care of the teeth, in which neither the private practitioner nor the hospitals can give
any hope of either providing sufficient or satisfactory relief for most of the cases requiring it." A
special Sub-Committee on the Medical Treatment of School Children was appointed in July, 1907,
and included thirteen representatives of the Council and eight representatives of outside interests,
such as the chief medical bodies, hospitals and charities. It has, by collecting information and taking
evidence, been able to present a clear and definite picture of the conditions existing and requiring
remedy.
The reference to the Sub-Committee was as follows:—
(i.) What is the existing provision for the medical treatment of school children.
(ii.) To what extent can this provision be rendered more available by the action (a) of
the hospitals, (b) of the Council ?
(iii.) What additional provision, if any, is desirable ?
(iv.) How should this provision be supplied ?
The report and appendices presented to the Education Committee on 8th December, 1908, extended
to forty pages. The substance is given using the actual words of the Sub-Committee as far as possible.
It was found that the cases requiring public attention could be conveniently taken under the
heads of teeth, vision, ringworm, suppurating ears, general debility and tuberculosis.
During the past six years great and increasing attention has been devoted to the questions of school
hygiene in London. The education authority began with the mere intention of preserving its scholars
from the grosser forms of infection, and of selecting from the ordinary school those children who needed
special instruction. Step by step, however, dealing with one subject after another, and gradually
increasing its staff, the Council has elaborated a system of school inspection. This system is admittedly
still incomplete, and different matters receive varying degrees of attention. The vision of all
children, for instance, is tested with substantial thoroughness, while their teeth have only been
examined in a few instances. As, however, the Council gradually extended the field of its operations,
the same result became apparent in one department after another. It was found that medical inspection
created a demand for medical attendance, and that that demand did not produce a corresponding
supply. It can now be shown in full detail that the health of many children is impaired, temporarily
or permanently, for want of medical treatment. It can also be shown that, in a considerable proportion
of cases, medical treatment is practically unattainable. A large proportion found to require
treatment do not obtain it. The reasons for this neglect are partly the ignorance or apathy of the
parents, and partly the real difficulty in the case of the poor in obtaining medical attendance. The
waits at the out-patients' department are usually long, two visits are generally required, and it is of
course impossible to examine children unattended by an adult. The parent has consequently to
spend two half-days in procuring a prescription for the child, and this, especially where the mothers
work, is sometimes an impossibility. Though the proportion of those who sought advice was not
great, the actual numbers who attended the hospital were largely increased, so much so that the
hospitals found themselves seriously overburdened by the numbers of children who attended. Some
issued notices respecting the number of children to be seen. The London Hospital, for instance, issued
a notice directing children under 12 to attend on Wednesdays only, and limited the number of those
seen to 15. The Great Northern Hospital were unable to make provision for more than 10 children
per week. St. George's Hospital wrote to point out that "the examination of these children prevents
many patients who require more urgent treatment from being seen by the ophthalmic surgeon." The
Victoria Hospital for Children complained of the "large batches of children who attend at the outpatients'
department on Wednesday afternoons." The secretary of the Royal London Ophthalmic
Hospital called the attention of the Council to the "great inconvenience caused by the attendance of
school children at this hospital on Saturdays." "This difficulty," he added, "is now becoming very
acute." Mr. Sydney Holland wrote on the 21st December, 1906, complaining that "24 children turned
up at the London Hospital on Saturday last," and in another letter stated "on January 12th our oculist
had 50 cases sent to him of children to be seen for refraction only. All our arrangements are made
for him to finish his work at one o'clock. He was working till three and then had these
50 cases to see. It is really intolerable." It is clear, therefore, with regard to the eyes of the children
that the resources of the hospitals have been seriously strained, while on the other hand, many children
with defective vision are compelled either to injure their sight, or to lose in great part the benefits of
education.
Teeth.—From the strong and unanimous evidence before the Committee it is clear that the
teeth of the children in the London schools are in an extremely unsatisfactory state. They have no
doubt that this state of affairs is mainly due to neglect in proper feeding and other matters during
infancy and childhood. The attention of parents should be drawn to the question and valuable preventative
work could be done through the schools. At the same time, it does not appear that sufficient