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154
Annual Report of the London County Council, 1910
Scabies.
Another disease which might be dealt with on similar lines is scabies or itch. Last autumn an
enquiry showed 520 children absent from this disease and having an average loss of attendance
of seven weeks equal to grant loss of £122. This represents the children absent in one
selected week so that there is probably a loss of grant approximating to £1,000 annually from this
cause. Practically all these cases can be cured in a week and yet a single family will sometimes
offend for months. The card index should also be followed out with this disease, and no mercy
shown to people who neglect the disease and suffer it to persist.
Medical Treatment.
i
The Council was the first educational authoritv to move in the matter of medical treatment
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for school children. This was done before legislation had enacted the medical inspection which has
brought the provision of medical treatment into such prominent position as a question of the day.
Treatment is not a statutory obligation, but has been introduced voluntarily by the Council in the
public interest. It is all done outside the Council's own service by arrangement with various
institutions of a charitable or semi-public nature. The administration has hitherto been done in the
Education Officer's department.
The general routine by which a child comes to be treated under the Council's scheme is that the
child, having been inspected by the doctor at the school and noted as having some defect, has a
white medical advice card filled in with its name and the nature of the defect. The card informs
the parents that the child has been found to have a certain defect, and advises that medical treatment
should be procured. It also states that the card itself gives no claim to treatment at any hospital.
If the parents are present at the time of the medical inspection the doctor generally gives some advice
to them and delivers the card at the time. A representative of the school care committee often also
attends and interviews parents as to their intentions in regard to treatment, or whether their means
are such that they intend to take advantage of the Council's scheme. When parents are not present,
the school nurse visits at the child's home and gives advice to the parent to seek treatment and
personally delivers the advice card. After each session given to medical inspection a form is sent to
the Medical Officer (Education), giving a complete return of the defects found in the children examined,
set out in accordance with the detailed schedule suggested by the Board of Education. Another form
is also filled in with the names of all the defective children and the nature of the defects where
medical treatment is advisable. This last list is gone through and the cases taken out where the
defect is included in the Council's scheme which provides for disorders of the eyes, throat and nose,
ears or skin. This selected list is then forwarded to the Education Officer, who makes further
arrangements. When the case has been given a sufficient time, it is further investigated, and if arrangements
are made by the school care committee for attendance at hospital, a voucher card is sent to
the parents which gives them the right to attend at a certain hospital at a determined hour, and obtain
treatment, for which they pay at a rate agreed upon by the school care committee.
Revision of
Treatment.
During the course of the medical inspection the school doctors have re-visited certain
schools to ascertain the results of the treatment received by the children found defective at former
visits.
At such visits the doctors looked through the medical registers and record cards, made enquiries
of the children and teachers as to any step which might have been taken, and inspected the children
to ascertain if the defect had been remedied or if it still needed attention. A note of the present state
was made in the medical register, and on the record card. Returns were forwarded to the office indicating
the children seen and whether or not they were still in need of treatment; a separate entry being made
for each defect.
Such enquiries into the history of 5,093 children, presenting 5,576 defects, showed the results
given in Appendix XIII.
Of the 5,576 defects, medical treatment or advice had been obtained for 2,741 and home treatment
not under medical supervision for 81, leaving 2,267 who had not been treated of whom 138 are known
to be no longer in need of treatment. Of those entered as not yet treated, treatment had been arranged
for in 312, while in 21 instances it had been arranged but refused. 415 children presented two separate
defects needing treatment; of these neither had been treated in 186, one in 89, and both in 140. 24
children presented three such defects of which none had been treated in 19, one in 8, two in 4, and all
three in 3. In revising the vision of children previously defective it was noted that spectacles had
been obtained but were not used in 55 cases, while in 36 the spectacles, though recently obtained, were
already lost or broken. Out of the total of 5,093 children three have been reported to have died prior
to the revision; this corresponds closely with the average death rate at the school age. Of the children
who had received medical advice and treatment, 2,183 were stated to have been treated at hospitals,
dispensaries or similar institutions, 329 by private practitioners, while in 229 instances it was uncertain
where the treatment had been obtained.
Tonsils and
Adenoids.
Attention has frequently been drawn to the treatment of children suffering from enlarged
tonsils or adenoids in complaints more particularly of children having been allowed to leave
hospital too soon. For most of these cases treatment at hospital other than by surgical operation
may be dismissed as unavailable. The usual method of treatment in London, however, is for the child
to attend at the out-patient room of the hospital on a fixed day, and for directions to be given
to the parent to ensure that the child does not attend after a heavy meal. These directions are not
always carried out. The operation, which consists generally of scraping off the adenoid growths
in the vault and sides of the pharynx and slicing off the greater part of the tonsils is then performed.