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Report of the Medical Officer (Education)
155
For one or two minutes there is in almost all cases very profuse haemorrhage. This continues
less freely for some hours, and the child is often sick. The child should be kept under observation
for five or six hours at least and, if possible, should be retained in hospital for at least 18 hours.
Children suffering from enlarged tonsils and adenoids are liable to many future troubles, e.g.,
discharging ears with a certain proportion of fatalities; slowly progressing deafness in later life ;
stupidity and indecision of character. It is to avoid these results that the cost, inconvenience, and
in a few cases the risks of operation, have to be balanced.
Actual statistics to make an effective comparison are not obtainable, but the impression exists
and appears reasonable that exposure to the cold and dust of the streets and often it must be added
the condition of many homes, during the period of depression following the shock of the operation
and the anaesthesia, lead to a higher incidence of serious accidents than occurs in cases which are kept
in rest and warmth in hospital until this period of depression is over. Every care is taken, but the time
available under the present conditions does not permit of long detention in hospital. Many thousands
of children are operated on without experiencing the slightest inconvenience after the first hour or so
after operation is passed, and as the unpleasant cases only are heard of they may considerably bias the
judgment. On the other hand, whilst it may be expected that the retention by the hospital of every
child operated on, for the night following the operation, would improve the results obtained, the
improvement would be very costly.
The Council decided to continue unit the 31st March, 1910, the arrangements made
during 1909 with the Queen Victoria Jubilee Institute for Nurses for the treatment of children
suffering from suppurating ears in the nursing districts of (1) Hackney and (2) Shoreditch and
Bethnal Green. The mode of procedure, of which the following is a brief summary, was similar
to that outlined in the annual report for the twelve months ended 31st December, 1909. Cards
were given to children found by the school doctors to be suffering from suppurating ears giving
advice to the parents and disclaiming responsibility on the part of the Council for treatment prescribed
or given; the homes of such children wrere then visited by the nurses, but no treatment was
given on the first visit, and any subsequent treatment was provided only under the direction of a
medical practitioner.
Suppurating
Ears.
The difficulties referred to in the last report were encountered in dealing with the cases
now under review. In discharging ears, medical examination is a necessary preliminary to any treatment
by the nurse. For instance, many cases of discharging ears are kept up by the presence of
adenoids. Operation on the adenoids may be all that is wanted for spontaneous recovery of the aural
condition, whilst without this operation treatment may be in vain. In many instances, however, the
parents refused to take their children to a doctor and as many as six visits were paid to some of
the homes before obtaining a doctor's prescription. Even after a prescription had been obtained
there was often extreme difficulty in attending to the children of parents who were continually changing
their addresses.
During the period from 1st January to 31st March, 1910, cards were issued in 16 schools for
226 children. An analysis of these cards shows that:—
(a) Treatment was unnecessary and no action was taken in eight cases.
(b) The parents of 54 children refused to see a doctor, but in 16 of these cases treatment
was given by the parents.
(c) Treatment was obtained at hospital or by private doctor in 8 cases, of these 1 was
cured and 7 were not cured.
(d) The nurses attended 156 cases and treated 52 of whom 16 were reported to be cured,
and 2 could not be traced.
The Superintendent of School Nurses was asked to examine all the cases and report with a
view to ascertaining the actual results of the experiment. She found that:—
Nurse not required—
(а) Treatment was unnecessary in 8 cases.
(b) 122 were treated by parents ; 20 were cured and 102 not cured.
(c) 48 obtained treatment at hospital or by private doctor; 11 were cured and 37 not
cured.
(d) In 7 cases reasons for non-treatment were not given and in 14 cases the children had
either left the school or were absent.
Work done by nurses.
(e) The nurses treated 52 cases and effected 11 cures.
(/) 9 cases reported cured were found to be suppurating again.
(stopped by the parents who continued treatment.
The nurses paid 2,610 visits to the homes. The cost of the experiment for the first three
months was £45, when 20 cures were effected by the nurses (£2 5s. a case); during the second period
of three months the cost was £45 when 11 cures were effected by the nurses (£4 2s. a case). During
the whole of the experiment (six months) the nurses effected 31 cures at a cost of £90 (£2 18s. a
case. In addition 44 children were cured by hospital, private doctor or parents, and 18 of these 44
were visited by nurses, who, however, gave no treatment. These 44 cures are as a result of the
scheme although not as a result of the nurses' treatment. If they are included the cost per case
cured becomes £1 4s. The experiment also had some effect on the parents. During the first three
months 25 per cent. and during the second three months 54 per cent. of the parents undertook the
treatment of the disease.
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