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137
Report of the County Medical Officer—Education.
Personal
hygiene.
A considerable advance is recorded. When medical inspection was first started, at least a quarter
of the doctor's time was spent on matters dealing with personal hygiene; the most elementary laws of
health, such as cleansing the teeth, a daily wash, not sleeping in the garments worn during the day,
were all neglected, but there is now much less need for the doctor to give advice on these matters,
though where there is obvious infringement no pains are spared to bring about a healthy mode of living.
Informal health talks given once a term to the pupils collectively would prove economical as well as
educational and would ensure the more essential details reaching each child. Three lectures a year on
personal health are given by the examining doctors to the students at the training colleges. The standard
of cleanliness in the trade schools for boys is as yet far below that of the secondary schools.
Dr. Tchaykovsky emphasises the importance of organising talks to girls attending the various
trade schools. These girls receive two years of special education between the time of leaving the elementary
school and beginning to work for their living and the great improvement in physique obtained
during the past two years when every attempt was made to get medical defects remedied is sufficient
assurance that a little time spent on special instruction in personal hygiene would not be wasted. It
might also prove useful to have an occasional lecture to mothers, many of whom are anxious to know
how to do the best for their children.
Dr. Riviere calls attention to an increase in the frequency of errors of refraction among students
in the training colleges. Since 1909 the number wearing glasses has increased from 15 per cent,
to 31 per cent, in the London Day Training college and from 11 per cent. to 21 per cent. in the Islington
Day Training college. In the former college the students are engaged in a combined university and
teaching course. The larger percentages wearing spectacles may in part be explained by the constant
medical supervision, which reveals defects which were liable to be overlooked in the past. Dr. Murrell
found 2.25 per cent, suffering from nervous strain and the increased number of slight cases of neurasthenia
suggests that the work is carried on at higher pressure than in the past.
There is marked improvement both in dental hygiene and in the number of carious teeth. Much
is now being done by the students to prevent as well as to remedy decay. Dr. Tchaykovsky points out
that the larger number of those suffering from decayed teeth in secondary schools are fee paying pupils
for instance at one school out of fourteen pupils with two or more dental defects twelve were fee-paying.
It is almost possible to diagnose a Council scholar by examination of the mouth, for medical inspection
with treatment as a sequel is showing itself in a raised standard of dental hygiene. Dr. Riviere also
notes great improvement in the care of the teeth in the training colleges, but observes that neglect in
the past is revealed more by the deficiency of teeth for mastication and the need for artificial dentures
than by the presence of existing dental disease.
Medical treatment.
The begin-
ning of the
Council's
medical
treatment
scheme.
The scheme for the medical treatment of school children in London began tentatively in January
1910, when arrangements were made with six hospitals for dealing with adenoids, enlarged tonsils, eye
defects and ringworm. During the year, the facilities made available were extended by the addition
of nine hospitals and three medical treatment centres, and provided for the treatment of some 26,000
children a year, suffering from affections of the eye, ear, nose and throat, and from ringworm.
With the exception that the Council's cases were treated on specified days by specially appointed
surgeons whose salaries were paid by the Council, on distinction was at first made at the hospitals
between children sent by the Council and the ordinary out-patients.
Early
hospital
arrangements
The first appointments were made from the central office on the application of head teachers
and school care committees after it had been ascertained that the parents were unable to make their
own provision for the treatment of the children. The view was then taken that, when the children passed
within the hospital organisation, all further responsibility was transferred from the Council to the
authorities of the hospital, and there Were at that time no arrangements for following up the cases. In
claiming the capitation payment agreed upon for the treatment, the hospitals informed the Council
whether or not the patients continued in attendance at the hospitals until discharged. This information
was, however, received too late to be of any service in following up cases which had ceased attendance
before being discharged. Later the authorities both of hospitals and centres undertook to inform
the Council daily of cases which failed to keep appointments. These cases were referred to the school
care committees with a view to securing that the children resumed attendance at the hospital or centre.
It was found, however, that there was still room for improvement, both in respect of the number of
children keeping first appointments and of the number of children who continued attendance at the
hospital until discharged, and it was thought desirable that arrangements should be made for the attendance
of an officer of the Council at the hospitals on the days when the children were dealt with.
Modification
of hospital
arrangements
In February, 1911, arrangements were made, at the request of the authorities of the London
Hospital, for an assistant organiser of school care committee work to attend the London Hospital to
regulate the attendance of the children and to supply immediate information to the school care committees
in regard to the treatment of the cases. At first her duties were limited to informing the school
care committees when children failed to keep appointments, and to making arrangements for bringing
into the Council's scheme children who attended the hospital without official appointments. Soon after
the work was extended so as to secure, wherever possible, voluntary nursing assistance in the homes and
treatment in convalescent homes where advised by the doctors at the hospital. Arrangements were made
to inform the school care committees of each step in the treatment, and they were specially asked to sec
that spectacles, if prescribed, were obtained and worn by the children.
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