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138
Annual Report of the London County Council, 1912.
In the autumn of 1911, all the hospitals included in the scheme agreed to allow the attendance
of a Council's officer for this work, and the work connected with making the appointments and of regulating
the attendance at the hospital was transferred from the central office to local offices. At the
Norwood and Wandsworth centres provision was made for the Council's nurses employed at the centres
in assisting the surgeons to jrive additional time in order to perform these extra duties.
Procodure at
hospitals and
centres.
The procedure within the hospitals and treatment centres is necessarily not uniform. The
authorities of all hospitals or centres reserve the right to refuse cases if they consider that the parents
are able to pay for private treatment. At some hospitals the children are dealt with entirely apart from
the ordinary out-patients, and the authorities regard the fact that the children have been sent by the
school care committees as evidence of their suitability, while at others they are received for registration
and the parents are questioned as to means by the almoner or inquiry officer in the general reception
room. In all cases, except the Metropolitan Ear, Nose and Throat Hospital, the children are treated
by surgeons specially appointed to deal with children referred to the hospital by the Council. Some of
the hospitals have provided separate departments for the treatment of children; others reserve special
times for school children, while in other cases the surgeons appointed for the Council's Work see the
patients in a reserved part of the ordinary out-patients' room. These special arrangements are of very
great advantage, as not only is the risk of a child contracting an infectious disease while in attendance
at the hospital reduced to a minimum, but the period of waiting at the hospital is considerably lessened.
In all cases involving operation the children are kept anart, from the ordinary out-patients.
The hospital.
The inclusion of the hospital as part of a permanent treatment scheme has met with some
criticism. The wording of Section 13 (1) b of the Education (Administrative Provisions) Act, 1907,
however, shows that it was intended by Parliament that all available voluntary agencies for treatment
should receive due consideration and, in London especially, the hospital was of necessity a very important
factor in the construction of a complete scheme. This is the view taken by the Board of Education,
which has generally advised that before the direct treatment of ailments is undertaken by the education
authority out of rate, advantage should be taken of existing institutions. The Board's chief medical
officer, in his annual report for 1909, wrote as follows :—
"That the State has called upon the local authorities to organise machinery for detecting the
ailments of school children many of whom are poor and necessitous, does not therefore make the claim
of these children upon these institutions (i.e.,the hospitals), any the less in principle though it rapidly
becomes wholly different in degree. Indeed, it is the difference in degree, the added bulk and burden
of work thus thrown upon the hospitals, which has in practice brought the honorary medical staff to
the verge of breakdown."
As the result of later inquiry and inspection by the Board's officers, the conclusion was drawn
that the hospitals fill, and must continue to fill, an important place in any comprehensive scheme for
the medical and surgical treatment of school children.
The treatment
centre.
The Council has supplemented the hospital scheme by entering into agreements with committees
of local medical practitioners for the treatment of certain defects at "Medical Treatment Centres." The
first centre of this kind was opened in July, 1910, at Hampstead, on the premises of the Kilburn Provident
Medical Institute, but was discontinued in July, 1911. A centre at Norwood was opened in
September, 1910, and was followed by another at Wandsworth in January, 1911. In August, 1911, the
Council submitted for the approval of the Board of Education a scheme providing for arrangements
with ten hospitals, and for the establishment of eleven medical treatment centres in addition to those at
Norwood and Wandsworth. The Board, however, withheld consent in respect of ten of the medical
treatment centres on the ground that they were not satisfied that the existing conditions were such as
to justify the particular form of development on such an extensive scale as proposed by the Council.
New proposals were made by the Council on the 19th March, 1912, and submitted to the Board. In
reply, on the 14th May, 1912, the Board again expressed the opinion that the establishment of a large
number of treatment centres were undesirable, and stated that the constitution of these centres would
need modification in several important respects, before they could form an integral part of the London
system of co-ordinated medical inspection and treatment. In the same letter the Board suggested that
a discussion of the whole question should take place between certain of the Board s officers and representatives
of the Council. Five members of the Children's Care (Central) Sub-Committee were selected to
represent the Council and met the officers of the Board on the 23rd May. Following this conference a
letter was received from the Board to the following effect:—
"The Board contemplate that (he Council's scheme will continue composite in character, and
might properly continue to include : —
(1) Hospitals with which the Council will have agreements on the basis of that now in
operation at the London Hospital, where the special arrangements practically constitute a
children's treatment centre within the hospital;
(2) Voluntary institutions of various kinds other than hospitals with which the Council
will have agreements;
(3) Medical treatment centres conducted on the lines of those now opened at Norwood
and Wandsworth, but with certain modifications."
With regard to the medical treatment centres, the Board held that the arrangements then existing
were not satisfactory for the following reasons :—
" 1. That the centres were not sufficiently under the direct supervision of the Council and its
School Medical Officer.