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139
Report of the County Medical Officer—Education.
2. That the centres were not sufficiently in touch with the Council's system of medical
inspection.
3. That the centres were not available for the further examination of school children
referred by the inspecting medical officer or for the examination of special cases referred by the
school nurse, school attendance officer, head teacher, or care committee.
4. That the centres were not available for the treatment of minor ailments."
Following this letter the Chairman and Vice-Chairman of the Children's Care (Central) Sub-Committee
interviewed representatives of committees of medical practitioners for the districts of Hackney,
Islington, St. Pancras and Poplar, with regard to the practicability of giving effect to the suggestions of
the Board of Education, with the result that the conditions of agreement were modified in certain respects.
The Education Committee in reporting these facts to the Council on the 23rd July, 1912, expressed
itself as being generally in agreement with the views of the Board. At the same time suggestions were
made for the establishment of medical treatment centres on the lines indicated by the Board, and for the
treatment of minor ailments, including discharging ears, external eye diseases, e.g., blepharitis and
conjunctivitis, skin diseases such as impetigo and sores, and such other conditions as require the daily
services of a nurse. The Council adopted the Committee's report with which were submitted the general
terms of agreement with committees of local medical practitioners as modified after consideration of the
suggestions of the Board of Education. These amended terms of agreement afterwards received the
approval of the Board, and are set out in the appendix to this report.
Nursing
treatment.
On the same date (23rd July, 1912) the Council adopted an important development of its medical
treatment scheme by agreeing to arrangements being made with local nursing associations for the employment
of the equivalent of a full time nurse in connection with six of the school treatment centres. It
was provided that the scope of the work should include the nursing treatment of children suffering from
minor ailments as already defined, and home visits after operations for adenoids, tonsils, etc. The
conditions of agreement contain clauses to secure the supervision of the work by the Council's school
medical officer, and the appointment of a doctor by the Committee of the Association, such doctor to be
selected by the Council from nominations made by the Association. The doctor appointed is to attend
at the centre on one half day a week to see the children and supervise the work of the nurse.
Points to be
considered in
a Treatment
Scheme.
In his report for 1910 the chief medical officer of the Board of Education has formulated some
rules for guidance in scrutinising the details and working of a medical treatment scheme. Briefly
it is stated that such a scheme must be considered in relation to the following points: (1) the
degree to which it meets the requirements of the area; (2) the means taken to secure that the child
is actually presented at the hospital, and that once under treatment, attendance is continuous; (3) the
arrangements made to ensure that the treatment given by the doctor is followed up, and supplemented
in whatever direction is necessary; (4) the degree to which the arrangements of the school medical
service in general, and of the primary medical inspection of the child in particular, are linked Up with
those for treatment, and similarly the degree to which such arrangements are again associated with
the subsequent re-eXamination of the child in school.
Action tken
in London
during 1912.
During the year under review, attention has been directed to all these points. For instance,
with regard to the degree to which the scheme of medical treatment meets the needs of the county as
a whole, much headway has been made towards providing centres in the districts remote from the
hospitals, and though there are still some topographical difficulties to be overcome, it is hoped in the near
future that every area will be provided with a convenient treatment centre. This aim has, of course,
only been brought within the bounds of possibility through the acceptance by the Board of Education
of the system of arrangements with committees of medical practitioners for the establishment of the
"Medical Treatment Centres" to which reference has already been made. More recently, the agreements
with nursing associations have been the means of making much needed provision as regards the
treatment of discharging ears, and other minor ailments requiring the services of a nurse. Concerning
the second point, the scheme of re-examination now provides for a complete record to be kept of every
child recommended for treatment, and every effort is made to secure the attendance of the child for
treatment until treatment is completed, and to prevent leakage. The third point of the Board is that
the arrangements should ensure that treatment is followed up and supplemented where necessary,
Here again, the "following up" System just referred to is of value, moreover, the agreements with nursing
associations provide that the nurse shall attend the centre and shall also visit the homes of the
children, thus combining treatment at the centre under the supervision of the doctor with the advantage,
in certain cases of home treatment. I11 consideration of the annual payments made by the Council the
nursing associations have further agreed to allow the nurse to visit the homes of children operated on for
tonsils and adenoids. This part of the scheme has not yet been fully developed, but a beginning has
been made. The fourth suggestion of the Board is the necessity for the co-ordination of inspection
and treatment. The inspecting doctor examines the child both before and after treatment, he is
directed to place his knowledge of the child at the service of the centre doctors, and he confers with
them at the treatment centres.
Mention has already been made of the modification of the agreements with medical practitioners
to secure (1) more direct supervision of the centre by the school medical officer; (2) the use of the centres
in connection with the scheme of medical inspection; (3) that the centres are available for inspection;
(4) that they are available for the treatment of minor ailments. It will thus be seen that effort is being
steadily directed towards securing co-ordination of inspection and treatment, and that considerable
progress has been made in developing a harmonious and unified scheme.
18820
s 2