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102
Annual Report of the London County Council, 1913.
Dental
Inspection.
Medical and
Dental
Treatment.
"Followingup."
Re-inspection
of
children
referred for
treatment.
Government
Grants.
Infectious
disease.
Personal
hygiene
scheme.
in medical inspection; that the temporary full time doctors should he engaged for 3 years, and the
part time doctors for 2 years; and that each permanent full time assistant should have a share in
the whole work of the department, including routine medical inspections of age groups ; special
inspections of ailing children outside age groups; following up of cases found defective (e.g.,
re-inspections, visiting treatment centres, and addressing parents); work in connection with open-air
schools, playground classes, feeding centres, physical exercise classes, holiday excursions, etc.;
medical inspections in special schools and higher education institutions; special work in connection
with investigation of eye and ear defects; public health work, including investigation of infectious
disease, buildings, tuberculosis, special reports, etc.
In addition to the general medical examination of elementary school children by the school
doctor, special dental inspections are made by qualified dentists, the services of the dentists engaged
in treatment work at the centres being utilised for the purpose. During the year, however, a
slight deviation from last year's method has been adopted, inasmuch as an address to parents on
the care of the teeth is given at the time of each dental inspection instead of once at each school.
Whilst the half-hour devoted to the address somewhat diminishes the time available for inspection,
this apparent loss of time is more than counterbalanced by the improved attendance of children
for treatment. During 1913 the total number of children examined by school dentists was
31,858, and 25,492, or 80 per cent., were found to require dental treatment.
As shown on p. 35 there has been during the year 1913 a very large increase in the
facilities provided by the Council for medical and dental treatment. This is specially to be
observed with regard to nursing treatment centres and dental centres, and further arrangements
are contemplated with a view to extending in yet greater degree such provision. At the end of
the year, if hospitals be included, there were in all 34 centres, providing for the treatment of
84,350 children, figures which may be compared with the 28 centres for the treatment of 73,058
children at the end of 1912.
The important branch of medical treatment work described as "following up" has also
received special attention throughout the year. Indeed, it was not until some little time after the
beginning of the year 1914 that the arrangements were completed. The work of the school care
committees has now been placed on a permanent basis, the organising staff has been increased,
their duties have been defined, and the section of this staff engaged upon medical treatment work
has been allocated to the public health department under the direct control of the school medical
officer.
Associated with the work of "following-up" is that of re-examination by the school doctor in
all cases in which treatment has been recommended and this supervision is carried out by means of
reinspections. The reorganisation of the medical staff to which reference has just been made has
rendered possible the necessary expansion in the work of reinspection. It is estimated that about
92,500 children are referred for treatment annually in London. During the year 1913 about
96,000 reinspections were made, but in many cases repeated examinations are needed to ensure
adequate medical supervision until treatment is completed, and the annual number of reinspections
is estimated at 150,000. Provision has now been made for this increase of work and changes of
method have been adopted with the object of preventing leakage.
In August, 1913, the Board of Education issued new regulations on this subject wherein
for the first time it is provided that grants will be made in respect of medical inspection in addition
to those formerly paid in respect of medical treatment and work ancillary to treatment. The
grant received for the year 1912 was £12,958 8s. 10d., approximately 58 per cent, of the cost of
treatment or 28 per cent, of the cost of inspection and treatment. The grant made in respect of the
work of inspection and treatment for the year ended 31st July, 1913, is £31,191 1s. 6d., or precisely
46 per cent, of the total expenditure as set out in the Council's claim. The letter of the Board
intimating this decision is as follows, and is dated 26th March, 1914:—
"1 am directed to inform the Authority that their application for grants under Part I. of the
"medical grant regulations in respect of the whole work of the school medical service connected
"with public elementary schools has received the consideration of the Board. They have decided
"to make a grant of £31,191 Is. 6d., and payment of this sum will shortly be made.
"In forwarding this large grant the Board desire to express their recognition of the
"improvements which have been effected in the work of the Authority's school medical service,
"and, in particular, their appreciation of the extension of the facilities for treatment."
In comparing the notifications of infectious disease among school children, it will be observed
that while diphtheria has remained almost stationary, scarlet fever shows a distinct increase on the
average numbers for the three preceding years. Measles shows a decline in the notifications
received from the schools, the total number for the year being the lowest recorded for eight years.
It may be remembered that the wave of prevalence reached its maximum of recent years in the early
part of 1911, and during 1913 the disease was at a low ebb. Advantage has been taken of this
diminished prevalence to study methods of limiting school outbreaks of measles and some discussion
of the question will be found in the subsequent report, pp. 98 to 102.
In the annual report for 1912 the development of the cleansing scheme was traced from the
voluntary work carried out in 1902, to the arrangements adopted by the Council in 1912, involving
the whole time employment of 22 nurses. At the end of that year agreements had been made with
16 borough councils for the use of their cleansing stations, the Council itself had established four
stations, and the Committee of St. Cecilia's House also provided facilities. During 1913 the
number of stations has been increased to 22, and at 18 of these treatment has been extended by the
inclusion of scabies. 858,691 children were examined, of whom 29,903 were found to be verminous.
15,241 children were cleansed by the parents and 41,458 cleansings were carried out by the
Council and borough councils. The very large increase in the number of children cleansed
voluntarily shows that parents are beginning to realise the importance of the subject, a result which