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Report of the County Medical Officer—Education.
105
treatment is or is not obtained for defects discovered in the course of medical inspection
and of the valuable work done in this connection by the care organisers.
5. In certain respects, however, the existing arrangements in regard to following
up do not appear to the Board to be altogether satisfactory. In the first place, the
Board understand that at present, although the greater part of the work undertaken
by the. care organising staff is concerned with the results of medical inspection and
treatment, this work is not in fact placed under the direct control of the school medical
officer. In the Board's view it is essential, if the work of the Council's school medical
service is to be carried on with full efficiency, that the whole of the school medical
work, including inspection, following up, and treatment, should be placed under the
control of the school medical officer. I am accordingly to suggest that the Council
should consider the advisability of transferring to the staff of the school medical officer
those care organisers who are engaged in work connected with the school medical
service, and that similarly arrangements should be made for that part of the work
of the voluntary care committees connected with the school medical service, some of
which cannot at present be considered satisfactory, to be carried on under the supervision
and control of the school medical officer. In this connection I am to invite the
attention of the Council to paragraph 4 of circular 792, and to point out that the Board
are only prepared to make grants under the medical treatment grant regulations in
respect of ancillary undertakings "if carried out by the school medical officer or his
staff or under his direction or supervision."
6. In the second place, the Board gather that, while the system adopted for
securing co-ordination between the school medical and school attendance departments
is in itself satisfactory, full use is not at present being made of it. They understand
that the number of children absent from school on medical grounds who are under
observation by the Council's medical officers, foims but a small fraction of the whole.
In this connection I am to say that it appears to the Board desirable that the medical
officer should be cognisant of all cases of children absent from school on medical
grounds for more than a specified period, with a view to ensuring that, on the one hand,
the children return to school as soon as they are fit to do so, and that, on the other
hand, they do not return too soon to their own detriment or that of other scholars.
7. In this connection, I am to remind the Council that the Board have on previous
occasions drawn attention to the desirability of establishing inspection centres to which
cases could be referred by the medical officers from routine medical inspection for more
detailed examination, and to which children could be sent by the teachers, school nurses,
attendance officers and care committees for examination. It will also be remembered
that in recent agreements with the committees of management of treatment centres
provision has been made for the use of the premises of the treatment centre for the
purpose of an inspection centre. The Board understand, however, that, in fact, very
little use has been made of the treatment centres for this purpose, and that the inspection
centres held at the offices of the divisional medical officers on Saturday mornings
have not proved altogether successful, owing to the difficulty of securing the attendance
of the children. It would appear that the centres have been regarded merely as places
where children could be examined at the request of the attendance officer, and not also
as centres serving a comparatively small area from which the school medical work might
radiate, and a continual supervision over individual children, so far as necessary,
might be exercised. I am accordingly to suggest that the Council should consider the
advisability of providing such facilities as will ensure that there shall be centres
reasonably available for all the children.
8. With regard to the arrangements for medical treatment, the Board desire to
draw the attention of the Council to the following points—
(i.) It appears that in certain cases the arrangements made do not secure that
the medical officers of the treatment centres are furnished with sufficient information
as to the nature of the defects for which the children are referred to the
centres.
(ii.) The Board understand that in certain districts the arrangements made
in regard to dental treatment, while providing for the inspection by a dentist of
children in the six to eight age group, include a considerable proportion of older
children selected by medical officers—thus interfering with the normal development
of the scheme of dental treatment on preventive lines. This may be a
temporary necessity, but should not be regarded as a permanent arrangement.
(iii.) The arrangements with regard to the treatment of minor ailments do
not appear to be altogether satisfactory. The Board understand that in practice
a large proportion of the children requiring such treatment do not obtain it,
partly owing to the insufficient supply of facilities for treatment and partly owing
to the absence of provision for securing the prompt attendance of the children at
treatment centres. The Board gather that at present but little difference is made
between such cases and the more serious cases, such as those requiring operative
treatment, and that before a child can be treated for a minor ailment all the
detailed procedure required in the more serious cases, including reference to the
care committee, is usually gone through. In the opinion of the Board, the first
essential of any scheme for the treatment of minor ailments which is to be effective
is that the children should be enabled to obtain treatment expeditiously.
23610 p