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106
Annual Report of the London County Council; 1913
I am also to suggest that the Council should consider further the existing
practice in regard to the treatment of cases of discharging ears. Having regard
to the fact that a certain proportion of these cases are of a serious nature, it seems
desirable, with a view to ensuring adequate treatment, that facilities should be
provided for an examination by an expert aural surgeon where this appears to be
necessary.
9. Finally, it appears to the Board desirable that the Council should consider
the possibility of extending the functions of the assistant medical officers. In the
opinion of the Board there is a serious danger that unless more variety is introduced
into the work of these officers the restriction of their duties, in practice largely to
routine medical inspection, re-examinations and special examinations, will have an
injurious influence on the work generally. At the present time the quality of the
Council's staff of whole-time assistant medical officers appears, as already indicated
in paragraph (2) above, to be high. It seems probable, however, that if the existing
limitations were to be maintained, either the enthusiasm of the medical officers for
their work would diminish with a resultant loss of efficiencv, or there would be a
tendency for the medical officers to seek employment in areas where a wider scope
for their activities presented itself. With a view to securing greater variety, I am
to suggest that in addition to carrying out the work of routine medical inspection in
his district, together with re-examinations and special examinations, each assistant
medical officer should be entrusted with other kinds of work, as, for example, the
further examination of visual defects, public health work, including investigations
of infectious diseases in schools, the medical inspection of children in secondary
schools, scholarship candidates, etc., work in connection with the special schools,
research and laboratory work, and some share in the working of the administrative
arrangements. The extension of the work of the inspection centres, recommended
in paragraph (7) above, would tend in the same direction. I am to add that it appears
to the Board that the work of treating minor ailments arises naturally out of the work
of the inspection centre, and can most effectively be carried on in intimate conjunction
with the work of the inspection centre by the officers responsible for that work. If
such an arrangement could be adopted in Loudon, it would not only widen the
scope of the assistant medical officers' work, but would, in the Board's view, tend to
remove many of the difficulties which have arisen through the separation of medical
inspection from medical treatment.
10, I am to request that the Board may be furnished in due course with the
observations of the Council on the matters referred to in the present letter.
Prior to the receipt of the Board's letter certain of its criticisms had been anticipated and were
receiving attention. The following observations may be made, taking the paragraphs in the Board's
letter in their numerical order.
Paragraphs 1 and 2 are introductory and state that subject to certain qualifications, the actual
work of medical inspection has been carried out satisfactorily by an efficient staff of medical officers,
and that the organisation of this section of the work as a whole is satisfactory.
In paragraph 3 of the Board's letter the suggestion is made that the weighing and measuring
of children and the testing of vision, usually performed by the nurse, are not adequately supervised by
the school doctors. It is,imperatively necessary in order that the requisite number of children shall be
examined by the doctor at each of his visits that some routine work should be carried out by the
nurse in preparation for the inspection. The results, moreover, of the physical measurements made
by the nurses during 1911 were found to be in complete agreement with the standards arrived at in
former years from measurements made by the medical officers. It has been arranged that in future
these officers shall themselves take the physical measurements both at the inspections and at
subsequent reinspections of children suffering from malnutrition. The school doctors have also been
instructed to examine all cases of defective vision reported as the result of the preliminary
examination by the nurse, and during the year the standard of defect for which children were
referred for treatment was raised from 6/18 to 6/12. In connection with the examination for
defective hearing it was arranged that the preliminary examination for hard-of-hearing classes should
be made by the school doctor, cases considered suitable being further examined by the Council s
otologist.
In paragraph 4 the Board expresses appreciation of the system of reinspection. As already
mentioned, the estimated number of first reinspections is 92,500 annually, and from the statistical
material at present available it may be gathered that some 62 per cent, require a second reinspection.
If this work is to be carried out in a complete manner it will, therefore, be necessary to provide for an
annual number of reinspections approaching 150,000. Moreover, the supervision of children in school
notified as "tuberculosis contacts" involves a large amount of additional labour. Extension of this
work in the direction indicated has now been provided for by the increase of staff.
Paragraph 5 deals with "following up." This isfully discussed on pp. 146 and 147. The arrangements
now made allocate to the school medical officer 's department the whole of the organising staff engaged
in medical treatment and "following up" and in effect follow generally the suggestion made by the
Board. In paragraph 6 the Board draws attention to the desirability of making greater use of the system
of co-ordination between the school medical officer's and the school attendance departments. An
arrangement is now in force whereby all children out of school on medical grounds for a period of three
months are reported by the attendance officers to the school medical officer. Some statistics as to the
working of this scheme will be found on p. 149,