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Report of the County Medical Officer—Education.
107
Paragraph 7 of the Board's letter deals with the establishment of medical inspection centres.
Arrangements had already been made for the school treatment centres to be available for special
medical inspections, but owing to the fact that the statutory inspections and reinspections in the
schools occupied the whole of the school doctors' time it was not possible to make arrangements for
special inspections as frequently as might be desirable. It was found difficult, moreover, to secure the
attendance of children on Saturday mornings. For these reasons special examinations were made in
the schools in conjunction with the ordinary statutory inspections. It is desirable that the number
of special inspections should be increased, and it is hoped to effect this by some rearrangement
during the ensuing year.
In paragraph 8 certain points in connection with medical treatment are criticised—
(1) It is pointed out that the arrangements which are made do not secure that the medical
officers of the treatment centres are furnished with sufficient information as to the nature of
the defects of the children referred to them. It was originally intended that the following-up
card made out in the case of each defective child should actually follow the child, and be available
at the centre for the information and use of the surgeon, but it was not found possible to carry
this into effect, owing to certain difficulties, one of which was that the organising staff was not,
at the time, under the direction of the school medical officer. Arrangements have now been
made for the work to be carried out, and the extra labour involved has been taken into account
in forming an estimate of the necessary organising staff.
(2) The Board point out that a considerable proportion of children older than the 6-8
age group are referred to dental centres for treatment, and they indicate that this, in their
opinion, is undesirable. The difficulty caused by congesting the centres with older cases is fully
realised and whenever possible this is avoided. It must be pointed out, however, that in some
areas no other provision for dental treatment exists, and in cases found by the school doctors
in urgent need of such treatment there would be failure to get relief, unless it were by utilising
the Council's arrangements. It is the practice, however, to restrict the making of appointments
for older children to those most urgently needing assistance, and to give facilities to them
only at times when there is an insufficient number of children of the 6-8 age group forthcoming
to fill the centre to its fullest capacity.
(3) The Board consider that the arrangements in regard to nursing treatment are not
satisfactory. This the Board find is partly owing to the insufficient supply of facilities, and partly
due to the absence of provision for securing the prompt attendance of the children treated at the
centres. As regards the ensuing year, further nursing treatment schemes have been sanctioned
by the Council in connection with the Peckham, Woolwich and Deptford treatment centres, and
in connection with the Battersea centre. With regard to the provision for securing the attendance
of children, it is evident that the method of supply which is adopted in the case of the more
serious ailments is not altogether suitable in cases requiring nursing treatment. Further, a serious
defect,which experience has disclosed, is that there is no provision for referring cases except through
the supervising doctor, who visits the centres, as a rule, only once a week. The result is that many
cases in urgent need of nursing aid are deferred until too late to prevent acute conditions passing
into the chronic stage, in which they require prolonged treatment before a cure can be effected.
The present agreements provide for re-inspections being made at the treatment centres, and a
system has been adopted whereby the school doctor will in addition inspect children referred by
care committee workers, school nurses, teachers and attendance officers, with a view to referring
immediately to the proper department those suitable to be dealt with under the Council's arrangements.
The organiser of care committee work at the centre will communicate with the Care Committee
in order that the necessary investigation and assessment may be made.
The Board further suggest that facilities should be provided for examination by an expert
aural surgeon of the more serious cases of discharging ears. In the experimental scheme which
was applied in the borough of Paddington it was found advantageous to refer all cases which resisted
treatment after a certain period to the Council's otologist. Mr. Yearsley, however, has the charge
of the deaf centres, which occupy most of his three sessions given weekly to the Council. He sees at
present at the head office a certain number of difficult cases referred by school doctors, but his other
engagements do not admit of extension of this work, and assistance has therefore been given him.
In the final paragraph the Board indicate the lines upon which, in their opinion, the school medical
service should, in future, be arranged. The Board further point out the necessity for giving, within the
limits of the service, a greater variety of work than is now provided for the rank and file of school doctors.
The Board suggest the following directions in which this extension of work should take place—
The further examination of visual defects ; public health work, including investigation of infectious
diseases ; the medical inspection of children in secondary schools ; of scholarship candidates, etc. ; work
in connection with special schools ; research and laboratory work ; and some share in tho administrative
arrangements. The Board also suggest that the medical supervision of nursing treatment work
could be carried out by the school medical staff. These points may be dealt with seriatim.
(a) Further examination of visual defects.—The Council's ophthalmic surgeon, Mr. Harman, is in
charge of blind schools and myope classes, which occupy nearly the whole of the three half-days per
week upon which he is retained by the Council. There are numerous cases of visual defect which it
is impossible adequately to examine at the routine inspections, and while Mr. Harman sees at the head
office a certain small proportion of children referred by school doctors, he is, like Mr. Yearsley, unable
to extend this work, owing to lack of time. There are among the permanent and temporary school
doctors a number who have had special training and experience in ophthalmic work, and allowance has
now been made whereby school doctors with suitable experience shall hold sessions for the further investigation
of cases both of visual and of aural defects.
23610
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