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Report of the County Medical Officer—Education.
135
In this group the number of cases requiring treatment forms more than 50 per cent. of those
examined. As might be expected, skin diseases are often detected and the children brought forward
for special examination. Cases of Phthisis and Infectious disease were frequently found at these
special inspections. These special cases, being selected, cannot be compared for statistical purposes
with cases found at routine examinations; the large numbers of cases requiring treatment
among them show the advantage that is derived from the frequent visits of the school doctor to
a school. In cases where the doctor is not due at a school for some time, the child if the case be
urgent is sent for examination to a school in the neighbourhood where the school doctor happens to
be in attendance. Some of the cases are those of children who have previously been excluded from
school for some cause and are being examined to ascertain their fitness or otherwise to return.
Other cases where there is a question as to the child's mental condition are brought forward for
the doctor's opinion as to whether the child should be submitted at the statutory examination
for admission to a school under the Elementary Education (Defective and Epileptic Children) Act.
It is arranged that special and urgent cases requiring a more thorough examination than
can be made in the school, and certain cases that are out of school, should be examined at a centre.
During the year 646 boys and 897 girls were examined at these special inspections. 872
of these cases were referred by the Divisional Superintendents, 243 by Head Teachers, 135 by
the Divisional Medical Officers or the School Doctors, 72 by the Care Committees, 30 by the
School Nurses, and 127 cases by the School Medical Officer. The Invalid Children's Care Association
brought forward four cases and the parents themselves asked for an examination in three
instances. Of the 1,543 cases examined, 560 cases were referred for treatment. Phthisis was the reason
for treatment in 76 cases, ear disease or hearing in 77, eye disease or vision in 133 cases, and malnutrition
in 43 instances. The figures relating to defects found are set out in the appendix.
In case of an outbreak of infectious disease in a school an examination is made by the school
doctor of the "contacts." If there is doubt the children are excluded and kept under observation.
This close scrutiny of children, who have possibly been exposed to infection, is work which must be
carried out, but which throws a very heavy burden upon the medical staff engaged in the schools.
Scarlet fever in particular is a disease which calls for much vigilant examination of contacts, inasmuch
as mild and missed cases are exceedingly common. The exceptional prevalence of this disease during
the past year has greatly added to the work of the department as may be gathered from the fact that
no less than 25,782 children were examined as contacts of sufferers from infectious disease
between April and December alone.
Sudden illness in School.—Many special examinations are asked for in cases where a child has a
fit in school. If necessary, a doctor is called in at the instance of the head teacher, and the facts are
reported to the school managers. The school doctor subsequently examines the child to determine
whether the case is one suitable for scheduling for examination under the Defective and Epileptic
Children Act, or whether the attack was due to some functional disorder of a temporary nature.
Special observation is kept upon these latter cases, and if any further attack occurs the fact is at once
reported and a further examination arranged.
Exemption from Domestic Economy Classes.—Where a girl is reported to be unfit for domestic
economy classes the school doctor makes a special examination and reports whether exemption should
be made on the ground of health. Anaemia, heart disease, aud rheumatism were the reasons for
advising exemption in many cases.
Medical Treatment
In the annual report for 1912 the growth of the Council's medical treatment scheme was
traced from its inception in January, 1910, until the close of the year to which that report related.
It was there shown that, beginning with arrangements with six hospitals, providing for the treatment
of some 12,000 children, the scheme had been developed so that by the end of the year 1912
12 hospitals, and 22 school treatment centres had been included, providing for the treatment of more
than 73,000 children, at an estimated cost of about £20,000. During 1913 these arrangements have
been further extended, so that at the end of the year means of treatment were available for 84,350
children, and further centres were contemplated which would have the effect of increasing to an
approximate total of 100,000 the number of children for whom facilities for treatment of one
kind or another are provided.
It has been found necessary during the year under review to make some readjustment as
regards the provision made at some of the hospitals and centres for the treatment of the several
ailments, due in part to the fact that children now being inspected in the intermediate age-groups, or
as leavers, have already been treated as the result of the provision made in 1910 and 1911. The
following notes show the reason of the changes made as regards each ailment separately.
Eye defects.—It was found that the numbers of children attending the hospitals and centres for
eye defects approximated very closely to the provision made under the agreements, and inasmuch as
it was deemed desirable to refer for further inspection children of the intermediate age-group whose
visual acuity was only 6/12 the provision made was increased accordingly.
Ear, nose, and throat ailments.—With regard to these ailments experience has shown that the
facilities for treatment arranged by the Council have effected a reduction in the number of school
children suffering from defects of this class, and the figures for 1912 showed that the number of
children suffering from enlarged tonsils and adenoids was 31,230 as against 35,614 in 1911. It was
found possible, therefore, to reduce the provision made under this heading at some of the centres,
It is only by keeping under continuous observation the children in whom unhealthy conditions
of the throat are found to exist that it is possible to form an opinion as to the grave dangers