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Report of the County Medical Officer—Education.
145
worm the increased provision already made is sufficient for present needs, but the ultimate demands
for X-ray treatment cannot be at present gauged.
The question of nursing treatment has already been discussed. It is obvious that larger
provision would be justified, and yet the number of patients treated falls considerably short of that
which might be expected. This form of treatment presents inherent difficulties inasmuch as regular
attendance for varying periods is required, and it follows that the centres must be relatively
numerous, and so situated as to be easily accessible from the children's homes. This end is being
kept in view.
As regards dental treatment Mr. Wallis reports that the attendance of children at the centres is
on the whole extremely good; the dentists and nurses appear to be popular and are assisted in every
way by the efforts of the local organisers and care committees. With the first two centres started,
viz., St. George's Dispensary and Poplar Hospital, a very real difficulty was experienced in securing
the attendance of a sufficient number of children, and it was often necessary to make a very large
number of appointments in the hope that perhaps one-third of the number might be kept. The
educative influences at work during the last two or three years have reduced this difficulty, and many
parents are now found ready and even anxious to secure treatment for their children. The
attendance of children at all the centres is still found at times to be subject to variation, which is due
perhaps to special local circumstances, weather conditions and similar influences which have a disturbing
effect of a temporary nature.
Treatment is as far as possible limited to children of 6, 7 and 8 years of age, but in many
cases children of other ages referred by the school doctor also receive attention. These older children
require considerably more of the dentist's time than the children of the selected age group, and in the
later schemes it has therefore been impossible to deal with them. Exception, however, has been
made in the case of children suffering from serious oral sepsis or cases in which operations for the
removal of adenoids or enlarged tonsils cannot be performed owing to the condition of the teeth. At
all the centres the principle adopted is that every saveable tooth is conserved and every unsaveable
tooth is extracted, so that after treatment each child's mouth should be free from any source of
dental sepsis. Considerable congestion has been experienced at some of the centres owing to the
large number of children awaiting treatment under an anaesthetic, and it has been necessary to
provide extra sessions in order to dispose of these cases.

A striking feature of the Council's medical treatment scheme as now constituted is the
development of the "Medical Treatment Centre." As pointed out in the last annual report the first
institution of this kind was opened in July, 1910, in Hampstead. An extension of use of this type of
centre was suggested by the Council in 1911, and as the result of a conference with the officers of
the Board of Education in May, 1912, some modifications were made in the agreements and arrangements
relating to certain new centres were approved. At the end of 1913 among the institutions
approved for the medical treatment of school children there were 16 centres specially established for
this work. Apart from the 9 general hospitals included in the scheme, moreover, treatment is
afforded at certain dispensaries and special hospitals, so that, adopting the classification of school
clinics as set out by the Chief Medical Officer of the Board of Education on pages 172 and 173 of
his annual report for 1912, there were in all 25 school treatment centres. Whilst it is now generally
admitted that the hospital is, in London especially, a most important element in the construction of a
complete scheme, the medical treatment centre possesses greater elasticity and lends itself in some
respects more readily than the hospital to the needs of the education authority.
On page 176 of the report to which reference has just been made, the Board's Medical Officer,
after discussing the difficulty of co-ordination between the hospital and the school medical service,
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