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146
Annual Report of the London County Council, 1913.
continues;—"Then, treatment as carried out at a hospital can seldom be complete in the fullest sense.
The arrangements do not allow of effective after care, and for this purpose the child who has been
treated must be transferred to the school clinic. Particularly in respect of what are called "minor
ailments" is hospital treatment of necessity somewhat unsatisfactory. A large proportion of these
conditions require daily treatment of a simple kind. This treatment is easily carried out by a trained
nurse under medical supervision. In regard to these ailments the actual provision of ointment or
lotion is the least important element in their treatment; it is the regular, careful, and appropriate
application that really matters. For this reason it may be said that the hospital is not, in most cases,
a satisfactory place for the treatment of such conditions."
In London the hospitals do not themselves undertake nursing treatment, but arrangements
have been made for this work to be done at 17 of the medical treatment centres. Another advantage
of the nursing treatment centre is its adaptability for dental work, and more recent extensions
of the treatment scheme have been in the direction of using premises for dental and nursing treatment
combined, this type making for economy in management, organisation, and nursing assistance.
"Following Up."
An important part of any medical treatment scheme, and one to which in London the Council
has paid particular attention, is the work briefly referred to as "following up." As mentioned in the
last annual report every large school or group of small schools has a School Care Committee, and the
work of these care committees is co-ordinated by a staff of paid organisers in the employ of the
Council. In connection with the scheme of medical treatment very considerable use has been made of
this organisation, which in effect acts as an intermediary between the education authority and the
parent. The work of the care committee, so far as medical treatment is concerned, deals with all the
processes which lie between the discovery of the defect in the child by the school doctor and the
arrival of the child at the appropriate hospital or treatment centre, the work of seeing that the child
attends the hospital or centre regularly until cured, and the carrying out of any adjustments required
in the home environment of the child during the course of treatment in order to facilitate the cure,
and subsequently in order to prevent the recurrence of the defect or disease.
The energies of the voluntary worker, or in her absence, of the organiser, are devoted to
persuading the parent of the importance of obtaining treatment, discussing with her the ways and
means of obtaining treatment, deciding which cases are suitable under the Council's scheme,
determining the time most suitable to the particular parent, applying for vouchers, assessing the
amount to be paid, explaining the necessary preliminaries and impressing the parent with the
necessity of observing the times mentioned, doing all that is possible to ensure that all appointments
are kept, receiving notices from the centre as to further visits necessary, ensuring, as far as possible,
that these visits are made, using further persuasion in cases where there has been failure to keep the
first or subsequent appointments, receiving reports from the organisers as to necessary adjustments
in the home and environment of the child, ensuring, so far as possible, that these are being carried
out, considering the ways and means to be adopted for supplying spectacles to each particular case (in
cases of defective vision), advising and helping the parents in every way necessary, and seeing that the
school doctor, at the re-inspection, is apprised of what has been done.
The conditions of no two cases are alike, and the whole of the work calls for tact, judgment,
thought, and knowledge. It is obvious that the medical section of care committee activity calls
for no less thought, tact and knowledge than any other section, and differs chiefly in the urgency and
and despatch with which the problems have to be met and dealt with. The chief part played by the
organisers in dealing with this work is the making it possible for the care committees to carry out the
important duties detailed above, and the success of the work, as a whole, depends upon the close
touch the organisers engaged in the work of "following up" in the treatment centres have with the
care committees, and the knowledge they have of the capacities, predilections and constitution of the
individual care committee with which they have to deal. It is clear, therefore, that it is absolutely
impossible to remove the organising of the following up" work from the general scope and structure
of the care committee organisation; the work must fail from the moment when the organisers, whose
chief function is making it possible for the care committees to do their work, are no longer in direct
touch with the care committee. During the year to which this report relates a committee of the
Council has given careful and prolonged consideration to the respective duties of the organisers and
the school care committees, and has had regard to the principles just enunciated in arranging that the
organising staff dealing with medical treatment and work ancillary to treatment should be wholly
included in the public health department under the supervision of the school medical officer, while
that portion of the staff which deals with non-medical work remains under the supervision of the
education officer.
As a temporary measure during 1913 as in 1912, one half of the time of one of the principal
organisers of children's care work, and the whole of the time of one of the district organisers was placed
at the disposal of the public health department, and the whole organising staff performed its duties in
connection with medical treatment under the direction of the school medical officer. The Board of
Education criticised the then existing arrangement in its letter of the 24th June, 1913, but as has
been noted the matter had already then, for some time, been receiving the attention of a committee
of the Council. So many considerations were involved, however, that it was not until the early part
of 1914, that the question was finally settled in the manner above described.
The method adopted for securing that each case is adequately "followed up" is as follows.
Each school care committee is notified of the date of medical inspection in the schools, and a
representative is invited to be present. The organisation thus provides for the committee to be
cognisant from the outset of all the details affecting the health of the children. If treatment is
required the parent is notified and the case is followed up by the school care committee. If found