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Report of the County Medical Officer—Education.
147
suitable for treatment under the Council's scheme an application is made by the care committee and
a voucher card is issued by the district organiser, who also arranges, through the care committee for
the case to be kept under observation until treatment is completed. For each child found to require
treatment a special card is kept at the school in addition to the medical record card. Upon this
special card, which is of a distinctive colour, the school doctor enters particulars of the defects found,
the care committees record the progress of treatment, and the school doctor again in turn notes the
results of reinspection. A record of defects and of the results of reinspection in respect of each child
examined is also kept at the central office in order to prevent leakage, and to form a rota for securing
medical supervision at stated intervals until the school doctor is satisfied that the treatment is
completed.
Towards the end of 1911 the work connected with the making of appointments for children to
attend the hospital and treatment centres was transferred from the central office to the district
organisers' offices, and arrangements were made for an officer of the Council to attend the hospitals
and centres for the purpose of regulating the attendance of the children and of enabling the cases to
be "followed up" until treatment was completed. Seven additional assistant organisers were
authorised for this work, four clerical assistants were transferred to district organisers' offices, and the
voucher and "following up" work in connection with the Norwood and Wandsworth centres was
performed by a nurse. Upon the transfer of the medical work to the public health department there
were, therefore, 12 officers engaged in this work, and the number of cases dealt with annually was
28,000 for medical treatment, and 8,000 for dental treatment. During the last two years, not only
has the number of cases for which the Council has provided treatment been almost trebled, but the
work of "following up" has been very considerably extended. Under existing arrangements a
member of the care committee is present at more than 80 per cent. of all medical inspections, and 70
per cent. of re-inspections. In order that the care committee may be in a position to follow up the
cases it is necessary that the officers who attend the hospital and centres should keep the committees
fully informed of all the stages in the treatment, and much additional work is thus entailed. Moreover,
more detailed information is now forwarded to the care committees than was the case two years
ago. The arrangements for the supply of spectacles in necessitous cases and for the visits of nurses
to the children's homes after operations have been performed, and generally the whole of the
"following up" work make additional calls upon the staff actually engaged in the treatment centres.
A most important point which should be here mentioned is that surgeons at hospitals and centres tend
more and more to rely upon the Council's organisation for the following up of the children treated
by them. Through the organisers they transmit to the school medical officer suggestions for the
modification of school curriculum in cases which formerly would have been given certificates for total
exclusion from school. This extends also to hospitals with which no agreements have been made, but
which admit and welcome the daily attendance of an organiser. From time to time additional staff
has been allowed as new centres were'opened, but no extra staff has been allowed in respect of the
developments which have taken place in the "following up" work, and it has been necessary for the
organising staff to work considerably beyond the ordinary office hours in order to cope with the work.
A careful inquiry has been made with a view go determining the amount of time taken up in carrying
on the work in connection with the hospitals and centres throughout the county, and, as a result, it
is found that one officer working full time can, with the necessary supervision, perform all the work,
including where necessary special visits to care committees and regular attendance at dental
inspections, connected with the treatment and "following up" of 2,200 medical cases or 4,400 dental
cases in a year.
This question of the necessary increase of staff was considered concurrently with the general
question of organisation and the number of officers now engaged upon this branch of the work
ancillary to medical treatment is 66, viz.:—One principal assistant organiser, five district organisers,
48 assistant organisers, and 12 clerks.
Reinspection of children found defective.
No system of "following up" can be looked upon as satisfactory which does not provide for the
reinspection of the child found defective by the school doctor. During the past year an attempt was
made to reinspect three months after inspection all children found defective, whatsoever the complaint
for which they had been referred for treatment or placed under observation. Those not found
satisfactorily treated were further reinspected six months after the first reinspection. Tables will be
found in Appendices VII-XV shewing the results of these reinspections.
Refraction cases.—The number of children reinspected during the year who had been referred
on account of defective vision was 16,698. Of these 9,339, or 56 per cent., were found at the first
reinspection to have been treated, while 44 per cent. had had no treatment. Of the 9,339 children
who had received treatment, in 5,842 cases, or 62.6 per cent.of those treated, and 35 per cent. of
the whole number referred, the treatment was found complete and satisfactory. Further, of those
who had procured treatment 6,713, or 72 per cent., had obtained it under the Council's scheme.
By the time the second reinspection was held it was found that 56 per cent. of outstanding
cases had received treatment, so that within a year of the defects being discovered 72.3 per cent. of
the children found with defective vision had been treated; in the great majority of cases (78 per
cent.) the results were complete and satisfactory.
Ear, nose, and throat ailments.—The number of children reinspected who had been recommended
for treatment for these defects was 16,000. Of these 7,137, or 44.6 per cent., had received treatment by
the time they were first reinspected, while the remaining 55.4 per cent. had not yet been dealt with.
It was found that 56.9 per cent. of those obtaining treatment had received it under the Council s
scheme. The records of second reinspection showed that of outstanding cases 39.6 per cent. eventually
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