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ADMINISTRATIVE COUNTY OF LONDON.
REPORT OF THE SCHOOL MEDICAL OFFICER (Dr. W. H. HAMER) FOR THE
YEAR 1915.
Introductory Note.
The following report on the school medical service is the fourth which has been submitted since
the resolution of the Council of 25th July, 1911, reorganising the work of the public health department,
and relates to the calendar year 1915.
As a result of the war, considerable difficulties have been experienced in continuing work already
undertaken and progress and development have necessarily been retarded, though it may be claimed
that, in the main, the standard previously attained has not been materially lowered. It was feared at
first that there might be difficulty in finding substitutes for the school doctors, 20 in number, who had
volunteered for war service ; it was, however, eventually found possible to replace them in all instances
and to deal with as much of the work as was absolutely necessary for the maintenance of efficiency. It
has, of course, been impracticable to obtain such complete results in these changing circumstances as was
possible with a more permanent staff. Want of experience and lack of knowledge of local conditions
necessarily militate against a full output of work in the case of newly-appointed officers, and the acquirement
of familiarity with all the details of the Council's arrangements necessarily takes time ; but it
has been practicable to maintain a nucleus of permanent doctors, a few of the older men and a number
of women, and with their assistance it has been possible to " carry on."
In the early days the question was raised as to the desirability of handing over the Council's
treatment centres to the military authorities, and the suggestion that the dental treatment of school
children should be suspended and the centres with their staffs utilised for the treatment of dental defects
among soldiers, seemed at one time to be likely to assume quite serious importance. Fortunately, it was
not found to be necessary to take this step, and the dental treatment of school children has been continued
throughout the year at all the centres at which provision is made for dental defect. It has not
been possible, however, to increase the provision made in the same proportion as in the previous year,
although four new centres have been opened providing for 6,160 cases, and the numbers at four other
centres have been increased by 4,180 cases annually.
The Board of Education on 25th January, 1915, issued a circular stating that they "of course
rely upon local education authorities to do their best to carry out the work of the school medical
service," and adding that they on their side would " make all reasonable allowance for special difficulties
arising out of the war." Later the Board expressed the opinion that the medical inspection of school
children of all ages who appear to be ailing, and the maintenance of any treatment at present being
undertaken, should be regarded as the first charge on the time of the staff.
On 28th March, 1916, the Board of Education informed the Council that a grant of £47,177. 17s. 5d.
would be made in aid of the school medical service connected with public elementary schools. The grant
has been assessed at the maximum rate, representing 50 per cent, of the Council's expenditure for medical
inspection and treatment. For the year ending 31st July, 1914, the grant made on the same basis was
£38,149. 7s. In the letter communicating the amount of grant, the Board direct attention to a previous
letter of 29th March, 1915, in which it was stated that the rate of grant would be subject to annual
revision, and that in fixing the rates in future years the Board would have regard not only to the maintenance
of the existing arrangements as regards scope, character and quality, but also to the extent to
which extensions and improvements are made with a view to meeting more completely the needs of the
area. Government grant ,
The policy of the Council has been to maintain the work of inspection generally at its former
level, although it has been found possible by a slight modification of the arrangements, and by the
support which the call upon the staff for special effort has received, to effect some economy. For
instance on 9th November, 1915, the Council approved the substitution of a preliminary inspection of
entrants followed by further examination of selected children in place of the detailed, examination of all
entrants. At the same time the school doctors were asked to examine 30 children each session in place
of 25, except in the case of selected entrants. These measures resulted in economy equivalent to the
time of 4½ doctors, and the staff was accordingly reduced to this extent. Concurrently, the
nursing staff was correspondingly reduced. Considerable reduction has been made on the
clerical side, many men have gone on war service and these- have not been replaced in a number of
instances by substitutes. In order to meet the shortage of staff, many returns of a statistical nature
have been temporarily dispensed with, and certain sections of the work, such as the register of out of
school children, have been given up. With regard to the Board's expression of opinion as to the maintenance
of treatment undertaken, the position of things may shortly be stated to be that the arrangements
actually in force under the Council's treatment scheme were continued. Some dental treatment
and nursing treatment centres, however, authorised at the beginning of the year, have not been opened,
but it is hoped gradually to proceed with the arrangements.
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