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An arrangement was made at the beginning of the summer term, 1916, by which lists of cases
which had been notified during the past 12 months by nurses and teachers, but had not necessarily
been seen by any inspecting doctor, were referred to the school doctors during the term for special
inspection at their routine visits to the schools. Lists concerning 650 children in 106 schools were dealt
with. Of these cases, 214 were found to be free from ear discharge; 73 have been untraced ; 22 were
absent from school on the doctor's visit, and not seen; 72 had left or been transferred, and were not seen.
In 219 cases, treatment was found to be still required, but already arranged; 50 cases were found to
be in an unsatisfactory condition. These are long-standing cases of great difficulty and with many
social complications. They include cases also needing major operations and institutional treatment
which is not available at the present time.
The amount of work entailed in the following up of these cases has been great, and it is proposed
to modify the arrangements by keeping lists of discharging ear cases in the schools, which will avoid
duplication of notifications, and by arranging that the school doctors shall see the ear cases before they
are referred to the care committees for following-up purposes.
In addition to these measures it was contrived, at the beginning of last summer term, that Dr.
Wells should hold regularly an inspection centre at the divisional offices, in order to advise upon the
more difficult cases in the same way as had already been found so advantageous in the South-Western
division.
One great difficulty which remains to be solved is that of obtaining suitable treatment for those
children who require radical operations for the purpose of curing the disease, and who should be admitted
to hospitals as in-patients. The need for accommodation of this kind is a pressing one, and it was
suggested that the Council should enter into negotiation with the authorities of one or two hospitals
in London with a view to arranging for the reservation of five beds for the purpose of enabling children
referred by the Council suffering from serious ear trouble to be admitted as in-patients, and that
expenditure not exceeding £260 a year should be authorised for this purpose.
The Council approached the Board of Education with a view to ascertaining whether the Board
would be prepared to recognise expenditure in this connection as a part of the Council's expenditure
under arrangements for treatment approved by the Board The Board, in their reply, deprecated any
departure of this kind under the existing circumstances and the proposal has therefore, for the time being,
dropped.
Education (Provision of Meals) Act.
Supervision
of dietaries.
All questions of alterations and modifications of the menus are referred to the school medical
officer. Actual samples of meals provided are forwarded to the public health department from time
to time for analysis, and the results are transmitted to the education officer with recommendations as to
the improvement of the dietary in cases where this appears to be inadequate. Similar provision exists for
examining samples of milk supplied to the schools.
Of 182 samples of milk supplied, 15 could only be described as "fairly satisfactory, being of poor
quality, and 17 per cent, of the remainder were found to be definitely "unsatisfactory," being deficient
in fat to an extent varying from 3 to 60 per cent, of the normal amount, whilst 16 samples were reported
as containing extraneous water varying between 5 and 30 per cent. In all cases where the results of
the examination in the Council's laboratory showed the samples to be unsatisfactory, the attention
of the medical officer of the borough, in which the milk was purchased, was called to the matter with
a view to samples being taken under the Sale of Food and Drugs Act. One sample of milk was examined
and found to contain dirt to such an extent as to render it unfit for food. Three samples were found
to be artificially coloured, but the presence of preservatives was not detected in any case. Of 51 meals
supplied, 21 were reported as being deficient in nutritive value for a complete meal, the average deficiency
in amount being about 25 per cent. ; in a few cases, the deficiency.was as much as 40 per cent. With
only two exceptions the quality of the food supplied at feeding centres has been satisfactory.
Children out of School for Long Periods.
The arrangement has continued whereby the attendance branch of the Education Officer s
Department submits each month to the school medical officer, medical certificates concerning all
children out of school for a period of three months on account of ill-health, but it has not been possible
to keep up fully the card index of the cases. The number of such children who were reported as absent
from school on the 1st November, 1916, and the conditions from which they were suffering were as
follows: rheumatic, including heart disease and chorea, 463 (19.83 per cent.); nervous, 152 (6.51 per
cent.); tuberculous, 430 (18.41 per cent.); anæmia and debility, 209 (8.95 per cent.); ringworm, 49
(2.10 per cent.); other diseases, 1,003 (42.92 per cent.); illegible and unsatisfactory certificates, 29
(1.24 per cent.).
The rheumatic group of diseases forms the highest proportion- nearly 20 per cent, of the total—
among the causes that produce protracted absences from school. Next comes tuberculosis in various
forms, with nearly 18'5 per cent. All cases of tuberculosis and epilepsy are still being registered, and
apparently unsatisfactory or doubtful conditions are being followed up, especially such conditions as
ringworm, scabies, and minor ailments.
Tuberculosis.
The Council continued during the year 1916 the work initiated under the scheme approved in
May, 1914, for the treatment of tuberculosis. An account of the work is given in the general section