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workers, teachers, school nurses and attendance officers, with a view to securing that the necessary action
should be taken in each case and that those urgent cases found to be suitable for treatment under the
Council's scheme should be referred immediately to the proper department. The number of cases
dealt with in this way during the year was 6,115, and the conditions found as a result of these examinations were as follows
Conditions of skin (3,328), including scabies, impetigo, eczema, septic wounds, etc.; conditions
of the eye (783), conjunctivitis, blepharitis, corneal ulcers, etc.; conditions of ear, nose and throat
(674), otorrhcea, enlarged glands, tonsils, adenoids; conditions of teeth (101); other cases (880),
including mumps, anaemia, tubercular diseases, lung defects, etc, while in 349 cases the child had already
been under treatment and at the time of examination was found to have been cured.
These facilities for the special examination of children have been so much appreciated that it
has been decided to extend the arrangements to 15 additional centres, making 25 in all.
"Following-up."
During the year the reinspections showed a considerable falling off in the proportion of children
who had obtained the necessary medical treatment. The committee therefore considered as to the
steps to be taken to effect an improvement. The following notice was inserted in the L.C.C. Gazette of
14th January, 1918 :—
"In order to assist care committees where the lack of voluntary workers is specially acute it has
been decided that, as a temporary measure, a portion of the routine work of 'following-up' after medical
inspections and reinspections may be done under certain conditions by the school nurses. In view
of the great demands already made on the time of the nurses, it will be understood that extra visiting
by the nurse can only be undertaken where the care committee is satisfied that it is impossible to arrange
in any other way for ths carrying on of the medical work.
"The following instructions have been issued to assistant medical officers and school nurses:—
"(1) Where the parent of a child needing treatment is present at the inspection or reinspection
and consents to obtain treatment, but neither the Care Committee representative
nor the head teacher is available to make the necessary arrangements, the school doctor shall
send the following-up card, suitably endorsed, to the divisional medical officer, who will take
the necessary action.
"(2) Where the parent of a child needing treatment is not present at the inspection it
has been the practice hitherto for the school nurse to deliver the advice card M.0.49 at the home.
In future, except in specially urgent cases, the nurse should not visit the home in cases of dental
defect, but in these and other cases in which it is decided that the nurse need not visit the
M.0.49 should be sent home by the child. Some of the nurses'time will thus be saved, and in
future at the inspection or reinspection in cases in which no parent is present the school doctor
(after consultation with the Care Committee representative, if present, or head teacher), shall
select cases for home visitation by the nurse. In these cases the nurse will take the advice card
M.0.49 or M.0.49 (R) to the home and will make every effort to see the parent and report the
result of her visits to the divisional medical officer upon the following-up cards.
"(3) In a tew specially selected schools the nurse will undertake the further following-up
of cases until the necessary treatment is obtained.
"With regard to (1), in order that the Care Committee may be kept fully informed, the nature
of any action taken will be communicated to the district organiser. It will, of course, be understood
that in the event of the Care Committee worker not being present at a particular inspection or reinspection,
but sending word that she wishes to take the necessary action, the following-up cards will be left
at the sohool for her.
"With regard to (2), where it has been the practice of the Care Committee representative to
deliver M.0.49 at the home, this procedure should not be altered. When the nurse visits, the result
of her visit will be reported by the Divisional Medical Officer to the District Organiser for the information
of the Care Committee, or, alternatively, where this can be mutually arranged, the nurse will send the
result direct to the honorary secretary of the Care Committee. The nurse will not follow up those cases
which the Care Committee representative has indicated that she will undertake. In connection with
the selection of cases for home visitation by the nurse, the Care Committee representative, if present,
will, of course, bear in mind the question as to whether the social condition of the child is such as to
warrant treatment under the Council's scheme.
"With regard to (3), by a temporary arrangement in a few selected schools where the dearth of
voluntary workers has been especially felt, a portion of the nurse's time has been set apart for the
routine'following-up'of cases requiring medical treatment until such time as the Care Committee can
be re-inforced.
"This has involved considerable re-arrangement of the nurses'work, and the small amount of
time available for 'following-up' work will not allow of any further claims on the nurses' services in
this connection.
"It is recognised that Care Committees are experiencing great difficulty in carrying on the'following-up'work
owing to war conditions, which take so many mothers from their homes all day.
It must, however, be understood that, in view of the very limited time at the disposal of the nurses,
help can only be given in very special cases and not as a matter of course. It is, therefore, hoped that
the Care Committee will endeavour to the utmost of their ability to carry on the work of 'following-up'
the children requiring medical treatment and observation."