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Co-operation between School Medical Service and Factory Surgeon.
In October, 1917, the Children's Care (Central) Sub-Committee agreed to allow the final reports
of the school doctors on "school leavers" to be sent to the City factory surgeon. The following report
has been received from the City factory surgeon on the working of the arrangement:—
"It was arranged that when a child, on leaving school, obtained work in a factory, the labour
exchange should send me Form A. stating the child's name and address, and an abstract of the school
doctor s report, as well as the name of the factory, under confidential cover. Although this arrange-
ment has been in operation for a few weeks only the results have been most satisfactory. I have obtained
a number of reports about the young persons starting work in the City of London, and in many instances
I have been able to continue the treatment of defects instituted by the school doctors. Sometimes the
reports sent me by the labour exchanges have shown that girls were under treatment at school for
chlorotic anæmia. I have been able to see that their treatment has been continued while in the factory,
have sent many such cases to their own doctors, have obtained the co-operation of the employers and
the assistance of the overlookers in seeing that these girls go on obeying their doctors' instructions and
they are given time to do so. In several instances defects which were not remedied at school have been
remedied now owing to this arrangement, while at work in the factory. Sometimes parents refuse to
follow the recommendations of the school doctors as to operation for adenoids, tonsils, carious teeth
and even the supply of spectacles, or to teach their children cleanliness. Yet, in many instances, these
refractory parents have given way when they found that their children might not be able to earn wages
until their physical defects, discovered years before at school and always deferred treatment, were
removed; for they know that the certifying surgeon has the power to refuse certain defective young
persons for certain employments under the Factories Acts. In most cares persuasion has succeeded,
when the parents discovered that I was in accord with the school doctors and co-operating with them
to obtain the proper medical treatment of the children. Many children on leaving school obtain employ-
ment in London through sources other than the labour exchanges. On finding such children in the
factories I send their names, addresses and school attended to the labour exchanges nearest their homes
on Form B. This form is returned to me with the full doctor's report attached, and on my next visit
to the factory I am able to continue the treatment or observation of the conditions (if any) of such young
persons in the same way as those placed at work by the labour exchanges. In the event of a young
person being found unsuitable to work in any particular trade, industry, or factory, and I refuse a
certificate of fitness, it has been arranged that the same procedure should be adopted, and the name
and address is sent to the labour exchange. The Local Juvenile Advisory Committee then proceeds to
obtain more suitable employment. Already several cases have been dealt with in this way. Cases of
quiescent pulmonary tuberculosis have been transferred from London printing works to better occupation
in the country, deformed children have been referred to various organisations for the supply of apparatus
and to centres for physical training, suitable work has been found for cripples, and even adults have
been dealt with in this way."
Education (Provision of Meals) Act.
The arrangements set out in previous reports for the supervision of dietaries have continued
throughout the year. The total samples of milk meals examined amounted to 565-of this number
218 (nearly 39 per cent.) could not be considered satisfactory, 46 being described by the chemist as of
"poor quality," whilst the remainder, 172, were definitely "unsatisfactory" either by reason of the
addition of water or a deficiency of fat. The maximum addition of water (41 per cent.) was found in
the supply to a school at Poplar, whilst a sample from a school at Stepney was reported as being
deficient in fat to the extent of 43 per cent., showing also the addition of 7 per cent. of water.
Another sample was found to contain extraneous matter (dirt) to such an extent as to render it unfit
for food.
The most serious adulteration was found early in the year, and arrangements were made for a
larger number of samples to be taken and for further enquiry concerning unsatisfactory samples.
Following upon this action a great improvement in quality occurred. This, however, has not been
maintained, and recent results are again very unsatisfactory; thus, of 70 samples examined last January,
53 (over 75 per cent.) were unsatisfactory, and during February 67 out of 72 samples examined (93 per
cent.) were unsatisfactory. Of these 5 in January and 11 in February which may have contained added
water up to 5 per cent. may be classed as of "poor quality." Setting these apart, it is found that of
the remainder no less than 40 per cent. in January and 54 per cent. in February contained 10 per cent.
or more of added water. An improvement was observed in March, i.e., leaving out of consideration
12 samples which may be described as being of "poor quality," only 8, or 13½ per cent., of the remainder
showed the addition of 10 per cent. or more of water.
Effort has been and is being made to remedy these conditions, and the medical officers of the
local authorities in whose districts the sellers' premises are situated are asked to co-operate with a view
to samples being collected under the Sale of Food and Drugs Acts and a considerable number of convictions
have been obtained.
Of 35 samples of meals, other than milk meals, supplied to necessitous children, one only was
reported after analysis as "unsatisfactory" as to quality. In many cases recommendations were
made as regards restoring the balance of the various ingredients and increasing the amount of available
nourishment.
Supervision
of dietaries.