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It has been necessary for the Council as the result of representations from the contracting authorities
concerned to increase the payments made in respect of the services of dentists and nursing associations
and to make special allowances for rent and drugs. It is estimated that the increased cost under
these heads during the forthcoming year will be about £2,500.
Education
Act, 1918.
Section 18 of the Education Act, 1918, extends the powers and duties of the Council in regard to
medical inspection and treatment to include children and young persons attending secondary schools
maintained by the Council. The Council already makes provision for the medical inspection of pupils
in secondary and trade schools, and it is not proposed at present to vary the existing arrangements in this
respect.
With regard to treatment, it has been a condition of the award of the Council's scholarships that
any defects from which scholars may be suffering shall be remedied before the scholarships are taken up.
A large number of the pupils, however, are found to require some dental treatment during the tenure
of their scholarships. Some also require their vision corrected, and a few need attention for ear, nose
and throat defects. The extent to which it is found impracticable to obtain medical treatment for
scholarship children under existing conditions varies very much in different schools, but from particulars
which have been ascertained it is clear that this difficulty is acutely felt in some instances at the present
time.
It has, therefore, been decided that in future the scholarship holders in secondary and trade schools
shall, if unable to obtain treatment privately, be eligible for treatment at the hospitals and treatment
centres at which special arrangements have been made under the scheme hitherto restricted to children
attending public elementary schools. The Council has also decided that the scheme for dental
inspection of the children shall be applied to the secondary and trade schools.
Reinspection of children noted as requiring treatment.
The measure of success of the Council's schemes for following up and securing treatment of
the children found at inspection to be ailing, is given by the results of reinspection. The primary
inspection is a point in time, but the remedial action is a process which takes a considerable time to
complete. It is therefore difficult to present the actual position at any given moment in the form of
a balance sheet. What can be done is to give the proportion of ailing children whose treatment has
commenced at given dates after the first discovery of their defects.
During the year, 199,114 reinspection reports were made upon children previously found to be
ailing. 39,307 of these were upon children kept under observation, but not referred for treatment,
97,766 upon children seen six months after their primary inspection and 62,041 upon children already
once reinspected, whose condition had not been entirely alleviated at the time of the first reinspection.
Detailed figures of the reinspection results are given in Table C on page 55.
It was found at first reinspections that 45,479 or 46.5 per cent. of the children in need of treatment
had not commenced to receive it after a six months' interval; at the second reinspection roughly half of
those previously left over had commenced treatment. The total result of the year's work was that 69 per
cent. of those requiring it had been brought under treatment by the time of their second reinspection.
This is an improvement upon the results in 1917, when the corresponding percentage was 67.6.
Quite half the cases under consideration, however, relate to children with dental defects discovered
by the school doctor. And it is precisely these cases which fail to obtain treatment in the
highest degree. It must be remembered that adequate provision has never yet existed for the treatment
of the mass of dental defect presented by the children in elementary schools and that the dental centres
under the plan laid down by the Board of Education deal when they are first opened with children
within specified age limits examined by the school dentists and only to a minor degree with the cases
found to require treatment by the school doctors.
If the dental figures be taken out, the results of following up are correspondingly improved, for
in all other classes of defect, more adequate facilities for treatment are provided and perhaps less disinclination
to undergo the ordeal of treatment exists. That the last mentioned factor is one to be
reckoned with is shown by the fact that the next class of ailments in order of " leakage " is that in which
operations for enlarged tonsils and adenoids are concerned.
It has always been the Council's policy not to press for treatment to the point of prosecution in
ordinary cases where an operation is involved. The considerations involved are of course, very complex,
but in the long run education and persuasion are more likely to be effectual than more Draconian methods.
Evidence is available which shows that the parents are now readier to receive and act upon the advice of
the school doctor than was the case a few years ago, and a harsh and threatening spirit would destroy the
growing trust of the parents.
Following up.
In last year's annual report some account was given of the measures adopted to combat the
falling off in the percentage of children who had obtained the necessary medical treatment for ailments
found on inspection. In a few specially selected schools, arrangements had been made for the school
nurse to undertake the following-up of cases until treatment was obtained. The thirty-seven schools
in question were those in special need of attention owing to the lack of voluntary workers, and these
schools have derived very great benefit from the assistance afforded by the Council's nurses. At the
close of the Summer term, 1918, a report was presented to the Central Care Committee in the following
terms :—
The re-inspection for the present term is now nearly completed, and the returns to hand for
these 37 schools, where 75 per cent, of the children have been re-inspected, show that of 1,319 cases