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As an instance in point, reference may be made to the delay in visiting cases of measles among young
children. It would appear that at present, in the case of children attending infant schools, as much
as a month may elapse before the school attendance officer visits. The fact should be realised that a
large part, probably the larger part, of the absences from school are on medical grounds real or alleged.
Much of the supervision entailed by such absences is naturally best carried out by school nurses; but,
whatever the detailed arrangements made may be, the broad principle should be borne in mind that
school attendance and school health are problems which are intimately related and cannot be dissociated
without detriment to both departments of the work.
5. The Board's medical officers state that the following up of ear cases has received considerable
attention since the last inspection, and they refer to the scheme adopted in two divisions for the supervision
of such cases by one of the authority's medical officers who possesses special experience of ear,
nose and throat work. The Board understand that it is hoped to extend the scheme to other divisions
shortly. They regret to learn, however, that there is inadequate opportunity at present for the general
daily nursing treatment of such cases at the treatment centres, and that the existing facilities for treatment,
viewed as a whole, cannot be regarded as satisfactory. Parents take their children to the hospitals
or treatment centres and carry out for a time the instructions given them as to syringing, but are disappointed
at the absence of immediate results and too often discontinue treatment. It would appear that,
while some improvement has been effected, the whole question needs further consideration, in view
of the serious risk to the child from the neglect of such defects.
(5. While the provision for medical inspection and treatment has, as already stated, been generally
well maintained and even extended, in spite of the war, it would seem that, largely owing to war
conditions, which have led to a depletion of the personnel of the care committees, the arrangements
for following up have suffered a serious loss of efficiency, and in certain cases have even broken down
altogether. The seriousness of the situation is increased by the fact that the falling off is most marked
in those districts where the need for following up and treatment is greatest. The Board's medical
officers report that in a number of schools in such districts the proportion of children obtaining treatment
has sunk to a very low figure, and that in some schools practically no treatment is secured, whether
under the Council's scheme or otherwise. The Board gather that the authority are endeavouring to meet
the difficulty by utilising their nurses for following up in 30 or 40 of the schools which have suffered
most. It would appear, however, that this measure is inadequate to the needs of the case, and that,
in view of the prolongation of the war and the probability that even after the war there will be a shortage
of suitable voluntary workers, the whole question of the present arrangements for following up should
be reconsidered with a view to placing the employment of the authority's staff of school nurses in the
work of following up on a wider and more permanent basis. The Board recognise and appreciate the
admirable and devoted work which has been carried out by many of the care committees, as well as by
the organisers appointed by the Council to assist the voluntary workers, and they are anxious that
these energies should be retained as far as possible for the benefit of the children. They suggest, however,
for the authority's consideration that the time has come to include the main burden of the work
of following up among the duties performed by the school nurses under the direct supervision of the
school medical officer, as is done in nearly all other large areas, reserving the care committees for cases of
special difficulty or cases which require particular forms of treatment, such as convalescent treatment
Or other assistance which such committees are specially qualified to procure or provide. In this connection
I am to direct the attention of the authority to the limitations at present imposed on the work of
the nurses, which, except in so far as arrangements have now been made for the nurses to undertake
the following up of dental cases, is practically confined to attendance and assistance at routine medical
inspection, cleanliness work, and the following up of children suffering from ringworm or scabies, and
to the failure to make the best use of capacity and experience which results from the employment of
fully-trained nurses in duties such as clerical assistance at routine medical inspection or leaving notices
at the homes of parents who are not present at the medical inspection of their children—duties which
could equally well be performed by untrained persons. I am also to draw attention to the delays which,
it is understood, frequently occur under the present arrangements. Thus, as regards defects of eyesight,
while it appears that treatment is obtained ultimately in the majority of cases, it would seem that
delays extending to 12 months occur in some cases before treatment is secured. Similarly, the Board's
medical officers state that there may be a delay of six months before a child recommended for milk
actually begins to receive it. Long delays detract considerably from the value of following up, and in
certain cases the results to the child may be serious. From the point of view of the working of the
authority's scheme generally, it is clear that it is of no avail for the authority to extend their provision
for treatment unless the arrangements for following up are, such as to provide the children requiring
treatment and with reasonable expedition.
7. It is important that efforts to improve the cleanliness of the children should not be allowed
to diminish owing to the work necessitated by the considerable increase of scabies in the area, which
has been caused by war conditions. The Board observe, from the school medical officer's report for
1916, that approximately one-third of the girls examined at routine medical inspection suffered from
uncleanliness of the head to a greater or less extent. They are aware that, as the nurses examine the
children for cleanliness at a preliminary visit of which the parents have no knowledge, the children are not
prepared as they usually are more or less when examined for cleanliness at routine medical inspection, and
also that, as a result of the war, there has probably been some relaxation of parental care. It is obvious,
however, that a condition of things in which practically one out of every three girls in the elementary