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schools of the metropolis is unclean cannot be regarded as satisfactory, and every effort should be made
to secure a considerable further improvement.
8. The Board observe, from the school medical officer's report for 1916, that, while spectacles
were prescribed during that year for 20,597 children, they were obtained in only 17,389 cases. I am
to remind the authority that it is a condition of the Board's sanction to arrangements for dealing with
defects of eyesight that steps will be taken to secure that children for whom spectacles are prescribed
actually obtain them, and afterwards to ascertain whether the spectacles are being worn properly and
with satisfactory results. The Board understand that at present spectacles are not provided by the
authority in necessitous cases, but that assistance in obtaining them is given by the local associations
of care committees, under the general guidance of the London Central Spectacles Committee. In view
of the increased cost of spectacles at the present time, the difficulties under which care committees are
working, and the apparent failure in a considerable number of cases actually to obtain the spectacles, I
am to suggest that the present arrangements should be reconsidered with a view to the authority themselves
undertaking the provision of spectacles in cases in which the parents are not in a position to pay
for them, as is now done by practically all the authorities who make provision for dealing with defects
of eyesight. Such cases should not be numerous; but it is important that the children should not
suffer by the withholding of the spectacles, which they require, and that the waste of the specialist's
time which occurs when spectacles are prescribed but not obtained, should not be allowed to continue.
The Board assume that arrangements have been made by the authority to enable parents who are in a
position to pay for spectacles to obtain them at contract rates ; but they will be glad to be informed
exactly what the position is in regard to this matter. In this connection, attention is invited to paragraph
186 of the report for 1913 of the Board's chief medical officer.
9. The Board desire to invite the attention of the authority to the following matters—
(1) It is very important that the whole of the authority's arrangements for securing the medical
treatment of cases requiring it should be under the direct supervision of the school medical officer,
whether the treatment required in a particular case is treatment for the provision of which the authority
is responsible, or whether it has to be obtained outside the authority's own scheme of treatment. It
will be observed that article 4 of the Medical Grant Regulations applies to treatment generally and
draws no distinction between treatment provided by the local education authority and treatment not
so provided. The scope of the school medical officer's supervision should extend to the administration
of the Education (Provision of Meals) Acts.
(2) It is regrettable that the authority's arrangements for open air education show no development.
As pointed out on page 76 of the report for 1916 of the Board's chief medical officer, there is
perhaps no form of treatment so needed at the present time, and none so certain in its remedial effects
as the open air school; yet there are still only two open air schools accommodating about 200 children
for the whole of the metropolis. The Board realise the difficulties of this nature, but in view of the
great importance of provision for open air education I am to suggest that the practicability of establishing
additional day open air schools should be considered even though it be necessary during the
war to utilise existing premises or temporary buildings which may not be altogether satisfactory for
the purpose. Attention is invited in this connection to paragraph 137 of the chief medical officer's
report for 1916.
(3) Closely connected with the question of open air education is that of provision for backward
children which needs much further attention than it has hitherto received, though valuable investigations
preliminary to action have, it is understood, been carried out by the Council's psychologist. It is probable
that the total number of children affected in the area is not less than 50,000 to 75,000. Even if
under present conditions it is impracticable to put a scheme into operation—at any rate full operation—
it is very desirable that the authority should give serious consideration to the problem and the various
methods of dealing with it through medical supervision, open air education, provision of meals, special
educational treatment (e.g., manual and physical training), etc., so that on the return of more normal
conditions it may be possible to take action without delay.
(10) Owing to war conditions it was impossible in the course of the recent inspection to form an
opinion as to the working of the system of quarter-time assistant school medical officers appointed
temporarily and employed solely for medical inspection in the public elementary schools in the districts
allotted to them. The authority will be aware that the Board have always entertained considerable
doubts as to the expediency of this system. Should the Council decide to adhere to it after the war
the Board will watch its working closely, and will arrange for a further inspection to be made which
would have regard to this point particularly.
11. I am to add that, in view of the general character of the report of their medical officers,
the Board have decided that they would be justified in sanctioning payment of grant for the year which
ended on the 31st March, 1917, at the maximum rate, and they will also be prepared to pay grant at
the full rate for the current year. In determining the rate of grant for subsequent years, however, the
Board will have regard to the action taken by the authority in view of the suggestions and criticisms
contained in the present letter, and in particular to the measures adopted to place the arrangements
for following up on a more satisfactory basis.
I am, Sir,
Your obedient Servant,
(Signed) E. H. Pelham.