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The points raised by the Board were dealt with by the Council in the following letters of the
11th July and 8th August, 1918.
The Council's
reply
of 11th
July. 1918.
11th July, 1918.
Sir,
1. The Council has had under consideration Mr. Pelham's letter of 27th March last (M. 49.18)
with reference to the London School Medical Service, and notes with satisfaction the expression of the
Board's appreciation of the thoroughness with which medical inspection of school children is conducted
in London, and of the increased facilities made by the Council for the treatment of the principal types
of malady. At the same time the Council observes that certain criticisms and suggestions with regard
to the School Medical Service are made by the Board, and that an intimation is given that in determining
the rate of grant in the future the Board will have regard to the action taken by the Council to meet
these points.
The suggestions made have received careful consideration, and I am directed to submit the
following observations thereon
2. Minor ailments and eyesight—In paragraph 3 the Board state that from the experience of
other areas they would expect the number of children requiring treatment annually for "minor ailments"
to be not less than 65,000 (10 per cent. of the total number of children in average attendance), and that
therefore the existing provision needs to be at least doubled in order to be comprehensive. With
reference thereto I am to point out that, during the year 1914, 14,634 children received treatment for
"minor ailments" at 25 centres, whereas the arrangements sanctioned for 1918-19 provide for the
treatment of 30,410 children at 38 centres. In addition there would be a considerable number of
children who would be treated at hospitals not included in the Council's arrangements, and by private
practitioners. Thus very substantial progress has been made in spite of the difficulties of the present
time. As opportunities occur further schemes for adding to the facilities will be considered by the
Council.
The Board also draw attention to the need for some extension of the arrangements for dealing
with defects of eyesight. With regard to this point, the Board are probably aware that during the last
two years the authorities of several of the hospitals have found themselves unable to continue to treat
school children owing to the demands made upon them by military requirements, with the result that
the facilities for the treatment of school children have been considerably reduced. The deficiency has
been met, to some extent, by arranging for extra sessions to be worked at the Council's centres, and,
wherever possible, steps are being taken to increase the provision in this way.
3. Branch inspection clinics—The Council note the views expressed in paragraph 4 of the Board's
letter with reference to the desirability of establishing branch inspection clinics in London. Whatever
may be the merits of this suggestion, the Council feels that in present circumstances, its adoption would
involve very considerable practical difficulties which will readily be appreciated by the Board. Meanwhile
the Council is extending the arrangements by which special and urgent cases are seen by the
school doctors at the treatment centres, and authority was recently given by the Council for these
facilities to be extended to 15 centres in addition to the 10 centres at which they were already accorded.
It appears to the Council to be more desirable to continue to knit together the inspection and treatment
arrangements, wherever possible, by such means than to embark upon a policy of erection of special
centres for medical inspection which would tend in the direction of separating inspection from treatment.
4. Treatment by Council's medical staff—With regard to the question of the Council's medical
staff taking part in treatment work, I am to point out that at the Whitechapel and Wapping centres,
arrangements have been made for the treatment of minor ailments to be directed by the Council's staff,
and that the extension of this practice at particular centres will receive the careful consideration of the
Council.
5. Co-ordination between school attendance staff and School Medical Service— With regard to
the Board's observations also in paragraph 4 as to the delay in visiting cases of measles amongst young
children, the Council thinks that the Board hardly realise the amount of co-operation which exists
between the attendance staff and the school medical service.
As indicating the desire of the Council that there should be as complete co-ordination as possible
between the attendance staff and the school medical service, it may be mentioned that, in addition
to the ordinary methods adopted for dealing with such cases, in 1913 an experimental scheme was put
into operation in the electoral areas of Southwark, W., Walworth and Bermondsey, with the object of
receiving earlier information of cases of measles, through the co-operation of attendance officers, and
thus securing more efficient control of the disease in infant schools. Special arrangements were made
whereby all children absent from infant departments of schools were visited by the attendance officers
within a week from their last day at school.
During the earlier period of the operation of the scheme there were clear indications that the
special methods employed in visiting absentees enabled the school medical officer, in many instances,
to take preventive measures at the school more promptly than would have been the case under normal
arrangements. The intervention of the war and the consequent difficulties, however, have prevented
the full working of the scheme in the experimental areas, but the question will be again considered as
to what extent the special methods adopted could be employed in other areas when measles becomes
more prevalent, and if it becomes necessary the Council will be prepared to apply this scheme to all
parts of London. It is difficult, however, for the Council to understand how, even under the ordinary
system of visitation it would be possible for a case of measles to remain unvisited for so long a period
as a month. I am, therefore, to invite the Board to be so good as to give particulars of any cases which
have come to their knowledge.
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