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One considerable difficulty has, however, been experienced, namely, that of obtaining suitable
treatment for children who require radical operations for the purpose of curing the disease, and who
should be admitted to hospitals as in-patients. It has been felt for some time that no arrangement,
for the treatment of ear cases can be complete or satisfactory which does not include some such provision.
In this connection, the following observations of the School Medical Officer are important:—
"Ear discharge amongst children is very common in this country. It is a frequent sequel of the
common infectious diseases such as measles or scarlatina, but apart from this it often results from
frequent colds and is often associated with the overgrowth of tonsils and adenoids. The medical inspection
of school children quickly demonstrated the wide prevalence of the condition, and its serious effects
upon the capacity of the children to profit educationally by school attendance. It was already well
known to the medical profession that chronic ear discharge is a serious menace to life itself, and a large
number of deaths from diseases originating in discharging ears takes place amongst the child population
yearly. Every medical man knows that a patient with chronic discharging ears is always on the
blink of a precipice, and that it is impossible to exaggerate the gravity of the condition. Whenever
a child patient dies in hospital from blood poisoning or from meningitis for which there is no obvious
cause, the pathologist always examines the middle ear in the expectation of there finding a neglected
and perhaps unknown focus of inflammation, and in the majority of cases his expectation is justified.
In addition to the toll of child life exacted by this condition, the results in loss of hearing amongst the
survivors are most serious, and the condition is moreover productive of chronic ill-health with much
loss of school attendance.
"The results of school medical inspection show that more than 12,000 children with discharging
ears are in attendance at school; there is, in addition, a number which cannot be estimated who are not
attending. There are some 7,500 children attending elementary schools who have some easily appreciable
deafness, and there are in addition 800 children attending deaf schools or "hard of hearing" classes.
From 100 to 150 children of school age die in London annually from diseases closely associated with
ear disease.
"A large proportion of children attending minor ailment centres and aural departments of treatment
centres suffer from chronic ear dischaige. In a great many cases no cure can be expected by
syringing and other local methods although these must be maintained in the absence of facilities for
radical treatment in order to limit, so far as possible, the ofiensiveness of discharge and danger of spread
of the disease to vital organs.
"Owing to the prevalence of the condition and the lack of facilities at London hospitals for dealing
with the cases, it was one of the first for which the Council found it incumbent upon it to provide at
treatment centres.
"The need for beds at hospitals arises directly out of the Council's work. It is practically impossible
to obtain in-patient treatment for those needing it at London hospitals ; the beds which are in existence
are fully occupied with acute cases, many of which have been left too late for anything effective to be
done to save hearing or even life. All these cases should have had earlier attention. The result of want
of this provision is that the centres are congested with the accumulation of cases which cannot be cured
by local measures, and the work of the centres becomes more and more difficult to carry on."
From a consideration of the above facts, the Council are strongly of the opinion that an arrangement
should be made with the governing bodies of one or two hospitals in London, whereby five beds
could be reserved for the in-patient treatment of children suffering from serious ear trouble and referred
under the Council's school medical treatment scheme, in the same way that beds are reserved by the
Council under the tuberculosis scheme. The time required for treatment would be on an average one
month for each case, so that 60 cases a year could be treated in this way.
As regards cost, the Council is advised that it could probably be arranged to reserve the five
beds for a sum of £1 a week for each bed, or £260 per annum. As some negotiation will be necessary, it
will probably be impracticable to put the scheme into operation before 1st January, 1919, in which
event the expenditure during the current financial year would not exceed £65.
Before taking further steps in the matter, the Council will be glad to receive the Board's approval
of the proposed arrangements and to receive an assurance that the expenditure involved will be allowed
to rank as approved expenditure for annual grant.
2. "Following up."- With regard to the Board's remarks on this subject, the Council is prepared
to agree that it is unfortunately the fact that owing to the depletion of School care committees in consequence
of the war, medical " following up " has, in common with other important work concerning the
welfare of school children inevitably suffered. In order to meet the situation, the Council has decided to
appoint, as from 1st September next, 12 additional temporary organisers at a rate of pay of £3 weekly,
and to raise from amongst successful care committee members a mobile corps of voluntary workers who
will work in six detachments in various parts of London where care committee activity is at a very
low ebb.
Six of the temporary assistant organisers will be placed in the Public Health Department and a
similar number in the Education Officer's Department, and the work of the staff will be co-ordinated
by the principal organiser.
It is hoped that the Board will agree that the appointment of this additional staff will result in
materially improving the standard of the medical "following up" work.
I am, Sir,
Your obedient Servant,
(Signed) R. Blair,
Education Officer,