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issues of the public health service. With the increase in the source of supply of cases resulting from the
raising of the age limit for compulsory education and the extension of the treatment scheme to secondary
and trade schools, it is evident that even now the provision of facilities has not reached a maximum and
further effort is still necessary before attaining the goal of efficiency, when it will be possible to
provide means of treatment for every child needing it, when the difficulties of topographical position are
eliminated, and when the appointment for treatment shall follow immediately upon the notification of
the need.
Consideration of the results of medical inspection shows that there is still a mass of unremedied
defect in all the classes of ailment treated under the Council's scheme, though this is more particularly
the case with regard to minor ailments and dental defect. Although a record number of children (47,414
received minor ailment treatment during 1919, some of the centres were overworked, and the total
number treated represents nearly 134 per cent. of the number for which agreement was made. The treatment
of dental defect presents another difficulty owing to the large number of failures to keep appointments
for operative treatment. This result of parental prejudice makes it necessary to arrange appointments
for a number of cases much in excess of the number treated. That there is a great and pressing
need for further means of dealing with the problem is evidenced by a reference to the results of inspection
in 1918. In that year it was noted that 55 per cent. of infants when they enter school already have
manifest caries ; 60 per cent. of the eight.year.old group, and 50 per cent. of the twelve.year.old children
are in like case. These facts have been borne in mind in arranging the scheme for treatment for the
current year, the provision for dental defect amounting to nearly 106,000 cases.
During the year 1919 the total number of cases treated was 169,200, as compared with 143,577
during 1918. The usual details are here summarised.
Defective
vision.
The number of eye cases dealt with under the Council's arrangements was 28,011, or 811 more
than in 1918. Spectacles were prescribed for 21,018 children, and 18,457 of them obtained spectacles.
Special
Treatment
for Squint.
The committee of the Roll of Honour Hospital for Children (Women s Hospital for Children,
Harrow.road) called attention to the work of the ophthalmic department under the Council's scheme.
Out of 1,147 children dealt with in this department the number of cases of squint totalled 181, i.e., 16
per cent, of the whole number. The ophthalmic surgeon stated that 134 of these cases of squint were
preventable, and 11 were partly preventable. In her opinion unless special treatment in addition to
glasses is adopted the greater number of the children lose the vision in the squinting eye through neglect.
The method of treatment adopted at the hospital is—
1. Refraction and ordering of glasses.
2. Treatment of the defective eye by blocking the good one, thus practising the eye. It
is stated that in the majority of cases under this treatment the vision completely returns in
the defective eye.
3. Teaching, by exercises, the two eyes to work together. This entails a considerable
amount of work. The co.operation of the mother and child must be obtained and constant
supervision be given.
The committee of the hospital suggested that a special squinting class should be formed, to which
all cases after refraction should be referred and at which special education should be given to the children
and their parents. It was also suggested that London County Council nurses should be detailed to
attend this class to learn the methods, and as far as a nurse can, carry out the treatment under the
surgeon's supervision. The committee asked that an extra session be allowed under the Council's
scheme at which squints alone might be treated.
The question raised was referred to Mr. Bishop Harman, who reported that it is very dubious
whether the treatment coming under heading 3 (viz., the re.education of the eyes to work together, at
a special class) will have any real effect. He has had a large experience of this method and has spent
untold hours teaching squinting children at hospital and the result is very unsatisfactory. The method
is very old and the earliest known exponent of the method confessed to the unsatisfactory nature of
the work. Mr. Harman's experience led him to substitute for procedure 3 in the above treatment an
operation for the cure of the squint. So soon, he thinks, as the squinting eye has been raised to an effective
standard of vision the tendons should be balanced; "after a squint of any duration there is a
definite alteration in the tendons and no juggling with stereoscopes will undo this."
Mr Harman maintains that this is the general experience of ophthalmic surgeons. He adds
that the educational treatment was first tried by Dr. Erasmus Darwin (the grandfather of Charles
Darwin) in 1778, but in spite of the fact that.the child upon whom it was tried was the only member
of the class and had every care and attention in his home surroundings, Dr. Darwin found that the
little patient discarded his device as soon as the oversight was withdrawn. The patience required even
with one child is almost superhuman and a long string of distinguished ophthalmic surgeons has made
a similar confession, and after trial they have all discarded the method.
The task, therefore, which the Roll of Honour Hospital proposed to take up is one from which
when the frailties of human nature are borne in mind, the bravest might recoil.
Hope, however, springs eternal in the human breast, and it is to be noted that all the distinguished
surgeons who have confessed their failure have been men, possibly the well.known superiority of patience
possessed by the other sex may triumph where mere man has failed.
The Council agreed that, as an experiment, which should be closely watched by one of the Council's
medical officers, a weekly extra session be allowed to the Roll of Honour Hospital for a period of one
year, and that each case of squint referred thereto should count as a new case for capitation purpose.
Ear, nose,
and throat
defects.
As in 1918 there is again to be recorded an appreciable increase in the number of cases treated
under this heading, 12,837, or 1,930 more than in 1918. It should be noted, however, that owing to the