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section the Council was empowered to cut the hair of children in cases where it was deemed necessary
that this should be done, and in many thousands of cases this procedure was followed. There was much
criticism of the Council's action, and in 1912, in order to meet the objection that the. scheme was too
drastic, amendments were approved which gave opportunity for the more extended voluntary use of
bathing facilities; when advantage was taken of these opportunities it was necessary in cases of relapse
to start again from the beginning in the scheme of procedure. It thus became possible for children
to be repeatedly cleansed at the Council's stations without permanent improvement resulting. The
scheme was therefore re-considered in February, 1914, and the number of voluntary baths was limited
to four series of three baths : two series after the preliminary notice (M.O. 24 A.) and two series after
the service of the first statutory notice (A 5 /149) This scheme, although it represented an advance
upon the earlier procedure, was still slow in operation in many cases, and the Sub-Committee (7.12.17)
decided to reduce the number of voluntary baths from four series of three to two series of three, viz.,
one series after M.O. 24 A., and one after statutory notice A. 5 /149.
Having regard to the very great improvement that has been effected, and to the extent to which
the need for strong action in the interests of public health is now appreciated, the scheme was again
revised with a view to speeding up the procedure. In the first place cases in which the head alone is
implicated were now brought into the general scheme. It has been pointed out above that in verminous
head cases a fortnight elapsed before the main scheme was brought into operation; this time could be
saved by abolishing the preliminary head scheme and applying the main scheme forthwith. In the
second place, amendment could with great advantage be made by an alteration in the present form
M.O. 24 A. This notice is sent in ordinary cases to parents who have been already told that the child
should be cleansed and given an opportunity to effect this. The form is also given straight away in
badly nitted cases. The form would be more effective were it altered so as to include a statement that
defaulters would render themselves liable to proceedings under the Act if the directions were not carried
out. If this were done the number of statutory notices that it would be necessary to serve should be
considerably reduced.
There is an important point in regard to statutory notices. The necessity for the service of
statutory notices upon the parent personally presents great difficulty and is frequently the cause of
considerable delay. The Act of Parliament contemplates action within 24 hours of the discovery of
the verminous condition and the delivery of the notice to the parent, but in many instances repeated
visits to the home are necessary before the father can be interviewed. It sometimes happens that it
is not possible personally to serve the notice upon the responsible parent at once; a considerable period
sometimes elapses between the application for and the service of the notices, and during the whole
time the child concerned must continue in attendance at school, otherwise the scheme becomes
inoperative.
Time could also be saved by still further reducing the number of voluntary baths offered.
Section 122 of the Children Act requires the parent or guardian to cleanse a verminous child within
24 hours, and it is now proposed that children who attend for a voluntary bath after the service of
statutory notice A. 5/149 should be cleansed in one operation. This might involve cutting of the hair.
The following amendments to the cleansing scheme were therefore recommended—
(1) Notice M.O. 24 to be revised and issued in cases of slightly nitted heads.
(2) Notice M.O. 24 A. to be made positive and to be issued (a) to parents who have ignored
M.O. 24; (b) in cases of badly nitted heads; (c) in cases with verminous or foul bodies or
clothing.
(3) Cases which attend voluntarily after service of statutory notice A. 5/149 to be cleansed
in one operation.
In the event of the foregoing proposals being approved it was pointed out that the inclusion of
head cases in the main scheme, together with the reduction of voluntary baths and more rapid service
of statutory notices would require the nursing staff at the cleansing stations to devote more time
to visiting schools for following up purposes. The number of cleansings has increased enormously,
the average for the years 1913 to 1916 being 45,711, as compared with 80,755 in 1917, 95,033 in 1918,
and 105,639 in 1919. The time of the present staff was therefore already more than fully occupied, and
it would be necessary to have two nurses at each of the cleansing stations. This involved the appointment
of five additional nurses.
In February, 1918, the Sub-Committee considered a report submitting a scheme for re-organising
the nurses' rota inspections. Attention was drawn to the fact that the proportion of school nurses'
time available for cleansing work had fallen from two-fifths to one-third, and that in order to speed
up the work, 18 additional nurses were required. Under the proposed plan the former method of
visitation for cleansing purposes would be replaced by one which would be much more effective. The
schools would be visited in turn and all the children seen examined, and then each school would be
re-visited by the school nurse during the third and fifth weeks subsequent to the initial visit. In the
intervening weeks the cleansing station nurse would visit the school, thus ensuring that all unsatisfactory
cases were kept under constant supervision. A still further visit would be paid later in the term by the
school nurse. By this arrangement each school would have a complete cleansing scheme during each
term: the irritating delays in dealing with special cases which were then unavoidable would no longer
occur, and the necessity for a higher standard of cleanliness would be brought home to the parents of
all the children, however slightly infected. The Sub-Committee had originally decided that it was not
practicable to apply the scheme to its full extent, but agreed to the appointment of five nurses forthwith
to be employed where the needs were most pressing. When the scheme was previously before the SubCommittee,
it was exceedingly difficult to obtain properly qualified nurses. This difficulty, however,
now no longer existed, and in view of the urgent need for dealing with verminous conditions in the
schools the Committee was recommended that the additional 13 nurses should be appointed.