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whole of the school medical work during the year. During the early part of the
year the combined effect of unemployment and the increased charges made for
treatment made it very difficult to keep the centres going at full strength.
Fortunately a recovery took place towards the end of the year, and it is anticipated
that the slackening off which resulted in this rather serious lack of full utilisation
of the facilities provided will no longer be apparent in the coming year.
The classes for stammering children were transferred during the year from the
Education Officer's department to that of the Medical Officer. They are now,
therefore, to be regarded as treatment centres, and during the year have been under
the medical supervision of Dr. Margaret Hogarth and Dr. E. J. Boome. 326 children
were treated in 1922, and of them 95 were discharged as provisionally cured. In
children who had previously been discharged after attendance there were four relapses
and further instruction was necessary. Dr. Margaret Hogarth has found that
in a certain number of children the methods of instruction appear temporarily to lose
their stimulus and there is a tendency for progress to be arrested after a certain point.
In such cases it is beneficial to intermit the instruction for a time, after which further
treatment progress again takes place. Three times as many boys as girls were
treated. In 191 cases out of 247 (where particulars could be obtained) the onset of
stammering occurred before the age of seven.
Stammering
children.
The onset of the ailment coincided with the first attempts at speech in the child's
babyhood in 83 cases. 131 cases were ascribed to shock and 17 to imitation, while
severe illness caused the complaint in 23 children. Heredity was (or seemed to be)
a factor in 88 cases and bad physique in 38 cases.
Inspection of the work of the School Medical Service by Medical Officers of the Board
of Education.
In March and April an inspection was made by the Board's Medical Officers
of the work of the School Medical Service in London. In forwarding the report of
their officers on 29th May, 1922, the Board stated that they were glad to endorse
the expressions of appreciation of the efforts made by the Council to provide an
efficient and comprehensive school medical service, and assumed that the criticisms
and suggestions made in the report would receive the Council's consideration in due
course. The conclusions of the Board's officers are quoted below:—
"Compared with the arrangements obtaining in well administered areas in other
parts of the country, the London scheme presents exceptional features; there are two
medical services, one for medical inspection, and one for treatment, practically
distinct and separate. Following up is done only to a limited extent by school
nurses; the main burden of the work is undertaken by the 5,000 voluntary care
committee workers acting under the direction and instruction of salaried organisers.
The whole of the arrangements for following up and treatment are so devised that at
any moment alternative provision is available, should for any reason the existing
arrangement fail.
"The scheme works well and successfully, not in certain localities only but in
London as a whole. The volume of inspection is in excess of the estimate and includes
not only the routine age groups, but also special cases and re-examinations, and covers
secondary and continuation schools as well as elementary; each child in the elementary
school is examined for cleanliness three times a year and oftener if necessary, in
accordance with a strict standard of scrutiny followed up rigorously until cleanliness
has been secured. Except in the case of dental work the volume of treatment
secured for every type of school defect reaches the normal estimate and even exceeds
it in most categories. Medical inspection and treatment have secured the sympathy
and interest of the parents. It is satisfactory to see the large groups of mothers at
inspections, keen to know what they should do for their children and prepared to pay
according to their means. It is an eloquent reply to critics who urge that the school
medical service tends to diminish the responsibility of the parent in the home.