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Admirable though it is as a whole, the London scheme is not of course free from
defects, and for the sake of convenience they are set out below:—
"(i) The care committees are not rendering uniformly effective service. Whilst
appraising the success already achieved, we desire to indicate the need for great
effort towards securing a larger number of interested, keen and effective workers.
We would also invite the Council to consider whether it is not possible to strengthen
some of the committees.
"(ii) The treatment scheme—We appreciate in full measure the success of the
Council in making treatment accessible to every family in the Metropolis by means
of the arrangements with hospitals and centres as well as by the moderate cost at which
the treatment is provided. At the same time we desire to draw attention to the need
for further administrative supervision in order that (a) time is not wasted by the
failure to supply medical and dental practitioners with a full complement of cases
at each session, (b) that practitioners may be discouraged from coming late and
going early. Further, (c) the Council should increase the professional supervision
of the treatment centres; this is needed particularly in the case of the administration
of anaesthetics, operation treatment for tonsils and adenoids, and dental work.
Finally, (d) as regards operative work and anaesthetics, it is essential that the skill
of those appointed to undertake the work in the centres should be in no way inferior
to that which obtains in the best managed hospitals.
"(iii) The cleanliness scheme—The cleanliness scheme is well administered.
Gross cases of uncleanliness are rare. Nevertheless the good results secured are not
obtained without some friction. This should be avoided as far as possible. In
addition to the steps already taken to prevent 'stigma,' it is suggested that the
examinations be conducted in such a way that no child becomes aware of another
child's condition and that, pending cleansing, the practice of segregating dirty
children at school be discontinued as far as possible. If however this is arranged,
there should be the least possible delay between the examination and the cleansing.
The longer the lapse of time between the two, the more difficult it is to avoid segregation
successfully and the consequent incidence of stigma upon the unfortunate child.
The criterion of a successful cleansing scheme is that it shall be acceptable to the
parent and to the child."
The report was carefully considered by the Education Committee, and on
13th November, 1922, a letter dealing with the three points referred to above was
forwarded to the Board to the following effect:—
(i) The Council was making every effort to secure that every school care committee
shall be an active organism.
(ii) The time at which the inspection took place was most unfavourable as compared
with 1921. During 1921 the centres were full to overflowing, and the pressure
on the accommodation was so great that patients had to be put on waiting lists,
and vouchers issued for dates long ahead. At the time of the inspection in 1922,
there was a falling-off in many areas, and centres were found to be working below
their normal output. The principal causes of this falling-off in the number of cases
for treatment were: (1) unemployment was acute: (2) unjustified attacks in a
section of the public press on throat operation work had momentarily affected the
position; (3) the inspection was carried out in the midst of the greatest prevalence
of infectious disease since the inception of school medical treatment; (4) the effect
of the increased charges on the parents was being felt by the parents. Steps had
now been taken to augment the supply of cases to the centres.
As regards the personnel of the treating doctors and administrative control of
the centres, the Council had given careful consideration to the need (i) for standardising
the qualifications and experience to be required of medical officers employed
at school treatment centres; (ii) for eliminating from the agreements, with the
committees of those centres, clauses which might unduly interfere with the output
of work at the centres.