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useful to have reports on their special cases, and they have always been most kind
in dealing with requests for reports from the hospital.
In conclusion, comment should be made on the attitude of the parents. It
is realised that they have come to regard the organisers as their friends to whom
they may always appeal for advice about their troubles, or problems connected with
their homes and children, and earnest endeavour is made to deal with their difficulties
sympathetically.
Middlesex
Hospital.
The arrangements for an assistant organiser to attend the aural sessions at the
Middlesex Hospital was started in May, 1925, and figures are attached shewing
the number of attendances made by children from Council elementary schools until
the end of 1927. There was a slight increase in the work during the last year when
the average number of new cases per session was 10.2 as against 9.2 in the previous
years.
Procedure
at the
hospital.
The children attending the hospital can be divided into three groups: 1. Referred
by private doctors with letters; 2. Attending with M.O., 49; as the result of
medical inspections in school; 3. Brought by parents who suspect ear, nose or
throat trouble.
The last group has to be examined first in the ordinary out-patient department by
the casualty surgical officer, who refers the children to the aural surgeon if necessary.
There are usually four surgeons present at a session. A patient with a letter from
a private doctor is seen by the honorary visiting surgeon, other new cases by the
aural registrar. Old cases, unless specially told to see the honorary visiting surgeon,
are seen by one of his assistants. The Council's organiser sees all patients in the
waiting room and makes a record card for each child attending a Council school,
as far as possible before the session starts. During the session she remains in the
room and interviews each parent after the surgeon has examined the child. She
notes the dates of all operations and arranges for the district nurses to visit the
homes.
In-patient
treatment.
A certain number of tonsil and adenoid cases is referred for admission on
account of:—1. Bad home conditions; 2. The state of the child's general health;
3. Distance from home. Such cases are marked by the surgeon, A—urgent; B—
fairly urgent, or C—can wait, according to urgency, and are sent for by the secretary
as vacancies occur. There is, however, a long waiting list, therefore cases marked
' C" have to wait for several months. Patients remain in from one to six days,
according to the nature of the case.
Charge for
treatment.
All patients are registered by a member of the almoner's staff, who takes notes
of their circumstances. A charge of 6d. per attendance is made where circumstances
are favourable, but those who cannot afford this are admitted free. This charge
covers medicine, etc., but not X-ray or operation. All operation cases see the
almoner for assessment before leaving the hospital.
A breathing exercise class is held at the hospital twice weekly. A certain
number of children is referred to this class after an operation for the removal of
tonsil and adenoids. Occasionally a child is sent who does not need an operation,
but has acquired the habit of breathing wrongly. The parents are present, and are
instructed how to supervise the exercises to be done at home. Twenty attendances
complete the full course, but patients who lives at a distance are frequently asked
to attend once only for instruction in the correct method of breathing. Reference
to this class varies with the surgeon. The number of cases referred in the years
1925-6-7 was 30, 54 and 94 respectively. Endeavour is made to keep in touch with
these cases, but it is difficult owing to the way the records are kept. On two
occasions, Mr. Somerville-Hastings has asked for the attention of Dr. Sikes to be
drawn to the way children were being taught to breathe in certain schools. In both
cases Dr. Sikes visited the school himself and went into the matter with the head
teacher.