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70
poverty or unsatisfactory housing conditions. Whatever the physician may do in
the way of improving the child's eyes temporarily by medical treatment, so long as
the real disease—a defect in the environment of the child—is left untreated, the
chronic inflammation of the eyes will return again and again.
Similarly, a child may be sent to a colony or sanatorium to recover from such
diseases as rheumatism or tuberculosis, but these conditions reflect some fault in
the home which is the true disease, and must be tackled by the social service department,
while the child is still away. Otherwise, upon his return, he will again contract
the disease, and all the time and money expended upon curing the doctor's disease
will be wasted because the true disease—maladjustment in the home—of which
even tuberculosis or rheumatism are only symptoms, has not been dealt with.
Therefore the medical officer who sees in the detection and treatment of medical
diseases the sole object and end of his endeavours will fail to perform really useful
work. Even the occurrence of a minor ailment in a child should lead to an attempt
to uplift the family or rather to assist the family to uplift itself. Many medical
officers still need enlightment in this respect. The efforts of the physician or surgeon
to cure the sickness of the child must be supplemented by the simultaneous efforts
of the social workers to cure the environmental defects in the home itself.
Perceiving the great results that flow from this combination of medical and social
effort, many of the great voluntary hospitals not included in the Council's scheme
proper have demanded the presence of care organisers without requiring any subsidy
from the Council for the treatment of child patients, and both the hospitals themselves
and the school service have greatly benefited by this extension of the scheme, in
the shortening of the duration of treatment, and by "following up" in the home
ensuring, so far as possible, its permanence when a cure has been effected.
The formal reinspections in school of children previously found ailing make it
possible to compile a statistical record of following-up. During the year the total
number of children reinspected was 193,260. Of these 133,462 were primary
reinspections, and 66,827 second reinspections, of children not discharged at
primary reinspections. Combining the results of first and second reinspections
in 1927 it is found that 76.4 per cent, of the children were discharged by the school
doctors, the condition for which they were under observation having been dealt
with. This is a better result than in the two previous years when the figure stood
at 75.4 and 75.5 per cent, respectively.
Ignoring dental defect the proportion of the children treated works out at
81.4 per cent. Somewhat better results were obtained in regard to dental treatment
than in the previous year ; at first reinspections 50.7 per cent, still needed treatment
in place of 53.1 per cent, in 1926 and 54.3 per cent, at second reinspections in place
of 53.7 per cent.
It is dental treatment which, of course, gives by far the most trouble in followingup.
Attention was drawn to the number of refusals to obtain treatment reported
at the dental inspection at a voluntary school in North St. Pancras on 19th September,
1927. The care committee secretary, who is also the head teacher in the infants'
department, enquired into the reasons for refusal in each case with the following
result:—
Of 38 cases referred for treatment, 4 children were treated by a private dentist,
1 was treated, and 2 desired treatment at a treatment centre. There were 31 refusals
and the following were the excuses given:—"teeth loose, father will remove them"
(3 cases); "all teeth are sound" (3 cases); "not bad enough at present" (10 cases);
some treatment effected, but completion refused (3 cases); "will not have fillings"
(3 cases); refusal without reason (4 cases); treatment deferred (4 cases); "treated
at home" (1 case). Thus the meagre result of this dental inspection was that
only 7 out of 38 children who need skilled dental treatment show any signs of
obtaining it.
Co-operation
of voluntary
hospitals.
Results of
reinspections.
A poor dental
result.