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Ophthalmia
in children's
residential
institutions.
The school
medical
officer.
II. The investigation of ophthalmia in children's residential institutions.—The
transference of the Poor Law schools to the Council's education system on 1st April,
1930, has been the means of focussing attention upon certain conditions which are
apt to be endemic in children's institutions. Amongst these an important place is
occupied by endemic ophthalmia. It became necessary to devote a considerable
amount of time to this at the Anerley residential schools when there was found to
be a considerable amount of ophthalmia complicated by the presence of a few children
who were considered to have trachoma. An identical condition also complicated by the
presence of trachoma was found to exist in one of the large philanthropic orphanages
in the county, the managers of which gladly welcomed the assistance of the school
medical service in investigating the condition and taking measures for its eradication.
Mr. Bishop Harman in opening a discussion in the section of ophthalmology at
the annual meeting of the British Medical Association, Winnipeg, 1930, gave the
following account of trachoma in London:—
" In former days the chief breeding places of trachoma in London were the Poor Law schools.
The children of destitute families were drafted into huge barrack schools. These schools were
ravaged from time to time by epidemics of ophthalmia, which was always endemic. Stephenson,
in an historical note, showed that the evil of these schools was known as early as 1848. In 1858
Bowman made recommendations regarding them. Ten years later similar recommendations
were made by George Critchett. Nettleship in 1874 inspected all these schools, and of one he
stated that ' not 15 per cent, of the eyes could be described as healthy.' A report in 1888 by
Litteljohn, the medical officer of one of the schools, in which he said ' Children have contracted
the disease in the school • • • to an appalling extent,' attracted the attention of Parliament.
An isolation school for ophthalmia was provided under the care of Sydney Stephenson. From
later London reports I find that the separate attempts of the local London Poor Law authorities
were amalgamated by the Metropolitan Asylums Board. Two ophthalmia schools were
established in the country north and south of London in 1903 and 1904 in charge of Treacher
Collins. At the time of the foundation of these isolation schools the average number of children
housed in the Poor Law schools was 10,800. The accommodation of the isolation schools was
720. In the first year 625 children were admitted, of whom 292, or 46 7 per cent., were suffering
from trachoma. The segregation of affected children was so efficacious that in 1918 there were
only 186 entries, and one of the isolation schools was closed. In 1921 there was a risk that the
other would be closed too for lack of cases. It was therefore determined to admit children also
from the elementary schools. Even with this far wider field from which to gather patients the
demand upon the resources of the school at Swanley has been below the accommodation. In
January, 1930, only 253 of the 364 beds were occupied. Thirty-nine were pauper children
gathered from the Poor Law schools with a roll of 6,375 children ; 12 were cases from outside
London ; and 152 were elementary school children. Of the total cases, 67 were trachomatous,
or 26'5 per cent.
" A most effective agency in the control of trachoma is the School Medical Service. For the
past twenty-five years I have been intimately connected with this work in the County of London.
My duties as ophthalmic consultant include work at a consultation centre at the County Hall, to
which are referred children whose sight presents special difficulties in education or medical
treatment.
" By Act of Parliament the education authority is responsible for the medical inspection and
treatment of the school children. The schools are visited regularly and all the children examined
in specified groups. Those requiring treatment are referred to their home doctors or to school
clinics maintained by the authority. Parallel with this arrangement there is the School Attendance
Department, which has the duty of investigating the reasons for the absences of children
from school. Absences of more than a specified period are reported to the head office for special
investigation. This dual organisation within and without the schools ensures a very complete
supervision of health of the children.