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27
The decline in numbers treated compared with 1932, amounts to three per cent.
Considering the influences which have brought about this decline the following
causes are disclosed:—
(1) Decline in school rolls.—As there are fewer children in the schools there is a
reduced field of work which must in the long run reduce the gross number of defects.
This can for a time be balanced by improved following-up. As the reduction of
the rolls has been gradual over some years and the number of children treated has
not shown a reduction until recently, this cannot explain to any great extent the
sudden drop.
Owing to the very disproportionate numbers of children in the schools at the
various ages, the number of children inspected has not been reduced pari passu each
year with the general fall in the total numbers of the children.
It is only this year that the number of inspections has been reduced. These
have now been reduced (from April, 1933) by about 4 per cent., staff having been
given up to this extent. The influence of this reduction has acted through rather
more than one half of the time under consideration.
It would be fair to suppose, therefore, that the drop in the figures for eyes and
ears, to the extent of 2.5 per cent., may be ascribed to fewer inspections following
on the decline in school rolls. Dental and minor ailments cases are not wholly or
even largely dependent for their discovery on routine medical inspections.
(2) Economy measures.—The reduction in inspecting staff cannot be called a
special economy measure as it was a natural corollary of the reduced numbers of
children to be inspected, and it has therefore been dealt with above. Other
economy measures introduced were:—
(a) Making the life of a voucher for eyes 12 months instead of 6 months.
Formerly at many centres children were brought up at 6 monthly intervals for
re-testing and counted as new cases. This practice has been discouraged, and in
any case they are no longer counted as new cases. This, together with the decline
in numbers on the roll, is held to account for the whole decline in children
treated for defective vision. It is a paper decline and not a real one.
(b) Increased charges affecting chiefly children suffering from tonsils and
adenoids and dental caries. There is reason to think that the increased charges
have had but a slight effect upon the number of cases of tonsils and adenoids,
but possibly a greater effect upon the number of dental cases.
(c) Alteration in the system of payment of grants. Formerly, with
capitation payments to the voluntary committee, there was an irresistible
urge in centres and hospitals with other departments to refer to the school
medical department all cases of school children, in order that additional income
should be secured. With the introduction of block grants in place of capitation
payments the edge of this urge has been somewhat blunted. This may have
tended to reduce the number of minor ailment cases. (Further reference to the
block grant system is made later in this report).
Taking the classes of complaint in order:—
(i) Eyes.—It has been explained that reduction in medical inspection and
abolition of the practice of counting certain children twice in the year explains
the whole of the drop in children treated for defective vision. A certain number
of the eye cases at hospitals consist of children suffering from external eye
diseases, and remarks later upon minor ailments will apply to them.
(ii) Tonsils and Adenoids.—There has been an almost phenomenal drop
in the number of cases of tonsils and adenoids, and this may be accounted for
by a variety of causes:—
(a) The arrears which had accumulated owing to the fact that
until three years ago there was insufficient accommodation have now
been overcome owing to the use of the Council's appropriated hospitals
for dealing with the excess of cases awaiting treatment.