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no time lost in visiting homes (often to find that the children were out) and it was
possible to give skilled nursing assistance to every child once, or even twice, every
weekday. This led to a great improvement in the conditions and the old trouble
of offensive ears in the classroom was got rid of.
Gradually minor ailment departments increased in number, until there are
now 70 covering the whole of London. The doctors in charge of minor ailments
were, however, not specialists in otology, and, though a much larger number of
discharging ears were cured than formerly, the departments still tended to be
clogged up by cases which remained uncured.
In order to ascertain whether something could not be done to reduce the
chronicity of these cases, it was arranged for Dr. Wells, who was then a school
doctor in the south-west division, to give up one session a week to carry on an " ear
inspection clinic," and to this were referred cases from the surrounding minor ailment
departments for special investigation and advice.
Through his connection with the Metropolitan Asylums Board, Dr. Wells was
able to secure in-patient treatment for those children who could not hope to be
cured of otorrhoea except by mastoid operation or other in-patient treatment.
The special inspection clinic proved to have great possibilities, and the system' was
gradually extended to other areas.
Dr. Eichholz of the Board of Education, who always took much interest in the
development of aural work from the point of view of prevention of deafness, pointed
out about 1920 the possibilities of zinc-ionisation treatment which Dr. Friel had
advocated.
The Education Committee in 1920, in sanctioning the extension of the inspection
clinics, approved the introduction into them of the zinc-ionisation method of treatment.
Dr. Friel himself was employed in the service, and the number of clinics
grew. At each of them an aural surgeon of experience was appointed. By this
time Dr. Wells had received a special appointment which allowed him to give his
whole time to the development of the work.
He also held an appointment with the Metropolitan Asylums Board, and
himself carried out the operations at the Cleveland Street infirmary.
In the first instance cases from the minor ailments departments which did not
clear up after three months treatment were brought to the special ear clinics for
investigation. Those suitable for ionisation were subjected to it; those needing
operations were sent to Cleveland Street. It was found desirable, however, to
obtain advice at the special clinics at an earlier stage in many cases; and in 1925
the school medical officer addressed a memorandum to the honorary secretaries
of the treatment centres on this point, asking that all cases which did not clear up
within a month should be referred for specialist examination.
There was still, however, a tendency on the part of the minor ailment departments
to retain cases unduly, and the principle was adopted of working through
all ear cases on the lists of the minor ailment centres in turn. This is the practice
which still obtains. All through the development of the scheme the importance
of ready and prompt transference of children needing it to in-patient treatment
has been borne in mind ; and the Council's school medical service has worked in
close co-operation with the Metropolitan Asylums Board's and latterly the Council's
special hospitals.
In the early years, before this liaison had been established, the work was very
greatly hampered through the long waits for hospital beds which made any
preventive scheme very difficult indeed. With the provision at Cleveland Street
this difficulty disappeared.
When the Downs hospital was made available for this work—largely to meet
the demands of the school medical service—Cleveland Street was closed.
Children returning from the Downs hospital are kept under observation. This
was done at Leighton Road after-care clinic by Mr. Wells, but the geographical
position of the clinic was unsatisfactory, and some two years ago the work was
moved to a more central position at St. George's dispensary, Blackfriars Road. As