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which required prolonged treatment but which did not entirely prevent education
so far as this could be carried out on the hospital premises. At a later date, certain
ear cases were received at the Downs hospital. Admission to these hospitals was
not exclusively or even chiefly through the school organisation, since the Metropolitan
Asylums Board naturally received cases direct from the institutions of the poor-law
guardians. In a similar manner largely but not exclusively, through the intermediation
of the Board, arrangements were completed for dealing with cases of
tuberculosis both pulmonary and surgical, and later for sufferers from osteomyelitis,
polioencephalitis and encephalitis lethargica. Such cases were often admitted from
hospitals ; but, so far as they were passed through the school organisation, the
children were seen by the consultant medical officers in the public health department
of the Council and arrangements made for their re-examination so soon as notification
of their discharge from hospital had been received, to determine the most
suitable provision for their further education.
As a result of the consolidation of services brought about by the Local
Government Act, 1929, the Council now controls a wide range of hospitals and
institutions, so that the procedure for following up and interchange of records
has been simplified. Large numbers of children still naturally attend voluntary
hospitals for treatment; but, when residential care for long periods is required,
these hospitals usually apply to the Council for the transfer of the children, and
in all cases the facilities available are kept before the notice of the professional
and social service staffs. Cases may be admitted to the Council's special hospitals
direct from either voluntary or the Council's general hospitals, but more cases than
formerly are now seen by the Council's consultant officers attached to the school
service, thus ensuring a somewhat more continuous record of observation should
the children subsequently attend a day special school. It has been possible to arrange
that from certain of the special hospitals the children shall come to the County
Hall on their discharge, and at the same time be seen and have the necessary notes
made on the special school record card if they are proposed for such form of subsequent
education. In any case, a recommendation is made by the head of the
special hospital as to the type of schooling suggested, and in some cases a certifying
officer pays regular visits to the hospital to determine the most desirable schooling,
just before the discharge of the patient, and notes the findings on the special
school card.
On discharge those children who have been admitted to special hospitals from
voluntary hospitals are referred for after-care or supervision to their hospital of
origin. Those who have been at the Princess Mary's or the Heatherwood hospital
are seen at after-care clinics which are held by the superintendents of those hospitals
at the County Hall. On these occasions minor repairs or adjustments to appliances
can be carried out, or the necessary data noted by the mechanic if more is required.
If necessary, children return to the hospital for further treatment or adjustment
of appliances. In the case of the Queen Mary's hospital, Carshalton, children
whose appliances need repair or readjustment return perhaps only for the day,
perhaps for a few days, according to the amount of attention required. In these
after-care clinics there is a close liaison with the school service ; and, where the
clinic is held at the County Hall, the surgeon can consult at once with a certifying
officer if he has any suggestions to make as to the modification of the educational
provision. It is now quite usual for orthopaedic cases to commence their treatment
in the special hospitals before attaining school age, and to attend day special schools
for the first time on their discharge. In older days a child was often in attendance
at a day special school for some time before admission to a hospital, or was
attending school with a limb or back immobilised for long periods, visiting a hospital
out-patient department from time to time for supervision by the surgeon in charge
of his case. Such instances are now very rare, those children who need prolonged
immobilisation are got away to special hospitals where they obtain the advantages
of country air and surroundings with education, even though they be for a long