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which he advocates would make the work merely an extension of that at a medical
inspection with the advantages of ample time for the examination and for the
discussion of problems with parents, and of conveniences which do not exist in all
schools. This, he admits, weakens the case for ad hoc clinics. He points out that
the facilities for treatment are available equally to the doctor in the centre and the
doctor in the school, that in the school there is the definite advantage of personal
contact with teachers and with care committee secretaries, and that geographical
considerations limit the scope of the centres unless their number is multiplied
considerably.
Dr. Batten in dealing with this question says : " It is quite possible that this
work could be as well or better done at special sessions in the schools, but there is
no doubt in my mind that it cannot be done adequately in the course of routine
medical inspections."
Extracts from the reports may well conclude with one from that of Miss Owen,
divisional treatment organiser (south-eastern division) which will reflect the opinion
of the social workers as distinct from that of the medical officers :—
One, if not the most important, factor in the work being done is in the education of the
parents. This is found to be possible as not more than 5 to 8 children are seen each session, and
by this means adequate time can be given to each child. There is no doubt that the absence of
hurry has reacted very favourably on the parents and in many cases where it was thought that
the parent had appeared to be on the defensive on arrival, he or she always left with no trace of
such an attitude and only with the apparent intention of carrying out the advice received, of
doing his or her share in making the necessary adjustments in the home life.
It might be argued that all the recommendations made come within the scope of the
existing scheme of school medical services, but the fact remains that they had not already been
made, and in spite of the existing scheme the condition of these 46 children was found to be such
that the school doctors considered they required further supervision.
It is obvious, also, that there is not sufficient time at a routine medical inspection for the
examining doctor to deal with each (subnormal) child in sufficient detail and it would seem
therefore necessary to have some other place where such detailed examination can be made in
these cases who, in spite of existing services, are still sub-standard physically. The nutrition
centre has in my opinion fulfilled this function and in doing so is most valuable, and I feel
strongly that it should be continued. In saying this I feel sure that those care committees who
have had contact with the centre would agree.
Following-up.
The returns of the school doctors who re-inspect children found at the routine
inspections in elementary schools to be ailing and in need of treatment make it possible
to compile a statistical record of following-up. During 1935, 158,686 children were
re-inspected, an increase of 12,066 on the number for 1934. At the first re-inspection
102,883 cases of defects requiring treatment (some children having more than one
defect) were reviewed. At the second re-inspection 47,975 cases not cleared up at
a first re-inspection were again reviewed. By combining the results of both reinspections
it is found that 82 • 3 per cent. of the children re-inspected were treated
or discharged as no longer requiring treatment. This figure is a great improvement
over that of the previous year when only 75.1 per cent. were found by the time the
second inspection was reached to have been satisfactorily dealt with. The result
in 1935 is the best ever attained in London.
It is the dental cases, which contribute more than one half of the cases to be
followed-up, that cause the most difficulty and give the worst results. If these
be eliminated the cases of defect satisfactorily dealt with, at the time of the second
re-inspection, reached the proportion of 85 .5 per cent.
The relatively poor result in 1934 was almost entirely due to failure to obtain
dental treatment. The better results in this respect in 1935 correspond with the
better condition of the teeth found at inspections, and reinforce the impression of
redoubled efforts on the part of social workers in response to the statements contained
in my recent reports.