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It was decided to include in the three-year programme, 1935-38, additional provision
for full investigation at special investigation centres of under-nourished children referred
from the ordinary school medical inspections and to have five centres, one in each
medical administrative division. The divisional medical officers each nominated, from
the staff engaged in their divisions, an assistant medical officer (part-time), specially
qualified in this work. To each centre, an experienced nurse was allotted and a specially
selected organiser with experience in social economics. Careful investigation was made
of the family budgets and dietaries, and advice on the latter was given to the parents.
The Organiser at the centre was in touch with the School Care Committee, who in
turn kept in touch with the children both at home and in school, and reported to the
Organiser for the doctor's information. When a period of observation in hospital was
desired, this was arranged at the Council's special hospitals for children. The clinics
started in 1935 and from the outset, children other than those suffering from malnutrition
were examined, the true function of the clinics being that of further inspection
and advice.
The control of infectious and parasitic diseases
Before 1891 (when the passing of the Public Health (London) Act made it compulsory
for the Medical Officer of Health to send a copy of the notification relative to certain
infectious diseases to the teacher of any school attended by children from infected houses)
there was no attempt to prevent the spread of infectious disease by precautionary
measures at school. In those days the schools were regarded as hotbeds for the dissemination
of infectious disease, and the only remedy the health authority could think of was
to close them during epidemics. However, as a report to the School Board for London
in 1900 pointed out: 'The closing of schools, besides leading to grievous educational
waste, is an admittedly ineffectual system of dealing with the spread of infection. The
children, healthy and infectious alike, are only driven out of school to associate freely
together in the streets.'
The Annual Report of the Medical Officer of the School Board for London for the
year ended 25th March, 1904, stated that, when the Head Teacher received the copy of
the notification of infectious disease from the Medical Officer of Health, 'all affected
children (whether suffering or coming from the home in which the disease exists) are
excluded from school'. If a child showed symptoms of measles, mumps, whooping
cough or chicken-pox (which were non-notifiable diseases) he was excluded.
The experience of the school medical service in London has been that the control of
infectious diseases occurring among school children' is best secured by a system of
immediate exclusion from school of individual scholars, who are themselves suffering
or suspected to be suffering from illness of an infectious or contagious character, and
the prompt notification by head teachers of such exclusion to the Divisional Medical
Officer and the Borough Medical Officer of Health concerned. Generally speaking,
routine disinfection of schools is considered to be valueless. Constant touch is kept with
the medical departments of the Borough Councils to ensure that children who have been
excluded do not spread infection by mixing with others. When the number of cases of
infectious disease reported from a particular school indicates a high prevalence, special
visits are made by a school nursing sister, and, if necessary, by a school doctor. This
system of notification by the head, and careful observation of the pupils in the school,
has been the practice for many years, and is an important contribution towards the
control of the spread of infectious disease.
At the time when the powers of the London School Board were transferred to the
Council, measles and whooping cough were often fatal diseases to very young children.
In his Annual Report for the year 1908, Dr. Kerr reported that the measles enquiry
which he had proposed to the School Board had been conducted in the district of
Woolwich by Dr. C.J. Thomas in co-operation with Dr. Davies, the Borough Medical
Officer of Health. The enquiry gave much valuable information in regard to the
distribution and methods of treating measles outbreaks in schools, resulted in a great
Nutrition
centres
General
Measles
172