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defects. In addition, 481 children were found at school medical
inspection to require observation or treatment for defects of
nose and throat, which often prove to be predisposing causes of
subsequent ear disease.
It is considered by the Ministry of Health and the Board
of Education that the adequate examination and treatment
of these cases require the services of an ear, nose and throat
specialist, that the Local Authority should have a certain
number of beds reserved in a hospital where operative treatment
can be carried out, and that the services of an aural
specialist should be available in connection with the Hospital
for Infectious Diseases.
The nucleus of any scheme for the successful treatment of
ear diseases must be an Aural Clinic in charge of a specialist.
To such a clinic children would be referred from the Council's
Maternity and Child Welfare and School Clinics. Obviously
it is advantageous if the Aural Surgeon of the special clinic
is also the surgeon in charge of the hospital beds to which the
cases referred from the clinic are admitted, and that he should
combine this office with that of Consultant Aural Surgeon to
the fever hospital.
Co-ordination of Duties.
In February, 1935, I submitted a special report drawing
attention to the difficulty, delay and duplication of effort
caused by the Council's health services being controlled by
three differently constituted Committees whose respective
and independently appointed staffs are engaged in dealing
with the same child and the same problem in different ways at
different age periods. In that report I pointed out that, with
the ever increasing scope and activities of the health services,
it is becoming increasingly difficult for any one of these Committees
dealing with the work of the health department to
take any action which does not concern the other two, the
result being delay and confusion occasioned by the increasing
necessity of referring matters from one Committee to another.
The following observations of Sir George Newman (Chief
Medical Officer of the Ministry of Health and Board of Education)
illustrate the difficulty of trying to deal with the health
of children in watertight groups.