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8785dffa-4214-47a5-96a6-a9d54fc54f4e | Already under Treatment. Treatment obtained Treatment not obtained Left or removed. Heart— Anæmia 4 — — 1 3 — Congenital 4 3 1 — — — Other organic 27 12 8 4 1 2 Functional !4 13 — — — 1 Lungs— Bronchitis 14 14 — — — — Suspected phthisis 26 18 5 — — 3 Phthisis 12 2 9 — — 1 Other disease 4 2 2 — — — tubercle (other than lungs) 3 — 3 — — — deformities— Rickets 4 4 — — — — 32 Table 7.—-continued. No. of Cases. Observations only. Already under Treatment. Treatment obtained. Treatment not obtained Left or removed. |
96745b27-717a-4bc3-9886-d98bbb84b5b0 | Lateral curvature 10 — — 10 — — Congenital dislocation of hip 3 — 3 — — — Other deformities 5 3 1 1 — — Nose, Throat, & Ear— - Tonsils 122 — — 17 99 6 Adenoids 79 — — 22 49 8 Otorrhœa 26 — 2 12 11 1 Deafness 11 4 3 1 3 — Nasal obstruction 5 — — 3 2 — Nervous Disease— Epilepsy 6 1 4 1 — — Chorea 3 — 1 1 1 — Infantile paralysis 2 1 — 1 — — Other disease 2 2 — — — — Mentally Deficient 14 12 2 — — — Deaf & Dumb 2 1 — 1 — — Defective Speech 3 1 — 2 — — Malnutrition 11 8 |
9edf91bc-1eb9-482d-8257-b337a50859ee | 1 2 — — Ringworm 77 — — 77 — — Defective Eyesight 155 — — 99 Oculist 17 Elsewhere 22 '7 Unclassified disease 4 — — 1 2 1 33 Eye Disease and Vision. During the year under review an attempt was made to follow up all children who had been referred to the School Oculist, Dr. Grace Banham, for eye disease or vision, since her appointment in September, 1910. It was found that 36 had removed to other areas and 149 had left school, making 185 who could not be traced. |
1dc0961b-2c0a-4ed7-84d2-f8d2eba80647 | 371 cases were still in the Acton Schools, grouped as follows:— Cases under treatment or awaiting treatment 65 Cases other than those requiring glasses 80 Cases for which glasses were prescribed 226 Total 371 Of the cases which should have been wearing glasses : 168 were wearing them; 17 were not, but obtained them on request; 41 were not wearing them; that is, 18 per cent. failed to wear the glasses needed. This failure to wear glasses prescribed is due to several reasons. Often the glasses are broken, and it is not thought worth while to mend them. At other times the child is not at first accustomed to wearing them, and will not persevere till the slight initial discomfort has worn off Sometimes the eyes have changed, or the frames have become too small, and the glasses need re-adjusting. |
7fadef82-f5b4-4534-85de-542b426955bf | To prevent this as far as possible, all children who have been noted as having defective vision or eye disease are seen after each routine inspection at the school with the other referred cases, as described in the section " following up." If necessary, they are referred again to the School Oculist, and fresh glasses are prescribed w here needed. In addition to this, a special register was compiled of cases which require special observation at frequent intervals, that is, cases of myopia and strabismus. 34 The following is an analysis of such cases at present in the Acton Schools :— Myopia. A. Excluded as unfit for an ordinary school (—20D) 1 B. High myopia (over —4.50 D)—In school with special instructions as regards near work, etc. 10 C. Low myopia—No special instructions 21 32 Group B are seen at frequent and regular intervals. At present in 8 cases the myopia is stationary, and in two increasing slightly. |
91011a70-cf0f-4531-9a75-dfde1560da59 | The Strabismus cases are as follows : — Internal strabismus 46 External ,, 3 Alternating concomitant 14 63 The revisits of the strabismus cases show very clearly the immense importance of early treatment and the provision of correcting glasses. In children of 7 and 8 the results of treatment are disappointing. The squint may sometimes disappear, but the sight does not return, and the child for all practical purposes has only one eye. Even at 5, the earliest age at which the Medical Officer can observe the defect, the sight is often much affected, though with perseverance in treatment an excellent result can still be obtained. Unfortunately, parents are very slow to believe that a squint is any drawback, and often do not understand that it is only a symptom of defective vision. Often they are convinced that at the mystic age of 7 the child "will grow out of it," and so the opportunity to preserve the sight is lost. |
234a54da-56f4-4537-822e-7a7059bf4f2f | On the other hand, the School Medical Officer now sees some children under school age at the Mothers' Welcome, and here some squints have been noticed, and the mothers persuaded to get treatment for children under 5 with excellent results. As a typical example of the good effect of early treatment, the 35 case of E. W. might be quoted. At 5 E. W. had vision only one-seventh of normal in the squinting eye, with the prospect of losing even that. She was provided with glasses. At her next visit she had no squint, and the sight had improved to threesevenths of normal. The glasses were altered to suit. At her third visit she had normal vision with glasses. |
a7cf04b2-a63c-429a-8bf7-51387e7db200 | There is some irony in the fact that when two months later the parents' attention was drawn to the fact that the child's glasses were broken, and that it was important they should be mended, the father replied that " the glasses were rubbish, and had never done any good." Fortunately, the facts were too strong for him ; he was convinced, and had the glasses mended. The revisits of special cases, while exceedingly necessary for efficient work, naturally absorb a large part of the time of the School Oculist, while the number of new cases continues as before. Therefore, in accordance with the resolution of the Education Committee, the School Oculist now attends once a week during the school year, instead of, as before, only 25 times. The cases to be seen by the School Oculist are selected by the School Medical Officer. They are either:— (1) Cases from routine medical inspection. (2) Special cases referred chiefly by head teachers. |
3d266446-2fd7-43ec-8d0c-b8d1e0abdfaa | (3) Transfers from outside districts. The head teachers are exceedingly vigilant in detecting signs of eye-strain, and a large proportion of the cases are sent up by them. All cases with vision 6/18, or any with better vision, if they show symptoms of any kind, are seen by the School Medical Officer and referred to the School Oculist, if the parents are unable to provide treatment. If examination under atropine is required, the parents' consent is given in writing, and the ointment is applied in school by the nurse. After the School Oculist's prescription for glasses has been given, the glasses are carefully tested again by the School Medical 36 Officer, and are then sent down to the school, accompanied by a note to the head teacher, asking him or her to see that they are worn regularly. At the same time, any special directions are given about the case. The parents pay from 3s. to 4s. |
2b8a2422-add5-477b-9eb6-e69f34b0e320 | 6d., according to the cost of the glasses which are provided. In necessitous cases they are given free. As already mentioned, these children then come up for review at each routine visit of the School Medical Officer. If the children move into another neighbourhood, the defect card is copied and sent with the Medical Inspection card to the new education authority. |
b0b16540-be37-47b5-9532-b48a596ee413 | For the past year the statistics are as follows:— Number of children examined (including observation cases) 270 Number of visits paid 556 Prescriptions granted 126 Glasses obtained 125 Detailed Account of Cases :— Refractions performed 118 Hypermetropic astigmatism 72 Hypermetropia 3 Alternating concomitant strabismus 7 Right internal strabismus 10 Left internal strabismus 21 Myopia 5 Myopic astigmatism 23 Nystagmus 1 Phlyctenular conjunctivitis 3 Corneal ulcers 6 Anterior polar cataract 1 Blepharitis 5 Conjunctivitis 3 37 Ringworm. |
f1fa50c8-a4c9-42e6-b835-f9c7ebe7386b | The statistics for the year are as follows:— Old cases 4 New cases during year 73 Total 77 Returned to school cured 50 Still under treatment 27 Treated by X Rays through Education Authority 34 Treated by X Rays elsewhere 6 Total 40 That is, 80 per cent. of the casts returned to school had X Ray treatment. Unfortunately, in many cases the parents only agree to X Ray treatment after a long period of exclusion from school. If X Rays were applied early the length of absence would be much less, and the loss of grant much reduced. In 25 cases treated in the last year, the total absence was 1,218 days, average per child 49 days. Absence from date of X Ray application 661, or 26 days per child. This difference would be still more striking if cases which have dragged on from former years were included. For example:— Case 1. Excluded 2½ years under constant treatment and observation. |
717d608d-940d-4324-80b2-97194cd8055d | X Rays on July 9th, 1913. Returned to school September 1st, 1913. Case 2. Excluded 11/3 years. X Rays September 9th, 1913. Returned November 3rd, 1913 There has been one case in which the hair is still thin over part of the area treated The condition is somewhat peculiar and unlike the usual type of X Ray baldness. It is probably due in part to a co-existing skin affection of the scalp. It will be noticed that there is an increase in the number of cases occurring during the year. The control of ringworm in the schools is complicated by two factors:— 38 1. The shifting nature of the school population. This is very marked in some schools, and as a result children suffering from ringworm come in from other districts, and may infect others before the condition is discovered. 2. Infection in children under school age. |
c7b5d325-0a00-4528-b2db-4f6d9d02665d | The tion Authority have no power to provide treatment for these cases, even if they are aware of them. In the meanwhile the children may act as centres of infection to children of school age, and some cases of re-infection after cure have been traced to such an untreated child at home. All cases sent to Dr. Arthur are selected by the School Medical Officer. The parents are interviewed, the nature of the treatment explained, and the slight risk of difficulty with the growth of the hair afterwards explained. If they agree their consent is obtained in writing, and an appointment made with the radiographer. Before returning to school each case is seen again by the School Medical Officer. It is the custom in Acton to let the child return to school as soon as the infected hair has fallen out. The child wears a cap or bonnet till the new hair has grown. Cases which do not receive X Ray treatment are visited regularly by the nurse, to see that treatment is being obtained. |
7e8979ab-d490-4fda-85d7-96048195b424 | Microscopic examinations are made of all doubtful cases. 14 such examinations were made, and spores were found in 12. Cases of ringworm of the body are treated by a nurse under the supervision of the School Medical Officer, if they are not attending a doctor. Children Under Five. A reference to the table of defects found at the medical inspection of entrants shows that before they come under the notice of the Education Authority they have already developed many diseases and defects. 39 3 per cent. have chronic diseases of the external eye, 3 per cent. have ear disease, 52 per cent. have decayed teeth, 16 per centenlarged tonsils, 6 per cent. adenoids, 4 per cent. rickets, and so on. Most of these defects, especially ear and eye trouble, are easy to remedy at their beginning, but if neglected they are exceedingly difficult to treat efficiently, and result in a large amount of unnecessary suffering and disability. |
d0da80b6-5ac0-43f0-b246-9d883f66103c | By the time these children reach school age, these conditions are already chronic, and the Education Authority is at considerable trouble and expense to remedy them. In the report of the Medical Officer of Health, an account will be found of the work done among children under one year. An attempt is now being made to bridge the gulf between one and five, and if possible prevent some of this unnecessary and wasteful suffering. This has been done in two ways. In the first place, the Committee of the Creche kindly considered a suggestion from the Medical Officers, and raised the age limit from four to five. It is now possible for a child to remain under trained supervision at the creche till he enters school, whereas before there was a year in which he was obliged to go to a "baby minder," or be left in charge of an older child. |
e29e8e0e-9b20-4f32-8fe1-d48c7c1a9a04 | Secondly, the mothers who attend the Babies' Welcome are urged to continue attendance at regular intervals till the child reaches school age, and they are invited to bring any other children they have, not yet attending school. These children are weighed regularly, and one of the Medical Officers present at the Welcome is able to give advice on health matters. This Babies' Welcome has only been working a year, and the last development a little under three months, but already 34 children between 1 and 5 are under supervision. Of course, only the mothers who are careful and anxious about their children will take the trouble to bring their little ones to the Welcome, but on the other hand, these are the very mothers who will carry out medical advice, and so prevent the development of chronic conditions. Already several mothers have obtained needed treatment in consequence of the advice given, e.g., early squints have been taken to hospital and had glasses fitted, slight cases of rickets have had special diet, and so on. 40 Cleanliness. |
124ed161-6be5-4230-8d58-da287c88a665 | A list of children found to have vermin or nits is handed to the nurse after each medical inspection, and the figures appear on her report. She visits these cases until she is satisfied with their condition. Now that a second nurse has been appointed, a routine inspection of heads is made in each school once a fortnight, and the cases are followed up at home. Here, again, many cases relapse as soon as the nurse's visits cease. Severe cases are excluded, and if they are not clean within a reasonable time, the case is taken into court. There has been a steady rise in the level of personal cleanliness since medical inspection was started, and—apart from statistics—this is shown in an unexpected way. |
4f301db5-697f-47ba-a35a-bb39ca189ed1 | The original cards which were printed for sending to the parents of verminous cases are found to be far too drastic for most of the cases occurring now, and as a result a second card has been printed, to be given to children who need some attention which does not involve exclusion from school. The condition of the children's heads depends to a large extent on the state of public opinion among the parents, and their attitude towards the subject of personal cleanliness. In some schools nits are not considered any disgrace, and the fact that "they are all dead" is considered a sufficient excuse for their presence. Some parents show very clearly that they consider the Medical Officers are demanding the impossible, and are altogether over-particular in commenting at all if nothing worse than nits is to be found. In other schools the most mildly worded notice is regarded as a deep disgrace, and messages of apology for the unfortunate discovery are sent at once. |
839cc304-c5bb-4c5e-8cd2-1661461edbe9 | It is not fair that careful mothers should have their children in contact with verminous or unclean companions, and a steady effort is maintained to raise the level of personal cleanliness throughout the schools. Sending notices which are not followed up is useless, and tends to make the parent think that they may be neglected with impunity. At first only the bad cases could be dealt with, but the improvement has continued, and now it is possible to follow up any case in which nits are present. 41 In one infant department an attempt was made to get complete freedom from nits, and a notice was sent out for every child affected—about 20 out of 400. Within three days all the heads were clean. This standard should be reached in every school, and it is necessary to educate the parents to believe that it is attainable, and that anything short of it is a disgrace. The success of the teachers in enforcing cleanliness depends on the attitude of the parents at home. Prosecutions. |
182e9345-63cd-4050-9b18-f7fbaf0b4a9a | (a) Under the Attendance Bye-laws. In four cases prosecutions were instituted against parents who had, after repeated warnings, failed to present their children in a sufficiently clean condition to attend school. In each case directions as to the treatment had been given, and repeated visits were paid by the school nurse before proceedings were taken. Convictions were obtained in all four cases, two cases being fined 5s., and two 10s. each. (b) Under section 12 (1) of the Children's Act, 1908. One case was dealt with under this Act. The particulars were as follows:— L. P., aged 7, was found in May, 1911, to be suffering from an alternating concomitant strabismus and mixed astigatism, and a notice was sent to the parent that the child's eyes required treatment. He refused to allow the oculist to proceed with the case. In November, 1911, a second notice was sent. |
0f3e2058-c3e4-48f7-968d-72965407d810 | The child was in four different schools under the Acton Authority, and in each one she was promptly referred to the Medical Officer by the Headmistress, because she complained of "seeing double." Frequent attempts were made to see the father to explain the necessity of his obtaining treatment, or of allowing treatment to be given by the School Oculist, but in vain. In June, 1912, the 42 Secretary wrote a letter pointing out the parent's liability under the Children's Act, 1908. In March, 1913, a final registered letter was sent, announcing that proceedings would be taken, and in May, 1913, the case was taken into Court. The father was fined 10s., and finally glasses were obtained for the child from Moorfields Hospital. The value of a personal interview, to which reference has been made before, was shown very clearly by the sequel to this case. Not long after a notice was served for a second child, who suffered from high myopia. |
06756800-ae37-45b3-9418-3c5fa43fd008 | The father came down to the offices to sign a consent for treatment, saying he could not afford another fine or journey to Moorfields Hospital. For the first time it was possible to explain the necessity for treatment, what the treatment really was, and what the effect on the child's future would be, if the condition was neglected. As soon as this had been done he signed readily, explaining that he thought the Medical Officer meant " to take the eyes out, tamper with them, and put them back," and that if he had understood at first he would not have raised any objections. Otorrhœa. Treatment in these cases has been unsatisfactory. 55 per cent. had treatment, but treatment in these chronic cases is not synonymous with cure, and frequently when the stimulus of the nurses' visits is withdrawn, there is a speedy relapse. This is a difficulty which we find with other chronic and disfiguring but neglected diseases, such as blepharitis and skin disease. |
8e1475b1-32e8-4c05-9700-a7764942f8f9 | Now that a second nurse has been appointed, it will be possible to arrange for children with ear discharge to come up daily for syringing. Apart from the unpleasantness of a neglected discharging ear, it may at any time lead to an acute and dangerous condition, which needs instant operation. Tonsils and Adenoids. This heading shows a large percentage of untreated cases. This is partly due to difficulty in obtaining treatment, but also 43 largely to a reluctance to have "cutting operations." Parents are not ready to believe that deafness, a vacant look, and general backwardness are due to enlarged tonsils and adenoids, and expect the child to " grow out of it." At the end of last year the Committee appointed a Surgeon and Anaesthetist to operate in cases selected by the School Medical Officers. The operating rooms will shortly be ready for use, and it is to be hoped that when we can offer treatment the percentage of neglected cases will diminish. |
dd1e897c-a3e7-423a-aa19-41f18bc7a5f7 | There is no argument for treatment so impressive as a successful case, and parents who can make their own arrangements are likely to be convinced of the value of early operation when they see the improvement in their neighbours' children. Teeth. There is no reference in the Table to the treatment of teeth. The enormous amount of decay present can be seen in the Table of Defects found at medical inspection, but, speaking generally, there has been no treatment up to the present. What little there was, was confined to the extraction of septic teeth, and there was no attempt at conservative treatment. The Table of Defects found at the medical inspection of school children shows the extent of dental caries in the district, though such records refer only to obvious dental disease, and take little or no account of the earlier indications of decay which reveal themselves only to the dental probe and mirror. It is usually found that the percentage of dental caries appears highest in those districts where a dentist conducts the examination. |
d6b3c11b-b440-4f22-9ecb-980eba6b9573 | As a result of the medical inspection of over 10,000 children, it was found that 86 per cent. of the children had obvious dental caries. In Cambridge, where the teeth were examined by a dentist, 96 per cent. had dental caries. 44 Speaking generally, not more than a few children out of every hundred will be found who fail to bear evidence of present or past dental disease. Among the infants examined in the Acton School in 1912, there were none without some caries, and 37 per cent. had four or more decayed teeth. Moreover, the prevalence of dental caries is as great among the children of parents more fa\oured as regards their social position in life as among the children of the poor. Of even greater moment is the fact that probably the majority of school children suffer more or less serious disability in some form or other, sooner or later, from dental decay. |
6b1a5207-d7f7-440e-b20f-d4cbc11da28b | Although the facts are now known, the effects of dental disease are but imperfectly recognised, because the effects on the health of the child and the adult are mostly of indirect character. It is probably true to say that there is no single ailment of school children which is responsible, directly or indirectly, for a larger proportion of the delicacy and disease which is found at every turn to handicap efficiency, both physical and mental. It is only of recent years that the influence of the teeth upon the general health has been realised. Decayed teeth entail diminished mastication, and diminished mastication brings about indigestion and impaired nutrition. But the decreased biting power reacts upon the jaws and face bones, which, owing to the fact that they onlywork half-time, fail to develop to their full size. The nasal air passages share in the mal-development of the jaws, and contract. |
ec1c890e-ccea-4e6b-b576-a09593586c40 | The lining membrane of the nose and nasal cavities becomes unhealthy, from time to time inflamed and blocked up, mouth breathing becomes habitual, reacting upon the nasal condition, so that the congestion or state of inflammation passes on to the formation of adenoid tissue. It is also held that a connection exists between diseased teeth and consumption. Some authorities claim that consumption can be, and is, contracted through diseased teeth. Apart from any unproved effects, it is undoubtedly true that the mouth is responsible for a multitude of sins so far as disease 45 is concerned. Dyspepsia, anæmia, headache, neuralgia, enlarged tonsils, and adenoids are due in a measure—perhaps a considerable measure—to the diseased condition of the teeth. These effects are not operative only in children. It was stated that over 3,000 soldiers were invalided home from South Africa during the war on account of the disabling effects of decaying teeth alone. |
072a02fe-52dc-4ddf-b8c0-7ea62a8d8d95 | It may seem surprising in face of the extent of the evil and far-reaching effects which follow, that more attempts should not have been made to grapple with the problem. One reason why the question was not faced by many authorities has been its magnitude. It was felt to be impossible to deal with the whole question, and it was difficult to decide how much should be done and in what way it should be approached. The local education authorities that did pioneer work on the question have had to modify their plan of procedure, and the Board of Education warn authorities now giving consideration to this question to put on one side any idea of undertaking to grapple with the entire problem of dental disease. The most, and indeed the best, that can be done by such authorities is to make a beginning. Fortunately at the present time, we have the experience of many authorities, and some of the centres where dental treatment is carried out have been visited. |
1fe3702f-2099-425c-8f3d-01174e7394ae | These centres were chosen as representative of widely varying conditions and administration, but while they differed among each other in detail, the most marked feature was the consensus of opinion as to the main method of attacking the problem. This uniformity had only been reached after experiments on differing lines, a fact which increases the importance of the final result. Before dealing with what is done by different authorities, it may be as well if we give, shortly, what are accepted as the causes of dental caries. The total mass of dental disease can be differentiated, so to speak, into its constituent parts, and the reason why the problem is approached in a certain way, may appear evident. 46 Causation of Dental Caries. The causation of dental caries is understood more thoroughly than that of the causation of any other disease in the body, and it is necessary to keep three facts relative to the disease in due proportion. |
dad41d3b-f5ba-4d02-b6ce-13890d876bc0 | Only so will it become clear to the Committee precisely in what direction, and to what extent, they are able to undertake effective measures to combat the disease. Firstly, by far the most important factor in the production of dental caries in children is unsuitability in the character of the diet provided from infancy onwards. The immediate cause of the disease is the accumulation about and between the teeth of fermentable carbohydrate material. These collections are due to (a) shape of the jaw and teeth, (b) presence of an unsatisfactory form of carbohydrate, (c) absence of some cleansing form of food, such as fresh fruit partaken of at the same time as the meal or subsequently or both. In the white races of Europe the jaws are undergoing a slow process of shortening. This change in the jaws reduces the jaws in size, crowds them together, and thus makes them more liable to disease. |
1751208f-85f1-4705-8192-1621183c8a99 | The change is undoubtedly due to the altered character of the food, and one of the factors in the etiology of caries is the pappy nature of the food which very young children are compelled to subsist upon. This kind of food does not compel the child to exercise the muscles of his face, and the shape of his teeth and mouth becomes irregular. In addition, another unsatisfactory form of food in the shape of sweets lodges in the irregularly shaped teeth. It is difficult to prevent children after they reach school age from wasting their money on sweets if they have been brought up on pap, for pap-feeding causes a pathological craving for sweets. It is said that children who have been properly brought up do not naturally like sweet things ; rather have they a liking for fish, flesh, fruit, and fat. |
3f62fe6f-a3b8-410b-98ba-eac774d3bd7a | Although hereditary conditions may in some instances predispose, in the main, hereditary influences are not the causes of dental disease, and if we get rid of harmful habits, it is claimed that we can get the teeth back to as good a condition as 100 years ago. 47 Secondly, the next line of defence is the maintenance of cleanliness of the teeth and mouth, obtained by training in the use of the tooth brush. What is called tooth-brush drill has been instituted in many schools, and it is claimed that in such schools dental caries is less prevalent. Unless care is exercised, the use of the tooth brush by children may do almost as much harm as good. There can be no doubt that much depends upon the manner in which the teeth are brushed. The fact is frequently overlooked that dental caries, in the large majority of instances, commences in the crown of the tooth, in the part, that is to say, not infrequently left untouched by the brush. |
68a482f9-fde3-4cd8-9521-1150e5bb2b1a | The molars at the back of the mouth which undergo decay, in the first instance, remain untouched. Apart from its effect upon the cleanliness of the mouth, the institution of a tooth-brush drill in the school would facilitate the work of the dentist. There is a necessity for a preliminary and persistent working up of the districts in which a clinic is placed, and there will always be a residuum of recalcitrant parents who decline to allow their children's teeth to be treated. Thirdly, every effort should be made to arrest dental disease at the very outset, and this aspect of the question is the one which more particularly bears upon the action of the Committee. |
a38e9004-3825-45cb-939b-d2d74780b4ed | The treatment by conservative methods of all existing disease in children, both younger and older, may rightly be regarded an impossible task, and, at present, at least, outside the range of practical politics; but treatment of dental decay at its earliest manifestations in the newly erupted teeth of the permanent set, i.e., between 6 and 8 years of age, has been shown to be quite feasible, and to be productive of results fully commensurate with the expenditure incurred. In no disease is it more imperative to view the actual treatment from the point of view of prevention. We doubt if the Board of Education will sanction any scheme in which the treatment is not based on preventive lines. Treatment must begin from the first moment disease shows itself, and, indeed, 48 before it shows itself. The recognition of this fact is of the utmost importance to the Committee when it comes to consider what practical measures of a direct kind it should adopt in order to remedy the state of affairs revealed by medical inspection. |
49bda7dc-fc05-4900-8a01-68baa074c05d | It suggests at once certain lines of action which are both practical and practicable. Inspection and Treatment. 1. The inspection as well as the treatment should be done by a dentist. It is important that the earliest signs of disease should be detected. Inasmuch as a very large number of children will have to be dealt with, it must be realised at the outset that the principle to be carried out is the greatest good to the greatest number, by which it is meant that an undue time must not be spent upon individual cases, as, for example, in carrying out elaborate root treatment extending over several visits. The early signs can only be detected by a dentist with the aid of the probe and mirror. It is quite possible to fill a tooth directly it becomes carious without causing the slightest pain to the child. The success which will attend any effort towards improving the teeth depends directly upon how near one can get to this painless treatment. 2. |
cdf9fde8-9678-4407-aa26-28e898ff1c18 | Inspection should not be delayed later than during the sixth year, and attention should be concentrated, in particular, upon the permanent set of teeth immediately upon their eruption. Whilst under an ideal system every school child should have its teeth regularly attended to, it is evident in large centres of population that the treatment must at first be limited to a comparatively small number, and for this reason some age limit must be imposed. The key to the situation is the preservation of the first permanent or so-called six-year molars. It is a most natural thing to say that the six-year molar appears at six years of age and probably becomes carious by the seventh year, therefore all that has to be done is to treat the seven-year children to save 49 these teeth. So great is the variation that it is not unusual with seven-year children to examine one with two molars so carious as to be beyond any means of conservative treatment, whilst the next may only have the points of one or two of these teeth just appearing through the gums. |
8b899a8b-1dc6-40ca-8e5b-06d80d076fc6 | The experience of most authorities who have established dental clinics points to the ages 6-8 years as the most suitable period for examination and treatment. 3. Each child found defective and in whom the defect has been remedied should be periodically supervised, and further treatment given if required in order to obviate the possibility of the disease becoming at any time extensive in character. The reinspection should take place at intervals of not less than a year. Although in time all children over 6 years of age would have to be treated, the amount of dental disease becomes appreciably less in after years if treatment has been carried out and continued in children over 6 years of age. For instance, the following figures represent the experience obtained in Cambridge. After filling every permanent tooth which shows the earliest trace of caries for children aged 6 years, the average number of carious teeth per child a year later is 1.5; 83 per cent. |
218777a2-89f7-4a2a-9c46-919ec01edcd8 | of the children develop fresh caries in their permanent teeth between the ages of 6 and 7 years, and 74 per cent. between 7 and 8 years. This great increase appears only in the period of the eruption of the first permanent molars, with a sufficient margin to allow all the four teeth to reach their final position in the jaw, one in contact with the other. Immediately afterwards the percentage of children with fresh caries drops to 45 per cent. for the year, and one would not expect any percentage above 40 in after years, except perhaps from 11 to 13, about which time the second molars appear. Applying these general principles to the problem before the Committee, we find that in January, 1913, the number of children in the schools between the ages of 6 and 8 was:— Boys 1,118 Girls 988 Total 2,106 so that this figure represents the school population to be dealt with. |
1a8753aa-0724-4db4-86d3-45012c688e38 | 50 It Is obvious that so large a number of children cannot be treated at once, and the experience of other authorities has led us to make a small start, and allow the work to develop gradually and naturally. This avoids any possibility of money being spent without a proportionate return, and is elastic enough to permit any necessary modification as the scheme develops. It was considered advisable to limit the treatment at first to three selected schools, for it is important to remember that at first parents may show some hostility to the treatment. They do not realise its importance, and this is more marked in the poorer districts. To a certain extent this can be overcome by special talks to parents about teeth by the Medical Officer or Dentist, and by demonstration of the difference between children with healthy mouths who have been treated and those who have not, but the most convincing argument is the smooth working of the dental centre, the fact that it is generally accepted as a matter of course, and that treatment is not necessarily painful. |
d7498426-3406-4c77-b5a3-c6df1afae198 | These considerations led us to recommend that to begin with the schools selected should be those where the parents have shown themselves ready to co-operate with the school medical service, as much depends on the attitude the parents adopt at the beginning of the scheme. In 1914 the scheme of treatment will, therefore, be extended to include teeth, and a Dentist has been appointed to attend at first one half-day a week. Arrangements have been made for him to inspect the teeth of children between 6 and 8 in three schools, the Priory, Central, and Southfield Road, and select those requiring treatment. He has already begun on this inspection. The treatment will be carried out in three rooms in the Council Offices. One of these is being fitted up as a treatment room for teeth, tonsils, and adenoids, one as a recovery room, and one as a waiting room. |
c5aef3d2-5163-4af3-9ea7-d425f2e69357 | 51 When we consider the effect of decaying teeth on health and nutrition, we realise the importance of such a step in improving the condition of the scholars, and the advisability of gradually extending the system to include all the schools. Work of the School Nurse. With the development of the new scheme for dealing with teeth and tonsils and adenoids, it was evident that the work was beyond the powers of one Nurse. The second Nurse appointed by the Committee took up her duties in January, 1914. In all their work the School Nurses are under the supervision of the Medical Officers. They carry out treatment in minor cases occurring in the schools for which they are responsible. In all cases of absence from school due to illness, they are notified by the Head Teacher on special cards. They visit at the homes, and report on the cases to the Medical Officers and the Education Department. They conduct systematic inspections of the schools, and follow up all cases of uncleanliness requiring attention. |
8d81b5f5-a685-4580-805d-3f9b7eb875a6 | They follow up cases referred from medical inspection, either to urge the importance of medical treatment, or to endeavour to obtain a higher standard of personal cleanliness, or to give advice on the treatment of chronic, but neglected eye or ear disease. Unfortunately many of these latter cases relapse when the nurses' visits cease. They also visit the schools to apply atropine ointment before refractions are done. The visiting in connection with the dental work and tonsils and adenoids is also done by them, and this often means several visits to one case before consent is obtained. 52 The following is a Table of the work done in 1913, before the appointment of the second Nurse:— Eye Treatment Cases. 463 visits were paid, and 79 children were treated. The distribution of these cases and the diseases treated were as follows:— No. of children treated. Defective sight. |
ee0e13cb-10e5-4c75-b28f-1bc59ea93587 | Acton Girls 1 1 Acton Infants 3 3 Beaumont Park Boys 2 2 Beaumont Park Girls 9 9 Beaumont Park Infants 3 3 Central Senior 1 1 Central Junior 5 5 East Acton 1 1 Priory Boys 1 1 Priory Girls 11 11 Priory Infants 3 3 Rothschild Infants 3 3 Southfield Road Infants 1 1 South Acton Senior Boys 2 2 South Acton Junior Boys 2 2 South Acton Girls 16 16 South Acton Infants 7 7 Acton Wells Mixed 2 2 Turnham Green R.C. 6 6 79 79 53 Visits Paid by School Nurse. Schools N.-East. N.-West. S.-East. S.-West. Total. |
07dba627-15cc-47b5-adb2-331bd784db4e | Acton 15 41 3 37 96 Acton Wells 130 4 — — 134 Beaumont Park — 1 54 47 102 Central 54 55 2 19 130 East Acton 25 — — — 25 Priory 97 80 42 140 359 Rothschild — — 60 101 161 South Acton — — 4 484 488 Southfield Road 51 1 97 — 149 Turnham Green R.C. — 3 11 l6 30 Lower Place (Willesden — 1 — — 1 No School — — — 1 1 372 186 273 845 1,676 Diseases. N.-East. N.-West. S.-East. S.-West. Total. Abscess 1 — — 1 2 Blepharitis 1 — — 5 6 Chicken Pox 19 12 5 12 48 Colds |
4c60344f-a043-4459-8c20-500ac2c253f9 | 13 8 5 10 36 Conjunctivitis and defective sight 9 13 14 78 114 Dermatitis — — — 1 1 Diphtheria — — 2 2 4 Diphtheria carrier — — — 2 2 Eczema 3 2 — 4 9 Herpes — — 1 — 1 Impetigo 21 15 15 68 119 Measles 104 29 74 109 316 Measles contact 11 11 11 31 64 Mumps 86 42 50 276 454 Otorrhœa 1 — 3 2 6 Psoriasis — — 1 4 5 Ringworm 27 13 30 51 121 Scabies 5 — 7 15 27 Seborrhœa — — — 1 1 Tonsilitis 26 10 10 22 68 Urticaria 2 — |
7c359345-1ed0-4991-ac81-f0da4c94c35e | 2 1 5 Verminous heads 12 10 20 41 83 Whooping cough 12 6 12 59 89 Miscellaneous 19 15 11 50 95 372 186 273 845 1,676 54 Provision of Meals. The Provision of Meals Act, 1906, is put in force in this district for those children who are under-nourished, and meals are provided through the holidays as well. Some dinners are provided at the Cookery Centres, but most are given at a Restaurant in Osborne Road, South Acton, at a cost of 2½d. |
bd8c2078-e75b-4e95-bdaa-d274a5ae512c | The figures are as follows:— Number of Meals at Restaurant 9,957 Number of Meals at Cookery Centres 1,327 11,284 Cost of Meals at Restaurant £103 14 4½ Cost of Meals at Cookery Centres 13 16 5½ £117 10 10 One of the great difficulties in providing satisfactory arrangements is the fluctuating number to be catered for. On some occasions the number dropped as low as 4, and others—as, for instance, during a strike—the number rose to 94. The Restaurant is not able to deal satisfactorily with such a number. The children have to go in in relays, the first-comers hurrying through their meal, while the later ones are obliged to wait outside till seats are vacant. If the weather is bad they are often wet and chilled before they can obtain a meal, and the conditions lead to noise and disorder. |
899d1334-effb-4199-850d-4fb8d257aa2c | The food itself is generally of good quality, but it is, of course, impossible in a public Restaurant to exercise any efficient control over the children, or to use the meal as a lesson in good manners and cleanliness. Many of the children rarely sit down to a properly laid meal, as the mothers who are at work have no time to prepare one in the middle of the day or to supervise the children. They come into the Restaurant with very dirty hands, hurry through their food in an unsuitable manner, and rush 55 out again. The Restaurant-keeper has complained several times of the difficulty of keeping order, and when the number of children is large an Attendance Officer is usually present, but this does not remedy the other drawbacks, and the service of the meal does not approach the standard of the Board of Education, which lays stress on the importance of the way in which the meal is served. Another difficulty is that many children are suffering from unsuitable food more than lack of food. |
82dc1512-5842-4ed1-90e9-1042e4bed334 | These children are often referred by the School Medical Officer for investigation, but inquiries show that they are not suffering from actual poverty, though their food is inadequate to nourish them. In some cases this is due to ignorance, but often it is because the mother has no time to prepare a midday dinner, and gives the child money to buy food. As a result, the midday meal may consist of pickles, biscuits, fried fish, or some equally unsuitable food, while this method of buying is disproportionately expensive. If it were possible for children to buy a cheap dinner from a feeding centre it would meet the difficulty of these under-nourished children, and at the same time reduce the great fluctuation in numbers which makes catering so difficult. Moreover, with such a system it would not be known which children were paying and which were receiving free dinners. At present the names of the children to receive meals are obtained from various sources:— 1. |
224aac62-7629-462a-b453-581ccf63cf19 | The School Medical Officers refer all cases coming under their notice at routine or special inspections. 2. The Teachers send up the names of children whom they consider to be in need of meals. 3. The parents apply for assistance. 4. The Attendance Officers report cases of poverty. 5. Various other sources—Charitable Organisations, Church Workers, etc., send in names. An investigation is made at once into the circumstances of the family, such as the total income, the outgoings for rent, and the number in the family, and on these facts the decision is made. 56 As a rule, when one or both parents are in regular work, meals are not granted, but no attempt is made to insist on a hard-and-fast rule, which may result in great hardship in individual cases. Each case is judged on its merits, and if there is a reasonable doubt, the child gets the benefit of it. |
abe1f683-2083-4492-9697-01f76cb51914 | Books of tickets are granted, available for a month at a time, and these are distributed daily by the Head Teachers, and given up at the Restaurant by the children. Table 8. Numerical Return of all Exceptional Children in the Area. Boys. Girls. . |
a3a2a9b6-0077-47eb-a80f-32f6d8fbc89f | Blind (including partially Blind)— Attending Public Elementary Schools — — — Attending Certified Schools for the Blind 2 1 3 Not at School — — — Deaf & Dumb (including partially Deaf)— Attending Public Elementary Schools 8 10 18 Attending Certified Schools for the Deaf 3 4 7 Not at School 1 1 2 Mentally Deficient— Feeble Minded— Attending Public Elementary Schools 16 6 22 Attending Certified Schools for Mentally Defective Children — 1 1 Not at School 1 1 2 Imbeciles— At School — — — Not at School — — — Idiots 1 — 1 Epileptics— Attending Public Elementary Schools 5 — 5 Attending Certified Schools for Epileptics — — — Not at School — 1 1 57 Table 8—continued. |
bad2350a-d0ed-42d9-80b6-41f60b2ea438 | Boys Girls Physically Defective— Pulmonary Tuberculosis— Attending Public Elementary Schools 2 1 3 Attending Certified Schools for Physically Defective Children — — — Not at School 3 6 9 Other forms of Tuberculosis— Attending Public Elementary Schools 1 2 3 Attending Certified Schools for Physically Defective Children — — — Not at School — — — Cripples other than Tubercular— Attending Public Elementary Schools 3 5 8 Attending Certified Schools for Physically Defective Children — — — Not at School 1 — 1 Blind Children. Three children are provided for in the Hants and Isle of Wight Home for the Blind, Southsea, and at present there are no others in the Acton area. Epileptic Children. if in school are kept under close and frequent supervision, and only those who do not have fits in the daytime are allowed to attend. The one excluded case is now just over school age. |
4d4ded75-e4fc-4ca0-a770-89e4c9dca108 | 58 Mentally Defective and Deaf Children. During the last year the London County Council have notified the Acton Education Committee that they are not prepared to admit any more outside children to their Special Schools for deaf or backward children. The consequence is that at present there are children in our schools who are quite incapable of benefiting by the ordinary class teaching, and the question of providing for them becomes a pressing one. The presence of an abnormal child in ordinary classes is bad in several ways. In a large class it is impossible to give him constant individual attention, the ordinary methods fail to arouse his interest, while the work is entirely beyond his capacity. As a result, he is entirely isolated, and either falls into an apathetic condition, or diverts his energies to mischief. In the latter case he acts as a storm centre to the class, displaying a. perverted ingenuity in naughtiness. |
6b6617b2-24ea-4392-8750-75255e1abf9e | If, on the other hand, the teacher devotes her attention largely to him, the whole class are retarded to his slow rate of advance, and become in their turn uninterested and restless. In either case, as he grows older and stronger, his strength is disproportionate to that of the 'other members of the class, and this often results in undesirable bullying of the smaller children. The presence of such a child in the class always means that the teacher's work is much heavier than usual and very disheartening. Besides the definitely mentally defective child, who needs a special syllabus, there is also the child who is backward. It is often not possible to say at first whether this backwardness is due to temporary causes, such as former ill-health, or to the very slow development of an otherwise normal mind, or whether the child is really mentally defective. Such a child needs much individual attention, and a modified syllabus. |
de545212-4758-4136-8c04-5408f153e21c | If left in a large class with a syllabus fitted to the needs of normal children his time is wasted, and any advantage from the education provided 59 is practically non-existent. Any scheme for abnormal children should provide for the accommodation of these children. They should be kept under observation, re-examined at frequent intervals, and gradually drafted out either to the ordinary schools when the special training has produced its effect on their slow, but normal, minds, or else to the class of definitely defective children. In this connection it is to be noted that the name of any special school is of considerable importance. Parents often raise the most vehement objections to their children attending a school to which they consider a stigma is attached, such as a "School for Mentally Defectives." |
fb4ee621-ad26-4e31-a41f-936ce202fce2 | It is always wise to refer to it as an "Observation School," or a "Special School," or some other non-committal term, and it is also a help in a small area, if other cases such as deaf or physically defective children are housed in the same building. Classes for very backward or mentally defective children should be kept small, so that the Teacher can give more individual attention, and the syllabus should contain provision for a great deal of handwork. A specially trained Teacher is essential. Mentally Defective and Backward Children. Boys. Girl's. Total. Excluded and unsuitable for education 3 — 3 Mentally defective 16 6 22 Extremely backward, requiring special arrangements 35 31 66 54 37 91 One other child attends a Certified School for Mentally Defectives. Provision needed for... 88 children. Roll No. 9,449 = .9 % of defective and backward children. |
9c6592c9-a188-4ea3-bc2f-7fcadd077378 | .26 % mentally defective only. 60 According to the estimate of the Royal Commission, .79 per cent. of the children in the Public Elementary Schools were feebleminded or imbecile. Deaf Children. The deaf child is in an entirely different category. He is often normally intelligent, but as one of his channels of communication with the outer world is cut off, he is much handicapped, and needs a special training to enable him to overcome his handicap. For practical purposes there are three grades of deafness:— A. The totally deaf, including deaf and dumb. B. The "hard of hearing," who can hear a little, but not sufficiently to follow in an ordinary class. C. The slightly deaf, who can hear sufficiently to be in an ordinary class if they can be near to the front. Classes A and B need special provision. The Committee has at present three children at the Royal School for Deaf and Dumb at Margate. |
9fa84b44-084c-4b0c-89ca-57ecbd4a751b | The modern idea is that it is better for deaf children to attend a Day School, because the conditions are more like those they will be obliged to meet later in life. They live with hearing people, and are obliged to use oral speech, while in institutions they tend to prefer the finger language. Moreover, if deaf children are brought up together, they tend to intermarry. As a large proportion of deafness is hereditary, and the chance of transmitting it is much increased when the tendency is on both sides, this is a somewhat serious consideration. The whole question of the marriage of deaf people needs investigation, and the gradual education of public opinion, but, in the meanwhile, to encourage intermarriages is not advisable. Of course, these remarks apply entirely to hereditary deafness, not to acquired or congenital forms. |
9f465638-9929-4b5e-a0a9-1cb3965dc321 | 61 On the other hand, the children in institutions are taught trades, and enabled to support themselves, so that, on the whole, it would seem better not to withdraw the children already sent to Margate, but any scheme of Day School for Deaf Children should certainly in future include the teaching of a trade, which means keeping the children beyond the present school age. In Ackmar Road L.C.C. School the Committee have 4 children who could be withdrawn if this was thought desirable. Table of Deaf Children. Boys. Girls. Total. Deaf and Dumb School, Margate 1 2 3 Ackmar Road, L.C.C. 2 2 4 Out of School 1 1 2 In ordinary Schools, totally Deaf 2 2 4 Hard of Hearing 6 8 14 12 15 27 Total not provided for 20 Lastly, there is a small group of cripples or otherwise physically defective children. |
412fd100-572b-41e8-96e1-208b88787f35 | Three of these should really be in a cripple school. The other three have special spinal chairs, or other modified arrangement in school. There are, therefore needing special provision:— Mentally Defective or Backward 88 Deaf or Hard of Hearing 20 Cripples or Physically Defective 6 114 In considering the question of meeting the need, it would probably reduce expenses per scholar and facilitate grouping into classes of more or less similar attainments, if the Committee invited the neighbouring areas to co-operate. They are also faced with the same problem, and if Acton provided a Special School, it might be possible to arrange to accommodate scholars from other areas. 62 TABLE 9. Appended is a table giving an analysis of the cases in the Acton schools:— School Mentally Defective Very Backward Deaf Hard of Hearing Cripples or Special Physically Defective Boys Girls Total Boys Girls Total Boys Girls Total Boys Girls Total Boys Girls Total Acton Boys 3 3 3 3 |
44ed89e2-361b-4c3f-925b-c41736f52a51 | Acton Girls 1 1 1 1 Acton Wells Infants and Mixed 1 1 1 1 1 1 Acton Wells Infants and Mixed 3 3 Beaumont Park Boys and Girls 5 5 Beaumont Park Infants 1 1 1 2 3 1 1 2 Central Junior 1 1 East Acton 1 1 2 1 1 2 Priory Boys 2 2 8 8 1 1 Priory Girls 1 1 4 4 1 1 Rothschild Infants 2 2 Rothschild Junior 3 3 9 14 23 2 South Acton Junior Boys 6 6 4 4 1 1 South Acton Infants 2 2 3 3 1 1 1 1 South Acton Senior Boys 1 1 Southfield Road Infants 2 2 1 2 3 Southfield Road Junior 1 |
ff0419fa-9bfd-4fcf-86bc-71e6709ee50e | 1 2 Turnham Green Roman Catholic 2 2 2 2 4 1 2 3 Totals 16 6 22 35 31 66 2 2 4 6 8 14 3 3 6 63 Tuberculosis. A register is kept of all cases of school age definitely known to have had phthisis, and if they are in school they are kept under close supervision. Cases in school are those in which the disease is arrested, and in which there is no risk of infection for other children. They are weighed fortnightly, and seen at each routine inspection. Any loss of weight or other unfavourable symptom is at once noted, and, if necessary, treatment is advised. Cases out of school are kept under observation, but at less frequent intervals. They are all under treatment, and in many cases are away in the country. |
24bfca09-d75a-4fd2-80b7-60b0d1fa6b7e | The Central Aid Society has given most valuable help in sending these children away to Convalescent Homes for long periods, as the usual short term is useless in such cases. Unfortunately, the children often relapse on returning to town life. It would be an advantage if they could attend an open-air class. In addition to actual cases, a large number of children are under supervision for "suspected phthisis." They are children— often of bad family history—who are below the usual weight, anaemic, and with chronic bronchitis, i.e., children who are of low resisting power and tuberculous tendency. They are weighed regularly, given free meals if necessary, and, where possible, recommended to the Central Aid Society for country holidays. These children would also benefit by an open-air school. Lately arrangements have been made to examine all children in the schools who are "phthisis contacts," and so are exposed to special risks of the disease. |
fcfc7ae8-37ed-42d3-9df5-988f3c53e14e | In this way it is hoped that early cases may be found while still in the curable stage, and that some cases may be prevented from occurring. Phthisis in children in early stages has a very good prognosis. When the Public Health Department receives a notification of Tuberculosis, the Health Visitor visits the home to give advice and obtain particulars. If there are any children of school age 64 she invites the mother to bring them up to the offices for examination. The Medical Officers are anxious that this should be regarded as an offer of advice and help to the family, and not in any sense as a persecution. So far the mothers who have attended have been grateful for the opportunity, and it has been possible to give them a little advice on the best way to prevent the infection of the children and to keep them healthy. If the mothers are unable to come to the offices, the children are noted down for medical examination at the next routine visit to the school they attend. |
7fbb457d-21ca-47f7-8747-76dbd2d59592 | The name of any child who should be kept under observation is transferred to a "Defect Card," and if treatment is required the parent is advised to obtain medical advice in the usual way. Throughout the confidential character of the notification of Tuberculosis is strictly observed. Lastly, cases of Bone and Joint and Gland Tuberculosis in the schools are also under medical supervision. The following are the figures at present available under the different headings:— In School. Treated at home. In Hospital, country, or Convalescent Home. Total. Notified as Phthisis 3 6 3 12 Suspected Phthisis 26 — — 26 Phthisis contacts — — — 21 Other Tuberculosis — — — 8 67 Mothercraft Classes. In the last report an account was given of the local conditions which render such classes particularly useful in Acton, and it was stated that an experimental class had been formed. |
6ca381a5-3f65-49de-8ea5-26f971401d9c | This was such a success that it was put on a permanent footing, and three schools sent down scholars for a course of lessons. At first these classes were confined to the schools in the poorer districts, but 65 it was evident that the instruction given would be valuable to every gril in schools, and that an extension of the classes was urgently to be recommended. In October, in accordance with the resolution of the Committee, the number of classes was raised to four a week. As a result, it has been possible to arrange for every department containing senior girls to send down parties of girls for a course of lessons at the creche, and we may fairly claim to have developed a permanent scheme, which is of the greatest practical value. In the smaller schools all the senior girls are able to attend the creche, but in the larger ones only some of the girls can do so at present, though all receive the preliminary teaching in the class-room. |
21dd4c24-532e-4991-86ab-78b1be7ec982 | The girls themselves are exceedingly anxious to attend these classes, and before all the schools shared the opportunity for special instruction, we received a pathetic message from one senior department, asking if arrangements could not be made for them "to learn to wash real babies" ! This department is in charge of a Headmistress, who gives an excellent course of lessons on infant care and management; the girls most of them had young babies at home whom they helped to mind, and they were very anxious to have a chance of carrying out on real babies and then reproducing at home the hygienic methods they had been taught on dolls. The scheme has aroused much interest, and has brought to the creche many people interested in educational and public health problems, so that it may be well briefly to recapitulate the arrangements as they are at present carried out. |
3437d8f1-c032-4cf0-b851-45c85629dd91 | The instruction begins in the school, where the senior girls are given a course of simple, practical lessons on hygiene, including such subjects as the clothes suitable for babies and small children, the simple laws of health, food, fresh air, cleanliness, etc. There is no hard-and-fast syllabus for these classes, and their value depends on the Teacher's power to make them apply to the conditions of the children's lives. The Teachers who give 66 these lessons are asked to accompany their girls to one course of lessons at the creche to insure uniformity of instruction. Slight differences in method often confuse children, and it is advisable that the teaching be the same throughout. For the lessons on bathing and dressing a baby, a specially made life-size jointed doll, which sinks in water, is used in most of the schools. The Teachers who have worked with it find it quite useful for the preliminary drill. |
f9260dce-0ec1-4a40-b559-1bcb5b28baa2 | The girls can make clothes for it, and learn the correct way of putting them on, and can be taught the details of washing without risk of chilling the baby while they are still slow in handling it. In some schools this class is given in a room with a fire— not a class-room—nursery fittings are borrowed for the occasion, and the conditions the girls will have to work under at home copied as far as possible. The next step is the course at the creche. This consists of 6 lessons of an hour each, and each class is limited to 6 girls, so that each may take a share in the work. The lessons are given by the Matron of the creche, Miss Lucas. She knows the local conditions, and is able to lay emphasis on those points which experience has shown are most neglected in Acton. The lessons begin with a short lecture. |
15f4e5e1-d35c-4e01-9d0a-d3732317fafa | The girls are supposed to have the main facts from the instruction in the school; then under the Matron's supervision they carry out the practical work. The lessons are:— 1. Clothing and dressing baby. 2. Bathing baby. 3. Baby's bed, sleep, and outing. 4. Washing baby's flannels. 5. Washing and making baby's bottle. 6. Signs of health and ill-health, and what to do till the doctor comes. Permission is obtained from the mother before any baby takes part in a demonstration, but visitors are much impressed by the placid contentment which the baby shows and the skilful handling of the class. 67 The girls write permanent notes of these lessons as compositions, and are urged to keep them for reference after they leave school. |
9d8c7179-79c7-4dd0-b0f8-59d253698374 | The classes are under the close supervision of the School Medical Officers, one of whom is often present at the demonstration, and visits are also paid to the preliminary classes in the schools. It is easy to find out by a little judicious questioning whether the children have grasped principles, or are repeating vaguely-understood formulae, and so far this latter error seems to have been avoided. It might be supposed that the mothers would regard the classes unfavourably, but experience proved the opposite. It is quite common to hear a child ask the Matron for the patterns of baby clothes used at the creche "because mother wants to copy them," and, in general, the mothers are glad to have their children taught by trained experts in this as much as in any other subject. During the hot weather of last summer, one mother whose baby was very ill borrowed her neighbour's little girl "because she had been to the nursery and knew the best ways." |
ad5f64a6-e47e-4386-819b-5e328a72dd51 | The child went in daily to make albumen water and sterilise the bottles and the milk, according to the doctor's instructions. It is satisfactory to be able to say that the baby recovered ! The value of work of this kind cannot be expressed in statistics, but in time it should show in an increased knowledge of the rearing of children, and in an improved level of health in childhood. One side result, though important in its way, is that the attitude of the girls to such subjects as infant care and home management is altering. Perhaps it was natural that when they were carefully taught so many other branches of skilled work they should assume that woman's work in the home was unskilled 68 and not attractive. Now they find it, too, demands, and should receive, trained and skilled intelligence, and they develop a legitimate pride in their own capacity for doing it well. |
6df98b0a-1a87-409e-8a73-cfdcb1057128 | The scheme works without any friction, thanks to the fact that the Teachers in the schools and the Matron at the creche have worked whole-heartedly for its success. Without such co-operation it could not have been carried through. The Committee pay 6s. a lesson for six girls; that is, 36s. a course of 6 lessons. The Committee of the creche receive also £15 for the Matron, who is recognised as a teacher on this subject. One member of the Education Committee is appointed to the Committee of the crêche, and one of the Medical Officers is an Hon. Medical Officer and a member of the House Committee of the creche. Control of Infectious Disease. The School Medical Officers are respectively Medical Officer of Health and Assistant Medical Officer of Health, so that the work of the two Departments is closely correlated. |
6e10147c-dca9-49b1-b870-fe7de3c42984 | During the year under review new arrangements were made, by which all children from Scarlet Fever or Diphtheria, and all contacts are examined by the Medical Officers before their return to school. A form, signed by one of the Medical Officers, is sent to the Head Teacher authorising him, or her, to re-admit the child. Swabs are taken of all suspicious sore throats, as well as of actual Diphtheria cases and their contacts. The details are given in the following paragraphs. Scarlet Fever. The district was comparatively free of Scarlet Fever, and, although neighbouring districts suffered severely from the disease, in no school was the incidence of the disease heavy. |
c00ea9f1-fd7a-41d5-ad77-b5a6b86ba283 | 69 The distribution of the notifications amongst school children was as follows:— Southfield Road 8 Priory 8 Rothschild Road 5 Central 5 South Acton 5 Beaumont Park 2 East Acton 2 Acton 2 37 Four cases occurred amongst pupils attending Private Schools in the district, and one child was in attendance at a school outside the district. Details as to the proportion of cases isolated in the Fever Hospital and in their own houses are given on a preceding page in the report of the Medical Officer of Health, and the usual precautions are adopted for the quarantine of the infected persons and those who come in contact with them. Where the case is nursed at home all the children of the house are excluded from school until a period of 8 days has elapsed from the time the patient is free from infection and the premises have been disinfected. The patient is excluded from school for 3 weeks after he is certified free of infection and the premises have been disinfected. |
248587ad-ae92-4744-b064-977442b2c1af | Where the case is removed to Hospital the contacts are excluded from school for 8 days after the removal, and the patient for 3 weeks after the discharge from the Hospital. But every case of Scarlet Fever and every contact is examined before they are allowed to return to school. Last year, in addition to the actual sufferers from the disease, 107 school contacts were examined on the expiration of their quarantine and before they resumed school attendance. 70 Some of the channels along which Scarlet Fever is spread remain obscure, but the opinion is becoming more universally held that the chief infecting material resides in persons, and not in things. Our methods may have to be changed, as our knowledge of the etiology and epidermiology of Scarlet Fever increases. Our procedure at the present time is based on the assumption that the spread of the disease in schools takes place under three conditions. Firstly, a certain number of those who have suffered from Scarlet Fever remain intermittently infectious for prolonged periods. |
a06f7179-2e6b-45d2-9fc5-7431457658c7 | These are the "infecting" cases which give rise to "return" cases, and they also probably give rise to a certain proportion of the school cases where the source of infection remains untraced. What the precise conditions are under which they continue in an infectious condition remain a subject of doubt and debate; but in a large proportion of the "return" cases in houses there is an abnormal condition of the mucous membrane of the nose and throat of the alleged "infecting" case. In some instances the patient develops a discharge from the nose or ear immediately on his return home from the Hospital. In other cases an enlargement of the tonsils and adenoids is present. In the report of the Medical Officer of Health an instance is given of the cessation of notifications from a certain area coincident with the removal of tonsils and adenoids in such a case. |
114361f1-6b39-4acf-b8c6-3ef9d72d4b9b | Basing our action on this experience, every convalescent case is examined before resumption of school attendance, and if any abnormal conditions of the nose and throat exist, an endeavour is made to have this abnormality remedied before the child attends school. If there is a sore present inside the nose, or an unhealthy discharge persists from the nose, the child is kept out of school and instructions given for its treatment. If there is an ear discharge present or the tonsils and adenoids are enlarged, an operation is advised. These children are noted and kept under observation, and are borne in mind as a possible focus of infection. Secondly, there is reason to believe that persons coming in 71 contact with Scarlet Fever may suffer from the disease in a mild form, without exhibiting all the symptoms. In Diphtheria the "carrier" case is well known; that is, a person may carry in his throat the germs of Diphtheria without exhibiting any of the symptoms of the disease. |
508bedba-4c42-4952-8126-897873150176 | Moreover, the "carrier" case may transmit the disease in a virulent form to those with whom it comes in contact. It is possible that a phenomenon somewhat similar in its character may occur in Scarlet Fever. In houses where Scarlet Fever has appeared, some of the children suffer from a sore throat, but do not exhibit any other symptom of Scarlet Fever. These instances of sore throat are possiblv abortive attacks of Scarlet Fever. The sufferers enjoy a certain amount of natural immunity, but can in this state, and subsequently, act as infecting agents to those with whom they come in contact and thus transmit the disease. It is difficult otherwise to explain those instances where Scarlet Fever recurs in a house after an interval of some weeks has elapsed since a case has been removed to the Hospital. |
f5dc6c01-e6b7-4fc8-aa04-15a4ff4edc86 | No undoubted proof of an incubation period of more than seven days has been adduced in the case of Scarlet Fever, and yet cases occur after an interval of some weeks has elapsed since any contact could have taken place with a previous case of the disease. The interval is probably bridged over by an abortive attack of the disease, the sufferer only exhibiting the symptoms of a sore throat. A possible instance of this kind is mentioned on a preceding page. Another instance might be cited. Four cases of Scarlet Fever occurred in the Cottage Hospital during the early part of the year. The date of the notifications were February 7th, February 12th, March 3rd, and March 7th. It will be seen that the interval which elapsed between the occurrence of the second and third case is considerably more than can be bridged over by the incubation period, and no explanation could be given apart from the occurrence of a possible abortive case exhibiting only the symptoms of a slight sore throat. |
51ac315f-9838-4dc3-bbb5-82ae2d0770d6 | Acting on this assumption, every school child from a house where a case of Scarlet Fever has occurred is examined at the end of 8 days after the removal of the patient to Hospital or after the disinfection of the premises, and if any history of recent sore 72 throat is obtained, the child is further excluded from school and kept under observation. Thirdly, in spite of every care and attention, mild cases sometimes escape detection and attend school in an infectious state. In some outbreaks these "missed" cases are the chief means by which the disease is spread. When inquiries are made into the history of a case of Scarlet Fever, the school and class to which the child belongs are noted, and if multiple cases occur within a short period in a class, all the children are examined. Measles. In last year's report there was an account of a Measles outbreak, which commenced in September, 1912. That outbreak continued into the first quarter of 1913. |
048b9a97-cd3a-484a-8d36-7acae55c04c5 | The first case was reported from Rothschild School in September, 1912, and about the same time other cases occurred in Beaumont Park School. Before the end of November the Central Schools had been invaded, and in 1912 these were the schools which suffered most. In December, 1912, the disease had made its appearance in the South Acton Infants' Department, and the school was closed for the Christmas holidays on December 13th, a week earlier than the other schools in the district. The Infants' Departments at Acton Wells and Southfield Road Schools were affected in the early part of January, 1913, and were not re-opened after the Christmas holidays until February 3rd. The Priory School was invaded in February and March. During the latter part of the year the district was entirely free of the disease. |
d55baa5f-73e5-464d-9884-5b5d7dd77d21 | The number of cases reported from the different schools was as follows Acton 16 Acton Wells 29 Beaumont Park 4 Central 2 Priory 56 Rothschild 6 South Acton 87 Southfield Road 81 73 It will be seen that before the beginning of 1913, the outbreak had spent itself in the Rothschild, Beaumont Park, and Central Schools. In 1913, only 4 per cent, of the cases notified occurred in these schools, whilst in 1912, the number was 72 per cent, of the total. The age distribution of the notified cases in the different schools was as follows:— 3-4 yrs. 4-5. 5-6. 6-7. 7-8. 8-9. 9-10. 10-11. 11-12. 12-13. |
f5a47f8b-9157-480c-aabc-35831236bbb5 | Acton — — 8 6 — 1 1 — — — Acton Wells 1 3 20 3 2 — — — — — Beaumont Park — — 1 1 1 — — — — 1 Central 1 — — — — — — — — — Priory 3 15 26 8 6 2 — 1 — 1 Rothschild — — 2 2 1 1 — — — — South Acton — 15 48 18 3 2 — — — 1 Southfield Road — 5 16 36 12 10 1 1 — — In addition to the cases which occurred amongst school children, the School Nurse visited the homes of 125 cases where Measles had occurred amongst children under school age. The ages of these children were as follows:— Under 1 year. 16 1-2 years. 36 2-3 years. 34 3-4 years. |
4e85a63e-01d9-46c9-beef-970ddd08f024 | 39 The usual regulations were adopted for the exclusion of school children from these houses. Diphtheria. 66 cases of Diphtheria occurred amongst school children, 58 of these being amcngst scholars in the Public Elementary Schools of the district. The distribution was as follows:— Priory 17 Central 11 Rothschild 8 Acton Wells 6 South Acton 6 Southfield Road 4 Beaumont Park 3 East Acton 2 Acton County School 2 Private Schools 5 Outside School 1 Acton 1 66 74 The percentage of cases occurring among school children is higher than that in any year since 1909. Last year the percentage was 56.3, compared with 49 in 1912, 55 in 1911, 56 in 1910, and 60 in 1909. It was only necessary in one instance to make an examination of all the children in a suspected class. |
a37d8d93-ebcc-47ae-bdbe-041432bff606 | A few virulent cases had occurred in Acton Wells School, and all the children with suspicious sore throats in the affected classes were examined; as a result, 2 children were found who were harbouring the Diphtheria bacillus. These children were excluded from school, and the notifications ceased. At the beginning of 1913, though, a systematic examination of all school children from houses where a case of Diphtheria had occurred was carried out. The usual period of quarantine was observed. The other children in the house were excluded from school for 8 days after a case was removed to the Hospital; or where the case was nursed at home, for 8 days subsequently to the disinfection of the premises at the end of the illness. At the end of the quarantine period all children from infected houses come to the offices, and a swab is taken from each throat. |
683d50f6-d5a5-4333-bb74-a94f661b4216 | Last year 187 contacts were examined in this manner, and of these 30 were found to harbour the Klebs-Loeffler bacilli. The figures are, of course, too small to draw any conclusions, but it will be readily appreciated how easily the disease is kept alive in a community, and how difficult it is to stamp out the disease in a school once it gets firmly established there. The behaviour of the contacts made it appear highly probable that the disease is kept alive in the community and fresh outbreaks lighted up chiefly by infected individuals who mingle with their fellows. The percentage of positive contacts varied at different times of the year, but a high percentage was shortly followed by an increase in the notifications in the district. Whenever a "contact" is found to be positive, he or she is excluded from school, and a further examination made at the end of another week. Altogether 220 swabs were examined from the throats of contacts; of these 172 were negative and 48 were 75 positive. |
f1013b94-5a21-46e2-9824-5784664d5da0 | Some contacts were found to be positive for a considerable time, but in the majority of instances the swab was negative on the second examination. Although it was not found necessary to examine systematically the throats of children in more than one school, the search for mild sore throats amongst scholars has been more stringent, and the Teachers exercise very great care to prevent any children with sore throats from attending school. How necessary this precaution was, is made evident from the result of the bacteriological examination of the swabs taken from children sent to the offices by the Teachers and the School Nurse. 190 children were examined, who had been sent by the Teachers on account of sore throats. Of these, in 33 instances the Klebs-Loeffer bacillus was present, and in 127 instances it was absent. |
7bb7f1a0-855b-462f-878a-987a84067aaf | It is impossible to give an estimate of the percentage of virulent cases amongst these positive contacts and sore throats, as the final test of virulence must, of course, depend upon the result of infection of guinea pigs, but out of the 63 there must have been a considerable number who were in a highly infective condition. Some of them were in the early stages of a typical attack of Clinical Diphtheria, and were isolated in the Fever Hospital. The point we wish to emphasise is, that the most hopeful ground for the control of Diphtheria generally lies in the school, and it is highly probable that this disease would be almost entirely stamped out if a systematic examination were made of all contacts, not "house-contacts" as at present carried out, but also "classcontacts." |
78404ceb-6d41-4451-bbe7-a40f029d21f4 | The percentage of "class-contacts" who would be found positive on examination is probably a higher one than we are led to believe The mild and the carrier cases are those which it is of the greatest importance to identify, especially in schools, for, if not recognised, the children may go about and prove a source of infection to all around. 76 Chicken Pox- Only 30 cases of Chicken-pox occurred amongst the Elementary School children last year, distributed as follows:— Southfield Road 10 Acton 6 Central 4 Priory 4 East Acton 3 Acton Wells 2 South Acton 1 30 Whooping Cough. Whooping Cough was prevalent in the Southern part of the district, especially during the earlier part of the year. It is characteristic of Whooping Cough, though, that its incidence is very light in children of school age. |
1b5e2a95-4185-4b9e-bf74-31fdf165039c | Whooping Cough is not a compulsorily notifiable disease, and we are dependent for our information on the death returns and the school notifications. The cases notified from the schools were distributed as follows:— South Acton 40 Rothschild 19 Southfield Road 13 Beaumont Park 11 Priory 5 East Acton 4 Acton 2 Acton Wells 2 Turnham Green 1 97 Open-Air Work. There is no special open-air school, but each Head Teacher makes as much use as possible of the playground sheds during 77 the summer. In some schools the babies carry their small chairs out under the trees for work in the summer, and the newer schools have gardening plots for the children to work in. Organised Games. were fully described in the last report. They consist of football, cricket, running, paper-chasing, jumping, and swimming for boys, and netball, cricket, skipping, running, and swimming for girls. |
bbbffa29-06e5-4751-9972-93c79dca6b40 | Some schools have four complete football and netball teams, including "practice teams," so that out of a department of 300 children, 130 play sufficiently well to be included in a team, beside numbers of beginners- The Teachers refer any child to the Medical Officers for examination, if since the last routine medical examination any question of fitness for sports or games has arisen. After each routine inspection all cases requiring modified drill or exclusion from games are notified to the Teachers. Swimming. During the season of 1913, 43 Swimming Classes were held weekly. 116 boys and 87 girls have earned the swimming certificate awarded by the Committee to children who have this year learned to swim, 40 yards in the case of boys and 20 yards in the case of girls. School. No. of per week, classes No. of ances. attend- No. of scholars in departcan swim, ment who No. |
d362b195-03d1-40a8-9709-2d5e4b711ed9 | who have learned to season, swim this Acton Boys 2 966 3° 22 Acton Girls I 264 4 4 Acton Wells Mixed 3 1,450 54 46 Beaumont Park Boys 6 2,945 70 37 Beaumont Park Girls 2 1,237 35 32 Central Senior 5 2,556 106 47 Central Junior 2 1,082 35 29 Priory Boys 4 1,562 51 33 Priory Girls 2 1,157 27 22 South Acton Senior Boys 5 2,248 89 59 South Acton Girls 3 1,595 33 17 Southfield Road Senior 6 2,615 115 62 Turnham Green R.C. 2 725 10 10 43 20,402 659 420 78 No. of lessons given by Mr. |
7708058c-10cb-41c1-805b-6dd581703f43 | Briant and his staff 7,078 It will be obvious that much of the work described in the Report could only have been carried out with the co-operation of the staff of the Education Department and the Teachers. We beg to thank them for their assistance in the work of medical inspection and in the compiling of this Report. We remain, Your obedient servants, D. J. THOMAS. ELSIE M. CHUBB. |
9b01395b-d1e8-4bc6-b158-7494ac617d2c | SBIflli ; ■ 1 AC.439 (1) ACTORV DUPLICATE army medical libraby Urban District of Acton. Annual Report of the Medical Officer of Health together with THE REPORT on the Medical Inspection of Schools, . . for the Year .. 1915. ACT 63 Urban District of Acton. Annual Report of the Medical Officer of Health . . For the Year . . 1915. 3 By the Order of the Local Government Board, dated December 13th, 1910, Article 19, section 14, it is prescribed that the Medical Officer of Health shall as soon as practicable after December 31st in each year make an Annual Report to the Council up to the end of December, on the Sanitary circumstances, the Sanitary Administration, and the vital statistics of the District. In addition to any other matters upon which he may consider it desirable to report, his Annua! |
72c4b62c-dbfa-426d-a443-1583e19e4bdd | Report shall contain the information indicated in the following paragraphs, together with such further information as We may from time to time require :— (а) An account of any influences threatening the health of the District, the prevalence of infectious or epidemic disease therein, and the measures taken for their prevention. (б) An account of all general and special inquiries made during the year. (c) An account of the work performed by the Inspector of Nuisances during the year, including the statement supplied in pursuance of Article 20 (16) of this Order. (d) A Statement as to the conditions affecting the wholesomeness of the milk produced or sold in the District. (e) A statement as to the conditions affecting the wholesomeness of foods for human consumption, other than milk, produced or sold in the District. (/) A statement as to the efficiency and quality of the water supply of the District and of its several parts, and in areas where the supply is from waterworks, information as to whether the supply is constant or intermittent. |
7f7887bc-df84-45ae-8346-538ac3cc9f16 | (g) A statement as to the pollution of rivers or streams in the District. 388822 4 (h) A statement as to the character and sufficiency of the arrangements for the drainage, and sewage disposal of, in all parts of the District. (i) A statement as to the privy, water-closet, and other closet accommodation in the District, including information as to the approximate number of each type of privy and closet. (j) A statement as to the character and efficiency of the arrangements for the removal of house-refuse, and the cleansing of earth closets, privies, ashpits, and cesspools in the District. (k) A statement with regard to the housing accommodation of the District as required by Article 5 of the Housing (Inspection of District) Regulations, 1910, and an account of any other action taken by the Council under the Housing, Town Planning, &c., Act, 1909, bearing on the public health. |
8149bedb-bb2f-477c-b7ee-e83ab217fa04 | (l) A statement as to the vital statistics of the District, including a tabular statement, in such form as We may from time to time direct, of the sickness and mortality within the District. Under section 132 of the Factory and Workshop Act, 1901 the Medical Officer of Health is also required in his Annual Report to report specifically on the administration of the Act in workshops and workplaces, and to send a copy of his Annual Report or so much of it as deals with this subject, to the Secretary of State, ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH FOR THE YEAR 1915. Council Offices, Acton, London, W. To the Chairman and Members of the Urban District Council of Acton. Miss Smee and Gentlemen, I beg to submit my Annual Report for the year 1915. For obvious reasons, many of the details usually inserted have been omitted and as much as possible of the report has been given in the form of tables. Some explanations are necessary. |
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