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The work of the York school clinic
88
PUBLIC H E A L T H .
T H E W O R K O F T H E YORK S C H O O L CLINIC.* By E. S. G A L B R A I T H , L.R.C.P. and S.E., D.P.H. (Lond.), Assistant School Medical Officer.
I H A V E been asked to read to you a paper on the York Medical Inspection Clinic and its working, and I propose to do so by giving you a short history of-(I.) Our clinic ; (2.) Its expansion ; (3.) The work which we at present carry out : (4.) The system which we have at present for its management. The CIinic.--Medical inspection in the York Elementary Schools under the Act of 19o 7 was commenced in September, 19o8. For two or three years prior to the official installation of the Act of 19o7 the medical officer of health of the city had carried out a certain amount of voluntary medical inspection amongst the scholars. Cases of ringworm of the scalp were excluded from school and treated by the lady health visitor. An important enquiry was made throughout the schools some years ago by Dr. Auden, who is now chief school medical officer for Birmingham, into the number of mentally defective children in the schools. Dr. Williams, now chief school medical officer for Bradford, was engaged here in carrying out the work of voluntary medical inspection and a "ringworm treatment clinic " prior to the passage of the Elementary Education Act of 19o7. Its Ex,bansion.--Under the Act an enlarged and official clinic was organised, and the treatment of ringworm was fully entered into. From the very first the Board of Education had granted permission for this treatment. I may here say that for the first eighteen months or two years after the passage of the Act our efforts at treatment at the clinic were confined to ringworm. During the year 19o 9 a special ringworm investigation was made throughout the schools, with the result that over 300 cases of tinea tonsurans were discovered. In every case a microscopic examination of the hairs was carried out. During the ordinary course of medical inspection Io cases of tines tonsurans were discovered. There were also 60 children already out of school on account of this disease. It will therefore be seen that close on 400 scholars were suffering from scalp ringworm in the year I9O9. The majority of these were * Read before the Yorkshire Branch of file Society of Medical Officers of Health at Yorkon Friday, October a4th, i913.
DECEMBER,
treated at the clinic by means of drugs. This was successful in a large number of cases, but it entailed great patience and perseverance on the part of all concerned, great loss of school attendances on account of the length of time taken to cure the disease, and, of course, class dis0rganisation to a certain extent. However, it is gratifying to be able to record that our efforts to lessen the disease amongst the scholars were attended with success, and that whereas in 19o 9 3 per cent of the children in the schools were suffering from scalp ringworm, in 191o this figure was reduced to o'3 per cent., and in 19tl to o'I per cent. A grant was made by the Education Committee to the local hospital towards the cost of new apparatus for the X-Ray treatment of ringworm during 1911. The clinic is also used for the supervision of children out of school on account of various ailments. In 1911 the Board sanctioned the treatment of other " m i n o r " ailments, including external eye diseases, otorrhcea, eczema, impetigo, etc. In 1912 an ophthalmic surgeon and a school dentist were appointed to the clinic. These are part-time officers, and since their appointment they have been kept very busy, being well supplied with cases. The dental surgeon is paid £1oo per annum for three half-days per school week. The ophthalmic surgeon is paid a retaining fee of ten guineas per annum and a fee of 5s. per case examined. The work we are at present carrying out is the ophthalmic and dental treatment of all elementary school children found to be defective in these respects who cannot afford to go to private practitioners, and whose parents are willing to allow such treatment. Also the treatment of all " m i n o r " diseases such as might otherwise be dealt with in the outpatients' department of a general hospital, with the exception of surgical operations. Children, not of the poorer classes, are first given the opportunity of consulting a private practitioner. The ophthalmic surgeon, who is also attached to the county hospital, refers all necessitous eye cases requiring surgical interference to the hospital, and they are attended to by him there. Numbers of squints have been thus dealt with. The dental surgeon inspects the children referred to him, extracts unsound and unsavable teeth when necessary, as a preliminary to conservative treatment of other teeth, and scales and fills where possible.
PUBLIC HEALTH.
1913.
EYE (~ LINIG.
Children who are suffering from a complaint, surgical or otherwise, who are not under private medical trealment, and who are not eligible for treatment at the clinic on account of the nature of the defect, are advised, and in some cases are supplied u ith a hospital or dispensary note. In o~'der to give you an idea of the work underteken and accomplished at our clinic, I will here give you a summary of the work done during the past six m o n t h s : BRIEF S U M M A R Y O F W O R K D O N E A T T H E SCHOOL
CLINIC,
JANUARY
TO
JULY,
1913
WOIlK
x934 983
General . . . . . . . . 5o~ T o t a l , i 8 6 Treatment . . . .. . 136.1 The following were the diseases and conditions from which the children suffered :-General Treatment Clinic. Clinic. R i n g w o r m of t h e b o d y . . . . 47 36 R i n g w o r m of t h e s c a l p . . . . 95 Pediculosis . . . . . . . . 74 12 Impetigo . . . . . . . . 92 20 Eczema . . . . . . . . 124 I4 Scabies . . . . . . . . I4 Ophthalmia . . . . . . . . 75 33 Blepharitis . . . . . . . . 22 io Keratitis . . . . . . . . 8 i Abscess . . . . . . . . 21 Otorrhoea . . . . . . . . 56 45 Debility . . . . . . . . iz Defective vision and squint .. 87 -Various . . . . . . . . 353 17 1080
188
N.B.--AII children attending the treatment clinic attend also t h e g e n e r a l c l i n i c a t l e a s t t w i c e , a n d t h e f i g u r e s m e n t i o n e d u n d e r " t r e a t m e n t c l i n i c " a r e a l s o i n c l u d e d in t h o s e mentioned under " general clinic." DENTAL CLINIC. WORK DONE BY THE DENTAL ASSISTANT SCHOOL MEDICAL OFFICER.
Inspections .. Fillings . . . . Dressings . . . . Regulations .. Extractions ..
. . . . .
. . . . .
. . . . .
. . . . .
652 538 655 270 0-89
1 N u m b e r of r o u t i n e c a s e s .. 675 l T o t a l , 790 N u m b e r of n o n - r o u t i n e e a s e s . . H5J N u m b e r of c h i l d r e n w h o h a v e b e e n f u l l y t r e a t e d . . 348 N u m b e r of c h i l d r e n w h o h a v e b e e n p a r t i a l l y treated . . . . . . . . . . . . . . . 337 N u m b e r of c h i l d r e n w h o h a v e r e f u s e d t r e a t m e n t . . 18 N u m b e r of c h i l d r e n w h o h a v e b e e n o n c e f o r i n s p e c tion, but have not been since . . . . . . 87 790 * The general clinic is held for purposes of inspection and supervision only. The treatment clinic (as its name implies I is held for the treaunent of minor ailments,
Bit
THE
OPHTHALMIC
~ N u m b e r of r o u t i n e c a s e s N u m b e r of n o n - r o u t i n e c a s e s
..
Details o f the above 153 cases : Myopia . . . . . . . . Hypermetropia . . . . . . Myolzic a s t i g m a t i s m . . . .
I
i
io44
DONE
ASSIST3_NT
SCHOOL
MEDICAL OFFICER. N u m b e r of c h i l d r e n w i t h d e f e c t i v e vision r e f e r r e d t o t h e o p h t h a l m ' c a s s i s t a n t s c h o o l m e d i c a l officer:
* GENERAL AND TREATMENT CLINICS, ~,VonK DONE BY THE ASSISTANT SCtlOOL MEDICAL OFFICER
( D r E . S. G a l b r a i t h ) T o t a l n u m b e r of c h i l d r e n w h o a t t e n d e d t h e general and treatment clinics . . . . T o t a l n u m b e r of a t t e n d a n c e s a t t h e g e n e r a l clinic . . . . . . . . . . . . T o t a l n u m b e r of a t t e n d a n e e s a t t h e t r e a t m e n t clinic . . . . . . . . . . . . Number o f clinics held
89
Hypermetropic astigmatism .. Mixed astigmatism . . . . Otherwise prescribed for .. Refused treatment . . . . Examination not completed ..
127~ 2 6 ) T o t a l , I53 8 36 1 2i
f
456[t i9 8
T o t a l , I53
1
I.chtded in the above 153 cases .'ere 3 ° squints : Right convergent squint . . . . i4~ Left convergent squint . . . . J2 Convergent squint both eyes .. i _ T o t a l , 3o Ahernating convergent squint .. zl Left divergent squint . . . . ,) G l a s s e s w e r e p r e s c r i b e d a n d o r d e r e d in i35 e a s e s , T h e s t a f f c o n s i s t s of t h e f o l l o w i n g : T h e m e d i c a l officer of h e a l t h is s c h o o l m e d i c a l of'ricer; W h o l e - t i m e a s s i s t a n t s c h o o l m ~ d i c a l officer ; Part-time ophthalmic surgeon ; Part-time dental surgeon ; Two whole-time school nurses ; Two whole-time lady clerks. T h e r e a r e five s c h o o l a t t e n d a n c e officers. (Clinics.--General, treatment, ophthalmic, and c l i n i c s a r e h e l d r e g u l a r l y t h r o u g h o u t t h e week.)
dental
Children absent from school on a c c o u n t of illness and children excluded from school by teachers on account of illness are notified to the clinic, and are supervised by that department. Notifiable infectious diseases are supervised by the Health Department. Children suffering from minor ailments, including mild cases of ringworm, eczema, impetigo, discharging ears, etc, are treated at the treatment clinic; ringworm cases are generally instructed to have X-Ray treatment at the county hospital. Children are also referred to the clinic by the Education Committee, the School Attendance Committee, the school attendance officers, and the parents of the children. SCARLET FEVER IN LONDON.--The a u t u m n a l increase of cases of scarlet fever in L o n d o n is especially large this year, the number of c a s e s of this disease notified being about twice as numerous as last year. T h e cases are distributed over London very m u c h in proportion to population, and are therefore probably due to natural behaviour of the disease rather than to any special cause of infection. It would be interesting to k n o w if other parts of the country are having a like experience. t ".14outine " cases are those discovered in school during medical inspection. " Non-routine" cases are those who have been otherwise discovered, or referred by head teachers or school managers,
PUBLIC H E A L T H .
T H E W O R K O F T H E YORK S C H O O L CLINIC.* By E. S. G A L B R A I T H , L.R.C.P. and S.E., D.P.H. (Lond.), Assistant School Medical Officer.
I H A V E been asked to read to you a paper on the York Medical Inspection Clinic and its working, and I propose to do so by giving you a short history of-(I.) Our clinic ; (2.) Its expansion ; (3.) The work which we at present carry out : (4.) The system which we have at present for its management. The CIinic.--Medical inspection in the York Elementary Schools under the Act of 19o 7 was commenced in September, 19o8. For two or three years prior to the official installation of the Act of 19o7 the medical officer of health of the city had carried out a certain amount of voluntary medical inspection amongst the scholars. Cases of ringworm of the scalp were excluded from school and treated by the lady health visitor. An important enquiry was made throughout the schools some years ago by Dr. Auden, who is now chief school medical officer for Birmingham, into the number of mentally defective children in the schools. Dr. Williams, now chief school medical officer for Bradford, was engaged here in carrying out the work of voluntary medical inspection and a "ringworm treatment clinic " prior to the passage of the Elementary Education Act of 19o7. Its Ex,bansion.--Under the Act an enlarged and official clinic was organised, and the treatment of ringworm was fully entered into. From the very first the Board of Education had granted permission for this treatment. I may here say that for the first eighteen months or two years after the passage of the Act our efforts at treatment at the clinic were confined to ringworm. During the year 19o 9 a special ringworm investigation was made throughout the schools, with the result that over 300 cases of tinea tonsurans were discovered. In every case a microscopic examination of the hairs was carried out. During the ordinary course of medical inspection Io cases of tines tonsurans were discovered. There were also 60 children already out of school on account of this disease. It will therefore be seen that close on 400 scholars were suffering from scalp ringworm in the year I9O9. The majority of these were * Read before the Yorkshire Branch of file Society of Medical Officers of Health at Yorkon Friday, October a4th, i913.
DECEMBER,
treated at the clinic by means of drugs. This was successful in a large number of cases, but it entailed great patience and perseverance on the part of all concerned, great loss of school attendances on account of the length of time taken to cure the disease, and, of course, class dis0rganisation to a certain extent. However, it is gratifying to be able to record that our efforts to lessen the disease amongst the scholars were attended with success, and that whereas in 19o 9 3 per cent of the children in the schools were suffering from scalp ringworm, in 191o this figure was reduced to o'3 per cent., and in 19tl to o'I per cent. A grant was made by the Education Committee to the local hospital towards the cost of new apparatus for the X-Ray treatment of ringworm during 1911. The clinic is also used for the supervision of children out of school on account of various ailments. In 1911 the Board sanctioned the treatment of other " m i n o r " ailments, including external eye diseases, otorrhcea, eczema, impetigo, etc. In 1912 an ophthalmic surgeon and a school dentist were appointed to the clinic. These are part-time officers, and since their appointment they have been kept very busy, being well supplied with cases. The dental surgeon is paid £1oo per annum for three half-days per school week. The ophthalmic surgeon is paid a retaining fee of ten guineas per annum and a fee of 5s. per case examined. The work we are at present carrying out is the ophthalmic and dental treatment of all elementary school children found to be defective in these respects who cannot afford to go to private practitioners, and whose parents are willing to allow such treatment. Also the treatment of all " m i n o r " diseases such as might otherwise be dealt with in the outpatients' department of a general hospital, with the exception of surgical operations. Children, not of the poorer classes, are first given the opportunity of consulting a private practitioner. The ophthalmic surgeon, who is also attached to the county hospital, refers all necessitous eye cases requiring surgical interference to the hospital, and they are attended to by him there. Numbers of squints have been thus dealt with. The dental surgeon inspects the children referred to him, extracts unsound and unsavable teeth when necessary, as a preliminary to conservative treatment of other teeth, and scales and fills where possible.
PUBLIC HEALTH.
1913.
EYE (~ LINIG.
Children who are suffering from a complaint, surgical or otherwise, who are not under private medical trealment, and who are not eligible for treatment at the clinic on account of the nature of the defect, are advised, and in some cases are supplied u ith a hospital or dispensary note. In o~'der to give you an idea of the work underteken and accomplished at our clinic, I will here give you a summary of the work done during the past six m o n t h s : BRIEF S U M M A R Y O F W O R K D O N E A T T H E SCHOOL
CLINIC,
JANUARY
TO
JULY,
1913
WOIlK
x934 983
General . . . . . . . . 5o~ T o t a l , i 8 6 Treatment . . . .. . 136.1 The following were the diseases and conditions from which the children suffered :-General Treatment Clinic. Clinic. R i n g w o r m of t h e b o d y . . . . 47 36 R i n g w o r m of t h e s c a l p . . . . 95 Pediculosis . . . . . . . . 74 12 Impetigo . . . . . . . . 92 20 Eczema . . . . . . . . 124 I4 Scabies . . . . . . . . I4 Ophthalmia . . . . . . . . 75 33 Blepharitis . . . . . . . . 22 io Keratitis . . . . . . . . 8 i Abscess . . . . . . . . 21 Otorrhoea . . . . . . . . 56 45 Debility . . . . . . . . iz Defective vision and squint .. 87 -Various . . . . . . . . 353 17 1080
188
N.B.--AII children attending the treatment clinic attend also t h e g e n e r a l c l i n i c a t l e a s t t w i c e , a n d t h e f i g u r e s m e n t i o n e d u n d e r " t r e a t m e n t c l i n i c " a r e a l s o i n c l u d e d in t h o s e mentioned under " general clinic." DENTAL CLINIC. WORK DONE BY THE DENTAL ASSISTANT SCHOOL MEDICAL OFFICER.
Inspections .. Fillings . . . . Dressings . . . . Regulations .. Extractions ..
. . . . .
. . . . .
. . . . .
. . . . .
652 538 655 270 0-89
1 N u m b e r of r o u t i n e c a s e s .. 675 l T o t a l , 790 N u m b e r of n o n - r o u t i n e e a s e s . . H5J N u m b e r of c h i l d r e n w h o h a v e b e e n f u l l y t r e a t e d . . 348 N u m b e r of c h i l d r e n w h o h a v e b e e n p a r t i a l l y treated . . . . . . . . . . . . . . . 337 N u m b e r of c h i l d r e n w h o h a v e r e f u s e d t r e a t m e n t . . 18 N u m b e r of c h i l d r e n w h o h a v e b e e n o n c e f o r i n s p e c tion, but have not been since . . . . . . 87 790 * The general clinic is held for purposes of inspection and supervision only. The treatment clinic (as its name implies I is held for the treaunent of minor ailments,
Bit
THE
OPHTHALMIC
~ N u m b e r of r o u t i n e c a s e s N u m b e r of n o n - r o u t i n e c a s e s
..
Details o f the above 153 cases : Myopia . . . . . . . . Hypermetropia . . . . . . Myolzic a s t i g m a t i s m . . . .
I
i
io44
DONE
ASSIST3_NT
SCHOOL
MEDICAL OFFICER. N u m b e r of c h i l d r e n w i t h d e f e c t i v e vision r e f e r r e d t o t h e o p h t h a l m ' c a s s i s t a n t s c h o o l m e d i c a l officer:
* GENERAL AND TREATMENT CLINICS, ~,VonK DONE BY THE ASSISTANT SCtlOOL MEDICAL OFFICER
( D r E . S. G a l b r a i t h ) T o t a l n u m b e r of c h i l d r e n w h o a t t e n d e d t h e general and treatment clinics . . . . T o t a l n u m b e r of a t t e n d a n c e s a t t h e g e n e r a l clinic . . . . . . . . . . . . T o t a l n u m b e r of a t t e n d a n e e s a t t h e t r e a t m e n t clinic . . . . . . . . . . . . Number o f clinics held
89
Hypermetropic astigmatism .. Mixed astigmatism . . . . Otherwise prescribed for .. Refused treatment . . . . Examination not completed ..
127~ 2 6 ) T o t a l , I53 8 36 1 2i
f
456[t i9 8
T o t a l , I53
1
I.chtded in the above 153 cases .'ere 3 ° squints : Right convergent squint . . . . i4~ Left convergent squint . . . . J2 Convergent squint both eyes .. i _ T o t a l , 3o Ahernating convergent squint .. zl Left divergent squint . . . . ,) G l a s s e s w e r e p r e s c r i b e d a n d o r d e r e d in i35 e a s e s , T h e s t a f f c o n s i s t s of t h e f o l l o w i n g : T h e m e d i c a l officer of h e a l t h is s c h o o l m e d i c a l of'ricer; W h o l e - t i m e a s s i s t a n t s c h o o l m ~ d i c a l officer ; Part-time ophthalmic surgeon ; Part-time dental surgeon ; Two whole-time school nurses ; Two whole-time lady clerks. T h e r e a r e five s c h o o l a t t e n d a n c e officers. (Clinics.--General, treatment, ophthalmic, and c l i n i c s a r e h e l d r e g u l a r l y t h r o u g h o u t t h e week.)
dental
Children absent from school on a c c o u n t of illness and children excluded from school by teachers on account of illness are notified to the clinic, and are supervised by that department. Notifiable infectious diseases are supervised by the Health Department. Children suffering from minor ailments, including mild cases of ringworm, eczema, impetigo, discharging ears, etc, are treated at the treatment clinic; ringworm cases are generally instructed to have X-Ray treatment at the county hospital. Children are also referred to the clinic by the Education Committee, the School Attendance Committee, the school attendance officers, and the parents of the children. SCARLET FEVER IN LONDON.--The a u t u m n a l increase of cases of scarlet fever in L o n d o n is especially large this year, the number of c a s e s of this disease notified being about twice as numerous as last year. T h e cases are distributed over London very m u c h in proportion to population, and are therefore probably due to natural behaviour of the disease rather than to any special cause of infection. It would be interesting to k n o w if other parts of the country are having a like experience. t ".14outine " cases are those discovered in school during medical inspection. " Non-routine" cases are those who have been otherwise discovered, or referred by head teachers or school managers,