1851

Capper, Dr. J. Rose Bradford, Professor G. D. Thane, Pro-fessor E. H. Starling, Professor F. M. Simpson, Lord Cromer,Sir Philip Magnus, Sir Edward Bush, Sir Thomas Barlow,Sir John Tweedy, Sir Dyce Duckworth, Mr. Sydney Holland,Sir J. Batty Tuke, Sir Norman Lockyer, Sir William Ramsay,Sir Alexander Pedlar, Sir James Reid, Sir Albert Rollitt,Sir J. W. Swan, Sir Victor Horsley, Sir T. B. Crosby,Dr. C. W. Kimmins, Professor A. Caldecott, Dr. T. Buzzard,Professor A. W. Crosley, Lieutenant-General Laurie,Professor A. R. Cushny, Dr. T. L. Mears, Dr. A. D. Waller,Mr. Stephen Paget, Dr. Ludwig Mond, Mr. P. M. Wallace,Mr. George Alexander, Mr. R. Blair, Mr. Hugh Chisholm,Dr. C. Carey Foster, and Dr. W, Garnett.

THE MEDICAL INSPECTION AND TREAT-MENT OF SCHOOL CHILDREN.

. ON June 21st a conference was held at the Institute ofHygiene on the subject of the Medical Inspection and Treat-ment of School Children. The conference room was wellfilled with an audience composed of medical men and personsinterested in education, and the President of the Institute,Sir W. H. BENNETT, occupied the chair.The PRESIDENT explained that the meeting had been called

in order that some definite information on the many im-

portant questions involved in the subject of medical inspec-tion might be obtained and forwarded to the proper quarter.Two points must not be lost sight of-the danger of

minimising parental responsibility and the recognition ofthe interests of the medical practitioner in relation to thetreatment of State-educated children.The first motion, proposed by Dr. J. C. THRESH (medical

officer of health of Essex) called upon the Board of Educa-tion to issue definite instructions securing uniformity in thestatistics relating to medical inspection. Dr. Thresh had

prepared the following statement :-

Statistics based on Reports received from 20 Counties andTn-n;m..s an England Children Emamined. over 40,000).

The total result of the figures was that 74’ 9 per cent. of thechildren examined required attention, though some allow-ance must be made for duplicates. Dr. Thresh remarkedthat the voluntary hospitals should not be expected to dealwith more than a minority of these cases.

Dr. J. F. BUTLER H. HOGAN seconded the motion, whichwas carried unanimously.Mr. J. HERBERT PARSONS proposed the second motion :That the various education authorities should be responsible for seeing

that the serious defects revealed by the medical inspection of schoolchildren are promptly attended to; that in the methods adopted dueremuneration should be secured to the medical practitioners doing thework; and that the authorities should, as far as possible, recover thecost, or a portion thereof, from the parents of the children attended.

Mr. Parsons expressed himself in favour of the establish-ment of school clinics for ophthalmic cases. It couldbe done quite satisfactorily without very large expense.The hospitals would not suffer if the school oculists, in the

. case of London, did the work which their titles suggested,instead of performing duties which teachers or nurses couldeasily be instructed to do. But why treat all classes ofdisease in school clinics ? To treat adenoids the clinic

, would have to be a hospital. Different methods should be, adopted to meet different circumstances.

Mr. H. S. BARAWELL thought that it would be a goodthing if the hospitals would fall in with the wish of theLondon County Council to utilise existing institutions, pro-

, vided it was certified that patients were unable to pay, and, that the almoner’s department should watch the cases.

, Payment should not be in the form of subscriptions or dona-tions or it would open the door to the suggestion that theCouncil should be entitled to appoint a certain number ofgovernors. The Council should pay by means of a capitationgrant of an elastic kind. He feared that, if the hospitals

-

said" No " and compelled the Council to face the questionof starting clinics, the whole matter would lapse, and

especially that dental treatment, which had not yet been

f decided upon, would never be undertaken.

Dr. DAVIDSON described the treatment of school children

ï by public authorities as another attempt to encroach on therights of the general practitioner.

s In reply to Dr. LILIAN CHESNEY, who asked what was’ to be done in country districts where hospitals were not

1 available,

Dr. STEPHENSON described the practice in Somerset in-

dealing only with ophthalmic cases. The school population’

was 60,000 and the yearly inflow of new children was 7000.About 10 per cent. required to have their refraction tested.

f A good proportion of this 700 needed to be seen more thanonce a year ; by doubling the figure they got 1400. Perhaps

e 400 were attended by other means than by the county council.

,1 They appointed an ophthalmic surgeon for £100 for tenweeks’ service, and he could see 20 children per day per

,- school week of five days, or 1000 children in ten weeks.

e Spectacles were bought under a large contract for 2s. 6d. apair and supplied free to the comparatively few parents whowere unable to pay for them.The motion was then carried with three dissentients.Dr. WILLIAM HILL moved a further proposition to the effect

- that educational authorities should avail themselves, in thefirst instance, of existing institutions for the treatment of

_

children whose parents were unable to pay. This would be, an excellent thing, he said, for large and small hospitals.

Dr. BARLOW seconded, on the ground that general practi-- tioners would lose nothing if this principle were adopted.

The motion was carried.A vote of thanks to the President terminated the

proceedings.

BRITISH MEDICAL BENEVOLENT FUND.

AT the June meeting of the committee 15 cases were con-sidered and grants amounting to E129 made to 12 of theapplicants, two cases being passed over and one postponedfor further inquiry. Dr. F. G. Crookshank was appointedhonorary local secretary at Barnes and Dr. C. E. Solomon anadditional local secretary at Liverpool. Appended is anabstract of the cases relieved :-

M.R.C.S., L.R.C.P., aged 38 years. Has had a small country prac-tice but for the last eight months has been incapacitated by generalparalysis of the insane and is now confined in an asylum. Smallsavings have been quite exhausted by providing a locum tenens andby unavoidable expenses of the illness, and so far it has not beenpossible to sell the practice. Two children, the younger only a fewmonths old. Voted £10 to the wife.Daughter, aged 53 years, oi late 1LR.C.S., L.S.A. No income ; health

too indifferent to undertake laborious or continuous work, but obtains alight post as companion when able to do so. Relieved three times, .830.Voted E10.Daughter, aged 58 years, of late L.S.A. No income. Has supported

herself as housekeeper or companion for the last 14 years, but is nowincapacitated by locomotor ataxy. Voted £12.Widow, aged 63 years, of M.D.Edin. Quite unprovided for at

husband’s death 18 months ago and endeavours to make a living byletting lodgings. Is allowed a few shillings a week by some distantrelations. Voted £6.Widow, aged 90 years, of F.R.C.S. Since husband’s death has been

living on the proceeds of the sale of furniture and now receives anOld Age Pension. No children ; is quite blind. Voted £18.Daughter, aged 52 years, of late L.R.C.P. Edin., L.S.A. Unable to

earn a living on account of heart disease and defective eyesight, and isdependent on two sisters who have to support themselves and can illafford to help. Relievecl four times. £36. Voted .810.Daughter, aged 60 years, of late ::U.RC.S., L.S.A. Has a pension of

1852

£14 a year from the Admiralty and receives a little help from Lloyd’sPatriotic Fund. Relieved 12 times, B70. Voted £5.

Daughter, aged 62 years, of late M.R.C.S., L.S.A. No income, andbeing mentally deficient is dependent on a relation who can onlyhelp with difficulty. Relieved three times, :B36. Voted :E12.

Widow, aged 62 years, of L.R.C.P., L.R.C.S. Edin. Since being left awidow, nearly 15 years ago, has supported herself by taking lodgers butfinds the necessary work increasingly difficult. Two children, onejust self-supporting, the other still at school. Relieved twice, £24.Voted £12.Widow, aged 31 years, of L.S.A. No income ; endeavours to maintain

herself by nursing, but has been incapacitated during the last threemonths by acute rheumatism, and is told that a rest is absolutelyessential before taking further cases. Three children, ten to three.Relieved twice, :B15. Voted £10.

Widow, aged 58 years, of L.R.C.P.,L.R.C.S., Ireland. Since husband’sdeath has endeavoured to support herself by maternity nursing, but isnow nearly blind. Relieved 15 times, :B137. No children. Voted £12.Widow, aged 59 years, of M.D. St. Andrews. No income. Slight

occasional help from children. Lets lodgings, but has been obliged topart with some of her furniture to make both ends meet. Relieved fiveimes, ,c60. Voted 212.

Contributions may be sent to the honorary treasurer, Dr.Samuel West, 15, Wimpole-street, London, W.

A COMPLIMENTARY DINNER TODR. J. F. W. TATHAM.

THE retirement of Dr. J. F. W. Tatham from the post ofSuperintendent of Statistics in the General Registry Officewas made an opportunity for entertaining him to a compli-mentary dinner at the Grand Hotel on June 17th.The chair was occupied by Sir Shirley F. Murphy, who was

supported by Dr. F. J. Allan, Dr. Bushell Anningson, Dr.G. Paddock Bate, Dr. Sidney Barwise, Dr. W. A. Bond, Dr.G. S. Buchanan, Dr. H. Timbrell Bulstrode, Mr. BrudenellCarter, Dr. A. K. Chalmers, Dr. S. Monckton Copeman,F.R.S., Dr. Sidney Coupland (Lord Chancellor’s Visitor inLunacy), Mr. R. Musgrave Craven, Mr. George H. Day, Dr.T. Hugh Dickson, Sir William Dunbar (the Registrar-General), Lieutenant-Colonel R. H. Firth, R.A.M.C., Dr.Wilfred W. E. Fletcher, Dr. F. E. Fremantle, Mr. KennethGoadby, Dr. James Kerr, Mr. George King, Mr. R. 0. K.

Lempfert (representing Dr. W. N. Shaw, F.R.S.), Dr. R.Bruce Low, Lieutenant-Colonel W. Grant Macpherson,C.M.G., R.A.M.C., Dr. J. Middleton Martin, Dr. J. C.McVail, Mr. G. Millson, Dr. A. A. Mussen (representing Dr.E. W. Hope), Dr. Arthur Newsholme (principal medicalofficer to the Local Government Board), Dr. G. Newman,Dr. James Niven, Colonel J. Lane Notter, Dr. H. FranklinParsons, Dr. J. F. Payne, Dr. George Reid, ProfessorW. J. Simpson, Dr. S. Squire Sprigge, Dr. T. H. C.

Stevenson, Dr. R. Deane Sweeting, Dr. J. F. J. Sykes, Mr.A. C. Waters, Dr. B.- A. Whitelegge, C.B. (H.M. Chief

Inspector of Factories), Dr. Dawson Williams, Dr. C. W. F.

Young, and Mr. G. Udney Yule. Dr. W. H. Hamer andMr. Herbert Jones acted as secretaries.

After the loyal toasts had been honoured Sir SHIRLEYMURPHY proposed the health of Dr. Tatham, and in re-ferring to the long connexion of the latter with all thatconcerns public health, he said: " ’We might with appro-priateness speak of his 16 years’ service at Somerset Houseas the crowning work of his life. Some people would saythat they had never heard of Dr. Tatham, but we who areengaged in public health work know more than any othershow greatly this country is indebted to him and are there-fore delighted to gather together to do him honour. Dr.Farr, one of his predecessors, realised what could be madeof the classification of diseases, and his system was so ablethat it only wanted modification. Dr. Tatham, in modifyingit, has brought it into line with modern scientific ideas."Sir Shirley Murphy continued by saying that he would notbe exaggerating if he alluded to the joint work of Dr.Tatham and of the Registrar-General as being one of the mostactive causes that could be found in diminishing the death-rate in this country. The tables that had been pub-lished in the reports of the Registrar-General were lessonsof the first importance, and those relating to infantile

mortality had thrown much light upon the causes of deathamong young children. When the system of death registra-tion was first proposed it was not intended that the cause ofdeath should be included in the information asked for, and itwas only during the passage of the Bill through the House of

Lords that this requirement was inserted. Although medicalcertification of death became compulsory in 1874, Dr. Farrsome time previously had approached the Royal Collegesand the Society of Apothecaries with a view to inducingmedical men to certify the cause of death voluntarily,so that it was due to the medical profession to saythat in 1874 Parliament was only continuing workwhich had been engaged in by our profession forsome time. One of the earliest subjects which attractedthe attention of the Society of Medical Officers ofHealth was the necessity of knowing not only the number ofcases of death, but of illnesses also, and Dr. Tatham, whilemedical officer of health of Manchester, took up the questionof notified disease and made arrangements with his colleaguesto send him records of disease in their districts, he himselfdistributing the combined records among the reporters. WhenDr. Tatham went to Somerset House the Local GovernmentBoard took over and extended this most useful work. Duringthe time that Dr. Tatham had been at Somerset House greatchanges had taken place in medical knowledge, and it wasnot too much to say that their guest had at all times placed thebest medical knowledge at the service of the Registrar-General.After referring to the admirable work which Dr. Tatham haddone as chairman of the Statistical Committee of the CancerResearch Fund and as a member of the Inter-DepartmentalCommittee on Physical Deterioration, Sir Shirley Murphyconcluded by recalling the fact that their guest’s earlierlife had been spent as a public health administrator, andpointed out the advantages to the State of being able toobtain recruits for responsible offices from among those whohad already shown themselves to be men of parts. In con-clusion, Sir Shirley Murphy said that Dr. Tatham had alwaysseemed to be the servant of the public health world, andso ready was he to render help to all those who asked for itthat he had made them feel that they had a right to hisservices and to his assistance.

Sir WILLIAM DUNBAR said that he was glad to be presentthat evening, not only to show his appreciation of the workof Dr. Tatham, but also to have an opportunity of thankingmedical practitioners for the way they had helped his bureau.Sir Shirley Murphy had spoken of the remarkable services ofDr. Tatham, and he was in the fortunate position of beingable to confirm the chairman’s words as few others could.The seven years he had spent at Somerset House had beenmade much happier and much pleasanter because it had beenhis good fortune to be associated with such an able colleagueas Dr. Tatham. Indeed, not being himself a statistician, itwould have been quite impossible for him to have written thereport on the last census without the assistance of Dr.

Tatham, of Mr. Noel Humphreys, and of Mr. Waters. Re-

ferring to the declining birth-rate, the Registrar-Generalsaid that he did not hold the pessimistic views which wereattributed to some persons. He certainly did not considerthat England was going downhill.

Dr. TATHAM, in response, said that when he realised theimport of the presence of so many eminent public healthofficers, he was impressed with the fact that he never knewthat he had so many sympathetic friends. He felt thathe did not owe the honour that had been done him to

any merits of his own, but rather to the general feelingof comradeship that existed between members of themedical profession and himself. Statistics, he said, mustbe more or less defective, but his aim had always beento reduce their defects to a minimum. Speaking with anexperience of 16 years, he could still express a very highopinion of the value of the certification of the cause

of death by medical men, and the replies to the 5000letters of inquiry which were sent out each year fromthe General Registry Office with a view of clearing updoubtful statements were distinctly helpful in securingaccuracy. When compared with the statistics of foreigncountries we had nothing to be ashamed of in those of ourown. When appointed Superintendent of Statistics he didnot sever his connexion from public health administrationwithout much searching of heart, but his life at SomersetHouse had been made happier and easier from the loyalsupport he had received from his colleagues in the medicalprofession as well as from every member of the staff. He

expressed the hope that his successor would be no lessfortunate in this respect.

Dr. WHITELEGGE submitted the toast of " The Chairman,"who responded in literally two words.