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On an average six sessions (half-days) are devoted to each school, that is about two sessions
to each department; among the poorer schools sometimes as many as three or four sessions may be
given to a department.
The first selection of the cases to be seen was made by the teachers. It is obvious that only
very marked cases of defect are likely to be thus noticed and that the beginnings of disease are the
stages at which detection is necessary, not when such damage has been done that the child is suffering
in its education. Between 20 and 30 per cent, of the cases submitted by the teachers were not suffering
in any way. For instance, the children submitted for defective hearing, a condition which should be
known to the teachers, varied greatly, some teachers presenting many cases, others none. Another
teacher will say that he has no children requiring examination by the doctor, whilst in the next school
a long string of healthy dunces may be presented. Speaking in the most general way, the teachers in the
provided schools make a more careful selection than those in non-provided schools ; and whilst in particular
instances the trouble and pains exerted by the teachers is very great, on the whole their assistance
and willing co-operation is only secured in a minority of cases, least often among the boys and most often
in the infants' schools. Some teachers regard the Medical Officer's work as inquisitorial, and a few
of the non-provided school teachers have even objected to the doctor's visits, whilst others have expressed
themselves as failing to see any use in it. A very short time may, however, be trusted to alter
all this.
Experience shows that medical inspection of schools extends and grows wherever it is introduced.
The following up of the cases is as yet done in a very imperfect way. Much of the advice given
is wasted. For instance, many of the children with offensive discharging ears have had this condition
for months and the parents cannot be induced to get them treated, and yet the condition is one of the
most fatal of the chronic troubles of childhood.
Many of the cases seen, and neglected or refused treatment by the parents, are either attending
school or are excluded for months or years through parental ignorance or indifference, which at present
we are helpless to prevent.
In some cases where hygienic conditions are at fault the Medical Officer of Health is informed
and action taken ; in others the school managers are informed and something done in this way ; but
where the teachers choose to exert themselves these difficulties seldom arise, and the physical and mental
conditions in any school are to a large extent an index of the teachers' point of view in respect of their
professional work.
The systematic keeping of individual records of each child, which is the ideal to be attained, is
not worth doing at present. In Germany, where the whole intellectual level of both teachers and
parents is considerably above that in this country, a card system (" The Wiesbaden System ") is worked
with good results. Every child is submitted to medical inspection in its first, third and fifth year of
school hfe, and those requiring it are kept under more frequent observation. Two-thirds of the children
referred in Mannheim during 1904-5 saw a doctor within 8 days, and 75 per cent, of the children
in Leipzic were submitted to their own medical man before the school doctor's next visit.
A register of some kind should be kept in each school, in which the Medical Inspector could make
entries in respect to premises or individual children where he thinks action should be taken, and this
register being submitted at each managers' meeting should also show the action taken and the ultimate
result. The work of the medical Inspector would be made more effective through the keeping of
such a register, and the school managers would also be enabled to exert a greater influence for the good
of the children.
The work of the medical inspectors in the various districts cannot be reported on at present so
as to be assessed at its full value, or to do justice to its extent. To the doctors themselves the
school work has proved of such interest that on an average they have taken very much more time and
trouble over this service than the conditions of their appointment either demanded or expected. A great
deal of work has been done in connection with special examinations, infectious diseases, the cleansing
scheme, and other enquiries, but of the regular routine of school inspection the following tables give a
survey. It should be added that visual troubles, except in the case of acute or dangerous diseases,
were left out of consideration till the spring, and consequently are not returned in these figures, with
the exception of certain serious cases ; dirt and vermin are left to the school nurses.