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17
dynamic situation for which it is designed to cater. Flexibility is of
the essence in this delicate and difficult field.
At school, periodic medical and dental examinations and health
checks (including screening of hearing and vision) of all the pupilsthere
are 47,815 on the roll of ordinary schools and 1,160 on that of
special schools at the present time in Wandsworth—are undertaken by
doctor, dentist and nurse respectively. Two school treatment centres
are run on behalf of the Inner London Education Authority, which
reinforce the facilities available in the child health clinics. Medical
and nursing advice is thus readily available to head teachers in relation
not only to individual children but also to environmental hygiene
(in which the public health inspector has an important contribution
to make), the control of infection and infestation, and to any other
school health problems. There is, of course, frequent contact with the
Medical Adviser to the I.L.E.A. and his staff, and with the Divisional
Education Officer. Indeed, close liaison with parents, general practitioners,
hospital consultants, social workers, teachers and relevant
statutory and voluntary organisations is imperative in the interests of
child health generally and of handicapped children in particular.
The importance of continuity of medical supervision in childhood
from birth to school-leaving age, highlights the potential crucial role
of the family doctor in the vital sphere of developmental paediatrics.
Ideally, as the Report of the Sub-Committee (of the Standing Medical
Advisory Committee of the Central Health Services Council) on Child
Welfare Centres recommended in 1967, the child health service at
present provided by local health authorities should become an integral
part of the work of the general practitioner; if this ideal were to be
realised on a country-wide basis, however, the development of group
practices, the provision of purpose-built accommodation, and the
attachment of health visitors would all need to be fostered. The SubCommittee,
under the distinguished chairmanship of Sir Wilfrid
Sheldon, envisaged: —
"... the Child Health Service of the future concentrating on the
maintenance of the health of infants and young children, detecting
at an early stage the presence of handicap and departures from
normal health, and giving advice and counselling to parents on the
manifold problems which may arise during the raising of a family.
The doctors who are to do this work will require special training and
experience, well in excess of what so widely obtains at the present
day. The clinics of the future must carry a high reputation for the
quality of their work...."
but recognised this to be a long-term matter. In the interim, therefore,
it strongly commended special training for both local health authority
medical officers and general practitioners engaged in this field. In this
borough, family doctors undertake over two-thirds of the clinical
sessions arranged for pre-school or school children and this active participation
in the child health services provided by the Council is doubly
welcome—it is in the spirit of the Sheldon Report and it enables the
preventive outlook to permeate the medical profession. Here again
the importance of thorough undergraduate medical and indeed nursine
education in the promotion of child health is only too clear—it will
also encourage, incidentally, better liaison between hospital and
general practitioner.