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The provision requisite for each of these classes must now be considered in detail.
Class 1.—As already stated a large number of the children in this class can only be effectively
treated by segregation in institutions intermediate between the hospital and the special schools
situated in the country, but in order adequately to provide for these children whose physical debilitation
and deterioration constitutes a grave national danger a number of residential schools will be
necessary.
Class 2.—The relatively small number of children belonging to this class will leave or be excluded
from school and be referred for treatment at home by private practitioners, or for in patient
or operative hospital treatment.
Class 3.—In this class are collected the very large mass of cases revealed by medical inspection,
namely, physical deficiencies, which can be readily and economically treated if dealt with together at
suitable centres conveniently situated in regard to the schools.
Two distinct propositions have been considered by the Committee—
(1) That the Council should make arrangements with the existing hospitals and dispensaries.
(2) That the Council should establish school surgeries or clinics at which treatment
should be provided by its own medical officers.
Both propositions are alike in that the cost of dealing with the deficiencies enumerated above
is to be provided out of the education rate.
(1) Efficiency—The Committee find that the hospitals in the metropolitan area not only are
concentrated in those areas in which there are fewest schools but, further, that the spatial accommodation
in their buildings is in many cases inadequate or cannot be extended.
The Committee find that at the present time the dispensaries in the metropolis are few in
number, are not as a rule situated conveniently for the schools, or provided with suitable or adequate
accommodation, and finally that in various large areas (e.g., one district in S.E. London, with a population
of over 300,000) there are no dispensaries.
We are informed that neither the provident dispensaries nor the friendly societies at present
deal with the greatest and most difficult part of the problem, namely, the treatment of the teeth, eyes,
suppurating ears, and other conditions which require continuous and skilled care and attention. Such
cases were, we were told, dealt with by obtaining hospital "letters" for the patients.
Treatment through any dispensaries must either be given at the residence of the medical
practitioners who are dispensary officers, or on premises specially provided. If the first system, which
we are informed is the present ordinary practice, is adopted, and if the parents are further required
to accompany their children, not only will it be difficult to secure premises sufficiently suitable to be
approved by the Board of Education, but a serious waste of time and wages, involving constant
difficulty and friction, must result, and would probably militate very seriously against the children
receiving the treatment they would require. If new and specially equipped premises are to be provided
for the dispensaries, the cost must be borne by the Council, and is not likely to be less than that
which would be entailed by the provision of similar premises under the direction of the Council itself.
It is clear, therefore, that the hospitals and provident dispensaries of the metropolis cannot
adequately provide the treatment required, and even if such service were attempted, the efficiency,
i.e., the time and care given to children at any of the charitable or provident institutions referred to
where both adults and children attend, would be less than that provided in a school surgery or clinic
designed and equipped for the special needs of the school children. The treatment in such a school
clinic would be furnished by school medical officers under the immediate direction of the Council.
(2) Economy.—Although the question of payment to existing institutions is necessarily surpassed
by the considerations just detailed, it must receive further discussion. Such payment would, as a
rule, cover two sources of expenditure; the cost of accommodation and equipment on the one hand,
and on the other the cost of skilled attendance.
The Committee has not received any estimate of such expenditure and therefore cannot institute
accurate comparisons, but payments to institutions and departments founded for other purposes
probably would not offer such return as money expended in the maintenance of a school surgery or
clinic arranged and reserved for the direct purpose of treating the defects of the children referred.
It must also be evident that the indefinite series of payments to a large number of separate
institutions and the endless adjustments and assessments of payments to the medical staffs of these
institutions involved by such a system can only result in inextricable financial confusion and possibly
extravagance, whereas the administration of school clinics by the education authority can be financed
with accuracy and economy.
The proposal that the State should subsidise from public funds charitable medical institutions
in order to create a claim on the benefits of such hospitals or dispensaries for children or persons under
State authority, educational or poor law, raises a new and serious question of principle. The representative
meeting of the British Medical Association has already fully considered this question and
is resisting the proposal on the ground that any State medical service must be adequately organised,
must be administered on a systematic basis, and must be clearly distinguished from work undertaken
for charitable motives.
Recommendations.
(a) That, as the existing provision of private and hospital practice sufficiently meets the requirements in
the case of children requiring operative and in-patient treatment (who are thus removed from the direct purview
of the educational authority), no further steps be taken in respect of this class.
(b) That the Council should establish school clinics at suitable centres in the metropolis for the medical treatment
of the defects included in class 3.