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A Minority Report was also submitted in reference to Question IV., as to the means which should
be adopted for the supply of certain additional provision necessary for the medical treatment of school
children—
The two simplest methods are—
1. To set up school clinics working under the immediate management and supervision of the local
education authority.
2. To utilise existing types of institutions, giving, if necessary, financial assistance.
It can be argued that the institution of school clinics would be simple and elastic. If the treatment of children
of school age were an entirely new problem demanding consideration for the first time, much might be said for placing
their health and education under the same authority, however keenly we might feel, as some of us do, that medical
treatment is not in principle a strictly educational duty and should not be cast on the education rate. The need
for providing treatment for children has, however, engaged public attention and has called into existence various
types of institutions whoso special function is to provide that treatment. We are confronted, therefore, by the
accomplished fact that the ground is to some extent already covered and must consider whether the existing
provision can be utilised as far as it goes and extended to meet the need. We must remember that, as part of their
daily routine, existing institutions can do and are doing, so far as their present resources permit, a great deal of
the work which the local education authority would do if it set up clinics. In many cases the necessary appliances
and accommodation are already provided, though at present the existing provision is inadequate. We understand
that at certain times even this provision is unused, but might be more fully utilised by arrangement, especially
if funds were forthcoming to provide additional staff. In this way part of the expenditure on buildings would be saved
which would otherwise be inevitable, and even if it were necessary to help an institution to extend its accommodation,
the room thus provided would be available for the general use of the institution when not required for children.
Again, the section of the Act which gives the local education authority the power under which any proposed action
would be taken, contains a special proviso "that in any exercise of powers under this section the local education
authority may encourage and assist the establishment or continuance of voluntary agencies and associate with itself
representatives of voluntary associations for the purpose."
This proviso clearly contemplates that the course we recommend was one which a local education authority
would do well to adopt, otherwise it is difficult to see why Parliament should have inserted words to this effect.
In short, the Act and circular explaining it evidently contemplate in the first place an attempt to use and extend
existing institutions, a view in which we concur. It must not be forgotten that existing institutions can deal with
persons during their entire life, while medical treatment provided by local education authorities in that capacity would
only be available to persons during their school career. An education authority could only treat between the ages
of three and, say, fifteen, and has no power over a child during the first three critical years of its life, when
greatest harm is usually done. Under our proposals a person would be treated all his life long, whether of school
age or not, at the type of institution which exists simply to supply such treatment. If the Council were to set up clinics
a person would be treated, say, at a hospital from birth to three, from three to fifteen at a school clinic, and from
fifteen onward at a hospital again. We have had before us the secretary of the Provident Medical Dispensaries
Association, who described to us the work of his society. The object of his society was to provide through the
general practitioners medical treatment for ordinary ailments of the working classes, and he assured us that an effort
would at once be made to open medical clubs or dispensaries where they might be wanted, if the Council gave any
encouragement.
Should the Council choose to use its power to treat, we think that the various hospitals, etc., should be
approached and asked what they would be prepared to do, if necessary, in return for financial aid.
In spite, therefore, of the attractiveness at first sight of the system of school clinics, we think it would be
unwise (by setting up, at the cost of the education rate and under the immediate management of the local education
authority, a number of what would in fact be children's hospitals) to add another type of institution providing medical
treatment to those already existing, unless and until such institutions have proved incapable of the extension and
co-ordination necessary to meet any given need.
They recommended that to supply the additional provision for the medical treatment of school
children, which has been found desirable, the Council should utilise existing types of institutions,
giving financial help, if necessary, and receiving special facilities in return for any grant of public
money.
The Education Committee on the 16th December, 1908, resolved :—
(а) 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 to supply the additional provision for the medical treatment of school children which has been
found desirable, the Council should utilise existing types of institutions, giving financial help, if necessary, and
receiving special facilities in return for any grant of public money, but that in districts where no suitable institution
exists, and where within a reasonable time it shall have been found impossible to make the necessary provision by an
extension of existing institutions, the Council should consider whether in default of other means it shall make the
provision itself.
DEVELOPMENT OP ARTICULATION.
A short account was given in the last Annual Report of the development of capacity for
articulating consonantal sounds. Some 650 children had been carefully tested with 227 test sounds
embracing 21 single, 75 double and 13 triple consonantal sounds. It was shown that the development
of articulatory capacity is not uniform, but by fits and starts and at different ages in the two sexes.
Dr. Ernest Jones has continued his enquiry analysing the development of each group of sounds and
the nature of the mistakes made. The investigations on consonantal sounds would be valueless unless
neighbouring sounds were also stated. These neighbouring sounds have an exceedingly great influence
on the enunciation of the sounds tested. This is true not only of neighbouring sounds but also of
comparatively distant ones. For instance, three children can pronounce the "th" sound in the word
"think" for every two who can pronounce it in the word "thin." In general, a sharp terminal
sound increases the facility with which the initial sound can be produced. Two investigators using
different test words might thus easily arrive at quite different conclusions. The word pronounced
immediately before the test word also exerts a considerable influence on the accuracy of the word in
question. The effect of the contiguous vowel is important but has not been followed up.
Replacements of consonants.—In studying the character of mispronounced words
replacements have been especially noted.
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