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Report of the Medical Officer (Education).
125
staff at the end of 1910 numbered 84 doctors, of whom 70 were men and 14 women, increased on
January 1st, 1911, to 114 doctors, of whom 96 were men and 18 women. The numbers of the staff
are as set out below :—
The original scheme of 1908 as completed in September,
1910.
The scheme as extended in 1910 to take effect from
January 1st, 1911.
Permanent Staff.
Medical Officer (Education).
Two Assistant Medical Officers (whole time).
Two Assistant Medical Officers (half time).
Seven Assistant Medical Officers (quarter time).
(Including specialists in mental, ophthalmic,
aural, orthopedic and dental work).
Temporary Staff.
12 Medical Inspectors (quarter time).
Permanent Staff.
Medical Officer (Education)
Four Assistant Medical Officers (whole time).
One Assistant Medical Officer (half time).
Eight Assistant Medical Officers (quarter time).
(Including specialists in mental, ophthalmic,
aural, orthopedic and dental work.)
Temporary Staff.
100 Medical Inspectors (quarter time).
All detailed enquiries in the way of important hygienic school work are carried out by the
permanent staff, who are trained and skilled hygienists. The medical inspection is not technical work
in this sense, but work which everyone qualified in medicine ought to be able to do. It presents
no special features which cannot be learned in a few weeks, and being such routine work, and there
being such an immense mass of it in London in comparison with the other medical work, it would always
be difficult to get a good class of officer to give up all his time to do this work unless a comparatively
high salary be offered. On the other hand the very highest type of medical practitioner can be secured
who is willing to do it for a time early in his medical career, but this good type of officer will not do it
always, and if these appointments were permanent the people who would retain such routine appointments
would be those wanting in activity and originality, and the staff would gradually come to
accumulate a large proportion of routine second rate workers content to go on in the groove. These
officers once in possession could not fairly be displaced, but this result is avoided by the rota method.
The criticisms which have been made in regard to medical inspection in London apply only
to a time when the staff was insufficient to cover the area. In May, 1910, before the scheme was
fully developed and when only 56 doctors were at work, a letter was received from the Board of Education
in which the opinion was expressed that the staff as proposed was insufficient for the work.
Suggestions for a further increase of "staff to do all that is likely to be required for the next three
years" was asked for by the appropriate sub-committee. As the Board of Education had foreshadowed
the examination of a third age group of children as likely to be required as a Code requirement, it was proposed
that an additional age group of children between 8-9 years old should be inspected in addition
to the entrants and leavers. It was pointed out, however, that the staff arranged a couple of years
before to be completed in September, 1910, was sufficient to carry out all Code requirements. Finally
it was decided to increase the staff as already shown as from January 1st, 1911. Such a staff is quite
sufficient to do all the medical inspection likely to be required by the Code and the children of the
extra age group in addition.
In previous years a good deal of careful work was done on the methods of medical inspection
especially with a view to ascertaining the points on which economies of time could be practised, for
although a thorough clinical examination might be made of every child, the results to be obtained
from such an examination would be quite incommensurate with the cost. For public health purposes
it is necessary to devise a method which will result in all defects of importance being noticed,
and yet will take up but little time, and consequently will not be unduly costly.
Prior to the statutory medical inspections being required we carried out the "routine" examination,
by which all children suspected of any defects were noted on special lists by the school teachers
and were seen by the school doctors on their visits. The doctors also went through the department and
picked out any children who seemed in need of examination. The simplest method was to "fall out"
all noted by the teacher and then inspect the rest. It is obvious that the personal equation of the
teacher is checked considerably by this method. Every child can be inspected, and if no time is
lost in entering up forms and making unnecessary investigations it is easy to check one child a
minute. This scheme is most effective in detecting children with ailments for treatment, and comparative
tests show that very few cases are missed.
The method now used ensures the finding of all the children with defects, but is much slower
than the older method owing to the clerical work and the detailed examination of the healthy cases.
The older method was temporarily retained during the year in the infants' departments; only selected
children were examined in full detail.
The time of examination is also decreased when the children are not stripped, and formerly when
the staff for medical inspection was numerically insufficient, stripping was not encouraged, as it took
one-third more time. When the children are stripped to the waist the examination gives a greater
impression of thoroughness and utility, and the fuller the examination the better does it seem to be
appreciated by the parents. There is no doubt of the influence which a first class examiner has on
both parents and teachers. The grip of such an examiner cannot be described, but it is at once felt,
and the effect of his work must outweigh any smaller considerations of office routine involved in the
Medical
Inspection.