View report page

Report of the County Medical Officer—Education. 101
CHAPTER XXXIII.
REPORT OF THE COUNTY MEDICAL OFFICER OF HEALTH AND SCHOOL
MEDICAL OFFICER (Dr. W. H.Hamer) FOR THE YEAR 1913.
Part II.— Education.
Introductory Note.
During the year 1913
progress has been made with the development of the school medical
work in the directions foreshadowed in the annual report for the year 1912. Among other things
attention has been especially directed to the reorganisation of medical and dental inspection and
reinspection, to the extension of facilities for medical and dental treatment, to "following-up," to
the effective control of infectious disease, and to widening the scope of the personal hygiene and
cleansing schemes.
As regards the routine medical inspection of children in elementary schools it may be noted
that 226,215 children were examined, and that 86,787 were referred for treatment for various
remedial defects. The question of the numerical strength of the medical staff and of the kind of
officers to be employed in this work has during the year received a considerable amount of
attention. The ordinary work of medical inspection had hitherto been carried out by a staff of
eight full time permanent, 22 full time temporary, and six part time school doctors distributed
in the several areas under the supervision of the four divisional medical officers. The inspection
of children in special schools and higher educational institutions, and other special work was
carried out by a separate staff of officers. Early in 1913 the Board of Education caused an
investigation to be made by its medical inspectors into the working of the administrative arrangements
for inspection and treatment then in force as the result of the decision of the Council of the
25th July, 1911. In the course of their enquiry the Board's inspectors visited the local offices of
the divisional medical officers, the treatment centres and the schools, and their comments and
criticisms were communicated to the Council in a letter dated 24th June, 1913. This letter is
reproduced in extenso on pp. 4-6, and inasmuch as the questions raised are fully dealt with in that
part of the report, it is unnecessary here to do more than state that the Board expressed general
approval of the arrangements for inspection and reinspection, but pointed out the need for certain
developments and further made a number of criticisms on points of detail. The methods
adopted for meeting these criticisms and the various considerations which influenced the Council
in arriving at its decisions are discussed in detail on pp. 6-8. In view of the importance of the
issues raised and inasmuch as the matter does not conveniently fall into place in the subsequenl
report it may be well here to refer to the fact that a subject which specially occupied the Council's
attention was the determination of the proportion of permanent to temporary, and of part time to
whole time officers, to be employed. In this connection I reported as follows:—
"The extremely satisfactory work which has been performed by the staff during the past
year could not possibly have been obtained from a staff previously untrained in the duties and
unskilled in the use of the necessary forms and symbols required in recording the results of medical
inspection. It is necessary that the school doctor should possess a training in public health; his
duties include reporting upon the sanitary and hygienic conditions in the schools under his charge,
and it is imperative that a considerable proportion of the staff should be skilled in the methods of
investigating outbreaks of infectious disease, inasmuch as prompt and decisive action must be taken
at the school itself, in order to avoid the dangers to life and interference with school work which
such outbreaks entail when extensive spread of disease takes place. Furthermore, it is desirable
that the staff, as a whole, should be thoroughly acquainted with school conditions, with educational
methods, and with the physical and mental development of normal and abnormal children, inasmuch
as it is their duty to advise in cases of backwardness, of retarded development, of speech
defect, and of other nervous conditions and defects which may render a child suitable for special
education. In this connection they should also possess a trained knowledge of the conditions of the
special sense organs in relation to education for these vitally affect a child's school progress.
The tilling up of the Board of Education's schedule for each child necessitates familiarity with a
number of special and complicated forms, symbols and criteria. Celerity and accuracy in assessing
and assigning to its proper category each particular item, under consideration during the inspection
of the child, must be attained if the work is to be both economically and satisfactorily carried out.
This knowledge, celerity and accuracy can only be acquired by the school doctor after considerable
practice. . . It was proposed when medical inspection was first undertaken in London that the
quarter-time staff originally employed should hold office only for three years. When new doctors
were appointed, the supervision and training, which their inexperience of the conditions of work
entailed, threw a great burden upon the supervising staff, and frequent changes resulted in such
slow and unsatisfactory work being done that the Council continued, as far as possible, to utilise
the services of the doctors beyond the limit of time originally fixed, with the result that permanency
and continuity in the work were, so far as possible, maintained."
As already mentioned, the general questions raised by the Board of Education's letter
concerning the work of the school medical staff are dealt with in succeeding pages, and it must,
therefore, here suffice to say that on 24th February, 1914, the Council decided that the number of
divisions should be increased to five, each under the control of a divisional medical officer; that 17
full time permanent, 20 full time temporary, and 20 part time school doctors should be employed
Medical
Inspection
and Staff
considerations.