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(d), (e) and (f)—Health surveys
"It is clear that the nature of the school health visitor's inspections has changed from
earlier years when the emphasis was, necessarily, on personal hygiene. Quite apart
from the introduction of comprehensive surveys of general health, discretion has already
been given to divisional medical officers to drop personal hygiene inspections at senior
boys' schools.
"We suggest that these changes should be recognised (i) by a change in terminology
from 'hygiene inspection' to 'health survey' and (ii) whilst retaining an annual
comprehensive health survey for all pupils, by giving divisional medical officers complete
discretion as to the frequency of intervening health surveys. For example, whilst, at
some schools, no regular, termly, health surveys may be necessary, at other schools
some, or all, of the pupils may need to be seen more often than once a term. We
consider that, in the context of the reduced incidence of defective hygiene the routine
inspection of all pupils once a term is unnecessary, and that the school health visitor's
time would be much better utilised through such a system of selective health surveys."
(g) and (h)—Vision testing
"Ideally the school health service arrangements should ensure, by vision testing, that
every child needing spectacles has them as soon as possible; that the spectacles are
changed whenever necessary during growth; and that the children leave school wearing
correct glasses. The follow-up and re-inspection procedures appear to ensure satisfactorily
that once a child has had glasses the necessary changes are made, but we have
given special attention to the vision testing arrangements.
"A child is normally now first tested for vision after reaching the age of 7 years but
the suggestion has been made in several quarters that it is desirable for routine vision
testing to be carried out for all 5-year-old entrants to school. It cannot be denied that
there are young children whose defective eyesight could be aided by spectacles, but the
questions that arise are (i) the practicability of testing all entrants each year to discover
such cases; (ii) the necessity for testing all entrants, when doubtful cases can always be
referred for special inspection; and (iii) whether any harm, medical or educational,
accrues in those cases who are not discovered until the age of 7 years.
"In view of the great practical difficulties of testing young children, who do not
know their letters, by subjective methods, such as picture charts, some authorities have
engaged ophthalmologists to test by objective methods. In London, with 50,000
entrants a year, this would be extremely expensive, even if the specialist staff were
available. Even subjective methods, using special charts, require two persons to carry
out the test, and a considerable amount of time on each case so that the possible
additional nursing staff requirements would be very large.
"Since reasonable doubts exist as to whether, in fact, any medical or educational
harm is suffered by those few children who, not having been picked out for special
medical examination, wait until 7 years of age before receiving spectacles, we consider
that a decision on the introduction of testing at a younger age should await the results
of special field studies.
"We consider that the ages at which vision is tested need not automatically be the
same as those at which periodic inspections are carried out and that vision testing can be
associated at whatever ages necessary with the annual school health visitors' comprehensive
health surveys. However, we consider that vision testing should remain,
as indeed it must, a part of each general medical inspection.
"This being so, and in view of the recommendations we are making as to the ages
at which periodic inspections should be carried out, we recommend that (i) vision
testing should also be carried out, either as part of the comprehensive health survey, or
at an ad hoc session at age 7 years; and (ii) the 13-year-old vision test by school health
visitors should be discontinued.
"In the future, should the results of the field trials establish it to be both desirable
and practicable to test all 5-year-old entrants' vision, and a scheme for this be introduced,
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