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department in the case of children in the care of the Council. In addition he makes a
comprehensive inspection of the school each year and completes a full report to the
principal school medical officer on hygiene, equipment and diet in addition to the
physical and mental health of the pupils and the general running of the school.
Day to day medical care is provided by a local general practitioner who holds the
appointment of visiting medical officer. He undertakes National Health responsibilities
and has all the children and most of the members of the staff" on his list. He has regular
days for visiting and visits cases of casual illness as required: in addition he carries out
a routine physical examination of each child at least once a year.
Nursing care is available at all boarding schools and some of the larger schools for
young children have a whole time nurse. In the majority of cases a local nurse is engaged
to visit daily and carry out minor ailment and other nursing duties in the school.
All ancillary medical services, i.e., dental, ophthalmic, and orthopaedic inspection
and treatment, speech therapy and psychiatric investigation are provided at each school,
in some cases directly by the Council, but at most schools through the school health
service of the local authority of the area in which the school is.
School
leaving
procedure
To meet the requirements of section 57 (5) of the Education Act, 1944, each child
suffering from a disability of mind who is about to leave school is examined to determine
whether or not he requires supervision after he has left. Unlike the school leaving procedure
under the 1921 Act, there is no reference to mental deficiency. The duty laid on
the medical officer is simply to advise whether or not the child should be reported to the
local health authority as in need of supervision after leaving school. The further question
whether or not the child may subsequently require statutory action or eventual certification
under the Mental Deficiency Act, 1913, does not arise at this stage. The date of the
medical examination may not be earlier than six months from the date of the issue of any
subsequent report under section 57 (6) and such a report must be issued not later than the
last day of the term in which the child's 16th birthday occurs. The local education
authority has a discretion in arranging a school leaving examination for children who,
although backward, are still in ordinary school. When the headteacher of a secondary
modern school considers the child's mentality is such that he will require further supervision
after leaving school, similar statutory procedure is followed as for a leaver from
a special E.S.N. school but it takes place at the age of 14½ instead of 15½ years.
The local education authority is not required to inform the parent of the date and
place of examination, the intention to examine or even the result. No right of appeal
exists and whether a report is issued to the local health authority is purely a matter for
decision by the local education authority.
When the approved medical officer recommends that a child should be reported
under section 57 (5) the social worker of the health department experienced in mental
health visits the parent and enquiries into the home circumstances of the family. A full
report is made on the social aspect of the case, with special reference to the type of home
in which the child will live, the ability of the parents to provide care and supervision
adequate for the type of mentality the child has and the parents' wishes as to the child's
future care. Although co-operation by the parent is not essential to any action under
section 57 (5), this last duty is most important because the consent of the parent or
nearest relative, which may require to be given formally in writing, may well be
necessary before any action can be taken under the Mental Deficiency Acts as a result of
a report under section 57 (5).
This social report is added to the child's school health and education records and the
complete dossier of the child's school life is then considered by the senior medical
officer in charge of this work throughout the County, who has to decide whether to
recommend that a report to the local health authority be issued, and to indicate to
the local health authority the form of care which may be provided if this is done. This
medical officer is the better able to recommend a report or otherwise as he is also responsible
for the immediate medical oversight of the Council's work under the Mental
Deficiency Acts.
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