View report page

132
I have chosen, then, what I call the historical approach—that is, noted our
expansion year by year and how, starting as a School Medical Service, we are slowly
changing over to a School Health Service. This necessity to be a medical and treatment
service as well as a preventive service was imposed upon us by circumstances,
if not by conscious design, but our idea of treatment was somewhat different from
that held by the usual medical agencies. Our aim was so to treat the child that " he
was able to benefit from the education provided for him." In other words, we dealt
with the whole child, not just a part of him. The child has always been more to us
than the disease and, in making him fit for education, we were making him fit for life
itself.
In the early years of this century medical treatment for many children was not
easy to come by. In his report for 1908 the Medical Officer of Health for Bradford,
Dr. Lewis Williams was constrained to say that, after 15 years of medical inspections,
the defects discovered among Bradford school children remained untreated despite
the medical agencies, the private practitioners, the Royal Infirmary, the Children's
Hospital and the E.N.T. Hospital apparently available to all.
Dr., later Sir, George Newman's reports endorsed all that the Bradford Medical
Officer of Health had found and it was soon evident that inspection without treatment
was a waste of time and money. It was not enough that skilled medical advice should
be available; it had to be organised before the children could take advantage of it ;
it had to be available in a form convenient of access or the neglectful parent would not
accept or seek treatment, or complete it when begun; and it had to be within the
parents' economic resources or free if the circumstances required it.
The great majority of defects found at these early routine medical inspections,
apart from those caused by poverty and under-feeding, were due to dirt and ignorance,
neglect and bad home conditions as well as to lack of medical care. The first clinics
set up were, therefore, "minor ailment" clinics in which a school nurse could work,
along with the school medical officer, and deal with these " dirt " diseases. The
growth of the minor ailment clinic was pitifully slow at first. The provision of any
treatment centres produced the usual protests about undermining the parents' sense of
responsibility—a complaint still heard to-day !
Growth of the Service.
As you see in Table II, by 1910 only 21 Local Education Authorities had provided
treatment centres. The greatest impetus to their extension came from the revelations
of the medical boards during 1914-18 and the clauses in the Fisher Act making the
provision of treatment facilities compulsory for the elementary school child. By 1938
there were still three areas where treatment facilities were not available.

Next to the poverty and dirt diseases, defective vision and dental caries and sepsis
were the outstanding defects revealed at the early inspections but these "special"
clinics also got off to a slow start, as Table II shows.
However, once the mass of obvious disabilities were provided for, progressive
education authorities began to enlarge their treatment facilities. They did this, not
to take work away from the existing agencies but because the treatment was, in the
main, not being provided at all or it was so difficult or expensive to obtain that it was