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Guidance Clinics would be the answer, with its team of specialists to whom we could
refer our disturbed children and their parents, but, obviously, there will never be
enough of these highly trained specialists to give an adequate service in every area of
the country ; the ordinary staff of the School Health Service and Child Welfare
Service will have to be the preventive team working with the mass of the child
population, sending only the seriously disturbed child to psychiatrist and special
clinic.
It is in this field of preventive mental health that the Health Visitor/School Nurse
has so much to give and I think that probably the Child Welfare Officer and School
Medical Officer should be one and the same person. Preventive health work begins
long before school age (as our Maternity and Child Welfare colleagues are well aware)
but many children do not show their difficulties until they get to school and the
School Health Service must continue this work of preventing or ameliorating emotional
difficulties and, if necessary, train itself more to do so.
We must also take stock of the retarded and the dull child. Intelligence testing needs
reviewing in the light of experience in the schools. The dogmatism of much of the
early work has been shown to be unwarranted and I think the time has come for us to
undertake some research work along with our educational psychologist and teacher
colleagues into the whole question of the educationally sub-normal child. The 1944
Act is nearly 10 years old; experience has been accumulating about the educationally
sub-normal child as distinct from the classification of backwardness under the 1921
Act and I, for one, am not too happy about it. Perhaps we could have a conference
with our colleagues of the Ministry of Education on these problems.
We could include in it the "problem family" and the juvenile delinquent. They
have always been the families who have refused to co-operate with us when treatment
was needed and, apart from the sterile procedure of prosecution, we have tended to
leave them too much to their own devices. We are seeking to find a new approach
to these families but we still have a lot to learn and must explore new ways with them.
What Changes Do We Need in the Future?
I hope I have said enough to show that our service is a flexible one; that as the
state of the children has altered so has our service grown or changed to meet their
need. Are we really just doing to-day what we did 45 years ago ?
Let me remind you of our origins (Newman, 1939). If there is anything that has
been proved over the last 50 years it is the remarkable vision of the men who laid the
foundations of the School Medical Service. Here are the eight questions which they
set out to consider when devising its structure.
1. Has the child had any illness in the past which would be likely to affect his
physical future?
2. What is the present condition of his body as regards cleanliness and nutrition?
3. Are his senses normal—hearing, seeing, taste, touch, smell?
4. Has he sound or decayed teeth?
5. Are the throat and tonsils normal and healthy?
6. Is he normal and sound in mind?
7. Does he show any sign of disease or deformity—rickets, tubercle, rupture,
glandular disease, ringworm, anaemia, epilepsy, psychoneurosis, etc.?
8. Has he any weakness or defect unfitting him for ordinary school life and
physical exercise or requiring any exemption from any branch or form of instruction ?
These questions may be put in an old-fashioned way but we still require an answer
to them. The medical history of the child must come from its parents and we must
still, by our examination, find an answer to the above questions—even if to-day,
fortunately, the physical ills are less severe and the emphasis has shifted to many minor
degrees of defect ; but the minor degrees of defect may not be so easy to detect and
to discuss the problem which may be presented by the child's personality can take a
long time.