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136
The Routine Inspection.
I do not think, therefore, that "rapid surveys" can cope with the more subtle
defects we are interested in to-day and I do not believe that the routine medical
inspection should be scrapped. The defects we are concerned with, if we are interested
in the whole child mentally as well as physically, do not strike the casual observer.
The parent should be with the child and, what is most important, the doctor must
have time to talk to her in a friendly and personal way so that she feels the School
Medical Officer is really interested in the child and not just its possible ailments.
I feel very strongly, then, that the routine medical inspection must stay and that
three is the minimum required. For the following reasons I would wish to retain the
inspection which takes place about the age of 10 to 11 years.
It is just as important to have a survey of the child after he has been some years in
school as it is when he enters school or leaves it to go out into the world. The School
Health Service has become a preventive service in a way it has never been able to be
until now, and this necessitates discussion with the parents as well as examination
of the child for defects. To find out how the child is progressing physically, mentally
and emotionally one must talk to the parent and make sure no worries have arisen
since the first examination.
Minor degrees of school failure are brought to our notice about this age; some
of this is due to innate dullness but some is also due to emotional or environmental
difficulties in home or school and it is important that help be given in such cases before
the child enters the secondary school.
Parents, too, still feel that this second routine inspection is worth while. In my
own district in 1952, 96.5 per cent. of parents attended the entrance examination;
79.5 per cent. of parents attended the second examination, and this in spite of some
30 per cent. of the mothers being at work. The drop in parents' attendance is very
marked when it comes to the final examination—38 per cent. of mothers attended this
inspection. It is true, of course, that the adolescent 14- to 15-year-old does not wish
the parent to attend the medical inspection, especially the boys and, also, he can speak
up for himself. If your last contact with the parent was eight or nine years before you
are going to know very little about that child at his final examination.
For these reasons I still favour a minimum of three routine inspections, which
has indeed been the consistent policy of the School Health Service Group.
The Minor Ailment Clinic.
In the area of Leyton these clinics have changed out of all knowledge. The packed
clinic, full of children with skin troubles, sores, otitis, verminous heads, with the
impetigo and adenitis which went with that state, are things of the past. These
dressing cases are so reduced in number that the work can be done by one nurse at
each clinic instead of two or three and so the staff can be released for school and home
visits.
The School Medical Officer still sees there the special cases referred by school
and medical staff but, of course, not so many cases of acute minor illness now as
formerly. Before the National Health Service Act the School Medical Officer saw
many sick children because the parent could not afford a private doctor.
Without the need to write a prescription a great deal could be done for these
children and in addition, being practitioners of preventive medicine, we could and did
discuss other facets of physical or mental well-being beside the immediate ailment.
Perhaps it is this type of case, which we find fruitful and rewarding because of the
opportunity it offers to us for preventive work, which our colleagues in curative
medicine do not want. They say that their surgeries and hospital out-patient departments
are filled with patients suffering from trivial complaints. In the case of the
children we are only too happy to relieve them of this burden, if they will allow us to
do so. I see signs that this work is coming back to us.
Changes in the Personnel of the School Health Service.
Since 1945 an increasing proportion of our nursing staff has been in possession
of the Health Visitor's Certificate and this should prove of great importance in the
field of mental health. Their training in the emotional development and the management
of children which has been of so much use to them when dealing with " under
fives " is not lost when the child goes to school, but this metamorphosis of the School
Nurse into Health Visitor could not come until the time was ripe for it, as it surely is
in many areas to-day, but not yet, I believe, in all areas of the country.