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137
The work of the minor ailment clinic and the struggle to get the school child
"cleaned up" needed the full-time energies of the State Registered Nurse. The
special training of the Health Visitor could not have been put to much use in the old
days: she would not have had enough time left over from her hygiene work; and
15 years ago, even in my own district I doubt if I would have welcomed the change.
In Leyton the cleanliness problem is a very minor one now; e.g., in 1952, 315 cases of
uncleanliness discovered in 25,000 inspections is a very small number and the majority
of these cases were of minor degrees of infestation.
Our Health Visitor/School Nurse can do the hygiene inspection in her school and
use it as the means to survey each child each term in her school. She is allowed to take
a proper amount of time to do it. From it she can refer to the clinic any child giving
cause for worry and it is not just a "hunt for nits". I think, therefore, in areas where
a high standard of cleanliness has been reached, it is a mistake to talk of it being a
waste of a highly trained person's time to do hygiene inspections for it is one of the
ways in which she gets to know her school children well, and not only the children
but the Head Teacher and the school staff, too. "Cleanliness Assistants" are not
required in an area such as ours: it would make only another person coming into
school and not be helpful to anyone. "Dilution" of the staff may be necessary
where there is a great shortage of trained personnel and the hygiene problem still a
serious one; but I do not think it is a movement to be encouraged in all districts.*
There is great danger in sending a multiplicity of people from the Health Department
into the schools; neither health staff nor school staff, let alone the children, ever
get to know with whom they should deal. Also, I think there is a danger that we
hedge ourselves about with a barrier of superiority, refusing to do the routine
tasks, forgetting that it is in the day-to-day work that we get to know our children
so well and so can see if any deviation from health and fitness is taking place.
The School Medical Officer.
Over the years our service has shown great flexibility in its organisation and in
coping with new situations. Similarly, our School Medical Officers have had to
acquire the new knowledge and skill to deal with these problems as they went along
by the hard way of experience; but perhaps this is not quite good enough for to-day.
Twenty years ago the service was still immersed in the ascertainment of physical
ills and the training that all doctors had fitted them more or less for this work;
many had post-graduate experience in fevers or children's hospitals and frequently
had a D.P.H. in addition. Most of the highly qualified, however, went on to administrative
work, but there was no requirement, as there was for Maternity and Child
Welfare work, that the School Medical Officer should have special post-graduate
experience and some School Medical Officers were not equal to the opportunities
that the School Health Services offered them. To-day we have highly trained Health
Visitors in our service and we must ask now for some special post-graduate experience
in our medical personnel. Do not mistake me. I am not asking for the label
"specialist " to be tacked on to us. We are, in the main, pretty ordinary folk who have
chosen to work in one branch of medicine; the general practitioner has chosen
another branch; so has the surgeon. But our medical education has not completely
fitted any of us for our chosen branch and to be skilful at whichever one we have
chosen we require extra training to do it well.
I think, therefore, all new candidates in the School Health Service should have the
same post-graduate training as is required for the Child Welfare Officer and, as soon
after appointment as possible, should take a course allied to the course already run
by the National Association for Mental Health, but dealing with the whole range of
child development, not just intelligence testing alone. Also, training in the assessment
of physical handicaps in hearing and seeing, etc., and visits to all types of
special schools should be part of this course. It should last for six to eight weeks and
all should take it in their first year of appointment. I am not thinking of a refresher
course but something more elaborate.
I should like our School Health Service Group to think this out and approach the
Ministry of Education medical officers and discuss the possibilities. These ideas are
not new. The late Dr. E. H. Wilkins, of Birmingham (1941), thought it was needed
and I believe he was right.
*1 do realise that many school medical officers have a serious infestation problem
still facing them in their schools and that the "cleanliness assistant" is very necessary
indeed, and could not be dispensed with without serious curtailment of the hygiene
work in these areas with a high infestation rate.