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APPENDIX I.
REPORT ON THE MEDICAL INSPECTION OF TODDLERS
BY MARGARET EMSLIE, M.B., CH.B.
The number of cases seen at the Toddlers Clinic in the year ending December, 1931,
amounted to 418 boys and 429 girls, full inspections, and 362 re-visits, making a total of 1,209
consultations. This compares with a total of 472 cases in the eight months ending December,
1930. There was an increase both in the number of cases seen per session and in the proportion
of parents accepting consultation when asked. There was noted, also, a tendency to make
use of the Clinic for re-inspection purposes, within the period of time suggested by the medical
officer, but cases requiring frequent observation were, wherever possible, referred to the ordinary
child welfare sessions. The response in regard to treatment, where recommended, was good.
The type of consultation that has become identified with these inspections deserves
perhaps some remark. The clinic is not intended to be a purely inspection clinic for
note-taking purposes ; it is intended to be of constructive benefit to the health and progress
of the child. For this reason, though it includes a routine examination (like school medical
inspection), it attempts to touch much more generally the questions of home management in
the pre-school child and to supply what may be wanting, or can be corrected in each case,
through domestic means, i.e., diet, exercise, hygiene, sleep, disciplinary training, etc., without
impinging on the sphere of medical treatment. The reasons for which patients attend the
clinic are diverse, and have to be considered, but the initial questions put in each case are framed
so as to give information of a general and accurate character bearing on the child's life and
environment, without impressing the mother that she is being asked for more than the usual
"facts," or that she is supplying a picture that, in reality, conveys much more than does
its simple physique. In the same way the advice that has to be administered is very often
given under a cloak since it is desirable not to disturb those mothers who come (very
definitely) not for advice, but for information, i.e., for a straightforward "vetting" or for the
treatment of some acknowledged defect that they would see no point in discussing in its wider
aspects. Opposed to these, but equally "coy," are the hyper-conscious women visiting a centre
for the first time, who, once having crossed its threshold, arm themselves for a lengthy, intimate,
unhurried conversation about the child that will cover the whole gamut of its life history at a
swoop, taking heed of all qualities, virtues and idiosyncrasies, and will fend the mother with
comprehensive and infallible advice to meet safely every possible event or accident till the
"occasion" for consultation arises again. Intermediately there are those mothers who have
attended a centre from time to time and who know, more or less, what to expect from the
consultation, only, this time, "more so." To reduce all these groups to a common denominator,
cover the ground, secure the information, and supply helpful advice is the basis of the work.
Just in so far, moreover, as one consultation eventually resembles another, whatever the
approach, is it likely that they are successful. The child obviously cannot be considered usefully
in parts, nor is prevention likely to succeed if it is applied under one or two headings only,
of possible defects, that leave aside the larger questions of environment.
The procedure with regard to the arrangement of examinations was as described last year.
The birthday month was chosen for the routine examinations, apart from special cases referred
in emergency by the health visitors, and invitations were sent to mothers to attend in that month.
The particular inducements offered to non-centre mothers varied with the case as has been
inferred, and were left to the health visitors who knew the conditions in the home. He visits
were arranged for at intervals suggested to the mother at the first examination, and patients
were called up by letter when a reminding home visit by the health visitor was not possible.
The first Table shows the results of the examinations.