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66
SCHOOL HEALTH SERVICES.
Staff.
All the full-time medical officers devote part of their time to work
in the school health services, the total being equivalent to that of twoand-a-half
full-time officers. Similarly, all the health visitors act as
school nurses, the total time they give being the equivalent of six fulltime
officers. During the year there were two health assistants engaged
on the work of head inspection and cleansing.
Medical Inspection.
When the school medical service was first instituted, it was appreciated
that those who were suffering from any abnormality or disability
requiring treatment could be found only by examining all, so the foundation
of the service is the routine medical inspection carried out for many
years on three age groups—the entrant, the intermediate and the leaver.
Children are examined about 25 to a session, the parents being invited
to be present. An important part of the procedure is the consultation of
the medical officer with the school staff and the advice given to the parents.
Children suffering from some disability requiring treatment are put in
the way of obtaining it. Some are found suffering from conditions not
needing treatment at the time, but possibly would later. Such children
are kept under observation, as are those suffering from such conditions as
defects of the heart where periodic examination is advisable to ensure
the disease is not progressing. These children will be kept under observation,
arrangements being made for them to be seen at the school when
the medical officer attends there a term or two or three terms later. In
other cases it is necessary the child should be seen at an earlier date or
it might be necessary he should be seen more frequently, or it might be
a case where a more detailed and time-consuming examination is advisable.
Such children will be given an appointment at the minor ailment clinic,
which they will continue to attend as long as this periodic observation
is considered necessary. This constitutes the second group of children
examined, the re-inspection. The third group is that of the specials.
These are children who are submitted to the doctor at the request either
of the parents or the teachers or the school nurses. These many examinations
are carried out throughout the year, about one th'ird of the school
population being examined each year as routines and frequently more
than half the school population altogether in one category or another.
The average of 25 per session examined allows only six minutes a
child—time enough for the brief examination of the normal child, but no
time for the child suspected of an abnormality and little enough time for
discussing the many problems raised by the parents. There has been
much criticism of the basis of the observation of the school child, more
particularly as so much of the time of the examining medical officer is
taken up in dealing with the normal child. No agreement, though, has
been reached on the basis of a satisfactory alternative. Many authorities
before the recent war favoured the carrying out of four routine inspections.
Middlesex was one, and the aim has been continued of examining on this
basis. With the raising of the school age, it will be possible to arrange
the four inspections at equal intervals. At present the last group is