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in other fields of medical care there has been tremendous progress, especially in the discovery
and refinement of specific drug treatment for many childhood disorders. Parallel with this advance,
was the impact made by the preventive services on the killer diseases of whooping cough and
diphtheria: 874 children per 1,000,000 under the age of 15 years were killed by whooping cough
in the five-year period 1901-1905; in the same period of time diphtheria accounted for 653
children per 1,000,000 under 15 years of age, and measles accounted for 955! In the four years,
1936-1939 these figures were still high—whooping cough 163 per 1,000,000; diphtheria 287
per 1,000,000 and measles 149 per 1,000,000. Today, diphtheria is a rarity; measles and whooping
cough are no longer killers—but they can maim.
During the Second World War, preparations were made by great social reforms for the
emergence of a welfare state. Part of this planning was directed towards education and resulted
in the Education Act of 1944 which became law on 1st April, 1945. The School Medical Service
became the School Health Service implying a change of medical thought from the curative or
treatment aspects of medical care to the prevention of defects and diseases by careful surveillance
of the school child from his entry into school to his leaving date. The emphasis was to maintain
good health by early inspection and early detection of variations from the normal, advice on food
and clothing, and active participation in measures designed to secure for the child a good environment
and early treatment where necessary.
The screening of thousands of children every year for general health purposes, specific tests
of hearing and visual acuity, mean a great deal of steady hard work where the main aim and
satisfaction is the establishment and maintenance of a healthy school population. In conjunction
with this is the continuing reinforcing of immunisation against diphtheria and tetanus. This is now
extended to protect the child against poliomyelitis and measles, and the children in the secondary
schools are offered BCG vaccination against tuberculosis. During 1971 teenage girls have been
offered rubella vaccination, to protect future mothers from the possible effects of German measles
virus on their babies during the first three months of pregnancy. The effect upon the unprotected
child can be disastrous, causing eye damage, loss of hearing, mental deficiency, and heart disease.
In addition to the inspection of school children, the school health service is concerned with
the ascertainment of handicapped children. This is dealt with more fully in Part III of this report.
The development of the school health service has been briefly sketched from its inception
in 1908 to its present role in 1971. What will be the position in 1974 when a newly-structured
National Health Service comes into being? Has the school health service a useful function to
perform in 1974 ?
There is no doubt that the Education Authority and teachers will look to a doctor for advice
concerning medical and psychological problems of children within the school situation. Doctors
so consulted will need to have had specialist training and experience not only in paediatrics and
social medicine but also to have some first-hand experience of the work of education methods
generally and special education methods in particular. These skills are already in the possession
of the medical officers of the school health service in post at the present time and this wealth
of expertise should not be lightly cast aside. There is a strong case to be made for the retention of
a school health service.
In general, three main methods of forming such a service present themselves:
(a) General practitioners and paediatricians could be asked to provide a service to the local
authority in respect of examination of children and advice to the authority concerning
their medical needs in the education situation. It is unlikely, however, that the extra
work involved in maintaining a service by medical practitioners already overburdened
with the task of caring for acute and chronic sick will be reasonable or indeed a
possibility.
(b) Local Education Authorities could set up a separate school health service. This would
mean competing for medical, nursing and administrative skills with the new National
Health Service. Such a service would be comparatively small and isolated and would
be unlikely to support a career structure sufficiently attractive to skilled personnel.
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