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A day school for the physically handicapped in
contrast to classes attached to normal schools
requires at least one hundred pupils to be a viable
unit, and the attainment of this number as can be
seen from the above figures, would require the
combined catchment area of at least four
boroughs making a total population of about
1,000,000 persons. Similarly a local authority
medical assessment unit for the care of these
children and out-patients attending the unit and
the hearing clinic with an associated school for
the deaf would require also a catchment area
with a population in the region of 1,000,000.
The provision for the assessment, care and
education of such categories of handicapped
children in the London Borough of Hounslow
accords with the above figures in that its two
special schools with associated assessment units
actually serve three adjacent boroughs on a
regional basis which combined with Hounslow
form a population of some 925,000 and as has
already been said, has in existence a team of
specialists supplied by the Regional Hospital
Board, the local education authority and the
local health authority in accordance with the
recent World Health Organisation
recommendations.
Whereas a medical officer of health/principal
school medical officer in an urban area with a
local health authority practice of 250,000
population would have on his list about forty
children sufficiently handicapped to attend a
school for the physically handicapped and a
medical officer of health/principal school medical
officer with a regional unit practice of 1,000,000
would have one-hundred-and-sixty such children
on his list, a single-handed family doctor on the
same proportional basis would be likely to have
on average less than one such child in his practice
of 2,500. In order to gain any knowledge of, or
insight into the complex series of paediatric
diseases that cause handicapping in childhood it
is necessary to see many such cases in order to
learn by comparisons of cases over a period of
time. Specialised doctors in local health
authorities and local education authorities are
therefore ideally placed to carry out such
essential work and to do research for the benefit
of the children.
The medical officer of health/principal school
medical officer practice of approximately 40,000
school children and 20,000 pre-school children
also enables his specialist departmental medical
officers and their ancillary teams of audiometricians,
nurses, orthoptists, etc to be ideally
placed to carry out overall sweep and specialised
screening tests in regard to the early detection of
visual, perceptual and hearing difficulties and
other paediatric handicapping conditions. Joint
medical records for children and complete
co-operation between family doctors and local
health authority doctors especially in health
centres with the help of computers may herald a
great advance in our service for children.
There is likely to be a shortage of doctors for a
decade or more and many local authority
departmental medical officers are highly skilled
in developmental paediatrics and allied
specialties. A high proportion of these excellent
doctors are women who may have reached high
places in other fields of medicine if they had not
had family or other commitments.
Although in the future some functions now
carried out by such doctors may more properly
be carried out by interested family doctors, the
specialist local authority doctor for the reasons
already stated will always be required for the
time consuming and complex tasks in child
development screening for the detection,
diagnosis, assessment and care of the handicapped
children and for recommending appropriate
schooling and carrying on adequate follow up.
Some degree of integration of these doctors
into family doctor group practices especially in
health centre practice within the field of
community medicine would seem the obvious
answer to many crucial and long standing
problems and the family doctors with whom I
have discussed this suggestion in the last two
years have all been very sympathetic and
agreeable to the idea. Unless some way of
integration is found the skill and the considerable
training these doctors have acquired are likely
to be wasted at a time of doctor shortage and the
vast body of knowledge and specialised techniques
built up since the turn of the century in child
development and school health could be thrown
aside and neglected just at a time when computer
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