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me one of his patients for a second opinion. This is using the School Clinic as if it were
a hospital Out-Patient department and I think this should be encouraged. In fact, the clinic
is a hospital out-patient clinic, held, for the convenience of its users, at a centre near
their homes. Were this clinic not in beings many of the children would have to be sent several
miles to the nearest out-patient clinic. This, indeed,, happens with the small neighbouring
boroughs, where such a consultative clinic is not held. Their rheumatic and infant-welfare
cases (I pick out two examples) are sent to my out-patient department at Whipps Cross Hospital.
Being held under the auspices of the School Health Service has great advantages, both
to the children and to the Assistant School Medical Officers. From the children's point of
view, (or rather, their parents), they haven't far to go and the ground is familiar to them.
They can be seen regularly and the follow-up machinery, which is an integral part of the School
Service, works very well. From the point of view of the school doctors, they don't lose sight
of the child. He is still their responsibility, they are informed of what is suggested about
him, they can see him when they like© Further, as they feel that the consultant is 'their'
consultant and that they can refer cases without fuss or bother, they are much readier to
refer cases; they don't feel that they are sending the child to an 'alien' institution.
This makes for much greater readiness in sending children for a second opinion; and this
readiness is greatly increased by the knowledge that the paediatrician is working in the
next room and is always willing to talk about the children. Because it is all part of the
same service, I have got to know the Assistant School Medical Officers personally and this
greatly improves the quality and value of the service.
A very pleasing feature of the work of the year has been the way in which parents
have responded to the suggestion that they should take the child to see the school medical
specialist. The 'Did Not Attend' is a comparatively rare event; the parents turn up for
the first interview, and for subsequent ones, with heartening regularity. This is all the
more surprising in that almost no treatment is supplied by the consultative clinic; but
apparently parents appreciate a sympathetic hearing and will in return listen to advice on
their problems.
One great disadvantage of the clinic is that there is no provision for pathological
or radiological services. This has been solved: the laboratory work is done at Whipps
Cross Hospital and the X-ray examinations by the kind co-operation of St.Mary's Hospital,
Plaistow. This involves the child and its mother in quite long Journeys; but the arrange.
ment has worked quite smoothly now for over a year and I consider it satisfactory.
The greatest difficulty has arisen in the relation between the Clinics and the local
general practitioners. Some of these have complained that the clinics are doing their work;
they say that the child is their responsibility and that now that everybody, irrespective
of his financial state, can have a family doctor, there is no need for the clinics (or for
the whole of the School Medical Service, for that matter)© I do not Intend to enter deeply
into this polemic, but I have to state that it was because of such statements made by the
general practitioners, that I agreed that the clinic should not offer any medicinal treatment©
This involves extra work; if I think a child needs iron for anaemia or phenobarbitone for
epilepsy, I now write to the family practitioner pointing this out and it is left to him to
order the drugs - or to decline, as he thinks fit. The method is cumbersome and timcdnsumlng
but at the moment I see no alternative to it.
I should like to say that the whole work depends upon the goodwill of the Assistant
School Medical Officers; without their willing co-operation, the clinics would close down
at once© I am deeply aware of the honour they do me by inviting my opinion on their chargeso"
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