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Welfare of School Children. It is perhaps not well-known that the School Health
Service Is the oldest statutory personal health service in the country, owing its formation
largely to the report of the Inter-departmental Committee on Physical Deterioration. This
Committee was set up as a result of national apprehension at the physical state of the
recruits during the Boer war and it identified the appalling defects in conditions bearing
on the physical and moral welfare of children and young persons and decided that these were
the most important factors in the alleged physical deterioration of the nation, and that
long-term policy of child welfare was urgently required. The School Medical Service, as it
was originally called, came into being with the passing of the Education (Administrative
Provisions) Act of 1907. Since then it has gradually developed, with West Ham to the fore
in certain fields. A strange position existed in the early days of the Service; altho'ugh
inspection revealed the need for treatment, local education authorities had no power to
spend money on this. The School Health Service has been fashioned by a process of evolution
to meet the special circumstances attending the life of the school child and from the
earliest days the attitude of the school doctor has been essentially that of a practitioner
of social medicine. We have now come to a new concept, "that of discovering the first signs
of failure of physiological adaptation which precedes the stage of pathological lesion, and
this pre-supposes a greater familiarity with what constitutes normality, which is recognised
not as a point in a scale but as a range." This point has been stressed by Dr.Hinden in one
of his reports .
All school children are inspected by a medical officer three times during their school
life - on entrance to school; at the age of ten years plus; and at fourteen years plus;
this final medical inspection enables the medical officer to give an opinion about the type
of work for which the boy or girl is physically suited. These inspections bring together
child, parent, medical officer and often the teacher, and provides an opportunity for
stimulating an interest in health matters as well as in allaying unnecessary anxiety.
Besides health education they also have the function of health assessment and detection
of faults.
Special inspections are also carried out at any time if for any reason a parent, teacher,
school nurse or health visitor wishes to have the doctor's opinion.
In addition to this work, children who have been referred for treatment or observation
are re-examined at intervals. It is interesting to note that now only 7.8 per cent of our
children have a defect found to require treatment when seen at periodic medical inspection.
In 1954, the number was 9.3 per cent. Apart from defects of vision and squint the percentage
found to require treatment was only 4.1.
School doctors are assisted in their work by school nurses and health visitors, who
inspect all children in school every term for personal hygiene. The nurses inspections of
personal hygiene are the basis of the "cleansing scheme". There has been great progress
since the early days of this work, but even to-day a small percentage of children are found
to be "dirty" and the work of inspection must therefore go on. Schools have played an
important part in the raising of general standards of hygiene. Health education in schools
is properly a responsibility of the teachers, though at times the medical officers and nurses
can help. This aspect of education is most important, not only in the interests of the
children themselves, but also because of their future influence as parents of the next
generation. The school nurse has many other important functions to perform. By regular
visiting of her area she can detect abnormal environmental conditions long before they have
resulted in departures from health which are Likely to be detected at periodic medical
inspections. The mental health of the child is receiving more and more attention in the
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