CHAPTER IX.

THE SCHOOL MEDICAL SERVICE AND ITS ALLIED

ACTIVITIES.

1. General Survey.

148. Anything like a complete survey of the work of the School Medical Service and its allied activities would be impossible within the limits of the space available in this volume, and is rendered unnecessary by the very full account given in the Annual Reports of the Board's Chief Medical Officer. All that is necessary in this report is to state briefly the leading facts and figures, which on the present occasion relate in the main to 1926, material for 1927 not yet being available.

149. The year under review was marked deeply by the prolonged stoppage in the coal industry and the General Strike. In spite of the disturbance and diversion of effort which these caused and the imperative need for restricting expenditure to essentials, it is satisfactory to be able to report that in no part of the field was ground lost, and in a number of directions substantial advances were made.

150. The growth of the School Medical Service from the infant service of pre-war days to robust adolescence ready at no distant date to develop into maturity and completeness, was referred to in our report last year. In Circular 1388, issued in February, 1927, the Board suggested that the first aim of national policy should be the completion of this service, and that authorities should concentrate on this definite aim. That steady progress was made during 1926 (before the issue of the Circular) towards this goal in spite of difficulties, the facts and figures given in subsequent paragraphs will show. It may confidently be anticipated that the returns for 1927 will reveal an even larger measure of expansion.

2. The School Medical Service in Public Elementary Schools.

151. With a school population of roughly 5,000,000, the total number of children brought under medical inspection during 1926 was 2,685,167, or about half, an increase of 65,817 compared with the previous year. Of this total, 1,821,577 were examined as routine cases, i.e., were children in the three prescribed age-groups (entrants,

(31652)

C2

8-year-olds, 12-year-olds), and 863,590 were examined as "special" cases, i.e., were presented by the parents, teachers, or school nurses. The number of "specials" shows an increase of nearly 43,000 over 1925. There were on the registers of public elementary schools about 600,000 children aged 5, and a similar number aged 12, and there were roughly 500,000 aged 8 (the smaller number being due to the low birthrate at the end of the war), making a total of about 1,700,000. It seems clear that the routine medical inspection of the prescribed age-groups was covered practically completely, and in addition, very large numbers of ailing children outside these groups were inspected. With a net so extensive and so closely meshed, it is reasonable to suppose that few cases requiring medical inspection, of whatever age, escaped it.

152. The total number of children found as a result of routine medical inspection to require treatment (apart from uncleanliness and dental disease) was 367,032, or 20.1 per cent. of the number inspected. The percentage for 1925 was 23.8 and the findings for the two years approximate closely, not only in the aggregate, but also as regards the different types of defect. Of the children examined as "specials," 241,826 were found to be in need of treatment for some important defect.

153. In addition to this volume of medical inspection, 2,213,721 children received dental inspection, an increase of nearly 175,000 over the previous year. Of these, 1,478,413, or 66.8 per cent., were found to require treatment, and 852,517 were treated (84,000 more than in 1925), equivalent to 57.7 per cent. of those needing treatment. The percentage for 1925 was 55.5.

154. Even this does not complete the story. It was explained last year that arrangements are made for all the children in the schools to be examined at regular intervals by school nurses for conditions of cleanliness, the aim being to examine them once a term, or say three times a year. The total number of such inspections in 1926 was 13,239,311, an average of 2.7 per child. The number of children found unclean was 850,842, or 6.4 per cent. of the number inspected. This compares with 6.5 per cent. in 1925, which was the lowest figure recorded up to that year for this defect.

155. The expansion of facilities for treatment noted in last year's report continued. Besides extensions of existing clinics 72 new school clinics were provided, bringing the total number up to 1,467. In addition, there was an increase of 34 in the number of hospitals undertaking work on behalf of the School Medical Service. It is interesting to note in this connexion that 11 clinics for treatment by artificial light were approved during the year. The total amount of treatment undertaken by authorities shows a corresponding increase. Of the common defects-minor ailments, defects of eye and ear, enlarged tonsils and adenoids-the number treated was 909,556, an

increase of 4.2 per cent. compared with the previous year. The increase of dental treatment already referred to was considerably greater, nearly 11 per cent.

156. While, however, the provision for medical inspection, which is the basis of the whole structure, is now practically complete, a good deal remains to be done before the same can be said of provision for treatment. Of the 317 Authorities, there were still two which made no provision for dealing with defects of eyesight; seven which did not provide for the treatment of minor ailments; 23 which had no dental scheme, and 59 which had no arrangements for the treatment of enlarged tonsils and adenoids. Orthopaedic treatment was undertaken in less than half of the areas. Even where treatment is undertaken provision is, of course, often incomplete. This is particularly the case as regards dental treatment. In 1926 the School Medical Service had the equivalent of 367 whole-time dentists. It is estimated that at least the equivalent of 1,000 is required to cover the ground with reasonable completeness. It will be evident, therefore, that, though the goal of a complete School Medical Service is now in sight, there is still a considerable distance to be travelled.

3. The School Medical Service of Higher Education.

157. Of the 147 authorities concerned, 133 carried out with varying degrees of completeness their duty of providing medical inspection of pupils in secondary schools and other institutions during 1926, an increase of four on the previous year. The number of schools and the number of pupils inspected were 1,070 and 179,000 respectively, these figures comparing with 1,040 and 150,800 in 1925. Of the 133 authorities undertaking medical inspection, some form of treatment was also undertaken by 106. In 99 areas, women doctors were employed for the medical inspection of girl pupils.

4. Special Schools for Children under 16.

158. The numbers of children ascertained by local authorities to be defective within the meaning of Part V of the Education Act, 1921, during the year 1926 were as follows:-Blind (including Partially Blind), 6,879; Deaf (including Partially Deaf), 6,508; Mentally Defective (non-notifiable cases), 33,364; Epileptic, 2,591; Physically Defective, 150,779; making a total of 200,121 children. These numbers do not differ materially from those of the previous year. Of these, 51,340 were during the year in attendance at special schools, 120,237 were in ordinary public elementary schools, 4,099 were in other schools, hospitals, institutions, etc., whilst 24,445 were at no school or institution.

(31652)

C3

The number of special schools under the different types and the amount of the accommodation provided are shown in the following table :

(a) 189 residential schools and 360 day schools.

(b) 14,639 for residential scholars and 31,057 for day scholars.

(a) 6 residential schools and 10 day schools.

(b) 271 for residential scholars and 495 for day scholars.

159. Advance has been made in two main directions. The first of these is the development of open-air schools for delicate children. Up to three years ago there were 66 of these schools. In 1925-26 nine new schools were provided, and in 1926-27 nine more. Although, as explained last year, many of these delicate children need only a relatively short period of attendance at an open-air school and the

effective accommodation is, therefore, larger than the nominal, the amount of provision under this head is still far from being adequate. The fact that a considerable number of proposals for the establishment of new schools of this type are included in their programmes shows that authorities realise the need for additional provision.

160. The other principal line of advance has been the development of schemes for the treatment of crippling defects. In last year's report special reference was made to this work, and it was pointed out that orthopaedic treatment was one of the most hopeful and encouraging developments of recent years, opening out the possibility of curing large numbers of crippled children who had hitherto been regarded as incurable. It is very satisfactory, therefore, to be able to report that the work continues to develop rapidly. During the year new schemes were approved in 47 areas, bringing the total number of local authorities with such schemes up to 132. Orthopaedic treatment under the schemes was carried out at 59 hospitals (20 also providing education), 122 school clinics and upwards of 100 voluntary clinics. This work is eminently suitable for voluntary effort, and it is much to be hoped that the fruitful co-operation of voluntary bodies with the local authorities which is already to be found in many parts of the country will be still further extended.

5. Vocational Courses for Blind, etc., Students over 16.

161. The number of students receiving instruction in full-time courses of vocational training approved by the Board during 1926-27 was 1,692, and of these 1,432 were blind. The corresponding figures for the previous year were 1,560 and 1,327 respectively. The courses were held in 39 institutions for the blind, 4 for the deaf, 8 for cripples, and 3 for epileptics, an increase of two courses (for cripples).

162. The provision for cripples which has existed for some years has recently been extended in connexion with orthopaedic hospitals. Courses are now in existence at the Wingfield Orthopaedic Hospital at Headington, at the St. Vincent's Orthopaedic Hospital, Eastcote, at the Forelands Sanatorium at Bromsgrove, and at the Shropshire Orthopaedic Hospital at Oswestry.

6. Organisation of Physical Training.

163. On the 31st March, 1927, 153 organisers of physical training -75 men and 78 women-were employed in the areas of 94 local education authorities. These figures do not differ materially from those for the previous year. Saturday and evening classes for teachers conducted by the organisers have been continued in a number of areas. In addition vacation courses for teachers were organised by the Board at Eastbourne for secondary school masters, by local education authorities at Barry, Bingley and Ilkley, by the

(31652)

C 4