Medicine And Books

The Health of the Schoolchild: A History of the School Medical Service in England and Wales

BMJ 1996; 312 doi: (Published 17 February 1996) Cite this as: BMJ 1996;312:452
  1. Leon Polnay

    Bernard Harris Open University Press, pounds sterling16.99, pp 260 ISBN 0 335 09994 7

    The Health of the Schoolchild provides a detailed history of the school medical services. It also provokes a very strong feeling of deja vu because it shows how current arguments about the value of selective or universal medical examinations, or the accuracy of collected statistics, have been rehearsed many times before. It also gives a powerful description of the “mission” of the service, and the sometimes competing views of politicians, educationists, and health professionals, especially where responsibility for funding is discussed. A few examples, in chronological order, taken from the book will illustrate these points.

    Firstly, the Physical Deterioration Report of 1904 found that there was “very abundant evidence of physical defects traceable to neglect, poverty and ignorance” and that “there is every reason to anticipate rapid amelioration of physique as soon as improvement occurs in external conditions.”

    Secondly, in 1908 James Kerr, the school medical officer for London, put forward the view that it was unnecessary to subject every child to a medical examination, and that there was little point in examining children for whom there was no prospect of proper medical treatment.

    By 1910 the battle was already being fought between those who felt that the medical inspection of each child should not occupy more than a few minutes and others whose opinion was that “the statistics will be unreliable, many defects will be overlooked, and the Medical Officer will have no time to think of what he is doing.”

    In 1913, the BMA recommended that the minimum starting salary for a full time school medical inspector should be pounds sterling500 a year, but a junior officer could be appointed for as little as pounds sterling250 a year. In the end “assistants” were appointed for pounds sterling30-50 a year.

    Many of us will feel great empathy with Dr John Underwood, who in 1930 complained that for three years the local education authority had failed to implement any of his recommendations; however, I could hardly see any contemporary critic writing as follows: “the School Medical Officer is partly to blame for his inability or unwillingness to influence a difficult and reactionary Committee.”

    The Health of the Schoolchild puts a serious face on this often ill understood service in the context of the social conditions and the important historical events of the 20th century. It describes its roles in overseeing health, health promotion, and treatment as well as controversies over “medical inspection.” I occasionally got lost in the detail, but this book would make excellent compulsory reading for our current politicians and planners as well as for practitioners.—LEON POLNAY, reader in child health, University of Nottingham

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