CHILD WELFARE

Evening Post, Volume CXV, Issue 35, 11 February 1933, Page 5

CHILD WELFARE

PROTECTION AGAINST

DISEASE

SCHOOL MEDICAL SERVICE

(Contributed by the Department of Health.) It has been noted how comprehensive is the School Medical Service, states Sir George Newman, England, in his annual report on. the health of the school child, but it would be a mistake to assume therefrom that parents are thereby relieved of all responsibility for caring for the health of their children. The scope of the treatment carried put through the agency of the School Medical Service is governed by certain general principles which he briefly examines as follows:— Children are subject to physical disabilities which may be divided into two groupß. In one group are the conditions which may be looked on as medical incidents in ' tfio child's life, and which in general should leave no permanent after-effects of a harmful character. Examples of this group are such misfortunes as an acute appendicitis, pneumonia,; or a fractured limb. Serious though they may be at the time of their occurrence, and though they produce some loss-of school attendance, they do^ not -as .a rule interfere seriously with ; education; nor are they potent caWes of subsequent ill-health. Facilities f^r the treatment of these acute conditions are usually available through Other agencies, and, that being so, the. School' Medical .Service is not expected to assume the responsibility of providing,for them. In the second group the -disabilities are. of a different character, and there are several reasons why official action is desirable in order to ensure that efficient treatment is provided for them. MOSTLY DEFECTS. In the first place, the "school diseases" are mostly defects or impairments which, if untreated, render the child incapable of deriving full benefit from the education which he must receive if he is to become a useful citizen. A child incapable of profiting to the fullest possible extent from this education is not only losing something himself but he acts as a brake and a clog in the class, retarding the progress of his fellow-pupils. The realisation of these facts was one of the most powerful influences in. initiating school medical treatment. In the second place the harmful effect of these disabilities is not always obvious Or, if it is, it ia often assigned by the parentsto some entirely different cause. A child may bo.thought to.be merely stupid when he is suffering from adenoids; he may be;blamed £ot laziness when the cause is debility arising from oral sepsis; or he may be considered fidgety and careless when the real trouble is chorea. Here are some serious conditions which to the parent do.not seem to cry aloud for treatment. Scepticism may be expressed even as to their existence or the effects which they produce, and in * any case there is: no apparent urgency to obtain treatment for them. It is for this reason that the stimulus to treatment in. many cases, must come from the school medical service, and the- school doctor must be in a position to.provide the facilities which will ensure • that these defects are rectified. On©' of the best examples is provided by dental treatment. The prime object of a school dental scheme is not to relieve the pain of an aching tooth, but to secure a healthy mouth. The aching toothy will itself usually insist on the necessity for treatment,,but insistence pn the need for removal of oral sepsis, or the conservative treatment of early caries, or the prevention of dental decay will in many instances have to be supplied by the school dental surgeon, who is in a position to provide the treatment which he considers necessary. Eyesight is another example. Every parent appreciates the disaster which blindness would inflict upon his child, but-very few can estimate either the insidious approach or the,gravity of defective.vision. They cannot know of the immaturity of the eyel. in childhood, nor the injurious effects of eye-strain, ■ improper, use, or apparently- trivial irritation or infection. They-do not see that "refractive error."! is. a. sign of need for correction in order to improve or save vision. • • ,••'..-'.. ' ■ ' . , . DANGER OF NEGLECT. In the third place, many of the disabilities in this group of school'diseases are capable of producing life-long physical handicaps • in, addition to the education handicap to which reference has been made. They are not passing- disturbances such,'as those mentioned as illustrations'o£ the first group. Visual defects, dental caries, damaged heart valves, crippling defects—these are not examples, which would be quoted by anyone who was desirous of describing the undoubtedly wonderful powers of recuperation and repair possessed by the human body. If untreated at an early stage, their harmful effects are not limited by the school-leaving age, or any other restriction. Defect of body or mind handicaps its victims,

and also his fellow-pupils in school, but the handicap does not Btop there— it continues right through "that larger school which men call life."

From what has been said it will ba obvious that the medical treatment of the school child comprehends a very wide_ sphere. The manifold and domestic care of the child by the mother is first and best of all; the nurture, discipline, and environment of the school come next (though it sometimes does not live up to its opportunity); and the school nurse and the private practitioner to whom the child is referred are very important agents. All this may be invaluable as direct arid indirect treatment. But it is not enough; and therefore there exists the organised system of the school medical service. This also is much wider and more pervading, than is often supposed. There is quite definite therapeutic value in school meals, in physical training, in the teaching of hygiene, and in lessons in the open 'air. Whatever builds up the body and recreates it is indirectly a form of treatment, often unconsciously applied for many slight and transient departures from normal health. Much depends upon the kind of meals, physical exercise; and teaching. They can each, all too easily, be innutritious, unremedial, and ineffective—monotonous, mechanical, and meaningless. .