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The annual report of the chief medical officer of the board of education
Public Health TIIE J O U R N A L OF
The Society of Medical Officers of Health. No. 5,
FEBRUARY, I91o.
T H E A N N U A L R E P O R T ,OF T H E C H I E F M E D I C A L O F F I C E R O F T H E BOARD OF E D U C A T I O N . W M A N ' S first annual report, which D R.hasN Ebeen awaited with special interest by his former colleagues, will well repay the most careful study. It gives the first authentic account of what is undoubtedly the most important public health movement of recent years, and it is particularly valuable in that it sets forth, clearly and unmistakably, the lines on which the movement has been organized and directed by the Board of Education and the administrative methods that have been adopted. The report is a document that will long remain as a conspicuous landmark in the progress of social reform. After a brief historical survey of the school hygiene movement in this country and abroad, Dr. Newman proceeds to discuss the administration of medical inspection by the local education authorities, and to this subject a considerable amount of space has advisedly been devoted. The introduction of medical inspection gave rise to a great extension of other branches of school hygiene, and necessitated administrative changes on a very large scale and within a short period of time. The magnitude of these changes is apparent from Dr. Newman's statement that, whereas before 19o 7 only a small minority of the local education authorities had made any arrangements for medical work in the schools, at the present time all the 328 education authorities of England and Wales are "endeavouring, generally speaking with considerable enthusiasm and success, to make adequate provision for the medical inspection of school children, and for meeting, more or less effectually, the collateral questions of school hygiene raised thereby." In some respects the development of school hygiene consequent upon the Education (Administrative Provisions) Act, 19o7, has
VOL. XXIII,
taken a course that is unusual in the history of public health administration. Hitherto progress has been gradual, spreading, largely through the agency of local Acts of Parliament, from town to town, and generally speaking it has taken place in response to peripheral rather than to central stimuli. Medical inspection, however, and the other school medical work to which it has given rise, introduced as it was in response to a strong national demand, came into operation simultaneously all over the country, and has been organized throughout under the guidance and direction of the Board of Education. The creation of this vast organization was a task that was beset with difficulties, and it speaks volumes for the skill and judgment w i t h which the policy of the Board of Education has been directed, as well as for the public spirit of the local authorities, that medical inspection was got to work so rapidly and efficiently. The policy of the Board in relation to the new work of school hygiene has been based on a principle that has long been advocated in this journal. The Board have insisted that the" new school medical service should "to the utmost extent work in with the existing machinery of medical and sanitary administration, devdloping and supplementing it as required, rather than supplanting it by bringing into existence new agencies, partially redundant and possibly competing." In this attitude the Board have received almost universally the support of the local education authorities. It appears that up to the end of the Educational (Code) year 19o8- 9 the Board have" recognized" 307 school medical officers in 3o7 of the 328 local educational areas, and in 224 of these areas the officer appointed is the medical officer of health of the area. In the 83 remaining areas the school medical officer in 76 cases has been appointed either to be under the supervision of the medical officer of health or directly to co-operate with him, a n d even in the remaining cases some degree of effective
162
PUBLIC
co-ordination has been secured. Dr. Newman attaches special importance to the most intimate co-operation between the school authority and the authority responsible for the administration of the wider branches of public health, and there can be no doubt that much of the success that has attended the Board's handling of the whole question of school medical work has been due to their firm adherence to this principle. In the organization of the school medical officer's department the Board have allowed considerable latitude to local authorities, having regard to the variations in local conditions; but the general rule has been for the authority to appoint a school medical officer and subsequently to give him as many whole-time assistants as was thought necessary. In some districts, however, part-time assistants have been appointed, and in some other cases the work has been distributed between whole-time and part-time assistants. Dr. Newman thinks it is too early for a final opinion to be formed as to the relative advantages of whole-time and part-time assistants, but he points out that there has been a tendency to discard the system of many part-time assistants for that of a few whole-time assistants. This change has actually taken place in Somerset, Wilts, and the Lindsey Division of Lincolnshire. It is interesting to note that 8 school medical officers, and no less than 60 assistant medical officers are women. One of the most interesting sections in the report is that which deals with the action taken by local education authorities in respect to medical treatment. Considering the novelty of the subject and the numerous difficulties that attend it, surprising progress' has been made in the provision of treatment for school children. It is true that only one authority, Bradford, has opened a fully equipped school clinic, but smaller clinics have been established in six other districts, and altogether no less than 55 authorities have made arrangements for treatment with the sanction of the Board. This is a matter in which Dr. Newman will probably be able to record very considerable progress when he issues his next annual report. M E D I C A L O F F I C E R S O F H E A L T H AS PARLIAMENTARY CANDIDATES. only medical officer of health, we T H Ebelieve, who was adopted as a Parliamentary candidate for the recent general election was compelled by a legal disability to withdraw
HEALTH.
FEBRUARYj
his candidature only a fortnight before going to the poll. Mr. Fremantle,.County Medical Officer of Health and School Medical Officer for Hertfordshire, and last year's President of the Home Counties Branch of the Society, has for three and a half years been the prospective Conservative candidate for the Parliamentary division of Rotherhithe. When first adopted as prospective candidate Mr. Fremantle held only a half-time appointment, but in May, 19o8, he was appointed to give his whole time to the duties of the County Council. The work in the constituency being evening work he was able to continue his candidature, and on December I7th last was adopted as candidate. On December 2Ist his attention was drawn by his opponent to Section 83 (I3) of the Local Government Act, 1888, which provides that " n o paid clerk or other paid official in the permanent employment of a County Council who is required to devote his whole time to such employment shall be eligible to serve in Parliament." It was evident, therefore, that he could not be nominated on January 14th unless he could resign his appointment by that date. As his County Council do not meet until February I4th and he is compelled by the terms of his appointment to give three months' notice of resignation, it was clear that he could not resign, even if he was prepared to do so, except by a special meeting of the County Council being summoned , and their being willing, if a quorum were obtained, to forgo the notice required. Another way out of the difficulty might have been found if his County Council had been willing to vary the terms of his appointment, since the Housing and Town-Planning Act, 19o 9 , which came into force last December, places no limitation on the appointments and practice of a county medical officer appointed before the passing of the Act. In the circumstances, however, the chances of Mr. Fremantle's becoming eligible were so slight that he was compelled to withdraw his candidature. It may be noted, however, that no medical officer of health is ineligible to serve in Parliament unless he is a county medical officer of health engaged to give his whole time to such employment ; and, political sympathies apart, Mr. Fremantle has many colleagues who hope that he may vary the terms of his appointment, and be in a position to represent the views of medical officers of health in Parliament at no distant date.
The Society of Medical Officers of Health. No. 5,
FEBRUARY, I91o.
T H E A N N U A L R E P O R T ,OF T H E C H I E F M E D I C A L O F F I C E R O F T H E BOARD OF E D U C A T I O N . W M A N ' S first annual report, which D R.hasN Ebeen awaited with special interest by his former colleagues, will well repay the most careful study. It gives the first authentic account of what is undoubtedly the most important public health movement of recent years, and it is particularly valuable in that it sets forth, clearly and unmistakably, the lines on which the movement has been organized and directed by the Board of Education and the administrative methods that have been adopted. The report is a document that will long remain as a conspicuous landmark in the progress of social reform. After a brief historical survey of the school hygiene movement in this country and abroad, Dr. Newman proceeds to discuss the administration of medical inspection by the local education authorities, and to this subject a considerable amount of space has advisedly been devoted. The introduction of medical inspection gave rise to a great extension of other branches of school hygiene, and necessitated administrative changes on a very large scale and within a short period of time. The magnitude of these changes is apparent from Dr. Newman's statement that, whereas before 19o 7 only a small minority of the local education authorities had made any arrangements for medical work in the schools, at the present time all the 328 education authorities of England and Wales are "endeavouring, generally speaking with considerable enthusiasm and success, to make adequate provision for the medical inspection of school children, and for meeting, more or less effectually, the collateral questions of school hygiene raised thereby." In some respects the development of school hygiene consequent upon the Education (Administrative Provisions) Act, 19o7, has
VOL. XXIII,
taken a course that is unusual in the history of public health administration. Hitherto progress has been gradual, spreading, largely through the agency of local Acts of Parliament, from town to town, and generally speaking it has taken place in response to peripheral rather than to central stimuli. Medical inspection, however, and the other school medical work to which it has given rise, introduced as it was in response to a strong national demand, came into operation simultaneously all over the country, and has been organized throughout under the guidance and direction of the Board of Education. The creation of this vast organization was a task that was beset with difficulties, and it speaks volumes for the skill and judgment w i t h which the policy of the Board of Education has been directed, as well as for the public spirit of the local authorities, that medical inspection was got to work so rapidly and efficiently. The policy of the Board in relation to the new work of school hygiene has been based on a principle that has long been advocated in this journal. The Board have insisted that the" new school medical service should "to the utmost extent work in with the existing machinery of medical and sanitary administration, devdloping and supplementing it as required, rather than supplanting it by bringing into existence new agencies, partially redundant and possibly competing." In this attitude the Board have received almost universally the support of the local education authorities. It appears that up to the end of the Educational (Code) year 19o8- 9 the Board have" recognized" 307 school medical officers in 3o7 of the 328 local educational areas, and in 224 of these areas the officer appointed is the medical officer of health of the area. In the 83 remaining areas the school medical officer in 76 cases has been appointed either to be under the supervision of the medical officer of health or directly to co-operate with him, a n d even in the remaining cases some degree of effective
162
PUBLIC
co-ordination has been secured. Dr. Newman attaches special importance to the most intimate co-operation between the school authority and the authority responsible for the administration of the wider branches of public health, and there can be no doubt that much of the success that has attended the Board's handling of the whole question of school medical work has been due to their firm adherence to this principle. In the organization of the school medical officer's department the Board have allowed considerable latitude to local authorities, having regard to the variations in local conditions; but the general rule has been for the authority to appoint a school medical officer and subsequently to give him as many whole-time assistants as was thought necessary. In some districts, however, part-time assistants have been appointed, and in some other cases the work has been distributed between whole-time and part-time assistants. Dr. Newman thinks it is too early for a final opinion to be formed as to the relative advantages of whole-time and part-time assistants, but he points out that there has been a tendency to discard the system of many part-time assistants for that of a few whole-time assistants. This change has actually taken place in Somerset, Wilts, and the Lindsey Division of Lincolnshire. It is interesting to note that 8 school medical officers, and no less than 60 assistant medical officers are women. One of the most interesting sections in the report is that which deals with the action taken by local education authorities in respect to medical treatment. Considering the novelty of the subject and the numerous difficulties that attend it, surprising progress' has been made in the provision of treatment for school children. It is true that only one authority, Bradford, has opened a fully equipped school clinic, but smaller clinics have been established in six other districts, and altogether no less than 55 authorities have made arrangements for treatment with the sanction of the Board. This is a matter in which Dr. Newman will probably be able to record very considerable progress when he issues his next annual report. M E D I C A L O F F I C E R S O F H E A L T H AS PARLIAMENTARY CANDIDATES. only medical officer of health, we T H Ebelieve, who was adopted as a Parliamentary candidate for the recent general election was compelled by a legal disability to withdraw
HEALTH.
FEBRUARYj
his candidature only a fortnight before going to the poll. Mr. Fremantle,.County Medical Officer of Health and School Medical Officer for Hertfordshire, and last year's President of the Home Counties Branch of the Society, has for three and a half years been the prospective Conservative candidate for the Parliamentary division of Rotherhithe. When first adopted as prospective candidate Mr. Fremantle held only a half-time appointment, but in May, 19o8, he was appointed to give his whole time to the duties of the County Council. The work in the constituency being evening work he was able to continue his candidature, and on December I7th last was adopted as candidate. On December 2Ist his attention was drawn by his opponent to Section 83 (I3) of the Local Government Act, 1888, which provides that " n o paid clerk or other paid official in the permanent employment of a County Council who is required to devote his whole time to such employment shall be eligible to serve in Parliament." It was evident, therefore, that he could not be nominated on January 14th unless he could resign his appointment by that date. As his County Council do not meet until February I4th and he is compelled by the terms of his appointment to give three months' notice of resignation, it was clear that he could not resign, even if he was prepared to do so, except by a special meeting of the County Council being summoned , and their being willing, if a quorum were obtained, to forgo the notice required. Another way out of the difficulty might have been found if his County Council had been willing to vary the terms of his appointment, since the Housing and Town-Planning Act, 19o 9 , which came into force last December, places no limitation on the appointments and practice of a county medical officer appointed before the passing of the Act. In the circumstances, however, the chances of Mr. Fremantle's becoming eligible were so slight that he was compelled to withdraw his candidature. It may be noted, however, that no medical officer of health is ineligible to serve in Parliament unless he is a county medical officer of health engaged to give his whole time to such employment ; and, political sympathies apart, Mr. Fremantle has many colleagues who hope that he may vary the terms of his appointment, and be in a position to represent the views of medical officers of health in Parliament at no distant date.