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The supervision of defective children
1925.
PUBLIC H E A L T H .
The Circular should receive the careful consideration of every E d u c a t i o n A u t h o r i t y in the Country. Bv including in the syllabus of instruction in their E l e m e n t a r y and S e c o n d a r y Schools a scheme of instruction such as t h a t outlined, they xxill a d v a n c e and p r o m o t e a k n o w l e d g e of the principles of i)ersonal hygiene, the practice of which c a n n o t fail to produce f a r - r e a c h i n g results. T h e t r a i n i n g of girls in the E l e m e n t a r y Schools from the a g e of 12 to 1:[ in subjects of a practical nature, which will fit them to look after the home, to rear healthy children, and give them the feeling that they k n o w the business of home m a n a g e m e n t will have effects which cannot be e x a g g e r a t e d . In the p a s t the provision for the t e a c h i n g of M o t h e r c r a f t and H o u s e c r a f t has been very inadequate and the p r o p o s a l s in the Circular if carried out in the efficient and t h o r o u g h w a y that their i m p o r t a n c e d e m a n d s will meet a much felt need. THE
SUPERVISION OF DEFECTIVE CHILI)REN.
Circular 13t9, issued 1)3" the Board of Educatioll lest J a n u a r y , has already aroused a r e m a r k a b l y keen interest, both on the part of the press, and of education authorities. The daily press ha~ given prominence to correspondence u r g i n g in p a r t i c u l a r the need for a d e q u a t e o r t h o p a e d i c schemes, and has e m p h a s i s e d the point in the editorial comments. Local educational a u t h o r i t i e s a p p e a r to have been in m a n y cases stimulated, and in others s o m e w h a t surprised, by the enquiries received from the B o a r d of E d u c a t i o n as to deviations between local and national prevalence of v a r i o u s types of defects. The B o a r d has solid g r o u n d s for satisfaction at the i m m e d i a t e response to the m o v e m e n t which it is initiating, for a fuller a s c e r t a i n m e n t of defective children, and for a m o r e a d e q u a t e m a c h i n e r y for the prevention and for the alleviation of these defects. N o t h i n g but g o o d can come out of the attention thus a g a i n concent r a t e d on the subject. The School Medical Service will do well to seize the o p p o r t u n i t y of using Circular 1349 to its fullest extent as a lever for o b t a i n i n g the provision of open-air schools, for the e s t a b l i s h m e n t or development of schemes for the prevention and the early t r e a t m e n t of crippling, etc. In r e g a r d to the a s c e r t a i n m e n t of defective children, it is p e r h a p s not out of place, without c a r p i n g criticism of the a d m i r a b l e plan a d o p t e d by the B o a r d of E d u c a t i o n for d r a w i n g the a t t e n t i o n of local a u t h o r i t i e s to the c o n t r a s t between their local and the national prevalence of such defects, nevertheless to refer to possible fallacies in such a corn-
203
parison. On the one h a n d local conditions, industrial or otherwise, m a y explain a deviation from the national s t a n d p o i n t in a p a r t i c u l a r direction without any error h a v i n g arisen in the procedure of a s c e r t a i n m e n t ; the coml)arison will obviously in this case be a useful one, in d r a w i n g attention to exceptionally bad or nnusually g o o d local conditions. On the other hand, there is possibly some fallacy in the national data. This m a y be illustrated by the experience of a district in which a recent careful revision of the r e g i s t e r of defective children, with a r e - e x a m i n a t i o n of all the children, and fresh a s c e r t a i n m e n t of all other k n o w n cases t h r o u g h all the channels ordinarily utilised for such a purpose, resulted, not in an increase, but in a c o n s i d e r a b l e decrease in the number of defective children r e m a i n i n g on the register. The e x p l a n a t i o n is o b v i o u s - - a r e g i s t e r which is not kept c o n s t a n t l y and s y s t e m a t i c a l l y up t'~ date m u s t a c c u m u l a t e g r a d u a l l y cases which, by reason of age, of vacancy, of death, etc., should have been removed froln its p a g e s . It is highly probable that such a r e m a r k applies to an apl)reciable, if not even a considerable, proportion of the local records on which the Board of Education previously based its national d a t a ; and to lhat e x t e n t the d a t a gives an e x a g g e r a t e d impression o! the prevalence of g r a v e physical or mental dcfectlon a m o n g the school population. In so far as the statistics paint too g l o o m y a picture, there are clearly g r o u n d s for thankftflness, but none for a failure to submit local d a t a to the most critical comparison with these for the country as a whole.
THE SANITARY OFFICERS
O R D E R , 1922.
In the fifth annual r e p o r t of the M i n i s t r y of Healtfi it is recorded t h a t d u r i n g the y e a r 1923-24 the Ministry a p p r o v e d 79 new a p p o i n t m e n t s of Medical Officers of Health. Of these 57 hold the specialist qualification prescribed by Article 5 of the S a n i t a r y Officers Order, 1922, b u t in the r e m a i n i n g cases the Minister dispensed with the requirements of the Article for various r e a s o n s and a p p r o v e d the appointments. These figures would a p p e a r to g i v e some basis for the c o m p l a i n t s which frequently reach the Society of Medical Officers of Health t h a t the S a n i t a r y Officers O r d e r , 1922, is too easily evaded by Local Authorities. This is nol only a g r i e v a n c e with whole-time Medical Officers who see public health a p p o i n t m e n t s filled by unqualified persons, but it is especially resented by those private p r a c t i t i o n e r s who have taken the D. P . H . and who find t h a t Local A u t h o r i t i e s attach
PUBLIC H E A L T H .
The Circular should receive the careful consideration of every E d u c a t i o n A u t h o r i t y in the Country. Bv including in the syllabus of instruction in their E l e m e n t a r y and S e c o n d a r y Schools a scheme of instruction such as t h a t outlined, they xxill a d v a n c e and p r o m o t e a k n o w l e d g e of the principles of i)ersonal hygiene, the practice of which c a n n o t fail to produce f a r - r e a c h i n g results. T h e t r a i n i n g of girls in the E l e m e n t a r y Schools from the a g e of 12 to 1:[ in subjects of a practical nature, which will fit them to look after the home, to rear healthy children, and give them the feeling that they k n o w the business of home m a n a g e m e n t will have effects which cannot be e x a g g e r a t e d . In the p a s t the provision for the t e a c h i n g of M o t h e r c r a f t and H o u s e c r a f t has been very inadequate and the p r o p o s a l s in the Circular if carried out in the efficient and t h o r o u g h w a y that their i m p o r t a n c e d e m a n d s will meet a much felt need. THE
SUPERVISION OF DEFECTIVE CHILI)REN.
Circular 13t9, issued 1)3" the Board of Educatioll lest J a n u a r y , has already aroused a r e m a r k a b l y keen interest, both on the part of the press, and of education authorities. The daily press ha~ given prominence to correspondence u r g i n g in p a r t i c u l a r the need for a d e q u a t e o r t h o p a e d i c schemes, and has e m p h a s i s e d the point in the editorial comments. Local educational a u t h o r i t i e s a p p e a r to have been in m a n y cases stimulated, and in others s o m e w h a t surprised, by the enquiries received from the B o a r d of E d u c a t i o n as to deviations between local and national prevalence of v a r i o u s types of defects. The B o a r d has solid g r o u n d s for satisfaction at the i m m e d i a t e response to the m o v e m e n t which it is initiating, for a fuller a s c e r t a i n m e n t of defective children, and for a m o r e a d e q u a t e m a c h i n e r y for the prevention and for the alleviation of these defects. N o t h i n g but g o o d can come out of the attention thus a g a i n concent r a t e d on the subject. The School Medical Service will do well to seize the o p p o r t u n i t y of using Circular 1349 to its fullest extent as a lever for o b t a i n i n g the provision of open-air schools, for the e s t a b l i s h m e n t or development of schemes for the prevention and the early t r e a t m e n t of crippling, etc. In r e g a r d to the a s c e r t a i n m e n t of defective children, it is p e r h a p s not out of place, without c a r p i n g criticism of the a d m i r a b l e plan a d o p t e d by the B o a r d of E d u c a t i o n for d r a w i n g the a t t e n t i o n of local a u t h o r i t i e s to the c o n t r a s t between their local and the national prevalence of such defects, nevertheless to refer to possible fallacies in such a corn-
203
parison. On the one h a n d local conditions, industrial or otherwise, m a y explain a deviation from the national s t a n d p o i n t in a p a r t i c u l a r direction without any error h a v i n g arisen in the procedure of a s c e r t a i n m e n t ; the coml)arison will obviously in this case be a useful one, in d r a w i n g attention to exceptionally bad or nnusually g o o d local conditions. On the other hand, there is possibly some fallacy in the national data. This m a y be illustrated by the experience of a district in which a recent careful revision of the r e g i s t e r of defective children, with a r e - e x a m i n a t i o n of all the children, and fresh a s c e r t a i n m e n t of all other k n o w n cases t h r o u g h all the channels ordinarily utilised for such a purpose, resulted, not in an increase, but in a c o n s i d e r a b l e decrease in the number of defective children r e m a i n i n g on the register. The e x p l a n a t i o n is o b v i o u s - - a r e g i s t e r which is not kept c o n s t a n t l y and s y s t e m a t i c a l l y up t'~ date m u s t a c c u m u l a t e g r a d u a l l y cases which, by reason of age, of vacancy, of death, etc., should have been removed froln its p a g e s . It is highly probable that such a r e m a r k applies to an apl)reciable, if not even a considerable, proportion of the local records on which the Board of Education previously based its national d a t a ; and to lhat e x t e n t the d a t a gives an e x a g g e r a t e d impression o! the prevalence of g r a v e physical or mental dcfectlon a m o n g the school population. In so far as the statistics paint too g l o o m y a picture, there are clearly g r o u n d s for thankftflness, but none for a failure to submit local d a t a to the most critical comparison with these for the country as a whole.
THE SANITARY OFFICERS
O R D E R , 1922.
In the fifth annual r e p o r t of the M i n i s t r y of Healtfi it is recorded t h a t d u r i n g the y e a r 1923-24 the Ministry a p p r o v e d 79 new a p p o i n t m e n t s of Medical Officers of Health. Of these 57 hold the specialist qualification prescribed by Article 5 of the S a n i t a r y Officers Order, 1922, b u t in the r e m a i n i n g cases the Minister dispensed with the requirements of the Article for various r e a s o n s and a p p r o v e d the appointments. These figures would a p p e a r to g i v e some basis for the c o m p l a i n t s which frequently reach the Society of Medical Officers of Health t h a t the S a n i t a r y Officers O r d e r , 1922, is too easily evaded by Local Authorities. This is nol only a g r i e v a n c e with whole-time Medical Officers who see public health a p p o i n t m e n t s filled by unqualified persons, but it is especially resented by those private p r a c t i t i o n e r s who have taken the D. P . H . and who find t h a t Local A u t h o r i t i e s attach