MEDICAL INSPECTION OF SCHOOLS. 53 1 



greater than is generally admitted by schemes of medical inspec- 

 tion of schools that deal, for the most part, merely with children 

 of school-going age. It is the obligation to ensure physical effi- 

 ciency in every child. To be strictly logical, the State should 

 medically inspect every citizen. In other words, school medical 

 inspection should be a branch of a State service of health, linked 

 up with the department that controls the drainage and public 

 health measures generally. 



Prevention of physical defects in infants before they are of 

 school-going age is in general easier and better than prevention 

 later on. Nor is it sufficient that the child should be examined 

 when he leaves school. The State should follow him up. It 

 should see that he is placed in an environment calculated to 

 ease instead of adding to whatever burden ])arental indiscretion 

 or natural insufficiency has thrown upon him ; it should attempt 

 to supervise his life in these surroundings, and should offer him 

 facilities for correcting new defects that arise through indus- 

 trial or economic causes. 



I think it is this aspect of school medical inspection, in its 

 broad relation to social efficiency, that I may preferably submit 

 for consideration, conditioned by the suggestion that it is not the 

 only, although possibly the most important, aspect of the work 

 that the Education Department of the Transvaal Province has 

 recently initiated. 



Perhaps I may, as a preliminary, indicate what are the basic 

 requirements of any scheme of medical inspection of schools that 

 aims at the practical, as apart from the purely theoretical, im- 

 provement of the children of the race. In the first place, it is 

 essential that such a scheme should be co-ordinated to the exist- 

 ing system of education, and make due provision for local con- 

 ditions and circumstances. The decentralisation that obtains in 

 France or Italy is, for example, quite impossible in the Transvaal 

 or in New South Wales, where medical inspection of schools 

 must, for the present at least, be under the direct control of the 

 central departmental authorit}^ and not delegated to the local 

 authority until such local authority is in a position effectively to 

 superintend its administration. Indeed, it is questionable if 

 certain aspects of medical inspection of schools can adequately 

 be visioned from a purely local, one might almost say, from a 

 Medical Officer of Health's point of view. Take, for example, 

 the investigation of and the provision for mentally defective chil- 

 dren. The percentage of such children in scattered rural areas 

 is usually low, but for the whole Province, and, moreover, for 

 the entire Union, it is high enough to warrant special recogni- 

 tion, leading ultimately to precautionary or remedial treatment 

 on a scale which necessarily will involve capital expenditure that 

 cannot be debited to local areas, but must be borne by the whole 

 Province, and perhaps ultimately again by the Union. Next, 

 take the matter of the incidence of infectious disease in schools. 

 At present it is regarded as purely a matter of local interest in 

 which the Medical Officer of Health for the district is primarily 



