53-2 :\1K1M(AL IXSPECTIOX OF SCHOOLS. 



■concerned. Rontine school ins})ection in larj^e areas such as those 

 controlled by the London County Council has, however, fairly 

 clearly demonstrated the fact that systematic investigation by 

 school doctors and careful schedtiling of schools on a basis of 

 liability to infection tends to limit the spread of epidemic of 

 measles and scarlet fever, and to some extent also of diphtheria. 

 Bluntly stated, if you know the percentage of immunity in cer- 

 tain schools in a specified district, you are far better able to 

 control the spread of a disease in that district than if you did 

 not know how riianv children were ])OtentiaI infection carriers. 

 Where the percentage of immune children is ttnknown there is 

 no alternative to school closure, a coin"se of action that necessa- 

 rily entails complete dislocation of the educational machinery in 

 that district, and that Ijy no means warrants the supposition that 

 the e])idemic can be limited or checked, since it is now fairly well 

 established that in such diseases as measles and whoo])ing-cough 

 extra school infection is ])robably as i:)otent a factor in spreading 

 the disease as is class infection. Local School Board areas are, 

 'from the point of view of the epidemiologist, arbitrarily demar- 

 cated in the Transvaal Province, and unless the data with regard 

 to immunity are collated with those of neighbouring districts, it 

 is unlikely that they will prove of much ])ractical valtie should 

 an epidemic of infectious disease break out. I do not by any 

 means minimise the importance of the work now being done by 

 local Medical Officers of Health, but it nmst be admitted that 

 such work w"ill be greatly aided, and its ])ractical value greatly 

 enhanced, by the complementary work of the school doctor cen- 

 trally conducted and regulated. 



Further, it is necessarv that the school medical officer shall 

 be directly responsible to the Education Department, no matter 

 whether such a Department is controlled bv the Provincial or by 

 the Union authorit}'. This is the ])rinciple which has been 

 adopted by the English Board, A\here the Chief Medical Dfficer, 

 while working in close harmony with the officials of the Local 

 ■Government Board, preserves an independence of ftmction and 

 control that has had the most satisfactory results so far as im- 

 provements in the hygiene of the national schools are concerned. 

 It is of even greater importance in this country, where decen- 

 tralisation, to the extent obtaining in Great Britain, is at present 

 impossible. 



Secondly, the important essential is that any scheme of 

 medical inspection of schools for the Transvaal Province, or, 

 indeed, for any community, shall concentrate its main attention 

 upon the removal of defects discovered in school children at the 

 routine inspections. The mere statistical elaboration of figures 

 showing the tirgent need to co])e with juvenile invalidity serves 

 no useful purpose in a civilisation that already recognises the 

 desirability of dealing with such invalidity on logical lines, and is 

 therefore largely a waste of time and of energy. 



Dr. Hackworth Stuart, Medical Adviser to tb.e ilanley* 



