5,V> Ali.DU'AL INSna'TJiiN OF SCHOOLS. 



(|Ucstion of the ])oor white, and the ahuost more im]jortant ijroh- 

 leni of masked paui)erism presented by units of the commumty 

 following certain underpaid occupations in rural and urban areas. 

 The effects of these factors of poverty, disease incidental to occu- 

 ]jation or to residence in unhealthy areas, and defects due almost 

 direct!}" to preventable ignorance, uncleanliness. and neglect, 

 upon the physique of the growing generation can hardlv l)e esti- 

 mated at present with ;iny degree of scientihc })recision. since we 

 entire!} lac!< t!ie data for com])arison. Rut as school n.iedical 

 ins])ection ])rogresses, such data wil! accumulate, and will i)rove 

 of immense \alue when tliese matters come under discussion in 

 tlie future. 



Suc!i, t!ien. are to m\- mind ,tlie essentials of anv scheme of 

 ratinna! medica! insj^xnion of schools that, wiili a broader ])ur- 

 vIqw and a wider sens" of its ol)!igations. visions its work as a 

 systematic atttick not UjKjn isolated defects discovered at school, 

 but u])on the root factors t!iat account for national inefficiency 

 due to preventable disease. It is impossil)le to deal at length with 

 tlie maimer in whicli it is ])roposed to ensure tlT.'it tliese essentials 

 shall !)e inevitable concomitants of anv scheme e!al)orated for 

 the 'I'ransvaal. but 1 may !)rietly sketch the general lines upon 

 whicli it is suggested that medical ins])eclion of schools should 

 jM-oceed. 



With regard to the tirst essential, co-ordination with the 

 central authorit} . \\ e have started S(|uarely, inasnuich as we have 

 made medical ins]:)ection of schools an integral part of the func- 

 tions of the De]>artment of lulucation. and have not divorced it 

 from the central atithority b}' pigeon-holing the new service into 

 another Dejxirtment. The medical insjjector of schools is now 

 one of the departmental ins])ectors, directb' res])onsible to the 

 department for carr}-ing out a scheme which has been drawn 

 up after consultation v.'ith the departmental officials, and with 

 due regard to local and dei)artmental necessities. This ])revents 

 overlap] )ing, obviates friction, and maintains luiimpaired the 

 functional integrit}' of the new service on the same basis as that 

 under the English Board of Education. Matters of public health 

 affecting local communities are dealt with in consultation with 

 local medical ofHcers of health, whose authoritv. in their own dis- 

 tricts, nmst be su])reme. Unfortunatelv there are still many 

 districts where no local medical officer of health exists, and where 

 the local district s;u-geon has a kind of semi-official authority, 

 with usuall}' no power to enforce it. Questions of procediu'e 

 during an outbreak of infectious disease in such unserved dis- 

 tricts present certain difficulties which nuist remain at ])resent 

 until the ])ublic health service in this countrv is controlled on 

 scien.tihc lines by a strong central authority. The want of such 

 central control is one of the difficulties that school medical offi- 

 cers in this country will have to struggle against. Another diffi- 

 cultv is the absence of any legislative sanction for the work they 

 are exj^ected to carry out, and the dual control that now exists in 

 some districts in consequence of the loosely-framed regulations 



