The Public Health Impacts of the School Medical Service
By its design, the School Medical Service established minimum standards for the health for British children. Its mission was to ensure:
i. That every school-child shall periodically come under direct medical and dental supervision, and if found defective shall be ‘followed up.’
ii. That every school-child found ill-nourished shall, somehow or other, be properly nourished, and every child found verminous shall, somehow or other, be cleansed.
iii. That for every sick, diseased, or defective child, skilled medical treatment shall be made available, either by the Local Education Authority or otherwise.
iv. That every child shall be educated in a well-ventilated, sanitary schoolroom or classroom, or in some form of open-air schoolroom or classroom.
v. That every child shall have, daily, organised physical exercise of appropriate character.
vi. That no child of school age shall be employed for profit except under approved conditions.
vii. That the school environment and the means of education shall be such as can in no case exert unfavourable or injurious influences upon the health, growth, and development of the child.
1Newman, An Outline of the Practice of Preventive Medicine, 59.The School Medical Service also provided doctors with a more “exact knowledge of the physical and mental condition of the school-child population of Britain.”
2Newman, The Building of a Nation’s Health, 208. Equipped with better knowledge of illness and defects in the schoolchild’s health, contemporaries like George Newman thought that treatment and prevention of ailments could be substantially improved. Thus, the School Medical Service both provided “immediate relief [to] the individual” from disease and disablement in school clinics, and also played an important role in ameliorating “the fundamental factors which are the determining causes of the need for assistance” through education and prevention.
3Annual Report to the City of Birmingham Education Committee for the Year 1910, 15–16. By design, the School Medical Service “blurred the boundaries between preventative and curative medicine.”
4Mooney, Intrusive Interventions, 115. It created a space for affordable and accessible treatments for malnourished or enfeebled English children suffering the ill effects of the urban penalty.
At times, the School Medical Service was put at odds with other systems of public health because it was administered by the Board of Education rather than the Medical Officer of Health. But the purpose of the School Medical Service was not to provide “a general public health service.” Rather, its objectives were to provide a service that was limited to children in public elementary schools with “clearly defined categories of defect.”
5“Note on the School Medical Service,” 1. Yet, as Newman strongly believed, “school hygiene cannot be divorced either from home hygiene . . . or from the health conditions of the community generally.”
6Annual Report for 1908 of the Chief Medical Officer of the Board of Education, 17. And thus, over time, the School Medical Service became an important partner in expanding systems of public health for English children in the first decade of the twentieth century.
As schools were providing free or low-cost meals to malnourished children, they were continuing the type of work that health visitors did for infants. School medical services were ensuring that children received a
nutritious diet essential to their healthy development. As the school curriculum increasingly incorporated lessons in physical and sanitary education at a critical developmental juncture in the child’s life, this work laid a foundation for a healthy adulthood by mitigating the “disabling effects” of the urban penalty. Most importantly, the establishment of the School Medical Service reinforced “the fact that the health of the child is the foundation of the national health.”
7Newman, An Outline of the Practice of Preventive Medicine, 58.Yet, despite its rapid growth, the system of clinics and services provided by the School Medical Service, much like the work of the health visitors, varied greatly across Great Britain.
8Mooney, Intrusive Interventions, 115. Only after the First World War did these programs for public health become fully subsumed into a nationalized system.