THE 

CASE FOR SCHOOL CLINICS. 


BY 

L . HADEN GUEST, M.R.C.S. (Eng.) 
L .R.C.P. (Lond.) 
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THE CAsE FOR ScHooL CLINics. 

R eprz"nted wz"th addz"tz'ons and correctz'ons by the courtesy of the 
"Dcnly N ews." 

IF we were really a practical nation instead of an obscurantist 
nation, we should do some very simple things for school children. 
We should, to begin with, treat them as individual boys and girlsand not as administrative units, with the possibility of a decimal 
point thrown in. The things that children need are known to very 
many thousands of English men and women ; they comprise good 
food, good clothing, good housing, and loving care. In educational 
matters educationists are so far agreed that in a genuinely representative 
congress, expressing unfettered opinions, there would be no 
serious differences of opinion on essentials. But we are not a 
practical nation, and I do not propose to discuss the detail of these 
practical things. There is a huge gap between what we know how 
to do and what we immediately proceed to do on any extensive 
scale. The why and wherefore of this is another matter; at present 
my concern is with the things that we can immediately proceed to 
do for the school child. 

On the roundabout route by which we approach common sense, 
the medical inspection of school children is a long step. By this 
inspection the problem is displayed and made graphic before our 
eyes. Before medical inspection theorists could argue ad infinitum, 
after medical inspection the argument must at least centre round the 
facts discovered. 

What Inspection Shows. 

The main subdivisions and groupings of children which medical 
inspection enables us to make, are, broadly speaking, the same for all 
schools. In every school the bulk of the children show an averagehealth which is comparatively satisfactory. And among the children. 
presenting defects of mind and physique there are two main groups. 
In both of these medical defects are present, but in the one 
the family circumstances are average or above the average, in the 
other group the circumstances are below the average. The first 
may be said to present simply medical defects, the second medical 
defects plus poverty.

The children who are average must not be thought by any 
means to be satisfactory. The average of one school is of necessitymade for that school, and applies to the particular children drawn 
from the homes round about it. The average of a school in a slum 
neighborhood would be below the average for a school in a district 
of well-paid artizans. In London, for instance, parts of Lambeth 
may be well below parts of Battersea. 


4 

The average is in no case very high, in the London CountyCouncil schools three decayed teeth are charted as normal, manyslight eye defects, many slight degrees of feeble nutrition, and manyslight deformities are " normal." None the less these things are 
handicaps in schoolwork, and in after life. Such average children 
are very "average" in general capacity, in character, and in graspof the duties of citizenship and of their part in life. 

To raise the average of child life in all schools to the level of 
the school with the highest average among children drawn from the 
same social stratum, to raise the average of all slum schools to the 
average of the best slum school, is a non-utopian ideal with a very 
concrete measure of its success, which we might well adopt into our 
municipal politics. 

The problem of the average child is largely a problem for the 
statesman and social reformer ; medical knowledge has made the 
problem concrete and definite, and can suggest some needed reforms. 
But the problem of the child with defects, whether purely medical or 
medical plus poverty, is predominantly a doctor's question. 

The Medical Group and the Poverty Group. 

The division into two groups is important from the standpointof treatment. The purely medical cases can get cured comparativelyeasily, the poverty cases only with difficulty. To treat a child with 
obstructed breathing and adenoids who is otherwise fairly sound and 
who comes from a decent home, is simple, and cure is probable. The 
parents of such a child will take trouble to see that the defect is 
remedied when it is pointed out to them. The decent home and the 
child's fairly sound condition are an indication that the parents have 
the desire and probably the time to see that proper treatment is 
applied. In every large town and accessible for most small towns 
and villages there are hospitals and dispensaries supplying facilities 
for treatment which can be taken advantage of by those having the 
desire and the time to do so. On the whole the great bulk of 
children presenting medical defects pure and simple will have those 
defects attended to by existing institutions when the parents become 
aware of what is needed. In this respect medical inspection putsthe child of the poor man on a level with the child of the rich man, 
by giving him an expert opinion on what should be done to put the 
child in the fittest possible condition. Medical inspection does a 
great work if it makes medical knowledge available to the parentsof all children. 

Difficulty of the Poverty Group. 

In the case of children presenting medical defects plus poverty,
the case is far different. To begin with, such children often present 
not one or two but a group ot defects, and complicated and continuous 
treatment may be required. The general condition of such 
children is not good, and the children do not give good results from 
treatment. Discharging ears in a badly nourished poor child for 
instance, take longer to get well than in a decently nourished 


5 


average child. But, worst of all, the parents of such poor children 
do not take them for medical treatment. Sometimes the parentswill not take them-these, I think, are the rarer cases-sometimes 
the parents do not think medical treatment necessary, these are 
commoner cases. Sometimes the parents cannot spare time to getthe children treated. This last class is as large as either of the two 
others, and may in certain localities be larger. In the first group 
come the children from drunken and vicious homes, in the second 
from feckless homes, in the third from overworked and underworked 
homes. We might call them the vicious, the feckless, and the poorhomes. 

The remedy for these conditions lies outside the scope of school 
organization, but the recognition of the existence of these conditions 
is very much a matter for school authorities. For the plain A B C 
af the facts is this, that it is no use treating defects of nose and 
throat, eye and ear, unless you treat the underlying debility of constitution 
produced by the home conditions. That means remedial 
school feeding firstly and open-air schools, school baths and gymnasia 
among other things as secondary methods. This state of thingsmeans also a new organization for getting the children treated. 

It may, in theory, be highly desirable to ''insist" on the parentsgetting remedied the defects pointed out to them by medical 
inspection. In practice the parents will either not do so, or onlypretend to do so, for in the matter of getting treatment it is fatally 
easy to pretend. If the poverty group children are to have their 
illnesses and ailments remedied, they will have to be (a) fed on a diet 
designed to improve their physique, and (b) sent to hospital or school 
clinic in charge of someone from the school by the authority of the 
school. 

The home conditions of such children also need tackling ; the 
necessity of open windows and soap and water need pointing out, 
and all kinds of complicated little details need discussing with the 
parents. These are the duties of the care committee, but if they 
are to be effectively carried out, if remedial feeding is to become a 
reality instead of a pretence, and if medical defects are to be cured, 
there is only one effective way of doing these things-all of these 
activities must centre round a school clinic. And the school clinic, 
the school doctors, and the school nurses must be as much a part of 
the school organization as the school teachers. 

The average children in council schools (who are nevertheless 

below the standard of their own possibilities), and the children with 

medical defects only, may be put aside for the moment; the children 

with defects plus poverty are an urgent problem demanding instant 

attention. 

The Morass of Destitution. 

Children belonging to the poverty group, as already defined, are 
the children sprung from the morass of destitution which quakes and 
shivers around the foundations of our civilization. These children 
come from definitely localized neighborhoods, from particular streets, 


6 


<md from special blocks of" model" dwellings. The poverty of destitution 
and demoralization is spotted over the surface of our towns 
as concretely as smallpox is spotted over the face of a man sick from 
this disease. The poverty spots are, however, mouths of the abyssinto which human life and our civilization sink away out of sight of 
man. And to children coming from the poverty spots, it is no use 
giving a box of ointment or a bottle of lotion to cure their diseases ; 
these things make no impression thrown into the abyss.

A mother equipped with patience, the desire of cleanliness, and 
the wish for health, may get some good out of a hospital out patientdepartment, even if the interview accorded by the doctor after hours 
of waiting be very brief. The mother from the demoralized poverty 
spot, even if she does arrive at the hospital, will get usually no helpof which she can avail herself. 

The doctor's point of view needs to be considered. A busy man, 
seeing very many similar cases, giving very frequently the same 
instructions, and meeting constantly with the same failure to getthose instructions adequately carried out, may sometimes get a little 
hopeless as to the value of his out patient work. 

A Typical Slum Mother. 

The advent of a typical slum (poverty spot) mother increases the 
doctor's feeling of hopelessness ten or twentyfold. Take a concrete 
case, that of a child with discharge from the ears. The mother of 
the case I have in mind is a person with tattered, frowsy, and safety-
pinned raiment, conforming generally to the blouse and skirt type ; 
the sleeves are torn to a conveniently free length, the waist is commodiously 
ample. Neither face nor hands are especially clean, the 
face is coarse in feature and grinningly amiable. Conversation 
Teveals much surface plausibility, with much genuine and deep laid 
sloth and inertia. The home is in two or three dark, semi-basement 
rooms, low, hung with lines on which hang flapping clothes, cumbered 
with backless chairs, decayed tables, peeling veneer chests of 
drawers, and iron bedsteads heaped with brownish coverings. 

Is it wonderful that, faced by the problem of treating the child of 
such a mother, living in such a home, the doctor may get a little 
despairing? Treatment which consists partly of syringing out the 
ears must inevitably fail of being carried out under cleanly conditions 
(aseptic is pure utopianism). Regularity is not understood ; 
any directions given, except with the most labored simplicity, are 
not understood. For unexplained reasons such a patient will frequently 
not attend to see the doctor and report progress. For 
other unexplained reasons the patient will try "a bottle of medicine 
" from some private dispensary or from some other publicinstitution. On other occasions the patient will attend in chargeof an incompetent person to whom it is useless to give instructions 
and from whom it is impossible to expect reasonable information. 
In the particular instance the person in charge was sometimes a 
drunken grandmother, and once or twice a sister only a year or 
two older than the patient. 


~7 

In such cases it may be possible to get parental consent to an 
operation for removal of tonsils or adenoids. That involves verylittle trouble to the parents, and is besides by way of being fashionable, 
and has proved of benefit to neighboring children. But an 
operation is the first part of the treatment and not the end. A 
child operated upon needs medical supervision and careful trainingbefore it may be pronounced cured. And this supervision and 
training it does not get. . 

Deeper Deeps. 

The case cited ~bove is by no means an especially bad one ; it 
may even be thought to belong to the aristocracy of the poverty 
group. It is still possible to treat a child of this kind by the united 
effort of school nurse, school teachers, school doctor, dispensary 
doctor, with the casual intervention of the clergyman, the district 
visitor, and a member of the care committee. But there are manychildren beyond these agencies. There is (I take examples at random 
as they occur to me from my own experience) the case of the blind 
woman, a widow, with verminous and ringworm smitten children. 
Medical treatment comes and goes, according to the aberrations of 
the patient's mother, but the conditions persist. To expostulatewith such a woman for sewing her child's clothing tightly upon its 
back is to get a glib explanation (glaringly denied by the conditions)
that this is done regularly every night after the equally regular bath. 
Nevertheless, however glaringly obvious the condition, the cure is 
not obvious under existing circumstances. To give a complete outfit 
of clean clothes is no remedy ; it has been tried more than once 
and failed. 

Another case is that of a child attending a school for mental 
defectives. The school nurse noticed the discharging ears, and 
managed, after considerable trouble with minor arrangements, to getthe child specially medically examined. At the examination the 
mother stated that the child was "under treatment." This, it 
appeared, meant one attendance in six weeks at a hospital out 
patient department, where she was given some lotion and some 
rapid and half-comprehended instructions. The mother then consented 
for a special arrangement to be made whereby the child was 
to be sent . from school to a public dispensary every day, in order 
that the ears might be properly syringed out and attended to by a 
nurse. The school doctor gave the mother a letter for the school 
teacher to the effect that the mother agreed to this, to be given to 
the school teacher by the child. Three days afterwards a teacher 
called on the dispensary doctor to enquire when treatment mightbegin, as she had heard about it from the nurse. It then appearedthat the letter had not been delivered. Another teacher then 
visited the child's home and secured the school doctor's letter. " It 
had been forgotten." After this the child attended at the dispensary 
most days, but never on Saturdays, when it "minded the 
baby." As soon as the summer vacation began, the child also 
ceased attending. After the summer holiday the ears, which were 


8 

in a most serious and foul condition, were found just as bad as they 
ever had been. The same thing occurred at the Christmas vacation. 
And these measures taken to get treatment were quite independentof numerous official letters and enquiries about the child, involving 
the labor of clerks and other officials on a fruitless task. 

Even when with great and, compared with the results, disproportionate 
exertion, such a child has been cured of one definite 
ailment, it very often presents another. Frequently a poverty 
group child shows more than one defect, often several defects, and 
the cure of one may leave the others unaffected. While the cure of 
all definite ailments may still leave the groundwork of anremia and a 
debilitated constitution unaffected. To get a poverty group child 
into a good state of health often involves prolonged and expensive 
treatment, one or more operations on ear, glands in the neck, tonsils 
or adenoids, a stay in hospital and at a convalescent home, and 
perhaps a prolonged three to six months holiday in some countrycottage, all of which means much money and very much expenditureof time and energy. 

The Necessity of the School Clinic. 

To continue the present methods of dealing with the poverty 
group children is to perpetuate the diseases and defects from which 
they suffer. Nothing but a special organization to meet the specialcase will be of any great service. What is done at present is of 
immense help in ameliorating disease, in easing pain, in keepingthe worse worst conditions from spreading too widely ; but what is 
done at present is costly, cumbrous, involves great labor, and effects 
little permanent result, in the poverty group often none. 

When medical treatment is as much a part of the school work as 
manual training or housewifery, then it will have a chance to be 
effective. The educated observation of the teacher will be at hand 
and at the doctor's disposal to supplement the haphazard observation 
of the parent, the report of the school medical inspector and the 
observation of the school nurse will be available, and the machineryof the school organization, with school nurse, attendance officer, and 
children's care committee, will be able to be used for the purpose of 
carrying out necessary instructions in the home and out of school 
hours. In a word, instead of endeavoring to treat an ailing child bythe agency of half a dozen badly co-ordinated or entirely separateinstitutions, with no effective grip anywhere, we shall be treatingthe same ailment as a part of the school life, with the necessary 
means entirely at our disposal, and with all the other agenciesadequately co-ordinated and properly effective. 

All the activities controlled and directed by the care committee 
should be worked in the closest co-operation with the school clinic. 
This is especially true of the provision of meals for necessitous 
children, but it is also true of the provision of boots and of clothing 
and of the arrangement of country holidays. 

In describing the suggested organization of the school clinic I am 
relying on my experience at the St. George's Dispensary in Black



9 

friars, where for some time past the medical staff have been experimenting 
in the direction of the school clinic. The patients at this 
dispensary are women, school children, and infants; the dispensaryis free to those too poor to pay for medical advice, and some 6,ooo 
patients, a large number of whom are school children, are seen every 
year. This figure probably represents the full number of patientswho can be seen in the space available and during the time the 
doctors are in attendance. 

Judging from this experience and that of others who have been 
pioneering on school clinic lines, one gets a very actual view of the 
conditions to be met. 

The Clinic Required. 

In every thickly populated locality schools are built fairly close 
to each other, and fall into groups. To supply the need of such a 
group only one clinic is required, and may well serve for sixteen or 
twenty schools, with a school population of something under a 
thousand each. 

To start a clinic the first necessity is to find a convenient building 
situated in the centre of the group, or as near this as may be. 
It is desirable, especially for small children, to have the clinic not 
more than twenty minutes' walk from any school. Greater distances 
are inconvenient, and much smaller distances highly desirable. The 
St. George's Dispensary is established in an old public house less than 
ten minutes' walk from nearly a dozen schools. 

A clinic must havt: a large waiting-room, one or two rooms for 
consultation with the doctor, and a r.oom for treatments and dressingby the nurse. 

A doctor should be in attendance at the clinic during school 
hours, and the head teachers of the schools belonging to the groupshould send there, in charge of the school nurse or other responsibleperson, all the children who are to have treatment. These children 
will be roughly those of the poverty group, but they will also include 
cases of discharging ears and other chronic ailments which need 
daily care, and cannot be attended to at a hospital. The children 
sent to the clinic would be normally those examined by the school 
doctor, whose parents were recommended to get them treatment, 
but who failed to obtain it on their own initiative, after a reasonable 
period, say a month. In some acute and urgent cases the clinic 
should render first aid, as it were, and the teachers should be encouraged 
to send children for examination whenever there was 
uncertainty as to its condition. 

A Sorting Out Centre. 

When a medical inspection of a school is made the defects discovered 
fall into very definite classes. Among them some children, 
for instance, will have defects of vision, some obstruction at the 
back of the nose caused by adenoids, some have discharging ears, 
and others threatening or incipient phthisis. Which of these ailments 
can the school clinic properly treat? Partly this must depend 


10 

upon the situation of the clinic. If it is near to a good specialhospital for eye diseases or for those of nose, throat, or any other 
special ailments, and if satisfactory arrangements can be made for 
treatment at that hospital, then it is a waste of energy to multiply 
treatment centres. But the clinic should always reserve to itself the 
power to treat any kind of case in the event of a child for anyreason failing to go to the special hospital. This does not mean 
that a recalcitrant eye case should be treated at the clinic, but that 
the child not getting treatment should be sent to the clinic and 
arrangements made, through the clinic organization, for the special 
treatment needed. All that is often wanted, when parents refuse or 
fail to get the suggested treatment, is a medical talk, giving them 
information or reassuring them about some not understood medical 
mystery.

This hypothetical instance gives the key to the line of treatment 
which must be adopted. The clinic will be the organization which 
sees that the child gets treatment. A large number of cases, those 
of diseases of ear, nose, and throat, many skin diseases, chest 
troubles, digestive troubles, and others, would be actually treated at 
the clinic. But the very severe ear trouble would be sent to hospital, 
the serious phthisis to the sanatorium, and the serious bone 
tuberculosis to the special hospital. The clinic, in fact, while acting 
as a treatment centre for those defects and diseases which can be 
con-veniently and economically treated in an institution fitted up in 
a simple and inexpensive way, would also act as a sorting centre, 
and draft off serious and special cases to the institution where their 
appropriate treatment could be obtained. 

Co-operation with Hospitals. 
The school clinic should work in the closest co-operation with 
the hospitals and dispensaries, and have standing arrangementswhereby certain classes of cases could be sent direct to them as soon 
as discovered. Some of the arrangements made at present with 
hospitals for treatment would fit in well. This means in practicethat the clinics would only need the simplest apparatus, and that for 
the complex cases the costly and elaborate hospital organization 
would be made use of. 

Existing Clinics. 

In Germany, of course, school clinics for the treatment of all 
varieties of school diseases have been in existence for some years, 
with the greatest possible benefit to the health of the children concerned. 
But it is not necessary to go to Germany for examples. 
These institutions are in existence already in various towns in 
England, the Board of Education having power to sanction their 
establishment under section 13 of the Education (AdministrativeProvisions) Act, 190 7 , under which medical inspection is carried on. 
In London voluntary agencies have established clinics at Bow, 
Deptford, and Blackfriars. In Cambridge a dental clinic established 
on a voluntary basis has now been taken over by the municipality 


II 

and is run as a publicly supported institution. In London a dental 
clinic is working at Deptford on two afternoons a week, and one is 
being established, as the result of a private experiment, to work on 
five afternoons a week at the St. George's Dispensary, Blackfriars. 
Bradford, Brighton, Sheffield, Southampton and York are amongother towns where school clinic treatment is provided. The clinic 
at Br~dford is open six days a week and treats children requiring 
spectacles) skin diseases, including X-ray treatment for ringworm,
children referred from medical inspection, and for admission to 
special schools, including open-air schools, cases of discharging ears 
{syringed daily by the nurses), and children who have been in contact 
with, or are recovering from, infectious disease. At Bradford 
the clinic is found not to interfere with ordinary medical practice~ 
and it is significant in this respect that a clinic has been established 
at Wandsworth, under the auspices of the local branch of the 
British Medical Association, and a treatment centre opened in Hampstead 
under the control of local medical practitioners. Probably the 
London County Council will be forced by pressure of circumstances 
to establish clinics in lieu of their present hospital system, a subcommittee 
of the Education Committee having reported strongly in 
favor of the system in 1908. 

Part of the reason for the establishment of school clinics lies in 
the fact that without them the large poverty group of ailing children 
cannot be adequately treated because their parents have not time to, 

_cannot, or will not, take their children to private doctors or hospitals.
Nevertheless a clinic may look forward to frequent visits from the 
parents and every possible endeavor should be made to get the 
parents to attend. There are very few of even the most demoralized 
slum dwellers who do not wish to do what they can for the good of 
their children. But when not only means, but all knowledge is 
lacking, it is idle to expect the observance of hygienic common sense. 
Many parents who cannot afford to wait for a whole morning or afternoon, 
or even the larger part of a day at a hospital, could manage to 
get to the clinic if a definite hour was fixed. 

The Clinic and Common Sense Hygiene. 

The clinic should, in fact, become the instruction centre for 
parents in the art of hygiene, the concrete examples being providedby their own children's ailments. Such concrete hygiene teaching,
supplemented, perhaps, by special demonstrations and talks for 
parents-on the care of the teeth, on breathing and on feeding, for 
instance-would do more for slum districts and poverty spots than 
years of abstract lectures in evening schools, admirable as these 
are. 

Above all the clinic must be simple, straightforward, and human. 
A laughing and a smiling child should be the rule, a solemn or a 
weeping child the exception. The doctors' and nurses' rooms should 
be places of happiness and kindliness. In this way the confidence 
of child and parent will be gained easily, treatment will be facilitated 
and the parents will try to obey and understand rules of treat



12 

~ent and hygiene. In my own experience I have met very few peoplemcapable of following simple hygienic and medical instructions. 

The Clinic and Poverty. 
In the preceding paragraphs I sketched the organization of the 
school clinic on its medical side, and indicated how it would deal 
with medically and surgically remediable ailments and defects. But 
among the poverty group children the worst disease, upon which 
the others do indeed largely depend, is poverty itself. Lack of 
boots, lack of clothing, and lack of food are not matters which the 
doctor can professionally remedy. But the school clinic should 
work in the closest touch with the care committee, and when the 
doctor has done all that is possible to put the ailing child straightfrom his point of view, the care committee agency must be called in 
to remedy poverty defects which otherwise would render (and do 
now render under present circumstances) all the medical labor in 
vain. The underfed child must be fed, the underclothed child 
clothed. The doctor will certify what social factors are likely to 
cause or allow a relapse of the illness or defect, and it must be the 
business of the care committee to take precautions accordingly. 

Remedial Feeding. 

This will mean in practice that the care committee must have a 
fund for supplying the needs of school clinic cases. The committee 
must go even further. The chief need of poverty group children 
often is carefully adjusted feeding, adjusted, that is, to their 
damaged and deteriorated digestive systems. This remedial feeding 
will inevitably be an important part of the school clinic's prescriptions, 
and will have to be something very different from the presenthaphazard meals, frequently all that is now provided under the Provision 
of Meals Act. These meals will be framed on the lines of a 
medical prescription, and might well (in some cases, at least) be 
distributed on the plan used by the excellent invalid kitchen in 
Southwark, which provides meals of different kinds to suit invalid 
digestions.

Used in this way it will be essential to see that the meal serves 

its purpose of feeding the child adequately and not of merely

staving off starvation. If the school meal was improved so as to 

become a really physiologically good meal, it would be unnecessary 

to have invalid cookery for special cases. If the meals are not so 

improved, it is difficult to see how otherwise the proper feeding of 

ailing and debilitated poor children is to be obtained: 

When one turns from feeding to consider the question of boots 

and clothes, it is clear that very much requires to be done. A 

school clinic will have only one answer to the conundrum as to 

whether it is better to treat recurrent attacks of bronchitis and throat 

trouble or provide a stout pair of boots and warm clothing. The 

drug bill and the bill of salaries and general expenses will be 

balanced against a bill for clothes and boots, and found to be much 

heavier. The bill is heavier now, but different pockets pay the 


13 


different bills ; and the hospitals that appeal for subscriptions do not 
consider it part of their duty to prevent the need for some of their 
work by subsidizing boot and clothing clubs for schools ; nor would 
they, as long as they are separated institutions, do much good bytheir subsidies, if given. 

Country Holidays. 
It is the same with another important aspect of care committee 
w~rk, that of providing for country holidays. The knowledgegamed at the school clinic will be of immense help in determining 
what children need this kind of holiday and what that. At the 
prese~t time the question of country holidays and of convalescence 
after Illness or sanatorium treatment are in a rather unorganized 
con.dition. Multitudes of children who would benefit by countryhohdays do not get them, many children who need seaside convalesc~
nce or sanatorium treatment do not get it, while, at the same 
ttme, financially unsuitable children are allowed to take advantage of 
chari~ies which are needed by others less well able to pay. The 
condttions at present are unavoidable, but a school clinic would 
make it easier to apply the charities to the best result. Given, 
then, that the care committee is working in close touch with the 
doctors, it should be possible to arrange for the optimum use of the 
agencies at the committee's disposal and probably for the holidaying 
of all those children whose condition urgently required it, and 
especially those threatened with tuberculosis. 
Very much valuable work is done by voluntary and paid health 
visitors, who endeavor by home visits and by plain talks to impress 
on the homes of poor people the common sense lessons of modern 
hygiene. The school clinic will do much to fortify and reinforce 
this health missionary work. For the clinic will not only act as a 
centre, a rallying point, and a reference on all questions connected 
with the health of the school child, but it will train the children and 
the parents themselves as health missionaries on their own account. 
As I have before mentioned, the discussion of a practical point of 
hygiene, say, that of open windows or of personal cleanliness, 
becomes not only concrete, bu~ vital, when it is dis~ussed :-vith _the 
parents with the ailment or deltcacy of a beloved chlid as tts obJeCt 
lesson. The lesson (it is a way with lessons) may have to be 
repeated but ultimately it will be effective. A school clinic properlyconduct~d should spread principles of hygiene very rapidly throughout 
its district. 
The Main Points. 

I have above pointed out how the school clinic will enable all 
cases of ailment or defect in school children to be adequately treated, 
how it will link the school organization with the present school 
doctors and school nurses and with the special and general hospitals. 

How, again, all the activities which haYe to do with feeding,
clothing, holidaying, and convalescence may be naturally groupedand co-ordinated with the clinic's medical work. And how, further, 


the activity of the clinic and its co-ordinated helpers will stretch 
outside the clinic, outside the school, and penetrate by means of its 
missionaries into the home itself, bringing the sweetness and lightof health to the parents of school children (particularly of the 
poverty group), clothed in the garb of their own thoughts and ideas, 
and exemplified by the occurrences of their daily lives. 

Nothing here suggested is utopian, nothing advocated is more 
than the grouping together of isolated and unco-ordinated practicalactivities already existing in one form or another. The school 
clinic, by medically studying the child, provides the natural centre 
and rallying point for all these activities. The agencies which are 
now working in a scattered and unco-ordinated way for the helpingof school children will be centralized by the clinic, organized, and 
made a hundred per cent. more effective than they can now be. 
And we may hope for great and almost unrealizable changes when 
the school clinic pours out health and help and kindliness in everycongested and poor district, for then the growth of child life, which 
now sinks down into the abyss, will spring up and grow healthilyinto the light and air of good human existence. 

Pure Utopianism. 

\Vhat I have spoken of aboye is practical to-day; that which 
follows will not be " practical" until to-morrow, when some of the 
preliminary work of clearing out the awful morass of slum child life 
shall have been performed. To-day it is only a dream, a dream of 
the time when the child at school shall grow as sweetly and as 
happily as a flower in a garden, when it shall stretch up its mind for 
knowledge as a flower for sunlight, and when all the strange and 
impish deformities and etiolations medical inspectors have to catalogue 
are relegated to infrequent hospitals and sanatoria with but 
very few beds in their wards. 

The school clinic will aim to get the level of all children up to 
the low "average" or "normal" of the relatively healthy in presentcouncil schools, and when that is accomplished we can begin our 
real work of devising means whereby that low, that all too low, 
average may be transcended ; the lethargic body grow supple,
nimble, and good to look upon ; the dulled senses quick, true, and 
responsive ; and the narrow mind actively growing and expanding.
All these things are within the sphere of the school doctor, all these 
things are within the scope ot present day medical knowledge.
The knowledge is here in reality; it is only the accomplishment in 
fact that is in Utopia-to-morrow.

In the good time when the poverty group child has grown into a 
sound average and the present average become robust, I look forward 
to a new kind of standard being introduced in schools-standards 
of imagination. In the present day children are only sent to 
the doctor when they are obviously deaf, or blind, or halt, or 
maimed. In the future the tests will be more subtle, and I confidently 
anticipate the time when "Peter Pan" or "The Blue 
Bird," or some such fairy tale, will be a compulsory subject of the 


15 


ordinary council school curriculum. At that day any child failing 
to reach, at any rate, the "Peter Pan" standard of imagination will 
promptly be sent to the school clinic. It is, after all, a rather 
serious reflection that there are many thousand "average" children 
to-day who do not reach this level. 

The first step towards the raising of the standard must be taken 
by raising the lowest, and by pouring so much health, help, and 
kindliness into the poverty group children that their all too low 
grade finally disappears. 

BIBLIOGRAPHY. 

Report M.O. (Education), L.C.C., p. 52, 1907; p. 21, 1908; p. 41, 1909. 


Report M.O., Dunfermline, 1909. 
Medical Inspection of Schools. DR. HOGAR.TH. Henry Frowde. 1909. 6s. 
Medical~Supervision in Schools. E. M. STEVENS. Balliere, Tindal & Cox. 19!0. 
Medical Inspection of Schools and Scholars. Edited by T. N. KELYNACH, M.D. 


P. S. Kmg. 1910. ros. 
Treatment of School Children. R. H. CROWLEY, M.D. Methuen. 1910. 3s. 6d. 
Public Health , 1909, p. 462, "A School Clinic for Contagious Skin Diseases." 
, 1910, p. 120, " Treatment of Teeth in Public Elementary Schools m 
relation to Public Health." 
, 1910, p. 295, " TheNeed for School Clinics for Defective Eyesight." 
1910, p. 370, ''Report on School Clinics." 
, 1911, p. 226, "Administrative Control of Ringworm." 
"A " Plea for School 1Clinics." MARGARET McMI LLAN. Progress, October, 1909, 

p. 243· 

meni of lts Rules and ihe followlng oan '111 o'llialned from 'be 
Beoreiary, ai ihe Fablan Offioe, 3 Olemen~'s Inn, London, W.O. 

FABIAN ESSAYS IN SOCIALISM. New Preface by B:eBl!!ARD SHAW. 
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WHAT TO READ on Social and Economic Subjects. Fifih edition, revised 


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I.-General Socialism in its various aspects.

TRAOTS.-ISI· The Point of Honour: a Correspondence on Aristocracy and 
Socialism. By RuTH CAVENDISH BENTINCK. 147. Capital and Compensation. 
By EDw. R. PEASE. 146. Socialism and Superior Brains. A reply 
to Mr. Mallock. By BERNARD SHAW. 142. Rent and Value. 138. Municipal 
Trading. 121. Public Service versus Private Expenditure. By Sir 
OLIVER LODGE. II3. Communism. By WM. MORBIB. 107. Socialism for 
Millionaires. By BEBNABD SHAW. 139. Socialism and the Churches. 
By Rev. JoHN CLIFFORD, D.D 133· Socialism and Christianity. By Rev. 
PERCY DEARMER (in cover with portrait of the author). 78. Sociaism and 
the Teaching of Christ. By Dr. J . CLIFFORD. 42. Christian Socialism. 
By Rev. S.D. HEADLAM. 79· A Word of Remembrance and Caution to 
the Rich. By JoHN WooLMAN. 75· Labor in the Longest Reign. By B. 
WEBB. 72. The Moral Aspects of Socialism. By BIDlll:EY BALL. 6g.
Difficulties of Individualism. By SIDNEY WEBB. s•· Socialism: True 
and False. By S. WEBB. 45· The Impossibilities of Anarchism. ByBERNARD SHAW (price 2d.). 7· Capital and Land (7ih edn. revised 1908).
5· Facts for Socialists (11th ed., revised 1908). 132. A Guide to Books 
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Many Poor? WELSH TRACTS-143· Sosialaeth yng Ngoleuni'r Beibl. 
Gan J. R. JoNES (Caernarfon). 141. Translation of 139. 87. Translation of 

78. 38. Translation of 1. 
11.-Applications of Socialism to Particular Problems. 
TBAOTB.-IS4· The Case for School Clinics. By L. HADEN GuEST. 153 
The Twentieth Century R~form Bill. By H . H. ScHLOESSER. I52. Our 
Taxes as they are and as they ought to be. By ROBT. JoNES, B.Sc. In 
cover, 2d. ISO. State Purchase of Railways. By EMIL DAVIES. In cover, 
2d. 149· The Endowment of Motherhood. By H. D. HABBEN. In cover, 
2d. I45· The Case for School Nurseries. By Mrs. TowNSHEND. 144. 
Machinery : its Masters and its Servants. By H. H. ScHLOESSER and 

C. GAME. 140. Child Labor under Capitalism. By Mrs. HYLTON DALE. 
~36. The Village and the Landlord. By EDw. CARPENTER. 131. The 
Decline in the Birth-Rate. By S. WEBB. 130. Home Work and Sweating. 
By Miss B. L . HuTCHINS. 128. The Case for a Legal Minimum 
Wage. I22. Municipal Milk and Public Health. By Dr. F. LAWSON 
DoDD. 125. Municipalization by Provinces. ug. Public Control of 
Electrical Power and Transit. 123. The Revival of Agriculture. II8. 
The Secret of Rural Depopulation. ns. State Aid to Agriculture: an 
Example. II2. Life in the Laundry. g8. State Railways for Ireland. 
124. State Control of Trusts. 86. Municipal Drink Traffic. 84. Economics 
of Direct Employment. 83. State Arbitration and the LivingWage. LEAl!'LET.-I04· How Trade Unions benefit Workmen. 
111.-Local 
Government Powers : How to use them. 
TRAOTS.-137· Parish Councils and Village Life. tog. Cottage Plans 
and Common Sense. By RAYMOND UNWIN. 76. Houses for the People.
99· Local Government in Ireland. 82. Workmen's Compensation Act. 
New edition for the Act of 1906. 62. Parish and District Councils. 54· 
The Humanizing of the Poor Law. By J. F. O.ui:EBHOTT. LEAFLETS.134
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A Labor Policy for Pubhc Authorities. Municipalization of Milk Supply. 
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IV. General Politics and Fabian Policy.
127. Socialism and Labor Policy. u6. Fab1aniam and the Fiscal 
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its Early History. Bv BERNARD SHAW