In considering the question of the relation of the State to education, we have adopted the position that it is the duty of the State to see to the adequate provision of the means of education, to their due distribution and to their proper organisation. At the same time we found that the obligation of the State in this respect did not necessarily involve that the whole cost of this provision should be borne at the public expense, and that no part of the burden should be placed on the shoulders of the individual parents. As regards the provision of elementary education, we indeed found that the whole burden might be legitimately laid upon the general taxpayer, upon the grounds either that the protective benefit of elementary education to the community was great, or that the hindrance opposed by the imposition of school fees to the fulfilment of a man's moral obligation to provide for the education of his children was so general that a case might be made out for freeing elementary education as a whole. But except from the position that the provision of education was a communal and not a personal obligation, we found no grounds for the contention that education throughout its various stages should be a charge upon the community as a whole.
But the provision of the means of education may involve much more than the mere provision of adequately equipped school buildings and of fully trained teachers, and we have now to inquire what other provision is necessary in order to secure the after social efficiency of the children of the nation, and what part of this provision rightly may be included within the scope of the duties of the State.
Is the medical inspection of children attending Public Elementary Schools one of these duties, and, if so, what action on the part of the State does this involve?
The importance of the thorough and systematic medical examination of children attending school as a necessary measure to secure their after physical and economic efficiency as well as for their intellectual development and welfare during the school period has been recognised by many Continental countries. To take but one or two illustrative examples, we may note that in Brussels every place of public instruction is visited at least once in every ten weeks by one of the sixteen doctors appointed for this purpose. The school doctor amongst other duties has to report on the state of the various classrooms, their heating, lighting and ventilation, and also upon the condition in which he has found the playgrounds, lavatories and cloakrooms attached to the school. Cases of illness involving temporary absence from school are reported to him as well as the cases involving prolonged absence from school.
Children are medically examined upon admission to school, and a record is made of their age, height, weight, chest measurement, etc. "Any natural or accidental infirmity is chronicled, state of eyes and teeth, dental operations performed at school, etc. This examination is repeated annually, so as to keep a record of each child's physical development." Great attention, moreover, is paid to the cleanliness of the children attending school, and the children are examined daily by the teacher upon their entrance to school.[16]
In most of the large towns of Germany a system of periodical medical examination and inspection of children attending school has also been established. E.g., in 1901 Berlin appointed ten doctors for this purpose, with the following amongst other duties:—
1. To examine children on their first admission as to their fitness to attend school.
2. To examine children with the co-operation of a specialist for the presence of defect in the particular sense organs (sight, hearing).
3. To examine children who are supposed to be defective and who may require special treatment.
4. To examine periodically the school buildings and arrangements and to report on any hygienic defects.[17]
In England, although there is no specific provision for the incurring of the expense of conducting the medical inspection of children attending the Public Elementary Schools, it is generally held that the expense may be legitimately included in the general powers assigned to educational authorities under the Act of 1870; and, especially since 1892, in several areas, a definite system of medical inspection has been established, and in many others there is a likelihood that some system of medical inspection will be organised in the immediate future. According to the Report of the Inter-Departmental Committee on the Medical Inspection and Feeding of School Children, published in November 1905, out of 328 local education authorities, 48 had established a more or less definitely organised system of medical examination, whilst in eighteen other districts teachers and sanitary officers had undertaken organised work for the amelioration of the physical condition of children attending Public Elementary Schools. As a rule, this inspection is limited "to the examination of the children and to the discovering of defects of eyesight, hearing, or physical development." When the existence of the defect is discovered, the parent is notified, but as a general rule the public authority does not include within its duties the treatment of the ailments and defects or the provision of remedial instruments when required.
Further, in no case has there been carried out a thorough anthropometric record, such as that in vogue in the schools of Brussels, of the condition of the physical nature of the child upon admission to school and his subsequent physical development.
In Scotland we find no general or adequate system of medical inspection carried out by the local school authorities. The Report of the Royal Commission on Physical Training (Scotland), issued in March 1903, declares, however, that such a system is urgently needed, mainly for remedial purposes. By this means defects in the organs of sight or hearing, in mental development, in physical weakness, or in state of nutrition, such as demand special treatment in connection with school work, might be detected, and by simple means removed or mitigated. But although in the Education (Scotland) Bill of 1905 provision was made for the institution of medical inspection at the public expense, yet through the failure of the Bill to pass nothing of a systematic nature has been done to organise the medical inspection of Elementary School children in any district in Scotland.