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Until the inauguration of a national system of school medical inspection in 1908' there were only a few full-time School Medical Officers (SMOs) in England and Wales. Some doctors had previously worked for Local Education Authorities (LEAs); indeed, even before the creation of the LEAs under the 1902 Education Act, some of the larger School Boards had appointed medical officers to carry out various duties including a general supervision of schools and school children. Most were part-time appointments. In 1902, the Congress of the Sanitary Institute in Manchester attracted seven School Board medical officers from Lancashire and Yorkshire as delegates, in addition to James Kerr, Medical Officer to the London School Board.2 Only Kerr, and his successor as Medical Officer to the Bradford School Board, Dr Ralph Crowley, were employed full-time. After the formation of the LEAs, more appointments were made, but most continued to be part-time, and were often held by the local Medical Officer of Health (MOH). Only in the larger LEAs was it more usual for the appointment to be given to a doctor independent of the Public Health Service.3 The advent of the School Medical Service (SMS) thus created a substantial new demand for medical staff, particularly for subordinates to conduct the required medical inspections.4 In his Annual report for 1910 the Chief Medical Officer to the Board of Education, George Newman, could report that 995 doctors were working within the SMS in a full- or part-time capacity.5 Almost all had been appointed by the LEAs within the previous two years.
As two recent additions to the literature on the SMS have noted,6 the rapid expansion of medical inspection, though welcome in a profession then seen as overstocked,' led to comment on the calibre of the recruits, and, subsequently, on their morale and career prospects. The MOH for Cheshire, Meredith Young, wrote: At present medical inspection is an occupation with a "dead end" .. . there is no doubt that if the best men are to be attracted and retained in the school medical service this defect will have to be remedied by the assurance of a definite progression not merely in salary but also in status and responsibility. We are at present running the risk of filling the ranks of...