536 Craft and provision of training in surveillance the elderly, or the disabled. The value of their without a solid basis in paediatrics is of limited health promoting activities with children is Arch Dis Child: first published as 10.1136/adc.75.6.536 on 1 December 1996. Downloaded from value. Many general practice trainees under- being questioned. Court's analysis was that the take a senior house officer post in paediatrics health visitor was ideally placed to take on the but spend too much time dealing with sick care of sick children in the community, children on the wards and not enough learning supported where necessary by a more special- about the problems that are common for the ised nurse based within the hospital depart- general practitioner. There are still insufficient ment. Most of those who fiercely declare their senior house officer posts for all general faith in health promotion oppose Court's view. practice trainees, with no immediate prospect Nevertheless many health visitors would wel- of rectifying this situation. We need a carefully come the opportunity to undertake the care of planned paediatric syllabus and training plan sick children at home, with appropriate sup- for every trainee, designed so that even those port; indeed, this already happens in many who cannot obtain a paediatric post can informal ways. The sad fact is that we still have participate in structured training. little research data to help us decide whether Community secondary care services are now his proposals would (in 1990s jargon) produce well established, but there are many unsolved more 'health gain' than a purely health problems. Little is known about the functions promoting model of health visiting. of the 'district handicap team' and the child protection service, or the reasons for the differ- In conclusion ences between trusts in the standard and The first law of 'O' level economics tells us that breadth of service provided. There is an resources are, and always will be, scarce. Don- impending manpower crisis in children's audi- ald Court wrote hopefully of a future time ology services. We are still very bad at assessing when 'the financial crisis would be contained and the benefits of what we do. Information there would once again be sustained growth in technology promised so much, but at present resources and public expenditure' (page 364) but our computers ingest immense amounts of he did not live to see this Utopian state of data at considerable expense, yet give little real affairs and I doubt if I shall either. information back. The description and analysis Rereading Fit for the Future, I reflected that of specific learning disability has generated a since 1976 the number of consultant paediatri- vast literature; and the service needs of school cians has increased more than threefold. age children and the place of the school health Should investment in medical care continue to service have been reviewed recently.8 expand at such a rate? Can we make better use Nevertheless, research into the potential ben- of existing resources? Is there a law of efits of sophisticated 'educational medicine', diminishing returns as we spend more and the multidisciplinary assessment of children more on health care? Would we do better to with problems affecting learning, is still virgin invest our 'sustained growth in resources', if it territory. ever comes, in housing and education rather than the health care system? http://adc.bmj.com/ Child health visitors 1 Court SDM. Fit for the future. Report of the Committee on 'The main justification for the distinction between Child Health Services. London: HMSO, 1976. prevention and treatment has been that they cannot 2 British Medical Association. Report ofthe Joint Working Party on Medical Services for Children. London: BMA, 1993. be combined without an unacceptable sacrifice of (EL(93)28.) preventive work ... [but] this distinction is wasteful 3 British Paediatric Association and Specialist Advisory Committee of the Joint Committee on Higher Medical and confusing to the parents and underestimates Training. Transition guidelines for non-consultant career-grade one doctors. London: BPA, 1996. the value to the family of having familiarfig- on September 25, 2021 by guest. Protected copyright. 4 British Paediatric Association. Towards a combined child ure . .. ifor] health promotion andfor illness' (page health service. London: BPA, 1991. 108). 5 Anonymous. Surgery needed-a survey of health care. The Economist 6 July 1991: 3-22 (suppl). Health visitors are currently uncertain of 6 Department of Health. Child health in the community: a guide their role. In addition to their traditional work to good practice. London: Department of Health, 1996: 21-2. with children and mothers, they are asked to 7 Hall DMB. Health for all children: report of the Joint Working undertake community development projects, Party on Child Health Surveillance. Oxford: Oxford Univer- sity Press, 1989 (lst Ed), 1996 (3rd Ed). specialist work such as tuberculosis contact 8 Polnay L. The health care needs of school aged children. tracing, and health promotion with adult men, London: British Paediatric Association, 1996. Donald Court: man of vision (1912-94) A W Craft The 1970s were a time of consolidation and 1942 in Newcastle upon Tyne. Among the new reflection for paediatrics in the UK. Paediatrics group ofyoung enthusiastic doctors who came Department of Child had begun to develop as a separate specialty into paediatrics after the war was Donald Health, Royal Victoria before the second world war and noteworthy Court. In the 20 year postwar period the Infirmary, Newcastle landmarks were the formation of the British organisation of the care of children underwent upon Tyne NEI 4LP Paediatric Association (BPA) in 1928 and the a rapid expansion with paediatric units being Correspondence to: establishment of the first full time professor of set up in most major, and many smaller, hospi- Professor Craft. child health James Spence) in England in tals. This growth had been largely uncoordi- Donald Court: man ofvision 537 nated and there was clearly a need to take stock after three years switched to medicine qualify- and reflect on how far we had come and where ing in Birmingham in 1936. His early work at Arch Dis Child: first published as 10.1136/adc.75.6.536 on 1 December 1996. Downloaded from to go in the future. Donald Court, one of the Great Ormond Street and the Westminster leaders of the postwar paediatricians, took a Hospital was followed by the Emergency leading role in this and in 1970 he entitled his Medical Service during the war and then to Charles West Lecture, delivered to the Royal Newcastle as a Nuffield fellow to work with College of Physicians of London, 'Child Professor James Spence in his newly formed Health in a Changing Community'. In this he department. This was a time of great said 'we must continue to strengthen the founda- opportunity and he joined a team which was tions ofpaediatrics in the biology of development, planning the 'Thousand Families' study in extend our studies of the social determinants of which he was particularly active between 1947 health and disease in child andfamily, especially by and 1954. The Thousand Families work and the use ofwell planned local records; seek with psy- domiciliary visits led him to the homes of over chology and psychiatry for a better understanding 3000 families during his first 15 years in New- of the development ofpersonality in the hope that castle and these clearly left a great impression we may find ways of diminishing maladjustment, on him and eventually led to the ideas first excessive anxiety and destructive aggression in our expressed in the Charles West Lecture.' In children and parents: treat our patients with 1950 on his return from the United States he increasing skill and consideration and try to as was appointed reader in child health and honestly as we can overcome the dichotomy of succeeded to the chair in 1955 after the treatment and prevention: establish these principles untimely death of Spence in 1954. in the education ofdoctors and others professionally He always had a view outside ofhis own spe- involved in the care of children'.' These ideas cialty and this was fostered when Spence were further developed in Paediatrics in the encouraged him to take an interest in speech. Seventies which he wrote with Tony Jackson This led to him being instrumental in setting when they were chairman and secretary of the up the Department of Speech Therapy in the Academic Board of the BPA.' It was no university and he was also a prime mover surprise therefore when Court was invited by behind the new Department of Human Genet- the secretary of state to chair a working party ics. He had a great ability to work closely with on the future of the child health services, its others and his collaborations with Issy Kolvin report being universally known as the Court in child and adolescent psychiatry and Philip report.' This report bears his stamp on every Gardner in virology were among the more page, written in beautiful English, quite unlike notable. His work with the virologists was the ugly verbiage of many such reports. It was especially important in cementing the links full of compassion, clearly reasoned, and based between the largely clinical descriptions of res- on careful research. He was greatly saddened piratory illness from the past with the rapidly and disappointed when it was received with less expanding scientific side, enabled by Gardner's than enthusiasm by the medical profession and pioneering work in rapid viral diagnosis.5 by the politicians who had commissioned it. Imparting his philosophies to medical students http://adc.bmj.com/ In 1978 when Donald Court was being pre- was seen as an important part ofhis life and he sented with the James Spence medal of the was not only an inspiring and popular teacher BPA the report was described by Otto Wolff as but also recognised the stress of medical being a decade or so ahead of its time.4 This student training and played a major part in the indeed has proved to be so.