&.& duplicate BRO 25 LONDON BOROUGH OF BROMLEY ANNUAL REPORT ON THE SCHOOL HEALTH SERVICE 1969. L. R. L. EDWARDS, M.D.(Lond.), M.B., B.S., M.R.C.S., L.R.C.P., D.P.H. Principal School Medical Officer. Sherman House, 16, Sherman Road, Bromley, BR1 3TF Telephone: 01-464-3333 CONTENTS Page No, Audiology Service 20 B.C.G.Vaccination 16 Cheyne Hospital 26 Child Guidance 18 Cleanliness Inspections 10 Clinics 35 Defects–Periodic and Special Medical Examinations 11 Dental Services 31 Diseases of Ear, Nose and Throat 15 Diseases of Skin 15 Employment of Young Children 29 Follow-up Examinations 10 Handicapped Pupils 22 Health Education and Home Safety 33 Health Visiting 31 Independent Schools 12 Infectious Diseases 16 Members of Education Committee 3 Minor Ailments 14 Ophthalmic Clinics 14 Orthopaedic Clinic 15 Orthoptic Clinic 14 Other Inspections 9 Other Medical Examinations 29 Periodic Medical Inspections 9 Phoenix Centre 26 Physical Education 30 Physiotherapy Clinic 15 Prefatory Letter 5 School Health Service 7 School Meals and Milk Service 30 School Psychological Service 20 Speech Therapy 16 Special Inspections 10 Special Schools 27 Staff 4 2 MEMBERS OF THE EDUCATION COMMITTEE (as at 31st December * Councillor F.J. Packer. F.C.I.S. (Chairman) * Councillor J.F. David (Vice-Chairman) Alderman C.H.E. Pratt (Mayor) Alderman Mrs. A.L. Gunn, J.P. Alderman Miss B.H. James, J.P. Alderman A.W. Waller * Councillor Mrs. M.M. Blackburn * Councillor R.A. Davies Councillor A.J. Day * Councillor R.G. Foster Councillor K.J. Harding * Councillor D.A. Heron Councillor R.W. Huzzard Councillor M.G. Law * Councillor Mrs. M.C. McClure, B.Sc. * Councillor P. McNally Councillor Miss K.A. Moore Councillor H.J. Palmer Councillor K.A. Pawsey * Councillor R.A. Sanderson, J.P. Councillor R.W. Spon-Smith * Councillor W.H. Stephenson * Councillor J.E. Swatton Councillor Mrs. J. Tatham Councillor R.A. Upton * Councillor Mrs. A.M. White Co-opted Members: Mr. J.H. Atkins, J.P. Mr. K. Coleborn Mr. J. Davies Miss M.C. Grobel, M.A. The Rev. Canon S.H. Hoffman, M.A. * Mr. N.L. Hevey Miss E.M.Huxstep, C.B.E., B.A. * Mr. W. Marsden Mrs. K.G. Wheeler Mr. C.E. Wiltshire, J.P. * Denotes Members of Primary Education and Welfare Sub-Committee. CHIEF EDUCATION OFFICER - D.R. Barraclough, M.A., Dip.Ed. 3 LONDON BOROUGH OP BROMLEY STAFF OF THE SCHOOL HEALTH SECTION (as at 31st December, 1969) Principal School Medical Officer L.R.L. Edwards, M.D. (Lond.), M.B., B.S., M.R.C.S., L.R.C.P., D.P.H. Deputy Principal School Medical Officer A.J.I. Kelynack, M.B., B.S., D.P.H. Senior Medical Officer P.A. Currie, M.R.C.S., L.R.C.P. * 10 Assistant Medical Officers Principal Dental Officer (Mrs.) C.M. Lindsay, L.D.S., R.F.P.S. (Glasgow) * 6 Dental Officers * 5 Sessional Dental Officers * 10 Dental Surgery Assistants * 1 Dental Hygienist * 2 Anaesthetists (sessional) Senior Speech Therapist * (Mrs.) M.M.Evans, L.C.S.T. * 2 Speech Therapists (Full time) + * 1 Speech Therapist + 4 Ophthalmologists + 1 Orthoptist + 1 Physiotherapist + 1 Orthopaedic Surgeon + 1 Consultant Psychiatrist Superintendent Health Visitor * (Miss) B.N. Chandler, S.R.N., S.C.M., H.V.Cert., Dip.Soc.Studies (Lond.) Deputy Superintendent Health Visitor * (Mrs.) L.A. Hamilton, S.R.N., S.C.M., H.V.Cert. Group Advisor * (Miss) C.M. Paxton, S.R.N., S.C.M., H.V.Cert. * 36 Health Visitors Chief Administrative Officer N.H. Collins, A.C.C.S., A.R.S.H. Senior Administrative Officer S.P. Judd, A.R.S.H. Senior Administrative Assistant (Miss) D.W. Gardner 1 Administrative Assistant 11 Clerical Assistants 1 Clinic Clerk (Full time) + 2 Clinic Clerks + 1 Shorthand Typist * Also employed in the Maternal & Child Health Service + Part time 4 To THE CHAIRMAN AND MEMBERS OF THE EDUCATION COMMITTEE Ladies and Gentlemen, I have the honour to present the fifth annual report of the School Health Service of the London Borough of Bromley. A considerable part of the report again deals with arrangements for special assistance to either physically or educationally handicapped children. Included for the first time are reports on activities for the physically handicapped children at the special school at Cheyne Hospital, West Wickham, and at the Phoenix Centre, Farnborough Hospital; both are hospitals situated within the administrative boundaries of the London Borough of Bromley. Health of School Children The health of Bromley school children is satisfactory with two exceptions. The Principal School Dental Officer indicates a need for increased dental health education to reduce the incidence of caries in infant school children. The Health Education and Home Safety Officer reports a disappointing increase in home accident figures. On the credit side, despite a notified increase of 309 cases of infectious illness, mainly due to measles, the beneficial effects of measles preventive vaccinations can already be appreciated. In 1969, when a biennial epidemic should have been experienced, the number of measles notified was limited to 411. For previous epidemic years, the figures were 1,730 (1967) and 2,218 (1965). There is a reduction of the waiting list for speech therapy from 133 (17 priority) to 64 (10 priority). This has been achieved in spite of a shortage of staff by an increase in attendances at clinics and at home and school visits. Audiology Service A further six medical officers attended short courses at the Nuffield Hearing and Speech Centre of the National Ear, Nose and Throat Hospital, on the "Diagnosis and Treatment of the Deaf Child"; and it has now become possible to include as part of each routine school medical examination, a sweep frequency hearing test. Children who fail are re-examined by an audiometric threshold hearing test. The School Health Service and the Welfare Section have combined in providing vocational guidance for hearing handicapped school children. A three classroom unit for partially hearing children has been opened in purpose built premises with facilities for speech training to enable the children to attend the Nursery, Infant and Junior classes of an adjacent school. The majority of the 22 children are severely deaf, and this Unit is participating in a wider Research Study on the education of severely deaf children in ordinary schools. In addition, 13 partially deaf children attend out-borough units and 7 deaf children attend residential schools for the deaf. Peripatetic teachers of the deaf assist 84 children at home, school and clinics. Thus a very comprehensive service for the deaf school child has been developed in the first five years of the Borough. School Psychological Service This service has now acquired new premises and full-time clerical assistance. A fourth special class for learning or behaviour problems has been established and increased liaison of the service with teachers of maladjusted children and teachers of remedial reading has been developed in a tutorial unit. The Child Guidance Service is developing closer links with the General Medical Practitioner service and this is shown by the increased percentage referrals to the Clinic over the past three years 11$ (1967)> 15% (1968) and 21$ (1969). 5 This service now has, by the nature of its organisation, a complete integration with the child psychiatric hospital and general medical practitioner services of the Borough. School Ophthalmic Service The provision of occluders and alternative vision testing charts has improved standards of accurate vision testing in schools. The Stycar testing of under 5 year olds at the Child Health Clinics provides an earlier screening. Routine eye tests are carried out at 5 years, 8 years 10 years and 14 years examinations and at special examinations when indicated. There is no delay in follow up and re-examinations, but clearly the ideal service should provide annual tests. Squint and amblyopia due to binocular vision or suppression of visual images can develop quickly after many childhood illnesses and for other reasons and produce permanent defects of sight. A great responsibility rests on those officers who carry out these tests but a further safeguard lies in the fact that the services of four consultant ophthalmologists are available under the supplementary ophthalmic service to examine all referrals from school or clinic. Orthopaedic Service The number of children at school medical examinations noted as needing or reoeiving treatment for defects of posture or minor deformities of feet decreased by 53• The number of attendances for remedial exercises decreased by 103. This improvement is an extension of that noted in previous reports and has raised the question of whether this service might more efficiently be provided entirely from hospital out-patients. To some extent this already happens when the hospital orthopaedic clinics receive patients referred directly from the general medical practitioner service. Diagnostic facilities are more easily available in hospital but treatment services at clinics may save valuable school time for the children and are often more convenient and acceptable to parents. Health Education The comprehensive report shows that we can never become complacent on this important subject. After rejoicing for several years on the progressive reduction in home accident figures, this year an increase of 1,379 casualties, shared between 915 adults and 464 children, has come as a shock. The local campaigns for 1970 are all directed towards the various identifiable causes but clearly the continuing and main effort must come from the home. Last year the new Health Education Council took over the functions of the Central Council for Health Education. It has set up a Working Party to consider in particular problems of sex health education, and in due course Authorities will receive recommendations. This difficult problem is mentioned later in this report under the heading of "The School and the Future Parent". In concluding this report, I wish to refer to the resignations of three Medical Officers, Dr. Maxwell in March, Dr. Hilton in July and Dr. Swistak in December. Dr. Maxwell had served the former Borough of Bromley for eleven years before transfer to the London Borough of Bromley and was an efficient and very popular Medical Officer. At the same time, we welcomed Dr. Menon in April, Dr. Lyttle in November and Dr. Parkinson in December, to the School Health Service. Finally, may I sincerely thank the Chairman and Members of the Committee for their sympathetic support throughout the year. Mr. Barraclough, the Chief Education Officer, his staff with special responsibilities, and the Heads of Schools, have continued to receive the advice and recommendations of the medical staff with extreme courtesy, and to encourage wholeheartedly the development of any worthwhile support service. My own staff, and in particular Dr. Currie, Senior Medical Officer, have worked diligently to introduce new ideas to improve the service for the handicapped child, and to work in unison with the Hospital and General Medical Services, and I am grateful to them for their efforts throughout the year. L.R.L. EDWARDS Principal School Medical Officer 6 SCHOOL HEALTH SERVICE The Borough has a duty to provide for the medical inspection at appropriate intervals, and to make arrangements for securing the provision of free medical and dental treatment pf pupils in attendance at maintained schools. The School Health Service, under the direction of the Principal School Medical Officer, administers these services on behalf of the Borough. It is the aim of the School Health Service, in collaboration with the Education Department, to be satisfied by means of these medical examinations that every child is able to receive the type of education best suited to his age, aptitude and ability. On his appointment as Senior Medical Officer, Dr. P.A. Currie pursued the policy of close liaison with the Head Teachers and was able, during the course of the year, to visit at least once, all maintained schools in the Borough. These are 34 secondary (including 2 direct grant) and 86 primary schools in the Borough; also 3 special day schools for educationally subnormal children. In January there were 45,551 pupils (an increase of 777) on the registers of the maintained primary, secondary, special and nursery schools. Routine Medical Inspections have continued to be given to all pupils entering the Infants' Schools, and are repeated when they reach the age of ten years and fourteen years. In addition, at eight years of age pupils are given routine tests of vision and hearing only; a full medical examination is only undertaken at this age if, for any reason, it appears necessary. It will be recalled that some difficulty had occasionally been experienced in obtaining the required standards for accurate vision testing in Schools. However, following the provision to all Health Visitors of an Occluder and 2 (different) Vision Testing Charts, these examinations have been facilitated. If at any time during a child's school career, the Head Teacher, Parent or Doctor is concerned about the health of a particular child, arrangements are made for a special examination to be carried out. Independent Schools may also participate in the School Health Service. Unfortunately, it was not possible to complete the programme of Routine Medical Inspections envisaged at the beginning of the year. This was due to the fact that the complement of Medical Officers was only at total strength for approximately one month during the year. In spite of the shortage of Medical Officers, however, the very important preventive health measure of B.C.G. Vaccination against Tuberculosis was given priority in order to complete the programme during the Spring and Autumn Terms. The total number of children attending both maintained and independent schools, who were examined in the routine age groups was 11,044. The physical condition of all the pupils inspected was satisfactory, and 1,970 pupils (17.8%) were found to require treatment. A further 4,005 children were given routine tests of vision and hearing, as a result of which 185 pupils (4.6%) were referred for treatment because of visual defects, and 28 pupils (.7%) were referred for treatment because of hearing defects. Follow-up examinations, referrals to General Practitioners, Specialist Clinics, and to Hospital Consultants are arranged as and when necessary. Further details of these examinations will be found later in the Report. A staff of ten Medical Officers devote approximately 50% of their time to work within the School Health Service. Each Medical Officer is responsible for a particular group of schools, so that regular contact between the Head Teachers and their own School Medical Officer is possible. 7 The schools allocated to each Medical Officer are grouped, as far as possible, around the Child Welfare Clinics which the particular Medical Officer also attends. This enables the Medical Officer to see both the child and its parent at the Child Welfare Clinic until the child becomes eligible for school, and then to continue seeing them both at school. This continuing care is valuable as it helps to build up a good relationship between the parent, child and doctor. The Borough co-operated in a National Child Development Study in the second follow-up of every child born in one week in 1958. The total number of children involved is approximately 16,000 and seventy of these children, who live in the Borough, were each medically examined and a very comprehensive form completed. Considerable help was given in doing this by the provision from the Sponsors of the Study, of a special vision testing chart, a detailed booklet of instruction and a half-hour tape recording with projector slides. As these may be retained they will be very useful for demonstrations to newly joined Medical Officers and Health Visitors. The aims of the study are to gather information about the educational progress, health, physical development and home background of these particular children. As information is collected at each stage it is possible to learn a great deal about children's abilities, behaviour, health and development at particular ages, and about the services which are provided. Finally, it was not possible to appoint either an Audiometrician or Psychotherapist, but it is hoped that approval will be given for these appointments to be made during the next financial year. 8 MEDICAL INSPECTION OP PUPILS ATTENDING MAINTAINED PRIMARY AND SECONDARY SCHOOLS (INCLUDING NURSERY AND SPECIAL SCHOOLS) TABLE A. - PERIODIC MEDICAL INSPECTIONS Age Groups inspected (By year of Birth) No. of pupils who have received a full medical examination PHYSICAL CONDITION of PUPILS INSPECTED No. of Pupils found not to warrant a medical examination Pupils found to require treatment (excluding dental diseases and infestation with vermin). Satisfactory Unsatisfactory for defective vision excluding squint) for any other condition recorded at Part II Total individual pupils No. No. (1) (2) (3) (4) (5) (6) (7) (8) 1965 and later 2 2 – – 1 1 1964 1145 1145 – 53 180 205 1963 2703. 2703 – 156 387 497 1962 159 159 – * 5 6 15 21 1961 ??? 191 – *3652 9 19 28 1960 75 75 – * 176 10 16 24 1959 2540 2540 – * 23 179 257 405 1958 240 240 – * 3 29 23 52 1957 150 150 – 24 33 53 1956 70 70 – 18 18 34 1955 2919 2919 – 263 265 514 l954 and earlier 213 213 – 35 19 52 TOTAL 10407 10407 – *3859 782 1233 1886 The physical condition of all the children inspected was satisfactory. * Tests of Vision and Hearing only at age of eight years. 182 Pupils referred for treatment because of Visual Defect 28 Pupils referred for treatment because of Hearing Defect OTHER INSPECTIONS Number of Special Inspections 1,249 Number of Re-inspections 1,949 3,198 SPECIAL INSPECTIONS Special inspections are carried out at any time during a child's school career if the head teacher, family doctor, parent or health visitor is concerned about the health of a particular child. A total of 1,249 special inspections was carried out during the year. RE-INSPECTIONS A re-inspection is an inspection arising out of one of the periodic medical inspections or out of a special inspection. A total of 1,949 reinspections was carried out during the year. FOLLOW-UP EXAMINATIONS Follow-up examinations, referrals to General Practitioners, Specialist Clinics, and to Hospital Consultants are arranged as and when necessary. CLEANLINESS INSPECTIONS These inspections are carried out by the Health Visitors. Children in the Infants Departments are inspected during the first six weeks of each term. Inspections in the Junior and Secondary schools are also carried out each term unless clear inspections are reported for three consecutive terms. In addition to the above, inspections are carried out at any time if and when necessary. (a) Total number of individual examinations of pupils in schools by Health Visitors 30,490 (b) Total number of individual pupils found to be infested 112 (c) Number of individual pupils in respect of whom cleansing notices were issued (Section 54(2), Education Act, 1944) 36 (d) Number of individual pupils in respect of whom cleansing orders were issued (Section 54(3), Education Act, 1944) Nil 10 DEFECTS FOUNd BY PERIODIC AND SPECIAL MEDLCAL INSPECTIONS MAINTAINED SCHOOLS Defect Code No. Defect or Disease PERIODIC INSPECTIONS SPECIAL INSPECTION ENTRANTS LEAVERS OTHERS TOTAL (1) (2) 4 Skin T 92 93 82 267 13 O 20 37 34 91 23 5 Eyes - a. Vision T 209 298 275 782 213 O 547 160 720 1427 204 b. Squint T 27 7 12 46 2 O 4 3 3 10 – c. Other T 9 2 13 24 1 O 8 2 5 15 – 6 Ears - a. Hearing T 30 8 20 58 39 O 122 28 180 330 68 b. Otitis Media T 35 – 8 43 2 O 20 1 6 27 1 c. Other T 1 1 – 2 1 O 3 – 6 9 – 7 Nose and Throat T 119 22 47 188 13 O 93 19 60 177 12 8 Speech T 37 3 22 62 27 O 55 3 10 68 13 9 Lymphatic Glands T 2 1 1 4 1 O 58 3 19 80 4 10 Heart T 12 2 8 22 1 O 24 9 13 46 4 11 Lungs T 56 14 16 86 10 O 24 15 35 84 4 12 Developmental a. Hernia T 8 3 7 18 2 O 6 1 3 10 6 b. Other T 12 7 31 50 10 O 46 33 40 119 19 13 Orthopaedic - a. Posture T 11 21 1 33 4 O 27 55 58 140 1 b. Feet T 43 34 47 124 21 O 54 44 41 139 3 c. Other T 17 28 19 64 2 O 25 16 19 60 5 14 Nervous System - a. Epilepsy T 5 4 9 18 5 O 8 2 2 12 2 b. Other T 6 5 8 19 4 O 19 13 24 56 7 15 Psychological - a. Development T 4 4 6 14 7 O 18 8 45 71 10 b. Stability T 13 8 12 33 15 O 83 55 143 281 12 16 Abdomen T 19 13 4 36 7 O 5 14 12 31 5 17 Other T 10 4 8 22 6 O 9 25 42 76 10 T = Treatment O = Observation 11 INDEPENDENT SCHOOLS Independent Schools, which so desire, have continued to participate in the School Health Service. At present 16 such schools take advantage of the facilities provided by the Service. Two schools closed during the year. A request was received from one school to join the Scheme and was subsequently visited. The accommodation was inspected and found to be satisfactory; it is hoped to commence routine medical inspections early next year. Subject to their parents' consent pupils attending these schools receive routine medical inspections (at the same ages as children attending maintained schools), and also have the advantage of access, where necessary, to the specialist clinics. Arrangements are also made as and when necessary for the special examination of any child. During the year 637 children were medically inspected and a further 146 children received tests of vision and hearing only. In addition, a total of £&& special inspections and 48 re-inspections was carried out. Further details, with a summary of the various defects found at these examinations are as follows 2- PERIODIC MEDICAL INSPECTIONS. Age Groups inspected (By year of Birth) No.of pupils who have received a full medical examination PHYSICAL CONDITION OF PUPILS INSPECTED No. of Pupils found not to warrant a medical examination Pupils found to require treatment (excluding dental diseases and infestation with vermin) Satisfactory Unsatisfactory for defective vision (excluding squint) for any other condition recorded at Part II Total individual pupils No. No. (1) (2) (3) (4) (5) (6) (7) (8) 1965 and later – – – – – – 1964 71 71 – 5 10 15 1963 72 72 – – 7 7 1962 9 9 – 1 2 3 1961 11 11 – * 139 – – – 1960 2 2 – * 2 1 – 1 1959 39 39 – * 5 1 4 5 1958 25 25 – 3 3 6 1957 26 26 – 3 1 4 1956 34 34 – – – – 1955 281 281 – 21 19 38 1954 and earlier 67 67 – 3 2 5 TOTAL 637 637 – * 146 38 48 84 The physical condition of all the children inspected was satisfactory * Tests of Vision and Hearing only at age of eight years 3 Pupils referred for treatment because of Visual Defects. - Pupils referred for treatment because of Hearing Defect OTHER INSPECTIONS. Number of Special Inspections 11 Number of Re-inspections 48 59 12 DEFECTS FOUND BY PERIODIC AND SPECIAL MEDICAL INSPECTIONS INDEPENDENT SCHOOLS Defect Code No. (1) Defect or Disease (2) PERIODIC INSPECTIONS SPECIAL INSPECTION ENTRANTS LEAVERS OTHERS TOTAL 4 Skin T 4 5 1 10 – O 2 2 – 4 – 5 Eyes - a. Vision T 5 24 9 38 5 O 25 5 6 36 2 b. Squint T – 1 1 2 – O – – – – – c. Other T – – 2 2 – O 1 – – 1 – 6 | Ears - a. Hearing T 2 – – 2 2 O 3 – – 3 1 b. Otitis Media T – – – – – O 2 – – 2 – c. Other T – – 1 1 – O – – – – – 7 Nose and Throat T 3 8 1 12 – O 10 1 2 13 – 8 Speech T 3 – – 3 – O – – – – – 9 Lymphatic Glands T 1 – – 1 – O 1 – – 1 – 10 Heart T – – – – – O – 1 6 – 11 Lungs T 1 2 1 4 O – 1 1 2 – 12 Developmental a. Hernia T 1 – – 1 – O – – – – – b. Other T – – 1 1 – O 1 7 5 13 – 13 Orthopaedic - a. Posture T – – – – – O – – 1 1 – b. Feet T 1 1 1 3 – O 3 2 1 6 – c. Other T 1 1 – 2 – O 4 2 – 6 – 14 Nervous System - a. Epilepsy t – – – – – O – – – – – b. Other T – 1 – 1 – O – 1 – 1 – 15 Psychological - a. Development T – – – – 4 O – – – – 1 b. Stability T – 2 1 3 – O 8 4 3 15 – 16 Abdomen t – – – – – O – – 1 1 – 17 Other t – – – – – O – 2 1 3 2 T = Treatment 0 = Observation 13 MINOR AILMENTS Minor ailments are treated by the Health Visitors at the Clinics, or at school if requested by the Head Teacher. These arrangements are found to avoid loss of school time which would otherwise be inevitable. Luring the year a total of 308 pupils was treated. TREATMENT OF PUPILS EYE DISEASES, DEFECTIVE VISION AND SQUINT Number of cases known to have been dealt withs:- External and other, excluding errors of refraction and squint 39 Errors of refraction (including squint) 4,018 Total 4,057 Number of pupils for whom spectacles were prescribed 1,737 OPHTHALMIC CLINICS These clinics are situated at Beckenham, Bromley, Chislehurst, Orpington, Penge and St. Paul's Cray. A total of 9 weekly sessions is held at these centres. In addition a session is held every other week at Bromley. A total of 711 new cases and 3,346 re-examinations was seen at the Clinics. The attendance at these Clinics continued to be very good on the whole, and it was again possible for both new cases and re-examinations to be seen without any undue delay. It would seem unnecessary to stress how vital it is that children's vision should be checked. It is not universally appreciated how defects of vision are often accepted by a child, and the parents are, therefore, not alerted to their existence. ORTHOPTIC CLINIC Patients seen at this Clinic are always referred by an Ophthalmologist. Three weekly sessions are held at the Bromley North Clinic, and one session per week at The Willows Clinic, Chislehurst. Patients not living in the areas served by these two clinics are seen at the nearest local Hospital. The following types of cases are referreds- a) Cases of obvious strabismus or squint. b) Patients suspected of having a strabismus. c) Amblyopic patients. d) Patients with any ocular muscle imbalance. e) Patients who are complaining of ocular symptoms, the cause of which is not obvious to the Ophthalmologist. Details of treatments and attendances are as followss- Number of new cases 59 Number on treatment 113 Number on occlusion 103 Number of treatments given 175 Number of cures with operation 11 Number of cures without operation 19 Cases discharged - cured a) Functional for binocular single vision 11 b) Cosmetic 16 Total number of attendances 713 Transferred or left the district 12 Number of sessions 184 Number on waiting list at 31.12.69 4 14 * DISEASES AND DEFECTS OF EAR, NOSE AND THROAT Number of cases known to have been dealt with Received operative treatment:- (a) for diseases of the ear – (b) for adenoids and chronic tonsilitis 609 (c) for other nose and throat conditions 156 Received other forms of treatment – Total 765 Total number of pupils in schools who are known to have been provided with hearing aidss- (a) during 1968 9 (b) in previous years 60 ORTHOPAEDIC AND POSTURAL DEFECTS Number known to have been treated (a) Pupils treated at clinics or out-patients 153 (b) Pupils treated at school for postural defects – Total 153 ORTHOPAEDIC CLINIC The Clinic is situated at Bromley North and caters for the surrounding population. Other parts of the area are covered by various Hospital Out-patient Departments. The attendances continued to be good and the Clinic is held according to need, which is approximately once a month. PHYSIOTHERAPY CLINIC Cases are treated at the Bromley North and Beckenham Town Hall Clinics and at Hospital Out-patient Departments. The majority of cases attending for treatment were referred direct from the Orthopaedic Consultant. Cases of general debility were referred to the Clinics for a course of sunlight. A total of 803 attendances was made at the two Clinics and of these 570 were for remedial exercises, etc., and 233 for sunlight. DISEASES OF THE SKIN (excluding uncleanliness) Number of pupils known to have been treated Ringworm - (a) Scalp – (b) Body – Scabies 23 Impetigo 2 Other skin diseases 135 TUo Q fr\ - 15 - B.C.G. VACCINATION In the effort to eradicate "tuberculosis, B.C.G. vaccination was again undertaken, with parental consent, on children in the 13-14 year age group, who are found to need this form of protection following upon a skin test. In addition, those who are shown by the skin test to need further investigation are referred, with the approval of the family doctor, to the appropriate Chest Clinic. During the year 3,774 children received a skin test and the 3,352 negative reactors received B.C.G. vaccination. Of the 237 children who were found to have a positive reaction to the skin test, 86 were referred to the appropriate Chest Clinic for further investigation. No further action was necessary in the case of the remaining 151 children who gave a positive reaction because of previous B.C.G. vaccination. It will be noted that fewer children were referred to the Chest Clinic on account of positive reactions. This is due to the new interpretation of the skin test. INFECTIOUS DISEASES 527 notifications of infectious diseases in children of school age were received during the year. Details of the notifications received are as belows:– Disease Total No. of cases 1st Quarter 2nd Quarter 3rd Quarter 4th Quarter Dysentery 38 7 24 3 4 Food Poisoning 2 – 2 – – Infective Jaundice 16 7 1 2 6 * Measles 411 176 167 61 7 Meningitis 1 1 – – – Scarlet Fever 51 30 12 4 5 Tuberculosis (Pul.) 6 3 1 2 – Whooping Cough 2 – – 2 – TOTALS 527 224 207 74 22 * In view of the introduction of measles vaccination the following figures would appear to be significants- Year No. of notifications received 1965 2,218 1966 440 1967 1,730 1968 111 1969 411 (as above) SPEECH THERAPY In the absence of Mrs.M.M.Evans from May, the duties of Senior Speech Therapist were most ably carried out by her locum, Miss V.M.Connery, who has rapidly won the affection of the children and the appreciation of parents and teachers alike. This year has shown a considerable number of staff changes. The year started with the full complement of staff allowed at present; three part-time therapists resigned, two were appointed and the year ended with one part-time post vacant. 16 Some areas of the Borough are satisfactorily staffed,.with Children being assessed soon after referral, but in other areas the Waiting List is still a cause for concern. Group therapy for language handicapped children has continued at the Masons Hill Clinic, Bromley, and has proved to be of great value. Luring the year four students from the Central School of Speech Therapy attended the Bromley and Beckenham Clinics, and several students from the Rose Bruford College of Speech and Drama attended the Clinics for observation study. The figures for 1969 are as follows Number of children referred by:- 1. Medical Officers in Department 121 2. Head Teachers 60 3. Hospital Consultants 5 4. General Practitioners 9 5. Parents 5 6. Health Visitors 9 7. Educational Psychologists 3 8. Teachers of the Deaf 3 9. Other districts 6 Total 221 Number of children seen in Clinic 437 Number of children seen in Special Schools (including Cheyne Hospital) 80 Total 517 Sessions were also held at Woodbrook Junior Training Centre in co-operation with the Senior Medical Officer Mental Health. Number of attendances s- 1. Clinics 2,845 2. Special Schools (including Cheyne Hospital) 530 The numbers for Special Schools above do not include Grovelands, as again, owing to resignations the figures are incomplete. Number of Home Visits 202 Number of School Visits 41 Number of Initial Interviews 197 Distribution of Casess:- Stammer 44 Dyslalia 159 Retarded Speech and language development 157 Interdental Speech 52 Lateral Speech 25 Deaf 12 Dysphonia 1 Dysphasia 5 Dysarthria 8 Nasal speech 11 Hyponasality 2 Cleft palate - repaired 16 General retardation 6 Dyspraxia 2 Total 500 Seventeen cases seen in the clinic have not been classified as therapy was either not indicated or being received elsewhere. 17 Cases Closed:— Improved 63 Reported improved 3 Removed 26 Refused appointments 12 Non-attendance after first interview 15 Failed interview appointment 11 Therapy not indicated 14 Having therapy elsewhere 5 Transferred 4 Total 153 At the end of the year the Waiting List was 64 including 10 priorities. CHILD GUIDANCE Through various sources, cases of psychological disturbance come to light and are referred, if necessary, to the appropriate Child Guidance Clinic. These Clinics, which are spaced throughout the district, are held in Hospital premises except at "The Willows", Red Hill, Chislehurst, which is the Council's own premises. The remaining Child Guidance Clinic sessions are held at Farnborough Hospital, "Stepping Stones", Bromley Hospital and at Sydenham Hospital, which serves the Borough of Bromley although it is outside the geographical limits. One Consultant Psychiatrist is now responsible for the Child Guidance work at local hospitals and at our own Clinic at Chislehurst. I am grateful to Dr.Rodriguez, Consultant Psychiatrist for the following report in respect of the Chislehurst Child Guidance Clinic, where he attends for 4 sessions per week. During 1969 the demands on the Clinic have remained practically unchanged. The number of referrals was 98 (1968 - 97)- The median length of the waiting list was 4 months (1968 - 6 months) ranging from 1 day to 84 weeks! - in the last case the parents had asked for the case to be deferred. Because of the lack of adequate treatment facilities we are still falling short of the goal of early diagnosis and effective treatment for all the children referred to the Clinic. This results in long waiting lists and causes frustration and even antagonism towards the Child Guidance Clinic amongst parents and referring agencies. The appointment of a Child Psychotherapist is urgently needed, and it is hoped to fill this next year. As in previous years every effort has been made by the members of the staff to co-operate with other care-giving professions, through informal meetings, case conferences and lectures. In March the School Psychological Service moved to its new premises at St. Paul's Wood Hill. Mrs. Preston and Mr. Bennett have attended the Clinic to carry out psychological assessments and also for regular case discussions. During the first half of the year, Mrs. Cameron, Social Worker, attended the Course on Community Care run by the London Boroughs Training Committee. Since 1st December she has increased her number of sessions, while still carrying on her duties as Mental Welfare Officer. No major repairs were carried out during the year. Some furniture and play material were replaced. Any future increase in the staff will highlight the limitations of the present building. Sixty seven new children from the Borough were investigated and taken on for treatment during the year (1968 - 67)• The number of children referred by local General Practitioners increased (1969 - 21 of all the referrals, 1968 - 15%, 1967 - 11%). This trend reflects no doubt the increasing awareness of the contribution the Child Guidance Clinic can make to the community. The total number of psychiatric interviews was 558. Close co-operation was maintained with other professionals in the field of education and child care, and efforts were made to improve communication with Head Teachers, Education Welfare Officers, Medical Officers in Department, 18 Children's Officers, Probation Officers and Health Visitors. Thirteen interdisciplinary case conferences were held in the Clinic. The staff also had quarterly meetings with the tutorial teachers at St. Paul's Wood Hill Unit. Ten students attended the Clinics 1 Health Visitor student, 1 Local Authority trainee, 1 Education Welfare Officer trainee, 1 Probation Officer trainee, 4 Social Work students, 1 Child Care Officer student, 1 Education student. Details of referrals and attendances during the year are as followss- Waiting Lists (a) Awaiting first interview 30 (b) Interviewed and awaiting treatment Nil In attendances (a) Active 92 (b) Periodic Review (holiday cases) 9 Number of cases closeds 94 Number of applications withdrawns (Failed repeatedly to attend for diagnostic interview) 25 Sources of Referrals Probation Officers 3 Court 4 Head Teachers 13 Medical Officers in Department 22 General Practitioners 21 Parents 2 Children's Officers 3 Hospitals (Paediatricians and Psychiatrists) 13 Chief Education Officer 6 School Psychological Service 9 Others 2 98 Number of new patients taken on for treatment during each month: January 5 May 2 September 2 February- 6 June 9 October 11 March 5 July 8 November 4 April 7 August 3 December 5 Number of Psychiatric Interviews: Number of Social Worker's Interviews: Quarter to 31st March 1969 146 151 Quarter to 30th June 1969 125 134 Quarter to 30th September 1969 127 155 Quarter to 31st December 1969 160 212 Number of Home Visitss Psychiatric Social Worker 81 Educational Psychologists - Other Staff - The Social Worker made 18 visits to different outside agencies. Number of School Visits: Psychiatric Social Worker 6 Educational Psychologists 6 19 SCHOOL PSYCHOLOGICAL SERVICE I am grateful to Mr. D.R. Barraclough, Chief Education Officer, for the following report on the School Psychological Services- This Service, which is part of the Education Department, has been hampered in the past by unsuitable buildings and by the fact that its staff was too small for the demands made upon it. In 1969, however, the School Psychological Service moved to St. Paul's Wood Hill where, for the first time, it had a place of its own and adequate accommodation. Pull-time clerical assistance was allocated to the Service and, in the financial year 1970-71, the number of educational psychologists is to be increased from two to three. Children are referred to the educational'psychologists by schools, by hospitals, by Child Guidance Clinics, by the Principal School Medical Officer and, of course, by the Chief Education Officer. Problems of learning and underfunctioning are by far the main causes of referral by schools. The behaviour problems are more commonly referred through the clinics. The intelligence quotient range is similar for children from all sources with the boys perhaps presenting a wider range of levels than the girls. In general, the children seen are in the lower half of the normal distribution for intellectual development. The educational psychologists have continued to be consulted over the selection procedure for secondary schools and have undertaken a survey of the remedial provision in reading and other basic skills in those schools. The screening of the top infant slow learners has become a well-established practice. In 1969, 122 infants were the subject of further investigation. Thereafter, thirty were discussed at three co-ordinating panel meetings and twenty-three were recommended for placement in special schools. The year brought increased liaison with the teachers of maladjusted children and with the teachers of remedial reading who make up the tutorial unit. The work of this unit has been affected by the prolonged illness of Mrs. Waite, and her untimely death in December 1969 greatly saddened all those who knew her and the quality of her work. The educational psychologists have also continued to give help at the Borough's four special schools. During 1969, a fourth special opportunity class was opened. These classes, which are valued by parents because they form part of normal schools, now exist at Churchfields Primary, Leesons Infants', Raglan Infants* and Midfield Primary Schools. They provide education for children between the ages of five and seven who have serious learning or behaviour difficulties or who need a substantial diagnostic period in a school situation. The development of these classes, which do not exist elsewhere, is greatly to the credit of Mrs. Preston, the Borough's Senior Educational Psychologist. AUDIOLOGY SERVICE Further development and satisfactory integration continued in this Service. During the year arrangements were made for a further six Medical Officers to attend the Short Course on "The Diagnosis and Treatment of the Deaf Child" at the Nuffield Hearing and Speech Centre. Two Medical Officers have particular responsibility in this field and I am happy to submit this report which can be considered as follows:- a) Routine Medical Inspections now include a sweep frequency test and those who fail are followed up with a threshold test. In the 5-6 years age group we wish to identify those children suffering from catarrhal deafness, a condition very common to this age group and a real handicap to the child, particularly if it is unsuspected. Those requiring treatment are then referred to local Ear, Nose and Throat Consultants, with the concurrence of the family doctor. Routine audiometry at the 10 and 14 years inspection would pick up any new cases of defective hearing from whatever cause. Early cases of otosclerosis, the deafness which affects adults and for which treatment has been developed in the postwar years, may be detected at the school leavers inspection, and are indeed sought, if the family history is positive. Audiometry at this stage also provides a base line of adult hearing for each individual, which, in this age of noise induced deafness, could prove a useful reference later. 20 Prom time to time also, a meeting of the ascertainment team is called at the Audiology Clinic to discuss and make recommendations regarding referrals for wider investigations, school placement and extra educational provision. Children discussed at these meetings are often additionally handicapped either in themselves or in their environment. We also have the assistance of the Welfare Officers for the Deaf and the Special Services Officer for the Handicapped, in providing vocational guidance for the hearing handicapped child. b) The Unit for Hearing Impaired Children has been included in a study on the extent to which it is practicable to educate severely deaf children in ordinary schools. This is being conducted for the London Institute of Education by Dr. Dale, Senior Lecturer in teaching of the deaf and partially hearing children, and supported by the Ewing Foundation. (Three other Boroughs are included in the survey and also children of a similar degree of deafness already placed in schools for the deaf.) The study provides a consultation service and a six monthly record of speech and language development, educational and social progress. These tests are conducted by Dr. Dale and his research associates. There are twenty-two children in the Unit - the majority are severely deaf. One who has only moderate hearing loss is now almost full-time in the normally hearing class and returns to the Unit only for spoech and language. There is also one partially hearing child in the Infants who has some speech training help from the Unit. Also under the heading "Audiology Service" I am grateful to Mr. D.R. Barraclougl Chief Education Officer, for the following report on the service for the hearing impaired childs- The Borough Unit for hearing impaired children was transferred to new, specially equipped premises at the Darrick Wood Schools in September 1969* By December 1969 number of children there were as followss- Nursery Groups : 8 Infant Class : 6 Junior Class : 8 These children are integrated as much as is practicable with hearing classes in the Infant and Junior Schools, and the two heads and their staffs have worked hard for the success of the Unit. No children over the age of 8 attend the Unit as these have previously been placed elsewhere. Thirteen children attend day schools for the deaf or partially hearing units outside the Borough. Seven attend residential schools for the deaf. The Borough's Peripatetic Service arranges for special help for 8 pre-school children, for 40 children with hearing aids at ordinary schools and for 44 children with hearing defects who do not wear hearing aids but who attend ordinary schools. The two Peripatetic Teachers of the Deaf have weekly sessions at home, in schools or at the Audiology Clinic with 20 children. They also attend fortnightly clinics taken by the Medical Officers in Department with special responsibility for the deaf child for assessing new cases and reviewing old ones. This has been very helpful for co-ordinating the medical and educational aspects of the work. Meetings to consider particular problem cases have continued, attended by Dr. Dale of London University, the Educational Psychologists and other members of the Authority's staff. The Connevans group hearing aids at the Part.ally Hearing Unit have been taken into use. The Peripatetic Teachers have acquired among other items a Phillips' Russaid radio-microphone for use in the Langley Park Boys' School by a severely deaf 11 year old and his teachers. This new development in communication for hearing impaired school children is proving successful, and it is hoped to acquire more Russaids in the future. The practice of purchasing individual commercial hearing aids on otologists' recommendations has continued, also the arrangements for maintaining these and National Health Service (Modresco) aids. 21 HANDICAPPED PUPILS It is the duty of the local authority to ascertain those children in its area who, having attained the age of two years, may require special educational treatment. These children usually come to the attention of the School Health Service through the Health Visitors, the Chief Education Officer, Parents and Hospitals. The officially recognised types of handicaps ares- Blind, Partially Sighted, Deaf, Partially Hearing, Physically Handicapped, Delicate, Maladjusted, Educationally Sub-Normal, Epileptic and Speech Defects. Once a child has been ascertained as handicapped surveillance is maintained and recommendations for special educational treatment are forwarded to the Chief Education Officer for his consideration and action. Special appointments are arranged for the Medical Officer to see these children, either at a Clinic or at the child's home, depending usually on the degree or type of handicap. Before a recommendation is made the advice of the various appropriate Hospital Consultants, with whom there is a very close liaison, is sought. During the year 81 boys and 27 girls were assessed as needing special educational treatment at special schools. Details of the various handicaps are included in the following table. The Borough is fortunate in possessing three day schools for educationally sub-normal pupils, and a report on each of these schools will be found later in this Report. The field of handicap is a very wide onej for instance, a large range of different conditions is included under the heading of "Physically Handicapped" and similarly "Delicate" can cover quite a number of different conditions. Obtaining the best possible arrangements for the education of the handicapped child requires time and pationce, but the effort involved is fully justified by the results obtained. It should be stressed that the assessment of a handicapped child does not consist merely in appraising the defects. The assets - what the child can do, the total environment etc., must not be forgotten. Further, there is a new approach to this often purely clinical examination,namely an attempt to see the child in the home and school environment because a handicap or defect can have a different meaning to a Doctor, a Parent or a Child. - 22 - - 23 - RETURN OF HANDICAPPED CHILDREN PART I New assessments and placements During the calendar year ended 31st December, 1969s- Blind (1) P.S. (2) Deaf (3) Tt.Hg. (4) P.H. (5) Del. (6) Mai. j E.S.N. (7) ! (8) Epil. (9) Sp.Def. (10) TOTAL (11) A How many handicapped children were newly assessed as needing special educational treatment at special schools or'in boarding homes? boys - - 1 4 6 10 13 47 - - 81 girls - - - 1 1 2 3 20 - - 27 How many children were newly placed B in special schools (other than hospital special schools) or boarding homes? (i) of those include at A above boys — 5 5 8 18 _ _ 36 girls - - _ 1 1 2 1 11 - - 16 (ii) of those assessed prior to January 1969 boys - - 1 1 1 1 2 7 - - 13 girls - - - - 2 3 1 5 - - 11 (iii) TOTAL newly placed B(i) and (ii) boys - - 1 1 6 6 10 25 - - 49 girls - - - 1 3 5 2 16 - - 27 PART II Children found unsuitable for education at School During the calendar year ended 31st December, 1969 (i) How many children were the subject of new decisions rocorded under Section 57 of the Education Act, 1944? 18 (ii) How many reviews were carried out under the provisions of Section 57A of the Education Act, 1944? 2 (iii) How many decisions were cancelled under Section 57-^(2) of the Education Act 1944? - PART III HANDICAPPED PUPILS AWAITIIG PLACES IN SPECIAL SCHOOLS OR RECEIVING EDUCATION IN SPECIAL SCHOOLS; INDEPENDENT SCHOOLS: IN SPECIAL CLASSES AND UNITS: UNDER SECTION 56 OF THE EDUCATION ACT, 1944; AND BOARDED IN HOMES. As at 22nd January, 1970 Blind (1) P.S. (2) Deaf (3) Pt.Hg. (4) P.H. (5) Del. (6) Mai. (7) E.S.N. (8) Epil. (9) Sp.Def. (10) TOTAL (11) How many children from the Authority's area were awaiting places in special schools other than hospital special schools? (l) Under 5 years of age (i) Waiting befoie 1st Januarv. 1969 (a) day places - _ - - _ _ - - - - - (b) boarding places - - — — _ - _ — - - (ii) Newly assessed since lat January. 1969 (a) day places boys — - - - 1 — - _ _ - 4 grirls — — — - - _ _ _ - - (b) boarding places boys — — 1 _ — 1 __ _ 2 girls — — - — — — 1 — — — 1 A (i) Waiting before 1st January, 19^9 (a) whose parents had refused consent to tl eir admission to a spscial school (a) dav places - - - - - - - - - - - (b) boarding places bovs - - - _ - - - - - - - girls - _ _ - - _ - - _ - - (a) day places boys - - - - _ - - - - - (b) others girls _ - - - s - - 5 (b) boarding places bovs - __ - - _ _ 1 - - (2) Aged 5 years and over girls - - - - - - - — * - - - (ii) Nc.vly assessed since 1st January, 1969 - (a) whose parents had refused consent to tlieir admissio to a special school (a) day places - - - - - - - - - - - - (b) boarding places boys — — — — _ 2 - - - - 2 girls - - - - - - - - - - - (a) day places boys - - _ 1 _ 24 — - 25 girls - - - 1 - - - 8 - - 9 (b) Others ((b) boarding places boys - __ — _ _ 1 4 - - - 5 girls — — — - — - l - - - 1 (3) Total number of children araiting admission to special schools other than hospital special schoolstotal of (l) and (2) above (a) day places boys - - - 3 1 1 29 _ - 34 girls - - _ 1 _ — _ - — — 14 (b) boarding places boys - - 1 _ — 5 4 2 - - 12 girls - - - - - - 2 - - - 2 - 24 - - Ss - HANDICAPPED PUPILS AWAIL'ING P1ACES IN SPECIAL SCHOOLS OK HECKIV1NU- JiJDUUATlOXil UN orhiCLaL SCHOOLS? bUJiOULb; Si-ttUlAl. CLaSajSS AMD UNITS: UNDER SECTION 56 OF THE EDUCATION ACT, 1944: AND BOARDED IN HOMES. As at 22nl January, 1970 Blind (1) P.S. (2) Deaf (3) Pt. Hg (4) P.H. (5) Del. («) Mai. (7) E.S.N. (8) Spil. (9) Sp.Def. (10) TOTAL (11) 3 How many pupils from the Authority's area were on the registers of:- (i) Maintained special schools (other than hospital special schools and special classes and units no.t formir.g part of a special school) regardless by what authority they are maintained day boys 1 - 4 5 6 14 7 2 168 - _ 206 girls - 4 1 5 8 5 - 128 - _ 151 boarding boys 1 - 1 - 6 1 3 10 — — 22 girls - - - - 6 7 — 1 — — 14 (ii) Non-msintained special schools (other than hospital special schools and special classes and units not forming part of a special school) wherever situated day boys _ - - - 4 — — — — 4 girls 1 1 _ - - 2 - - - - 3 boarding boys 2 1 6 - 4 8 6 6 — — 33 girls 4 - 1 - 3 3 1 3 - - 15 (iii) Independent schools under arrangements made by the Authority day boys - - - 4 1 — 2 1 1 _ 9 girls - - - 1 - - - - - — 1 boarding boys - - 2 - 2 _ 28 1 - - 33 girls - - 4 - 1 - 6 4 - — 1.5 (iv) Special classes and units not forming part of a special school boys - - - 8 - - _ - - _ 8 girls _ — - 9 - - - - — — 9 How many children from the Authority's area were boarded in ??? nd not already includcal in B above boys - _ — - — _ _ _ - -..... girls - - - - - - - - - - - How many handicapped pupils (irrespective of the ansa to which thoy belong) were being educated under arrangenents made by the authority in accordance with Section 56 of the Education Act, 1944 (i) in hospitals boys _ _ - _ _ - _ - - - - girls _ - - - - - - - - - - (ii) in other groups e.g. units for Spastics, etc. boys - - - - 12 - - — — - 12 girls _ ~- - - 7 - — - — - 7 (iii) at home boys - - - - 2 _ - 1 - - 3 girls - - - - - - - - - - - Total number of handicapped children requiring places in speci§l schools! receiving education in special schools; independent schools5 special classes ar.l units; under Section 56 of the Education Act, 1944 and bofrded in homes. boys 3 5 15 21 46 22 45 218 1 - 376 girls 5 4 6 16 29 16 9 151 - - 236 totals of A(3): B(i) to (iv)s. C : D(i) to (iii) CHEYNE HOSPITAL, WEST WICKHAM I am grateful to Dr. J. Richings, Paediatrician, Farnborough Hospital, for the following reportg- Cheyne Hospital, ¥est Wickham is a long-stay Children's Hospital of sixty beds. The majority of cases admitted are severely disabled children who require nursing care, intensive physiotherapy and education. Cases of Spina Bifida and Cerebral Palsy make up the majority of children. Children are admitted up to the age of ten years. In the past year four children were discharged home or transferred to suitable residential hospital schools. Miss Miles became the new head of the school in September, 1969s the children have all enjoyed her lively approach to education and have benefited accordingly. Cheyne now has the services of a part-time Medical Social Worker. This has proved very helpful to both parents and staff. THE PHOENIX CENTRE FOR CHILDREN WITH CEREBRAL PALSY. I am grateful to Dr. C.H. Upjohn, Paediatrician, Farnborough Hospital, for the following reports- The Phoenix centre was opened at Farnborough Hospital in April 1959Initially it was proposed to take 19 children of school age, but over the years the number has gradually increased and children now attend as soon as it is apparent that they are suffering from cerebral palsy. The youngest begin attending before the age of 1 year (youngest admission was at 5 months) for physiotherapy and advice regarding management at home by the parents. During the past year 9 children of school age have attended daily during the school term and there are 10 children between 3 and 5 years of age who attend the infants' group and who have their own teacher allotted to them. These children also have all the medical treatment required at these attendances. There are 12 children, under 3 years of age, who attend for medical treatment as required, and in this age group there are 5 hemiplegic children. Altogether more than 30 children are attending the unit. The staff includes:- one consultant paediatrician, and one clinical assistant, two physiotherapists (one full time and one part-time) two full time and one parttime school teachers from the borough, a full time occupational therapist, a parttime speech therapist, one nursing warden, one nursing auxiliary! cadet nurses are appointed regularly to the unit to help with care of the children and to receive instructions in the care of handicapped children! there are also Norland Nurses who attend during their training period at Farnborough Hospital. In addition consultants from other specialities attend, including the orthopaedic consultant (who pays regular visits), the E.N.T. surgeon and the dental surgeonj all children are seen by Mr. Owen the ophthalmic specialist. - 2£>- SPECIAL DAY SCHOOLS FOR EDUCATIONALLY SUB-NORMAL CHILDREN Goddington School, Orpington Twenty children left during the year and 21 were admitted - the school roll was maintained at 129. The medical work continued as before with one session a week devoted to "special" medicals and total reassessments of the children. Discussions with the teaching staff and other agencies have continued in the spirit of frankness and mutual confidence. The child and his family derived clear benefit from such multi disciplinary approach. Two teachers having left, Miss Davies and Mr. Hoey filled the resulting vacancies. The advent of the mini-bus described in the closing paragraph of the last Report proved to be a milestone in the School's outside activities. Goddington combined with Grovelands to borrow each other's buses so that two classes could visit places of interest at any one time. Swimming remains a popular activity throughout the year. Many children attend Swanley Baths in the evenings, together with three Goddington Teachers who provide lessons and supervision. The joint swimming pool project with Blenheim Junior School is very near completion and it should be in use during the early part of the Summer Term, 1970. The Parents and Friends of Goddington School have raised nearly £2,400 towards the cost of the pool - a truly magnificent effort from a small body of people. The senior boys and the senior girls have extended their activities considerably. Their two classrooms have been adapted and furnished so that the children now regard themselves as young adults. Easy chairs, carpets, record players etc., have been installed. This was possible through the generosity of the Rotary Club of Orpington and the Round Table Clubs of Orpington and Farnborough. Thirty-two boys and girls have been in employment since the School opened in 1964. The children maintained a close contact with the School and some come to spend a day at their old School. They are all well integrated socially and lead a successful life. Just as an ordinary school prepares a child for adult life, the Special School has this task made more difficult through intellectual retardation, frequently complicated by social and emotional problems of the children. In spite of the difficulties, in 1969 as in the year before, Goddington has achieved its targets and objectives. St. Nicholas School, West Wickham Number of Children on roll Boys 64 Girls 47 Total 111 Staff Headmaster Deputy Head 9 Full time Assistant Teachers 1 Part time Teacher for Housecraft 3 Housemothers - 1 full time & 2 part time with responsibility for welfare and social training of the children A routine annual inspection of every child in the school is arranged with an appointment system so that parents can be present. - 27 - There axe many secondary disabilities or handicaps. ( Number of children receiving treatment for: E^ye defects 30 Heart murmurs 6 Minor hearing defects 3 Neurological disease 2 Brain damage 5 Mongols 5 Hydrocephalus 1 Autistic 5 Under treatment for psychological, emotional & behaviour problems 10 Controlled epilepsy or petit mal 6 Children from broken homes, problem families, poor 1 omes or socially deprived 13 Immigrant children unable to keep pace in ordinary school 6 Physical deformities 3 Asthma and other chest complaints 3 All the children have learning difficulties but not all because of the above secondary disabilities and they all work at their own level and speed. The aim is for the majority of school leavers to be placed in employment suited to their limited capacity where they can cope with a reasonable degree of success. There were 10 school leavers during the year who obtained jobs in industry, super-markets, commerce and outdoor work under supervision. The Speech Therapist gives all new entrants an initial screening and has weekly sessions with all those who have speech difficulties. Physical education, swimming, woodwork and pottery are popular activities, and the cover for the heated outdoor swimming pool is in the process of being built which will enable swimming to take place all the year round. "Old" boys and girls of the school meet the two senior classes once a month at the St. Nicholas Club held in the school during an evening, and a link is maintained with the school, staff and friends for as long as they would like to belong to the Club. Grovelands School, St. Paul's Cray. There are now 121 children on roll including thirty-two who were admitted during the year. Of thoso who left, nine entered employment, one is unemployed and no information available about onej one child was transferred to a Training Centre and another went to a Residential School. Eight left the area and five went went back to normal schools. The 121 children at Grovelands cover a wide range of ability. I.Q.'s are between 46 and 80 with ages of 7 - 16 years. Many children have multiple handicaps including cerebral palsy, epilepsy, poor sight, various physical handicaps and a high proportion have difficulty with speech. The Welfare Assistants have divided their time between helping in Class I, carrying out speech practice as instructed by the Speech Therapists and contributing to the general physical well-being of the children. This included assistance on outings in the minibus. They also arranged hair dressing sessions for the senior girls. There have been no staff changes this year which has done much to maintain continuity of lessons. Drama has been less practical than usual but there has been considerable interest in Art. Pupils have visited exhibitions and taken part in outings for painting and sketching subjects of their choice. The corridors in school have been enlivened by some of the results. Independence has been encouraged by allowing pupils to find their own way to and from school, and going shopping in Sidcup and Orpington to purchase the ingredients for cookery classes with the purpose of giving some idea of home budgeting. One class combined Cookery with Geography by preparing and eating a traditional dish from the area being studied. This was a great success. Boys 28 N and Girls find their way around the district with the aid of maps, time-tables and telephones, training which will be useful to them when they leave school. A clocking in and out scheme has been started for senior pupils and also the cultivation of a small area of the grounds. A local Nursery was visited to purchase plants and there has been a good display of bulbs throughout the school. Many of the children come from poor back-grounds with lack of stimulation and interest from their parents, and several are in care. Attempts are made to impress upon parents the extra need for the retarded child to be encouraged to use speech, and to gain confidence and ability by doing as much as possible for themselves. The active P.T.A. have continued their activities by making and helping to equip a library area which is being well used. Newspapers are delivered daily and read and discussed according to the ability of the individual child. The usual visits by minibus included several trips to London, local places of interest and factories, etc. with the purpose of future employment in mind. There have been social evenings,a Concert, Sports Meetings and the usual seasonal activities. The boys continue to produce attractive and useful pieces of woodwork and have also been showing interest in book-binding and basket work. Medical examinations, vision and hearing tests, dental, speech and hospital treatments have taken place as usual. The whole staff combine to see that each child receives as much help as possible, socially as well as academically. Their pupils have a greater difficulty than those in ordinary schools in settling successfully in an increasingly competitive outside world. EMPLOYMENT OP YOUNG CHILDREN 319 children were examined by the Medical Officers in Department during the year. Certificates were issued in 317 cases, and in only two cases were the certificates not issued. Boys Girls Delivery of newspapers and milk etc. 193 52 Shop Assistant 14 30 Waitress — 3 Entertainment 2 4 Clerk — 1 Library Assistant 2 6 Hairdresser's Assistant - 3 Gardener 1 1 Meals on Whoels — 1 Warehouseman's Assistant 1 - Garage help 3 - 216 101 OTHER MEDICAL EXAMINATIONS The following examinations were carried out by Medical Officers during the vears- Training College candidates 398 Teachers (including two for other Authorities) 78 Total 476 - 29 - I am grateful to Mr. D.R. Barraclough, Chief Education Officer, for the following reports on Physical Education, and the School Milk Meals Servicess- PHYSICAL EDUCATION During the last five years there has been a steady programme of installing trampolines in all secondary schools. By 1971, all secondary schools will be in possession of this valuable piece of equipment. It is the first piece of apparatus other than the water in a swimming bath which allows the big overweight person to work equally as well as the more athletically built youngster. In the primary schools a similar programme of gradual supply of indoor climbing equipment has resulted in a quarter of the junior schools possessing this apparatus. This equipment enables these schools to carry on with adventurous gymnastic lessons indoors throughout the inclement season. Prom the point of cost efficiency it is a much better proposition that the outdoor equipment which lies unused because of rain and cold for long periods of the year. Many of the junior schools have considered the ability to swim as so important that they have collected fairly large sums of money to build their own Learner swimming pools. About a quarter of the Junior Schools already possess their own pool and as a result they are successful in teaching almost all school leavers to swim 20 yards or more. Children at schools without learner pools roceive ten swimming lessons at the public baths in their final junior year. Consideration is being given to supplying all-weather training surfaces instead of the more traditional grass areas. These fine "granite chippings" surfaces are invaluable for games that are played throughout the two hundred days of a school year. A single grass pitch can be used for seven games a week and even this cannot be allowed in wet weather whereas an all-weather surface can be used twelve hours a day throughout the year without any deterioration. When combined with floodlighting, these future pitches could be a boon to the young adults of Bromley. One such pitch near Kennington Oval has served the community there for over thirty years. A great deal of the physical education programme is related to playing games with other schools outside school hours. This involves the teaching staff in many hours of after-school duties training the many squads from whom the teams are selected to play at weekends, when the master or mistress again will be involved in refereeing the game. In addition, many other activities are being correlated with physical education. These include the Duke of Edinburgh Award Scheme and such activities as camping, canoeing, rock climbing and orienteering. The detailed preparation for expeditions involving these subjects are onerous. The safety of young people taking part in these activities must always be a care, responsibly borno. by the teacher and the Authority encouraging this work. Members of the teaching staff have been encouraged to take the Mountain Leadership Certificate which means that they have prepared themselves in a most thorough fashion, and have been carefully assessed as persons capable of dealing effectively and safely with hazards. Last year four teachers qualified for this award. SCHOOL MEALS AND MILK SERVICES The average daily number of meals served during 1969 was 35>300 or 6,700,000 in the year. A return for a day in October 1969 showed that the daily number of pupils (all of primary school age) drinking 1/3 pints of milk was 23,306 in the maintained schools and 1,665 in non-maintained schoolsequal to 1,040 gallons daily. Canteens which came fully into use included Langley Park Boys who are now producing upwards of 600 meals per day, and Kentwood Boys which moved to the former Beckenham and Penge Grammar School premises in the autumn of 1969. Convenience foods were introduced here for the first time at a Borough School, and early impressions would appear to indicate general approval of this type of meal. During 1969 "the School Meals Service were asked to provide approximately twenty meals daily to Stembridge Hall, and eighteen daily to the TTork Centre at Beckenham. 30 TH3 HEALTH VISITOR IN THE SCHOOL HEALTH SERVICE 1,698 School Medical Sessions (including B.C.G. sessions) were carried out during 1969. These were prepared, and in the Infant and Junior Schools, attended by Health Visitors. 29,954 individual school children have been examined at hygiene inspections, necessitating home visits to the parents of 112 to advise them of treatment for infested heads, a decline of 65 from 1968. 308 children were treated for minor ailments involving 1,397 treatments of which 835 were for conditions of the skin. A series of Health Education talks have been given in five senior schools, and the Health Visitor is often asked to contribute one or two in a series of sessions in Courses for school leavers. Visits to some of the Clinics have also been arranged for school leavers and the Services explained. DENTAL SERVICES Mrs. C.M. Lindsay, Principal School Dental Officer. The complement of dental staff comprising five full time and five part time Dental Officers, has been fully maintained although there has been a change in the part time dental staff. Despite an increase in the incidence of sick leave of both dental and nursing staff, the output of work has not decreased. There has in fact been an increase in some branches of the conservative work and almost all the maintained schools in the Borough have received dental inspections within the year. There is always a minimum of 500 orthodontic cases undergoing treatment. This year 160 new cases were undertaken and 132 cases successfully completed. This eminently satisfying branch of the dental department is much appreciated by the parents of the children treated. There is still a large incidence of caries in the infant schools especially in the new entrants and a great need for increased Dental Health Education is desirable. The Chief Dental Officer thanks all the Head Teachers for their help and co-operation to the Dental department. The Dental staff gratefully acknowledge the excellent work done by Dr. Morris and Dr. Miller in administering dental anaesthetics at the Clinics. - 31 - ATTENDANCES AND TREATMENT Ages 5 to 9 Ages 10 to 14 Ages 15 and over Total First Visit 3174 2131 360 5665 Subsequent Visits 6757 8194 1242 16193 Total Visits 9931 10325 1602 21858 Additional courses of treatment commonced 380 281 96 757 Fillings in permanent teeth 2511 6322 1625 10458 Fillings in deciduous teeth 9005 2125 11130 Permanent teeth filled 2018 5202 1291 8511 Deciduous teeth filled 7767 895 8662 Permanent teeth extracted 62 238 53 353 Deciduous teeth extracted 1103 332 1435 General anaesthetics 424 236 9 669 Emergencies ... ... ... ... 126 49 11 186 Number of Pupils X-rayed 179 Prophylaxis 3718 Teeth otherwise conserved 367 Number of teeth root filled 15 Inlays 3 Crowns 37 Courses of treatment completed 5479 ORTHODONTICS Cases remaining from previous year 343 New cases commenced during year 163 Cases completed during year 132 Cases discontinued during year 3 No. of removable appliances fitted 191 No. of fixed appliances fitted 8 Punils referred to Hosnital Consultant 1 PROSTHETICS 5 to 9 10 to 14 15 and over Total Pupils supplied with F.U. or F.L. (first time) - - - - Pupils supplied with other dentures (first time) - 1 1 2 Number of dentures supplied 1 1 1 3 ANAESTHETICS General Anaesthetics administered by Dental Officers - INSPECTIONS (a) First inspection at school. Number of pupils 34295 (b) First inspection at clinic. Number of pupils 2638 Number of (a) + (b) found to require treatment 12052 Number of (a) + (b) offered treatment 8693 (c) Pupils re-inspected at school or clinic 1243 Number of (c) found to require treatment 578 SESSIONS Sessions devoted to treatment 2978 Sessions devoted to inspection 293 Sessions devoted to Dental Health Education 55 _ 32 - HEALTH EDUCATION & HOME SAFETY HEALTH EDUCATION SCHOOL and the FUTURE PARENT. The great majority of children will later marry, set up a home, and bring up children of their own. In doing so they will satisfy their own deepest human needs, and at the same time play an important part in the building up of society. To play this part harmoniously and effectively, through early marriage, the first experiences of housekeeping, childbirth and the rearing of children from infancy until they stand on their own feet, calls for a wide range of practical skills and of human understanding. On the practical side, the partners in a marriage will between them have to handle money matters, the management of the household, the feeding of the family, and the care of children of all ages. These demands are not impossibly exacting, as many examples of happy family life show, but there is no doubt that some preparation for marriage is necessary, and that a framework of practical skills and emotional understanding can and should be laid down during school years. How far this instruction should be given in the home and how far at school is a matter of judgments but children seldom get at home all the training they need, and there is a persistent and growing demand for instruction at school. A good deal cf such instruction is now given at school in courses which include the practical drills, nutrition and the budgeting of money, time and energy. Both boys and girls may join in discussions on such matters as personal relationships, setting up a home, child-care and the responsibilities of parenthood. Many schools, during the past years, have included mothercraft in the curriculum for the girls who leave school at fifteen. A great many schools realising the importance of this subject to girls about to marry at even earlier ages than in the past, now plan a course for the older girls, sometimes taken by the Health Visitor, which gives a broad view of motherhood and introduces the Welfare Services and the help that is available when they have their first baby. Such courses include visits to Child Welfare Clinics, Nurseries or Nursery Classes, and girls may go in twos and threes to work in the nurseries for a day each week for half or a whole term. Schoolgirls often have small brothers and sisters to look after at home. It is then all to the good if they bring home some of the new ideas learned at school. Yet there remains a slight risk of the new learning clashing with mothers' ideas; and it is not good at such a stage for girls to become involved in any conflict which may confuse their trust in their mothers' judgment. The general health education and home economies teaching in secondary schools should make an excellent foundation for family responsibilities. Boys and girls who appreciate the importance of good health and have some knowledge of how to achieve and maintain it will later on want their own children to be well fed, housed, clothed and cared for. At the same time, girls will have learned how to cook, clean and sew, and the boys how to be handy and helpful around the house. Probably the most debatable issue in the whole of this field is concerned with the nature and scope of instruction in sex relationships. As a result aspects of sexuality and associated problems are often either exaggerated or passed over. Lack of sensible guidance on sex can lead to unhappiness and broken marriages. Should instruction on sex problems be given at school? Opinions differ or are divided. Some feel strongly that anything of the kind is more often than not unwise? many married people have lived happy lives without such instruction. They argue that boys and girls of good character will of their own accord develop satisfactorily towards adult life and marriage and find out what they need to know from reputable sources. Yet recent surveys have shown that in some areas only a minority of children learn sex from a reliable adult source the majority are instructed by other children. Fear and misunderstanding often arise out of such a situation, whereas children who have received an adequate insight into this most important aspect of human life feel deeply grateful to the adult who imparted it, and the demand for a more definite form of instruction does seem to reflect a great need. 33 Certainly the evidence suggests that many parents are grateful when the school is willing to take over part of this responsibility. The co-operation of parents should of course be sought at all times. Many Head Teachers have found it valuable to invite parents to meetings at which can be shown books and various aids to teaching which will be used in the work at school, and can hear talks about the kind of information and help their children may need at particular stages of their development. Talks of this nature are often given by school doctors, nurses or teachers, but it is emphasised that speakers so chosen should be qualified by personality, background and training, to speak on this subject. HOME SAFETY. From January to December 19&9, a "total of 9>509 home accidents cases were treated at the hospitals of Beckenham. Farnborough, Orpington and Bromley. Of these 5?484 were adults and 4,025 wore children. In 1968, the overall total from those hospitals was 8,130 and of these 4,569 were adults and 3,561 were children. This shows an increase of 1,379 more casualties in 1969, as compared with the previous year. Of these 915 were adults and 464 children. This increase is most disappointing, although enquiries reveal that the majority of these accidents, both to the adults and children, wore of a minor category The result however is the same - more and more- effort must be made to make the general public aware of Accident Prevention. Therefore education of the public must be the first priority, and must consist of example, teaching, exhortation and publicity to all sectors on all faults. To ignore any sector is wasted effort. It is useless educating the child without educating the mother, it is also useless educating the elderly, without educating those who might have to look after them. Once again the throe most prominent causes of these home accidents, with possible complications, according to the statistics supplied by the Hospital Authorities are given as follows. 1. FALLS This is a chief danger to old people. 2. BURNS/SCALDS Affect both young and old people. 3. POISONING This is adanger to adults, especially in relation to coal gas, medicinal substances, through overdoses, mistakes etc., and also to the very young who find drugs, tablots, medicines, detergents etc. loose in cupboards, drawers etc. LOCAL CAMPAIGNS, I97O In an effort to reduce these appalling numbers of home accidents, the Home Safety Committees of the Borough, have co-operated with the Royal Society for the Prevention of Accidents in their National Campaign for the year as follows5- JANUARY - MARCH "Face the facts" APRIL - JUNE Babies - The first three years. JULY - SEPTEMBER Care of medicines - R.o.S.P.A. Leaflets/Posters. OCTOBER - DECEMBER Winter hazards. - 34 - DETAILS OF CLINICS CLINIC ADDRESS WEEKLY SESSIONS Hold as follows; (By appointment only) OPHTHALMIC; School Clinic, The Willows, Red Hill, Chislehurst. Monday - a.m. School House, 55 Chislehurst Road, Orpington. Monday - all day. Mickleham Road Clinic, St. Paul's Cray. Monday - a.m. North Clinic Station Road, Bromley. Monday - a.m. Wednesday - a.m. Friday - p.m. Saturday - a.m. (Alternate) School Clinic, Town Hall, Beckenham. Wednesday - p.m. School Clinic, Oakfiold Road, Penge. Friday - a.m. ORTHOPTIC? North Clinic, Station Road, Bromley. Monday - p.m. Tuesday - all day. School Clinic, The Willows, Red Hill, Chislehurst. Thursday - a.m. *ORTHOPAEDIC: North Clinic, Station Road, Bromley Friday - p.m. (monthly) *PHYSIOTHERAPY: School Clinic, Town Hall, Beckenham Monday - p.m. Thursday - a.m. North Clinic, Station Road, Eromley Tuesday - a.m. Friday - a.m. 35 *Children living in Beckenham and. Bromley are referred to these Clinics. Children living in tho remainder of the Borough are referred to; Orpington Hospital; Farnborough Hospital; Queen Mary's Hospital, Sidcups or tc The Children's Hospital, Sydenham. SPEECH; Assemblies of God Church Rooms, Monday Masons Hill, Bromley. Wednesday all day Thursday Tuesday Friday p.m. School Clinic Monday Town Hall, Beckenham. Wednesday) all day Friday Tuesday - a.m. The Clinic, Tuesday - all day Kimmcridge Road, Thursday - a.m. Mottingham, S.E.9. Hawes Down School Clinic, Tuesday Hawes Lane, West Wickhgm. Wednesday P.m. School Clinic, Monday - p.m. The Willows, Chislehurst. Wednesday - a.m. CLINIC ADDRESS WEEKLY SESSIONS Hold as follows: (By appointment only) *CHILD GUIDANCE: The Willows, Red Hill, Chislehurst. Tuesday • All day Friday *Cases arc also referred, to the Child Guidance Clinics at Bromley Hospital, and the Children's Hospital, Sydenham. Cases may also be seen at the Child Guidance Clinic at Parnborough Hospital, having been referred via tho Paediatricians. DENTAL School Clinic, The Willows, Red Hillj Chislehurst. Monday All day Wednesday School House, 55 Chislehurst Road, Orpington. Monday All day Tuesday Wednesday Thursday Friday Mickloham Road, St. Paul's Cray. Monday All day Tuesday Wednesday Thursday Friday Kimmeridge Road, Mottingham Tuesday All day Thursday Friday North Clinic Station Road, Bromley. Monday All day Tuesday Wednesday Thursday Friday South Clinic, Princes Plain, Bromley. Monday All day Tuesday Wednesday Thursday The Pavilion, Recreation Ground, Church Road, Biggin Hill. Friday All day School Clinic, Town Hall, Beckonham. Tuesday All day Wednesday Thursday Hawcs Down Clinic, Havres Lane, West Wickham. Tuesday a.m . All day Wednesday Thursday School Clinic, Oakfield Road, Penge. Monday All day Tuesday Wednesday- a.m. Thursday - p.m. Friday - a.m. - 36 - CLINIC ADDRESS WEEKLY SESSIONS Held as follows: (By appointment only) *SPECIAL EXAMINATION CLINICS School Clinic, Oakfield Road, Penge. Thursday 9.30 - 11.0 a.m. The Willows, Red Hill, Chislehurst. 2nd and 4"th Thursday in month, 4.15 - 5 Mickleham Road Clinic, St. Paul's Cray. 2nd and 4"th Thursday in month, 4.15-5 P.m. School House, 55 Chislehurst Road, Orpington. 2nd Friday in month, 2.0 - 4 P.m. *In addition to these fixed times, appointments are arranged as and when necessary at other clinics for the purpose of carrying out special examinations etc. MINOR AIIMENT FACILITIES - See page 14 - 37 -