AC 44113 EAS 17 COUNTY BOROUGH OF EAST HAM. EDUCATION COMMITTEE. REPORT of the SCHOOL MEDICAL OFFICER For the year ended 31st December, 1940. MALCOLM E. BARKER, M.R.C.S. (Eng.), L.R.C.P. , D.P.H. , (Lond. ) 1. MEMBERS OF THE COUNCIL. The Mayor:*Alderman Edward Francis Markey, J-P. The Deputy Mayor;Councillor William James Davis. Aldermen:- *Joseph Walter Barton, J.P. *Charles William Brading, C.R.P. , J.P. *Thomas William Burden. * Richard John Pell (Vice-Chairman of the Education Committee) ""'Thomas Irwin Lethaby, J.P. (Chairman of the Education Committee) * Walter Thomas Newling, J.P, Annie Taylor (Mrs.), J.P. *Frederick Welch. *Beatrice Wilkens (Mrs. ) Councillors:- Charles Edward Beckett. William Henry Whittock Beecham. *Leslie Alfred Victor Bennett. *Ethel Maud Charlotte Brace (Mrs.) *Lendoranna Minnie Brignell (Mrs. ) *Charles William Dixon. Eric Cyril Boyd Edwards, LL.B. * Sydney Arnold Elson. Bertie George Goodenough. *Harper Bernard Harper, J.P. *John Albert Hart. Henry Joseph Hooper. Walter Edwin Hurford. Herbert Percy Jackson. *Harold Joseph, J.P. , F.A.L.P.A. *Bertram Arthur Keene. *Winifred May Knight (Mrs.) John Linsley Linsley-Thomas. *Robert William Moger, J.P. *George Horace Moncar. Robert Wilfred Payne. William Henry Pooley. Alfred Prior. * Alice Beatrice Spencer (Mrs.) *53-William Thompson. William Bertram Warncken. *Alfred Tom Yates Watson. Thomas William Williams. *Ernest Albert Wood. *Denotes Members of the Education Committee. Co-opted Members of the Education Committee. Mrs. W. F. Hyland. Mr. A. E. Francis. Mrs. L. A. Lethaby. Mr. E. J. Sullivan. 2. COUNTY BOROUGH OF EAST HAM EDUCATION COMMITTEE. TO THE CHAIRMAN AND MEMBER 3 OP THE EDUCATION COMMITTEE. Mr. Chairman, Ladies and Gentlemen, I have the honour to present the Annual Report on the School Medical Department of the County Borough of East Ham, for the year ended 31st December, 1940. In 1939 there were 15,151 children on the Elementary School Roll. The numbers for 194O showed considerable fluctuation from a maximum of 9,008 to a minimum of 1,500. The number of routine and special cases of elementary school children examined totalled 3,883, of whom 1,254 were re-examined at the, time of re-inspection in the schools. As was the case last year, the information contained in my report is mainly statistical and no new developments or departures have occurred this year. From the data which will be found under the separate sections of this report It will be appreciated that the needs of the scholars, as regards health, physical development and fitness, are being met in as complete and efficient a manner as circumstances permit. The Schools were open throughout the year until September 9th, and during this period the School Medical Service continued to function in all respects for the very reduced number of scholars remaining in the area. Prom September 9th until December 2nd the schools remained closed, and, so far as air-raid conditions would allow, arrangements were made for the continuance of medical supervision and treatment at the School Clinics, and for home visiting by the School Nurses, with the object of maintaining as close contact' as possible with the scholars. Education recommenced on December 2nd and it was decided to carry out a rapid, but complete, cleanliness and general survey, followed by a routine medical examination, of all children in attendance at school, with the object of determining the effect of aerial bombardment, shelter life and rationing upon the child population. At the same time the full activities of the School Medical Service were resumed, and the campaign to encourage attendance at the Clinics for protective inoculation against Diphtheria was intensified. These measures were well advanced by the end of the year, and the early results are encouraging. During the year the medical examination of 2,807 children prior to evacuation has entailed considerable work, and at the outset the numbers were so high that it became necessary to enlist the services of local general practitioners, whose ready response and complete co-operation were extremely gratifying. I wish to express my appreciation of the keen interest and loyal -co-operation of all the members of my staff, and my thanks are also due to Mr. A. A. Garrard, Secretary to the Education Committee, and to the Teachers, for their great help and courtesy on innumerable occasions. In conclusion, I respectfully beg to express my indebtedness to the Chairman and Members of the Local Education Committee for the earnest consideration and support that they have given to the work of the School Medical Service. I have the honour to be, Ladies and Gentlemen, Your obedient Servant, School Medical Officer. 3 MEDICAL INSPECTION. The following is a synopsis of School Medical Work for the year 1940 as compared, with previous statistics. Comparative Statement of Work. 1956 1937 1938 1939 1940 Routine & Special Inspection (on school premises):- Secondary 1,016 700 931 Nil Nil Elementar 9,037 9,064 8,186 5,461 3,888 Re-Inspection 5,664 3,063 3,385 1,832 1,254 Consultations at Inspection Clinic 16,708 15,327 14,124 8,737 1,047 Number of Treatments at Clinic 27,976 21,387 20,954 13,851 639 General Cleanliness Visits to Schools 281 292 338 204 92 Nurses' Visits to Homes 3,558 3,408 4,686 2,197 390 Children Examined for Cleanliness 44,145 41,725 40,821 22,185 10,503 FINDINGS OF MEDICAL INSPECTIONS. There are no outstanding features to report in regard to the findings of medical inspection, and since the re-opening of the schools in December the physical standard of the scholars examined has been surprisingly satisfactory. It is true that so far only a small number of scholars have been under review, but air-raid conditions and rationing do not appear to have affected the physical or nervous condition of these children to any appreciable extent. On the other hand, there is evidence that the abnormal conditions of life and lack of regular exercise and athletic recreation are having some untoward effect upon the physical and mental stamina, posture and muscular tone of many children. The necessity for more regular physical training, gymnastics, organised games and athletic pastimes is strongly indicated. The incidence of principal defects requiring treatment or needing to be kept under observation is shown in Table II. The following comparative table serves to indicate the number and percentage of children found to be in need of medical or surgical treatment in the three specified age groups inspected during the year 194O:- Group. Number of Children. x Percentage of Children found to require Treatment. Inspected. xFound to require Treatment. 1939 1940 1939 1940 1939 1940 Entrants l,l6l 946 163 96 14.0 10.1 Second Age Group 1,213 1,738 104 64 8.5 3.6 Third Age Group 865 940 69 86 7.9 9.1 Totals 3.239 3.624 336 246 10.3 7.3 x Excluding defects of Nutrition, Uncleanliness and Dental Diseases. 4. (a) Uncleanliness. The School Nurses have carried out cleanliness surveys of all children in the elementary schools during the year 1940. A high standard of personal hygiene is maintained although there have "been instances of children returning to East Ham suffering from scabies, impetigo and pediculosis; "but these cases have readily responded to treatment. Comparative table:- Year. Number Examined. Number with Nits. Number with Head Vermin. No. of Exclusion Certificates. 1938 40,821 1,144 153 317 1939 22,185 759 36 102 1940 10,503 216 17 15 (b) Minor Ailments. The incidence of minor ailments continues to show a decline. (c) Tonsils and Adenoids, 5.09 per cent. of the children examined during the year were referred for treatment for "tonsils and adenoids", either separately or combined, as compared with 5.2 per cent. in the year 1939. (d) Tuberculosis. Boys Girls Total Pulmonary Tuberculosis 1 3 4 Other forms of Tuberculosis 1 2 3 2 5 7 (e) Skin Disease and (f) External Eye Disease. At medical inspections during the year 81 children were found to "be suffering from skin affections (as compared with 1/2 in the year 1939) and 9 cases of external eye disease were discovered (as compared with 65 in the year 1939). (g) Vision. Only children with marked visual defect have been referred for treatment and these, including cases of strabismus, numbered 86. In addition, there were 52 children in whom there was evidence of a lesser degree of visual defect and these are being kept under observation. (h) Ear Disease and Hearing, O.38 per cent. of the children examined were found to be suffering from otitis media (1.0 per cent. in 1939). The percentage of deaf children was 0.07, the corresponding figure for last year being 0.08. (i) Dental Defects. The percentage of children found, as the result of dental inspection in the schools, to be in need of dental treatment was 65.07 per cent., as compared with 64.3 per cent. for last year. (3) Nutrition. Children found at the routine medical inspection to be suffering from malnutrition, in any degree, numbered 25, or approximately 0.7 per cent. of the children inspected. (See Table IIB). 5. INFECTIOUS DISEASES. The incidence of measles, chicken-pox, scarlet fever, diphtheria, whooping cough and mumps showed a marked decline. FOLLOWING UP. The School Nurses have paid 390 visits to the homes of children in whom defects were found at medical inspection, and for special investigation purposes. MEDICAL TREATMENT. During the year 1940 3,170 attendances were made for treatment at the various clinics, and there were 2,266 attendances for consultation with the Medical Officers. (a) Minor Ailments. An analysis of the chief minor ailments treated at the School Clinics, and otherwise, will be found in Table IV, Group I. (b) Tonsils and Adenoids. Of the children referred for treatment, 90 received operative treatment during the year 1940. The scheme for treatment remained the same as detailed in previous reports. (c) Tuberculosis. The arrangements for the treatment of Tuberculosis have been continued on the lines fully set forth in the reports for previous years. (d) Skin Diseases. For the most part these are treated at the General Clinic, but some cases of chronic and of the rarer skin diseases are referred to the dermatological departments of the London Hospital, East Ham Memorial Hospital and Queen Mary's Hospital, 'Vest Ham. (e) External Eye Disease. Twenty-four cases (65 in 1939) of external eye disease were treated at the School Clinics. (f) Vision. During the year 1940 the Ophthalmic Clinic was held once a week from January to the 5th October and once a fortnight from the 29th October to the end of the year. One hundred and fifteen accepted treatment in respect of visual defect during the year 1940 (of these 3 children with markedly defective vision had not been seen by the Ophthalmic Surgeon) and, including 10 cases awaiting treatment at the termination of the year 1939, 122 cases have been treated in the past year. There are also 29 children who accepted treatment during 1939 and 1940 but who pre evacuated and have therefore not been seen by the Ophthalmic Surgeon in this Borough. 6. Mr. S. C. Reeve-Flaxman, the Ophthalmic Surgeon, reports as follows:- General Clinic. Baby Clinic. Number of new cases 122 37 Glasses prescribed 62 13 Glasses not necessary 60 24 Glasses obtained 58 13 Special treatment 27 9 Re-examinations 294 19 Discharged 33 5 Referred to Hospitals 1 1 The Sight-Saving Class at Monega Road School has been discontinued since the outbreak of war. (g) Ear Disease. During the year 1940 35 Aural Clinic sessions were held. The total attendances at the Aural Clinic was 535, making an average attendance at each session of 15 patients. Ionisation treatment was carried out in 2 cases, 3 applications being made. Mr. Arthur Miller, F.R.C.S, , the Aural Surgeon, reports as follows:- Thirty-five clinics were held during the year, with a total attendance of 535. Thirty-two per cent. of the cases were, after treatment, discharged cured. I operated on 80 East Ham children for septic tonsils and adenoids. The statistical reports is as follows:- Cases of Chronic Otitis Media 19 Discharged 5 Cases of Deafness 1 " - Other Ear. Cases 26 " 7 Cases of Chronic Rhinitis 20 " 7 Other Nose Cases 21 " 6 Cases of Enlarge Tonsils and Adenoids 141 " 54 Other Throat Cases 19 " 1 (h) Dental Defects. The age groups inspected were from five years to fifteen years inclusive, which' totalled 3,862; those referred for treatment number 2,547 and the 'specials" cases referred by the School Medical Officer and Head Teachers were 52. The number of attendances at the dental clinics was 2,079. (See Table IV, Group V - Dental Defects.) There has been a disappointing decline in the number of children presented for dental treatment', viz. 43.8 per cent. of the children referred, as compared with 75 per cent. for the year 1939. 7. Maternity and Child Welfare Centres. Details of the dental work done for the Maternity and Child Welfare Centres are shown in the following table:- No. of Sessions devoted to treatment. No. of Attendances. No. of Permanent Teeth. No. of Temporary Teeth. Adults Children Extracted Pilled Extracted Pilled 39 106 210 144 52 211 48 Total No. of Extractions Total No. of Fillings No. of Administrations of General Anaesthetics No. of other Operations. Permanent Teeth. Temporary Teeth. 355 100 12 77 55 (i) The Light Clinic. The following table furnishes a brief summary of the cases treated by general and local irradiation throughout the year:- Number of Children Treated (General) 34 Number of Children Treated (Local) 1 Number of Attendances (General) 2450 Number of Attendances (Local) 42 Number of Attendances (Local & General) 2492 OPEN-AIR EDUCATION. Residential Open-Air Schools. The following statistical table gives particulars of the number of children admitted to these schools during the year 1940:- PARTICULARS OP THE NUMBER OP CHILDREN WHO WERE RESIDENT IN SCHOOLS OF RECOVERY BETWEEN 1st JANUARY AND 31st DECEMBER 1940 AND THE PERIODS OP THEIR STAY BETWEEN THOSE TWO DATES. SCHOOL. NO. OP MONTHS. totals 1 2 3 4 5 6 7 8 9 10 11 12 B G B G B G B G B G B G B G B G B G B G B G B G b g Ogilvie 1 - - - - - - - 2 2 - - - - - - - - - - - - - - 3 2 I.C.A.A. (hdots. ) 1 - - - 1 - - 2 1 1 - - - - - - - - - - - - - - 3 3 St. Catherines. - - - 1 - - 1 - - - - 2 1 1 - - - - - - - 1 1 3 3 8 St. Dominic's. 1 - 2 - 1 - - - - - - - - - - - - - 1 - - - 7 - 15 - Suntrap. - 1 - - - - - - - - 1 - - - - - - - - - - - - - l 1 SCHOOL. NO. OF WEEKS. totals. 3 7 8 9 11 15 18 20 22 28 29 32 B G b g B G B G B G B G B G B g B G b G b G B G b g Russell Cotes. - 1 1 - 2 - 1 — 4 2 1 - 2 - 1 — — 1 1 - 2 - 2 2 17 6 8. SYNOPSIS OF CASES REFERRED TO EAST HAM I.C.A.A. "BY SCHOOL MEDICAL SERVICE DURING 1940. Diseases from which the children were suffering:- Tuberculosis 8 Pre-Tuberculosis 9 Cervical adenitis 1 Bronchial conditions 4 Debility and Malnutrition 2 Infantile Paralysis 2 Spina Bifida 1 27 Action taken:- Convalescent treatment 14 Surgical instruments provided 3 Parents refused treatment offered 2 Sanatorium treatment 8 27 Delicate, debilitated and physically defective children, who require change of air and environment and the regulation and routine of a healthy life have derived great benefit as the result of the keen activity of the Local Branch of the Invalid Children's Aid Association. PROVISION OF MEALS. Despite the shortage of certain items of diet considered of importance during the period of growth, in general the nutrition of the scholars is good. War conditions have rendered the Central Dining Centres somewhat impracticable, but the Teaching Staffs have overcome this difficulty by arranging for meals to be prepared and served in the Schools. In several cases manifesting signs of early mal-nutrition a marked improvement has resulted from the attendance of the children for the dinners thus provided. The meals are excellent, the cost is small, and the Head Teachers, so ably assisted by Teachers and older girl scholars, are performing a very valuable service in this connection. Under present circumstances, as many parents as possible are being encouraged to allow children to remain at school for the mid-day meal, and a rapidly increasing number are availing themselves of this privilege. CO-OPERATION OF PARENTS. During the year 1940 the number of parents who were present at the routine medical inspections was 3,322 (2,857 in 1959), that is. 85.4 per cent. of the cases examined (81.1 per cent. in 1939). CO-OPERATION OF VOLUNTARY BODIES. The National Society for the Prevention of Cruelty to Children has been of great assistance in our efforts on behalf of children whose parents have proved indifferent or stubborn. 9. l6 such cases have been dealt with by the Society's Inspectors as the result of direct reference from the School Medical Service, during the year 1940. The following table indicates the work performed by the Society:- Condition. Number of Cases. Treatment Obtained. Treatment Arranged. Cases under Observation. Moved out of Area. Tonsils and Adenoids 2 1 1 - - Dental Caries 2 1 1 - - General Neglect 2 1 improved - 1 - Others 10 4 improved 1 — 5 l6 7 3 1 5 The fact that Court Proceedings wore avoided in every case is deserving of special mention, and the Society is to be congratulated upon the excellent results achieved. BLIND. DEAF„ DEFECTIVE AND EPILEPTIC CHILDREN. Mentally Defective Children. Total number of children notified during the year ended 31st December 1940 by the Local Education Authority to the Local Mental Deficiency Authority under the Mental Deficiency (Notification of Children) Regulations 1928 7 The Day Special School for Mentally Defective Children was closed at the outbreak of war and many of the children were evacuated to Banstead or by private arrangements. No children have been Certified as mentally defective during 1940. SECONDARY SCHOOLS. Owing to the evacuation of scholars and' closure of the Secondary Schools, routine medical inspection was not carried out during the year 1940. EMPLOYMENT CHILDREN AND YOUNG PERSONS: Twelve boys have been specially examined in accordance with the Bye-laws, and these were found to be fit for employment. No school children were examined under the Regulations dealing with the Employment of Children at Entertainments. 10. TABLE I. medical inspections of children attending public elementary schools. A - routine medical inspections. Number of Inspections in the prescribed Groups: - Entrants 957 Second Age Group 1655 Third Age Group 1244 Total 3836 Number of other Routine Inspections 52 Grand Total 3888 b - other inspections. Number of Special Inspections and Re-Inspections 1254 TABLE II. CLASSIFICATION OP THE NUTRITION OP CHILDREN INSPECTED DURING THE YEAR IN THE ROUTINE AGE GROUPS. Age-groups. No. of Children Inspected A (Excellent) B (Normal) C (Slightly subnormal) D (Bad) No. % No. % No. % No. % Entrants 957 81 8.46 870 90.90 6 0.62 - - Second Age- group 1635 172 10.51 1650 88.68 13 0.79 - - Third Age- group 1244 243 19.53 995 79.98 6 0.48 - - Other Routine Inspections 52 13 25.00 39 75.00 - - - - TOTAL 3888 509 13.09 3354 86.26 25 0.64 - - TABLE III. BLIND CHILDREN & DEAF CHILDREN. There are no totally or almost totally blind or deaf children who are not at the present time receiving education suitable for their special needs. 11. TABLE IV. TREATMENT TABLES. GROUP I - MINOR AILMENTS (excluding Uncleanliness, for which see Table VI). Disease or Defect. Number of Defects treated or under treatment during the year. Under the Authority's Scheme. Otherwise. Total. (1) (2) (3) (4) Skin. Ringworm Scalp:- (i) X-Ray Treatment. - - - (ii) Other Treatment. - 1 1 Ringworm Body - 1 1 Scabies 23 - 23 Impetigo 22 2 24 Other skin disease 86 - 86 Minor Eye Defects. (External and other, "but excluding cases falling in Group II.) 32 4 36 Minor Ear Defects. (Treatment for more serious diseases of the ear (e.g. operative treatment in hospital) is recorded in the body of the Annual Report. ) 16 - 16 Miscellaneous, (e.g. minor injuries, bruises, sores, chilblains, etc. ) 524 9 533 Total:- 705 17 720 GROUP II - DEFECTIVE VISION AND SQUINT (excluding Minor Eye Defects treated as Minor Ailments - Group I) No. of Defects dealt with. Under the Authority's Scheme. Otherwise. Total. ERRORS OF REFRACTION (including squint). 122 - 122 (Operations for squint are recorded separately in the "body of the Annual Report). Other defect or disease of the eyes (excluding those recorded in Group I). - - - Total:- 122 - 122 No. of Children for whom spec- tacles were (a) Prescribed 62 - 62 (b) Obtained 58 4 62 12. GROUP III - TREATMENT OP DEFECTS OP NOSE AND THROAT. NUMBER OF DEFECTS. Received Operative Treatment. Received other forms of Treatment. Total number treated. Under the Authority's Scheme, in Clinic or Hospital. By Private Practitioner or Hospital, apart from the Authority's Scheme. Total. (1) __ (2) (5) (4) (5) 84 6 90 36 126 GROUP IV - ORTHOPAEDIC AND POSTURAL DEFECTS. Postural defects which received non-residential treatment otherwise than at an orthopaedic clinic are not recorded in this Table. A child may be recorded in more than one category and therefore the total number of children treated will not necessarily be the same as the sum of the figures in the separate categories. Under the Authority's Scheme. (1) Otherwise. (2) Total Number treated (see note above). Residential treatment with education Residential treatment without education Non-residential treatment at an orthopaedic clinic Residential treatment with education Residential treatment without education No presidential treatment at an orthopaedic clinic (i) (ii) (iii) (i) (ii) (iii) - - 4 - - - 4 TABLE V - DENTAL INSPECTION AND TREATMENT. The heading "Specials" in this Table relates to all ren inspected by the School Dentist otherwise than in the course of the routine inspection of children in one of the age groups covered by the Authority's approved scheme, namely, to children specially selected by him, or referred by Medical Officers, Parents, Teachers, etc., on account of urgency. The number spected in each routine age-group is separately shown, as well as the total, but under "Specials" only the total number is given. Temporary fillings, whether in permanent or temporary teeth, are recorded as other operations. (l) Number of children inspected by the Dentist. (a) Routine age-groups. Age 5 6 7 8 9 10 11 12 13 14 15 Total. Number 97 154 351 544 531 597 562 529 424 69 4 3862 (b) Specials (see note above) 52 (c) TOTAL (Routine and Specials) 3914 (2) Number found to require treatment 2547 (3) Number actually treated 1117 (4) Attendances made by children for treatment 2079 13. (5) Half-days devoted to:- (7) Extractions:- Inspection 15 Permanent Teeth 1425 Treatment l6l Temporary Teeth 1890 TOTAL 176 TOTAL 3325 (6) Fillings (see note above) (8) Administrations of general anaesthetics for extractions 108 Permanent Teeth 620 Temporary Teeth 197 TOTAL 817 (9) Other Operations:- Permanent Teeth 121 Temporary Teeth 236 357 TABLE VI - UNCLEANLINESS AND VERMINOUS CONDITIONS. All cases of uncleanliness, however, slight, are recorded. The Return relates to individual children and not to instances of uncleanliness. (i) Average number of visits per school made during the year by the School Nurses 4 (ii) Total number of examinations of children in the Schools by School Nurses 10503 (iii) Number of individual children found unclean (see note above) 88 (iv) Number of individual children cleansed under Section 87 (2) and (3) of the Education Act, 1921 Nil (v) Number cases in which legal proceedings were taken:- (a) Under the Education Act, 1921 Nil (b) Under School Attendance Byelaws Nil