Borough of Walthamstow REPORT of the School Medical Officer for the year 1930. 67974 CONTENTS. Accommodation 7 Medical Inspection 9 After-Care 37, 40, 42, 48 Medical Examination 54 Attendance Officers 3,15,34 Medical Treatment 19 Aural Clinic 4 Mental Deficiency 46 Baths 32 Milk 31 Blind School 3,39 Minor Ailments 4, 12 Boot Fund 37 N.S.P.C.C. 36 Chickenpox 17 Nurses 3, 5, 18 Clinics 4, 9 Nursery School 3, 49 Clothing 11 Nutrition 11 Committee 2 Open Air Education 3, 28, 31 Convalescent Homes 48 Orthopaedic Treatment 4, 44 Co-ordination 6 Parents, Co-operation of 33 Crippling 13,27 Physically Defective School 43 Deaf School 42 Physical Training 31 Defective Children 39 Playground Classes 28 Dental Defects 13,25 Population 7 Dental Treatment 3, 26 Rheumatism 3 Diphtheria 16 Sanitary Accommodation 7 Diastolisation 25 Scarlet Fever 17 Ear Disease 13,24 School Journeys 28 Employment 52 School Camps 28 Exclusions.. 18 Skin Disease 12,17 Eye Disease 12,21 Smallpox 15 Eye Treatment 4,21,40 Spectacles 22 Following-up 18 Staff .5 Footgear 11 Stammering 48 Hearing 24 Statistics 54, 55, 56, 57, 58, 59 Heights 10 Swimming 32 Hospital Treatment 20 Teachers, Co-operation of 34 Hygiene 7 Tonsils and Adenoids 12, 20 Invalid Children's Aid Association 35 Tuberculosis 12,20 Infectious Diseases 4,13 Uncleanliness 11 Introduction 3 Vaccination 15 Legal Proceedings 19 Vision 12,21 Massage 4 Voluntary Bodies 35 •Meals, provision of 31 Weights 10 Measles 17 Whooping Cough 17 2 EDUCATION COMMITTEE. Chairman: Alderman Mrs. M. Norrish. Deputy Chairman: Councillor B. Cole. The Mayor, Councillor V. L. McEntee, J.P., M.P., and the Deputy Mayor, Councillor W. H. Morris. Aid. A. Eve, J.P. Coun. J. Camp. Aid. H. Frost, J.P. Coun. P. Friedberg. Aid. G. Gibbons. Coun. Miss B. A. Henderson. Aid. Mrs. C. McEntee, J.P. Coun. E. C. Redhead. Aid. A. J. Wye. Coun. Ross Wyld. The late Aid. W. J. McGuffie, J.P. Co-opted Members: P. Astins, Esq. Rev. T. B. Caulkwell. G. A. Bubbers, Esq. Miss E. M. Pracey, B.Sc. Rt. Rev. Mgr. W. 0'Grady. Rev. I. Renshaw. Mrs. McGuffie. Miss C. Demain Saunders, J.P. Mrs. Smith. Director of Education and Chief Executive Officer: S. W. Burnell, LL.B., B.Sc. 3 To the Chairman and Members of the Walthamstow Education Committee. Ladies and Gentlemen, I have the honour to present herewith a report on the work of your School Medical and other Services during 1930. From the Departmental standpoint the outstanding event of the year was the retirement of Dr. J. J. Clarke, first School Medical Officer to your Authority, who, as you are aware, has built up what I consider to be a well-organised and efficient service. I would like to take this opportunity of acknowledging Dr. Clarke's invariable willingness to help and his ready response to any appeals made by me since taking up my duties. The year 1930 being the last of the quinquennium an attempt has been made to review the work of the past five years. It will, I trust, be agreed that both quality and quantity have been well up to the standard of previous years. The extensions of service during 1930 included the appointment of a second Dental Surgeon early in the year, and of two School Nurses. Your Committee's future programme includes, I believe, two new Nursery Schoolsone each in the Higham Hill and Wood Street areas-an Open Air School, and new buildings for the Blind School. In addition a proposal to set up a Rheumatism Supervisory Centre has been approved by your Committee and the scheme now awaits the sanction of the Board of Education. I gratefully acknowledge the consideration and courtesy I have received from you and the friendliest co-operation and help from your Director of Education, Mr. S. W. Burnell. Dr. Clarke in his report for 1929 particularly stressed the indebtedness of the service to the Superintendent Attendance Officer, Mr. S. J. Longman. To this I can only add my own appreciation of his invaluable help. The report includes contributions from many other persons all given so readily that its compilation has been a pleasant task. I have the honour to be Your obedient servant, A. T. W. POWELL, School Medical Officer. 4 SCHOOL CLINICS. Aural Monday, 2-4.30 p.m. Lloyd Park. Minor Ailments Monday, 9-12 a.m. Lloyd Park and Low Hall Lane. Wednesday, 9-12 a.m. Lloyd Park and Low Hall Lane. Thursday, 2-4.30p.m. Lloyd Park. Friday, 9-12 a.m. .. Lloyd Park and Low Hall Lane. Saturday, 9-12 a.m. Lloyd Park. Ophthalmic Tuesday, 2-4.30p.m. Lloyd Park. Thursday, 9-12 a.m. Lloyd Park. Saturday, 9-12 a.m. Lloyd Park. Orthopaedic— (a) Consultant .. 3rd Thursday, 9.30— 12.30a.m Physically Defective ,School. (b) Massage .. Monday Tuesday 1.30 . Wednesday 4.30 p.m. Ditto. Friday Thursday, 9.30-12.30a.m. Ditto. Infectious Disease— Contacts Tuesday, 9-12 a.m. Lloyd Park. 5 1. STAFF OF SCHOOL MEDICAL DEPARTMENT. School Medical Officer. J. J. Clarke, J.P., L.R.C.P., D.P.H. (to 3/4/30). A. T. W. Powell, M.C., M.B., B.S., D.P.H. (from 1/7/30). Assistant School Medical Officers. D. Broderick, M.B., B.Ch., B.A.O., D.P.H., Barrister-at- Law. (Acting School Medical Officer, 4/4/30 to 30/6/30.) Miss Mary C. Sheppard, B.A., M.B., B.Ch., B.A.O., D.P.H. Miss Mary C. Clarke, M.B., B.C'h., B.A.O. Specialist Part-time Medical Officers. Aural Surgeon .. A. R. Friel, M.A., M.D., F.R.C.S.I. Orthopaedic Surgeon .. B. Whitchurch Howell, M.B., B.S., F.R.C.S. Ophthalmic Surgeon .. H. J. Taggart, B.A.. M.B., B.Ch., B.A.O., F.R.C.S., D.O.M.S. Dental Surgeons. Mrs. W. Rosa Thorne, L.D.S., R.F.P.S., D.D.S. G. A. Picton-Evans, L.D.S., R.C.S. (Eng.). (Appointed 14/1/30.) School Nurses. Miss M. McCabe, S.R.N., H.V. Cert. (1919). (Supt.) Miss F. Brophy, S.R.N., C.M.B. Miss M. Dunne, S.R.N., C.M.B. (Appointed 5/3/30.) Miss D. A. Dolling, S.R.N. Mrs. J. Morris, S.R.N., C.M.B. (Appointed 7/4/30.) Dental Nurses. Miss Bacon, Cert. S.I.E.B. and H.V. (R.S.I.). Mrs. F. Mc William. Masseuses. Miss A. M. Theobald, C.S.M.M.G. (part-time). (Appointed 3/2/1930.) Miss M. Scott, C.S.M.M.G. (part-time). (Appointed 6/10/30.) Vice Miss Dora Gillman (deceased). Clerical Staff. H. J. Smith (Chief). G.W.West. F.J.Aylward. R.A.C. Green. L. Rushton. 6 2. CO-ORDINATION. Close co-ordination is ensured by the fact that the Medical Officer of Health is also School Medical Officer and Maternity and Child Welfare Officer. The majority of the Clinics in connection with the School Medical Service are held in the offices of the Health Department at Lloyd Park Mansion, which also houses the School Attendance Department. The co-ordination between the two Departments is extremely valuable, especially in regard to the following matters:-Control of infectious disease in schools (particularly of Smallpox), provision of meals and of boots for necessitous children and of milk on medical grounds, ascertainment and after-care of Blind, Deaf, Defective and Epileptic children, and arrangements for Convalescent Home treatment. The allocation in "Sessions" of the Assistant Medical Officers' time is as follows — Name. Education Committee. M. & C.W. Public Health Medical Committee . Committee . spection . Clinics. Dr. Broderick 8 3 — — Dr. Sheppard .. 1 6 3 1 Dr. Clarke 8 2 — 1 All cases suspected of suffering from Tuberculosis are referred directly to the Tuberculosis Officer from whom reports on individual cases are received, together with subsequent weekly reports on progress and recommendations as to treatment. Co-operation is received from the local branch of the Invalid Children's Aid Society, particularly in regard to children recommended for Convalescent Home treatment. It is regrettable that the duties of Health Visitor and School Nurse cannot be combined (owing to the special qualifications required by the former), so as to secure continuity of nursing supervision from infancy to school leaving age. Future vacancies amongst the School Nursing Staff should be filled with candidates holding the qualifications necessary to enable them also to work as Health Visitors, tending, ultimately, to an unified nursing service. The Nursery School is extremely valuable in bringing the too often neglected "toddler" under regular medical supervision. 7 3. THE SCHOOL MEDICAL SERVICE IN RELATION TO PUBLIC ELEMENTARY SCHOOLS. School Hygiene.—The following table shows the number of schools in the Borough and the accommodation, etc.:— Number of Schools and Accommodation. Seating Accommodation. Boys . Girls. Infts. Mxd. Boys. Girls. Infts. Mxd. Provided 18 18 15 6 6690 6292 5705 2460 Non-provided 1 2 2 2 244 472 437 618 Special Schools— Mentally Defective — — — 1 — — — 130 Deaf — — 1 — — — 20 Blind and Myope Centre - — — 1 — — — 65 Physically Defective Centre - — — 1 — — — 80 Nursery School — — — 1 — — — 150 Totals 19 20 17 13 6934 6764 6142 3523 1930. 1929. 1928. 1927. 1926 Number of Children on Register, Dec. 31st 19,432 19,592 19,749 20,197 20,636 Average Attendance 16,972.1 16,734.1 17,571.8 17,907.7 18,312.5 Percentage Attendance 87.5 85.7 87.8 87.8 88.3 Population (Registrar General's Estimate) 124,800 124,800 122,400 124,330 125,500 Percentage of School children to population 15.57 15.7 16.13 16.09 16.4 One new Non-provided School (St. Patrick's Mixed) was completed and opened during the year. The school is a well-planned one-storey building in an open situation. The accommodation is mixed and for 304 children. A detailed sanitary survey is made of each school by each Medical Inspector at the conclusion of the medical inspection of individual Departments. Any recommendations made are then forwarded to your Director of Education. During the year the Committee considered the conversion of existing trough closets to pedestal water-closets and the replacement of automatic flushing by individual flushing. All schools with the former type of sanitary accommodation were inspected and a full report was forwarded to your Director. The Board's consent to a complete scheme of conversion was subsequently obtained and the work will be put in hand during the year. 8 The advisability of installing separate flushing cisterns instead of the present automatic flushing at some schools which have separate pedestals is more difficult to decide. The advantages of the separate flush are the probable economy of water and the inculcation of hygienic habits. The advantages of the automatic flush are easier maintenance and smaller liability to freeze. Most Head Teachers of Infants' Departments appear to prefer the automatic system. The following is a list of the alterations and repairs which have been reported to your Committee as having been effected during 1930:— Higham Hill Infants' School.—Taking down wall at entrance gate and putting length of iron railings to give view of traffic in road. Higham Hill Junior School.- Removal of division railings in playground. Edinburgh Road School.—Removal of old automatic flush W.C.'s and providing new and larger pans with separate flushing cisterns. Making good and re-covering flat roofs. Markhouse Road School.—Extension of iron railings to separate Junior Boys' School out-offices from Infants' playground. Provision of Art Room and Staff Room in Boys' Department. Out-office extension at the Junior Department. Removal of solid galleries in Boys' Department . Gamuel Road School.-Provision of bath cubicle and spray bath in Boys' Department, and a Staff W.C. and a roof to outoffices in the Girls' Department. Removal of all decayed turrets. Wood Street School.—Improvements to heating apparatus in the Girls' Department. Blackhorse Road School.-Provision of wall bench with drawers and cupboards in Science Room in Girls' Department. Marsh Street Boys.—Provision of Science room. Pretoria Avenue School.—Providing Lantern Light room. Modernising W.C.'s at Girls' Department. Provision of new radiators and connecting to existing system to give additional heat in corridor in the Infants' Department. 9 Joseph Barrett School.—Removal of solid galleries at Boys' and Girls' Departments and provision of combined Domestic Subjects Centre and store room in Girls' Department. Making good and re-covering flat roofs in Boys' Department . Coppermill Road School.—Removal of solid galleries in Boys' Department. Provision of cloak room to open-air classrooms in Infants' Department. Provision of a Domestic Subjects room for Girls, and a Handicraft (Woodwork and Metalwork) room for Boys' Department. Also staff rooms for Boys' and Girls' Departments. St. Saviours' Infants.—Providing glazed folding screen. Selwyn Avenue School. Removal of solid gallery in Infants' Department. Chapel End School. Making good and re-covering flat roof in the Infants' Department. Various Schools.- Re-surfacing block flooring. Improvements to heating system and apparatus, and replacement of old radiators. Providing Science, Handicraft and Metalwork benches and store cupboards. 4. MEDICAL INSPECTION. No change has been made in the method of selection of children for inspection from that adopted in previous years. All children are examined at least three times during their school career, i.e., as "Entrants," "Intermediate" and "Leavers." Children found at inspection with medical defects are referred for treatment either to their family Doctor or to the School Clinics, or, if only requiring supervision, are "re-inspected" once a year or more frequently if possible. Complete lists of children eligible for routine inspection under the above three groups are made out from the current duplicate registers supplied by the Superintendent School Attendance Officer. The schools are notified of the children to be inspected and invitations are issued to all parents to attend the inspection. The inspections are carried out by the Medical Officers assisted by one of the School Nurses. Schools are arranged in groups so that continuity of inspection by the same Officers is secured. The following Table gives a summary of the returns of Medical Inspections for the last five years:— 10 1930. 1929. 1928. 1927. 1926. Entrants 2547 2290 2661 2242 2671 Intermediates 1905 1540 2303 2040 1294 Leavers 1631 1779 1979 2361 2645 Total Routine Inspections 6083 5609 6943 6643 6610 Other Routine Inspections 345 89 145 148 130 Special Inspections 4078 3316 3587 3080 3059 Re-inspections 12499 14692 13008 14701 18326 Total 16577 18008 16595 17781 21385 Thus, in spite of the fact that the Medical Staff was one below establishment for approximately three months, the total of Routine Medical Inspections for 1930 was 830 more than during 1929. The reduction of 1,431 in the number of re-inspections is probably due to variations in the number of children attending the School Clinics. The schedule of medical inspection prescribed by the Board of Education has been closely followed. 5. REVIEW OF THE FACTS DISCLOSED BY MEDICAL INSPECTION. The following Tables show the average heights and weights by age groups, sexes, and are compared with the anthropometric standard. A further comparison is made between (A) schools serving more prosperous areas and (B) schools serving poorer areas:— Boys. A. Average Height Average Weight Anthropometric Standard Age. (inches). (pounds). Height. Weight 5—6 41.0 38.0 40.44 37.74 8—9 47.5 54.0 46.94 49.95 12—13 55.0 75.5 55.48 73.86 B. 5—6 41.0 40.0 40.44 37.74 8—9 49.0 56.0 46.94 49.95 12—13 53.5 72.5 55.48 73.86 Girls. A. 5—6 41.5 39.5 40.68 36.68 8—9 48.0 53.0 47.39 52.05 12—13 55.5 75.5 54.88 72.66 B. 5—6 40.5 39.0 40.68 36.68 8—9 49.5 56.5 47.39 52.05 12—13 54.5 74.0 54.88 72.66 11 CLOTHING, FOOTGEAR AND NUTRITION. The Table below similarly compares with the above in schools different areas and by age and sex groups:— Entrants. Clothing. Footgear. Nutrition. ■ factory . factory . factory . factory . lent. mal. % % % % % % A—Boys 100 — 100 — 85 15 B—Boys 92 8 90 10 80 20 A—Girls 100 — 100 — 84 16 B—Girls 93 7 93 7 89 11 Intermediate. A—Boys 100 98 2 60 40 B—Boys 91 9 91 9 84 16 A—Girls 98 2 92 8 57 43 B—Girls 94 6 91 9 86 14 Leavers. A—Boys 100 100 74 26 B—Boys 98 2 98 2 84 16 A—Girls 98 2 98 2 78 22 B—Girls 91 9 93 7 57 43 Uncleanliness.—An average of 10 visits per school was made during the year by the School Nurses, who made a total of 105,029 examinations and who found 1,288 individual children to be unclean. No children were cleansed under arrangements by your Committee, nor were any legal proceedings taken. The following Table gives comparative figures for the past five years:— 1930. 1929. 1928. 1927. 1926. Average number of visits per school10 8 9 10 10 Total number of examination105,029 88,920 117,020 113,294 113,377 Number of individual children found unclean 1,288 1,259 1,567 1,582 2.239 Percentage Uncleanliness 1.13 1.42 1.33 1.39 1.08 The decrease in the number of individual children is satisfactory, for uncleanliness is most emphatically an index of the general conditions of the home, and of "sanitary conscience." 12 Minor Ailments.- The total number of defects found at both medical inspection and re-inspections to be requiring treatment is given below and is compared with similar findings during 1929:— 1930 1929. Ringworm—Head 25 27 Body 56 33 Scabies 30 15 Impetigo 556 361 Blepharitis 111 69 Conjunctivitis 83 64 Otorrhoea 143 152 Enlarged Glands 34 48 Defective Speech 26 9 Bronchitis 130 54 Tonsils and Adenoids.—The following comparison is given of the findings in 1930 and 1929:— 1930. 1929. ment. vation . ment. vation. Enlarged Tonsils 95 170 97 273 Adenoids 4 4 13 7 Enlarged Tonsils and Adenoids . 335 91 218 23 Totals 434 265 328 303 Tuberculosis.—As noted in previous reports, Pulmonary Tuberculosis is rarely met with during school age, and during 1930 one definite case required observation, while one suspected case required treatment and one required observation. Two cases of Non-pulmonary Tuberculosis required treatment and two required observation. All four cases were Glandular. These numbers do not represent the total Tuberculosis incidence amongst school children in view of the fact that children are usually referred to the Tuberculosis Officer for his final diagnosis. Skin Diseases.-In addition to those conditions detailed under minor ailments, 243 other skin defects required treatment and 1 required observation. Corresponding figures for 1929 were 174 and 6. External Eye Diseases.—Findings under this heading have been discussed under "Minor Ailments." Vision.—553 defects of Vision required treatment and 11 required observation. The 1929 figures were 441 and 27 respectively. 13 In addition there were 54 squint defects requiring treatment and 4 requiring observation, against 18 and 6 in 1929. Ear Disease and Hearing.—The following figures compare the findings of 1930 and the previous year:— 1930. 1929. Defective Hearing 61 82 Otitis Media 143 152 Other Ear Disease 80 60 One defect required observation in 1930 against 14 in 1929. Dental Defects. -1,801 dental defects were found to require treatment in 6,428 children inspected by the Medical Officers during routine inspections. The more complete dental inspections carried out by the Dental Surgeons showed 10,817 children to be requiring treatment out of 19,557 examined, or over 55 per cent. Crippling Defects.—Eleven cases required treatment, and two required observation. Table 2 (Board of Education) at the end of the Report contains a detailed statement of defects found by medical inspection during the year. 6. INFECTIOUS DISEASE. The control of infectious disease in your area is effected on the lines detailed in the Board's "Memorandum on Closure of and Exclusion from School," 1927. Notifiable infectious disease is chiefly brought to notice by notifications received from local Doctors under the Infectious Diseases Notification Act. The following Table details the monthly notifications received under this Act in respect of children of school age:—• Non- Scarlet Fever. Diphtheria . clinical Diphtheria . Smallpox. Chicken pox. January 62 30 2 5 — February 41 15 3 7 — March 21 20 1 6 61 April 28 27 2 2 95 May 24 20 — 7 76 June 15 16 1 6 53 July 24 30 5 13 44 August 14 11 — 17 42 September 21 30 9 8 13 October 19 40 5 — 18 November 40 29 6 1 24 December 46 33 7 — 45 Totals 355 301 41 72 471 u The cases discovered by the Medical Staff and included in the above Table, were as follows:— Scarlet Diph- Small- ChickenFever. theria. pox. pox. 19 70 30 21 Non-notifiable infectious disease is chiefly brought to light by the weekly returns made by Head Teachers under the local "Regulations as to Infectious Diseases in Schools." The monthly figures were as follows:— Sore Throat. Measles. Whooping Cough. Mumps. Chickenpox. Ringworm and Scabies. Impetigo, Sores, etc. January 10 55 3 19 62 _ 20 February 11 405 1 28 113 — 20 March 5 718 2 65 114 3 20 April 3 294 1 52 54 — 1 May 11 87 — 48 57 2 4 June 5 16 5 5 38 — 3 July 9 4 14 — 22 1 4 August — 2 4 — — — 2 September 5 — 18 1 8 — 13 October 3 — 9 — 14 — 6 November 12 2 25 5 10 5 December 1 — 7 — 4 1 2 Totals 75 1583 89 223 496 7 100 The following were the weekly average numbers of children away from School owing to:— Exclusions. Chickenpox. Measles. Whooping Cough. Sore Throat. Influenza. 222 73 189 17 39 50 Diarrhoea. Mumps. Ringworm. Scabies. Various. Totals. 3 38 9 2 633 1275 To secure further control of Infectious Disease a weekly clinic is held on Tuesdays at 9.30 a.m. at Lloyd Park at which all contacts of cases of Diphtheria and Scarlet Fever are seen as well as all 15 school children after discharge from the Isolation Hospital or from Home Nursing. Exclusion from school is rigidly enforced until all fear from infection has disappeared. A total of 783 swabs were taken from suspicious throats and noses at the School Clinics alone. The incidence of the various infectious diseases amongst school children during the last quinquennium is reviewed below:— (a) Smallpox.—This disease first appeared late in 1929, and although 10 cases were notified only 1 occurred in a child of school age. Unfortunately during 1930 the picture was very different, for a total of 72 cases occurred amongst children of school age. The maximum incidence was during July and August when 13 and 17 cases were notified respectively. Typical examples of ' 'school outbreaks'' were as follows:— (1) Forest Road Infants' School.—A boy of 5 years of age was brought to the School Clinic on 4th July, 1930, for "Spots" which the Assistant Medical Officer diagnosed as Smallpox. The school was immediately visited and lists of vaccinated and unvaccinated children were made out. For a period of three weeks all unvaccinated absentees were visited by the Sanitary Staff who brought three further cases to notice, and which would probably have been otherwise missed. All were contemporary infections at the same class and had obviously been infected at school by a "missed" case. Repeated examination of every child at school failed to find this infecting source or any further missed cases. Secondary cases amongst contacts amounted to 18, of whom 9 were school children. The last case of this "group infection" was found on 6th September, although the actual school involved had been released from suspicion by the end of July. (2) Gamuel Road Boys'' School.—A boy aged 10 years was notified on 7th September, 1930, by his Doctor to be suffering from Smallpox and on enquiry was found to have attended school in an infectious condition. The same routine with regard to the visiting of unvaccinated absentees from school was carried out, but the visiting in this instance was carried out (through the kind co-operation of the Superintendent School Attendance Officer) by the Attendance Officer for the School. This Officer reported all absentees away with suspicious symptoms and these cases were at once visited by the School Medical Officer, and excluded from school until released from observation. By this system two further cases were discovered and the school was ' 'cleared'' in three weeks, repeated examinations of all children at school being carried out in order to detect missed cases. 16 The success of the foregoing procedure in controlling Smallpox in schools is a sufficient reply to those critics who clamour for School Closure. Although an enormous amount of work is entailed for the Attendance and Medical Departments, control during school time is far more effective than during holidays. The vaccinal findings at Gamuel Road School are summarised below:— Vaccinated. 76; Unvaccinated, 233: Total. 309 ; Vaccinated. 24%. It is a significant fact that of all the 72 school children affected with Smallpox during 1930 not a single one had been vaccinated. The moral and the remedy for Smallpox is obvious. Fortunately, the type of Smallpox was consistently mild and no case caused undue anxiety during hospital treatment. (b) Diphtheria.—The quinquennial incidence has been as follows:— Number of Non-clinical Maximum Year. cases. Diphtheria Incidence. 1930 301 41 40 in October. 1929 194 17 42 in October. 1928 163 19 39 in November. 1927 161 23 22 in September. 1926 148 23 29 in October. The very greatly increased incidence during 1930 is a matter of grave concern and demands that consideration should be given to the introduction of a scheme of immunisation which is the only scientific means of preventing the disease. One school—Selwyn Avenue Infants'—showed recurrent cases during the latter part of the year when the following number of cases were notified:— July. August. September. October. November. December. 1—4 6 — 4 Repeated visits were paid to this school and every child in attendance was examined at each visit and doubtful cases excluded and/or swabbed. The infection coincided with a series of cases at a Children's Home whose inmates attended this group of schools. Several visits were paid to this Home. 17 (c) Scarlet Fever.—The incidence during the last five years has been as follows:— Year. Number of Maximum cases. Incidence. 1930 355 62 in January. 1929 392 81 in October. 1928 462 84 in October. 1927 348 43 in March. 1926 304 52 in October. (d) Chickenpox.—This disease first became notifiable in March, 1930, 471 cases being notified amongst School children during the remainder of the year. In addition 25 further cases were notified by Head Teachers. Every case has been visited by a Medical Officer and in view of the fact that 5 cases notified as Chickenpox were, on visiting, diagnosed as Smallpox, there is no question that notification of Chickenpox is of value in the control of Smallpox. (e) Measles.—This disease is not notifiable under the Infectious Diseases Notification Act, but the following were notified by the Head Teachers under the Regulations as to Infectious Diseases in schools:— Maximum Deaths. Year. Number Incidence. All Ages. 5—15 yrs. 1930 1583 February-April 25 3 1929 851 March-May 1 — 1928 2010 February-May 17 1 1927 49 April 1 — 1926 1148 January-April 4 1 It is probable that 1931 will show a comparatively low incidence. No deaths from Measles were registered in persons over 15 years of age, so that the toll taken amongst pre-school children can be gauged especially during the severe epidemic of 1928. Unfortunately parents generally fail to recognise the severity and fatality of Measles and rarely give it the attention it demands. The schools chiefly affected are shown under (g) (1) below. (f) Whooping Cough.—The quinquennial incidence was as follows:— ] Number of Maximum Year. cases. Incidence. Deaths 1930 89 November 2 1929 851 April-June 17 1928 163 November-December 5 1927 460 January 18 1926 343 November-December 9 18 The mortality from Whooping Cough is therefore seen to be even graver than that from Measles and again its occurrence is only too often not taken sufficiently seriously. (g) (1) Action under Article 45 (b) (i.e., attendance below 60 per cent, of number on register):— Twenty-six Certificates were granted as follows:— Number of School. Certificates . Month. Disease. Higham Hill Infants' 4 February Measles. ,, ,, Temp. Infants' 3 February and March Measles. Markhouse Road Infants 1 February .. Chickenpox Measles. Pretoria Avenue Infants' 6 February and March Measles. Queen's Road Infants' 3 February and March Measles. Maynard Road Infants' 3 March Measles. Blackhorse Road Infants' 3 March and April Measles. Winn's Avenue Infants' 1 April Measles and Mumps. Wood Street Infants' 2 April Measles. (g) (2) Action under Article 53 (b) (exclusion of individual children):— At Medical Inspection 23 At School Clinics 1487 (g) (3) Action under Article 57 (school closure by the Sanitary Authority):— Nil. 7. FOLLOWING UP. The School Nurses made 863 visits to the homes of children as set out below:— Tonsils and Adenoids 367 Dental Defects 162 Unclassified 112 Whooping Cough 61 Measles 53 Defects of Hearing, etc. 40 Defects of Vision, etc. 30 Chickenpox 14 Sore Throat 13 Mumps 4 Scabies 2 Impetigo.. 2 Colds 2 Ringworm 1 19 The total for the year is rather smaller than that for the previous four years which were 1,019, 1.304. 1.137 and 1,218, due chiefly to the reduction of Infectious Disease visits paid. The School Nurses attend at all medical inspections and staff the various Clinics, e.g., Minor Ailment, Ophthalmic, Aural, Ringworm and Tonsillectomy Clinics, and also carry out extensive uncleanliness surveys as already detailed. Several "following up" visits were paid at the request of the Almoners of various Metropolitan General Hospitals and written reports given of the findings. If parents fail to remedy defects after repeated home visits, warning letters are sent by the School Medical Officer or the assistance of the N.S.P.C.C. is obtained. No legal action was necessary during 1930. 8. MEDICAL TREATMENT. (a) Minor Ailments.—The treatment of minor ailments is carried out at the eight sessions of the School Clinics which are detailed earlier in the report. All are "Medical Officer's" sessions except that on Thursday afternoon, which is staffed by a School Nurse. Table IV, Group 1 (Board of Education) at the end of the Report, shows the number of defects treated during the year, mostly at the above Clinics. The actual work done at the two Clinics is shown on the Table given below. 3,717 children were seen at first inspection and they made 9,237 subsequent attendances, a total of 12.954 for the year. First Attendances. Reinspections. Number Excluded from School. Number to Return to School. Boys. Girls. Boys. Girls. Boys. Girls. Ringworm 19 20 23 14 280 137 Scabies 9 15 59 110 Impetigo, Sores, etc. 215 151 130 90 1942 1120 Skin 53 44 88 89 371 389 Verminous Head, etc. — 8 — 1 — 24 Sore Throat 134 232 16 20 369 382 Discharging Ears and Deafness 10 3 117 118 286 293 Defective Vision — 222 222 2 — External Eye Diseases 62 44 80 67 432 284 Tonsils and Adenoids 2 — 80 74 115 131 Mumps 11 18 — — 17 9 Various 201 236 384 395 1109 1376 Totals 716 771 1140 1090 4982 4255 20 Number of children seen at first inspection 3717 Number of children sent by Attendance Officers, etc. 72 Number of attendances made by children 12954 Number of children sent by Head Teachers 3645 Number of swabs taken 783 Number of specimens of hair examined for Ringworm 11 (b) Tonsils and Adenoids.— Your Committee's Scheme of treatment of these defects consists of:— (a) An arrangement with the Walthamstow Dispensary under which cases are operated upon there by the Honorary Medical Officers, Messrs. Anthony, Buchan and Philip. A fee of £1 per case for Tonsils and Adenoids, 15s. for Adenoids only, and 10s. for Tonsils only is paid to the Dispensary. Parents are given detailed instructions with regard to pre and post-operative care, and after recovering from anaesthesia patients are, if necessary, taken home by car. One of the School Nurses, who assists at the operation, visits each case the following morning, and if there is any suspicion of post-operative haemorrhage the patients are sent in to Whipps Cross Hospital. Three cases were so admitted during 1930. Patients are seen after seven days at Lloyd Park by a Medical Officer. This Scheme appears to be as nearly perfect as Out-Patient treatment can attain, but there is no question that such operations should only be carried out under In-Patient conditions, the patient being admitted the day before operation and discharged not earlier han the succeeding day. (b) An arrangement under which the Connaught Hospital admits cases the day previous to the operation and are discharged when fit. The fees are £1 Is. Od. for the operation and 8s. per day for maintenance. Children are treated under this scheme when the home conditions are considered unsatisfactory. The following Table shows the number of cases treated during the last five years:— Year. At Dispensary. At Connaught Hospital. At Sanatorium. Privately. Total. 1930 310 53 — 5 368 1929 260 36 — 8 304 1928 230 38 31 11 310 1927 262 — 69 15 346 1926 174 — 31 7 212 (c) Tuberculosis.—Cases of actual and suspected Tuberculosis are referred to Dr. Sorley, Tuberculosis Officer to the Essex County 21 Council, which Authority administers the Tuberculosis scheme in the Borough. The numbers of school children examined by him during the last five years were:— Year. Boys. Girls. Total. 1930 78 73 151 1929 104 89 193 1928 101 87 188 1927 113 85 198 1926 101 76 177 Seventy-three children referred from the School Medical Service were classified as follows:— Pulmonary Tuberculosis. Non-Pulmonary Tuberculosis. NonTuberculous. Requiring to be kept under observation. Boys. Girls. Boys. Girls. Boys. Girls. Boys. Girls. 1 1 - 2 1 5 28 35 Close liaison was maintained with the Tuberculosis Officer who very kindly sent weekly reports in respect of each child seen. Recommendations for treatment made by him were carried out, as far as possible. Arising out of these, 60 children received free milk. (d) Skin Disease.—The number of cases of skin disease treated is shown in the table detailing the work done at the School Clinics. In addition 10 cases of Ringworm of the scalp were referred to the London Hospital for X-ray treatment at a cost of £2 12s. 6d. per case, towards which parents contributed a total of £1 18s. Od. (e) External Eye Disease.— Treatment for these cases is given at the School Clinics. (See Table.) (/) Vision.— The medical treatment facilities provided by your Committee for defects of vision, etc., consist of (1) a Blind School staffed on the medical side by a part-time Consulting Ophthalmic Surgeon, Mr. H. J. Taggart, F.R.C.S., and (2) three weekly Refraction Clinics under the care of Dr. Sheppard, who refers special or difficult cases to Mr. Taggart's Consultant Clinics, and which she attends, so maintaining a close liaison. Mr. Taggart's report will be found under Section 17 of the report. Three weekly Eye Clinics are held at Lloyd Park as detailed below. All defects of vision are referred here by other Medical 22 Officers and are. if necessary, followed up for the remainder of the child's school life. Dr. Sheppard has kindly contributed the following account of the good work done during 1930:— "During 1930 the Eye Clinics were held at Lloyd Park as usual on Tuesday afternoons and Thursday and Saturday mornings. The Saturday Clinic is principally devoted to seeing those children who have obtained new glasses during the week, and to checking the lenses and the 'fit' of the frames. In my opinion correctly fitting frames are of paramount importance in the correction of defective vision, especially where there is any 'eye strain' or squint, and often it has been my unpleasant duty to insist that the lenses be changed from a badlv fitting gilt heirloom to a common steel frame. "The average number of children seen per session was 19 with an average of 6.5 children submitted to retinoscopy. '"The provision of glasses is greatly facilitated by the weekly payment system in vogue. One hundred and seventy-one parents took advantage of this scheme and only seven had to have glasses given free by your Committee. ''The following Table shows the number of attendances made by children at the Clinic—it does not include children treated for external diseases of the eye. Disease. No. of Children seen at Clinic. No. of Attendances made by children. Average No. of Attendances per Child. Boys. Girls. Boys. Girls. Boys. Girls. Hypcrmetropia 88 107 217 283 2.5 2.6 Myopia 67 100 157 210 2.3 2.1 Hypermetropic Astigmatism 66 97 183 259 2.7 2.7 Myopic Astigmatism 28 29 63 63 2.3 2.2 Mixed Astigmatism 28 30 96 93 3.4 3.1 Odd Eyes 24 25 55 90 2.3 3.6 Glasses not required (Nystagmus, Cataracts et c.) 24 48 47 84 2.0 1.8 Total 325 436 818 1082 2.5 2.48 "By 'odd eyes' is meant those cases where the child is suffering from long or short sight in one eye while the other is normal. It is often difficult to persuade the parent that this type of case requires glasses as there is no obvious improvement with glasses owing to the normal vision in one eye, nevertheless glasses are even more necessary than when both eyes are affected as the abnormal eye rapidly loses its sight from disuse. 23 Defects. Number of Boys. Number per cent. Number of Girls. Number per cent. Total. Children. Per cent. Hypermetropia 31 20.39 34 17.89 65 19.01 Myopia 33 21.71 45 23.69 78 22.80 Hypermetropic Astigmatism 27 17.76 38 20.00 65 19.01 Myopic Astigmatism 12 7.89 9 4.70 21 6.15 Mixed Astigmatism 8 5.27 10 5.26 18 5.26 Odd Eyes 17 11.19 18 9.48 35 10.23 Glasses not required 24 15.79 36 18.94 60 17.54 Totals 152 100.00 190 100.00 342 100.00 "The above Table is a record of the new cases seen at the Clinics and requiring attention. Included in this Table are those children found suffering from Squints of the following types:— Boys. Girls. Convergent R 8 9 L 15 12 Divergent R — 1 L — — Occasional R 2 — L 2 1 Alternating — 4 Three hundred and thirty-one new cases were seen during 1930 and 2,252 attendances were made. Five hundred and forty cases were prescribed for and all obtained the necessary spectacles, the cost to the Education Committee being £44 15s. 3d., to which parents contributed £44 7s. 9d. Table IV (ii) (Board of Education) gives further particulars. "Those included under the heading 'Glasses not required' are the following:— Disease. Boys. Girls. Disease. Boys. Girls. Albino 1 - Optic Atrophy L 1 - Chorea 1 - Anophthalmia R 1 - Anterior Poliomyelitis — 1 Injury to Eye 2 - Abnormal Macula - 1 Injury to Sympathetic Nerve - 1 Old Interstitial Keratitis 2 - Secondary Optic Atrophy 1 - Double Cataracts 1 2 Phlyctenular Conjunctivitis 2 1 Nystagmus 1 1 Headaches due to Anaemia, Debility and Habit Spasms 10 26 Corneal Nebulae 1 2 Anterior Synechia — 1 24 (g) Ear Disease and Hearing.— Minor defects under the above heading are treated at the Minor Ailment Clinics, the numbers treated being given in the Table relating to the work of these Clinics. Refractory or special cases are referred to the weekly Consultant Aural Clinic held on Mondays from 2—4.30 p.m. by Dr. A. R. Friel who has again been good enough to report on the valuable work done at this Clinic as follows:— Nature of Disease. Total. Cured Lost Sight Of. Still under Treatment. Hospital Treatment. Acute Suppurative Otitis Media 60 51 1 6 2 Chronic Suppurative Otitis Media due to— (a) Tympanic Sepsis 31 27 2 2 — (6) Tympanic Sepsis and Granulations 10 7 1 2 - (c) Tympanic Sepsis and Polypus 4 4 — — — (d) Tympanic Sepsis and Cholesteatoma 1 - - - 1 Tympanic conditions:— - - - - - (a) Rhinitis 5 4 — 1 - (6) Tonsils (enlarged or inflamed) 2 1 — — 1 (c) Pharyngitis 2 2 — — — (d) External Otitis 1 1 — — - Attic Disease 6 2 - 2 2 Mastoid Disease 12 1 - 2 9 External Otitis Media 20 19 - 1 - Not diagnosed 2 - — - 2 Totals 156 119 4 16 17 "The 4 cases 'lost sight of' include 2 who have left School and 2 who have left the district. "The above Table includes all the cases of active suppurative disease treated at the sessions of the Aural Clinic at Lloyd Park. The majority of the patients were school children, but there were also babies from the Infant Welfare Centre and 'toddlers' from the Children's Clinic at Mark house Road. "The policy of the Health Department is to supervise the health of the children from birth till they leave school. This is particularly wise in the case of disease of the ears. "Acute inflammation in the ear occurs frequently before the patient has entered school. If treatment is given before the disease becomes chronic nearly every case clears up quickly. It means that the child enters school free of discharge from the ear and with little or no impairment of hearing. The Clinic for Infants and Toddlers at Mark house Road and the Aural Clinic at Lloyd Park work together, and Dr. Sheppard sends any cases requiring special treatment to the Aural Clinic. 25 "In addition to ear cases a fair number of children are seen with Chronic Nasal Catarrh. For many of these the treatment devised by Dr. Gautier of Paris and known as diastolisation is given. The treatment is usually painless, is unattended by risk and is in most cases efficient and the results are rapidly obtained. It is a real advance in the treatment of a troublesome condition. "The system of organisation adopted when the Clinic was begun is adhered to. Every patient is given a written appointment stating the day and hour for next visit. Waste of valuable time waiting to be seen, is by this method avoided. Parents are more willing to bring their children if their time is not wasted. "Miss Brophy attends the Clinic and also visits the Minor Ailment Clinics. She has carried out efficiently the diastolisation treatment during the week as often as is necessary and her help has been most valuable. "The Clinic is also indebted to Mr. Rushton, the Organising Clerk, who makes the appointments for the patients and ensures the absence of friction." The Clinic was begun in March, 1927, and the annual totals have been:— Year. Total. Cured. Lost sight of. Under Treatment. Needing Hospital Treatment. 1927 (9 months) 138 90 6 25 1 1928 175 110 18 20 27 1929 152 112 9 14 17 1930 156 119 4 16 17 (h) Dental Defects.— A second Dental Surgeon was appointed in February and assumed duty on 1st March. The following Table shows a Summary of Tables IV (iii) (Board of Education) for the past five years:- Year. Inspec tions. Requiring Treatment . Per cent. Actually Treated. Retreated . Fillings. Extrac tions . Gas Anaesthetics . Other Operations. 1930 19557 10817 55.3 6286 237 5622 10816 4186 676 1929 8422 4442 52.7 3455 392 2277 5848 2571 373 1928 8463 4533 53.5 3677 479 2354 5906 2641 471 1927 10327 5582 54 4073 2280 2866 6273 2850 1426 1926 8299 5799 69.1 3679 2082 2894 6084 2702 1970 26 The Dental Surgeons have submitted the following reports:—- Mrs. Thome, L.D.S., reports:— ''The past year has seen an extension in the School Dental Service, a branch of the Public Health Service which is the least catered for of all, but of which the benefits from treatment are unquestioned. This expansion has given time for greater attention to children approaching the leaving age and which has fully justified itself by the willingness of parents to follow up treatment commenced while in Infants' Schools. "Routine inspections in schools is a great factor in accepting the proffered advice and treatment, and now that the service is extended it may be wisely urged that this inspection should cover the remaining age groups of senior scholars. This is already the practice in three Departments in consequence of which incidence of dental disease shows the lowest percentage. Practically the same families accept treatment whenever needed or advised, though the idea of the Dental Clinic as a convenient and inexpensive place for extraction of teeth is still prevalent in a certain type of parent. "The punctual keeping of appointments made shows a hopeful increase. So many conditions arise affecting and influencing attendance, and it is the aim of the Clinics to keep a uniform number of patients without overcrowding and consequent rush treatment with unavoidable re-appointments. "Some of the reasons for failure to keep appointments may be summed up as sickness, lack of initiative to accept treatment when the patient is no longer suffering acutely, domestic ties, parents engaged in industry and unable to accompany the child, and it is to be regretted that to these must be added apathy. The difficulties are met, when discovered, by every accommodation that the Clinic can afford. "The Teachers use every encouragement for children to receive treatment at the Clinic, and they work in close co-operation with the Dental Staff. They merit our grateful thanks for their loyalty. "Whenever possible, instruction in oral hygiene is given to the young patients at the time of treatment ." Mr. G. A. Picton-Evans, L.D.S., reports:— "The apathy of the parents generally towards dental treatment for the children is deplorable, and it is hoped that some scheme will be formulated whereby the parents may be educated to the need for early conservative treatment and to enlighten them regarding the fallacy that deciduous or milk teeth need no attention. 27 "I am very grateful to the Head Teachers for the assistance they have given in this direction, but much more must be done. In one case 151 children at a school were found to require treatment. Of these, 34 took advantage of the facilities offered by the Clinic. The number obtaining the attention of private dentists was negligible. "School inspections have been arranged so that the children of the 5-8 age group are inspected more frequently than the older children. This method is found to be more profitable than if each school and department were inspected in turn before a second inspection of any one school or department was made. "Attendance at the Clinic of those given appointments has appreciably improved, due chiefly to notifying the Head Teachers of the children to whom appointments were given, and enlisting their assistance to see that the appointments are kept. "The number of 'specials', those children needing urgent casual attention, is rather misleading, for of the number attending the Clinic as specials many do not really need the urgent attention that their presence suggests. "It is much to be regretted that the conservative treatment allowed at the Clinic is of a rather limited nature. One is frequently faced with the necessity for extensive treatment which as yet is not provided for. "Orthodontic treatment is also sorely needed, but the worried parent and child have to be turned away with advice to seek the services of a private dentist whose fees they can seldom afford. "To get the apathetic parent interested is the outstanding need, and this with the aid of all concerned in the welfare of the children should soon be another accomplishment." (i) Crippling Defects and Orthopaedics.— Medical treatment for these defects is obtained under a comprehensive Orthopaedic Scheme in charge of the Consultant Orthopaedic Surgeon, Mr. Whitchurch Howell, F.R.C.S., who has a monthly clinic at the Physically Defective School. Mr. Howell also acts as Honorary Surgeon to the Brookfield Orthopaedic Hospital, a voluntary Institution of 30 beds recognised as a Hospital School by both the Ministry of Health and the Board of Education. Two masseuses divide their time between the Hospital and the Orthopaedic Clinic and the Physically Defective School. Your Committee's cases have priority of admission to the Hospital. Details of the work done under the scheme are given in the section dealing with Defective Children. (Section 17.) 28 9. OPEN-AIR EDUCATION. (a) Playground Classes.— Most schools appear fully to utilise favourable weather conditions for playground classes, physical exercises and organised games. (b) School Journeys.- The following school journeys were made during the year:— School. Number. Place. Date. Shernhall Special 26 Ryde, Isle of Wight 3rd-17th April. North Central 34 Mortehoe Whitsuntide. „ „ 34 Wimereaux „ South Central 24 Boulogne „ (c) School Camps.— The following particulars are taken from the report made to your School Management Committee by your Director of Education:— "Objects.—(i) To supply the benefits of a country holiday, particularly for those children whose home circumstances render such a change desirable and who would derive the physical advantages of such a change. "(ii) To inculcate good habits of conduct and of personal and domestic hygiene. "(iii) To take advantage of all local resources which would contribute to the education of the children. "Selection of Children.— It was agreed that the selection of children should be on grounds of poverty, overcrowding and under-nourishment rather than for physical reasons alone. "All children were carefully selected by the Head Teachers and required to pass a medical examination by the School Medical Officer. Only children over 11 years of age were sent and usually the ages ranged between 13 and 14 years. "Site of Camp.— A standing Camp at St. Helens, Isle of Wight, was rented for six weeks at very reasonable rates which included canvas equipment and food. The delightful situation of the camp on high and well-drained ground, near to the sea and within easy distance of places of great historical interest, together with the interesting railway and sea journey, made the time a memorable one in the lives of the children. Numerous grateful letters from them and from their parents testify to the enjoyment and benefits in health and outlook which these children have gained at the critical period when they are about to leave school and take up their work in the world. 29 ''Equipment.— Full instructions were sent to the schools as to equipment to be taken. The Committee supplied kit-bags and arranged for their conveyance to and from the stations and the camp. "The duration of the Camps, the Schools and the numbers of boys attending were as follows:— Duration. Schools. Number of Boys. 7th to 21st June . Mark house Road Boys 29 Copper mill Road 26 St. Saviour's 4 North Walthamstow Central 1 Total 60 21st June to 5th July. Marsh Street 20 William Morris 19 Winns Avenue 19 Selwyn Avenue 4 Total 62 5th to 19th July Joseph Barrett 20 Chapel End 20 St. George's 3 Wm. Elliott Whittingham 20 Total 63 "Finance.— The estimated cost of the Camp for six weeks was £500 and an expenditure not exceeding this amount was sanctioned by the Board of Education. The actual expenditure was £495 13s. 4d." The following report by Mr. Taylor was made to your Committee:— "Site and Equipment.— The site was an excellent one, being situated on high ground and well drained. The sanitary arrangements were excellent. The sea-shore and bathing facilities were 10 minutes' walk from the Camp. Bathing was safe. From the camp grounds ocean liners could be seen passing. Boys slept in Bell tents (8 boys to a tent), each boy being provided with a ground sheet and three blankets. A marquee was provided for meals and an extra Bell tent for stores. Kit bags provided by the Committee for the boys were a great boon. "Arrangements were made at the Camp for (a) Bank, (b) Library, (c) Post Office, (d) First Aid and Medical attention. Officers were appointed to take charge. 30 ''Each group deposited from £6 to £8 in Bank which was drawn out in small sums as required by boys. "An issue of approximately 90 Library Books was made to each group. The books were excellent and evidently chosen with great care—just the books boys wanted to read. Post Office and First Aid arrangements worked splendidly. "All travelling took place on Saturdays. There was excellent transport from Walthamstow to Waterloo, and very comfortable travelling in reserved carriages from Waterloo to Portsmouth Harbour. The boats were invariably crowded as were the carriages on the Isle of Wight Railway. (Saturday is a busy day for traffic on the Island.) "Food.— The food was good, wholesome, well cooked, and there was plenty of it. With very slight variations, the food for Masters and Boys was the same. The camp provided mugs and plates, the Masters and Boys had to supply knives, forks and spoons. All Mess duties were carried out by Masters and Boy Orderlies, who worked in rota. Meals: Breakfast, 8a.m.; Dinner, 1p.m.; Tea, 5p.m.; Supper, 8 p.m. "Weather.— The weather during the whole Camp period was splendid and greatly added to the happy and beneficial time which each boy undoubtedly enjoyed. "Tone and Discipline.— Tone and Discipline were excellent and the most cordial relations existed between the boys and the villagers. The boys, mainly drawn from the poorest homes, entered very quickly into the spirit of camp life and learned many valuable lessons. A few boys in each group were weaklings, but fortunately the weather was very kind for them. "Lessons.— A comprehensive scheme of work was adhered to in accordance with a time-table which included lessons in Health and Morals.'' (d) Open Air Classrooms in Public Elementary Schools.— There are four open air classes at the following Departments—Forest Road Junior Boys (38), and Girls (39), and two at Coppermill Road Junior Mixed (75), attended by the numbers of children shown. M iss Wilde (Forest Road Girls' Department) notes:— "Remarkably beneficial results, the children's spirits improve with their general health with a corresponding improvement in their attendance and capacity to benefit from their lessons. Many parents have visited the school to express gratification at the improvement in their children's health." 31 Mr. Taylor (Forest Road Boys' Department) notes:— "The boys benefit physically and mentally one definite proof being the invariably good attendance." The above reports point to the need of more open air classes and classrooms pending the erection of an open air school. (e) There are no day or residential open air schools in the Borough. 10. PHYSICAL TRAINING. This is carried out in the schools according to the Board's Syllabus. In addition three Specialist Instructors are employed, one for each Central Boys' School and one for the two Central Girls' Schools. Well-equipped gymnasia are provided at each of the Central Schools and at the Marsh Street Senior Boys' School. The latter gymnasium is also used by boys attending the Mark house Road Senior Boys' School. The Education Committee has acquired the North Walthamstow Sports' Ground (4¼ acres). This, with the extensive playing fields at Chestnuts Farm, and the use of the several parks, makes reasonable provision for organised games for all schools in the area. When remedial exercises are considered necessary by the medical staff, cases are usually referred to the Orthopaedic Clinic. 11. PROVISION OF MEALS. (i) Your Committee provide a mid-day dinner for the children of necessitous parents at the Canteen Centre in High Street. Adequate cooking, service and dining arrangements exist. The menus are varied and consist of a joint, vegetables and pudding. The following Table shows the work done in recent years under the Scheme:— Year. Number of Children. Number of Meals. Average Meals per Child. 1930 310 32,750 105.6 1929 347 33,232 95.7 1928 144 41,441 287 1927 142 40,413 288.7 1926 125 27,614 220.9 The average cost per meal during 1930 was 6.24d. (ii) Milk was supplied to 301 children on medical grounds by recommendation of the Medical Staff after examination of children either at School or at Clinics. The number of children supplied during the four preceding years was 331, 270, 180 and 112. 32 (iii) National Milk Publicity Council's Scheme. Towards the close of the year a questionnaire was sent to all schools by your Director of Education to discover the number of children supplied with milk under the above scheme, and to discover whether there was any considerable number of children who were not provided with milk on account of inability to pay. The following summary The following summary has been supplied by Mr. Burnell:— Higham Hill Boys' 40 Wood Street Boys' 150 ,, ,, Girls' 80 ,, „ Girls' 130 ,, ,, Infants' 120 ,, ,, Infants' 130 Maynard Road Boys' 150 Joseph Barrett Girls' 66 Pretoria Avenue Boys' ,, Girls' 120 St. Mary's Girls' 40 150 St. Saviour's Girls' 36 Markhouse Road Infants' 120 St. Patrick's 72 Forest Road Girls' 50 Special Schools 300 Coppermill Lane Boys' 66 Girls' 47 ,, ,, Infants' 30 Thus 1,857 children received milk in schools—over 10 per cent, as compared with a National percentage of 9. The "inability to pay" queries may be summarised as follows by number of schools:—No inability, 6 ; Unable, 3; Inability of a few to a considerable number, 7. One Head Teacher observed that "children who have milk generally show least sign of neglect." The co-operation of the Head Teachers of those schools which have not adopted the scheme is earnestly invited in view of the very great benefits which accrue. At the same time it must be admitted that unless assistance is given to those "unable to pay" it is the children who most need the milk who are denied its benefit. 12. SCHOOL BATHS. There are no School Swimming Baths in your schools, but good use is made of the Municipal Baths under the supervision of your Committee's Swimming Instructor. Mr. Burnell has kindly sent the following particulars:— "Fifty scholars from each Senior School attend the Swimming Bath every Tuesday and Wednesday from May to September inclusive for instruction in swimming. Two teachers attend with each party for the purpose of discipline and instruction and special arrangements are made for the schools to continue attendance in accordance with the scheduled times during the Summer Vacation. 33 "A Swimming Instructress is also appointed each year (Miss F. M. Walker), who also trains the girls in Life Saving, and the use of the Bath is granted on each Monday, after the Summer Vacation, in the afternoons to the end of September (when the Bath is closed), for this purpose. A swimming Instructor is not appointed for the boys. "A Swimming Gala is held once a year in September, when the trophies, prizes and medals are competed for. Swimming Diplomas are awarded to girls for 30 yards, 43 yards, 100 yards, and ¼-mile, and boys for 43 yards, 100 yards, and ¼-mile. "The Education Committee appoints a Swimming Committee every year upon which teachers are co-opted, and the Organising Secretaries to the Swimming Committee are Messrs. S. Cuming and L. F. Bristow. "A Shower Bath is provided at Gamuel Road Boys' School." 13. CO-OPERATION OF PARENTS. Written notifications of medical inspection are sent by Head Teachers to parents inviting their attendance. The presence of the parent at the inspection affords the Medical Inspector full opportunity to explain how to remedy any defects found and is in every way encouraged. The following Table shows the attendance of parents during 1930:— Boys. Number of Inspections. Number of Parents. Per cent. Entrants 1292 1103 85 .3 Intermediate 928 606 65.3 Leavers 927 332 35.8 Girls. Number of Inspections. Number of Parents. Per cent. Entrants 1230 1073 87.2 Intermediate 962 693 72.0 Leavers 946 490 51.7 31 The following Table compares the percentage attendances of parents for the last five years:— Boys. 1930. 1929. 1928. 1927. 1926. Entrants 85.3 82.1 84.9 83.0 74.0 Intermediate 65.3 61.7 67.7 64.3 61.4 Leavers 35.8 31.9 32.7 29.2 28.2 Girls. 1930. 1929. 1928. 1927. 1926. Entrants 87.2 84.3 85.5 86.3 80.8 Intermediates 72.0 69.6 71.8 71.5 64.3 Leavers 51.8 46.9 52.2 44.4 42.6 The percentage of parental attendances fluctuate from year to year, but maintain a high level. The decreasing parental interest with increasing age is a factor met with in medical inspection in all areas. 14. CO-OPERATION OF TEACHERS. Renewed acknowledgment must be made of the excellent cooperation received from Head Teachers. Preparation for medical inspection entails considerable extra work, and with very rare exceptions the keenest interest is taken in the findings and most generous help in "following up." The personal influence of the Head Teacher with the parent often secures the help of the still too frequent ignorant parent. Unfortunately, many schools still exist with no separate medical inspection room, and in these cases Head Teachers are generous in allowing the use of their own rooms. Provision of medical inspection rooms should invariably be made in the design of any new schools to be erected. 15. CO-OPERATION OF SCHOOL ATTENDANCE OFFICERS. The Attendance and School Medical Departments are housed under the same roof, and the closest co-operation has been received from Mr. Longman, the Superintendent Attendance Officer and his staff. His unrivalled personal knowledge of every certifiable defective child in the Borough and his sympathetic relations with the parents has been of inestimable value. The Attendance Department has also co-operated fully in the following ways—provision of convalescent home treatment and of milk on medical grounds; collection of fees for spectacles and for orthopaedic treatment and 35 in the control of Smallpox, notably at Gamuel Road Boys' School, where an outbreak was limited to 3 cases very largely through the co-operation of the School Attendance Officer concerned — Mr. Springbett. 16. CO-OPERATION OF VOLUNTARY BODIES. Excellent co-operation has been experienced with various voluntary bodies. (a) The Invalid Children's Aid Association, through its Secretary, Miss D. Lewis, has given unstinting help, notably in respect of arrangements for Convalescent Home Treatment at St. Catherine's Home, Ventnor, and of after-care visiting in connection with scholars attending the Physically Defective School and Brookfield Hospital. Miss Lewis has kindly contributed the following statistics relating to the work of the Walthamstow Branch during 1920:— Table of Cases, 1930. Referred by— Medical Men, Hospitals, Dispensaries 197 Tuberculosis Dispensaries 30 School Officials 60 I.C.A.A 4 C.O.S. and other Voluntary Bodies 9 Naval and Military Agencies 3 Public Assistance Committee 1 Parents 11 Others 5 Total 320 Defects— Tuberculosis—Glands 1, Joints 3 4 Anaemia and Debility 69 After-effects of Illness 11 Marasmus and Malnutrition 3 Disease of Glands, non-tubercular 5 Pneumonia, Bronchitis, Asthma, etc. 40 Bones, non-tubercular 48 Congenital Deformities 17 Paralysis 23 Injuries 3 Rheumatism, Chorea, Heart 42 Carried forward 265 36 Defects—continued. Brought forward 265 Diseases of Nervous System 9 Mental Deficiency 4 Hernia 5 Diseases of the Eyes 5 ,, ,, Nose and Throat 2 ,, ,, Ears 7 ,, ,, Digestive Organs 3 Various 20 Total 320 Help Given to Old and New Cases, 1930. Old. New. Total Sent to Special Hospitals and Convalescent Homes 47 146 193 Extensions from previous years 51 — 51 Provided with Surgical Boots and Appliances 32 47 79 Provided with Carriages — 1 1 Provided with Massage and Exercises 1 4 5 Provided with Clothing — 2 2 Referred for Visiting and Advice 3 104 107 Referred by I.C.A.A. to other Agencies 3 30 33 Referred by I.C.A.A. to Guardians 2 4 6 Totals 139 338 477 (b) Inspector Francis of the South-West Essex Branch of the N.S.P.C.C. contributes the following statistics and notes relating to the work done during 1930:— No. of Cases. Nature of Offence, etc. How dealt with. 25 Neglect 21 Warned and advised 22 Advice sought 3 Prosecuted 3 Various 1 "Supervision visits totalled 138, involving 32 boys and 35 girls, and 21 pre-school children. Cases were referred, where necessary, to the various Clinics and 1 child is improving after treatment at Brook field Hospital. A large increase in the number of "nervous" cases was noted, many being due to parents and guardians leaving children unattended at night. The Society has had to prosecute in three cases, the parents being convicted with loss of the custody of the children, who are now doing well in other homes." 37 (c) Central Boot Fund Committee.— The Honorary Secretary, Mr. A.J. Blackhall, has very kindly sent the following account of the work of the Boot Fund during 1930:— "The fund was inaugurated in 1911, when 170 pairs of boots were distributed for the year. Since this period the demands on the Fund have increased to such an extent that during the past seven years, from 1924, when the Fund was revived after the Great War, 4,888 pairs of boots have been distributed at a cost of £1,962 7s. 5d., averaging roughly a distribution of 666 pairs of boots each year at a cost of £280 6s. 9d. The number of pairs of boots distributed during 1930 was 635, at a cost of £253 Is. 8d. The fund derives its income from proceeds of Concerts. Dramatic Performances, Donations etc., and the boots are supplied under contract with local firms. The aim of the fund is to provide boots for all necessitous school children, thus relieving the anxiety of many parents where prolonged periods of unemployment have made it impossible to get boots for their children, and, at the same time, enabling scholars to attend school who would otherwise be unable to do so if the fund had not existed. "The Committee is composed of members appointed by the Walthamstow Education Committee with additional representatives from local organisations in the Town. "Every precaution is taken in seeing that only the most deserving applicants receive assistance, each case being investigated by the Attendance Officer for the District. Forms are filled in for each application, which are placed before the various Attendance Committees appointed by the Walthamstow Education Committee. These forms are kept for future reference." (d) The Honorary Secretary for the Mental Welfare and After-Care Committee, Mr. L. A. Bristow, has kindly supplied the following report of his Committee's work during 1930:— "This Committee is a voluntary organisation and its chief work is to keep in friendly touch with scholars when they leave the Shernhall Street Special School, and to give them any help and advice that may be needed. An annual re-union Social is organised to further our efforts in this direction. We also work in close cooperation with the Essex Voluntary Association, and carry out on their behalf the visiting of Defective Children who have been placed under Statutory Supervision. "Many of the cases on our visiting list are urgently in need of Institutional care, and have been for some years. There is a great lack of institutional accommodation and we have made special efforts on behalf of these cases, some of whom are a danger to themselves and others." 38 (e) The following information has been extracted from the Annual Report of the Walthamstow Association of Tuberculosis Care Helpers. The Association made the following grants in respect of children:- Nourishment, 8; Christmas Grants, 15; Cases sent to Convalescent Home (Myson's Farm. Epping Green), 20. In cooperation with the Education Committee, 46 cases of Physically Defective Children were sent to St. Catherine's Home, Ventnor. (f) Co-operation with Brook field Orthopaedic Hospital and with the Walthamstow Dispensary in respect of treatment for Tonsils and Adenoids is acknowledged elsewhere. (g) Miss Turner, Secretary of the Essex Voluntary Association for Mental Welfare, sends the following report on the work of the Occupation Centre provided by that Association:— ''Essex Voluntary Association for Mental Welfare. Occupation Centres for children unfit for the Shernhall Special School (roughly, those whose intelligence quotient is below 50). and those over school age who are unable to take their place as independent citizens, or face the problems of life unaided, are held by the Essex Voluntary Association at the Settlement, Greenleaf Road, Walthamstow, by kind permission of Mr. Le Mare. "This work is made possible by a grant to the Association from the Essex County Council. "The classes are held daily, except on Saturdays, as follows:— Mornings: For children of both sexes, and Elder Girls; in charge, Mrs. Louis. Afternoons: For Elder Boys; in charge, Miss Carter. "Occupation Centre training aims at overcoming anti-social tendencies and making the child fit more happily into his home, and all that this implies. Progress in reading and writing are no longer the criteria by which the child's progress is judged. Some of the pupils certainly do learn to read, but the written and spoken word is no longer the media of instruction; progress is made by children who have not yet mastered the art of speech. "At the Morning Centre there is class work in drill, dancing, singing, speech training and rhythmic work, with individual handwork in raffias and wools for the older girls and apparatus work and sense-training for the younger children. Lunch time, when the children take cocoa prepared by the elder girls, gives an opportunity for the learning of table manners, and with this self-restraint and self-control, very hard lessons to master. "In nearly all cases parents willingly co-operate with the Supervisor by continuing at home the training given in Centre hours. In this they are helped by the Voluntary Association who, through 39 local voluntary workers, keep in touch with the family, ready to make suggestions when behaviour difficulties arise. It does sometimes happen, however, that when a child is first excluded from the Special School, the parents are unwilling at first to acknowledge that only his welfare is being considered; they fail to understand that he will progress further, and be happier, if taught with those of his own level of intelligence than with those to whose attainments he cannot aspire. At the Centre the Supervisor's greatest difficulty is with children who have become most imbued with their inferiority, whether in their homes or at school matters not; they are the 'solitary' children who sometimes appear to be unfriendly, and who fail for a long time to respond to any stimulus. "The Elder Boys' Handicraft Class, held in the afternoons, does not savour so strongly of 'school.' The youths come 'to work' and each boy receives 50 per cent, of the profits on articles of his own making, the other 50 per cent, going towards the cost of spoiled materials. Pay day is once a month. The chief occupations at present are woodwork, brush-making, cane-basketry and chaircaning, as well as manilla rope hearth brushes and rush sink mats. Goods are made now only to order. "The Boys' Class meets a very real need; these big lads are not only definitely unhappy if unoccupied, but they tend rapidly to deteriorate, whereas if kept usefully occupied they are happy, use up some at all events of their superfluous energy, and are more controllable. "At each Centre the Supervisor will gladly welcome visitors." 17. BLIND, DEAF, DEFECTIVE AND EPILEPTIC CHILDREN. (a) The ascertainment of children defective within the meaning of Part V of the Education Act, 1921, under the above headings is as near perfection as is possible, owing to the periodical scheduling which the Attendance Department carry out over the whole Borough. In this way defective children are known long before attaining school age, and are dealt with appropriately after examination by the Medical Staff. (b) The arrangements made for the supervision of mentally defective children in Special Schools include the provision of an Occupation Centre by the Essex Voluntary Association for Mental Welfare as already detailed under Section 16 (g). (c) General Review of work of Special Schools:— (i) Blind School.—Your Committee provide a Blind School at Wood Street with accommodation for 85 children of both sexes. The 40 following Table shows the classification of children attending the School at the end of 1930:— "Blind within the Act." "Partially Blind." Walthamstow. Other Authorities. Walthamstow. Other Authorities. Boys 4 1 28 6 Girls 6 4 21 7 Total 10 5 40 13 The After-Care of the children comes under the purview of the After-Care Committee and the Walthamstow Committee for the Care of the Blind. The work done at the School is detailed in previous Annual Reports and in the following interesting report of the Consultant Ophthalmic Surgeon, Mr. H. J. Taggart, F.R.C.S.:— "During the past year I visited Walthamstow on six occasions. I examined all the children attending the Special School and saw 14 others who were referred to me by Dr. Sheppard. Three children requiring operative treatment were admitted to the Western Ophthalmic Hospital under my care. "The following is a tabular statement of the defects for which 82 children were attending the Myope School:— Boys. Girls. Anophthalmia L. Central Nebula R 1 — ,, ,, Cataract and Myopia R 1 1 ,, ,, Glioma 1 — Nystagmus with Hypermetropic Astigmatism 1 — ,, ,, Macular Haemorrhages 1 1 Myopia 1 — ,, ,, Corneal Scarring 1 — ., ,, Vitreous Opacities 1 — ,, ,, Undeveloped Maculae — 1 ,, ,, Pigmentary Changes at Maculae 1 - ,, ,, Alternating Squint — 1 ,, ,, Polar Cataract L. and Leucoma R. - 1 Cataract L., High Myopia R 1 — Double Congenital Cataracts 4 4 Leucoma with Irregular Astigmatism 1 — Carried forward 15 9 41  Boys. Girls Brought forward 15 i 1 Leucoma due to Ophthalmia — 1 Albino with Myopic Astigmatism — 2 Dislocation of Both Lenses — 1 Interstitial Keratitis 1 4 Choroidal Coloboma 1 — Double Coloboma Iris and Choroid — 1 Coloboma R. and Pupil filled with Calcareous Deposit 1 - Optic Atrophy 1 - Injury to Optic Centres - 1 Hypermetropic Astigmatism 2 2 Myopic Astigmatism 15 8 Myopia 7 10 Totals 43 39 '"It will readily be realised that many difficulties are experienced in arranging such diverse material in suitable classes so as to enable them to acquire an all-round education, the aim of the work being to give the maximum amount of instruction with the minimum use of sight. For this, special apparatus has been devised and suitable arrangements as to light, movement, and position of desks are made. "The children are divided into two groups— 'The Partiallysighted' and those 'Blind within the meaning of the Act.' The former use their eyes for their work, reading and writing a very large type. Selected passages for reading are printed on large sheets of black paper by the teacher and then the boys copy these lessons, printing them with large rubber type. In this way a great number of books are accumulating. After a course in typewriting, the Senior Class is able to type their compositions, but the Junior Classes write on blackboards or large sheets of paper. The latter group of children, 15 in number, is taught the 'Braille System' for reading and writing and use 'The Taylor Frame' for arithmetic. "As ordinary books are not permitted, the Teacher reads aloud to the children for about half an hour each day and the important news is read each week. The instruction given follows very much the same lines as that given in the ordinary School, whilst in addition a variety of manual work is taught. "In order that the younger children may come into closer contact with the normal child, the juniors attend the adjacent Elementary School for History, Geography and Nature Study. The Seniors take all their studies at the Myope Centre. 42 "The manual work consists of hand and machine knitting and cardboard modelling for the girls; printing, bookbinding and brush work for the boys; whilst all the children do raffia work, clay modelling and gardening. In addition, the 'Braille' children learn chair-caning and rushing, staining, polishing and caneweaving. "Since many of the children are suffering from high and progressive Myopia, the physical training is suitably adapted by using smooth, gentle exercises from the Board of Education Syllabus, and suitable dances. "Of those removed from the Register during the year, one boy left the district, one went for further training and the other two have had only casual employment. The girls are all in suitable work. "From the above it will be obvious that to make a success of such a school, it is not sufficient to have teachers who possess special certificates; they must also possess that more important qualification —a sympathetic and intelligent interest in each individual child. I can say, without hesitation, that Miss Balls and her staff are ideal teachers, guides and friends to the children under their care. (ii) Deaf Centre.— The following report on the work of the Centre during 1930 has been contributed by Mrs. Smith, the Head Teacher:— "This Centre has a capacity for 20 children and is situated adjacent to the William Morris Schools. On the roll on 31st December, 1930, were 21 children—Congenitally Deaf, Boys 7 and Girls 5; Semi-Deaf, Boys 2 and Girls 3; Aphasic, Boys 3 and Girls 1. "One boy comes from the Leyton area, and one from the Chingford area. "During the year one girl has left school and is employed in a toy factory. "The scholars are taught on the oral method, i.e., speech and language by means of lip reading. The older children also learn the ordinary elementary school subjects. In addition a good variety of handwork is done by the children, who show great talent for this subject. The girls also learn needlework, machining and knitting, laundry and cooking; the boys boot-repairing and carpentry. 43 "At the Annual Prize-giving, an Entertainment was given by the whole School, and great merit was accorded to the speech and to the dancing of the children." (iii) Physically Defective School.— Your Committee provide a Physically Defective School with accommodation for 80 pupils of both sexes. The School is under the Orthopaedic charge of Mr. B. Whitchurch Howell, F.R.C.S., Consulting Orthopaedic Surgeon to your Committee, who holds a monthly Clinic assisted by two part-time Masseuses. The remaining staff consists of a Head Teacher, two Assistant Teachers, one Art Mistress, a Craft Master, and the Ambulances are staffed by a Nurse and two Ambulance drivers. In addition there is a Cook and a female Attendant. The School is provided with a well-equipped Orthopaedic and Massage room in which daily Massage Clinics are held. I am indebted to Miss Scott, C.S.M.M.G., for the following summaries of defects for which children were admitted, and of the Clinic attendances during 1930:— Defects. Boys. Girls. Anterior Poliomyelitis 15 12 Rickets 4 1 Congenital Dislocation of Hip — 1 Achondroplasia 1 — Tubercular Joints 10 4 Talipes 11 11 Erbs Paralysis 1 1 Torticollis — 1 Genu Valgum and Varum 3 — Visceroptosis 1 — Congenital Defects 2 5 Spastic Paralysis 7 6 Scoliosis, Kyphosis, Lordosis 7 5 Arthritis, Polyarthritis 1 4 Fractures 1 — Perthe's Disease 1 — Spina Bifida 1 — Osteomyelitis 2 — Heart Disease 22 8 Pseudo Hypertrophic Paralysis 1 — Number of cases seen by Surgeon— Children under School age 102 School children 358 Total 460 44 Number of Attendances for Orthopaedic and Massage Treatments (including children of all ages) 2189 Number of Sessions held— Medical Inspections 10 For Treatment 195 Miss Scott has also kindly supplied the following particulars of admissions to, and operations at, Brookfield Hospital under your Committee's Orthopaedic Scheme:— Admissions:— Under 5 years of age 12 Five years and over 9 Already in Hospital on 1st January, 1930 " 12 Classification. Under 5 years. 5 years 6 over. Spastic Paralysis — 2 Talipes 2 1 Genu Valgum and Varum 4 1 Rickets 7 — Anterior Poliomyelitis — 2 Torticollis — 1 Scoliosis — 1 Congenital Deformities 1 1 ,, Dislocation of Hip 2 — Arthritis 1 3 Fractures — 1 Old Tubercular Hip — 1 Osteomyelitis — 1 Adhesions of Spine — 1 Operations—Number and Classification of:— Under 5 years. 5 years 6 over. Osteoclasis 5 — Removal Bony Block (olecranon) - 1 Reduction Congenital Dislocation— 1st position 2 — 2nd position 4 — 3rd position 1 — Manipulations 5 3 Open Elongation of T.A. - 4 Tenotomies 2 — Abscesses (aspirated) Whitman's Astragalectomy 4 — - 1 Steindler' a Operation (foot) - 2 Open Division Sterno Mastoid — 1 Arthrodesis Tarsal, Metatarsal Joint — 1 Osteotomies 6 1 Amputation Digits 1 — 45 Plaster of Paris— Plaster Jackets 1 ,, Beds 2 ,, Spicas 7 ,, Splints (various) 28 Dental Treatments 10 Miss Thompson has kindly supplied the following report for 1930:— ''At the beginning of 1930 there were 68 Scholars on the roll; at the end of the year there were 65. During that time 37 children were admitted, but 40 left. Of these 40, 3 boys and 3 girls left to go to work. One boy went on to the Technical College, and 1 boy went to Clarke's College. The great majority of the children therefore left the Physically Defective School to return to the ordinary Elementary Schools as normal children. Four who went to Brookfield Hospital have returned or will return shortly. "The School at present has approximately 60 per cent. of boys and only 40 per cent. of girls, and the new admissions were mostly young children. Heart cases are increasing; Orthopaedic cases form a smaller portion of the School than formerly. "In January, 1930, the old scholars met at the School for a Dinner. About 24 were present and the Mayoress, Alderman Mrs. McEntee, was chief guest. In September, 1930, the Walthamstow Rotary Club gave the children a great treat again. The destination this time was Hampton Court and though the weather was unkind, it made not the least difference to the children's enjoyment. The private cars were appreciated most of all. The Girls' Department of the Joseph Barrett School came to the Centre one morning in May and gave a performance of the Crowning of the May Queen. This was watched most eagerly by the crippled children and letters expressing their gratitude were sent to Miss Lovejoy, the Head Mistress. Other kind friends of the Cripple School are Mr. and Mrs. Evans, who give sweets every Christmas for each child. The usual Christmas party was held and games carried on to a later hour than formerly. "A beautiful picture entitled 'The Workshop in Nazareth,' was presented to the School by Mr. Gillman in memory of Miss Dora Gillman, a Masseuse on the Staff of the Centre, who passed away after a brief illness in June, 1930. "In addition to the ordinary School curriculum, Art is being taught by Miss Longman, and Upholstery by Mr. Deacon. The girls' needlework still maintains its high standard under Miss Wakefield's guidance. Girls leaving School find their skill in Needlework a great asset. 46 "Thanks are due also to the After-Care Committee for their invaluable assistance with difficult cases." The After-Care Committee does valuable work in supervising the welfare of children after leaving School. The following examples are extracted from your Committee's Minutes:— "Situation not yet found. Juvenile Employment Officer is keeping in touch with this boy." ' 'Two boys are making satisfactory progress as Apprentices to the Tailoring Trade." "Endeavours are being made to acquire a piece of ground for a workshop for this boy, who is making good progress repairing Surgical Boots at home. He is now doing his work in the shop of a friend at Leyton, as he was asked to discontinue work at home on account of complaints from neighbours." ''This boy is at present engaged at home stringing Toy Tennis Bats for Messrs. ''That this girl had applied for a situation at a Leather Factory, her lessons in Art at School proving a strong recommendation." (iv) Mentally Defective School.—During 1930, 55 children were examined by your Committee's Certifying Officers for alleged Mental Deficiency with the following results:— Number. Classification. Recommendations. 2 Normal To remain at present School. 2 Not Mentally Deficient 4 Dull and Backward 4 Much improved 17 For re-examination 2 in 3 months; 11 in 6 months; and 4 in 12 months. 1 Border line M.D. To remain at Physically Defective Centre at present. 16 Mentally Defective 13 to go to Mentally Defective School and 3 various other recommendations. 1 Ditto, and other defects Residential School for Multiple Defects. 4 Imbeciles Notified to Essex County Council. 4 Idiots Your Committee's Special School has accommodation for 130 mixed children. A mid-day meal is served and an After-Care Committee is in existence. 47 Miss Purcell, the Head Mistress, has contributed the following notes on the work during 1930:— "Average number of Scholars:—Boys, 45; Girls, 22; Total, 67. ''During the year 11 children left (9 boys and 2 girls), as follows:— To Occupation Centre 2 To Institutions 3 Awaiting Institutional Treatment 1 Greengrocer's Assistant 1 Cabinet-making 1 Milk Roundsman 1 Page Boy 1 Laundrywork 1 "The School is divided into two parts (a) The Nursery Class entirely separate from (6) The Educables, Upper and Lower Schools. "The curriculum follows that of a 'free' school, i.e., the Timetable is approximate and no academic results are aimed at. The reward of a teacher's work is the conscious development of each child's personality and mentality which is not measurable according to examination standards. The tuition is entirely individual: each child taking its own time to develop. "Boys and Girls learn cookery and housewifery. Unfortunately, owing to re-organisation, laundry work had to be discontinued. Other general subjects such as leather stitching, loom, and rug making, knitting, simple dances and games are taken by both sexes. "The girls are learning machine stocking making besides sewing machine work and ordinary knitting. "The boys take gardening, boot repairing, woodwork, brushmaking and simple upholstery. While useful work has been done by individuals, much time has been spent repairing and making apparatus for the classes. "Where necessary, children are bathed every week or oftener as occasion demands. Older boys and girls can, and do, enjoy a hot bath whenever they wish. An attendant supervises the bathroom and is responsible for behaviour in the dining-room and on the home journey by road and car. "Last April, 14 boys and 10 girls in charge of the Head Teacher and the Attendant, went to Ryde, where a delightful fortnight was enjoyed by everyone. Nearly all the beauty spots and places of historic interest were visited as well as a factory where aero and hydro-planes were assembled. Many miles were walked daily, but the greatest charm of all was found in the woods. Increase in weight was accompanied by improved health and awakening mentality. All were loth to come back from Nature's School to that of bricks and mortar. Though few expressed their gratitude to the Committee the parents really felt grateful for the outlay of £65 which had been made. 48 "Ti.e health of the children is carefully and sympathetically attended to by the Medical Staff at the Park. The provision of glasses is so often followed by rapid mental awakening that eye treatment becomes an important part of the school life. "Although at present the After-Care Committee can do little more than follow up, with friendly interest, scholars who have left it meets periodically in readiness to carry out any suggestion which may benefit even one child. "The After-Care Committee provided both refreshments and entertainment for old scholars and parents early after Easter, 1930, and the packed hall (kindly lent by the Church Hill Road City Mission) testified to the excellence of the arrangements and the appreciation of all present. "A Parents' Evening was held in January of this year for the first time and was well attended. The Upper School gave a play, 'The Pied Piper of Hamelin," with amusing additions by the scholars themselves. At the next it is proposed to introduce the After-Care visitors to the parents in order to foster a greater spirit of mutual friendliness and helpfulness. "This report could not close without a word of appreciation of the happy spirit existing between every member of the staff, as well as of the scholars. The School motto is "Happiness—Usefulness," and is the aim of all who are in any way connected with Shernhall Street Special Schools." (v) Stammering Classes.—The Stammering Classes were continued on Monday and Thursday afternoons at Marsh Street School under the charge of Mr. Bradfield The results are summarised as follows:— Left. Remaining . Nearly Cured. Good Progress. Nearly Cured. Good Progress. Unsatisfactory . Boys (22) 3 3 1 12 3 Girls (5) 1 1 — 3 — (vi) Convalescent Home Treatment, etc.—120 children were sent away for Convalescent Home Treatment, etc., during 1930, in addition to 34 children remaining in Homes at the end of 1929. Of these, 3 were in Epileptic Colonies and 3 in Institutions for the Blind. The following were the Homes utilised, the numbers of children recommended being indicated:—Westgate, 32; Ventnor, 31; Godalming, 14; St. John's, Kemp Town, 6; West Wickham, 5; 49 Seaford, 5; Edgar Lee Home, 4; Hawkenbury, 4; Cleveland, 4; Coldash, 3; Hayling Island, 3; Maidenhead, 2; Northcourt Hospital, 2; Kearsney, 2; Brookland, 1; Sternthwaite, 1; Dover, 1. The conditions for which children were sent included the following:—Debility, 59; Heart Disease, 9; Rheumatism, 8; Bronchitis, 7; Anaemia, 7; Asthma, 5; Chorea, 4; Pneumonia, 4; Malnutrition, 3; Fibrosis, 2; Adenitis, 2; Otorrhoea, 2; and 1 each of the following—Alopecia, Abscess, Nephritis, Suspected Tuberculosis, Paralysis, post-Encephalitis, Epilepsy and Blepharitis. In addition, 29 new cases were sent away in conjunction with the Walthamstow Association of Tuberculosis Care Helpers, in addition to 10 cases remaining over from 1929. A total of 17 new cases were admitted to Brookfield Hospital, in addition to 11 cases remaining over from 1929. Thus a grand total of 166 children were sent to Homes and Institutions by your Committee during 1930, in addition to the 55 cases remaining over from 1929. It will be realised what an enormous amount of work this has entailed for Mr. Longman and his assistant colleagues, and for the local branch of the Invalid Children's Aid Association. 18. NURSERY SCHOOL. Your Committee provide one Nursery School at Low Hall Lane with accommodation for 150 children. The buildings form three sides of a square with full access to fresh air and sunshine, and are constructed of timber framing (lined with asbestos sheeting) on concrete foundation. The cost (excluding site) was £3,725. representing £24 17s. Od. per place. The cost of equipment totalled £641, and included the following items:—Tables and Chairs, £290: Kitchen, £144; Educational Apparatus and Toys, £117; Cupboards, £64: and Staff Room Furniture, £26. The amusements include a "Jungle Gym," Sandpit, Slides and Swings. Pets are also kept. The following is a summary of the daily procedure drawn up by your Director of Education :— 8.30 to 9.30 Arrival of children. Examination of children by the School Nurse. Overalls. Hygiene (cleaning of teeth, drinks of water, handkerchief practice, baths). Attention to flowers and pets. Care of schoolroom, dusting of tables, chairs, etc. Setting of tables for mid-morning lunch. Free play. 50 9.30 to 10 Informal opening; very simple hymn and prayer. Morning conversation. Registration. Musical appreciation. Songs (Nursery Rhymes). Singing games. Simple rhymes, dramatisation or physical exercises and games. (Toddlers have part of this period separate from the older children.) 10 to 10.20 Hygiene. Visits to lavatory. Washing hands. Preparation for mid-morning lunch. (Children pour out milk and hand mugs round.) 10.20 to 10.40 Mid-morning lunch. 10.40 to 11 Group work:—(i) Clearing away tables and chairs, washing mugs, sweeping, dusting, (ii) Children not engaged in "housework period" have play on outdoor apparatus, sand and toys. 11 to 11.30 Occupations (varied) or Gardening. Nature or Story, with handwork or dramatisation, or conversation from picture books, or musical appreciation (including simple rhythm, band and singing games). 11.30 to 12 Preparation of beds (each teacher is responsible for her own set of beds, children assisting). Children not helping have free play. Hygiene, visits to lavatory, washing of hands and face, tidying hair, bibs. Picture books. Preparation of tables for dinner by the children. 12 to 12.50 Dinner. Certain children chosen to serve and hand out the dinners. 12.50 to 1.45 Romp in garden. Drinks of water. Hygiene— visits to lavatory, washing, cleaning teeth, removal of overalls and shoes. Rest period: 1.30 to 3.15. Some baths given as children wake up. 3.15 to 4.15 Children help to fold and put away blankets, pillows and beds. Putting on of shoes. Hygiene. Drink of warm milk. Games or free play (in the open, weather permitting) or stories. Occupations (determined by the mood of the children), or Music (songs or band). N.B.—A time-table as such has no place in the Nursery School, but some plan of procedure is essential. This is elastic, except for mealtimes and sleep. The mid-day meal menus consist of meat, fish, egg or soup with two vegetables and pudding (milk or steamed) or fruit. 51 Parents pay Is. 8d. per week towards meals, unless assisted. Children are brought to School and taken away by relatives, and one "open" day per month is held. In addition to the daily attendance of a School Nurse, all children are examined on admission by a Medical Officer who also sees delicate children at frequent intervals, and who orders Cod Liver Oil and Malt when necessary. In addition a Medical Officer attends at the adjoining School Clinic on three morning sessions and at the Welfare Clinic (held in the adjoining premises) on three afternoon Sessions, thus affording ample facilities for dealing with medical emergencies. The staff consists of a Head Teacher, 1 Certificated Assistant, 1 Uncertificated Assistant, and 4 Junior Assistants; 6 girls from Senior Girls' Departments are detailed for instruction every three weeks and attend continuously for this period. A notable feature during the year has been the repeated visits paid by Deputations from other Authorities. A visit was also paid by members of the Women Public Health Officers' Association, and by representatives of a large number of Authorities who attended the Nursery School Conference in London last October. The following table gives the approximate expenditure for the year ending 31st March, 1931, and has been kindly supplied by Mr.Burnell: £ Teachers' Salaries 906 Teachers' Superannuation (Authority's Contribution) 33 Salaries and Wages, Domestic Staff 499 Fuel, Light and Cleaning 115 Apparatus, Stationery, etc. 100 Cost of Meals 526 Loan Repayment 309 Rates 61 Equipment, etc. 63 Insurance Acts Contributions 16 Repairs, etc. 218 Laundry 87 Total 2,933 Parents' Payments for Meals 191 Net Cost £2,742 19. SECONDARY SCHOOLS. The Authority for the provision of Secondary Schools in your Borough is the Essex County Council. 52 20. CONTINUATION SCHOOLS. There are no Continuation Schools in the Area. 21. EMPLOYMENT OF CHILDREN AND YOUNG PERSONS. (i) and (ii) The conditions of employment of children and young persons in the Area and the work of the Juvenile Employment Bureau is very fully set out in the appended report by Mr. R. Dempsey, the Juvenile Employment Officer: "The year commenced with a very favourable outlook and it was hoped that before the close the troubles of unemployment would have reached their peak position and show a decided improvement in industrial progress. This was not to be. By the middle of the year it was evident that matters were becoming much worse and the staff of the Bureau were overwhelmed with young people from 14 to 18 years of age who were being discharged from their employment. Fewer vacancies were being notified by employers as the year proceeded, so that by the time Christmas arrived the Bureau found itself in the position of having on its registers large numbers who had not been employed since the middle of the year, as well as an unusually large number of children who had left school in July, and had not yet obtained any employment. A special feature was the great increase of boys and girls who had come from the Secondary and Technical Schools, including many who had obtained Matriculation and other Certificates which would normally secure for their holders immediate employment. "In view of the large numbers of juveniles who were unemployed in this area, the Juvenile Employment Committee have organised 'Junior Instruction Centres at the Bureau, at which boys and girls receiving Unemployment Benefit are obliged to attend in order to receive benefit. They attend in morning and afternoon sections for three hours each day. "The syllabus includes the following subjects:— Girls.—General Knowledge, Reading, Home Nursing, Firstaid and Hygiene, Needlework, English, Letter-writing, Singing, Organised Games and Housewifery. Boys.—Organised Games, Current Topics, Literature, Practical Arithmetic, Geography, History, Letter-writing, English, Woodwork and Metalwork, Debating, General Science, Shorthand, Brushmaking and Boot Repairing. 53 ''The registrations at the Bureau during the year were as follows:— Fresh applications— Boys. Girls. Insured (over 16 years) 504 445 Not Insured (under 16 years) 535 713 Re-registrations— Insured 538 304 Not Insured 419 541 Total 1996 2003 "Employment was obtained for 1,338 boys and girls. "An important development of the work of After-Care has taken place during the year. The Juvenile Employment Committee, with the co-operation of the Juvenile Organisations Committee, has started an evening club at the Bureau known as the Young People's Institute or Welfare Club. To this club the Juvenile Employment Officer invites those boys and girls who have left school and who, owing to family circumstances, health or physical defect, would not be able to join any other club for boys and girls. This has been a great success. About 60 boys and 40 girls have attended very regularly on two evenings each week (two for boys and two for girls). A Billiards Table has been provided by a generous townsman who also gave some valuable oil paintings to the club. "The Welfare Committee which controls the club from funds received from voluntary sources, provide various games—ping-pong, chess, draughts, darts, bagatelle, and sundry books and papers of interest to young people. "The supervision is in the hands of the Juvenile Employment Officer who has obtained valuable assistance from a number of young men and women who are keenly interested in the welfare of boys and girls, and who have given their spare time very generously to this work. The first year of the club has been somewhat experimental, but it is anticipated that it will develop into a very valuable system for supervising and guiding those difficult boys and girls who, having left school, are often in a hopeless position on account of their surroundings, their health or other reasons." (iii.) Employment of Children (Street Trading Byelaws).—Two hundred children were examined by the Medical Staff under the Employment of Children Byelaws, and all were passed as fit for employment chiefly in milk and newspaper delivery. Alterations of these Bye-laws in the direction of raising the minimum age for employment to 13 years and of prohibiting employment of children during the early mornings when schools are in session have been approved by the Education Committee and confirmed by the Borough Council. 54 22. SPECIAL INQUIRIES. NIL. 23. MISCELLANEOUS. The following examinations were made during 1930 by the Medical Staff:— New appointments 58 Prolonged sickness 22 24. STATISTICAL TABLES. The Statistical Tables required by the Board of Education follow:— TABLE I. Return of Medical Inspections. A.—Routine Medical Inspections. Number of Code Group Inspections. Number of other Routine Inspections. Entrants. Intermediates. Leavers. Total. 2547 1905 1631 6083 345 B.—Other Inspections. Number of Special Inspections. Number of Re-Inspections. Total. 4078 12499 16577 TABLE II. Return of defects found in course of Medical Inspection in 1930. Defect or Disease. Routine Inspections. Special Inspections. Number of Defects. Number of Defects. Requiring Treatment. Requiring to be kept under observation but not requiring Treatment. Requiring Treatment. Requiring to be kept under observation but not requiring Treatment. 1 2 3 4 5 Malnutrition .. 4 — 158 — Uncleanliness (See Table IV., Group V.) — — — — Skin. Ringworm, Soalp — — 25 — ,, Body 2 — 54 — Scabies — — 30 — Impetigo 23 — 533 — Other Diseases (Non-Tuberoulous) 7 1 236 — Eye. Blepharitis 28 1 83 — Conjunctivitis 10 — 73 — Keratitis — — 1 — Corneal Opacities — — — — Defective Vision (excluding Squint) 263 7 290 4 Squint 45 4 9 — Other Conditions 3 — 80 — Ear. Defective Hearing 39 — 22 — Otitis Media 24 1 119 — Other Ear Diseases 5 — 75 — Nose and Throat. Enlarged Tonsils only 03 161 2 9 Adenoids only — 3 4 1 Enlarged Tonsils and Adenoids 195 85 140 6 Other Conditions 4 1 450 — Enlarged Cervical Glands (Non-Tuberculous) 6 96 28 — Defective Speech 16 5 10 — Teeth—Dental Diseases (See Table IV., Group IV.) 1801 — — — Heart and Circulation. Heart Disease, Organic 34 4 17 1 ,, Functional 84 46 7 2 Anaemia 29 5 21 — Lungs. Bronchitis 123 21 7 — Other Non-Tuberculous Diseases — — — — Tuberculosis. Pulmonary, Definite — 1 — — ,, Suspected 1 1 — — Non-Pulmonary Glands 2 — 2 — ,, Spine — — — — Hip — — — Other Bones & Joints — — — — Skin — — — — ,, Other Forms — — — — Nervous System. Epilepsy 1 3 2 — Chorea — — 10 4 Other Conditions — — 4 — Deformities. Rickets — 1 — — Spinal Curvature 3 — — — Other Forms 7 1 1 — Other Defects and Diseases 108 11 676 — Number of Individual Children having Defects which required Treatment (Excluding Uncleanliness and Dental Diseases.) Group. Number of Children. Percentage of Children found to require Treatment. Inspected. Found to require Treatment. 1 2 3 4 Code Groups:— Entrants 2547 200 7.8 Intermediates 1905 271 14.2 Leavers 1631 235 14.4 Total (Code Groups) 6083 706 11.6 Other Routine Inspections 345 47 13.6 55 TABLE III. Return of all Exceptional Children in the Area. Boys. Girls. Totals. Blind (including partially blind). (i) Suitable for training in a School or Class for the totally blind. Attending Certified Schools or Classes for the Blind 4 0 10 Attending Public Elementary Schools — — — At other Institutions 2 2 4 At no School or Institution — — — (ii.) Suitable for training in a School or Class for the partially blind. Attending Certified Schools or Classes for the Blind 28 21 49 Attending Public Elementary Schools — — — At other Institutions — — — At no School or Institution — — — Deaf (including deaf and dumb and partially deaf). (i.) Suitable for training in a School or Class for the totally deaf or deaf and dumb. Attending Certified Schools or Classes for the Deaf 7 5 12 Attending Public Elementary Schools — — — At other Institutions — — — At no School or Institution — — — (ii,) Suitable for training in a School or Class for the partially deaf Attending Certified Schools or Classes for the Deaf 5 4 9 Attending Public Elementary Schools — — — At other Institutions — — — At no School or Institution — — — Mentally Defective. Feebleminded (cases not notifiable to the Local ControlAuthority) Attending Certified Schools for Mentally Defective Children 38 22 60 Attending Public Elementary Schools — — — At other Institutions 3 — 3 At no School or Institution 6 6 12 Notified to the Local Control Authority during the year, Feebleminded 1 — 1 Imbeciles 3 4 7 Idiots 1 2 3 56 Boys. Girls. Totals. Epileptics. Suffering from severe epilepsy. Attending Certified Special Schools for Epileptics — — — In Institutions other than Certified Special Schools 2 — 2 Attending Public Elementary Schools — — — At no School or Institution — 1 1 Suffering from epilepsy which is not severe. Attending Public Elementary Schools — — — At no School or Institution — — — Physically Defective Infectious pulmonary and glandular tuberculosis. At Sanatoria or Sanatorium Schools approved by the Ministry of Health or the Board — — — At other Institutions — — — At no School or Institution — — — Non-infectious but active pulmonary and glandular tuberculosis. At Sanatoria or Sanatorium Schools approved by the Ministry of Health or the Board — 1 1 At Certified Residential Open Air Schools — — — At Certified Day Open Air Schools — — — At Public Elementary Schools 6 12 18 At other Institutions — — — At no School or Institution — — — Delicate children (e.g.. pre - or latent tuberculosis, malnutrition, debility, anaemia. etc). At Certified Residential Open Air Schools 20 16 36 At Certified Day Open Air Schools — — — At Public Elementary Schools 76 76 152 (Open Air Classes) At other Institutions .. — — — At no School or Institution 3 7 10 Active non-pulmonary tuberculosis. At Sanatoria or Hospital Schools approved by the Ministry of Health or the Board 1 4 5 At Public Elementary Schools 34 23 57 At other Institutions — — — At 110 School or Institution — 2 2 Crippled Children (other than those with active tuberculous disease). e.g., children suffering from paralysis, etc., and including those with severe heart disease. At Certified Hospital Schools 6 10 16 At Certified Residential Cripple Schools 1 5 6 At Certified Day Cripple Schools 21 18 30 At Public Elementary Schools — — — At other Institutions 1 1 2 At no School or Institution — 1 1 TABLE IV. Return of Defects Treated during the Year ended 31st December, 1930. TREATMENT TABLE. Group I.—MINOR AILMENTS (excluding Uncleanliness, for which see Group V.). Disease or Defect. Number of Defects treated, or under treatment during the year. Under the Authority's Scheme. Otherwise. Total. Skin— Ringworm—Scalp.. 32 1 33 Ringworm—Body 56 — 56 Scabies 30 — 30 Impetigo 552 1 553 Other skin diseases 245 4 249 Minor Eye Defects (external and other, but excluding cases falling in Group II.) 248 1 249 Minor Ear Defects 217 — 217 Miscellaneous (e.g., minor injuries, bruises, sores, chilblains, etc.) 604 91 695 Total 1984 98 2082 GROUP II.—DEFECTIVE VISION AND SQUINT (excluding minor Eye Defects treated as Minor Ailments—Group I.). Defect or Disease. No. of Defects dealt with. Under the Authority's Scheme. Submitted to refraction by private practitioner or at hospital, apart from the Authority's Scheme. Otherwise. Total. Errors of Refraction (ineluding Squint) 336 12 – 348 Other Defect or Disease of the Eyes (excluding those recorded in Group I.) 30 30 Total 366 12 — 378 57 58  Under the Authority's Scheme. Otherwise. Total number of Children for whom spectacles were prescribed 540 12 Total number of children who obtained or received spectacles 540 12 Group III.—Treatment of Defects of 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. 363 5 368 — 368 Group IV.—Dental Defects. (1) Number of Children who were:— (a) Inspected by the Dentist: Aged: Routine Age Groups 5 2811 Total 14524 6 3389 7 3012 8 1730 9 1175 10 1180 11 379 12 356 13 399 14 93 Specials 5033 Grand Total 19557 (b) Found to require treatment 10817 (c) Actually treated 6286 (d) Re-treated during the year as the result of periodical examination 237 59 (2) Half-days devoted to:— Inspection 69 Treatment 778 Total 847 (3) Attendances made by children for treatment 6523 (4) Fillings:— Permanent teeth 1024 Temporary teeth 4598 Total 5622 (5) Extractions:— Permanent teeth 1503 Temporary teeth 9313 Total 10816 (6) Administrations of general anaesthetics for extractions 4186 (7) Other operations:— Permanent teeth 34 Temporary teeth 642 Total 676 Group V.—Uncleanliness and Verminous Conditions. (i.) Average number of visits per school made during the year by the School Nurses 10 (ii.) Total number of examinations of children in the Schools by School Nurses 105029 (iii.) Number of individual children found unclean 1288 (iv.) Number of children cleansed under arrangements made by the Local Education Authority — (v.) Number of cases in which legal proceedings were taken:— (а) Under the Education Act, 1921 — (b) Under School Attendance Byelaws —