WAL 22 AC 4411(2) NH WALTHAMSTOW BOROUGH OF MALTHAMSTOW EDUCATION COMMITTEE. REPORT of the School Medical Officer for the Year 1939 Borough of Walthamstow EDUCATION COMMITTEE. REPORT of the School Medical Officer for the Year 1939 1 CONTENTS. Accommodation 4 Medical Treatment 11 After-care 33 Mental Deficiency 33 Attendance Officers 30 Milk Meals 27 Artificial Light Treatment 18 Milk in Schools Scheme 28 Audiometer 14 Minor Ailments 8 11 Aural Clinic 15 Mumps 19 Blind School 34 N.S.P.C.C. 32 Boot Fund 32 Nursery School 41 Brookfield Hospital 39 Nutrition 7, 1 1 Chicken Pox 10,19 Nutritional Surveys 8 Open Air Education 22 Child Guidance 40 ,, ,, School 36 Clinics 4 Orthopaedic Treatment 10,37 Committee 2 Orthoptic Clinic 13 Convalescent Home Treatment 41 Parents, Co-operation of 30 Co-ordination 4 Parents, Payments by 44 Crippling 10,17 physical Training 23 Deaf School 35 Playground Classes 22 Defective Children 60 Population 4 Dental Defects 9, 17 Re-inspections 7 Dental Treatment 9,17 Rheumatism 17 Diphtheria 19 Ringworm 9, 19 Diphtheria Immunisation 20 Sanitary Accommodation 4 Ear Disease 9, 14 Scabies 9, 19 Employment of Children 44 Scarlet Fever 19 Exclusion 19, 22 School Journeys 22 Eye Disease 9, 12 School Camps 22 Following up 10 Secondary Schools 41 Health Education 44 Skin Diseases 8, 11 Hearing 9, 14 Spectacles 12 Heart Disease 9,17 Speech Therapy 40 Hospital Treatment 14 Staff 4 Hygiene 4 Special Enquiries 44 Impetigo 9, 19 Statistics 46 Invalid Children's Aid Assoc. 30 Swimming 22, 24 Infectious Diseases 19 Teachers, Co-operation of 30 Infectious Diseases Clinic 20 Tonsils and Adenoids 9, 14 Introduction 3 Tuberculosis 10. 18 Massage 37 Uncleanliness 8, 11 Meals. Provision of 27 Vaccination 21 Measles 19 Vision 9, 12 Medical Inspections 7 Voluntary Bodies 30 Medical Examinations 46 Whooping Cough 19 2 EDUCATION COMMITTEE. Chairman: Alderman Miss E. M. Pracy, B.Sc. Deputy Chairman: Alderman A. 6. Bottomley. His Worshipful the Mayor, Alderman H. Frost, J.P. The Deputy Mayor, Alderman Mrs. C. McEntee, J.P. The Chairman, Finance Committee, Alderman Ross Wyld. Ald. G. Gibbons, J.P. Coun. S.N. Chaplin. Ald. W. B. Fitt. Coun. Mrs. E. M. Miller. Ald. W.J. Sharp. Coun. G. S. Mace. Ald. W. H. Shaw. Coun. G. M. Page. Coun. Mrs. L. P. Bailey. Coun. Mrs. E. A. Smith. Co-optative Members: P. Astin, Esq., J.P., C.A. E. J. Mumford, Esq. Mrs. E. M. Hammond . Rt. Rev. Mgr. W. 0' Grady, V .G. S. G. Haskins, Esq., E.C.C. Mrs. Sharp. A. J. D. Llewellyn, Esq. S. A. Watson, Esq. Rev. G. W. M. Laurence. Director of Education and Chief Executive Officer: S. W. Burnell, Esq., LL.B., B.Sc. 3 To the Chairman and Members of the Walthamstow Education Committee Ladies and Gentlemen, I beg to present herewith a report upon the work of the School Medical Department for the year 1939. After the outbreak of war in September, 1939, every effort was made to curtail the services as little as possible and the maximum number of staff was sent to the reception areas where they did excellent work. The nutritional findings showed a continued improvement, and less uncleanliness was found. It was not possible to continue diphtheria immunisation in the schools after the outbreak of war. I have again to acknowledge your encouragement, the cooperation of my colleagues in other Departments, and the loyalty and help of those in my own. I have the honour to be Your obedient servant. A. T. W. POWELL, School Medical Officer. 4 School Clinics.—The School Clinics were as shown in the 1938 report up to the outbreak of war. Since the war the Audiometer and Speech Therapy Clinics have been suspended, Minor Ailments Clinics at Lloyd Park only, Rheumatism Clinic was held fortnightly, Massage Clinic twice weekly, and the Orthoptic Clinic was closed until December when the usual twice weekly clinics were resumed. 1. STAFF OF SCHOOL MEDICAL DEPARTMENT. The staff of the Department was the same as for the 1938 report with the following alterations:— Dental Surgeons— Miss F.N. Macdonald, L.D.S., R.C.S. (resigned 30/8/39). Mr. B. M. A. Gilbert, L.D.S., R.C.S. (resigned 14/3/39). Miss E. M. McRaith, L.D.S., R.C.S. (appointed 28/8/29). Mr. G. P. L.Taylor, L.D.S., R.C.S. (appointed31/8/39). 2. CO-ORDINATION. As given in the Report for 1938. 3. THE SCHOOL MEDICAL SERVICE IN RELATION TO PUBLIC ELEMENTARY SCHOOLS. School Hygiene and Accommodation.—The following table shows the number of schools in the Borough and the accommodation: Number of Schools and Accommodation. Boys. Girls. Infts. Mxd. Seating Accommodation. Boys. Girls. Infts. Mxd. Provided 15 15 14 8 5,675 5,552 5,868 3,248 Non-Provided 1 2 2 3 208 362 437 929 Special Schools— Mentally Defective — — — 1 — — — 130 Deaf Centre — — — 1 — — — 20 Myope Centre — — — 1 — — — 85 Open Air School — — — 1 — — — 200 Nursery School — — — 1 — — — 150 Totals 16 17 16 16 5,883 5,914 6,305 4,762 5 1939. 1938. 1937. 1936. 1935. July 21. Dec. 31. Dec. 31. Dec. 31. Dec. 31. Number of Children on Register 15,794 15,980 16,525 17,265 17,845 Average Attendance 13,943.4 14,282.3 14,909.1 15,386.2 16,140.5 Percentage Attendance 88.5 88.8 88.7 88.3 89.4 Population 130,800 131,900 131,900 133,600 134,490 Percentage of School Children to Population 12.07 12.1 12.5 12.9 13.2 School Hygiene.—A detailed sanitary survey is made by the medical inspector at the conclusion of the medical inspection of individual departments. Mr. Frank H. Heaven, A.R.I.B.A., Architect to the Education Committee, reports as follows :— Structural Additions and Alterations.—The following works have been carried out during the year, viz.:— Pretoria Avenue Central Kitchen.—In order to centralise the cooking for the feeding of necessitous and other school children, the Infants' School premises at Pretoria Avenue have been converted into a centre where the meals for some eight hundred children are cooked and then distributed to various school dining centres in the Borough. A large kitchen with cleansing and storage rooms, stock and staff rooms with a dining room have been provided. Constant hot water from gas boilers, together with modern electrical equipment for the preparation of the food, up-to-date apparatus for the cooking, and insulated containers for the transport of the food by motor van to the various centres are special features of the equipment. William Morris Central School.—The remodelling and enlargement of these premises was completed in March and has provided, in addition to improved facilities for class work in each school, a new metalwork room fitted with motorised machines, an Art room with flat roof for out-of-doors study, and a Science room complete with every convenience for advanced work in the sciences for the boys; a similar Art room and Science room for the girls, with a Domestic Subjects room replete with conveniences for teaching domestic subjects and a self-contained housewifery section consisting of a living room, bedroom, kitchenette, bathroom with W.C., and lavatory. A communal dining room with well-fitted kitchen and larder accommodation meets the needs of the Staff and scholars requiring meals on the premises. 6 Dining Centres.—In connection with the scheme of central cooking, three additional dining centres have been provided. Removal of Galleries.—One hundred and fifty-seven stepped or sloping galleries have now been removed and floors relaid with jointless coverings or hardwood blocks. Floors.—The wood block floors to two Staff rooms, one Infants' assembly hall and one gymnasium have been sanded and regraded. Renovations and Repairs.—The policy of executing external repairs prior to annual renovations of schools has been extended to six further schools. The painting to the exteriors of five schools and the interiors or part interiors of twelve schools and to portions of eight Caretakers' houses have been completed in bright colourings, together with the usual lime whiting of out-offices at all schools. Heating.—Supplementary heating by overhead electric panels, considerable remodelling and repairs to hot water heating schemes with one new steam boiler and radiator shields have been carried out at eighteen schools. Lighting.—Re-wiring and the provision of new electric light fittings have been provided in needlework and handicraft rooms, an assembly hall and a gymnasium at senior schools. Sanitation.—Defective cold water supplies have been renewed or provided in seven instances, ten new drinking fountains installed and paper towel cabinets fitted at three Infants' schools. Fitments.—Sundry fitments, as dark blinds, wall exhibition panels, sliding blackboards, library shelving, seats and cupboards for physical training purposes, needlework tables and wardrobe with store cupboards have been provided. Some of the Infants' and Junior Mixed schools have been entirely re-desked. Minor Works .—Extensive repairs to roofs, ceilings, partitions, walls, adjustments of doors to eliminate noise and facilitate fire exits, removal of old-fashioned coppers, the provision of glazed covered ways and additional window openings to lavatories and other minor additions and improvements have been executed. Play fields.—Improvements to water supplies have been carried out at the Salisbury Hall Playfield. Playgrounds.-—One new playground has been constructed, re-surfacing to four and major repairs to thirteen other areas have been carried out. 7 School Gardens.—Three school gardens and four borders have been provided. Boundaries and Fences.—Brick division walls have been removed to improve light and air conditions at two schools. Hostilities.—By reason of the outbreak of war and the evacuation of children, ordinary school activities ceased and many of the buildings have been appropriated for various A.R.P. and other services. Previous to hostilities, Pretoria Avenue Boys' and Girls' Schools had been entirely handed over to the Borough Council and are being used as A.R.P. and Canteen Stores. Due to the partial re-opening of schools, works of protection against air raids have been provided at a number of schools. 4. MEDICAL INSPECTION. The age groups of the children inspected have been those defined under the three code groups of the Board of Education. There has been no departure from the Board's schedule of medical inspection. The following table gives a summary of the returns of medical inspection up to the outbreak of war:— A. Routine Medical Inspections:— Entrants 1,459 Second Age Group 1,003 Third Age Group 840 Total 3,302 Other Routine Inspections 220 Grand Total 3,522 B. Other Inspections:— Number of Special Inspections and Re-inspections 24,318 5. REVIEW OF THE FACTS DISCLOSED BY MEDICAL INSPECTION. (a) Nutrition.—The statistical returns relating to nutritional findings at medical inspections are given below in the form required by the Board's Administrative Memorandum issued on the 31st December, 1934. 8 Classification of the Nutrition of Children Inspected during the Year in the Routine Age Groups. Age Groups. No. of Children Inspected. "A" Excellent "B" Normal. "C" Slightly Subnormal. "D" Bad. No. % No. % No. % No. % Entrants 1,459 618 42.3 763 52.2 76 5.2 2 0.1 2nd Age Group 1,003 410 40.8 528 52.6 65 6.4 — — 3rd Age Group 840 417 49.6 388 46.1 33 3.9 2 0.2 Other Routine Inspections 220 97 44.0 112 50.9 11 5.0 — — Totals 3,522 1,542 43.7 1,791 50.8 185 5.2 4 0.1 The findings may be shown comparatively as follows:— A and B. C. D. 1939 94.6 5.2 0.1 1938 93.7 6.1 — Nutritional Surveys.—These surveys were carried out after the medical inspection of each school along the lines detailed in the 1936 report. The classification of the children singled out at these surveys from the whole of the scholars at each school inspected for more detailed examination was as follows:— A. B. C. D. 22 182 196 10 (b) Uncleanliness.—No children were cleansed under arrangements by your Committee, nor were any legal proceedings taken. The following table gives comparative figures for the past two years:— Up to 21st July, 1939. 1938. Average number of visits to schools 3 4 Total examinations 31,194 42,886 Number of individual children found unclean 997 1,285 Percentage uncleanliness of average attendance 7.1 8.9 Cases of chronic uncleanliness are followed up in the home. (c) Minor Ailments and Skin Defects.—The following is the number of skin defects found during the year:— 9 1939. 1938 Ringworm—Head 5 9 Body 12 31 Scabies 47 54 Impetigo 114 160 Other skin diseases 254 285 Total 432 539 (d) Visual Defects and External Eye Diseases.—The number of patients requiring treatment and observation was as follows:— 1939. 1938. Treatment. Observation . Treatment. Observation . Visual defects 257 31 309 19 Squint 44 4 47 10 External Eye Disease 357 3 479 — (e) Nose and Throat Defects.—The number of patients requiring treatment and observation was as follows:— 1939. 1938. Treatment . Observation . Treatment. Observation . Chronic Tonsillitis only 125 272 152 260 Adenoids only 2 6 5 16 Chronic Tonsillitis and Adenoids 3 5 8 16 Other conditions 272 3 307 2 The 272 cases of other conditions are made up of sore throats and defects requiring diastello treatment. (f) Ear Disease and Defective Hearing.—Patients requiring treatment:— 1939. 1938. Defective Hearing 69 113 Otitis Media 135 242 Other Ear Disease 44 94 (g) Dental Defects.— Requiring Gas Anaesthetic. Other Operations. Inspection. treatment. Per Cent. Actually treated. Fillings. Extractions. 1939 5,721 4,682 81.8 3,415 3,721 5,048 2,674 1,150 1938 11,245 9,209 81.8 5,842 5,974 10,608 4,723 2,162 10 Reference to dental inspection and treatment at Secondary and Technical Schools is made in Section 16. (h) Orthopaedic and Postural Defects.—A total of 77 deformities was found to require treatment. Nearly every cripple is being discovered under the Maternity and Child Welfare Scheme, and is receiving treatment either under your Authority's scheme; at one of the Metropolitan Hospitals; or from the family doctor. (i) Heart Disease and Rheumatism.—The findings were as follows:— 1939. 1938. Requiring Treatment. Observation. Requiring Treatment. Observation. Heart Disease- Organic 13 12 45 7 Functional 19 7 13 13 Anaemia 26 1 59 4 Total 58 20 117 24 (J) Tuberculosis.—The same arrangements as for 1938. (k) Other Defects and Diseases.—The following table shows the numbers of various other defects which were found:— 1939. 1938. Requiring Treatment. Observation. Requiring Treatment. Observation. Enlarged Glands 76 — 133 — Defective Speech 18 5 36 11 Bronchitis 70 8 79 13 Epilepsy 6 — 5 1 Chorea 4 — 5 4 Other Defects 1,180 71 2,100 28 6. FOLLOWING UP. The school nurses paid a total of 2,700 home visits during 1939. The visits are classified below:— External Eye Diseases 94 Mumps 21 Measles 49 Whooping Cough 757 Tonsils and Adenoids 101 Uncleanliness 177 Chicken Pox 304 Impetigo and Sores 241 Vision 186 Dental Failures 147 Otorrhoea 158 Ringworm 12 Sore Throat 48 Scabies 48 Various 326 Deafness 31 11 7. ARRANGEMENTS FOR TREATMENT. (a) Nutrition.—Treatment facilities as in 1938. The following shows the quantities of tonics supplied during 1939:— Cod Liver Oil. Parrish's Food. Syrup Lacto Phosphate. Cod Liver Oil and Malt. Cod Liver Oil & Malt & Parrish's Food. 21lbs. 115½lbs. 47lbs. 6621bs. l,2841bs. (b) Uncleanliness.—Facilities as for 1938. (c) Minor Ailments and Diseases of the Skin.—Treatment facilities as for 1938. Children suffering from ringworm of the scalp which does not readily respond to local treatment are referred for X-ray treatment to the Queen's Hospital for Children. During 1939, 3 patients were referred. The numbers referred during the previous 5 years were: 1938, 3; 1937, 1; 1936, 6; 1935, 6; 1934, 11. Cases of scabies not responding to treatment are referred to the Public Assistance Service for in-patient treatment. Table IV, Group 1 (Board of Education), is given at the end of the report, and shows the number of defects treated during the year. The work done at the school clinics is shown in the table given below:— First Inspections. Re-inspections. Number Excluded under Art. 20B. Number not Excluded. Boys. Girls. Boys. Girls. Boys. Girls. Ringworm 10 2 1 - 46 10 Scabies 20 21 4 3 81 100 Rheumatism 3 9 57 64 178 230 Impetigo, Sores, etc. 45 29 136 84 821 405 Skin 19 26 53 75 206 256 Verminous Head, etc. 2 43 5 77 16 328 Sore Throat 49 32 9 3 91 54 Discharging Ears and Deafness 2 - 132 111 428 447 Defective Vision — — 31 42 — 1 External Eye Diseases 34 43 90 115 486 479 Tonsils and Adenoids — — 12 11 — — Mumps 1 2 — — — — Various 162 153 612 606 2,318 2,152 Totals 347 360 1,142 1,191 4,671 4,462 12 First attendances numbered 3,040 against 4,339 in 1938, and re-attendances 9,133 against 12,624, the total attendances being 12,173 against 16,963. The attendances at Lloyd Park and Markhouse Road Clinics are summarised below:— First Inspections. Reinspections. Total. Grand Total. Excluded. Not Excluded. Boys. Girls. Boys. Girls. Boys. Girls. Boys. Girls. Lloyd Park *Markhouse 208 204 761 764 2972 2749 3941 3717 7658 Road 139 156 381 427 1699 1713 2219 2296 4515 Total 347 360 1142 1191 4671 4462 6160 6013 12173 *Up to outbreak of War. (d) Visual Defects and External Eye Diseases.—Treatment for the latter is given at the school clinics (see Table IV, Group 1, at the end of the report). Dr. Sheppard has kindly contributed the following account of the work done during 1939:— "There were 1,753 attendances at the Eye Clinic during 1939. 342 of these were submitted to retinoscopy, 279 being new cases. "The following table shows the defects found in the new cases seen:— Defect. Under 7 years. 7-11 years. Over 11 years. Secondary Schools. Total Boys. Girls. Boys. Girls. Boys. Girls. Boys. Girls. Boys. Girls. Hypermetropia 9 13 12 13 11 9 1 2 33 37 Hypermetropic Astigmatism 8 5 13 14 7 16 2 1 30 36 Myopic Astigmatism - - 1 4 6 11 3 3 10 18 Mixed Astigmatism - - 2 6 4 3 3 3 9 12 Myopia — - 12 10 20 26 9 17 41 53 Various 4 4 6 14 4 9 4 3 18 30 Totals 21 22 46 61 52 74 22 29 141 186 13 "The details of the group described as various are as follows:— Defects. Boys. Girls. Squints 13 14 Headaches, anaemia, styes, debility, etc. 5 7 Exophthalmos — 1 Colobomo of Macula 2 — Photophobia in bright light 1 1 Choroiditis 1 — Posterior Synechia 1 — Injury — 1 Amblyopia — 1 Totals 23 25 "The types of squints seen and treated are given in the next table:— Under 7 years. 7-11 years. Over 11 years. Total. Boys. Girls. Boys. Girls. Boys. Girls. Internal— R. 6 3 3 1 - 3 16 L. 2 3 4 2 2 2 15 External— R. — 1 — — — — 1 L. — — — — — 1 1 Alternating 3 8 1 3 3 1 19 Occasional- R. — — — — — — — L. 2 1 1 — — 1 5 Total 13 16 9 6 5 8 57 "The routine of the Eye Clinic continued as usual until evacuation took place in September; therefore, as August is a holiday month, the tables shown above relate almost entirely to seven months' work. "During September and October, as was to be expected, the Eye Clinic almost entirely disappeared, but by December there was a considerable improvement in the numbers attending." Orthoptic Clinic.—The following report on the work of this clinic has been given by Miss G. H. Montague Smith, the Orthoptist: "Owing to the outbreak of war, and hence the evacuation of the children, the work of the Orthoptic Clinic has been somewhat curtailed. The clinic did not re-open after the summer holidays until December, when it was found that enough children had returned to make it worth while. Since then the number of 14 attendances has been well up to standard. The figures given below, therefore, only account for eight months' work." Total number of cases seen during 1939 46 Number of new cases 26 Unsuitable for treatment 2 Failed to attend 1 Waiting list 17 Amblyopias (Cured 5, Improved 5, Unchanged 1) 11 Cases treated with Orthoptic Exercises— Cured 4 Awaiting operation 2 Discontinued 1 Still under treatment or observation 11 Total number of attendances 386 Number of clinics 59 (e) Nose and Throat Defects.—The scheme for treatment remained the same as detailed in previous reports. The following table shows the number of cases treated:— Year. At Connaught Hospital. Privately. Total. 1939 51 9 60 1938 110 2 112 (f) Ear Disease and Defective Hearing.—(i) Mastoid Disease. —No children were referred to the Prince of Wales's General Hospital, Tottenham, for mastoid operation under your Committee's scheme. (ii) Ear Disease.—Minor defects under this heading are treated at the minor ailments clinic, the numbers treated being given in the table relating to the work of these clinics. Audiometer Testing.—A weekly testing session was held in the schools, and of 924 examined, 55 (or 5.9 per cent.) children showing a hearing loss of 9 units or over were referred to the fortnightly clinic held by Dr. Francis Clarke. Sixty-one new cases attended these clinics, making a total of 138 attendances. 13 sessions were held, 10.6 cases per session being seen. Ear Clinic.—Dr. Francis Clarke reports as follows:— "The direction and work of the aural clinic proceeded normally along the lines indicated in the report for 1938 until the end of the summer vacation, roughly the half-year. Then, with the outbreak of war, and the consequent closure of the schools and evacuation of the children, the clinic, like the other services, became materially 15 disorganised. One session a week has been retained for those children who have remained in the district. The other fortnightly session has had to be suspended. The attendance at the clinic during the war has been very good, especially since the medical inspection in the schools has been resumed. "The total number of cases seen at the clinic in 1939 was 324, as against 484 in 1938. "A very large number of children was evacuated before the prescribed course of treatment was completed, which accounts for the high percentage shown in the returns of 'lapsed' treatment, 'left, or lost sight of.' "We have, however, been able to make a good start with the new conservative treatment of tonsils known as Peter's Suction Method, and this work is being carried on satisfactorily, though in diminished numbers at the present time. Twenty-eight cases of definitely enlarged and diseased tonsils were treated by suction during the year. Although this is far below the numbers we had hoped to do, still we are satisfied that the results achieved in this group of cases are highly satisfactory and encouraging and warrant this new method being widely used for school children. Only 14 cases were referred for operation as against 30 in 1938. The numbers of cases of enlarged tonsils being referred for operation are being steadily reduced, and it is hoped that the suction method will obviate operation in the large majority of cases. It has many advantages over operation. "The other special treatments such as zinc ionisation for otorrhoea, displacement for sinus defections and diastolisation for nasal conditions have all been continued. 48 cases were treated by zinc ionisation with over 90 per cent. cures. 12 were treated by displacement, and in every case the antrum was found, after a course of treatment, clear of muco-pus. "The special audiometric examination of school children generally has had to be curtailed to those attending the aural clinic only. Also the Deaf School cases have been removed from this area which has disorganised the help of the modern electrical aids to hearing established in the Deaf School. "The arrangement for the supply of special tonics, medicines, cod liver oil, etc., to suitable cases, has been continued, and is a valuable adjunct to the treatment prescribed at the Clinic. "The general work of the clinic is proceeding satisfactorily and the attendance is good." 16 EXPLANATORY NOTES ON CLASSIFICATION TABLES. Tables A and B. "Treatment" Column D ("Antiseptic Treatment").—Drugs used:—Carbolised Glycerine with Menthol; Grieswold's Aniline Dye Mixture; .1% solution of Acriflavine in spirit; Boric-Iodine powder. Column E ("T./A. Conservative, Nasal").—Mandl's Iodine paint; Wells' Iodine-Aether-Glycerine paint; Peter's Tonsil Suction; Gautier's Diastolisation; Wells' Iodine Vapour Inhalation. Column F ("T./A. Operation").—Those cases where operation was advised at clinic and operation performed during the year; or still awaiting operation on 31st December, 1939. "Result.'' Column I.— "Still under treatment or observation." This column refers to (a) children who attended the clinic towards the end of the year and were not discharged before 31st December, 1939, and "Observation"—children who were discharged but who return periodically for observation, as to permanency of result. Column J.— "Left"—children who left school or district before completion of treatment. "Lapsed"—children who failed to attend as required. Column K ("Referred to Hospital").—Operations usually required:—Mastoidectomy; Sinus operations. Table C. "Secondary Conditions." These defects are in respect of the same children as those under "primary" defect, with the added secondary complication. Column H ("Antiseptic Treatment").—Peter's Nasal paint. Spray or pack nasal cavity with Grieswold's Aniline Dye Mixture or Collosol Argentum. Column I ("Proetz Displacement").—Method employed in Nasal Sinus Suppuration cases—emptying sinus under negative pressure and filling with Ephedrine solution. "Nasal Obstruction." Chiefly due to deflected septum; irregular formation; hypertrophied turbinates. TABLE A. 1939 ACUTE OTITIS MEDIA. (i) CHILDREN OVER. 5. Diagnosis . Total (Ears) Tonsils and Adenoids. Treatment. Result. Zinc Ionisation. Antiseptic Treatment. Tonsils and Adenoids Conservative: Nasal: Diastolisation. Tonsils and Adenoids Operation. Cured. Improved. Still under Treatment or Observation. Left or Treatment Lapsed. Referred to Hospital for Operation. Declined Treatment. A B C D E F G H I J K L Acute Non-Suppurative Otitis Media 18 *(4) 2 Operation before Clinic — 2 — — 2 — — — — — 16 No Operation — 15 — — 15 — — 1 — — Acute Non-Suppurative Otitis Media with Nasal Conditions: Enlarged Tonsils and Adenoids 10 1 Operation before Clinic — 1 1 — 1 — — — - — 9 No Operation — 9 2 2 9 - - - - - Acute Suppurative Otitis Media 30 7 Operation before Clinic 1 6 — — 6 — - 1 — — 23 No Operation 1 22 — — 20 — — 3 — — Acute Suppurative Otitis Media with Nasal Conditions: Enlarged Tonsils and Adenoids 33 *(3) 7 Operation before Clinic 1 7 3 — 7 - - - - - 26 No Operation 4 23 13 1 18 — 2 6 — — Totals 91 7 85 19 3 78 — 2 11 — — (ii) CHILDREN UNDER 5. A B C D E F G H I J K L Acute Non-Suppurative Otitis Media 1 — Operation before Clinic - - - - - - - - - - 1 No Operation — 1 — — 1 — — — — — Aoute Suppurative Otitis Media 16 *(3) Operation before Clinic - - - - - - - - - - 16 No Operation — 16 — — 8 — — 8 — — Acute Suppurative Otitis Media with Nasal Conditions: Enlarged Tonsils and Adenoids 6 Operation before Clinic — - - - - - - - - 6 No Operation — 6 4 2 3 — — 3 — — Totals 23 — 23 4 2 12 — — 11 — — *The figures in brackets indicate the number of cases with Bi-lateral Otorrhoea. TABLE B. 1939 CHRONIC SUPPURATIVE OTITIS MEDIA. Diagnosis. Totals. (Ears) Diagnosis. Tonsils and Adenoids. Treatment. Result. (Children over 5.) Chronic Tympanic Sepsis Complicated by:— Granulations: Simple Polypi. Mastoid Disease. Enlarged Tonsils and Adenoids. Nasal Catarrh: Rhinitis: Sinusitis. External Otitis: Eczema. Primary (Ear) Collateral (Nose and Throat) Cured. Improved. Still under Treatment or Observation. Left or Lapsed Treatment. Referred to Hospital for Operation. Declined Treatment. Old Operation. No Operation. Zinc Ionisation. Antiseptic Treatment or Cautery. Tonsils and Adenoids Conservative: Nasal: Diastolisation. Tonsils and Adenoids Operation. A B C D E F G H I J K L M N O A Granulations: Simple Polypi 5 1 — - — — — Operation before Clinic 1 1 — 1 - - - - - 2 1 1 - — — No Operation 4 2 — 1 1 1 1 - - B Mastoid Disease 7 - 4 1 — — — Operation before Clinic 3 3 — 3 1 1 - - - — — 2 — — — No Operation 2 2 - - - - - 2 - - C Enlarged Tonsils and Adenoids 9 - - - - - - Operation before Clinic — — — - - - - - - *(2) — — — 8 1 — No Operation 9 — 3 - 5 1 1 1 - - D Nasal Catarrh: Rhinitis or Sinusitis 8 - 1 — — 3 1 Operation before Clinic 2 3 3 5 - - - - - *(2) — — — 1 2 — No Operation 2 1 2 3 - - - - - E External Otitis: Eczema 5 - - - - - 2 Operation before Clinic — 2 — 2 - - - - - *(2) - - - - - 3 No Operation 1 2 — 3 - - - - - Totals 34 3 6 4 9 6 6 24 16 8 - 23 3 3 4 — — Chronic Suppurative Otitis Media solely (Tympanic Sepsis only) 20 Children over 5 years 4 Operation before Clinic 4 - — — 3 — — 1 - - *(1) 16 No Operation 11 6 — 11 - - 5 - - Chronic Suppurative Otitis Media solely ( Tympanic Sepsis only) - Children under 5 years - Operation before Clinic — — — — — - - - - - — No Operation — — — - - - - - - - Chronic Suppurative Otitis Media with Nasal Conditions: Tonsils and Adenoids 6 Children under 5 years Operation before Clinic — — — — — — - - - *0) 6 No Operation 2 4 2 1 2 2 2 - Grand Totals 60 41 26 10 1 39 3 3 12 2 - * The figures in brackets indicate the number of cases with Bi-lateral Otorrhoea, with the exception of Disease: see below:- Mastoid Disease—Bi-lateral Otorrhoea. (a) Post-Operation 2 (b) "No Operation" - TABLE C. 1939 NOSE AND THROAT CONDITIONS. (i) CHILDREN OVER 5. Diagnosis. (Primary) Total. Tonsils and Adenoids. Secondary Conditions. Treatment. Result. Deafness. Nasal Catarrh. Enlarged Tonsils and Adenoids. Diastolisation. Antiseptic Treatment. Proetz Displacement. Tonsils and Adenoids. Cured. Improved. Still under Treatment or Observation. Left or Treatment lapsed. Referred to Hospital for Operation. Declined Treatment. Conservative Treatment. Operative Treatment. A B C D E F G H I J K L M N O P Q Sinusitis: Rhinitis 11 Operation before Clinic 5 — — — 4 2 5 — — — 2 — 3 — — No Operation 6 1 — — 1 2 5 — — — — — 6 — — Nasal Obstruction , Rhinitis 16 Operation before Clinic 7 1 — — 7 2 — - — 5 1 — — I — No Operation 9 2 — — 9 6 — - — 4 1 — 4 — — Nasal Catarrh 59 Operation before Clinic 13 6 — — 12 1 — — — 7 — — 6 — — No Operation 46 29 — 1 39 7 — 2 — 23 5 — 18 — — Enlarged Tonsils and Adenoids 38 Operation before Clinic - - - - - - - - - - - - - - - No Operation 38 8 17 — 11 3 2 26 11 11 — 2 23 — 2 Totals 124 124 47 17 1 83 23 12 28 11 50 9 2 60 1 2 (ii) CHILDREN UNDER 5. A b C D E F G H I J K L M N 0 p Q Nasal Catarrh 1 Operation before Clinic - - - - - - - - - - - - - - - No Operation 1 - - - 1 - - - - - - - 1 — - Enlarged Tonsils and Adenoids 3 Operation before Clinic - - - - - - - - - - - - - - - No Operation 3 - - - - - - 3 - - - - 3 — — Totals 4 4 — — - 1 — — 3 — — — — 4 — — 17 TABLE D. MISCELLANEOUS CASES. Diagnosis. Total. Cured. Wax: Foreign Body in Ear, etc. *25 25 Eczema 1 1 Totals 26 26 * Previous "T and A" operation = 7. (g) Dental Defects.—Propaganda: Folders.—Copies of the illustrated folder, "The Story of a Tooth," and the pamphlet, "What about your Teeth," issued by the Dental Board of the United Kingdom, have been given to the senior children. Treatment of Secondary and Technical Pupils.—The work done for the Essex County Council is shown below and is not included in Table V, at the end of the report. INSPECTIONS. Ages. Total Inspected. No. Offered Treatment. % requiring Treatment. 11 yrs. 12 yrs. 13 yrs. 14 yrs. 15 yrs. 16 yrs. 17 yrs. 18 yrs. 19 yrs. Total 195 76 215 238 177 42 10 4 3 960 830 86.4 TREATMENT. No. of Children. Attendances. Extractions. Anaesthetics. Fillings. Other Operations. Temp. Teeth. Perm. Teeth. Local. General. Perm. Teeth. Perm. Teeth. 462 1,029 57 179 20 134 1,097 132 (h) Orthopaedic and Postural Defects.—Details of the work done under the scheme are given in the section dealing with Defective Children (Section 13). (i) Heart Disease and Rheumatism.—Dr. Sheldon contributes the following report on the work of the Rheumatism Clinic during 1939:— 18 RHEUMATISM CLINIC, 1939. Number of sessions 40 „ „ attendances 541 „ „ new cases 133 „ „ old cases 408 „ discharged 136 „ still under treatment 166 „ of new cases with rheumatic or cardiac defect.. 27 „ referred to Hospital as in-patient 1 „ „ „ „ „ out-patient 7 „ „ for tonsils and adenoids operation 10 „ „ „ dental treatment 26 „ „ to P.D. Centre 1 , , „ „ Open Air School 3 „ excluded from school 19 „ „ half-time school 1 „ „ from games and exercises 15 „ to begin games and exercises 15 „ seen after scarlet fever 4 „ „ „ diphtheria 13 „ with cardiac defect after scarlet fever — „ „ „ „ „ diphtheria 1 „ referred for convalescent home treatment 26 „ sent away 23 „ referred in 1938 and sent away in 1939 in addition to the above 1 „ refused — „ withdrawn — „ waiting — „ evacuated whilst on waiting list 3 (j) Tuberculosis.—The number of school children examined during the year was: boys 55 and girls 60, of which 12 boys and 11 girls were referred by the School Medical Staff. 24 of the cases were sent by private practitioners, and 68 were examined as contacts. At the end of the year the live register of notified cases of school age was: Pulmonary 36, Non-Pulmonary 46. (k) Artificial Sunlight Treatment.—The arrangements with the Connaught Hospital detailed in the 1936 report were continued. Two children of school age were referred for treatment, and a total of 29 treatments was given at a total cost of £2 18s. Od. 19 8. INFECTIOUS DISEASES. Control is on the lines detailed in the Board's "Memorandum of Closure of and Exclusion from School, 1930." Notifications in the 5-15 years age group during 1939 were as follows (1938 cases shown in parenthesis):—Scarlet Fever 123 (163), Diphtheria 26 (44), Bacillary Dysentery 2 (13). Pneumonia 14 (24), Erysipelas 1 (1), Enteric nil (1), Encephalitis Lethargica nil (2). Among the cases discovered by the medical staff, and included above, were:—Non-Clinical Diphtheria 2, Scarlet Fever 3. The monthly figures were as follows:— Sore Throat. Measles. Whooping Cough. Mumps. Ringworm & Scabies. Impetigo Sores, etc. Chicken Pox. January 6 2 54 8 3 - 17 February 2 - 24 3 2 4 27 March 1 3 73 1 1 9 23 April — 9 62 — — - 4 May 1 17 230 1 — 5 17 June — 11 54 — 1 2 61 July — 5 34 - 4 5 21 August — — — - - - - September — — — - - - — October - - - - - - - November - - - - - - - December - - - - - - - Total—1939 10 47 531 13 11 25 170 Total—1938 35 1,454 96 250 12 76 413 The following are the weekly average numbers of children away from school owing to exclusions and the non-notifiable infectious and other diseases named:— Exclusions. Chicken Pox. Measles. Whooping Cough. Sore Throat. Influenza. 1939 44 52 20 149 33 120 1938 50 53 150 16 33 29 20  Diarrhœa Mumps. Ringworm . Scabies. Various. Totals. 1939 2 4 2 7 531 964 1938 4 27 2 4 516 884 Infectious Diseases Clinic.—As in previous years, all children discharged from the Isolation Hospital or after home isolation for infectious diseases were seen, and particular care was taken to refer all cases with any suspicion of rheumatism or of cardiac defect to the next rheumatism clinic. Eighteen children were referred, 13 following diphtheria, 3 following scarlet fever, 1 in connection with the scheme detailed below, one from Immunisation Clinic. Sore Throat Follow-up Scheme.—All children reported to have had a sore throat are invited in writing to attend the infectious disease clinic approximately four weeks after the onset of sore throat. The primary purpose is to make sure that no cardiac complications have followed the sore throat. 146 cases were seen in 1939, and one case was referred to Dr. Sheldon. The following table shows the work done at the infectious disease clinic, the large majority of patients being of school age:— Number of clinics held in connection with Infectious Diseases and Immunisation 51 Number of attendances made 2,233 Average attendance per session (66.0 up to outbreak of war) 43.7 Number of scarlet fever cases discovered 2 Number of virulence tests taken in diphtheria carriers 4 Number of children recommended to rheumatism clinic 18 Number of children recommended to ear clinic 16 Diphtheria Immunisation.—Immunisation was carried out at the weekly clinic on Tuesdays at 3 p.m. and at Infants' Departments, along the lines detailed in the previous reports. The following summarises the work done during 1939:— 21 Schick tested for the first time 67 Negative (including pseudo and negative) 27 Positive (including pseudo and positive) 40 Total number of immunisations completed during 1939:— (a) School age 499 (b) Pre-school age 318 (c) Over school age 1 Total 818 Number not completing immunisation or left district 164 Number of Schick tests following immunisation, 1939 54 Number of re-Schick tests following immunisation in previous years 384 Number of attendances made at clinic for immunisation 1,901 Immunisation at schools (included above):— Number completely immunised 474 Number partly immunised 39 Number having second dose, immunised with single dose in previous years 107 It was decided to Schick test those children who had been immunised with 2 doses A.P.T. in previous years, but who had had no posterior Schick. 531 such children were sent for and 271 responded. Of these, 18 gave a positive result, i.e., 6.6 per cent. had lost some of their immunity and were given another dose. Vaccination.—The vaccinal condition of each child examined at routine medical inspection was noted, and a summary shows the following:— Number Examined. Number found to be Vaccinated. Percentage Vaccinated. Entrants Boys 744 143 19.2 Girls 715 113 15.8 2nd Age Group Boys 656 176 26.8 Girls 347 90 25.9 3rd Age Group Boys 393 95 24.1 Girls 447 124 27.7 Total 3,302 741 22.4 22 Action under Article 20 (b) (Exclusion of individual children): At medical inspection 4 At School Clinics 706 Action under Article 22 (School closure).—Nil. Action under Article 23 (b) (i.e., attendance below 60 per cent. of number on register).—Nil. 9. OPEN AIR EDUCATION. (а) The facilities for open air education were as given in 1938 report. (b) School Journeys.—The following school journey was made during the year:— School. Place. Date. Shernhall Special Cheltenham April, 1939. (c) School Camps.—School camps were held at Guildford Park, St. Helens, for boys, and the Manor House, Sandown, for girls, during May and June. Three contingents of 66 boys were in camp for fourteen days each between the 12th May and 23rd June, and four contingents of 48 girls for similar periods between the 5th May and 30th June. A total of 390 children were sent away. (d) Swimming.—As in previous years, two members of the staff at the Public Baths were appointed as swimming instructors to the boys, and one instructress for the girls. Swimming instruction was given to the boys on Tuesdays (all day) and Thursday mornings, and to the girls on Wednesdays (all day) and on Monday mornings. The Council also granted the use of the swimming bath as follows:— (a) Life Saving.—One afternoon throughout the season for boys and girls. (b) Summer Vacation Passes.—Use of the bath during the summer vacation—25 passes to each school according to time-table. 23 10. PHYSICAL TRAINING. The following extracts have been taken from a report submitted to your Committee by the P.T. Organisers, Miss Hawkes and Mr. Last:— "Introduction.—Any regular visitor to our schools during the past year could scarcely fail to note the disturbing effects which the succession of international crises had upon educational progress. The propagation of new ideas, of improvements in teaching technique through the usual channels of teachers' courses and meetings, was regretfully abandoned. Children in contact with worried adults at home and at school suffer considerable, but often undetected, emotional disturbance and distress. 'War warps the intellect and tortures the spirit.' There is little doubt that the joyous but disciplined activity of the Physical Training lesson did much to divert the minds of our children from the horrors of modern warfare. "The magnificent effort of the teachers in maintaining a high standard of morale amongst their pupils must be acknowledged. "Physical Education in the Schools.—The interpretation of the detailed lessons and tables of exercises contained in the official syllabus for Infants' and Junior Schools continues to improve. The lessons are generally more complete and the recreative side of the training is becoming more purposeful and truly educational, but, as previously noted, the standard of attainment at the end of the Junior School course varies too widely. "The Hygiene of Physical Training.—Of the many moral qualities developed through a comprehensive scheme of Physical Education, surely none is of greater importance than the cultivation of self-respect. The tremendous social experiment of evacuation disclosed in far too many of our children a deplorable lack of appreciation of a hygienic way of life. Physical Education, rightly conceived and practised, would create a high regard for personal fitness, cleanliness and general efficiency. Much more could be done to stimulate our pupils' interest in this aspect of the work. "Clothes.—We are grateful for the continued provision of plimsolls. There is an urgent need for the provision of hygienic shoe lockers in all types of schools. 'It is now generally recognised that the value of Physical Training is largely enhanced by a shower bath or rub down after exercises are completed. The hygienic importance of this procedure would, however, be largely lost if the children are to put on again the same damp clothes as they have been wearing for the actual exercises, and to sit in them for the remainder of the school day.' 24 "The implication of this quotation from the Board of Education Circular of October, 1936, is that special clothing and shoes are necessary for post-primary children whose Physical Training involves work of a strenuous character, and we are pleased to report further improvement in the efforts made to provide these children with suitable clothes. "Playing Fields.—In our first annual report for 1936 we urged that our aim should be to provide all post-primary children, and children in their last year in Junior Schools, with the opportunity of enjoying a weekly games period on a playing field. Last year, owing to the extensive improvements carried out at Salisbury Hall and the hiring of the Walthamstow Cricket and Lawn Tennis Club ground, this ideal was realised, or rather provision was made for the attendance of these children on the playing fields time-table. The chief factor militating against regular attendance is, in most cases, the distance of the playing field from the school. "Whilst good use is made of the playing fields from May to October, for the remaining winter months we estimate that, in the case of the boys, less than 50 per cent., and in the case of the girls less than 25 per cent., of the time allocated is actually spent on the fields. The drainage of clayey soils is admittedly difficult, and the principal cause of this limited use of the fields during the winter months is undoubtedly the muddy condition of the ground. "The generous co-operation of the Parks Committee enabled the privilege of using tennis courts at Lloyd Park and Low Hall Farm to be extended to Senior as well as the Central Girls' Schools. "Teachers' Classes.—Reference has already been made to the difficulty of organising the usual classes during the past year. Two women and one man were generously granted leave of absence to attend special Advanced Three-months' Courses in order to qualify for teaching in fully-equipped gymnasia. Other enthusiastic teachers attended courses held in London by the Central Council for Recreative Physical Training, and summer holiday courses at Scarborough. "Swimming.—The transference of the swimming instruction of the Monoux School to the South-West Essex Technical College placed a further 700 places at the disposal of Walthamstow children, raising the total from 1,200 to 1.900 possible visits per week. "Whilst there are over 5.000 children in the post-primary schools alone (excluding medical cases) who should receive regular swimming instruction, there should be no difficulty about filling 1,900 places. For years past the limited accommodation has 25 restricted the full development of this important part of the children's Physical Education. Swimming instruction has been limited to the privileged few, and this has served to standardise what is really a very poor demand. In Walthamstow less than 50 per cent. of the eligible children attend for swimming instruction. Unfortunately, the curtailment of the swimming season, and consequent inability to hold the usual examinations, makes it impossible to indicate the extent of improvement by an increase in the number of certificates obtained. For the sake of continuity, however, the following table is reproduced:— "Number of certificates obtained: Lengths. 100 yds. 1/4-mile. ½-Length on back. Royal Life Saving Society Certificates. Elem. Inter. Medallions Girls: 1936 280 222 116 207 39 36 5 1937 373 221 155 218 40 40 11 1938 312 200 162 191 41 42 13 1939 175 1st exam. only. no examination. 27 26 (2 bars) 5 1st examination only. Boys: 1936 273 166 104 147 50 24 — 1937 375 249 138 200 41 16 — 1938 342 197 132 172 50 31 5 1939 219 no examination. 47 — 9 1st exam. only. 1st examination only. "Play Centres.—The following centres were opened in May and conducted on similar lines as for 1938:— Playgrounds. Parks and Recreation Grounds Blackhorse Road School. Aveling Park. Chapel End School. Higham Hill Rec. Wood Street School. St. James' Park. Selwyn Avenue School. "The construction of air-raid shelters in the parks interfered with the full development of the scheme, and made it impossible to re-open the centre at Selborne Road Recreation Ground. The closure of this ground emphasises the urgent need for further recreational facilities in this district. Activities at the Higham Hill ground were also seriously restricted. "Regular visits were paid to all centres throughout the season, and once again we wish to thank the Parks Committee and the various members of their staff who contributed so much towards the successful working of the scheme. 26 ' 'As an experiment, nine selected playgrounds were opened for roller skating for two evenings per week during the summer term. Visits to these centres indicated that, after the first fortnight, few children used these playgrounds. The skaters were confined chiefly to the 10-12 age groups, and very few remained after 8 p.m. "Out-of-School Activities.—Close contact has been maintained with the enthusiastic body of teachers responsible for the very efficient and valuable work of the Walthamstow Schools' Athletic, Cricket, Football and Swimming Associations. "Physical Training and Games for Adolescents and Adults.—Two additional Keep-Fit classes for women and girls, making a total of twelve, were held, with an average attendance of 25 throughout the season. "Physical Education in the Reception Areas.—(Note: On the outbreak of war Miss C. M. Hawkes was seconded for full-time emergency duties with the Barking Education Committee, whilst Mr. Last remained at the disposal of Mr. Burnell, and was sent to Bedford.) "Urgent administrative and billeting problems occupied the whole of thq stay in Bedford, with the exception of one week prior to recall to Walthamstow on October 12th. It is obvious, for the following reasons, that we must be prepared to accept some deterioration of the normal standard in Physical Education:— "(a) Lack of adequate facilities, principally in the provision of suitable playground space and indoor accommodation. Many of the playgrounds in the rural areas are small and badly surfaced, rendering the use of suitable shoes (if any) impossible, except under specially favourable conditions. "(b) Inability, owing to lack of accommodation, apparatus and specialist teachers, to develop suitable progressive work for senior children. "(c) The breakdown of the specialist system. Many teachers who, by reason of age or health, have lost touch with modern Physical Education are now called upon to take their own classes, and it is obvious that such teachers require much help. "Supplies of essential physical training and games apparatus were despatched to all schools as soon as possible after evacuation. The five weeks of exceptionally fine weather which followed immediately upon evacuation allowed full scope for outdoor pursuits, and change of air and diet, together with the curtailment of the number of hours spent sitting in classrooms, all combined to produce an immediate and marked improvement in the health and physique of the majority of the children. 27 "Home Education Scheme in Walthamstow.—The strict ban on any grouping of children for formal lessons in the re-opened schools made it impossible to carry out any really effective work in Physical Education. Provision for organised games was made on those playing fields and parks with suitable air raid protection and within easy reach of the children's homes. "With the provision of air raid protection and the re-opening of certain schools, it has been most encouraging to note the pleasure with which children have welcomed the opportunity of participating once again in the joyous disciplined communal activity provided by the Physical Training lesson. From the few classes already seen at work, the need for an immediate resumption of systematic corrective exercise is depressingly apparent. 'A healthy mind cannot inhabit an unhealthy body without being affected by its sickness; a healthy body cannot house an unhealthy mind without losing its strength: and an unhealthy character cannot be the efficient partner of either.' "Physical Training for the A.R.P. Services.—Physical Training now forms part of the daily programme for the personnel of all A.R.P. centres. Obviously the success, efficiency and popularity of the work depends largely upon the services of qualified teachers. There is no doubt that the teaching of Physical Training and general opinions regarding the subject have suffered severely from the kindly intentions of the uninformed amateur. A short eight-week course for intending teachers and leaders has been conducted at the Wm. Morris School, but these leaders still require further considerable help and training to enable them to teach with confidence and success. "The upheavals of the past year have brought us into closer contact with the Director of Education and his administrative staff, to whom we offer our sincere thanks for their willing assistance and cheery optimism during days of especial difficulty." 11. PROVISION OF MEALS. (1) Mid-day Meals.—The number of meals was as follows:— Year. Number of Children. Number of Meals. Average Meals per Child. 1939 790 67,788 85.8 1938 797 94,990 119.2 1937 801 93,791 117.1 1936 732 91,133 124.5 (2) Milk Meals.—Milk was supplied on medical grounds to 4,304 children on the recommendation of the medical staff after the examination of children either at school or clinics, the total 28 number of meals being 1,028,595. The number of children supplied during the preceding year was 5,177, and the number of meals 1,453,915. (3) Milk in Schools Scheme.—The arrangements detailed in former reports were continued in 1939, all the milk supplied being pasteurised milk sold under licence. The progress of the scheme since 1936 may be seen from the following table:— Number on Roll. Receiving Free Milk. Available for Voluntary Milk. Receiving Voluntary Milk. Percentage receiving Voluntary Milk. Total receiving Milk. Percentage receiving Milk. March, 1936 17,545 2,188 15,357 7,647 43.21 9,835 56.05 October, 1936 17,144 2,705 14,439 7,652 52.09 10,357 60.41 March, 1937 16,760 2,918 13,842 7,307 43.59 10,225 61.0 October, 1937 16,526 3,549 12,977 7,463 46.3 11,102 66.63 March, 1938 16,254 3,964 12,290 7,155 58.2 11,119 68.4 October, 1938 15,912 3,926 11,986 7,255 60.5 11,181 70.2 March, 1939 15,829 4,267 11,562 6,902 59.6 11,169 70.5 It is a local requirement of the scheme that only pasteurised milk sold under licence shall be supplied, i.e., the cap on the bottle should be labelled "pasteurised milk." Bacteriological, etc., Control.—During the year, 9 samples of milk were obtained by the Chief Sanitary Inspector for analysis. These were examined for bacteriological counts and all were satisfactory, the highest being 12,000 per mill., and the lowest 850 per mill. All were examined by the phosphatase test and all were satisfactory . Vacation Scheme.—Distribution centres were opened during the school holidays in 1939. The number of meals served is shown below:— 29 DISTRIBUTION OF MILK DURING SCHOOL HOLIDAYS, 1939. Centre. Voluntary. Official. Totals. Grand Total. Easter. Whitsun. Summer. Easter. Whitsun. Summer. Easter. Whitsun. Summer. Markhouse Road 506 510 1,791 1,170 1,128 5,270 1,676 1,638 7,061 10,375 Maynard Road 407 433 1,581 798 674 2,984 1,205 1,107 4,565 6,877 Mission Grove 530 528 2,469 889 771 3,723 1,419 1,299 6,192 8,910 Thorpe Hall 506 449 2,205 763 647 2,860 1,269 1,096 5,065 7,430 Winns Avenue 710 594 2,687 1,198 993 4,713 1,908 1,587 7,400 10,895 Totals 2,659 2,514 10,733 4,818 4,213 19,550 7,477 6,727 30,283 44,487 30 Milk was supplied at 22 centres during Christmas holidays, the quantity supplied being as follows:— Voluntary. Official. Totals. 1/3 Pts. ½ Pts. 831 1,516 2,347 12. (a) CO-OPERATION OF PARENTS. The following table shows the attendance of parents during 1939:— Boys. Number Inspected. Number of Parents. Per cent. 1939. Per cent. 1938. Entrants 744 670 90.0 91.0 2nd Age Group 656 478 72.8 79.1 3rd Age Group 393 196 49.8 35.1 Totals 1,793 1,344 74.9 65.4 Girls. Entrants 715 660 92.3 92.9 2nd Age Group 347 284 81.8 83.1 3rd Age Group 447 285 63.7 65.0 Totals 1,509 1,229 81.3 78.7 Grand Total 3,302 2,573 77.9 72.1 (b) CO-OPERATION OF TEACHERS. Renewed and grateful acknowledgment for the co-operation of Head Teachers and their staffs must be made. Generous help and co-operation has invariably been experienced. (c) CO-OPERATION OF SCHOOL ATTENDANCE OFFICERS. The Superintendent Attendance Officer and his staff have again co-operated with the work of the school medical service, and there is almost daily proof of the advantage resulting from it. (d) CO-OPERATION OF VOLUNTARY BODIES. (a) The Invalid Children's Aid Association.—Miss Lewis, the Secretary, has kindly contributed the following report:— "I give below the statistical tables for 1939, which reflect the curtailment of our work by reason of the war. 65 children were away in homes at the outbreak of war, and only 3 were removed by their parents. 24 were sent away during the period 1.9.39 to 31 31.12.39, and there were 37 children away on the latter date. Work during the autumn has largely consisted in rounding up the children for the Specialist clinics, and one hopes that when the system of medical inspection is in full swing the children who must surely be needing our care will be referred to us. "In common with other social services, we have seen the shattering of 20 years' constructive work, but we must do what we can for the children remaining here and endeavour to hold on, knowing that there will be vital work to do when the present dislocation is over. "New cases (in addition to many re-applications) were referred by:— Over 5 years. Under 5 years. Total. Medical men, Hospitals and Dispensaries 68 24 92 Medical Officer of Health and Infant Welfare Centres - 5 5 Education Committees and School Medical Officers 31 1 32 Local Authorities under schemes for— (1) Rheumatism 20 1 21 (2) Orthopaedic Care 68 70 138 Invalid Children's Aid Association 1 — 1 Voluntary Agencies 1 - 1 "Classification of Cases:— Anaemia and Debility 33 1 34 After-effects of acute illnesses 5 6 11 Marasmus and Malnutrition 4 1 5 Rheumatism, Chorea and Heart 19 1 20 Heart (Congenital) 1 1 2 Diseases of Lungs (Non-T.B.)— (a) Bronchitis, Pneumonia, etc. 20 6 26 (6) Asthma 1 2 3 Glands (Non-T.B.) 5 1 6 Diseases of Bones (Non-T.B.) 48 57 105 Diseases of Digestive Organs — 1 1 Paralysis 3 1 4 Nervous Conditions 12 2 14 Congenital Deformities 16 16 32 Diseases of—Ears 4 4 8 Eyes 2 — 2 Nose and Throat 4 1 5 Accidents 4 — 4 Various 8 — 8 Totals 189 101 290 32 Help given to Old and New Cases (all ages):— Old. New. Sent to Special Hospitals and Convalescent Homes 28 128 Extensions from previous years 70 — Provided with Massage and Exercises — 17 Referred for visiting and advice 125 148 Clothes 18 Totals 223 311 "Number of visits paid, 1,095. "Average length of stay in Convalescent Home, 13 weeks 4 days. "24 children were sent away from the rheumatism clinic." (6) National Society for the Prevention of Cruelty to Children.—The following summary of the work done in Walthamstow during 1939 is reported by Inspector Luff:— Nature of Offence. How Dealt with. Neglect 61 Warned and advised 66 Assault and ill-treatment 8 Otherwise dealt with 8 Advice sought 6 Convicted 2 Various 1 Total 76 Total 76 Number of children dealt with over 5 years of age: boys, 67; girls, 62. Number of children under 5 years of age, 54. 214 supervisory visits were made during the year, and 90 miscellaneous visits were made. (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 1939:— "Owing to the period of national emergency, the distribution of footwear for the year ended 31st December, 1939, can be divided into two distinct periods. The normal distribution of footwear was undertaken up to the 31st July, during which time approximately 650 pairs of boots and shoes were distributed at a cost of approximately £200. ' 'The Government scheme for the evacuation of school children to the reception areas found many children ill-shod to withstand the hard wear of country roads, and in consequence very heavy 33 demands were made upon the funds in the preliminary stages of the evacuation. During the months of August and September, 1939. over 300 pairs of boots and shoes were distributed to Walthamstow scholars at *a cost of approximately £100. "In all, over 1,050 pairs of boots and shoes have been distributed to school children during the 12 months at an approximate cost of £330." (d) The Honorary Secretary of the Mental Welfare and AfterCare Committee sends the following report compiled by Miss S. C. Turner, of the Mental Welfare Section, Essex County Council:— "The Junior Occupation and Training Centre under Miss Drury and the Craft Class for senior boys under Miss Carol Wood remained open until the summer holiday. Rapid changes which followed the outbreak of war are the outstanding features of 1939. "Occupation Centre children were not included in the Government Evacuation Scheme, so a limited scheme was carried into effect by the Essex County Council on the 6th September, 1939. A surprisingly small number of those eligible. 17 out of 39, took part in the scheme, although in many cases parents had arranged the private evacuation of their defectives. "The evacuees who could not be admitted to one of the branches of the Royal Eastern Counties Institution are in the care of staff from the various Occupation Centres at Chandos Hall (for senior lads) and at Brandon House (for girls and juniors), Clacton. Five children have returned home. The parents of a few who were prevented from participating in September now wish them to join the evacuated parties, and it is hoped that some may be enabled to do so when accommodation becomes available. "In the case of defectives whose parents sent them away privately, efforts are made to keep in touch through members of the family at home. In other cases they have been referred for continuance of supervision to the Local Authority in whose area they are staying. "The following gives the numbers in the various categories of children normally resident in Walthamstow:— Under statutory supervision 112 Under guardianship 2 On licence 6 Under voluntary supervision 213 34 "The Mental Welfare and After-Care Committee have again shown that they have the interest of Walthamstow defectives at heart; whereas the help they have given to the Mental Welfare Section has been very greatly appreciated. Among their activities they organised outings in the summer for the junior centre and the senior boys' class; at Christmas they made generous donations to the Christmas funds of the Clacton Centres and also enabled some Walthamstow parents to visit their children there. Grateful thanks are due to them." 13. BLIND, DEAF, DEFECTIVE AND EPILEPTIC CHILDREN. (i) Blind School.—The following table shows the classification of children attending the school at the end of 1939:— Blind. Partially Blind. Walthamstow. Other Authorities. Walthamstow. Other Authorities. Boys 3 3 17 3 Girls — 2 18 4 Totals 3 5 35 7 The work done at the school is detailed in previous annual reports, and the Consultant Ophthalmic Surgeon, Dr. P. McG. Moffatt, reports as follows:— "The work of the Myope School has been carried out with the usual care and efficiency by Miss Balls and her assistants until the end of the summer term. It is greatly to be regretted that the war has interrupted the valuable training the children were receiving." The Head Teacher, Miss M. L. Balls, has kindly sent the following report:— "About 90 per cent. of the children availed themselves of the Milk Marketing Board's scheme for the purchase of milk in school up to the first week in September. "On the outbreak of war the school was evacuated to the Hutton Residential School (L.C.C.) at Hutton, Essex. "In this we were particularly fortunate, in that the children were all housed together under ideal conditions governing 35 modation, feeding, bathing and medical attention, whilst with some modifications in the curriculum classes are carried on for four and a half hours daily. During the spell of fine weather in September and October the children enjoyed long rambles in the country, and classes were held in the open air. The health and physique of the evacuees to Hutton has obviously improved, while the children's eye conditions have been periodically inspected and treated by the Committee's medical specialist. "The school accommodates 85 children, but the number on roll during the year did not exceed 64. During the year 14 children left school. "One boy was transferred back to the elementary school, as the state of his eyes had improved with the care taken by the doctors and teachers. "One boy went to the Royal Normal College for the Blind for further training. "One boy went to a training school for chefs. "Two boys went into the building trade. "One boy went to learn poultry farming. "One boy went to learn dairy work. "One boy went as shop assistant. "One boy went as typist in a warehouse. "Two girls went to a florist shop to learn the trade. "One girl went as shop assistant in a confectioners' shop. "One girl went as typist and cashier in a large drapery store. "One girl is working at hand knitting and knitting machine work. "His Majesty's Inspector, Mr. Lumsden, has visited the school during the year and expressed satisfaction at the work accomplished there. He has also visited the evacuation centre, making a thorough inspection of all the conditions." (ii) Deaf School.—All children in attendance were examined by Dr. Francis Clarke, your Aural Surgeon. Any of the children requiring further advice during the year were referred to the weekly aural clinic. In addition, the children were given the usual medical inspection and re-inspection. Miss V. K. Mitchell, the Teacher in Charge, reports as follows:— "The following table shows the children on the register:— 36  Deaf within the meaning of the Act. Partially Deaf. Speech Defects. Aphasic. Cleft Palate. Jan., 1939 6 7 2 4 1 Dec., 1939 5 6 1 4 1 "Two children were admitted during the year and four left. Six boys took boot repairing and brushmaking for half a day per week and four took woodwork. No girls were of the right age to take cookery or laundry. "The school was evacuated to Kessingland, Suffolk, with three other deaf schools. There were 18 children on the register. Fourteen children came with us, one of whom came from the Margate Deaf School. We were moved to Gileston, Glamorgan, on October 9th with five other deaf schools. One girl left in November and one boy returned to Margate Deaf School. Two children have returned home temporarily. School is being carried on here during normal school hours, although under crowded conditions. The health of the children is good. The condition of several of the children's ears has improved. Of the six children left in Walthamstow all require special teaching except one, who could possibly be taught in a hearing school." (iii) Open Air School.—Miss Thompson, the Head Teacher, reports as follows:— "The work of the school was carried on, on similar lines to previous years. Early in the year many cases of bad posture were noted— walking with hands in trousers pockets, lolling against posts, etc., tending to accentuate sunken chests and rounded backs. Dr. Clarke, Miss Hawkes and Mr. Last, organisers of P.T. in the district, joined with the staff whole-heartedly in a campaign to remedy this, and a special set of exercises was agreed on for practice. Miss Goddard specialised for this work, but the teaching staff co-operated throughout the day. A noticeable improvement had been gained by the midsummer holidays. 13 children were discharged for transfer to ordinary elementary schools in July. "On September 1st, 85 of the 143 children on roll were evacuated as a school unit to Hopton, near Lowestoft. Here they remained seven weeks. For the first month the weather was most favourable and children spent all day out of doors, sometimes walking to adjacent villages, sometimes playing on the sands or taking lessons 37 in the Camp grounds. The effect on their appearance was excellent. Flabby flesh became firm, and movement was more active and controlled. "Asthma cases were not so happy. Attacks were frequent and rather prolonged. "In October, the Authorities decided to move the camp to warmer quarters, and the Holiday Camp known as the Riviera, Bowleaze Cove, Weymouth, was chosen as our winter home. When Christmas arrived all children were in excellent health except for widespread chilblains on hands, feet and legs. "A wonderful Christmas was experienced by both children and staff. The hotel management entered into the spirit of entertainment with a zest. The children presented their own play, 'Cinderella,' on Christmas night, to the astonishment of the locality, who thought of debilitated and crippled children as helpless and only to be pitied. It is now realised that the aim of special schools for this class of children is to enable them to rise above the supposed limitation of physical defects. "The children, while living in the heart of this beautiful Dorset country, are learning something of country life and its interests in animal and bird life. The senior boys have become keen fossil hunters. "68 children are still on roll, our evacuated school register, of whom 23 are orthopaedic cases." (iv) Orthopaedic Scheme.—The arrangements whereby the Superintendent Health Visitor and the Welfare Masseuse attended each clinic was continued. The close liaison has proved very valuable. A total of 13 Consultant sessions were held in 1939. The scheme is under the clinical charge of Mr. B. Whitchurch Howell, F.R.C.S., Consulting Orthopaedic Surgeon. The following tables show the work done at the clinics:- 38 ORTHOPAEDIC SCHEME. Defects. Boys. Girls. 5-16 years. Under 5 yrs. Over 16 yrs. 5-16 years. Under 5 yrs. Over 16 yrs. Anterior Poliomyelitis 8 4 5 21 1 19 Scoliosis, Kyphosis and Lordosis 3 1 - - 12 - Bowed Tibia 1 19 — — 6 - Rickets— (a) Genu Varum — 6 — — 2 - (6) Genu Valgum 8 15 — 10 11 - Pes Piano Valgus 50 14 2 14 10 - Spastic Paralysis 9 1 — 5 4 - Arthritis 1 3 3 1 — 2 Talipes— (a) Equino Varus 8 — 3 5 2 — (6) Equino Valgus 1 — — 2 3 — (c) Mid-tarsal Varus — — — — 1 — (d) Calcaneo Valgus 1 — — — 1 — Torticollis — — — 2 4 — Congenital Dislocation of Hip - - - 3 8 - Osteomyelitis — — — 1 — — Congenital Defects 10 4 — 4 3 — Amputation—Leg — — — 2 — — Ataxia 1 — — — — — Hammer Toe 1 — — 2 — — Erb's Paralysis — — — 3 — — Baker's Cyst 1 - - - - - Asthma 1 — — — — — Digitus Varus 1 — — 1 — — Hemihypertrophy — — — 1 — — Hallux Valgus — — — - — 1 Hallux Rigidus — — — 1 — — Freiburg's Disease — — — 1 — — Amyatonia — — — — 1 — Miscellaneous 3 6 — 1 6 — Surgical Tuberculosis 5 — — 1 1 1 Cerebellar Ataxia 1 - - - - - Webbed Toe - - - - 1 - Totals 114 73 13 86 77 23 Number of cases seen by the Surgeon:— From Physically Defective Centre 36 From other schools 150 Over school age 30 Under school age 130 Total 346 39 New cases seen by the Surgeon:— School age 86 Under school age 84 Total 170 Total number of examinations by Surgeon 516 Total number of cases discharged by Surgeon 26 Average number of examinations made per session 32.2 Cases closed by Surgeon for non-attendance 22 Number of attendances for orthopaedic and massage treatment 2,976 Average number of attendances per session 9.4 Number of sessions held:— For medical inspection 16 For treatments 314 Total number of visits by Instrument Maker 23 (v) Brookfield Orthopaedic Hospital. — Miss Garratt, C.S.M.M.G., has kindly summarised the admissions and operations done during 1939 as follows:— Admissions (Walthamstow cases only):— Under 5 years of age 3 5 years and over 3 Total 6 Number who were already in Hospital on January 1st, 1939 3 Classification of Defects. Under 5 years. 5 years and over. Anterior Poliomyelitis 1 1 Talipes— (a) Equino Varus 1 — (b) Calcaneo Valgus — 1 Arthritis — 1 Epiphysitis Hip — 1 Spastic Hemiplegia 2 - Classification of Operations. Under 5 years. 5 years and over. Tenotomy— Tendo Achilles 1 2 Arthrodesis— Foot 1 (vi) Mental Deficiency—Ascertainment.—Ascertainment has proceeded along the lines detailed in previous years. 40 Certification.—The School Medical Officer and two of the assistant School Medical Officers are recognised by the Board of Education as certifying officers. A summary of the work done under this heading during the year is given below:— Not Mentally Defective, or Dull and Backward 28 Border-line Mentally Defective 2 Mentally Defective 12 Imbeciles 1 Totals 43 School for Mentally Defective Children.—Your Authority provide a special school with accommodation for 130 children. (vii) Child Guidance.—One case first referred in 1936 and four cases referred in 1938 still continued the London Child Guidance Clinic. Nine new cases were referred to the London Child Guidance Clinic and two new cases to the Tavistock Clinic. 166 attendances were made by these patients at a cost of £32 19s. 6d., against which certain recoveries were made. (viii) Speech Therapy.—Miss I. M. S. Knight, the Speech Therapist, reports as follows:— "The treatment for speech correction continued on much the same lines as in other years. As I travel round the County of Bedfordshire, working on slightly different lines since evacuation took place, I occasionally meet children who used to attend the clinic, and without exception there has been no relapse into old habits, but rather the reverse. "Since evacuation took place it has been my privilege to make contact with types of cases in need of psycho-therapy, including delinquency, enuresis, difficult behaviour, nervous symptoms and, of course, speech cases. "The quick response and complete recovery in most cases of enuresis was very gratifying after a few talks on psychological lines brought down to the level of the child's understanding. This 41 may seem far removed from speech therapy, but not when we consider that many of these symptoms may be tied up in a stammerer and many cases of defective speech. ' 'Much of the success of the work I must attribute to the kind co-operation of the Head Teachers for infoimation and help received Table of Results. Discharged Cured. Left School. left District. Withdrawn 9 5 1 1 Convalescent Home Treatment.—156 children were sent away for convalescent home treatment during 1939. There were 70 children remaining in convalescent homes and hospital schools on December 31st, 1939. The conditions for which children were sent included the following:—Debility, 19; Heart, 11; Rheumatism, 14; Chest, 23; Anaemia. 11; Malnutrition, 3; Nervousness, 10; after infectious illness, 10; Surgical, 10; Ear Disease, 9; Various, 36. A total of 44 children were sent to the convalescent homes or heart homes from the rheumatism clinic. The average length of stay in all homes has been 13 weeks and 4 days. 14. FULL-TIME COURSES OF HIGHER EDUCATION FOR BLIND, DEAF, DEFECTIVE AND EPILEPTIC STUDENTS. The Authority for the provision of such courses is the Essex County Council. 15. NURSERY SCHOOL. The medical and nursing supervision continued mainly on the lines detailed in previous reports, i.e., (a) examination of new admissions at the school clinic as soon as possible after admission to school; (b) stripped examinations of each child once per term; and (c) annual routine examinations. Parents are invited to be present at examinations (b) and (c). 16. SECONDARY SCHOOLS. The Authority for the provision of Secondary Schools in Walthamstow is the Essex County Council. 42 (a) Dental Inspection and Treatment.— Reference has been made in Section 7 (g) to the dental inspection and treatment of pupils attending Secondary and Technical Schools. (b) Medical Inspection and Treatment.— The inspection and treatment of the pupils attending the Secondary and Technical Schools was continued during 1939. The following table shows the findings at medical inspection:— High School. Sir George Monoux Grammar. S.W. Essex Technical College. Girls. Boys. Boys. Girls. Number inspected:— Entrants 85 82 135 130 12 years old 79 141 6 82 15 years old 76 96 139 87 Total 240 319 280 299 Specials 192 8 131 173 Parents present 191 214 159 231 Number referred for treatment (excluding Dental and Uncleanliness) 74 72 49 69 Number referred for observation 48 49 41 58 Number referred for treatment (excluding Vision, Dental and Uncleanliness) 47 52 44 55 Nutrition— A 99 113 146 112 B 127 193 124 176 C 14 13 10 11 D — — — — Defects:— Skin— Requiring treatment 15 3 6 14 Requiring observation 2 - — — Blepharitis, requiring treatment 4 1 4 2 Conjunctivitis, requiring treatment 1 4 2 3 Defective Vision, excluding Squint— Requiring treatment 25 22 5 14 Requiring observation 9 4 6 Squint— Requiring treatment — — 1 — Requiring observation 1 — — 1 Other conditions of Eyes— Requiring treatment — — — 3 Reouirine observation 1 2 Deafness— Requiring treatment — — 1 - Requiring observation 2 — — - Otitis Media— Requiring treatment - - - 1 Requiring observation 1 - - - 43  High School. Sir George Monoux Grammar. S.W. Tech Coll Essex nioal age. Girls. Boys. Boys. Girls Other Ear Diseases— Requiring treatment — — — — Requiring observation 1 — 1 — Enlarged Tonsils— Requiring treatment 5 4 — 3 Requiring observation 21 2 5 20 Other conditions of Nose and Throat— Requiring treatment 2 — — 3 Requiring observation 1 — — 2 Cervical Glands— Requiring treatment — — — 1 Requiring observation 1 — — 2 Speech— Stammer— Requiring treatment — 1 - — Requiring observation — 1 — — Other forms— Requiring observation — 1 — — Teeth, requiring treatment 10 13 4 4 Heart— Organic, requiring observation - - 1 - Functional— Requiring treatment 1 2 1 - Requiring observation — 1 3 — Anaemia— Requiring treatment — — 1 1 Requiring observation 1 — — — Lungs— Other conditions (nontubercular)— Requiring treatment — — — 2 Requiring observation — 6 — 1 Bronchitis— Requiring observation — 1 — — Chorea, requiring treatment — 1 — — Deformities—Rickets— Requiring treatment — 5 2 — Requiring observation — — 1 — Spinal Curvature, requiring treatment 2 - - 7 Other forms— Requiring treatment 10 26 20 17 Requiring observation 3 5 2 12 Other Diseases and Defects— Requiring treatment 12 9 6 1 Requiring observation 2 12 5 1 44 The number of attendances made at the clinics for treatment is shown below:— Minor Ailments 323 Ophthalmic 99 Orthopaedic 388 Rheumatism 14 Aural 55 Speech 75 17. PARENTS' PAYMENTS. The approved scales for the recovery of fees in respect of treatment is the same as given in 1938 Report. 18. HEALTH EDUCATION. As for 1938. 19. SPECIAL ENQUIRIES. As for 1938. 20. MISCELLANEOUS. (i) Employment of Children and Young Persons.— Mr. R. Dempsey, the Juvenile Employment Officer, gives the following report on the work of the Bureau:— "The year under review has been an eventful one, involving much work by the staff, who were greatly handicapped by the prevailing conditions. At the beginning of the year the hopes expressed in the last report of an industrial and commercial improvement were shattered by the September crisis of 1938, from which no industry recovered owing to the continued fear of war throughout the year. As a consequence the Bureau was unable to carry out its policy effectively as to choice of employment owing to the lack of the better type of openings for young people and the large number of qualified candidates for the few good vacancies which were offered. "The number of vacancies notified was 2,952, an increase of 381. There was an increase of 143 in the number of boys and girls placed in employment. The total number being 2,774. "Owing to the industrial uncertainty throughout the year, the Bureau did not place so many juveniles in other districts. The 45 total number placed through other exchanges was 548. a decrease of 36. "With regard to Unemployment Insurance, the total number of claims to benefit made by juveniles was 1,560, an increase of 135. "Unemployment Insurance books were issued to 2,200 new entrants, this being a decrease of 70. ' 'At the annual exchange of unemployment books in July the total number of books exchanged was 5,605, a decrease of 315. "The total amount of Unemployment Benefit paid was £1,095, an increase of £140. "Industrial Distribution.— The annual exchange of Unemployment Insurance books indicates that boys and girls were employed in Walthamstow during the year in the following age groups:— Boys, 14-15 years 1,204 Boys, 16-17 years 1,721 Girls, 14-15 years 1,102 Girls, 16-17 years 1,578 "During the year, in the preparation for the putting into force of the 'beneficial employment' provisions of the Education Act, 1936—which were due to take effect as from September, 1939—a complete survey of employments within the area of the Bureau was carried out and much information was collected concerning the conditions of employment in every firm in the district. It was intended that this valuable information should be set out in the annual report of the Juvenile Employment Committee. "The outbreak of the war and the suspension of the Education Act, 1936, have rendered the information at least temporarily ineffective, and it is proposed to defer its publication until a later date when, after revision, it will be of greater use." (ii) Employment of Children.—109 children were examined by the medical staff. All were passed as fit for employment. (iii) Employment of Children in Public Entertainments.— Licences were granted to 9 children for employment on production of satisfactory certificates from the medical staff. 46 (iv) Medical Examinations.— The following examinations were made during 1939 by the medical staff:— New Appointments. Teachers 24 Others 12 21. STATISTICAL TABLES. The statistical tables required by the Board of Education follow. TABLE II. CLASSIFICATION OF THE NUTRITION OF CHILDREN INSPECTED DURING THE YEAR IN THE ROUTINE AGE GROUPS UP TO 31st AUGUST, 1939. Age-Groups. Number of Children Inspected. A (Excellent). B (Normal). C (Slightly subnormal). D (Bad). No. °/ /o No. °/ /o No. % No. or /o Entrants 1,459 618 42.3 763 52.2 76 5.2 2 0.1 Second Age-Group 1,003 410 40.8 528 52.6 65 6.4 — — Third Age-Group 840 417 49.6 388 46.1 33 3.9 2 0.2 Other Routine Inspections 220 97 44.0 112 50.9 11 5.0 — — Total 3,522 1,542 43.7 1,791 50.8 185 5.2 4 0.1 TABLE I. MEDICAL INSPECTIONS OF CHILDREN ATTENDING PUBLIC ELEMENTARY SCHOOLS. A.—Routine Medical Inspections. Number of Inspections in the prescribed Groups :— Entrants 1,459 Second Age Group 1,003 Third Age Group 840 Total 3,302 Number of other Routine Inspections 220 Grand Total 3,522 B.—Other Inspections. Number of Special Inspections and Re-Inspections 24,318 47 TABLE III. BLIND CHILDREN. Not at present time receiving Education suitable for their special needs. At a Public Elementary School. At another Institution. At no School or Institution. Total. — — 1 1 DEAF CHILDREN. Not at present time receiving Education suitable for their special needs. At a Public Elementary School. At another Institution. At no School or Institution. Total. — — 2 2 TABLE IV. Return of Defects Treated during the Year ended 31st December, 1939. TREATMENT TABLE. Group I.—Minor Ailments (excluding Uncleanliness, for which see Table VI). Disease or Defect. Number of Defects treated, or under treatment during the year. Under the Authority's Scheme. Otherwise. Total. (1) (2) (3) (4) Skin:— Ringworm— Scalp:— (i) X-Ray Treatment 3 — 3 (ii) Other Treatment 1 — 1 Ringworm— Body 11 — 11 Scabies 55 3 58 Impetigo 105 — 105 Other skin disease 196 6 201 Minor Eye Defects 318 3 321 (External and other, but excluding cases falling in Group II) Minor Ear Defects 239 8 247 Miscellaneous (e.g., minor injuries, bruises, sores, chilblains, eto.) 1,341 142 1,483 Total 2,269 161 2,430 48 Oroup II.— Defective Vision and Squint (excluding Minor Eye Defects treated us Minor Ailments—Group I). No. of Defects dealt with. Under the Authority's Scheme. Otherwise. . Errors of Refraction (including squint) (Operations for squint should be recorded separately in the body of the School Medical Officer's Report.) New 235 Old 63 4 302 Other defect or disease of the eyes (excluding those recorded in Group I) 41 2 43 Total 339 6 345 Under the Authority's Scheme. Otherwise. Total No. of Children for whom spectacles were— (a) Prescribed 420 4 424 (6) Obtained 416 4 420 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. (1) (2) (3) (4) (6) (i) (ii) (iii) (iv) (i) (ii) (iii) (iv) (i) (ii) (iii) (iv) - 51 — — 8 — 1 — 8 51 1 - 212 272 (i) Tonsils only, (ii) Adenoids only, (iii) Tonsils and Adenoids, (iv) Other defects of the nose and throat. 49 Group IV.— Orthopaedic and Postural Defects. Under the Authority's Scheme. (1) Residential treatment with education. Otherwise. (2) Nonresidential treatment at an orthopaedic clinic. Total number treated. Residential treatment with education. Residential treatment without education. Nonresidential treatment at ail orthopaedic clinic. Residential treatment without education. (i) (ii) (iii) (i) (ii) (iii) Number of Children treated 7 1 221 - - - 229 TABLE V. DENTAL INSPECTION AND TREATMENT. (1) Number of children inspected by the Dentist:— (a) Routine age-groups: Age 5 622 Total 4,610 6 594 7 535 8 259 9 331 10 384 11 328 12 454 13 538 14-16 565 (b) Specials 1,111 (c) Total (Routine and Specials) 5,721 (2) Number found to require treatment 4,682 (3) Number actually treated 3,415 (4) Attendances made by children for treatment 6,717 (5) Half-days devoted to:— Inspection 43 Treatment 1,007 Total 1,050 (6) Fillings:— Permanent teeth 2,846 Temporary teeth 875 Total 3,721 (7) Extractions:— Permanent teeth 1,012 Temporary teeth 4,036 Total 5,048 50 (8) Administrations of general anaesthetics for extractions 2,674 (9) Other operations:— Permanent teeth 1,014 Temporary teeth 136 Total 1,150 TABLE VI. UNCLEANLINESS AND VERMINOUS CONDITIONS. (i.) Average number of visits per school made during the year by the School Nurses 3 (ii.) Total number of examinations of children in the Schools by School Nurses 31,194 (iii.) Number of individual children found unclean 997 (iv.) Number of individual children cleansed under Section 87 (2) and (3) of the Education Act, 1921 - (v.) Number of cases in which legal proceedings were taken:— (a) Under the Education Act, 1921 — (b) Under School Attendance Byelaws — Statement of the Number of Children notified during the Year ended 31st December, 1939, by the Local Education Authority to the Local Mental Deficiency Authority. Total number of children notified, 2. Analysis of the above Total. Diagnosis. Boys. Girls. 1. (i) Children incapable of receiving benefit or further benefit from instruction in a Special School:— (a) Idiots — — (b) Imbeciles — — (c) Others — 2 (ii) Children unable to be instructed in a Special School without detriment to the interests of other children:— (a) Moral Defectives - - (6) Others — — 2. Feeble-minded children notified on leaving a Special School on or before attaining the age of 16 — — 3. Feeble-minded children notified under Article 3, i.e., "special circumstances" cases Note.— No child should be notified under Article 3 until the Board have issued a formal certificate (Form 308M) to the Authority. 4. Children who in addition to being mentally defective were blind or deaf - - Note.— No blind or deaf child should be notified without reference to the Board—see Article 2, proviso (ii). Grand Total — 2 cX