C.I AC 4411 (1) WALTHAM STOW WAL 71 With the Compliments of the Me&ical Officer of Health and School Medical Officer, Borough of Walthamstow. BOROUGH of WALTHAMSTOW EDUCATION COMMITTEE REPORT of the SCHOOL MEDICAL OFFICER for the year 1941 A.T.W. POWELL, M.C. ,M.B., ,B.S. ,D.P.H. - COMTENTS Accommodation 4 After-care 14 Attendance Officers 14 Artificial Light Treatment 11 Aural Clinic 9 Blind School 15 Boot Fund 15 Brookfield Hospital 17 Chicken Pox 11 Child Guidance 17 Clinics 4 Committee 2 Convalescent Home treatment 18 Co-ordination 4 Crippling 10,16 Deaf School 16 Defective children 15 Dental Defects 7 Dental Treatment 10 Diphtheria 11 Diphtheria Immunisation 12 Ear Disease 6,9 Employment of Children 19 Exclusion 12 Eye Disease 6 Following up 7 Health Education 19 Hearing 6,9 Heart Disease 7,10 Hospital Treatment 9 Hygiene 4 Impetigo11 Invalid Children's Aid Assc 14 Infectious Diseases 11 Introduction 2 Meals, Provision of 3,13 Medical Inspections 5 Medical Examinations 19 Measles 11 Medical Treatment 7 Mental Deficiency 17 Milk Meals 3,13 Milk in Schools Scheme 3,13 Minor Ailments 6,7 Mumps 11 N.S.P.C.C 15 Nursery School 18 Nutrition 3,7 Open Air Education 13 " "School 16 Orthopaedic treatment 10,16 Orthoptic Clinic 8,9 Parents, Co-operation of 13 Parents, Payments by 13,18 Physical Training 13 Population 4 Re-inspections 5 Rheumatism 11 Ringworm 11 Scabies 11 Scarlet Fever 11 School Journeys 13 School Camps 13 Secondary Schools 10,18 Skin Diseases 3,6,7 Speech Therapy 17 Staff 4 Special Enquiries 19 Statistical Tables 19 Swimming 13 Teachers, Co-operation of 14 Tonsils and Adenoids 9 Tuberculosis 7,11 Uncleanliness 6 Vaccination 12 Vision 6,8 Voluntary Bodies 14 Whooping Cough 11 1. EDUCATION COMMITTEE. CHAIRMAN: Councillor 3. N. Chaplin. Deputy Chairman: Alderman Mrs. C. McEntee,J.P. His Worshipful the Mayor, Councillor J.H.Williams , J.P. The Deputy Mayor, Councillor R.S.A. Russell, J.P. The Chairman, Finance Committee, Alderman Ross Wyld. Ald. Mrs. L.P. Bailey. Ald. Miss E.M. Praoy. Ald. A. G. Bottomley, O.B.E. Ald. W.H. Shaw. Ald. G. Gibbons, J.P. Goun. F.W. Gentle. Ald. W.B. Fitt. Coun. A.E. Mallett. Ald. Mrs.E.M. Miller. Coun. Mrs. E.A.Smith. Co-optative Members: P.Astin, Esq., J.F.,C.A. Rev: G.W.M.Laurence. J. Owen Clover, Esq., A..J.D. Llewellyn, Esq., Mrs. M. A. Gilman. E.J. Mumford, Esq., S.G.Haskins, Esq., E.C.C. Rt. Rev. Mgr. W.O'Grady, V.G., Director of Education and Chief Executive Officer: E.Gwyn Thomas, B.A., Ph. D. To the Chairman and Members of the WALT HAMSTOW EDUCATION committee Ladies and Gentlemen, I beg to present herewith a report on the work of the School Medical Department during 1941. The war does not appear as yet to have had any obvious effect on the physical and mental welfare of the children and the nutritional level of the previous year has been maintained. The effects of the provision of school meals and milk have been highly beneficial. Cleanliness as revealed by routine head inspection has improved considerably. The increased incidence of scabies has continued. Alterations in the strength of the medical, dental and nursing staff are detailed. In particular the retirement of Dr. Broderick and the resignation of Miss McCabe are to be noted after many years service. The work of the Department has been maintained upon the lines desired by the Board of Education. Again I beg to acknowledge the help of the Committee and the good work of the Staff. I have the honour to be, Your obedient servant A.T.W.POWELL School Medical Officer 3. School Clinics - As for 1939. 1. STAFF OF SCHOOL MEDICAL DEPARTMENT (a) The services of the following were loaned to the areas specified for the period stated- CORNWALL FROM TO Dr. M.C.Clarke, M.B. ,B.Ch. ,B.A.O. Feb: 1941 April 1941 Oct: 1941 Stilla way. RUTLAND Mr. L.W. Elmer, L.D.S. ,R.C.S. (Eng). Sept:l939 Still away. Miss Sanford, Dental attendant. Sept.1939 Still away. (b) Resignations etc,. Date Mr. G.P.L,Taylor, Assistant Dental Surgeon. H.M. Forces 2. 6.41. Dr. D. Broderick, Senior Assistant School Resigned 15. 8.41. Medical Officer. Dr. M. Watkins, Deputy School Medical Assumed Officer. duty. 18. 8.41. Mr. D.M.Cushing, Assistant Dental Surgeon H.M.Forces 21. 6.41. Miss M. McCabe, Supt: School Nurse. Resigned 1.10.41. Miss E. McRaith, Assistant Dental Surgeon. Resigned 27.12.41. 2. CO - ORDINATION As given in the report for 1939. 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 available during 1941:- Boys. Girts. Infants. Fixed. Provided 4 4 17 15 Non-provided - 1 2 3 Special Schools- Mentally Defective - - — 1 Myope Centre - - - 1 Open Air School - - - 1 Totals 4 5 19 21 1941 1940 1939 1938 1937 Number of children on Register, Dec. 31st. 9445 6270 15794 15980 16525 Average At tendance 6659.1 4707.2 13943.4 14282.3 14909.1 Percentage ” 84.5 75.6 88.5 88.8 88.7 Population 109400 109400 130800 131900 131900 Percentage of School children to population. 8.6 5.7 12.07 12.1 12.5 school Hygiene- Mr. Frank H. Heaven, A.R.I.B.A., Architect to the Education Committee, reports as follows Structural additions and alterations - Air raid protection. Additional protection to meet the increase numbers of scholars returning from evacuation areas has been provided at ten schools. An air raid shelter with heat and light has also been provided at the North Walthamstow Schools Sports Field. 4. Heating - Bunkers for reserve stocks of fuel have been erected in order to cope with breakdowns in transport of fuel at peak periods. Improved heating arrangements and boilers have been provided at seven schools. Renovations - Interior renovations have been deferred, but external painting to three schools has been executed. Provision of Meals - Two new central kitchens have been approved, that at Joseph Barrett to provide 350/400 meals per day has been opened and one to cater for 1,000/1,200 meals per day will be completed at Wood Street in the early part of 1942. In order to meet a sudden demand for midday meals and pending completion of the above centres two emergency kitchens were set up. Hot meals are transported to the schools on five days each week. Provision of Milk and Meals - Equipment for the washing of milk mugs and dinner plates etc., have been, or will be, completed in a short while at all school premises. Sanitation. - Minor improvements have been carried out at several schools. Fire Watching.- Suitable arrangements for sleeping, heating and feeding of fire watcher parties have been set up at the school premises. Youth Centres - Three centres for Youth Club activities have been provided at schools and blackout arrangements completed. War Time Nursery - The Open Air School at Walthamstow House has been taken over and is being adapted for this important socialservice. 4. MEDICAL INSPECTION. The following table gives a summary of the returns:- A. Routine Medical Inspections- Entrants 1631 Second age group 546 Third age group 1255 Total 3432 Other routine inspections 157 Grand Total 3589 B. Other Inspections- Number of Special inspections and re-inspections 20457 5. REVIEW OF THE FACTS DISCLOSED BY MEDICAL INSPECTION Classification of the Nutrition of Children Inspected during the year in the routine age groups. No. of Children "A" Exc ellent “B" Normal “C" slightly Subnormal “D” Bad Entrants 1631 167 10.23 1379 84 .54 85 5.21 - _ 2nd Age Group 546 175 32.05 343 62.82. 28 5.10 - — 3rd Age Group 1255 513 40.86 686 54.66 55 4.38 1 0.079 Totals 3432 855 24.91 2408 71.63 168 4.89 1 1.029 Other Routine Inspections. 157 58 36.94 92 58.59 6 3.18 1 0.63 5. The findings may be Show comp ativoly as follows:- A&B. C. D. 1941 95.07 4.89 0.029 1940 95.5 4.67 0.07 (b) Uncleanliness - Ho children were need under arrangements by your Committee, nor were legal proceedings taken. The following table gives comp rative figures for the past two years 1941 1940 Aver: ge number of visits to schools 6 5 Total examinations 24434 16908 Number of individual children found unclean 255 689 Percentege uncleanliness of average attendance 8.8 12. 7 Cases of chrenic uncleanliness are followed up in the home. (c) Minor Ailments and Skin Defects- The following is the number of skin defects found to require treatment- 1941 1940. Ringworm - Head 3 2 Body 8 8 Scablies 145 55 Impetigo 61 47 Other skin diseases 220 133 Total. 437 245 (d) Visual Defects and External Eye Diseases:- The number of patients requiring treatment and observation was as follows:- 1941 1940. Treat ment. Observation Treat ment. Observation. Visual defects 182 78 58 3 Squint 7 20 - External Eye Disease 153 4 151 - (e) Nose and Throat Defects:- The number of patients requiring: treatment and observation was as follows:- 1941. 1940. Treat ment. Observetion Treat ment . Observation. Chronic Tonsillitis 135 236 91 48 Adenoids only 15 7 4 - Chronic Tonsillitis and Adenoids. 21 14 13 - Other conditions 167 - 152 - The 167 cases of other conditions are made up of sore throats and defects requiring diastello treatment. (f) Jar Disease and Defective Hearing- Patients requiring treatment- 1941 1940. Defective Hearing 11 11 Otitis Medies. 17 85 Other Ear Disease 7 2 6. (g) Dental Defects - Inspec -tion Requiring Treatment . Per Cent Actually Treated Fill ings Extract ions. General Anaesth etics. Other Operations. 1941 7542 5230 69.3 2382 4361 2947 1348 1686 1940 8793 7371 83.8 2945 5086 3387 1690 1592 (i) Heart Disease & Rheumatism - The findings were as follows:- 1941 1940 Treat ment Observation Treat ment Observation Heart Disease - Organic 15 6 14 1 Functional. 10 9 7 1 Anaemia 28 8 26 - (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 to require treatment:- Enlarged Glands 39 Speech 50 Bronchitis 64 Epilepsy 4 Chorea 3 Other defects 688 6. FOLLOWING UP. The school nurses paid a total of 3307 home visits during 1941. 7, ARRANGEMENTS FOR TREATMENT. (a) Nutrition - Treatment facilities as in 1939. The following shows the quantities of tonics supplied during 1941- Cod Liver Oil Parrish's Food Syrup Lacto Phosphate Cod Liver Oil and Malt Cod Liver Oil &Malt & Parrish's 31 lbs. 83lbs. 30½1bs. 697lbs. 821lbs. (b) Uncleanliness. Facilities as for 1939. (c) Minor Ailments and Diseases of the Skin:- Treatment facilities as for 1939. The work done at the school clinics is shown on the table given below Conditions FIRST INSPECTIONS ReInspections Number excluded under Art. 20 B Number not Excluded Boys Girls Boys Girls Boys Girls Ringworm 1 1 3 4 1 4 Scabies 64 55 1 3 327 395 Rheumatism - — 35 41 88 130 Impetigo, Sores etc 36 17 50 36 376 196 Skin 24 30 40 61 142 181 Verminous Head etc. 5 71 12 106 34 488 Sore Throat 11 14 2 6 6 19 1 Reference to dental inspection and treatment at Secondary and Technical schools is made in Section 16. (h) Orthopaedic & Postural Defects - A total of 81 deformities was found to require treatment. Clinic Table continued. FIRST INSPECTIONS Number excluded under Art.20 B. Number not Excluded Re- inspections Boys 3 Girls Boys Girls Boys Girls Discharging Ears — - 144 104 389 27 5 Defective Vision - - 18 24 — 2 External Eye Disease 11 23 41 46 176 289 Humps 1 1 - - - - Tonsils & Adenoids - - 14 5 — - Various 82 105 378 378 1740 1470 Totals 235 317 748 814 3279 3449 Number of children seen at first inspection 8114 Number of children sent by Attendance Officers 93 Number of attendances made by children 8842 Number of children sent by Head Teachers 2021 2021 Number of swabs.be taken 87 Number operated on for Tonsils and Adenoid 7 Number of children seen by Ophthalmic Surgeon - New cases 362 Prescribed for 306 Total inspections 1521 First attendances numbered 8114 against 1386 in 1940, and re-attendances 6728 against 3014, the total attendances being 8842 against 4400. (d) Visual Defects and External Eye Disease. Treatment for the latter is given at the school clinics. Dr. Sheppard has kindly contributed the following account of the Work done during 1941 "I am sure your Committee will be pleased at the way the children have attended the eye clinic during 1941. "There were 1712 attendances at the eye clinic during the year. 460 of these were submitted to retinoscopy, 362 being new cases. The following table shows the defects found in the new cases seen Under 7 yrs 7-11 yrs Over 11 yrs Secondary Schools Totals Bys Gls Bys Gls Bys Gls Bys Gls Bys Gls Hypermet ropia 16 12 12 16 8 5 - 3 36 36 Hypermetropic Astigmatism 7 7 21 22 8 2,2 1 4 37 55 Myopic Astigmatism 1 1 3 4 7 3 1 8 12 16 Mixed Astigmatism - - 5 4 5 5 1 1 11 10 Myopia - 2 4 6 20 14 3 10 27 32 Various 29 14 15 10 12 9 - 1 56 34 Totals 53 36 60 62. 60 58 6 27 179 183 The details of the group described as various are as follows - \ Defects Boys Girls Total Squints 33 18 51 Headache, anaemia, styes, debility. 16 13 2.9 Nystagmus 1 - 1 Cataracts 2 - 2 No visual defect - 7 7 The Orthoptist has continued her work during the year with excellent results." 8. The following report on the work of the Orthoptic Clinic has been given by Miss G.H.Montague-Smith , Orthoptist "The children attended well apart from the first two months of the year with the following results Number of new cases 27 Number of attendances made 958 Failed to attend 3 Transferred 1 Unsuitable for orthoptics 1 Under observation 6 Cases treated with orthoptic exercises - Discharged - Cured 6 Cosmetic 3 - 11 Unresponsive 2 Rest from treatment 5 Still on treatment 10 Waiting list 1 (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 Frivately Total 1941 5 4 9 1940 14 3 17 (f) Ear Disease and Defective Hearing. Ear Clinic - Dr. Francis Clarke reports as follows "The work of the aural clinic has been carried on without interruption during the year and the attendance has been uniformly good at the usual weekly session. It is noted that a fairly considerable number of children seen at the weekly Consultation clinics and referred for treatment to the Treatment clinics during the week, have "lapsed" and did not complete the full course of treatment prescribed. A number of these no doubt, has been due to evacuation, change of residence and in some cases the parents have not been able to take the younger children for regular treatment as they are at work during the day. "A special "Follow-up" is being trade during the ensuing year to find out this present condition and make further appointments for their treatment at the clinic. A good many more cases of tonsil suction treatment have been done during the past-year. In all, 37 cases were treated by the suction method with very satisfactory results. This is an excellent method of treating unhealthy tonsils in suitable cases, and obviates the necessity for operation in the large majority. Seventy cases were referred for operation out of 90 examined. In these instances the tonsils were very "greatly hypertrophied and accompanied by large adenoid masses which required removal, or were badly diseased and acutely septic, or symptoms of acute rheumatism v?ere beginning to develop; and in some instances the children were too young and nervous to have suction treatment. We are steadily increasing the number being treated by suction. The majority of the parents are satisfied and report favorably on the quiescence of the symptoms. It is satisfactory to report that out of the 362 cases seen st the clinic for the year only 49 were cases of chronic otorrhoea and 15 of these were old' cases where a mastoid operation had already been done. 31 of the 49 were discharged cured. 9. The welcome fall in the relative numbers of chronic otorrhoea cases now seen is no doubt due to the early detection and treatment of acute and incipient instances of otitis, more especially amongst pre-school children, and also to the treatment of pre-disposing factors in the nose and throat. 183 cases of diseased nose and throat conditions alone were seen during the year. Zinc ionisation has been used as the main treatment of chronic otorrhoea with very satisfactory results. Proetz method of sinus displacement has been used where pus or muco pus has been suspected in the sinuses. It is a sound and reliable method and well tolerated by even quite young children. For nasal catarrh, rhinitis, deafness due to' catarrh etc., diastolisation has been the chief method employed. In a certain number of suitable cases of rhinitis the Argyrol Pack method has been used satisfactorily. Dmphasis is laid on the necessity of the early detection and treatment of any diseased or incipient conditions in the ear, nose or throat of young, especially pre-school, children, and their steadily increasing number at the clinic is a great advance in this direction. It no doubt entails a good deal of inconvenience for the mothers when treatment at the clinic is necessary, but in a large number of cases the treatment can be carried out at home under suitable directions and the child kept under observation at regular intervals. The increased modern facilities provided at this new clinic in the Town Hall have helped very materially in the successful working of the clinic. On the whole, we have not noticed that war conditions have affected the general health, nutrition, morale, or nervous conditions of the children." (g) Dental Defects - Treatment of Secondary and Technical Pupils The work done for the Essex County Council is shown below and is not included in Table IV at the end of the report. INSPECTIONS 11 Yrs. 12 yrs 13 yrs 14 yrs 15 yrs 16 yrs Total No. offered treatment % Requiring treatment 162 126 210 138 63 10 709 381 53.7 TREATMENT No. of Children Attend ances. Extractions Temp. Teeth Perm. Teeth. Anaesthetics. Local General Fillings Perm. Teeth Other Operations . Perm. Teeth 189 517 - 73 - 61 436 151 (h) Orthopaedic and Postural Defects. Details of the work done under the scheme are given in the section dealing with Defective children. (i) Heart Disease and Rheumatism. Dr. Sheldon contributes the following report on the work of the Rheumatism Clinic during 1941:- 10. RHEUMATISM CLINIC 1941 Number of sessions 24 " " attendances 278 " " new cases 81 " " old cases 197 discharged 58 " still under treatment 86 " of new cases with rheumatic or cardiac defect 5 " referred to hospital as In-patient - " " " " " Out-patient 14 " " for tonsils and adenoids operation 14 " " " dental treatment 7 " " to Physically Defective Centre 1 excluded from school 4 " " half time school 1 " " from games and exercises 5 " to begin games and exercises 3 " seen after scarlet fever 2 " seen after Diphtheria 3 " referred for convalescent home treatment 15 sent away 15 " referred to Open Air School 1 (j) Tuberculosis. The number of school children examined during the year was boys 44 and girls 45, of which 4 boys and 9 girls were referred by the school medical staff. 16 of the cases were sent by private practitioners, end 60 were examined as contacts. At the end of the year the live register of notified cases of school age was - Pulmonary 21, Non-pulmonary 30. (k) Artificial Sunlight Treatment. as for 1940. 8. INFECTIOUS DISEASES. Notification in the 5-15 years age group during 194}. was as follows (1940 cases, shown in parenthesis) - scarlet fever 62 (49) diphtheria 17 (6), Pneumonia ]6 (4), erysipelas 1 (nil), cerebro spinal meningitis 5(2), measles 611 (28), whooping cough 171 (4). The last two named diseases were made notifiable in October 1939. Among the cases discovered by the medical staff and included above were scarlet fever 1, non-clinical diphtheria 1. Non-notifiable infectious diseases 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 Chicken Pox Ringworm & Scabies Impetigo Sores etc January - 75 - 7 8 1 - February - 30 15 - 1 - 1 March - 20 1 4 - - 3 Apri1 - 240 3 1 5 - 1 . May 2 347 50 6 1 3 3 June — 76 62 - 3 - 2 July — 4 61 - — 1 1 August - - - - - - September 1 - 50 1 1 1 5 October - 1 51 1 - - 2 November - - 47 9 - - 2 December - — 26 - 2 8 2 Total 3 793 366 29 21 14 22 The following are the weekly average numbers of children away from school owing to exclusions and the non-notifiable infectious 11. and other diseases named :- Exclu sions Chicken Pox Meas les. Whoop -ins Courh Sore Throat Influ enza. Diar: Mbs . Scab les. Various Total 1941 16 6 81 89 13 44 2 7 10 251 519 1940 9 25 24 2 10 6 - - 3 211 292 Infectious Disease Clinic - Follow up arrangements as detailed in 1939 report. The following table shows the work done at the infectious disease clinic No. of clinics held in connection with Infectious Diseases and immunisation 51 Number of attendances made 2357 Average attendances per session 46.2 No. of children recommended to rheumatism clinic. 3 Number of children recommended to Ear Clinic 4 Diphtheria Immunisation Immunisation was carried out at the weekly clinic on Tuesdays, and also at all Departments in the schools The following summarises the work done- . Total number of immunisations completed during 1941- School age 1200 Pre-school age 755 Over school age 16 1971 Number not completing immunisation or left district 126 Number found pre-Schick negative 16 Number of posterior Schicks 16 Number of attendances made at Clinic for immunisation 2046 Number of typhoid inoculations given 50 Immunisation at schools (included above) Number completely immunised 1148 Number partly immunised 66 Number having extra dose immunised in previous years. 438 Vaccination - The vaccinal condition of each child examined at routine medical inspection was noted, and a summary shows the following Number Examined No,found to be vaccinated Percentage Vaccinated Entrants Boys. 800 144 18.0 Girls. 831 120 14.4 2nd Age Group Boys. 262 64 24.4 Girls. 284 44 15.4 3rd Age Group Boys. 666 131 19.6 Girls. 589 118 13.7 Total 3432 621 18.0 Action under Article 20(b) (Exclusion of individual children) At Medical Inspection 19 At School Clinics 552 Action under Article 22 (School closure) Nil Action under Article 23(b) (i.e., attendance below 60% of number on Register) Not operative. 12. 9. 0PEN AIR EDUCATION. school Journeys and Scliool Camps- There were none during- thus year. Swimming- Swimming instruction was given throughout the week to boys & girls 10. PHYSICAL TRAINING. The following is extracted from a report made by the organiser of Physical Education to your Director of Education:- "Vital capacity tests using a spirometer and carried out by Senior school boys compared very favorably v?ith the results of similar tests by secondary school boys in the Midlands and fourth year Central school boys gained an average of 46.8% compared with 34% by A.T.C. cadets in a series of Rfficiency Tests. Much more could be attempted on the above lines to stimulate in our pupils a high regard for personal fitness, cleanliness and general efficiency. "Full advantage was immediately taken of the completion of the air-raid shelter at the North Walthamstow ground in September, to provide a weekly games period for over seven hundred children from seven schools at this valuable field. Good use has also been made of playing pitches and tennis ???curts at Lloyd Park; the programme of school visits to St. James' Park has been somewhat curtailed by difficulties of maintenance. Youth organisations and Civil Defence Units have made good use of the excellent facilities at the Salisbury Hall playing field which, with the loss of Low Hall Farm and the Chestnuts grounds, has become firmly established as the only Centre for games and athletics for our Youth. 11, PROVISION OF MEALS. I; School Heals. The following details are extracted from a report made to the Education Committee by the Director of Education:- Meals supplied during week ended 31st October 1941 - 8450 at 16 centres (excluding staff meals). Meals were cooked at the Central Kitchen, Open ???School, Wm. Morris School, and Chapel and and Joseph Barrett Domestic science rooms. Future plans then included the opening of the dining room at Maynard Rd school, and completion of solid fuel kitchens at Joseph Barrett and wood st. myope Schools, providing approximately 1300 meals daily. Charges made to parents were determined by the Committee's scale of necessity, the maximum charge being 5d per meal. The number of meals provided was 171,852 as compared with 25,042 during 1940. (2) Milk Meals. 479.360 milk meals were supplied to children on medical grounds on the recommendation of the medical staff. The number of meals supplied during the preceding year was 486,188. (3) Milk in Schools scheme. The arrangements detailed in former reports were continued in 1941, all the milk supplied being pasteurised milk sold license. During the school vacations Centres were opened for the supply of milk meals. The number supplied was as follows Voluntary Official Total Easter 3971 3398 7369 Whitsun 4500 2403 6903 Summer 28872 10020 38892 Christmas 17946 4152 22098 12 (a) CO-OPERATION OF PARENTS The following table shows the attendance of parents during 1941:- Boys. Number Inspected. No. of Parents Percent 1941 Percent 1940 Entrants 800 732 91.5 88.9 2nd Age group 262 186 70.9 88.5 3rd age group 666 226 33.8 54.2 Total. 1728 1144 66.2 81.7 13. GIRLS No. Inspected No. of Parents Percent 1941 Percent 1940 Entrants 831 766 92.1 92 .2 2nd Age Group 284 236 83.0 64.9 3rd Age Group 589 316 53.6 58.6 Totals 1704 1318 77.3 81.0 Grand Total 3432 2462 71.1 81.3 12 (b ) . CO-OPERATION OF TEACHERS. As for 1940. (c). CO-OPERATION OF SCHOOL ATTENDANCE OFFICERS. As for 1940. (d). CO-OPERATION OF VOLUNTARY BODIES. (a) The Invalid Children's Aid Association - Miss Lewis, the Secretary, has kindly contributed the following report "Convalescent Home Treatment, which in the last decade, had soared to an average between two and three hundred a year, was maintained at the low figure reached in 1940, namely 53 cases. Of these, 9 were under 5, a figure which has not varied for two or three years, and which is very low considering that the under 5 population has not evacuated to any considerable extent. 15 were sent away from Dr. Sheldon's clinic but only two of these are registered here as rheumatic. "There is a dearth of beds available owing to the closure of. the coastal homes and as the year advances, children may have to wait too long for vacancies. A renewal of the policy of reserved beds might come me as a recommendation from my Committee later on." "New cases (in addition to re-applications) were referred by:- Over 5 yrs. Under 5 yrs Tuberculosis Dispensary 1 - Medical Men, Hospitals and Dispensaries 29 24 Medical Officer of Health and Infant Welfare Centres - 2 Education Committees and School Medical Officers 9 - Local Authorities under schemes for (i) Rheumatism 16 - ( ii)Orthopaedic care 5 11 Invalid Children's Aid Association 2 1 Totals 62 38 Classification of cases:- Tubercular Glands 1 - Anaemia and debility 18 1 After Infectious illness 5 3 " acute illness 2 - Marasmus and Malnutrition 2 2 Rheumatism, Chorea and Heart 4 - Heart (congenital) 1 - Diseases of lungs (non T.B.) (a) Bronchitis, Pneumonia etc 12 7 (b) Asthm 3 1 Glands (Non-tubercular) 2 Diseases of bones (non T.B.) 5 14 Diseases of digestive organs 1 - Paralysis 1 1 Nervous conditions 2 Congenital deformities 2 3 Accidents - 1 Air raids 1 - Various - 5 14 "Help- giren to old new cases (all ages) Old New Sent to Special Hospitals and to Convalescent Homes... 44 9 Extension from previous years 23 Provided with surgical boots and appliances 22 24 Average length of stay in Convalescent Home 19 6/7 weeks Children sent away from Rheumatism Clinic 15 (b) National Society for the Prevent ion of Cruelty to Children - The following is a summary of the work done in Walthamstow during 1941 Nature of Offence How dealt with Neglect 13 Warned or advised 15 Advice sought 2 Otherwise dealt with 1 Illtreatment 1 16 16 Number of children dealt with over five years of age, Boys 9, Girls 5. Number of children under 5 years of age 19. 76 supervisory visits were made during the year, and 58 miscellaneous visits were made. Enquiries made for other branches 9 (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 1941 "During the 12 months ended 31st December 1941, approximately only 300 pairs of boots have been distributed at a cost of £150. Although the number of children in the Borough has increased during the year owing to return from the reception areas, the number of parents eligible for free footwear has materially decreased, presumably owing to the number of parents employed in war work, and the increased parental income. 13. BLIND, DEAF, DEFECTIVE AND EPILEPTIC CHILDREN. (i) Blind School - The following table shows the classification of children attending school at the end of 1941:- Waltham stow Blind Partially Blind Boys - 12 lx Girls - 9 Evacuated to Hutton L.C .C .Residential School Boys - - Girls - 4 x One boy attending from Chingford. The Head Teacher, Miss M.L. Balls has kindly sent the following report:- "During the year 1941, the children of the Myope Centre were again accommodated at the Hale End Road Open Air School. At the same time many of the children remained in the Country with relatives to whom they had evacuated, while six children stayed at the Hutton Residential school to which they had been evacuated in September 1939, under the Government Scheme. The work of the Myope school was carried out as normally as possible under the restricted conditions prevailing at the Open Air School. » Dr. Sheppard has been assiduous in the care of the children's eyes both at Hutton and at the Hale End Road School. During the year two boys and two girls left school. They are all in suitable employment. 15. One boy is packing and despatching shoes in a shoe factory and one is working in a tool making factory. Both girls found employment as shop assistants at the Co-operative Stores. (ii) Deaf School. This school has been evacuated since the outbreak of war. (iii) Open Air School. Miss Thompson, the Head Teacher, reports as follows:- "During the year the numbers have increased almost to capacity of the classrooms at the disposal of this school, and very good progress in health has been made in nearly every case. Both day and night raids have been absent several months. Some asthma cases ere being treated in the clinic. At the end of the year there were in attendance 16 orthopaedic, 3 cardiac and 27 debilitated children'.' (iv) Orthopaedic Scheme. 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 clinic:- ORTHOPAEDIC SCHlME BOYS GIRLS 5-16 yrs Under 5 vrs Over 16 yrs 5-16 yrs Under 5 yrs Over 16 yrs Anterior Poliomyelitis 12 1 2 8 1 10 Scoliosis, Kyphosis Lordosis 5 - - 13 - - Surgical Tuberculosis 4 - 1 2 — — Rickets- (a) Genu Varum . 4 30 - 1 15 — (b) Genu Valgum 14 21 - 7 22 - Pes Planc Valgus 119 21 1 50 10 - Spastic Paralysis 10 2 - 3 1 1 Arthritis 2 1 1 2 - 2 Talipes:- (a) Equino Varus 11 2 1 5 6 - (b) Equino Valgus - - - - 2 - (c ) Pes Cavus 1 - - 1 1 - (d) Caicaneo Valgus - 1 - - 2 - Torticollis 1 3 - 4 4 2 Ataxia 1 - - - - 1 Osteomyelitis - - 1 1 - Amputation of leg - - 1 - - Congenital dislocation of hip - 6 1 - Hallux Valgus 1 - - 9 - - Hammer Toe 1 - - 2 - - Petthe's disease — - - 2 - - Frieberg's " 1 - - 2 - - Oilier's " - - - - 2 - Kohler's " - - - 1 - - Spina Bifida 1 - - - - - Congenital defects 11 4 - 10 6 — Asthma 5 - - 2 - - Miscellaneous 4 6 1 8 4 - Totals 208 92 8 140 75 14 Number of cases seen by Surgeon- From Physically Defective School 26 From other schools 117 Over school age 24 Under school age 86 Total 253 16. New cases seen by Surgeon:- School age 63 Under school age 67 Total 130 Total number of examinations by Surgeon 383 Total number of cases discharged by Surgeon 37 Average number of examinations made per session 38.3 Number of attendances for orthopaedic & massage treatment 2436 Average number of attendances per session 5.5 Number of sessions held - Inspection 10 Treatment 439 Total number of visits by instrument maker 14 Number of children known to be evacuated 99 Defects seen at Orthopaedic Clinic in Children under 5 years of age Anterior Poliomyelitis 2 Rickets - (a) Genu Vargum 43 (b) Genu Valgum 43 Pes Piano Valgus 31 Spastic Paralysis 3 Talipes 14 Torticollis 7 Congenital dislocation of Hip 1 Congenital defects 10 Miscellaneous 10 Arthritis 1 Oilier's disease 2 (v) Brookfield Orthopaedic Hospital:- This hospital has been closed since the outbreak of war. (vi) Mental Deficiency Ascertainment - Ascertainment has proceeded along the lines detailed in previous years. 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 8 Mentally Deficient 9 Feeble Minded 1 Imbecile 3 Border line cases 2 (vii) Child Guidance - 3 cases were referred during 1941. (viii) Speech Therapy - Miss I.M.S.Knight, Speech Therapist reports as follows "Re-organisation of the speech therapy classes commenced just previous to Easter 1941, and shortly after Easter classes were started, but it was not until September 1941 that each Centre became properly organised. The list of Centres is as follows - St. Mary's R.C., Hale End Open Air School, Thorpe Hall Infants, Queen's Road Infants, Markhouse Road, Maynard Road, Roger Ascham, Chapel End, Higham Hill and Handsworth Avenue Schools and William Morris Deaf Centre. At each Centre the children from the nearest schools are expected to attend. This method is working well and I have found the close contact with Head Teachers and Teachers most helpful and the attendance of the children is certainly better. Classes with the present method in progress must of necessity be of shorter duration and each child can only be seen once each week instead of twice, as it was before the war. The parents co-operate well after reassurance that a child recommended for 17. speech therapy is not necessarily considered to be of low mentality. Parents are. encouraged to visit the clinic and watch a lessen in progress. The numbers attending have risen from 42 at the beginning to 111 on the 31st January 1942, and on the whole, results have been satisfactory. A trial with relaxation treatment for a number of children considered by the Head Teacher of one of our schools to be suffering in some way from nervousness has been in progress since 33.10.41. Here I have discussed certain childish fears with the group from time to time, including at the request of the children, the bombing of London 1940-41. I believe as far as possible the children got rid of many inhibitions during these talks. Their confidence grew so they discussed quite freely their fears and inhibitions. Group work of this kind can be of infinite value and much so called naughtiness re-directed into useful channels" Convalescent Home Treatment - 53 children were sent eway for treatment during 1941. There were 23 remaining in convalescent homes and hospital schools on December 31st 1941. The conditions for which children were sent included the following - Debility and. Anaemia 17, Heart and Rheumatism 5, Malnutrition 3, Bronchitis 10, Asthma 2, Nervousness 1, after infections illness 6, Air Raid injury 1, Various 6. A total of 15 children were sent to convelesosent homes or heart homes from the rheumatism clinic. The average length of stay in all homes has been 19 6/7 weeks. 14. FULL TIME COURSES OF HIGHER EDUCATION FOR BLIND, DSAF, DEFECTIVE & EPILEPTIC STULERTS. The .authority for the provision of such courses is the Essex County Counoil. 15. NURSERY SCHOOL This school has been evacuated since the outbreak of war. 16. SECONDARY SCHOOLS The Authority for the provision of Secondary Schools in Walthamstow is the Essex County Council. (a) Dental Inspection & Treatment - Reference has been made in Section 7 (g) to the dental inspections and treatment of pupils attending Secondary and Technical Schools. (b) The following table shows the findings at Medical Inspection Number inspected- Entrants 167 474 12 years old 176 15 years old 131 Parents present 293 Number referred for treatment (excluding dental and uncleanliness) 105 Number referred for observation 42 Number referred for treatment (excluding vision, dental and uncleanliness.) 85 Nutrition A. 188 B. 267 C. 19 D. - 18. Defects Requiring Treatment Requiring Observation Skin 16 - External Eye Disease- Blepharitis 6 - Conjunctivitis 3 - Defective Vision 6 - Ear Defects - Deafness 15 3 Otitis Media 1 - Nose and Throat- Enlarged Tonsils - 12 “ “ & Adenoids 1 10 Other conditions 1 1 Speech 1 - Teeth 9 - Heart - Organic 1 — Functional 1 5 Anaemia 1 Rheumatism — 2 Lungs - Other conditions (non-T.B). 1 1 Chorea - 1 Spinal Curvature 3 — Other forms of deformities 45 1 Other diseases and defects 15 6 17 PARENTS PAYMENTS The approved scales for the recovery of fees in respect of treatment is the same as given in the 1938 report. 18 HEALTH EDUCATION As for 1938. 19 SPECIAL INQUIRIES As for 1938. 20 MISCELLANEOUS (i) Employment of Children. 57 children wre examined by the medical staff. All were passed fit for employment. (ii) Employment of Children in Public Entertainments. No children were examined under these regulations. (iii) Medical Examinations. The following examinations were made during 1941 by the medical staff Teachers Others 21 STATISTICAL TABLES. The statistical tables required by the Board of Education follow:- TABLE I Medical inspections of children attending Elementary schools. A. Routine Inspections. Number of inspections in the prescribed groups Entrants 1631 Second age group 546 Third age group 1255 Total 3432 Number of other routine inspections 157 Grand total 3589 B. Other Inspections. Number of special inspections and re-inspections 20457 19. TABLE II. Classification of the Nutrition of Children Inspected during the year in the Routine Age Groups No. or children inspected A B C D Excellent Normal Slightly sub-normal Bad No. % No. % No % No. % 3432 855 24.91 2408 71. 63 168 4.89 1 0.029 TABLE III. Group I. Treatment of Minor Ailments (excluding uncleanliness, for which see Table V). Total number of defects treated or under treatment during the year under the Authority's scheme 1920 Group II. Treatment of Defective Vision and Squint (excluding Minor Eye defects treated as Minor Ailments - group 1). Errors of Refraction (including squint) Other Defects or disease of the eyes. Number of children for whom spectacles were - Pre sc ri b ed Obtained 323 39 306 306 Group III. Treatment of Defects of Nose and Throat. Received Operative Treatment Received other forms of treatment. Total 5 164 169 TABLE IV Dental Inspection and Treatment. (i) Number of children inspected by the Dentists (a) Routine age groups. Age 5 yrs. 6. yrs. 7 yrs. 8 yrs. 9 yrs. 10 yrs. 11 yrs. 12 yrs. 13 yrs. 14 yrs. 15 yrs. Total 722 756 744 744 715 723 759 703 769 191 40 6896 (b) Specials 646 (c) Total (routine & specials) 7542 (2) Number found to require treatment 5230 (3) Number actually treated 2382 (4) Attendances made by children for treatment 6235 (5) Half days devoted to (7) Extractions Inspection 59 Permanent teeth 500 Treatment 1003 Temporary teeth 2447 (6) Fillings (8) Administrations of general annaesthetics for Permanent teeth 1979 extractions 1348 Temporary teeth 2382 (9) Other Operations Permanent teeth. 979 Temporary teeth. 707 20 TABLE V VERMINOUS CONDITIONS Average number of visits per school made during the year by the school nurses 6 Total number of examinations of children in the schools by the school nurses 24434 Number of individual children found unclean 595 TABLE VI BLIND AND DEAF CHILDREN Number of totally or almost totally blind and deaf children who are NOT at the present time receiving education suitable for their special needs Blind, Nil. Deaf, S. MENTALLY DEFECTIVE CHILDREN Total number of children notified during the year ended 31st December 1941, by the local Education Authority to the Local Mental Deficiency Authority, under the Mental Deficiency (Notification of Children) Regulations, 1928 9 21. .