WAL 72. With the Compliments of the Medical Officer of Health and School Medical Officer, Borough of Walthamstow. BOROUGH 07 WALTH&MSTOW EDUCATION COMMITTEE REPORT of the SCHOOL MEDICAL OFFICER for the year 1942 A.T.W.POWELL, M.C.,M.B.,B.S,D.P.H. CONTENTS Accommodation 4 After care 13 Attendance Officers 13 Artificial Light Treatment 16 Aural Clinic 9 Blind School 14 Boot Fund 14 Brookfield Hospital 16 Chicken Pox 11 Child Guidance 17 Clinics 4 Committee 2 Convalescent Home treatment 17 Co-ordination 4 Crippling 6, 10 Deaf School 15 Defective children 14 Dental Defects 6,10 Dental Treatment 6, 10 Diphtheria 11 Diphtheria Immunisation 11 Ear Disease.6, 9 Employment of Children 18 Exclusion 11,12 Eye Disease 6, 8 Following up 7 Health Education 18 Hearing 6, 9 Heart Disease 10 Hospital Treatment 9 Hygiene 4 Impetigo 11 Invalid Children's Aid Assc: 13 Infectious Diseases 10 Introduction 3 Meals, Provision of 12 Medical Inspections 5 Medical Examinations 18 Measles 11 Medical Treatment 7 Mental Deficiency 16 Milk Meals 12 Milk in Schools Scheme 12 Minor Ailments. 6, 7 Mumps 11 N.S.???.C.C 14 Nursery School 14 Nutrition 5, 7 Open Air Education 12 " " School 15 Orthopaedic treatment 6.10,15 Orthoptic Clinic 8 Parents, Co-operation of 13 Parents, Payments by 10 Population 4 Re-inspections 5 Rheumatism.7., 10 Ringworm 11 Scabies 11 Scarlet Fever 11 School Journeys 12 School Camps 12 Secondary Schools 17 Skin Diseases 6 Speech Therapy 17 Staff 4 Special Inquiries 10 Statistical Tables 18 Sunlight' Treatment 10,16 Swimming 12 Teachers, Co-operation of 13 Tonsils and denoids 6, 9 Tuberculosis 7,10 Uncleanliness 5 Vaccination 12 Vision 6, 8 Voluntary Bodies 13 Whooping Cough 11 1. EDUCaTION committee CHAIRMAN: Councillor S. N'. Chaplin. Deputy Chairman: Alderman Mrs. C. Mc???ntee, J.P. Tie Worshipful the Mayor, Aid: Mrs. E.M.Richards, j.P. The Deputy Mayor, Councillor .T.H.Williams, J.P. The Chairman, Finance Cormrittc. , Alderman Ross Wyld. Aid. Mrs. L. P.Bailey. Coun: F. .Gentle Aid. A.G. Bottomley, O.B.E. Coun: E. Mellett Aid. w.B.Fitt Coun: A.E.Manning Aild. Mrs. S.M.Miller Coun: R.V.a.Russell Aid. Miss E.M.Iracey, B.Sc: Coun: Mrs. E.A.Smith Aid: ???. H.Shaw. Co- optative Members I.Astin, Esq: J.P. Mrs. E.A.Lowton Rev: Clifford Barrett A.J.D.Llewellyn, Isq: Mrs. M. A. Gilman. Rev: J.E.McKinley. S.C-.Haskins, Esq: E.J. Mumford, Esq: Rev: G.W.M.Laurence. Rt. Rev. Mgr.W. O'Grady, V.G. Director of Education and Chief Executive Officer. E.Gvvyn Thomas, B.A., Th.3. 2. To the Chairman and Members of the WALTHAMSTOW EDUCATION COMMITTEE Ladies and Gentlemen,, I present herewith a report on the work of the School Medical Department during 1942. The physical and mental well-being of the children again shows no obvious deterioration due to war conditions. The expansion of the school meals scheme has unouestionably helped in maintaining nutrition. Uncleanliness decreased slightly but scabies increased. Treatment facilities became available in the autumn. Facilities for artificial, sunlight treatment were made available at the Orthopaedic clinic. Staff changes were frequent amongst the medical and dental staffs. Your consideration and the Work of the staff were again appreciated. 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 perio^ stated - CORNWALL FROM TO Dr. M. C. Clarke, M.B. .B.Ch. ,B.A.O. Oct: 1941 21.9.41 RUTLAND Mr. L. 17. Elmer, L.D.S., R.C.S. (Eng) Miss Sandford, Dental attendant. Sept: 1939. Sept: 1939. 2.2.8,4??? 22.8.4??? (b) Resignations etc., Dr. M. Watkins, Deputy School Medical Officer. H.M,Forces 20.3.42. Dr. H. Brodie, Temporary Deputy School Assumed duty 2.3.42. Medical Officer. Resigned 1.9.42. Dr. J. H. Crichton, Temporary Deputy School Assumed duty 14.9.42. Medical Officer Resigned 14.12,42 2. C 0 - ORDT NAT I ON - As given in report for 1939. 3. THE SCHOOL MEDICAL SERVICE IN RELATION TO PUBLIC ELEBEITTAEY??? SCHOOLS. School Hygiene and Accommodation:- The following table shows the number of schools in the Borough available during 1942:- Boys. Girls . Infan ts . Mixed. I rovided 4 5 17 16 Non-provided. - 1 2 3 Special Schools - Mentally Defective - - - 1 Myope Centre - - - 1 Open Air School - — 1 Totals 4 6 19 22 1942 1941 1940 1939 1938 Number of children on Register, Dec. 31st 11675 944 5 6270 15794 15980 Ave rage Attendance 9610. 2 6659.1 4707.2 13943.4 11282.3 Percentage " 83.4 84.5 75.6 88.5 88.8 Population 94170 1094 1094.00 130800 131900 Percentage of School children to population 12,3 8.6 5.7 12.07 12.1 School Hygiene - Mr. Frank H. Heaven, . A.R.I.B.A., Architect to the Education Committee, reports as follows “Most of the school premises used for storage of furniture of homeless people have no been released, fumigated and restored to educational purposes. "Additional protection to provioie for scholars returning from reception areas has been erected at sixteen schools. n air raid shelter has also been built at the Salisbury Hall Schools playing, fie1d. 4. "School premises have been maintained in repair within imposed limits of expenditure. Four classrooms at the ood Street Girls school are being reconditioned after fire in order to meet the need for additional accommodation. II unnual painting work has been deferred, except in rooms restored to teaching purposes and the Good Street Central Fitchen. "Nineteen school areas have been repaired or re-surfaced. "The Central kitchen at Wood Street was opened on the 14th August, that at Joseph Barrett on the 19th January, and those at Chapel End, Pretoria Avenue and wm. Morris Schools have been equipped with additional apparatus to meet with increased needs, and with blackout shutters in order to allow of work being carried on at full capacity. "Dining Centres have been opened at seven additional schools. "New lavatory basins with improved cold and hot water supplies have been fitted at certain schools and a new effluent drain arranged at the Grange Nursery School, E& rnham Common. "Bunkers for reserved stocks of fuel have been added at three schools. A number of new boilers and additions to existing boilers have been fitted with consequent improvement in the heating of the school concerned. Some defective lighting services have been renewed. "Owing to war restrictions, economies in the lighting of corridors have been effected. The ventilation of rooms at the Hale Ind Schools has been amplified. 4. MEDICAL INSPECTION. The following table gives a summary of the returns :- A. Routine Medical Inspections - Entrants 1708 Second age group 505 Third age group 912 Total 312.5 Other routine inspections 335 Grand Total 3460 B. Special inspections & Re-inspections 15767 5. REVIEW OF THE FACTS DISCIOSED BY INSPECTIONS Classification of the Nutrition of Children Inspected during the year in the routine age groups No. of "B" - "C" slightly "D" Children Excellent . Normal Subnormal Bad Entrants 1706 392 22.95 12 39 72.95 77 4.50 - 2nd Age Group 505 135 26.73 320 63.36 50 9.90 - 3rd Age Group 912 345 37.82 500 54.82 67 7.34 ____ Totals 3125 872 27.90 2095 65.88 194 6.21 - Other Routine. Inspections 335 105 31.34 206 61.49 24 7.16 - The findings may be shewn comparatively as follows :- A & B C D 1942 93.79 6.21 - 1941 95.07 4.89 0.029 lb) Uncleanliness - No children were cleansed under arrangements By your Committee, nor ere any legal proceedings taken. 5. The following table gives comparative figures for the past two years 1912 1941 Average number of visits to schools 5 6 Total examinations 33899 24434 Number of individual children found unclean 609 595 Percentage uncleanliness of average at tendance 6.3 8.8 Cases or chronic uncleanliness are follow up in the home . (c) Minor Ailments and Skin Defects The following is the number of skin defects found to require treatment - 1942 1941 Ringworm - Head 2 3 Body 9 8 Scabies 300 145 Impetigo 162 61 Other skin diseases 451 220 (d) Visual Defects and External Eye Diseases The number of patients requiring treatment and observation was as follows :- 1942 1941 Treat ment. Observation Treat ment. Obser vation Visual defects 215 42 182 78 Squint 114 8 57 7 External Eye Dis: 72 4 153 4 (e) Nose and Throat Defects:- The number of patients requiring treatment and observation was as follows :- 1942 1941 0 Treat ment. Obse r vation Trea t me nt. Cbser vation Chronic Tonsillitis 256 225 135 236 Adenoids only 4 3 15 7 Chronic Tonsillitis & Adenoids 41 21 21 14 Other conditions 294 90 167 - The 294 oases of other conditions are made up of sore throats and defects requiring diastello treatment. (f) Ear Disease and Defective Hearing : - I'atients requiring treatment - 1942 1941 Defective Hearing 28 11 Otitis Media 75 17 Other Ear Disease 114 7 (g) Orthopaedic & Postural Defects - A total of 175 deformities vva-5 found to require treatment" (h) Dental Defects Inspec -tion. Requiring T re a t ment. Per Cent Actually Trea terl. Fill ings Extract ions. Gene ral Ana esth etics. Other Opera tions 1942 7730 5851 75.6 3210 5670 3962 22,13 1527 1941 7542 5230 69.3 2382 4361 2947 1348 1686 Reference to dental inspection and treatm nt at Scoondary and Technical Sc'ools ir made in Section 15. 6 (i) Heart Disease & Rheumatism - The findings were as follows :- 194 2 1941 Treat ment. Obs er vation Treat ment. Ob servation Heart Disease - Organic 6 3 15 6 Functional. 7 11 10 9 Anaemia 38 10 28 8 (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 27 Speech 20 Bronchitis 7 3 Epilepsy 1 Chorea 2 Other defects 916 6. FOLLOWING UP. The school nurses paid a total of 3549 home visits during 1942. 7. ARRANGEMENTS FOR TREATMENT. (a) Nutrition - Treatment facilities as in 1939. The following shows the quantities of tonics supplied during 1942- Cod Liver Oil Parrish's Food Syrup Lac to Ihosphate Cod Liver Oil and Malt Cod Liver Oil & Malt & Parrish's 14½ lbs. 116½ lbs. 22 lbs. 221 lbs. 121 lbs. (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 be lor-; :- Conditions FIRST INSPECTIONS Reinsnections Number excluded under A,rt. 20 B Number not Excluded Boys Girls Boys Girls Boys Girls Ringworm 1 2 1 3 8 6 Scabies 115 141 18 14 602 759 Rheumatism — - 36 49 109 140 Impetigo, Sores etc. 72 55 77 68 422 307 Skin 51 51 101 112 259 280 Verminous Head etc 8 74 33 159 60 442 Sore Throat 24 25 11 16 55 46 Discharging Ears — - 182 177 531 360 Defective Vision - - 36 47 1 2 Humps 35 26 4 5 20 28 External Eye disease 27 40 67 45 161 301 Tonsils &. Adenoids 1 - 10 13 12 17 Various 130 118 733 735 2558 2061 Totals. 464 532 1309 1443 4798 4749 Number of children seen at first inspection 3748 Number of children sent by Attendance Officers 130 Number of attendances made by children 13295 7. Number of children sent by Head Teachers 3618 Number of swabs taken 181 Number operated on for Tonsils and Adenoids 5. Number of children seen by Ophthalmic Surgeon - New cases 276 Prescribed for 295 Total inspections 1923 First attendances numbered 3748 against 2114 in 1941, and re-attendances 9547 against 6728, the total attendances being 1322 against 8842. (a) Vis ual Defects and External Eye Diseases. Treatment for the latter is given at the school clinics. Dr. Sheppard has kindly contributed the following account o the work done during 1942 :- "There has been no alteration in the routine of the eye clinic during the past. year. The number of children failing to keep appointments has been larger than usual probably due to the mothers being engaged in war work and so being unable to attend. Under 7 yrs 7-11 yrs Over yr 11 s Secondary Schools Totals Bys Gls Bys Gls Bys Gls Bys Gls Bys Gls Hypermetropia 10 7 11 , ! 10 5 13 1 3 27 33 Hypermetropic Astigmatism. - 5 8 21 9 13 1 3 18 42 Myopic Astigmatism. - 2 4 l 2 4 2 3 8 10 Mixed Astigmatism 1 - 3 3 3 8 - 3 7 14 Myopia 1 1 6 8 16 8 5 6 28 33 Various 25 23 12 11 13 7 3 2 53 43 Totals 37 38 44 54 48 63 12 20 141 175 The details of the group described as various are as follows Defects Boys Girls Total Squints 26 57 Headache, anaemia, styes, debility 19 16 35 No visual defect 3 1 '£ The Orthoptist has continued her work during the year with excellent results". The following report on the work of the Orthoptic clinic has been given by Miss G.H, Monta gue-Smith , Orthoptist : - New cases 55. Old cases 33 Number of attendances.95 Cases treated with orthoptic exercises and for Amblyopia 52 Cured of Amblyopia 4 Awaiting operation 5 Discharged - Cured 6) Improved 7 ) 18 Unresponsive 5) 05 Still under treatment 25 Attending for "Tests" only 27 On waiting list 5 Unsuitable for treatment 4 Operations for Squint 2 8 (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 1942 54 9 63 1941 5 4 9 (f) Mr Disease and Defective Hearing. Ear Clinic - Dr. Francis Clarke reports as follows:- "The number of patients seen at the Aural clinic during 1942 was greatly in increase of that of the previous years since the outbreak of war, mainly due to the steady return of those evacuated during the war years 1939-1942, and accordingly the number of attendances at the treatment sessions proportionately increased. "The general scheme of work in operation during the past years has been carried on in 1942. A greater number of children has been treated for "diseased" tonsils by the recently introduced method of "Suction", and on the whole, the results are good and justify the continuance of this method. Mow, one regular fortnightly session is set apart for this treatment alone. A very interesting point in connection with this treatment is the remarkably good attendance of the children (with their parents) until the prescribed course is finished. Very seldom has there been more than one absentee from an appointment list of about 15, and more often none. This would tend to show that the parents are satisfied, and appreciate an improvement in the child's condition. "The had a slight increase during the year in the number of cases of acute otorrhoea, following, as usual, an increased amount of measles and scarlet fever. "The early and successful treatment of these acute ear conditions is most important, to prevent their becoming chronic. the wish here to stress the importance of "Suction" treatment, from the very start of the otorrhoea. It empties the middle ear of the accumulated discharge and consequently relieves the tissues of the attendant irritation and pain, which retard healing, and equally provides free drainage by keeping the perforation potent. Daily suction and thorough cleansing, followed by a two or three hourly application of 2% Carbolic Glycerine drops has given excellent results - always remembering to treat any associated nasal conditions at the same time. "Sinus infection cases have been treated by Iroetz Displacement, method and the nasal catarrh and rhinitis cases by Dia stolisation. "The number of cases now seen of chronic otorrhoea are very few and these are treated by the established method of Zinc Ionisation, which, in our experience, still gives the best and Quickest results. ""The Deaf School which was temporarily evacuated at the outbreak of war has returned, and suitable cases are referred there for appropriate treatment. "It might be said that the unavoidable dislocation caused in the regular working of the clinic in the first year or two of the war has now nearly disappeared. During the year we have not noticed amongst the children attending the clinic any abnormal deterioration in general health or nutrition or any neglect where a large number of the mothers are engaged in war work". 9 (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 2 39 154 134 2 331 204 61.6 TREATMENT No. of Children Attend ances. Extractions Anaesthetics. Fillings Perm. Teeth Other Operations. Per???:Teeth Temp, Teeth; Perm. Teeth Local General 120 334 3 69 2 64 301 38 (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 1942:- RHEUMATISM CLINIC 1942 Number of sessions 26 " " attendances 339 " new cases 92 " old cases 247 " discharged 163 " still under treatment 106 " of net. cases with rheumatic or cardiac defect 10 " referred to hospital as In-patient - Out-patient - " " for tonsils and adenoids operation 13 " " " dental treatment 14 " " to Physically Defective Centre 1 excluded from school 1 " " half time school 1 " " from games and exercises 6 " number to begin games and exercises. 6 " seen after scarlet fever 3 " seen after Diphtheria 5 " referred for convalescent home treatment 17 " sent away 13 " referred to Open Air School 1 (j) Tuberculosis - The number of school children examined during the year was - boys 36 and girls 41 - of which 5 boys and 2 girls were referred by the school medical staff. 29 of the cases were sent by private practitioners, and 41 were examined as contacts. At the end of the year the live register of notified cases of school age was - Pulmonary 34, Non-pulmonary 23. (k) Artificial Sunlight treatment - The number of children treated was 20 making 213 attendances. 8. INFECTIOUS DI??? Notification in the 5-15 years age group during 1942 was as follows (1941 cases shown in parenthisis) - scarlet fever 281 (62) diphtheria 4 (17), pneumonia 12 (16), erysipelas 4 (l), cerebro spina 1 meningitis Nil (3) measles 418 (611), whooping cough 46 (171). The last two named diseases were made notifiable in October 1939. Two cases of scarlet fever were discovered by the medical staff* 10. 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 Fox Ringworm & Scabies Impetigo Sores etc. January _ - 21 20 5 1 - February - 1 11 19 20 4 7 March - 4 5 54 58 7 1 April 1 85 12 58 28 4 15 May - 76 9 85 30 7 7 June - 239 20 115 26 1 4 July 2 178 20 59 32 2 9 August - 21 7 18 32 2 1 September - 1 2 20 18 1 2 October - - 3 15 33 - 2 November 2 4 — 81 53 7 - Decemb er 4 8 - 47 20 _ 2 Total 9 617 110 591 355 36 50 The following are the weekly average numbers of children away from school owing to exclusions and the non-notifiable infectious and other diseases named :- Exclu sions Chic ken Fox Meas les. Whoop -ing Cough Sore Throat Influ enza. Diar Mps. Scab ie s. Ring worm Tar- ious. Total. 1942 43 47 60 34 30 33 5 86 2.5 1 412 776 1941 16 6 81 89 13 44 2 7 10 - 251 519 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 conrection with Infectious Diseases 52 No. of attendances made 770 Average attendance per session15.6 No. of children recommended to Rheumatism Clinicle 14 No. of children recommended to ear clinic 15 No. of clinics held in connection with immunisation 52 Number o.f attendances made 3642 Average attendances per session 70.4 The following summarises the work done Total number of immunisations completed during 1942 - School age 2.312.) Fre-school age 1555) - 3898 Over school age 31) Number not completing immunisation. 360 Number found pre-schick negative (all ares) 32 Number found pre-sohick positive (all ages) 35 Number of posterior schicks 124 Number found positive 5 Number fcund negative 119 Number of typhoid inoculations given 26 No. of Dick tests for scarlet fever 35 Number found negative 20 Number found positive 15 Immunisation at schools included in above total Number completely immunised 2016 Number partly immunised 93 Fo.having an extra dose immunised in previous years 998 11 Vaccination - The vaccinal condition of each child examined at routine medical inspection was noted, find a summary shows the following Number Examined No, found to be vaccinated Percentage vaccinated Entrant s Boys 830 149 17.9 Girls 878 136 15.4 2nd Age Group Boys 20 4 25 12.2 Girls 301 46 15.2 3rd Age Group Boys 515 99 19 .2 Girls 397 72 18.1 Total 3125 527 16.8 Action under Article 20 (b). (exclusion of individual children) At Medical Inspection 38 At School Clinics 996 Action under Article 2 2 (school closure Mil Action under Article 23(b) (i.e., attendance below of number on Register Not operative. 9. OPEN AIR EDUCATION School Journeys and School Camps - There were none during the year. Swimming - Swimming instruction was given throughout the season to boys and girls. 10. PROVISION OP MEALS (i) School Meals. The following is compiled from the report of the Director of education to your Committee in September 1942, and from additional information kindly supplied by him "By January 194 2 , 2 1 50 meals per day were being supplied from five kitchens In September 1942 the wood Street kitchen - with an ultimate capacity of 1000 meals per day - was opened. The total meals supplied per day in September was approximately 3500. This rose by the end of the year to approximately 4000 per day, cooked at six kitchen and served at schools. Plans for further expansion are on hand in order to meet the growing demand for midday meals. The quality of the food supplied and the standard of cooking have been maintained at a high level, and the school meals have undoubtedly contributed to the maintenance of good health among school children. The influence of the meals in the formation of good dietetic habits is beginning to be apparent. The Director of Education stresses that much of the success of the scheme is due to voluntary supervision on the part of the touchers and to the good work of the kitchen staffs under the school meals supervisor . 2. Milk Meals. 402.652 milk meals were supplied to children on medical grounds on the recommendation of the medical staff. The number of meals supplied durinrs the preceding year was 479360. 3. Milk in schools scheme. The arrangements detailed in former reports were continued in 1942, all the milk supplied being pasteurised milk sold under license. 12 . During the school vacations, Centres were opened for the supply of milk, meals, The number supplied was as follows  Voluntary Official Total Easter 9282 1780 11062 Whit sun 8793 1670 10463 Summer 18011 3439 21450 Christmas 797 19994 20791 Mid-term 10064 1154 11218 11. (a) C0-0PERATlON OF PARENTS The following table shows the attendance of parents during 1942 Boys Number Ins pected. No. of Parents. Perc ent 19435 Percent 1941 Entrants 830 727 87.5 91.5 2nd Age group 204 160 78.4 70 .9 3rd Age group 515 155 30.0 33.8 Total 1549 1042 67.2 66.2 Girls Eat rants 878 676 87 .3 92.1 2nd Age group 301 239 79.4 83.0 3rd Age group 397 145 36.5 53.6 Total 1576 1060 67.8 77.3 Grand Total 3125 2193 70 .1 71.1 11. (b) CO-OPERATION OF TEaCHERS . As for 1940 (c) CO-OPERATION OF SCHOOL ??? 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 rerort:- The number of children sent away last year doubled itself: there were 106 as compared with 53 in 1941 and 52 in 1940. There was very great difficulty in placing the children owing to lack of accommodation and infection in the Homes. The ssociation is making every effort to remedy this deficiency, but suitable houses have, for the most part, been taken by the Government and children have often to wait as long as two months for a bed - a situation which defeats the intention of the referring doctors. A very satisfactory feature in spite of wat conditions, is the low number of children referred suffering from anaemia, debility and malnutrition. Those with advanced heart disease have become rare. Table of cast. s. Referred by - Tuberculosis Dispensary 3 Medical Men, Hospitals and Dispensaries 49 Medical Officer of Health and Infant Welfare Centres 6 Education Committees and School Medical Officers 33 Local Authorities under schemes for - (i) Rheumatism 15 (ii) Orthopaedic care. 136 Invalid Children's Aid Association 3 Others 6 Total 251 13 Classification of coses - Tubercular glands 2 Anaemia and debility 8 After infectious illness19 " acute illness 4 Marasmus and malnutrition 6 Rheumatism, Chorea and Heart 20 Heart (Congenital) 1 Diseases of lungs (Non T.B.) (a) Bronchitis, Pneumonia etc16 (b) Asthma 2 Glands ;(non-tubercular. ) 3 Diseases of bones (Non T.B.)100 Diseases of digestive organs 1 Paralysis 3 Nervous conditions12 Congenital deformities 37 Accidents 5 Air raids 6 Hernia 1 Diseases of skin 1 " " Ear 2 " " Nose and throat 2 Help given to old and new cases (all ages) - Referred for visiting and advice 74 Sent to Special Hospitals and convalescent homes 106 Extension from previous years 33 Provided with surgical boots and appliances 52 massage and exercises 9 Average length of stay in convalescent home 13 3/7 weeks Children sent away from Rhaumatism clinic 13 Clothes 19 (b) National Society for the Prevention of Cruelty to Children - The following is a summary of the work done in 'althamstow during 1942 :- Nature of Offence How dealt with Neglect 16 21 Advice sought 3 Advised. 4 Ill-treatment 3 Other wrongs 3 —■ Total 25 25 Number of children dealt with over 5 years of age, Boys 2? Girls 16. Number of children under 5 years of age 16. 60 supervisory visits were made during the year, and 70 miscellaneous visits were made. (c) Central Boot Fund Committee The Honorary Secretary Mr. A.J Blackhall has very kindly sent the fallowing account of the work of the boot fund during 1942 ''During the 12 months ended 31st December 1942, 415 pairs of boots have been distributed at an approximate cost of £230." 12. BLIND, DEAF, DEFECTIVE AMD EPILEPTIC CHILDREN (1) Blind School - The following table shows the classification of children attending the school at the end of 1942 14  Waltham stow Woodford Tottenham Hornsey Total Boys Girls Boys Girls Boys Girls Boys Girls Boys Girls Blind - — — - 1 _ 1 - 2 - Partially Blind 14 10 1 - 2 2 1 - 18 12 The Head Teacher, Miss M.L.Balis has kindly sent the fo1lowing report: - "During the year 1942 the children of the Blind and Myope School were again accommodated at the Hole End Open Air School. Twe girls still remain in the reception area, "The work of the Can tre was carried on as normally as possible under restricted conditions prevailing at the Open Air School. Dr. Sheppard has given careful and regular attention to the eyes of the children and Dr. Clarke, after a routine examination of all the pupuls, expressed satisfaction with their general health. Aidental examination was held and the necessary treatment followed. 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 "The Open Air School has increased its numbers through the year. 58 new admissions with 5 re-admissions (after hospital treatment) have been made. 10 children were returned to ordinary elementary schools and 4 were allowed to take up work suitable to their physical condition." (iv) Orthopaedic Scheme. The scheme is under the clinical charge of L'r, B,"Whitchurch Howell, F.R.C.S., Consulting Orthopaedic Surgeon. The follovring table shows the work done at the Clinic ORTHOPAEDIC 3CHEMF BOYS GIRLS 5-16 yrs Under 5 yrs Over 16 yrs 5-16 yrs Under 5 yrs Over 16 yrs Anterior Poliomyelitis 16 - 1 9 1 10 Scoliosis, Kyphosis, Lordosis. 12 - - 20 - 1 Surgical Tuberculosis. 6 - - 5 - 1 Rickets- (a) Genu varum 1 22 - - 10 - (b) Genu Valgum 18 14 - 16 25 - Pes Piano Valgus 88 17 1 64 10 - Spastic Paralysis 8 2 - 6 - - Arthritis 2 - 1 2 - 2 Talipes - (a) Equino Varus 10 2 1 8 1 - (b) Equino Valgus - - — 1 - - (c) Fes Cavus 1 - - 2 - — (d) Calcaneo Valgus. 1 1 - - 1 - Torticollis 2 4 - 4 3 - Osteomyelitis — - - 1 - - Amputation of leg - - - - - 1 Congenital dislocation of hip - - . 6 1 1 Hal lux Valgus - - - 14 - - Hammer Toe 1 - - 5 - - Perthe's Disease - - - 1 - - Frieberg's 1 - - 2 - — Cerebella Ataxia - - - 1 — — Kohler's disease - - - 1 - — Spina Bifida - - - 1 - — Congenital defects 10 9 - 11 8 — Asthma 5 - - 6 - - Miscellaneous 3 4 — 11 3 - Totals 185 75 6 194 63 17 15 Number of cases seen by Surgeon - From Physically Defective School 46 From other schools 188 Over school age 34 Under school age 119 Total 387 New cases seen by Surgeon - School age 97 Under school age 72 169 Total number of examinations by Surgeon 556 Total number of cases discharged :by Surgeon 32 Average number of examinations made per session 42.8 Number of treatments given 1867 Number of attendances for After Care 1979 Number of Ultra Violet Light treatment 69 Total number of treatments 3915 Average number of attendances per session 8.8 Number of sessions held - Inspection 13 Treatment 447 Total number of visits by Instrument maker 21 Number of children known to be evacuated 86 Defects seen at Orthopaedic Clinic in Children under 5 years of age. Anterior Poliomyelitis 1 Rickets - (a) Genu Varum. 32 (b) Genu Valgum 39 les llano Valgus 27 Spastic Paralysis 2 Talipes - (Equino Varus 3, Calcaneo Valgus 2) 5 Torticollis. 7 Congenital dislocation of Hip 1 Congenital defects 17 Miscellaneous 7 Admissions to Runwell Emergency Hospital - Pes Plano Valgus 1, Congenital Talipes Equino Valgus 3, Hammer Toe 1, Anterior Poliomyelitis (Talipes valgus) 2, Diplegia 1, Torticollis 2, Congenital dislocation of Hip 1. Operations Performed Arthrodesis 7, Tenotomy (Tendo Achillis 4, Sterno Mastoid 2), Reduction of Hip 2, Total 15. Ultra Violet Ray Treatment - During the latter part of the year a mercury vapour sunlight lamp was provided at the orthopaedic clinic. Treatment is given by Miss Garratt, C.S.M .G. who has the necessary qualifications. At the end of the year 11 patients were given 69 treatments. (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 M.D. or Dull and Backward 23, Mentally Deficient 8, To be notified to County 1, Feeble minded 3, Imbecile 4, Decertified 1, To be released at Christrras 2, Release for work 1, To leave school 16. Not fit for school 1, To be re-examined at 7 years 1, To continue at ordinary school 4,Not fit to leave school 1, To have further trial at Open Air school 1, Re-examine in six months 1, To attend special class in public elementary school 5, Recommended for residential institution 1, Nil wrong 1, Fie-cons id era t ion for child guidance 1, To remain in Myope School 1, To remain in mentally defective school 1. (vii) Child Guidance - 5 cases were referred during 1942. (viii) Speech Therapy - Miss I.II.S .Knight, Speech Therapist reports as follows : - "The number of children on the roll on December 31st was 154 made up as follows :- Stammer 63, Cleft Palate 6, Lisp 30, Other Defects of speech 55.increase The greatest/in numbers is amongst stammerers. Occasionally a withdrawal is made, but without exception these cases arise where parents do not wish to co-ope rote. I encourage parents to watch a lesson in progress because the follow up of the work at home is very important. By observing for themselves the parents see the method of a proach in practice and it helps the over anxious parent to realise that true progress only comes in easy stages. A class was held at Chanel End Infants school for exercises in relaxation. The selected cases were not of defective speech but children of the nervous type. The experiment was tried and found to be satisfactory. Nervous tension disappeared in every case in a very natural and easy manner. The class terminated in December. Several cases of anhonia have been reported. It is a condition that is due either to organic or purely functional reasons but one which should take priority over the simpler articulation cases in the matter of treatment. In May 1942 the classes were inspected by a Medical Officer of the Board of Education who saw the work being attempted under war conditions. It was suggested that fewer clinics should be in operation and by December a scheme was evolved whereby the work was organised in five clinics a week instead of eleven. This commenced in January 1943." Convalescent Home Treatment - 106 children were sent away for treatment during 1942. There were 48 remaining' in convalescent homes and hospital schools on December 31st 1942. The conditions for which children were sent included the following - Debility and Anaemia, 12, Heart and Rheumatism 14, Malnutrition 2, Bronchitis 20, Asthma 2, Nervousness 10, after infectious illness 13, Various 13. A total of 13 children were sent to convalescent homes or heart homes from the Rheumatism clinic. The average length of stay in all homes has been 13 3/7 weeks. 13. FULL TIME COURSES OF HIGHER EDUCATION FOR BLIND D,&F. DEFECTIVE 8c STILE "TIC STUDENTS. The Authority for the provision of such courses is the Essex County Counci1. 14. NURSERY SCHOOL. This school has been evacuated since the outbreak of war. 15. SECONDARY XH00LS. The Authority for the provision of Secondary Schools in althamstow is the Essex County Council. (a) Dental Inspection & Treatment - Reference has been made in 17. 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 2 26) 12 years old 168) - 472 15 years old 78) Parents present 203 Number referred for treatment (excluding dental and uncleanliness) 58 Number referred fb r observation 160 Number referred for treatment (excluding vision, dental and. uncleanliness) 42 Nutrition - A. 124 B. 302 C. 46 D. - Defects Requiring Treatment Requiring Obsvtion. Skin 5 4 Eyes - Blepharitis - 1 Vision 16 8 Squint 1 1 Other conditions. - 1 Ear Disease 1 1 Nose & Throat - Enlarged Tonsils 4 33 Adenoids 1 - Enlarged Tonsils & denoids 1 1 Other conditions 13 32 Glands (Non T.B.) - Sub-maxilliary 1 3 Cervica1 - 1 Speech - Stammer - 2 Teeth 4 4 Heart - Organic 1 3 Rheumatism - 1 Lungs - Other conditions (Non T.B.) - 14 Spinal Curvature 2 14 Other forms of deformities 20 38 Other diseases and defects 3 11 16 PARENTS PAYMENTS The approved scales for the recovery of fees in respect of treatment is the same as given in the 1138 report. 17 HEAITH EDUCATION As for l938. 18 SPECIAL ENOUIRIIC As for 1938. 19 MISCELLANEOUS (i) Employment of Children - 42 children were examined by the medica1 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 1942 by the medical staff:- Teachers 24 Others Nil 20 STATISTICAL TABLES. The Statistical tables required by the Board of Education follow 18. TABLE I Medical Inspections of children at tending Elementary Schools. A. Routine Inspections. Number of inspections in the prescribed groups - Entrants 1708 Second Age Group 505 Third Age Group 912 Total 3125 Number of other routine inspections 335 Grand total 3460 B. Other Inspections. Number of special inspections and re-insectiorns 15767. TABLE II. Classification of the Nutrition of Children Inspected during the year in the Routine Age Groups. No. of children inspected A Excellent 3 Normal C Slightly D No. % No. % subnormal Bad No % No. % 3125 872 27.90 2059 65.88 194 6.21 - - TABLE III. Group 1. Treatment of Minor Ailments (excluding uncleanliness, for which see Table V). Total number of defects treated or under treatment durine the year under the Authority's scheme 3473 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 diseases of the eyes. Number of children for whom spectacles werePrescribed Obtained 280 39 291 291 Group 111. Treatment of Defects of Nose and Throat. Received Operative Trea tmen t Received other forms of treatment. Total 54 231 285 TABLE IV. Dental Insneetion and Treatment. (i) Number of children inspected by the Dentists 7224 (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 < 387 553 596 673 762 898 87 2 984 940 211 48 7224 (b) Specials 506 (c) Total (routine and specials) 7730 19. (2) Number found to require treatment 5851 (3) Number actually treated 3210 (4) Attendances made by children for treatment 7330 (5) Half days devoted to (7) Extractions Inspection 60 Permanent 754 Treatment 936 Temporary 3208 (6) Fillings Permanent 3055 (8) Administrations of general Temporary 2615 anaesthetics for extractions 2213 (9( Other Operations Permanent teeth 1358 Temporary teeth 169 TABLE V Verminous Conditions Average number of visits per school made during the year by the school nurses 5 Total number of examinations of children in the schools by the school nurses 33899 Number of individual children found unclean 609 T -BLL VI. Blind and Deaf Children. Number of 'totally or almost totally blind and deaf children who are MOT at the present time receiving education suitable for their special needs Blind, Nil. Deaf, 4. 20.