Wal 74 BOROUGH OF WALTHAMSTOW EDUCATION COMMITTEE REPORT of the SCHOOL MEDICAL OFFICER for the year 1944 A. T. W.POWELL , M.C . ,M.B. , B.S. , D.F.H. SCHOOL MEDICAL OFFICER. CONTENTS Accommodation5 Attendance Officers15 Aural Clinic 9 Blind School 16 Boot Fund 16 Chicken Pox 15 Child Guidance 18 Clinics 4 Committee 2 Convalescent Home Treatment 21 Co-ordination 5 Crippling7,12,17 Deaf School 17 Defective children 16 Dental Defects7. 12 Dental Treatment7. 12 Diphtheria 12 Diphtheria Immunisation12 Ear Iisease7. 9 Employment of Children 22 Exclusions 8.13 Eye Disease 7.9 Following up 8 Health Education 22 Hearing 7. 9 Heart Disease7. 12 Hospital Treatment 9 Hygiene 5 Impetigo 8. 13 Invalid Children's Aid As so 15 Infectious Diseases 12 Introduction 3 Meals, Provision of 14 Medical Inspection 6 Measles 13 Medical Treatment 8 Kedical Examinations 82 Mentall Deficiency 18 Milk in School Scheme 14 Milk Meals 14 Minor Ailments 6, Mumps 13 N.S.P.C.C. 16 Nutrition 6,8 Nursery School 21 Open Air Education 14 Open Air School 17 Orthopaedic Treatment 7, 12,17 Orthoptic Clinic 9 Parents, Co-operation of 14 Parents, Payments by 22 Re-inspections 6. 8 Rheumatism 7. 12 Ringworm 8 Scabies 8 Scarlet Vever. 12 School Journeys 14 School Camps 14 Secondary Schools 21 Skin Disease 6. 8 Speech Therapy 21 Staff 5 Statistical Tables 22 Sunlight Treatment 12,18 Swimming 14 Teachers, Co-operation of 15 Tonsils & Adenoids 7. 8 Tuberculosis 7. 12 Uncleanliness 6.8 Vaccination 13 Vision 7. 8. 9 Voluntary Bodies 15 Whooping Cough 13 1. EDUCATION COMMITTEE. CHAIRMAN: Councillor S.N.Chaplin. Deputy Chairman: Councillor J.H.Williams. The Worshipful the Mayor,. Aid.A.E.Manning, J.P. The Deputy Mayor, Aid. Mr s.E.M.Miller, J. P. The Chairman, Finance Committee, Aid.Ross Wyld, J.P. Aid. Mrs.L.P.Bailey,. J.P. Coun. A.Crosier (Dec'd) Aid. Mrs.C.McEntee, J.P. Coun. F.Gentle Aid. Miss E.M.Pracy, B.Sc. Coun. J.F.Green Aid. W.B.Fitt Coun. E.Mallett Aid. W.H.Shaw. Coun. Mrs E.A. Smith. Co-optative Members. P.Astins,. Esq.,. J.P. Mrs. E. A. Lowton Rev. Clifford Barrett A.J.D.Llewellyn, Esq. C.S.Garrett, Esq. Rev. J.E.McKinley Mrs.M.Jarman Rt.Rev.Mgr.W.0'Grady, V.G. S.G.Haskins, Esq. Director of Education and Chief Executive Officer: E.Gwyn Thomas, B.A. , Ph.D. 2. To the Chairman and Members of the WALTHANSTOR . EDUCATIOIN COMMITTEE. Ladies and Gentlemen, I beg to submit, herewith, a report on the School Medical Service for the year 1944. The nutritional assessments at medical inspections placed 96.9% in the excellent and normal group, as compared with 93.7% in 1943. The excellent school meals scheme contributed materially to the maintenance of adequate and even improved nutrition. Cleanliness inspection revealed greater cleanliness but ringworm, scabies and eye defects were increased. I regret to have to record that Dr.Mary Clarke left your Service on account of ill health. I have again to thank you for your consideration and to express my appreciation of the good work of the Staff. I am, Your obedient servant, A. T . W. POWELL, School Medical Officer. 3. SCHOOL CLINICS. Aural Monday 2 - 4.30 p.m. Town Hall Child Guidance Monday 2 p.m. Old Education Offices x Minor Ailments Monday Wednesday 9 a.m. - 12 noon Town Hall Friday Saturday Tuesday 9 - 11 a.m. Handsworth Ave. School Thursday 9-11 a.m. Low Hall Lane Ophthalmic Tuesday Thursday 9 a.m. - 12 noon Town Hall Saturday Orthopaedic - (a) Consultant Third Thursday in each month Open Air 9.30 a.m. - 12.30 p.m. School (b) Massage Monday and Sunlight Tuesday 1.30 - 4.30 p.m. Open Air Wednesday School Friday Thursday 9.30 a.m. - 12.30 p.m. Open Air School Orthoptic Tuesday 9.30 a.m. - 4.30 p.m. Town Hall Friday Speech By appointment Old Education Offices. Rheumatism Alternate Thursdays 2 - 4.30 p.m. Town Hall x Immunisation Tuesday 2 p.m. Town Hall x Scabies Wednesday 2 p.m. Town Hall x Infectious Disease Wednesday 3 p.m. Town Hall All clinics, except those marked "x" are "Appointment" clinics. 4. 1. STAFF OF SCHOOL MEDICAL DEPARTMENT. Resignations and Appointments:- Dr. M. Clarke Assistant School Medical Officer Assumed duty 22. 3 .29 Resigned 31. 10 .44 Dr.M.Edmond Temporary Assistant School Medical Officer Assumed duty 4. 9 .44 Mrs.P.Herrison Temporary Assistant Dental Surgeon „ „ 19. 1 .42 Resigned 12. 2 .44 Dr.A.Hiphet Temporary Assistant School Medical Officer Assumed duty 6. 12 .43 Resigned 31. 8 .44 Mr.R.E.Hyman Temporary Assistant Dental Surgeon Assumed duty 20. 3 .44 Resigned 30. 9 .44 Mr.C.Shamash Temporary Assistant Dental Surgeon Assumed duty 13. 12 .44 Mr.J.L.Taylor Temporary Assistant Dental Surgeon Assumed duty 11. 4 .44 Resigned 24. 6 .44 Miss E. Woods Temporary Dental Clerk Assumed duty 11. 4 .44 2. CO-ORDINATION. As given in 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 available during 1944:- Boys. Girls. Infants. Mixed. Provided 5 5 17 17 Non-provided - 1 2 4 Special Schools - Mentally Defective - - - 1 Myope Centre - - - 1 Open Air School - - - 1 Deaf Centre - - - 1 Totals 5 6 19 25 1944 1945 1942 1941 1940 Number of children on Register, Dec.31st 9236 12185 11675 9445 6270 Average attendance 8488.5 10106.7 9610.2 6659.1 4707.2 Percentage attendance 78.4 84.1 83.4 84.5 75.6 Air.Frank H.Heaven, A.R.I.B.A., Architect to the Education Committee contributes the following:- Renovations - Renovations to sundry rooms at the Residential Nursery School, Farnham Common, have been effected. Heating - Heating Boilers have been repaired and replaced at various schools. Sanitation - Hot water supplied to lavatory basins have been provided to 5 schools. Additional hot water storage has been provided at one school and drinking fountains repaired or replaced at another school. Irovision of Additional dining room facilities have been provided Milk & Mleals- at 3 schools. Central Kitchens - The existing kitchens have been maintained at full capacity. New kitchens have been opened at Selwyn Avenue and Higham Hill. The temporary kitchen at Chapel End School has been Closed. Additional facilities have been provided at the Pretoria Avenue and Wood Street kitchens. 5. 4. MEDICAL INSPECTION. The following gives a summary of the returns:- A. Routine Medical Inspection - Entrants 659 Second Age Group 1063 Third Age Group 1691 Total 3413 Other routine inspections 156 Grand Total 3569 v. ^ B. Special inspections and Re-inspections 15917. 5. REVIEW OF THE FACT DISCLOSED BY INSPECTIONS (a) Classification of the Nutrition of Children inspected during the year in the routine age groups: - No. of Children "A" Excellent "B" Normal "C" Slightly Subnormal "D" Bad Intrants 659 326 49.46 308 46.73 24 3.64 1 0.15 2nd.Age Group 1063 326 30.66 715 67.36 22 2.06 - - 3rd.Age Group 1691 572 33.82 1063 62.86 56 3.31 - - Totals 3413 1224 35.86 2086 61.11 102 2.98 1 0.02 * Other routine inspections 156 56 23.07 112 71.79 8 5.12 - - The findings may be shown comparatively as follows:- A & B C . D. 1944 96.97 2.98 0.02 1943 93.71 6.26 0 .02 (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:- 1944 1943 Average number of visits to schools 3 5 Total examinations 20346 32802 Number of individual children found unclean 726 1093 Percentage uncleanliness of average attendance 8.5 10.8 Cases of chronic uncleanliness are followed up in the home and as set out in section 7 (b). (c) Minor Ailments and Skin Defects:- The following is the number of skin defects found to require treatment- 1944 1943 Ringworm Head 8 4 Body 38 24 Scabies . 364 205 Impetigo 79 120 Other skin diseases 426 256 6. (d) Visual Defects and External Eye diseases:- The number of patients requiring treatment and observation was as follows:- 1944 1943 Treatment . Observation. Treatment . Observation . Visual defects 391 93 195 40 Squint 91 32 62 7 External Eye Diseases. 237 8 51 2 (e) Nose and Throat defects - The number of patients requiring treatment and observation was as follows:- 1944 1943 Treatment . Observation. Treatment . Observation. Chronic Tonsillitis 261 419 249 176 Adenoids only 19 42 17 10 Chronic Tonsillitis & Adenoids 29 7 45 29 Other conditions 340 8 321 8 The 340 cases of other conditions are made up of sore throat and defects requiring diastello treatment. (f) Ear Disease and Defective Hearing - Patients requiring treatment - 1944 1943 Defective Hearing 33 39 Otitis Media 129 120 Other ear diseases 127 161 (g) Orthopædic and Postural Defects - A total of 386 deformities was found to require treatment. (h) Dental Defects - Inspection. Requiring Treatment Per Cent Actually treated Fillings Extractions Genera Anaesthetics Other Oprtns. 1944 6736 4169 61.8 3207 3983 2760 1628 2303 1943 8051 6842 84.9 3943 5521 4473 2608 2246 Reference to dental inspection and treatment at Secondary Schools and Technical Schools is made in section 7G. (i) Heart Disease and Rheumatism - The findings were as follows - 1944 1943 Treatment . Observation. Treatment . Observation . Heart Disease Organic 33 10 22 13 Functional 31 40 19 7 Anæmia 92 12 50 — (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 137 Speech 28 Bronchitis 108 Epilepsy - Chorea 4 Other defects 1094 7. 6. FOLLOWING UP The school nurses paid a total of 1958 home visits during 1944. 7. ARRANGEMENTS FOR TREATMENT. (a) Nutrition - Treatment facilities as in 1939. The following shows the quantities of tonics supplied during, 1944:- Cod Liver Oil. Parrish's Food. Syrup Lacto Phosphate. Cod Liver Oil and Malt. Cod Liver oil Malt & Parrish. 7 lbs.. 36 lbs. 20 lbs. 217 lbs. 236 lbs. (b) Uncleanliness - Treatment with Lethane was carried out extensively with satisfactory results and advice and treatment is now available at all clinics and welfares. Steel combs are supplied at the various centres at cost price and on loan in cases of necessity. Great difficulty occurs in some homes on account of mothers being at Work and in consequence the work of the Health Visitors and School Nurses has increased considerably. (c) Minor Ailments and Diseases of the Skin. Treatment facilities as for 1938. The work done at the school clinics is shown on the table given below:- Conditions FIRST INSPECTIONS. Number under excluded Art.20 B. Number not Excluded Reinspections Boys Girls Boys Girls Boys Girls Rinpworm 18 30 9 7 52 53 Scabies 93 84 27 30 562 488 Rheumatism 1 2 8 20 97 66 Impetigo, Sores etc. 60 29 109 67 765 357 Skin 56 42 91 83 254 283 Verminous Head etc. 14 86 22 129 56 460 Sore Throat 23 20 35 23 92 58 Discharging Ears 3 2 97 111 259 298 Defective Vision 1 1 114 135 291 362 Mumps 57 48 92 94 407 368 External Eye Diseases 3 3 72 68 91 93 Tonsils & Adenoids 2 1 2 - 2 - Various 96 94 423 478 1912 1868 Totals 427 442 1101 1245 4840 4754 Number of children seen at first inspection 3215 Number of children sent by Attendance Officers 72 Number of attendances made by children 12809 Number of children sent by Head Teachers 3143 Number of swabs taken 131 Number of specimens of hair examined for Ringworm 2 Number operated on for Tonsils and Adenoids 27 Number of children X-rayed 1 Number of children seen by Ophthalmic Surgeon-New cases 290 - Frescribed for 351 Total Inspection 1995 First attendances number 3215 against 4232 in 1943 and re-attendances 9594 against 12494, the total attendances being 12809 against 16726. 8. (d) Visual Defects & External Eye Diseases.- Dr.Sheppard has kindly contributed the following account of the work done during 1944:- "There were 380 new cases seen at the Eye Clinic during 1944 and these, as well as the ordinary periodical inspections, made 2424 attendances. The following tables summarise the defects found in the new cases. found in the new cases. There were no alterations made in the clinic routine during the year". Under 7 yrs. 7-11 yrs. Over 11 yrs. Secondary Schools Total By s . Gls . Bys. Gls. Bys. Gls. Bys. Gls. Boys Girls Hypermetropia 4 1 11 17 5 10 1 3 21 31 Hypermetropic Astigmatism 1 3 15 10 11 10 1 8 28 31 Myopic Astigmatism 2 1 2 1 8 4 8 6 20 12 Mixed Astigmatism 1 1 4 7 3 6 2 2 10 16 Myopia 1 1 5 6 24 24 11 26 41 57 Various 18 19 19 11 15 18 6 7 58 55 Totals 27 26 56 52 66 72 29 52 178 202 The details of the group described as "various" are as follows:- Defects Boys Girls Total Squint 22 19 41 Headaches, anæmia, styes, debility, etc. 19 20 39 No visual defects 17 16 33 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.Montague Smith, Orthoptist:- New cases 60. Old cases 109. No. of attendances 1452. It is impossible to give the normal full report owing to so much evacuation. The treatment of so many children has been curtailed and the all important factor in orthoptics, i.e., continuity of treatment has been severely affected. Some of the clinics had to be cancelled, although now they are working fully again. In February two extra sessions were begun, and Miss Meyer appointed to take over the additional work, so that at the present time there are six sessions held weekly. (e) Nose and Throat Defects - The scheme for treatment remained the some as detailed in previous reports. The following table gives the number of cases treated:- Year At Connaught Hospita1. Privately Total. 1944 27 1 28 1943 46 7 53 (f) Ear Disease and Defective Hearing - Ear Clinic:Dr.Francis Clarke reports as follows:- The work of the ear, nose and throat clinic was carried on during 1.944 along the same lines as in previous years. A total number of 396 new coses were seen and appropriate treatment arranged for. Of this total, 129 were ear cases; 96 acute and 33 chronic and 223 were nose and/or throat cases. 9. These figures are very interesting in view of the fact that only 33 cases of chronic otitis were found in a total of 396 children referred to the aural clinic. The number of cases of chronic otorrhœa has declined remarkably in the last decade and this decline is mainly due to the concentration of attention on the early recognition and efficient treatment of otitis in its earliest stages and especially on the treatment of the predisposing factors to this condition, especially affections of the nose or throat. The largely increased number of children, many under school age, now seen and treated for nose and throat affections, has a very important bearing on the number of otitis cases occurring in the school population. Preventive treatment and treatment in the very earliest stages is strongly emphasised in the whole school medical routine. The detection of defects amongst school children is always important but prompt and practical treatment is doubly important. Unfortunately, a pood deal of disorganisation affected the clinic, like all the other clinics, during the year, on account of the persistent bombing which went on during most of the year. Large numbers were evacuated, which interupted the set course of treatment, and various attendances were not kept owing to immediate local raids and bombs, so that we found an unduly high number of children could not complete their treatment. It is hoped that we will be able to contact most of these cases in the coming year as they return and sessions become more normal, and resume, where necessary, the suspended treatment. The main princirles of treatment have been carried on as in previous years. We would wish to call attention here to the marked improvement in the successful treatment of acute otorrhœa by the use of suction. The prompt cure of acute otorrhœa is so important that we now insist on every case, where it is possible, attending the clinic for special treatment. The customary method of giving the parents "drops" and directions for use at home is not satisfactory, as the majority of the parents, with the best intentions, are not able to carry out the essential details necessary for successful treatment. The clinic has every facility and the staff are trained in this particular work and the end results are altogether much more satisfactory. The suction method is a valuable accessory to our equipment. The middle ear can be emptied of the irritating discharge, the perforation kept patent to allow drainage and a mild protective inflammation produced which helps healing considerably and a better contact allowed between the antiseptic used and the affected parts. For chronic otorrhœa we invariably use zinc ionisation with adjuncts such as silver nitrate cautery, antiseptic packs, Sulzberger powder in the cases of old post mastoid operations, with granulations etc. For rhinitis and nasal catarrh the Gautier method of Diastolisation is largely employed with or without installations of colloidal silver. We have treated during the year, 46 cases of 'unhealthy' or hypertrophied tonsils by conservative methods; tonsil suction, (1eters method); tonsil painting combined with nasal treatment. The conservative methods., especially suction, has a definite place in the treatment of tonsils In suitable cases the results are remarkably good 46 cases of diseased tonsils were referred for operation, but nearly half this number were those from the waiting lists of previous years which had to be cleared up. In certain instances amongst very young children where the tonsils and especially the adenoids have become, as a result of their hypertrophy, definitely obstructive and are diseased, there is no satisfactory alternative to removal. Taking the total number of children seen during the year generally, we must say that the general standard of health, physique, nutrition has been well maintained and quite satisfactory we have not noticed any obvious deterioration in general health, 10. considering the many shortages and restrictions in diet, holidays and special foods, unavoidable in wartime. Total number of new cases seen at Clinic 396 ACUTE OTITISPEDIA. Acute suppurative otitis 71 „ non- „ „ * 25 (bi-lateral - 13) Total 96 CHRONIC OTITISPEDIA. without complications 15 Post-operated mastoid 11 (bi-lateral,- 5) with naso-pharyngeal complications 7 Total 33 NOSE AND THROAT. Sinus (inflammation: pus or muco-pus in nasal sinuses) 11 Rhinitis (including deflected septa, nasal obstruction) 79 Nasal catarrh 41 Enlarged, unhealthy tonsils, adenoids 92 Total 223 MISCILLANEOUS CASES. wax in the ear; epistaxis; examination, E.N.T;hearing; foreign body, nose or ear; injuries: external otitis 44. TREATMENT AND RECOMMENDATIONS. Acute suppurative otitis media. Suction and antiseptic drops; with nasal treatment where indicated; instructions to parents regarding home treatment. Acute non-suppurative otitis Analgesic-antiseptic drops; with media. nasal treatment where required and instructions to parents, re home tr.m. Chronic suppurative otitis. Zinc ionisation, with antiseptics, cauterisations, etc. where indicated and co-lateral nasopharyngeal treatment where indicated. (Ionisation, 24 cases) Rhinitis. Diastolisation and vibratiry massage and antiseptics where indicated. Diastolisation and vibration. (Diastolisation, 140 cases). Sinus. Proetz 'displacement' with antiseptic treatment where indicated.('displacement' cases,10.) Enlarged Tonsils. Treated by conservative methods, tonsil suction, tonsil paint, or recommended operative removal. Treated by conservative methods,46. Referred for operative treatment,46. Note. These 46, (referred for operation) include cases from the previous year's waiting list: children too young for 'suction' and some who were not amenable to suction treatment and those in which the parents preferred operation. 11. (g) Dental Defects - Treatment cf secondary and Technical Pupils The work done for the Esæx County Council is shown below and is not included in Table IV at the end of the report. Inspections. 11 12 13 14 15 16 17 No.offered % Requiring yrs. yrs. yrs. yrs. yrs. yrs. yrs. Treatment. Treatment. 120 229 249 262 201 46 1 705 64.0 Treatment. No. of Attend children ances Extractions Temp. Perm. Teeth Teeth Anæsthetics. Local General Fillings Other Operations Permanent Parmanent Teeth. Teeth. 326 943 99 174 29 193 762 194 (h) Orthopædic 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. - The following is a report on the work of the Rheumatism Clinic during 1944:- Number of sessions 12 " " new cases 37 " " old cases 77 " discharged 27 " still under treatment 34 " of new cases with rheumatism or cardiac defect 6 Number excluded from school 2 " " half time school 1 " " from games and exercises 1 " to begin games and exercises 3 " referred for convalescent home treatment 3 " sent away 3 " referred to Open Air School 3 (j) Tuberculosis. The number of school children examined during the year was - boys 45 and girls 40 - of which 17 boys and 14 girls were referred by the school medical staff. 32 of the cases were sent by private practitioners, and 22 were examined as contacts. At the end of the year the live register of notified cases of school age was - Pulmonary 32 Non-pulmonary 24. (k) Artificial Sunlight Treatment. The number of children treated was 133, making 1356 attendances. 8. infectious diseases. Notification in the 5-15 years age group during 1944 was as follows:- (1943 coses shown in parenthesis) - scarlet fever 124 (55) diphtheria 9 (15), pneumonia 15 (19), erysipelas Nil (Nil), Cerebro-spinal meningitis 1 (Nil), measles 208 (245), whooping cough 55(27), dysentery 25 (37), Anterior Poliomyelitis Nil (1). Non-notifiable infectious disease is chiefly brought to light by the weekly returns made by Head Teachers under the local "Regulations as to Infectious Diseases in Schools". 12. The monthly figures were as follows:- Sore Throat Measles Whooping Cough MumpsChicken Pox Ringworm & Scabies Impetigo Sores etc. Sore Eyes January - 13 1 1 - - - - February 3 75 19 1 - 2 6 6 March 1 222 29 1 3 — 1 7 April 1 144 17 — 6 — 2 2 May 3 62 10 21 8 3 1 1 June - 37 3 2 26 - - — July - 7 1 5 7 - - - August - - - - - - - — September - - - - — - - — October 1 - 2 5 - - - — November 4 — — — 1 — 4 December 1 - - - 1 - 2 - Totals 14 560 82 36 52 5 16 16 average The following ere the weekly/numbers of children away from school owing to exclusions and the non-notifiable infectious and other diseases named:- Exclusions Chicken pox Measles & G.M. Whooping Cough Sore Throat Influenza Diar. Mps. Scablies. Ring worm Varlous Total 1944 33 14 147 41 23 18 5 4 24 3 373 685 1943 96 53 40 23 48 105 7 11 24 2 525 937 Immunisation and Infectious Disease Clinic. Follow-up arrangements were as detailed in the 1939 report. The following table shows the work done at the infectious disease clinic:- No. of clinics held in connection with Infectious Diseases 52 No. of attendances made 404 Average attendance per session 7.7 No. of children recommended to Rheumatism Clinic 1 No, of children recommended to Ear Clinic 3 No. of clinics held in connection with immunisation 51 No. of attendances 911 Average attendances per session 17.8 The following summarises the work done - Number of children completing immunisation during 1944 - School age 191) Pre-school age 862) - 1057. Over school age 4) Number of children already immunised who received an extra dose 38 Number immunised by General Practitioners 80 Number of Schick tested for Positive 4 - 9 first time Negative 5 S.T.after Immunisation - Positive 3 - 54. Negative 51 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 351 69 Girls 308 59 19.1 2nd. Age Group Boys 555 107 19.2 Girls 508 79 15.5 Number Examined Number found to be vaccinated Percentage vaccinated. 3rd. Age Group Boys 835 168 20.1 Girls 856 228 26.6 3413 710 20.8 Action under Article 20(B) (exclusion of individual children) At medical inspection 7 At school clinics 869 Action under article 22. (School Closure) Nil. Action under Article 23(B). (i.e., attendance below 60% of number on Register) Not operative. 9. OPEN AIR EDUCATION. School Journeys and Camps. There were none during the year. Swimming. Swimming instruction was given throughout the season to boys and girls. 10. PROVISION OF MEALS. The Director of education has kindly supplied the following - (1) "Previous to June 1944, when a further evacuation of children took place, approximately 5,000 meals daily were supplied to school children from seven kitchens. After evacuation, the number of meals supplied dropped to about 3,000 daily, and one kitchen was, therefore, closed. From the latter part of 1944, this figure has been increasing daily as the children return from the reception areas. In spite of difficulties which have arisen from time to time through enemy action the quality of the food supplied and the standard of cooking have been maintained at their high level and it has felt that this has been a contributory factor in maintaining the children's health at a good standard. The continued co-operation of the teachers in the voluntary supervision of the dining arrangements is much appreciated by the authority and the help of the kitchen staffs, under the supervision of the Supervisor of school meals, has contributed much to the continued success of the arrangements". (2) Milk Meals - 125,557 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 213,390. (3) Milk in school scheme - The arrangements detailed in former reports were continued in 1944, all the milk supplied being pasteurised milk sold under license. During the school vacations, Centres were opened for the supply of milk meals. The number supplied was as follows:- Easter 9879 Summer 14617 hitsun 8489 Christmas 8779. 11. (a) CO-OPERATION OF PARENTS. The following table shows the attendance of parents during 1944:- Number Inspected. No. of Parents Per Cent 1944. Per Cent. 1943. Entrants Boys 351 324 92.3 81.5 Girls 308 279 90.5 83.3 2nd. Age Group Boys 555 405 72.9 62.7 Girls 508 348 68.5 76.2 3rd. Age Group Boys 835 211 25.2 15.2 Girls 856 405 47.3 53.8 Totals 3413 1972 57.7 62.7 14. (b) CO-OPERATION OF TEACHERS. Renewed and grateful acknowledgement 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. (d) CO-OPERATION OF VOLUNTARY BODIES. (a) The Invalid Children's Aid Association - Miss D.E.Taylor, Secretary of the local branch, has kindly contributed the following report:- "This past year has shown a marked increase of work at the Child Guidance Clinic, until the Education Committee decided to appoint a full time worker. A decreasing number of medical cases would seem to point to the fact that rationing and the attacks of V1 and V2 did not affect the health of those children who remained in Walthamstow too adversely. Debility and shock following air raid incidents did occur, and we were able to send urgent cases away for immediate convalescence. There was a remarkably low incidence of heart trouble during the whole year. Cases were referred by:- Medical Practitioners, hospitals and dispensaries 40 Tuberculosis dispensaries and T.E.After Care Committees 0 Education Committees, School Medical Officers, Welfare Centres 32 Local Authorities under schemes for:- (i) Rheumatism 4 (ii )Orthopædic care 39 Assistance Boards and Public Assistance Committee 4 I.C.A.A 47 C.O.S. and other voluntary agencies 4 Parents 10 Others 2 182 Suffering from:- Anæmia and debility 12 After effects of infectious illness 10 Marasmus and malnutrition 1 Rheumatism chorea and heart 8 Diseases of lungs (non T.B.) (a) Bronchitis, pneumonia etc.18 (b) Asthma 2 Diseases of digestive organs 3 Nervous conditions 11 Congenital deformities 21 Hernia 1 Diseases of ears 3 Diseases of eyes 4 nose and throat 18 Child Guidance 56 Various 14 182 HELP GIVEN TO OLD AND NEW CASES (ALL AGES). Sent to special Hospitals, Nursing and Convalescent Homes 62 Provided with Surgical Appliances and carriages 14 Referred for visiting and advice 77 Referred by I.C.A.A. to other agencies 29 182 15. (b) National Society for the Prevention of Cruelty to Children The following is a summary of the work done in walthamstow during 1944:- Nature of Offence How dealt with Neglect 34 framed 36 Advice sought 7 Advised 7 Ill-treatment 2 Otherwise dealt with 1 Other wrongs 1 Total 44 Total 44 Number of children dealt with over 5 years of age - Boys 20, Girls 38. Number of children under 5 years of age - Boys 19. Girls 17. 116 supervisory visits were made during the year, and 99 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 1944:- "During the 12 months ended 31st.December 1944, 330 pairs of boots and shoes were distributed, at a cost of £212. 12. blind, deaf defective & epileptic Children . The Head Teacher, Miss M.L.Balls has kindly sent the following report:- "From January, 1944 until the middle of June, the work at the Myope Centre proceeded quietly and as uneventfully as war conditions would permit. During the latter part of June, and for the remained of that term, the time-table was disorganised and many of the children either evacuated or stayed at home. At the end of this term also, Mrs.Lee left us as her health had seriously deteriorated. After the summer holiday, many of the children returned from the Reception Areas, and the three classes - Infants, Juniors and Seniors - have since been in charge of two teachers. As wall space is limited, find lighting so unsatisfactory, progress in reading and writing has not been as marked as it might have been under better conditions. During the year, parties of students under the Tottenham Public Health and Social Training Scheme, and from the Training Colleges for Teachers, visited us, and expressed their thanks for the help and information afforded them. In October, we were sorry to lose am old and valued friend of the Myope Centre. For many years Dr.May Clarke had conducted the routine medical examinations in this school, and had always shown a kindly interest in every child coming under her care. Her departure is a personal loss to us all. Finally, we would like to express our deep gratitude to Dr.Sheppard who has been so attentive to the welfare of the children eyes, and who has so unfailingly encouraged the staff by her sympathetic understanding of the difficulties of sight-saving and education in this school". 16. (i) Blind School - The following table shows the classification of children attending the school at the end of 1944:- Walthamstow Out of District Total. Boys Girls Boys Girls Boys Girls Blind 1 2 1 2 2 Partially 11 11 4 4 15 15 Blind (ii) Deaf School - Kiss V.K.Mitchell, the Head Teacher, reports as follows:- "On April 1st. 1944, the school had 16 children on the roll, classified as follows:- Deaf within the meaning of the Act. Partially Deaf. Aphasic. 12 3 1 (1 of these has normal language.) "During the year (April 1944 to April 1945) five children left, four of them to go to schools outside the London area because of the danger from flying bombs and one to go to work with his father as a Pasterer. Two children have been admitted, one of them a boy under school age and the other a partially deaf girl of eleven. The attendance during the year was very poor because of enemy activity." (iii) Open Air School - Miss E.Thompson, the Head Teacher, reports:- "The work of the Open Air School suffered severely from interrupted attendance throughout the year. But in spite of this 16 were discharged by the school medical officer as fit to return to the ordinary elementary school. Evacuation during enemy action accounted for considerable withdrawals, and many of these are still away from Walthamstow. Two senior boys (over 14) attended evening school after the summer holidays, and were placed No.2 and No.5 on the Christmas examination list. This was considered very gratifying, since this school received delicate and almost inevitably backward children. Classification of scholars on roll at end of 1944 was as follows:- Debilitated 34 Orthopædic 16 Asthma 6 Cardiac 8 Epileptic 2. (iv) Orthopaedic Scheme - The scheme is under the clinical charge of Mr.B. Whitchurch Howell, F.R.C.S., Consulting Orthopædio Surgeon. The following table shows the work done at this Clinic:- ORTHOPAEDIC SCHEME. Boys Girls 5-15 yrs. Under 5 yrs. Over 16 yrs. 5-16 yrs. Under 5 yrs. Over 16yrs. Anterior Poliomyelitis 10 - 5 9 - 10 Scoliosis,Kyphosis,Lordosis 24 - - 30 3 2 Surgical Tuberculosis 7 - 1 2 - - Arthritis 2 — 1 - - 3 Rickets - (a) Genu Varum 4 28 — 4 9 - (b) Genu Valgum 31 10 - 30 22 — Pes Planus Valgus 128 22 - 92 9 - Hammer Toe 1 - - 9 - - Perthe's Disease - - - 2 - - Amputation of leg - - - - - 1 Congenital dislocation of Hip - - - 3 2 1 Spastic Paralysis 9 2 - 5 2 - Talipes - (a) Equino Varus 9 4 1 4 6 - (b) Pes cavus 1 - - 1 - - (c) Calcano Valgus 1 1 - - 6 - Congenital defects 20 6 - 16 11 - Hallux Valgus 1 - - 11 - - Torticollis 1 4 - 5 9 - Digitus Varus — - - 5 1 - Osteomyelitis - - 2 - - - Achondroplasia - - - 2 - — Miscellaneous 10 2 - 21 3 — Totals 259 79 10 251 83 17 17. Number of cases seen by Surgeon - From Physically Defective School 45 From other schools 291 Over school age 29 Under school age 112 Total 477 New cases seen by Surgeon - School age 152 Under school age 62 Total number of examinations by Surgeon 691 Total number of cases discharged by Surgeon 129 Average number of examinations made per session 46.1 Number of treatments given 1394 Number of attendances for after care 2431 Number of ultra violet light treatments 1356 Total number of treatments 5181 Average number of attendances per session 12.5 Number of sessions held - Inspections 15 Treatment 429 Total number of visits by Instrument maker 10 Number of children known to be evacuated 61 Admission to Runwell Hospital - Onycho Gryphosis 10 Operation performed - Removal of Toe Nail and 1st.Phalanx Digit. Defects seen at Orthopaedic Clinic in Children under 5 years of age Rickets - Genu Varum 37 Scoliosis 3 Genu Valgum 32 Torticollis 13 Fes Planus Valgus 31 Congenital Dislocation Hip. 2 Spastic Paralysis 4 Digitus Varus 1 Talipes - Equino Varus 10 Congenital Defects 17 Calcarneo Valgus 7 Miscellaneous 5 (v) Mental Deficiency - Ascertainment. Ascertainment has proceeded along the lines detailed in previous years. Certification - The school medical officer and one 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:- Mentally Deficient 3, Mentally Deficient (Feeble minded) 4, Imbecile 2, Border line cases 2. Notified under Art 2A.2. To remain at Special School 1. To have a trial at Mentally Defective School 1. School for Mentally Defective Children - Miss R.E.A.Lock, the Teacher in Charge, reports as follows:- "During the year there has been an average of 28 scholars. Chronological ages range from 5½ - 15½ and IQ's s from 38-78. Valuable co-operation has been obtained with the School Psychologist. The school activities have consisted of three "R" work, mainly in the mornings, with wood, cane and knitting machine occupations in the afternoons. There has been no noticeable deterioration of the health and general morale of the children despite war conditions. Scholars leaving the school during the year have had no difficulty in obtaining suitable employment". (vi) Child Guidance Clinic - Miss G.M.Hammond, B.Sc., Psychologist to the clinic contributes the following report:- 18. "This report covers the period January 1st. to December 31st.1944. During the year 261 new cases have been referred to the clinic, an average of 21 per month. This includes the period June - July when the Psychologist was engaged upon duties connected with ' evacuation due to the fly-bomb attacks and very few referrals were received. In spite of this interruption the variety of the problems offered has increased and the sources of referral have expanded as the detailed statistics at the end of this report proved. Although the majority of the children are sent on the initiative of the teaching staff, an increasing number are referred by the School Medical Department General Practitioners, Probation Officers (through the Juvenile Court) other L.E.A's, and by the parents themselves. This is an indication that the value of psychological treatment for problems of behaviour and for nervous symptons is being more widely recognised. Throughout the year 63 cases have been treated at the Clinic (in 18 cases treatment was cut short by evaouation). 4C new cases received full diagnosis by the Clinic team. 20 cases have been closed. 15 of these children are adjusted and the remaining five, two of whom have left school, are improved - that is, 75% of cases closed are adjusted, and the remaining 25% improved. We ascertain by our follow-up system to what extent the adjustment or the improvement is maintained. STAFF. We have to state with deep regret that Dr.N.H.Bore, B.A., M.R.C.S., L.R.C.P., Psyohiatrist to the Clinic, made her last attendance on September 1st. before she died on September 12th. Ve owe to her inspiring leadership and auspicious beginning, many happy contacts between the Clinic and bodies and individuals whose work impinged upon ours and the shaping and inspiration of our policy. In September Dr.E.Whatley, M.B., B.S., was appointed Fsychiatrist to the Clinic. She attends one session per week and her work includes diagnosis, treatment and administration. A joint conference occurs at the end of every session at which we have welcomed the co-operation of the Director Of Education, the Medical Officer of Health and his assistants, Head Teachers and Frobation Officers. we have also had interested visitors from other areas, end Social Science Students from the South-west Essex Technical College attend regularly every month. By May, 1944, the volume of work had increased to such an extent that we felt the need for a second Psychiatric session per week, the full-time services of a Social Worker and more clerical help. A report to this effect was put before the Education Committee and these requests were granted. Then followed the fly-bomb attacks and the number of children in the Borough was reduced by evacuation. It was, therefore, decided to leave the second Psychiatric session in abeyance until more normal times. Nevertheless the volume of referrals continued to increase and it became imperative that our part-time Social Worker should come on a full-time basis. On November 1st. Miss M.Russell was appointed full-time Social Worker. She interviews parents both at the Clinic and in their hones as well as individuals and Agencies concerned with the child's welfare. The Isychologist is in attendance at the Clinic every afternoon for diagnostic testing, remedial teaching, play interviews and play groups. PSYCHOLOGICAL WORK IN THE SCHOOLS. This important part of a Isychologist's work occupies the rest of her time and it is ooncerned with the prevention of mental illness, as the clinic work proper is concerned with the healing of the mentally sick. Diagnostic testing and advisory work takes place in the schools where contact with the teaching staff is thus easily maintained. School failure is a fruitful cause of anxiety, degression, apathy in other words, mental ill-health. An experimental attempt has been made to deal with the core of backwardness in a junior school. The 19. result has been recorded and we await the opportunity to extend the methods employed. Work in this field is made doubly difficult by the shortage of teaching staff but the success of the experiment encourages us to believe that valuable work can be done towards the prevention of mental illness along these lines. The Pyschologist acts in an advisory capacity to the Education Authority on the psychological aspect of the varied problems concerned with educationally backward and difficult children. She is concerned with special aptitudes and the measures necessary for ensuring the proper education of children possessing them. She also undertakes the mental testing of children under consideration for certification by the Medical Officer." REPORT ON THE WORK OF VALTHAMSTOW CHILD GUIDANCE CLINIC, JANUARY - DECEMBER 1944. Total number of cases referred January - December 31st 1944 261 Number of cases investigated by Psychologist and/or Social Worker 242 Number of cases having received full diagnosis by Clinic team 40 Number of cases recommended for intensive treatment 33 Number of cases under treatment on December 31st 27 Number of cases awaiting full diagnosis and treatment 18 Number of cases treated and under treatment throughout year 63 In 18 cases treatment was cut short by evacuation. The 7 cases not treated were disposed as follows: 1 Adjusted after initial interview. 1 Recommended for Nursery School. 1 Transfer to Forest School. 1 To be transferred to residential special school. 3 Advice given at school and at home. Number of cases treated and closed 20 Status at closure:- Adjusted 15 Improved 5 (2 of these have left school)- Problem as referred. Nervous Disorders. Habit Disorders. Fears 6 Sleep 1 Seclusiveness 1 Movement 1 Depression 1 Feeding 1 Excitability 2 Excretory 7 Apathy 2 Nervous pains & Obsessions 1 Paralysis 2 13 12 Behaviour Disorders. Unmanageable 7 Temper 2 Aggressiveness 4 Jealous Behaviour 1 Demanding attention 2 Stealing 4 Lying & romancing 1 Truancy 2 Sex Difficulty 3 26 Educational & Vocational Difficult Backwardness 7 Inability to concentrate 1 Inability to keep jobs 2 Special disabilities 2 12 For special examination. Admission to special homes and hostels 1 Psychological exam. 26 Educational advice 173 200 20 Source of Referral. Schools 211 Other L.E.A.'s 5 S.M.O. 22 Juvenile Court (Probation Officers) 4 Attend.Dept. 10 Gen.Practitioners 2 Welsh B.of Health 1 Cent.Adv.Bureau 1 Parents 5 246 15 Total from all sources 261. Summary of Attendances. For Pyschiatric or Psychological Interview 672 For Interview by Social Worker 155 Visits by Social Worker 230 These include: Home visits 211 Interviews with relatives, ministers & youth Leaders 14 Visits to agencies and institutions 5 (vii) SPEECH THERAPY - Miss I .M.S .Knight, the Speech Therapist, reports general increase 'in numbers referred for Speech Therapy - particularly in cases of stammer referred from infant schools - and in spite of evacuation. There was considerable interference in routine treatment. In the treatment of stammer Miss Knight stresses the need to remove all nervousness and anxiety in the younger patient and the avoidance of excitement in the older patient. Particular emphasis is Laid on relaxation and postural exercises. (viii) CONVALESCENT HOME TREATMENT - 54 children were sent away for Treatment during 1944. There were 38 remaining in convalescent homes and Hospital schools on December 31st 1944. A total of 3 children was sent convalescent homos or heart homes from the Rheumatism Clinic. 13. FULL TIME COURSES OF HIGHER EDUCATION FOR BLIND, DEAF, DEFECTIVE & EPILEPTIC STUDENTS. The Authority for the prevision of such courses is the Essex County Council. 14. NURSERY SCHOOL. This school has been evacuated since the outbreak of war. 15. SECONDARY SCHOOLS. The Authority for the provision of Secondary Schools in Walthamstow is the Essex County Council, for which your Committee provide the following services (a) Dental Inspection and Treatment - Reference has been made in Section (g) to the Dental inspection and treatment of pupils attending Secondary id Technical Schools. (b) The following table shows the findings at Medical Inspections - Number inspected - Entrants 77 ) 12 years old 454 ) - 794 15 years old 263 ) Specials 221 Parents present 433 umber referred for treatment (excluding dental & uncleanliness) 237 uruber referred for observation 88 umber referred for treatment (excluding vision, dental and uncleanliness) 189 21. Nutrition - A 224 28.2 B 547 68.0 0 23 2.8 D nil. Requiring Requirinj Defects - treatment. observati 3kin 26 3 Eyes - Conjunctivitis 2 1 Blepharitis 4 Vision 48 23 Squint 1 1 Other conditions 3 1 Ear Disease 5 Nose & Throat - Enlarged Tonsils 12 27 Adenoids 2 Enlarged Tonsils & Adenoids 3 1 Other conditions 7 3 Glands (Hon T.B.) Sub-maxillary 5 Cervical 4 5 Teeth14 1 Heart - Organic 3 Functional 1 6 Anæmia 1 Rheumatism 3 Lungs - Bronchitis 3 Other conditions (Non T.B.) 4 Deformities - Spinal Curvature 1 Other forms 72 26 Other diseases and defects 29 6 16. PARENTS' PAYMENTS. The approved scales for the recovery of fees in respect of treat® is the same as given in the 1953 report. 17. HEALTH EDUCATION - as for 193 8. 18. MISCELLANEOUS . (i) Emoloyment of children. - Thirteen children were examined by the medical staff. (ii) Employment of children in public Entertainments - Three children were examined under these Regulations. (iii) Medical Examinations. The following examinations were made dur! 1944 by the "medical staff - Teachers 30. Others 4. 19. STATISTICAL TABLES. The statistical tables required by the Board of Education follow: TABLEI. Medical Inspection of children attending Elementary Schools A. ROUTINE INSPECTIONS. Number of inspections in the prescribed groups - Entrants 659 Second age group 1063 Third age group 1691 Total 3413 Number of other routine inspections 356 Grand total 2569 B. OTHER INSPECTIONS. Number of special inspections and re-inspections 15917 TABLE II- Classification of the Nutrition of children inspected during the year in the Routine Groups. A D C D In. Of Children Inspected . Excellent Normal Slightly subnormal Bad. No. % No. % No. % No. % 3413 1224 35.86 2085 61.11 102 2.98 1 0.02 TABLE III. Group 1, Treatment of Minor Ailments (excluding uncleanliness, for which see Table Y.) Total number of defects treated or under treatment during the year under the Authority's scheme 2964. Group 2. Treatment of defective vision and squint (excluding Minor Eye defects treated es Minor Ailments - Group Errors of Refraction (including squint). Other defects or Diseases of the oyes. Number of children whom spectacles prescribed. for were Obtained. 421 72 419 419 Group 3. Treatment of Defects of Nose and Throat. Received operative Treatment. Recevied other froms of treatment. Total Total 27 146 173 TABLE IV. Dental inspection and treatment. (1) Number of children inspected by the Dentist 6043. (a) Routine Age Groups Age 5 yrs. 5 yrs, 7 yrs. 8 yrs, 9 yrs. 10 11 yrs. yrs. 12 yrs. 13 yrs. 14 yrs. 15 yrs. 16 yrs. Total 768 695 614 495 457 468 573 752 818 290 108 5 6043 (b) Specials 693 (c) Total (routine and specials) 6736 Number found to require treatment 4169 Number actually treated 3207 Attendances made by children for treatment 7460 Half days devoted to - 7. Extractions - Inspection 56 Permanent 531 Treatment 1103 Temporary 2229 Fillings - 8. Administrations of genral anaesthetics for extractions 1628 Permanent 3032 Temporary 951 9 . Other Operations - Permanent 2160 Temporary 143 23 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 20346 Number of individual children found unclean 726 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, NIL. 24.