ESSEX EDUCATION COMMITTEE BOROUGH OF WALTHAMSTOW Committee for Education REPORT of the BOROUGH SCHOOL MEDICAL OFFICER for the year 1947 A. T. W. POWELL, M.C., M.B., B.S., D.P.H. BOROUGH SCHOOL MEDICAL OFFICER ESSEX EDUCATION COMMITTEE BOROUGH OF WALTHAMSTOW Committee for Education REPORT of the BOROUGH SCHOOL MEDICAL OFFICER for the year 1947 A. T. W. POWELL, M.C., M.B., B.S., D.P.H. BOROUGH SCHOOL MEDICAL OFFICER CONTENTS Accommodation 5 Attendance Officers 18 Artificial Light Treatment 15 Aural Clinic 12 Blind School 20 Chicken Pox 16 Child Guidance 24 Clinics 4 Committee 2 Convalescent Home Treatment 32 Co-ordination 5 Crippling 21 Deaf School 20 Defective Children 20 Dental Defects 9 Dental Treatment 15 Diphtheria 15 Diphtheria Immunisation 16 Ear Disease 9, 12 Employment of Children 34 Exclusion 10, 16 Eye Disease 9, 11 Following up 10 Hearing 9, 12 Heart Disease 9 Hospital Treatment 12 Hygiene 8 Impetigo 9, 10 Invalid Children's Aid Association 18 Infectious Diseases 15 Introduction 3 Meals, Provision of 17 Medical Inspections 8 Medical Examinations 34 Measles 15 Medical Treatment 10 Mental Deficiency 23 Milk in Schools Scheme 17 Minor Ailments 10 Mumps 10 N.S.P.C.C. 19 Nursery School 32 Nutrition 8 Open Air Education 17 „ „ School 21 Orthopaedic Treatment 9, 15, 21 Orthoptic Clinic 12 Parents, Co-operation of 18 Physical Training 17 Plantar Warts 34 Re-inspections 8 Rheumatism 9, 15 Ringworm 8 Scabies 8 Scarlet Fever 15 School Camps 17 Secondary Grammar & Technical Schools 32 Skin Diseases 8, 10 Speech Therapy 31 Staff 5 Statistical Tables 37 Teachers, Co-operation of 18 Tonsils and Adenoids 9, 12 Tuberculosis 9, 15 Uncleanliness 8, 10 Vaccination 17 Vision 9, 11 Voluntary Bodies 18 Whooping Cough 15 WALTHAMSTOW COMMITTEE FOR EDUCATION 1946 - 1947 Chairman: Alderman E. C. Redhead, J.P. Deputy Chairman: His Worship the Mayor, Alderman S. N. Chaplin, J.P. Cty. Aid. P. Astins, J.P. Coun. Mrs. B. E. Bottomley. Aid. W. B. Fitt. Aid. T. Fitzpatrick. Coun. L. J. J. Hodson. Cty. Aid. J. Hewett, J.P. (deceased). Coun. A. J. Llewellyn. Coun. G. S. Mace. Aid. A. E. Manning. Aid. Mrs. C. McEntee, J.P. Aid. Mrs E. M. Miller. Coun. D. R. Perry. Coun. W. F. Savill. Coun. W. H. Shaw. Coun. Mrs. E. A. Smith, J.P. (deceased). Aid. Ross Wyld, O.B.E., J.P. Miss B. E. Cockrell. Mr. Ray Lamb. Mrs. Jarman. Rev. D. A. Kino. Rev. J. E. McKinley. Rt. Rev. Mgr. W. O'Grady, V.G. Borough Education Officer: E. T. Potter, B.Sc. To The Chairman and Members of the Walthamstow Committee for Education. Ladies and Gentlemen, I beg to present herewith a report on the work of the School Health Service for 1947. Staff shortage, medical, nursing and clerical to some extent affected the work of the service. The Architect's report shows the increased attention paid to maintenance and improvements. The attention paid to the needs of the school meals service and to sanitary conditions is particularly noteworthy. The nutritional findings appear to show that there has been no marked deterioration. Cleanliness surveys show a marked reduction in the amount of uncleanliness. Dr. Francis Clarke's report on the ear clinic draws attention to the marked reduction in cases of chronic ear discharge—a very different picture from twenty years ago. Dr. Watkins contributes an interesting article on the incidence, treatment and prevention of plantar warts. The work of the Child Guidance Clinic continues to grow and the difficulties of accommodation have not yet been overcome. Once more I have to record my appreciation of your consideration and that of the Borough Education Officer and his staff, and the good work of all the staff concerned in the School Health Service. I am, Your obedient Servant, A. T. W. POWELL, Borough School Medical Officer. 4 SCHOOL CLINICS Aural— Monday 2—4.30 p.m. Town Hall. Child Guidance— Wednesday 10 a.m.—1 p.m. 2—4 p.m. High Street. Thursday Dental Clinic— Monday 9 a.m.—4.30 p.m. Town Hall. Tuesday Wednesday Thursday Friday Saturday 9 a.m.—12 noon Town Hall. *Minor Ailments— Monday 9 a.m.—12 noon Town Hall. Wednesday Friday Saturday Tuesday 9 a.m.—11 a.m. 1.30 p.m.—2.30 p.m. Sidney Burnell School. Friday Thursday 9 a.m.—11 a.m. Low Hall Lane. Ophthalmic— Monday 9 a.m.—12 noon Town Hall. Tuesday Thursday Saturday Orthopœdic— Third Thursday in each month: 9.30 a.m.—12.30 p.m. Open Air School. Massage and Sunlight— Monday 9 a.m.—5 p.m. Open Air School. Tuesday Wednesday Thursday Friday Orthoptic— Monday 1.30 p.m.—4.30 p.m. Tuesday 9.30 a.m.—4.30 p.m. Town Hall. Thursday Friday 1.30 p.m.—4.30 p.m. Speech Therapy— By appointment High Street. Rheumatism— Held monthly 2 p.m.—4 p.m. Town Hall. *Immunisation— Tuesday 2 p.m. Town Hall. *Scabies— Wednesday 2 p.m. Town Hall. *Infectious Disease— Wednesday 3 D.m. Town Hall. All clinics, except those marked "*" are "Appointment" clinics. 5 1. STAFF OF SCHOOL MEDICAL DEPARTMENT Resignations and Appointments:— Dr. M. Edmond, Asst. School Medical Officer. Appointed, 4.9.44; resigned, 1.5.47. Dr. C. G. Chadwick, Asst. School Medical Officer. Appointed, 1.1.45; resigned, 22.11.47. Mrs. C. S. Adams, Dental Attendant. Appointed, 21.6.43; resigned, 30.11.47. 2. CO-ORDINATION Co-ordination is secured by the fact that all the school medical staff also carry out duties for other health services. The school nursing staff is equivalent to five whole-time nurses. 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 at the 31st December, 1947. Boys. Girls. Mixed. Infants. Nursery. County Secondary Grammar 1 2 — — — County Secondary Technical — — 1 — — County Secondary Modern 3 3 6 — — County Primary Junior 2 2 12 — — County Primary Infants — — — 15 — Voluntary Secondary Modern — — 1 — — Voluntary Primary — 1 3 2 — County Nursery — — — — 1 Special Schools for:— Educationally Sub-normal — — 1 — — Myope Centre — — 1 — — Open Air School — — 1 — — Deaf — — 1 — — 1947. 1946. 1945. 1944. 1943. Number of Children on Register, 31.12.47 16,463 15,776 12,753 9,236 12,185 Average Attendance 14,470.6 14,004.6 10,189.2 8,488.5 10,106.7 Percentage Attendance 86.9 86.0 80.0 78.4 84.1 Mr. Frank H. Heaven, A.R.I.B.A., Architect to the Education Committee contributes the following:— Additions and Alterations.—Many improvements have been effected in accommodation and equipment at Primary and Secondary Schools. 6 Central Kitchens.—The existing kitchens have been maintained and additional equipment provided. Deprotection.—All the A.R.P. protective works erected at Schools during the war have now been removed and the various rooms renovated and restored to normal use again. Heating.—Many heating defects have developed and been remedied, including replacement of complete boilers at two schools, and the installation of a pump at another. Supplementary heating has been installed where "background" heating has not met the full demand. Gas operated boilers have been installed at two schools, in lieu of fuel-fed boilers, in order to minimise labour and economise in fuel consumption. This type of boiler can be more scientifically controlled in regard to consumption and output. Bunkers have been set up at three schools to provide accommodation for stocks of emergency fuel. Hot Water Supplies.—Additional equipment and supplies have been provided at nine schools for the washing of hands before and after meals. Lavatories.—These have been improved by structural alterations where necessity has arisen. Lighting—Additional lighting facilities have been provided at lavatory blocks at two schools where evening continuation classes are provided. Two of the classrooms at the Joseph Barrett Secondary School have been equipped with alternative methods of lighting by fluorescent lamps operating under direct and semi-indirect conditions. Maintenance.—Educational properties and play areas have been maintained in repair within the limits of expenditure and the restrictions imposed by the economic conditions obtaining throughout the year. Particular attention has been given to fences at seven schools, flooring at one school, roofing at three schools and the playgrounds at all schools. Medical Services.—A Dental Clinic has been equipped and opened at No. 1 Guildsway as an extension of the services provided in the Borough for school children. The Child Guidance Clinic at 263 High Street has received attention in regard to additional facilities for its functions, and a scheme of considerable alteration and improvement has been approved in principle by the Ministry of Education to meet demands for this service from surrounding areas. Playfields.—These have been maintained, chiefly by direct labour, in satisfactory playing condition throughout the year. 7 An additional playing field of three and one-quarter acres has been acquired at Selwyn Avenue. Provision of Meals and Milk.—Two Air Raid Shelters have been converted into Dining Rooms and Sculleries with heating and lighting in order to meet immediate pressing demands for extra accommodation. The kitchens at all the schools have been maintained and additional equipment provided as required from time to time. The war damaged annexe to the Parochial Hall at St. Patrick's School has been transferred to the Education Authority, and it has been repaired and rendered available for use as a much needed dining room and scullery, including complete new heating and lighting systems. An additional scullery has been provided at the Mission Grove Junior Mixed School. A new dining room and kitchen of prefabricated construction to provide 500 meals has been erected at the Sir George Monoux Grammar School. New dining rooms and kitchen have also been approved for early erection at three other schools. Raising of the School Leaving Age.—Major improvements in the buildings and equipment have been carried out at three secondary schools in order to meet the problems arising from the raising of the school leaving age. Two prefabricated buildings have been erected, one at the Blackhorse Road Secondary Girls' School, and one at the William Elliott Whittingham Secondary Boys' School, to provide additional classroom and practical room accommodation respectively. Renovations.—Extensive repairs and complete renovation to interiors have been carried out at nine schools. Unfortunately, owing to high costs, similar work at other schools has had to be postponed until next year. The orthopaedic rooms at the Hale End Special Mixed School were re-decorated during the summer recess. Sanitary Fittings.—Improvements have been effected in the washing arrangements at two schools in order to deal with subnormal children and smaller children attending an Infants' school. Sites and Properties.—Rooms which have been released from Civil Defence and other war-time occupations at three schools have been renovated and made available for educational purposes. War Damage.—A considerable quantity of repair work has been carried out at nine schools, but other work still remains to be completed as and when better conditions in the building trade obtain. 8 4. MEDICAL INSPECTION The following gives a summary of the returns A. Routine Medical Inspection:— Entrants 1,338 Second Age Group 1,424 Third Age Group 1,618 Total 4,380 B. Other Inspections:— Special Inspections 223 Re-inspections 12,123 Grand Total 12,346 5. REVIEW OF THE FACTS DISCLOSED BY INSPECTIONS (a) Classification of the Nutrition of Children inspected during the year in the routine age groups:— Number Inspected "A" Good "B" Fair "C" Poor No. % No. % No. % Entrants 1338 436 32.5 872 65.1 30 2.2 2nd Age Group 1424 586 41.1 792 55.6 46 3.2 3rd Age Group 1618 708 43.7 849 52.4 61 3.7 Totals 4380 1730 39.5 2513 57.3 137 3.1 The findings may be shown comparatively as follows A and B. C. D. 1947 96.6 3.2 — 1946 97.8 2.1 — (b) Uncleanliness.—The following table gives comparative figures for the past two years:— 1947. 1946. Average number of visits to schools 4 4 Total examinations 32,671 27,739 Number of individual children found unclean 939 314 Percentage uncleanliness of average attendance 6.5 2.2 (c) Minor Ailments and Skin Defects.—The following is the number of skin defects found to require treatment:— 1947. 1946. Ringworm—Head 6 3 Body 11 24 Scabies 84 158 Impetigo 88 135 Other skin diseases 307 319 9 (d) Visual Defects and External Eye Diseases.—The number of patients requiring treatment and observation was as follows:— 1947. 1946. Treatment. Observation. Treatment. Observation . Visual defects 146 206 166 196 Squint 31 31 77 70 External Eye Disease 261 9 202 6 (e) Nose and Throat Defects.—The number of patients requiring treatment and observation was as follows :— 1947. 1946. Treatment. Observation. Treatment. Observation. Chronic Tonsillitis 71 106 114 317 Adenoids 5 — 12 6 Chronic Tonsillitis and Adenoids 15 27 22 13 Other conditions 261 12 252 10 The 261 cases of "other conditions" are made up of sore throat and defects requiring diastello treatment. (f) Ear Disease and Defective Hearing.—Patients requiring treatment:— 1947. 1946. Defective Hearing 26 29 Otitis Media 64 34 Other Ear Diseases 152 103 (g) Orthopedic and postural Defects.—A total of 236 deformities were found to require treatment. (h) Dental Defects.— Requiring General Anaesthetics. Other Operations. Inspection. Treatment. Per Cent. Actually treated. Fillings. Extractions. 1947 1,697 962 56.6 4,154 3,673 4,006 2,704 4,471 1946 5,613 3,218 57.3 4,218 5,564 5,233 2,870 4,557 Reference is made to dental inspection and treatment at Secondary and Technical Schools in Section 7H. (i) Heart Disease and Rheumatism.—The findings were as follows:— 1947. 1946. Treatment. Observation. Treatment. Observation. Heart Disease—Organic 11 4 15 15 Functional 8 8 12 6 Anaemia 84 3 77 4 (j) Tuberculosis.—All children suspected either of pulmonary or glandular tuberculosis are referred to the Tuberculosis Officer for final diagnosis. 10 (k) Other defects and Diseases.—The following Table shows the number of various other defects which were found to require treatment:— Enlarged Glands 46 Speech 42 Bronchitis 99 Epilepsy 2 Chorea 1 Other defects 1,494 6. FOLLOWING UP The School Nurses paid a total of 1,129 home visits during 1947. 7. ARRANGEMENTS FOR TREATMENT (a) Malnutrition.—The following shows the quantities of tonics issued during 1947:— Cod Liver Oil. Parrish's Food. Syrup Lacto Phosphate Cod Liver Oil and Malt. Cod Liver Oil and Malt and Parrish's Food. Emulsion. 104 lbs 271 lbs. 83 llbs. 1,032 lbs. 1,124 lbs. 164 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. (c) Minor Ailments and Diseases of the Skin.—Treatment of minor ailments is carried out at the seven sessions of the school clinics, all of which are in the charge of a medical officer. The number of cases of skin disease treated is shown in the table detailing the work done at the school clinics:— Conditions. First Inspections. Re-inspections. Number Excluded. Number not Excluded. Boys. Girls. Boys. Girls. Boys. Girls. Ringworm 9 4 8 7 16 17 Scabies 26 24 18 27 53 52 Rheumatism 1 — 10 9 10 19 Impetigo, Sores, etc. 45 16 94 55 322 179 Skin 16 11 167 156 443 318 Verminous Head, etc. 11 87 36 153 208 1,397 Sore Throat 47 56 25 34 108 75 Discharging Ears and Deafness 20 20 106 89 738 482 Defective Vision — — 40 58 12 18 External Eye Disease 16 15 73 100 159 182 Tonsils and Adenoids 3 2 88 133 140 193 Mumps 6 3 — — 1 7 Various 156 183 1,271 1,242 2,998 2,871 Totals 356 421 1,936 2,063 5,208 5,810 11 Number of children seen at first inspection 4,776 Number of children sent by Attendance Officers and Attendance Committees 42 Number of attendances made by children 15,794 Number of children sent by Head Teachers 3,822 Number of swabs taken 430 Number of specimens of hair examined for Ringworm — Number operated on for Tonsils and Adenoids 181 Number of children X-rayed — Number of children seen by Ophthalmic Surgeon:— New cases 439 Prescribed for 526 Total inspections 2,772 First attendances number 4,776 against 5,292 in 1946, and re-attendances 11,018 against 10,257, the total attendances being 15,794 against 15,449. (d) Visual Defects and External Eye Diseases.—Dr. Sheppard has kindly contributed the following account of the work done during 1947:— There were 489 new cases seen at the Eye Clinic during 1947 and these, as well as the ordinary periodical inspections, made 2,864 attendances. The following tables summarise the defects found in the new cases:— Defect. Under 7 years. 7-11 years. Over 11 years. Secondary Schools. Total. Boys. Girls. Boys. Girls. Boys. Girls. Boys. Girls. Boys. Girls. Hypermetropia 11 12 19 9 5 10 4 8 39 39 Hypermetropic Astigmatism 2 2 13 17 3 7 6 2 24 28 Myopic Astigmatism — 3 5 5 3 2 6 5 14 15 Mixed Astigmatism — — 5 5 3 4 — 3 8 12 Myopia — — 7 12 16 26 11 15 34 53 Various 21 30 27 49 29 44 8 15 85 138 Totals 34 47 76 97 59 93 35 48 204 285 The details of the group described as "various" are as follows:— Defects. Boys. Girls. Totals. Squint 37 55 92 Headaches, anæmia, styes, debility, amblyopia, etc. 22 46 68 No visual defects 26 37 63 Totals 85 138 223 12 (e) Orthoptic Clinic.—Mrs. K. S. Box, S.R.N., 3.C.M., has contributed the following report on the work done at the clinic:— Number of patients treated for squint and heterophoria 70 Number discharged cured 40 Number Improved 16 Still under treatment 14 Number of patients with Amblyopia 30 Number discharged cured 21 Number improved 3 Still under treatment 6 Number cured by operations 18 Number of patients under observation 80 Number of new cases 86 Total number of attendances 751 In November two sessions a week were allocated to patients from Ilford under an arrangement made with the Medical Officer of Health for Ilford. The total number of attendances made by Ilford patients was 84. (/) 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. 1947 181 — 181 1946 107 1 108 (g) Ear Disease and Defective Hearing.—Ear Clinic. Dr. Francis Clarke reports as follows:— The work carried out at the Ear, Nose and Throat Clinic during the past year, 1947, has followed along similar lines to those of previous years. Attendances at the weekly Aural sessions have been well maintained, and the attendances for the various treatments prescribed have considerably improved. It is very important that when a course of special treatment is prescribed, it should be completed, but there is always a certain number of instances when the patient fails to attend to complete the full course. This is most noticeable in the case of the younger children of five years or under. In these instances the parents have to attend with the children, and it is very often inconvenient for them to spare the time. But taking all thess circumstances into account, the attendances generally have been very satisfactory. WALTHAMSTOW 1947 TABLE "C" NOSE AND THROAT CONDITIONS SCHOOL CHILDREN Diagnosis. Primary Conditions. Totals. Tonsils and Adenoids. Secondary Conditions. Treatment. Results. Otitis Media. Deafness. Nasal Catarrh, etc. Enlarged Tonsils and Adenoids. Diastolisation. Antiseptic Treatment. Proetz Displacement. Tonsils and Adenoids. Cured. Improved. Still under Treatment or Observation. Left School or Treatment Lapsed. Referred Hospital for Operation. Did not attend or Declined Treatment. Conservative Treatment. Operative Treatment. A B C D E F G H I J K L M N O P Q R Sinusitis : Rhinitis 24 Operation before Clinic 3 — — — — 1 3 3 — — 2 1 — — — — No Operation 21 — — — 1 1 16 11 1 — 11 4 2 2 1 1 Nasal Obstruction : Rhinitis 89 Operation before Clinic 17 1 1 — 1 10 10 — — — 15 — — 2 — — No Operation 72 6 3 — 18 29 56 4 14 — 45 5 2 12 2 6 Nasal Catarrh 142 Operation before Clinic 20 — 6 — — 20 2 — — — 15 3 1 1 — — No Operation 122 — 15 — 14 89 33 — 10 — 98 2 3 9 — 10 Enlarged Tonsils and Adenoids 92 Operation before Clinic — — — — — — — — — — — — — — — — No Operation 92 — — 20 — 7 11 — 62 1 34 5 6 12 33 2 Totals (School) 347 7 25 20 34 157 131 18 87 1 220 20 14 38 36 19 PRE-SCHOOL CHILDREN Nasal Conditions : Sinusitis : Rhinitis 9 Operation before Clinic — — — — — — — — — — — — — — — No Operation 9 — 1 — — 2 7 — — — 6 — 1 2 — — Enlarged Tonsils and Adenoids 4 Operation before Clinic — — — — — — — — — — — — — — — — No Operation 4 — — — — — — — — — — — — — — — Enlarged Tonsils and Adenoids with Nasal Conditions 3 Operation before Clinic — — — — — — — — — — — — — — — — No . Operation 3 — — — — — 2 — 2 — — — — 2 1 — Totals (Pre-school) 16 — 1 — — 2 9 — 6 — 8 — 1 6 1 — Grand Totals 363 7 26 20 34 159 140 18 93 1 228 20 15 44 37 19 TABLE "D" MISCELLANEOUS CASES Examined for:— Affections of the Ear. Nose and Throat : Advised, Special cases of Deafness for admission to special classes, or Deaf School: Recommendations and Reports made. Colds, and other conditions 98 Clinic treatment not required. Foreign body in nose 1 Removed. Epistaxis (nose bleeding) 9 Treated. Wax in ears, only 2 Removed. Hay Fever 1 Treated. Total 111 Tonsils and Adenoids already removed in above cases 19 SUMMARY Total number of cases seen in 1947 549 School 517 Pre-school 32 "A" & "B" — Ear cases: School 61 Pre-school 14 "C" — Nose and Throat: School 347 Pre-school 16 "D" — Miscellaneous: School 109 Pre-school 2 13 During the greater part of the latter half of the past year, on the advice of the Ministry, the operation for the removal of tonsils and adenoids was suspended on account of the epidemic of poliomyelitis in the London area. This was a very reasonable and justifiable precaution, for the leading authorities on the subject have shewn that there is a certain relationship between tonsillec tomised patients and poliomyelitis. This has been very clearly demonstrated in special investigations conducted in the United States, and we have had at least one instance in Walthamstow to corroborate this decision. The operation for the removal of tonsils is never an urgent one, as evidenced by many Hospitals having a waiting list, which, they say, will take from one to two years to clear. The suspension of the operation, concurrent with this waiting list, during an epidemic of poliomyelitis, is done to take every possible safeguard to protect the patient, and cannot be considered to have any undue deleterious or damaging effect on the patient's health. At the Ear, Nose and Throat Clinic it has been the practice for a number of years to limit the number of tonsil operations to the very minimum. This decision has been based on the results observed where tonsils and adenoids have been removed after a more or less routine fashion. During the period of the epidemic the recommendations for operations were postponed in all cases. In no instance to our knowledge have we found any patient to have suffered any undesirable effect from this postponement. In the majority of these cases we have resorted to other methods of treatment along conservative lines, such as tonsil suction and tonsil painting, and especially to treatment of nasal conditions which are commonly found in association with diseased or "enlarged" tonsils. In previous reports we have stressed the importance of the close relationship between certain nasal affections such as sinusitis, rhinitis and diseased tonsils, and the necessity of treating these conditions as a preliminary to any radical surgical treatment of the tonsils. We wish, again, to emphasise this line of approach to the "tonsil problem." One striking fact in the year's returns is the very small number of cases of chronic otorrhoea. In all, only sixteen cases were seen at the clinic during the year. This is a remarkably small number for a school population of the size of Walthamstow. In the past, chronic "running ear" was one of the commonest complaints amongst a school population, and one of the most serious. There cannot be any doubt that the adequate treatment now available for the successful treatment of "acute discharging ears"— the forerunner of the chronic type — and the detection and treatment of nasal defects, always a potential source of ear trouble, in the younger age groups, has had a most important effect in the prevention of chronic discharging ears and its inevitable sequelae of deafness. 14 There was a total number of 59 cases of acute otorrhoea and 13 of these were among the pre-school age group. In all, 49 cases were cured after treatment, three were still under treatment at the end of the year, two were referred to hospital for operation and five lapsed treatment. The earliest possible cure of the acute discharging ear is of the utmost importance to prevent chronicity. The French method of Diastolisation for such nasal affections as rhinitis, nasal catarrh, mouth-breathing, catarrhal deafness, etc., has been extensively employed during the year. In all, 159 cases have received this treatment. We can strongly commend its use in suitable cases. Two special Aural sessions were held at the School for the Deaf and where necessary special treatment has been provided. The general health of the children attending the clinic has been found satisfactory and we have not noticed any signs of malnutrition or debility. 15 (h) Dental Treatment.—The treatment of Secondary and Technical Pupils is shown below and is not included in Table IV at the end of the report. No. of Children. Attendances. TREATMENT Extractions. Anaesthetics. Fillings. Other Operations. Temp. Teeth. Perm. Teeth. Local. General. Perm. Teeth. Perm. Teeth. 433 1,067 74 141 22 166 730 282 (i) Orthopaedic and Postural Defects.—Details of the work done under the scheme are given in the section dealing with Defective Children. (j) Heart Disease and Rheumatism.—The following is a report of the work done at the Rheumatism Clinic during 1947:— Number of sessions 10 „ „ new cases 37 „ „ old cases 104 „ „ attendances 141 „ discharged 62 „ still under treatment 38 „ of new cases with rheumatism or cardiac defect 14 „ referred for tonsils and adenoids 3 „ excluded from games and exercises 2 „ to begin games and exercises 2 „ referred for convalescent home treatment 4 „ referred to hospital 9 (k) Tuberculosis.—The number of school children examined during the year was 179 boys and 113 girls, of which 31 boys and 28 girls were referred by the School Medical Staff. 81 of these cases were sent by private practitioners and 152 were examined as contacts. (i) Artificial Sunlight Treatment.—The number of children treated was 267, making 2,954 attendances. 8. INFECTIOUS DISEASES Notification in the 5-15 years age group during 1947 was as follows, the figures for 1946 being shown in parenthesis: Scarlet Fever, 175 (125); Diphtheria, nil (18); Pneumonia, 20 (12); Erysipelas, 2 (nil); Cerebrospinal Meningitis, 1 (2); Measles, 388 (171); Whooping Cough, 62 (46); Dysentery, nil (9); Anterior Poliomyelitis, 8 (nil). 16 Non-notifiable infectious diseases are chiefly brought to light by the weekly returns made by Head Teachers under the local "Regulations as to Infectious Diseases in Schools." The following are the weekly average numbers of children away from school owing to exclusions and the non-notifiable infectious and other diseases named:— Exclusions. Chicken Pox. Measles & G.M. Whooping Cough Sore Throat. Influenza. Diarrhoea. Mumps. Scabies. Ringworm. Various. Total. 1947 21 14 79 32 50 49 3 6 2 2 410 668 1946 26 46 32 40 46 45 4 41 2 10 471 762 Immunisation and Infectious Diseases Clinic.—Follow-up arrangements were as detailed in the 1939 report. The following table shows the work done at the Infectious Disease Clinic:— Total number of immunisations completed during 1947 2,658 (a) School age 810 (b) Pre-school age 1,844 (c) Over school age 4 Number already immunised and given a re-inforcing dose 3,541 The above total includes 152 children immunised at "Brookscroft" and 366 by private practitioners. Number of Schick tested for the first time 15 Negative (including pseudo and negative) 9 Positive (including pseudo and positive) 6 Number of Schick tests following immunisation 67 Number positive 2 Number negative 60 Not seen 5 Number of clinics held 52 Number of attendances made 1,795 Average attendance per session 34.5 Immunisation at Schools (included in above figures):— Number completely immunised 713 Number partly immunised 97 Number already immunised given an extra dose 3,147 Number of clinics held in connection with Infectious Disease 52 Number of attendances made 380 Average attendance per session 7.3 17 Number of children recommended to Rheumatism Clinic — Number of children recommended to Ear Clinic 3 At the end of 1947 the position in regard to the immunisation of children aged 5 to 14 years was: — Total 5.9 10.14 5.14 years years years Number protected 632 199 831 Vaccination.—The vaccinal condition of each child examined at routine inspections was noted, and a summary shows the following:— Number examined. Number found to be vaccinated. Percentage vaccinated. Entrants Boys 458 122 26.6 Girls 413 119 28.8 2nd Age Group Boys 489 77 15.7 Girls 733 134 18.2 3rd Age Group Boys 581 86 14.8 Girls 753 163 21.6 Totals 3,427 701 20.4 9. OPEN AIR EDUCATION From March onwards arrangements were made for the medical examination of parties of 40 boys and 40 girls each four weeks, before proceeding to the permanent school camp at Itchingfield, Sussex, and three parties of 11 boys and 11 girls before proceeding to the permanent school camp at Kennylands, Reading. 10. PHYSICAL TRAINING Your Committee share the services of two whole-time Organisers with a neighbouring area. Co-operation has continued along the lines of previous years. 11. PROVISION OF MEALS The average number of meads supplied daily to school children in December, 1947, was 8,775. The quality of the food supplied and the standard of cooking have been maintained at the previous high level. Milk in Schools Scheme.—The arrangements detailed in former reports were continued in 1947, all the milk supplied being pasteurised milk sold under licence. 18 12. (a) CO-OPERATION OF PARENTS The following table shows the attendance of parents during 1947:— Number Number of Per cent. Per cent. Inspected Parents 1947 1946 Entrants— Boys 458 366 79.9 87.3 Girls 413 370 89.5 84.8 2nd Age Group —Boys 489 349 71.3 73.7 Girls 733 598 81.5 79.4 3rd Age Group —Boys 581 174 29.9 30.4 Girls 753 412 54.7 41.6 (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 O. M. Barnard, Secretary of the local branch has kindly contributed the following report Number of new cases 277 Number of old cases 41 318 Number of weeks' convalescence provided 1 ,941 Number of children sent away convalescent 232 Number of home visits paid 463 Over Under Cases Referred by:— 5 years. 5 years. Voluntary Hospitals and Private Practitioners 56 27 Tuberculosis Dispensary 2 — General Hospitals under a Public Authority 11 2 School Medical Services 149 10 Local Authority under Schemes for— (i) Rheumatism 5 — (ii) Orthopaedic care 19 13 Maternity and Child Welfare Centres — 3 Voluntary bodies 1 6 Parents 5 6 I.C.AA. visitors and others 2 — Transferred from I.C.A.A. Branches 1 251 67 19 Suffering from:— Anaemia, debility and malnutrition 49 4 After effects of acute or infectious illness or operation 39 15 Bronchitis and pneumonia 55 12 Asthma 6 1 Rheumatism, chorea and heart 25 2 Other crippling defeots (non-T.B.) 20 22 Nervous conditions 11 3 Diseases of : (a) Ear, Nose and Throat 30 3 (b) Eyes — 1 (c) Skin 4 1 Accidents 3 1 T.B. contacts 3 — Tuberculosis (a) Lungs 1 — (b) Various 2 — Various 3 2 251 67 Help given to old and new cases:— Children sent to Convalescent Homes and Residential Open Air Schools 204 28 Provided with Surgical Appliances 2 16 Transferred to other agencies 3 2 Referred for visiting and advice 17 10 226 56 (b) National Society for the Prevention of Cruelty to Children.—The following is a summary of the work done in Walthamstow during 1947:— Nature of Offence How dealt with Neglect 28 Warned 33 Advice sought 15 Advised lb Immoral surroundings 1 Ill-treatment 4 48 48 dumber of Children dealt with - Under 5 years Over 5 years Boys Girls Boys Girls 22 27 47 - 42 149 supervisory visits were made during the year and 80 miscellaneous visits were made. 20 BLIND, DEAF, DEFECTIVE AND EPILEPTIC CHILDREN (i) Blind School.—The following table shows the classification of children attending the school at the end of 1947:— Walthamstow Pupils. Out of District Pupils. Myope. Blind. Myope Blind Boys 10 — 9 1 Girls 10 — 11 1 Miss M. L. Balls, the Head Teacher, reports as follows:— During the year, the work at the Myope Centre was still accomplished at the Hale End Open Air School. The school year was uneventful. The weather during the spring term was severe enough to cause much illness among the children, and gas heaters were installed in an effort to render working conditions more comfortable. During the beautiful summer weather the children were able to work out in the sunshine and their studies benefited from the very congenial surroundings. At the end of the autumn term arrangements were made for the Myope Centre to be removed to Wood Street School. Visitors during the year included parties of students from training colleges for teachers and public health schools for training health visitors who will work under the National Health Scheme. Dr. Sheppard paid her usual visits during the year and also made many special examinations of children at the school clinic. We would like to thank her for her continued help and encouragement in our work. During the year the eyes of two boys and one girl improved sufficiently to allow of their return to secondary schools. One boy left the centre and is learning french polishing, and one girl left and is learning to make suit cases. (ii) Deaf School—Miss V. K. Mitchell, the Head Teacher, reports as follows:— In January, 1947, the school had 13 children on the roll between the ages of two and 15 years. There were 13 boys and two girls, 13 totally deaf within the meaning of the Act, one partially deaf and one backward child (it is impossible to decide yet whether this child is deaf or not). 21 During the year, until December, 1947, one child was admitted in March who proved unsuitable for this school, a boy of six years was admitted in September, a girl of four years in November and a girl of six years in December. All were totally deaf. A boy of 16 years left in October to work as an engraver and is doing well. In December, 1947, there were 17 children on the roll between the ages of three and 11 years. The attendance at school is always very good. Hearing aids are used whenever they are of benefit. (iii) Open Air School.—Mr. Williams, the Head Teacher, reports as follows :— The year has not been remarkable for any great changes in the school. In spite of the severe winter the general health of the children has maintained a fair level as shown by the improved attendance. Gas heaters have been installed in all classrooms to replace coal stoves, but it is too early yet to judge their effect on the children's health. During the year 54 children (including 12 re-admissions) were admitted, and 38 were discharged. The average attendance was 62 and the average number on roll was 75. At the end of the year the classification was as follows:— Orthopaedic 17 Debilitated 29 Cardiac 4 Asthma 22 Miss Waid, assistant mistress at this school since 1938, retired at the end of the year. I would like to record my appreciation of her services to the school. I would also wish to thank all staff, medical, teaching, welfare and domestic for their valued co-operation in the work of the school. (iv) ORTHOPEDIC SCHEME The Scheme is under the clinical charge of Mr. B. Whitchurch Howell, F.R.C.S., Consulting Orthopaedic Surgeon. The following table shows the work done at this clinic 22 Defects. Boys. Girls. 5-16 years. Under 5 years. Over 16 years. 5-16 years. Under 5 years. Over 16 years. Anterior Poliomyelitis 11 2 4 11 2 12 Surgical Tuberculosis 2 - 4 2 - 1 Scoliosis—Lordosis Kyphosis 18 1 - 12 - 2 Arthritis 1 - 1 - 1 3 Rickets— - (a) Genu Varum 6 24 - 10 8 - (6) Genu Valgum 37 32 - 30 30 - Pes Piano Valgus 110 21 2 78 22 - Spastic Paralysis 10 1 2 6 6 - Progressive Muscular Atrophy 1 1 - - - - Talipes— (a) Equino Varus 11 4 3 4 12 - (b) Calcaneo Valgus - 9 - - 10 - (c) Pes Cayus 3 - - 1 - Torticollis 3 7 - 7 2 - Osteomyelitis - - 1 - - - Congenital Dislocation of Hip - - - 4 - 1 Hallux Valgus 2 - - 14 - 1 Hammer Toe 3 - - 9 - - Perthes Disease - - - 1 - 2 Achondroplasia - - - 1 1 1 Digitus Varus 2 - - 4 - - Amputation Leg - - - - - 1 Congenital Defects 14 7 3 10 10 1 Miscellaneous 19 3 — 14 8 2 Totals 253 112 20 218 112 27 23 Number of cases seen by Surgeon:— From Physically Defective School 44 From other Schools 327 Under School age 175 Over School age 46 Total 592 New cases seen by Surgeon:— School age 100 Under school age 74 Total 174 Total examinations made by Surgeon 766 Total number of cases discharged by Surgeon 98 Average number of examinations made per session 54.7 Number of treatments given 1,888 Number of attendances for after care 2,339 Number of ultra-violet light treatments 2,954 Total number of treatments 7,181 Average number of attendances per session 16.1 Number of sessions held:— Inspections 14 Treatments 447 Total number of visits by instrument maker 8 Admissions to Queen Elizabeth Hospital for Children 4 Admissions to Black Notley 17 Operations performed 26 Defects seen at Orthopaedic Clinic in Children under 5 years of age:— Anterior Poliomyelitis 4 Scoliosis—Lordosis Kyphosis 1 Arthritis 1 Rackets— (a) Genu Varum 32 (b) Genu Valgum 62 Pes Piano Valgus 43 Spastic Paralysis 7 Progressive muscular atrophy 1 Talipes— (a) Equino Varus 16 (b) Calcaneo Valgus 19 Torticollis 9 Achondroplasia 1 Congenital defects 17 Miscellaneous 11 Total 224 (v) Mental Deficiency.—Miss R. E. A. Lock, Teacher in Charge of the School for Mentally Defective Children, reports as follows:— The number on roll during the year has averaged 54—34 boys and 20 girls. Chronological ages range from 6.6 to 15 plus, and intelligence quotients from 48 to 75. 24 One boy and one girl reached the age of 16 years and both proceeded to gainful employment in local factories. One boy was excluded as ineducable. The school has been extended slightly during the year. Three classrooms in the Open Air School have been made available for our use. Both children and staff appreciate the change. New entrants during the year have on the whole been less unstable than those of the previous year. The health of the children has been well maintained. (vi) Child Guidance Clinic.— Dr. Elizabeth Whatley, Psychiatrist to the Child Guidance Clinic, reports as follows:— TABLE 1 Analysis of problems referred to the Clinic Nervous disorders, e.g., fears, depression, apathy, excitability 40 Habit disorders and physical symptoms, e.g., enuresis, speech disorders, sleep disturbances, feeding difficulties, tics, fits 66 Behaviour disorders, e.g., unmanageable, tempers, stealing, lying, sex problems 44 Educational, e.g., backwardness, failure to concentrate 17 Court cases 8 Total 175 TABLE 2 Source of referral. Medical Officer of Health and School Medical Officers 98 Head Teachers 42 Speech Therapist 3 Education Department 2 Psychologist 4 Parents 5 Private Doctors 6 Court 8 Other Clinics or Psychiatrists 5 Social Agencies 1 Miscellaneous 1 Total 175 25 TABLE 3 Analysis of cases closed during 1947 (including cases referred in previous years) Adjusted after treatment 5 Improved after treatment 9 No change after treatment 3 Interrupted due to non-co-operation 6 Placed away from home 5 Approved school placing 1 Diagnosed and closed 9 Spontaneously adjusted after partial service 3 Miscellaneous causes and removal 3 Total 44 TABLE 4 Number of interviews during 1947—Psychiatrists and Psychiatric Social Workers Psychiatrists— Diagnostic interviews 99 Treatment interviews 438 Group — 4 children 10 Psychiatric Social Workers— Interviews 722 Home visits 174 Others 44 Waiting List, December 31st, 1947— Diagnostic 49 Treatment 4 Comment on Figures for 1947 It will be seen from the notes of the cases dealt with during 1947 that more time was spent in treating individual children than in seeing new cases for diagnosis than in 1946. This was not due to the fact that the rate of referral had naturally slowed, but because there were so many cases awaiting treatment from 1946 that a determined effort was made to deal with this aspect of the work. The diagnostic waiting list throughout the year remained at a disturbingly high level and towards the end of the year the waiting list was closed to all but the most urgent requests for advice and help. 26 The figures for the problems referred and sources of referral for the past year do not differ significantly with those of the Country as a whole. Development Plan Under the recently approved scheme the Walthamstow Child Guidance Clinic is to serve an enlarged area which will include the neighbouring Borough of Leyton and much of the Forest Division of Essex. The Clinic will therefore be serving a school population of approximately 40,000 children of school age. Extensive structural alterations to the building at 263 High Street have been passed by the Local and County Committees during the year, to accommodate seven clinical workers and two clerical staff. These plans are awaiting sanction by the Ministry of Education, but so far there is no possibility of work commencing in the near future ; it is considered unlikely that work will begin before autumn, 1948 at the earliest. This inevitable delay in carrying out the structural alterations holds up our work very considerably, particularly for the areas outside Walthamstow. Staffing During the year new staff appointments have been made to meet the increased work of the Clinic under the new arrangements. There has been no increase in Psychiatric sessions during the year, four sessions weekly having been worked, but since June, 1947, Dr. Helen Gillespie has acted as Psychiatrist for two of the four sessions. In August 1947 Mrs. E. Kelly resigned her appointment as Psychiatric Social Worker and we were very sorry to lose her valuable and efficient work. Mrs. I. M. Seglow was appointed with special reference to the new areas and commenced duties in September. Miss A. M. Marshall was appointed as Educational Psychologist from 1st September, 1947, but her work will be in the schools of the new areas under the expanded scheme. Miss Russell returned to the Clinic on the 1st October after one year's absence, having completed her year of special training in Edinburgh, and we were very glad to welcome her back. Mrs. K. Barker was appointed as play therapist for five sessions a week and commenced duty at the beginning of October. 27 Miss Hammond resigned her appointment as Educational Psychologist at the end of the year to take up work with the Finchley Education Committee ; Miss Hammond had been working at the Clinic since it was first opened and we wish her every success in her new work. Interim Period During this interim period when the staff is increased and accommodation has not yet been adapted to meet the increased work we are experiencing considerable difficulty in accommodating six (and when a successor to Miss Hammond is appointed, seven) Clinical workers in the rooms which are at present available. Selection of Cases for Treatment It is sometimes felt by those referring a child or having some knowledge of a case sent to the Child Guidance Clinic that children who need it are not taken on for treatment and vice versa. A few words on this point may not be out of place as in a service of this kind such matters interest not only those who are immediately concerned with a particular child but also those responsible for the service. The decision in a particular case can be a complex one, but every effort is made to ensure that the treatment side of the service is available for the children who are suitable for continued attendance, and have a reasonable chance of benefiting from it. Factors influencing this decision are:— The child's intelligence—a child of very dull intelligence is generally unable to benefit from treatment interviews. The parent's intelligence; this too can affect the practical issue in a decisive way, as parents are occasionally so limited themselves that they are incapable of arranging for the child to be brought for interviews, or to keep any useful contact with the Psychiatric Social Worker. The nature and degrees of disturbance in the child. In general the serious emotional disturbances and the more pronounced devia tions and distortions of normal character development in children are the ones we attempt to adjust with individual treatment—in other words, individual treatment, often involving many regular attendances is reserved for the more seriously disturbed children. This, however, does not always imply that the cases showing the most obvious symptoms, such as acute behaviour disorders, are 28 necessarily the most damaged or in the most need of help. A neurotic fear which causes little overt alteration in normal behaviour, and is not a nuisance to others, may need prolonged treatment if the child is to adjust and develop normally. But a child who has been mismanaged, and in consequence is out of control, may with some advice and understanding of his particular difficulty settle quickly and easily and cease to be a problem. The parents willingness to co-operate in further work for the child is very important, and the extent to which they are capable of this is not always apparent at the first interview. Sometimes parents superficially very anxious to have help in understanding and dealing with the child, prove later to be unable to modify their attitude or opinion, or to accept that their own difficulties are closely bound up with the child's. On the other hand, parents who have appeared relucant to see the trouble as it affects the child, and may be actively hostile towards it, do after a time prove really willing and able to co-operate in helping him. The child's accessibility and desire to overcome his difficulty or understand his problem is also significant when assessing the value of treatment. Here it may be some time before a definite decision can be reached. Social and economic factors may be of prime importance in causing disturbances in a child and here the Clinic service can be of little direct help. The family may be put in touch with a social agency which can assist them, but in such cases the root of the trouble is outside the scope of the Child Guidance Clinic. Occasionally a child is so unstable that he is virtually not able to benefit from any form of treatment however intensive or prolonged. These children are generally found to be psychotic or near psychotic in their make-up, and little at present can be done for them except to give such advice on management as will minimise the difficulties of handling and relieve those caring for the child from the anxiety resulting from their very natural wish that " something should be done." Lastly, but no means least, there is the question of human need. Although we may be unable to see ourselves any way of relieving the mental distress of parents or child, or of solving the problem presented to us, we do at times see parents or children whose urgent need is to have someone willing to listen to their troubles, or to befriend and support them. For this we make no apology, believing that there is still much to learn about the therapeutic situation, and finding that an attempt to meet this human need, even in comparative ignorance of the factors involved, may produce results we have not forseen or hoped for. 29 Miss Hammond, Educational Psychologist, contributes the following report:— The great majority of children were referred to the Psychologist for backwardness primarily, but there were usually accompanying symptoms. Among the educational problems the varied causes for retardation were evident. Dullness was the most outstanding single causative factor. Absence from school at critical points in learning progress, causing failures to grasp the foundation processes of reading and numbering, was also responsible for a large number of failures. On the other hand it was found that many children who were apparently failures in school work were actually working up to capacity. Some were of Special School grade and were recommended for admission to that school. The great majority, however, were capable of adapting to school life and learning, when the real nature of their limitations was understood by their Teachers, and allowances and adjustments accordingly made. A few were found to be ineducable. The number of school cases and school visits had to be reduced in 1947 as compared with 1946 because of the increased number of children needing individual remedial teaching at the Clinic, and the Psychologist was asked to undertake this work. During the latter part of the year she took 16 children per week for remedial teaching and in the earlier part of the year 15 children per week. The following table gives the statistics:— Walthamstow Children:— Total number referred (including those re-examined and those carried over from 1946) 91 Total examined (including re-examinations) 85 Advice given in School 58 Recommended for physical examination for transfer to the Special School 13 Remedial teaching 3 Special School cases recommended to leave school 2 Cases found ineducable 5 Cases recommended to remain another year in Infants School 2 Referred to Child Guidance Clinic for full diagnosis 7 Awaiting examination 6 Transferred to other schools 1 Carried over from 1946 10 30 Miss Marshall, Educational Psychologist was appointed from September 1st, 1947 to work mainly in the Leyton Borough and Forest Divisions. Her work has consisted it the testing of all children referred to the Child Guidance Clinic from those areas (and from Walthamstow also, after the resignation of the Walthamstow Educational Psychologist) and in the systematic visiting of the Leyton Schools, where individual children were interviewed and tested. Miss Marshall reports as follows:— The total number of individual tests given during the three months was 146, distributed as follows:— Forest Division—Tests before referral 9 Leyton—Tests before referral 17 Walthamstow—Tests before referral 4 Forest Division — Educational problems — individual tests in school 23 Leyton Division—Educational problems—individual tests in school 93 146 In addition, the Psychologist administered two group tests in Secondary Modern Schools, for the purpose of assisting in the grading of the eleven year old entrants. Altogether, 252 girls were tested, 157 in one school and 95 in the other. Grading was done in the light of the Group Test results, checked by reference to the record card from the primary school. Of the 116 children tested individually in school at the request of the Head Teacher or the School Medical Officer, 62 were from Junior departments and 54 from modern secondary schools. Some of them were interviewed because of their failure to make progress in school, some because their behaviour was disturbing the work of the class or school and was causing anxiety to the parents or teachers, and some because they were doing very well in school, and their teachers find it helpful to have an accurate assessment of their abilities and attainments. The 116 tested may be grouped as follows:— Dull 40 (I.Q's 65.85) Average 63 (I.Q's 85.115) Bright 13 (I.Q's over 115) 31 Backwardness in Reading One of the main problems occurring in every school is that of backwardness in reading. Leaving the bright and the dull children out of account, there still remain 63 children of average intellectual ability of whom 46 are retarded, more or less seriously, in reading. The proportion of boys amongst this backward group is much higher than of girls, i.e. 9 girls to 37 boys. The Psychologist is attempting, in a variety of ways, to assist the teachers to meet this problem, first by the assessment of the child's innate ability and degree of retardation in reading; Secondly by the investigation of the difficulties of individual children and their grouping for purposes of remedial teaching; and thirdly, by supplying information on remedial teaching to the teachers who must tackle it. (vii) Speech Therapy.—Miss C. M. Gregory reports as follows:— At the beginning of the year the numbers of children in need of speech treatment were increasing steadily ; the waiting list had grown to such a length some children would not have received attention for eighteen months to two years. Just about this time (July, 1947) another speech therapist was appointed. This appointment halved the amount of work to do, and eased the overcrowding in the classes, reducing them to more manageable numbers. Four students from the West End Hospital for Nervous Diseases attend here two days a week. They are competent in dealing with minor cases such as lisps, which fact enables me to run two classes concurrently on these days. Four days a week a bus is used for transport of infant and younger junior children with great success. Miss V. Babbington, who was appointed as additional Speech Therapist in July, 1947, has contributed the following report:— The number of cases treated are divided almost equally between stammerers and dyslalics, and in both it is interesting to note the greater percentage to be among boys. This upholds the generally accepted view that speech defects and disorders are more prevalent among boys than among girls. Treatment, for the most part, is individual; the students working in the clinic have made this easier. 32 Many school and home visits have been paid in addition to the interviewing of parents in the Clinic. Attendances at the clinic have been regular, and I should like to take this opportunity to express appreciation to the teaching staffs, and particularly Head Teachers, for their constant co-operation. (viii) Convalescent Home Treatment.—228 children were sent away for treatment during 1947. There were 45 remaining in convalescent homes and hospital schools on December 31st, 1947. 14. FULL TIME COURSES OF HIGHER EDUCATION FOR BLIND, DEAF, DEFECTIVE AND EPILEPTIC STUDENTS The Authority for the provision of such courses is the Essex County Council. 15. NURSERY SCHOOL Miss F. D. Harris, the Head Teacher of the Nursery School, reports as follows:— During 1947 we had 25 cases of measles, 18 of whooping cough and 3 of chicken pox. Apart from these and the usual colds the children's health was very good. A School Nurse has visited us about twice a week, and has found very few minor ailments. Each Thursday, when necessary, children have attended the School Clinic at the Child Welfare Centre. Owing to the shortage of medical staff it has not been possible to arrange for children to be medically examined on admission. However, they have all had this examination before the end of the term in which they have been admitted. The children benefited greatly from the fine summer weather, and spent many happy hours in the garden. In contrast, the increasing number of "under-fives" playing in the streets is distressing. The waiting list for the Nursery is never-ending, and a child's name has to be on it for at least a year before he is admitted. 16. SECONDARY, GRAMMAR & TECHNICAL SCHOOLS (a) Dental Inspection and Treatment.—Reference has been made in Section 7 (h) to the dental inspection and treatment of pupils attending Secondary, Grammar and Technical Schools. 33 (b) The following table shows the findings at Medical Inspections: — Number inspected:— Entrants 467 12 years old 202 15 years old 284 Total 953 Specials 146 Grand Total 1,099 Parents Present 636 Number referred for treatment (excluding dental and unclean- liness) 250 Number referred for observation 139 Number referred for treatment (excluding vision, dental and uncleanliness) 188 Nutrition— A 393 B 532 c 28 Requiring Requiring Defects. treatment. observation. Skin 16 2 Eyes— Blepharitis 3 5 Vision 52 72 Squint 4 4 Other conditions 3 Ear Disease 8 Nose and Throat— Enlarged Tonsils 4 4 Enlarged Tonsils and Adenoids 1 Other conditions 9 Glands (Non-T.B.) — Sub-maxillary — Cervical 1 Teeth 19 5 Heart— Organic 3 2 Functional 4 7 Speech 1 Anaemia Rheumatism 3 4 Lungs—Brondhitis 5 — Otlher conditions (non-T.B.) .2 1 Deformities—Spinal Curvature 1 — Other forms 93 9 Otlher diseases and defects 32 12 34 17. MISCELLANEOUS (1) Employment of Children.—54 children were examined by the medical staff. (li) Employment of Children in Public Entertainments.— Eight children were examined under these regulations. (iii) Medical Examinations.—The following examinations were made during 1947 by the medical staff: Teachers, 63; Others, 44. Medical Examination of Kitchen and Dining Room Staff.— Your Committee decided that the examination of such staff should in future include a rectal swab in an endeavour to reduce the risk of employing disease carriers. Plantar Warts in School Children (Verrucca) Dr. M. Watkins has kindly contributed the following report on the incidence, treatment and prevention of Plantar Warts:— "Plantar warts can be a very troublesome condition and cause considerable pain and disability if they remain untreated for any length of time. "A great deal of controversy has arisen lately as to the most efficient form of treatment. "The following is a review of 150 cases—94 girls and 56 boys —in school children who were referred for treatment through the school health service in 1947. "The facilities for treating this and other foot conditions is widely known in this Borough and this number cannot be taken as a fair indication of the incidence of plantar warts in a school population of 16,463. Monthly Rates Jan. Feb. Mar. Apr. May June July Aug.Sept. Oct. Nov. Dec. Total 13 11 7 13 10 8 7 1 22 21 21 16 150 "The low incidence in August is of no significance as attendances in all clinics during school holidays show a considerable falling off, but the slight rise in the following three months may have resulted from the increased activities of the children during the summer months, especially swimming. "The incidence for the year in age groups is as follows:— Infants Juniors Seniors 5-7 yrs. 7-11 yrs. 11-15 yrs. 7% 27% 66% 35 "There is a significant rise in the 1145 years age group, probably due to increased participation in physical training, swimming, dancing, etc. Position of Warts "The right and left feet were equally affected. The majority of cases had one wart only; 11 had multiple warts on one foot and 12 multiple warts on both feet. "Eighty per cent. of the warts occurred in the plantar metatarsal area and anteriorily and twenty per cent. on the heels, the large majority being situated on the pressure points. Outside this series only one has been encountered on the protected area afforded by the longitudinal arch. Treatment "The treatment was carried out entirely by Registered Medical Auxiliary Chiropodists in the Municipal Foot Clinic. "The standard treatment adopted in most cases was as follows:— (a) Swabbing the whole foot with surgical spirit. (b) Removal of any mass of callous tissue to facilitate the action of the acid to be applied. (c) The area surrounding the wart was painted with Collodion or Tine. Benzoin Co. to prevent irritation by Zinc Oxide Plaster. (d) The wart was localised with a stockinette cover in which a small hole was cut, approximating the size of the wart. (e) Chlorosal (Salicylic Acid 60%, Chloralis Hydras 5%) was applied through the hole in the stockinette, and a felt pad, cut so that no direct pressure resulted, was placed over the wart. (f) The whole dressing was then enclosed in stockinette and secured with adhesive strapping. "The patient was instructed to keep it dry and to return in seven to fourteen days and have the treatment repeated. The above procedure takes from six to eight minutes to complete for each growth. "On the average three treatments only are necessary, but two subsequent visits at monthly intervals are insisted upon for checking the results. Monochloracetic acid and silver nitrate were occasionally used instead of Chlorosal. 36 "The procedure is painless in the majority of cases, but in those that experience pain it passes off in a very short time. "The average number of attendances before final discharge was 5.6 and the average number of treatments 3.8. Results of Treatment "Fifty-nine children who had completed their treatment not less than nine months previously were followed up. All these were selected at random from the higher age group, as they could give more reliable information to questioning. "In no case was there a recurrence and only four children showed any signs of the location of the warts. These were in the form of small localised callosities. None of the others showed any signs of where the warts had been. Indeed the majority of the children had themselves forgotten the site of the warts and several did not know which foot. "Advantage was taken at this examination of noting any associated foot abnormality. Two cases had slight pes planus and six a moderate degree of Hallux Valgus, but the position of the warts in these cases could not be associated with the deformities. "The children were questioned about their activities:— 36 used the swimming bath all the year round. 15 used the swimming bath in summer only. 39 used shower baths regularly after P.T. 2 only had used communal gym shoes. "Of the many hundred cases treated before at the foot clinic none have had to be referred for more energetic measures. Prevention "Without the precise knowledge of its aetiology, preventive measures are mainly directed towards excluding established cases from places which favour its spread, i.e. from swimming baths and showers. Frequent examination of the feet of children using the above places should be carried out. "It is doubtful whether the use of disinfectants to the surrounds of baths and showers are of any value. "It was noted that in a great number of affected children a primary stimulus, probably in the form of an abrasion, may have been produced by nails jutting into the shoe or by ill-fitting shoes. Some stress, therefore, should be laid on properly fitting and comfortable shoes. 37 Comments "Conservative treatment is eminently suitable for warts and is the method of choice in the school child. "Chiropodists are competent persons to deal with this condition. Surgical procedure with the administration of an anaesthetic is wasteful of medical manpower. "Other forms of treatment expose the patient to risk of scarring and ulceration on pressure points. "Little or no discomfort and very little limitation of activities results from conservative treatment. "The expenditure of time and money compares very favourably with other forms of treatment." 18. STATISTICAL TABLES The statistical tables required by the Ministry of Education follow. TABLE I MEDICAL INSPECTION OF CHILDREN ATTENDING MAINTAINED PRIMARY AND SECONDARY SCHOOLS A.—Routine Inspections Number of Inspections in the prescribed Groups:— Entrants 1,338 Second Age Group 1,424 Third Age Group 1,618 Total 4,380 Number of other Routine Inspections 223 Grand Total 4,603 B.—Other Routine Inspections Number of Special Inspections and Re-inspections 12,123 TABLE II CLASSIFICATION OF THE NUTRITION OF PUPILS INSPECTED DURING THE YEAR IN THE ROUTINE AGE GROUPS Number of pupils Inspected A (Good) B (Fair) C (Poor) No. % No. % No. % 4380 1730 39.5 2513 57.3 137 3.1 38 TABLE III Group I.—Treatment for 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, 3,855. 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 were : Prescribed. Obtained. 358 131 535 535 Group III.—Treatment of defects of Nose and Throat. Received Operative Treatment. Received Other Forms of Treatment. Total 181 648 729 Group IV.—Orthopaedic and Postural Defects. (a) No. treated as in-patients in 'hospitals or hospital schools 21 (b) No treated otherwise 450 Group V.—Child guidance Treatment and Speech Therapy. (a) No. treated under OhiId Guidance arrangements 175 (b) No. treated under Speech Therapy arrangements 126 TABLE IV DENTAL INSPECTION AND TREATMENT (1) Number of children inspected by the Dentist— (a) Routine Age Groups 2,198 (b) Specials 679 (c) Total (Routine and Special) 2,877 (2) Number found to require treatment 1,919 (3) Number actually treated 4,587 (4) Attendances made by pupils for treatment 10,949 (5) Half days devoted to— Inspection 17 Treatment 1,578 Total 1,595 (6) Permanent teeth 3,266 Temporary teeth 1,139 Total 4,405 39 (7) Extractions— Permanent teeth 940 Temporary teeth 3,281 Total 4,221 (8) Administration of general anaesthetics for extractions 2,870 (9) Other operations— Permanent teeth 4,029 Temporary teeth 752 Total 4,778 TABLE V INFESTATION WITH VERMIN (i) Total number of examinations in the schools by the school nurses or other authorised persons 32,671 (ii) Number of individual pupils found unclean 627