BOROUGH OF WALTHAMSTOW Committee for Education REPORT of the BOROUGH SCHOOL MEDICAL OFFICER for the year 1949 A. T. W. POWELL, M.C., M.B., B.S., D.P.H. BOROUGH SCHOOL MEDICAL OFFICER BOROUGH OF WALTHAMSTOW Committee for Education REPORT of the BOROUGH SCHOOL MEDICAL OFFICER for the year 1949 A. T. W. POWELL, M.C., M.B., B.S., D.P.H. BOROUGH SCHOOL MEDICAL OFFICER CONTENTS Accommodation5 Artificial Light Treatment 22 Aural Clinic 12 Audiometry18 Chicken Pox 23 Child Guidance 34 Clinics 4 Committee 2 Convalescent Home Treatment 40 Co-ordination 5 Crippling 31 Dental Defects 9 Dental Treatment 20 Diphtheria 23 Diphtheria Immunisation 23 Ear Disease 9 Employment of Children 40 Enquiry Officers 25 Exclusion 23 Eye Disease 8, 11 Following up 10 Hearing 9, 12 Heart Disease 9, 22 Hospital Treatment 12 Hygiene 5 Impetigo 8 Invalid Children's Aid Association 26 Infectious Diseases 23 Introduction 3 Meals, Provision of 24 Measles 23 Medical Inspections 8 Medical Treatment 10 Milk in Schools Scheme 24 Minor Ailments 10 Mumps 23 N.S.P.C.C 27 Nursery School 40 Nutrition 8 Open Air Education 24 Orthopaedic Treatment 31 Orthoptic Clinic 12 Parents, Co-operation of 25 Physical Training 24 Re-inspections 8 Rheumatism 9, 22 Ringworm 8 Scabies 8 Scarlet Fever 23 School Camps 24 School for the Deaf 29 Educationally Sub- Normal 33 Partially Sighted 27 Physically Handicapped 30 Skin Diseases 8, 10 Speech Therapy 38 Staff 4 Statistical Tables 40 Teachers, Co-operation of 25 Tonsils and Adenoids 12 Tuberculosis 22 Undeanliness 8 Vaccination 24 Vision 8, 11 Voluntary Bodies 25 Whooping Cough 23 WALTHAMSTOW COMMITTEE FOR EDUCATION 1949 - 1950 Chairman : Alderman S. N. Chaplin. Deputy Chairman : Councillor W. H. Shaw. Ex-Officio: The Worshipful the Mayor: Alderman E. C. Redhead, j.p The Deputy Mayor: Councillor Miss D. Wrigley, b.a., j.p. Chairman of Finance Committee: Alderman Ross Wyld, o.b.e., j.p. Cty. Ald. P. Astins, c.b.e., j.p. Ald. Mrs. L. P. Bailey, j.p. Ald. W. B. Fitt. Ald. T. Fitzpatrick. Coun. H. C. Fisher. Coun. H. Fulton. Coun. F. Kewley (resigned Feb., 1950). Coun. A. J. D. Llewellyn. Coun. G. S. Mace. Ald. A. E. Manning. Ald. Mrs. C. McEntee, j.p. Ald. Mrs. E. M. Miller. Coun. W. F. Savill. Mrs. H. A. Christy. Mr. C. S. Garratt. Rev. D. A. King. Mr. R. Lamb. 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 School Health Service in Walthamstow during 1949, and I would offer the following comments on various matters :— The provision of additional sanitary accommodation has been commenced, but unfortunately owing to the "rationing" of expenditure allowed, it will be many years before the arrears of war-time renovation are overtaken and re-modelling is possible. Nutrition remained good and the percentage noted as "poor" remained practically unaltered. Dr. Clarke contributes a detailed analysis of the work of the Ear, Nose and Throat Clinic and demonstrates the good work done. A full audiometric survey of children of suitable ages was carried out, and the results are analysed by Dr. Melville Watkins. Facilities for Dental Treatment, although not adequate, remained far more satisfactory than in most other areas. There is reference by Mr. Elmer, your Senior Dental Surgeon, to the "awareness" of parents and pupils in regard to the value of dental treatment. Increasing attention was given to the control of Tuberculosis in schools, and there appears to be every argument for the annual routine X-ray examination both of teaching staff and "leavers," preferably by an increased provision of Mass Radiography. Diphtheria Immunisation has again been stressed in the schools and progress maintained. There was no confirmed case of Diphtheria in the Borough. School Meals reached a new peak of over 10,000 per day in the Autumn, and Milk Meals were nearly 15,000 per day. Reading lenses were tried out in the school for the partially sighted and observations on their use are given by the Headmaster. Your Committee is fortunate in the possession of 4 Special Schools in Walthamstow for the various types of handicapped children, and an increasing amount of help has been given to pupils from other areas. The alterations to the accommodation at the Child Guidance Centre were completed and enabled an increase to be effected in the staffing in order to assist with cases from adjoining areas. In conclusion, I would wish to thank the Members of your Committee for your consideration and support, and also the Borough Education Officer and his colleagues. The staff engaged in the School Health Service have contributed in maintaining both the volume and the standard of the work done, and I would wish to acknowledge their co-operation and help. I am, Your obedient Servant, A. T. W. POWELL, Borough School Medical Officer. 4 Resignations: 1- STAFF. Miss M. A. Young (Health Visitor/School Nurse) 31.3.49 Miss I. N. MacPherson (Health Visitor/School Nurse) 30.4.49 Dr. W. H. Craike (Psychiatrist) 30.8.49 Mrs. V. Tait (Speech Therapist) 23.12.49 Appointments: Dr. J. A. R. Cripps (Asst. School Medical Officer) 7.2.49 Dr. W. H. Craike (Psychiatrist) 14.2.49 Miss E. M. Downing (School Nurse) 14.3.49 Miss E. C. Carey (School Nurse) 14.4.49 Miss M. O'Leary (Audiometrician) 2.5.49 Miss J. A. Jones (School Nurse) 2.6.49 Dr. C. Haffner (Psychiatrist)15.7.49 Miss G. E. Williams (Health Visitor/School Nurse) 15.8.49 Mr. J. C. Timmis (Dental Surgeon) 1.12.49 Mrs. M. E. West (Clerical Asst.—Part-time) 21.11.49 Aural— SCHOOL CLINICS Monday 2 p.m.—4.30 p.m. Town Hall. Child Guidance— Monday Tuesday 10 a.m.—1 p.m. Child Guidance Centre, Wednesday 2 p.m.—5 p.m. 223, High Street. Thursday Dental Clinics— Monday to Friday 9 a.m.—4.30 p.m. Town Hall. Saturday 9 a.m.—12 noon. Town Hall. Monday Tuesday [ 2 p.m.—4.30 p.m. 1, Guildsway. Wednesday to Friday 9 a.m.—4.30 p.m. 1, Guildsway. Saturday 9 a.m.—12 noon. 1, Guildsway. Monday Wednesday 9 a.m.—4.30 p.m. Sidney Burnell School. *Minor Ailments— Monday Wednesday Friday 9 a.m.—12 noon. Town Hall. Saturday Tuesday 9 a.m.—11 a.m. Sidney Burnell School. Friday 1.30 p.m.—2.30 p.m. Sidney Burnell School. Monday Thursday 9 a.m.—11 a.m. Low Hall Lane. 5 Ophthalmic— Monday Tuesday Thursday 9 a.m.—12 noon. Town Hall. Saturday Orthopædic— Monthly 9 a.m.—12 noon. Open-Air School. Massage and Sunlight— Monday to Friday 9 a.m.—5 p.m. Open-Air School. Orthoptic— Monday Thursday 9.30 a.m.—4.30 p.m. Town Hall. Speech Therapy— By appointment 223, High Street, and Open-Air School. Rheumatism— Monthly 2 p.m.—4 p.m. Town Hall. *Immunisation— Tuesday 2 p.m. Town Hall. *Scabies and Infectious Disease— Wednesday 11 a.m. Town Hall. All Clinics, except those marked * are " appointment" Clinics 2. CO-ORDINATION. Coordination is secured by the fact that all the school health staff also carry out duties for other health services. The school nursing staff is equivalent to 6½ 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, 1949:- Boys. Girls. Mixed. Infants. Nursery. County Secondary Grammar 1 2 — — — County Secondary Technical — — 2 — — County Secondary Modern 2 2 6 — — County Primary Junior 2 2 12 — — County Primary Infants — — — 15 — Voluntary Secondary Modern — — 1 — — Voluntary Primary — — 3 2 — County Nursery — — — — 1 Special Schools for :— Deaf 1 Educationally Sub-normal — — 1 — — Partially Sighted — — 1 — — Physically Handicapped — — 1 — — Number of Children on Register, 31st December 1949 1948 1947 1946 1945 17652 17154 16463 15776 12573 Average attendance 15950.7 14928.9 14470.6 14004.6 10189.2 Percentage attendance 90.3 86.7 86.9 86.0 80.0 6 Mr. Frank H. Heaven, A.R.I.B.A., Architect to the Education Committee, contributes the following : — Amenities.—Many such have been provided, as curtains to staff rooms, mirrors and soap dispensers in staff and scholars' cloakrooms, indicator lights to outside lavatories, call and fire bells, fire equipment, wire guards to windows where there is an element of danger from breaking glass, barriers to entrance gates in dangerous roads, built-in cupboards, exhibition panels, shelves, wall boards, sand trays and pits, and the sanding and sealing of hall floors where they are used for school meals. Central Kitchens.—These have been maintained, and additional equipment provided to meet increased demands, and all five have been re-decorated inside and one on the outside. New lavatory accommodation for female staff has been provided at one kitchen. Craft Rooms.—External fluorescent lighting has been fitted at one Youth Centre. Heating and lighting systems have been improved, particularly in craft rooms. Gymnasia.—Equipment of a special nature has been provided at one Infants' School, and additional equipment at secondary schools. Heating.—Heating arrangements have been maintained and new boilers installed as required. Extensions have been effected at three schools. Space heaters operated by electricity, gas and solid fuel have been installed in nine cases where the existing service has been found inadequate. Lighting.—Artificial lighting, chiefly of the fluorescent type, has been installed at eight schools, in class, craft and staff rooms, and certain rooms used by partially sighted scholars. Maintenance.—All educational properties have been kept in a good standard of repair, within the limits of approved expenditure. Yearly vacuum cleaning of recently decorated schools is now a policy, adopted to remove accumulated dust and dirt, and so preserve the premises in a clean condition for a much longer period between decorations. New Buildings.—Two new blocks containing classrooms, cloakrooms and laboratories for chemistry or physics have been erected and put into use at the S.W. Essex Technical School (Hoe Street Branch). Playfields.—These are maintained by direct labour, except special works, such as re-turfing lawns, etc., which is carried out by contract. Enclosures have now been renewed to three tennis courts. Trees have been lopped, felled where dangerous, and new replanted at two playfields. Two Open-Air Theatres have been reconditioned, and schemes prepared for the provision of changing and lavatory accommodation, showers, etc., for both sexes at two playfields. 7 Provision of Meals and Milk.—The kitchens and sculleries at schools have been kept in good condition, and additional equipment provided as necessary. Two new dining rooms have been erected and opened, one at Chapel End Secondary and Junior School and one at Hale End Special School. Plans and estimates for five new dining rooms and kitchens have been prepared and submitted, but, owing to reasons of economy, dictated by the Ministry of Education, these have been deferred. Sculleries have been renovated at twelve schools. Floors to halls used as dining rooms have been sanded and sealed with plastic material to render them free from grease stains. Hot cupboards have been ordered for 39 schools and are now in progress of being delivered and fixed. Renovations.—Complete renovations to exteriors of six schools and interiors of six schools have been carried out in bright colour schemes, and at the schools' library in High Street. Seventeen staff rooms have been redecorated where circumstances required early attention. Owing to high costs and limited funds, it has not been possible to proceed with as much school decoration as is needed, but the leeway, which occurred during the war years, is being reduced. Sanitation.—Cold water supply tanks and automatic flushing tanks have been installed or renewed to comply with the Metropolitan Water Board Regulations. Hot water supplies, chiefly from gasOperated appliances, have been installed at 16 schools for staff and scholar usage, principally for school meals purposes. Nine mixed water showers, for use in connection with gymnasia have been installed at one school and at the Marsh Street Youth Centre. Electric hand driers for both sexes have been fixed at one school. Additional lavatory accommodation, consisting of W.C.'s, lavatory basins, washing troughs and sinks, with cold and hot water supplies, have been fixed or are due to be installed at five schools. Sites and Properties.—Additional sites for educational purposes have been acquired at Wood Street School, Temples Field and Roger Ascham School. Sound Equipment.-—Radio equipment is being provided under a progressive scheme, and provision has been made for the necessary electricity supplies to receivers and loudspeakers. Visual Aids.—Equipment is being supplied under a similar scheme, and ancillary work of blacking-out and provision of screens has been carried out to ensure satisfactory results. War Damage, Etc.—A very large amount of war damage repairs and works of reinstatement after use of buildings by A.R.P. and N.F.S. Services has been carried out at seven schools. 8 4. MEDICAL INSPECTION. The following gives a summary of the returns :— A. Periodic Medical Inspections— Entrants 2,795 Second Age Group 1,978 Third Age Group 2,059 Total 6,832 B. Other Inspections— Special Inspections 187 Re-inspections 323 Total 510 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 2795 1803 64.5 857 30.7 135 4.8 Second Age Group 1978 1432 72.4 495 25.0 51 2.6 Third Age Group 2059 1487 72.2 526 25.5 46 2.2 Totals 6832 4722 69.1 1878 27.5 232 3.4 (b) Uncleanliness.—The following table figures for the past two years :— 1949. comparative 1948. Average visits to schools 4 4 Total examinations 39,625 32,897 No. of individual children found unclean 1,087 970 Percentage uncleanliness of average attendance 6.8 6.4 (c) Minor Ailments and Skin Defects.—The following was the number of skin defects found to require treatment :— 1949. 1948. Ringworm—Head 2 2 Body 8 13 Scabies 5 21 Impetigo 59 48 Other skin diseases 356 326 (d) Visual Defects and External Eye Diseases.—The number of patients requiring treatment and observation was as follows :— 1949 1948. Treatment. Observation. Treatment. Observation. Visual Defects 321 245 292 203 Squint 68 14 44 6 External Eye Disease 381 26 388 9 9 (e) Nose and Throat Defects.—The number of patients requiring treatment and observation was as follows :— 1949 1948. T reatment. Observation. T reatment. Observation. Chronic Tonsillitis 103 345 98 54 Adenoids 30 7 8 4 Chronic Tonsillitis and Adenoids 72 40 18 10 Other conditions 453 54 487 75 The 453 cases of "other conditions" are made up of sore throat and defects requiring diastello treatment. (f) Ear Disease and Defective Hearing.—Patients requiring treatment:— 1949. 1948. Defective Hearing 85 31 Otitis Media 84 33 Other Ear Diseases 233 259 (g) Orthopaedic and Postural Defects.—A total of 303 deformities were found to require treatment. (h) Dental Defects.— Inspect' tion. Requiring T reatment. Per Cent. Actually treated. Fillings. Extractions. General Anaesthetics. Other Operations. 3,240 2,232 68.8 6,127 4,053 4,859 2,854 5,798 (i) Heart Disease and Rheumatism.—The findings were as follows :— 1949 1948. T reatment. Observation. T reatment. Observation. Heart Disease—Organic 7 7 9 12 Functional 2 55 9 4 Anaemia 62 28 58 24 (j) Tuberculosis.—All children suspected either of pulmonary or glandular tuberculosis are referred to the Chest Physician for final diagnosis. (k) Other defects and Diseases.—The following Table shows the number of various other defects which were found to require treatment:— Enlarged Glands 67 Epilepsy 6 Bronchitis 91 Other Defects 2,408 Speech 73 10 6. FOLLOWING UP The School Nurses paid a total of 1,565 home visits during 1949. 7. ARRANGEMENTS FOR TREATMENT (a) Malnutrition.—The following shows the quantities of tonics issued during 1949 :— Cod Liver Oil. Parrish'* Food. Syrup Lacto Phosphate Cod Liver Oil and Malt. Cod Liver Oil and Malt and Parrish's Food. Emulsion. 31 lbs. 149 lbs. 42½ lbs. 884 lbs. 1,796 lbs. 157½ 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. Special treatment is available at the Borough Council's Cleansing Centre. (c) Minor Ailments and Diseases of the Skin.—Treatment of minor ailments is carried out at the eight 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 1 1 1 4 5 4 Scabies 1 2 — — 1 2 Rheumatism 2 — 2 4 28 28 Impetigo, Sores, etc. 14 14 69 26 182 117 Skin 5 4 100 133 224 237 Verminous Head, etc. 5 53 30 97 95 1,187 Sore Throat 25 36 13 12 37 63 Discharging Ears and Deafness 15 11 116 96 603 449 Defective Vision —_ — 14 46 26 67 External Eye Disease 26 25 79 92 205 266 Tonsils and Adenoids 4 4 66 59 65 53 Mumps — — — — — — Various 100 107 1,209 1,045 3,012 3,399 Totals 197 257 1,689 1,614 4,483 5,872 11 Number of children seen at first inspection 3,757 Number of children sent by School Enquiry Officers and Committees 17 Number of attendances made by children 14,112 Number of children sent by Head Teachers 1,157 Number of swabs taken 81 Number of children seen by Ophthalmic Surgeon :— New cases 444 Prescribed for 574 Total inspections 2,966 First attendances number 3,757 against 5,086 in 1948, and re-attendances 10,355 against 11,404, the total attendances being 14,112 against 16,490. (d) Visual Defects and External Eye Diseases.—Dr. Sheppard has kindly contributed the following account of the work done during 1949 :— There were 444 new cases seen at the Eye Clinic during 1949, and these, as well as the ordinary periodic inspections, made 2,966 attendances. The following tables summarise the defects found in the new cases :— Defect. Under 7 years. 7-11 years. Over 11 years. Total. Boys. Girls. Boys. Girls. Boys. Girls. Boys. Girls. Hypermetropia 13 25 16 18 7 18 36 61 Hypermetropic Astigmatism 12 12 8 10 20 22 Myopic Astigmatism 1 5 5 7 6 12 Mixed Astigmatism 1 1 6 2 2 4 8 Myopia 1 2 8 12 32 58 41 72 No visual defects 25 27 35 26 25 24 85 77 Totals 40 54 73 79 79 119 192 252 Refractions New Old 405 190 Re-inspections 1,999 Treatments 372 Totals 2,966 12 Number of children for whom spectacles were— (a) Prescribed 574 (b) Obtained (estimated) 560 Inspections at the School for the Blind and Partially Sighted Under 7 years 7-11 years Over 11 years Total Boys. Girls. Boys. Girls. Boys. Girls. Boys. Girls. Hypermetropia — — 1 — 3 2 4 2 Hypermetropic Astigmatism — — 1 2 1 1 2 3 Myopic Astigmatism — — 3 3 7 4 10 7 Myopia — — 6 7 — 1 6 8 Totals — — 11 12 11 8 22 20 Refractions New Old - 4 Re-inspections 97 (e) Orthoptic Clinic.—Mrs. K. S. Box, S.R.N., S.C.M., D.B.O., has contributed the following report on the work done at the Clinic :— Number of cases investigated 160 Number of cases treated for Squint and Amblyopia— Cured 30 Still under treatment 98 Cured of Amblyopia 25 Cured by operation 9 Total attendances during year 1,052 (f) Nose and Throat Defects.—Operative treatment, where necessary, is provided either at the Connaught Hospital or Whipps Cross Hospital. (g) Ear Disease and Defective Hearing.—Dr. Francis Clarke reports as follows :— "The main purpose of the Ear, Nose and Throat Clinic, one of several clinics of the Education Authority, is to detect, examine and treat all those defects and diseases of the ear, nose and throat found amongst the school population in the Borough, excepting those cases which require hospital in-patient treatment, operations, anaesthetics. By far the greater majority of these clinic cases are discovered during the regular school medical inspections and at the school clinics. A certain number are referred by the local doctors, Health Visitors, etc. 13 In addition to the school population, the scheme of the Clinic also embraces the pre-school age groups. Children in these preschool age groups suffering from any ear, nose and throat defects are found during the medical inspection of Nurseries, Infant Welfare clinics, etc., and by the Health Visitors during their routine work. The inclusion of all pre-school children in the scheme and full provision for their treatmert is very important. Systematic attention to the pre-school age groups yields a return in terms of lower incidence of certain defects at the school entrant age, which compares favourably with the percentage of corrections subsequently attained. The provision of such clinics, properly staffed and equipped by the Local Authority must serve a most important part in any Health Scheme. A very considerable number of the defects discovered during regular school inspections and treated at these clinics would otherwise have escaped detection and treatment until they had reached a chronic stage, with perhaps added complications, when the prospects of a successful cure were very greatly lessened. These clinics, by reason of their local situation, have the great advantage that they can provide, locally, for the children, the necessary treatment, daily, when required, which would be extremely difficult and in many cases practically impossible to obtain at hospitals on account of the time and staff required, the distance in travelling and traffic problems. In the great majority of instances the children can safely attend the local clinics from school without their parents; this would be quite impossible if they had to travel long distances to hospitals through busy traffic, as well as the very considerable amount of time lost from school. Looking over the Returns of the Clinic for the past year, 1949, we find the figures in some of the more important groups of diseased conditions bear out substantially the substance of the preceding remarks, with especial reference to acute and chronic middle ear disease in children. During the course of the year there were only 26 cases of chronic otorrhoea ; twelve of these were cases without ' complications'; and eleven of the twelve were quickly cured by zinc ionisation treatment. The remaining 14 were cases involving serious complications—polypii, diseased mastoid and 4 post-operated mastoids, which are amongst the most intractable of all cases of middle ear discharge to get 'dry.' 14 There were not any cases of chronic ear discharge amongst the pre-school age groups. This is exceedingly satisfactory and bears out our repeated statements about the importance of early and successful treatment of acute otorrhæa. In both school and pre-school groups there were only 23 cases of acute otorrhæa, or middle ear affection. Twenty-one of the 23 were discharged, cured, after a very short period of regular daily treatment at the clinic. In many of our previous reports we have stressed the importance of the early, regular and correct technique of treatment in these acute cases—important, in preventing the condition from becoming chronic and thus developing complications,—with the consequent delay and difficulty in securing final cure; and equally important, to prevent impairment of the hearing. As is well known, the longer the ear continues to 'run,' the greater the damage to the hearing. In connection with the presence of ear disease and hearing, an audiometer survey of hearing of nearly all the school children who had reached an age when they could write down simple single numbers spoken from a "Voice" recorded, was carried out during the year. This was the first complete ' hearing survey' since the war years. Previously such surveys had been done. The results of this survey are given separately in a special report which follows. Those children who 'failed' the hearing tests and were found to have impaired hearing were referred to the Aural Clinic for detailed examination and treatment, where necessary. The number of cases so referred was surprisingly small for a school population of the size of Walthamstow. We can only conclude that the regular systematic school medical inspections and the early detection and prompt treatment of any middle ear defects found, or any conditions such as nasal disease, predisposing to ear affection and deafness, had a definite material influence in the production of such a satisfactory hearing survey. As in previous years, the largest group of cases requiring treatment was made up of those children suffering from various affections of the nose and throat. The only cases in this group which required hospital treatment were those referred for the removal of tonsils and adenoids. There were 19 of these diseased 15 tonsils and adenoids' referred to hospital for operation. This is a very small number, relatively, to the numbers that are usually referred from other sources for tonsil operation. We again wish to emphasise the necessity and advisability of restricting the number of tonsillectomies. If a detailed examination is made of every case referred as a ' potential tonsillectomy' and all the co-existing and contributory factors, such as nasal and nasal sinus infections, hygienic and nutrition conditions carefully looked into and corrected, it will be found that a surprisingly large number of 'cases suitable for operation' do not require operation. The operation by itself will not cure or benefit these cases. There is ample evidence of this in the number of post-operative cases, where the original symptoms still persist, which one sees amongst the school population during the course of medical inspections and at the clinics. While awaiting operation any cases which are referred from the clinic are periodically reviewed and given conservative treatment such as throat painting or nasal treatment where indicated. In most instances the operation is delayed several months on account of the long waiting lists at the hospitals. It is of the first and vital importance to treat and correct any pre-disposing or exciting cause of 'diseased tonsils' before deciding on tonsillectomy. First things come first and care must be taken not to mistake the ' sign ' for the ' disease.' During the course of the year a number of children were found to have nasal sinus infections and these were treated chiefly, except for a few cases which required other special treatment, by first, a short course—about 6 to 8 applications—of hydrostatic nasal douches, using warm normal saline solution ; each douche was followed by nasal instillations of 10 to 20% argyrol. After 6 to 8 douche treatments they were then given a course of Proetz 'nasal sinus displacement,' using, after the initial weak ephedrine solution, a 10% solution of Albucid (Scherings). We have found this line of treatment to give very satisfactory results. One hundred and fifteen cases were treated by Gautier's nasal diastolisation for various nasal conditions, including 'nasal catarrh'; rhinitis, mouth-breathing, obstruction, impaired hearing, etc. The results from this treatment, carefully and correctly carried out. 16 are very satisfactory. In the cases of impaired hearing in children arising from nasal conditions and where the ear mechanism itself is not damaged, we have found diastolisation to give, uniformly, the best and quickest successful results. Correct normal nasal respiration is of primary importance to the general health of the child. It is in this connection that diastolisation will be found to be a most valuable aid. During the year two special aural sessions were held at the School for the Deaf when all the children attending were examined and arrangements made for any cases requiring special treatment. The standard of the general health of the children seen at the clinic was well maintained and satisfactory. There were only a few cases which might be described as of sub-normal standard and these patients were receiving the necessary care and treatment from the school clinic medical staff." TABLE "A" ACUTE OTITIS MEDIAwalthamstow 1949 SCHOOL CHILDREN. Diagnosis. Total (Ears). Tonsils and Adenoids. Treatment. Results. Zinc Ionisation. Antiseptic Treatment. Tonsils & Adenoids Treatment: Nasal Treatment, etc. Tonsils & Adenoids Operation. Cured. Improved. Still under Treatment or observation. Left School or Treatment Lapsed. Referred to Hospital for Operation. Did not Attend or Declined Treatment. a b c d e f g h i J k l Acute Non-Suppurative Otitis Media 3 1 Operation before Clinic — 1 — — 1 — — — — — 2 No Operation — 2 — — 2 — — — — — Acute Non-Suppurative Otitis Media with Nasal Conditions: Enlarged Tonsils and Adenoids. 1 — Operation before Clinic — — — — — — — — — — 1 No Operation — 1 — 1 1 — — — — — Acute Suppurative Otitis Media 11 •(2) 3 Operation before Clinic — 3 — — 1 — — 2 — — 8 No Operation 1 8 2 — 8 — — — — — Acute Suppurative Otitis Media with Nasal conditions : Enlarged Tonsils and Adenoids 5 — Operation before Clinic — — — — — — — — — — 6 No Operation — 5 5 — 5 — — — — — Totals 20 1 20 7 1 18 — — 2 — — PRE-SCHOOL CHILDREN. Acute Non-Suppurative Otitis Media — — Operation before Clinic — — — — — — — — — — — No Operation — — — — — — — — — — Acute Suppurative Otitis Media 2 — Operation before Clinic — — — — — — — — — — 2 No Operation — 2 — — 2 — — — — — Acute Suppurative Otitis Media with Nasal Conditions : Enlarged Tonsils and Adenoids 1 — Operation before Clinic — — — — — — — — — — 1 No Operation — 1 1 — 1 — — — — — Totals 3 — 3 1 — 3 — — — — — Grand Totals 23 1 23 8 1 21 — — 2 — — * The figures in brackets indicate the number of cases with Bi-lateral Otorrhoea. TABLE "B" chronic suppurative otitis media SCHOOL CHILDREN WALTHAMSTOW 1949 Diagnosis. Diagnosis. Tonsils and Adenoids. Treatment. Results. Chronic Tympanic Sepsis, Complicated by :— Totals (Ears). Mastoid Disease. 1 Enlarged Tonsils and Adenoids Nasal Catarrh : Rhinitis : Sinusitis. External Otitis, Eczema. Primary (Ear). Collateral (Nose and Throat). Cured. Improved. Still under Treatment : Observation. Left School or Treatment Lapsed. Referred to Hospital for Operation. Did not attend or Declined Treatment. Granulations : Simple Polypii. > < d Operation No Operation. Ionisation. Antiseptic Treatment. Cautery, etc. Mastoid Operation. T onsils/Adenoids. Conservative Treatment. Nasal Treatm. Tonsils and Adenoids Operation. SCHOOL. A Granulations : Simple Polypii 5 *(2) A B C D E F G H I J K L M N O P 4 — — — — — Operation before Clinic — — — — — — — — — 4 — 1 — — — — — No Operation 1 1 — — — 1 — — — — — B Mastoid Disease 4 *(1) — — 2 — — — Operation before Clinic 2 2 — — — — — — — 2 — — 2 — — — — No Operation 2 — — — — — — — — — — C Enlarged Tonsils and Adenoids — — — — — — — Operation before Clinic — — — — — — — — — — — — — — — — — No Operation — — — — — — — — — — — D Nasal Catarrh : Rhinitis: Sinusitis 5 — — — — — — Operation before Clinic — — — — — — — — — — — — — — — 5 — No Operation 3 5 — 5 — 5 — — — — — E External Otitis : Eczema — — — — — — — Operation before Clinic — — — — — — — — — — — — — — — — — No Operation — — — — — — — — — — — Chronic Suppurative titis Media, solely 12 •(3) — 3 Operation before Clinic 2 — — — — — — — — — 1 — 9 No Operation 6 5 — — — — — — — — — Totals (School) 26 5 2 2 — 5 12 16 13 — 5 — 19 — — — 6 1 PRE-SCHOOL CHILDREN — — Operation before Clinic — — — — — — — — — — — pre-school. Chronic Suppurative Oitis Media, solely — No Operation — — — — — — — — — — — Chronic Suppurative Otitis Media, with Nasal Conditions : Tonsils/Adenoids . — — — — — — — Operation before Clinic — — — — — — — — — — — — — — — — — No Operation — — — — — — — — — — — Totals (Pre-School) — — — — — — — — — — — — — — — — — — Grand Totals 26 5 2 2 — 5 12 16 13 — 5 — 19 — — — 6 1 * Figures in Brackets—Cases of Bi-Lateral Otorrhoea or Mastoid. TABLE "C" NOSE AND THROAT CONDITIONS WALTHAMSTOW 1949 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 T reatment. Operative Treatment. a b c d e f g h i J k l m n o p q r Sinusitis : Rhinitis 19 Operation before Clinic 3 — — — — — 3 3 — — 2 — — 1 — — No Operation 16 — 1 — 1 4 15 12 1 — 7 2 3 3 — 1 Nasal Obstruction : Rhinitis 77 Operation before Clinic 13 2 5 — — 5 10 1 — 5 2 3 2 — 1 No Operation 64 6 9 — 9 36 47 3 8 — 36 7 7 10 — 4 Nasal Catarrh 76 Operation before Clinic 8 — 4 — — 8 2 — — — 4 2 — 1 — 1 No Operation 68 6 20 — 6 54 19 — 5 1 47 7 2 8 — 4 Enlarged Tonsils and Adenoids 49 Operation before Clinic — — — — — — — — — — — — — — — — No Operation 49 1 1 12 — 4 6 — 37 2 18 2 3 8 18 — Totals (School) 221 15 40 12 16 111 102 19 51 3 119 22 18 33 18 11 PRE-SCHOOL CHILDREN Nasal Conditions : Sinusitis : Rhinitis 10 Operation before Clinic — — — — — — — — — — — — — — — — No Operation 10 1 3 — — 3 8 — — — 9 1 — — — — Enlarged Tonsils and Adenoids 2 Operation before Clinic — — — — — — — — — — — — — — — — No Operation 2 — — 1 — — — — 1 — — — — 1 1 — Enlarged Tonsils and Adenoids with Nasal Conditions 3 Operation before Clinic — — — — — — — — — — — — — — — — No Operation 3 — — — — 1 3 — 3 — 1 2 — — — — Totals (Pre-school) 15 1 3 1 — 4 11 — 4 — 10 3 — 1 1 — Grand Totals 236 16 43 13 16 115 113 19 55 3 129 25 18 34 19 11 17 TABLE "D" MISCELLANEOUS CASES Conditions Total Tons./Ads. previously removed. Preschool Examined for:— Affections of the ear, nose, throat; special cases of deafness for admission to Deaf School, etc.: Re-examinations of cases previously treated; observations ; examinations re speech, etc.; colds and other conditions 29 7 1 Advised; recommendations and reports made. Clinic treatment not required. Examinations at the School for the Deaf 19 8 — Recommendations for Hearing Aids; treatment where required. Special deaf cases 7 3 — Treated. Wax in Ears 4 — — Removed. Epistaxis 2 — — Treated. Laryngitis 1 — — Treated. 62 18 1 SUMMARY Total number of cases seen at Clinic during 1949 347 School 328 Preschool 19 'A'—Acute Ear conditions— School 20 Pre-School 3 'B'—Chronic Ear conditions— School 26 Pre-school — 'C'—Nose and Throat conditions— School 221 Pre-school 15 'D'—Miscellaneous E.N.T. conditions— School 61 Pre-school 1 Audiometry.—A whole-time Audiometrician was appointed by the County Council, and was seconded for duty in Walthamstow during 1949/50. 18 Dr. Melville Watkins has contributed the following observations on the survey:— Clinical Assay of Group Audiometry Testing It was decided that every child found with a decibel loss of 12 and above should, in the first instance, be seen by the School Medical Officer who would then refer suitable cases to the Ear, Nose and Throat Consultant. The statistical analysis of those invited to attend the Clinics was as follows:— Primary School Secondary School Total The number invited to attend the Clinics 77 72 149 Numbers actually seen at Clinics 66 55 121 Number with unilateral loss of hearing only 60 50 110 Number with bilateral loss of hearing 17 22 39 Number with severe unilateral loss of hearing of 30 D or over 19 12 31 Number with severe bilateral loss of hearing of 30 D or over 6 4 10 Note.—The Audiometrician's report shows a total of 152 children referred for treatment, but of these, three were ineducable and are not included in the 149 above. Causation of Deafness. It is often difficult to diagnose the specific cause of deafness, but an attempt has been made below to list the causes under the more obvious presenting symptoms and signs, together with the history:— Primary School Secondary School Total 1. Nasal Catarrh 23 14 37 2. Otorrhœa (Present) 3 3 6 3. Otorrhœa (Past) 16 13 29 4. Following Mastoidectomy 4 12 16 5. Wax or foreign body 12 5 17 6. Following Infectious Diseases 4 1 5 7. Following Tonsillectomy 1 — 1 8. Gross Adenoidal and Tonsillar enlargement 1 1 2 9. Probably hereditary 1 — 1 10. Polypus — 1 1 11. Trauma (3 due to bomb-blast) 1 3 4 12. Congenital (Atresia) — 2 2 Total 66 55 121 It is interesting to note that of the numbers seen at the Clinic, 34 had their tonsils and adenoids removed at varying times previously; also 74 had already been under treatment at some time or another for the condition which was thought to be the cause of the deafness. 19 31 children were referred to the Specialist Ear, Nose and Throat Clinic. The majority of these had not been treated previously. Owing to various difficulties, re-testing of those treated was not carried out, but 27 of these reported an improvement in their hearing. All these had a unilateral loss, wax and simple nasal catarrh being the main causes. Three children were referred to hospital for possible hearing aid. Two were found suitable for such aids. One was referred for Pure-Tone Audiometer Testing. The number of children found to have permanent defective hearing in one ear were 28, the probable cause being as follows:— Following Mastoidectomy 13 Chronic Middle Ear Disease 10 Trauma 2 Congenital Malformation 1 Polypus 1 Meningitis 1 28 The number of children found to have permanent defective hearing in both ears were eight, the causes being :— Bilateral Mastoidectomy 3 Bilateral Chronic Middle Ear Disease 4 Congenital 1 8 Audiometry.—Miss M. O'Leary reports as follows:— The re-commencement of Audiometry in Walthamstow after the gap caused by the war years, has, in my opinion, been a success. Group-testing of school children was carried out in all secondary and junior schools where facilities permitted, including four special schools, and I am glad to report that, contrary to earlier expectations and due to the co-operation of Head Teachers concerned, it has proved possible for me to test all children in the above-mentioned groups, which together totalled 33 school departments. Facilities for Testing.—To produce the best results from a hearing test, a quiet room is essential. Owing to conditions prevailing in schools and to school accommodation being used to capacity, tests have been carried out whenever possible in spare classrooms, but as classes are very large, few schools have spare rooms. In such circumstances accessory rooms have been given up for the testing, e.g., Library rooms, Science rooms, Woodwork rooms, Dark rooms, Medical rooms, etc., and in one school the 20 Headmaster had to evict his staff from their dining-room as he had no other accommodation. At another school the playing field was used to free a class-room. Method of Testing.—Using a 4.A. Western Electric Speech Audiometer, the children were tested simultaneously in groups of 24, commencing with the older children and working through the whole school. The time given to each group of children was approximately 15 minutes, but with younger and retarded children 20-25 minutes is necessary. In most schools the School Secretary or two prefects were responsible for bringing the children backwards and forwards to the testing room; in this way no time was lost between tests, and a diligent watch was being kept for would-be trespassers who might otherwise have vitiated the tests. Special forms were given to each child on which he/she made a written record of numbers heard (the numbers vary in amplitude from +30 to —3 decibels). For those children who were unable to write down numbers, the "Monitor Method" was used, i.e., the child repeated the numbers he heard to the monitor, who wrote them down. The children who failed in the first test were given a second, and, if necessary, a third test, before being referred to the School Clinic for further examination. It was deemed desirable to refer to the Clinic any child with a decibel loss of 12 and over in either ear. The following is a summary of the total number of children tested and referred:— Type of School Number Tested No. of children referred for treatment. Total Percentage Boys Girls Secondary 2,921 66 2.2 29 37 Junior Schools 4,733 75 1.5 38 37 Open-Air Schools 74 4 5.4 4 — School for the Educationally Sub-Normal 75 5 6.6 3 2 School for the PartiallySighted 48 2 4.1 11 1 Totals 7,851 152 1.9 75 77 Finally, I should like to place on record my sincere appreciation of the help and co-operation extended to me in my work by the Borough School Medical Officer and his staff. (h) Orthopaedic and Postural Defects.—Details of the work done under the Scheme are given in the section dealing with Handicapped Children. (i) Dental Treatment.—In March revised interim rates of salaries were agreed by the County Council. 21 In October one of the whole-time Dental Staff from the General Dental Service transferred to the School Dental Staff which then became equivalent to 5 1/11th whole-time Dental Surgeons. Mr. L. W. Elmer, Senior Dental Surgeon, submits the following report:— A feature of the year's work has been a large increase in the number of parents who have brought their children to the clinic, quite voluntarily, for regular inspection. A disadvantage of this, hopeful as it is in demonstrating the increasing dental "awareness" of the people, has been that it has not been found possible to examine any large proportion of children at schools. It would, however, be manifestly unfair to refuse treatment for the children of these keen parents, and a dental inspection not followed speedily by treatment is rather useless. Referring to the statistical tables at the end of the report, the 1,840 children under the heading "Periodic Age Groups" were those examined at schools. The 1,400 entered as 'Specials' are those referred by teachers and school nurses with gross sepsis or toothache, and were, in the main, needing extractions. It will be noted that some 4,000 more children were actually treated than were found to require treatment under these two headings. This figure is accounted for by the children referred to in the first paragraph, who should, perhaps, be rated as 'Specials.' On the other hand, they were undoubtedly inspected periodically. In view of the shortage of school dental officers due to the demands of the general dental service, it is fortunate that the "austerity" diet of the last ten years, together with the "supplementary" diet of expectant mothers, has had at least one good result. The improvement of the teeth of the children noted during the war years has continued. It would certainly appear that some items of pre-war consumption, notably a plentiful supply of sweets and sugar and the high extraction loaf, were doubtful luxuries, and not so desirable as is popularly imagined. To offset this improvement, malformation of the jaws and overcrowding of the teeth seem to be more widespread than ever. It has, unfortunately, not been possible to classify more fully the operations undertaken during the year, but a very large proportion of the permanent teeth extracted were for the relief of this overcrowding and the majority of the 'other operations' on permanent teeth refer to the fitting and adjusting of appliances for the correction of irregularities. Among other methods, oral screws were supplied, and this simple form of appliance shows, in my opinion, a very fair promise of success in many cases of irregularity 22 of the teeth and malformation of the jaws. In common with all other methods of correction of the jaws and teeth, it is essential to have the co-operation of both child and parent. An Orthodontic specialist has attended here weekly and to him are referred the more complicated and difficult cases for advice and treatment. The X-ray machine has been of great benefit in assisting diagnosis in many of these cases, as also in the treatment of fractured incisors, etc. During the year 203 appliances were made in our own laboratory and the advantage of consultation between the surgeon and the technician has been amply demonstrated. This is indeed almost essential. (j) Heart Disease and Rheumatism.—The following is a report of the work done at the Rheumatism Clinic during 1949:— Number of sessions 13 „ „ attendances 156 „ „ new cases 31 „ „ old cases 35 „ discharged 36 „ still under treatment 30 „ of new cases with rheumatism or cardiac defect 5 „ referred to Hospital—Out-patient 5 In-patient 4 „ referred for Tonsils and Adenoids 2 „ referred for Dental Treatment 1 „ excluded from school 1 „ to return to school 1 „ excluded from games and exercises 1 „ to begin games and exercises 1 „ referred to Orthopaedic Clinic 2 „ referred from Forest Division 16 (\) Tuberculosis.—The number of school children examined during the year was 98 boys and 143 girls, of which 33 boys and 74 girls were referred by the School Medical Staff. 134 of these were sent by private practitioners and 210 were examined as contacts. (1) Artificial Sunlight Treatment.—The total attendances for treatment were 6,577. 23 8. INFECTIOUS DISEASES Notification in the 5-15 years age-group during 1949 was as follows, the figures for 1948 being shown in parenthesis: Scarlet Fever, 113 (168); Diphtheria, Nil (1); Pneumonia, 7 (21); Erysipelas, 1 (1); Cerebrospinal Meningitis, Nil (1); Measles, 658 (632); Whooping Cough, 67 (558); Dysentery, 1, (2); Anterior Poliomyelitis, 10 (2). Non-notifiable infectious diseases are usually 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:— Chicken Pox. Measles & G.M. Whooping Cough Sore Throat. Influenza. Diarrhoea. Mumps. Scabies. Ringworm. Various. Total. 1949 109 248 7 8 — — — — — 22 394 1948 41 19 73 58 18 3 48 1 1 418 680 Immunisation Clinic.—Follow-up arrangements were as detailed in the 1939 Report. The following table shows the work done at the Clinic:— Total immunisations completed during 1949 1,989 (a) School age 304 (b) Pre-school age 1,684 (c) Over school age 1 Immunisation at schools (included above):— Number completely immunised 213 Number partly immunised 50 Number already immunised given an extra dose 1,459 During the past five years the percentages of children protected in the various age-groups were as follows:— Year Population Percentage Immunised Under 5 years 5-15 years 0-15 years 1945 103,320 40.7 80.4 65.7 1946 118,660 50.3 77.4 67.7 1947 123,100 52.4 86.0 72.2 1948 122,700 61.5 91.5 79.2 1949 123,400 62.5 96.2 82.1 24 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 1,370 501 36.6 Girls 1,425 538 37.7 2nd Age Group Boys 930 214 23.0 Girls 1,048 243 23.1 3rd Age Group Boys 891 223 25.0 Girls 1,168 348 29.8 Totals 6,832 2,067 20.2 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 7 boys and 7 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 During October and November the daily number of meals exceeded 10,000 or some 59% of the numbers on the School Roll. During the same period the daily milk meals total averaged nearly 15,000 per day or some 80% of the total on the School Roll. Food Poisoning.—Two small series of cases which might come under this category were investigated and dealt with. Inspection.—Visits were made by the Medical and other Staff to school canteens and kitchens, and suggestions were made from time to time in order to try and minimise food borne infection. 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 previous reports were continued in 1949, all the milk supplied being pasteurised milk sold under licence. 25 Particulars of samples of milk taken in schools during the year are as follows:— Pasteurised, for bacteriological examination 16 Pasteurised, for biological examination 4 Test Results— Bacteriological—Methylene Blue and Phosphatase —All satisfactory. Biological—All negative. 12. (a) CO-OPERATION OF PARENTS The following table shows the attendance of parents during 1949:— Number Inspected Number of Parents Per cent. 1949 Per cent. 1948 Entrants Boys 1,370 1,233 90.0 94.8 Girls 1,425 1,304 91.5 91.4 2nd Age Group Boys 930 556 59.7 67.4 Girls 1,048 719 68.6 70.4 3rd Age Group Boys 891 168 18.8 21.4 Girls 1,168 344 29.5 44.4 (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 ENQUIRY OFFICERS The Senior School Enquiry Officer and his staff have again co-operated with the work of the School Health Service. (d) CO-OPERATION OF VOLUNTARY BODIES Ministry of Education Circular 179—Handicapped Pupils.— In connection with the consideration given to this Circular, your Committee recommended that the existing arrangements for the admission of pupils to Holiday Convalescent Homes by arrangement with the Local Branch of the I.C.AA. should continue, including a grant of some £200 per annum plus a placement fee of 10/- per child in residential schools not under their management. 26 (a) The Invalid Children's Aid Association.—Mrs. Osora, Secretary of the local branch, has kindly contributed the following report:— Number of applications 263 Number of weeks convalescence provided 1,316 Number of children sent away convalescent 203 Number of home visits paid 590 Cases Referred by:— Over 5 years. Under 5 years. Hospitals and Medical men 101 32 School Health Services 82 8 Local Authority under schemes for:— (a) Rheumatism 5 — (b) Orthopædic care 7 — (c) Child Guidance 3 — Child Welfare Centres 2 2 Voluntary Bodies 5 2 Parents 6 4 Transferred from other I.C.A.A. Branches 4 — 215 48 Suffering from:— Anaemia, Debility, Malnutrition 44 5 After-effects of acute or infectious illness or operation 46 21 Bronchitis or Pneumonia 37 9 Asthma 6 — Rheumatism, Chorea, Heart 12 1 Nervous conditions 14 1 Diseases of— (a) Ear, Nose and Throat 20 5 (b) Eyes 2 — (c) Skin 3 — Various 31 6 215 48 Help given to old and new cases:— Children sent to Convalescent Homes and Residential Open-Air Schools 193 20 Transferred to other agencies 6 6 Referred for visiting and advice, Help and follow-up 35 34 234 60 27 (b) National Society for the Prevention of Cruelty to Children.—The following is a summary of the work done in Walthamstow during 1949:— Nature of Offence How dealt with Neglect 40 Warned 44 Ill-treatment 4 Advised 19 Advice sought 19 63 63 Number of Children dealt with:— Under 5 years Over 5 years Boys Girls Boys Girls 39 36 50 42 152 supervisory visits and 147 miscellaneous visits were made during the year. HANDICAPPED CHILDREN (i) School for the Partially Sighted.—The following table shows the classification of children at the end of the year:— Walthamstow Pupils Essex County Pupils Out-County Pupils Blind Partially Sighted Blind Partially Sighted Blind Partially Sighted Boys . — 8 — 3 — 13 Girls 2 6 1 — 1 10 Mr. G. M. Williams, the Head Teacher, reports as follows:— It will be noticed that the word "blind" has disappeared from the official title of the School. The four children so classified are all awaiting entry into Residential Blind Schools and in future the School will only cater for Partially Sighted cases. The revolutionary change of medical opinion as to the necessity for restrictions previously imposed in respect of the use of the printed letter and in limitation of the physical training syllabus has caused us to examine and adjust our teaching techniques and methods. A wider use of printed books, exercise books, pens and pencils has now been introduced, and in this connection a regular supply of books from the school library has been much appreciated. In the early part of the year eighteen of the latest type of reading lenses were supplied and have been used almost exclusively by the senior class. (Some observations on the use of these lenses are given at the end of this report.) 28 The medical supervision of the school has been adequately catered for, the ophthalmic side being in the hands of Dr. Sheppard, who made three visits per term and has in addition made many special examinations at the school clinic. A routine medical examination by Dr. Watkins was made for each individual child. Each child has had a hearing test by the audiometrician, and one child was referred for further treatment. The supply of new glasses and repairs to broken glasses has been a source of much loss of school time, although towards the end of the year there was some easement of the position. On this point the Committee has been asked to supply a reserve pair of glasses. On the building side, improved forms of fluorescent lighting have been approved for the classrooms and should add greatly to the efficiency of the school work during the winter months. The school made educational visits to the London Zoo, the Natural History Museum, and attended the Marionette Theatre. In swimming, four primary certificates have been obtained. During the year six children left the school as follows:— 1 boy transferred on trial to Sir George Monoux Grammar School, 1 boy transferred to Wm. Elliott Whittingham Secondary Boys' School, 1 girl transferred to a Residential Blind School, 1 boy left for employment in a cabinet works, 1 girl left for employment as a hospital domestic worker, 1 girl left for employment as a factory packer. The school was visited during the year by student teachers, student health visitors and the County School Medical Officer. The staff was completed by the appointment of Mrs. R. Tunstead and Mr. R. J. Crosbie to the teaching staff and of Mrs. Chapman as Welfare Attendant. I would like to express my appreciation of all staff for their efforts on behalf of the children and particularly to Miss Ramage, upon whom, as senior assistant, much responsibility has fallen. During the year the average attendance was 35.62 and the number on roll 42.21. 29 Reading Lenses.—These lenses (size 6in. x 4in.) have a magnification of about They are mounted upon a heavy stand and are so arranged that the lens can be moved in both horizontal and vertical planes. They cover approximately half the reading page of an ordinary sized book. Their purpose is to dispense with the need for large type books and to bring ordinary printed matter (12-point type and less) within the visual field of the partially sighted. I have to make the following observations on their use:— (a) The usual sloping school desk is not suitable for their use. A flat table or desk is necessary. (b) They are most suitable for older children over 11 years, i.e., children who have already learnt to read. (Most infant readers are printed in large type—18-point and larger). (c) The children who obtained most benefit from their use were those whose sight was in the region 6/24—6/36 Snellen. The very high myopes complained of headache and strain after use. (d) A reading lesson of 30 minutes was the maximum time for use. (This may be due to the fact that these children have never been used to longer lessons of a concentrated nature.) (e) The optimum reading position for each individual has to be found and then supervision is necessary to see that maximum benefit in conjunction with good reading posture is obtained. A weakness of the lens is that there is no adjustable stand or rack to hold the book in place. (f) These lenses have given good results in nature study lessons, and those activities where the eye can concentrate on the lens without distraction. It was found to be detrimental to try to use the lenses in conjunction with writing in an exercise book or paper. Partially sighted in ordinary schools could obtain benefit from the use of these lenses, especially those who in the front places can follow the blackboard, but are having difficulty with ordinary printed matter. (ii) School for the Deaf.—Mrs. I. J. M. Burt, the Head Teacher, reports as follows In January, 1949, there were 20 pupils on the Register, fifteen boys and five girls aged from four years two months to twelve years one month. 30 One child was ineducable, two partially deaf, four had very slight residual hearing and thirteen were totally deaf. In May, 1949, the ineducable child was transferred for trial to the school for the educationally sub-normal, but was found to be unsuitable there also. When this child was removed a partially deaf boy of six years was admitted. In September, 1949, a totally deaf boy of eleven years left to go to the Royal Schools for the Deaf, Margate, and a totally deaf boy of three years was admitted in his place. The roll remains unaltered at twenty. In January, 1949, Mrs. Corner commenced duties here as assistant and in September Miss Bridget Read joined the staff as an uncertificated teacher. She is gaining experience before going to college in September, 1950. Dr. Francis Clarke, the Ear, Nose and Throat Consultant, made examinations in March and October. Dr. Watkins visited the school in March and examined all the children. During the year six children have received Medresco Hearing Aids, and on the whole they have been satisfactory. In some cases there has been a marked improvement in speech. The smaller children find the standard insets rather large and uncomfortable, and when they are ill-fitting the subsequent noise is very distressing both to the wearer and to the people around him. Moulded insets will, I hope, replace the standard ones in time, and should prove much more satisfactory. The percentage of attendance has been high all through the year, reaching 100 per cent. one week and over 90 per cent. quite frequently. There has been very little illness indeed. (iii) School for the Physically Handicapped.—Mr. G. M. Williams, the Head Master, reports as follows:— This year the work of the school was greatly aided by the abnormally fine summer and the long spells of dry weather, which enabled us to take full advantage of 'Open Air' conditions. The general health of the children was amazingly good, and a high average attendance was reached. The new pre-fabricated dining room and kitchen unit was completed towards the end of the year. This should prove to be a valuable addition to the premises. 31 On the basis of last year's experiment the school was again opened during the summer holiday and a voluntary attendance of 91.5 per cent. was maintained. Parties of students from training colleges and student health visitors visited the school, and we were also visited by Dr. Henderson and Dr. Asher from the Ministry of Education. In swimming, one elementary and eight primary certificates were gained. One boy paralysed from the waist downwards was taught to swim and gained his first certificate, which was personally endorsed by the Mayor in recognition of the effort involved. The school made educational visits to the London Zoo, the South Kensington Science Museum and to the films 'Hamlet' and 'Scott of the Antartic.' The audiometrician made several visits to the school and each child's hearing was tested. During the year, 42 children (including five re-admissions) were admitted and 36 were discharged. The average attendance was 66.1 and the average number on roll 73. At the end of the year the classification of cases was as follows:— Orthopaedic 32 Cardiac 7 Delicate 18 Chest (Asthma and Bronchitis) 16 Miscellaneous 5 Total 78 Mrs. M. Teuber joined the teaching staff during the year. Dr. M. Watkins has made regular weekly visits and his personal interest in the children is of inestimable value to the school. 1 must again acknowledge my indebtedness to the staff, medical, teaching, welfare, domestic and transport for their valued co-operation. (iv) Orthopaedic Scheme.—The Scheme is under the Clinical charge of Mr. B. Whitchurch Howell, F.R.C.S., Consulting Orthopædic Surgeon. The following tables show the work done at the clinic:— 32 Defects. Boys. Girls. 5-16 years. Under 5 years. Over 16 years. 5-16 years. Under 5 years. Over 16 years. Anterior Poliomyelitis 11 3 6 11 3 13 Surgical Tuberculosis — — 4 2 — — Scoliosis, Lordosis, Kyphosis 29 3 — 25 4 2 Arthritis 2 — 3 — — 4 Rickets— (a) Genu Varum 3 14 — 3 10 — (6) Genu Valgum 23 27 — 38 28 — Pes Piano Valgus 84 39 4 61 26 1 Spastic Paralysis 6 2 — 5 2 — Progressive Muscular Atrophy 2 1 — — — — Osteo Genesis Imperfecta 1 — — — — — Talipes— (a) Equino Varus 10 3 3 3 4 1 (b) Calcaneo Valgus — 10 — — 14 — (c) Pes Cavus 3 1 — — — — Torticollis 4 12 — 7 5 1 Osteomyelitis — — 1 — — 1 Congenital Dislocation of Hip — — — 3 — 2 Schlatters disease 2 — — 1 — — Cerebellar Ataxia 2 — — 1 1 — Spina Bifida 1 1 — — — — Hallux Valgus 3 — — 9 — — Hammer Toe 2 — — 5 — — Perthes Disease — — — 2 — 1 Achondroplasia — — — 1 1 1 Amputation Leg — — — — — 2 Digitus Varus 1 1 1 6 1 — Congenital Defects 15 7 1 10 6 2 Miscellaneous 30 4 1 20 2 — Totals 234 128 24 213 107 31 33 Number of cases seen by Surgeon:— From Physically Defective School 36 From other Schools 242 Under School age 166 Over School age 36 Total 480 New cases seen by Surgeon:— School age 78 Under School age 60 Total 138 Total examinations made by the Surgeon 618 Total number of cases discharged by the Surgeon 148 Average number of examinations per session 56.2 Number of treatments given 2,081 Number of attendances for after-care 2,263 Number of ultra-violet light treatments 2,23 3 Total number of treatments 6,577 Average number of attendances per session 14.9 Number of sessions held:— Inspections 11 Treatment 441 Total number of visits by instrument maker 6 Admissions to Queen Elizabeth Hospital for Children 9 Admissions to Black Notley 4 Operations performed 15 Defects seen at Orthopaedic Clinic in Children under 5 years of age:— Anterior Poliomyelitis 6 Scoliosis, Lordosis, Kyphosis 7 Rickets— (a) Genu Varum 24 (b) Genu Valgum 55 Pes Piano Valgus 65 Progressive Muscular Atrophy 1 Spastic Paralysis 4 Talipes— (a) Equino Varus 7 (b) Calcaneo Valgus 24 (c) Pes Cavus 1 Torticollis 17 Cerebellar Ataxia 1 Spina Bifida 1 Achondroplasia 1 Digitus Varus 2 Congenital Defects 13 Miscellaneous 6 Total 235 (v) School for the Educationally Sub-Normal.—Miss R. E. A. Lock, Head Teacher of the School for Educationally Sub-Normal Children, reports as follows:— The number of children on the School Roll is now 73; 26 girls and 47 boys. 34 Two boys were transferred to Institutions during the year. Eight boys proceeded to employment and of these six are still in their original posts and two have already bettered themselves. One girl returned to her normal school and two are now employed. Two ineducable children were excluded and recommended for Institutional treatment. Both boys and girls have taken part keenly in swimming activities, and four certificates were gained during the year. Efforts will be made as soon as possible to gain football and netball activities for senior scholars. (vi) Child Guidance Clinic.—Dr. Helen Gillespie, Psychiatrist to the Child Guidance Clinic, submits the following report:— Staffing.—The structural alterations to the clinic premises having been completed, and the rooms suitably furnished and equipped, it was possible to increase the clinic staff, and Dr. Haffner and Dr. Craike were appointed as Psychiatrists early in the year. Dr. Craike found it necessary to resign his appointment in August, 1949. Dr. Haffner commenced his duties in July, 1949, and is now working six sessions a week. Following the resignation of Mrs. Seglow at the end of 1948, we were without a second Psychiatric Social Worker until May, 1949, when Mrs. Robinson took up her duties, but she resigned in November, 1949. Mr. Secretan left the clinic in August, 1949, and Miss E. M. Smith took his place as Educational Psychologist in Walthamstow. Mrs. Barker has been working six play therapy sessions since March, 1949. TABLE 1 Analysis of Problems referred to the Clinic Walthamstow Outer Area I. Nervous disorders, e.g., fears; depression; apathy; excitability 32 13 II. Habit disorders and physical symptoms, e.g., enuresis; speech disorders; sleep disturbances; feeding difficulties; tics; fits; etc. 39 18 III. Behaviour disorders, e.g., unmanageable; tempers; stealing; lying; sex problems, etc. 40 28 IV. Educational, e.g., backwardness; failure to concentrate 18 8 V. Court cases 2 3 Totals 131 70 35 TABLE 2 Analysis of cases closed during the year (including cases referred in previous years). Walthamstow Outer Area Improved and recovered 48 14 Interrupted due to non-co-operation 20 6 Placed away from home 8 5 Diagnosis and advice only 31 8 Spontaneously improved after partial service 14 9 Recommended E.S.N. School and School for the Physically Handicapped 3 2 Cases closed for miscellaneous causes 4 7 Totals 128 51 WAITING LIST The Waiting List at the end of 1949 was:— Walthamstow 36 Outer Area 30 These comparatively low figures may be attributed to the closing of the waiting list in March, 1949, which has led to a temporary reduction in the number of cases being referred since that date. Psychiatric Social Worker—Interviews and Visits Interviews Home Visits Other Calls Walthamstow 591 14 74 Outer Area 183 18 — REPORT OF THE PLAY THERAPIST Mrs. K. B. Barker reports as follows:— During the past year, in addition to individual therapy, three small groups, with three or four children in each, have been formed. This work is still experimental in the sense that (a) the bases for grouping, and (b) the purposes best served by this kind of therapy, are still being worked out. With regard to the former, the groups at present consist of children of roughly the same age, all of whom have received some individual help and who are considered likely to make a good contact with each other. The purposes served vary with the groups. A group of pre-adolescent girls has been used by them chiefly for the expression and development of their strivings for independence in the home. Here, it has been interesting to contrast the behaviour of an overaccepted only child with that of a girl who is burdened with responsibility for several younger brothers and sisters. 36 The second group of 8—9 year old children is used chiefly for the purpose of giving experience in sharing the therapist's attention and dealing with the sibling-jealousy situation, preparatory to their leaving the clinic. The third age-group is formed of 5 and 6-year-olds who are withdrawn, and who are finding it difficult to make contact with other children. In varying degrees, however, all of these purposes except the first are served by all groups. REPORT OF THE EDUCATIONAL PSYCHOLOGIST Miss E. M. Smith reports as follows:— During the year the psychologists for Walthamstow area gave individual Intelligence Tests to 197 children (64 girls and 133 boys) who had educational or psychological difficulties. These figures show an increased proportion of girls—32% as against 25% last year. The greatest number of cases were presented from Junior Schools. The following tables will show the school and age placement of all cases:— School Placement Preschool Secondary Total Infant Junior Modern Gram. Tech. Special Girls 6 11 29 7 2 4 5 64 Boys 3 31 51 36 1 4 7 133 Age Placement Age 5 6 7 8 9 10 11 12 13 14 15 Girls 8 6 10 10 6 7 9 2 3 2 1 64 Boys 9 18 17 18 16 4 17 13 9 10 2 133 Totals 17 24 27 28 22 11 26 15 12 12 3 197 It will be seen that the majority of Educational or psychological problems come to light during the Junior School period, but there is also indication that the age for transfer to secondary schools produces a considerable number. These children were brought to the attention of the psychologist mainly through teachers and school medical officers. The following table indicates all sources of referral to the psychologist and the percentages of children from them:— Source of Referral % of Girls % of Boys Head Teachers 53 72 School Medical Officer 25 12 Parents 14 5 Speech Therapist 3 5 Court — 4 Miscellaneous 5 2 37 Eighteen girls and 29 boys were further referred to the psychiatrist for interview and possible treatment. The remainder were almost entirely educational problems. The range of intelligence of children dealt with by individual tests is shown below Girls Boys Total Per cent. Above average I.Q. (116+) 8 14 22 11 Average I.Q. (86-115) 17 73 90 45 Below average I.Q. (85—) 39 46 85 44 64 133 197 100 Within the rather large group below average, eight girls and eight boys were found to be educationally sub-normal. These children present a problem to the schools because of the lack of accommodation in more suitable establishments. They are a source of disturbance in their classes because of their inability to join in normal work, and cause unnecessary dissipation of the energy and time of teachers who should not be dealing with these children needing special apparatus and techniques of teaching. School Visits.—A new Educational Psychologist was appointed in September, since when 42 school visits have been made, as follows:— Infants' Schools 7 Junior Schools 24 Secondary Schools 7 Special Schools 4 Reading retardation is still found to be the greatest cause of backwardness among children in Primary and Secondary Schools. There still seems to be a serious lack of suitable reading material in the schools, due partly to publishing delays, and partly to a lack of knowledge about reading matter and reading methods beyond the infant level. Whenever asked, the psychologist gave information on these matters, sometimes to Head Teachers, sometimes to Head Teachers with a group of the staff. Group Testing.—At the Head Teachers' requests tests were carried out with backward groups in two primary and two secondary schools. In all, 80 children were tested with appropriate nonverbal tests. As a result of these tests it was possible to discover those children whose school retardation was due to some other cause than lack of mental ability, and who merited special or individual teaching. Coaching.—The psychologist (since September) has been giving weekly coaching periods to 16 children, of whom 14 needed 38 help for retardation in reading, one in arithmetic and one in handwriting. Details of the reading cases, with retardation and progress are given below:— Child Age years Reading Age (at September) Reading Age (at December) Amount of Progress in 3 months Yr. m. Yr. m. Yr. m. Girl 7 — 5 0 6 2 1 2 + Boy 8 5 5 6 7 1 2 Boy 9 — 5 0 5 8 8 + Girl 9 — 5 0 6 4 1 4 + Boy 11 7 2 9 0 1 10 Boy 12 8 1 9 1 1 0 Boy 12 8 2 8 8 6 Boy 12 6 2 6 9 7 Boy 13 6 2 6 9 7 Boy 13 7 6 9 2 1 8 Boy 14 6 5 7 0 7 (at November) Boy 7 5 3 Not yet re-tested Boy 13 — 5 0 Boy 14 — 5 0 Average progress in three months — 1 yr. 5 months. (vii) Speech Therapy.—Treatment centres are provided at the Old Education Offices, High Street, and at the Open-Air School. Miss C. M. Gregory reports as follows:— About 201 children were treated this year. Attendances were good, even amongst those who had to find their own way to the Clinic. 125 children were treated weekly, the greatest proportion being infant cases with some of pre-school age, which reveals that parents are becoming more aware of facilities provided. There has been a drop in the numbers of junior and senior children requiring attention—these comprise only one-third of the clinic patients. Infant stammerers, though comparatively few in number, show a marked improvement when taken out of cramped and over-tense surroundings, i.e., when parents manage to acquire their own flat or house. Transport for the Clinic has kept up to a remarkable level, especially as the Transport Officer has had so many calls on his cars for other sudden and urgent work. I would like to thank the Heads of Schools for their kindness and helpfulness to my students when they visit. Mrs. V. Tait reports:— Attendances have again been good and results encouraging. 39 Unfortunately the number of patients has decreased slightly since September when I attended the clinic half-time only. My colleague, Miss Gregory, kindly absorbed one school into her own area, so that cuts were not so drastic as they might otherwise have been. Tables referring to attendances and a clinical analysis follow. In addition, advice has been given to the parents of children too young for treatment, and these children will be kept under observation. As I am now leaving, I should like to express appreciation of the co-operation I have always had from all departments, particularly from Head Teachers, whose interest is invaluable. Annual Report and Clinic Analysis. High St. Clinic Open-Air Sch. Clinic No. of cases in attendance at beginning of year 76 74 New cases admitted during year 117 41 Transfers from other clinics 8 2 201 117 Cases ceasing attendance before cure or discharge 10 8 Cases discharged as incapable of benefiting by further treatment 2 Cases temporarily discharged, to resume treatment later 19 5 Cases discharged cured 51 46 Transfers to other clinics 5 8 Cases still in attendance at end of year 114 50 Total attendance during year 3,512 1,255 No. of Cases suffering from:— High St. Clinic Open-Air Sch. Clinic Physiological or psychological defects— (a) Stammer 60 53 (b) Clutter 9 — Voice Defects— (a) Aphonia — — (b) Dysphonia — 1 (c) Rhinophonia 9 3 Defects of articulation— (a) Dysarthria — 5 (b) Dyslalia 110 48 Language defects— (a) Idioglossia — — (b) Delayed Speech 7 3 Aphasia— (a) Congenital word deafness 1 — (b) Congenital word blindness — — (c) Other — — Defects due to abnormality of special senses— (a) Blindness — — (b) Deafness 2 1 (c) Other — — Probable mental deficiency 3 3 Other types of defect — — 40 (viii) Convalescent Home Treatment.—135 children were sent away for treatment during 1949. There were 24 children remaining in convalescent homes and hospital schools on December 31st, 1949. 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, reports as follows:— Attendance at the Nursery School during 1949 was very good, except for a period at the beginning of the summer term when there was an epidemic of measles. During the year there have been 40 cases of measles, 7 of scarlet fever, 4 of chickenpox and one of whooping cough. School Clinics are now held twice a week at the Centre adjoining the school, affording extra facilities for medical supervision. It is still impossible to satisfy the demand for admission to the Nursery School. 16. MISCELLANEOUS (i) Employment of Children.—282 children were examined by the medical staff. (ii) Employment of Children in Public Entertainments.— Six children were examined under these regulations. 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 2,795 Second Age Group 1,978 Third Age Group 2,059 Total 6,832 41 B.—Other Routine Inspections Number of Special Inspections and Re-inspections 510 C.—Pupils found to require Treatment Total number of individual pupils found at periodic medical inspection to require treatment (excluding dental diseases and infestation with vermin) 1,178 TABLE II A.—RETURN OF DEFECTS FOUND BY MEDICAL INSPECTION. Requiring treatment 1,476 For observation 1,916 B.—CLASSIFICATION OF THE GENERAL CONDITION OF PUPILS INSPECTED DURING THE YEAR Number of pupils Inspected A (Good) B (Fair) C (Poor) No. % No. % No. % 6,832 4,722 69.1 1,878 27.5 232 3.4 TABLE III INFESTATION WITH VERMIN Total number of examinations 39,625 Total number of individual pupils found to be infested 1,087 TABLE IV TREATMENT TABLES Group I—Minor Ailments (excluding uncleanliness)— Total number of defects treated, or under treatment, during the year, under the Authority's scheme 3,390 Group II—Defective Vision and Squint— Errors of refraction 590 Other defects 372 No. of pupils for whom spectacles were— (a) Prescribed 574 (b) Obtained (estimated) 560 Group III—Treatment of Defects of the Nose and Throat— 287 children were treated at the Authority's Clinics. Group IV—Orthopædic and Postural Defects— Number treated as in-patients in hospitals or hospital schools 13 Number treated otherwise 447 Group V—Child Guidance Treatment and Speech Therapy— Number treated under Child Guidance arrangements 179 Number treated under Speech Therapy arrangements 318 42 TABLE V DENTAL INSPECTION AND TREATMENT Number of pupils inspected by the Authority's Dental Officers— (a) Routine Age Groups 1,840 (b) Specials 1,400 3,240 Number found to require treatment 2,232 Number actually treated 6,127 Attendances made by pupils for treatment 11,614 Half-days devoted to— (a) Inspection 16 (b) Treatment 1,736 Fillings— (a) Permanent Teeth 3,061 (b) Temporary Teeth 992 Extractions— (a) Permanent Teeth 1,039 (b) Temporary Teeth 3,820 Administration of general anæsthetics for extraction 2,854 Other Operations— (a) Permanent Teeth 4,361 (b) Temporary Teeth 1,437