C4411(1) WALTHAMSTOW WAL 80 BOROUGH OF WALTHAMSTOW Committee for Education REPORT of the BOROUGH SCHOOL MEDICAL OFFICER for the year 1950 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 1950 A. T. W. POWELL, M.C., M.B., B.S., D.P.H. BOROUGH SCHOOL MEDICAL OFFICER CONTENTS Accommodation 6 Artificial Light Treatment 26 Aural Clinic 13 Child Guidance 19 Clinics 4 Committee 2 Convalescent Home Treatment 24 Co-ordination 5 Crippling 16 Dental Defects 10 Dental Treatment 11 Diphtheria 27 Diphtheria Immunisation 27 Ear Disease 10, 13 Employment of Children 36 Enquiry Officers 29 Exclusion 27 Eye Disease 9 Following up 10 Handicapped Children 31 Hearing 13 Heart Disease 10, 18 Hygiene 6 Impetigo 9 Invalid Children's Aid Association 30 Infectious Disease 27 Lectures on Good Grooming 36 Mass Radiography 25 Meals, Provision of 28 Medical Inspections 4 Medical Treatment 10 Milk in Schools Scheme 29 Minor Ailments 9, 11 N.S.P.C.C. 31 Nursery School 35 Nutrition 9, 10 Open Air Education 28 Orthopaedic Treatment 10, 16 Orthoptic Treatment 13 Pediatric Clinic 23 Parents, Co-operation of 29 Physical Training 28 Re-inspections 8 Rheumatism 10, 18 Ringworm 9 Scabies 9 School Camps 28 School for the— Deaf 34 Educationally Sub- Normal 35 Partially Sighted 32 Physically Handicapped 32 Skin Diseases 9, 11 Speech Therapy 23 Staff 4 Statistical Summary 37 Teachers, Co-operation of 29 Tonsils and Adenoids 9 Tuberculosis 10, 24 Uncleanliness 9, 10 Vaccination 28 Vision 9, 12 Voluntary Bodies 29 Whooping Cough 27 WALTHAMSTOW COMMITTEE FOR EDUCATION 1950 - 1951 Chairman : Alderman S. N. Chaplin. Deputy Chairman : Councillor W. H. Shaw. Ex-Officio : The Worshipful the Mayor: Councillor A. E. Simmons, j.p. The Deputy Mayor: Alderman E. C. Redhead, j.p. Chairman of Finance Committee: Alderman Ross Wyld, o.b.e., j.p. Cty. Aid. P. Astins, C.b.e., j.p. Ald. Mrs. L. P. Bailey, j.p. Ald. W. B. Fitt. Ald. T. Fitzpatrick. Ald. A. E. Manning. Ald. Mrs. C. McEntee, j.p. Ald. V. L. McEntee, c.b.e. Ald. Mrs. E. M. Miller. Coun. E. W. H. Battey. Coun. H. C. Fisher. Coun. H. Fulton. Coun. G. S. Mace. 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 in the following pages a report on the School Health Service in Walthamstow, the twenty-first for which I have been responsible. On the whole, the position is satisfactory in spite of difficulties. On the debit side is the failure, on financial or other grounds, to provide new sanitary accommodation in schools and to remodel the old. Until this is done and washing facilities are provided and adequately used it is no surprise that there is such a low standard of elementary personal hygiene. On the credit side, the nutritional findings are satisfactory, as were the findings of the various medical inspections and the treatment of the defects discovered. During the year treatment facilities were increased by the commencement of a Pediatric Clinic under the clinical charge of Dr. Elchon Hinden, Paediatrician to Whipps Cross Hospital, where patients are admitted if and when necessary. Dental treatment facilities remained if not fully adequate far more so than in many other comparable areas. Staffing generally was reasonably adequate, but it is with regret that I have to report the resignation through ill-health of Mr. H. J. Smith and his death soon after. Mr. Smith was in administrative charge of the School Health Service for many years. Dr. Mary Sheppard was unfortunately absent through illness for the last quarter of the year and is not yet able to return to duty. Reference is also made in the Report to the trial opening of the Open-Air School during the summer holidays, and the gratifying response. This was supplemented by the holding of Open-Air Classes at High Beach. The fight against Tuberculosis was continued by the routine chest x-ray examination of teaching staff, by the visit of the Mass Radiography Unit and finally by participation in the Medical Research Council's B.C.G. Vaccine Trials. Once again I wish to thank the Chairman, Members and other officers of your Committee for unfailing consideration and support. The help of the Borough Education Officer has always been generously available. The staff of the School Health Service has again maintained the volume, and, I believe, the efficiency of work done, and I wish to record my appreciation. I am, Your obedient Servant, A. T. W. POWELL, Borough School Medical Officer. 4 Resignations : 1. STAFF. Miss O'Leary (Audiometrician) 1.2.50 Dr. D. B. Hudson (A.C.M.O.) 10.6.50 Miss E. C. Carey (School Nurse) 3.8.50 Mr. C. Shamash (Dental Surgeon) 31.8.50 Miss G. E. Williams (Health Visitor/School Nurse) 31.8.50 Mr. H. J. Smith (Administrative Asst.) 2.11.50 Dr. E. R. Tivy (Ophthalmologist—Part-time) 30.11.50 Appointments: Miss A. M. Hemmings (Speech Therapist) 18.1.50 Miss K. M. Munday (Health Visitor/School Nurse) 23.1.50 Mrs. G. H. Salter (Health Visitor/School Nurse) 8.5.50 Mrs. M. Crosier (Clerk) 22.5.50 Miss D. Anklesaria (P/T. Dental Surgeon) 25.5.50 Dr. R. A. Irani (A.C.M.O.) 12.6.50 Mrs. E. Levis (Health Visitor/School Nurse) 18.9.50 Dr. R. Bulsara (Ophthalmologist—Part-time) 26.9.50 Dr. E. R. Tivy (Ophthalmologist—Part-time) 28.9.50 Miss E. M. P. Collins (School Nurse) 1.11.50 Mr. A. T. Wade (Administrative Asst.) 2.11.50 Dr. I. D. R. Gregory (P/T. Ophthalmologist) 4.12.50 SCHOOL CLINICS Aural— Monday 2 p.m.—4.30 p.m. Town Hall. Cardiac and Rheumatism— Monthly 2 p.m.—4 p.m. Town Hall. Child Guidance— Monday to Friday 10 a.m.—1 p.m. 2 p.m.—5 p.m. Child Guidance Centre, 263, High Street, E.17. Dental Clinics— Monday to Friday 9 a.m.—4.30 p.m. Town Hall. Saturday 9 a.m.—12 noon. Town Hall. Monday Wednesday Thursday Friday 9 a.m.—4.30 p.m. 1, Guildsway. Tuesday 2 p.m.—4.30 p.m. Saturday 9 a.m.—12 noon. 1, Guildsway. Monday Wednesday 9 a.m.—4.30 p.m. Sidney Burnell School. 1, Guildsway. 5 *Minor Ailments— Monday Wednesday Friday Saturday 9 a.m.—12 noon. Town Hall. T uesday 9 a.m.—11 a.m. Sidney Burnell School. Friday 1.30 p.m.—2.30 o.m Sidney Burnell School. Monday Thursday 9 a.m.—11 a.m. Low Hall Lane. Pediatric— Alternate Thursdays 9 a.m.—12 noon. Town Hall. Ophthalmic— Monday Wednesday 9 a.m.—12 noon. Town Hall. T uesday 2 p.m.—4 p.m. Town Hall. Friday or Saturday 2 p.m.—4 p.m. 9 a.m.—12 noon. Town Hall. Orthopedic— 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— Tuesday 9 a.m.—4.30 p.m. Town Hall. Speech Therapy— By appointment 263, High Street and Open-Air School. *Immunisation— Wednesday 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. Co-ordination 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 seven whole-time nurses. 6 3. THE SCHOOL HEALTH SERVICE IN RELATION TO PRIMARY AND SECONDARY SCHOOLS. School Hygiene and Accommodation.—The following table shows the number of schools in the Borough at the 31st December,1950 :— 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 — - 1950 1949 1948 1947 1946 Number of Children on Register, 31st December 18211 17652 17154 16463 15776 Average attendance 15993.5 15950.7 14928.9 14470.6 14004.6 Percentage attendance 87.8 90.3 86.7 86.9 86.0 Mr. Frank H. Heaven, A.R.I.B.A., Architect to the Education Committee, contributes the following:— Additions and Alterations.—Additional storage space has been provided at three schools. Amenities.—Many of these have been provided in the form of ironing points in needlework and other rooms, plugs for electricity in laboratories, removal of spiked tops to railings, communicating doors to babies' lavatories, turfing of lawns, provision of dressing room for gymnastics, reinstatement of fences, a rest room for girls, road safety barriers, removal of useless walls and minor structures which interfered with proper use of play areas, exhibition shelving in classrooms, cupboards for staff rooms, garden plots for scholars, sanding and sealing of hall and dining-room floors, new coverings to floors, glazed draught screens to windows, and the conversion of two roof lofts into usable spaces. Central Kitchens. — The buildings and the cooking apparatus have been maintained in working order and improvements and replacements effected at each kitchen. Craft Rooms.—Wood and metal work machinery, electrical and gas drying cabinets have been installed, and improvements made in heating, lighting and hot water supply arrangements, and some science rooms and rooms for biology and light craftwork have been provided with new fittings and furniture. Also, a greenhouse with potting shed, cold frames, etc. has been built at one school, and a pottery kiln at another, domestic science rooms have been redecorated. 7 Drama.—Certain Assembly Halls have been provided with stage beams and curtains, stage lighting and improved acoustic properties effected. Further Education.—The play area at the Marsh Street Youth Centre has been resurfaced for games, and the whole of the interior of the buildings decorated in bright colours. Gymnasia.—Many of the infants' schools have been equipped with climbing bars and nets, balancing boards, and some of the senior schools with suitable equipment for indoor exercises. Heating. — Existing systems have been maintained. A new system has been installed in the east wing of the Walthamstow High School for Girls, and new boilers with accelerator pumps elsewhere. Space heaters, chiefly operated by gas, have been installed to supplement inadequate systems at six schools. Lighting. — Artificial lighting has been brought up to modern standards in many rooms, particularly those in which art, needlework, and similar work is carried out, the improvement, in most cases, being effected by the use of fluorescent fittings. The external lighting at one school has been improved by the use of fluorescent lamps. Maintenance.—All the educational properties are up to a good standard of repair within the limits of the approved expenditure. The annual vacuum cleaning of newly decorated schools has been carried out to maintain general cleanliness. Many of the school-keeper houses have been repaired and renovated to bring them up to the standard required by service regulations. Reinstatements after fires have been effected at two schools. Playfields.—These are maintained by the grounds' staff. Special contract works are carried out as required and have included trees about the perimeters of two playfields. Large play areas have received treatment, to bring them into playable condition, at the Sir George Monoux Grammar School, and at The Chestnuts. Hedges have been levelled and land drains laid at the Salisbury Hall Schools Playfield. Playgrounds.—These have all received attention, in some cases complete re-surfacing has been carried out. Provision of Meals and Mil\.—The canteens at Schools are in a good condition and additional equipment has been provided to meet the demand for school meals, etc. Serving hatches between canteen and dining hall are in hand at three schools. Thirty-eight hot cupboards for the warming of plates and service of meals have been supplied and fixed. 8 A pass gate between a central kitchen and adjoining schools has been formed to speed up the delivery of meals. Renovations.—Complete renovation of the exteriors of three schools and interiors of nine schools, and part interiors of another three schools were completed during the year, also the interior of the Marsh Street Youth Centre and the exterior of the Guildsway Dental Clinic. The interiors of some Domestic Science Rooms, Head Teacher and Staff rooms have also been renovated. Sanitation. — Improvements to scholars lavatories have been effected at four schools. Additional washing facilities have been installed at two schools. Cold water services have been improved or renewed to comply with the Water Board's Regulations. Hot water supplies, chiefly from gas water heaters, have been installed at eight schools for staff or scholars usage. Sound Equipment.—A further instalment, under a progressive scheme, has been made of radio and gramophone equipment with extensions and loud speakers to classrooms. Visual Aids.—A further instalment of instruments on similar lines to the last has been made, and screens and blackout fixed at eight schools. War Damage, etc.—Progress is being made towards complete reinstatement after damage by enemy action, and occupation by Civil Defence and other public services. The work has been completed at three schools and at the North Walthamstow Sports Ground, and is well in hand at the Wm. McGuffie Secondary School. 4. MEDICAL INSPECTION. The following gives a summary of the returns :— A. Periodic Medical Inspections— Entrants 2,456 Second Age Group 1,687 Third Age Group 1,603 Total 5,746 B. Other Inspections— Special Inspections 765 Re-inspections 531 Total 1,296 9 5. REVIEW OF THE FACTS DISCLOSED BY MEDICAL INSPECTIONS. (N.B. -The numbers given below refer to medical and special inspections and do not include other examinations at clinics.) (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 2456 1815 73.9 575 23.4 66 2.7 Second Age Group 1687 1176 69.7 461 27.3 50 2.9 Third Age Group 1603 1128 70.4 455 28.4 20 1.2 Totals 5746 4119 71.7 1491 25.9 136 2.4 (b) Uncleanliness.—The following table gives comparative figures tor the past two years :— 1950. 1949. Average visits to schools 4 4 Total examinations 43,141 39,625 No. of individual children found unclean 923 1,087 Percentage uncleanliness of average attendance 5.8 6.8 (c) Minor Ailments and Skin Defects.—The following was the number of skin defects found to require treatment and observation :— Treatment Observation Ringworm—Head — — Body 2 Scabies 2 1 Impetigo 4 — Other skin diseases 57 41 (d) Visual Defects and External Eye Diseases.—The number of patients requiring treatment and observation was as follows :— Treatment Observation Visual Defects 299 71 Squint 49 19 External Eye Diseases 30 32 (e) Nose and Throat Defects.—The number of patients requiring treatment and observation was as follows Treatment Observation Enlarged Tonsils 58 320 Adenoids 19 9 Enlarged Tonsils and Adenoids 34 46 Other Conditions 169 56 The 169 cases of "other conditions" are made up of sore throat and defects requiring diastello treatment. 10 (f) Ear Disease and Defective Hearing. — The number of patients requiring treatment and observation was as follows:- Treatment Observation Defective Hearing 35 23 Otitis Media 37 37 Other Ear Diseases 8 20 (g) Orthopaedic and Postural Defects.—A total of 321 deformities were found to require treatment. (h) Dental Defects. Inspection at Schools. Requiring General Other Inspected. Treatment. Per Cent. Actually treated. Fillings. Extractions. Anæsthetics. Operations. 1,732 1,125 64.9 6,105 3,980 6,033 3,584 8,244 (i) Heart Disease and Rheumatism.—The findings were as follows :— Treatment Observation Heart Disease—Organic 6 12 Functional 3 52 Anaemia 13 6 (j) Tuberculosis.—All children suspected either of pulmonary or glandular tuberculosis are referred to the Chest Physician for final diagnosis. (\) Other Defects and Diseases. — The following shows the number of various other defects which were found to require treatment :— Enlarged Glands 29 Epilepsy 4 Bronchitis 55 Other Defects 184 Speech 26 6. FOLLOWING UP The School Nurses paid a total of 1,235 home visits during 1950. 7. ARRANGEMENTS FOR TREATMENT (a) Malnutrition.—The following shows the quantities of tonics issued during 1950: — Cod Cod Liver Oil Cod Liver Parrish's Syrup Lacto Liver Oil and Malt and Oil. Food. Phosphate and Malt. Parrish's Food. Emulsion. 9½ lbs. 253¾ lbs. 63¾ lbs. 1,026 lbs. 1,330 lbs. 211 lbs. (b) Uncleanliness.—Treatment with lethane was carried out extensively with satisfactory results and advice and treatment is 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. 11 (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 following table detailing the work done at the school clinics :— First Inspections Re-inspections Boys Girls Boys Girls Ringworm—Scalp 1 - 4 2 Body 1 1 1 - Scabies - - - - Impetigo 55 38 85 43 Other Skin Defects 120 141 307 288 Verminous Head 34 142 62 825 Discharging Ears and Deafness 44 72 257 330 Tonsils and Adenoids 46 34 38 41 Defective Vision (including squint) 59 67 14 23 External Eye Disease 92 104 234 242 Sores 20 30 26 24 Various 1,215 1,040 2,420 2,893 Totals 1,687 1,669 3,448 4,711 First attendances number 3,356 against 3,757 in 1949, and re-attendances 8,159 against 10,355, the total attendances being 11,515 against 14,122. (d) Dental Treatment. — The position in regard to Dental staffing remained as in recent years, the equivalent of 47/llths whole-time Dental Surgeons being available for School Dental work at 31st December. The facilities of the dental workshop which was established by the Borough Council prior to the appointed day, under the National Health Service Act, 1946, were available to the School Dental Service, especially in regard to orthodontic work. Mr. L. W. Elmer, Senior Dental Surgeon, submits the following report — " Once again it has been impossible to carry out many routine inspections at the Schools. Parents have continued, in increasing numbers, to ask for appointments for inspection and treatment, and it is, in the main, the children of these parents who have received treatment. A proportion of these children have, of course, only attended for the relief of pain, but the greater number have asked for and received complete treatment. " The number of children inspected by the dental surgeons at the Schools was 1,732. Of these it was found that 1,125 required treatment. The specials, in number 4,951, are those whose parents asked for and received appointments for treatment. 6,105 children were treated making 12,474 attendances, an average of two each during the year." 12 (e) Visual Defects and External Eye Diseases.—Dr. Mary Sheppard, who had carried out refractions in the School Clinic for some 25 years, was unable to continue after mid-September owing to illness. The work was then shared by Dr. Eric Tivy and Dr. Ratan Bulsara, and later by Dr. Bulsara alone. Both are recognised by the Regional Hospital Board as Specialist Medical Officers in regard to Ophthalmic work. The following tables show the work done in 1950 :— Defect. Under 7 years. 7- yea 11 rs. Over 11 years. Total. Boys. Girls. Boys. Girls. Boys. Girls. Boys. Girls. Hypermetropia 8 18 30 31 16 14 54 63 Hypermetropic Astigmatism 3 - 3 10 3 6 9 16 Myopic Astigmatism - - - 1 2 1 2 2 Mixed Astigmatism - - - - 2 1 2 1 Myopia 2 — 15 18 41 45 58 63 No visual defects 9 17 18 28 16 35 43 80 Totals 22 35 66 88 80 102 168 225 Refractions Re-inspections Treatments T otals New Old 384 3 54 2,160 205 3,103 Inspections of Children attending the School for the Partially Sighted Under 7 years 7-11 years Over 11 years Total Boys. Girls. Boys. Girls. Boys. Girls. Boys. Girls. Hypermetropia - 1 1 1 4 1 5 3 Hypermetropic Astigmatism - - - - - 1 - 1 Myopic Astigmatism - - 1 1 5 1 6 2 Myopia - — 1 10 5 3 6 13 Totals - 1 3 12 14 6 17 19 Refractions Re-inspections New 1 Old 11 83 13 Special Supervision at the School for the Partially Sighted. Dr. Irene Gregory has carried out a special supervisory visit to the school. Dr. Gregory has special experience in similar work in another area. Repair of Spectacles. Early in the year considerable difficulty existed in regard to the repair of spectacles and the progress of children at the School for the Partially Sighted was particularly affected. Approval was finally given to the provision of a duplicate pair at the expense of the Authority on prescription by the Ophthalmic Specialist. Later authority was given for provision to be made through the Supplementary Ophthalmic Service. (/) 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 145 Number of cases treated for Squint and Amblyopia 103 Number cured of both Squint and Amblyopia 20 Number cured of Amblyopia only 18* Number cured by operation 3 Still under observation and treatment 70 * Eight of these cases are still under treatment for Squint. Total attendances during the year 1,135 (g) Ear, Nose and Throat Clinic.—Dr. Francis Clarke reports as follows :— The number of 41 cases of otorrhoea (discharging ears) seen at the E.N.T. clinic was comparatively small in relation to the total number (285) of ear, nose and throat conditions examined during the year 1950. This follows much the same pattern as found in the last few years. The total number of chronic discharging ears was 18. Of these, 10 had tympanic sepsis solely and no complications, and all were treated by zinc ionization. Eight of the ten were quite 'dry' after one or two treatments. The remaining eight were either mastoid cases,—some already operated on and two who 14 required operation,—or cases with other complications such as sinusitis, granulations, etc. The total number of acute discharging ears was 23. All these were treated daily at the clinic by suction and a suitable antiseptic such as albucid, penicillin or Grieswold dyes mixture. Twenty of the 23 were discharged cured after six to twelve days' treatment. Prompt and careful attention to the treatment of acute discharging ears is all important in the prevention of chronic otorrhoea and preservation of the hearing. The suction method has been found a valuable and indispensable aid in the treatment. The greater proportion of cases treated during the year was for nasal conditions such as sinusitis, rhinitis, nasal obstruction with mouth breathing, etc., and functionally hypertrophied or unhealthy tonsils, usually secondary to some primary nasal defects, and impaired hearing. About 30% of all children referred to the clinic with definite nasal symptoms, or in many instances as 1 diseased tonsils and adenoids ' have sinus infection. It is very important to bear this in mind in relation to tonsillectomy. The sinusitis which is primary must be treated first. The removal of the tonsils in the presence of sinus infection will not cure the sinusitis but may well aggravate it. Two examples of this have been seen during the year. A certain number of children were found who had definite sinusitis and whose names were on the waiting lists for tonsillectomy, without, apparently, receiving any treatment for the sinusitis. This procedure needs revision. The sinus infection requires local and immediate attention and should not be left untreated for the long periods as now obtains for removal of tonsils, which, in the end will not cure the sinusitis. A number of these cases were treated successfully during the year by Proetz displacement method and concurrently, where indicated, local tonsil treatment. The same remarks equally apply to certain other urgent conditions, such as otitis media (otorrhoea), impaired hearing, nasal obstruction, rhinitis. In the case of children especially, Proetz displacement will clear up satisfactorily the large majority of sinus infections, and it is very interesting to observe the effect that successful sinus treat- TABLE "A" ACUTE OTITIS MEDIA WALTHAMSTOW 1950 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 1 J k l Acute Non-Suppurative Otitis Media - - Operation before Clinic - - - - - - - - - - - No Operation - - - - - - - - - - Acute Non-Suppurative Otitis Media with Nasal Conditions : Enlarged Tonsils and Adenoids. 5 1 Operation before Clinic - 1 - 1 - - - - - (1) 4 No Operation — 4 - - 4 - - - - - Acute Suppurative Otitis Media 5 1 Operation before Clinic - 1 - - 1 - - - - - 4 No Operation — 4 — — 4 — - — — — Acute Suppurative Otitis Media with Nasal conditions : Enlarged Tonsils and Adenoids 13 3 Operation before Clinic — 3 3 — 3 - - - - - (4) 10 No Operation — 10 3 — 7 - 2 1 — — Totals 23 — 23 6 — 20 - 2 1 — — PRE-SCHOOL CHILDREN. Acute Non-Suppurative Otitis Media — — Operation before Clinic - - - - - - - - - - No Operation - - - - - - - - - - Acute Suppurative Otitis Media — — Operation before Clinic - - - - - - - - - - — No Operation - - - - - - - - - - Acute Suppurative Otitis Media with Nasal Conditions : Enlarged Tonsils and Adenoids — — Operation before Clinic - - - - - - - - - - — No Operation - - - - - - - - - - Totals — - - - - - - - - - - Grand Totals 23 — 23 6 — 20 — 2 1 — — * The figures in brackets indicate the number of cases with Bi-lateral Otorrhoea. TABLE " B" CHRONIC SUPPURATIVE OTITIS MEDIA SCHOOL CHILDREN WALTHAMSTOW 1950 Diagnosis. Diagnosis. Tonsils and Adenoids. Treatment. Results. Chronic Tympanic Sepsis, Complicated by :— Totals (Ears). Granulations : Simple Polypii. 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. Old Operation No Operation. Ionisation. Antiseptic Treatment. Cautery, etc. Mastoid Operation. Tonsils/Adenoids. Conservative Treatment. Nasal Treatm. Tonsils and Adenoids Operation. SCHOOL. A Granulations : Simple Polypii 3 A B C D E F G H I J K L M N O P 1 1 — — Operation before Clinic 1 - - - - - - 1 - 1 - 1 - - - - - No Operation 1 1 - - - - - - - - - B Mastoid Disease 2 — 1 - - - - Operation before Clinic 2 2 - - - - - - - 2 - — - 1 — - - No Operation - - - - - - - - - - - C Enlarged Tonsils and Adenoids 1 - - - - - - Operation before Clinic - - - - - - - - - - - - - - 1 - - No Operation 1 - - - 1 1 - - - - - D Nasal Catarrh : Rhinitis : Sinusitis 2 - - - - 1 - Operation before Clinic 1 - - - - 1 - - - - - - - - - 1 - No Operation 1 - - 1 - 1 - - - - - E External Otitis : Eczema — - - - - - - Operation before Clinic - - - - - - - - - - - - - - - - - No Operation - - - - - - - - - - - Chronic Suppurative Otitis Media, solely 10 — - Operation before Clinic - - - - - - - - - - - (2) — - No Operation 8 1 - 1 - 8 - - 1 - 1 Totals (School) 18 2 2 1 1 2 = 16 4 - 2 1 11 — 2 1 3 - PRE-SCHOOL CHILDREN PRE-SCHOOL. Chronic Suppurative Otitis Media, solely — — Operation before Clinic - - - - - - - - - - - — No Operation - - - - - - - - - - - Chronic Suppurative Otitis Media, with Nasal Conditions : Tonsils/Adenoids — - - - - - - Operation before Clinic - - - - - - - - - - - - - - - - - No Operation - - - - - - - - - - - Totals (Pre-School) - - - - - - - - - - - - - - - - - - Grand Totals 18 2 2 1 1 2 — 15 4 - 2 1 11 - 2 1 3 1 * Figures in Brackets—Cases of Bi-Lateral Otorrhoea or Mastoid. TABLE "C" NOSE AND THROAT CONDITIONS WALTHAMSTOW 1950 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 T reatment. 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 T reatment. A B C D E F G H I J K M N O P Q R S Sinusitis : Rhinitis 34 Operation before Clinic 6 — — — — 1 6 6 — - 4 - 1 1 — — No Operation 28 4 1 — 5 1 24 22 3 — 15 — 5 4 2 2 Nasal Obstruction : Rhinitis 78 Operation before Clinic 12 2 4 — — 8 6 — — — 5 3 1 2 1 — No Operation 66 7 12 — 21 21 46 — 18 2 36 8 13 8 — 1 Nasal Catarrh 4!) Operation before Clinic 3 — 2 — — 3 — — — — 2 1 — — — No Operation 42 3 7 — 6 24 16 — 1 — 27 6 3 4 1 1 Enlarged Tonsils and Adenoids 18 Operation before Clinic - - - - - - - - - - - - - - - - No Operation 18 — — 4 - 1 3 — 17 — 8 1 6 — 3 — • Totals (School) 175 16 26 4 32 59 101 27 39 2 97 19 29 19 7 4 PRE-SCHOOL CHILDREN Nasal Conditions : Sinusitis : Rhinitis 6 Operation before Clinic - - - - - - - - - - - - - - - - No Operation 6 1 — 1 1 5 — 1 — 4 — 2 — — — Enlarged Tonsils and Adenoids 3 Operation before Clinic - - - - - - - - - - - - - - - - No Operation 3 — — 2 - — 2 — 3 — 1 — 2 — — — Enlarged Tonsils and Adenoids with Nasal Conditions — Operation before Clinic - - - - - - - - - - - - - - - - No .. Operation - - - - - - - - - - - - - - - - Totals (Pre-school) 9 1 — 2 1 1 7 — 4 — 5 — 4 — — — Grand Totals 184 17 26 6 33 60 108 27 43 2 102 19 33 19 7 4 15 ment has on many 'large' and unhealthy-looking tonsils. ' Large,' angry-looking tonsils reduce in size by 50%, and return to normal appearance when the sinusitis is cured. A number of children were treated for rhinitis, nasal obstruction, mouth breathing, etc., by diastolization with the usually good results which follows from this line of treatment. It must be emphasized here, in regard to diastolization, that the case must be suitable and that the technique, so carefully worked out by its French authors, must be correct in every detail if the desired results are to be obtained. In the case of impaired hearing in children due to such nasal conditions as rhinitis, tubal catarrh, nasal obstruction, diastolization with vibration gives the most successful results. The early detection and treatment of impaired hearing in the child is most important in order to prevent this defect becoming chronic and permanent in later life. During the year, two special E.N.T. examination sessions were held at the School for the Deaf. Treatment was prescribed where necessary and two cases which required special ear treatment, ionization, were treated at the Aural clinic. Hearing aids have been supplied to a number of children at the school and these aids have been found very helpful in the education of these children. On the whole, the attendances of the children at the clinics for their various treatments have been satisfactory. A certain number of cases, 21, did not complete the course of treatment prescribed. Some of these left the district or left school ; others failed to attend through illness, etc., and a few were referred to hospital for tonsils/adenoids operation by their private doctor. With the exception of a few cases, the standard of general health of all the children seen at the clinic during the year was well maintained and good. In the instances where it was considered advisable, the school medical staff prescribed such useful remedies as cod liver oil and malt, tonics, vitamin preparations, etc., and also arranged for periods of convalescent treatment in the country for suitable cases. In this respect, the school and pre-school children of Walthamstow are well cared for. 16 TABLE"D" MISCELLANEOUS CASES Conditions Tons./Ads. Preschool Total already removed. Examined for :— Affections of the ear, nose, throat; special cases of deafness for admission to the Deaf School; reexamination of cases previously treated; observations; examinations, re speech, etc.; colds and other conditions 48 14 3 Advised; recommendations and reports made. Clinic treatment not required. Foreign Body in Nose 2 — — Removed. Wax in Ears (solely) 5 2 — Removed. Epistaxis 5 — — Treated. 60 16 3 SUMMARY Total number of cases seen at clinic during 1950 285 School 273 Pre-school 12 ' A '—Acute Ear conditions— School 23 Pre-school — ' B '—Chronic Ear conditions— School 18 Pre-school ' C '—Nose and Throat conditions— School 175 Pre-school 9 ' D '—Miscellaneous E.N.T. conditions— School 57 Pre-school 3 (h) Orthopædic Scheme.—The Scheme is under the clinical charge of Mr. B. Whitchurch-Howell, F.R.C.S., Consulting Orthopædic Surgeon, assisted by Miss H. Garratt, C.S.P., who has again given effective and conscientious treatment to her patients. The following tables show the work done at the clinic:— 17 Defects. Boys. Girls. 5-16 years. Under 5 years. Over 16 years. 5-16 years. Under 5 years. Over 16 years. Anterior Poliomyelitis 8 3 8 13 3 12 Surgical Tuberculosis 1 — 4 — — 2 Scoliosis, Lordosis, Kyphosis 4 1 1 31 1 2 Arthritis 1 — 3 — — 4 Rickets— (a) Genu Valgum 22 19 — 24 25 — (b) Genu Varum 2 14 — 1 10 — Pes Piano Valgus ' 102 18 5 52 23 1 Spastic Paralysis 9 1 — 8 2 — Progressive Muscular Atrophy 3 — — — — Osteo Genesis Imperfecta 1 — — — — — Talipes—(a) Equino Varus 10 3 3 0 4 1 (b) Calcaneo Valgus 5 9 — 2 7 — (c) Pes Cavus 5 — — — — — (d) Mid Tarsal Varus 4 5 — 1 — Torticollis 4 11 — 10 8 — Osteomyelitis 1 — 1 — 1 Congenital Dislocation of Hip — — — 4 — 2 Schlatters Disease 1 — — 1 — — Cerebellar Ataxia 2 1 — 2 — — Spina Bifida 1 1 — — — — Hallux Valgus 2 — 1 12 — — Hammer Toe 3 — — 5 — — Perthes Disease — — — 1 — 2 Achondroplasia — — — 1 1 1 Amputation Leg — — — — — 2 Digitus Varus — 1 1 5 — — Congenital Defects 9 6 2 9 2 1 Miscellaneous 23 1 — 15 2 — Totals 223 94 29 201 89 31 18 Number of cases seen by Surgeon :— From Physically Defective School 34 From other Schools 321 Under School age 162 Over School age 41 Total 558 New cases seen by Surgeon :— School age 104 Under School age 59 Total 163 Total number of examinations made by the Surgeon 721 Total number of cases discharged by the Surgeon 118 Average number of examinations per session 65.5 Number of treatments given 2,076 Number of attendances for after-care 2,568 Number of ultra-violet light treatments 2,505 Total number of treatments 7,149 Average number of attendances per session 16.5 Number of sessions held—Inspection 11 Treatment 433 Number of visits by instrument maker 10 Admissions to Hospital 15 Operations performed 12 Defects seen at Orthopædic Clinic in Children under 5 years of age :— Anterior Poliomyelitis 6 Scoliosis, Kyphosis, Lordosis 2 Rickets— (a) Genu Valgum 44 (b) Genu Varum 24 Pes Piano Valgus 41 Spastic Paralysis 3 Talipes— (a) Equino Varus 7 (b) Calcaneo Valgus 16 (c) Mid Tarsal Varus 6 Torticollis 19 Cerebellar Ataxia 1 Spina Bifida 1 Achondroplasia 1 Digitus Varus 1 Congenital Defects 8 Miscellaneous 3 Total 183 (i) Heart Disease and Rheumatism.—The following is a report on the work done at the Rheumatism Clinic during 1950 :— 19 Number of sessions 10 „ „ attendances 134 „ „ new cases 28 „ „ old cases 29 „ discharged 33 „ still under treatment 24 „ of new cases with rheumatic or cardiac defect 5 „ referred to Hospital—Out-patient 1 In-patient 2 „ referred for Tonsils and Adenoids 1 „ referred for Dental Treatment 2 „ to begin part-time school 1 „ to begin full-time school 1 „ to begin games and exercises 1 „ referred for convalescent home treatment 3 „ sent away convalescent 3 (i) Child Guidance Centre.—The Senior Psychiatrist, Dr. Helen Gillespie, reports as follows :— Staffing.—The Clinic was considerably understaffed as regards Psychiatrists' sessions. Although there is an establishment of nine psychiatric sessions per week, only five have been worked from the beginning of June up till 27th November. In November two additional sessions became available. In January, 1950, Miss Roubicek was appointed as Psychiatric Social Worker, but resigned iri March in order to take up a teaching post in the north. The Centre carried on without a Psychiatric Social Worker for Leyton and the Forest Division until Miss A. M. Laquer was appointed to the post in September, 1950. Miss Marshall, Educational Psychologist, undertook a large proportion of the psychiatric Social Worker's duties in addition to her own. Mrs. Barker, Flay Therapist, has reverted to working only five sessions instead of six since the 15th Mav. 1950. Table I Table II Problems referred to the Clinic Cases diagnosed I. Nervous disorders, e.g., fears; depression; apathy; excitability 61 45 II. Habit disorders and physical symptoms, e.g., enuresis; speech disorders; sleep disturbances; feeding difficulties; fits; etc 56 26 III. Behaviour disorders, e.g., unmanageable; tempers; stealing; lying; sex problems, etc. 70 36 IV. Educational, e.g., backwardness; failure to concentrate 26 18 V. Court cases 3 3 Totals 216 128 20 TABLE III. Analysis of cases closed during the year (including cases referred in previous years). Improved and recovered 24 Interrupted due to non-co-operation 26 Placed away from home 17 Diagnosis and advice only 33 Spontaneously improved after partial service 11 Recommended E.S.N. School and School for the Physically Handicapped 7 Cases closed for miscellaneous causes 9 Total 127 Comments:— In Walthamstow there has been a marked decrease in the referral of educational problems. This may be due to the improvement in the sifting, thanks to the co-operation between the teachers and the Educational Psychologist. The increased figure in one of the other areas may be attributed to an expanding school population. It will be noted that the waiting list is now increased compared with the end of 1949, when the numbers were artificially reduced by the closure of the list. There is no significant change in the type of problems referred. TABLE IV. Waiting List. The Waiting List at the end of 1950 was 118. TABLE V. Psychiatric Social Workers—Interviews and Visits. The total of interviews and visits was 1,109. REPORT OF THE EDUCATIONAL PSYCHOLOGIST 1950 (Miss E. M. Smith, M.A.) During the year the Psychologist was responsible for work in the Borough of Walthamstow; in September the Chingford district was added, so that the school population which the Psychologist now serves is approximately 23,000. Individual tests were given to 241 children (150 boys, 91 girls), and 61 children were assessed in schools by means of nonverbal group tests. As last year there is an increase in the pro- 21 portion of girls who present educational and psychological difficulties. Figures for the past three years are as follows :— % Boys % Girls 1948 75 25 1949 68 32 1950 62 38 The children seen by the Psychologist have come from all types of schools, and from all age groups as the following tables show :— Table I.—-School placement of Children seen by Psychologist. Preschool Infants Juniors Sec. Modern See. Grammer Sec. Tech. Special Over School age Total Girls 12 26 26 7 l 3 16 — 91 Boys 10 29 47 26 4 3 29 2 150 Table II.—Nos. of Children in different age groups seen by Psycholotrist. Ages 5 and under 6 7 8 9 10 11 12 13 14 15 Total Girls 18 19 6 11 6 12 7 5 0 4 3 91 Boys 18 15 29 13 15 11 20 9 7 7 6 150 Totals 36 34 35 24 21 23 27 14 7 11 9 241 There has been a significant decrease in the number of children from Junior Schools, but 11+ still seems to be the peak age for children beyond the Infant stages who have been seen. The majority of these eleven years old's experienced some difficulty in adjusting themselves to Secondary School life. The Psychologist saw children at the request of Head teachers, medical officers, parents and others. Table III gives the sources of referral with percentages of cases from each source. Table III.—Case Referral. Source of referral Boys Girls No. % No. % Head Teacher 90 59 53 58 Medical Officers 30 20 22 25 Parents 11 7 6 6 Speech Therapists 5 4 3 3 Court 2 2 — — Miscellaneous 12 8 7 8 The children ranged in intelligence from the extremely brilliant to the ineducable. Table IV shows the numbers in the three large categories of intelligence — above average, average, and below average :— 22 Table IV.—Intelligence Rating. Girls Boys Total Per cent. Above average I.Q. (116+) 7 16 23 9 Average I.Q. (86-115) 42 71 113 47 Below average I.Q. (85—) 42 63 105 44 The group of "below average "children includes those already attending the E.S.N., who were retested during the year as well as a large group found to need E.S.N, schooling, although still attending normal schools. The provision of accommodation of these children is inadequate for the numbers in need, and there is a long waiting list. The difficulty of placing a child in the E.S.N, school has been found to be a cause of apathy among teachers over reporting such children. From the 241 children tested by the Psychologist 37 boys and 32 girls were referred to the Psychiatrist for interview and possible treatment. The remaining children had difficulties which had been pro-' voked by unskilled handling at home, or which were mainly educational. Some advice to parents or teachers was usually found to produce satisfactory results. Twenty-three children were given individual special coaching by the Psychologist, who also taught two groups of backward readers in schools. Special classes to deal with backward children are still greatly needed, but both lack of staff and lack of accommodation prevent their formation. In the course of her work the Psychologist paid 144 visits to schools, allocated as follows :— Table V.—Visits to Schools. Infants' Schools 25 Junior Schools 42 Secondary Modern Schools 52 Secondary Grammar and Technical Schools 6 Special Schools 19 144 Three children were seen at home. During the year the Psychologist has given two courses of lectures to teachers on "Activities in Schools" and "The Teaching of Reading." The attendance at these lectures reflects the interest and enthusiasm of Infant and Junior School staffs. Talks have also been given to Parent-Teacher Associations and other interested groups in the Borough. 23 (k) Paediatric Clinic.—In July Dr. Elchon Hinden Paediatrician to Whipps Cross Hospital, commenced a fortnightly Paediatric Clinic, and up to the end of the year 71 patients had been seen. The commencement of this Clinic was brought to the notice of all Medical Practitioners, and has proved of great value, especially in view of the ready availability of in-patient treatment at Whipps Cross Hospital. (l) 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 :— During this last year 152 children have been treated. This is about 50 less than the year 1949-50, because the Clinic was closed during the summer term owing to leave of absence. The average weekly attendance was 110. About 75 per cent of the Clinic attendances were made by Infants, 5 per cent by Seniors and the rest—20 per cent—by Juniors. The proportion of Infants who stammer to dyslalics is 1:8. There is a slightly stronger tendency for stammering and dyslalia to come together in an Infant child. Of the Juniors, only one in seven has an ordinary speech defect ; the rest are stammerers. Every one of the Seniors (none of whom is a girl) has a stammer. I would like to thank the Heads of Schools for being so co-operative, and the transport officer for seeing that the bus is always available, though he has many calls on his transport. Miss A. M. Hemmings reports :— The majority of children treated this year have been of Infant school age, there being twice as many boys as girls. Attendances have been regular, thanks to the school bus, and most of the children have been treated individually. A marked difference in progress is noticed according to the degree of co-operation of parents, and treatment is often facilitated by advice from the other medical services. I should like to thank Head Teachers, especially those of the Special Schools for the interest that they have taken in Speech Therapy. 24 Annual Report and Clinical Analysis. High St. Open-Air Clinic Sch. Clinic No. of cases in attendance at beginning of year 104 52 New cases admitted during year 48 50 Transfers from other clinics — 8 152 110 Cases ceasing attendance before cure or discharge 4 2 Cases discharged uncured as incapable of benefiting by further treatment 4 — Cases temporarily discharged, to resume treatment later 3 12 Cases discharged cured 44 32 Transfers to other clinics - 7 Cases still in attendance at end of year 100 57 Total attendances during year 1.016 1.967 No. of New Cases suffering from:— High St. Open-Air Clinic Sch. Clinic Physiological or psychological defects— (a) Stammer 54 37 (b) Clutter 3 1 Voice Defects— (a) Aphonia — — (b) Dysphonia — — (c) Rhinophonia 5 4 Defects of articulation— (a) Dysarthria — 4 (b) Dyslalia 80 54 Language defects— (a) Idioglossia — (b) Delayed Speech 4 — Aphasia— (a) Congenital word deafness — (b) Congenital word blindness — — (c) Other — — Defects due to abnormality of special senses (a) Blindness — — (b) Deafness — — (c) Other — — Probable mental deficiency 5 9 Other types of defect 1 1 152 110 (m) Convalescent Home Treatment.—126 children were sent away for treatment during 1950. There were 17 children remaining in convalescent homes and hospital schools on December 31st, 1950. (n) Tuberculosis.—The number of school children examined during the year was 130 boys and 120 girls, of whom 34 boys and 42 girls were referred by the School Medical Staff, and the remaining 174 by private practitioners. 197 children were examined as contacts. 25 PREVENTION OF TUBERCULOSIS IN YOUNG PEOPLE In Mid 1950 an approach was made by the Medical Research Council for co-operation in carrying out trials of Anti-Tuberculosis Vaccine in order to try to obtain evidence of the value of B.C.G. Vaccine in persons exposed to the ordinary conditions of life in this country, and to decide ultimately whether a vaccine can be used for general immunisation. The proposals were approved and were put into effect in the Autumn. The trials relate to children about to leave Secondary Modern Schools at the age of 15 years with regular follow-up examination for at least 3 years. Circulars explaining the scheme and inviting volunteers are sent at the beginning of each term to the parents of children who are to leave at the end of the next following term. The routine is that during the penultimate school term, all scholars are x-rayed and tuberculin tested, and of those who are negative (i.e. those who have never been infected with tuberculosis) one half receive B.C.G. and the other half does not—this constitutes the control group. The routine follow-up covers all groups, i.e. those who are tuberculin positive, the inoculated and the controls. The preliminary organisation and the recruitment of volunteers is carried out by the School Health Service which notifies the Medical Research Council, which undertakes the detailed organisation and work. During the final school term, i.e. 12 to 16 weeks after the initial examination etc., there is a second tuberculin test and x-ray of all who were negative at the first test. Later, all groups will be x-rayed and tuberculin tested at regular intervals for at least 3 years and will receive follow-up visits by the Health Visitor/School Nurses. The Medical Research Council's team began in Walthamstow in November, 1950, using the West Avenue Welfare Centre. Acceptances were : boys 67, girls 62, total 129. It is to be hoped that the trials will point the way to general immunisation against tuberculosis, and that the success claimed in other countries by the use of B.C.G. will be repeated in this country. Mass Radiography.—The Mass Radiography Unit of the North-East Regional Hospital Board visited Walthamstow during 1950. Every endeavour was made to secure the examination of as many as possible of the school staffs and of school leavers. A total of 365 school staff was examined together with 3,015 school leavers and children aged over 13½ years. 26 In addition 1,034 persons were examined at the South-West Essex Technical College. No case of active tuberculosis was found amongst the school staff. Of the children, five boys had healed primary tuberculosis, but none had any active disease. Of the girls, three had inactive primary tuberculosis, three had active primary pulmonary tuberculosis, one had active post-primary disease and one had active pleurisy. No active disease was found amongst the group examined at the South-West Essex Technical College. Medical Examination of Teachers. —For many years it has been the custom to make each appointment to the staff of the Committee subject to a medical examination, and since 1943 this examination has included an X-ray examination of the chest, since no clinical examination alone can exclude pulmonary tuberculosis. The issue of Ministry of Health Circular 64/50 focussed renewed attention on the need to ensure that no person with respiratory tuberculosis should be engaged for employment which involves close contact with groups of children, unless and until the disease is arrested. Such persons were stated to require an X-ray of the chest and, where possible, an annual re-examination. Whenever possible the facilities of the Mass Radiography Unit are used, but since this unit does not appear to be able to visit any area more frequently than biennially, this is no effective substitute to the medical examination and chest X-ray required by your Committee. It is understood that the Ministry of Education is considering the recommendation of the National Joint Tuberculosis Council in regard to the introduction of compulsory X-ray examination on admission to teaching training. (o) Artificial Light Treatment.—The total attendances for treatment were 2,505. (p) Integration of the Work of Special Schools and Clinics.— Dr. Watkins reports the following interesting case :— "The following is an interesting example of the value and co-operation of various specialist clinics provided by a Local Education Authority. "A girl aged five years moved into this area with her parents, and was found to have the dual handicap of complete deafness and a congenital heart condition. She had apparently been in a residential school for the deaf at the age of four, but was discharged when it was found that she had a heart condition. 27 "On moving to this area, she was immediately admitted to the day school for the deaf. Her general condition was that of a child years younger. Respiratory infection complicated her heart condition, prognosis was poor, and activities very much restricted, and school progress painfully slow. "She was seen by the Authority's Cardiologist, who admitted her to hospital for investigation. She was found to have a cardiac lesion which was operable. This was done and within six months there was a remarkable change in the girl. She gained weight rapidly, lost her respiratory infection, was more alert and activities became normal for a child of her age. "The Psychologist assessed her intelligence at 160 and it was decided that she should have the benefit of a boarding school education for the deaf. This is now in the process of being arranged." 8. INFECTIOUS DISEASES Notification in the 5-15 years age-group during 1950 was as follows, the figures for 1949 being shown in parenthesis: Scarlet Fever, 116 (113); Diphtheria, 1 (Nil); Pneumonia, 3 (7); Erysipelas, 1 (1); Meningococcal Infection, 1 (Nil); Measles, 111 (658); Whooping Cough, 224 (67); Dysentery, Nil (1); Poliomyelitis, 1 (10). 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. 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 1950 1,334 (a) Pre-school age 1,073 (b) School age 261 (c) Over school age — The number of children notified by Head Teachers in conformity with the Regulations as to non-notifiable and other diseases in schools, were as follows :— Chickenpox Measles Whooping Cough Sore Throat Influenza Mumps Ringworm Various Total 39 7 83 — 146 1 4 280 28 Immunisation at schools (included above) :— Number completely immunised 200 Number partly immunised 56 Number already immunised given an extra rinse 1 737 During the past five years the percentages of children protected in the various age-groups were as follows:— Percentage Immunised Year Population Under 5 years 5-15 years 0-15 years 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 1950 122,700 60.5 96.5 81.9 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 1,222 389 31.8 Girls 1,234 434 35.2 2nd Age Group Boys 848 182 21.5 Girls 839 173 20.6 3rd Age Group Boys 818 202 24.7 Girls 785 219 27.9 Totals 5,746 1,599 27.8 9. OPEN AIR EDUCATION From March onwards arrangements were made for 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 9,000 or some 49% 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. 29 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 the previous reports were continued in 1950, all the milk supplied being pasteurised milk sold under licence. Particulars of samples of milk taken in schools during the year are as follows :— Pasteurised, for bacteriological examination 15 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 1950 at the periodic medical inspections :— Number Inspected Number of Parents Per cent. 1950 Per cent. 1949 Entrants— Boys 1,222 1,035 84.7 90.0 Girls 1,234 1,040 84.3 91.5 2nd Age Group—Boys 848 510 60.1 59.7 Girls 839 562 66.9 68.6 3rd Age Group—Boys 818 191 23.3 18.8 Girls 785 225 28.7 29.5 (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 most effectively with the work of the School Health Service. (d) CO-OPERATION OF VOLUNTARY BODIES Your Committee recommend that the existing arrangements for the admission of pupils to Holiday Convalescent Homes by arrangement with the Local Branch of the I.C.A.A. 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. 30 (a) The Invalid Children's Aid Association.—Mrs. Osora, Secretary of the local branch, has kindly contributed the following report :— Number of applications 236 Number of weeks convalescence provided 1,004 Number of children sent away convalescent 140 Number of home visits paid 673 Over Under Cases Referred by :— 5 years. 5 years. Hospital and Medical men 93 22 School Health Services 51 4 Local Authority under schemes for :— (a) Rheumatism 15 (b) Orthopaedic care 16 (c) Child Guidance 1 Child Welfare Centres Voluntary Bodies 10 2 Parents 14 5 Transferred from other I.C.A.A. Branches 3 203 33 Suffering from :— Anaemia, Debility, Malnutrition 10 3 After-effects of acute or infectious illness or operation 68 11 Bronchitis or Pneumonia 28 7 Asthma 7 Rheumatism, Chorea, Heart 12 1 Nervous conditions 7 Diseases of— (a) Ear, Nose and Throat 21 7 (b) Eyes — — (c) Skin — — Various 12 4 Needing advice and help only 38 — 203 33 Help given to old and new cases :— Sent to Convalescent Homes and Residential Open-Air Schools 135 14 Transferred to other agencies 10 4 Referred for visiting, advice, help and follow-up .48 6 31 (b) National Society for the Prevention of Cruelty to Children.—The following is a summary of the work done in Wakhamstow during 1950 :— Nature of Offence How dealt with Neglect 36 Warned 43 Ill-treatment 7 Advised 24 Advice sought 24 67 67 Number of Children dealt with Under 5 years Over 5 years Boys Girls Boys Girls 30 39 35 43 193 supervisory visits and 189 miscellaneous visits were made during the year. HANDICAPPED CHILDREN The following number of special examinations were carried out by the medical staff in respect of the categories stated. Examinations Re-examinatioins (a) Blind — 1 (b) Partially Sighted 2 1 (c) Deaf 10 — (d) Partially Deaf 4 — (e) Delicate 10 — (f) Diabetic — — (g) Educationally Suh-normal 23 4 (gi) Ineducable 10 2 (h) Epileptic — 1 (i) Maladjusted 5 1 (j) Physically Handicapped 15 1 (k) With Speech Defect — — (l) Multiple Defects 3 1 Totals 82 12 The numbers of children at the Special Schools in Walthamstow at the end of 1950 were as follows :— Partially Sighted E.S.N. Phyaically Handicapped Deaf Total Percentage Walthamstow 13 58 66 14 151 68.6 Forest 4 17 13 4 38 17.3 Ilford 2 — — 3 5 2.3 Leyton 1 — — 1 2 0.9 Middlesex 23 — — — 23 10.5 West Ham 1 — — — 1 0.4 Totals 44 75 79 22 220 100.0 32 (i) School for the Partially Sighted.—The following table shows the classification of children at the end of the year :— Walthamstow Pupils Partially Essex County Pupils Partially Out-County Pupils Partially Blind Sighted Blind Sighted Blind Sighted Boys — 6 — 4 — 11 Girls 2 5 1 2 — 13 The three blind children are awaiting admission to Residential Schools. Mr. G. M. Williams, the Head Master, reports as follows :— The year has been one of steady progress and consolidation. The health of the children has been good and a satisfactory attendance maintained. Dr. Sheppard made one routine ophthalmic inspection at the school before her illness supervened, and her ready assistance has been greatly missed. Dr. I. Gregory, M.B., D.O.M.S., has taken her place and has made one inspection. Dr. Watkins, in December, made two visits to complete a full school medical inspection and commented favourably upon the improved posture of the children, particularly the senior boys. We would like to attribute this to the wider latitude now allowed in Physical Training. The school has been visited during the year by His Majesty's Inspectors, Student Health Visitors and pupils from Training Colleges. On the educational side, two new types of reading lenses have been acquired and a film strip projector. Educational visits have been made to South Kensington Science Museum, the Natural History Museum and also to Bertram Mills Circus at Olympia. Miss P. Hardy replaced Mrs. Tunstead, who resigned at Easter. Mr. Crosby attended the Course for Teachers of Partially Sighted Children at Sunninghill, Berkshire, in September. I would like to express my appreciation of all staff for their efforts on behalf of the school and particularly to Miss P. Ramage, upon whom, as senior assistant, much responsibility has fallen. (ii) School for the Physically Handicapped.—Dr. Melville Watkins, Deputy Borough School Medical Officer, who is in clinical charge of the Open-Air School, has reported as follows in regard to the special classes at "Suntrap," High Beach. 33 Advantages gained by holding extra classes at "Suntrap," Epping Forest: — (a) It enables the school to admit more pupils, thus reducing the waiting list. (b) It was envisaged that equivalent numbers would benefit sufficiently to return to their normal school for the winter months. This objective was fully realised and the ordinary benefits of the Special School were accelerated by the more complete open air life. (c) The buildings are by no means ideal for an open air school. The opening of "Suntrap" made up for these deficiencies and were suited to a certain category of child, e.g., those with respiratory conditions. (d) It is medically (and possibly administratively) beneficial to have a homogenous group of this kind. The children can then all take part in the same activities under ideal conditions, i.e., activities not determined by a "mixed bag " of physical conditions, e.g., heart cases and cripples. (e) There is no definite objective evidence of benefits obtained, i.e., progress in height and weight, but on clinical evidence the benefits were decisive. Mr. G. M. Williams, the Head Master, reports as follows In a school of this type the year's activities are greatly dependent upon and influenced by weather conditions. The year's inclement weather greatly emphasised the inadequacy of the school buildings and general amenities of the site. In spite of this the attendance for the year was maintained at 82.1 per cent., but the general level of health was not as good as former years, as shown by the increase of broken attendances. To offset this an experimental Open-Air Group was held at High Beach, Loughton, during the summer term. The school continued the practice of former years in opening during part of the summer holidays, a voluntary attendance of 93 per cent. being maintained in the period. Educational visits were made to the South Kensington Museum, the London Zoo, and a special Christmas visit to the Bertram Mills Circus at Olympia. By courtesy of the Mayor of Walthamstow, a full day's outing to Ashbridge Common (National Trust Property), Berkshire, was organised. 34 We were visited during the year by His Majesty's Inspectors, members of the staff of St. Osyth's Training College, the Education Officer British Army of Occupation of the Rhine, the Superintendent of Schools for Toronto, and Social Science and Training College students. During the year 45 children were admitted (including five re-admissions and 32 were discharged. The average number on roll was 74.6 and the average attendance 61.2. At the end of the year the classification of cases was as follows :— Orthopaedic 23 Cardiac 6 Chest (Asthma and Bronchitis) 23 Delicate 20 Miscellaneous 7 Total 79 We still feel the loss of Miss Mazengarb, Nurse-Welfare Attendant, who is still absent owing to continued ill-health. In her place we have to record our appreciation of Mrs. Matthew, School Nurse, for her daily visits to the school and for the active interest she has taken in our work. Dr. Watkins has made regular weekly visits, including two to High Beach Open-Air Group. It is impossible to rate too highly the value of this personal interest in the welfare of the children. Mrs. W. Morris, senior assistant in the school, has also carried a greatly increased burden of responsibility during the year. I must again acknowledge my indebtedness to all staff, teaching, medical, welfare, domestic and transport, for their valued co-operation in the work of the school. (iii) School for the Deaf.—Mrs. I. J. M. Burt, the Head Teacher, reports as follows :— At the beginning of 1950 there were 20 children on the roll— 16 boys and four girls—their ages ranging from three years nine months to 12 years one month. In February one girl was withdrawn temporarily for health reasons ; during the year two more boys and one girl were admitted, the roll now standing at 22— 18 boys and four girls. The age range is now three years nine months to 14 years one month. Of these 22 pupils there are eight with partial hearing of varying degrees, and two whose mentality is so low as for them to profit very little from this type of school. 35 In all, 16 children now possess hearing aids. We find that, whilst most derive some benefit from them, a few benefit enormously; on the other hand a small number appear not to benefit at all. The recent practice of moulding the inserts to fit the individual child has added a great deal to their comfort and general usefulness. The school has received visits from Dr. Francis Clark, the Ear, Nose and Throat Consultant, Dr. Powell, Dr. Watkins and Dr. Miller Wood. The health of the school has been exceedingly good and the attendance very high, many weeks being 100 per cent. (iv) School for the Educationally Sub-Normal.—Miss R. E. A. Lock, Head Mistress of the School for Educationally Sub-Normal Children, reports as follows:— Number on roll have averaged 65 for the year, and the intelligence quotient range has been up to 76. Five low grade children have been excluded as ineducable— two of the number have been admitted into residential institutions. Of the senior scholars who left during the year only one girl has failed to gain employment. Two boys returned to ordinary elementary school. Since the appointment of a new master, the senior boys have been able to form a football team, and so far have had three matches with other schools in the Borough. Senior boys and girls are still attending swimming instruction weekly and have gained one more certificate. Attendance has been well maintained throughout the year, and the incidence of epidemics and minor ailments has been low. 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 Mistress, reports as follows :— The Nursery School is always filled to capacity (90 children) and the waiting list is never-ending. Many of the children are admitted because their homes are dreadfully overcrowded. Some live in upstairs flats, and have to be kept quiet and still to avoid complaints from the people living on the ground floor. 36 Less than half of the mothers go out to work. Some of these do part-time work and some do work in their homes. The few who take on permanent, full-time jobs have to find someone to fetch the child to and from school, and to look after him during the holidays. During 1950, the summer term was the best from the health point of view. In March there were 12 cases of mumps, and between September and December there were 30 cases of Whooping Cough. 16. MISCELLANEOUS (i) Employment of Children.—163 children were examined by the medical staff. (ii) Employment of Children in Public Entertainments.— Ten children were examined under these regulations. (iii) Staff Appointments.—114 teaching staff and 222 other staff were examined during the year. (iv) Lectures on Good Grooming.—These lectures were continued each term to pupils about to leave Grammar, Technical and Secondary Modern Schools. They were given by a lecturer from outside the Education and School Health Services. In view of certain difficulties, they were attended by Members of the Medical and Nursing Staff as observers during 1951. Prior to this, the good reports of the Head Teachers concerned had been reported to the Committee for Education by the Borough Education Officer. The following is typical:— "The lecture, which I have personally heard, has been a thoroughly sound one, rounding off the teaching of hygiene insofar as it affects the person and dress, and the emphasis is on cleanliness and health rather than on make-up. This last is dealt with in a very sensible way and the essence of it is restraint." In a detailed report on one of the lectures, Dr. Stansfield states that:— "The first part consisted of advice regarding general tidiness, attractiveness, care of the hair, and points in regard to diet and the skin. 37 "The second part of the talk was on personal hygiene and appearance. Advice was given on proper hair washing, and brushing, proper teeth cleaning and care of the teeth. The lecturer emphasised tidy, neat hair styles and that there was no excuse for fancy ' perms' and nitty heads. "Body cleanliness was next discussed, bathing, washing, and the use of deodorants. "Feet and shoes, and proper care of the feet was next demonstrated, with care and detail. This information must have been most valuable to the pupils. "Clothes, what to wear, how to wear it, and how to take care of it, was a very good talk in itself. The girls were advised how to budget for a sensible and all-purpose wardrobe. Also advice was given on how to dress correctly for interviews, and for different jobs, yet be attractive and efficient. "This was a most interesting and valuable talk, which should be given to all senior girls. The lecturer was attractive in herself, and impressed the girls, who were most appreciative of the talk. It is to be hoped that the lecture becomes routine in all schools. It might be worth considering talks on similar lines for certain groups of boys leaving school." STATISTICAL SUMMARY I. MEDICAL INSPECTION. A. Routine Inspections 5,746 B. Special Inspections and Re-inspections 1,296 C. Pupils found to require treatment 869 II. DEFECTS FOUND AT MEDICAL INSPECTION. Requiring treatment 1,444 For observation 1,729 CLASSIFICATION OF GENERAL CONDITION OF PUPILS. Nutrition 'A'—Good 4,119 ,, 'B'—Fair 1,491 ,, 'C'—Bad 136 5,746 [Statistical Summary continued overleaf 38 STATISTICAL SUMMARY—continued III. INFESTATION WITH VERMIN. Total number of examinations 43,141 Individual pupils found to be infested 923 IV. TREATMENT. (a) Minor Ailments—total defects treated 3,430 (b) Defective Vision and Squint— Errors or refraction 427 Other defects 214 Pupils for whom spectacles were—prescribed 668 obtained 346 (c) Nose and Throat Defects—number treated 285 (d) Orthopaedic and Postural Defects— Treated as in-patients 10 Treated otherwise 508 (e) Child Guidance and Speech Therapy— Number treated under Child Guidance arrangements 216 Number treated under Speech Therapy arrangements 262 (f) Dental Inspection and Treatment— Number inspected—(i) Routine Age Groups 1,732 (ii) Specials 4,951 Number found to require treatment 6,076 Number actually treated 6,105 Attendances made for treatment 12,474 Half-days devoted to—Inspection 18 Treatment 2,115 Fillings—Permanent teeth 2,816 Temporary teeth 1,164 Extractions—Permanent teeth 1,279 Temporary teeth 4,654 Administration of general anaesthetics for extraction 3,584 Other operations—Permanent teeth 5,960 Temporary teeth 2,284