Public Health Dept. Repents COLLECTION COPY WAL 81 AC 4411(1)WALTAAMSSTOW BOROUGH OF WALTHAMSTOW Committee for Education REPORT of the BOROUGH SCHOOL MEDICAL OFFICER for the year 1951 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 1951 A. T. W. POWELL, M.C., M.B., B.S., D.P.H. BOROUGH SCHOOL MEDICAL OFFICER CONTENTS Accommodation 8 Artificial Light Treatment 31 Aural Clinic 16 Child Guidance 21 Clinics 6 Committee Members 2 Convalescent Home Treatment 29 Co-ordination 8 Crippling 19 Dental Defects 12 Dental Treatment 14 Diphtheria 31 Diphtheria Immunisation 32 Ear Disease 12, 16 Employment of Children 42 Enquiry Officers 35 Exclusion 31 Eye Disease 12 Follow-up 13 Handicapped Children 36 Hearing 12, 16 Heart Disease 12, 20 Hygiene 8 Impetigo 11,13 Invalid Children's Aid Association 35 Infectious Disease 31 Meals, Provision of 34 Medical Inspection 11 Medical Treatment 13 Milk in School Scheme 34 Minor Ailments 11, 13 N.S.P.C.C 36 Nursery School 42 Nutrition 11 Open Air Education 3 3 Orthopaedic Treatment 18 Orthoptic Treatment 16 Pediatric Clinic 26 Parents, Co-operation of 34 Physical Training 33 Re-inspection 11 Rheumatism 12,20 Ringworm 11, 13 Scabies 11,13 School Camps 33 School for the Deaf 41 Educationally Sub- Normal 41 Partially Sighted 39 Physically Handicapped 40 Skin Diseases 11 Speech Therapy 27 Staff 4 Statistical Summary 42 Teachers, Co-operation of 35 Tonsils and Adenoids 12, 16 Tuberculosis 12, 29 Uncleanliness 11 Vaccination 23 Vision 12, 15 Voluntary Bodies 35 Whooping Cough 31 WALTHAMSTOW COMMITTEE FOR EDUCATION 1951 - 1952 Chairman: Alderman S. N. Chaplin. Deputy Chairman: Councillor W. H. Shaw. Ex Officio: The Worshipful The Mayor: Alderman Lord McEntee, C.b.e., j.p. The Deputy Mayor: Councillor A. E. Simmons, j.p. Chairman of Finance Committee: Alderman Ross Wyld, o.b.e., j.p. Cty. Aid. P. Astins, c.b.e., j.p. Ald. A. E. Manning. Ald. Mrs. L. P. Bailey, j.p. Ald. Lady C. McEntee, j.p. Ald. W. B. Fitt. Ald. Mrs. E. M. Miller. Ald. E. C. Redhead, j.p. Coun. A. W. Ellis. Coun. H. C. Fisher. Coun. H. Fulton. Coun. L. Jones. Coun. G. S. Mace. Coun. W. F. Saville. 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. Mr. Chairman, Lord and Lady McEntee, Ladies and Gentlemen, I have the honour to present in the following pages a report on the work of the School Health Service in Walthamstow during 1951. The following matters appear to call for some comment. Dr. Mary Sheppard resigned her appointment on grounds of ill-health after nearly 30 years of conscientious service to the people of the Borough. Some progress was made with sanitary improvements to the schools, but unfortunately financial stringency has severely limited the programme. Dental staffing remained good when compared with similar areas but even so, the Dental Service continued largely as a " Casualty " Service. The Senior Dental Officer makes an inter esting comparison between the dental condition of 5 and 6-year old children examined in 1936 and 1951 at the same school. Towards the end of the year child guidance for the pre-school child was begun at a welfare centre. The chest x-ray examination of teachers on appointment had to be suspended by the instruction of the Local Education Authority. A special programme of visits was arranged for foreign delegates, at the request of the Ministries of Education and Health. Dr. Watkins contributes an interesting report in regard to his attendance at a Course with regard to " The Care of the Deaf Child Reference is made to the work done at the four special schools, particularly those for the Partially-Sighted and the Deaf, which serve a large catchment area. Once again I have to thank all the Members of your Committee for their consideration, the Borough Education Officer and his staff for their help, and the good work of all colleagues in the School Health Service. I am, Your obedient Servant, A. T. W. POWELL, Borough School Medical Officer 4 1. STAFF OF THE SCHOOL MEDICAL DEPARTMENT There was considerable variation in medical staffing during the year, largely owing to illness and domestic reasons. Dr. Sheppard was absent through sickness for the whole year and ultimately found it necessary to resign on medical grounds—the resignation became effective early in 1952. Dr. Irani was granted maternity leave. Temporary appointments were made and the services of Dr. Philippa Carter, and, later, Dr. Joyce Beattie, were obtained. Such frequent changes in medical staffing do not make for the maintenance of a satisfactory service. In regard to Dental Staffing, the services of Mr. C. Lancer, B.D.S., were obtained for 8 sessions per week in February, but he left for private practice in October. In addition one of the part-time dental surgeons reduced the weekly sessions worked from 4 to 2—a reduction largely due to the fact that the award of the Dental Whitley Council made no recommendation in regard to sessional fees which still continue on a completely unrealistic pre-war basis. In the Orthoptic Service Miss Dearlove succeeded Mrs. Box in February and Mrs. Silvester succeeded Miss Dearlove in October for 4 sessions per week with 2 sessions per week remaining not staffed. Appointments in the School Health Service still remained delegated at the end of the year to the Health Area Sub-Committee, subject to review from time to time by the Committee for Education. Borough School Medical Officer and Medical Officer of Health : A. T. W. Powell, M.C., M.B., B.S., M.R.C.S., L.R.C.P., D.P.H. Deputy School Medical Officer : M. Watkins, M.R.C.S., L.R.C.P., D.P.H. Assistant County Medical Officers : Mrs. Joyce Beattie, L.R.C.P., M.R.C.S., M.B., B.S., D.P.H. (Apptd. 24.5.51 ; Res. 21.7.51. Apptd. 10.9.51 ; Res. 30.11.51). Miss Phillippa Carter, M B., B.S. (Apptd. 15.2.51 ; Res. 16.6.51). Trevor T. Currie, M B., B.S. (Apptd. 8.1.51). Miss Roshan A. Irani, M.D., M.S., M.R.C.O.G. James R. Mayer, M.R.C.S., L.R.C.P., M B., B.S., D.P.H. (Apptd. 18.6.51 ; Res. 21.7.51). Miss M. Sheppard, M.A., M B., B.Ch., B.A.O., D.P.H., Barristerat-Law. Mrs. Jessie A. Stansfield, MB., Ch.B., D.P.H. (Res. 13.1.51). J Specialist Part-time Medical Officers : Aural Surgeon: F. P. M. Clarke, B.A., B.Sc., L.R.C.S. (Ed.), L.R.C.P., L.R.F.P.S. (Glas.). Ophthalmologist: R. Bulsara, B.Sc., M B., B.S., D.O., D.O.M.S. Orthopaedic Surgeon: B. Whitchurch Howell, M.B., B.S., F.R.C.S. Paediatrician : E. Hinden, M.D., M.R.C.P. Physician-in-Charge, Cardiac and Rheumatism Clinic: Miss M. Wilmers, M.D., M.R.C.P. Psychiatrists: Mrs. Helen Gillespie, M.R.C.S., L.R.C.P. C. Haffner, M.B., Ch.B., D.P.M. (Res. 31.10.51). Educational Psychologists: Miss E. M. Smith, M.A. Miss A. M. Marshall, B.A. Psychiatric Social Workers : Miss M. Russell. Miss A. M. Lacquer. Play Therapist: Mrs. K. Barker (Part'time). Dental Surgeons : Mr. L. W. Elmer, L.D.S., R.C.S. (Eng.), (Senior). Mr. G. P. L. Taylor, L.D.S., R.C.S. Mr. R. E. Hyman, L.D.S., R.C.S. Mr. R. Tait, B.Sc., L.D.S., R.C.S. (Part'time). Mr. C. Lancer, B.D.S. (Apptd. 14.2.51 ; Res. 19.11.51). Mr. J. Timmis, L.D.S., R.C.S. Miss D. Anklesaria, L.D.S., R.C.S. (Part-time). Health Visitors/School Nurses (Part-time to School Health Service) : Miss A. C. Keenan, S.R.N.,S.C.M.,H.V.Cert. (Superintendent). Miss R. Boyd, S.R.N., S.C.M., H.V.Cert. Miss M. B. Cassidy, S.R.N., S.C.M., H.V.Cert. (Res. 16.3.51). Miss E. DuRandt, S.R.N., S.C.M., H.V.Cert. Miss E. L. Cunnington, S.R.N., S.C.M., H.V.Cert. Miss D. G. Legg, S.R.N., S.C.M., H.V.Cert. Mrs. L. Lambert, S.R.N., S.C.M., H.V.Cert. (Apptd. 1.2.51) (Part-time). Mrs. E. Levis, S.R.N., S.C.M., H.V.Cert. (Part-time). Miss K. Munday, S.R.N., S.C.M., H.V.Cert. Miss O. North, S.R.N., S.C.M., H.V.Cert. Miss J. M. Palmer, S.R.N., S.C.M., H.V.Cert. Mrs. I. C. Stern, S.R.N., S.C.M., H.V.Cert. (Apptd. 1.9.51). Miss A. Stuart, S.R.N., S.C.M., H.V.Cert., T.B.Cert. (Deceased 17.4.51). Mrs. G. H. Salter, S.R.N., S.C.M., H.V.Cert. Miss A. Wright, S.R.N., S.C.M., H.V.Cert. 6 School Nurses : Miss M. A. Campbell, S.R.N. Miss P. Collins, S.R.N., S.C.M. (Res. 22.9.51). Miss E. M. Downing, S.R.N. Mrs. J. Haynes, S.R.N., S.C.M. (Apptd. 1.9.51). Mrs. J. Matthew, S.R.N., S.C.M. (Res. 30.5.51). Mrs. M. Wheeler, S.R.N. (Apptd. 7.8.51). Dental Attendants (Part-time to School Health Service) : Miss D. Sanford (Senior). Miss J. Bradley (Res. 4.9.51). Mrs. M. A. Dumper, S.R.N. (Part-time). (Apptd. 26.9.51). Miss G. M. Hutchins. Miss N. E. Hutchinson (Apptd. 10.9.51). Miss S. Snowdon. Mrs. M. E. Wright. Miss E. Weatherill (Receptionist). Dental Technicians (Part-time to School Health Service): Mr. G. H. Higgins. Mr. H. J. Edmunds. Orthoptists (Part-time). Mrs. K. M. Box, S.R.N., S.C.M., D.B.O. (Res. 25.1.51). Miss J. F. Dearlove, D.B.O. (Apptd. 25.1.51 ; Res. 25.9.51). Mrs. E. Sylvester, D.B.O. (Apptd. 31.8.51). Masseuse: Miss H. Garratt, C.S.P. Speech Therapists : Miss C. M. Gregory, L.C.S.T. Miss A. Hemmings, L.C.S.T. 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 Clinic, 263, High Street, E.17. 7 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. 1, Guildsway Saturday 9 a.m.—12 noon. 1, Guildsway. Monday Wednesday Thursday 9 a.m.—4.30 p.m. Sidney Burnell School. *Minor Ailments— Monday Wednesday Friday Saturday 9 a.m.—12 noon. Town Hall. 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. Pediatric— Alternate Thursdays 9 a.m.—12 noon. Town Hall. Ophthalmic— Tuesday Thursday Friday 2 p.m.—4 p.m. 2 p.m.—4 p.m. 9 a.m.—12 noon Town Hall. Town Hall. Town Hall. Friday or Saturday 2 p.m.—4 p.m. 9 a.m.—12 noon. Town Hall. Orthobcedic— Monthly 9 a.m.—12 noon. Open-Air School. Massage and Sunlight— Monday to Friday 9 a.m.—5 p.m. Open-Air School. 8 Orthoptic— Tuesday Friday 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 service staff also carry out duties for other health services. The school nursing staff is equivalent to seven whole-time nurses. 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, 1951 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 — — 1951 1950 1949 1948 1947 Number of Children on Register, 31st December 18970 18211 17652 17154 16463 Average attendance 16561.6 15993.5 15950.7 14928.9 14470.6 Percentage attendance 87.0 87.8 90.3 86.7 86.9 Mr. Frank H. Heaven, A.R.I.B.A., Architect to the Education Committee, contributes the following : — Additions and Alterations.—Conversion of one of the Open-Air Blocks at the Hale End Special School is in progress to receive the William Morris Deaf School which is to be transferred from Gainsford Road. 9 Amenities.—These have been provided at many of the schools in the form of garden borders at Infants' and Junior Schools, seats in playgrounds, mesh fences to railings and boundary walls, turfing of lawns, play tables and seats, sealing of floors of hall, gymnasium, dining room, classroom and staff rooms, exhibition panels on walls, toy cupboards and wall shelving, sandpit and a platform for stage plays at various schools. Central Kitchens.—The buildings and apparatus have been maintained in good order and improvements made to hot water installations. Further Education.—The play area at the Marsh Street Youth Centre has been re-surfaced and floodlit for evening play and the exterior re-decorated. Gymnasia.—Several of the halls in Secondary Schools have been equipped with gymnastic apparatus, as climbing ropes, wall bars, etc. Heating.—Existing systems have been maintained. A new system provided at the Forest Road Junior and Infants Schools. New boilers at 3 schools, gas fires, and space heaters at other schools and Central Kitchens. Owing to long deliveries now experienced when ordering new boilers, oil-heated radiators have been made available to meet emergencies which arise. Lighting.—Artificial lighting has been improved by raising the wattage of lamps in certain cases, and the installation of fluorescent lighting in 9 schoolrooms. Maintenance.—All the educational properties are up to a good standard of repair. Annual vacuum cleaning of newly decorated premises is carried out in order to maintain general cleanliness. Windows are cleaned inside and outside on 5 occasions each year. A defective floor in a classroom has been renewed and the external pointing to the walls of part of one school renewed before internal decorations are put in hand. Playfields.—These are maintained by the ground staff in a satisfactory condition. Special contract works have been carried out to provide new fences, lay down newly acquired land for playing purposes and to renovate certain worn sections of play areas. A new Canteen has been built at the North Walthamstow Sports Ground, a new playing field acquired in Billet Road, an existing pavilion repaired at Salisbury Hall and the Air Raid Shelter there and at North Walthamstow Sports Ground converted into ablution blocks for both sexes with sanitary accommodation and hot showers. Three tennis courts have been provided. 10 Playgrounds.—A large area at the George Gascoigne Secondary School has been cleared of builders' material and made playable. Division fences have been removed, to increase the play area at Markhouse Road Secondary School and new carriage gates inserted in boundaries at four other schools. Provision of Meals and Milk.—The canteens at the schools have been maintained in good condition and minor improvements made as a new vegetable store, serving hatches and the extension of services to meet additional needs. Renovations.—Complete renovation of the exteriors of 10 schools and the interiors of 6 schools and part interiors of 4 schools, have been carried out during the year. The exteriors of 3 and the interiors of 6 other buildings have been completed, as well as a larder, servery, hall and gymnasium. Sanitation.—The conversion from automatic flushing to individual flushing has been carried out at two schools. The house drains to a schoolkeeper's premises re-laid, a slop-sink provided and a hot water supply boiler have been installed at two schools. The distempering of all outdoor lavatories has been executed. Apparatus for the disinfection of gymnasium shoes, etc., has been set up at Pretoria Avenue Store. Cold and hot water supply tanks have been renewed and hot water supplies to lavatory basins provided at Secondary and Primary Schools. War Damage.—Progress is still being made with the repair of premises. The roof of the Coppermill Road Infants' School has been reinstated and ceilings to two classrooms at Edinburgh Road Junioi School and of two halls and four classrooms at the George Gascoigne Secondary School renewed. Sanitary Arrangements. The Chief Sanitary Inspector reports that :— Special reports were submitted regarding two schools where the sanitary accommodation did not conform to the standards of the district. In other schools several items of less importance were brought to light and remedial action taken. 11 4. MEDICAL INSPECTION. The following gives a summary of the returns :— A. Periodic Medical Inspections— Entrants 1,735 Second Age Group 1,413 Third Age Group 2,578 Others 174 Total 5,900 B. Other Inspections— Special Inspections 715 Re-inspections 985 Total 1,700 (b) Uncleanliness.—The following table gives comparative figures for the past two years :— 1951. 1950. Average visits to schools 4 4 Total examinations 33,559 43,141 No. of individual children found unclean Percentage uncleanliness of average 840 923 attendance 5.1 5.8 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 1735 934 53.9 774 44.6 27 1.5 Second Age Group 1413 820 58.0 584 41.3 9 0.7 Third Age Group 2578 1619 62.8 931 36.1 28 1.1 Others 174 102 58.6 62 35.6 10 5.8 Totals 5900 3475 58.9 2351 39.9 74 1.2 (c) Minor Ailments and Skin Defects.—The following was the number of skin defects found to require treatment and observation :— Treatment Observation Ringworm—Head 1 — Body 1 1 Scabies 2 — Impetigo 2 1 Other skin diseases 110 84 12 (d) Visual Defects and External Eye Diseases.—The number of patients requiring treatment and observation was as follows :— Treatment Observation Visual Defects 431 298 Squint 58 30 External Eye Diseases 44 65 (e) Nose and Throat Defects.—The number of patients requiring treatment and observation was as follows :— Treatment Observation Enlarged Tonsils 60 227 Adenoids 20 12 Enlarged Tonsils and Adenoids 53 67 Other Conditions 135 139 (f) Ear Disease and Defective Hearing. — The number of patients requiring treatment and observation was as follows :— Treatment Observation Defective Hearing 34 40 Otitis Media 40 67 Other Ear Diseases 24 26 (g) Orthopaedic and Postural Defects.—A total of 505 deformities were found to require treatment. (h) Dental Defects. Inspection at Schools. Requiring General Other Inspected. Treat' ment. Per Cent. Actually treated. Fillings. Extractions. Anaesthetics. Operations. 1,836 1,155 62.9 5,754 4,227 6,072 3,453 8,623 (i) Heart Disease and Rheumatism.—The findings were as follows :— Treatment Observation Heart Disease—Organic 7 18 Functional 6 53 Anaemia 31 14 (j) Tuberculosis.—All children suspected of either pulmonary or glandular tuberculosis are referred to the Chest Physician for final diagnosis. (JO Other Defects and Diseases. — The following shows the number of various other defects which were found to require treatment :— Enlarged Glands 29 Epilepsy 5 Bronchitis 59 Other Defects 144 Speech 27 13 6. FOLLOW-UP The School Nurses paid a total of 2,199 home visits during 1951. 7. ARRANGEMENTS FOR TREATMENT (a) Malnutrition.—The following shows the quantities of tonics issued during 1951 :— Cod Cod Liver Oil Cod Liver Parrish's Syrup Lacto Liver Oil and Malt and Oil. Food. Phosphate and Malt. Parrish's Food. Emulsion. 18 lbs. 342½ lbs. 24 lbs. 1,552 lbs. 1,498 lbs. 104 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. (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 Body 5 8 9 13 Scabies 2 5 - 1 Impetigo 10 5 14 6 Other Skin Defects 83 76 237 319 Verminous Head 27 117 81 559 Discharging Ears and Deafness 49 51 285 267 Tonsils and Adenoids 28 35 42 30 Defective Vision (including squint) 71 82 11 14 External Eye Disease 91 105 123 138 Sores 10 14 27 25 Various 1,100 1,132 2,450 2,242 Totals 1,476 1,630 3,279 3,615 First attendances number 3,106 against 3,356 in 1950, and re-attendances 6,894 against 8,159, the total attendances being 10,000 against 11,515. The operation of the National Health Service Act, 1946, has naturally tended to lessen attendances at minor ailment clinics, since children can now be seen by the family doctor without fee. 14 The new cases and total attendances for three complete years and the half-year before and after the " appointed day " are given below :— SCHOOL CLINIC New cases. Total attendances. 1945 4,301 Average 12,815 Average 1946 5,292 15,449 1947 4,776 4,790 15,794 14,686 1948 Jan. June 3,246 Total 10.356 Total July.Dec. 1,840 5,086 6,134 16,490 1949 3,757 Average 14,112 Average 1950 3,356 11,515 1951 3,106 3,406 10,000 11,876 (d) Dental Treatment. — The position in regard to Dental staffing remained as in recent years, the equivalent of 4 7/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 of 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 :— "I regret that there has been no permanent improvement in the staffing situation. A visiting Dental Surgeon from South Africa gave welcome additional assistance during part of the year, but apart from this the staff remains as before, i.e., the equivalent of 4 7/11 dental surgeons. " The situation remains, therefore, much the same as in 1950, when the major portion of the treatment was that given on direct request from the parents. Some 60% of these children required extractions and about 40% were given conservative and orthodontic treatment. Were it possible to augment the dental staff it should be possible to at least reverse these proportions as the number of patients to whom preventive dentistry is acceptable increases yearly. But there still appears to be no escape from what is mainly a ' casualty ' service. " I should like to report, in a more hopeful vein, the following. In 1936 I examined the five and six-year-old children in one school and found that only 5% of them were free from dental defects. "In December of this year I examined the same age-group, and found, to my surprise, that the percentage of children without defects was as high as 40%. This may or may not be significant. 15 "So far as I can ascertain, the habits and conditions of living were about the same in the two groups with the exception, of course, of the food. Many more children now have school meals and milk than before the war, with Cod Liver Oil and Orange Juice. This may well be the reason for the improvement. Following a request in the early part of the year, I give below the results of the inspection of some 5-year old and 6-year old groups, showing the incidence of dental defects :— Incidence of Dental Caries. 5—6year-old Groups No. Examined Decayed Missing Filled Total Defects 5 yrs. 6 yrs. 5 yrs. 6 yrs. 5 yrs. 6 yrs. 5 yrs. 6 yrs. 5 yrs. 6 yrs. Boys 100 41 135 71 68 61 32 22 235 154 Girls 62 34 91 62 46 44 16 27 153 133 162 75 226 133 114 105 48 49 388 287 5-yr. old group 6-yr. old group Boys Girls Total Boys Girls Total No Defects 23 15 38 2 2 4 1 Defect 21 12 33 10 2 12 2 Defects 15 10 25 — 5 5 3„ 13 8 21 7 8 15 4 „ 16 4 20 8 5 13 5+ 12 13 25 14 12 26 100 62 162 41 34 75 (e) Visual Defects and External Eye Diseases.—The Eye Clinic continued in the clinical care of Dr. Bulsara. The following tables show the work done in 1951 :— New Cases. Under 7 years. 7-11 years. Over 11 years. Total. Boys. Girls. Boys. Girls. Boys. Girls. Boys. Girls. Hypermetropia 12 10 2 9 9 18 23 37 Hypermetropic Astigmatism 24 27 25 24 13 27 62 78 Myopic Astigmatism - 1 8 6 28 33 36 40 Mixed Astigmatism - 2 2 1 5 4 7 7 Myopia 1 — 10 14 29 54 40 68 No visual defects 23 14 10 13 16 24 49 51 Totals 60 54 57 67 100 160 217 281 Refractions Re-inspections Treatments Totals New Old 486 427 2,410 269 3,592 Number of children for whom glasses were :— (i) Prescribed 898 (ii) Obtained 843 16 Inspection of Children attending the School for the PartiallySighted. Dr. Bulsara contributes the following table, which shows the classification of children attending the Partially-Sighted School who were examined during the year at the Eye Clinic. I. Congenital Defects — Cataracts 8 Coloboma (complete) 1 Albino 3 Colour Blind 1 II. Acquired Defects— Refractive errors—High myopia 15 Optic atrophy 2 Ophthalmia Neonatorum with Anterior polar cataract 1 Supply of Spectacles. Delay in supply had already decreased by the beginning of the year. The position further improved on the appointment of a Dispensing Optician by the Hospital Management Committee. This whole-time appointment became effective on 8th May, 1951, the optician's services being shared with the Forest Division. Free choice is afforded but few parents exercise it in favour of a private optician. (f) Orthoptic Clinic.—Mrs. E. Silvester, D.B.O., has contributed the following report on the work done at the Clinic :— Number of cases investigated 118 Number of cases treated for Squint and Amblyopia 202 Number discharged 30 Still under observation and treatment 172 Total attendances during the year 1,142 (g) Ear, Nose and Throat Clinic.—Dr. Francis Clarke reports as follows :— During the year 1951 the work of the ear, nose and throat clinic has been carried on along similar lines to those of previous 17 years. The general attendances have been very satisfactory and the regular weekly sessions throughout the year have always been full. The total number of new cases seen at the clinics during the year was 259, and the number who attended for prescribed treatment was 328. Total attendances were 1,020. As has been found in previous years, by far the greater proportion of new cases seen were those complaining of affections of the nose and throat, and a small number with impaired hearing. The number of cases of 'discharging ears' has, for many years, been very small. The prompt and correct treatment of the acute discharging ear is a very important factor in the prevention of the ' chronic running ear ' and permanently impaired hearing. In order to ensure that the acute otorrhcea cases are efficiently treated and heal as quickly as possible, all cases are treated at the clinics where the clinic staff are trained and experienced in the special technique and methods advised. The results have been very satisfactory and the ' running ears ' have become quite 'dry' quickly. Most of the cases of chronic otorrhcea that we have seen gave a history of a prescribed treatment being carried out at home, or of no treatment. Attention is again drawn to the number of children complaining of various ' nasal conditions,' tonsillar affections, colds, etc., and some whose hearing is seriously impaired, who have sinus infections. It is imperative that the sinus condition is recognised and efficiently treated till ' clear.' If this is done it will be found that a surprisingly large number of symptoms, such as recurring sore throats, colds, etc., will abate and the general health of the child noticeably improve. Proetz displacement was regularly employed and used for a number of cases during the year and is a most useful method of diagnosing and treating these sinus infections in children. In previous years reference has been made to the very good results obtained in selected cases of nasal conditions by Gautier's method of diastolisation. In cases of hypertrophic rhinitis, mouthbreathing (not due to organic malformations), congestion and turgescence of the turbinate tissues, impaired hearing due to nasal conditions, etc., diastolisation is an ideal method of treatment. It is not used in cases of suppuration or sinus infections. 18 During the year a certain number of children were seen giving a history of sore throats, 'enlarged tonsils,' frequent colds, etc., for whom tonsillectomy has been suggested. Before tonsillectomy is resorted to a detailed examination is essential to seek the primary cause in any nasal-sinus condition that may be present. The point to remember is that in the presence of certain nasal affections or sinus disease, left untreated, awaiting tonsillectomy, tonsillectomy will not cure the condition. The special clinics of the Local Authorities serve a very useful purpose for the school population. They are conveniently situated, locally, and therefore the children can attend for examination and treatment as required with the minimum loss of school time, without the inconvenience and risk of long journeys through busy traffic, and as well, the majority of children come for treatment without their parents, which is an important consideration to working parents. The parents appreciate what is being done for their children at these clinics and on the whole, are very co-operative in carrying out the advice, recommendations and treatment given. The usual annual special ear, nose and throat session was held at the School for the Deaf for the examination and treatment of those children attending the School. In this school I found that the children are well cared for and their progress very satisfactory. I did not find any case of discharging ear amongst those deaf children. There were certain cases of 'nasal conditions' for whom appropriate treatment was arranged. The general health of the children seen at the Aural Clinic during the year, with a few exceptions, was very good. These latter might be considered to be below average standard for age, but their undersize, etc., was not due to any lack of nutrition or care. Tonics, cod liver oil and malt, etc., are always provided by the School Health Service where indicated, and are a very great benefit. (h) Orthopaedic Scheme.—The Scheme is under the clinical charge of Mr. B. Whitchurch-Howell, F.R.C.S., Consulting Orthopaedic 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 :— ORTHOPEDIC SCHEME Defects. Boys. Girls. 5-16 years. Under 5 years. Over 16 years. 5-16 years. Under 5 years. Over 16 years. Anterior Poliomyelitis 9 2 6 12 3 11 Surgical Tuberculosis 1 — 2 1 — 1 Scoliosis, Lordosis, Kyphosis 18 1 2 35 1 — Arthritis 1 — 3 — — 3 Rickets— (a) Genu Valgum 20 16 — 15 17 — (b) Genu Varum 2 13 — 1 9 — Pes Piano Valgus 103 23 2 64 15 — Spastic Paralysis 12 — — 6 4 — Progressive Muscular Atrophy 2 1 — — — — Osteo Genesis Imperfecta 1 — — — — — Talipes—(a) Equino Varus 9 3 3 6 2 1 (b) Calcaneo Valgus 4 5 — I 7 — (c) Pes Cavus 4 — 1 — — — (d) Mid Taisal Varus 2 — — — 1 — Torticollis 0 4 — 10 4 1 Osteomyelitis 1 — 2 — — 1 Congenital Dislocation of Hip — — — 4 — 1 Schlatters Disease 1 — — 3 — — Cerebellar Ataxia 1 — — 3 — — Spina Bifida 1 1 — — — — Hallux Valgus 2 — — 27 — — Hammer Toe 4 — — 6 — — Perthes Disease — — — — — 2 Achondroplasia — — — 2 — 1 Amputation Leg. . — — 1 — — 2 Digitus Varus 2 — — 8 1 — Congenital Defects 8 4 1 4 1 1 Miscellaneous 24 2 2 22 — 1 Totals 237 75 25 230 65 26 19 20 Number of cases seen by Surgeon :— From Physically Defective School 34 From other Schools 283 Under School Age 126 Over School Age 39 Total 482 New cases seen by Surgeon :— School Age 82 Under School Age 20 Total 102 Total number of examinations made by the Surgeon 584 Total number of cases discharged by the Surgeon 120 Average number of examinations per session 58.4 Number of treatments given 2,292 Number of attendances for after-care 2,517 Number of ultra-violet light treatments 2,522 Total number of treatments 7,331 Average number of attendances per session17.7 Number of sessions held—Inspection 10 Treatment 417 Number of visits by Instrument Maker 10 Admissions to Hospital 14 Operations performed 12 (i) Heart Disease and Rheumatism.—The following is a report on the work done at the Clinic during 1951 :— Number of sessions 10 „ „ attendances 127 „ „ new cases 26 „ „ old cases 32 „ discharged 27 „ still under treatment 28 „ of new cases with rheumatic or cardiac defect 4 „ referred to Hospital—Out-patient In-patient 4 „ referred for Tonsils and Adenoids 1 „ referred for Dental Treatment — „ to begin full-time school 1 ,, referred for convalescent home treatment 1 „ sent away convalescent 1 21 (;') Child Guidance Centre.—The Senior Psychiatrist, Dr. Helen Gillespie, reports as follows :— Staffing.—During 1951 the average number of psychiatric sessions worked was 7½ per week. Dr. Haffner resigned from the Clinic in October, and since then only six sessions have been worked each week. There has also been a reduction in the number of sessions worked by the Play Therapist from 5 to 4 per week, but we hope to increase this to six during the next year. Miss Russell, Psychiatric Social Worker, was badly missed during the last three months of the year. We welcome her return and are glad that she has made a good recovery from her illness. Comments.—It will be seen from Table I that there has been some increase in the number of cases referred. There has also been a very striking increase in the number of cases closed during the year—216 as against 127. This increased figure reflects the greater amount of psychiatric time available as compared with last year. With an increase of cases closed it has been possible to devote more time to the diagnosis and treatment of new cases, which should bear fruit in 1952. Prophylactic work with pre-school children.—An important new departure during the year has been the setting up of a clinic for under-fives in connection with the Maternity and Child Welfare Centre at West Avenue. This was made possible by the very enlightened and co-operative attitude of Dr. H. K. Cowan (County Medical Officer of Health) and Dr. A. T. W. Powell, who were keen to see the far-reaching possibility in work of this kind for the prevention of future emotional troubles in children and of the education of young parents in their handling, which often has a good effect also on the children of a family about whom we have not been consulted. This is an aspect of child guidance work whose importance is becoming increasingly recognised, and it is gratifying that Walthamstow should be in the forefront of this very promising new development. The fact that one is able to deal with these problems on the spot at the Maternity and Child Welfare Centre is very re-assuring to the parents, who might feel disconcerted and discouraged if it were suggested that their problems were of such magnitude as to require reference to a Child Guidance Clinic. A considerable proportion are, in fact, relatively simple cases which can be dealt with in two or three interviews by suitable discussion with the mothers, who are often ignorant of what is to be expected at the normal stages of development. Beside these, however, there are also a number of difficulties and severe problems not only in children but in the mothers, some of which require intensive and prolonged treatment. 22 Experience has shown that when a child's problem is taken in hand early, the prospects of solving it are much brighter than if it is allowed to drag on to school age, when children are customarily referred to the Child Guidance Clinic. It is hoped that local medical practitioners, and doctors working in the Maternity and Child Welfare Service, will make full use of the facilities now provided in the Borough for the treatment of the under-fives. Children are seen by appointment only. In the following Tables the numbers of children seen from Leyton Borough and Forest Division are not included. TABLE I. Analysis of figures for 1951 Number of cases Referred to the Clinic 1ll „ „ „ Diagnosed at the Clinic 62 (a) Psychiatrist. Diagnostic Interviews 62 Treatment Interviews 298 Other Interviews 16 (b) Psychologist. Cases Treated 21 Treatment Interviews 418 Other Interviews 298 School Visits 167 (c) Play Therapist. Treatment Interviews 321 (d) Psychiatric Social Worker. Interviews at Clinic 579 Home Visits 10 Other Interviews 56 (e) Waiting List at 31.12.1951. Cases for Diagnosis 70 Awaiting Treatment — 23 TABLES II and III. Analysis of Problems Referred and Cases Diagnosed Referred Diagnosed I. Nervous disorders, e.g., fears; depression; apathy; excitability 26 33 II. Habit disorders and physical symptoms, e.g., enuresis; speech disorders; sleep disturbances; tics; fits; etc. 29 12 III. Behaviour disorders, e.g., unmanageable; tempers; stealing; lying; sex problems, etc. 50 13 IV. Educational, e.g., backwardness; failure to concentrate 6 4 V. Court cases — — Totals 111 62 TABLE IV. Analysis of Cases Closed during the Year (including cases Referred in previous years) Improved and recovered after treatment 47 Improved after partial service 12 Diagnosis and advice only 12 Interrupted due to non-co-operation 41 Closed for miscellaneous causes (removed from area, placement at E.S.N. School, etc.) 8 Total 120 REPORT OF THE EDUCATIONAL PSYCHOLOGIST FOR 1951 Miss E. M. Smith, M.A., contributes the following:— The psychologist was made responsible for work in Chingford schools in addition to those in Walthamstow in September, 1950. 1951 is, therefore, the first complete year in which this extension of the work has been covered. In this report, however, figures for Walthamstow only are given. 24 During the year 298 children were given individual tests (200 in Walthamstow). The percentage of boys as compared with girls has significantly risen—69 per cent. boys and 30 per cent. girls. The school placement and age-range of these children is included in the following tables:— Table I.—School placement of Children seen by Psychologist. PreSchool Infants Junior Sec. Modern Grammar Technical Special Totals Boys 6 36 47 25 5 4 20 143 Girls 3 18 10 5 5 — 16 57 Apart from these rather special figures, the normal tendency to find the greatest number of problems in the Infant and Junior School is borne out. Table II.—Children seen by the Psychologist in the different Age-Groups. Under 5 yrs. 5 6 7 8 9 10 11 12 13 14 15 Totals Boys 5 7 10 26 14 13 16 18 16 4 5 8 143 Girls 3 5 10 12 5 3 3 6 3 4 1 2 57 The greatest number of problems are presented to the Psychologist from the 7 and 11 year age-group. This is normal expectation, and indicates the extent to which children have difficulty in adjusting to a new school environment. Head Teachers have again made the largest demands from the Psychologist. More than half the total number of children were seen at the teachers' request. Details of the referring agencies are given in Table III. Table III.—Cases Referred. Source Boys Girls Total Head Teachers 75 34 109 Medical Officers 33 10 43 Parents 11 5 16 Miscellaneous 10 2 12 Family Doctor 3 4 7 Speech Therapist 6 2 8 Juvenile Court 5 — 5 Table IV, giving the numbers of children falling in each of three main intelligence groups show an unusually large proportion of children with poor intelligence. This is due to the fact that during the year the Psychologist has done more work than 25 previously in testing and reviewing educationally sub-normal children. To make this quite evident a separate category has been made for chidren with I.Q.s below 70. The larger proportion of girls in this group is unusual. Table IV.—Intelligence Rating. Boys Girls Total Above Average I.Q. (116 + ) 20 6 26 Average I.Q. (86—115) 69 19 88 Dull (I.Q. 70—85) 31 16 47 E.S.N. (I.Q. less than 70) 23 16 39 Provision for E.S.N. children continues to be inadequate. The setting up of one or two special classes, under psychological vision, to augment the work of the E.S.N. School, would mean help for more children, and relief for teachers in normal schools. (Note.—This matter is under consideration.) Ninety-three children (72 boys, 21 girls) amongst those tested individually by the Psychologist, were recommended for further psychiatric diagnosis and treatment. Twenty-one were taken for individual coaching in particular subjects, 17 for reading, three for arithmetic and one for French. Six or the boys helped in reading improved sufficiently during the year to be able to join in the work of their class. The improvement they showed is as follows:— Reading Age before coaching. Reading Age at cessation of coaching. Boy A 6.9 9.0 B 7.6 10.0 C 7.0 9.9 D 6.9 8.0 E 4.7 7.6 F 5.0 8.5 The rest of the group made slower but steady progress. As far as possible, the Psychologist spends half her time in schools, and during the year made 167 visits, allocated as follows among the different type of schools:— Infants' and Nursery 37 Junior 41 Secondary Modern 16 Grammar and Technical 6 Special Schools 20 Three children were visited in their homes. 26 In a number of Junior Schools in both districts group tests of intelligence and attainment were carried out with 426 children. The most interesting feature revealed by these tests was the noticeable degree of under-functioning among children of superior intelligence, in every school concerned. During the summer term a Student Psychologist came to the Clinic for a (practice) period of practical work. She visited various schools and did tests under supervision. A course of lectures given by the Psychologist on "The Problems of Backwardness," was well attended by teachers from a wide radius. It should be recorded that the majority of these teachers work in Infant and Junior Schools. More informal lectures and talks have been given to Parent-Teacher Associations and other interested groups. (k) Pædiatric Clinic.—The Clinic was continued under the clinical charge of Dr. Elchon Hinden, Paediatrician to Whipps Cross Hospital, who reports as follows:— The work at the Clinic has followed the lines of the first year's work. The great bulk of the children were referred by the Medical Staff of the Health Services. The number of new patients seen was 93, roughly equally divided between school- and pre-school children. It is noteworthy that the general physique and nutrition of the children was very good ; patients were more often referred for obesity than for leanness. The majority of the patients were suffering from 'cold' complaints, disorders of growth and development, or from behaviour disturbances. The commonest single ailment was enuresis; the usual acute infections of childhood were conspicuous by their absence. This is as it should be; plainly a clinic which meets only once a fortnight is no place for the treatment of urgent disease. In general, the pattern of disease in childhood is changing. Infections as a whole are becoming much less frequent; not only the non-specific catarrhal infections, but the acute exanthemata and their complications are much less important than they were. Even rheumatic heart disease and tuberculosis have become relatively rare complaints in childhood. This means that more and more time of the preventive services is taken up with development and behaviour. It must be admitted at once that disturbances in these fields are much less understood than the ordinary medicine and surgery of childhood, and in the absence of precise knowledge there is a danger that doctors may promise more than they can perform, so forfeiting the confidence of the public. With regard to behaviour, every parent wants to bring up his child in his own image; there is no generally-accepted standard of what constitutes a 'good citizen,' and often the pediatrician finds he is being asked questions in the fields of ethics, education and philosophy, which 27 this paediatrician at any rate finds himself quite unable to answer! This changing trend in child health is a most stimulating experience and presents a challenge to our organised knowledge which has not as yet been answered. The majority of children could be dealt with at once; often all that was required was reassurance that the deviation from the normal which had been observed, was nevertheless within normal limits. Occasionally pathological and radiological investigations were needed, and these were carried out at Whipps Cross Hospital, whose close and informal Co-operation was of very great value to the work of the Clinic. A number of children were admitted there for clinical investigation. In particular, all enuretic children were offered a period of hospital stay in order accurately to observe their bladder function, and some 20 accepted and have been admitted. In all cases, the child's family doctor was fully informed about the consultation and findings. In conclusion, I should like to thank all the local General Practitioners who have allowed me to examine their patients, and the assistant Medical Officers who have done me the honour of seeking my opinion. Under 5 Years. Over 5 Years. New Cases 51 42 Total Attendances 58 52 Physical Defects: (a) Asthma — 2 (b) Heart Disease — 2 (c) Other 43 13 Referred to Hospital 12 18 Discharged 11 22 Psychological Disorders: (a) Enuresis 7 23 (b) Other 1 2 Referred to Hospital 2 21 Discharged — 6 (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 157 children were treated for various defects—mostly comprised of stammerers and dyslalics. Ninety-six interviews were given and 90 visits to school departments to follow up the work done in the Clinic. Twenty-five home visits were also made as a follow-up measure. About 15 children were referred to the Ear, Nose and Throat Clinic for nasal catarrh with slight deafness. Treatment resulted in a tremendous improvement in their speech and general alertness. 28 There has been no appreciable change in the numbers and types of defect since last year. Five children have been referred for I.Q. assessment and those at a low I.Q. level, i.e., under 65, benefitted very little from speech treatment, as these children progress in their own time and do not respond successfully to direct speech stimulation. Of the new patients, 37.5% more boys were admitted than girls. 30% of the new intake were stammerers of infant age. I would like to take this opportunity to thank all heads of schools for their interest and co-operation, the transport officer for his care and efficiency, and the Child Guidance Clinic for the considerable help and interest they have shown in cases on which I have asked their advice. Miss A. M. Hemmings reports:— The distribution of cases has been very similar to that of 1950, except that towards the end of the year the number of young dyslalics referred increased, this being comparable no doubt with the general increase of entrants to school and who are post-war babies. Speech Therapy students have been attending the clinic weekly, some of whom have actually treated the patients, while first-year students have observed treatment. In addition to these students, visits have been paid by student health visitors to observe the operation and scope of a Speech Therapy Clinic. In September we welcomed a visitor from Trinidad who wished to learn methods used in Speech Therapy. to learn methods used in Speech Therapy. This visitor is a teacher, and when she returns to Trinidad will organise speech training in the island, as at present there are no facilities for speech therapy. Annual Report and Clinical Analysis. High St. Clinic Open-Air Sch. Clinic No. of cases in attendance at beginning of year 100 57 New cases admitted during year 54 52 Transfers from other Clinics 3 2 Re-admitted for further treatment — 12 157 123 Cases ceasing attendance before cure or discharge Cases discharged improved and incapable of benefitting by further treatment 3 4 Cases temporarily discharged, to resume treatment later 2 17 Cases discharged cured 52 30 Transfers to other Clinics 5 3 Cases still in attendance at end of year 95 69 Total attendances during year 2,952 2,515 29 No. of Cases suffering from:— High St. Clinic Open Air Sch. Clinic Physiological or psychological defects— Stammer 58 40 Clutter - 1 Voice Defects— Rhinophonia 6 3 Defects of Articulation— Dysarthria - 5 Dyslalia 85 63 Language Defects— Delayed Speech 3 3 Probable Mental Deficiency 5 7 Other types of Defects - 1 157 123 (m) Convalescent Home Treatment.—91 children were sent away for treatment during 1951. There were six children remaining in convalescent homes and hospital schools on December 31st, 1951. (n) Tuberculosis.—The number of school children examined for the first time during the year was 245 boys and 258 girls, of whom 25 boys and 30 girls were referred by the school medical staff, and 102 boys and 99 girls by private practitioners. 247 children were examined as contacts. PREVENTION OF TUBERCULOSIS (i) Chest X-ray Examination of Teachers on Appointment.— Since 1943, i.e., before the appointed day under the Education Act, 1944, it had been the custom to insist on newly-appointed teachers passing a chest x-ray examination. In February attention was drawn to the fact that a fee would be payable to the Regional Hospital Board and the Chest Physician, but in view of the issue of Ministry of Health Circular 64/50 in July, 1950, commending the x-ray examination of all persons in close contact with children, your Committee decided to continue the examinations. Later the Local Education Authority decided to take no action in the matter in view of the possibility of a conference being convened at national level to decide future action. Your Committee again decided to continue the examinations, but later they had to be discontinued since the Local Education Authority had disallowed the provision made in your Committee's estimates. Your Committee then recommended that the matter be referred to the Ministry of Education as a dispute between the Borough Council and the Local Education Authority, but this proved impracticable, since under 30 the terms of the Walthamstow Education Scheme the standard of medical examinations is a matter for the Local Education Authority. In April, 1952, Circulars 248/9 were received from the Ministry of Education, and briefly they may be summarised as follows:— 1. Local Education Authorities are to do whatever is practicable to implement the recommendations of the Joint Tuberculosis Council, especially in regard to teachers and attendants in nursery schools. X-ray examinations will depend on local resources. 2. Teachers and intending teachers will be required to undergo chest x-ray examinations as from the 1st April, 1953. The examination of other employees will be a matter for Local Education Authorities. 3. Annual chest x-ray examinations to be done as far as practicable. The circulars also refer to the existing grounds for suspension from employment, to the follow-up of cases of high incidence amongst children, and to the fees payable for individual examination. 4. Non-maintained schools are recommended to follow the same suggestions. (ii) Anti-Tuberculosis Vaccine Clinical Trials (B.C.G.).—The B.C.G. field trials of the Medical Research Council referred to in the 1950 report continued during 1951 and the "leavers" of each term were invited to participate. The response to the invitations were as follows:— Easter 1951 Summer 1951 Christmas 1951 No. of school leavers 285 414 414 No. of acceptances 146 205 207 Percentage of acceptances 56.5 49.5 50.0 No. attending first test 129 166 191 Percentages, 1st attendances to leavers 45.2 40.1 46.1 Total positive to OT 1/3000 and 1/100 49 54 60 Total inoculated with B.C.G. 41 47 57 No. of controls 33 49 59 Leavers admitted in their final term at School— Total completing examination and admitted to trial 26 11 Total positive 11 4 No. inoculated with B.C.G. 6 4 No. of controls 9 3 The total admitted to trial was 486. 31 (o) Artificial Light Treatment.—The total attendances for treatment were 2,522. 8. INFECTIOUS DISEASES Notification in the 5-15 years age-group during 1951 was as follows, the figures for 1950 being shown in parenthesis: Scarlet Fever, 85 (116); Diphtheria, Nil (1); Pneumonia, 12 (3); Erysipelas, Nil (1); Meningococcal Infection, Nil (1); Measles, 1,085 (111); Whooping Cough, 262 (224); Dysentery, 34 (Nil); Poliomyelitis, 4 (1). Non-notifiable 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 number of children notified by Head Teachers in conformity with the Regulations as to non-notifiable and other diseases in schools, was as follows:— Chickenpox Measles Whooping Cough Sore Throat Influenza Mumps Ringworm Various Total 50 380 60 35 — 12 — 44 581 Gastric Influenza.—In September some 49 cases of sickness were reported at a Girls' School. Absences were mainly only for one day. Twelve of the children did not take school meals. Detailed visits, inspections and examinations were carried out by the Medical and Sanitary staffs. Food and milk samples were examined but no definite conclusion was reached as to the nature of the infection nor of the cause. Probably it was a virus infection usually referred to either as gastric influenza or winter vomiting. Attention was drawn to an epidemic of vomiting with occasional sickness, which had affected an Infants' School in September. The total number of cases was 52, roughly half of which had occurred in the previous fortnight. The usual enquiries and inspections, both at the school and at children's homes, were carried out and the position was discussed with the Consultant in Pathology for the area, who suggested that 32 in view of the negative pathological findings the condition was probably one of "winter vomiting." Some 72 children were visited by the School Nurse, and the total number of cases was 84 before the outbreak ended naturally at the beginning of December. Bacillary Dysentery (Sonne).—In February a question was raised as to the supply of paper towels in schools other than infants' schools, which were already being supplied. The cost to supply all schools was found to be prohibitive, and it was finally decided to supply paper towels to those schools in which dysentery had occurred and until cases had ceased for two weeks. Bacillary Dysentery at Nursery School.—The first case of Sonne Dysentery was notified in mid-February, the school being cleared by mid-April with a total of 42 cases. The routine which had been worked out for the control of Day Nurseries was applied, including the prophylactic use of a sulphonamide (Thalazole). Immunisation Clinic.—The arrangements were as detailed in the 1939 Report. The following table shows the work done at the Clinic:— Total immunisations completed during 1951 1,477 (a) Pre-school age 1,212 (b) School age 265 (c) Over school age — Immunisation at schools (included above):— Number immunised 196 Number awaiting second dose 32 Number already immunised given an extra dose 1,709 During the five years to 1950 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 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 33 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 860 304 35.3 Girls 875 254 29.0 2nd Age Group Boys 684 182 26.6 Girls 729 172 23.6 3rd Age Group Boys 1,146 286 24.9 Girls 1,432 266 18.6 Others Boys 109 32 29.3 Girls 65 20 30.9 Totals 5,900 1,516 25.7 9. OPEN AIR EDUCATION From February onwards arrangements were made for medical examination of parties of up to 40 boys and 40 girls each four weeks, before proceeding to the school camp at Itchingfield, Sussex, and three parties of 6 boys and 6 girls before proceeding to the 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. A question in regard to the disinfection of gymnasium shoes was raised during the year. The war-time practice had been to share these, provided children wore their own socks. After careful consideration of the matter, your Committee decided to instal a gas-heated drying cabinet, operating at 80/90° F. in order to treat the shoes after a preliminary application of a disinfecting powder. Delivery of the cabinet had not been effected at the end of the year. 34 11. PROVISION OF MEALS During October and November the daily number of meals exceeded 9,000 or some 47.5% 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. 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. Routine inspections were carried out by the Sanitary Inspectors. Improvements in the arrangements for the drying of crockery are gradually taking place, but cloth drying is still practised to a considerable extent and will continue until such time as it is possible to provide draining racks and adequate and modern sterilising sinks, or rinsing sinks fitted with very hot water supplies. Augmented washing facilities for scholars partaking of school meals are desirable. Milk in Schools Scheme.—The arrangements detailed in the previous reports were continued in 1951, 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 16 Pasteurised, for biological examination Nil (scheme ternporarily suspended) Test Results— Bacteriological—all satisfied the Methylene Blue and Phosphatase tests. 12. (a) CO-OPERATION OF PARENTS The following table shows the attendance of parents during 1951 at the periodic medical inspections:— Number Inspected Number of Parents Percent. 1951 Per cent. 1950 Entrants— Boys 860 674 78.4 84.7 Girls 875 730 83.4 84.3 2nd Age Group- Boys 684 421 61.6 60.1 Girls 729 540 73.9 66.9 3 rd Age Group- Boys 1,146 261 22.8 23.3 Girls 1,432 438 30.6 28.7 Others— Boys 109 54 49.5 - Girls 65 41 63.1 - 35 (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 13/- per child in residential schools not under their management. (a) The Invalid Children's Aid Association.—Mrs. Osora, Secretary of the local branch, has kindly contributed the following report:— Number of applications 238 Number of home visits paid 615 Cases Referred by:— Over 5 years. Under 5 years. Hospitals and Medical men 71 19 School Health Services 69 2 Local Authority under schemes for:— (a) Rheumatism 12 2 (b) Orthopaedic care 16 — (c) Child Guidance 5 — Voluntary Bodies 6 1 Parents 24 7 Transferred from other I.C.A.A. Branches 4 — 207 31 Suffering from:— Anaemia, Debility, Malnutrition 29 3 After-effects of acute or infectious illness or operation 59 12 Bronchitis or Pneumonia 34 1 Asthma 5 — Rheumatism, Chorea, Heart 16 — Nervous conditions 14 2 Diseases of— (a) Ear, Nose and Throat 21 3 (b) Eyes 3 — (c) Skin 6 2 Various 20 8 207 31 36 Help given to old and new cases:— Children sent to Convalescent Homes and Residential Open-Air Schools 109 7 Transferred to other agencies 5 7 Referred for visiting and advice, help and follow-up 41 36 155 50 (b) National Society for the Prevention of Cruelty to Children.—The following is a summary of the work done in Walthamstow during 1951:— Nature of Offence How dealt with Neglect 27 Warned 36 Ill-treatment 9 Advised 21 Advice sought 21 57 57 Number of Children dealt with:— Under 5 years Over 5 years Boys Girls Boys Girls 34 21 38 40 HANDICAPPED CHILDREN The following number of special examinations were carried out by the medical staff in respect of the categories stated. Examinations Re-examinations (a) Blind — 1 (b) Partially Sighted 1 — (c) Deaf 2 2 (d) Partially Deaf — — (e) Delicate — 8 (f) Diabetic — — (g) Educationally Sub-normal 7 2 (gi) Ineducable 1 18 (h) Epileptic — 1 (i) Maladjusted 1 — (j) Physically Handicapped 37 12 (k) With Speech Defect — 2 (l) Multiple Defects — 2 Totals 49 48 37 The numbers of children at the Special Schools in Walthamstow at the end of 1951 were as follows: — Partially Sighted E.S.N. Physically Handicapped Deaf Total Percentage Walthamstow 9 56 77 10 152 64.7 Dagenham 1 — — — 1 0.4 Forest 6 12 6 13 37 15.7 Ilford 2 - - 9 11 4.7 Leyton 3 — — 3 6 2.6 Romford 6 — — — 6 2.6 Middlesex 21 — — — 21 8.9 West Ham 1 — — — 1 0.4 Totals 49 68 83 35 235 100.0 ASCERTAINMENT AND REHABILITATION OF PHYSICALLY HANDICAPPED CHILDREN The Ministries of Health and Education, on behalf of the World Health Organisation, United Nations International Children's Emergency Fund, and the United Nations Department of Social Affairs, organised a course in March for interested persons from abroad. In particular, the Ministry of Education wished to show the work of the School Health Service. At the request of the Ministry a programme of visits was arranged in Walthamstow, which included reception by the Mayor at the Town Hall and visits to the Open-Air School for Physically Handicapped Children (where cases were demonstrated by Dr. Hinden, Pædiatrician, and Dr. Watkins). At this demonstration the various "opposite numbers" in Walthamstow of the visitors were present. After lunch the school kitchen was inspected, and later the Nursery School, the adjoining Child Welfare Centre and School Clinic, and lastly the Child Guidance Clinic. The Deaf Child. During the year Dr. Watkins attended a refresher course in the care of the deaf child and held at Manchester. Dr. Watkins reports as follows:— The course began with a visit to the Royal Residential Schools for the Deaf. The schools cater for the partially deaf and totally deaf. Those with equal degrees of deafness were taught together in their own age-groups. The fullest advantage was taken of any residual hearing to teach by means of ordinary speech. Hearing aids were used extensively in this group. The hearing aids were operated centrally, each child using headphones which could be individually adjusted for pitch and intensity to suit the child and to suit each ear. 38 Lip-reading was obviously the main means of communicating with the child. Interesting methods were used for teaching and encouraging speech in children at every opportunity. It was revealing how lip-reading could be successfully taught to toddlers of two and upwards. The Headmaster stressed the importance of schooling at this early age. Watching these children in the classroom, at games and at play, it was difficult to realise they were severely or totally deaf, and it showed clearly the excellent results that can be attained by modern methods of teaching of the deaf child. A very instructive demonstration was given by Prof. and Dr. Ewing on the ascertainment and assessment of defective hearing in children of all ages. It was clear that this is a highly specialised technique that needs much experience. As many as six or more interviews or examinations are needed in some cases for accurate assessment. A point of great practical importance was brought out in the course of this demonstration, and that was how a baby of even twelve months could be assessed with a fair degree of accuracy, after several interviews. The methods and apparatus used could reveal loss of hearing both in intensity and pitch. The extreme importance of ascertainment of deafness at the earliest age possible was emphasised, so that lip-reading could be started early. The parents have an extremely important part to play, and special clinics are held to instruct parents in the art of teaching the child in lip-reading. It was felt that this instruction was of paramount importance. A lecture was delivered by Professor Lambert on the causes of deafness and modern methods of treatment. There appears to be less incrimination of the much maligned tonsil in the causation of deafness these days, although tonsillectomy has occasionally a rightful place in treatment. Much was said about the allergic states of the nasopharynx in repeated upper respiratory infections leading to deafness ; Antihistamine drugs find a place in modern treatment in such cases. Two very instructive lectures were given on the assessment of mental abilities, achievement, and special educational treatment of the deaf child. Although novel test material was demonstrated in the assessment of intelligence, it was clear that this is very skilled work and even in skilled hands, observation over a period is necessary to achieve any degree of accuracy. Conclusion. This was a very useful and instructive course. The main points of note were the following:— (1) Very early assessment of deafness is possible and should be sought. (2) Early training in 39 lip-reading is possible. (3) The role of the parent in teaching lip-reading is paramount. (4) Special Clinics for parent guidance. (5) Accurate assessment of intelligence of the deaf child is possible. (6) Normal scholastic achievements can be attained by special educational methods. (7) Early attempts at class teaching, e.g., from the age of two, is possible with excellent results. (8) The establishment of a Centre for the assessment and training of the deaf child such as the one in Manchester would need a large catchment area with some millions of population. School for the Partially Sighted. Mr. G. M. Williams, Head Master, reports as follows:— The following table shows the classification of children at the end of the year:— Walthamstow Essex County Out-County Totals Boys Girls Boys Girls Boys Girls Boys Girls Blind 1 1 3 1 — — 4 2 Partially Sighted 4 3 7 7 10 12 21 22 5 4 10 8 10 12 25 24 The catchment area from which the children are drawn is almost 30 miles across, comprising the Forest, Ilford, Romford, Dagenham and Leyton Divisions of Essex, and the Tottenham, Wood Green, Enfield, Hornsey Divisions of Middlesex and from West Ham. This is almost the limit of travel even for older children and it will be appreciated that some of the smaller children have to make a long and tedious journey each day to school. The medical supervision of the School has been well catered for. Dr. I. Gregory has made a special visit each term to examine the children's sight, and a 3-day full general medical examination was made by Dr. Watkins who commented favourably on the general condition of the children. Most children are now in possession of a second pair of glasses, and breakages are quickly put in hand without loss of school time. The school made educational visits to the C.W.S. Boot Factory, National History Museum, Ideal Homes Exhibition, Bertram Mills' Circus at Olympia, and to St. Andrew's Paper Mills. During the year two children were transferred to ordinary school, one to High School, one to Residential School for the Blind, and five left for employment. The School was visited by student Teachers, student Health Visitors, County Medical Staff, and various individuals (one from Sierra Leone, two from South Africa, one from Trinidad). 40 I would like to express my appreciation to 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 39.69 and the number on roll 45.33. School for the Physically Handicapped. Mr. G. M. Williams, Head Master, reports as follows:— This year there has been a marked drop in the average attendance showing that the general health was not so good as in former years. This may have been influenced by the greater number of younger children now in the School. The average age of the children in this School has fallen by 4 years, there being now two infant classes as against one formerly. The experiment of an Open-Air Group in the Forest was again carried out, but the difficulty of securing adequate accommodation limited the project to a period of four weeks. Even this short essay proved to be well worth-while. In March the School was visited by foreign delegates attending a course on the Ascertainment and Rehabilitation of Physically Handicapped Children. The School continued the practice of former years in opening during part of the summer holidays, when a 90% voluntary attendance was maintained. Educational visits were made to Saffron Walden, South Kensington Science Museum, Ideal Homes Exhibition and a special visit to the seaside. We were visited during the year by Student Teachers, Student Health Visitors and individuals from Malaya, Sierra Leone, and Trinidad. Dr. Watkins has made regular weekly visits and his interest is invaluable to the working of the School. We have had daily visits from the School Nurse and a total of 1,065 minor treatments were given. Mrs. Meyer joined the staff as Nursing Assistant in October. Mrs. W. Morris, as Senior Assistant, has carried a great burden of responsibility during the year. I must again acknowledge my indebtedness to all Staff, teaching, medical, welfare and transport, for their valued co-operation in the work of the School. 41 William Morris Deaf Centre. Mrs. I. J. M. Burt, Headmistress, reports as follows:— At the beginning of 1951 there were twenty children on the roll, and at the end of the year the numbers had increased to thirtyfour, increased accommodation having been made available. Seventeen children were totally deaf, and one of these seems ineducable (a four-year-old). Seventeen children were partially deaf, and four of these may be educationally sub-normal. During the course of the year four boys left. Three went to residential schools for the deaf, and one has been attending the George Gascoigne Secondary School (for children with normal hearing). Eighteen new children were admitted during the year of all ages between two to thirteen years and of all degrees of deafness and mental development. There were three qualified teachers at the end of 1951. The annual examination by the Aural Specialist was carried out in addition to the usual medical inspection. School for Educationally Sub-Normal Children. Miss R. E. A. Lock, Headmistress, reports:— The average number on roll was 65. Two boys and three girls were excluded as ineducable. Four boys and four girls proceeded to employment during the year. So far, only one boy has failed to hold a job. The School was visited by students in training on two occasions. Three batches of E.S.N. Diploma Students from London University visited the School. A Psychologist from the Royal Eastern Counties Institute has carried out further research during the year. A Social Science Research Worker from the same Institute has been following up those who have left school recently, in order to ascertain the Social Quotient. Some of the senior scholars entered for the local School Sports and all stayed the course. Eight swimming certificates were gained during the year. 42 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's good health record was not maintained at the beginning of 1951. Attendance during the Spring term was the lowest I have ever known owing to Influenza and colds in January and February and an outbreak of Dysentery in March. Everything possible was done to prevent the spread of Dysentery, but the result was disappointing as fifty-one children and three adults caught the disease. During the rest of the year the children's health was good. 16. MISCELLANEOUS (i) Employment of Children.—142 children were examined by the medical staff. (ii) Employment of Children in Public Entertainments.— Seven children were examined under these regulations. (iii) Staff Appointments.—87 teaching staff and 265 other staff were examined during the year. STATISTICAL SUMMARY I. MEDICAL INSPECTION. A. Routine Inspections 5,900 B. Special Inspections and Re-inspections 1,700 C. Pupils found to require treatment 1,488 II. DEFECTS FOUND AT MEDICAL INSPECTION. Requiring treatment 1,828 For observation 2,444 CLASSIFICATION OF GENERAL CONDITION OF PUPILS. Nutrition 'A'—Good 3,475 „ ' B'—Fair 2,351 „ 'C '-Bad 74 5,900 43 III. INFESTATION WITH VERMIN. Total number of examinations 33,559 Individual pupils found to be infested 840 IV. TREATMENT. (a) Minor Ailments—total defects treated 3,010 (b) Defective Vision and Squint— Errors or refraction 486 Other defects 108 Pupils for whom spectacles were—prescribed 898 obtained 843 Orthoptic Clinic—cases treated 202 (c) Nose and Throat Defects—number treated 328 (d) Orthopaedic and Postural Defects— Treated as in-patients 14 Treated otherwise 832 (e) Child Guidance and Speech Therapy— Number treated under Child Guidance arrangements 231 Number treated under Speech Therapy arrangements 280 (f) Dental Inspection and Treatment— Number inspected— (i) Routine Age Groups 1,836 (ii) Specials 4,530 Number found to require treatment 5,685 Number actually treated 5,754 Attendances made for treatment 14,607 Half-days devoted to—Inspection 19 Treatment 2,527 Fillings—Permanent teeth 3,258 Temporary teeth 969 Extractions—Permanent teeth 1,382 Temporary teeth 4,690 Administration of general anaesthetics for extraction 3,453 Other operations—Permanent teeth 5,891 Temporary teeth 2,732