WAL 36 BOROUGH OF WALTHAMSTOW Committee for Education REPORT of the BOROUGH SCHOOL MEDICAL OFFICER for the year 1952 A. T. W. POWELL, M.C., M.B., B.S., D.P.H. BOROUGH SCHOOL MEDICAL OFFICER 67975 BOROUGH OF WALTHAMSTOW Committee for Education REPORT of the BOROUGH SCHOOL MEDICAL OFFICER for the year 1952 A. T. W. POWELL, M.C., M B., B.S., D.P.H. BOROUGH SCHOOL MEDICAL OFFICER 1 CONTENTS Accommodation 10 Artificial Light Treatment 35 Aural Clinic 21 Boarding School Education 36 B.C.G. Trials 33 Child Guidance 26 Clinics 8 Committee Members 4 Convalescent Home ment 33 Co-ordination 10 Crippling 23 Dental Defects 16 Dental Hygiene 18-50 Dental Treatment 18 Diphtheria 35 Diphtheria Immunisation 36 Disinfection of Gym. Shoes 37 Ear Disease 16 Ear, Nose and Throat Clinic 21 Employment of Children 52 Enquiry Officers 41 Epidemic Nausea and Vomiting 35 Exclusion 35 Eye Clinic 20 Eye Disease 15 Follow-up 16 Good Grooming 52 Handicapped Children 43 Health Education 50 Hearing 16 Heart Disease 16-25 Hygiene 10 Impetigo 14 Invalid Children's Aid Association 41 Infectious Disease 35 Liaison with Hospital Services 7-10 Meals, Provision of 40 Medical Inspection 13 Medical Treatment 17 Milk in School Scheme 40 Minor Ailments 14-17 N.S.P.C.C. 42 Nursery School 50 Nutrition 14 Open Air Education 36 Orthopaedic Treatment 16-23-44 Orthoptic Treatment 21 Paediatric Clinic 30 Parents, Co-operation of 41 Physical Training 37 Re-inspection 13 Rheumatism 25 Ringworm 14 Scabies 14 School Hygiene 10 School Camps 36 Special Schools 43-45 School for the:— Deaf 47 Educationally Sub-Normal 50 Partially Sighted 46 Physically Handicapped 46 Skin Diseases 14-17 Specialist Clinics 19 Speech Therapy 31 Squint 15 Staff 7-10 Statistical Summary 52 Swimming 37 Teachers, Co-operation of 41 Tonics 17 Tonsils and Adenoids 15 Tuberculosis 16-33 Uncleanliness 14-17 Vaccination 36 Vision 15 Voluntary Bodies 41 Whooping Cough 35 WALTHAMSTOW COMMITTEE FOR EDUCATION 1952 - 1953 Chairman: Councillor S. N. Chaplin. Deputy Chairman: Alderman W. H. Shaw. Ex-Officio: The Worshipful the Mayor: Councillor W. F. Savill, j.p. The Deputy Mayor: Alderman Lord McEntee, c.b.e. Chairman of the Finance Committee: (Walthamstow Borough Council): Alderman Ross Wyld, O.B.E., J.P. Aid. Mrs. L. P.- Bailey, j.p. Aid. G. S. Mace. Aid. H. C. Fisher. Aid. A. E. Manning. Aid. W. B. Fitt. Aid. Lady McEntee, J.P. Aid. E. C. Redhead, J.P. Coun. A. W. Ellis. Coun. Mrs. E. M. Miller. Coun. H. Fulton. Coun. E. G. Richards. • Coun. A. E. Simmons Mrs. H. A. Christy. Mr. R. Lamb. Mr. C. S. Garratt. Rev. J. E. McKinley. Rev. D. A. Kino. Rt. Rev. Mgr. W. O'Grady, v.g. Borough Education Officer: E. T. Potter, B.sc. 5 To the Chairman and Members of the Walthamstow Committee for Education. Once again I have the honour of presenting a report on the work of the School Health Service in the Excepted District of Walthamstow. It has been another year of good work and steady progress, and the following matters appear to justify comment. The frequency of changes in the medical staff causes disquiet and is bound up primarily with the unsatisfactory position in regard to recruitment to the health services generally. The resignation of Dr. Mary Sheppard was referred to in last year's report but although away through sickness for a large part of 1951 the resignation actually became operative early in 1952. It is difficult to replace a medical officer of nearly 30 years' service in a town like Walthamstow, and especially to re-establish the intimate knowledge of the family life of those with whom the work lies. Of necessity, the recruitment of many of the professional staff now has to rely on married women. The arrangement with Whipps Cross Hospital whereby members of the School Nursing Staff accompany the Paediatrician and begun late in 1951, was extended in 1952 to the medical staff. Accommodation in schools is often taxed, and in the last six years there was an increase of 3,512 children on roll since 1947, or an increase of 21.3%. This has at times produced difficulties in regard to the conditions under which medical inspections are carried out. At long last a commencement has been made with the remodelling and renovation of some of the unsatisfactory sanitary accommodation at schools. Turning to the findings of medical inspections, there were at least 479 dirty children discovered at head inspections. Although this represents a lower percentage than that found in many areas it leaves no room for complacency. The difficulty here is that of dealing with a hard core of dirty families which keep up infestation. There was a considerable increase in the incidence of squint and reasons are suggested. The nutritional condition of children was good and those of poor nutrition only represented half of those found in 1951. The position in regard to dental staffing continues far better than in many comparable towns. The assistance of a dental hygienist became available—and with marked success. Attendances at minor ailment clinics have now apparently reached a new but reduced equilibrium since the appointed day of the National Health Service Act, which made available free medical service to dependants. 6 The end of the year, and more especially the beginning of 1953 brought a threat to the continuance of the specialist clinics in their present form. The Regional Hospital Board appears to envisage the absorption of these clinics into the general hospital service which would appear to be a very great pity. A new system has been operated in order to communicate the findings of specialists in the School Health Service to the family doctors in regard to their own patients. The preventive aspect of Child Guidance in seeking out behaviour difficulties in pre-school children has proved well worth while. A reference is made in the report of the Educational Psychologist to the new departure in starting voluntary classes for adolescent illiterates and with promising results. Unfortunately difficulties continue in regard to the routine chest X-ray examination of school -staff on appointment, and the Local Education Authority will apparently not approve the payment of travelling expenses of such staff when attending a Mass Radiography Unit. The Medical Research Council's Field Trials with B.C.G. appear to be promising and the follow-up period has now been reached with good attendances even though the participants have left school. The Mass Radiography Unit is to re-visit the Town in 1953 and a good acceptance rate has already been recorded both for staff and children. A special report is contributed by one of the organisers of physical training, and bears tribute to the excellent work done in Walthamstow through many years. The provision of school meals reached a percentage of 45 and of 75 in regard to school milk. A special section is included with regard to the outstanding achievement of the former Walthamstow Education Committee in the provision of special schools for handicapped children. It would not be proper to conclude this introduction without expressing appreciation to the Chairman and Members of the Committee, the Borough Education Officer and his staff, and not least, to all the staff of the School Health Service, and all others who carried out the work or helped in it, or who have contributed to this report. I am, Your obedient Servant, A. T. W. POWELL, Medical Officer of Health and Borough School Medical Officer. 7 1. STAFF OF THE SCHOOL MEDICAL DEPARTMENT There has again been considerable variation in medical staffing during the year. Dr. Sheppard found it necessary to resign on medical grounds early in the year after a prolonged absence through sickness; Dr. Currie resigned in July; and Dr. Irani was granted maternity leave from September to December. The services of Dr. Collmann and later Dr. Carter were obtained, both as permanent appointments, and Dr. Beattie again did temporary duty during the period of Dr. Irani's absence. Such frequent changes of medical staff do not make for the maintenance of a satisfactory service, although the position now appears fairly stable. Liaison with Hospital Services. During the autumn of 1951 the appropriate Committees agreed that the Health Visitors and School Nurses should in turn attend the ward rounds of Dr. Hinden, Paediatrician, Whipps Cross Hospital, who holds a fortnightly session at the Town Hall Clinic. At the end of a trial period of six months it was apparent to all concerned that the arrangement was well worth while. Information as to home conditions became more fully and quickly available to the Paediatrician and, after the child's discharge from hospital, the School Nurse ensured that his advice was followed in the home. For the School Nurse her knowledge is kept up to date and she learns of new advances in the treatment of children's diseases. During 1952 the arrangement was extended to the medical staff, who in turn accompany the Paediatrician on his ward rounds and with benefits similar to those outlined above. The position in regard to Dental staffing has shown a definite improvement. A dental surgeon previously employed part-time was appointed full-time and at the end of the year a further full-time officer was engaged. In the Orthoptic service the help ol Miss Donovan was obtained in June for two sessions per week. Mrs. Sylvester and Miss Donovan together devoted six sessions per week to the clinic until December, when Mrs. Sylvester began maternity leave. Miss Donovan has since then carried out three sessions per week, leaving three sessions unstaffed until early in 1953. 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. 8 Appointments. Date Appointed. Miss D. Anklesaria, lds, rgs. Dental Officer 3.4.52 Mrs. Joyce Beattie, mb, bs, dph. Asst. County Medical Officer 22.9.52 Mrs. Philippa Currie (nee Asst County Medical Officer 25.8.52 Carter), mb, bs. Mrs. June Collmann, mb, bs. Asst. County Medical Officer 1.2.52+ Mrs. A. H. Daniels, bds. Dental Officer 15.12.52 Miss E. A. Donovan, dbo. P/T Orthoptist 11.6.52 Mrs. J. M. A. W. Foulkes, srn, Supt. Health Visitor/School scm, Hv.cert. Nurse 29.12.52 J. E. G. Vincenzi, .mrcs, lrcp, dpm. P/T Psychiatrist 14.2.52* Resignations. Date Resigned. Mrs. Joyce Beattie, mb, bs, dph. Asst. County Medical Officer 21.12.52 Trevor T. Currie, mb, bs. Asst. County Medical Officer 4.7.52 Mrs. J. Haynes, srn, scm. School Nurse 3.10.52 Miss A. C. Keenan, srn, scm, Supt. Health Visitor/School hv.cert. Nurse 24.12.52 Miss K. Muntlay, srn, scm, hv.cert. Health Visitor/School Nurse 30.12.52 Miss M. Sheppard, ma, mb, b.cii, bao, dpm, Barrister-at-Law. Asst. County Medical Officer 18.1.52 J. E. G. Vincenzi, mrcs, lrcp, dpm P/T Psychiatrist 29.12.52 *Appointed by Regional Hospital Board, †Dr. Collmann also performed locum tenens duty from 21.1.52 to 31.1.52. SCHOOL CLINICS Aural— Monday 2 p.m.—4.30 p.m. Town Hall. Cardiac and Rheumatism— Monthly (Friday) 2 p.m.—4 p.m. Town Hall. Child Guidance— Monday 10 a.m.-1 p.m. Child Guidance Clinic, to Friday 2 p.m.—5 p.m. High Street, E.17. Dental Clinics— Monday to 9 a.m.—4.30 p.m. Town Hall. Friday Saturday 9 a.m.—12 noon Town Hall. Monday to 9 a.m,—4.30 p.m. 1, Guildsway. Friday 9 Saturday 9 a.m. —12 noon 1, Guildsway. Monday Wednesday 9 a.m.—4.30 p.m. Sidney Burnell School Tuesday 2 p.m.—4.30 p.m. West Avenue. Thursday 9 a.m.—4.30 p.m. West Avenue. Friday 9 a.m.—4.30 p.m. West Avenue. *Minor Ailments— Monday Wednesday Friday 9 a.m.—12 noon Town Hall. Saturday Tuesda.v 19 a.m.—11 a.m. Sidney Burnell School Friday Monday 9 a.m.—11 a.m. Low Hall Lane. Thursday Paediutric— Alternate Thursdays 9 a.m.-12 noon Town Hall. Ophthalmic— Tuesday 2 p.m.—4 p.m. Town Hall. „ . . 9 a.m.—12 noon Town Hall. Friday 2 p.m.—4 p.m. Town Hall. Saturday 9 a.m.—12 noon Town Hall. O rthnpaedic— Monthly (Wednesday) 9 a.m.—12 noon Open Air .School. Massage and Sunlight— Monday to 9 a.m.—5 p.m. Open Air School. Friday Orthoptic— Wednesday 9 a.m.—4.30 p.m. Town Hall. Speech Therapy— By appointment 263, High Street and Open Air School. 10 * 1minimisation— Wednesdays 2 p.m. Town Hall. *Scabies and Infectious Disease Contacts— Wednesdays 11 a.m. Town Hall. All Clinics, except those marked * are "appointment" Clinics. 2. CO-ORDINATION (a) Staff—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 6½ whole time nurses. (b) Family Doctors,—Improved arrangements were made during the year to keep the family doctor informed as to the findings of specialists in regard to children referred for specialist diagnosis and treatment. (c) Reports from Hospitals—Except in one notable instance (the paediatric department of a nearby hospital) few hospitals send a summary on discharge of children admitted to their wards. When such summaries are received they are of great value and are attached to the appropriate medical inspection files. 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:— Boys 1 Girls Mixed Infants Nursery County Secondary Grammar 2 — — — County Secondary Technical — — 2 — — County Secondary Modern 2 2 6 — — County Primary Junior 2 2 12 — — County Primary Infanls — — — 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 — — 1952 1951 1950 1949 1948 Number of Children on Register, 31st December 19975 18970 18211 17652 17154 Average attendance 16587.8 16561.6 15993.5 15950.7 14928.9 Percentage attendance 82.9 87.0 87.8 90.3 86.7 The increase in the number of children on the school registers in six years amounts to 3512, i.e. 21.3% of the 1947 roll. 11 Mr. Frank H. Heaven, A.R.I.B.A., Architect to the Education Committee, contributes the following:— Additional Sites.—Additional lands, to increase the areas of school sites, have been acquired at Wood Street School (Corbett, Road), Joseph Barrett Secondary Schools (in Chestnut Avenue and Brooke Road), and Wm. Elliott Whittingham Secondary Boys' School (in Higham Hill Road). The site at Wood Street has been fenced. Additions and Alterations.—Two additional classrooms with cloakroom space have been constructed at Coppermill Junior Mixed School. The building is of non-traditional construction and includes many new features in its framework of aluminium, thermacoustic wall, ceiling and roof construction, factors of daylight and artificial light illumination, and thermal control of artificial space heating. One of the blocks at the Hale End Special School has been converted to house the Wm. Morris Deaf School, and a new lavatory block erected. A Group Hearing Aid Room is soon to be added. Galleries have been removed, floors levelled, relaid and treated with plastic at six schools. Amenities.—These have been provided at a number of the schools in the form of Garden Beds, Shelving, Exhibition Panels, Blackboards, Screen Doors, Stage Platforms, Sun Blinds, Wardrobes and Needlework Cupboards. Sealing of floors of staff rooms (2), classrooms (4), halls (9) and gymnasiums (3), renewal of floor coverings, additional ventilation, new footway, and mesh fences to railings and boundary walls, seats in playgrounds and playfields. Central Kitchens.—The buildings and apparatus have been maintained in good order, improvements made to food stores and operation rooms, and a new staff lavatory provided at Wood Street kitchen. Further Education.—The play area at the George Gascoigne school has been re-surfaced, improved lighting to facilitate the playing of games in one hall and the provision of electric points for craftwork at another centre. Gymnasium.—Several halls in secondary schools have been equipped with gymnasium apparatus, such as booms, climbing ropes, wall bars, etc., and the floors sealed with plastic. 12 Heating.—Existing systems have been maintained, and major extensions and improvements made at two schools. Supplementary heating installed at five schools, an accelerating pump at one and new boilers at two schools. Oil heated radiators are held in reserve to meet any emergencies which may arise from the breakdown of normal heating apparatus. Lighting.—improvements have been effected and consumption of electricity reduced by the installation of fluorescent lighting at four school halls. Stage lighting has been installed at two schools and external lighting at two other schools. The replacement of existing gas lighting by electric lighting has been recommended for the Woodford Green Primary School. Maintenance.—All education properties have been maintained in a good condition of repair, vacuum cleaning of newly decorated premises continued, and windows were cleaned five times a year. Play fields.—These are maintained by the Ground Staff. Special works, as the new fence at Salisbury Hail Schools Playfield and the preparation and seeding of new sites have been carried out by contractors. The demolition of an insanitary lavatory block at North Walthamstow Sports Ground has improved the play area. One of the temporary dressing pavilions at Salisbury Hall Schools Playfield was burnt down. Its re-erection is being considered. An additional site at Temples Field has been acquired. It has been levelled, seeded and fenced. Cricket nets and pitches and jumping pits have been provided at four playfields. Playgrounds.—These have received the usual maintenance and annual repairs and surfacings. The ground at Mission Grove Infants' School has been regraded and newly surfaced. Provision of Meals and Milk.-—'The canteens at schools are maintained in good condition. Remodelling has taken place at the Joseph Barrett School and fixed windows have been converted into opening windows, for ventilation purposes, at three school kitchens. Extraction fans have been provided at fourteen canteens. Renovations.—Complete renovation of the interiors of eight schools has been carried out during the year, also the interiors of six other buildings, as well as the interior of the Youth Employment Bureau Hall. 13 Sanitation.—The conversion from automatic flushing to individual flushing of W.C's has been carried out at two schools. New lavatory basins w ith cold and hot water services have been installed at nine schools. The provision of new W.C's and new lavatory basins with cold and hot water services for both sexes are in hand at Coppermill Road Secondary School, and tenders for similar schemes at the Coppermill Road and Forest Road Junior Mixed and Infants Schools have been accepted. Hot water services have been provided to staff lavatories at two schools and to scholars' basins at one Infants' School. The showers have been renewed at one gymnasium. The distempering of all external lavatories has been carried out. Visual Aids.—The installation of apparatus and screens has continued and halls or rooms have been provided with blackout blinds or curtains at fourteen schools. War Damage Reinstatement.—Substantial progress in reinstatement has been made at five schools and at two other educational premises. Civil Defence Reinstatement.—Reinstatement of the grounds at the Monoux building has been completed. Sanitary Arrangements.—Routine inspections were made by the sanitary inspectorate and various minor defects were brought to light and remedied. 4. MEDICAL INSPECTION. The following gives a summary of the returns: — A. Periodic Medical Inspections— Entrants 2,173 Second Age Group 1,312 . Third Age Group 1,490 Others 133 5,108 B. Other Inspections— Special Inspections 159 Re-inspections 1,927 2,086 Owing to the increase in the number of children on the school rolls (21.3%) since 1947 and the consequent overcrowding of accommodation it was not always possible for medical inspection to take place under satisfactory conditions. Special facilities have been provided in the newer schools. 14 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" Bad No. % No. % No. % Entrants 2173 1473 67.79 687 31.62 13 0.59 Second Age Group 1312 936 71.34 373 28.42 3 0.24 Third Age Group 1490 1176 78.99 307 20.60 7 0.4 Others 133 64 48.12 63 47.37 6 4.5 Totals 5108 3649 71.43 1430 28.0 29 0.57 (b) Uncleanliness.—The following table gives comparative figures for the past two years:— 1952 1951 Average visits to schools 4 4 Total examinations 38,733 33,559 No. of individual children found unclean 479 724 Percentage uncleanliness of average attendance 2.9 5.1 The number of individual children found in England and Wales in 1950 to be infested represented 7% of the school population, and 6% in 1951. In Walthamstow the highest and lowest percentages since 1947 were 6.2 in 1949 and 2.4 in 1952. The average number of children found to be unclean during these six years was 873 or 4.8% 6f the school population. Individual inspections in the schools ranged between 43,141 in 1950 and 32,671 in 1947. Although the percentage found unclean in 1952 was the lowest ever recorded, the existence of 479 unclean children in the schools leaves no room for complacency. (c) Minor Ailments and Skin Defects.—The following was the number of skin defects found to require treatment and observation:— Treatment Observation Ringworm—Head 3 — Body — — Scabies — — Impetigo 5 1 Other skin diseases 107 53 15 (d) Visual Defects and External Eye Diseases.—The number of patients requiring treatment and observation was as follows:— Treatment Observation Visual defects 351 152 Squint 104 40 External Eye Diseases 60 49 Squint.—The totals of children requiring- treatment or observation for squint during the last five years, and the totals of medical inspections and re-inspections were:— 1948 1949 1950 1951 1952 Treatment and Observation 50 82 68 88 144 Medical Inspections and re-inspections 7,679 7,342 7,042 7,600 7,194 The annual number of medical examinations did not alter materially and enquiry is proceeding as to the reasons for the apparent increased incidence which may be linked with that of whooping cough and measles. There is also increased awareness on the part of the medical and nursing staff of the need for early treatment and knowledge of the facilities which are available. It is hoped that parents and teaching staff will be equally aware of the need to bring any case of squint, however slight, under observation at the earliest possible age. Dr. R. Bulsara, D.O., D.O.M.S., considers that the apparent increased incidence may be accounted for by the following reasons:— 1. The increased care of mothers regarding the physical well-being of the children. 2. The popularity of the Infant Welfare Centres, and the care and knowledge of the medical and nursing staff in detecting squint and in referring minor degrees of squint which previously might not have been detected or referred for treatment and observation. 3. Close co-operation between teachers and the medical staff. (e) Nose and Throat Defects.—The number of patients requiring treatment and observation was as follows:— Treatment Observation Enlarged Tonsils 50 151 Adenoids 14 6 Enlarged Tonsils and Adenoids 40 41 Other conditions 136 98 16 (/) Ear Disease and Defective Hearing.—The number of patients requiring treatment and observation was as follows:— Treatment Observation Defective hearing 35 18 Otitis Media 36 30 Other Ear Diseases 10 10 (g) Orthopaedic and Postural Defects.—A total of 401 deformities were found to require treatment. (h) Dental Defects.— Inspection at Schools. Requiring' Children General Other TreatPer Actually Inspected. ment. Cent. treated, ings. tions. thetics. tions. 2,653 1,874 70.7 6,153 4,603 7,149 4,445 9,620 (i) Heart Disease and Rheumatism.—The findings were as follows:— Treatment Observation Heart Disease—Organic 6 13 Functional 4 64 Anaemia 16 11 (j) Tuberculosis.—All children suspected of tuberculosis are referred to the Chest Physician for final diagnosis. The notifications of tuberculosis in the age group 5-15 years have been as follows:— 1948 1949 1950 1951 1952 Pulmonary 7 9 5 9 5 Non-pulmonary 4 5 2 4 4 Totals 11 14 7 13 9 (k) Other Defects and Diseases.—The following shows the number of various other defects which were found to require treatment:— Enlarged glands 35 Epilepsy 4 Bronchitis 97 Other defects 179 Speech 28 6. FOLLOW-UP. The School Nurses paid a total of 2,010 home visits during 1952. 17 7. ARRANGEMENTS FOR TREATMENT. (a) Tonics.—The following- shows the quantities of tonics issued during 1952:— Cod Cod Liver Oil Cod Liver Parrish's Syrup Lacto- Liver Oil and Malt and Oil. Food. phosphate. and Malt. Parrish's Food. Emulsion l5½lb. 190 1b. 34 1b. 1,282 1b. 2,102 1b. 51 lb. (b) Uncleanliness.—Treatment with Suleo was carried out 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 charge of a medical officer. The number of cases of skin disease is shown in the following table detailing the work done at the school clinic:— First Inspections Re-inspections Boys Girls Bovs Girls Ringworm—Scalp - - - — Body — 2 — — Scabies 1 1 — 1 Impetigo 17 12 26 28 Other Skin Defects 79 82 265 246 Verminous Head 18 101 132 733 Discharging Ears and Deafness 52 46 199 198 Tonsils and Adenoids 33 22 37 37 Defective Vision (including squint) 56 81 7 23 External Eye Diseases 101 119 92 118 Sores 7 4 7 5 Various 1149 1007 2846 2648 Totals 1513 1477 3612 4032 First attendances number 2,990 against 3,106 in 1951, and re-attendances 7,644 against 6,894, the total attendances being 10,634 against 10,000. The following table shows the new cases and attendances at Minor Ailment Clinics since 1948. The position now appears to be fairly static and probably reflects the tendency for children to be taken to their family doctors 1948 1949 1950 1951 1952 New Cases 5,086 3,757 3,356 3,106 2,990 Attendances 16,490 14,112 11,515 10,000 10,634 18 (d) Dental Treatment.—Mr. L. W. Elmer, Senior Dental Surgeon, submits the following- report:— I am happy to report that during 1952 there was a definite improvement in the staffing position. During the year a dental surgeon previously employed in a part-time capacity was appointed as a fulltime officer and in the closing weeks of the year a further full-time officer was engaged. This occurred too late to make any great difference to the work undertaken during the year under review, but I have high hopes that in the future a greater proportion of the school population may be inspected and treated regularly, with increased conservative work and, I trust, fewer extractions. This conservatives work is waiting to be done and can only be done if more time can be devoted to it—and the less conservative work that is done the more extractions will be needed. It will thus be seen that a great effort will be needed to break a vicious circle. Although 200 less Half days have been devoted to treatment this year 800 more children have been inspected under routine age groups. This is in spite of the fact that over 2,000 more "specials" have presented themselves for treatment. Administrations of general anaesthetics have increased by 1,000. Four hundred more children have been treated in about the same number of attendances as last year. Fillings in permanent teeth have increased by about 600, but total extractions are increased by over 1,000. Orthodontic treatment, dressings, etc., are a little down, but conservative treatment for deciduous teeth has increased by 1,000. The above would appear to be a "mixed bag" of results, but until it becomes possible to inspect all children regularly we cannot expect the proportion of conservative to extraction work to improve appreciably. The results would appear to be satisfactory as representing an interim period. Dental Hygiene.—Miss Watts commenced duty as Dental Hygienist in Walthamstow in December 1951, and it was arranged for her to attend on two days per week. Initially much of her work was the scaling and polishing of teeth of school children, but it soon became obvious that the type of mouth requiring this sort of treatment was, fortunately, very rare. It became clear that much more useful work of this kind was needed in the mouths of expectant and nursing mothers. Even here, the supply was far from inexhaustible. 19 It was finally decided that the hygienist could most profitably spend her time, apart from the limited number of grossly dirty mouths, in giving both individual and group tuition in dental hygiene. In this she has been outstandingly successful. She has shown great enthusiasm for her work and reports from headmasters, headmistresses and health visitors confirm the success of her lectures and individual tuition. Miss Watts could have saved a great deal of dental officers' time if she had been permitted to apply topical silver nitrate applications to already stoned interstitial cavities in temporary teeth, but this is apparently not allowed. (Note by S.M.O.—Further comments are given under Health Education on page 50). A summary of the work done at the clinic during the year is shown in the statistical tables at the end of the Report. (e) Specialist Clinics.—With effect from the 1st April, 1952 the Local Education Authority decided to transfer the responsibility lor the specialist clinics to the Regional Hospital Board. The clinics concerned were the Cardiac, Ear, Nose and Throat, Ophthalmic, Orthopaedic, and Paediatric Clinics. In addition the responsibility for the medical staffing of the Child Guidance Clinic was transferred to the Regional Hospital Board. This decision was received with regret by the Committee, which urged the Local Education Authority to continue the administration of the specialist clinics as part of the School Health Service. The Committee also considered that prior consultation with the Borough Council as the Divisional Executive for an Excepted District, should have been undertaken. During 1953 the Regional Hospital Board has apparently decided to transfer or even to absorb some or all of these specialist clinics into the Group Hospital. This appears to be most inadvisable since most of the children attending these clinics are not really invalids but are suffering from some variation from the normal and it would not appear advisable for them to mix with the acute and chronic sick—largely adult—in a crowded out-patients department. The existing facilities are claimed to be adequate and there would be difficulty in knowing the findings of Lhe specialist at the hospital. The Committee has decided lo make strong representations on the matter to the Local Education Authority. If the clinics are to be taken away from the School Health Service, then at least there should be separate sessions for children at hospitals and they should not be "absorbed" into the existing Hospital Service. 20 (i) Eye Clinic.—The following tables show the work done in 1952:— New Cases Under 7 years 7-11 years Over 11 years Total Boys Girls Boys Girls Boys Girls Boys Girls Hypermetropia 17 25 14 18 10 12 41 55 Hypermetropic Astigmatism 15 21 23 29 14 29 52 79 Myopic Astigmatism 2 3 4 10 14 28 20 41 Mixed Astigmatism Myopia 2 2 14 11 34 42 50 55 Other Eye Defects 9 15 9 12 9 17 27 44 No visual defects 18 22 13 13 12 16 43 51 Total 63 88 77 93 93 144 233 325 Number of children for whom glasses were—Prescribed 955 Obtained 995 Number of re-inspections 2,988 Number of treatments 55 Total attendances 3,701 Inspection of Children attending the School for the Partially Sighted. Dr. Evans contributes the following' table, which shows the classification of children attending the Partially-Sighted School and who were examined during the year at the Eye Clinic. 1 Congenital Defects— Cataracts 9 Coloboma (complete) 1 Albino 4 Nystagmus 7 2. Acquired Defects— Refractive errors—High myopia 13 Optic atrophy 3 Ophthalmia Neonatorum with Anterior polar cataract 1 Choroido retinitis 2 Keratitis 2 21 Supply of Spectacles. The attendance of the dispensing optician from the Hospital Management Committee is of very great advantage to all concerned. (ii) Orthoptic Clinic.—Mrs. E. Silvester, D.B.O., has contributed the following report on the work done at the clinic:— Number of cases investigated 135 Number of cases treated for squint and amblyopia 206 Number discharged 100 Number referred to hospital for operation 52 Number operated on 33 Total attendances during year 2,005 (iii) Ear, Nose and Throat Clinic.—Dr. Francis Clarke reports as follows:— During the past year, 1952, ihe attendances at the regular weekly E.N.T. clinic have kept well up to the average of previous years. Those children who were examined at the aural clinic and for whom it was considered necessary to have a course of special treatment at the treatment clinics also attended regularly to complete their treatment. There are always a few who will either not attend, or fail to complete the treatment but this number is usually very small. During the course of the year a system was introduced of making a special report for the general practitioner with whom the patient is registered, in each new case referred to the clinic. The medical officer who in the first instance refers the child to the E.N.T. clinic for examination, etc., records the essential clinical notes of the conditions which he finds on a special form and this form, with notes, is sent to the clinic with the patient. After detailed examination at the clinic, the final clinical findings, diagnosis and suggested treatment are filled in the space provided on the form and a copy is sent to the general practitioner and school medical officer. The principle of the system is sound as it establishes a useful liaison between the family practitioners and the Public Health Service. The main defects found amongst the children seen at the E.N.T. clinic were much the same as those referred to in previous reports. I must again note the considerable reduction in the instances of chronic ear discharge. There were less than a dozen cases of chronic otorrhoea seen during the year and of these, three were old post-operated mastoids which are usually verv intractable. 22 Zinc ionization is the standard treatment which was found most successful for the majority of cases of chronic otorrhoea but in the case of post-operated mastoids it is not always successful. I have found in these long standing operated cases a considerable improvement with the use of some new 'antiseptic' drugs such as Chronalgicin, Chloromycetin, etc., applied locally in the operation cavity after the necessary cleansing out. The best treatment for chronic ear discharge, is its prevention and in this connection 1 wish, again, to stress the importance of the adequate treatment of ear discharge in its earliest stage to prevent both chronic discharge and its usual sequel, impairment of hearing. A considerable number of patients referred to the clinic for such common conditions as frequent colds, recurring sore throats, deafness, nasal obstruction and mouth breathing, etc., have been found to be suffering from nasal sinus infection. The incidence of sinus infection amongst children complaining of the above symptoms is much greater than is commonly suspected. This can be explained by the fact that the cardinal signs of nasal infection are not always obvious and can be discovered only on a detailed examination and a test wash-out of the sinuses. A number of these cases were found at the clinic during the year and all were very satisfactorily treated by Proetz nasal displacement method, using weak ephedrine, warm normal saline, albucid, etc., solutions. Correctly employed this is a valuable method of treatment besides its importance in diagnosis. In suitable cases of nasal obstruction, e.g., hypertrophic rhinitis, mouth breathing, impaired hearing, etc., I have extensively used, as in previous years, Gautier's nasal diastolization method. The results in suitable cases are excellent and the improvement in hearing in cases of deafness of certain types is remarkable as compared with the usual methods of syringing the ears, nose drops, Politzer inflation and the removal of tonsils and adenoids, which in the majority of instances, do not appear to shew any improvement. I will only briefly refer to the subject of the removal of tonsils and adenoids. The principle here remains the same as reported at some length in past years. The tonsils should not be removed until a thorough and detailed examination is made of the nasal cavity, nasal sinuses and other possible factors, to exclude any possible primary source secondarily affecting the tonsils. In the majority of instances when such exciting factors are located and treated, the 'tonsils' subside without further trouble. The indication for the removal of adenoids is 'absolute' i.e. when they are found, definitely, to be a cause of nasal obstruction. 23 Treatments for practically all the E.N.T. defects found after examination at the clinic, are carried out at the aural clinic or the treatment clinics arranged in connection with the aural clinic. Only those cases which require operation, such as the removal of tonsils and adenoids, mastoid operation, those cases requiring" a very special investigation for deafness, and hearing aids, are referred to hospital. Approximately these are not more than a dozen in the course of the year. I find that the general results of clinic treatment carefully carried out are very satisfactory. The other special clinics i.e., the dental, eye, psychiatric, speech, chest and heart clinics, have been very helpful in connection with certain cases seen at the aural clinic. Occasionally associated with ear, nose and throat abnormal conditions are defects which come within the scope of these other specialities, requiring special opinion and treatment. The fact that these special clinics are situated locally, have regular sessions and times, are easily accessible and have been very co-operative, plays an important part in the smooth running and success of the aural clinic and is a great advantage to the general well being of the patient. Besides, this arrangement is very convenient for the parents, saving time, longer journeys and delays in the necessary examination, which must inevitably happen when children are referred to distant centres. The usual annual sessional E.N.T. clinic for the deaf children at the School for the Deaf was held during the year at the school. Treatment for those requiring' it was arranged at the aural clinic. The general health of the children seen at the ear, nose and throat clinic during the year, apart from their particular ear, nose or throat defects, was very satisfactory. Only a very small number could be considered below the average standards of development and nutrition. The number of children who attended the clinic and total attendances during the year are shown in the Statistical Summary at the end of this Report. (iv) 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;— 24 ORTHOPAEDIC SCHEME Defects. Boys. Girls. 5-16 years. Under 5 years. Over 16 years. 5-16 years. Under 5 years. Over 16 years. Anterior Poliomyelitis 8 1 7 13 3 8 Surgical Tuberculosis 2 — 1 — — — Scoliosis, Lordosis, Kyphosis 38 1 — 48 1 1 Arthritis 1 — 2 — — 2 Rickets—(a) Genu Valgum 15 13 — 20 9 — (b) Genu Varum — 14 — 4 8 — Pes Piano Valgus 141 11 — 93 13 — Spastic Paralysis 7 1 2 5 2 - Progressive Muscular Atrophy 2 1 - - - - Osteo Genesis Imperfecta 1 — — — — - Talipes—(a) Equino Varus 10 1 3 2 5 1 - (b) Calcaneo Valgus 1 - 1 6 - (c) Pes Cavus 6 — 1 — — - (d) Mid Tarsal Varus 2 — — — 1 - Torticollis 5 3 — 9 2 — Osteomyelitis 1 — 2 — — 1 Congenital dislocation of the hip — — 5 — 1 Schlatters disease 1 — — 2 — — Cerebellar Ataxia 1 — — 3 — — Spina bifida 2 — — — — — Hallux Valgus - — — 25 — — Hammer Toe 4 — — 3 — — Perthes disease - — — — — 1 Achondroplasia - — — 1 — 1 Amputation leg - — 1 — — 2 Digitus Varus 2 — — 6 — - Internal derangement of knee 1 — — 1 — — Erbs paralysis — 1 — — — 1 Kohlers disease — — — 1 — — Congenital defects 11 3 1 9 — — Miscellaneous 22 2 — 29 — — Totals 284 55 19 283 46 18 25 Number of cases seen by Surgeon: — From Physically Defective School 32 From other Schools 295 Under School Age 85 Over School Age 16 Total 428 New cases seen by Surgeon:— School Age 56 Under School Age 37 Total 93 Total number of examinations made by the Surgeon 521 Total number of cases discharged by the Surgeon 119 Average number of examinations per session 57.9 Number of Treatments given 3,736 Number of attendances for after-care 2,833 Number of ultra-violet light treatments 2,215 Total number of treatments 8,784 Average number of attendances per session 19.6 Number of sessions held—Inspection 9 Treatment 448 Number of visits by Instrument Maker 12 Admissions to Hospital 18 Operations performed 19 (v) Heart Disease and Rheumatism.—The Specialist Clinic in the charge of Dr. Mary Wilmers has continued on a monthly basis. It is a pleasure to record that Dr. Wilmers has carried on the work commenced by Dr. Wilfred Sheldon on a weekly basis in 1931. The fewer sessions now necessary are a reflection of the fewer cases of these conditions now found in children. The follow ing is a report on the work done at the Clinic during 1951:— Number of sessions 9 ,, ,, attendances 83 ,, ,, new cases 18 ,, ,, old cases 28 ,, discharged 20 ,, still under treatment 22 ,, of new cases with rheumatic or cardiac defect 3 ,, referred to Hospital—Out-patient — In-patient 2 ,, referred for dental treatment 1 to begin full-time school 1 26 (vi) Child Guidance Clinic.— The Senior Psychiatrist, Dr. Helen Gillespie, reports as follows:— Staffing.—During 1952 the number of psychiatric sessions worked per week was nine, five of these being- devoted to the cases referred by the Borough of Walthamstow and Chingford, and four to the other areas, which include the Borough of Leyton and the Forest Division. The number of sessions worked was increased this year due to the appointment in February of Dr. Vincenzi, who, however, resigned in December. In September an additional Play Therapist, Miss Elizabeth Daunton, was appointed for two sessions per week, thus bringing up to six the total number of play therapy sessions worked. Comments.—It will be observed that the figures for cases closed during the year show a slight increase, corresponding to the increased number of psychiatric sessions worked, and that the various categories of results of treatment remain in much the same proportion. The waiting list has been reduced from 138 at the end ol 1951 to 70 at the end of 1952, although there has been a slight increase in the number of cases referred. This gratifying change may be attributed to the greater amount of psychiatric time available. Prophylactic work with pre-school children.— This clinic has now been running for a year, and is held on alternate Tuesday mornings. Most of the cases are referred by the medical officers in attendance at the Child Welfare Clinics in the Borough. During the first year 19 children have been diagnosed and treated, and fourteen of these have already been discharged after satisfactory results were obtained. A further five are still under observation or treatment. These figures confirm the wisdom of the Authority in setting up this clinic, and the good results that can be obtained by this form of early treatment at a pre-school stage, as I predicted in my last annual report. 1 found this group of mothers particularly receptive and co-operative, and this has contributed largely to the good therapeutic results obtained with children. I would like to see an expansion of this side of the work, and would welcome yet more cases. I hope that all the Child Welfare Services in the Borough will make use of the facilities provided. Such a clinic may offer some solution to certain of the problems in the non-physical sphere which are so often presented to the paediatrician, as pointed out by Dr. Hinden in his report for 1951. The following is an analysis of the cases treated: — Habit disorders 6 Sleep disturbances 1 Fears 5 Behaviour disorders 7 27 TABLE I. Analysis of figures for 1952 Number of cases referred to the Clinic 140 ,, ,, ,, diagnosed at the Clinic 1ll (a) Psychiatrist. Diagnostic interviews 1ll Treatment interviews 543 Other interviews 2 (b) Psychologist. Cases treated 352 Treatment interviews 411 Other interviews 25 School visits 147 (c) Play Therapist. Treatment interviews 186 (d) Psychiatric Social Worker. Interviews at clinic 870 Interviews elsewhere 29 (e) Waiting list at 31.12.52. Cases for diagnosis 28 Awaiting treatment 2 ( The above table includes Chingford cases) TABLES II and III. Analysis of Problems Referred and Cases Diagnosed Re- Diag- ferred nosed I. Nervous disorders, e.g., fears; depressions; apathy; excitability 28 38 11. Habit disorders and physical symptoms, e.g. enuresis; speech disorders; sleep disturbances; tics; fits; etc. 53 27 III. Behaviour disorders, e.g. unmanageable; tempers ; stealing ; lying; sex problems; etc. 44 36 IV. Educational, e.g., backwardness; failure to concentrate 15 8 V. No basic disturbance of child, i.e., mainly parenlal anxiety — 2 140 111 (The above tables include 17 cases referred and 15 cases diagnosed from Chingford). TABLE II.—Cases Referred. Source Boys Girls Total Head Teachers 116 52 168 School Medical Officers 48 25 69 Parents 10 —- 10 Borough Education Officer 3 — 3 Speech Therapist 3 3 6 Hospitals, Private Doctors, etc. 3 2 5 Juvenile Court 2 1 3 Others 7 2 9 28 TABLE IV. Analysis of Cases Closed during the Year (including cases referred in previous years) Improved and recovered after treatment 46 Improved after partial service, i.e. before diagnosis 24 Diagnosis and advice only 11 Interrupted, e.g. on parents' initiative 37 Closed for miscellaneous causes (removed from area, placed at E.S.N. School, etc.) 12 130 (The above table includes Chingford cases) REPORT OF THE EDUCATIONAL PSYCHOLOGIST FOR 1952 Miss E. M. Smith, M.A., contributes the following: — The psychologist has continued to be responsible for work in both Walthamstow and Chingford schools. In this report figures for Walthamstow schools only are shown. During the year 352 children were given individual tests (277 Walthamstow and 75 Chingford). There was a slight increase in the proportion of girls to boys, as compared with last year; 65% of tests were given to boys, 35% to girls. The ages of children tested ranged from three years six months to sixteen years six months. Their places in the schools are shown in the following table:— TABLE I.—School Placement of Children seen by Psychologist Pre- Sec. School Infants lunior Modern Grammar & Technical Special Totals Boys 8 44 64 25 8 43 192 Girls 3 32 30 10 2 8 85 These children were brought to the notice of the psychologist hv the ap-eneies listed below: — 29 As one would expect, teachers are the main source of reference to the psychologist. The children are also referred for a variety of reasons, but the main school reason is failure in school attainment. This is sometimes a failure in a specific subject (e.g. reading), and sometimes a general poverty of attainment. TABLE III.—Reasons for Test Requests. Boys Girls Total "Backwardness" 68 30 98 Specific failure in reading 16 6 22 Request for assessment of intelligence 40 25 65 Need for suitable school placement 24 22 46 Anxiety states 14 14 28 Anti-social behaviour 14 12 26 Enuresis 7 2 9 Stammer 4 1 5 Vocational Guidance 6 2 8 Review of old cases 19 3 22 Miscellaneous 6 4 10 It is appropriate to point out here that of the 92 children referred as "backward" 38 of them (41%) had I.Q's above 90, i.e., they were of average or better intelligence. The range of I.Q's within this 38 was from 90 to 149 (average 107). The two children with highest I.Q's (140 and 149) were both failing in secondary modern schools. Two children were at Grammar Schools and two at Technical Schools. The scope of these failures surely indicates the urgent need for more remedial classes under properly trained teachers. One such class is arranged in Walthamstow at Secondary Modern level. The range of I.Q's amongst the total number of children tested is given below. TABLE IV.—Intelligence Rating. Boys Girls Total Above 130 15 2 17 116-130 21 8 29 85-115 101 52 153 70-84 40 33 73 Below 70 41 26 67 Out of a total of 67 children (54 Walthamstow, 13 Chingford) with I-Q's below 70, 22 are already attending an appropriate special school. The remaining 45 (36 Walthamstow, 13 Chingford) are either ineducable or are attending normal schools. The need for more accommodation and teachers for the educationally subnormal remains urgent. 30 During the year the psychologist made 147 visits, allocated to the different types of school as follows: Nursery and Infant Schools 34 Junior Schools 56 Secondary Modern Schools 31 Grammar and Technical Schools 6 Special Schools 20 Four children have been visited in their homes. The psychologist has continued to give coaching to children with particular difficulties. Twenty have had individual coaching, while two remedial groups for secondary modern girls have attended after school hours for help in reading. Group tests of intelligence and attainment have been carried out at three junior schools at the head teachers' request. When a class for illiterates over school age was formed in Walthamstow , the psychologist helped in a voluntary capacity in the initial ascertaining of reading levels, and later in teaching a group, as the whole class proved to be too large to he satisfactorily dealt with by one teacher. Not the least important part of the work is lecturing to teachers and parents. During the year a course of lectures was given to teachers on "Psvchologv in the Service of the Schools." Lectures to parents and youth leaders have been given on a varietv of topics. These have been well attended and the great number of questions asked shows clearly the need parents have of such instruction, and their anxietv to do the "right thing" for their children. In the Spring term, a student psychologist from the Birmingham University Remedial Education Centre did some practical work in the Walthamstow schools under the supervision of the psychologist. (vii) Paediatric Clinic.— The clinic was continued under the clinical charge of Dr. Elchon Hinden, Paediatrician to Whipps Cross Hospital, who reports as follows:— Work in the clinic has proceeded on the same fines as in 1951. The bulk of the children seen have presented minor deviations from the normal, or else have been suffering from behaviour disorders. Acute medicine has, rightly, been absent; a pleasing feature has been the very small number suffering from chronic rheumatic heart disease. I have the impression that in height and weight the children compare favourably with those born before the war, and I think that the standard of parental care is rising also. Poor housing still seems the major detrimental environmental factor. The radiological and pathological departments at Whipps Cross Hospital have continued their welcome service to the clinic, 31 so greatly enhancing its value. A number of children have also been admitted to hospital there for investigation and treatment. I am grateful to my colleagues, the Assistant School Medical Officers, for referring the children to me. Under 5 years Over 5 years New cases 17 62 Total attendances 25 94 Physical Defects: (a) Asthma — 2 (b) Heart disease — 2 (c) Other 7 13 Referred to Hospital 1 13 Discharged 1 5 Psychological Disorders: (a) Enuresis 4 36 (b) Other — 3 Referred to Hospital 2 33 Discharged . — 1 (/) Speech Therapy.—Treatment centres are provided at the Old Education Offices, High Street, and at the Open Air School. It is the practice of both therapists to refer for I.Q. assessment any child who does not respond to treatment. The location of the Child Guidance Clinic at the Old Education Offices facilitates this arrangement. Miss C. M. Gregory reports as follows:— This year 144 children were treated, a decline of 13 on last year. The boys needing treatment outnumber the girls by 2 : 1. In the past five years the numbers in this clinic have fluctuated surprisingly little considering that in 1947 the children were born and reared during the unsettled days of the war, whilst now in these quiet days one might expect a different type of child and fewer numbers. But this does not obtain. A quick survey shows the following numbers treated: — 1948 186 1950 152 1949 201 1951 ... 157 There is a slight decline this year on all previous years. Fewer children were admitted and the greater proportion of these were dyslalies and lisps. One third were stammerers. There is still a continued inflow of pre-school children, which reflects on the awareness of parents of the facilities provided. Eighty-one interviews were given, 40 school visits were made and five homes were visited as a follow-up measure. The attendances in the holidays were quite good, being on the average 33% of total attendance 32 I would like to thank the transport officer for his able and constant care this year. Also the members of the Child Guidance Clinic who have been unfailingly helpful in giving their time and advice to various cases. Miss A. M. Hemnifngs reports:— This year a greater number of children have been seen. In consequence the waiting list has been eliminated, enabling cases to be interviewed almost as soon as they have been referred. As usual there was a preponderance of dyslalic cases, a number of these having an open bite jaw due to thumb sucking. Many children were suffering from catarrh which would have been a great deal less troublesome had parents taught them to use a handkerchief regularly. The visits to schools proved most beneficial. The majority .of cases in the clinic were referred as a result of consultation with head teachers. It has been found necessary to pay more frequent visits to the infants' schools to deal with the large number of cases in this age group. In this way it is hoped to keep the number of children to be treated from junior and senior schools at a minimum. Annual Report and Clinical Analysis. High St. Clinic Open-Air Sch. Clinic No. of cases in attendance at beginning of year 95 69 New cases admitted during year 47 47 Transfers from other clinics 2 7 144 123 Cases ceasing attendance before cure or discharge 1 5 Cases discharged improved and incapable of benefitting by further treatment 4 3 Cases temporarily discharged before cure, to resume treatment later 3 2 Cases discharged cured 34 52 Transfers to other clinics 10 3 Cases still in attendance at enrt of year 92 58 Total attendances during year 2884 2688 Number of Cases suffering from : 1. Physiological or Psychological defects— (a) Stammer 37 30 (b) Clutter 13 1 2. Voice defects— (a) Dysphonia - 1 (b) Rhinophonia 12 4 3. Defects of articulation— (a) Dysarthria — 4 (b) Dyslalia 76 76 4. Language defects— Delayed speech 2 3 5. Probable mental deficiency 4 4 144 123 33 (g) Convalescent Home Treatment.—131 children were sent away for convalescence during 1952. There were 10 children remaining in convalescent homes and hospital schools on December 31st, 1952. (h) Tuberculosis.— The number of school children examined for the first time during the year was 99 boys and 91 girls, of whom 23 boys and 18 girls were referred by the school medical staff, and 76 boys and 73 girls by private practitioners. 158 children were examined as contacts. PROTECTION OF SCHOOL CHILDREN AGAINST TUBERCULOSIS. 1. Chest X-ray Examination of Teachers on Appointment. The position in regard to this matter was set out in the report for last year, including the reasons leading to the cessation of the former practice of requiring all newly appointed staff (except clerical) to undergo a chest X-ray examination. Although the local Chest Clinic has been equipped with an Odelca miniature X-ray apparatus it has so far not proved possible for staff to be referred as a routine. Instead, every endeavour has been made to refer staff for chest X-ray examination to the Mobile Mass Radiography Unit and the static unit at Finsbury but the difficulties in such an arrangement are obvious when compared with local facilities. Unfortunately, travelling expenses have to be borne by the persons concerned. Every endeavour will be made during 1953 to operate the recommendations of Ministry of Education Circular No. 248 in regard to the initial and annual chest X-ray of all staff concerned with groups of children. 2. B.C.G. Immunisation. The Anti-Tuberculosis Vaccine Trials of the Medical Research Council continued with success, and preliminary results show a good response in regard to re-attendances even after school leaving. There is also an apparent maintenance of the tuberculin positive conversion which it is hoped indicates protection. The statistics for 1952 were as follows: — Slimmer Leavers, 1952.—Admitted in their penultimate Term at school: — No. of school leavers 440 No. of acceptances 268 Percentages of acceptances 61.0 No. attending first test 243 Total positive to OT 1/3000 and 1/100 101 Total inoculated BCG 48 No. of controls 66 34 Easter Leavers, 1952.—Admitted in their final term at school: — Total completing examination and admitted to trial 21 Total positive 10 No. inoculated with BCG 4 No. of controls 7 Follow-up of volunteers was commenced in June and of a total of 276 under observation, 225 returned for the annual X-ray, i.e., 81%. Dr. T. M. Pollock, Physician in charge of B.C.G. Trials has very kindly contributed the following report:— During the year the Medical Research Council's Clinical trial of the anti-tuberculosis vaccine, BCG, has continued in Walthamstow. This scheme is designed to determine whether the vaccine, at present used in Britain for nurses and others in contact with the disease, is of sufficient value for It to be advised for general use. Those participating in the trial are all volunteers from Secondary Modern Schools, and over 50,000 young people from North London, Manchester and Birmingham are taking part. In Walthamstow the intake of volunteers from the schools began in November, 1950 and finished in February, 1952. Eight hundred and sixty-three young people from the Borough are now in the scheme. Each child had, on entry, a chest X-ray and skin test, and a proportion were given the vaccine. To determine the efficacy of the vaccine it is necessary to keep a close watch on all taking part for the next three years, and this is being done in two main ways. The first is by regular visits from Health Visitors. In Walthamstow each volunteer is visited twice a year by a Health Visitor, who keeps the child in touch with the scheme and records the necessary medical details. This work, so essential in this research, has been carried out by the Health Visitors with enthusiasm and with painstaking care. It is a pleasure to record how well the work is being done. The second way in which volunteers are supervised is by taking an annual chest X-ray of each, to determine if unsuspected tuberculosis is present. Tuberculosis is a common disease in young people, and these annual chest X-rays are thus an important health safeguard. They are carried out at the West Avenue Welfare Clinic by mobile mass radiography methods. The sessions are held in the late afternoon and evening, and the Health Visitors assist in the work. A very high proportion—85% of the volunteers to whom appointments have been sent, have taken advantage of the opportunity to have a chest X-ray. This good response at the annual re-examination has.been most heartening, and it is a true indication of the high degree of help and co-operation accorded by the Borough. We are confident that this response will be maintained to the end of the trial. 35 3. Special Investigations. Routine tuberculin patch testing takes place at school clinics and whenever a case of tuberculosis is notified in a teacher or child, the fullest investigation is undertaken. During 1952 only one case of tuberculosis became known amongst school staff. This was a cook at one of the school kitchens who had long been under observation and treatment at a teaching hospital where she was ultimately found to be sputum positive. At the end of the year arrangements were in hand to examine all her colleagues, who agreed, without exception to undergo chest X-ray examination. (t) Artificial Light Treatment.—The total attendances for treatment were 2,215. 8. INFECTIOUS DISEASES. Notification in the 5-15 years age group during 1952 was as follows, the figures for 1951 being shown in parenthesis: Scarlet Fever, 327 (85); Diphtheria, Nil (Nil); Pneumonia, 15 (12); Erysipelas, Nil (Nil); Meningococcal Infection, 1 (Nil); Measles, 868 (1,085); Whooping Cough, 81 (262); Dysentery, 2 (34); Poliomyelitis, 3 (4). 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 Mumps Various Total 126 168 11 81 41 427 Epidemic Nausea and Vomiting.—Reference was made in the 1951 Report to this condition under the heading of "Gastric Influenza". In January 1953 attention was drawn to vomiting which had affected teachers and staff during the autumn term at one of the High Schools for Girls. Three members of the staff and 19 pupils were involved. The conditions resembled that noted in the 1951 Report and continued after the re-opening of the school in 1953. Up to the end of January 6 more staff and 20 additional pupils had suffered from vomiting. The 1953 cases were accompanied by a few cases of catarrhal jaundice. 36 During the five years to 1951 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 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 1951 120,900 58.1 99.3 83.0 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 1,072 411 38.3 Girls 1,101 423 38.43 2nd Age Group Boys 520 173 33.27 Girls 792 291 36.5 3rd Age Group Boys 751 188 25.0 Girls 739 222 30.0 Others Boys 76 18 23.7 Girls 57 12 21,1 5,016 1,702 34.0 Immunisation against Whooping Cough.—This is available to pre-school children only since the severity and danger of whoopingcough is less at school age. 9. OPEN AIR BOARDING SCHOOL EDUCATION. During the past year, 7 boys were medically examined prior to returning, at each term, to Elmbridge Boys' School, Cranleigh, Surrey, and a further 28 boys and girls received examinations before proceeding to Kennylands Park School, Reading, Berks., for the Spring, Summer and Autumn terms. 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 1952 1,461 (a) Pre-school age 1,177 (b) School age 284 (c) Over school age — Immunisation at Schools (included above): — Number immunised 216 Number awaiting second dose 7 Number already immunised given an extra dose 1,452 37 Premises at the Jubilee Retreat, Chingford, became available in July and were used by parties from most of the Special Schools. 10. PHYSICAL TRAINING. The Committee shares the services of two whole-time Organisers with a neighbouring area. Co-operation has continued along the lines of previous years. Disinfection of Gymnasium Shoes.—Disinfection by the application of a powder followed by dry heat, and referred to in last year's report, was found to be not satisfactory. After considerable trial, a method was evolved by which shoes were left in contact for 60 minutes with formaldehyde vapour in the central chamber of a steam disinfector. Sufficient steam was admitted to produce a slightly humid atmosphere, and no damage was apparently done to the material. Bacteriological tests were satisfactory. Swimming.—The following report has been contributed by L. E. Last, Esq., the Organiser of Physical Education: — Introduction.—The promotion of education in swimming has been the declared policy of the Ministry of Education for at least 20 years, and the undoubted value of swimming as an exercise for health and development entitles it to rank high as part of the normal physical training of every medically fit child. The most outstanding feature of the development of school swimming during the post war years has been a real improvement in facilities due (a) to the generous co-operation of the Principal of the South-West Essex Technical College, whereby the College Bath is now available for classes from the South-West Essex Technical School, the Sir George Monoux Grammar School and the Walthamstow High School daily from 9.00 a.m.—4.00 p.m., and until noon on Saturday (b) to the more liberal provision of transport by school buses, and (c) the appointment of two fully qualified specialist swimming teachers. Organisation of School Classes.—With few exceptions school swimming classes are organised on a voluntary basis, and under existing staffing regulations, this selection of pupils creates obvious difficulties. The increase in available weekly pupil-places from 2,900 in 1939 to 3,800 in 1952 suggests that consideration might now be given to the possibility of treating swimming as an integral part of the curriculum for the last year in Junior and the first year in Secondary Schools. Our aim must be to produce the maximum number of swimmers and there is a very real need for the provision of an additional bath specially designed with a large shallow water area for use during the initial stage of instruction. Good relationships have been established by the specialist and visiting class teachers, the majority of whom are able to render 38 valuable assistance with the coaching. The cork hand floats provided at the High Street Baths have proved most useful. During 1952—49,266 attendances were recorded at the High Street Baths, 27,033 boys and 22,233 girls, while attendances at the Technical College bath averaged approximately 1,800 weekly. Holiday Swimming.—From 4.30—5.30 p. m. Monday to Friday, and from 9.00—10.30 a.m. on Saturdays and during school holidays, children are admitted to the High Street Baths at the reduced charge of 2d. In 1952, good use was made of this concession by 10,816 boys and 5,553 girls. These figures possibly reflect the effect of the demands of domestic duties made upon the leisure time of the girls. Royal Life Saving Society's Examinations.—During the Autumn and Spring terms three periods a week were reserved at the High Street Baths for the preparation of candidates for these examinations, and during 1952, the following successes were gained: — Intermediate Certificates 43; Bronze Medallions 36; Bars to Bronze 3; Bronze Cross 1. Mention must also be made of the excellent work by individual schools in preparing pupils for these examinations, either during the normal school swimming periods, or conducted as an out-ofschool activity. The following awards were gained :— School Intermediate Certificates Bronze Medallions Bronze Bars 12 3 4 Bronze Crosses Instructor Certificate Award of Merit Sir George Monoux G.S. — 25 - 2 1 6 Woodford High — 32 15 16 2 1 — 8 2 Wm. Morris Tech. School 7 14 - 2 — — J. Barrett Sec. Boys — 8 - — 1 — Winners of the Bronze Medallion are granted a pass giving free admission to the High Street Baths and the continuation of this generous concession is much appreciated as an incentive in encouraging pupils to undertake this valuable and strenuous training. Walthamstow Schools' Swimming Association.—Another important post-war development has been the formation of the Walthamstow Schools' Swimming Association. The enthusiastic officers and committee of this Association conduct periodic examinations in a comprehensive set of standards involving correct style in a variety of swimming strokes, as well as the usual speed tests. These tests, sponsored by the L.E.A. and adopted by the Essex Schools' Swimming Association are largely based on tests devised by the Walthamstow Association to promote progressive training 39 and their use for the past 6 years has resulted in a marked improvement in style as well as speed. Tribute must also be paid to the excellent work of the Association in organising the competitive work of school swimming, and the following extracts from the Hon. Secretary's Annual report gives some indication of the scope of this valuable and efficient work: — Swimming Certificates awarded in 1952.—(1951 figures in brackets). Primary 905 (890) Intermediate 20 (16) Elementary 312 (192) Advanced 3 (4) Speed Tests.—1st Class 6 (18), 2nd Class 19 (12), 3rd Class 15 (17). Special Training Classes for promising swimmers.—In addition to the usual Summer Term special classes at the local baths, some of the most promising swimmers were selected to attend a special course at the S.E. Essex Technical College, Barking, under the able direction of Mr. C. Laxton. Excellent progress was made. Walthamstow Schools' Swimming Galas.—Once again the annual highlight of the work of the Walthamstow Schools' Swimming Association proved a great success. The amended regulations resulted in closer contests for aggregate points, and helped to "spread" the distribution of individual trophies. We were very grateful to Councillor S. Chaplin, our President, for supplying an additional trophy. Keen enthusiasm was well sustained for the three consecutive evenings occupied by these Galas early in July. The W. E. Taylor Shield for the highest percentage of children able to swim, provoked tremendous enthusiasm throughout the year. Joseph Barrett Boys' School won this trophy for the Secondary Schools by achieving the splendid standard of 58.4% of scholars "on roll" able to swim at least 25 yards, and Mission Grove Primary School retained the trophy for Junior Schools for the second year, with 27% of the members of 3rd and 4th year scholars able to swim. I liter-District T earn Races at neighbouring galas were regularly supported by our boys' and girls' teams who consistently gained "runners-up" places except at West Ham, when the boys' team won. Schoolboys and Schoolgirls Team Championships in Essex.— It is gratifying to note that five teams from individual Walthamstow Schools competed and that two Boys' and two Girls' teams reached the finals. The Essex County Schools' Championship at Leyton in July provided a very keen contest for our best swimmers, who competing in all events, succeeded in 'winning' through to most finals, but secured only one County Championship, viz., the Breast 40 Stroke (Girls under 15). Five girls and two boys from Walthamstow represented Essex at the Eastern Counties Championship held at Stowmarket, Suffolk, and for the third year in succession helped the County to secure an overwhelming 'victory' by winning 32 events out of a possible 34. One girl (a County Champion), from McGuffie School won the girls' 100 yards under 15 Breast Stroke Championship. These five girls also represented the Eastern Counties at the English Schools Championships held at Bristol in October. They recorded very good times in their events, but failed gloriously to win National honours in a memorable competition which included Olympic swimmers. Individual School Galas.—A further indication of the growing interest and enthusiasm in swimming is given by the steady increase in the number of schools—6 in 1952, which organised successful school galas. These galas involve much extra work for the Bath Superintendent and his staff, to whom we are indebted for ever ready and willing service. 11. PROVISION OF MEALS. During October and November the daily number of meals exceeded 9,000 or some 45% of the numbers on the School Roll. During the same period the daily milk meals total averaged over 15,000 per dav or some 75% 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 1952, 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 4 Test Results— Bacteriological—all satisfied the Methylene Blue and Phosphatase tests. Biological—all negative. 41 12. (a) CO-OPERATION OF PARENTS The following table shows the attendance of parents during 1952 at the periodic medical inspections:— Number Inspected Number of Parents Per cent 1952 Per cent 1951 Entrants— Boys 1,072 986 91.8 78.4 Girls 1,1.01 1,014 92.15 83.4 2nd Age Group —Boys 520 365 70.2 61.6 Girls 792 624 78.8 73.9 3rd Age Group —Boys 751 285 37.9 22.8 Girls 739 294 39.5 30.6 Others— Boys 76 40 52.63 49.5 Girls 57 33 57.89 63.1 The importance of parental attendance at medical inspections cannot be over-stressed. It is regrettable, but understandable, that the percentage should decrease with the increasing- age of the child. The "leaver" inspections are of importance in regard to fitness for employment, and the attendance of parents at these inspections is to be encouraged. (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, especially in the use of their private and staff rooms for medical inspection—often at great inconvenience. (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 The Committee recommended that the existing arrangements for the admission of pupils to Holiday Convalescent Homes by arrangement with the Local Branch of the I.C.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:— Children referred by:— Under 5 Over 5 Hospitals 4 31 School Health Services 2 58 General Practitioners 3 41 9 130 Children referred hy : — Under 5 Over 5 Hospitals ... ... . , ... ... ... , . 4 31 School Health Services ... ... ... ... 2 58 General Practitioners ... ... ... .. 3 41 9 130 Children referred by: — Under 5 Over 5 Hospitals ... ... ... ... ... ... ... 4 31 School Health Services ... ... ... ... 2 58 General Practitioners ... ... ... .. 3 41 9 130 42 Suffering from: — Anaemia, Debility 1 14 After effects of acute or infectious illness or operation 3 58 Bronchitis or Pneumonia 1 17 Asthma — 3 Rheumatism, Chorea, Heart — 7 Nervous conditions 1 3 Diseases of:— (a) Ear, Nose, Throat 1 23 (b) Eyes — — (c) Skin 1 2 Various 1 3 9 130 Children referred for visiting, advice, help or follow-up:— Under 5 Over 5 Hospitals 3 4 Local authority under schemes for: — (a) Rheumatism — 7 (b) Orthopaedic care 2 14 (c) Child Guidance — — Voluntary bodies 1 10 General Practitioners — 2 Parents 1 15 I.C.A.A. Branches — — 7 53 Children, sent for convalescence 8 119 Children sent to R.H.B. 1 6 Children sent to R.O.A.S - — Transferred to other branches — 5 9 130 Number of home visits paid 761 (b) National Society for the Prevention of Cruelty to Children.—The following; is a summary of the work done in Walthamstow during 1952:— Nature of Offence How dealt with Neglect 30 Warned 36 Ill-treatment 6 Advised 14 Advice sought 14 50 50 Number of Children dealt with: — Under 5 years. Over 5 years. Boys Girls Boys Girls 22 17 42 37 43 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 — — (b) Partially Sighted — — (c) Deaf — (d) Partially Deaf — — (e) Delicate 20 — (f) Diabetic (g) Educationally Sub-normal 14 11 (gi) Ineducable 9 8 (h) Epileptic 3 — (i) Maladjusted 4 (j) Physically Handicapped 7 (k) With speech defect — — (l) Multiple defects — — 57 19 Walthamstow Special Schools.—The numbers of children at the special schools in Walthamstow at the end of 1952 were as follows:— Partially Sighted E.S.N. Physically Handicapped Deaf Total Percentage Walthamstow 7 58 73 9 147 63.9 Dagenham — — — 3 3 1.3 Forest 5 8 8 15 36 15.7 Ilford 1 — — 6 7 3.0 Leyton 1 — — 6 7 3.0 Romford 5 — — — 5 2.2 Middlesex 25 — — — 25 10.9 Totals 44 66 81 39 230 100.0 The numbers of children in residential special schools and homes at the end of the year were as follows:— Maladjusted 19 Delicate 5 Deaf 5 Blind 4 Epileptic 3 Cardiac 1 Educationally Sub-normal 1 38 The former Walthamstow Education Committee had a tradition, of which it may well be proud, in regard to special educational treatment. 44 The first school to be started was that for deaf children which was opened in April, 1900 at Queen's Road School with a class of 5. It was transferred to Gainsford Road in April, 1902, and from there to Hale End Road at Easter, 1952.' The provision of a group Hearing Aid has been approved, and will shortly be installed. The consultant to the Ear, Nose and Throat Clinic visits the school to see all the children once per term. The next school to be opened was that for the Educationally Sub-normal, which was commenced in April, 1903 at the Old Marsh Street School. In August, 1907 it was transferred to the Marsh Street Centre, in October, 1908 to Shernhall Street, and in October 1940 to Hale End. The third special school to be set up was that for the blind and partially sighted which was opened in February, 1918. The school is visited once a term by the appropriate consultant, who examines and advises in regard to all the children. The fourth and last special school was that for the physically defective which opened at the Joseph Barrett School in February, 1924. Since this school is so closely connected with the orthopaedic scheme (which is threatened with absorption into the Hospital Service) a special note has been compiled and is set out below. WALTHAMSTOW ORTHOPAEDIC SCHEME In 1923, Mr. Whitchurch Howell, F.R.C.S., Orthopaedic Surgeon to the then Queen's Hospital, Hackney Road, attended at Lloyd Park for one session each month in order to examine any child affected with crippling. Surgical treatment was given at the Queen's Hospital, and the work was entirely voluntary. In February, 1924, a "Physically Defective Centre" was opened at the Joseph Barrett School by utilising a portion of the building used by the Infants' School. Two good classrooms were available, a combined rest and exercise room, and a dining room and kitchen. The staff consisted of a head teacher, assistant teacher, two part-time physiotherapists, and assistant physiotherapist, nurse, cook and ambulance driver. On the 31st December, 1924, there were 55 names on the register. Mr. Whitchurch Howell was in surgical charge of the children, and daily physiotherapy was given. The annual report for that year remarks on the great strides made by the children both mentally and physically. In June, 1924, a residential hospital school for physically defective children was opened at Brookfield, Highams Park. There was accommodation for 36 children, and the staff consisted of a matron, night nurse, two part-time physiotherapists, a teacher, and visiting V.A.D's. The school was recognized by the then Board of Education. 45 The hospital was situated on the borders of Epping Forest, and was administered as a voluntary hospital. The orthopaedic hospital continued until the outbreak of war in 1939, when circumstances combined to bring about closure. The physically defective school was transferred from the Joseph Barrett School to the newly erected open-air school at Hale End on the 21st September, 1936. At the same time the ground floor rooms of Hale End House were adapted to provide a suite of 3 rooms (including a large treatment room), as a physiotherapy clinic for the Borough. With the closure of the Brookfield Hospital, Miss Garratt, one of the previous part-time physiotherapists, gave her whole time to the work of the physiotherapy clinic at the Hale End School. This arrangement has proved ideal, i.e., the location of the orthopaedic and the physiotherapy clinics at the Open-Air School where all the phvsically defective children in the Borough requiring nonresidential special education are treated and accommodated. The four special schools provide reasonably adequate facilities for handicapped children in the Borough requiring non-residential special educational treatment. The position now, however, is complicated by requests from the adjoining Forest Division to admit their handicapped children following from the rapid influx of such children from London County Council rehousing in Essex. With the removal, of the William Morris School for the Deaf to the Hale End site three of the special schools are now accommodated at Hale End, i.e., the School for the Physically Handicapped, the Educationally Sub-normal and for the Deaf and the Partially Deaf. The School for the Blind and Partially Sighted remains nearby at the Wood Street premises. The School for the Physically Handicapped and for Delicate Children was inspected by the officers of the Ministry of Education in 1949, and it is of interest to find that practically every suggestion made in Chapter XIII of "The Health of the School Child" for 1950/51 has been in operation. The one exception is the follow-up of children six to twelve months after discharge from the School and this, it is hoped, will be remedied during 1953. The various facilities at Hale End seem worthy of summary— the monthly orthopaedic clinic is held here; a whole-time physiotherapist has a large treatment room available with adequate apparatus including a mercury vapour sun lamp; a medical session is held once a week and the school nurse visits occasionally as required since there is a welfare assistant available with some nursing experience; the Consultant Paediatrician visits; one of the Speech Therapy Clinics is located here; there are facilities for bathing and for shower baths; an up-to-date prefabricated kitchen and dining room is available; the school opens during the summer 46 holidays and additional accommodation is made available in the summer at premises in Epping Forest. Intelligence assessments are made on admission and afterwards when necessary. School for the Partially Sighted. Mr. G. M. Williams, Head Master, reports as follows:— The following table gives the classification of children on a locality basis at the end of the year:— Walthamstow. Other Essex Divisions. Out County Boys 5 6 12 Girls 2 6 13 7 12 25 At the Ophthalmic Session held at the School in December, it was found that 15 children had visual Acuity (Snellen) 6/60 or less. 12 children had visual acuity of 6/36. 2 children visual acuity 6/24 and 14 children visual acuity 6/18 or more. As in the previous years the Medical Supervision of the School has been well maintained, for Dr. I. Gregory, M.B., D.O.M.S., has made two visits and given much helpful advice, Dr. Watkins has made medical inspections of selected children, and has seen all school leavers. Miss Cunnington, H.V., has regularly visited the school and has done much useful work to bridge the gap between home and school in difficult cases. I must put on record our appreciation of the very ready help and co-operation of Dr. Evans and the Staff of the Eye Clinic who have examined all children in the School during the year. On the educational side much steady work has been done. There has been some experimental work with Physical Training apparatus and the Senior Boys, who also participated in the Walthamstow School Sports. During the vonr 11 children left school as follows:— 2-—to employment. 1—to Technical College. 1—to Junior Technical College. 4—to Schools for the Blind. 2—to Residential Partially Sighted Schools. 1—to Hospital School. I would like to express my appieciation to Miss Ramage, Mr. Crosby and Miss Hardy for their efforts on behalf of the children. During the year the average attendance was 39.1 and the number on roll 42.9. School for the Physically Handicapped. Mr. G. M. Williams, Head Master, reports as follows:— This year shows an improvement in the general health of the children which has been reflected in higher all round attendance 47 figures. The experiment of an Open-Air Group in the Forest was modified this year, in the light of previous experiences, and instead of one selected Group, each class in turn visited the centre which was situated at the Jubilee Retieat, Chinglord, on a relatively high, quick draining site on the edge of the Forest. Although there were certain physical disadvantages at the site, it is generally felt that the children benefit by spending even odd days of the high summer in the country. The School continued the practice of former years in opening during the summer Holidays when again a voluntary attendance of over 90% was maintained. Selected individual children competed in the Walthamstow School Sports and it was noted that several former pupils were also competitors. The School has benefitted considerably by the wiring of two of the classrooms lor Radio reception and certain alterations of playgrounds and paths have contributed to the general welfare of the children. The Senior Girls should benefit by the new Domestic Science Room which was just completed at the end of this year. Dr. Watkins has made 33 weekly visits and has taken a keen interest in the welfare of the children. A total of 1,607 minor treatments have been given. The children on roll at the end of the year was as follows:— Delicate (Ministry of Education category E) 36 Physically Handicapped (Ministry of Education category J) 35 Others (Ministry of Education category F.H.) 8 81 The School has attempted to foster the parents of Spastic Children Association, there being now 10 children of this type in the school. I must again acknowledge my indebtedness to all Staff, teaching, medical, nursing, welfare and transport for their valued co-operation in the work of the School. School for the Deaf. Following the transfer of the school to the Hale End Site it was decided to instal a group hearing aid. Installation should be completed in 1953. With an increase in the number on roll to 39 the new premises were becoming inadequate, but the position should be eased by the provision of an extra room for the Group Hearing Aid. Mrs. I. J. M. Burt, Headmistress, reports as follows:— At the beginning of 1952 there were thirty-five children on the roll, seventeen partially and eighteen totally deaf. 48 Mrs. Corner, first assistant, was ill for three months, and Miss Black from New Zealand joined the staff. On April 8th, the school met at Gainsford Road for the last time. A deaf group has been taught there for fifty years. It was one of the first day schools in the country for deaf children. The school is now at Hale End Road. Three boys left during the year. Two were K.S.N, as well as a little deaf, but as the first defect was by far the greater, they were found unsuitable for this school. One boy left to go to Tunmarsh Lane School, West Ham. Seven new children were admitted making the final total thirtynine, fifteen of whom are partially and twenty-four totally deaf. There have been no epidemics and not one case of infectious disease. There are no "running ears'', and that is unusual in a school for the deaf. Dr. Francis Clark, E.N.T. Specialist, made his usual aural inspections, and commented on the good health and bearing of the children. At the end of the year a classification was carried out in attendances on the definitions given by Professor and Mrs. Ewing, i.e.:— CLASS 1. Those with "impaired hearing" loss of 10 to 15 decibels. Includes the slightly deaf who would be able to hear well enough from a front desk to take lessons with normal children in an elementary school. CLASS II. The "Partially Deaf" showing a loss of 20 to 40 decibels. Those not deaf enough for inclusion in a special school but too deaf to be taught with normal children. CLASS III. The "severely deaf" with a loss of 50 decibels or more. Represents the "hearing capacity" in most children in special schools for the deaf. On this basis there were 17 in the partially deaf group, the remainder being classed as severely or totally deaf. The exact classification of children is not a simple matter, and I am indebted to Mrs. Burt for the following observations:— "One or two in the baby group may eventually be classified as partially deaf, but when they are very small they do not always use the residual hearing they have, so it is difficult to be sure. I have had children who appear to be deaf, who, after acquiring language entirely by lip reading, have begun to attend to sounds 49 which, presumably, must have been within their hearing range all the time, but which at first did not interest them. So I am disinclined to make a definite pronouncement until a child has had a few terms in the baby-room. With regard to the common education of the deaf and the partially deaf, in theory I am against mixing the two categories for the following reasons:— The methods of teaching a child who already has acquired limited language through hearing, and one who has no idea that spoken language even exists, are utterly different. In the first case more vocabulary must be added to what exists already, faulty speech must be corrected, and lip reading of words already known must be taught. In the second case, every word must be acquired slowly and laboriously by lip reading, and all speech must be built up, sound by sound, from the beginning, by the Help of feeling and sight, while every language form must be presented, over and over again, and the progress is very slow. To the first, the communication of thought by spoken language is already a reality and a common-place (though its construction may be faulty), to the second it is non-existent until education begins. It is an advantage for the intelligent deaf to have the oral atmosphere and the stimulus of mixing with the partially deaf, but the latter ought themselves to have the stimulus of the companionship of the hearing, not the deaf. Here, in spite of all this, we find in actual fact that, by keeping the children separated in class, while the instruction is given, but allowing them to mix freely in out-of-class activities, the deaf benefit enormously, and the partially deaf do not seem to suffer. This would not be the case in a residential school, where the children did not spend the greater part of their lives in a normal home environment. Of course, in Walthamstow, the older children, both deaf and partially deaf, have lessons in domestic science, dressmaking, woodwork, and metal work, with hearing children in a large Secondary School, so that they are not segregated in a deaf world. This is a great spur to good speech and lip reading, and to normal behaviour. The best for which we can hope is a compromise, or the lesser evil. If bv separating the deaf from the partially deaf, the numbers would be too small to make workable units, and the deaf therefore had to go to a residential school and the partially deaf to a normal one, the damage both to mental and to emotional development would be immeasurably greater than that caused by educating them together." 50 School for the Educationally Sub-normal. Miss R. E. A. Lock, Headmistress, reports as follows:— The number on the roll has again averaged 65. During the year three boys who showed marked improvement generally have returned to secondary schools on a six months trial basis. One boy was transferred to residential school and two more were excluded under Section 57 (3). Of the six scholars who left aged 16 years during the summer term, only one low grade girl has failed to find employment. Students from London University again used the school for observation purposes. One teacher of E.S.N, children from Sweden spent a day in the school. She thought the English methods far more advanced than those in Swedish schools. My thanks for a good year are due to the excellent work of the teaching staff, and in good measure to the medical and health visiting staffs for their support. 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 Headmistress, reports as follows:— Attendance at the Nursery School during the past year has been very good apart from a small outbreak of mumps in the early part of the year. I am glad to say that pressure on accommodation is not as bad as it was and the waiting list is not so long. Recently I have admitted three children on request from the Health Services and their progress has been most satisfactory. 16. MISCELLANEOUS (i) Health Education—(a) Talks by Dental Hygienist.— In November Miss J. Watts commenced a series of talks in dental hygiene to Grammar, Technical, and Secondary Schools. In some cases arrangements had to be postponed into the New 51 Year. The comments of all Head Teachers were invited at the end of the talks, and the following extracts will be of interest. The Head Master of Sir George Monoux Grammar School reports:—"We found the talks very helpful and extremely well delivered. I should like to have the lecture repeated each year." The Head Master of William Morris Technical School states that both pupils and members of staff present were enthusiastic about the content and usefulness of the talk and also its presentation. The following are extracts from reports from the headmasters and headmistresses of secondary schools:— "We felt that her talk was valuable. It was felt that the film which was shown was in certain respects unsuitable. We felt it devoted too much attention to, and had too many very unpleasant pictures of, pyorrhea." "Her lecture is useful in consolidating previous instruction." "I believe the lecture was of real value. The film was excellent and held the attention of the scholars." "I believe this to be an excellent innovation. I would add, however, the sound film (one of the finest of its type that I have seen) added in no small measure to the general interest." "The showing of the film before the lecture was very good technique. It was a very good film, clear and easy to understand and well within the range of 2nd and 3rd years in the Secondary Modern School." "The children were obviously interested. The technicolour film was very good and helped to stimulate interest. The talk was very informative and comprehensive. It was not too technical." "It was a good talk and I would be pleased to have two talks, one to our firsts and one to our seconds." "I should welcome it again in about twelve months time. The film is one of the best diagramatic teaching films that I have seen. It is well planned in its teaching progression and the graphic representation is excellent. It really left little to be said afterwards. Handling of questions, which were numerous and sensible, was very good." "The talk proved to be both interesting and instructive." 52 (b) Good Grooming.—The lectures on good grooming were referred to on page 36 of the Annual Report for 1950. Essentially they are lectures to girls on hygiene and are given at secondary schools. Five such lectures were given in 1952. (ii) Employment of Children.—133 children were examined by the medical staff. (iii) Employment of Children in Public Entertainment.—Six children were examined under these regulations. (iv) Staff Appointments.—111 teaching staff and 262 other staff were examined during the year. (v). Medical Examination of Prospective Teachers.—As from 1st April, 1952 prospective teachers have been medically examined to determine medical fitness for training. As far as possible the examination included a chest X-ray. Ten candidates were examined during the year. (vi) Sanitary Towels in Schools.—All schools have means of issuing sanitary towels on request. Supplies are held by Head Teachers and assistant teachers. STATISTICAL SUMMARY I. MEDICAL INSPECTION. A. Routine Inspections 5,108 B. Special Inspections and Re-inspections 2,086 C. Pupils found to require treatment 1,422 II. DEFECTS FOUND AT MEDICAL INSPECTION. Requiring treatment 1,719 For observation 1,797 CLASSIFICATION OF GENERAL CONDITION OF PUPILS. Nutrition 'A'—Good 3,649 'B'—Fair 1,430 'C'—Bad 29 III. INFESTATION WITH VERMIN. Total number of examinations 38,733 Individual pupils found to be infested 479 IV. TREATMENT. (a) Minor Ailments—Total defects treated 2,770 (b) Defective Vision and Squint— Cases treated for errors of refraction 1,728 Other defects 308 Pupils for whom spectacles were—prescribed 955 obtained 995 Orthoptic Clinic—cases treated 206 (c) Nose and Throat Defects—number treated 276 total attendances 1,120 53 (d) Orthopaedic and Postural Defects- Treated as in-patients Treated otherwise 759 (e) Child Guidance and Speech Therapy— Number treated under Child Guidance arrangements 273 Number treated under Speech Therapy arrangements 267 (f) Dental Inspection and Treatment— Number inspected— (i) Routine age groups. 2,653 (ii) Specials 6,578 Number found to require treatment 8,141 Number actually treated 6,153 Attendances made for treatment 14,645 Half days devoted to—Inspection 21 Treatment 2,230 Fillings—Permanent teeth 3,879 Temporary teeth 724 Extractions—Permanent teeth 1,626 Temporary teeth 5,543 Administration of! anaesthetics for extraction—Local 229 General 4,445 Other operations—Permanent teeth 5,783 Temporary teeth 3,837 BRITISH LEGION PRESS BRITISH LEGION VILLAGE MAIDSTONE, KENT