BOROUGH OF WALTHAMSTOW Committee for Education REPORT of the BOROUGH SCHOOL MEDICAL OFFICER for the year 1954 A. T. W. POWELL, M.C., M B., B.S., D.P.H. BOROUGH SCHOOL MEDICAL OFFICER BOROUGH OF WALTHAMSTOW Committee for Education REPORT of the BOROUGH SCHOOL MEDICAL OFFICER for the year 1954 A. T. W. POWELL, M.C., M.B., B.S., D.P.H. BOROUGH SCHOOL MEDICAL OFFICER CONTENTS Accommodation 9 Boarding School Education 38 B.C.G. Trials 30 B.C.G. at Schools 31 Cardiac Clinic 22 Child Cuidance 22 Clinics 8 Committee Members 4 Convalescent Home Treatment 29 Co-ordination 9 Crippling 20 Dental Defects 14 Dental Hygiene 16 Dental Treatment 15 Diphtheria Immunisation 37 Ear Disease 13 Ear, Nose and Throat Clinic 17 Employment of Children 50 Enquiry Officers 41 Epidemic Nausea and Vomiting 34 Eye Clinic 16 Eye Disease 13 Follow-up 14 Gastric Influenza 34 Good Grooming 49 Handicapped Children 43 Health Education 49 Hearing 13 Heart Disease 14 Hygiene 9 Impetigo 13 Invalid Children's Aid Association 42 Infectious Diseases 32 Jelly Testing of School Children 30 Liaison with Hospital Services 9 Mass Radiography 30 Meals, Provision of 39 Medical Inspection 12 Medical Treatment 14 Milk in Schools Scheme 40 Minor Ailments 13 Miscellaneous 49 N.S.P.C.C. 43 Nursery School 49 Nutrition 12 Open Air Education 38 Orthopaedic Treatment 13 Orthoptic Treatment 17 Paediatric Clinic 26 Parents, Co-operation of 40 Physical Training 38 Re-inspection 12 Ringworm 13 Scabies 13 School Hygiene 9 School Camps 38 Skin Diseases 14 Special Schools 43 School for the— Deaf 47 Educationally Sub- Normal 49 Partially Sighted 44 Physically Handicapped 45 Specialist Clinics— Cardiac 22 Child Guidance 22 Ear, Nose and Throat 17 Ophthalmic 16 Orthopaedic 20 Paediatric 26 Speech Therapy 27 Squint 13 Staff 7 Statistical Summary 51 Swimming 39 Teachers, Co-operation of 41 Tonics 14 Tonsils and Adenoids 13 Tuberculosis 14 Ultra Violet Light Treatment 29 Uncleanliness 12 Vaccination 37 Vision 13 Voluntary Bodies 42 Whooping Cough 32 Whooping Cough Immunisation 37 WALTHAMSTOW COMMITTEE FOR EDUCATION 1954 - 1955 Chairman: Councillor S. N. Chaplin Deputy Chairman: Alderman W. H. Shaw Ex-Officio: The Worshipful the Mayor: Councillor Mrs. S. Candy, j.p. The Deputy Mayor: Alderman T. W. Smith Chairman of the Finance Committee (W.B.C.): Alderman Ross Wyld, o.b.e., j.p. Ald. Mrs. L. P. Bailey, j.p. Ald. S. G. Mace Ald. H. C. Fisher Ald. Lady C. McEntee, j.p. Ald. W. B. Fitt, o.b.e. Ald. A. E. Manning Ald. E. C. Redhead, j.p. Coun. C. Clayden Coun. J. W. Pringle Coun. H. Fulton Coun. W. F. Savill Coun. Mrs. E. M. Miller Coun. J. M. Wight Mrs. H. A. Christy Rev. D. A. King Rev. K. H. Druitt Mr. R. Lamb Mr. L. V. Head Canon Prendergast Borough Education Officer: E. T. Potter, B.Sc. 5 To the Chairman and Members of the Walthamstow Committee for Education. I beg to present in the pages following, a report on the School Health Service in the Excepted District of Walthamstow during 1954. The report is largely routine in nature but I would offer the following comments. There were several changes in medical staffing resulting in considerable loss of continuity in medical supervision. Uncleanliness again established a new low record but even so, 235 individual children were found to be infested. Many of these were "chronics " from sub-standard or problem families. In March, Dr. A. T. Wynne, F.D.S., a medical and dental officer of the Ministry of Education, inspected the dental services in Walthamstow. A report was subsequently received from the Ministry and became the basis of a discussion with representatives of the County Education Committee. The report referred to the need to provide individual surgeries at the Central Clinic at the Town Hall and the necessary work is to be carried out during 1955 by the erection of half-glazed metal partitions. The provision of a Recovery Room and Patients' Lavatory was recommended at the Guildsway Clinic but these items are being deferred in view of the proposed erection of the nearby Priory Court Health Services Clinic during 1955. When completed, the Guildsway Clinic will be removed to the new Health Services Clinic. The Consultant Clinics in regard to Cardiac, Ear, Nose and Throat, Ophthalmic, Orthoptic, Pediatric and Psychiatric defects, continued as in previous years. The Consultants in Charge have contributed interesting reports on the work of the clinics. Family doctors were advised of the findings and treatment recommended. Protection of school children against tuberculosis was along the lines reported in previous years with the addition of B.C.G. vaccination of school leavers. Other measures carried on from last year included chest X-ray examination of teachers on appointment, mass radiography examinations, participation in the B.C.G. trials of the Medical Research Council and the tuberculin jelly testing of school entrants. The incidence of infectious disease was smaller in total but larger in respect of measles and bacillary dysentery. The latter condition affected one group of schools quite severely, and the outbreak served to emphasise once again the need for strict personal hygiene, i.e., the washing of hands after the use of the water closet. 6 Immunisation against diphtheria and whooping cough was continued although the bulk of immunisation is done during preschool years. It is important to appreciate the need for reinforcing or " booster " doses against diphtheria during school life. The overall percentage of school children found at medical inspections to be vaccinated against smallpox was only 26.2. A " new look " in physical education is commented upon by one of the Committee's organisers. The Head Teachers of special schools have again reported on the work at their schools. The voluntary summer opening at the school for the Physically Handicapped attained a 90% attendance, hydrotherapy in the form of swimming facilities for suitable children was continued, the new Mark III hearing aids were obtained for those children found to be suitable at the School for the Deaf, and an interesting case report is given. In regard to Health Education, lectures on good grooming were continued, talks on nursing were given, a pre-nursing exhibition of the Ministry of Labour visited the Borough, and Mothercraft lectures were begun in some schools. Once again I wish to express my appreciation to the Chairman and Members of the Committee, to the Borough Education Officer and his staff, and particularly the staff of the School Health Service whose work is reported upon in the following pages. I am, Your obedient Servant, A. T. W. POWELL, Borough School Medical Officer. 7 1. STAFF OF THE SCHOOL MEDICAL DEPARTMENT The position with regard to medical staffing remained reasonably static until mid-way through the year, when both Dr. Bulsara and Dr. Thorne were granted maternity leave. During their absence the services of Dr. Williams, Dr. Bell and Dr. Clay were secured on a sessional basis. Several temporary part-time appointments were made in the professional dental staff before Mr. R. Wolf was finally appointed in a full-time capacity in July. Appointments in the School Health Service still remain delegated to the Health Area Sub-Committee, subject to review from time to time by the Committee for Education. A ppointments Dr. Marjorie Bell, m.b., b.s., d.c.h. K. Boobyer, b.d.s., m.d.s., r.c.s. Miss C. Borthwick - - Dr. Margaret Clay, m.b., ch.b., d.c.h. Mrs. H. L. Hammond, s.r.n. S. Lowe, b.d.s., l.d.s., r.c.s. A. Quaife, b.d.s., l.d.s., r.c.s. Miss B. Smith Dr. C. L. Williams, b.sc., m.r.c.s., l.r.c.p., d.p.h. R. Wolf. b.d.s.. l.d.s.. r.c.s. - Date Appointed Temp. Asst. Cty. Medical Officer 9.8.54 Temp. P/T. Dental Officer 1.4.54 Speech Therapist 1.10.54 Temp. Asst. Cty. Medical Officer 28.5.54 21.9.54 School Nurse 14.6.54 Temp. P/T. Dental Officer 8.2.54 Temp. P/T. Dental Officer 18.2.54 Dental Attendant 29.11.54 Temp. Asst. Cty. Medical Officer 26.5.54 8.7.54 3.8.54 13.9.54 Temp. P/T. Dental Officer 13.4.54* * Full time from 19.7.54 Resignations K. Boobyer, b.d.s., m.d.s., r.c.s. Miss M. Campbell, s.r.n. Miss C. Gregory Dr. Pamela J. Thorne, l.r.c.p., m.r.c.s., d.c.h. S. Lowe, b.d.s., l.d.s., r.c.s. A. Quaife, b.d.s., l.d.s., r.c.s. Miss B. Riche - - - Mrs. M. Wheeler, s.r.n. Dr. Margaret Clay, m.b., ch.b., d.c.h. Dr. Marjorie Bell, m.b., b.s., d.c.h. - - - - Dr. C. L. Williams, b.sc., l.r.c.p., m.r.c.s., d.p.h. - Date Resigned Temp. P/T. Dental Officer 29.4.54 School Nurse 30.8.54 Speech Therapist 25.8.54 Asst. County Medical Officer 1.11.54 Temp. P/T. Dental Officer 13.7.54 Temp. P/T. Dental Officer 13.3.54 Dental Attendant 29.10.54 School Nurse 19.4.54 Temp. Asst. Cty. Medical Officer 1.6.54 12.11.54 Temp. Asst. Cty. Medical Officer 21.8.54 Temp. Asst. Cty. Medical Officer 1.6.54 19.7.54 27.8.54 23.10.54 8 2. SCHOOL CLINICS Aural— Monday 2 p.m.—4.30 p.m. Town Hall. Cardiac and Rheumatism— Quarterly (Friday) 2 p.m.—4 p.m. Town Hall. Child Guidance— Monday 10a.m.-1p.m. Child Guidance Clinic, Friday 2 p.m.—5 p.m. 263, 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 Saturday 9 a.m.—12 noon. 1, Guildsway. Monday Wednesday 9a.m.-4.30p.m. Sidney Burnell School. Monday to 9 a.m.—4.30 p.m. West Avenue. Friday *Minor Ailments— Monday Wednesday 9 a.m.—12 noon. Town Hall. Friday Saturday Tuesday 9 a.m.—12 noon. Sidney Burnell School. Monday 9 a.m.—11a.m. Low Hall Lane. Thursday Pediatric— Alternate Thursdays 9 a.m.—12 noon. Town Hall. Ophthalmic— Tuesday 2 p.m.—4 p.m. Town Hall. Friday 9 a.m.—12 noon. Town Hall. 2 p.m.—4 p.m. Town Hall. Saturday 9 a.m.—12 noon. Town Hall. 9 Orthopaedic— 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— Tuesday 9 a.m.—12 noon. Wednesday 9 a.m.-4.30 p.m. Town Hall. Speech Therapy— By appointment. 263, High Street and Open Air School. * Immunisation— Wednesday 2 p.m. Town Hall. All Clinics except those marked * are " appointment " Clinics. 3. 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 seven whole-time nurses. (b) Family Doctors.—Family Doctors are informed as to the findings of specialists in regard to children referred for specialist diagnosis and treatment. (c) Reports from Hospitals.—Few hospitals send a summary on discharge of children from their wards. When such summaries are received they are of great value and are attached to the appropriate medical files. (d) Liaison with Hospital Services.—The medical and nursing staff continue to visit in turn the ward rounds of Dr. Hinden, Paediatrician, at Whipps Cross Hospital. 4. SCHOOL HYGIENE AND ACCOMMODATION Accommodation.—The following table shows the number of schools in the Borough at the 31st December: — Boys Girls Mixed Infants Nursery County Secondary Grammar 1 2 — — — County Secondary Technical — — 2 — — County Secondary Modern 2 2 6 — — County Primary Junior 2 2 12 — — County Primary Infants — — — 15 — Voluntary Secondary Modern — — 1 — — 10 Boy: > Girls Mixed Infants Nurserv Voluntary Primary — — 3 2 — County Nursery — — — — 1 Special Schools for:— Deaf — — 1 — — Educationally Sub-normal — — 1 — — Partially Sighted — — 1 — — Physically Handicapped 1954 1953 1 1952 1951 1950 Number of Children on Register, 31st December 20157 20174 19975 18970 18211 Average attendance 18139.6 17936.9 16587.8 16561.6 15993.5 Percentage attendance 90.0 88.9 82.9 87.0 87.8 The increase in the number of children on the school registers over the last eight years amounts to 3696, i.e. 22.4% of the 1947 roll. Mr. Frank H. Heaven, A.R.I.B.A., Architect to the Education Committee, contributes the following:— Sites and Properties.—A derelict property in Higham Hill Road has been demolished preparatory to the erection of additional classrooms on the site. New Buildings.—Two additional classrooms have been erected at the Chapel End School, and a contract for an additional craftroom has been let. Additions and Alterations.—Improvement of the Group Hearing Aid Room and the provision of a covered-way and seats have been completed at the Wm. Morris Deaf School. Central Kitchens.—The buildings and apparatus have been maintained in good order and sundry improvements made at the Pretoria Avenue kitchen. The interiors or exteriors of five blocks have been renovated, and War Damage repairs completed at the Wood Street kitchen. A contract has been let for a new dining room and kitchen for the Wm. Morris Technical School, and this is nearing completion. Heating.—Tenders for re-modelling of heating systems at three primary schools have been accepted, and schemes for the remodelling of the systems at the Chapel End School and the Marsh Street Youth Centre prepared. Existing systems have been maintained including the provision of several new boilers. Lighting.—Improvements have been effected in lighting in the Hall of the Wm. E. Whittingham Secondary Boys School, and needlework and other craftrooms at other schools. 11 The gas lighting at the Woodford Green Primary School has been replaced by electric lighting, and the remodelling of the electric lighting at the Woodford High School and Wood Street Junior School completed. Maintenance.—Education properties have been maintained in a good condition of repair: vacuum cleaning at all schools, and the cleaning of windows four times in the year carried out. The St. Mary's C. of E. Infants School, on transfer to the Committee as a controlled school, has been extensively repaired and improvements made in heating and lighting. Playfields.—These are maintained by the Ground Staff. Special works, as land drains (1), levelling and seeding (2), and renewal of fences (1), have been carried out by contracts. The changing rooms and showers with canteen and lavatory blocks at the North Walthamstow Schools Sports Ground have been painted inside and outside, and a new machine store erected, as well as a dressing hut at the Temples Field. Playgrounds.—These have been repaired and re-surfaced, as well as entrance drives and footway approaches. A new playshed has been erected at the Chapel End Infants School. A contract has been let for the extension of the playground at the Hale End Special School. Provision of Meals and Milk.—The canteens at schools are maintained in good condition. Improvements, such as additional hot cupboards, fish fryers, rinsing sinks, glazed sinks, etc., have been effected at five schools. A contract has been let for a new canteen and store at the Coppermill Road Junior School, and the transfer and remodelling of the kitchen at the Technical School, Hoe Street, carried out. The renovation and conversion of the former kitchen into a dining hall is also in hand. Sanitation.—The conversion from automatic flushing to individual W.C. suites has been carried out at two schools. New lavatory basins with hot and cold water supplies have been installed at one junior and one secondary school. A contract has been let for the first instalment of the new lavatories with washing facilities at the Woodford Green Primary School. All the external lavatories have been distempered. Routine inspections have been made by the Sanitary Inspectorate and minor defects reported and remedied. 12 5. MEDICAL INSPECTION The following gives a summary of the returns:— A. Periodic Medical Inspections— Entrants 1,979 Second Age Group 1,073 Third Age Group 2,030 Others 228 Total 5,310 B. Other Inspections— Special Inspections 2,055 Re-inspections 5,450 Total 7,505 Owing to the increase in the number of children on the school rolls (22.4%) 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. 6. REVIEW OF THE FACTS DISCLOSED BY MEDICAL INSPECTION (N.B.—The numbers given below refer to medical and special inspection at schools and do not include other examinations at clinics.) (a) Classification of the Nutrition of Children inspected during the year in the routine age groups:— "A" « B » "C" Number Inspected Good Fair Bad No. '% No % No. % Entrants 1.979 1,459 73.7 518 26.2 2 0.1 Second Age Group 1,073 846 78.8 217 20.2 10 0.9 Third Age Group 2,030 1,541 75.9 482 23.7 7 0.3 Others 228 135 59.2 83 36.4 10 4.4 Totals 5,310 3,981 75.0 1,300 24.5 29 0.5 (b) Uncleanliness.—The following table gives comparative figures for the past two years:— 1954 1953 Average visits to schools 4 4 Total examinations 34,547 36,031 No. of individual pupils found unclean 235 387 Percentage uncleanliness of average attendance 1.29 2.16 The highest and lowest percentages since 1947 were 6.2 in 1949 and 1.29 in 1954. The average number of children found unclean 13 during these eight years was 718 or 3.5% of 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 1954 was the lowest ever recorded, the presence of 235 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 — — Body — — Scabies — — Impetigo 3 — Other skin diseases 204 107 (d) Visual Defects and External Eye Diseases.—The number of patients requiring treatment and observation was as follows:— Treatment Observation Visual Defects 456 142 Squint 74 13 External Eye Diseases 33 47 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:— 1954 1953 1952 1951 1950 Treatment and observation 87 182 144 88 68 Medical inspections and re-inspection at school 8,332 10,714 7,194 7,600 7,042 (e) Nose and Throat Defects.—The number of patients requiring treatment and observation was as follows:— Treatment Observation Enlarged Tonsils 70 90 Adenoids 3 2 Enlarged Tonsils and Adenoids 39 35 Other conditions 55 32 (f) Ear Disease and Defective Hearing.—The number of patients requiring treatment and observation was as follows:— Treatment Observation Defective Hearing 87 31 Otitis Media 17 6 Other Ear Disease 18 9 (g) Orthopaedic and Postural Defects.—A total of 218 deformities were found to require treatment. 14 (h) Dental Defects.— Inspection at schools. Requiring Children actually treated Fillings Extractions General Anaesthetics Other Operaations Inspected Treatment Per cent. 6.435 3.671 57.0 7.385 9.283 1 9,677 5.039 8.475 (i) Heart Disease and Rheumatism.—The findings were as follows:— Treatment Observation Heart Disease —Organic 7 7 Functional 4 39 Anaemia 4 7 (j) Tuberculosis.—All children suspected of either pulmonary or other 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:— 1950 1951 1952 1953 1954 Pulmonary 5 9 5 3 — Non-pulmonary 2 4 4 4 — Total 7 13 9 7 — (k) Other Defects and Diseases.—The following shows the number of various other defects which were found to require treatment:— Enlarged Glands 15 Epilepsy 13 Bronchitis 37 Other Defects 124 Speech 23 7. FOLLOW-UP The School Nurses paid a total of 1,007 home visits during 1954. 8. ARRANGEMENTS FOR TREATMENT (a) Tonics.—The following shows the quantities of tonics issued during 1954:-— Cod Liver Oil Parrish's Food Syrup Lacto Phosphate Cod Liver Oil and Malt Cod Liver Oil and Malt and Parrish's Food Emulsion 30 lbs. 312 lbs. 18½ lbs. 719 lbs. 1,041 lbs. 41 lbs. (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 Hackney Borough Council's Cleansing Centre. (c) Minor Ailments and Diseases of the Skin.—Treatment of minor ailments is carried out at the seven sessions of the school clinics, all of which are in charge of a medical officer. The number 15 of cases of skin diseases is shown in the following table detailing the work done at the school clinics:— First Inspections Re-inspections Boys Girls Boys Girls Ringworm—Scalp — 1 — — Body — — 2 — Scabies — 1 2 I Impetigo 14 3 17 5 Other Skin Defects 63 29 163 168 Verminous Head 4 37 18 178 Tonsils and Adenoids 17 7 25 26 Other E.N.T. conditions 22 22 79 62 Defective Vision (including squint) 61 80 19 21 External Eye Disease 51 55 71 84 Sores 1 3 2 1 Various 739 572 2,093 2,200 Totals 972 810 2,491 2,746 First attendances number 1,782 against 2,397 in 1953, and reattendances 5,237 against 6,147, the total attendances being 7,019 against 8,544. The following table shows the new cases and attendances at Minor Ailment Clinics since the "appointed day" in July 1948. The decrease probably reflects the tendency for children to be taken to family doctors. 1948 1949 1950 1951 1952 1953 1954 New Cases 5,086 3,757 3,356 3,106 2,990 2,397 1,782 Attendances 16,490 14,112 11,515 10,000 10,634 8,544 7,019 (d) Dental Treatment.—Mr. L. W. Elmer, Senior Dental Surgeon, submits the following report:'— "The year 1954 was marked by a visit from a medical and dental inspector of the Ministry of Education. He pointed out that our practice of the past few years was wrong in several particulars. " An important point made was that every endeavour should be made regularly to inspect considerably more children at the schools instead of relying upon the children who presented themselves as ' specials.' A further point was that, instead of undertaking the extensive repair of badly decayed teeth at the request of parents, it should be the policy to restore larger numbers of teeth which could be done more easily and would need less time. " Again, it was suggested that less attention should be paid to the conservation of deciduous teeth and that less time be given to the more popular types of dental treatment, such as orthodontics. It was explained that this would enable larger numbers of extractions and simple fillings to be carried out. " With many patients in the middle of courses of treatment, it was obviously not possible to alter arrangements immediately, but we have commenced carrying out the suggestions made. Owing to 16 a dental resignation in the early part of the year and sickness in the latter part this has not been possible as speedily as anticipated. " Nevertheless, with less sessions worked, the number of routine inspections has been nearly doubled to a total of 6,435, fillings increased from 7,125 to 9,283 and extractions from 8,515 to 9,677. " The increase has been greater in the treatment of younger children but, at the suggestion of the late Chief Dental Officer, these children have been inspected first. " It should be noted that, of the 2,360 sessions listed as treatment sessions, 135 were carried out by the visiting orthodontist and during 252 sessions a dental surgeon was acting as anaesthetist. " In addition to the items of treatment listed in the statistical table, 61 children were supplied with artificial replacements of fractured teeth, 18 were supplied with crowns for fractured incisors and 247 orthodontic appliances were supplied for the correction of irregular teeth." Dental Hygiene.—As has been mentioned previously, there has been little necessity for scaling and polishing of teeth among school children, but Miss Watts has been very usefully and successfully employed in giving talks on dental hygiene to the schools. These talks have been illustrated by films supplied by the. Dental Board and have resulted in an ever increased interest in the dental health of both children and their parents who frequently will not wait for routine dental inspection before requesting an appointment. SPECIALIST CLINICS (All Specialist Clinics are staffed as to Consultants by the Regional Hospital Board. Day to day administration has continued unaltered.) (a) Eye Clinic.—The following tables show the work done in 1954:— New Cases. Under 7 years. 7-11 years. Over 11 years. Total. Boys. Girls. Boys. Girls. Boys. Girls. Boys. Girls. Hypermetropia 6 10 3 11 2 9 11 30 Hypermetropic Astigmatism 18 22 17 25 14 27 49 74 Myopic Astigmatism 8 13 22 13 30 26 Mixed Astigmatism 3 1 3 10 13 9 19 20 Myopia 5 — 15 18 25 35 45 53 Other Eye Defects... 10 25 8 11 4 8 22 44 No visual defects ... 7 5 14 20 17 17 38 42 Totals 49 63 68 108 97 118 214 289 17 Number of children for whom glasses were :— Prescribed 983 Obtained 983 Number of re-inspections 3,974 Number of treatments 47 Total attendances 4,524 Supply of Spectaclcs.—The attendance at Eye Clinics of the dispensing optician provided by the Hospital Management Committee is of very great advantage to all concerned. There is no compulsion to obtain spectacles through official sources and parents can go to their own opticians if they prefer. (b) Orthoptic Clinic.—The following shows the work done at the clinic:— Number of cases investigated 70 Number of cases treated 265 Number referred to hospital for operation 10 Number operated on 11 Number discharged 23 Total attendances during the year 1,316 (c) Ear, Nose and Throat Clinic.—Dr. Francis Clarke reports as follows:— " The usual weekly session of the Ear. Nose and Throat Clinic has been carried out at the Central Clinic during the past year as in previous years. Each session throughout the year has had a full attendance, including new cases, cases undergoing treatment, and those under review who have had treatment but for whom it is desirable to have periodic examinations as to progress to see if the results of treatment are being maintained, e.g., cases of impaired hearing, nasal obstruction and certain cases of chronic otorrhoea. " The majority of parents are keenly interested in the work of the clinic and the progress made by children undergoing treatment. They attend regularly as required. The children's attendance at the treatment clinics has also been satisfactory. This type of clinic serves a very useful purpose in the area of a large school population and fulfills a very important function in school medical work. A number of serious defects, many in their early stages and which can quite easily pass unnoticed by the parents, are discovered by the school medical officers at their regular school medical inspections and children's clinics. The importance of these various defects and their potential serious disabilities, not only in the local areas of the ear, nose and throat, but on the general health, if left untreated, is then explained to the parents and the opportunity is provided for these patients of having their ailments examined in detail and appropriate treatment carried out at the treatment clinics. The more important among these various defects are, impaired hearing (when only one ear is involved the condition is frequently 18 unnoticed by parents), recurring attacks of earache or otitis media which is often the precursor of serious deafness, nasal obstruction and its many sequelae, e.g., mouth breathing, impaired hearing, colds, eye effects, effect on lungs and chest and general health, etc. " Very often the importance of the early recognition and treatment of symptoms such as occasional discharge from the ear, sore throat (often the result of diseased nasal conditions), early cases of sinusitis (usually referred to by the parents as a ' chronic cold in the head' or ' chronic catarrh') is not sufficiently appreciated by parents. All these conditions and symptoms require immediate correct diagnosis and appropriate treatment to prevent later serious permanent disability. The aural clinic provides the necessary examination and treatment and the results obtained have been, in the main, very satisfactory. It has also the advantage of easy access for the children, without the risk of long travelling and the minimum of inconvenience for the parents because the majority of the children over seven years are able to attend for treatment without the parents. Practically all the required treatments are carried out at the clinics and the parents are saved the worry and trouble of trying to undertake treatments correctly, which is indeed impossible for them in most cases. " The majority of children referred to the clinic during the year were primarily cases of nose and throat affections. The number of instances of chronic discharging ears now seen at the clinic is very small, about half a dozen, and most of these are post operative mastoids of long standing with periodical recurrence of discharge. For most cases of chronic otorrhoea without mastoid complications, the zinc ionisation method of treatment is undoubtedly the most rapid and efficient. Post-operative mastoids with much granulation tissue are not suitable for ionisation. I have found during the year, two such cases to do very well and become ' dry' with Chloromycetin, used locally and daily for 10 to 12 days. It is of course essential in these cases to see that the naso-pharynx is healthy and if not the abnormal condition must receive the necessary correction. " During the course of the year a certain number of children with impaired hearing were seen at the clinic. In some of these children the hearing defect was slight but in others well marked. Except in the case of two patients who had a definite history of ear disease and previous discharge, the hearing loss in the others was due to diseased or unhealthy conditions in the naso-pharynx secondarily affecting the ear. After a course of diastolisation and ear inflation the hearing loss was restored. Most of these early cases of deafness without serious complications are amenable to treatment and will recover their hearing, but it is vitally important that they should be discovered and treated as early as possible. These cases are very important, for here is the beginning of chronic deafness later. The origin is usually an unhealthy naso-pharynx and this 19 requires close clinical exploration and correction. If left untreated the general rule is for the hearing loss to become progressive and permanent. I have found in the examination of a large number of children with defective hearing, discovered during audiometric surveys of schools, that in many cases the defect was due to an unsuspected sinusitis and when the sinus trouble was cured the hearing was restored to normal without any local ear treatment. These cases are much more frequent than is usually recognised. Sinusitis is quite common in even quite young children and is responsible for many signs and symptoms which are often wrongly attributed to other sources. "During the year a number of chronic purulent sinusitis cases were treated at the clinic. When the condition is diagnosed and this is confirmed by washing out the sinuses, a course of treatment is then given which consists usually of Proetz nasal sinus displacement therapy once a week until the return fluid is clear. The displacement treatments are carried out at the end of each clinic session. The results obtained have been remarkably good. " 'Nasal obstruction,' and this embraces a variety of forms, is perhaps one of the commonest ailments seen among school children referred to the clinic. These patients or their parents usually describe the symptoms in such popular terms as 'chronic catarrh,' 'nose always stuffy ' or ' mouth breather.' Its causes and its influence locally and on the general health, its diagnosis and treatment form a very large subject and can only be referred to here to point out the importance of finding out the origin of the obstruction and instituting immediate treatment. "The French method of treatment known as diastolisation, evolved by Professor Gautier and his staff some years ago at his Paris clinic is one of the most successful modern methods of treatment so far known for a very large number of cases of ' nasal obstruction,' especially in children. This method has been widely used for many years at the Walthamstow clinic. Generally the results are very good, indeed, in many instances, quite remarkable. Its curative effects are especially noticeable in cases of impaired hearing in children where the hearing defect is due to certain unhealthy conditions in the naso-pharynx, e.g., hypertrophic rhinitis, etc. "A speech-audiometer which shows accurately the extent of the hearing loss for speech in either ear is always available at the clinic for testing children referred with impaired hearing. As soon as these children are seen at the clinic appointments are made for them to have an audiometer hearing test. Then, after a course of treatment, a further test is made and this will show what progress has been made in recovery or otherwise. The audiometer is not suitable for testing the hearing of children under seven years of age. 20 "In the beginning of October a special aural clinic session was held at the School for the Deaf for those children attending this school. A few children were found who required clinic treatment and one with intermittent ear discharge. On the whole, the educational progress made by the children attending this school is remarkably good. The school is fitted with a Western Electric Group Hearing Aids Unit, and its advantage in assisting the teaching of the deaf are highly spoken of by the head teacher. "The general health and nutrition of the children seen at the clinic during the year were, with perhaps a few exceptions, well up to standard. Among the large number of school children who are supplied with such useful nutritional food adjuvants as cod liver oil and malt, Parrish's Food, calcium lactophosphates, etc., on the recommendation of the school medical officers were many of those patients who attended the aural clinic. This is a most useful service, for a good standard of health is a most important factor in the recovery of patients suffering from ear, nose and throat affections." The numbers of cases who attended the clinic during the year and the total attendances are shown in the statistical summary at the end of this Report. (d) Orthopaedic and Physiotherapy Clinic.—The clinic is under the Clinical charge of Mr. G. Rigby Jones, M.C., F.R.C.S., Consultant Orthopædic Surgeon at the Connaught Hospital, who has kindly contributed the following:— "The Orthopaedic Clinic at Hale End School has continued satisfactorily during the last year but the arrangements for the consultant attending have still not been made definite by the Regional Hospital Board and consequently I am continuing to attend in an honorary capacity. "During the year a depolarised galvanisation unit has been purchased through the Hospital Management Committee and this is particularly valuable in patients suffering from infantile paralysis and in the small child since it provides electrical stimulation to paralysed muscles which is not painful. "The position with regard to in-patient treatment of children at the Connaught Hospital has improved very considerably during the last year and the hospital is now able to offer almost immediate admission for those requiring it." The following tables compiled by Miss Garratt, C.S.P., Physiotherapist, show the work done at the clinic:— 21 ORTHOPAEDIC SCHEME Boys. Girls. 5-16 years Under 5 years. 16-18 years. 5-16 years. Under 5 years. 16-18 years. Anterior Poliomyelitis 13 — 1 14 2 1 Surgical Tuberculosis 1 — — — 1 1 Scoliosis, Lordosis, Kyphosis 49 1 1 34 3 1 Arthritis 1 — — 1 — — Genu Valgum 8 11 — 9 3 — Genu Varum — 6 — 1 3 — Pes Valgus and Valgus Ankles 97 16 — 63 15 — Spastic Paralysis 11 — 1 7 1 2 Schlatters Disease 2 — — — -— — Progressive Muscular Atrophy 2 — — — — — Osteo Genesis Imperfecta 1 — — 1 — — Talipes—(a) Equino Varus 9 1 — 4 — — (b) Calcaneo Valgus 3 1 — — 2 — (c) Pes Cavus 1 1 — — — — Torticollis 5 2 — 2 — — Congenital dislocation of the hip 1 — — 2 — — Cerebellar Ataxia 2 — — 1 — — Spina Bifida 2 — — 2 — — Hallux Valgus — — — 10 — — Perthes Disease 1 — — 1 — — Slipped Epiphysis — — — 1 — — Achondroplasia — — — 1 — — Diaphyseal Aclasis 2 — 1 — — — Digitus Varus 4 — — 5 — — Overlapping toes 4 2 — 6 4 — Hammer toe 5 — — 10 — — Other congenital defects 5 3 — 3 — — Miscellaneous (including chest conditions) 67 3 — 66 3 — Totals 296 47 4 244 37 5 22 New cases seen by Surgeon:— School Age 92 Under School Age 23 Total 115 Number of cases seen by Surgeon:— From Physically Defective School 21 From other Schools 284 Under School Age 60 Over School Age 7 Total 372 Total number of examinations made by the Surgeon 487 Total number of cases discharged by the Surgeon 121 Average number of examinations per session 40.6 Number of treatments given 6,298 Number of attendances for after-care 2,540 Number of sessions held—Inspection 12 Treatment 446 Number of visits by Instrument Maker 13 Admissions to Hospital ... 25 Operated on in Out-patients Departments 2 Operations performed 32 Children transferred from Connaught Hospital 16 (e) Cardiac Clinic.—The Specialist Clinic in the charge of Dr. Mary Wilmers has continued. The reduction in sessions now necessary is a reflection on the fewer cases of these conditions now found in children. The following is a report on the work done at the Clinic during 1954:— Number of sessions 4 „ „ attendances 56 „ „ new cases 10 „ „ old cases 27 „ „ discharged 9 „ of new cases with cardiac or rheumatic defect 1 „ referred to hospital—Out-patient 5 In-patient 3 „ still under treatment at end of year 21 (f) Child Guidance Clinic.—The Consultant Psychiatrist, Dr. Helen Gillespie, reports as follows:— "Staffing.—There have been no changes in the clinic staff, but there are two vacant play therapy sessions to be filled when a suitable candidate offers. "Comments—The waiting list shows a very slight increase on the previous year, although there had been a very considerable increase in the number of children referred from the Leyton and Forest Divisions. 23 "It is interesting to note that there has been an increase in the number diagnosed as suffering from nervous disorders, such as fears, depressions, apathy and excitability. As these are the children whose symptoms are less conspicuous for their nuisance value, it is encouraging to find that more of them are being recognised and referred. "In general, the clinic's activities have continued very much on the pattern of last year. "The following tables show the work of the clinic during the year. Figures for Walthamstow cases only are shown." TABLE 1 Analysis of Figures for 1954 Number of cases referred to the Clinic 95 diagnosed at the Clinic 52 (a) Psychiatrists Diagnostic interviews 52 Cases taken on for treatment 17 Treatment interviews 478 Other interviews 2 Number of psychiatric sessions per week 4½ (b) Psychologists Clinic cases tested 51 Cases given remedial education 13 Treatment interviews (remedial education) 185 School visits on behalf of clinic cases 13 Other interviews at clinic 25 (c) School Psychological Service Individual cases seen 221 Number referred to clinic 17 (d) Play Therapists Cases treated 15 Treatment interviews 267 (e) Psychiatric Social Workers Interviews at clinic 571 Interviews elsewhere 9 (f) Waiting List Cases for Diagnosis 43 Awaiting treatment 7 24 TABLES II and III Analysis of Problems Referred and Cases Diagnosed Referred Diagnosed I. Nervous disorders, e.g. fears; depressions; apathy; excitability 16 28 II. Habit disorders and physical symptoms, e.g., enuresis; speech disorders; sleep disturbances; tics; fits; etc. 37 5 III. Behaviour disorders, e.g., unmanageable; tempers; stealing; lying; sex problems, etc. 39 15 IV. Educational, e.g., backwardness; failure to concentrate 3 3 V. No basic disturbance of child, i.e., mainly parental over-anxiety — 1 95 52 TABLE IV Analysis of Cases Closed during the Year (including cases referred in previous years) Improved and recovered after treatment 29 Improved after partial service, i.e., before diagnosis 14 Diagnosis and advice only 12 Interrupted, e.g., on parents' initiative 40 Closed for miscellaneous causes (removed from area, placement at E.S.N. School, etc.) — No change 1 96 REPORT OF THE EDUCATIONAL PSYCHOLOGIST FOR 1954 Miss E. M. Smith, M.A., contributes the following:— "The Educational Psychologist has again been responsible for psychological work in Walthamstow and Chingford. In all, 266 children (225 Walthamstow, 41 Chingford) were given individual intelligence tests and 162 (139 Walthamstow, 23 Chingford) visits were made to schools. This report will deal with the work done in Walthamstow, and further figures will relate solely to Walthamstow. "Individual tests were given to 148 boys and 77 girls either at the Child Guidance Clinic or in schools. The allocation of these children in the different types of school is shown:— Type of School Number of children Infant 34 Junior 93 25 Type of School Number of children Secondary Modern 25 Grammar and Technical 15 Special 50 Residential school for maladjusted 2 Pre-school children 6 225 "Two extensions to the work of the psychologist have been made during the year:— (1) The testing and recommendation to suitable Walthamstow schools of children who come to live in the area and who have attended a selective school in another area. (2) The testing and assessment of Grammar and Technical school children who in the opinion of the Head Teacher have proved to be unsuitably placed. "The following analysis shows the range of I.Q's found amongst children who have been tested individually. Intelligence Quotient Number Per cent. Below 75 (E.S.N.) 64 28.4 76-89 (Dull) 53 23.6 90-115 (Average) 78 34.7 116+(Superior) 30 13.3 "In the E.S.N. group 22 children were already attending an E.S.N. school, 6 were pre-school age Mongol children and the remaining 36 were still in normal schools. "During the year 139 visits were made to schools to test children or have discussions with teachers either about individual children or on various educational topics. These visits were divided between all types of schools as follows:— Infant schools 45 visits Junior „ 56 „ Secondary Modern 7 „ Technical and Grammar 7 „ Special schools 24 „ "Visits have also been made to the homes of several children and to a Remand Home to administer tests. "Twenty-five parents were interviewed by the psychologist either at school or at the Child Guidance Clinic. "A survey of the reading attainment of children aged seven was undertaken at the request of the Committee for Education during July and September. About 1,000 children were given an individual reading test. Three junior schools asked for group tests to be administered by the psychologist. 26 "In the Spring term a student psychologist from the Birmingham University, Institute of Education, came to the Child Guidance Clinic for a month's practical experience. During the year three Training College Students, two Assistant School Medical Officers and a German Head Teacher of a Special school visited the psychologist in order to see the work done. "A course of lectures on 'The Teaching of Reading in the Junior School' given to teachers and a course on 'Adolescence' given to House Mothers at the request of the Home Office, were undertaken. The psychologist has also spoken to various parentteacher groups on educational or psychological topics." (g) Pædiatric Clinic.—The clinic was continued under the clinical charge of Dr. Elchon Hinden, Paediatrician to Whipps Cross Hospital, who reports as follows:— "The work of the clinic has continued along the same lines as in previous years. The majority of the children seen are suffering from abnormalities of growth and development, or from behaviour disorders. Organic disease is rarely encountered, but the disability and embarrassment caused by these functional derangements is very considerable. "Obesity is a condition which is often referred to the clinic. In many instances the child was sent by an Orthopaedic Surgeon, who first saw the patient because he was suffering from knock-knee. This is almost an invariable accompaniment of obesity, and it is very hard to cure while the child remains heavy. Unfortunately, the weight of the child is equally difficult to control. Rarely do we find gross glandular disturbance in these children; in the great majority of cases, the obesity is familial. One or both of their parents are overweight, and so are other relations too. The children are big as well as fat, and I believe that their size is ' normal " for their genetic constitution. It follows that to reduce their weight is really to make them unnaturally thin, and this is nearly always a fruitless task, unless the children are prepared to undertake really drastic dieting. This calls for a degree of self-control that very few children (and not many adults, either) possess. Most of the girls reach puberty early, and thereafter their rate of growth slows down considerably, so that soon their age catches up with their weight, and their appearance becomes more normal. The boys take longer to mature and the delay at times causes parental anxiety about their poor genital development; but this nearly always rights itself in time. "Parents are often very concerned about the obesity, but as a rule the children are not bothered by their excessive size, were it not that their school-mates point the finger of scorn at them. This can make them very self-conscious, and is responsible for a great deal of distress. I have known a child request a change of 27 school in order to escape the mockery. Children can be very cruel to each other. "I should like to thank the Assistant School Medical Officers for referring the children to me, and the general practitioners for granting them permission to do so; and my colleagues, the Pathologist and Radiologist at Whipps Cross Hospital for kindly offering me the facilities of their laboratories." Over 5 years Under 5 years New cases 104 32 Total attendances 161 53 Physical Defects:— No. of cases 62 36 Referred to hospital 32 9 Discharged 22 13 Psychological Disorders:— (a) Eneuresis 57 1 (b) Other 1 1 Referred to hospital 39 — Discharged 4 1 (h) Speech Therapy.—Treatment centres are provided at the Old Education Offices, High Street, and at the Open Air School. The arrangements of previous years have continued in regard to the selection and reference of children for speech therapy. Cases are brought forward as a result of medical inspection and reinspection and by reference through Head Teachers. In order to exclude any medical condition and in order to assess the degree of the speech defect to negative the possibility of deafness, partial deafness, or of a psychological cause of the defect, a full medical report is recorded on the case papers sent to the speech therapist. The School Medical Officers are invited to follow up their cases during the course of treatment and arrangements have been made for a review of the case, preferably by the School Medical Officer who referred the case, and before discharge from treatment. Miss C. M. Gregory, who resigned in August, submitted the following report before she left:— "Only 80 children have been treated so far this year, a marked decline on last year's total figure of 144. This drop may be accounted for by the fact that only 14 new cases have been sent in by the school medical department. All these newcomers were six years and over. "Forty-five school visits were made, 50 interviews were given and 5 home visits paid for follow up purposes. 28 "The average age of the children in the clinic is now 6 years 1½ months, a drop of years on last year's report. "The staff of the Child Guidance Clinic has been very helpful with advice, and the transport officer has been most cooperative." Miss C. Borthwick took up duty at the High Street Clinic in October, and submits the following report on the work done during the last quarter of the year:— "This year the clinical attendance has rather suffered from a two months' break before I came to the clinic in October, but there is now a waiting list of five. "My first two weeks were spent in visiting schools. Fifty-six children were found to require speech therapy and thirty-seven of these children have so far been referred. All on the waiting list should receive treatment early in the New Year. "No waiting period exists for those whose parents are able and willing to bring them to the clinic, but I have endeavoured to limit the number of other children so that only four attend each hourly session. "Even so, children attending in groups have the disadvantage of a shorter period of treatment and also the therapist cannot work in such close co-operation with the parents. On the other hand, regular attendance is ensured and the children often benefit from the contact with others experiencing similar difficulties. "I have found that, compared with other clinics in which I have worked I treat very few senior children. This I attribute to the fact that Walthamstow has long since had good facilities for Speech Therapy and treatment has been received at an early age." Miss A. M. Hemmings reports:—• "Again the number of cases treated and their distribution is very similar to that of last year. Of the cases temporarily discharged last year, six were reviewed and discharged as cured this year, having maintained their improvement in speech. These six are in addition to those recorded as cured in the accompanying figures. "Good use was made of the recording machine, mainly for the permanent recording of long term cases: many of these are pupils at the School for the Physically Handicapped. "Some children have now made as many as three permanent recordings. Unfortunately, the problem of editing has not yet been solved, and if no solution is found, I am afraid that the difficulties may prove to be prohibitive in the making of permanent recordings. 29 "I was able to make one recording this year which is possibly unique. A puberphonic patient read a passage from a book, first in his original high pitched voice, and then in a fully developed masculine voice: he did this without a pause. "The number of junior and secondary school children newly referred and who have had no speech therapy treatment whatsoever is low. This, of course, is a most satisfactory reflection on the work of preceeding years, i.e., in remedying speech defects before children leave infant schools." Annual Report and Clinical Analysis. High St. Clinic Open-Air Sch. Clinic Number of cases in attendance at beginning of year 66 67 New cases admitted during the year 47 52 Transfers from other Clinics — 3 113 122 Cases ceasing attendance before cure or discharge 4 9 Cases discharged improved and incapable of benefiting by further treatment 8 5 Cases temporarily discharged before cure, to resume treatment later 10 5 Cases discharged cured 31 38 Transfers to other Clinics — 1 Cases still in attendance at end of year 60 64 Total attendances during year 1,542 2,441 No. of Cases suffering from:— 1. Physiological or Psychological Defects: (a) Stammer 29 25 (b) Clutter — — 2. Voice Defects: Rhinophonia 6 8 3. Defects of Articulation:— (a) Dysarthria — 4 (b) Dyslalia—Multiple 46 63 Simple 24 21 4. Language Defects (delayed speech) 4 1 5. Probable mental deficiency — 1 6. Other types of defect — 2 109 125 (i) Convalescent Home Treatment.—126 children were sent away for convalescence during 1954. There were 7 children remaining in convalescent homes and hospital schools on December 31st, 1954. (j) Tuberculosis.—The number of school children examined for the first time during the year was 154 boys, 111 girls of whom 72 boys and 49 girls were referred by the school medical staff and 82 boys, 62 girls by private practioners. Forty-five boys and 24 girls were examined as contacts. (k) Ultra Violet Light Treatment.—The total attendances for treatment were 1,482. 30 9. PROTECTION OF SCHOOL CHILDREN AGAINST TUBERCULOSIS (a) Chest X-ray Examination of Teachers on Appointment.— The position in regard to this matter was set out in the Report for 1951, 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 at the Mobile Mass Radiography Units and the static units at Finsbury and Holloway Road, but the difficulties in such an arrangement are obvious when compared with local facilities. (b) Special Follow-up by Mass Radiography.— In the Autumn a case of infectious pulmonary tuberculosis was notified who had been in attendance at a Grammar School. Parents of all children who might have been in contact were invited to consent to examination at the Mass X-ray Unit, which made a special visit to the school for the purpose. The result of the examination was satisfactory. (c) Tuberculosis Vaccine Trials (Medical Research Council).— The follow-up of the vaccinated and control groups begun in June 1952 continued during 1954. Dr. T. M. Pollock reports as follows:— "Once again we had a very good response in Walthamstow and the completed figures show that 79% of the young people returned for their second annual re-examination. Of these young people 76% completed their skin test. In addition 34% of those who failed to come last time took advantage of the further invitation." (d) Jelly Testing of School Children. This was begun in 1953 and was described in the Report for last year. The following shows the work done in 1954. Number of children invited 1,570 Number accepted 1,234 Number refused 336 Number of children tested 1,121 Negative 1,070 Positive 37 Doubtful 5 Absent for reading 9 31 (e) B.C.G. Vaccination of School Children. Following the County Council's agreement in April 1954 to extend B.C.G. Vaccination to school children, arrangements were made to implement the scheme in Walthamstow. A preliminary explanatory talk was given to all Head Teachers of secondary schools. Great interest was shown in the scheme and their full support was obtained. All general practitioners in the area were circularised and given full details. The Chest Physician was informed of each step and his advice and guidance sought whenever necessary. Talks to parents were not proceeded with as it would have been difficult to arrange to give them to any considerable number. The explanatory leaflet was considered sufficient. Many parents have sought the advice of Head Teachers before allowing their children to participate. Two medical officers were selected to undertake the work and to attend for the required instruction at the Hospital for Sick Children, Great Ormond Street. B.C.G. vaccination was commenced on the 15th June, the routine adopted being as follows. Dates for the Mantoux testing and vaccination are agreed with the Head Teacher six weeks before. Explanatory leaflets and consent forms sent to the school for distribution by the Head Teacher to the appropriate age group, i.e., in the year preceding the 14th birthday. The consent forms are returnable within a fortnight so that the requisite amount of tuberculin test material and B.C.G. can be ordered four weeks in advance. The tuberculin testing is carried out on a Tuesday and the reading and B.C.G. vaccination on the following Friday. For preliminary testing the Mantoux intradermal method with 0.1 ml. of tuberculin has been used up to now. The Heaf Multiple Puncture apparatus has not yet been used for this preliminary test, but is being used in 1955 for the post-vaccination tests. B.C.G. vaccine usually arrives on a Thursday morning. Only once has the vaccine not arrived and considerable effort had to be made to obtain supplies in time. The non-arrival of the vaccine can upset the whole B.C.G. programme since this has been arranged six weeks in advance. All secondary schools had been visited by the end of the year, and of the 1,548 children invited 825 accepted, giving an acceptance rate of 53.3%. 32 Number of Mantoux positive 145 Percentage positive 18.6 Number of Mantoux negative 635 Number absent 45 B.C.G. given 630 Absent or not done 5 By arrangement with the Chest Physician all the Mantoux positives were offered Chest X-ray at the Chest Clinic. None of those accepting were found to have active disease. No complications, as defined in Section 18 of Ministry of Health Memo 324/BCG, have arisen, although many children have been seen with small ulcers which are a normal concomitant of successful vaccination. These children have been seen owing mainly to parental apprehension, although a fully explanatory note is given to each child vaccinated. Arrangements have now been made for family doctors to be notified when children on their lists in this age group are Mantoux positive or have been vaccinated. 10. INFECTIOUS DISEASES Notifications from general practitioners of infectious diseases occurring in the 5-14 year age group were as follows:— 1953 1954 Measles 413 489 Whooping Cough 352 180 Scarlet Fever 217 136 Bacillary Dysentery 34 108 Pneumonia 15 11 Tuberculosis 8 — Food Poisoning 5 3 Poliomyelitis 2 — Meningococcal Infection 1 2 Encephalitis 1 1 Paratyphoid 1 — Typhoid 1 — 1,050 930 Bacillary Dysentery. Up to the 5th March a total of 48 cases had been notified from the three departments of the Forest Road and Wm. McGuffie Schools, i.e., 37 in the Junior Mixed, eight in the Infants and three in the Secondary Departments. The existence of an "outbreak" had only become definitely proved bacteriologically by the 10th February, when, after 33 sultation with the Borough Education Officer, a letter was sent to the parents of all children attending the Junior Mixed Department, together with a leaflet of advice on the precautions to be taken. On the same date all doctors in the town were notified so that suspect cases could be investigated where necessary. The usual routine precautions for schools were also adopted by arrangement with the Education Department and the Head Teacher. On the following day similar action had to be taken in regard to the Infants' Department except that it was not again necessary to advise family doctors. The usual enquiries at school canteens, school kitchens and in the homes of absentees were made and on reviewing the results it appeared that the first known case was a child reported by the family doctor to be suffering from food poisoning at the beginning of February. Owing to the infectivity of bacillary dysentery the probability of symptomless carriers, and the very cold weather at that time and the consequent freezing of water closets between February 2nd and 5th, the condition spread fairly rapidly in the Junior Department from child to child. School meals and milk did not appear to have been involved. In view of the possibility of undetected cases at other schools, and again after consultation with the Borough Education Officer, a circular letter was addressed to all Head Teachers on the 22nd February advising as to personal and environmental hygiene and the measures to be operated if a case was suspected of dysentery. The advice was on the lines of the memorandum on bacillary dysentery issued by the Ministry of Health. The attention of Head Teachers was also drawn to the preventive measures necessary by a circular from the Borough Education Officer on 26th February. Apart from those cases at the Forest Road School, single cases were notified from Winns Avenue Junior Mixed Department, Chapel End Junior Mixed Department, Roger Ascham Junior Mixed Department, and from St. Mary's and St. Patrick's R.C., but not all were confirmed bacteriologically since all cases of diarrhoea at a time like this are apt to be labelled dysentery, and without proof. Bacillary dysentery is an acute infection of the gastro intestinal tract, fortunately rarely fatal but highly infective. The condition is now endemic in most communities and is being studied by a special committee of the Medical Research Council. It is commonest during the first three months of the year, and in previous attacks at schools and day nurseries up to nearly 50% of the children have been affected before the outbreak terminated. 34 In 1952 there were 34 cases at schools, but multiple cases only occurred at eight departments, the highest being five in one department. In the other twelve departments there was only one case in each. An article in the medical press states: "and the (condition) abates only when it has run its natural course." The only known method of control is by proper personal and environmental hygiene which unfortunately is still so conspicuously absent in the community at large. By 9th March the total of cases was 62 at ten school departments with 39 cases out of 530 children on the roll of the worst affected school. The general criterion of re-admission to school in proven cases was a negative rectal swab and/or fully formed stools for at least seven days. I would like to acknowledge the help of the Borough Education Officer and his staff and the teaching staff in the very considerable work which has been involved in dealing with these cases. Gastric Influenza and Epidemic Nausea and Vomiting. During 1954 there were four schools involved in outbreaks of epidemic nausea and vomiting. The first was at Forest School in June when five boys and three staff were affected. Rectal swabs were taken from three of the boys but all proved negative. The outbreak was mild. Early in November a message was received from Thorpe Hall School stating that three children had complained of abdominal pain and nausea with no diarrhoea. The school was visited by the medical and sanitary staff who examined all children and inspected the kitchens respectively. A day or two later a message was received from Winns Avenue Infant School stating that ten children were absent with diarrhoea and vomiting, and eight others for unknown reasons. The school was visited by the medical and sanitary staff. Swabs were taken but were proved negative. The outbreak lasted three or four days. About five days later a similar message was received from Blackhorse Road Secondary Girls School where six girls were affected, but with one exception, all remained at school. All pathological specimens taken were negative and the "outbreaks" were considered to be in the nature of epidemic vomiting rather than of food infection. Scarlet Fever and Streptococcal Tonsillitis at an Infants' School. Although the scarlet fever incidence in the Borough was considerably less in 1954 than in 1953, i.e., 187 cases against 289, a 35 very troublesome outbreak occurred at an infants' school during the autumn term. The weekly incidence was as follows:— 11th September 4 6th November Nil 18th „ Nil 13th „ 1 25th „ 3 20th „ 1 2nd October 6 27th „ Nil 9th „ 6 4th December 1 10th „ 3 llth „ 1 23rd „ Nil 18th „ 1 30th „ Nil 25th „ Nil This modern infant school, with accommodation for 240. opened in December 1953, comprises six classrooms (each with washbasin), assembly hall, school kitchen and up-to-date sanitary accommodation. Attention was first drawn to the number of cases of scarlet fever at the end of September and the District Sanitary Inspector and the School Nurse were at once sent to inspect the premises and the children respectively. On 5th October, a member of the medical staff examined the noses, throats and hands of all children in school. Out of 148 children in attendance, 12 with injected fauces were excluded and 2 "peelers." Although twelve children with injected fauces were excluded there were 64 other children who showed some slight injection of their fauces. At a later similar "mass" examination in November there were 47 children out of 147 in attendance with similar slight injection, and as a matter of interest a "control" examination was carried out at a nearby infants' school where there had been no scarlet fever for a considerable time. Here the findings were 51 children with slightly injected fauces out of 163 in attendance, i.e., a very similar percentage. It was concluded, therefore, that slightly injected fauces appeared to be the average winter norm last winter. A circular letter of advice was sent to the parents of all children. Copies were also sent to doctors practicing in the locality with a covering letter. Parents were asked not to send children to school unless quite fit. After consultation with the medical staff of the Ministry of Health on 7th October, a further circular letter was sent to parents intimating that swabs of all children and staff would be taken the following week. As a result eight heavy nasal carriers were excluded with appropriate instructions to the parents to consult their doctors. The question of mass prophylaxis was considered but was postponed for further consideration. The organisms were Type 4 streptococci and were sensitive to penicillin and sulphonamide. 36 Notification continued ana by the 15th October, the total was 22. Since the mid-term closure was approaching, it was extended by a few days and finally included the period 22nd October to 3rd November, i.e., eleven clear days, a period longer than the normal maximum incubation period for scarlet fever. On resumption on 3rd November, all children in attendance were examined by the medical staff and doubtful cases were excluded. Almost daily medical supervision was given during the whole of this period and exclusion with swabbing was carried out in all doubtful cases. Individual classes were examined on several occasions and with the approach of Christmas, it was agreed that school festivities be reduced to a minimum and school assemblies discouraged. Christmas closure was between 17th December and 4th January, i.e., 17 clear days and it was hoped that in spite of Christmas parties, the outbreak might be terminated. As an added safeguard, a further circular letter was addressed to parents on 16th December stating that all children in attendance on re-assembly in the New Year would be swabbed and carriers excluded. Routine disinfection was carried out of the whole school. As a result of the second mass swabbings, three heavy nasal carriers were excluded. In spite of these measures, three cases were notified in January 1955, and two further cases towards the end of March. The recurrence of cases in 1955 following the Christmas school closure resulted in the arrangement of a conference in January between the medical staff of the Ministry, the medical officer of the Laboratory Service, and the local medical staff. The whole position was reviewed and the school was visited, and as a result the seating of the children was re-arranged and the need for adequate cross ventilation of class-rooms was emphasised to the staff. No record of this outbreak would be complete without an expression of thanks to the medical staff of the Ministry of Health and to Drs. Tomlinson and Marsh of the Public Health Laboratory Service. Extreme mildness has been typical of the whole outbreak and no serious cases are known to have occurred. In consequence some parents have been very lax in sending unfit children to school in spite of warnings by circular letters. At no time has a case been found among the staff, and school dinners and school milk have not been suspect. 37 This continued outbreak appears to have been due to persistent carriers in a non-immunised infant group linked with frequent carelessness in sending unwell children to school. Apart from the two mass swabbings a total of 267 swabs were taken from September to December and 192 since the beginning of January in connection with this school outbreak alone. 11. IMMUNISATION (a) Against Diphtheria.—Two hundred and fifty nine primary immunisations were done in children of school age and 1,469 "booster" doses were given in school immunising sessions. During the five years to 1954 the percentage of children protected in the various age groups were as follows:— Year Under 5 years 5-15 years 0-15 years 1950 60.5 96.5 81.9 1951 58.1 99.3 83.0 1952 49.4 98.3 79.6 1953 44.4 92.5 73.8 1954 42.5 96.1 75.3 (b) Against Whooping Cough.—Immunisation against whooping cough has been available for many years to children of preschool age but in April 1953, immunisation was made available to children of all ages. Seventeen children over five years of age were immunised against whooping cough during 1954, but it should be stressed that the main effort was directed towards children of preschool years, of whom 1,022 were immunised. (c) Vaccination.—The vaccinal condition of each child examined at routine medical inspection was noted, and a summary shows the following:— Number examined Number found to be vaccinated Percentage vaccinated Entrants Boys 1,063 229 21.5 Girls 916 187 20.4 Second Age Group Boys 496 152 30.6 Girls 577 249 43.1 Third Age Group Boys 966 224 23.2 Girls 1,064 275 25.8 Others Boys 130 45 34.6 Girls 98 33 33.6 5,310 1,394 26.2 38 12. OPEN AIR BOARDING SCHOOL EDUCATION During the year four boys were medically examined prior to returning at each term to Elmbridge Boys' School, Cranleigh, Surrey, and a further 14 boys and girls received examinations before proceeding to Kennylands Park School, Reading, Berks, for the Spring, Summer and Autumn terms. Premises at the Jubilee Retreat have again been used by parties from most of the Special Schools. 13. PHYSICAL TRAINING The Committee shares the services of two whole-time Organisers with two neighbouring areas. Co-operation has continued along the lines of previous years. Physical Education in Primary Schools.—Miss G. G. Powell, Physical Training Organiser, reports as follows:— "Possibly no subject in the primary schools curriculum has changed so completely during the last few years as has physical activity, a change summed up so well in the use of the new name Physical Education in place of the old Physical Training or Drill. This newer type of work is based upon the natural desires of a young child to run, to leap, to climb, and all traces of military drill seem at last to have disappeared. "Simple compensatory exercises, remedial in character, are still included to compensate for the limitations on growth and development due to the unnatural conditions imposed on young children by life in large cities, but children are encouraged to work to their own rhythm and pace, to be responsible for their own efforts and to co-operate in small groups rather than to stand in four straight lines and work in class unison to the teacher's commands. A large part of the time available is spent in the practice of agility movements including the use of simple climbing apparatus, designed to develop skill, speed, strength and dexterity, and to give opportunity for a wide range of experience. Such methods help to develop self-confidence, initiative and inventiveness. In addition, each child is enabled to work at his or her own pace, thus in a large class the slower pupil does not feel discouraged, nor need the teacher hold back those who are more skilful. " This change has been greatly encouraged by the publication by the Ministry of Education of two books—Moving and Growing (1952) and Planning the Programme (1953)—which replace the Board of Education's Syllabus of Physical Training (1933) and which give much practical help to the teacher attempting new methods. The Committee's Organisers of Physical Education have taken training courses for Walthamstow teachers at which these new methods of teaching have been demonstrated and discussed, and are planning another such course for the summer of 1955. 39 "Particular emphasis in recent years has been on the use of simple climbing apparatus, never before included in the Ministry of Education Scheme for Primary Schools. All Infant Schools in Walthamstow have been equipped with playground apparatus to our own specification, i.e., a commando net, simple climbing ropes and steel climbing bars. All Junior Schools in the Borough have some playground climbing apparatus, i.e., a horizontal ladder, steel climbing bars and in some cases a steel window ladder. Some schools have special difficulties such as small, irregularly shaped, or sloping playgrounds, which make the provision of such apparatus difficult. When funds become available much more needs to be done to provide apparatus for school- halls for use in inclement weather. In schools where climbing apparatus has been in use for some time it is interesting to note the development in the children of self-confidence, of bodily skill, and of increased strength in the muscles of the back, shoulders and chest, resulting in better posture. "It is hoped, with the co-operation of the School Medical Officer, to experiment with the adaption of this apparatus for use in the Special Schools of the Borough." Swimming. -The Walthamstow Schools' Swimming Association's report for the year ended 31st December, 1954, refers to the following achievements:— Standard (Graded) Tests.—During the past year the following certificates were gained:— 834 Primary 23 Intermediate 216 Elementary 10 Advanced Speed Tests.—Twenty-one 3rd class; nineteen 2nd class; and ten 1st class Speed Certificates were gained during 1954. Life Saving Classes and Achievements.—The usual classes were organised by the Schools' Swimming Instructor, and, as in previous years, several schools, including Grammar Schools, held " internal " classes, resulting in the following awards in all:— Intermediate Certificates 9 Bronze Medallions 60 Bars to Bronze Medallions 2 Bronze Crosses 10 Awards of Merit 3 Bar to above 1 Scholar Instructors Certificate 1 14. PROVISION OF MEALS During October and November the daily number of meals exceeded 8,000 or some 40% of the numbers on the school roll. During the same period the daily milk meals total averaged over 15,000 per day or some 75% of the total on the school roll. 40 Inspection.—Visits were made by the medical and other start to school canteens and kitchens, and suggestions were made from time to time in order to try to minimise food-borne infection. The quality of the food supplied, and the standard of cooking has been maintained at the previous high level. Routine inspections were carried out by the sanitary inspectorate. 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 with very hot water supplies. Additional hand washing facilities for scholars are very necessary especially in view of the endemicity of bacillary dysentery. Milk in Schools Scheme.—The arrangements detailed in previous reports were continued in 1954. all the milk supplied being pasteurised milk sold under licence. Thirteen samples of pasteurised milk were taken by the sanitary staff for bacteriological examination during the year. All satisfied the methylene blue and phosphatase tests. In addition to the above statutory tests, two of the samples (both from the same school) were examined by the laboratory for the presence of the Haemolyticus Streptococcus. Both gave negative results in 10 millilitres. Sampling for biological tests has been carried out at one local dairy on delivery of milk from various farms. This dairy supplied some of the milk to schools. 15. CO-OPERATION (a) Co-operation of Parents.— The following table shows the attendance of parents during 1954 at the periodic medical inspections:— No. No. of Per cent. Per cent. Inspected Parents 1954 1953 Entrants— Boys 1.063 987 92.9 90.9 Girls 916 852 93.0 93.2 2nd Age Group—Boys 496 333 67.1 ' 79.9 Girls 577 532 92.2 83.9 3rd Age Group—Boys 966 201 20^8 23.2 Girls 1.064 342 32.1 35.9 Others— Boys 130 79 60.8 64.8 Girls 98 58 59.2 60.3 The importance of parental attendance at medical inspections cannot be overstressed. It is regrettable, but understandable, that the percentage should decrease with the increasing age of the ch+ld, and with the considerable employment of mothers. 41 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. The circulars issued each week by the Borough Education Officer to Head Masters and Head Mistresses of schools in the Borough were, with his co-operation, utilised in disseminating information. The following matters were referred to during 1954:— 15th January. Circulation of forms of reference for appointments and treatment at school and dental clinics. 26th February. Bacillary Dysentery. Reference was made to a separate circular issued by the Borough School Medical Officer and detailing the preventive steps which should be taken. Heads were asked to ensure that on the first definite case of bacillary dysentery routine and continuing disinfection should be carried out along the lines advised. 19th March. Stressing the need for telephonic notification of all children suffering from diarrhoea and vomiting. 30th April. Stressing the avoidance of food and drink two hours before attending a dental gas session. 18th June. Drawing attention to the precautions necessary on the occurrence of a case of poliomyelitis, i.e., to follow up all absentees, immediate rest in bed for all suspects, avoidance of unnecessary re-grouping in an affected school, and the discouraging of assembly and mixing of classes. 25th June. Suggesting the routine disinfection of lavatory seats and handles with " white " fluid to combat dysentery and poliomyelitis. 19th November. Suggesting (a) further talks and demonstrations by the Dental Hygienist, (b) absence of pupils from schools— School Enquiry Officers pay follow-up visits. Prompt notification of actual and suspected cases of diarrhoea and vomiting requested. 3rd December. Requesting early information as to any suspected winter epidemic. (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. 42 (d) Co-operation of Voluntary Bodies. The existing arrangements for the admission of pupils to holiday convalescent homes by arrangement with the Local Branch of the I.C.A.A. continued. (i) The Invalid Children's Aid Association.—Mrs. Osora, Secretary to the local branch, has kindly contributed the following report:— Children referred by: — Under 5 years Over 5 years Hospitals 2 19 School Health Service 2 57 General practitioners 2 42 6 118 Classification of above cases: — Under 5 years Over 5 years Anasmia, debility 3 18 After-effects of acute or infectious illness or operation 1 34 Bronchitis or pneumonia 20 Asthma 6 Rheumatism, Chorea. Heart 3 Nervous conditions 4 Accidents 2 Diseases of—Ear, Nose and Throat 1 15 Eyes 3 Skin 1 Jaundice 6 Other defects 1 6 6 118 Children sent for convalescence 2 114 Children sent to Regional Hospital Board Homes . 1 2 Children sent to Residential Open Air Schools — 2 3 118 Children referred for visiting, advice, help or follow-up: — Under 5 years Over 5 years Hospitals 3 5 Local Authority under schemes for— (a) Rheumatism — 8 (b) Orthopedic care — 12 (c) Child Guidance — 1 Voluntary Bodies 5 6 General practitioners 1 5 43 Under 5 years Ovei 5 veai s Parents 4 9 I.C.A.A. Branches 2 3 15 49 Number of visits paid 834 (ii) National Society for the Prevention of Cruelty to Children. The following is a summary of the work done during 1954:— Nature of Offence How dealt with Neglect 33 Warned 32 Ill-treatment 5 Advised 17 Moral danger 1 Prosecuted 1 Beyond control 1 — Advice sought 10 50 50 Number of Children dealt with : — Under 5 years Over 5 years Boys Girls Boys Girls 41 47 33 26 HANDICAPPED CHILDREN The following number of special examinations were carried out by the medical staff in respect of the categories state:— (a) Blind 1 (b) Partially Sighted 2 (c) Deaf — (d) Partially Deaf 1 (e) Educationally Subnormal 34 (f) Epileptic 2 (g) Maladjusted 2 (h) Physically Handicapped 6 (i) Speech — (j) Delicate 16 64 Walthamstow Special Schools.—The number of children at the special schools in Walthamstow at the end of 1954 were as follows:— Partially Sighted E.S.N. Physically Handicapped Deaf Total Percentage Walthamstow 8 68 63 9 148 59.2 Forest 6 11 15 13 45 18.0 Middlesex 18 — 1 — 19 7.6 Romford 4 — — 4 8 3.2 Leyton 2 — 1 4 7 2.8 44 Dagenham Parrially Sighted E.S N. Physically Handicapped Deaf Total Percentage 4 — — 3 7 2.8 IIford 2 — — 11 13 5.2 South Essex 2 — — — 2 0.8 Barking — — — 1 1 0.4 Totals 46 79 80 45 250 100.0 The position at the School for the E.S.N, is a cause for considerable concern because at a review of the waiting list in the spring of 1955 there were 34 cases with intelligence quotients of 75 or under still remaining at ordinary schools. These included at least five cases whose admission to a special school was of some urgency. The number of children in residential special schools and homes at the end of the year were as follows:— Maladjusted 16 Deaf 5 Delicate 6 Educationally Subnormal 5 Blind 4 Epileptic 3 39 (a) School for the Partially Sighted.—Mr. G. M. Williams, Head Master, reports as follows:— " There were 46 children on roll at the end of the year. Of these eight came from Walthamstow, 20 from other Boroughs and Divisions in Essex comprising Barking, Dagenham, Forest, Ilford: Leyton. Romford and S.E. Essex, and 18 out-county children from the Middlesex Boroughs of Edmonton, Enfield, Hornsey, Tottenham and Wood Green. " At the special ophthalmic session held at the school in December, it was found that 15 children had visual acuity (Snellen), after correction, of 6/18 or more, four children acuity of 6/24, eight with 6/36 and 18 children visual acuity of 6/60 of less. Three children were certified as blind and are now awaiting transfer to schools for the blind, and two children were recommended for transfer to ordinary schools. " As in previous years the specialist ophthalmic medical supervision of the children has been well maintained. Dr. I. Gregory, M.B., D.O.M.S., has made two visits for the purposes of ophthalmic examinations and has given much helpful advice. The medical staff of the Eye Clinic have also made regular ophthalmic examinations of all children in the school, and their very ready and willing help has been much appreciated. In February, Dr. Watkins made .a full medical inspection of each child, and in addition has 45 seen each school leaver and certain selected children. There has. also been one session for diphtheria immunisation. The School Nurse has made regular visits for head, foot and general welfare supervision, and the Health Visitors have made home visits in certain difficult cases. "Miss Smith, Educational Psychologist, has visited the school on three occasions for the purpose of testing, and Miss Williams, Psychological Research Worker of the University of Birmingham Institute of Education made two visits to test all children with sight 6/60 or less. "On the educational side, the practice of sending the senior girls to the Domestic Science Centre at Hale End has continued, and now the senior boys have commenced woodwork at Hale End on one session per week. During the summer term parties of children from the school made regular visits to the Jubilee (Open Air) Retreat, Chingford. "Three pupils left school for employment, and all were interviewed by the Youth Employment Officer, each being satisfactorily placed in industry. "As in previous years, there have been many visitors to the school including medical students, student health visitors, training college students, teachers and a visitor from Germany. "At the end of the summer term. Miss P. Hardy, Assistant Teacher, left to undertake a long visit to Australia, her place being taken by Miss D. Coote. It is with deep regret that the death of Miss M. L. Mahoney, for many years an assistant teacher at this school, has to be recorded. "I have to acknowledge my very deep appreciation of the efforts of the teaching and welfare staff on behalf of these handicapped children. "During the year the average number on roll was 46.3 with an average attendance of 40.12." (b) School for the Physically Handicapped.—Mr. G. M. Williams, Head Master, reports as follows:— "The work of the school is influenced to a large extent by the weather and particularly so by adverse weather. In this respect 1954 will rank as a very indifferent year. The buildings are designed to take maximum advantage of sunshine and are not well fitted for inclement weather conditions. During a very cold January spell the attendance dropped to under 50%, and throughout the year the poor sunshine record was reflected in a lower standard of general health and bad attendance. On many days even in the summer it was necessary to keep all classrooms closed. 46 "From May to September, Classes 1 and 2 went regularly to the Forest Centre at the Jubilee Retreat, Chingford, but they were confined to the buildings for the greater part of the period. "Throughout the year a selected party of more seriously crippled children, in the charge of Mrs. Meyer, has been attending the South West Essex Technical College swimming bath, where, with the co-operation of Miss Fuller, much useful hydrotherapy has been given. Several of these children have gained swimming certificates. "The school continued the practice of former years in opening during the summer holidays when a voluntary attendance of over 90% was maintained. "Visitors to the school during the year included students from training colleges for teachers, student health visitors, 'Queens' district nurse trainees, doctors, Her Majesty's Inspectors and three teachers from Germany. "Miss Smith, Educational Psychologist, has made five visits to the school to see selected children, and lias given much helpful advice. The Youth Employment Officer visited three times to interview school leavers, of whom two have been found to be unemployable, and the remaining five have been suitably placed in employment. "Of 34 children who were taken off the roll during the year, seven left as being over statutory age, 18 were transferred to ordinary schools, four were transferred to residential schools and five were admitted to hospital. Twenty-nine children were admitted during the year including five re-admissions. "Dr. Watkins has made regular weekly visits to the school, and has taken an active interest in all departments. Each child has been medically examined at least three times per term, and several have had weekly supervision. During the summer term several pupils who had been discharged during the previous year were recalled for medical examination and follow-up. "A total of 1,704 minor treatments have been given at the school. The children on roll at the end of the year were classified as follows:— Delicate (Ministry of Education Category j) 35 Physically Handicapped (Ministry of Education Category h) 40 Epileptic (Ministry of Education Category f) 5 80 "The average number on roll during the year was 75.5 with an average daily attendance of 59.41. 47 "I must again put on record my appreciation of all my colleagues on the staff, teaching, nursing, welfare, domestic and transport, for their valued co-operation in the work of the school." Swimming Instruction for cases of Poliomyelitis.—This has been in operation in Walthamstow for some three or four years, and a weekly 'bus party is made up from the special schools. (c) School for the Deaf.—Mrs. I. J. M. Burt. Headmistress, reports as follows:— " The year began with 40 children on roll. "For a few days at the end of February many children and members of the staff suffered from severe diarrhoea and sickness. Food poisoning or dysentery were suspected, but although all cases were immediately excluded and subjected to tests the results were negative. "In May, Dr. Francis Clarke and Mrs. Dodd, County Audiometrician, tested children with the new Mark III Medresco Hearing Aid. They recommended the issue of Mark III aids to children who wore their aids regularly and derived benefit from them. This has since been done. "During May, Dr. Watkins carried out a full medical inspection. "During the summer the school took part in both Junior and Senior Sports Days, with credit. "In October, Dr. Francis Clarke, who is in charge of the Ear, Nose and Throat Clinic, examined the children. "The general health of the pupils throughout the year has not been so good as in previous years. Catarrhal colds have been prevalent and respiratory complaints generally have caused much more absence than ever before. "One girl was transferred from this school to Churchfields Primary School in September. She came to us two years ago with only rudimentary speech and no lip reading ability and she could not read, write or count. In two years she has learned to speak clearly, read fluently and to write clearly expressed English composition, and has reached the normal standard for her age in arithmetic. We are glad to hear that, in a class of hearing children of her own age, she was second and had one mark less than the boy who took first place. "One boy and one girl left school at the end of the year—the girl to do dressmaking and the boy shoe repairing. Both are happy in their work. 48 "The number on roll at the end of December was 45. Only nine children are from Walthamstow, and 36 are from other districts. "The totally deaf number 20 and the other 25 are either partially deaf or with at least some, if little, residual hearing." The following report by the Headmistress is of interest:— "G. was a very difficult child to deal with when she first came to this school in March 1953. "Most children who are deafened as she was go through a period of bewilderment and bitterness, but in most cases that period is not long. They respond to love and understanding, and when they can lip-read, as they can very soon, they become adjusted to the new circumstances and make rapid progress. "G. was with us for months before she showed even a spark of interest in anything, and, far from responding to a casual gesture of affection, she positively shrank from it, and angrily repulsed the person offering it. She had been here for three months before 1 saw her smile. For long, in spite of almost superhuman patience on the part of staff and children, she remained an unhappy little 'lone wolf,' and we felt that to force the pace would have been to court failure and would do more harm than good. "We eventually broke down this resistance to all attempts at friendship by giving her charge of a baby girl who came with her in the same school bus and what we had failed to do, L. achieved. "G. became protective and gentle with the little girl, and one by one we added to her brood. After a while she came diffidently to us to tell us of their needs or little clevernesses and gradually she became more and more co-operative, accepting other motherly little girls as assistants, and even leaving the babies to their own devices to play with her contemporaries at normal games. "I discovered quite by accident that she has a passion for animals, and I opened the flood gates one day by mentioning her pet cat. It was a real joy to see the poor little tightly-shut-up child opening out and forgetting to be unfriendly. Since that day her lipreading has improved rapidly and her attitude to others has changed. "Her speech was inaudible when she first came, and her written work illegible. Her voice is still not good—it is hoarse and a little too quiet, but she is now amenable to correction, so it will go on improving, and her written work is good. "She still does have fits of moodiness, but they are few, and her general school work is showing steady, if slow, progress. She will never be 'the life and soul of the party,' but at least she has accepted her disability, and is happy and uninhibited when with her 49 schoolfellows, both at work and at play, and she takes praise and blame from her teachers in a perfectly normal way." (d) School for the Educationally Subnormal.—Miss R. E. A. Lock, Headmistress, reports as follows:— "Since the appointment of an infant teacher the number on the school roll has been raised to approximately 82. "There have been one or two staff changes during the year. One master has been granted 12 months' leave of absence in order to attend the E.S.N. Diploma course at London University. A woman teacher took his place. A part-time teacher of handicrafts was appointed. "Despite these changes, the teacher/child relationship is excellent. "My grateful thanks are due to the staff for their efficient team-work. "The health of the children has been good throughout the year." 17. 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. 18. NURSERY SCHOOL Miss F. D. Harris, the Headmistress, reports as follows:— " There is nothing outstanding to report. The children's health was very good apart from an outbreak of measles which occurred during the last weeks of the Christmas term." 19. MISCELLANEOUS (a) Health Education.—Two talks on child health were given to Parents Association meetings. Good Groomihg.—Fifteen lectures on good grooming were given at schools during the year. Nursing Exhibition.—During October a mobile Nursing Exhibition provided by the London Appointments Office of the Ministry of Labour, visited four schools in the area and was attended by parties from other schools. A talk on " Nursing as a Career " was given by the Superintendent Health Visitor to the parents of girls interested in the 50 fession at Blackhorse Road Secondary Girls' School in June. The Headmistress kindly made all arrangements. There was a good attendance and marked interest was shown by the audience. Many questions were answered after the talk. Mothercraft Lectures.—A series of twelve lectures on Mothercraft has been started at certain secondary schools to girls in their last year, and these are given by the Health Visitor/School Nurses. Up to the present they have been held at Markhouse Road and Sidney Burnell Schools. Pre-Nursing Course.—A Pre-Nursing Course at the Wm. Morris Technical School was recognised during 1954. (b) Employment of Children.—192 children were examined by the medical staff. (c) Employment of Children in Public Entertainment.—Eight children were examined under these regulations. (d) Staff Appointments.—86 teaching staff and 443 other staff were examined during the year. (e) Medical Examination of Prospective Teachers.—44 candidates for admission to Training College were examined during the year. (f) Sanitary Towels in Schools.—All schools have means of issuing sanitary towels on request. Supplies are held by Head Teachers and assistant teachers. The total numbers of the various items of consultation and treatment carried out in the School Health Service during 1954 have been extracted and are set out below:— Head Inspections 34,547 Dental Treatment 17,999 Dental Inspection 13,126 Orthopaedic and Physiotherapy 10,320 Minor Ailments 7,019 Medical Inspections 5,310 Speech Therapy 3,983 Eye Treatments 4,524 Other Inspections at Schools 3,022 Orthoptic 1,316 Child Guidance 1,849 Home Visits 1,007 Aural Clinic 760 Paediatric Consultations 214 Cardiac Clinic 56 105,052 51 I 20. STATISTICAL SUMMARY MEDICAL INSPECTION A. Routine Inspections 5,310 B. Special Inspections and Re-inspections 9,776 C. Pupils found to require treatment 1,235 II DEFECTS FOUND AT MEDICAL INSPECTION Requiring treatment 1,518 For observation 1,305 CLASSIFICATION OF GENERAL CONDITION OF PUPILS Nutrition 'A'—Good 3,981 „ ' B '—Fair 1,300 ' C '—Bad 29 III INFESTATION WITH VERMIN Total number of examinations 34,547 Individual pupils found to be infested 235 IV TREATMENT (a) Minor Ailments—total defects treated 1,782 (a) Defective Vision and Squint— Cases treated for errors of refraction 1,781 Other defects 29 Pupils for whom spectacles were—prescribed 983 obtained ... 983 Orthoptic Clinic—cases treated 265 (c) Nose and Throat Defects—number treated 237 total attendances 760 (d) Orthopaedic and Postural Defects— Treated as in-patients 25 Treated otherwise 620 (e) Child Guidance and Speech Therapy— Number treated under Child Guidance ments 248 Number treated under Speech Therapy ments 234 (f) Dental Inspection and Treatment— Periodic Specials (a) Number of pupils inspected 6,435 6,691 (b) Number found to require treatment 3,671 6,434 (c) Number referred for treatment 3,671 6,434 (d) Number actually treated 2,104 $281 (e) Attendances made for treatment 4,558 13,441 (f) Half days devoted by—- (a) Dental Officers to (i) treatment 2,360* (ii) inspection 49 (b) Hygienists to (i) treatment 60 (ii) other purposes . 9 52 (g) Fillings (i) Permanent teeth 6,322 (ii) Temporary teeth 2,961 (h) Number of teeth filled (i) Permanent teeth 5,887 (ii) Temporary teeth 2,765 (i) Extractions (i) Permanent teeth— (a) on account of caries 1,336 (b) for other purposes 234 (ii) Temporary teeth— (a) on account of caries 7,200 (b) for other purposes 907 (J) Anaesthetics (i) Local 709 (ii) General 5,039 (k) Other operations (i) Permanent teeth 6,038 (ii) Temporary teeth 2,437 (1) Number in (k) carried out by oral hygienists 386 (m) Analysis of figures in (k)— Orthodontic 2,209 Silver Nitrate 1,809 Scaling 405 Syringing Sockets 148 Other 3,904 Includes 135 sessions by visiting orthodontist and 252 sessions where a dental surgeon was acting as anaesthetist.