AC 4411(1) WAL 46 BOROUGH OF WALTHAMSTOW Committee for Education REPORT of the BOROUGH SCHOOL MEDICAL OFFICER for the year 1957 A. T. W. POWELL, M.C., M.B., B.S., D.P.H. BOROUGH SCHOOL MEDICAL OFFICER 1 BOROUGH OF WALTHAMSTOW Committee for Education REPORT of the BOROUGH SCHOOL MEDICAL OFFICER for the year 1957 A. T. W. POWELL, M.C., M.B., B.S., D.P.H. BOROUGH SCHOOL MEDICAL OFFICER INDEX Section 1 — Staff 8 Section 2 — School Clinics 8 Section 3 — Co-ordination 8 Section 4 — School Hygiene and Accommodation 9 Section 5 — Medical Inspection 12 Section 6 — Review of the Facts disclosed by Medical Inspection 13 Section 7 — Follow-up 15 Section 8—Arrangements for Treatment (Specialist Clinics) 15 Section 9 — Protection of School Children against Tuberculosis 31 Section 10 — Infectious Diseases 33 Section 11—Vaccination and Immunisation 42 Section 12 —Open Air Boarding School Education 43 Section 13—Physical Training 43 Section 14 — Provision of Meals 43 Section 15 — Co-operation 45 Section 16 — Handicapped Children and Special Schools 47 Section 17—Full-time Courses of Higher Education for Blind, Deaf, Defective and Epileptic Pupils 55 Section 18 — Nursery School 55 Section 19 — Miscellaneous 55 Section 20 — Statistical Summary 58 Accommodation 9 Employment of Children 58 Audiometry 22 Enquiry Officers 46 Boarding School Education 43 Epilepsy 58 B.C.G. Trials 31 Eye Clinic 19 B.C.G. at Schools 32 Eye Disease 14 Child Guidance 24 First Aid 56, 57 Chiropody 15 Follow-up 15 Clinics 8 Food Poisoning 36 Colour Vision Tests 14 Food Hygiene 44 Committee Members 4 Good Grooming 55 Convalescent Home Handicapped Children— Treatment 31 Deaf 50 Co-ordination8 E.S.N. 51 Deafness, Prevention of 21 Epileptic 49 Dental Anaesthesia 18 Partially Sighted 51 Dental Defects 14 Physically Handicapped 53 Dental Treatment 17 Health Education Lectures 55 Diphtheria Immunisation 42 Hearing Defects 14 Dysentery 33 Heart Disease 13 Ear Disease 14 Hospital Reports 8 Ear, Nose ξ Throat Clinic 21 Hygiene 9 Educational Psychology 26 Illiterates 49 Ineducable Children 48 Infectious Diseases 3 3 Influenza 38 Invalid Children's Aid Association 46 Liaison with Hospital Services 8 Mass Radiography 31 Meals, Provision of 43 Medical Examinations 58 Medical Inspection 12 Medical Treatment 15 Milk in Schools Scheme 45 Minor Ailments 16 New Schools 11 N.S.P.C.C 47 Nursery School 55 Nutrition 13 Open Air Education 43 Orthodontics 18 Orthopaedic Treatment 22 Orthoptic Treatment 21 Paediatric Clinic 27 Parents, Co-operation of 45 Physical Training 43 Physiotherapy 22 Poliomyelitis 39 Pre-Nursing Courses 56 Refresher Courses 58 Re-inspection 12 Ringworm 34 Sanitary and Washing Accommodation 11 School Hygiene 9 Skin Diseases 16 Special Schools 49 School Clinics 8 School for the— Deaf 50 Educationally Subnormal 51 Partially Sighted 51 Physically Handicapped 5 3 Smoking and Cancer 56 Specialist Clinics— Child Guidance 24 Ear, Nose and Throat 21 Ophthalmic 19 Orthopædic 22 Paediatric 27 Spectacles 20 Speech Therapy 28 Staff 8 Statistical Summary 58 Teachers, Co-operation of 45 Tonics 16 Tuberculosis 15, 31 Tuberculosis Vaccine T rials 31 Ultra Violet Light Treatment 31 Uncleanliness 13 Vaccination— B.C.G. 32 Poliomyelitis 42 Smallpox 42 Visual Defects 14 Voluntary Bodies 46 Welfare 44 Welfare Foods 44 Whooping Cough Immunisation 42 Wingfield Music Club 55 X-ray Examinations 31 WALTHAMSTOW COMMITTEE FOR EDUCATION 1957 — 1958 Chairman: Alderman S. N. Chaplin, j.p. Deputy Chairman: Councillor Mrs. E. M. Miller (Deceased) Ex-Officio: The Worshipful the Mayor: Councillor J. W. Princle, j.p. The Deputy Mayor: Alderman G. R. Lowton, j.p. Chairman of the Finance and General Purposes Committee: Alderman Ross Wyld, o.b.e., j.p. Ald. Mrs. L. P. Bailey, j.p. Ald. G. S Mace Ald. W. B. Fitt, o.b.e. Ald. A. E. Manning Ald. H. Fulton Ald. W. F. Savill. Ald. The Lady McEntee, o.b.e., j.p. Coun. Mrs. E. L. Baldwin Coun. Mrs. W. M. Palethorpi Coun. Mrs. S. Candy. Coun. A. F. Whicher. Coun. J. Hammond. Mr. L. V. Head, j.p. Rev. W. E. Smith Mr. R. Lamb Rev. R. Waters. Rev. Canon Prendergast Miss D. E. Wyld Borough Education Officer: E. T. Potter, B.Sc., j.p. 5 To the Chairman and Members of the Walthamstow Committee for Education. I beg to submit herewith a report on the work of the School Health Service in the Excepted District of Walthamstow for the year 1957 and to offer the following comments. There were comparatively few changes in regard to staff and adequate replacements were available. Unfortuntaely, however, the appointment of Senior Dental Officer for Walthamstow remained vacant throughout the year since the position has not yet been satisfactorily resolved with the Local Education Authority. Although some progress was made in regard to the improvement of sanitary accommodation many of the recommendations made by your Committee were not approved. Further reference is made to the matter in the body of the Report and attention must be drawn to the extract from the. Report of the Borough Education Officer to the effect that approximately one half of all the children attending Walthamstow schools are accommodated in premises erected before the Walthamstow School Board went out of existence following the Education Act, 1902. On the credit side are the erection of the McEntee Technical School and of the extension to the Warwick Secondary Boys' School. Other improvements affecting school health and hygiene are listed in the Report of your Architect. The nutritional condition of children as assessed at medical inspection was well maintained and even showed a slight improvement. The incidence of verrucae (plantar warts) was halved but even so, cases occurred at twenty-three school departments. It is fortunate that the facilities of the Health Area Sub-Committee's Chiropody Clinics are available to school-children. Your Committee's views in regard to the Authority's scheme for the supervision of the Dental Service in Walthamstow are fully set out. Apart from the vacant appointment of Senior Dental Officer one of the whole-time dental surgeons left at the beginning of December and leave of absence for professional study was given to another whole-time dental surgeon during the same month. As a result the volume of work was substantially reduced but the Service was still fortunate in retaining at the end of the year the services of four whole-time dental surgeons and two part-time dental surgeons representing a grand total of forty-six sessions per week on the part of all staff, i.e. whole-time and part-time. 6 Attention is invited to the reports by Mr. Tait in regard to orthodontic treatment and to the ready availability of this form of treatment in Walthamstow and also to Dr. Churchill's report in regard to dental anaesthesia. The five specialist clinics continued to do good work, and reference is made to the resignation of Dr. F. Clarke on attaining the age limit. Dr. Clarke gave good service in Walthamstow for 20 years. Mr. Alan M. Cammock was appointed by the Hospital Management Committee to succeed Dr. Clarke and by your Committee to give specialist supervision to the children at the School for the Deaf. The Hospital Management Committee also made available the services of a part-time clerk to assist at the Orthopaedic Clinic. Dr. Hinden comments on the decline in the severity of rheumatic fever "now a disease of trifling importance," and pays tribute to the work of Dr. Wilfrid Sheldon and Dr. Mary Wilmers who were in charge of the former Rheumatism Supervisory Centre at Walthamstow and which is now merged with Dr. Hinden's Paediatric Clinic. The section on Speech Therapy refers to a trial scheme at the Sir George Monoux School and to the increased co-operation of parents. B.C.G. vaccination continued, but on three occasions the vaccine failed to arrive on time and special arrangements had to be hurriedly improvised. The year was one of interest and at times of anxiety owing to the incidence of infectious and communicable diseases. In January there were three cases of Flexner dysentery at Higham Hill Junior School. In February a sharp outbreak of ringworm of the scalp and skin occurred at St. Mary's R.C. School and amongst the children accommodated at the Convent. In July there was an outbreak of food poisoning and epidemic nausea and vomiting at Selwyn Avenue Schools, followed in October by influenza. In November there were two deaths in five-year-old children attending the same class at Copper Mill Infants' School and within a period of some seven weeks. Both deaths were from a very acute form of infection of the upper respiratory tract. Over the whole year there was a succession of cases of poliomyelitis amongst all sections of the population. These outbreaks are more specifically reviewed in the Report. Although immunisation against diphtheria is primarily required to be done in the first year of life many parents unfortunately decline to give their consent at that time but change their minds when 7 immunisation is again offered to their children at school. As a result 302 primary immunisations were done in children of school age and, equally important, 1,245 booster doses were given to children who had been previously immunised. These booster doses are essential in order to maintain adequate immunity. Vaccination against smallpox received an impetus following the notification of a case of smallpox in an elderly female in July. Vac cination against poliomyelitis which had been commenced in 1956 was extended eventually to cover the age group between six months to the fifteenth birthday. Unfortunately supplies of vaccine were inadequate and continued to be so. It is a pleasure to record once more the Co-operation of those on whom so much of the success of the Service depends and particularly that of parents and teachers. The section in regard to handicapped children refers fully to the work of ascertainment and certification and the splendid work done at your Committee's four special schools and so well reported upon by the respective head teachers. All four schools were visited in the course of the year by Medical Officers of the Ministry of Education. The provision of a pure tone audiometer and a speech recorder through the Principal School Medical Officer, Essex, was of great value. The Head Teachers of the two High Schools for Girls and of one of the Technical Schools contribute reports in regard to their schemes for pre-nursing training. In view of the suggestion made by the chief Medical Officer to the Ministry of Education a review has been compiled of the progress of the School Health Service since its inception in 1907 and this report has been issued separately. Again I wish to express appreciation of the help and consideration shown to me by the Chairman, Members and Officers of the Committee for Education and to record the excellent work of the staff of the School Health Service. I am, Your obedient Servant, A. T. W. POWELL, Borough School Medical Officer. 8 1. STAFF OF THE SCHOOL HEALTH DEPARTMENT Appointments. Date Appointed Mrs. E. Labrom Part-time Dental Attendant 20.2.57 Miss J. A. Rasor Speech Therapist 15.10.57 Resignations. Date Resigned Mr. P. J. Pearce, b.d.s. (London) Dental Officer 30.11.57 Miss R. F. Millington, s.r.n., s.c.M., H.v. Cert. Q.N. Health Visitor/School Nurse 1.12.57 Miss A. Hemmings Speech Therapist 31.8.57 Resignation of School Dental Officer. Mr. P. J. Pearce, B.D.S., resigned as from the 4th December, and although the vacancy was advertised, no applications were received until January, 1958. 2. SCHOOL CLINICS The Minor Ailments and Dental Clinics previously accommodated at the Sidney Burnell Secondary School are now transferred to the adjacent Health Services Clinic at Silverdale Road. 3. CO-ORDINATION (a) Staff.—Co-ordination was secured by the fact that all the school health staff also carried out duties for other health services. The School Nursing staff was equivalent to seven whole-time nurses. (b) Family Doctors.—In 1953 one of the items noted in one of the periodical circulars to Family Doctors referred to the availability of School Medical Records at school leaving. An undertaking was given that these records would be sent forward on request, but few such requests have been received. It is desirable to send to Family Doctors a summary of a child's medical history before or shortly after leaving school and it is hoped to try out such a scheme during 1958. Whenever a consultant opinion is obtained through the School Health Service, a copy of the report is always sent to. the Family Doctor. (c) Hospitals.—Several hospitals continued to send summaries of their discharge reports in regard to children, notably Whipps Cross, St. Ann's and Ilford Infectious Disease Hospitals, Canadian Red Cross and the Prince of Wales Hospitals. The Medical and nursing staff continued to visit Dr. Hinden's children's wards at Whipps Cross Hospital. 9 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 7 — — County Primary Junior 2 2 12 — — County Primary Infants — — — 15 — Voluntary Secondary Modern — — 1 — — Voluntary Primary — — 3 2 — County Nursery — — — — 1 Special Schools for:— Deaf — — 1 — — Educationally Subnormal — — 1 — — Partially Sighted — — 1 — — Physically Handicapped — — 1 — — 1957 1956 1955 1954 1953 Number of Children on Register, 31st December 20182 20224 20072 20157 20174 Average attendance 17552.3 18328.2 18014.0 18139.6 17936.9 Percentage attendance 87.2 90.6 89.7 90.0 88.9 The increase in the number of children on the school registers over the last ten years amounts to 3,028, i.e. 17.6% of the 1948 roll. School Hygiene and Accommodation.—In January, 1957, the Committee noted that none of their recommendations regarding improvements to lavatory and washing facilities urgently required at certain schools had been approved. It was agreed that the position be noted and kept under review. In July the Committee for Education agreed that further representation be made to the Local Education Authority with a view to the inclusion in the minor capital building programme of additional projects to provide improvements in the sanitary and washing facilities at various schools already recommended by the Committee. In November the following resolutions were approved by the Committee for Education:— Higham Hill Junior Mixed and, Infants' Schools.—The Borough Education Officer reported that although this work was approved as a Minor Project for the financial year 1958/59, the Local Education Authority had requested the Committee to reconsider the work involved in view of the anticipated transfer of the school to other premises within a few years. A full discussion ensued, 10 and it was resolved that it be a recommendation to the Local Education Authority that the whole project as approved, be carried out. Woodford High School.—The Borough Education Officer reported the receipt of letters from the Local Education Authority and the Ministry of Education referring to the report of H.M. Inspectors on the full inspection Of the school in 1955, in which the provision of additional lavatories was recommended. The Committee resolved that it be reaffirmed that at many schools in Walthamstow there is urgent need for improved lavatory and washing facilities, and that the Local Education Authority be informed that in the opinion of the Committee the necessary works at the various schools be undertaken as soon as possible and in the order of priority shown in the list already submitted to the Local Education Authority in connection with the programme of Minor Capital Projects for the year 1958/59. Educational Building.—The Chairman drew attention to this clause (157) and expressed his grave concern about the probable effects of Ministry of Education Circular 331 on the Committee's building projects. Urgent projects for which the Committee had long been pressing, such as adequate and up-to-date lavatory accommodation in various schools and the provisions of kitchens and dining rooms, besides other projects, were in danger of being postponed indefinitely. Premises.—The Borough Education Officer in his Annual Report for 1957 states as follows:— "It is some indication of the size of this problem that approximately one half of all the children in Walthamstow schools are accommodated in premises erected before the Walthamstow School Board went out of existence following the Education Act, 1902." Routine Inspection of Sanitary Accommodation.—The medical staff and the public health inspectors continued their routine inspection of sanitary accommodation and all necessary action was taken in regard to defects brought to light. New Schools.—The first part of one new school, the McEntee Technical School, which has accommodation for 500 pupils, was brought into use just before the summer vacation. The buildings are modern in style, layout and construction but the medical inspection accommodation is not altogether adequate. Mr. T. L. Rampton, A.R.I.B.A., A.R.I.C.S., Architect to the Committee for Education, reports as follows:— 11 New Buildings, Additions and Alterations. Projects in course of being carried out:— Child Guidance Clinic Alterations and provision Date of completion 263 High Street. of new waiting room. December, 1957. Walthamstow High Additional Classroom Date of completion School for Girls. Changing Room and April, 1958. Showers. The Winns J.M. Conversion of Shelter Date of completion School. to Boys' Lavatories and February, 1958. Canteen. Major Projects:— The McEntee Technical This was completed in May, 1957, and School, 1st Phase. brought into full use in September, 1957. Warwick Sec. Boys' School. This was completed and brought into use in Extensions. March, 1957. Sanitary and Washing Accommodation. A number of improvements have been carried out:— Higham Hill J.M. School. A limited amount of remodelling the washing facilities. Woodside J.M. and Infants' New lavatory blocks with washing facilities Schools. were erected under the direction of private architects. "The Margaret Brearley" New washing facilities and staff lavatory have E.S.N. School. been provided. Others are in progress:— Mark House Sec, School. Remodelling of Boys' and Girls' lavatories with washing facilities. The Winns Junior School. Conversion of shelter into Boys' lavatories with washing facilities. When this amount of work carried out is set against what is required to bring the accommodation at so many schools up to standard, it is obvious that unless a major programme of reconstruction is agreed by the Ministry of Education, it will be many years before the problem is solved. Finance is the major obstacle and this yearly becomes more difficult. Maintenance. Annual distempering of Out Offices and the regular quarterly cleaning to all windows have been carried out. Heating. The first instalment of remodelling and converting to oil fired boilers at the Chapel End Secondary School was completed, and the installation brought into use early in the year. Although only a section has been carried out, temperature in rooms is much improved. 12 Existing systems have been maintained, new sections and replacement of certain parts have been necessary at a number of schools. Remodelling is still required in a number of the older schools. This work is, like other necessary improvements, awaiting available money. Lighting. Existing systems have been maintained and minor improvements carried out. Provision of Meals. The canteen scullery at "The Margaret Brearley" E.S.N. School was completed last November. Washing-up facilities at a number of schools have been improved and rinsing sinks installed. The extension at the Warwick Secondary School consists of Craft Rooms on three floors with some additional sanitary accommodation. It is of interest to note that the new block is partly built on the site of three dwellings (Nos. 196/200 Wood Street) damaged by enemy action. In addition, the site and garden of an individual unfit house cleared in 1956/57 has been added to the school grounds and will enable the erection of an assembly hall in future years. The plans in regard to new buildings, i.e., the Sidney Chaplin Secondary School and the Warwick Secondary Girls' School and the conversion of existing buildings at the latter site for dining purposes and further education, were examined and discussed with the Borough Education Officer, especially in regard to facilities for medical inspection. 5. MEDICAL INSPECTION The following gives a summary of the returns:— A. Periodic Medical Inspections— 5 year age group 1,355 10-12 year age group 1,562 14 year age group 622 Others 604 Total 4,143 B. Other Inspections— Special Inspections 2,557 Re-inspections 3,148 Total 5,705 13 Owing to the increase in the number of children on the school rolls since 1947 and the consequent crowding of accommodation it was not always possible for medical inspection to take place under satisfactory conditions. Special facilities have been provided in some of 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:— Number Inspected Satisfactory Unsatisfactory No. % No. % 5 year age group 1,355 1,315 97.1 40 2.9 10-12 year age group 1,562 1,548 99.1 14 0.9 14 year age group 622 607 97.6 15 2.4 Others 604 600 99.3 4 0.7 Totals 4,143 4,070 98.2 73 1.8 (b) Uncleanliness.—The following table gives comparative figures for the past two years:— 1957 1956 Average visits to schools 4 4 Total examinations 32,980 20,443 No. of individual pupils found unclean 109 97 Percentage uncleanliness of average attendance 0.6 0.5 The number of individual children found unclean during 1957 was 109, i.e. a percentage of 0.5 of the number of children on the roll. This compares very favourably with some areas where it is understood up to 15 per cent. of children are involved. These unclean children form the hard core of uncleanliness still left in the Borough and the continuation of even this comparative handful of unclean children is a matter for great regret and a reflection on the few dirty homes which continue to exist in spite of all the efforts of the social services. (c) Minor Ailments and Skin Defects.—The following was the number of skin defects found to require treatment or observation:— Treatment Observation Ringworm—Head 38 — Body 9 — Scabies 1 — Impetigo 2 — Other skin disease 203 55 14 (d) Visual Defects and External Eye Defects.—The number of patients requiring treatment or observation was as follows:— Treatment Observation Visual Defects 503 65 Squint 83 15 External Eye Diseases 47 29 Colour Vision Testing.—Testing is carried out with the Ishihara test cards by the School Nurses at the periodic medical inspections for the intermediate and leaver age groups. Any doubt' ful case is reported to the School Medical Officer. (e) Nose and Throat Defects.—The number of patients requiring treatment or observation was as follows :— Treatment Observation Enlarged Tonsils 42 112 Adenoids 2 2 Enlarged tonsils and adenoids 17 19 Other conditions 138 101 During the year the medical inspection schedules were scored to show those children who had been subjected to tonsillectomy. The resultant analysis is as follows:— Number Inspected Boys Tonsillectomy Boys Girls % Girls % 5 year age group 682 673 35 5.1 42 6.2 10-12 year group 606 956 72 11.8 116 12.1 14 year age group 344 278 49 14.2 50 17.9 Others 252 352 48 19.0 69 19.6 Totals 1,884 2,259 204 10.8 277 12.2 (f) Ear Disease and Defective Hearing.-All school medical officers are provided with electric auriscopes and a full examination of the ears is carried out at each medical examination. The number of patients requiring treatment and observation was as follows:— Treatment Observation Defective Hearing 24 56 Otitis Media 22 40 Other Ear Disease 34 5 (g) Orthopaedic and Postural Defects. A total of 202 defects were found to require treatment. (h) Dental Defects:- Inspection at Schools Children General Other Requiring actually Fill- Extrac- Anaes- Oner- Inspected Treatment Per cent. treated ings tions thetics ations 6,905 3,915 56.7 5,510 7,912 6,254 3,139 4,013 15 (i) Heart Disease and Rheumatism.—The findings were as follows:— Treatment Observation Heart disease—Organic3 10 Functional 3 64 Anaemia 6 1 (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:— 1952 1953 1954 1955 1956 1957 Pulmonary 5 3 — 1 — 6 Non-pulmonary 4 4 — 1 2 1 Total 9 7 — 2 2 7 (k) Other Defects and Diseases.—The following shows the number of various other defects which were found to require treatment:— Enlarged Glands 16 Bronchitis, etc. 93 Speech 31 Nervous System 21 Other defects 147 7. FOLLOW-UP The School Nurses paid a total of 452 home visits during 1957. 8. ARRANGEMENTS FOR TREATMENT (a) Chiropody.—Reference was made in last year's Report to the prevalence of verrucae and at the end of 1956, 106 children from twenty-five departments were under treatment at the Foot Clinic. In six departments there were six or more cases. At the end of 1957 there were 47 cases under treatment from twenty-three departments with 5 cases in one department. 4 in two departments, 3 in five departments, 2 in four departments, and 1 each in the remaining eleven departments. The overall picture was one of considerable improvement during 1957. 16 (b) Tonics.—The following shows the quantity of tonics issued during 1957:— Cod Liver Oil Parrish's Food Cod Liver Oil and Malt and and Malt Parrish's Food 47 lbs. 84 lbs. 1,055 lbs. (c) 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. (d) 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. Head Teachers were notified that as from December 1st the Medical Staff would be available to see children without appointment only between 9—10 a.m. It was suggested that when it was inconvenient for a parent to attend at this time and any cases requiring considerable consultation, a special appointment should be arranged. Such appointments would be dealt with between 10 a.m. and noon. The number of cases of minor ailments is shown in the following table detailing the work done at the school clinics:— First Inspections Re-inspections Boys Girls Boys Girls Ringworm—Scalp — 4 8 6 Body 3 — 4 4 Scabies — 1 — — Impetigo 7 8 32 26 Other Skin Defects 85 78 271 175 Orthopaedic conditions 56 42 56 31 Tonsils and Adenoids 10 11 7 7 Other E.N.T. conditions 60 51 66 79 Defective Vision (including squint) 61 71 11 12 External Eye Diseases 50 55 37 36 Nervous and Psychological Disorders 54 29 24 15 Various 489 346 724 682 Totals 874 696 1,240 1,073 First attendances numbered 1,570 against 1,565 in 1956 and re-attendances 2,313 against 2,149, the total attendances being 3,883 against 3,714. The following table shows the new cases and attendances at Minor Ailment Clinics since the "appointed day" in July, 1948. The decrease reflects the tendency for children to be taken to family doctors. 17 1949 1950 1951 1952 1953 1954 1955 1956 1957 New cases 3,757 3,356 3,106 2,990 2,397 1,782 2,017 1,565 1,570 Attendances 14,112 11,515 10,000 10,634 8,544 7,019 5,797 3,714 3,883 (e) Dental Treatment:— School Dental Service. The Committee had under consideration a communication from the Local Education Authority inviting observations on a proposal that the establishment of staff for the County Health Department be varied by the creation of four posts of Area Dental Officer with a view to arrangements being made for the grouping of two or more Health Areas under each Officer. In this connection it was tentatively suggested that the Boroughs of Walthamstow and Leyton with the Forest Division be grouped. Resolved:—(a) That the Local Education Authority be informed that the Committee reaffirms their previous resolution urging the retention of the post of Senior Dental Officer in Walthamstow, which was held by Mr. L. W. Elmer until his retirement recently. (b) That a full statement of the facts and of the Committee's views on various aspects of this matter, including the size of the establishment of Dental Officers in Walthamstow, their appointment as officers within the Education Service and the appointment of one of them as a Senior Dental Officer be sent to the Chairman of the Finance and General Purposes Sub-Committee of the Essex Education Committee. Priority Dental Service. The Health Area Sub-Committee agreed to equip the dental surgeries at the Town Hall for the new air jet spray technique and in order that this might be done, two of the three dental units previously approved for purchase during the current financial year had been deferred. The Sub-Committee had also agreed that the screening of the surgeries at the Town Hall should be completed at an approximate cost of £112, of which £36 would be charged to the Education Account. Mr. G. P. L. Taylor submits the following report:— "Since the retirement from the School Dental Service in December, 1956, of Mr. L. W. Elmer, there has been no Senior Dental Officer in Walthamstow. This has made the control and administration of the Dental Department more awkward. In addition, the loss of Mr. Elmer's professional services, the resignation of Mr. P. J. Pearce and the temporary absence of Mr. J. C. Timmis on a course of instruction at the Royal College of Surgeons, has substantially reduced the professional strength of the Department. 18 This means that during 1957 fewer sessions were worked, and the number of children inspected at school was only 6,905 as compared with 10,529 in the previous twelve months." Orthodontics. The following report has been submitted by Mr. R. V. Tait, B.Sc., L.D.S., R.C.S., the visiting orthodontist:— "During 1957, 101 new patients were accepted for observation or treatment at the orthodontic clinic. 80 patients were discharged after satisfactorily completing their treatment. A further 190 chlidren were examined and advice given to the school dental officers regarding their orthodontic treatment. "The main feature of the year's work has been the continued development of standardised techniques of orthodontic treatment making use of simple designs of removable appliance. This has greatly extended the range of orthodontic abnormalities which can be satifactorily treated by school dental officers who may have had no special orthodontic training. This increases the interest and variety of the school dental officer's work, as well as enabling a larger number of children to be treated. "It is perhaps worth pointing out that Walthamstow must be one of the few areas in the country where any child in need of orthodontic treatment can readily obtain this without appreciable delay at the school dental clinic. "The following figures show the work done in 1957:—" Total number of sessions 129 Appointments—Made 1,246 Kept 1,109 Cases brought forward from 1956 226 New cases commenced during 1957 101 Cases completed during 1957 80 Cases for which treatment was completed with appliances 53 Cases discontinued 25 Removable appliances fitted 100 Fixed appliances fitted 6 Cases seen in consultation with School Dental Officers 190 Dental Anaesthesia. Dr. Henry Churchill, Consultant Anaesthetist, reports that during the past three years some ten thousand nitrous oxide ("gas") anaesthetics have been given to children attending the Town Hall Dental Clinics. No premedication is used since this would involve a longer recovery time and might prevent a return home by public transport. 19 Dr. Churchill comments on the infrequency with which children arrive in an alarmed or worried condition and ipays tribute to the good handling of such children by the dental attendants. He stresses the importance of a planned layout for a dental clinic, in which respect Walthamstow is most fortunate. He also stresses the great advantage of using oxygen with nitrous oxide in giving a satisfactory anaesthetic to young children with a positive pressure apparatus and mentions the promise of even further improvements which are to be made available in an apparatus which has recently been designed. Dr. Churchill concludes that at present it seems as if Halothane may well replace the older anaesthetics (such as Ethyl Chloride, Vinyl Ether, Trilene, etc.) as the safest and most convenient for dental use. His objection to the use of the older anaesthetics lies in the longer recovery time, the greater incidence of vomiting and the problem of getting children home. Conditions of a satisfactory School Dental Scheme. During the year an extract from "The Health of the School Child" (Report of the Chief Medical Officer of the Ministry of Education for the years 1954 and 1955) was re-circulated to all medical and dental staff. In view of the continuing shortage of dental surgeons, the medical staff and head teachers were advised that dental treatment was to be given by appointment only and that no "casual" treatment was to be given. This became all the more necessary in order that the comparatively small number of routine dental inspections carried out at schools could be increased. The medical staff were asked to restrict their own referral of dental patients to cases of gross sepsis and toothache, with special consideration to children attending special schools. 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 Visual acuity of all children is tested at entrant medical inspections, but even so this may mean several months delay after admission. "Toddler" examinations are held before school entry, not only to test visual acuity, but to detect the defects which many children are known to show at entry to school. Dr. Hilton Ho states that he has already cut down the use of Atropine as a cyclopegic except in young children under 5 years. For children above five years of age Homatropine and Cocaine 20 drops are used followed by Eserine drops after the examination is completed; thus the child's near vision is affected for 4—6 hours only. The following table shows the work done during 1957 :— New cases Under 7 years. 7-11 years. Over 11 years. Total Boys Girls Boys Girls Boys Girls Boys Girls Hypermetropia 9 13 6 9 8 8 23 30 Hypermetropic Astigmatism 9 17 9 18 11 6 29 41 Myopic Astigmatism 2 6 11 17 11 18 24 41 Mixed Astigmatism 1 1 1 4 3 - 5 5 Myopia 1 2 22 33 32 32 55 67 Other Eye Defects 15 19 26 27 8 13 49 59 Totals 37 58 75 108 73 77 185 243 Number of children for whom glasses were— Prescribed 969 Obtained (a) through the Hospital Service optician 889 (b) through outside opticians 70 Number of re-inspections 3,774 Total attendances 4,140 Supply of Spectacles.—Mrs. Suckling, the Ophthalmic Optician employed by the Hospital Management Committee, attends at seven sessions each fortnight, and of the 969 prescriptions issued, 889 were obtained through her and 70 were taken to outside opticians. 318 spectacles were provided for the first time. During the year 1,072 patients were attended to for repairs and there were 55 complete replacements of glasses. The average time taken to obtain glasses through the clinic is 10 to 14 days, although many of the repairs were ready in 7 days. In addition there were about 750 odd fittings for which no charge was made. In the opinion of the optician a very good service is operated for the School clinics. The very considerable saving to the Exchequer will be obvious. 21 (b) Orthoptic Clinic.—The following shows the work done at the clinic:— Number treated for the first time 59 Number referred to hospital for operation 31 Number discharged 101 Total attendances 1,290 (c) Ear, Nose and Throat Clinic.—This year marked the retirement at the end of the summer term of Mr. Francis Clarke, F.R.C.S. (Ed.), who has served generations of Walthamstow schoolchildren with great kindness and skill since 1938. Mr. Clarke was very popular both with the patients and with his colleagues on the staff, and his retirement on superannuation was regretted by all. We were fortunate, however, in obtaining the services of Mr. Alan Cammock, B.M., D.L.O., who was appointed to succeed Mr. Clarke on August 19th. Mr. Cammock also holds the appointment of Ear, Nose and Throat Surgeon at the Connaught Hospital and this connection has already proved most fruitful in the arrangement of prompt treatment where hospital facilities are required. During the year 320 attendances were made at the clinic, 126 being new cases, and hospital treatment was obtained as follows:— Removal of Tonsils 20 Removal of Adenoids 4 X-ray of sinuses, etc. 12 Other treatment 5 Mr. Cammock has been appointed by the Committee for Education to visit and advise at the William Morris Deaf School and has shown great interest in the arrangements for the training of deaf children. The Prevention and Alleviation of Deafness.—In June, 1957, the Ministry of Health issued a memorandum on this subject and sufficient copies were obtained for circulation to all medical, health visiting, school nursing and home nursing staff together with the following advice. 22 The importance of early recognition and adequate treatment and training was stressed and the provision of a suitable hearing aid as indicated. Special attention should be paid at all school medical inspections, but particularly those of entrants, to the child's hearing for conversational voice and the condition of the ears as revealed by auriscopy. All doubtful cases should be referred to the school clinic for full examination, including audiometry, since some forms of deafness, e.g., high tone, are difficult to detect otherwise. An accurate assessment of the hearing should be made before any child is referred for speech therapy, for psychiatric examination, or for an intelligence test. Similarly children who have had meningitis, head injuries, or otitis should be examined for hearing loss on their return to school. Audiometric Testing.—In addition to the gramophone audiometer which has been available for some years, a pure tone audiometer was made available by the Principal School Medical Officer during 1957 and has been particularly useful in the testing of children attending the school for the deaf. In addition, between October and the end of the year, 60 children were tested on referral from routine medical inspection. (d) Orthopaedic and Physiotherapy Clinic.—This is under the clinical charge of Mr. G. Rigby-Jones, M.C., F.R.C.S., Consultant Orthopaedic Surgeon at the Connaught Hospital. Mr. Rigby-Jones reports that treatment at the clinic remains in the very capable hands of Miss Garratt, and the only change of note during the current year has been the appointment of a part-time Clinical Secretary by the Forest Group Hospital Management Committee. Mrs. Clark is attached to the Orthopaedic Department at Wanstead Hospital, and also performs the secretarial work for the Orthopaedic School Clinics in the Forest Group area. Her appointment has been a welcome addition and relieves Miss Garratt of a considerable amount of secretarial work. The following tables compiled by Miss Garratt, C.S.P., Physiotherapist, show the work done at the clinic:— 23  5-16 yrs. Boys Under 5 yrs. 16-18 yrs. 5-16 yrs. Girls Under 5 yrs. 16-18 yrs. Anterior Poliomyelitis 13 3 — 14 — 2 Surgical Tuberculosis — — — 1 — — Scoliosis, Lordosis, Kyphosis 76 1 - 98 1 - Arthritis 1 - - 1 — — Genu Valgum 13 15 — 14 6 — Genu Varum — 8 — — — — Pes Valgus and Valgus ankles 62 8 1 26 5 — Spastic paralysis 11 1 1 11 1 — Schlatter s disease 1 — — 3 — — Progressive muscular atrophy 3 — — 1 — — Osteo genesis imperfecta 1 — — — — — Talipes—(a) Equino varus 9 1 1 4 — — (b) Pes cavus 3 — — 1 — — (c) Metatarsus varus - 3 - - 2 - Torticollis — 1 — 1 — — Congenital dislocation of hip — 1 — 2 1 — Hallux rigidus — — — 6 — — Hallux valgus 1 — — 4 — — Spina bifida 3 — — 1 — — Perthes disease 2 — — 1 1 — Achondroplasia — — — 1 — — Diaphyseal aclasis 1 — — — — — Digitus varus 2 — — 6 — — Overlapping toes 1 1 — 4 2 — Hammer toe 1 — — 5 — — Claw toes — — — 7 1 — Arthrogryposis multiplex congenitae — 1 — — — — Slipped epiphysis — — — 1 — — Transverse myelitis — — — 1 — — Other congenital deformities 11 2 — 4 2 — Miscellaneous (including chest conditions) 88 7 — 52 3 — Totals 303 53 3 270 25 2 New cases seen by Surgeon— School age 91 Under school age 31 Total 122 Number of cases seen by Surgeon- From Physically Defective School 39 From other schools 415 Under school age 99 Over school age 3 Total 556 24 Total number of examinations made by Surgeon 678 Total number of cases discharged by Surgeon 98 Average number of examinations per session 45.2 Number of treatments given 8,075 Number of attendances for after-care 1,676 Number of sessions held— Treatment 443 Inspection 15 Number of visits by Instrument Maker 43 Admissions to Hospital 22 Operated on in out-patient department 4 Operations performed 26 Children transferred from Connaught Hospital 26 Total number of treatments 10,057 (e) Child Guidance Centre.—In February the Committee for Education recommended that in view of the large increase in the number of cases referred to the Child Guidance Centre, mainly from the Forest Division, the number of play therapy sessions be increased from eight to nine per week. The Consultant Psychiatrist, Dr. Helen Gillespie, reports as follows:— "There have been several changes of staffing during the year. We regret the loss of the services of Dr. Casimir, who left at the end of the year to take up an appointment as Consultant Psychiatrist at Grays Child Guidance Centre. Three months before leaving he reduced his sessions from 4 to 2. "There has been an increase of play therapy sessions, the average worked during the year being six per week. Miss LowBeer, having taken up her appointment here on April 16th, hopes to be able to work two more sessions in 1958. We have not been successful in filling the vacancy for an extra psychiatric social worker. "Some improvements have been made in the waiting room accommodation, and more room is being provided for the clerical staff. We are still, however, short of consulting rooms and an extra play room is needed now that we have the full complement of play therapy sessions. "The number of cases referred was 31 less than in the previous year, as we asked for fewer references until the waiting list can be dealt with. The number of cases diagnosed was reduced by 63. The total number of cases treated during the year was 293, as against 343 in 1956. This has naturally led to an increase of the waiting list from 113 in 1956 to 155 in 1957. 25 "The reduction in the work of the clinic is due to the lesser number of sessions worked by the psychiatrists. There was an unfortunate series of absences owing to illness among the staff, and this, coupled with Dr. Casimir's resignation, led to a loss of 21 psychiatric sessions." The following tables show the work of the clinic during the year. Figures for Walthamstow cases only are shown:— TABLE I Analysis of Figures for 1957 Number of cases referred to the clinic 83 Number of cases diagnosed at the clinic 45 (a) Psychiatrists Diagnostic interviews 47 Cases taken on for treatment 21 Treatment interviews 252 Other interviews 2 Total number of psychiatric sessions (including Chingford cases) 148 (b) Psychologists Clinic cases tested 38 Cases given remedial education 15 Treatment interviews (remedial education) 238 School visits on behalf of clinic cases 25 Other interviews at clinic 21 (c) School Psychological Service Individual cases seen 214 Number referred to clinic 7 (d) Play Therapists Cases treated 14 Treatment interviews 264 (e) Psychiatric Social Workers Interviews at clinic 642 Interviews elsewhere 10 (f) 'Waiting List Cases for diagnosis 56 Awaiting treatment 3 (g) Total cases treated during the year 115 26 TABLES II and III Analysis of Problems referred and Cases diagnosed Referred Diagnosed 1. Nervous disorders, e.g. fears, depressions, apathy, excitability 15 20 II. Habit disorders and physical symptoms, e.g. enuresis, speech disorders, sleep disturbances, tics, fits, etc. 13 3 III. Behaviour disorders, e.g. unmanageable, tempers, stealing, lying, sex problems, etc. 49 16 IV. Educational, e.g. backwardness, failure to concentrate 6 4 V. No basic disturbance of child, i.e. mainly parental over-anxiety — 2 83 45 TABLE IV Analysis of Cases Closed during 1957 (Including cases referred in previous years.) I. Improved and recovered after treatment 34 II. Improved after partial service, i.e. before diagnosis 9 III. Diagnosis and advice only 14 IV. Interrupted, e.g. on parents' initiative 20 V. Closed for miscellaneous causes (removal from area, placement at E.S.N. School, etc.) 10 87 REPORT OF THE EDUCATIONAL PSYCHOLOGIST FOR 1957 Miss E. M. Smith, M.A., reports as follows:— "This year the psychologist's work was somewhat limited by a period of ill-health. "Ninety visits were made to Walthamstow schools in order to give individual tests to children. Group tests were also given As usual the majority of visits were made to Infant and Junior schools; twelve visits were made to the Margaret Brearley School and eight to other special schools in the Borough. Five home visits were also made. 27 "In all 215 children were given individual tests either at school or in the Child Guidance Centre. This number included six children of pre-school age, and two children from other areas who needed special assessment before being transferred to a local grammar or technical school. The psychologist had discussions with 17 parents about the particular problems which their children presented. Seven children were referred by the psychologist for treatment at the Child Guidance Centre, and 29 were found to be in need of special education at an E.S.N. school. Four children were found to be both mentally and physically handicapped. "Eighteen children were given remedial education, usually in reading, but several needed help in arithmetic, one in spelling and one in algebra. "During the year the psychologist gave a course of lectures on the developmental aspects of the Junior School curriculum, and three lectures on adolescent problems." (f) Paediatric Clinic.—The clinic was continued under the clinical care of Dr. Elchon Hindon, Paediatrician to Whipps Cross Hospital, who reports as follows:— "There has been no material change in the work of the school consultative clinic. As before, most of the children are referred by the School Medical Officers; in a few cases the initiative comes from a teacher or from the family doctor. It is noteworthy that 'malnutrition' is hardly ever a reason for referring a child nowadays. "Rheumatic fever used to be a major scourge of school' children. There was a heavy death-rate in the initial attack, ranging from 10% to 30%; and of those who did not die, up to one third were left with damaged hearts. Those children had very little chance of escaping a life of invalidism, with auricular fibrillation and death in congestive failure menacing them from their thirties onwards. At best, an attack of rheumatic heart disease meant several months of illness and school absence, and the next few years blighted by the fear of relapse. The treatment of the actual clinical illness was not the responsibility of the public health authorities, but the overall supervision of the child and his education, and particularly the prevention of relapses, clearly was. Often special educational methods—from home teaching to the hospital school— were required for the disabled children. "The post-war years have seen a great decline in the severity of this fell disease. Attacks are milder, and hardly ever fatal; complete recovery is the rule, and relapse is rare. It is not certain what exactly is responsible for this. Undoubtedly, the new chemical drugs (first the sulphonamides, and now penicillin) have had a 28 powerful effect; but it is likely that improved housing and nutrition are also very important. Finally, we have to consider a secular* change in the invasive powers of the haemolytic streptococcus—the causative organism. This is shown, similarly, in the declining incidence and severity of scarlet fever. We should not be too complacent about this: what wanes may wax again. But be the causes what they may, there is no doubt of the effect; and in Walthamstow, as in the rest of the country, rheumatic fever is now a disease of trifling importance. The numbers of children attending the Rheumatism Supervisory Clinic, and particularly the new patients, have so fallen off that its Medical Director, Dr. Mary Wilmers, has felt justified in suggesting closing the clinic as a separate entity, and amalgamating it with the general school consultative clinic; and this was done from the beginning of 1957. I feel that many generations of Walthamstow school children owe a great debt of gratitude to Dr. Wilmers and to her predecessor, Dr. Wilfrid Sheldon, for their painstaking and most valuable work. "I should like to thank my colleagues in the School Health Service for the honour they do me in seeking my opinion, and the family doctor for permitting the reference; and to my colleagues at Whipps Cross Hospital, Dr. Walther, Pathologist, and Dr. Tettmar, Radiologist, for granting me the facilities of their departments." Over 5 years Under 5 years New cases 57 24 Total attendances 99 47 Physical Defects: Number of cases 43 24 Referred to Hospital 10 15 Discharged 9 8 Psychological Disorders : Enuresis 14 — Other 2 — Referred to Hospital 5 — Discharged 2 — (g) Speech Therapy.-Treatment centres are provided at the Old Education Offices at High Street and at the Wingfield House School. The arrangements for previous years have continued in regard to the selection and reference of children for speech therapy. During the summer term Miss Hemmings undertook speech therapy training at the Sir George Monoux Grammar School by special arrangement with the Headmaster, who reports that to * Secular.—A slowly progressive change. 29 begin with two classes were taken between 12.30 and 2 p.m. As particular faults became identified, one class was allocated to general vowel and other training, and the other for individual training. Since the immediate need was to correct the diction of boys shortly leaving school, treatment was concentrated on the third form and above. Mr. Stirrup goes on to state that one interesting result of the experiment has been to indicate the need for orthdontic and possibly medical treatment in some cases. The availability of a speech recorder was most valuable in recording progress. Miss C. M. Borthwick, L.C.S.T., reports as follows:— "The figures for the annual report have been set out in a somewhat different manner this year, the chief change being that cases under observation are shown. This includes those attending for interview and advice only and those returning for check-up following treatment. The classification of speech defects has also been simplified and clarified. "An innovation this year has been an afternoon meeting of mothers, to whom a talk on speech therapy was given. Between twenty and thirty mothers attended. This was only a small percentage of those invited, but nevertheless enough to make the meeting a success. Considerable interest was expressed and it did encourage one or two to request private interviews with me. I hope to make this meeting an annual event. "We have now a new tape recorder, a Vortexion. This is a far superior machine to any we have used before and will prove a great asset to the clinic." Miss J. A. Rasor, L.C.S.T., reports:— "An examination of the figures shows a distribution of cases similar to that of last year; however, it is interesting to note that the introduction of the new analysis of speech defects reveals that a fair percentage of stammerers have varying degrees of dyslalia. "Although not shown in this analysis it is also a feature of other stammerers to have an accompanying voice defect. The relief of these, cause or effect, symptoms has in many cases led to the successful removal of the principal difficulty of stammering. "Discussion with parents and head teachers has brought to light the increased incidence of nervous behaviour, such as enuresis and nail biting, accompanying even very slight speech defects and the general characteristic of 'nervous' mumbling is still a very common mark of the old dyslalic patient. 30 "Attendance this year has been somewhat lower than in last year, and in this final term it was 20 per cent. less than for the same period in 1956. Over 60 per cent. of these absences were due to illness; this has in some cases resulted in quite a substantial break in treatment. In one instance a patient missed a whole half term due to an almost continuous run of minor ailments. "A measure of contact has been made with the parents of children attending the clinic by means of home visits and holiday appointments. It is hoped to establish greater co-operation in these cases in an attempt to shorten the relatively long period of treatment these children undergo to correct quite simple defects. "Of those cases temporarily discharged in 1956, three were found to be in no need of further treatment and were discharged cured, four were put under observation for a further period and two were able to continue treatment. "I should like to take this opportunity of expressing my apprecation of the co'operation and help offered me by all departments since being appointed as Speech Therapist at this clinic." Annual Report and Clinical Analysis. High St. Clinic Open Air School Clinic Number in attendance at beginning of year 64 57 Number under observation at beginning of year 43 10 New cases 67 31 Transfer from other clinics— (a) within County — 1 (b) outside County — 1 Number of cases re-admitted after discharge 1 2 Total new entry 68 35 Cases discharged— (a) Cured 64 12 (b) Improved 4 2 (c) Defaulted 5 4 (d) Left district 7 4 (e) Transferred to other clinics 1 2 (f) No progress 1 — Cases in attendance at end of year 65 67 Cases under observation at end of year 28 11 Total attendances during year 2,152 2,020 Number on waiting list at end of year — 3 Analysis of Defects of children attending Clinic and under observation during year:— Stammering and Cluttering 49 10 Dyslalia 114 65 Stammering and Dyslalia 3 8 Delayed language development 3 1 31  High St. Clinic Open Air School Clinic Cleft Palate Speech 2 2 Voice defects— (a) Defects of nasal resonance 4 3 (b) Aphonia — — (c) Dysphonia — 1 Neurological Speech defects— (a) Aphasia — 1 (b) Dysarthria — 6 Probable mental deficiency 5 5 (h) Convalescent Home Treatment.—77 children were sent away for convalescence during 1957. There were two children remaining in convalescent homes and hospital schools on December 31st, 1957. (i) Tuberculosis.—The number of school children examined for the first time during the year was 104 boys and 106 girls, of whom 23 boys and 16 girls were referred by the school medical staff and 81 boys and 90 girls by private practitioners. 43 boys and 36 girls were examined as contacts. (j) Ultra Violet Light Treatment.—The total attendances for treatment were 306. 9. PROTECTION OF SCHOOL CHILDREN AGAINST TUBERCULOSIS (a) Chest X-ray Examination of Teachers on Appointment.— There has been no difficulty in insisting that all teachers on appointment in Walthamstow be required to undergo a chest x-ray examination. During 1957 the total of such examinations was 75. 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 staff are referred to the Mobile Mass Radiography Units and the static unit at Drayton Park, but the difficulties in such an arrangement are obvious when compared with local facilities. All staff engaged in the School Meals Service are also subjected to x-ray examination of the chest on appointment. (b) Tuberculosis Vaccine Trials (Medical Research Council). —Dr. T. M. Pollock, Physician in charge of the vaccine trials, arranged for the annual follow-up in Walthamstow to be made in June. Subsequently Dr. Pollock reported that of 202 young persons invited for these fifth annual chest x-ray examinations, 117 32 attended, i.e. 58 per cent. of the total invited. Of these 117, 69 per cent. completed the skin test. Again of the 115 who did not attend the previous check-up, 32 attended during 1957. (c) B.C.G. Vaccination of School Leavers.—The scheme followed was described in the Report for 1954 and continued during the year under review. Unfortunately it is still considered necessary by the Ministry of Health to supply the vaccine through the Local Health Authority at Chelmsford instead of direct, and on three occasions special arrangements had to be hurriedly improvised since the supply had not arrived at the proper time. The Heaf multiple puncture apparatus has been used exclusively during 1957 and with complete success. All secondary schools have been visited during the year and of the 1,926 children invited 1,246 accepted, giving an acceptance rate of 64.7 per cent. 1957 1956 1955 Number of Heaf positive 165 176 109 Percentage positive 13.8 14.2 13.0 Number of Heaf negative 1,026 1,064 740 Number absent 55 28 8 B.C.G. given 1,026 1,053 728 Absent or not done 11 12 By arrangement with the Chest Physician all the Heaf positive children were offered chest x-ray at the Chest Clinic. None were found to have active disease. No complications as defined in Section 18 of the 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 mainly owing to parental apprehension, although a fully explanatory leaflet is given to each child vaccinated. Arrangements have continued for family doctors to be notified when children on their lists in this age group are Heaf positive or have been vaccinated. 829 conversion tests were carried out on children who were given B.CG. in 1956. Nine gave a negative result to the test but all showed a good vaccination scar. 33 10. INFECTIOUS DISEASES Notifications from general practitioners of infectious diseases in the 5-14 year age group were as follows:— 1957 1956 Measles 753 286 Whooping Cough 113 185 Scarlet Fever 70 75 Pneumonia 2 6 Dysentery 4 21 Tuberculosis 7 2 Food Poisoning 17 4 Erysipelas — 2 Poliomyelitis 8 — Meningococcal Infection 1 — 975 581 Flexner Dysentery at Higham Hill Schools. Case Sex Age Class at School Onset Remarks 1. F 7 yrs. 16 11.1.57 Notified as a case of food poisoning treated at home; Flexner Type Z. (a baby brother aged nine months became infected 19.1.57). 2. M 7 yrs. 16 Admitted to hospital 21.4.57 as a case of suspect appendicitis; Flexner Type X. 3. M 7 yrs. 13 13.4.57 Admitted to same hospital as a case of ? encephalitis ? meningitis; Flexner Type X. During January and February nine other children from this school and four others from the associated infants' school were examined with negative results. After the diagnosis of the first case and in view of the unsatisfactory sanitary and washing accommodation at this particular school, hand basins were placed in each classroom so that children could rinse their hands in a solution of Eenzalkonium chloride after using the sanitary accommodation. Cases 2 and 3 were brought to notice during the school holidays and after consultation with the medical staff of the Ministry of Health it was decided to notify all parents during the school vacation as to the position and urge them not to present for readmission any child who had suffered from diarrhoea or bowel irregularity during the school holidays. Such children were not to 34 be presented until negative faecal specimens had been obtained. At the same time family doctors practising in the locality of the school were advised as to the position and their co-operation was requested. Fortunately nothing further transpired. Ringworm at St. Mary's R.C. School. Dr. Poole, Deputy Medical Officer of Health, reports as follows:— "On February 21st information was received from a skin specialist that he had diagnosed a very infectious type of ringworm among children resident at St. Mary's Convent, Shernhall Street. "The scalps of twenty-three children were affected and the majority had been attending the St. Mary's R.C. School where there were about 450 children on roll. Since it was obvious that the infection must have been present for some time, for about 18 per cent of the 130 children resident in the Convent to have been affected, it was at first feared that a similar proportion of the non-resident children attending the school might already have, or be incubating, the disease. "Accordingly top priority was given to the control of the epidemic and the Deputy Medical Officer of Health and a School Nurse were relieved of all other duties to concentrate on the examination of the entire school. "This was greatly facilitated by the purchase of a special fluorescent lamp (Wood's Light), which enabled the lesions to be detected before they became visible to the naked eye, and there is no doubt that the speed and thoroughness with which repeated examinations were carried out prevented the occurrence of a very serious outbreak by ensuring the immediate exclusion and treatment of all children found to be affected. Circular letters were sent to the parents of all children attending the school and also to all doctors practising in the district and the utmost co-operation was received from everyone concerned. "Arrangements were made for all cases too advanced for local treatment, including all scalp infections which required epilation by x-rays, to be treated at the Skin Department of the London Hospital, which also was instrumental in arranging the admission to Goldie Leigh Hospital of those cases for whom adequate nursing facilities were not available at the Convent or at their own homes. "When, as a result of the preliminary examinations, it became apparent that the infection was mainly confined to the Convent children, arrangements were made for all these to be segregated and taught separately. Pressure was exerted by parents of some 35 day children to have the school closed, but this was resisted since it was considered that close and repeated examinations of the children at risk gave the best chance of checking the outbreak and preventing its spread to other schools. The correctness of this view was amply demonstrated by the small number of non-resident children who became infected. "The School and Convent authorities gave invaluable assistance by carrying out the precautions advised by the Medical Officer of Health. At school close contact between the children (e.g. "pair work" in P.E.) was avoided and supervision exercised to prevent caps, combs, scarves, etc., becoming a source of spread. "At the Convent all toilet articles, clothing, bedding and other fomites were thoroughly disinfected and the already excellent standard of hygiene maintained. All premises were fumigated with formalin vapour by the Health Department staff. "In all, 35 cases of scalp ringworm and 13 cases of ringworm of the skin occurred and all healed satisfactorily with normal regrowth of the hair in the epilated cases. The highest incidence was 25 scalp cases and 1 skin case amongst 82 Convent children. "The original source of infection was never traced. On the assumption that the fungus had been introduced into the Convent by children recently admitted, or returning from a period in their own homes, all such cases were traced back by the courtesy and co-operation of the Medical Officers of Health of the appropriate districts, but in none was a source discovered. The causative organism of this type of ringworm (Microsporon audouini) rarely affects adults or animals so that its importation was almost certainly due to contact with an infected child, but the length of time which must have elapsed between the introduction of the infection and its recognition prevented the identification of its origin. "Thanks to improved social and hygienic standards, and the vigilance of School Nurses, ringworm of the scalp is now comparatively rare among school-children, but the occurrence of an outbreak involving 18 per cent of a community is a salutory warning not to disregard this condition which, although not dangerous to life, can so easily disrupt a school programme and, for the individual, mean the complete loss of scalp hair for a matter of months—a matter of special concern in the case of girls. The last case concerned on the 14th March, i.e. the outbreak was brought under control in three weeks." 36 Food Poisoning at Selwyn Avenue Schools. On Wednesday, the 10th July, the Headmistress at the Selwyn Junior School reported that 14 children were absent due to attacks of vomiting. Of the 14 only 5 had taken school dinners and on this history and especially since a sample of the school dinner showed no bacteriological abnormality, a provisional diagnosis of epidemic or "winter" vomiting was made. During the next three days, 40 further absentees were reported. On Monday, the 15th July, the Headmistress of the Infants' Department reported 11 children absent with diarrhoea and vomiting, together with one member of the staff. On the same day 5 children were reported away with diarrhoea and vomiting from the Boys' Department, together with 4 of the dining room attendants and 1 member of the kitchen staff. (The school kitchen at this group of schools is in a former classroom in the Girls' Department.) At this stage it appeared that of the children affected about a half were in receipt of school meals, and that in addition to epidemic nausea and vomiting a diagnosis of food poisoning had to be made. The results of the faecal specimens from children, kitchen and dining room staffs later showed that many were in fact suffering from food poisoning due to Salmonella Typhi Murium mainly of one untypable strain, but with one member of the staff affected with a different, but untypable strain. Later the former strain was reported upon as to sensitivity against various drugs, which were employed to treat the carrier conditions which resulted. As soon as a diagnosis of food poisoning was made, the parents of all children (over 1,100) were advised by letter as to the position, the precautions to be taken and to call in the family doctor if their children were suffering from diarrhoea and vomiting. The position was also brought to the attention of all family doctors in the Borough. As from the 19th July and purely as a precaution, no further meals were supplied from the school kitchen, arrangements being made to supply from another kitchen. The Head Teachers of the three departments were asked to report daily by telephone the names and addresses and the class of all children absent with diarrhoea and vomiting, together with the name of the family doctor if known. There was no clue as to the vehicle of the infection, and Dr. Betty Hobbs of the Central Public Health Laboratory was asked to 37 visit and advise. A full inspection was made and various samples were collected for bacteriological examination, but all proved negative and no cause was discovered. Dr. Betty Hobbs, in a subsequent communication, stated that "there are so many foodstuffs contaminated with salmonella these days that the organism could have been introduced into the kitchen in an uncooked substance." In this connection boned meat from abroad appears to be particularly liable to contamination and although such meat may be adequately sterilised by cooking, it may well infect the hands of kitchen staff together with tables and utensils used in the kitchen. Such bacterial contamination, of course, is not visible to the naked eye. The final total of children absent from school with diarrhoea or diarrhoea and vomiting appeared to be 58 and of these 20 were bacteriologically proved cases of food poisoning. In addition some 84 children were reported absent with vomiting and were regarded as cases of epidemic nausea and vomiting. Among the school kitchen and dining room staffs, 18 symptomless carriers were found and all were bacteriologically cleared before being allowed to resume work. Complaints were received from parents as to the inadequacy of the sanitary and washing facilities, but all these premises were cleansed and redecorated—as was the school kitchen—during the school vacation. C1. welchii Food Poisoning. The report for 1956 refers to an outbreak of food poisoning at Chapel End Secondary School, and the recommendations made by Dr. Betty Hobbs of the Central Public Health Laboratory at Colindale after a very extensive investigation. These investigations are referred to on pages 35 and 36 of the report for 1956. Dr. Betty Hobbs revisited Walthamstow in 1957 for a check up on the effectiveness of the new technique, and I am indebted to the Deputy Chief Public Health Inspector for the following notes:— "Previously meat and gravy mixed was put in containers in the hot plate until service or distribution, and the additional gravy was stood on top of the hot plate to keep 'hot.' "Now all meat after slicing is placed into containers which go into the steamer and remain there until such time as they are placed into further insulated containers for distribution or placed on trolleys 38 for service in adjoining dining rooms. Similarly, the gravy now remains in a boiling vat at simmering temperature until distribution or dished up for service. "The meat in this instance consisted of legs of lamb with bone, roasted in a medium oven, indicating thermometer showing 325° F. approximately." Dr. Betty Hobbs agreed that the investigations during 1957 confirmed the effectiveness of the precautionary measures which had been suggested for the storage of sliced meat pending distribution from a central kitchen to surrounding schools. Influenza. In accordance with the general measures suggested by the Ministry of Health, arrangements were made with the Borough Education Officer to obtain information in regard to the incidence in schools. A letter of advice was drawn up and circulated by the Borough Education Officer to all Head Teachers. The steps suggested included the prompt exclusion of all staff and children with early symptoms, the importance of securing maximum ventilation in all classrooms, and the avoidance of combining classes, assemblies, etc. I am indebted to the Borough Education Officer for the following comparisons:— The percentage of whole week absences rose from 1.2 at the beginning of September to 10.9 for the week ending 18th October, and 14.9 for week ending 25th October, declining to 3.2 for the week after half term closure, i.e. week ending 8th November, and rising again to 6.1 for the last week of term, i.e. week ending 20th December. Over the same periods the average percentage of absences, i.e., including short absences, was 8.1 at the beginning of September, rising to 16.2, 19.5, 21.9 and 19.6 in the four weeks of October, dropping to 7.8 on resumption after half term closure, and rising again to 12.3 before the last week of term. On the 22nd October (the date of maximum incidence) over 30 per cent. of children at Infants' Departments were absent, 20 per cent. from junior schools and just under 19 per cent. from secondary schools. For comparison, the maximum incidence amongst adults according to sickness benefit claims lodged at the Ministry of National Insurance was during the fortnight ended the 23rd October. No deaths from influenza occurred amongst school-children, but one child aged five years died of phlegmon of the glottis and acute streptococcal pneumonitis during the weeking ending 12th October. This fatality is referred to separately in the report. 39 Poliomyelitis. Of 21 cases notified in the Borough during 1957, 6 were of pre-school age, 8 of school age, and 7 were Oiver school age. Particulars are as follows of children of school age:— Case No. Sex Age Onset Paralytic or Nonparalytic Remarks on Hospital discharge 1. M 6 yrs. 26 Jan. N.P. Complete recovery, Type 1. 2. M 7 yrs. 27 Jan. N.P. Complete recovery. 3. F 7 yrs. 2 Feb. P. Very slight limp. 4. M 10 yrs. 17 Feb. P. Slight facial paralysis ing speech; weak left leg. Polio virus not isolated. 5. F 11 yrs. 24 Jul. N.P. Complete recovery. 6. M 9 yrs. 24 Jul. N.P. Complete recovery. 7. M 6 yrs. 11 Aug. P. Right leg paralysed, ing caliper. Type 1. 8. M 5 yrs. 19 Aug. P. Slight limp. The same school was involved in cases 1 and 3, but case 1 was only finally diagnosed by a second blood serum investigation in July. Acute Infection of the Respiratory Tract. On October 4th and November 23rd two five-year old children attending the same class at Copper Mill Infants' School died after very acute illnesses. The causes of death, after Coroner's postmortems were stated to be in the first case, phlegmon of the glottis and acute streptococcal pneumonitis, and in the second case, phlegmon of the glottis. Post mortem bacteriological examination in the second case showed nothing significant and no haemolytic streptococci. These fatalities were first brought to light on the 26th November by the Headmistress of the school and shortly afterwards by the Family Doctor. There was reason to think that the infection might be primarily influenzal with secondary bacterial infection, possibly streptococcal. The absentees from school (presumably mainly due to influenza) at the respective dates of death were 11% and 9%, i.e., considerably lower than the general average at infants' schools. The school health records showed that both children had been adequately protected against diphtheria. Immediate notice was given in writing to the parents of all children attending this particular class that their presence at school in the afternoon of November 26th would be presumed as permission to take nose and throat swabs. This was carried out and in addition all other staff and children at the school were subject to 40 a visual examination of the nose and throat, and having regard to the time of the year and compared with similar mass examinations previously carried out in the winter at other schools, the findings were not significant and the fauces seemed to be less injected than expected. Arrangements were made for all absentees to be visited by the school and welfare staffs and all Family Doctors and parents were advised as to the position. Doctors were advised as to the acute onset and fatal progress and parents for their part were told that although there was not necessarily any connection between the two deaths, the Family Doctor should be called at once if any of their children appeared to be unwell and the doctor's attention was to be drawn to the fact that the child was in attendance at this particular school. An outline of the position was conveyed to the appropriate Medical Officers of the Ministries of Health and Education, the Principal School Medical Officer of Essex, and the Public Health Laboratory Service. A consultation was arranged for the next day (November 27th) with Medical Officers of the Ministry of Health and of the Public Health Laboratory Service, whose help is gratefully acknowledged together with the co-operation of H.M. Coroner and his pathologist. Following the nose and throat swabbings of the class concerned, the whole class and the teacher were excluded until all had been proved negative for haemolytic streptococci Group A, and arrangements were made to swab the whole staff and scholars as soon as possible and this was done on December 2nd. When the results came to hand, all Group A carriers were excluded and referred to their family doctors for treatment. No absentee child was readmitted until negative swabs had been obtained. Several children had complained of nausea and vomiting, but all gave negative swabs and were regarded as cases of "winter vomiting." Daily medical sepervision continued until the Christmas closure and the following shows the positive findings out of a school with 170 children. Class 1— A/4 (2): A/12 (1): A/28 (1): C (1): Total = 5 Class 2—A (untyped) (1): C (2): ,, = 3 Class 3— A/2 (1): A/12 (1): A/28 (1): C (1): „ = 4 Class 4— A/12 (1): A/28 (2): O (1) ,, = 4 Class 5—A (untypable) (1): A/12 (1): A/28 (1): C (2): „ = 5 Grand Total: 21 (The class concerned was class 4) Children carrying Group A streptococci were not re-admitted until cleared. Urine tests were arranged for those carrying nephritogenic Types 4 and 12. 41 In view of the findings in regard to Group A streptococci, it is of interest to note that no case of scarlet fever had been notified from this school in 1957, and indeed the incidence of scarlet fever in the Borough has been unusually low throughout the year. It is relevant to recall that during the outbreak of mild scarlet fever at the Sidney Burnell Infants' School in 1954/5 a child, aged five years, in attendance at that school died on the 3rd December, 1954, from a phlegmonous infection of the glottis and streptococcal bronchitis. The cause of death was certified after a Coroner's Post Mortem without Inquest. The Post Mortem bacteriological examination in that case showed a Streptococcus Viridans, whereas the scarlet fever cases were due to Haemolytic Streptococci Group A, Type 4. Comment: Cases of this nature are, fortunately, very rare and appear to present great difficulty in regard to prognosis. The family doctor may consider a case to be either one of spasmodic croup or of laryngismus stridulus (laryngeal tetany), which conditions are usually not serious or fatal, although the symptoms may be alarming. Alternatively, the condition may be one of acute laryngitis (Acute Laryngotracheo-bronchitis), Acute Supraglottic Oedematous Laryngitis, Oedematous Laryngitis; Phlegmonous pharyngitis, or Oedema of the Glottis, all of which may be rapidly fatal and for which admission to hospital may be necessary with adequate facilities for tracheotomy. A recent article in the medical press (Beale, A. J., et. al. 1958 Brit.med.J. I, 302) in regard to laryngotracheobronchitis states that this condition is common in North America, is often called croup after the most prominent symptoms, that mortality is now negligible owing to modern methods of treatment, but that the causation is obscure, although the lack of bacteriological cause suggests a virus. In the cases reviewed in this article (all of which had been admitted to hospital) the disease was sufficiently severe to raise the possibility of tracheotomy. Exclusion from School on account of Infectious Illness. During the course of the year the Borough Education Officer circulated to all schools copies of the revised Memorandum issued by the Ministries of Health and Education. 42 11. IMMUNISATION (a) Against Diphtheria.—302 primary immunisations were done in children of school age and 1,245 "booster" doses were given in school immunising sessions. (b) Against Whooping Cough.—Eleven children over five years were immunised against whooping cough during 1957. The main effort of whooping cough immunisation was directed towards children of pre-school years, of whom 977 were immunised. (c) Vaccination against Smallpox.—The vaccinal condition of each child examined at routine medical inspection was noted, and a summary shows the following:— Number inspected Number found to be vaccinated Percentage vaccinated Entrants Boys 682 219 32.1 Girls 673 228 33.8 10-12 year Age Group Boys 606 251 41.4 Girls 956 448 46.8 14 year Age Group Boys 344 116 33.7 Girls 278 98 38.8 Others Boys 252 85 33.7 Girls 352 143 40.6 4,143 1,588 38.3 The percentage in 1956 was 34.0. In July a case of smallpox was notified in an elderly female and somewhat naturally, an increased demand resulted for vaccination. The total of vaccinations done during the whole year for children in the 5-14 years age group was 1,405 primary vaccinations and 415 secondary vaccinations. (d) Vaccination against Poliomyelitis.— The primary group announced in January, 1956, as being eligible for vaccination consisted of children born in the years 1947/54 inclusive. In May, 1957, children born in the years 1955/56 also became eligible and a further opportunity was given for the registration of those children in the 1947/54 group who had failed to register. In November, 1957, eligibility for vaccination was extended to children born between 1943/46 inclusive and so covering the age range from six months to the fifteenth birthday. The (estimated) number of children of school age vaccinated during 1957 was 2,513. 43 12. OPEN AIR BOARDING SCHOOL EDUCATION During the year four boys and three girls were medically examined prior to returning each term to Kennylands Park School, Reading, Berks, and a further four boys received examinations before proceeding to Elmbridge Boys' School, Cranleigh, Surrey, for the Spring, Summer and Autumn terms. Premises at the Jubilee Retreat have again been used by parties from most of the day 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. 14. PROVISION OF MEALS During October and November the daily number of meals exceeded 8,000, or some 40 per cent. of the numbers on the school roll. During the same period the daily milk issues averaged over 15,000 per day, or some 75 per cent of the total on the school roll. School Meals Service.—The Borough Education Officer, in his report for 1957 states:— "In April the price charged for a school meal was raised by the Government from l0d. to 1/- and the number of children having dinner at school declined from a daily average of 8,806 to 7,959. A rise in numbers was apparent at the beginning of the Autumn term but, owing to the Influenza epidemic, this was not maintained. The Committee continued to provide dinners during school holidays at selected centres, but the number dropped well below 400, which was the daily figure for 1956. "An additional kitchen was opened during the year at the new McEntee Technical School in Billet Road. Most of the children served by this kitchen had previously had their meals in the refectory at the South-West Essex Technical College and this development, therefore, did nothing to relieve the overloading at the other kitchens. "During January and February the Ministry of Education conducted a thorough survey of the School Meals Service in Walthamstow. The report issued subsequently confirmed the known fact that in many cases the premises in Walthamstow used for the 44 School Meals Service are inadequate and substandard. A result of this survey has been that two kitchens, not built owing to the building restrictions imposed during the previous year, have been placed high on the list of Essex major projects for the School Meals Service for 1958. A kitchen and dining hall for the Sidney Burnell Secondary Modern School were considered such urgent necessities that permission was given for work to commence almost immediately. Minor improvements have continued to be made in schools to improve service and washing up facilities. The survey report indicated that the food value of the meals and the standard of cooking were quite satisfactory. However, rising food costs during the year created some difficulties. "Half-yearly contracts for the supply of all foodstuffs were completed following the receipt of competitive tenders. "The gradual changeover to new type dining furniture was continued." Welfare. "During the past year £552 was spent on the supply of clothing for necessitous children to enable them to attend school and 50,267 meals free of cost were supplied to 343 children." Welfare Foods for Schoolchildren under Five Years. In acordance with the decision of the appropriate Ministries, Head Teachers were notified in November that the supply of orange juice had been discontinued after the second birthday. No change was made in regard to the supply of cod liver oil for consumption at schools in addition to the normal home supply of welfare foods. The permitted quantity available for schools for each child under five remains at one 6-oz. bottle each three months. Inspection.—Mr. W. Richards, Chief Public Health Inspector, reports as follows:— " During 1957 the following inspections were carried out Schools 61 School kitchens 71 "Various types of defects were found as a result of these inspections; those of a minor character being reported direct to the Education Architect. "Major defects found included insufficient sanitary accommodation and washing accommodation. These were reported through the School Medical Officer to the Borough Education Officer. "Unsatisfactory conditions mainly in respect of food handling and equipment were found in the school kitchens. Advice and instructions were given to staff in respect of these matters. 45 Milk in Schools Scheme. — The arrangements detailed in previous reports were continued in 1957, all the milk supplied being pasteurised milk sold under licence. Five samles of milk were taken by the Public Health Inspectors for bacteriological examination during the year. All satisfied the methylene blue and phosphates tests. Sampling for biological tests (tuberculosis) has also been carried out at two local dairies on delivery of milk from various farms. These dairies supply the milk to some schools. Of 79 results from these samples only two were unsatisfactory and these were duly reported to the County Medical Officer of Health for appropriate action at the farms in question. 15. CO-OPERATION (a) Co-operation of Parents. The following table shows the attendance of parents during 1957, at the periodic medical inspections:— Number Inspected No. of Parents Per cent. 1957 Per cent. 1956 Entrants— Boys 682 646 94.7 93.9 Girls 673 620 92.1 91.3 10-12 year Age Group— Boys 606 495 81.6 84.1 Girls 956 815 85.1 79.0 14 year Age Group— Boys 344 73 21.2 27.8 Girls 278 84 30.2 34.7 Others— Boys 252 73 28.9 3 3.0 Girls 352 107 30.4 32.7 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 child, and with the considerable employment of mothers. 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 acknowledgment 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 Headmasters and Headmistresses of schools in the Borough were, with his co-operation, utilised in disseminating information. 46 (c) Co-operation of School Enquiry Officers. The Senior School Enquiry Officer and his staff have again co-operated most effectively with the work of the School Health Service. (d) Co-operation of Voluntary Bodies. The existing arrangements for the admission of pupils to holiday convalescent homes by arrangement with the local branch of the I.C.A.A. continued to operate satisfactorily. (i) The Invalid Children's Aid Association.—Miss Starkey, Secretary to the local branch, has knidly contributed the following report:— Children referred by:— Under 5 years Over 5 years Hospitals 1 5 School Health Services 2 39 General Practitioners — 29 3 73 Classification of above cases:— Under 5 years Over 5 years Anaemia, debility 1 30 After effects of acute or infectious illness or operation — 10 Bronchitis or pneumonia 1 4 Asthma — 9 Rheumatism, chorea, heart 1 3 Nervous conditions — 1 Diseases of—Ear, Nose and Throat — 1 Skin — 1 Other defects — 14 3 73 Children sent for convalescence 71 Children sent to Regional Hospital Board Homes — Children referred for visiting, advice, help or follow-up:— Hospitals 1 Voluntary Bodies 1 Parents 2 Health Visitors and Head Teachers 7 Number of visits paid 291 Office interviews with parents 74 47 (ii) National Society for the Prevention of Cruelty to Children.—The following is a summary of the work done during 1957:— Nature of Offence How dealt with Neglect 21 Warned 10 Ill-treatment 2 Advised 17 Advice sought 3 Beyond control 1 27 27 Number of Children dealt with:— Under 5 years Over 5 years Boys Girls Boys Girls 8 20 20 27 16. HANDICAPPED CHILDREN. The following number of special examinations were carried out by the medical staff in respect of the categories stated :— (a) Blind 1 (b) Partially Sighted 1 (c) Deaf — (d) Partially Deaf — (e) Educationally Subnormal 36 (f) Epileptic — (g) Maladjusted — (h) Physically Handicapped 6 (i) Speech — (j) Delicate 16 Five children were known to be suffering from diabetes and all except one were at ordinary schools. During the year the provisions for the education of handicapped pupils in Walthamstow were reviewed and several visits were paid by Dr. T. K. Whitmore, Senior County Medical Officer for Child Health. Dr. G. M. Fleming of the Special Services Branch of the Ministry of Education, visited all the special schools and was accompanied on his visit to the Deaf School by his colleague Dr. Charles Huss. 48 Dr. Poole attended a course at the Royal National Throat, Nose and Ear Hospital on the Early Diagnosis and Care of the Deaf Child, and the provision of a pure-tone audiometer through the Principal School Medical Officer enabled an up-to-date assessment to be made of all the children attending the Walthamstow School for the Deaf. It was found possible to return two children to hearing schools, one being provided with an improved (transistor) hearing aid, and similar aids were provided for two other children with great benefit to them. A campaign to ensure the early diagnosis and treatment of defects of hearing was commenced and regular audiometry sessions arranged, to which were referred all children in whom a suspicion of hearing loss arose. It is hoped substantially to reduce the residual handicap of deaf children by securing early and intensive treatment and training. An additional class was opened at the Margaret Brearley School for Educationally Subnormal Pupils giving an additional twenty places (total 120) and this has permitted some reduction of the waiting list, but at least one more class is needed to provide accommodation for children who are so backward as to need special educational treatment. In spite of serving such large areas both Wingfield House School for the Physically Handicapped and the Joseph Clarke School for the Partially Sighted were able to provide vacancies for all urgent cases, including 14 from the County of Middlesex. General improvement in the physical condition of children is reducing the need for open air schooling but the increasing school population of the Forest Division is leading to an overall increase in the number of handicapped children requiring accommodation at the Walthamstow special schools and the available vacancies at Wingfield House are rapidly being filled. Educationally Subnormal Children.—The records of the Education Department include two large bound volumes containing very full records of educationally subnormal children and dating back to 1903. One book contains the names of 251 boys up to the last entry in March, 1921, and the other, the names of 200 girls up to February, 1922. These volumes are still frequently consulted in regard to subnormal persons for whom information is required from time to time. Ineducable Children.— During January the Committee had under consideration a communication from the Association of Municipal Corporations regarding the arrangements made for ineducable children under Section 57 of the Education Act, 1944, and asking for the Borough Council's opinion on a suggestion that 49 such children should not be the responsibility of the Local Health Authority but should remain within the sphere of activity of the Education Authority until the age of 16 years. The Borough Education Officer and the Borough School Medical Officer outlined the general position regarding ineducable children and gave details of the number living in the Borough and of the Occupation Centres provided by the Health Authority for their welfare and training. Classes for Illiterates.—The Borough Education Officer circularised Head Teachers in August stating that once again an evening class was being arranged for illiterates and backward readers, and help was requested in bringing it to the notice of any such persons. As before, the class was limited to persons over school age, and although intended primarily for young people, other adults could be accepted. Classes were free and conducted by the Educational Psychologist. Walthamstow Special Schools.—The number of children in the special schools in Walthamstow at the end of 1957 were as follows:— Partially Sighted E.S.N. Physically Handicapped Deaf Total Percentage Walthamstow 5 103 58 6 172 61.21 Forest 7 4 22 15 48 17.08 Middlesex 12 — 1 1 14 4.98 Romford 5 — — 5 10 3.56 Leyton 2 1 3 4 10 3.56 Ilford 2 — — 8 10 3.56 Dagenham 4 — — 2 6 2.13 South Essex 5 — — 2 7 2.49 Barking — — — 2 2 0.71 East Ham — — — 1 1 0.36 Cheshunt — — — 1 1 0.36 Totals 42 108 84 47 281 100.00 The number of Walthamstow children in residential special schools and homes at the end of the year were as follows:— Maladjusted 2 Delicate 2 Educationally Subnormal 5 Blind 5 Epileptic 4 Deaf 1 Speech 1 Physically Handicapped 2 50 Special Schools. (a) School for the Deaf.—Mrs. L. Corner, Acting Headmistress of the William Morris School for the Deaf, reports as follows:— "The school re-opened at the beginning of 1957 with 47 children on roll and with five classes. A part-time teacher was appointed for two days per week and in September a new class (the sixth) was commenced for the senior deaf pupils, the teacher to do auditory training as far as possible throughout the school especially when some of the pupils were attending at their secondary schools. The midday attendant was appointed as welfare attendant and a replacement obtained as midday attendant. "Visits were paid by the medical staff in order to discuss the use of transistor aids and five such aids were obtained on permanent loan from two makers. A transistor aid was provided for a senior girl who left at Easter to take up a post in the Air Ministry where she is reported to be doing well. Other transistor aids have been provided for one child who is holding his own at Copper Mill School and a girl left for her secondary modern school. "A speech training unit was provided in February and a pure tone audiometer in June, since when Dr. Poole has taken audiograms of all children requiring it. "We badly require another speech training unit and a teacher to use it whole time. We hope also to bring ourselves in line with other schools for the deaf by installing at least one 'loop' aid, also a small sound-proof room for auditory training. "A dental inspection was held here in September, the children's teeth being in excellent order. "We were pleased to welcome Mr. Cammock, our new Ear, Nose and Throat Surgeon. "Mr. Lumsden, H.M.I., has visited the school, as have also Dr. Huss and Dr. Fleming from the Ministry; also various doctors from neighbouring areas, Health Students and Teachers' Training College students. "There were 47 children on roll at the end of the year." The following table shows the allocation of pupils at the School for the Deaf over the previous seven years:— 51  1950 1951 1952 1953 1954 1955 1956 Walthamstow 14 10 9 8 9 6 5 Forest 4 13 15 16 13 18 14 Ilford 3 9 6 7 11 7 10 Leyton 1 3 6 5 4 5 5 Middlesex - - - - - - 1 West Ham - - - - - - - Dagenham 3 2 3 2 2 Romford 2 4 5 7 Barking 1 2 2 S. Essex 1 2 Totals 22 35 39 40 45 46 48 (b) School for the Educationally Sub-normal.—Miss R. E. A. Lock, Headmistress, reports as follows:— "During the year an extension to the main building was completed and fully equipped with wash basins, constant hot water and staff lavatories. This has eased the personal hygiene problem considerably. "The school is now fitted with radio and radiogram equipment. We are grateful for this as the younger children benefit from the music and movement lessons. "Our children were singularly fortunate during the recent influenza epidemic. Comparatively few succumbed. "Students from the E.S.N. Diploma Course of the University of London continue to use the school for their training." (c) School for the Partially Sighted.—Mr. G. M. Williams, Headmaster of the Joseph J. Clarke School for the Partially Sighted, reports as follows:— "This school with accommodation for 45 children and a large catchment area comprising the Metropolitan area of Essex, i.e. Walthamstow, Leyton, Chingford, Wanstead and Woodford, Ilford Barking, Dagenham, Romford, Hornchurch, Chigwell, Purfleet, the Forest Educational Division Area, and the N.E. Middlesex areas of Tottenham, Edmonton, Enfield, Hornsey and Wood Green, has now only 42 children on roll, at a time when the school population figures are running at a high peak. This reflects favourably upon the high standards of ocular hygiene at large, and on the general preventative services available for the pre-school child. "It is now possible that the figure of incidence of partial sightedness amongst school children given by the Ministry of Education should be further reviewed, bearing in mind that many of these children are now catered for in ordinary schools. 52 "As in previous years, the opthalmic supervision has been well maintained. Dr. I. Gregory, M.B., D.O.M.S., has made two visits to the school for the purpose of examination and has given much helpful advice with selected cases. Certain children have been recommended for further consideration as to whether individual high powered optical aids will be of benefit. "The medical staff at the Eye Clinic have made regular ophthalmic examinations, and Mrs. Suckling the optician has given efficient service in the repair and supply of spectacles. The ready and willing help of all Eye Clinic staff has been much appreciated. "At the special ophthalmic session held at the school in December, the visual acuity (Snellen) after correction was as follows:— 7 children with acuity less than 6/60 7 „ „ „ of 6/60 13 „ „ „ of 6/36 8 „ „ „ of 6/24 5 „ „ „ of 6/18 12 children had monocular vision only. "Dr. G. Poole, School Medical Officer, has made routine medical inspections of all school leavers and additional special cases. "Miss Smith, the Educational Psychologist, made three visits for testing purposes, and Miss Hemmings, Speech Therapist, two visits. "The school provided facilities for the medical inspection of children attending St. Patrick's R.C. School, which is adjacent to the premises. "Visitors to the school during the year included Dr. Fleming from the Ministry of Education, Dr. Whitmore, Senior Medical Officer for Child Health of the Essex County Council, School Medical Officers of the Forest Division, Orthoptists, Student Health Visitors, Student District Nurses, Training College Students, postgraduate medical students, a Norwegian teacher and a Swedish teacher. "At a test of illumination standards in the classrooms made by Mr. Rampton the Education Architect, each room varied between 35-50 lumens, according to position of the meter, a very satisfactory result. "In the period under consideration, 7 children left, two being transferred to ordinary schools, two to other partially sighted schools, one boy was declared ineducable, and two girls left to employment, one being registered as a disabled person and the other as a blind person. There were four children admitted. 53 "The average number on roll during the year was 40.4 with an average attendance of 36.03. "I have to put on record my deep appreciation of the efforts of the teaching, welfare and transport staff on behalf of the children in the school." (d) School for the Physically Handicapped.—Mr. G. M. Williams, Headmaster of the Wingfield House School for the Physically Handicapped, reports as follows:— "The school, with an accommodation for 95 children, has now 89 children on roll with four children awaiting admission. The catchment area of the school has increased and now comprises Walthamstow, Leyton, Chingford, Wanstead, Woodford, Chigwell, Loughton, Debden, Waltham Abbey and Harlow. Two children have also been admitted from Middlesex. "A new feature is the staying on at school of several severely handicapped senior children over the statutory leaving age, because of the difficulty or delay in obtaining either training or employment. "The number of children with more than one handicap has increased, several children having physical handicaps allied to educational subnormality; four children have three or more defects. There are twelve non-ambulant children on roll. "During the summer months there was a marked subsidence of part of the main building necessitating underpinning—this was done in the Autumn term. The kitchen and dining room were decorated internally during the summer holiday as well as certain rooms in the main building. "The school was kept open during the summer holiday period on a voluntary basis, 45 children attending and maintaining a 92% attendance. Visits were made to Thorpe Bay, Whipsnade Zoo, Bishop's Stortford and to the forest, and throughout the whole period only one day had to be spent inside. "Visitors during the year included Dr. Fleming of the Ministry of Education, the School Medical Officers of the Forest Division, a teacher from Heidelberg, post-graduate medical students, student health visitors, district nurse students and Training College students. "The teaching staff was depleted by the resignation of Mr. Thompson, who after many years of valuable service accepted appointment as Head Teacher of a Residential Physically Handicapped school. His place has been taken by Mr. Ellis, B.A. "Miss Hemmings, L.C.S.T., a Speech Therapist who has always taken an active and co-operative interest in the school and gave much helpful advice, resigned on marriage in September and was missed by staff and children alike. 54 "Dr. Poole and Dr. Werren have made regular weekly visits to the school, and their very ready and willing help has at all times been available for children and parents alike, and has been much appreciated. "Mr. Taylor of the School Dental Service attended the school in September, and held a full dental inspection. "Mrs. Leach, S.R.N., School Nurse, has attended daily and has assisted in the care and management of the children, and has undertaken audiometry on selected cases. A total of 2,627 minor treatments have been given by the nursing staff. "The school has enjoyed the valued co-operation of the Orthopaedic Clinic, and Miss Garratt, C.S.P., has given much helpful advice and assistance during the year. "Miss Smith. Educational Psychologist, made three visits for the purpose of examination and advice, and Mr. Berry, Youth Employment Officer, interviewed all leavers. "Through the helpful and valued co-operation of the I.C.A.A., three children were sent away for convalescent holidays during the year and six others assisted by family visits and advice. "As in former years, swimming instruction was continued at the Technical College baths, a mixed class attending every Friday, asthmatics in particular being encouraged to join this class as well as other physically handicapped children. Several swimming certificates were gained. "The children on roll at the end of the year were classified as follows:— Delicate (Min. of Ed. category " j ") 34 Physically Handicapped ( ,, " h") 45 Epileptic ( „ " f") 3 "During the year 23 children left the school, 11 being transferred to ordinary schools, 4 to residential schools, 2 to the School for the Educationally Sub-normal, 4 to employment and 2 left the district. "The average number on roll was 86.6 and an average attendance of 67.1 was registered. "I must again put on record my deep 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." 55 Delicate and Physically Handicapped Children.—The table below gives an analysis of the principal defects in children attend' ing Wingfield House (P.H.) School during November, 1957. Boys Girls Boys Girls Asthma 15 3 Epilepsy 2 1 Bronchitis 5 1 Muscular Dystrophy 2 — Bronchiectasis 1 2 Osteogenesis Imperfecta 1 — Collapse of Lung 2 — Delicate and Immature 2 5 Congenital Hips — 1 Congenital Heart 1 1 Cretin (treated) 1 2 Rheumatic Heart 2 3 Spina Bifida — Cerebral Palsy (Congenital) 4 9 Congenital Hypoglycaemia 1 — Cerebral Palsy (Post Meningitic) 1 4 Neurological Bladder — 1 Habit Spasm — 1 Anterior Poliomyelitis 2 — T.B. Bone — 1 Traumatic Paralysis — 1 Chronic Otitis 1 3 Totals 45 39 Wingfield Music Club.—Arrangements were made following a meeting of the Committee for Education for Members to view a short film made by the British Broadcasting Corporation of a performance by the orchestra of this club, which is associated with the School for the Physically Handicapped. The film had previously been televised. 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, Headmistress, reports as follows:— "This year has been notable for epidemics. In February there was measles, in October, influenza, and in November, mumps. "During the summer the children's health was good and the fine weather was very much enjoyed by all." 19. MISCELLANEOUS Health Education. (a) Good Grooming.—The Borough Education Officer in his Annual Report for 1957 states:— "Lectures in 'good grooming' were again arranged for girls in secondary schools. Twenty of these lectures were given during the year." 56 (b) First Aid Instruction in Schools.—During the year the Borough Education Officer enquired as to the extent in which instruction in first aid was given in schools. It was found that instruction was given in the following schools:— 1 Grammar; 2 Secondary Modern; 3 Junior and Infants'. Some first aid instruction was included with other subjects at the following schools:— 1 Technical; 5 Secondary Modern; 4 Junior and Infants'. Subsequently and at a meeting with the Head Teachers of Secondary Schools, it was generally felt that a formal course in first aid was not necessary provided there was instruction in regard to the treatment of emergencies with emphasis on home safety and the prevention of accidents in the home. Instruction should also be given as to hygiene and personal cleanliness. (c) Walthamstow Educational Fellowship.—Amongst the lectures arranged in this course was one on the School Health Service given by the Medical Officer of Health and the Borough School Medical Officer of Leyton. Approximately seventy teachers and others interested in the School Health Service attended the lecture, which was followed by a useful discussion. (d) Smoking and Lung Cancer.—The Committee considered a report on the Conference arranged by the Royal Society of Health in relation to smoking and lung cancer and referred the matter to the Teachers' Joint Consultative Committee for further consideration. (e) "Balanced Meals" and "Care of the Feet."—In June posters in regard to "Balanced Meals" and "Care of the Feet" were issued to the head teachers of secondary girls' and mixed schools. Pre-Nursing Courses. (a) Walthamstow High School.—Miss M. M. Burnett, M.A., states as follows:— "The usual Pre-Nursing Course was run at Walthamstow High School. Two girls completed the course and both passed the Preliminary Examination of the General Nursing Council." (b) Woodford County High School.—Miss K. M. Chapman, M.A., states as follows:— "With regard to pre-nursing and tuition in other allied subjects, our procedure until recently has been to have what is called a Pre-Nursing Course, registered with the Ministry of Education 57 and the General Nursing Council. We also have a considerable number of girls each year taking an alternative course which leads to the necessary exemption from Part I of the Pre-Nursing Examination : in this, with a sound, varied education, they take the Ordinary Level Examination in Human Physiology, Anatomy and Hygiene. (c) William Morns County Technical School.—Mr. H. P. Williamson, M.Sc. (Educ.), B.Sc., reports as follows:— "This school continues to provide a Course leading to exemption from Part I of the General Nursing Council's Preliminary Examination. It is not now usual for Preliminary Part I at the Examination to be taken as such, students obtaining exemption as a result of passing the subject of Human Biology in the General Certificate of Education at Ordinary Level. The main features of the Course remain the same. The basic subjects, English, History, Geography, Mathematics and P.E., are continued side by side with General Science and Anatomy and Physiology, Hygiene and the elements of Public Health. "Visits to Hospitals, Welfare Departments, Milk Pasteurisation Plants and Public Services such as Water Works and Sewage Disposal Plants continue to form an integral part of the Course for the full appreciation of which they are essential. A number of girls who have followed this Course at School are now qualified nurses serving in London area hospitals. All of these and the nurses already in training are unanimous in their opinion that the School Pre-Nursing Course has been a great help to them while in hospital. "Not all, either girls or parents, realise that a nurse should be a really well educated person and to this end it is highly desirable that boys and girls taking up nursing as a career should remain at school until they are 18 years of age and able to begin their full nursing training in hospitals. Some girls think that if they leave school at 16 years, follow some clerical occupation for a year or so, and then go to hospital, they are as well placed to render first rate nursing services as if they had continued their full-time education. This is not so. The more responsible the work demanded of nurses, the more important it is that their standards of general education on entering nursing training should be as high as those required for entry to teaching training and similar occupations. "The School has room for more girls in this Pre-Nursing Course and the attention of our young people is called to the satisfying career of service which nursing provides." First Aid Equipment in Schools.—In October the Borough Education Officer circulated to Head Teachers a list of approved first aid equipment to be maintained in schools. Head Teachers 58 were requested to bring their equipment up to the prescribed scale and to pay particular attention to the provisions required in work' rooms and laboratories. Holidays for Diabetic and Epileptic Children.—Two diabetics and one epileptic were recommended for holidays. Refresher Courses and Post-Graduate Instruction.—Members of the medical staff attended the courses set out below:— (a) Residential course on the School Health Service held at Bristol. (b) Course in Dental Anaesthetics at Eastman Dental Hospital. (c) Course in regard to Educationally Subnormal Children held by the National Association for Mental Health to enable medical officers to qualify as Certifying Officers. (d) Week-end Course in Mental Health at the Wansfell Training College. (e) Course of Lecture Demonstrations on "The Deaf Child" at the Royal National Throat, Nose and Ear Hospital. Arrangements were made for Mr. J. C. Timmis, School Dental Officer, to be granted leave with pay to attend a special dental course at the Royal College of Surgeons during December and January, 1958. Employment of Children.—322 children were examined by the medical staff. Employment of Children in Public Entertainment.—Three children were examined under these regulations. Staff Appointments.—83 teaching staff and 390 other staff were medically examined during the year. Medical Examination of Prospective Teachers.—45 candidates for admission to Training College were examined during the year. Sanitary Towels in Schools.—All schools have means of issuing sanitary towels on request. Supplies are held by Head Teachers and Assistant Teachers. 20. STATISTICAL SUMMARY I. Medical Inspection. A. Routine Inspections 4,143 B. Special Inspections and Re-inspections 5,705 C. Pupils found to require treatment 1,381 59 II. Defects found at Medical Inspection. Requiring treatment 1,619 For observation 1,408 Physical Condition of Pupils seen at Medical Inspection. Satisfactory 4,070 Unsatisfactory 73 III. Infestation with Vermin. Total number of examinations 32,980 Individual pupils found to be infested 109 IV. Treatment. (a) Minor Ailments.—Total defects treated 1,570 (b) Defective Vision and Squint. Cases treated for errors of refraction 1,483 Other defects 23 Pupils for whom spectacles—prescribed 969 obtained 959 Orthoptic Clinic—cases treated 232 (c) Nose and Throat Defects. Number treated 102 Total attendances 1,290 (d) Orthopaedic and Postural Defects. Treated as in-patients 22 Treated otherwise 470 (e) Child Guidance. No. of cases diagnosed and which received treatment at clinics— (i) Psychiatrist—Cases treated 87 Interviews 252 (ii) Psychotherapist—Cases treated 14 Interviews 264 (iii) Psychiatric Social Worker— Parents treated or advised 155 Interviews 652 (iv) Educational Psychologist- Cases given remedial education 15 Interviews 238 60 (f) Speech Therapy.—Number treated 282 (g) Dental Inspection and Treatment. Periodic Special Number of pupils inspected 6,905 2,822 Found to require treatment 3,915 2,775 Number offered treatment 3,602 2,775 Number actually treated 3,498 2,012 Attendances made for treatment 10,209 3,917 Half days devoted to—Inspection 54 Treatment 2,813 Fillings—permanent teeth 6,084 temporary teeth 1,828 Extractions—permanent teeth 4,532 temporary teeth 1,716 Anaesthetics—local 330 general 2,809 Orthodontics— Treated with appliances 448 Removable appliances fitted 204 Fixed appliances fitted 45 Total attendances 2,570 Artificial dentures fitted 38 Other operations—permanent teeth 3,210 temporary teeth 803