AC 4411 (1) WALTHAMSTOW Act. WAL 48 BOROUGH OF WALTHAMSTOW Committee for Education REPORT of the BOROUGH SCHOOL MEDICAL OFFICER for the year 1958 A. T. W. POWELL, M.C., M.B., B.S., D.P.H. borough school medical officer BOROUGH OF WALTHAMSTOW Committee for Education REPORT of the BOROUGH SCHOOL MEDICAL OFFICER for the year 1958 A. T. W. POWELL, M.C., M.B., B.S., D.P.H. borough school medical officer INDEX Section 1 — Staff 7 Section 2 — School Clinics 9 Section 3 — Co-ordination 10 Section 4—School Hygiene and Accommodation 10 Section 5—Medical Inspection 13 Section 6 — Review of the Facts disclosed by Medical Inspection 14 Section 7—Follow-up 16 Section 8— Arrangements for Treatment (Specialist Clinics) 16 Section 9 —- Protection of School Children against Tuberculosis 28 Section 10—Infectious Diseases 30 Section 11 — Vaccination and Immunisation 33 Section 12—Open Air Boarding School Education 33 Section 13 — Physical Training 33 Section 14—Provision of Meals 35 Section 15—Co-operation 36 Section 16 — Handicapped Children and Special Schools 39 Section 17 — Full-time Courses of Higher Education for Blind, Deaf, Defective and Epileptic Pupils 48 Section 18 — Nursery School 48 Section 19 — Miscellaneous 49 Section 20 — Statistical Summary 51 Accommodation 10 Audiometry 20 Boarding School Education 33 B.C.G. Trials 29 B.C.G. at Schools 29 Child Guidance 22 Chiropody 16 Clinics 9 Colour Vision Tests 15 Committee Members 4 Convalescent Home Treatment 28 Co-ordination 10 Dental Anaesthesia 19 Dental Defects 15 Dental Treatment 18 Diphtheria Immunisation 33 Dysentery 31 Ear Disease 15 Ear, Nose and Throat Clinic 20 Educational Psychology 24 Employment of Children 50 Enquiry Officers 37, 49 Eye Clinic 19 Eye Disease 14 Follow-up 16 Food Hygiene 36 Good Grooming 49 Handicapped Children- Deaf 42 E.S.N 44 Partially Sighted 45 Physically Handicapped 46 Health Education 49 Hearing Defects 15 Heart Disease 15 Hospital Reports 10 Hygiene 10 Illiterates 25 Infectious Diseases 30 Invalid Children's Aid Association 37 Liaison with Hospital Services 10 Mass Radiography 29 Meals, Provision of 35 Medical Examinations 51 Medical Inspection 13 Medical Treatment 16 Milk in Schools Scheme 36 Minor Ailments 17 New Schools 12 N.S.P.C.C. 38 Nursery School 48 Nutrition 14 Open Air Education 33 Orthodontics 18 Orthopaedic Treatment 20 Orthoptic Treatment 20 Paediatric Clinic 25 Parents, Co-operation of 36 Physical Training 33 Physiotherapy 20 Pre-Nursing Courses 50 Re-inspection 13 Ringworm 14, 17 Sanitary and Washing Accommodation 12 School Hygiene 10 Skin Diseases 17 Special Schools 42 School Clinics 9 Schools for the— Deaf 42 E.S.N. 44 Partially Sighted 45 Physically Handicapped 46 Specialist Clinks— Child Guidance 22 Ear, Nose and Throat 20 Ophthalmic 19 Orthopaedic 20 Paediatric 25 Spectacles 20 Speech Therapy 27 Staff 7 Statistical Summary 51 Teachers, Co-operation of 37 Tonics 17 Tuberculosis 16, 28 Tuberculosis Vaccine Trials 29 Ultra Violet Light Treatment 22 Uncleanliness 14 Vaccination— B.C.G. 29 Poliomyelitis 33 Smallpox 33 Visual Defects 14 Voluntary Bodies 37 Welfare 49 Whooping Cough Immunisation 33 X-ray Examinations 28 WALTHAMSTOW COMMITTEE FOR EDUCATION 1958 — 1959 Chairman: Alderman S. N. Chaplin, j.p. Deputy Chairman: The Deputy Mayor, Councillor J. W. Pringle Ex-Officio: The Worshipful the Mayor : Councillor C. J. Crosbie, j.p. The Deputy Mayor : Councillor J. W. Pringle Chairman of the Finance and General Purposes Committee: Alderman Ross Wyld, o.b.e., j.p. Ad. W. B. Fjtt, o.b.e. Ald. H. Fulton Ald. J. R. Lowton, j.p. Coun. Mrs. E. L. Baldwin Coun. Mrs. S. Candy Coun. J. Hammond Ald. A. E. Manning Ald. W. F. Savill Ald. Miss D. Wrigley, b.a. Coun. G. S. Mace Coun. Mrs. W. M. Palethorpe Coun. A. F. Whicher Nominated by the Local Education Authority : Mrs. L. P. Bailey, j.p. Ald. the Lady McEntee, o.b.e., j.p. Co-opted Members: Mr. L. V. Head, J.P. Mr. R. Lamb Rev. Canon Prendergast Rev. W. E. Smith Rev. R. Waters 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 my Twenty-ninth and last Annual Report as Borough School Medical Officer for the calendar year 1958. wish to offer the following comments. Some progress was made in regard to the renovation and modernisation of the sanitary accommodation at schools, but very much more remains outstanding. With regard to major capital works, details are given in the extracts which are printed in the following pages from the Annual Report of the Borough Education Officer. These works comprise the completion of the second stage of the McEntee Technical School, of the part occupation of the Sidney Chaplin Secondary Modern School, the commencement of the new Chapel End Infants School, and of the anticipated occupation of the Warwick Secondary Modern Girls School in January, 1959. In addition, plans for the extension and alterations at the Chapel End and Sidney Burnell Secondary Modern Schools and the gymnasium and changing rooms at the Sir George Monoux School were completed during 1958. The appointment of a Senior Dental Officer referred to in last year's report still remains vacant and it has not even been possible to recruit a dental officer in his place. The arrangements made by the Hospital Management Committee for the specialist staffing of the Special Clinics continues very satisfactorily and reference is made to the excellent arrangements for the supply and repair of spectacles by the Dispensing Optician. Two classes were begun for the reception of dull and backward children. Dr. Hinden draws attention to the earlier maturation of our children and its bearing on the question of juvenile delinquency. 6 With regard to infectious and communicable diseases, there was the usual small outbreak of scarlet fever and tonsillitis and unfortunately a return of bacillary dysentery, which has continued into 1959. Good progress was made in immunisation and vaccination against smallpox, diphtheria, whooping cough, tuberculosis and poliomyelitis. The means are now at hand to eradicate all these diseases completely and the responsibility now rests with the public. Acknowledgment must again be made of the co-operation of parents and teaching staff in general, and of the school enquiry and welfare officers. Dr. Poole has contributed a report in regard to handicapped children and has taken responsibility for the ascertainment and placement of such children. He draws attention to the larger proportion of emotionally disturbed children seen by the School Medical Officers. A case committee was set up to consider the employment of handicapped school leavers. The Borough is extremely fortunate in possessing four special schools, all established during the tenure of office by my predecessor, the late Dr. J. J. Clarke. The reports of the Head Teachers of the special schools refer to the fine work which they continued to carry out during 1958. As the time for my retirement draws near, I wish to record my pleasure at having been permitted to work in such a progressive Borough for nearly thirty years and to record the unfailing help and consideration which I have received from the Chairman, Members and Officers of your Committee and its predecessor, the Walthamstow Education Committee. 1 would also record the excellent work which the staff of the School Health Service, present and past, have given, and particularly Dr. Poole and to Mr. Alen Wade, who has helped to compile this report and many of its predecessors. I am. Your obedient Servant, A. T. W. POWELL, Borough School Medical Officer. 7 1. STAFF OF THE SCHOOL HEALTH DEPARTMENT—1958 Borough School Medical Officer and Medical Officer of Health: A. T. W. Powell, M.C., M.B., B.S., D.P.H. Deputy Medical Officer of Health and School Medical Officer: G. H. G. Poole, M B., B.S., D.(Obst.)R.C.O.G., D.P.H. School Medical Officers: Miss C. P. Dooley, L.R.C.P.I. & L.M., D.P.H. Mrs. M. Edwards, M.B., B.Ch., C.P.H. (Part-time). Mrs. J. H. W. Newman, M.B., Ch.B., D(Obst)R.C.O.G., D.P.H. (Part-time) G. B. Taylor, M.B., B.S., D.C.H., D(Obst)R.C.O.G. (Apptd. 1.5.58. Res. 30.6.58). Miss J. P. Werren, M B.. B.S., D.C.H., D(Obst)R.C.O.G. Specialist Part-time Medical Officers (appointed by Regional Hospital Board): Ear, Nose and Throat Surgeon : A. N. Cammock, M.B., B.Ch., D.L.O. Ophthalmologists : Miss I. D. R. Gregory, M.B., Ch.B., F.R.C.S., D.O.M.S H. Ho, M.R.C.S., L.R.C.P., D.L.O., D.O.M.S. Orthopaedic Surgeon : G. Rigby-Jones, M.C., T.D., M.A., M B., B.Chir F.R.C.S. Paediatrician : E. Hinden, M.D., M.R.C.P. Psychiatrists : Mrs. H. Gillespie, M.R.C.S., L.R.C.P., W. P. Gurassa, M.D., B.S., M.R.C.P. (from 27.1.58). Dental Surgeons: Miss D. Anklesaria, L.D.S. Mrs. S. Forbes-Miric, L.D.S. (Part-time). Mr. R. Hyman, L.D.S. Miss S. Johnson, B.D.S. (Apptd. 25.1.58, Res. 18.5.58). Mr. R. V. Tait, L.D.S. Orthodontist. (Part-time). Mr. W. Landes, Stat. Exam. (Part-time). Mr. R. T. Mills, L.D.S. (Parttime). Mr. G. P. L. Taylor, L.D.S. Mr. J. C. Timmis, L.D.S. Health Visitors/School Nurses (Part-time to School Health Service). Mrs. J. M. A. Foulkes (Superintendent). Miss R. Boyd. Miss E. L. Cunnington. Miss E. duRandt. Mrs. E. M. Geary. Mrs. J. L. Haynes (Apptd. 1.9.58). Mrs. D. E. Lambert (Part-time). Miss D. G. Legg. Mrs. E. Levis. Miss O. North. Miss J. M. Palmer. Miss. E. Rowston (Apptd. 1.1.58). Mrs. G. H. Salter. Miss M. E. Waghorn. Miss A. O. Wright. (All the above are S.R.N., S.C.M., H.V.Cert.). 3 School Nurses: Mrs. A. Dunford, S.R.N. Mrs. B. Jones, S.R.N. Mrs. M. Leach, S.R.N. Mrs. J. Mountford, S.R.N., C.M.B.(Part I) (Apptd. 1.8.58). Educational Psychologists: Miss E. M. Smith, M.A. Miss A. M. Marshall, B.A. Speech Therapists : Mjss C. S. Borthwick, L.C.S.T. Miss J. A. Rasor, L.C.S.T. Play Therapists (Part-time) : Miss H. Carr. Miss F. Low-Beer. Mrs. K. Barker (Res. 30.1.58). Miss L. Folkart (Res. 31.8.58). Mrs. R. Reed, S.R.N. (Res. 20.7.58), Clinic Nurse : Mrs. P. Crisp, S.R.N. Psychiatric Social Workers : Miss M. Russell. Miss A. M. Laquer. Miss J. Court (Apptd. 13.10.58). Orthoptist: Miss W. Baxter.* Physiotherapist: Miss H. Garratt, C.S.P.* * Appointed by Hospital Management Committee. Dental Attendants (Part-time to School Health Service) : Mrs. D. Rosser (Senior). Mrs. D. Allen (Part-time). Mrs. S. Dewey. Miss G. Hutchins. Miss N. Hutchinson. Mrs. E. Labrom (Part-time). Mrs. M. Stewart, S.R.N. (Part- time). Mrs. E. Wood. Mrs. M. Wright. Miss E. Weatherill. (Dental Clinic Clerk). Dental Technicians (Part-time to School Health Service) : Mr. G. H. Higgins. Mr. C. Allen. Administrative and Clerical Staff: Mr. F. J. Aylward (Senior Administrative Assistant). Mr. R. T. Prudden. Mrs. M. Crosier Miss H. Kelsey. Mr. C. J. Bradley Miss V. Jennings. Mr. G. B. Martin. Miss T. Sparrow. Mr. A. T. Wade. Miss J. M. Ayrton Miss M. Game. Mrs. A. Speechley (Res. 11.6.58). Miss C. Thompson. Mrs. P. Wells (Apptd. 30.6.58). 9 2. SCHOOL CLINICS Aural— Friday 2 p.m.— 4 p.m. Town Hall. Child Guidance— Monday to Friday 10 a.m.— 1 p.m. 2 p.m.— 5 p.m. Child Guidance Clinic, 263 High Street, E.17. Dental Clinics— Monday to Friday 9 a.m.— 4.30 p.m. Town Hall. Saturday 9 a.m.—12 noon Town Hall. Monday to Thursday 9 a.m.— 4.30 p.m. 1 Guildsway. Saturday 9 a.m.-—12 noon 1 Guildsway. Thursday 9 a.m.—12 noon Silverdale Road. Friday 9 a.m.— 4.30 p.m. Silverdale Road. Monday 2 p.m.— 4.30 p.m. West Avenue. Tuesday to Friday 9 a.m.— 4.30 p.m. West Avenue. 'Minor Ailments— Monday, Wednesday, Friday, Saturday 9 a.m.—12 noon Tuesday 9 a.m.—11a.m. Monday, Thursday 9 a.m.—11a.m. Town Hall. Silverdale Road. Low Hall Lane. Massage and Sunlight— Monday to Friday . . 9 a.m.— 5 p.m. Wingfield House School. Ophthalmic— Tuesday 9 a.m.—12 noon Wednesday (Alt.) 9 a.m.—12 noon 2 p.m.— 4 p.m. Thursday 2 p.m.— 4 p.m. Friday 9 a.m.—12 noon (Alt) 2 p.m.— 4 p.m. Saturday 9 a.m.—12 noon (Alt) Town Hall Orthopaedic— Monthly (Tuesday) 1.30 p.m.— 4 p.m. Wingfield House School. Orthoptic— Monday, Wednesday, Friday 9 a.m.—12 noon 2 p.m.— 4.30 p.m. Town Hall. Paediatric— Alternate Thursdays 9 a.m.—12 noon Town Hall. Speech Therapy— By appointment 263 High Street and Wingfield House School. Immunisation— Wednesday 2 p.m.— 4 p.m. Town Hall. All clinics except those marked * are appointment clinics. 10 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 eight whole-time nurses. (b) Liaison.—During the year letters were addressed to family doctors in regard to Bacillary Dysentery, Precautions against Communicable Diseases and Winter Epidemics. (c) Hospitals.—Several hospitals continued to send summaries of their discharge reports in regard to children, notably Whipps Cross, St. Anns 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. 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 8 — — 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 — — 1958 1957 1956 1955 1954 Number of Children on Register, 31st December 19,743 20,182 20,224 20,072 20,157 Average attendance 17716.0 17552.3 18328.2 18014.0 18139.6 Percentage attendance 92.2 87.2 90.6 89.7 90.0 Educational Premises.—The following extracts are taken from the Annual Report of the Borough Education Officer to the Committee for Education:— 11 Maintenance of Premises. Maintenance of the Committee's property was carried out during the year. The sum of money available has had to be carefully husbanded because of the increased expenditure on old buildings. Many of the schools are not only old but were planned when standards of school requirements were entirely different from those to-day. Approaches to the Local Education Authority resulted in an additional sum of £4,780 being made available for maintenance works. The Committee is aiming at having schools decorated externally and internally at intervals of five and seven years respectively. For some years the periods have been much longer, but during the past year buildings which received attention five years ago externally and nine or ten years ago internally received attention. The Margaret Brearley E.S.N. School was extensively damaged by fire on the 19th March. The provision of temporary accommodation for the school and the reinstatement of the building provided a challenge to all concerned. Classrooms at the Pretoria Avenue School were reinstated for use as a temporary annexe for the William Morris Technical School. Playgrounds. The normal programme of repairs and resurfacing of playgrounds was carried out during the Summer holidays, but the wet weather created difficulties for the contractors. Floors. During recent years wood block floors have from time to time been sanded and then sealed with a plastic preparation. It has been established that the regular sanding reduces the life of the wood blocks and it was decided to maintain surfaces by the application of an oil seal. Experience to date indicates that the new method has given good results. Some seventy classrooms still have stepped or sloping galleries and the programme of levelling has been continued. Unfortunately the sum of money available has been limited. Heating. Maintenance of installations was carried out during the year; a number of boiler sections required renewal. The number of oilfired installations has continued to increase and specialist assistance has been obtained to keep them in efficient operation. Heating systems in a number of schools require to be remodelled. Some are inadequate, whilst with other systems there is the ever-present possibility of breakdown. 12 Lighting. Normal maintenance has been carried out during the year. The standard of lighting in the older schools does not conform to modern requirements and some improvements and renewals have been effected. Remodelling has been recommended by the Committee, but only to a very limited degree has it been agreed by the Local Education Authority. Cleaning. The washing down of walls in the schools has been continued and has helped in overcoming the depressing conditions resulting from the infrequent decorating of premises. The practice of cleaning windows four times a year, with an additional clean at schools in certain localities, was continued. Lavatories. The oft-repeated representations made by the Committee on the need to remodel many lavatories has brought results. During the year the following work was carried out:— Mark House Sec. School Remodelling of Boys' and Girls' lavatories The Winns Junior School Conversion of Shelter into Boys' lavatory School Meals Service. Routine maintenance has been carried out at all establishments A prefabricated dining hall was erected at the Higham Hill Junior School. The existing shelter was converted into scullery for the Winns Junior School. At the St. Mary's C.E. Infants' School the scullery was remodelled and the drainage system renewed. BUILDING PROJECTS. The following projects were undertaken during 1958 some were completed while others were in hand at the end of the year (a) Minor Capital Works—Cost of each not exceeding £10,000. School Project Thomas Gamuel Infants Kitchen. Remodelling of Lavatories and additiona washing facilities. Thomas Gamuel Junior . Staff lavatory. Walthamstow High School for Girls Additional Classroom, Changing Room and Showers. (b) Major Capital Works. Chapel End New Infants School. Work on site was commenced in September, 1958. Site works were delayed in the Autumn by the exceptionally wet weather. Good progress was made subsequently and it is considered that the scheduled date for completion, viz., September, 1959, will be adhered to. Cost—£48,693. Chapel End Secondary School. Plans for the extension and alterations to the school were completed and the work will commence early in 1959. Cost— £64,832. 13 McEntee Technical School. The second stage of this school was completed in May. 1958 Cost—£67,326. Sidney Burnell Secondary Modern School. Plans for the extension and alterations to the school were completed and the work will commence early in 1959. Cost— £78,556. Sir George Monoux Grammar School. Plans for a new gymnasium with changing rooms were completed and work will commence early in 1959. From a fund raised within the school, it is intended that additional changing rooms and a pavilion will be completed at the same time and as a part of the same scheme. Cost—£26,000. Sidney Chaplin Secondary Modern School. This school was due for completion in December, 1958, but the contract has been extended for three months. A number of classrooms were brought into use in September. 1958. Cost— £143,630. Warwick Secondary Modern Girls' School. This school is due for completion in April, 1959. Excellent progress was made and the main block was brought into use by the school as from 1st January, 1959. Cost—£140,151. William Fitt Secondary Modern School. This new school was originally scheduled for inclusion in the 1958/59 Building Programme, but has been transferred to the 1959/60 Programme. It is planned to erect a new school on part of Aveling Park. A public enquiry was held in November to consider objections by local residents to the acquisition of this site and it is hoped to receive a decision from the Ministry early in 1959. (A favourable decision was subsequently received). 5. MEDICAL INSPECTION The following gives a summary of the returns A. Periodic Medical Inspections— 5 year age group 1,385 10-12 year age group 1,957 14 year age group 1,775 Others 401 Total 5,518 B. Other Inspections- Special Inspections 1,808 Re-inspections 1,868 Total 3,676 14 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 inspection and special inspection at schools and do not include other examinations at clinics). (a) Classification of the General Condition of Children inspected during the year in the routine age groups:— Number Inspected Satisfactory Unsatisfactory No. % No. % 5 year age group 1,385 1,375 99.3 10 0.7 10-12 year age group 1,957 1,943 99.3 14 0.7 14 year age group 1,775 1,757 99.0 18 1.0 Others 401 391 97.5 10 2.5 Totals 5,518 5,466 99.1 52 0.9 (b) Uncleanliness.—The following table gives comparative figures for the past two years 1958 1957 Average visits to schools 4 4 Total examinations 34,641 32,980 Number of individual children found unclean 93 109 Percentage uncleanliness of average attendance 0.6 0.6 (c) Minor Ailments and Skin Defects.—The following was the number of skin defects found to require treatment or observation:— Treatment Observation Ringworm—Head - - —Body - - Scabies 3 - Impetigo - - Other skin disease 259 99 (d) Visual Defects and External Eye Defects.—The number of patients requiring treatment or observation was as follows:— Treatment Observation Visual defects 776 117 Squint 90 18 External Eye Diseases 64 26 15 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 doubtful case is reported to the School Medical Officer. Of the 3,734 children tested during the year, eighty-eight were found to have some defect of colour vision. (e) Nose and Throat Defects.—The number of patients requiring treatment or observation was as follows:— Treatment Observation Enlarged Tonsils 31 91 Adenoids 17 10 Enlarged Tonsils and Adenoids 30 14 Other conditions 88 116 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 Tonsillectomy Boys Girls Boys % Girls % 5 year age group 680 705 33 4.8 29 4.1 10-12 year age group 959 998 145 15.1 141 14.1 14 year age group 889 886 112 12.6 141 15.9 Others 208 193 18 8.6 14 7.2 Totals 2,736 2,782 308 11.2 325 11.6 (/) 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 25 114 Otitis Media 31 51 Other Ear Disease 40 2 (g) Orthopaedic and Postural Defects.—A total of 278 defects were found to require treatment. (h) Dental Defects— Inspection at Schools Requiring Children actually treated Fillings Extractions General Anaesthetics Other Operations Inspected Treatment Per cent 7,231 3,704 51.2 4,774 10,036 5,376 2,718 4,363 (i) Heart Disease and Rheumatism.—The findings were as follows:— Treatment Observation Heart Disease—Organic 6 25 Functional — 122 Anaemia 3 1 16 (/') Tuberculosis.—All children suspected either of 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 1958 Pulmonary 5 3 — 1 6 — Non-pulmonary 4 4 — I 2 1 2 Total 9 7 — 2 2 7 2 (k) Other Defects and Diseases.—The following shows the number of various other defects which were found to require treatment:— Enlarged Glands 5 Speech 45 Other defects 166 Bronchitis, etc. 105 Nervous System 26 7. FOLLOW-UP The School Nurses paid a total of 1,036 home visits during 1958. 8. ARRANGEMENTS FOR TREATMENT (a) Chiropody.—Mr. R. J. King, the Chief Chiropodist, reports as follows:— "The Children's Clinic still flourishes and is an important part of our work, but time is limited with only one session per week. In spite of this, 2,512 treatments were given to 699 children, making 3.5 treatments per patient: of these 1,044 were boys and 1,468 girls. New patients totalled 505, of whom 212 were boys and 293 were girls." In the Health Report for 1957 reference was made to an extract from the Report of Dr. Davies, Principal School Medical Officer at Huddersfield to the effect that many girls who have perfect feet at their ten-year-old examination have severe deformities by the time they reach school leaving age, many of such a degree that they may eventually require operative treatment. Dr. Davies went on to state that the present day fashion of continued all day wear of shoes of a "slip on" or "casual" type, which must of necessity be too small so that they can stay on, or cause cramping of the toes to keep them on, can during these formative years, cause hallux valgus, painful bunions and curling under of the toes, sometimes of such a degree that the nails are walked on. In view of these statements, the medical staff and the chiropodists were asked during 1958 to give their opinion of the position in Walthamstow and with the following result:— "I have been struck by the very unsuitable shoes worn by senior girls." 17 "After a medical inspection at a girls' high school, 1 wrote to the Headmistress commenting on the unsatisfactory shoes worn by the girls to whom fashion appears to be all-important and who seem to dictate to their parents about their footwear." "I have observed the occurrence of hallux valgus due to wearing too narrow fitting shoes of the casual type." "The practice of wearing unsuitable shoes of the casual type is widespread in Walthamstow where a large proportion of teenage girls seem to have some deformity of the feet." "I spend a great deal of time at school medical inspections discussing footwear with the parents. The parents are largely against casual shoes, but children seem to have their own way as to what they consider fashionable." (b) Tonics.—The following shows the quantity of tonics issued during 1958 Parrish's Food Syrup Calcium Lactophosphate Cod Liver Oil and Malt Cod Liver Oil and Malt and Parrish's Food 69¼ lbs. 1½ lbs. 193 lbs. 831 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. 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 1 — — — Body — 1 1 7 Scabies — 2 — 2 Impetigo 14 5 76 13 Other Skin Diseases 83 59 131 146 Orthopaedic conditions 63 72 61 40 Tonsils and Adenoids 17 17 6 6 Other E.N.T. conditions 74 54 70 48 Defective Vision (including squint) 88 76 9 10 External Eye Diseases 24 20 33 16 Nervous and Psychological disorders 42 27 27 10 Speech 45 34 9 — Heart and Circulation.. 14 15 3 9 Respiratory Diseases 26 10 19 10 Developmental 24 6 6 2 Various 429 281 582 589 Totals 944 679 1,033 908 18 First attendances numbered 1,623 against 1,570 in 1957, and re-attendances 1,941 against 2,313, the total attendances being 3,564 against 3,883. The following table shows the new cases and attendances at Minor Ailment Clinics since 1950. The decrease reflects the tendency for children to be taken to family doctors. 1950 1951 1952 1953 1954 1955 1956 1957 1958 New cases 3,356 3,106 2,990 2,397 1,782 2,017 1,565 1,570 1,622 Attendances 11,515 10,000 10,634 8,544 7,019 5,797 3,714 3,883 3,563 (e) Dental Treatment.— School Dental Clinic.—Mr. G. P. L. Taylor submits the following report:— "There has not yet been an appointment of a Senior Dental Officer in Walthamstow since December, 1956, when Mr. L. W. Elmer retired from the School Dental Service. The administration of the dental department has suffered accordingly during this period. "The Department lost the full-time services of Miss S. Johnson in May, but this has been offset by the appointment of three parttime dental surgeons on a sessional basis. It is still most desirable, however, that a full-time appointment be made to replace the services of Mr. Elmer. "An interesting feature of the latter part of the year was the monthly visit of students from the Dental School of the London Hospital. These visits enable them to see the many sides of a school clinic in practice. It is to be hoped that these visits will encourage some recruits to the School Dental Service. "Although fewer sessions were worked during the year, there was a slight increase in the number of children inspected at school, and the total attendances at the clinics were only slightly lower. "I am very glad to say that the number of fillings done has increased by over 2,000, and that the number of general anaesthetic cases has been reduced by about 400. This would indicate that the number of anaesthetic sessions could be reduced and those sessions devoted to conservative treatment." Orthodontics.—The following report has been submitted by Mr. R. V. Tait, B.Sc., L.D.S., R.C.S., the visiting orthodontist "I am happy to report that the Dental Department has continued adequately to meet the local demand for orthodontic treatment. There is no waiting list of patients. This is largely due to the number of patients receiving orthodontic treatment from the school dental officers, with advice or assistance from the orthodontic clinic where necessary. "Treatment is carried out mainly by means of simple removable appliances using standardised designs which experience has proved to be capable of giving satisfactory results over a wide range of 19 orthodontic abnormalities. Fixed appliances are only used for the most difficult conditions for which no effective removable appliances have yet been developed. "The following figures show the work done in 1958." Total number of sessions 135 Appointments—Made 1,201 Kept 1,034 Cases brought forward from 1957 236 New cases commenced during 1958 100 Cases completed during 1958 73 Cases for which treatment was completed with appliances 53 Cases discontinued 38 Removable appliances fitted 108 Fixed appliances fitted 8 Cases seen in consultation with School Dental Officers 114 Dental Anaesthesia.—Dr. H. J. Churchill, Consultant Anaesthetist, reports as follows:— "Since I came to work in Walthamstow in 1955, I have given rather more than 8,000 gas and oxygen anaesthetics to Walthamstow children and some 1,500 in another area. In that time Mr. Timmis must have given at least 6,000, so that the grand total exceeds 15,000. I think the dental surgeons have found that in the cases in which a general anaesthetic was indicated an administration of plain gas and oxygen has been satisfactory. "There is just one thing to bring to notice, namely that a firm specialising in the production of such apparatus is working on a new type of Walton apparatus, which will be a great improvement on the model in use now, and when it becomes available I strongly recommend that two of these be bought. In view of the amount of work done in Walthamstow, the expense would be fully justified. "I would like again to mention the very patient, skilful and devoted work of all the nursing staff without which the measure of success which we have, I think, achieved, would not have been possible." SPECIALIST CLINICS ( All Specialist Clinics are staffed as to Consultants by the Regional Hospital Board. Day to day administration has continued unaltered). (a) Eye Clinic.—The following shows the work done in 1958:— New Cases Under 7 years 7-11 years Over 11 years Total Boys Girls Boys Girls Boys Girls Boys Girls Hypermetropia 10 7 15 2 8 5 33 14 Astigmatism 17 21 20 34 22 27 59 82 Myopia 4 3 16 50 47 31 67 84 Other Eye Defects 24 21 14 13 10 9 48 43 Total 55 52 65 99 87 72 207 223 20 Number of children for whom glasses were Prescribed 1,136 Obtained (a) through the Hospital Service 1,034 (b) through private opticians 86 Total attendances 4,286 Supply of Spectacles.—The following shows the number of spectacles provided during the past eight Years:— 1951 1952 1953 1954 1955 1956 1957 1958 843 995 1,063 983 905 966 889 1,034 During 1957 and 1958 respectively, seventy and eighty-six spectacles were obtained from "outside" opticians. The employment of a whole-time dispensing optician by the Hospital Management Committee provides an "on-the-spot" Service for the provision, fitting, and repair of spectacles and a large saving in cost. It is a Service much appreciated by parents, who have a completely free choice in the matter. (b) Orthoptic Clinic.—The following shows the work done at the Clinic:— Number of new cases 148 Number of treatments 170 Number referred to hospital for operation 28 Number discharged 58 Total attendances 1.490 (c) Ear, Nose and Throat Clinic.—During the year 326 attendances were made at the clinic, 108 being new cases. Hospital treatment was obtained as follows:— Removal of Tonsils and Adenoids 36 Removal of Adenoids 2 X-ray of sinuses, etc. 11 Other treatment 20 Audiometric Testing.—During the year 359 children were tested with the pure tone audiometer on referral from medical inspection. (d) Orthopaedic and Physiotherapy Clinic. This 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. The following tables compiled by Miss Garratt, C.S.P., Physiotherapist, show the work done at the clinic 21  5-16 yrs. Boys Under 5 yrs. 16-18 yrs. 5-16 yrs. Girls Under 5 yrs. 16-18 yrs. Anterior Poliomyelitis 17 — 1 14 — — Surgical Tuberculosis — — — 1 — — Scoliosis, Lordosis, Kyphosis 74 — 1 87 1 — Arthritis — — 1 — — — Genu Valgum 12 5 — 13 7 — Genu Varum — 3 — — 2 — Pes Valgus and Valgus Ankles 46 10 1 36 5 — Spastic Paralysis 12 1 — 19 1 — Schlatter's Disease 1 — — 1 — — Progressive Muscular Atrophy 1 — — 1 — — Osteo genesis imperfecta 1 — — — — — Talipes—(a) Equino varus 7 1 2 5 — — (b) Pes cavus 5 — — 1 — — (c) Metatarsus varus — 3 — — 4 — Torticollis — 1 — — — — Congenital dislocation of hip — 1 — 1 2 Hallux rigidus — — — 5 — — Hallux Valgus 2 — — 3 — — Spina bifida 4 — — 1 — — Perthes disease 2 — — 1 1 — Digitus varus 2 — — 6 — — Overlapping toes 3 1 — 2 1 — Hammer toe 1 — — 5 — 1 Claw toes 1 — — 4 — 1 Arthrogryposis multiplex congenita — 1 — — — — Slipped epiphysis — — — 1 — — Transverse myelitis — — — 1 — — Osteomyelitis — 1 — — — — Taut tendo achilles 7 2 — 10 — — Other congenital defects 9 1 — 4 1 — Miscellaneous (including chest con ditions) 85 4 — 39 5 — Totals 292 35 6 261 30 2 New cases seen by Surgeon— School age 102 Under school age 32 Total 134 Number of cases seen by Surgeon— From Physically Defective School 41 From other schools 374 Under school age 50 Total 465 22 Total number of examinations made by Surgeon 599 Total number of cases discharged by Surgeon 93 Average number of examinations per session 42.8 Number of treatments given 8,229 Number of attendances for after-care 1,822 Number of sessions held—Treatment 443 Inspection 14 Number of visits by Instrument Maker 48 Operated on in out-patient department 2 Operations performed 24 Children transferred from Connaught Hospital 5 Total number of treatments 10,292 Attendances for Ultra Violet Light Treatment 241 (e) Child Guidance Centre.—The Consultant Psychiatrist, Dr. Helen Gillespie, reports as follows:— "The full complement of psychiatrist sessions (nine) has been worked during most of the year, Dr. W. P. Gurassa having joined the staff at the end of January. In addition the full establishment for play therapist sessions has been filled since October, and a total of ten is now being worked by Miss H. Carr and Miss F. Low Beer, who now share the work since Mrs. Barker and Miss Folkart left the clinic during the year. "We now have three full-time Psychiatric Social Workers, Miss Joan Court having been appointed during October. There has also been an increase in clerical staff. Mrs. E. M. Goody who was on the clerical staff here during the last eleven years left the clinic in October. "More cases were diagnosed during the year (214 against 144 in 1957) and more were taken on for treatment by the psychiatrists, chiefly in the Walthamstow area. The explanation is to be found in the fact that in 1957 much psychiatric time was lost through under-staffing. It is a matter for satisfaction that the total waiting list for cases for diagnosis has been reduced from 155 to ninety-four. "During the year thirty-one Court cases were seen. We are always glad to undertake this work, but are unfortunately quite quite often unable to see them under the period of three weeks, except for very urgent cases. The number seen presents an increase of such cases over those referred from the Courts during 1957(5)." The following tables show the work of the clinic during the year. Figures for Walthamstow cases only are shown:— 23 TABLE I Analysis of Figures for 1958 Number of cases referred to the clinic. 83 Number of cases diagnosed at the clinic 83 (a) Psychiatrists— Diagnostic interviews 86 Cases taken on for observation and treatment 34 Treatment interviews 241 Other interviews 1 Total number of psychiatric sessions (including Chingford cases) 167 (b) Psychologists— Clinic cases tested 72 Cases given remedial education 13 Treatment interviews (remedial education) 281 School visits on behalf of clinic cases 16 Other interviews at clinic 32 Other interviews outside clinic 47 (c) School Psychological Service— Individual cases seen 376 Number referred to clinic 10 (d) Play Therapists— Cases treated 16 Treatment interviews 148 (e) Psychiatric Social Workers— Interviews at Clinic 590 Interviews elsewhere 15 (f) Waiting List— Cases for diagnosis (by doctors) 46 Waiting treatment — (g) Total cases treated during the year 103 24 TABLES II and 111 Analysis of Problems referred and Cases Diagnosed Referred Diagnosed 1. Nervous disorders, e.g. fears, depressions, apathy, excitability 16 21 2. Habit disorders and physical symptoms, e.g. enuresis, speech disorders, sleep disturbances, tics, fits, etc. 15 14 3. Behaviour disorders, e.g. unmanageable, tempers, stealing, lying, sex problems, etc. 46 38 4. Educational, e.g. backwardness, failure to concentrate 6 6 5. No basic disturbance of child, i.e. mainly parental overanxiety — 4 83 83 TABLE IV Analysis of Cases Closed during 1958 1. Improved and recovered after treatment 24 2. Improved after partial service, i.e. before diagnosis 10 3. Diagnosis and advice only 6 4. Interrupted, e.g. on parents' initiative 21 5. Closed for miscellaneous causes (removal from area, placement at E.S.N, school, etc.) 4 65 The following extracts are taken from the Annual Report of the Borough Education Officer to the Committee for Education:— Work of Educational Psychologist. There has been a most interesting year's work. In addition to an extension of work in the Clinic, the year has seen the formation of two special classes to help more backward pupils, a survey of the intelligence of children attending the Wm. Morris Deaf School, and a follow-up testing of infant reading, as well as the normal work in schools. 25 Altogether 376 children have been given individual intelligence tests. Seventy-two of these children have been referred to the Child Guidance Centre for psychiatric help. Twelve were referred from Juvenile Courts, and fourteen were pre-school children. The T.Q. range was as follows:— Number of Children below 75 101 76-90 130 91-110 86 111-125 24 above 126 24 Of the children tested nineteen were attending the Margaret Brearley E.S.N. School and thirty were placed in the newly-formed special classes at Mission Grove and Woodside Junior Schools. It is evident that more such classes could usefully be formed both at Junior and Secondary levels. These children who have had one term in such classes have all shown marked general improvement, though no testing has as yet been done. Five children were visited at home for tests, and forty-seven parents were given advice on the educational problems of their children. During the year the Psychologist made 133 visits to schools, distributed as follows:— Type of School Number of Visits Infant 24 Junior 71 Secondary Modern 10 Gr./Tech. 2 Special Schools 26 Fifteen children came to the clinic for remedial teaching. In all there were 303 teaching sessions for this purpose. Four talks have been given to parent groups on topics relating to child development and behaviour. Two lectures were given on "Adolescence" as part of the Home Office course for House Parents, and three on "Backwardness in School" to teachers. Elementary English Class. The class in Elementary English for adults and young people above school age, who are illiterate or backward in reading and writing continued to meet on one evening per week. Thirty-three persons, many of whom came from outside Walthamstow, enrolled and achieved a total attendance of 974 student hours. (f) Paediatric Clinic.—The clinic was continued under the clinical care of Dr. Elchon Hinden, Paediatrician to Whipps Cross Hospital, who reports as follows:— 26 "The work of the school consultative clinic has not changed significantly over the past year. The maintained good health of the schoolchild has shown itself in a low level of referrals. As in the past, most of the children are picked out by the school health medical officers at their routine inspections. "The increasing size of school children is a matter of general knowledge; it is perhaps not so well known that biological maturity now occurs much earlier than formerly. Wherever detailed statistics have been kept, the figures show that the onset of puberty is advancing by about one year, every thirty years of time. It follows that the weight and height of children today are not really comparable with those of their fellows of the same chronological age, one or two generations ago; for now they are, compared with them, at an advanced "pubertal age"—and that is what matters. Certainly most of the schoolboys and schoolgirls who are referred to me after their final inspection, when they are about to leave school, are clearly young men and women, and not children at all. "Plainly, this earlier ripening of children is a matter of great importance both to the educationalist and sociologist. It is a curious paradox that a century ago children left school at eleven or twelve, when they were still children, and were expected to work and behave as adults ; whereas now they are kept at their lessons till fifteen at least, and treated as children, while in fact they have been adult for a couple of years! It is ironical that the school-leaving age should be rising just as steadily as the age of adolescence is falling. The difference between the way society treats these young people and the obvious maturity of their bodies, is bound to set up stresses in their personalities, and may well be an important factor in the most paediatric disease of our time—juvenile delinquency. "I should like to thank my colleagues in the School Health Service for the honour they do me in asking my opinion, and the family doctors for permitting the reference ; and 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 45 18 Total attendances 113 33 Physical Defects: Number of cases 88 33 Referred to Hospital 13 5 Discharged 18 7 Psychological Disorders: Enuresis 7 — Other 5 — Referred to Hospital 2 — Discharged 2 — 27 (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. Miss C. M. Borthwick, L.C.S.T., reports as follows:— "As may be seen from the figures, the total number of attendances at the clinic is higher than last year. The majority of children attending are from primary schools and of these most are from the Infants' departments. Indeed, only 16 per cent of the patients are from secondary schools, and this is an indication of the value of early treatment. Also, only 20 per cent of the patients attend for treatment of a stammer, and this again suggests that preventive work is done by treating young children suffering from dyslalia, a speech defect which, if left untreated, is often associated with stammering. "Figures again confirm that speech defects are more common amongst boys than girls, the former being 69 per cent of the total number of children attending the clinic. "Weekly visits to schools have been continued. Not all children interviewed are taken on for treatment, but most are kept under observation for a while in school if it is considered that treatment may be required at some future date. "Occasional home visits are also made, and all mothers are interviewed at least once in the clinic. When necessary every effort is made to interview fathers as well." Miss J. A. Rasor, L.C.S.T., reports:— "The total new entry for this year is almost double that of last. Despite this, however, by the end of December the number of children attending for treatment was considerably less than at the same time the previous year. This situation has provided the opportunity for approximately 20 per cent of patients to receive treatment more frequently or for a longer period each session. "As in previous years, regular visits have been made to the schools; referrals subsequent to these visits have provided 75 per cent of the new cases entering the clinic this year—a reflection of the attention paid to speech standards at school. By comparison, only 10 per cent of new patients were referred as a result of parents' concern or interest in speech. "The unusually high number of patients re-admitted after discharge is accounted for by the fact that four of them were re-accepted after defaulting or being withdrawn before treatment was completed. Of those patients under observation at the end of 1957, one defaulted, two recommenced treatment, three were kept under observation for a further period, and five were found to be in no need of further treatment. "Latest additions to clinical equipment are a sandtray and tools, and a painting easel, both of which are providing valuable scope for play and expression work. This apparatus has proved of particular benefit in the treatment of the increased number of preschool children now attending the clinic." 28 Annual Report and Clinical Analysis. High Street Clinic Open Air School Clinic Number in attendance at beginning of year 65 67 Number under observation at beginning of year 28 11 New cases 60 56 Transfers from other clinics- (a) Within County 3 1 (b) Outside County — 1 Number of cases re-admitted 5 5 Total new entry 68 63 Cases discharged (a) Cured 53 40 (b) Improved 3 3 (c) Defaulted 1 12 (d) Left District 1 2 (e) Transferred to other clinics 3 4 (/) No progress 3 - Cases in attendance at end of year 71 52 Cases under observation at end of year 26 28 Total attendances during year 2,201 2.245 Analysis of Defects of Children attending Clinic and under observation during year:- Stammering and Cluttering 27 9 Dyslalia 96 82 Stammering and dyslalia 4 20 Delayed language development 3 8 Cleft palate speech 1 3 Voice defects 2 3 Speech defects of neurological origin 1 9 Probable mental deficiency — 7 (h) Convalescent Home Treatment.—Fifty-seven children were sent away for convalescence during 1958. There were three children remaining in convalescent homes and hospital schools on December 31st, 1958. (i) Tuberculosis.—The number of school children examined for the first time at the Chest Clinic during 1958 is shown in the following figures supplied by the Chest Physician :— Boys Girls Referred by School Medical Officers 15 11 Referred by private practitioners 57 60 Examined as contacts 22 33 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 1958, the total of such examinations was ninety-two. 29 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 or 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, reports that of the 277 young people invited for their sixth annual X-ray, 152 attended, i.e. 55 per cent. and of these 56 per cent completed the skin tests. In addition thirty-nine attended of the 161 who defaulted on the previous occasion. (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. The Heaf multiple puncture apparatus has been used exclusive!) during 1958 and with complete success. All secondary schools have been visited during the year and of the 2,147 children invited 1,218 accepted, giving an acceptance rate of 56.7 per cent. 1958 1957 1956 1955 Number of Heaf positive. 131 165 176 109 Percentage positive 11.6 13.8 14.2 13.0 Number of Heaf negative 995 1,026 1,064 740 Number absent 92 55 28 8 B.C.G. given 995 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 owing mainly 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. 785 conversion tests were carried out on children who were given B.C.G. in 1958. Sixteen gave a negative result to the test but all showed a good vaccination scar. 30 10. INFECTIOUS DISEASES Notifications from general practitioners of infectious diseases in the 5-14 year age group were as follows:— 1958 1957 Measles 269 753 Whooping Cough 29 113 Scarlet Fever 75 70 Pneumonia 5 2 Dysentery 167 4 Tuberculosis 2 7 Food Poisoning 7 17 Poliomyelitis 1 8 Meningococcal Infection — 1 555 975 Scarlet Fever and Tonsillitis. In mid-March several cases of scarlet fever were notified amongst children attending Thorpe Hall Infants School and the parents of all children were circularised requesting their co-operation in ensuring that no unfit child be sent to school. Symptoms and signs were described and parents were also advised that if further cases developed, the attendance of their children at school would be presumptive of their agreement for nose and throat swabs to be taken. This became necessary on 25th March, and before the school was cleared one month later, out of a total of 162 on roll six cases of scarlet fever had been notified and thirty-two children had been found to be carrying haemolytic streptococci. Random typings showed these to be Type 4 (one), Type 22 (one) and Type 28 (two). School meals and milk were not implicated, and as on a previous occasion some years ago at the same school, the outbreak appeared to be due to case to case infection. In May a case of scarlet fever occurred at Mark House Infants School and later on in the same school there was a number of children with sore throats and ear discharge. An appeal was made to the parents not to send their children to school unless quite fit. At the end of September the Headmaster of the adjoining secondary school stated that since the beginning of the autumn term there had been some fifteen cases of sore throats, mainly in two classes. There was no nausea or vomiting and sample swabs gave negative results. In November a circular letter had to be sent to parents of children attending the Infants School and on the same lines as the one addressed to the parents of children attending the secondary school. All swabs were negative. 31 Bacillary Dysentery (Sonne). The year was an unfortunate one in regard to this infection, there being 138 known cases at schools out of a total of 230 notified or known in the Borough amongst all ages. The school first affected was Greenleaf Primary in February. The usual routine was followed, parents and doctors being informed and the appropriate "drill" followed at school. The organism was found to be sensitive to Chloromycetin and streptomycin, but resistant to the sulphonamides. There were only thirteen cases out of 501 on roll and the school was cleared by the 24th March. In 1954 there had been forty-two cases at this school and although in the meantime the sanitary accommodation had been reconditioned, the money allowed had apparently become exhausted before the washing accommodation could be renovated. This was always inadequate and it was situated in the main school building, well away from the renovated water closet block. During April and May there were at all ages only seven cases notified in the Borough, but in June the first cases were notified from Mark House Infants School, and by the end of the summer term no fewer than fifty-three cases had been found out of 117 children on roll in spite of the strictest precautions and the utmost co-operation from the parents, headmistress and her staff. Here again the sanitary accommodation was inadequate and outmoded and too far separated from the washing accommodation in the main block. For this reason bowls of benzalkonium chloride were placed outside the water closets for children to rinse their hands in before proceeding to the main block to wash. It is of interest that some children were demanding the same facilities at home and arrangements were made to supply the solution through the school at cost price. This is an interesting example of health education in the home through the schools. The school was declared free from infection by the end of the summer term, but one further case occurred in December. Soon after the outbreak came to light at the Mark House School, cases were notified from the nearby Nursery School, but this outbreak was cleared quite quickly with a total of ten cases in all. Also in July eleven cases were notified from the Edinburgh Junior Mixed School and in addition there were sixteen other cases from eight different schools. Of the eighty-nine cases at schools up to the end of the summer term, seventy-three were at six schools situated in the St. James' Street Ward. The total in the Borough in the first half year was 150. No case was notified or became notified during August or September and it was hoped that the Borough was at last clear of infection. 32 Before the schools closed for the summer term, all Head Teachers of schools affected were asked to make a careful enquiry on re-assembly on the 2nd September in respect of any suspect cases during the school holidays. They were told that no children from affected families would be permitted to attend school until cleared by the Health Department after rectal swabbing and that unknown and unnotified cases might continue. For many years free washing facilities have been provided at all Walthamstow public conveniences and in view of these outbreaks of dysentery, all public convenience attendants were told by the Borough Architect, Engineer and Surveyor as to the need to disinfect seats, chain handles, etc. after use, and particularly at conveniences situated at playgrounds. It was agreed that this routine should be followed throughout the school holidays. In addition attendants were warned on two occasions that they would be subject to dismissal if washing facilities were in any way refused to the public and especially to school children. Special precautions were arranged at the holiday school meals centre serving the Ward, and arrangements were made with the welfare officer in charge to ensure that all children washed their hands before taking school meals. During the remainder of the year there was only the one case notified at Mark House School at all the schools affected before the summer holidays. During October, November and December there were fifteen, seventeen and seventeen cases respectively at schools, i.e., a total of forty-nine, of 138 for the whole year. Of these autumn cases sixteen were at the Woodside Junior Mixed School and eleven at the Mission Grove Infants School and smaller numbers at nine other schools and in Wards other than the St. James' Street Ward. It appears that the spread of infection was again from case to case and through the medium of the water closets at school (and in the home) especially where not followed by immediate and adequate hand-washing. The essence of control in day schools is repeated emphasis on hand cleanliness, the exclusion of infected children and of any symptomless carriers which may be found. During the course of the year letters giving the full information were sent to the parents of over 2,000 children on the rolls of nine schools, to all Head Teachers in Walthamstow on two occasions and to family doctors on five occasions. It was hoped that at least these letters would stimulate handwashing in the community. Of twenty-one schools affected in all, there were thirteen which had only one or two cases, which is a tribute to the control effected by parents and teachers. Of these twenty-one schools not fewer than nine had old, worn out and unsatisfactory sanitary and washing accommodation all awaiting remodelling, and which had been postponed from year to year because of financial stringency. It is clear that bacillary dysentery will always be with us until adequate washing facilities are available and until every adult and child is willing to use such facilities at all times. 33 11. IMMUNISATION (a) Against Diphtheria.—127 primary immunisations were completed in children of school age and 478 "booster" doses were given in school immunising sessions. (b) Against Whooping Cough.—Thirteen children over five years were immunised against whooping cough during 1958. The main effort of whooping cough immunisation was directed towards children of pre-school years. (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 680 285 41.9 Girls 705 322 45.6 10-12 year Age Group Boys 959 418 43.6 Girls 998 468 46.9 14 year Age Group Boys 889 345 38.8 Girls 886 404 45.6 Others Boys 208 92 44.2 Girls 193 94 48.2 5,518 2,428 44.0 The percentage in 1957 was 38.3. The total vaccinations done during the whole year for children in the 5-14 years age group was sixty-two primary vaccinations and twenty secondary vaccinations. (d) Vaccination against Poliomyelitis.—In November 1957 the eligibility of children for vaccination consisted of the age group six months to fifteen years; thus covering the whole of school life. During 1958, 7,582 children of school age were vaccinated. 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. During the year parties from the day special schools have again visited the Jubilee Retreat Field Study Centre at Chingford. 13. PHYSICAL TRAINING The Committee shares the services of two full-time Organisers with neighbouring areas. Co-operation has continued along the lines of previous years. 34 The following extracts are taken from the Annual Report of the Borough Education Officer to the Committee for Education:— Primary Schools. Teachers in primary schools have continued to show a keen interest in Physical Education and the work has been steadily progressing. A training course for teachers in infant schools was well supported in spite of difficulties caused by the bus strike. One Infant and three Junior Schools have been equipped with climbing ropes during 1958. Many other schools need this equipment and will be supplied as the necessary money becomes available. Secondary Schools. Many problems of accommodation and equipment have resulted from having the unusually large numbers of children now in secondary schools. Progress has been hampered by lack of proper facilities—modern fully equipped gymnasia, shower baths and changing rooms. These will shortly be provided at two schools—the Warwick Girls' and the Sidney Chaplin—but the majority of secondary schools will still continue to work under unsatisfactory conditions. There is a marked national shortage of qualified teachers of Physical Education and the conditions in many schools in the Borough have rendered it extremely difficult to attract staff. In consequence some schools have found it impossible to provide an adequate and satisfactory programme of Physical Education. Nevertheless, some interesting experiments have been started in boys' schools on the content of the Physical Education lesson, with particular reference to the development of strength and stamina and to the methods of acquiring gymnastic skills, and in girls' schools on modern methods of Movement Training. Games. All schools have made good use of the playing fields and have tried to maintain a full games programme in spite of large numbers. Two schools—the Walthamstow High and the William Morris Technical—have introduced lacrosse into their schemes for girls, the first maintained schools in Essex to do so. William Morris Boys have started to use the Ainslie Wood ground at Chingford, sharing it with Chingford schools. This has helped to relieve the serious overcrowding of the Salisbury Hall grounds. The most urgent need has been for hard tennis/netball courts at Salisbury Hall. Tennis is a most valuable game and one which children are most likely to continue after leaving school. It is very disappointing that so few children in the Borough have an opportunity to learn to play. A training course in the teaching of netball was held in 1958 and was well supported. 25 Swimming. A course for teachers on The Teaching of Swimming to Beginners was held at the South-West Essex Technical College Bath at the beginning of the Summer Term and was well attended. During 1958 changes became necessary in the hours during which the swimming bath at the South-West Essex Technical College was available for schools. From the Autumn Term it was arranged that whole school forms should receive swimming instruction and by careful adjustments of the time-tables for the use of the College Bath the High Street Bath and Leyton High Road Bath it was possible to provide a swimming period for almost all Junior school children in their fourth year and Secondary school children in their first year. The experiment proved successful and it is intended to continue the arrangements although the Leyton High Road Bath will not be available for Walthamstow Schools during the Summer Term 1959. It will be necessary to make use of the Whipps Cross Open-Air Pool. Dancing. Primary Schools continued to show great interest in dancing. In some secondary schools the position was not so satisfactory ; time-table problems often prevented the subject from receiving the attention it should have had. Courses for teachers have been held in English and Scottish Country Dancing. 14. PROVISION OF MEALS The following extracts are taken from the Annual Report of the Borough Education Officer to the Committee for Education:— School Meals. The number of children having dinners daily averaged about 8.500 during the year and the total number of dinners provided was 1,626,973. This is an increase of 600 daily over the previous year. The number of kitchens in use remains at fifteen. The Committee continue to provide dinners during school holidays at selected centres for reduced numbers. New dining furniture has been installed in several schools, adding greatly to the amenities, and the family service method previously introduced has been extended to four more schools. The Committee invited tenders and accepted contracts for groceries, milk, greengroceries and meat during the year. Minor improvements continued to be made in the schools to improve service and washing-up facilities. Note by School Medical Officer: Some 40% of children on the school roll took meals and over 15,000, or some 75% had school milk. 36 Inspection.—Mr. W. Richards, Chief Public Health Inspector, reports as follows:— "I have to report that during 1958 the following inspections were carried out:— Schools 90 School kitchens 97 "Various types of defects were found as a result of these inspections and those of a minor character were reported direct to the Education Architect to be remedied as soon as possible. "Other 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 the staff in respect of these matters. Milk in Schools Scheme.—"Eleven samples of pasteurised milk for bacteriological examination, all of which satisfied the Methylene Blue and Phosphatase tests, were taken under the above scheme during 1958." 15. CO-OPERATION (a) Co-operation of Parents.— The following table shows the attendance of parents during 1958 at the periodic medical inspections:— Number inspected No. of Parents Per cent. 1958 Per cent. 1957 Entrants Boys 680 642 94.4 94.7 Girls 705 664 94.2 92.1 10-12 year Age Group Boys 959 793 82.7 81.6 Girls 998 848 84.9 85.1 14 year Age Group Boys 889 119 13.4 21.2 Girls 886 266 30.0 30.2 Others Boys 208 152 73.1 28.9 Girls 193 151 78.2 30.4 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 'leavers' inspections are of importance in regard to fitness for employment, and the attendance of parents at these inspections is to be encouraged. 37 (b) Co-operation of Teachers.— Renewed and grateful acknowledgement for the co-operation of Head Teachers and their staffs must be made. Generous help and co-operation has invariably been experienced, especially in the use of their private and staff rooms for medical inspection—often at great inconvenience. The circulars issued each week by the Borough Education Officer to Headmasters and Headmistresses of schools in the Borough were, with his co-operation, utilised in disseminating information. The following matters were referred to:— Milk in Schools.—A request for immediate reports to be made as to the presence of foreign bodies, especially glass splinters in milk bottles. Dental Extractions.—The need for no food or drink (not even sweets) to be taken at least three hours before the anaesthetic. Ascertainment of Handicapped Children.—A request was made for information as to children wearing hearing aids and others suspected of defective hearing. The help of Head Teachers was particularly appreciated in distributing publicity material in regard to vaccination against poliomyelitis and in publicising the National "Guard that Fire" campaign. At the invitation of the Borough Education Officer, Dr. Poole attended meetings of Head Teachers dealing with these matters. (r) 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.— (i) The Invalid Children's Aid Association.—The Association reviewed the service it had undertaken for Local Authorities for the placement of children in recuperative holiday homes and decided to discontinue this work from the end of September. Adequate local arrangements were then made. The Committee recorded their appreciation of the active and valuable co-operation of the Walthamstow Branch of the Association over many years. Miss H. Thompson, Secretary of the Essex Branch of the Association has kindly contributed the following report for the period January to September. 1958:— 38 Children referred by:— Under 5 years Over 5 years Hospitals — 1 School Health Service — 26 General Practitioners 2 4 2 31 Classification of above cases:— Anaemia, debility 1 16 After effects of acute or infectious illness or operation — 2 Bronchitis or pneumonia — 4 Asthma 1 2 Nervous conditions — 2 Diseases of Ear, Nose or Throat — 3 Other defects — 2 2 31 Children sent for convalescence 27 Children sent to Regional Hospital Board Homes — Children referred for visiting, advice, help or follow-up Hospitals 1 Voluntary Bodies — Parents 1 Health Visitors and Head Teachers 4 Number of visits paid 102 Office interviews with parents 24 (ii) National Society for the Prevention of Cruelty to Children.— The following is a summary of the work done during 1958:— Nature of Offence How dealt with Neglect 31 Warned 26 Ill-treatment 8 Advised 19 Advice sought 6 — — 45 45 — Number of children dealt with:— Under 5 years Over 5 years Boys Girls Boys Girls 24 37 46 56 39 16. HANDICAPPED CHILDREN The following number of special examinations were carried out by the medical staff in respect of the categories stated :— (a) Blind (b) Partially Sighted 2 (c) Deaf — (d) Partially Deaf — (e) Educationally Sub-normal 37 (f) Epileptic 3 (g) Maladjusted 4 (h) Physically Handicapped 4 (i) Speech — (j) Delicate 21 Seven children were known to be suffering from diabetes and all except one were at ordinary schools. Dr. Poole has submitted the following report "Arrangements for the provision of special educational treatment for handicapped children continued to be most satisfactory. For those suffering from mental or emotional handicaps the position has improved considerably in the past year but much still remains to be done for children in these categories. "Wingfield House School for the Physically Handicapped, Joseph Clarke School for the Partially Sighted, and the William Morris Deaf School have all worked to capacity and while it has not been necessary to defer admission (except for children under five years of age) there is need to provide additional reception classes at both the School for the Deaf and at Wingfield House. "It is well recognised that whatever the handicap, the earlier the age at which the child is brought under effective treatment and training, the better is the final result. This is particularly true of deaf children, who are being admitted at the age of three years or even younger, but there is a good case for the admission of other categories of physically handicapped children below the age of five years as soon as additional staff and premises can be provided. "Since the aim of the special school is to fit its pupils to return to normal schools wherever possible, it is evident that an extra year at the beginning, instead of at the end of school life, would be of greater value in many cases besides providing very real relief to the parents of severely handicapped children. 40 "The Special Schools continue to serve a very wide area. The number of pupils attending from various districts was as follows :— Partially Sighted Deaf Open Air School Educationally Subnormal Walthamstow 7 5 56 99 Forest 6 15 29 —• South Essex 5 3 — Barking 2 4 — — Dagenham 2 — — — Ilford 4 10 — — Leyton 2 5 2 4 Romford 4 6 — — Middlesex 12 2 2 — Herts — 1 — — Totals 44 51 89 103 "In addition thirty-six Walthamstow children are at present accommodated in residential special schools as shown below, and three physically handicapped children are receiving home tuition. Blind 7 Deaf 1 Delicate 6 Educationally sub-normal 8 Epileptic 4 Maladjusted 6 Physically Handicapped 3 Speech 1 Mentally Handicapped Children.—"The additional class at the Margaret Brearley School provided in 1957 has helped considerably in reducing the waiting list for the admission of educationally sub-normal children, but the present total of 120 places is still insufficient to cover the need. To some extent this has been met by the establishment of two small remedial classes for dull and backward children ; one at Woodside Junior School for children aged 9-10 years and one at Mission Grove for the 7-8 years age group. However, the waiting list is again building up and there appears to be a need for the establishment of two or more remedial classes for children of secondary school age. "One is always reluctant to recommend the transfer of any child to a special school as this inevitably means some deprivation of its opportunities for normal development and increases the risk of perpetuating a 'handicapped' attitude into adult life. This consideration applies especially to the transfer of children of secondary school age to the E.S.N, school. 41 "Nevertheless, although in any group someone must always be at the bottom, there are some children in secondary modern schools so far behind their age group in ability and attainment that they are unable to progress unless given a disproportionate amount of the teacher's time. The transfer of one such 'lame duck' to a remedial class where more individual attention can be given will not only raise the child's own attainment but may positively benefit the class he has left by allowing them to proceed at a faster rate. "Dr. Carmel Dooley was approved by the Minister of Education on the 4th September, 1958 for the formal ascertainment of educationally sub-normal pupils and has since performed numerous examinations under Dr. Poole's supervision, and subsequently alone. Emotionally Disturbed Children.—"An increasing proportion of the pupils attending the doctor's clinics are seen with symptoms of nervous or emotional difficulties, often manifest as behaviour disorders, enuresis, nervousness, sleeplessness, truanting, and failure to make expected progress at school. Whether there is any real increase in these conditions or whether they are given prominence by the comparative reduction in the number of purely physical ailments now seen at the clinics, is difficult to determine, but one has the impression that, whether there really are more disturbed children or not, more of them are being referred to the school doctors. "Many of these children respond satisfactorily to advice and treatment and only those who fail to do so, or those with more serious psychological disturbances, are referred to the Child Guidance Clinic, but despite this selection and the successful work of the school doctors the waiting period for an appointment with the Psychiatrist remains at about ten months for non-priority cases. Much of this delay is occasioned by the intervention of numbers of priority referrals, e.g. from the Juvenile courts, but it is encouraging to note that during the year the number on the waiting list (Walthamstow cases only) was reduced from fifty-six to forty-six. Employment of Handicapped School Leavers.—"The current reduction in the demand for juvenile labour in the district is being reflected in the increasing difficulty in obtaining suitable employment for pupils leaving the special schools, particularly those who remain severely handicapped. "A case committee of officers was set up with the co-operation of the Borough Education Officer to consider individual cases and co-ordinate effort. Two meetings were held (a third having to be postponed because of illness) and representatives of the Principal School Medical Officer, the Borough Education Officer, the Borough School Medical Officer and the Youth Employment Officer discussed general provisions and individual cases brought up by the Head Teachers of the special schools and by the Educational Psychologist. 42 "The greatest problem was found to be the placement of those children who were so heavily handicapped, often with more than one disability, as not to be employable in any ordinary sense and unlikely to be made so by any vocational training. "Arrangements have since been made for all handicapped pupils to be notified to the County Welfare Officer before they leave school so that the size of the problem can be assessed and suitable provisions made by the County Welfare Authorities. "It is hoped that arrangements will be made in the near future for the establishment locally of a workshop where these young people can be given some work, even if only of a recreational nature, and can enjoy the stimulus of companionship, which is denied them so long as they remain home-bound." Special Schools. (a) School for the Deaf.—Mrs. L. Corner, Acting Headmistress from 1.9.56 to 21.4.58, was succeeded by Mr. K. S. Pegg, appointed 22.4.58 as Headmaster of the William Morris School for the Deaf, who reports as follows :—■ "The school re-opened in January, 1958 with forty-seven on roll. During the year eight children were admitted and three left. Two of the three children were transferred to other schools, one to a school for the deaf in Middlesex and the other to a secondary modern school for girls. The third left to take up employment as a carpenter. The roll at the end of the year was as follows :— Class Grade Age Range No. on roll conoGEnital Acquired Hereditary Kernicterus Prematurity Unspecified Post Men Other Aetiology Unknown M. F 1 Reception 3-7 5 5 1 2 1 3 3 2 Deaf 8-11 3 4 1 1 — 3 1 — 1 3 P.D. 7-12 5 6 — — — 2 2 2 5 4 Deaf 9-11 3 2 1 — — 2 2 — — 5 Deaf 13-15 5 2 — — — 3 2 1 1 6 P.D 12-16 6 6 1 — — 4 5 2 — Totals 27 25 4 3 1 17 12 5 10 Catchment Area.— Barking 2 Barkingside 1 Chadwell Heath 3 Chigwell 1 Chingford 1 Dagenham 1 Edmonton 1 Harlow 3 Hornchurch 1 Hutton 1 Ilford 7 Leyton 5 Loughton 4 Nazeing 1 Purfleet 1 Romford 6 Walthamstow 5 Wanstead 1 Woodford Bridge 4 Woodford Green 2 Cheshunt (Herts.) 1 "A number of hearing aids were supplied to children attending normal schools, and in some cases children attended once or twice a week for auditory training or practice in lip-reading. It is hoped that, in the near future, it will be possible to help more children in this way. 43 "During the year we have taken delivery of a further Speech Training Unit, which is of great use in the school. A number of cases have tried the "Telesonic Induction Loop System." This system is designed to provide high quality sound reproduction while eliminating those restrictions on movement and classroom layout which the earlier type of "fixed" installation demanded. This trial is continuing, and we are expecting a supply of Medresco Transistor Aids which are more powerful than the aids originally supplied to the children, with the added advantage that they can be used at home as an individual hearing aid and at school in the loop induction system. "Mr. Taylor of the School Dental Service attended the school in September, and held a full dental inspection. A total of 159 minor treatments have been given by the nursing staff. An average attendance of 86 per cent was recorded. "Miss Smith, Educational Psychologist, made a number of visits to the school for the purpose of examination. "During the year we have received visits from Dr. Powell, Dr. Poole, Dr. Whitmore, Senior County Medical Officer for Child Health, Dr. Leung from Hong Kong, Dr. Carlotta of the World Health Organisation, Mr. Cammock, Dr. Thould, Speech Therapists, Teachers of the Deaf, Nursing Sisters, Health Visitors and Students from Teachers Training Colleges." During the year formal approval was received from the Ministry of Education in regard to the provision of commercial transistor aids. Pending the provision of Medresco transistor hearing aids, commercial aids were obtained on the recommendation of Mr. Cammock, the Ear, Nose and Throat Consultant appointed to the school. Through the generosity of the Parent/Teacher organisation magnetic recording tapes were made available and a speech record was made of every child attending the school. Loop Induction Hearing Aid.— Even with the best adjustment possible, an ordinary hearing aid produces great distortion because of interference by background noises. These noises cannot be eliminated in a class-room of small children. The Loop Induction system overcomes this difficulty by providing direct communication between the teacher's microphone and the child's ear-piece. The child's hearing aid incorporates a three-position switch (1) Listening Loop only. (2) Normal microphone plus listening loop. (3) Normal microphone only. On position (1) it is possible to hear the teacher's voice clearly despite noisy surroundings. 44 This system has already been adopted and has given excellent results in several schools for the deaf and the new Government transistor aids to be issued to children at deaf schools will all incorporate the Loop Receiver. The systems so far installed have been supplied by commercial firms and it is not known when and if a Government transmitter, as distinct from the receivers, will be produced. Judging by the delays which have arisen over the production of the Government transistor aids, any further development may take a considerable time. It is anticipated that suitable transistor aids incorporating the Loop Receiver will be issued to children attending deaf schools fairly early in 1959 and it was recommended that three commercial transmitters be obtained at a cost of approximately £60/£70 each so that three classes can be equipped with the Loop system. There is already installed one Group Aid suitable for the senior class but this is a fixed aid necessitating the use of head-phones plugged in to the child's desk and is unsuitable for young children. The Loop system, on the other hand, allows children to move about in the class and even in the playground and still clearly hear the teacher's voice. The teacher also can move freely, within the limits of a long lead (suspended from the ceiling) and can move among the class and demonstrate on the blackboard, etc. (b) School for the Educationally Sub-normal.—Miss R. E. A. Lock, Headmistress of the Margaret Brearley School, reports as follows :— "The number on roll has averaged 100 throughout the year. "During the night of March 30th, fire broke out in the roof of the school. Three classrooms and part of the hall were severely damaged. "Accordingly we were obliged to move the children to another school in the Borough. We were received with so much kindness by the Head and staff that emotional upsets were minimised, although the children hated the thought that "their" school was burned. "By Herculean efforts on the part of Architects and building operatives, we were able to return to our own premises at the beginning of September to the obvious delight of the children. "I offer my grateful thanks to all who helped during what was undoubtedly a very bad break. "London University Diploma (E.S.N.) students have continued to use the school for observation purposes during the year. "The health of the children has been well maintained during the year." 45 (c) School for the Partially Sighted.—Mr. G. M. Williams, Headmaster of the Joseph J. Clarke School, reports as follows :— "The school has now a roll of forty-five with the further extension of the catchment area to include Hutton. "As in previous years the ophthalmic supervision of the school has been well maintained. Dr. I. Gregory, M.B., D.O.M.S., made visits in May and October for the purpose of examination and has given much helpful advice. The medical staff of the Eye Clinic have made regular ophthalmic examinations and Mrs. Suckling has given ready and efficient service in the supply and repair of spectacles. The willing help of all at the Eye Clinic has been much appreciated. "At the end of the year the visual acuity (Snellen) after correction was as follows :— 3 children had acuity less than 6/60 7 „ „ „ of 6/60 12 „ „ „ of 6/36 14 „ ,. „ of 6/24 9 „ „ „ of 6/18 There were seventeen children with monocular vision, and three children with additional handicaps. "In June there was a full medical inspection of all children in the school, and Mr. Taylor from the school dental clinic visited the school for dental inspection. "The hearing of all new admissions and certain selected cases were tested on the pure tone audiometer by Mrs. Leach of the School Nursing Service. "Visitors during the year included medical officers from Jugoslavia, the Phillipines, Hong Kong, post graduate medical students, student health visitors, district nurses and training college students. "During the Whitsuntide holiday a party of twelve children under the care of Mr. Crosbie spent a week at the Isle of Wight in company with the Woodside School Camp party. This proved to be a most instructive and worthwhile venture. "At the end of the summer term Miss Ramage, deputy Head Teacher, retired from teaching, having given many years of valuable service to the school. She was the sole remaining link between the former Walthamstow Blind School and the present partially sighted school. The vacancy thus caused was filled by the appointment of Miss R. Baggs to the staff. "The average number on roll during the year was forty-three, with an average attendance of 34.2. Seven children were admitted, and three children were taken off roll, one boy being transferred to a school for the Blind, one boy leaving to be trained for industry as a Blind Person, and one girl suitably placed in light factory work. 46 "I have to express my thanks to all staff, teaching, welfare and transport for their continued efforts on behalf of the children." The table below shows the principal defects in the children at the school at the end of the vear :— Boys Girls Boys Girls Albinism 3 5 Ectopia Lentis — 1 Anisometropia 1 — Microphthalmos — 1 Cataract 7 2 Myopia 3 6 Cerebral defect 1 - Nystagmus 2 - Choroiditis — 1 Optic atrophy 3 1 Coloboma 1 1 Retinal defects 4 — Corneal ulceration 1 — Retrolental fibroplasia — 1 (d) School for the Physically Handicapped.—Mr. G. M. Williams, Headmaster of the Wingfield House School, reports as follows :— "At the end of the year the school had a roll of eighty-nine children with three children awaiting admission. During the year there have been persistent requests for admission of handicapped children below the age of five years who are in need of nursery education. It has not been possible to give places to these young handicapped children as the accommodation and staffing are not available. "The number of children with more than one handicap shows no sign of diminishing ; there were twenty-one children with poor mentality allied to other defects ; three children were found to have hearing disabilities necessitating provision of hearing aids ; thirteen were having regular speech therapy and four children have three major defects. There were eight non-ambulant children on roll. "During the summer holiday period internal renovations and decorations were carried out to rooms in the main building. The school was kept open during part of the summer holiday period on a voluntary basis. Forty-two children attended and maintained a good average attendance throughout the period. Visits were arranged to Thorpe Bay and Shoeburyness, and Forest walks and rambles were undertaken by the more ablebodied. "Visitors to the school during the year included medical officers from Jugoslavia, the Phillipines and Hong Kong, post-graduate medical students from Whipps Cross Hospital, Teacher Training College students and a hospital almoner. "Miss Foster resigned from the teaching staff in August, her place being taken by Miss Gooch. "An Officers' Case Committee to consider placement of school leavers in employment was set up and two meetings were held during the year. "Dr. Poole has made regular weekly visits and his ready help has at all times been available for children and parents alike. This has been much appreciated. 47 "Mr. Taylor of the School Dental Service attended the school in October 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 in selected cases. A total of 1,473 minor treatments have been given. "The school has enjoyed the valued co-operation of both Miss Garratt of the Orthopaedic Clinic and Miss Rasor of the Speech Clinic, and in each case much helpful assistance has been given. "Miss Smith, the educational psychologist, made four visits for the purpose of examination and advice, and Mr. Harvey. Youth Employment Officer, interviewed all leavers. "A health educational film show was given to the school in September and a safety-first demonstration was held in December. "The children on roll at the end of the year were classified as follows :— Delicate (Category 'j') 32 Physically Handicapped (Category 'h') 51 Epileptic (Category 'f') 6 89 "During the year thirty children left the school, sixteen being transferred to ordinary schools, seven to employment, two to residential schools, two to E.S.N.schools and three died. "The average number on roll was 88.8 with an average attendance of 67.3 being 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." The attached table shows the analysis of principal defects in children at the school during November 1958 :— Asthma 15 Epilepsy 3 Bronchitis 7 Muscular Dystrophy 1 Bronchiectasis 2 Osteogenesis imperfecta and fragilitas ossium 2 Spastic Athetosis 1 Delicate and immature.. 10 Kypho-scoliosis 1 Congenital heart 5 Cretin 2 Rheumatic heart 4 Spina bifida 3 Cerebral Palsy— Congenital hypo-glycaemia 1 congenital 16 Neurological Bladder 1 post meningitic 2 Habit spasm and chorea 2 Anterior poliomyelitis 3 T.B. bone 1 Haemophilia 1 Chronic otitis 1 Traumatic Paralysis 1 Nephritis 1 48 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 :— "Attendance was exceptionally low during January and February, when many children had chicken-pox and influenza. There were also several cases of bronchitis. "Our health record was very good during the summer apart from a small outbreak of dysentery in June. Fortunately this developed over a week-end, and the number of cases was confined to ten." The Medical Officer for the Nursery School, Dr. J. P. Werren, reports as follows :— "The Nursery School has eighty-four pupils aged 2-5 years and there are seventy-five awaiting admission. "Most of the pupils are normal healthy children admitted at their parents' request, but a few have been recommended on medical grounds for emotional disturbances related to lack of sufficient scope for play at home. These have benefitted greatly, though two of these children were referred to the Child Guidance Clinic for their persistently aggressive behaviour which was a menace to the other children. "Each child has an annual medical inspection and the health of the children is excellent on the whole, the catarrhal child with recurrent upper respiratory tract infection being the most common medical problem encountered. The proximity of the Nursery School to the Markhouse Clinic permits of close liaison between the teaching and medical staff. "The response to diphtheria immunisation is good and, at the last medical inspection, only four children had not been immunised. "The school is built on the open air principle and the children spend most of their playtime out of doors. The play space is, however, inadequate for eighty-four children and this was commented upon when H.M. Inspector visited the School. "The menus are planned by Miss Harris, the Head Teacher, and the food is cooked on the premises. The meals are well balanced and the food attractively served, and it is not unusual for the children to ask for second or even third helpings. No mid-morning drink or snack is served but they have a milk drink on arrival at school. 49 "Absenteeism was greatest in the Spring term when there was an outbreak of Chicken Pox, and several children were also away with flu and bronchitis. The staff are interested in health education and there is a parent-teachers association which meets once a term. During 1958, three meetings were held : (1) Miss Mary Noble, a representative from 'Andrex' spoke on 'bathroom habits' and 'Dangerous Droplets' and showed some film strips. (2) Miss Smith, Educational Psychologist, gave a talk about behaviour problems in young children. (3) Mr. A. Nicoll, Chiropodist, spoke about foot health. "These meetings were each attended by about thirty parents." 19. MISCELLANEOUS (a) Health Education.— (i) During the year the following publications issued by the Central Council for Health Education were distributed to Head Teachers :— 1. Control of Infection in Schools. 2. Health Education in Schools. (ii) Dr. Poole spoke to a meeting of the Walthamstow Education Group on the work of the School Health Service. (iii) The Borough Education Officer in his report for 1958 states that lectures on Good Grooming were again arranged for girls in secondary schools. Nineteen of these lectures were given during the year. (b) Enquiry and Welfare Work.— The Borough Education Officer in his Annual Report for 1958 to the Committee for Education states that :— The Enquiry and Welfare Officers continued to provide liaison between families and the schools. They handled enquiries relative to the supply of clothing and free meals in necessitous cases, encouraged co-operation with the School Medical Department and as necessary promoted contacts with the Assistance Board, with the Children's Officer and with Officers of the various voluntary bodies, such as the Invalid Children's Aid Association, Women's Voluntary Service and the National Society for the Prevention of Cruelty to Children. The Senior Enquiry Officer continued to act as Guardian ad Litem under the Adoption of Children Acts and during the past year placed before the Juvenile Court sixteen cases in which Adoption Orders were granted. 50 Welfare.—During the past year £465 was spent on the supply of clothing for necessitous children to enable them to attend school and 51,557 meals free of cost were supplied to 395 children. Problem Families.—In co-operation with the Health Department, advice was given in respect of difficult children, some of them with difficult parents. There.were a few other cases which were referred to the National Society for the Prevention of Cruelty to Children for investigation. (c) Pre-Nursing Courses.— (i) Walthamstow High School.—Miss M. M. Burnett, M.A., states that no pre-nursing course was held during 1958. (ii) Woodford County High School.—Miss K. M. H. Chapman. M.A., states as follows :— "We do not now hold a pre-nursing course at this school. We do, however, take the London University G.C.E. in Human Anatomy, Physiology and Hygiene." (iii) William Morris County Technical School.—Mr. H. P. Williamson, M.Sc.(Educ.), B.Sc., reports as follows :— "A most interesting and useful school course is one leading to exemption from Part I of the General Nursing Council's Preliminary Examination. "In 1954, however, the necessary amendment to the Nurses Rules 1951, giving the Council power to grant exemption from Part I of the Preliminary Examination, received the approval of the Minister of Health, and certain syllabuses were accepted by the Council for this purpose. "Our pupils now work on the Syllabus of the University of Cambridge Local Examinations in the subject "Human Biology". "Three girls were successful in the 1958 examination. Concurrently with this, the girls study General Science to G.C.E. 'O' level and other G.C.E. subjects forming a good general education. "In the year 1957/58, the following pupils or ex-pupils started nursing or allied work :— St. Bartholomew's Hospital Student Nurse (1) Whipps Cross Hospital Laboratory Assistant (1) College of Physiotherapy, London. Student (1) Royal Free Hospital Acceptance for Student Nurse (1) London Hospital Acceptance for preliminary work in Convalescent Homes (2) (d) Employment of Children.—316 children were examined by the medical staff. 51 (e) Employment of Children in Public Entertainment.—Twelve children were examined under these regulations. Staff Appointments.—101 teaching staff and 327 other staff were medically examined during the year. Medical Examination of Prospective Teachers.—Nineteen 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 5,518 B. Special Inspections and Re-inspections 3,676 C. Pupils found to require treatment 1,705 II. Defects found at Routine Medical Inspection. Requiring treatment 2,055 For observation 1,822 Physical Condition of Pupils seen at Medical Inspection. Satisfactory 5,466 Unsatisfactory 52 III. Infestation with Vermin. Total number of examinations 34,641 Individual pupils found to be infested 138 IV. Treatment. {a) Minor Ailments.—Total defects treated 1,622 (b) Defective Vision and Squint. Cases treated for errors of refraction 1,557 Other defects 16 Pupils for whom spectacles—prescribed 1,136 obtained 1,120 Orthoptic Clinic—cases treated 232 (c) Nose and Throat Defects. Number treated 190 Total attendances 326 (d) Orthopaedic and Postural Defects. Treated as in-patients 32 Treated otherwise 516 52 (e) Child Guidance. Distribution of treatment or supervision— (i) Psychiatrist: Special diagnostic cases 31 Children under treatment 96 Children awaiting treatment — Number of cases supervised 55 (ii) Psychotherapist : Children treated 44 Awaiting treatment — (iii) Psychiatric Social Worker : Cases advised 356 Awaiting advice — (iv) Educational Psychologist : Children given remedial education 22 Awaiting remedial education (/) Speech Therapy—New cases treated 127 (g) Denial Inspection and Treatment. Periodic S pecial Number of pupils inspected 7,231 3,418 Found to require treatment 3,704 3,404 Number offered treatment 3,136 3,400 Number actually treated 3,108 1.666 Attendances made for treatment 10,219 3,714 Half days devoted to—Inspection 56 Treatment 2,346 Fillings—permanent teeth 8,107 temporary teeth 1,929 Extractions—permanent teeth 1,271 temporary teeth 4.105 Anaesthetics—local 1,162 general 2,718 Orthodontics— Treated with appliances 274 Removable appliances fitted 170 Fixed appliances fitted 12 Total attendances 1,965 Artificial dentures fitted 27 Other operations—permanent teeth 3,418 temporary teeth 945 53 APPENDIX SCHOOL HEALTH SERVICE 1930-1958 New Schools 1930 School Nursing Staff increased. St. Patricks. 1931 Rheumatism Clinic established. 1932 Immunisation against diphtheria menced. 1933 Orthodontic treatment begun. 1935 Third dental team appointed. Thorpe Hall. Medical and dental inspections undertaken for County Education Committee. 1936 Whole-time speech therapist appointed. Hale End O.A.S. 1937 Fourth dental team appointed. 1938 Orthoptic treatment begun and Scabies Clinic opened. 1940 Decision that all school staff have chest x-ray on appointment. Sidney Burnell Secondare. Educational psychologist appointed and Child Guidance Clinic opened. 1944 Additional Child Guidance services. 1945 1st April—Appointed Day under Education Act, 1944. 1946 Child Guidance service extended to Leyton Borough and Forest Divisions. Three new dental clinics provided. 1948 Commencement of post-War renovation of sanitary accommodation. School meals over 10,000 per day. 80% of children under fifteen years immunised against diphtheria. 1949 Orthodontic appliances made in Dental Workshop. Immunisation against whooping cough begun. Paediatric Clinic commenced. Beginning of Medical Research Council B.C.G. Trials. 1953 Appointment of additional dental team. Sidney Burnell Infants Provision of Group Hearing Aid at School for the Deaf. Tuberculin testing of school entrants. First Aid instruction to Teaching Staff. 1954 Improvement to Dental Surgeries at Town Hall. Mothercraft lectures at schools. B.C.G. vaccination at schools commenced. 1955 Specialist Dental Anaesthetist made able. Audiometric survey. Rheumatism Clinic merged with Paediatric Clinic. 1956 Increased mothercraft teaching at dary schools. 1957 Dysentery, Ringworm, Food Poisoning and poliomyelitis outbreaks occurred. McEntee Technical. Jubilee Review of School Health Service (1907/1957) prepared. 1958 Two classes started for Dull and Backward children. Warwick Secondary Girls. Sidney Chaplin Secondary.