AC 4411(A) WAL 50 BOROUGH OF WALTHAMSTOW Committee for Education REPORT of the DIVISIONAL SCHOOL MEDICAL OFFICER for the year 1959 MELVILLE WATKINS, M.R.C.S.. L.R.C.P.. D.P.H. DIVISIONAL SCHOOL MEDICAL OFFICER BOROUGH OF WALTHAMSTOW Committee for Education REPORT of the DIVISIONAL SCHOOL MEDICAL OFFICER for the year 1959 MELVILLE WATKINS, M.R.C.S., L.R.C.P., D.P.H. DIVISIONAL SCHOOL MEDICAL OFFICER INDEX Section 1-Staff 7 Section 2-School Clinics 7 Section 3-Co ordination 8 Section 4-School Hygiene and Accommodation 9 Section 5-Medical Inspection 11 Section 6-Review of the facts disclosed by Medical Inspection 11 Section 7-Follow-up 14 Section 8-Arrangements for Treatment (Specialist Clinics) 14 Section 9-Protection of Schoolchildren against Tuberculosis 28 Section 10-Infectious Diseases 29 Section 11-Vaccination and Immunisation 30 Section 12-Open Air Boarding School Education 31 Section 13-Physical Training 31 Section 14-Provision of Meals 31 Section 15-Co-operation 32 Section 16-Handicapped Children and Special Schools 33 Section 17-Full time Courses of Higher Education for Blind Deaf Defective and Epileptic Pupils 41 Section 18-Nursery School 41 Section 19-Miscellaneous 41 Section 20-Statistical Summary 43 Accommodation 9 Follow-up 14 Audiometry 18 Food Hygiene 31 Boarding School Education 31 Good Grooming 43 B.C.G. at Schools 28 Handicapped Children Child Guidance 19 Deaf 34 Chiropody 14 Partially Sighted 37 Clinics 7 Physically Handicapped 39 Colour Vision Tests 12 Heart Disease 13 Convalescent Home Treatment 27 Hospital Reports 9 Co ordination 8 Hygiene 9 Dental Defects 13 Infectious Diseases 29 Dental Treatment 15 Liason with Hospital Diphtheria Immunisation .. 30 Services .. 8 Dysentery 29 Mass Radiography 28 Ear Disease 13 Meals Provision of 31 Ear Nose and Throat Clinic 17 Medical Examinations 43 Educational Psychology 23 Medical Inspection 11 Employment of Children 42 Medical Treatment 14 Enquiry Officers 32 Milk in Schools Scheme 32 Eye Clinic 17 Minor Ailments 12 14 Eye Disease12 N.S. P. C. C 33 Specialist Clinics- Nursery School 41 Child Guidance 19 Nutrition 11 Ear, Nose and Throat 17 Open Air Education 31 Ophthalmic 17 Orthodontics 16 Orthopaedic 18 Orthopaedic Treatment 18 Paediatric 23 Orthoptic Treatment 17 Spectacles 17 Speech Therapy 25 Paediatric Clinic 23 staff 7 Parents, Co-operation of 32 statistical Summary 43 Physical Training 31 Physiotherapy 18 Teachers, Co-operation of 32 Pre-Nursing Courses 41 Tonics Tonsillectomy 12 Re-inspection 11 Xuberculosis 13 Ringworm 12 27 , 28. School Hygiene 9 Uncleanliness 11, 14. Skin Diseases 12 Vaccination - Special Schools 34 B. C. G. 28 School Clinics 7 Poliomyelitis 30 Smallpox 30 Schools for the Visual Defects 12 Deaf 34 E.S.N 36 Whooping Cough Partially Sighted 37 yes action 30 Physically Handicapped 39 X-ray examinations 28 WALTHAMSTOW COMMITTEE FOR EDUCATION 1959 - 1960 Chairman.: Councillor J. W. PRINGLE. Deputy Chairman. The Worshipful The Mayor: Alderman S.N. CHAPLIN, J.P. Ex Officio: The Worshipful the Mayor: Alderman S.N. CHAPLIN, J.P. The Deputy Mayor: Councillor C.J. CROSBIE Chairman of the Finance and General Purposes Committee: Alderman ROSS WYLD, 0. B. E., J. P. Nominated by the Local Education Authority: County Aid. Mrs. ,L.P. BAILEY, J. P. Aid. the Lady McENTEE, O.B.E. ,J.P. Co opted Members: Mr. L. V. HEAD, J. P. Rev. W. E. SMITH Mr. R. LAMB Rev. R. WATERS Rev. Canon PRENDERGAST (Deceased) Miss D. E. WYLD Borough Educat ion Officer. E. T. POTTER, B. Sc. , J. P. Aid. W.B. FITT, O.B.E. Aid. A. E. MANNING (Deceased) Aid. H. FULTON Aid. W. F. SAVILL Aid. G.R. LOWTON, J. P. Aid. Miss D. WRIGLEY, B. A. Coun. Mrs. E.L. BALDWIN Coun. Mrs. W. M. PALETHORPE Coun. Mrs. S. CANDY Coun. A. F. WHICHER Coun. J. HAMMOND Coun. 0. F. J. MCCARTHY Coun.G.S. MACE (from Sept. 1959) 5 To the Chairman and Members of the Walthamstow Committee for Education. Mr. Chairman, Ladies and Gentlemen, I have the honour to present my first Annual Report on the School Health Services for 1959. My observations upon the work of the Department for the full year must of necessity be incomplete since I only commenced duties in November. I am very much aware of my good fortune in succeeding Dr. A.T. W. Powell who developed an unrivalled School Health Service. This rich legacy will make an excellent foundation upon which any evolutionary changes in the pattern and future trends of the Service can be firmly based. The Report reveals once again the high level of general health of the school population. One unsatisfactory feature stands out and that is the continued high incidence of caries. Closely associated with this is the great shortage of school dental officers which precludes the more frequent routine inspection of all school children. This shortage in its turn reflects in some degree, as Mr. Tait mentions in his report, upon the orthodontic waiting list which for the first time for several years has reached the fifty mark. The incidence of infectious diseases was not unduly great but Sonne Dysentery provided us with its usual difficulties with regard to its prevention. Plantar warts could be justly regarded under this heading, and it is note-worthy that treatments for this condition accounted for 2,316 out of a total of 2,647. Mental health, especially in the young, is exercising our attention increasingly. The School Medical Officer and Health Visitor/School Nurse have an extremely important part to play. To this end they must be equipped to detect early minor deviations from the norm and early maladjustment in order to prevent serious major breakdownslater on, which are all too often too intractable to treat. The school medical officer has his interest in this subject stimulated whilst undertaking a course on the ascertain ment of the educationally subnormal child, but this is not enough. A more intensive form of training, in my opinion, 6 is needed. Partly to meet this need Dr. Gillespie and Dr. Hoffman, Consult Psychiatrists, commenced regular Case Conferences for medical officers and health visitors at the Child Guidance Clinic. This promises to be of great value to our professional staff. I would like to thank all who have contributed to this Report, and to all the staff for their co-operation, also to our colleagues in the Education Department. My thanks too, to the Chairman, Vice-Chairman, and Members of the Committee for Education for their consideration and interest. I am, Your obedient Servant, M. WATKINS, Divisional School Medical Officer. 7 1. STAFF Appointments. Date Appointed Miss E.Kenny,S.R.N.,S.C.M.(Part I)H.V.Cert. 1. 4. 1959 Miss M.Loughton,S.R.N.,S.C.M.,H.V.Cert,S.F.N. 6. 4. 1959 Miss A.Bone,S.R.N.,S.C.M.,H.V.Cert.,Q.D.N. 9. 4. 1959 Dr. M.Watkins, M.R.C.S.,L.R.C.P.,D.P.H. 1.11. 1959 Mrs, M.Saywell,S.R.N.,S.C.M.(Part I) 12. 10. 1959 Resignations. Date Resigned Mrs. G.Salter,S.R.N.,S.C.M.,H.V.Cert. 17.12. 1959 Miss E.Cunnington,S.R.N.,S.C.M.,H.V.Cert. 22. 3.1959 Miss E.Rowston,S.R.N.,S.C. M.,H. V. Cert. 20. 9.1959 Dr A T.W. Powell,M.C.,M.B.,B.S. .D.P.H. 31. 10. 1959 Mrs.J,Mountford,S.R.N.,S.C.M.(Part I) 31. 8.1959 2. SCHOOL CLINICS Aural - Monday 2 p.m.- 4-p.m. Town Hall. Child Guidance Monday to Friday 9 a.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 Wed. 9 a.m.- 4.30 p.m. Priory Court. Thursday & Friday 9 a.m.- 4.30 p.m. Silverdale Road. Monday to Friday 9 a. m. - 4.30 p. m. West Avenue. * Minor Ailments- Monday, Wednesday, Friday, Saturday 9 a.m.- 12 noon Town Hall. Tuesday 9 a.m.- 11 a.m. Silverdale Road. Monday, Thursday 9 a.m.- 11 a.m. Low Hall Lane. Massage and Sunlight - Monday to Friday 9 a.m.- 5 p.m. Wingfield House School. 8 Ophthalmic Tuesday 9 a.m.- 12-noon ) 2 p.m. - 4 p.m. ) Wednesday (Alt.) 9 a.m.- 12 noon ) Town Hall Thursday 2 p.m. - 4 p.m. ) Friday 2 p. m. - 4 p. m. ) Saturday (Alt.) 9 a. m. - 12 noon ) Orthopaedi c Monthly (Tuesday) 1.30 p.m.- 4 p.m. Wingfield House School Or thoptic Monday 9 a. m. - 12 noon ) Tuesday 9 a. m. - 12 noon ) Wednesday 9 a.m.- 12 noon ) Twon Hall 2 p.m. - 4 p.m. ) Thursday 2 p.m. - 4 p.m. ) Friday 9 a.m.- 12 noon ) Paediatric Thursdays (Alt.) 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. 3. CO-ORDINATION (a) Staff. Co-ordination is secured by the fact that all the school health staff also carried out duties for other health services. The School nursing staff is equivalent to 7& whole-time nurses. (b) Liason. Family doctors were informed as to the findings of specialists in regard to children referred 9 for specialist diagnosis and treatment. (c) Hospitals.- Several hospitals continued to send summaries of their discharge reports in regard to children, notably Whipps Cross, St. Anns and IIford Infectious Disease Hospitals, Canadian Red Cross and the Prince of Wales Hospitals. The 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 - - 1959 1958 1957 1956 1955 Number of Children on Register 31st Dec. 18, 920 19,743 20,182 20,224 20,072 Average attendance 16922.6 17716.0 17552.3 18328.2 18014.0 Percentage attendance 89.4 92, 2 87.2 90.6 89.7 Educational Premises.- The following extracts are taken from the Annual Report of the Borough Education Officer to the Committee for Education:- Maintenance of Premises. Although the total annual expenditure under this head was not large compared with the sums spent on capital 10 projects, nevertheless it formed an important section of the work because of the large number of small items involved. The perennial difficulty of keeping ageing buildings in repair remained, the remodelling of older schools and the replacement of some of them by modern buildings will help to solve this problem. In addition to the normal allocation for the upkeep of buildings and grounds a sum of £4,885 was granted by the Local Education Authority for the very old buildings, viz. those built before 1900. Expenditure on renovations was maintained at about the same level as in previous years and costs if anything were slightly lower. The policy of not concentrating the work in the summer holiday period, but spreading it over the whole year was continued. Buildings which received attention were those painted last externally 5 years and internally 8 years previously. The policy of using bold colour schemes, selected in consultation with Head Teachers, was applied generally. The normal programme of repairs and maintenance and minor improvements to playgrounds, floors and heating and lighting installations was carried out. Cleaning. The washing down of walls in the schools has been carried out as in previous years and all walls recommended for this treatment have now been cleaned. Those done in the first year are now due for attention again. Walls washed during the past year have included those of indoor lavatories in addition to classrooms. Upkeep of Grounds. The school playing fields continued to be maintained satisfactorily by the Committee's ground staff under the control of a Foreman Groundsman. The garden areas were increased by the addition of the Warwick Secondary Girls' School, the Sidney Chaplin Secondary Mixed School and the Chapel End Infants' School. 11 5, MEDICAL INSPECTION The following gives a summary of the returns:- A. Periodic Medical Inspections - 5 years age group 1414 10-12 year age group 2560 14 year age group 1964 Others 530 Total 6468 B. Other Inspections - Special Inspections 1656 Re-inspections 2077 Total 3733 6. REVIEW OF THE FACTS DISCLOSED BY MEDICAL INSPECTION (N.B. The numbers given below refer to medical inspections and special inspections 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 Satisfactory Unsatisfactory inspected No % No % 5 year age group 1414 1398 98.9 16 1.1 10 12 year age group 2560 2547 99.5 13 0.5 14 year age group 1964 1955 99.5 9 0.5 Others 530 524 99.0 6 1.0 Totals 6468 6424 99 3 44 0.7 (b) Uncleanliness.- The following table gives comparative figures for the past two years.- 1959 1958 Total examinations 16073 34641 No of individual children found unclean 108 93 Percentage uncleanliness of average attendance 0.6 0.6 12 (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 - - Impetigo 1 - Other skin diseases 296 107 (d) Visual Defects and External Eye Defects.- The number of patients requiring treatment or observation was as follows:- Treatment Observation Visual Defects 1006 223 Squint 105 25 External Eye Diseases 76 33 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 4967 children tested during the year, 94 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 47 125 Adenoids 6 2 Enlarged Tonsils & adenoids 46 17 Other conditions 106 113 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 727 687 42 34 10-12 year age group 1299 1261 165 165 14 year age group 977 987 136 132 Others 274 256 38 45 Totals 3277 3191 381 376 13 (f) Ear Disease and Defective Hearing -All school medical officers are provided with electric auriscopes and a full examination of the ears is carried out at each medical inspection. The number of patients requiring treatment or observation was as follows Treatment Observation Defective Hearing 19 231 Otitis Media 29 96 Other Ear Disease 21 16 (g) Orthopaedic and Postural Defects - A total of 416 defects were found to require treatment. (h) Dental Defects - Inspection Inspected at Schools Requiring treatment Children actually treated Fillings Extractions General Anaes thetics Other operations 5456 2886 2322 9792 4976 2601 4428 (i) Heart Disease and Rheumatism.- The findings were as follows Treatment Observation Heart Disease - Organic Functional 6 20 1 121 Anaemia 10 - (j) 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 1959 Pulmonary 5 3 - 1 - 6 - 4 Non pulmonary 4 4 - 1 2 1 2 3 Total 9 7 - 2 2 7 2 7 (k) Other Defects and Diseases - The following shows the number of various other defects which were found to require treatment.- Enlarged Glands 5 Bronchitis 84 Speech 63 Nervous system 36 Other defects 225 14 7. FOLLOW - UP The School Nurses paid a total of 671 home visits during 1959. 8. ARRANGEMENTS FOR TREATMENT (a) Chiropody - Mr. R.J King, the Chief Chiropodist reports as follows - The Children s Clinic gave 2,647 treatments to 709 children, making 3 7 visits per child. 2,316 of these treatments were for verruca pedis, 1,441 being given to girls and 875 to boys. New patients amount to 379 140 boys and 239 girls. The footwear of the girls leaves much to be desired in a great many cases as large numbers are wearing casual or slipper type shoes which cannot be fitted the correct length owing to the difficulty of keeping them on thus function and growth are being restricted. Here I feel parents need more guidance, and in some cases should set an example by their own footwear.1" (b) Tonics.- The following shows the quantity of tonics issued during 1959 Parrish's Food Syrup Calcium Lactophosphate Cod Liver Oil and Malt Cod Liver Oil & Malt with Parrish's Food 65½ lbs. 1½ lbs. 34 lbs. 774 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 15  First Ii Boys ispections Girls Re-insj Boys )ections Girls Ringworm - Scalp - - - - Body 1 - 2 Scabies - - - - Impetigo 4 1 10 21 Other Skin Diseases 107 88 267 282 Orthopaedic conditions 88 112 53 30 Tonsils and adenoids 75 74 133 121 Other E.N.T. conditions 34 35 14 27 Defective vision (including squint) 64 64 6 5 External Eye Diseases 38 34 17 17 Nervous and Psychological Disorders 46 26 18 18 Speech 50 28 1 2 Heart and Circulation 33 22 9 9 Respiratory Disease 17 9 14 9 Developmental Defects 47 15 10 9 Various 214 169 405 286 Totals 818 677 958 836 First attendances numbered 1495 against 1623 in 1958. and re attendances 1794 against 1941, the total attendances being 3289 against 3564 The following table shows the new cases and attendances at Minor Ailment Clinics since 1951 The (e) Dental Treatment.- School Dental Clinic.- Mr. G.P.L. Taylor submits the following report; I should like to mention yet again that the lack of a Senior Dental Officer in Walthamstow has seriously handicapped the work of the Department As this situation has continued since December 1956 the effect is now being felt very much, particularly in the administrative side of the work. decrease reflects the tendency for children to be taken to family doctors. 1951 1952 1953 1954 1955 1956 1957 1958 1959 New cases 3106 2990 2397 1782 2017 1565 1570 1622 1495 Attendances 10000 10634 8544 7019 5797 3714 3883 3563 3289 16 "The professional side of the Department also suffers the loss, in the near future, of the full time services of Mr J C.Timmis on his appointment as Assistant Chief Dental Officer at Chelmsford "Consequently there has been a further slight reduction in the amount of dental treatment carried out in Walthamstow, and I feel that the only way the Department can function at its best is under one Senior Officer, as recommended by the Walthamstow Committee for Education during 1957." Orthodontics - The following report has been submitted by Mr R V Tait B. Sc., L.D.S., RC.S., the visiting orthodontist:- Although rather fewer sessions have been worked in the Orthodontic Clinic during 1959, due chiefly to my absence for health reasons there has been no reduction in the number of patients seen However, there has been an appreciably increased number of patients referred to the Orthodontic Clinic, and it has not been possible to deal immediately with all cases requiring advice or treatment It is with regret that I must report that, for the first time for several years, there is now a waiting list of over fifty patients "It also appears that fewer orthodontic cases have been dealt with by the School Dental Officers this year With the increasing incidence of oariesin children it is likely that School Dental Officers will be forced to devote less of their time to orthodontic treatment as they endeavour to deal with dental pain, and it may prove difficult to continue to provide the adequate orthodontic service that has been available in Walthamstow in recent years. The following figures show the work done in 1959: Total number of sessions 117 Appointments - Made 1024 Kept 860 Cases brought forward from 1958 246 Cases completed during 1959 113 Cases for which treatment was completed with appliances 58 Cases discontinued 23 Removable appliances fitted 58 Fixed appliances fitted 4 Cases seen in consultation with School Dental Officers 69 17 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 1959 New cases Under 7 years 7-11 years Over 11 years Total Boys Girls Boys Girls Boys Girls Boys Girls Hypermetropia 10 7 20 14 18 9 48 30 Astigmatism 18 13 46 27 23 24 87 64 Myopia 4 3 39 41 56 53 99 97 Other Eye Defects 32 28 20 19 10 20 62 67 Totals 64 51 125 101 107 106 296 258 Number of children for whom glasses were 1136 prescribed Glasses obtained (a) through the Hospital Service optician 1034 (b) through outside opticians 86 Supply of Spectacles - 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 of cost. It is a service much appreciated by parents who have a completely free choice in the matter. (b) Orthoptic Clinic - The following shows th done at the clinic Number of new cases e work 127 Number of treatments 80 Number referred to hospital for operation 14 Number discharged 46 Total attendances 1591 (c) Ear, Nose and Throat Clinic.- During the year 479 attendances were made at the clinic. 168 being new cases, Hospital treatment was obtained as follows Removal of Tonsils and Adenoids 62 Removal of Tonsils 2 Removal of Adenoids 3 X ray of sinuses, etc. 3 Other treatment 5 18 Audiometric Testing.- During the year 310 children were tested with the pure tone audiometer on referral from medical inspection. (d) Orthopaedic and Physiotherapy Clinic.- This clinic continues under the clinical charge of Mr.G.Rigby Jones, M.C., F.R.C.S., Consultant Orthopaedic Surgeon at Connaught Hospital. Mr. Rigby Jones reports that the clinic continues to work very well under Miss Garratt s guidance. The following tables compiled by Miss Garratt C.S.P Physiotherapist, show the work done at the clinic:- Boys Girls 5-16 Under 16-18 5-16 Under 16-18 yrs. 5 yrs. yrs yrs 5 yrs. yrs. Anterior Poliomyelitis 15 1 1 11 - - Surgical Tuberculosis - - - 1 - - Scoliosis, Kyphosis, Lordosis 83 2 1 116 _ - Genu Valgum 7 2 - 13 3 - Genu Varum - - - - 4 - Pes Valgus and Valgus ankles 47 3 2 25 2 - Cerebral Palsy 9 2 - 13 2 - Schlatters Disease - - - 2 - - Progressive Muscular Atrophy 2 - - 1 - - Osteo Genesis Imperfecta 1 - - - - - Talipes, (a) Equino Var us 8 1 - 6 - 1 (b) Pes Cavus 3 - - 1 - - (c) Metatarsus Varus - 1 - - 3 _ Torticollis 1 - - 1 - - Congenital dislocation of hip 1 1 - 3 - - Hallux Rigidus - - - 3 - - Spina Bifida 2 - - 2 - - Hallux Valgus 2 - - 5 - - Perthes Disease 2 - - 1 - - Digitus Varus 1 - - 5 - - Overlapping toes 2 1 - 1 1 - Hammer toe 2 - 1 4 - - CI aw toes 1 - - 4 - - Arthrogryposis multiplex congenitae 2 - - . - - Slipped epiphysis - - - 1 - - 19 Transverse pyelitis 5-16 yrs. Boys Under 5 yrs. 16-18 yrs. 5-16 yrs. 2 Girls Under 5 yrs 16-18 yrs. Osteomyelitis 1 1 - - - - Taut hamstrings and tendo achilles 11 1 - 15 - - Other congenital defects 11 1 - 3 3 - Miscellaneous (including chest conditions) 84 7 - 57 7 1 Totals 298 24 5 296 25 2 New cases seen by Surgeon- School age 117 Under school age 15 Total 132 Number of cases seen by Surgeon - Prom Physically Defective School 27 From other schools 126 Under school age 48 Over school age 1 Total 502 Total number of examinations made by Surgeon 634 Total number of cases discharged by Surgeon 91 Average number of examinations per session 45.3 Number of treatments given 8 289 Number of attendances for after-care 1.558 Number of sessions held - Treatment 441 Inspection 14 Number of visits by Instrument Maker 50 Operated on in out-patient department 1 Operations performed 33 Children transferred from Connaught Hospital 10 Total number of treatments 10.067 Attendances for Ultra Violet Light Treatment 220 (e) Child Guidance Centre.- The Consultant Psychiatrist, Dr Helen Gillespie, reports as follows Staffing: Dr Gurassa left the clinic in July and was succeeded by Dr. Hoffman who began work in September. There are now eleven Psychiatric sessions a week and we accordingly hope to be able to cope better with the demands made on the clinic. 20 In addition there is now an establishment for nine play therapy sessions. So far only seven of these have been worked, five by Miss Helen Carr and two by Miss F.R. Salzberger, who joined the clinic staff in August in place of Miss P. Low Beer, who left in October. We hope to find a suitable play therapist in the near future to take on the remaining sessions. General Comments: Comparison of the figures for 1959 with those for 1958 show few significant changes. There have, however, been a considerable increase in the number of treatment interviews, both by the psychiatrists and the play therapists, in the Leyton and Forest areas. This can be attributed to fuller staffing, and is a matter for satisfaction. The number of cases referred and diagnosed at the clinic remains much the same as last year. In the Forest area there has been a slight fall in the number of cases referred (from 82 to 71) probably owing to the opening of the Harlow Clinic, but this does not seem to have made any marked difference to the pressure on our own clinic. Referral of pre-school children. I would again like to stress the need for early reference to the clinic of pre school children Activities of the Staff outside the Clinic: Discussion groups for Health Visitors were started in October by our Psychiatric Social Workers, Miss Lacquer and Miss Court, and are held fortnightly at this clinic for Health Visitors in the Leyton area. These promise to be of value for the promotion of mental health in a wider area than that covered by our direct clinical activities. In these groups the Health Visitors discuss problems they meet in their work at the Maternity and Child Welfare Clinics and in their visiting areas. Other groups were also started in December for the Medical Staff and Health Visitors attached to the Infant and Maternity Welfare Services in Walthamstow, and are held by Dr Gillespie and Dr. Hoffman fortnightly. Children showing difficulties in their development which present problems to their mothers are discussed from the point of view of causation and 21 better methods of handling" by the Maternity and Infant Welfare Staff. There has also been a widening of areas of co ■ operation between the clinic and the Probation Officers and their clients during the past year, and we are gratified by this development." The following tables show the work of the clinic during the year. Figures for Walthamstow cases only are shown: TABLE 1 Analysis of Figures for 1959. Number of cases referred to the clinic 82 Number of cases diagnosed at the clinic 67 (a) Psychiatrists- Diagnostic interviews 67 Cases taken on for observation and/or treatment 38 Treatment interviews 237 Other interviews 1 Total number of psychiatric sessions (including Chingford cases) 194 (b) Psychologists Clinic cases tested 53 Cases given remedial education 14 Treatment interviews (remedial education) 173 School visits on behalf of clinic cases 20 Other interviews at clinic 15 Other interviews outside clinic 12 (c) School Psychological Service- Individual cases seen 312 Number referred to clinic 10 (d) Play Therapists- Cases treated 15 Treatment interviews 185 (e) Psychiatric Social Workers- Interviews at Clinic 518 Interviews elsewhere 12 22 TABLE IV Analysis of Cases Closed during 1959 1. Improved and recovered after treatment 25 2. Improved after partial service, i.e. before diagnosis 4 3. Diagnosis and advice only 12 4. Interrupted, e.g. on parent's or adolescent patient's initiative 19 5. Closed for miscellaneous causes (removal from area, placement at ESN School, etc.) 12 6. Spontaneous improvement 6 78 TABLES II and III Analysis of Problems referred and Cases Diagnosed Referred Diagnosed 1. Nervous disorders, e. g. fears, depressions, apathy, excitability ... 18 26 2. Habit disorders and physical symptoms, e.g. enuresis, speech disorders, sleep disturbances, tics, fits, etc. 19 7 3. Behaviour disorders, e.g. unmanageable, tempers, stealing, lying, sex problems, etc. ... ... 42 22 4. Educational, e.g. backwardness, failure to concentrate 3 7 5. No basic disturbance of child, i.e. mainly parental overanxiety 82 5 67 (f) Waiting list- Cases for diagnosis (by doctors) 29 Waiting treatment - (g) Total cases treated during the year 119 23 The following extracts are taken from the Annual Report of the Borough Education Officer to the Committee for Education:- Work of Educational Psychologist During the year 312 children have been seen by the pyschologist, and given individual intelligence tests, generally at the request of Head Teachers, or the School Medical Officer. The range of intelligence followed the normal pattern. With the establishment of special classes, a third one being set up in September, much more help has been available to children of dull intelligence who need a slower pace, and more individual help than is possible in normal classes.- As circum stances permit more such special classes could well be established. During the year the Pyschologist made 126 visits to schools, distributed as follows Type of School Number of Visits Infant 24 Junior 58 Special Schools ... 35 Secondary Schools 9 Home and hospital visits were also made. Fourteen parents were given advice on educational problems of their children. Fourteen children have attended the Child Guidance Clinic regularly for remedial education, 173 sessions being used during the year. In the Spring term the psychologist attended a course on the Psychological Testing of Deaf Children which was both interesting and useful. For the third year the pyschologist lectured on Adolescents to a Home Office refresher course for House parents. (f) Paediatric Clinic.- The clinic was continued under the clinical care of Dr. Elchon Hinden Paediatrician to Whipps Cross Hospital who reports as follows:- The work at the Walthamstow Clinic has proceeded along the same lines as heretofore. The number of 24 children referred by the Assistant School Health Officers has remained at about the same level. One of the biggest changes which has taken place in infant feeding within recent years is the virtual abandonment of breast feeding. In the majority of cases, natural feeding has stopped by the first month: a few babies continue till three months are over, but it is a rarity to find a mother who goes on after that. And this, in spite of many women's sincere desire to nurse their babies themselves. The phenomenon has occurred over the whole of Western Europe and the U.S.A : it is only in the backward peasant countries of the world that breast-feeding is carried on as nature meant it to be, till the baby is able to deal with solid food. The causes of the break down of this physiological function have so far defied analysis: it remains unique, and the failure defies all attempts to put it right. Doctors are helpless when the breast runs dry. The trouble seems to lie deep in our present culture, and by the time it shows itself in failing lactation, it is long past cure. One speculation, which has as good a chance as any other of being right, starts with the observation that it is no longer thought decent to breast-feed a baby in public. Before the first world war, it was commonplace to see a woman nursing her baby in a train, in a park, even on her own doorstep. It followed that young girls grew up familiar with the act, and took it in their stride when they became mothers themselves Nowadays, breast feeding in public offends modesty and children in their impressionable days do not see it, except when (rarely) they belong to large families. It has no part in their memories; and when they play 'mothers and fathers , breast feeding does not enter. By the time they marry, their breasts have undergone a spiritual disuse atrophy. The majority of babies, then, have to be reared on other milk, administered from a man-made utensil; and it is a piece of great good fortune for the human race that technology showed us how to fashion a rubber teat just as the natural nipple fell into disfavour. Practically the only milk used in infant feeding in this country is cows' milk; and in the end it is cows' milk which is reconstituted from most of the tins of baby food (this statement does not apply to the minority of 25 infant foods which have been modified to resemble human milk). We can see then, how pointless it is to try to put right a feeding problem by changing the brand of milk they differ from each other as little as the milk from one good dairy differs from the next, and less than the milk of one mother differs from that of her neighbour. When an artificially fed baby is not thriving, it is proper to review the whole of the regime, remembering that the brand on the can is the least important of all the factors. I am grateful to my colleagues in the public health service for sending the children to me, and to the family doctors who consented to the referral. doctors wno consented to the referral. I should also like to thank Dr. P. Tettmar, radiologist, and Dr. W.W Walther. pathologist, at Whipps Cross Hospital for making me free of their services." Over 5 years Under 5 years New cases 66 13 Total attendances 127 39 Physical Defects: Number of cases 116 39 Referred to Hospital 14 4 Discharged 31 5 Psychological Disorders : Enuresis 8 - Other 3 - Referred to Hospital 3 - Discharged 2 - (g) Speech Therapy.- Treatment centres are provided at the Old Education Offices at High Street and at the Wingfield House School. The arrangements for previous years have continued in regard to the selection and reference of children for speech therapy. Mrs. C.S. Yorks, L.C.S.T., reports as follows "Figures show that numbers in the clinic have remained fairly stable, and fortunately there is seldom any delay in commencing treatment, although occasionally children who have to be brought by school bus must await a place in a suitable group. These children who attend in groups generally require a longer period of treatment 26 as they do not receive so much individual attention and their parent's help and co operation cannot be obtained in the same degree. This does however affect only a very small minority. Most children referred to the clinic are originally interviewed in school, and this year 130 children have been seen. 51 of this number were recommended for treatment. 36 are to be kept under observation in school and the remainder were found to have no speech defect. The clinic is now equipped for sand and water play. both of which are proving very valuable in encouraging the younger children to express themselves more freely " Dr. A A Eisenstadt, A.M., PhD , reports:- "The clear delineation of clinic procedure, and the generous assistance of Mrs. Yorks and other colleagues made the temporary change of therapists at mid year a fairly smooth and efficient one. During the summer months when school was closed, new referrals, parent interviews, and earlier cases were handled. There has been a decrease in the number of defaulters. This would suggest a growing realization of the importance of good speech on the part of children and parents. Nevertheless, as in earlier years the greater part of the clinic case load has come from school referrals. A slight increase in the number of cases readmitted can be noted. This is partly due to temporary withdrawal by certain children from the programme. It may also suggest the advisability of a somewhat longer period of clinic therapy to reinforce the assimilation of new speech habits. On the whole, the rate of turnover and the number discharged as cured reflect a gratifying responsiveness to direct therapy and parental counselling." Annual Report and Clinical Analysis High Street Clinic Open Air School Clinic Number in attendance at beginning of year 71 57 Number under observation at beginning of year 26 28 New cases 58 64 Transfers from other clinics (a) Within County 4 3 (b) Outside County . 2 Number of cases readmitted 1 7 Total new entry 63 76 27 High Street Clinic Open Air School Clinic Cases discharged - (a) Cured 33 48 (b) Improved 6 8 (c) Defaulted 9 5 (d) Left District 4 3 (e) Transferred to other clinics 7 2 (f) No profress 1 2 (g) Left school 1 _ Cases in attendance at end of year 65 67 Cases under observation at end of year 36 22 Total attendances during year 2, 020 2, 204 Analysis of Defects of Children attending Clinic and under observation during year:- Stammering and Cluttering 39 11 Dyslalia 110 80 Stammering and dyslalia 3 16 Delayed language development 3 11 Cleft palate speech 1 1 Voice defects 5 3 Speech defects of neurological origin 1 12 Probable mental deficiency 1 8 (h) Convalescent Home Treatment.- Fifty-one children were sent away for convalescence during 1959. There were three children remaining in convalescent homes and hospital schools on December 31st, 1959. (i) Tuberculosis.- The number of school children examined for the first time at the Chest Clinic during 1959 is shown in the following figures supplied by the Chest Physician, Boys Girls Referred by School Medical Officers 6 5 Referred by private practitioners 76 73 Examined as contacts 24 22 28 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 1959, the total of such examinations was 103. 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) 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 exclusively during 1959, and with complete success All secondary schools have been visited during the year and of the 2.882 children invited 1,382 accepted giving an acceptance rate of 47 9 per cent. 1959 1958 1957 1956 Number of Heaf positive 99 131 165 176 Percentage positive 7.8 11.6 13.8 14.2 Number of Heaf negative 1, 168 995 1,026 1,064 Number absent 115 92 55 28 B. C. G. given 1, 168 995 1,026 1,053 Absent or not done 1 _ _ 11 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 29 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. 933 conversion tests were carried out on children who were given B.C.G. in 1959. Twenty five gave a negative result to the test but all showed a good vaccination scar. 10. INFECTIOUS DISEASES Notifications from general practitioners of infectious diseases in the 5-14 year age group were as follows:- 1959 1958 Measles 617 269 Whooping Cough 46 29 Scarlet Fever 226 75 Pneumonia ... 5 5 Dysentery ... 110 167 Tuberculosis 7 2 Food Poisoning 7 7 Poliomyelitis 3 1 Meningococcal Infection _ _- 1,021 555 School Outbreaks (i) Suspected Food Poisoning at Forest School, Whipps Cross - Thirty-three boarders reported sick. All suffered from nausea and/or vomiting; thirteen had diarrhoea and eight had pyrexia (Highest 100.6°F.) In addition a number of boys were away, their parents having reported they were suffering from diarrhoea and sickness. One master had complained of nausea. Food poisoning was not confirmed. (ii) Dysentery.- During the three weeks ended 7th February 1959 eleven children attending Chapel End Infants School and fourteen from Greenleaf Infants School were notified as suffering from dysentery. Odd cases 30 were notified from various other schools, but in no case did the disease reach any alarming proportions. (iii) Scarlet Fever,-Seven cases of Scarlet Fever were notified in children attending Selwyn Avenue Infants School during the period 28th September 1959 and 9th October 1959. Although several others suffered from sore throat no further cases occurred. 11. IMMUNISATION (a) Against Diphtheria,- 134 primary immunisations were completed in children of school age and 589 •booster" doses were given in school immunising sessions (b) Against Whooping Cough.- Seven children over five years were immunised against whooping cough during 1959 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 727 316 43.4 Girls 687 300 43.7 10-12 year Age Group Boys 1, 299 465 35.8 Girls 1, 261 485 38.4 14 year Age Group Boys 979 370 37.7 Girls 987 413 41.8 Others Boys 274 119 43.4 Girls 256 131 51. 1 6,470 2, 599 40. 1 The percentage in 1958 was 44.0 The total vaccinations done during the whole year for children in the 5-14 years age group was thirty five primary vaccinations and thirty-eight secondary vaccinations. (d) Vaccination against Poliomyelitis - During 1959 3774children between five and fourteen years of age were vaccinated and 7994 received 3rd (booster) doses. 31 12. OPEN AIR BOARDING SCHOOL EDUCATION 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. 14. PROVISION OF MEALS School Meals Service The number of children having dinner at school during the past year has continued at approximately 8 000 daily. Pour new kitchens have been completed and brought into use at the schools enabling dinners to be cooked and served on the premises. A corresponding reduction has been made in the number of transported meals. The "Family Service" whereby the food is put into dishes for eight children and served by the children at their own tables has been introduced in these schools and has proved satisfactory. It is hoped that as the number of individual kitchens increases this service may be brought into use in more schools. Inspection,- Mr. W. Richards, Chief Public Health Inspector reports as follows: " I have to report that during 1959 the following inspections were carried out: Schools ... 112 School Kitchens ... 75 Various types of defects were found as a result of these inspections and those of a minor characte r were reported direct to the Education Architect to be remedied as soon as possible. Major defects found included insufficient sanitary accommodation and washing accommodation. These were reported through the School Medical Officer to the Borough Education Officer. 32 Unsatisfactory conditions mainly in respect of food handling and equipment were found in the school kitchens. Advice and instructions were given to staff in respect of these matters. Milk in Schools Scheme,-Ten samples of pasteurised milk for bacteriological examination were taken under the above scheme during 1959, one of which failed the Phosphatase Test." 15, CO-OPERATION (a) Co-operation of Parents.- The following table shows the attendance of parents during 1959 at tne periodic medical inspections Number inspected No. of Parents Per cent. 1959 Per cent. 1958 Entrants Boys 727 650 89.4 94.4 Girls 687 635 92.4 94.2 10-12 year Age Group Boys 1,299 1,017 78.2 82.7 Girls 1,261 1,067 84.6 84.9 14 year Age Group Boys 979 139 14. 2 13.4 Girls 987 233 23.6 30.0 Others Boys 274 164 59.8 73.1 Girls 256 171 66.8 78.2 The importance of parental attendance at medical inspections cannot be over-stressed. It is regrettable but understandable, that the percentage should decrease with the increasing age of the child, 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. (b) Co-operation of Teachers, - Renewed and grateful acknowledgement for the cooperation of Head Teachers and their staffs must be made. Generous help and co-operation has invariably been experienced, especially in the use of their private and staff rooms for medical inspection - often at great inconvenience. (c) Co-operation of School Enquiry Officers - The Senior School Enquiry Officer and his staff have again co-operated most effectively with the work of the School Health Service. 33 (d) National Society for the Prevention of Cruelty to Children,- The following is a summary of the work done during 1959: - Nature of Offence How dealt with Neglect 18 Warned or Advised 43 Ill-treatment 8 Moral Danger 2 In Juvenile Court 1 Advice Sought 17 Dropped 1 45 45 Number of children dealt with: Boys Girls 51 61 (42 under 5 years of age) 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 1 (c) Deaf 1 (d) Partially Deaf 1 (e) Educationally Sub normal 49 (f) Epileptic 2 (g) Maladjusted 5 (h) Physically Handicapped 11 (i) Speech _ (j) Delicate 10 Five children were known to be suffering from diabetes and all were at ordinary schools. The number of pupils attending the Special Schools from various districts was as follows:- Partially Sighted Deaf Open Air School Educationally Subnormal Walthamstow 9 8 42 104 Forest 6 15 23 3 South Essex 6 2 _ _ Barking _ 2 _ _ Dagenham 4 - _ _ Ilford 1 12 _ _ Leyton 1 4 7 _ Romford 6 7 _ 1 Middlesex 9 1 _ _ Herts _ 1 _ _ Forest Gate _ 1 1 _ Totals 42 53 73 108 34 In addition forty-two Walthamstow children are at present accommodated in residential special schools as shown below, and three physically handicapped children are receiving home tuition. Blind 4 Deaf 1 Delicate 7 Educationally Sub-normal.. 7 Epileptic 4 Maladjusted 14 Physically Handicapped 4 Speech 1 Special Schools. (a) School for the Deaf. - Mr. K. S. Pegg, Headmaster of the Williajn Morris School for the Deaf, reports as follows:- "The school re-opened in January, 1959, with fiftytwo children on roll. During the year ten children were admitted and nine left. The school leavers are divided as follows: Employment Further training Transferred to other schools. 1 boy employed as a surgical cabinet maker: 1 girl for training as a comptometer operator. (Training now complete and girl employed). 1 girl to E.S.N, school. 1 boy full apprentice ship in the printing industry. 1 boy returned to previous school. 2 girls working as machinists in a clothing factory (1 training in the evenings as a copy typist.) 1 girl for training as a copy typist. (Has since returned to this school). 1 girl returned to previous school in U.S.A. The roll at the end of the year was as follows:- Class Grade Age Range No. on rol 1 CONGENITAL ACQUIRED Aetiology Unknown Heredi tary Kerniterus Unspec■ i tied Post Men Other M. F. 1 Mixed 3-7 4 3 1 1 2 - - 3 2 Mixed 7-10 4 5 - 1 4 - 1 measle s 3 3 P.D. 8-12 6 4 2 - 2 1 1 flu 1 measle 4 Deaf 9-12 2 4 1 _ 3 1 _ 1 5 Deaf 12-16½ 7 3 _ 1 3 4 1 T.B. otitis media 1 6 P.D. 12-15 7 4 1 - 2 4 2 measles 2 Totals 3-16½ 50 23 5 3 16 10 6 13 35 Catchment Area.- Barking 2 Harlow 3 Purfleet 1 Barkingside 1 Hornchurch 1 Romford 7 Chadwell Heath 3 Hutton 1 S. Woodford 1 Cheshunt 1 Ilford 7 Waltham Abbey 1 Chigwell 1 Leyton 5 Walthamstow 8 Edmonton 1 Loughton 4 Wanstead 1 Nazeing 1 Woodford Bridge 3 A number of hearing aids have been supplied to children attending normal schools and several children have attended once or twice a week for auditory training and practice in 1 ip-reading. During the year every child attending this school was issued with an 0.L.57 hearing aid (these are MEDRESCO aids incorporating an induction loop receiver) but unfortunately they have proved to be extremely fragile, and spares and replacements have been in very short supply. Whilst as far as possible minor repairs, the issue of batteries, leads etc. are carried out at school, major repairs are carried out at the Hearing Aid Distribution Centre. Because of breakages a large number of children have had their original aids replaced by the O.L.56 model (without induction loop), and a few children are having to wear the bulky O.L.35 aid during the period in which their own transistor aids are being repaired. Three hundred and ten children attended the school for Pure Tone Audiometric Tests and a number for Speech Audiometry. The pure tone tests are very ably conducted by Mrs. Leach, S. R. N. The construction of an acoustically treated room is now complete, and this additional space is of great assist ance for testing and training. In the early part of the year the Western Electric Group Aid was re-sited, and can now be used more conveniently. A full medical inspection was carried out by Dr. Werren on the 16th, 17th and 18th February and in November Mr. Taylor conducted a dental inspection. Miss Smith, Educational Psychologist visited the school several times for the purpose of examination. A total of one hundred and forty seven minor treatments have been given by the nursing staff. 36 During the year we have received visits from Dr. Powell, Dr. Poole, Dr. Whitmore, Mr. Cajumock, Dr. Richards, Dr. Jones, parties of Health Visitors, District Nurses, Miss Smith and Miss Watt, Speech Therapists, The Secretary of the National Deaf Childrens Society, students from training colleges, Miss Wyld, Mrs. Glasscoe, Mrs. Amey, Mrs. Nockles, Miss Wing, Miss Berks, Miss Scott and Miss Bickersteth". (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 remained steady at the 110 mark throughout the year. Placement of school leavers has been most satisfactory, three boys having been admitted to apprenticeships in the metal trade. This is unusually good, as there is always a danger that E.S.N, boys may of their own volition choose dead end jobs. Several students from the London University E. S. N. Diploma Course visited during the year. One was with us for eight weeks final school practice. He gained his Diploma. Twelve students from Clacton Training College paid us a visit in May. We were fortunate in having two dental inspections this year, and one full Medical Inspection. I appreciate the new arrangement whereby we receive periodical visits from a school doctor specifically appointed to hold a watching brief on the school. We have been served well by Dr. Dooley, and also by the school nurse who visits regularly. I offer the medical department my very grateful thanks for this co operation. Our new master was appointed at Easter. Many school visits have been made during the year e.g. to the Zoo, Southend-on Sea and to the Cutty Sark. Pull use has been made of Epping Forest for nature study purposes. The Borough Psychologist has paid many visits to the school during the year. 37 My grateful thanks are offered to my staff for their very loyal and devoted service at all times. (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 44 - with yet another extension of the catchment area to include Basildon New Town. As in previous years the pattern of ophthalmic care and clinical supervision has been well maintained. Dr.I Gregory, M, B..D. 0. M. S. made visits in May and November, for the purpose of examination, seeing all new admissions, all leavers or transfers, and gave much helpful guidance on special problems, notably on the recommendation for provision of low visual acuity aids. Dr. Ho and the Eye Clinic Staff have made regular ophthalmic examinations, and Mrs. Suckling has given a very 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.- 2 children had acuity less than 6/60 5 " of 6/60 14 of 6/36 8 of 6/24 13 of6/18 There were 21 children with monocular vision, and 1 child with defective vision and severe speech defect, 1 child with defective vision and physical handicap, 5 children with defective vision and poor intellectual capacity. In November Mr. Taylor made a full dental inspection of all the children and eight subsequent treatments were given. Dr. Werren medically examined all children in the school during the month of July, 2 children being referred for postural correction. The hearing of all new admissions are tested on the pure tone audiometer by Mrs. Leach of the School Nursing Service. Heads, hands and feet are examined each term by Mrs. Crisp, S.R.N. During the year 3 children were receiving Speech Therapy. Visitors to the School during the year included Student Paediatricians, Training College Students District Nurses and Student Health Visitors from Essex and Middlesex. 38 Following the successful venture of last year a party of 12 children under the care of Mr. Crosbie spent a week in the Isle of Wight in company with the Woodside School Camp Party. Much benefit was obtained from the very valuable contacts made between normal and handicapped children. Due acknowledgement must be made to the Woodside School who so generously allowed us this privilege. At the end of October Miss Hardy who has been both Junior and Infant Mistress, and who has rendered sterling service to the school, left us to take up a teaching post in the Middle East. Her place has been taken by Miss Kiel. A new venture during the year was the participation of the school in the London Partially Sighted Schools Sports at North House, Wimbledon. 3 Certificates were won by the school. 1 Senior boy was successful in obtaining certificates at Royal School of Arts summer examinations in English, and certificates in English, Handwriting, and Distinction in Arithmetic at the London Chamber of Commerce Spring Examinations. There are now 8 Senior children who travel to school independently by public transport, 4 of these making journeys involving change of buses and trains. On several foggy days they arrived even when school buses were cancel led. The average number on roll during the year was 44.84 with an average attendance of 39. 2. During the year 9 children were admitted and 11 were taken off roll as follows:- 2 (Visual Acuity 6/12 6/9) were transferred to normal schools 2 (Visual Acuity 6/12 6/18) " " E S.N school 2 children " Residential P S S 3 children left the area. 1 child was transferred to Speech Defect School 1 boy left to employment having gained a pre-apprenticeship year with an Electronic Engineering Firm I have to express my thanks to all my colleagues, teaching, Welfare, transport for their continuing efforts on behalf of the children. 39 The following table shows the principal ophthalmic defects of the children on the school roll:- Boys Girls Boys Girls Albinism 2 4 Ectopia Lentis _ 2 Anisometropia 1 Microphthalmus _ 1 Cataract 9 3 Myopia 4 3 Cerebral Defect 1 Nystagmus 2 1 Choroi - 1 Optic atrophy 3 1 Coloboma 1 1 Retinal Defects 2 - (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 number of children on roll reached the unusually low figure of seventy three, since it had been found possible to discharge thirty five children, of which twenty six transferred to other schools. As before, in many cases physical handicap is often allied with dull or poor intellectual capacity and sixteen children on roll have intelligence quotients in the 60-80 range. Thirteen children have had regular speech therapy during the year and twenty six attended the physiotherapy clinic. There were seven non-ambulant children on roll. During the summer holiday period the school was kept open on a voluntary basis. Thirty one children attended and made a 77.8% attendance. Visits were arranged to Shoeburyness, Whipsnade and the Forest. Visitors to the school included post graduate Medical Students from Whipps Cross Hospital, Student Teacher and a visiting teacher from Rhodesia. The school premises and facilities were granted to the Kingsley Physically Handicapped School for a day visit to London in the Summer Term. The school also offered facilities to the Walthamstow Care Committee of the Essex I.C. A. A. which met on two occasions during the year. The school enjoyed the valued co-operation of Miss Garratt of the Orthopaedic Clinic, and of Miss Rasor of the Speech Clinic. In the Summer holiday Miss Rasor went to the U.S.A., and in her place we welcomed Dr. Eisenstadt. an American Spegch Therapist, who has proved a most agreeable colleague. Miss Smith, the educational psychologist 40 made four visits for the purpose of examination and advice, and Mr. Harvey, the Youth Employment Officer, made two visits to interview all leavers. On one occasion the Disabled Resettlement Officer from the Ministry of Labour accompanied the Youth Employment Officer. Dr. Poole has made regular weekly visits and his ready help has at all times been available for children, parents and staff alike. This has been much appreciated. The Officers Care Committee to consider placement of school lsavers in employment met on ©ne occasion when the area Social Welfare Officer was present. Mr. Taylor of the School Dental Service attended the school in November and held a full dental inspection. Mrs. Leach, S. R. N., school nurse, has attended daily, and has assisted in the general care and management of the children, and has made home visits in selected cases. A total of 906 minor treatments have been given. At the Autumn Examinations of the Royal Society of Arts one girl was successful in obtaining certificates in English and Arithmetic. The children on roll at the end of the year were classified as follows Delicate (Category j ) 23 Physically Handicapped (Category h') 48 Epileptic (Category 'f') 2 During the year thirty five children left the school, thirteen being transferred to ordinary schools, four to employment, seven to residential schools, five to E.S.N, schools, one to residential training, one to the Spastic Unit, one having home tuition, and one unemployable, also two having left the district. The average number on roll was 79, with an average attendance of 62. 2" The table below shows the analysis of principal defects of children at the school during December, 1959: 41 Boys Girls Boys Girls Asthma 8 6 Neurological Bladder 1 Bronchiectasis 2 Chorea 1 1 Bronchitis 3 Arthrogryposis 2 _ Heart Conditions 3 3 Perthes Disease 1 _ Poliomyelitis .. 2 Congenital Malform ation of Limbs 1 Traumatic Paralysis _ 1 Cretin 1 Fragilitas Ossium 1 Kidney Disease 2 T. B. Bone 1 Epilepsy 1 1 Haemophiliacs 3 Muscular Cerebral Palsy 3 10 Dystrophy 2 Others 13 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: - From the health point of view the past year has been one of the worst I have known. A measles epidemic from January until the end of March produced a total of thirty four cases more than twice the number we had in 1957. Attendance improved during the summer, but there were six cases of scarlet fever, and several children were away with sore throats and colds. The glorious summer was enjoyed by all of us, and the children were out of doors most of the day. But it was disappointing to return in September to three months of low attendance, due to coughs, colds and "flu. We did not have a full school until the beginning of December.' 19 MISCELLANEOUS (a) Pre Nursing Courses. (i) Walthamstow High School. Miss M. M. Burnett, M. A. states that no pre nursing course was held during 1959. (ii) Woodford County High School. Miss K. M. H. Chapman, M. A. . states as follows We have ceased to have a pre nursing course, as all our girls who are interested in this take the Ordinary 42 Level Human Anatomy. Fifteen girls took this examination last year, and of our leavers one left to do dentristry, seven to follow nursing as a career, two to do radiography, three to do physiotherapy, one for chiropody and one for optics. (iii) William Morris County Technical School.-Mr. H.P. Williamson, M. Sc, (Educ.), B. Sc., reports as follows:- "Our pupils continue to work on the Syllabus of the University of Cambridge Local Examinations in the subject Human Biology', based on General Science and supported by other G. C. E. subj ects to provide a good general education. Twelve girls were successful in the 1959 G.C.E. "Human Biology" Examination. Any of these girls who enter Nurse Training will be exempt from the Pre Nursing Part 1 Examination. During the year the Group visited the National Dairy Show at Olympia, the Metropolitan Water Purification Works at Green Lanes, Stoke Newington, and the Rainham Sewage Disposal Works, with T. T. Attested Herd. For the second year running, a pupil of the Group was awarded 1st Place for the best Essay in Group 6 on The National Dairy Show. Miss White, Assistant Nursing Officer to the North East Metropolitan Regional Hospital Board, visited the school in December and described present day Nurse Training to the girls, illustrating her talk with coloured lantern slides. During 1959, the following pupils or ex pupils started nursing or allied work. Royal Free Hospital London Student Nurses (2) London Hospital Convalescent Home Pre Student Nurse (1) Guy s Hospital, London Preliminary Work in Staff Home with Acceptance for Student Nurse Training (1) Handsworth Avenue Day Nursery E. 4. Student Nurse (1) I am pleased to record that one ex pupil, who qualif ied as S.R.N, at Hertford County Hospital during the year, was Bronze Medallist in her year." (b) Employment of Children.- 256 children were examined by the medical staff. 43 (c) Employment of Children in Public Entertainment.- Six children were examined under these Regulations. Staff Appointments.- 87 teaching staff and 355 other staff were medically examined during the year. Medical Examination of Prospective Teachers.-Forty three 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. Good Grooming Lectures. Lectures in ' Good Grooming' were given to girls in Secondary Schools during their last term at school. 20. STATISTICAL SUMMARY I. Medical Inspection. A. Routine Inspections 6,468 B. Special Inspections and Re inspections. 3,733 C. Pupils found to require treatment 2,154 II. Defects found at Routine Medical Inspection. Requiring treatment 2,520 For observation 2 511 Physical Condition of Pupils seen at Medical Inspection. Satisfactory 6,424 Unsatisfactory 44 III. Infestation with Vermin. Total number of examinations 16,073 Individual pupils found to be infested 108 IV. Treatment. (aj Minor Ailments. Total defects treated 1,495 (b) De feet ive Vision and Squint. Cases treated for errors of refraction. 2.697 Other defects 2 Pupils for whom spectacles - prescribed 1,156 obtained 1,016 Orthoptic Clinic cases treated 387 (c) Nose and Throat Defects. New cases 168 Total attendances 479 44 (d) Orthopaedic and Postura 1.Defects. Cases treated 510 (e) Child Guidance. Distribution of treatment or supervision(i) Psychiatrist; Diagnostic interviews 67 Treatment interviews 237 Other interviews 1 (ii) Psychotherapist: Treatment interviews 185 (iii) Psychiatric Social Worker: Number of interviews 530 (iv) Educational Psychologist: Individual cases seen 312 (f) Speech Therapy New cases treated 139 (&) Dental Inspection and Treatment. Periodic Special Number of pupils inspected 5 456 2, 176 Pound to require treatment 2,886 2 139 Number offered treatment 2 313 2 136 Number actually treated 2 322 1 137 Attendances made for treatment 10 490 2 693 Half days devoted to Inspection 48 Treatment 2,332 Fillings permanent teeth 8.039 temporary teeth 1,753 Extractions permanent teeth 1,271 temporary teeth 3. 705 Anaesthetics local 1 015 general 2 601 Orthodontics Treated with appliances 414 Removable appliances fitted 102 Fixed appliances fitted 4 Total attendances 1 624 Artificial dentures fitted 41 Other operations permanent teeth 3 840 temporary teeth 588