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chief groups. The table of physical defects in 2,141 crippled and invalid children shews the proportions in
which the various diseases exist in our school population. The reason for the retention of the majority
of these children in such centres is evident. A child with tuberculous disease of the hip, with severe
paralysis or with a heart lesion is not fit either to walk any considerable distance to school, or to mix
with healthy children. Unless he is educated at a special centre he will probably not be educated at
all. Certain of these cases might be dealt with more fully than was possible in previous reports.
Spastic paralysis.—Twenty per cent. of these cases are also mentally defective. Owing, however,
to the difficulty of getting them to and from school it is impossible to send them to special schools for
the mentally defective. The majority of these children will repay education, and it should be clearly
understood that the existence of paralysis due to a brain lesion is not inconsistent with a high mental
ability. One boy with hemiplegia had not only reached the sixth standard in his ordinary work at 16,
but was also able to do excellent designing with his left hand, his right being useless.
Progressive paralysis.—Ten of these children (nine boys and one girl) were cases of pseudohypertrophic
muscular atrophy. It has been necessary to exclude three of these during the past year owing
to the steady progress of the disease having extended to a complete loss of the power of walking. When
once the diagnosis is fully established there is no public benefit to be obtained from the education of
these children, although no doubt for a time they are interested and their burden lightened by school
and its events. The remaining cases were of Friedreich's Ataxia, one of the peroneal type of muscular
atrophy, and one of doubtful nature.
Congenital syphilis.—This widespread and destructive disease is fortunately only represented
by extremely small numbers in these special schools. The bone lesions due to congenital disease do not
show up before 11 or 12, and are rare and progress slowly, so that they do not interfere much with school
life. It is in respect to other organs like the eye, ear, and brain that damage is marked educationally.
Chorea.—Recurring attacks of chorea are responsible for serious loss of attendance. Children
affected in this way are better for a year or two at an invalid school where they are kept quieter and
are under more strict observation. It is found by experience that children who have suffered from
repeated attacks whilst at the ordinary school can attend an invalid school regularly and remain apparently
quite well.
Phthisis.—The number of cases is extremely small, and in several the vague history and absence
of physical signs make the actual diagnosis very doubtful. Those children who have actual signs or
expectoration have to be excluded, but the numbers thus excluded are small. The cry of abundant
phthisis in our elementary schools has no foundation in facts.
Mentally defective.—The six mentally defective children were all admitted for observation, and
eventually transferred to a centre for mentally defectives. There are, however, many children showing
some mental defects in addition to their physical defects. In them the difficulty of transport
necessitates their retention as physically defective.
Children with trivial dejects.—These include convalescents from acute illnesses and operations,
delicate, weakly anaemic children, in whom no defined disease is diagnosed ; nervous children, children
in whom chronic ill health is also the cause of backwardness and great irregularity of attendance.
Many of these are admitted for observation only. Owing to the small classes, the presence of the school
nurse and the frequent attendance of a medical officer, it is soon possible to place each child and ascribe
its backwardness or irregularity to the proper cause. The majority of such cases only remain about a
year and then return to the ordinary school. The delicate, anaemic and nervous children often improve
ereatlv whilst attending the invalid school.