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157
Report of the Medical Officer (Education).
The congenital causes could probably be lessened in number by the application of eugenic
principles, the most immediate of which would be the withdrawal of all support from adult " deaf and
dumb " institutions, which, as Professor Graham Bell has suggested, are tending to develop a deaf mute
variety of the human race.
Of the other causes it is reasonable to suggest that all the cases of suppuration or middle ear catarrh
due to adenoids, and half the cases of deafness due to scarlatina or measles could be prevented by prompt
employment of preventative measures. This would give a saving of cases of the following nature :—
Suppuration due to adenoids 51
Middle ear catarrh due to adenoids 40
Half the scarlatinal cases 20
Half the measles cases 36
147
It may be fairly estimated that these 147 cases out of the 454 acquired, one-third of the cases, or
32.4 per cent., could have been prevented.
Epilepsy.
The need for provision tor the education and care of epileptic children has been referred to
annually since the first of these reports. The absence of this provision is a great gap in the educational
system of London. The requirement is not great in bulk, but where it exists is intense, and can only
be satisfactorily met by a residential institution. The family of an epileptic suffers severely, although,
fortunately, the numbers of such families are not very great. Now the foreshadowing of legislative
changes makes any authority hesitate before committing itself to the large capital expenditure needed
to satisfy the requirements of this problem. Meanwhile tentative arrangements have been made for
some cases to be taken at Chalfont and Lingfield.
In view of the fact that 300 children in London are not receiving education on account of epilepsy
a suggestion for a small home for the worst cases has been considered during the past year. In considering
the establishment of such an institution it has to be remembered that epileptics show wide
variations in the degree of their affection and in their mental condition. Some have a fit only at
intervals of several months, while others may have many fits in the course of a single day. Some are
highly intelligent and attain to a good standard of scholarship, while others are of the most vegetative
type of imbecility. Some are placid, others violent, insane it may be for short periods, measured in
minutes, or longer periods, days, months, or even years. An individual of any one type may, with
apparent suddenness, change to another. As a consequence classification has always been a matter of
difficulty, and on the Continent it has been found advantageous to establish large colonies in which
there is provision for farm colonies and workshops for those able to labour, schools of various grades,
homes for the more defective, places of restraint, almost cages, for the more violent imbeciles, and
asylums for those temporarily insane. All these institutions being under one management classification
and transfer are easy, so that the best means can be adopted for the present and future welfare of each
individual. In the absence of a special authority to deal with the feeble-minded generally such provision
is scarcely possible and the present problem is the case of the epileptic of school age, 7 to 16.
A certain number who have fits of a mild type at rare intervals or who suffer only from the lesser
grade of the affection known as petit mal are allowed to remain in the ordinary schools, or in the
special schools if the epilepsy is associated with a degree of deficiency rendering instruction in the ordinary
school impracticable. In these cases the teachers are warned of the inadvisability of endeavouring to
push the children. In a number of instances, however, medical certificates are submitted showing that,
in the opinion of the physicians on the staff of well-known hospitals, the children should be for long
periods or even permanently excluded from work under the conditions prevalent in the Council schools.
On the other hand there are also many cases in which it is suggested that some schooling should be
attempted, but in which the fits recur with such frequency or violence as to cause a disturbance of
school routine and discipline, rendering their presence most undesirable even apart from the effect on
other non-epileptic children. Generally speaking, however, the epileptic children are also to a greater
or lesser degree mentally deficient, either permanently or for a time after each fit. Experience has shown
that accommodation can only be obtained for those slightly affected and who present little or no sign
of mental defect, whereas it is the rather worse grade who are most in need of residential care. This
is the more so as they not infrequently come from families of a poorer mental stock and do not receive
that good home influence and training which is so important a part, of education.
In a small home in which no great amount of grading could be undertaken, it is necessary to
assume that the children would be approximately of one level, neither the best for whom some accommodation
would be available nor the worst who would need both more immediate attention and probably
ought to have permanent custodial care at the expiration of the school period. A home for from 40 to
60 children could be filled with those whose mental qualities would correspond to the intermediate
grades of the special schools. It is wisest to assume that the fits will persist throughout the life of the
individual, though in a considerable number great improvement will result. Education has, therefore,
to be directed towards occupations which would involve no personal danger in the event of a seizure.
Work on the water, about machinery or on scaffolding and the like is contra-indicated. The choice will
generally be restricted to sedentary occupations, and though farm colonies play their part in the custodial
treatment of adults, it may be doubted if it is of much avail to endeavour to lead a town bred