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therapy rooms have been provided and one room
at the new Heston clinic. Similar facilities were
also planned for the new clinics under
construction and for future extensions to existing
buildings. These purpose equipped rooms are
particularly necessary in view of the increasing
number of pre-school children who are being
referred for treatment.
In November, a speech therapy clinic was
started at the Hanworth junior training school for
two sessions weekly. The session previously held
at Cranford Infants school was discontinued
when the new Heston clinic was opened. The
Cranford children now go to Heston clinic.

'There are some 100 children on the roll and of
these ten are under the age of five years. The sex
distribution is fairly typical: 34% girls and
66 % boys.
Supervision following the initial diagnostic
interview varies according to the severity of the
asthma. Whereas some children attend only for
the diagnostic consultation others may attend
monthly or even more frequently whilst others
may be seen only once yearly to check progress.
Much value is laid on the primary interview
when a comprehensive history is taken to
elucidate the likely 'trigger' factor in the child's
asthma.
Skin tests using Bencard's Allergy Products are
done routinely but are not necessarily conclusive
as even in the same child different factors might
be operative at different times.
Since De Bono's Whistle has become available,
easy assessment of lung-function has become
possible in a clinic setting. The peak expiratory
flow rate^(PEFR) is regularly measured and
progress assessed clinically and on ventilatory
capacity: many children appear to have 'outgrown'
their asthma but may be left with
significant impairment of lung-function.
Treatment facilities in a local authority clinic
are necessarily restricted to antispasmodics,
antihistamines, desensitisation, breathing
exercises and instructions to parents in regular
tipping if pulmonary congestion occurs. Much
emphasis is laid on the psychological management
of this psychosomatic illness in order to relieve
the considerable intrafamilial tensions which
accompany the recurrence of airway obstruction
in an asthmatic child.
Should steroid treatment be considered
necessary the child is referred, with the
concurrence of the family doctor, to an
appropriate hospital department. There are at
present five severely ill children in attendance who
are receiving this treatment. Steroid dependence
with its associated growth impairment is now
avoided by giving short courses of predisolone
or intramuscular ACTH.
It was considered that preseasonal
hyposensitisation against grass-pollen was
indicated in six children: four were subject to
severe pollenasthma, two to severe pollenosis.
47
A further 81 children treated in schools are not
included in this analysis.
Asthma and allergy clinic
I am grateful to Dr Prothero MD DCH
Departmental Medical Officer for submitting the
following report on the work of the allergy clinic
during 1966.