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Report of the Medical Officer (Education).
157
The length of the ambulance rounds has been the hindrance hitherto in lengthening the School
hours, but as the centres are multiplied and the districts get smaller this is a gradually vanishing
difficulty. Other improvements which might be suggested are school baths for such children as the
doctor certifies as suitable. There are considerable difficulties in maintaining some of these children
in a clean condition and verminous clothes may need consideration. Some children with discharging
wounds are kept out of school for lengthy periods, in many of these cases this could be avoided if the
nurse was permitted to change dressings by arrangement with the doctor who has the child under
his care. Possibly this will become feasible as the new treatment scheme for co-ordinating school and
hospital work is developed.
The provision of suitable education for epileptic children continues to present great
difficulties. The voluntary institutions restrict their accommodation to children of the least
troublesome type. These are the very children with whom parents and guardians are often unwilling to
part. For the remainder of cases for whom provision is more urgently needed on account of the distress
caused by their presence in poor families, no possibility of educational and colonial treatment is found.
Such children are placed in the Council's schedules as " Invalid" but this term merely denotes that they
are unfit for any existing educational institutions. During the year 196 epileptic children have been
scheduled during the course of medical examinations; of these 1 was considered imbecile, 4 were
found fit for special (M.D.) schools, 7 were capable of attending ordinary day schools, 67 were certified
as fit for epileptic colonies (i.e., falling within the limits set forth in the prospectuses of voluntary
agencies) and 117 were regarded as unfit for any existing educational institution. Certificates were
furnished on behalf of 31 of the children who were suitable for colonies but the number actually sent
thereto was only 19. To illustrate the difficulty in securing proper educational treatment for these
children and the restriction of the limits insisted upon at present it may be remarked that of the
children considered fit for colonial treatment and upon whose behalf certificates were filled in five were
refused admission into Chalfont.
Epileptics.
There is at present no special accommodation for children who are both mentally and
physically defective. Those who are unable to walk to an M.D. school have to be excluded
altogether. The number so excluded is, however, very low. In the report for 1906-7 a
table showing the backwardness of children in the P.D. schools was included and showed
that most of these children are from 1 to 5 or 6 years behind their proper standard and that
about 20 per cent, are, in the opinion of the teachers, of exceptionally low mental ability. Yet the
number of children transferred from phvsically defective to mentally defective schools or excluded for combined defect is not large.
Combined
Mental and
Physical
Defect.

Of the 41 left in the P.D. schools 22 suffer from spastic paralysis, are so crippled as to be incapable
of getting to an M.D. school and are being given a further trial. The other 19 belong to
various groups and if there is no marked mental improvement a physical improvement will probably
shortly permit their transfer to an M.D. centre. Apart from the cases of spastic paralysis the only
groups which show an abnormal proportion of mental defect are—
Rickets—19 out of 163 children.
Congenital club foot—6 out of 74 children.
Excluding these three groups the proportion of mentally defectives is probably no higher
amongst physically defectives than among the healthier children. But as already mentioned, backwardness
amounting to mental stagnation is very common and it is extremely difficult, during the
first years of attendance, to determine whether these children are strictly speaking mentally
defective. It is quite common for a child to come into school at 7 or 8 knowing nothing and
apparently for the first year incapable of learning anything. Yet many of these children, after progressing
very slowly for several years, suddenly make a start and reach a level of Standard IV. or
V. in ordinary work, and in addition learn to do very good handwork. This is probably due to the
fact that previous to admission to school these children were chronic invalids and had not been taught