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158
Annual Report of the London County Council, 1910.
anything, so that their educational attainments are nil and they have not even acquired the faculty
for learning. Two points in the education of physically defective children seem to arise from this—
1. That these children must not be hastily classed as mentally defective until they
have been under observation for some considerable time.
2. That they ought in some cases to be given the advantage of special education after
their physical defect is well, in order that they may make up the great educational loss they
have suffered earlier.
Referring to the special classes already alluded to, rickety children are admitted to the special
schools on account of (1) severe deformities; (2) active rickets. The former should soon be cured by
surgical means, the latter by proper hygiene and feeding. Club foot can be cured up to a certain stage
by surgical measures, after this the child should walk well enough in instruments to be able to get to
an M.D. centre. Thus mentally defective children belonging to these classes need only remain at
the special P.D. schools for a short period during which the remedial measures are being carried out.

This gives the number attending the schools during 1910 or leaving during that year; in
addition 56 children had left or been excluded from school previous to 1910 (Hemiplegia, 27; Paraplegia,
15; Diplegia, 14); of these 29 were mentally defective (Hemiplegia, 13; Paraplegia, 6;
Diplegia, 10), so that the proportion who are mentally defective is very high.
Epilepsy is common amongst children with hemiplegia, the proportion represented in the table
is much too low. Some authorities give the percentage as high as 70 per cent., in many cases the
fact that the child is an epileptic is concealed by the parents, in many others the epileptic fits only
commence in later childhood. A large number of children with diplegia have defective speech (12
out of 37); this is rare in the other forms of paralysis. In hemiplegia a certain amount of improvement
may take place in the physical condition largely as a result of re-education of the paralysed
muscles and of their motor centres in the brain. In paraplegia and diplegia little improvement can
be expected. Surgical treatment in these cerebral paralyses has proved to be of only very limited
use. In suitable cases the division of tendons and use of appropriate instruments leads to improvement
in walking, but operative measures on the upper limb seldom end in any permanent benefit.
When the large proportion of mental defect or dullness, the difficulty in walking, the loss of use of
one arm in hemiplegia or of both in diplegia, and the speech defect in the last class, are considered,
it must be clear that the majority of these children can never become self-supporting. Segregation
in suitable homes in which they may carry out a considerable amount of work under supervision
seems to be the only reasonable method of providing for such children among the poor.
Remediable
Physical
Defect.
Routine examination in the special P.D. schools may lead to considerable improvement
in individual scholars. The best results are obtained where an active manager (often a
representative of the Invalid Children's Aid Association or Ragged School Union) undertakes
personally to urge the treatment necessary upon the parents and to follow up the case. For
example, many of the children with bad rickety deformities have been sent to hospital and have had
these corrected by osteotomy. The failure to secure treatment of this sort is often due to
parental indifference or obstinacy. Amongst the cases of club foot there were four which had never
been treated, and four completely relapsed. In these eight cases the children were walking upon pads
situated upon the tops of the feet. In four out of the eight successful treatment was ultimately
obtained after much trouble. G. D., æt. 7, with double club foot had been treated in infancy, but the
after-treatment had not been continued and the feet had completely relapsed. Efforts were made from
February to November, 1909, to persuade the parents to take the child to the hospital. At the latter
date the mother attended the school at a medical visit and was shown a child who had been successfully
treated. She thereupon took the child to the Orthopaedic Hospital, where the feet were successfully
treated last year and the child is now walking flat upon both feet. Such success cannot always
be obtained. D. V., set. 6, attending a South London special school, has untreated club feet. The
parents have been repeatedly seen and urged to secure treatment between December, 1908, and the
present time, but they absolutely refuse to permit any operation. This was suggested as a suitable
case for prosecution under the Children Act, but so far it has not been considered advisable to take
proceedings. It seems clear, however, that the child is being rendered a permanent cripple
owing to the parents' obstinacy.
Many instances of remediable defect are seen among the children with infantile paralysis; out
of 496 children with this disease 139 had both lower limbs affected and 32 of these had never walked
up to the time of admission to school. As a result of suggestions for treatment 13 of these have subsequently
been enabled to walk with or without crutches, 5 others were still under treatment when
last seen, and 5 are still under observation in school before treatment is recommended. In 9 cases
treatment suggested is not yet being carried out by the parents. Very few even of the most severely
paralysed children should be given up as hopeless. Nearly all can be enabled to get about in some