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158
Annual Report of the London County Council, 1911.
epileptic child back to the land. The general principle of life in such a school must be to secure a
maximum of uniformity; excitement of every kind, overstrain in work, and irregularity in meals and
sleep being avoided. If overstrain and worry are avoided education can continue along the ordinary lines,
but longer intervals between lessons and probably shorter periods for each lesson would be advantageous.
It may be found necessary to modify the instruction given to individuals should worry and recurrent
seizures be found to follow any special subject. This has not been found a practical working difficulty
in the German epileptic schools. Exercise is important, but this and games will require special regulattion,
or the excitement in the playground may be more harmful than the mental work in the schoolroom.
Personal influence and supervision are the determining factors, so that the personality of the
superintendent, teaching staff and, indeed, of all the officers is of manifold greater importance than
any considerations of site or structure of building. As regards the epileptic seizures it will be necessary
to bear in mind that from time to time children will suffer from these and may need immediate attention,
so that a special couch will be needed in each room on which they can be placed during the attack and
on which they may remain for a time. After the attack is over there is usually a period in which the
individual is not quite responsible for his actions, so that he needs watching. It has been found that
children can remain on the couches in the classrooms or recreation room without disturbing the rest of
the class. The trouble caused in the ordinary or special schools arising from curiosity on the part of
some children and nervousness on the part of other children and the teachers disappears in a home or
colony where a fit is an hourly occurrence. As regards the structural arrangements these seizures have
to be considered in two ways. A child may be seized anywhere, so that it is necessary that immediate
and easy access to it may be always possible, which will necessitate special arrangements in regard to
the desking of the classrooms and the construction of the bathroom, lavatories and offices. As the
children are liable to fall, though usually after a warning, unnecessary furniture and sharp edges must
be avoided, and facilities be available for keeping children from falling out of bed. All staircases must
have doors at each landing and all windows be specially guarded. This is the more necessary, as in the
post-epileptic condition children may wander about in a condition of sleep walking. The Board of
Education are believed to discourage stairs in epileptic homes, but with proper precautions they have
been found abroad to present no real difficulties or dangers, so that this can scarcely be enough to settle
the design of a building if other considerations render a two or more storied edifice more desirable. The
great German institutions have three or more stories to each building both for children and adults. It
is also advisable that unbreakable materials be used in place of glass and earthenware to avoid danger
from broken pieces. The sleeping accommodation must be arranged to admit of instant supervision and
detection of seizures, and the beds and bedding must be of materials so arranged as to diminish the risk
of suffocation. It is necessary to arrange for night supervision. How far this will be required may
vary from time to time. With some it may be enough for an attendant to be immediately adjacent
and able to hear any sound in the dormitory. At any given time some children will be unable to receive
instruction and arrangements for their supervision in the recreation room or dormitories will be needed.
There will be the usual risk of illness and infection, so that provision will be required for a sick
room and isolation rooms.
Probably dormitories of not more than 12 beds will be found the most convenient, though all
numbers from 4 to 60 or more are provided in existing institutions. Too large a number increases the
risk of disturbance of rest at night. Bathroom, lavatory and office accommodation should be on the
same floor and within easy reach of the dormitories. Sufficient recreation room must be provided to
avoid the excitement of large gatherings, but if one room is available for those "not in school," the
other rooms could no doubt be adapted to multiple purposes. Two nurses will be necessary at any rate
at the beginning, though their duties will doubtless become lighter as the teachers and others become
more used to dealing with epileptics. All the officers will require ample off-duty hours, as this class
of work involves much more strain than an ordinary school or even hospital, the unexpected being very
trying. Ample playground space, preferably grass, covered with facilities for gardening and outdoor
occupations is desirable, but in all the arrangements it must be remembered that no child or even group
of children can be left long without supervision.
Heart
disease.
The importance of rheumatism among young children, as an insidious and almost unnoticed
disease, exerting a powerful debilitating effect in anaemia, probably also retarding normal mental development,
and sometimes leading to serious disturbances of the heart mechanism which, however, may not
be detected till long after, has lately been increasingly recognised.
Dr. Norman, analysing his notes of children with respect to heart disease, found 9 boys (0.72 per
cent.) among 1,235, and 28 girls (2.33 per cent.) among 1,198. In 2 of the 9 boys and 1 of the 28 girls
a congenital malformation was diagnosed. A boy and a girl showed signs of the aortic valve being
affected, otherwise all the cases were defects in action of the mitral valve. There were from three to
four times as many defects among the girls as among boys and chiefly the elder girls.
Dr. Hadfield has made a preliminary enquiry in N.E. London as to the prevalence of rheumatism,
and provisionally suggests that larger numbers of children than is usually supposed pass through
rheumatism or chorea without heart disease appearing during school life, or as he terms it, permanent
heart disease. This may, however, not be a permanent escape, as after some years definite signs may
appear, and in older scholarship or pupil teacher candidates the gradual development of definite valvular
signs is noted occasionally in the changing heart sounds. He rejected cases of indistinct or doubtful
heart affection from his figures.