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210 Annual Report of the London County Council, 1913.
Physical
conditions.
Speech—Articulatory Defects.—A considerable number of defects of speech have been noted
in connection with the examination of children in the special (M.D.) schools. These are in some
measure associated with the greater frequency of nasal obstruction and slight deafness among these
children, but are often an expression of a retarded development. The delayed onset of speech
recorded above persists, and is even accentuated, with growth.
Errors of refraction are common among special school children, who present greater difficulties
than the normal with regard to treatment. The parents are often careless with regard to securing
treatment, and when this has been obtained the children themselves are found to lose or break their
glasses with greater frequency than children in the ordinary elementary schools.
The fit and condition of spectacles worn by children in the special (M.D.) schools have been
investigated by Dr. A. C. Williams, who finds defects are more common than in the ordinary
elementary schools. The special schools children are particularly liable to lose or ill-use their
spectacles, and they are returned more seldom to the hospital whence the lenses were ordered in order
that the fit might be tested. The conditions merit attention, since the treatment of visual defects
and, notably, of cases in which squint or eye-strain is present, loses much of its value if the lenses
are not properly centred. Out of 42 cases in which spectacles had beer. supplied the fit was good in
14, not quite perfect without padding in 9. Glasses were seriously ill-fitting in 5 ; broken, bent or
otherwise damaged in 12, and lost or rarely worn in 2. The causes of the defective conditions
are:—
(1) Initial inaccurate fitting. This was much more frequent when the spectacles were
sent by post than when they were supplied locally. Of those supplied locally, 83 per cent.
were good, 17 per cent. fair and none bad; while of those sent by post, 25 per cent. were
good, 35 per cent, fair, and 40 per cent. bad. This failure of the postal method of supply
was illustrated in the series investigated in the ordinary schools in 1912, in which 56 per
cent, of spectacles thus forwarded were found to be ill-fitting.
(2) The weakness of the frames of the spectacles, bending nearly always taking place
at the junction of the bridge.
(3) Ill-treatment of the glasses by the children. Serious ill-usage was noted in 30 per
cent, of the cases, quite apart from minor scratches and general dirtiness. All but five of
the 62 children had spectacle cases.
Dr. Williams suggests that an arrangement, whereby the children can be supplied locally
instead of by post, is greatly to be preferred. No glasses can be considered suitable unless actually
fitted to the child who wears them ; further, in case of discomfort or small injury, the necessary
alteration can be made promptly and at trifling cost. Neglect and ill-use of spectacles is so common
that some form of supervision is needed. In some schools the teachers pay special attention to the
spectacles, and may even keep them at the school to avoid loss, but this procedure cannot be adopted
in cases in which constant use is essential.
Nasal obstruction.—Conditions of the nose and throat have long been recognised as leading to
conditions which closely simulate mental deficiency. Indeed, since their action is mainly by means
of partial deafness the sufferers may be regarded as temporarily defective through physical
disabilities or sensory deprivation. In this connection Dr. A. C. Williams has devoted special
attention to ascertaining the relative frequency of nasal obstruction in the ordinary elementary and the special
(M.D.) schools.

Besides these, there are cases of habitual mouth-breathing without nasal obstruction Insufficient
nasal breathing has long been recognised as an accompaniment of many forms of mental
deficiency, and associated with a high palate, small naso-pharynx and a conspicuous lack of nasal
hygiene. Under these circumstances, a relatively smaller amount of adenoid growth might give rise
to symptoms requiring operative relief. The proportion of cases referred for operation from different
types of schools is—Special school children, 8.6 per cent; ordinary school children, 5.8 per cent.;
junior county scholars, 3.5 per cent.
Dr. Williams has noted the children's mental condition before and after the operation in 57 cases
in mentally defective schools, and finds—A real improvement in brightness and power of concentration
in 7 ; a slight improvement, not certainly attributable to the effect of the operation, in 8 ; no
change whatever, beyond the ordinary progress with advancing age noted in the special as in other
schools, in 42. The improvement was probably to be attributed to improved hearing, though such
improvement was only noted in a few instances. The results tend to show that the children examined
had not been examples of spurious deficiency due to adenoids and partial deafness.
Lack of control.—Examples of lack of control of spinal reflexes, or of precipitancy of demand
for natural relief, have been met with among a certain number of low grade mentally defectives, some
of whom have been classed as imbeciles, and others invalided for a time from school attendance for
the purpose of securing treatment.