View report page

216 Annual Report of the London County Council, 1913.
rheumatism, while long hours of ordinary school subjects have been found to encourage chorea. Hence
it is that the travelling to school in an ambulance and the spending of half the day in manual occupations
have a preventive function. A case in which the rheumatic condition has once returned is
much more unfavourable than one in which there has been a single attack only, so that care is desirable
for a long period after the original attack, in order to avoid such an untoward event. The
prospects of health for a rheumatic subject with a damaged heart turn largely upon the choice of
occupation, for exposure and strain may lead to the early ending of a lite which in sheltered and
sedentary surroundings might well have attained the average expectancy. Cases are on record in
which advice as to occupation on leaving school has been neglected, and the subject has died within a
short period ; while others, instead of being able to earn a partial living, have been converted into
confirmed invalids.
An investigation into the prospects of children in the schools showed that nearly half had a
reasonable chance of looking forward to a normal existence if they were able to take ordinary care.
A study of the causes of prolonged absence of children from school shows that heart disease
is responsible for about 10 per cent., and the increase in the numbers attending is largely due to the
more general realisation of the advantages of the invalid schools, so that children now attend who at
one time were kept away under medical certificate, which could not have been contested successfully
in court. The children suffering from heart disease deemed suitable for the physically defective
schools are those in whom compensation has been but recently established or in whom there is a risk
of recurrent attacks of illness leading to further damage. Fully compensated cases with no recent
rheumatic history who are able to continue their ordinary occupations are not deemed suitable for
admission.
A study of 1,234 cases who had been in the physically defective schools at some period during
the years 1908—1912 showed the following results—
Still in physically defective school 507
Elementarv school 136
Mentally defective school 13
Private, secondary, and other schools 12
A.t woik 201
Left at 16—unfit for much work 61
Invalided 81
Died 93
Lost sight of—ailing at last note 30
Lost sight of—fair condition at last note 60
Left London 40
1,234
It is probable that the majority of those who were lost sight of subsequent to being invalided
have died. There has thus been a fatality rate of between 8 and 15 per cent. in five years, but, on the
other hand, 30 per cent. have been able to return to the ordinary schools or to proceed to productive
employment. The results obtained from the treatment of cases of heart disease are fully as great as
in those of any other crippling lesion.
The first medical inspection of all children in the ordinary school has now been completed,
and it is probable that there will be little fluctuation in the natural groups, and the types of disease
represented are likely to have reached the constant level.
The lower map included in diagram K. shows the distribution of physically defective children
expressed as a percentage of children on the roll in each educational administrative area. Correction
has been made for residential institutions.
A considerable amount of attention has been given to the question of making provision for
boys who are physically defective and over 12 years of age and great difficulty has been found in
dealing with the matter. Those children who are invalids ( heart cases), and who will, to a great
extent, be incapacitated in later life should be permitted to remain in an ordinary physically defective
school. Of those who need further educational treatment it is possible that some may be able to
travel to handicraft centres and receive manual instruction thereat, but these cases would benefit
most by treatment in residential schools. The latter would perhaps be the most economical and best
done by extending a system of scholarships available to such institutions as Chailey. These
measures would cover the whole range, but considerable elasticity should be allowed so as to
include the difficult cases.
Organised physical exercises are desirable for nearly all children ; a few are unsuitable
for exercises of any type. The latter class comprises recumbent cases, children in plaster or
Thomas splints and those with severe types of heart disease. In such cases a note to the effect
that the children are unfitted for physical exercises is made on the medical record card to which
teachers can and do refer; these decisions are revised by the doctor at his visits to the schools.
With these exceptions, all children in the physically defective schools can do breathing exercises
and simple free arm movements. A few of the children could carry out the whole course of
physical exercises given in the Board of Education's syllabus, but there are others suffering
from paralysis or joint disease who would be unable to perform the movements of trunk or
limbs. Were the complete syllabus adopted the differentiation involved would be complicated and
difficult to fit in with the school organisation. It would, therefore, seem most advisable that in each
Special
Schools for
physically
defective
children who
are over 12
years of age.
Physical
exercises for
physically
defective
children.