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The special schools were visited at least once a quarter, and every child was seen at least once
during the year. During these visits the scholars were re-classified, 183 were transferred to elementary
schools, 31 from physically defective to mentally defective schools, 1 from mentally defective to physically
defective school, 27 were excluded from mentally defective schools as imbecile, 41 were invalided
on medical grounds, and 101 over 14 years of age were excluded as no longer certifiable.
Rota visits.
During the year there were referred by the local education authority to the local authority under
the Mental Deficiency Act 258 cases, of which 99 were feeble-minded, 134 imbeciles and 25 idiots.
Mental
Deficiency
Act.
Mr. Yearsley in his analysis of the results of the examination of children nominated for admission
to deaf schools found that out of 177 certified to be deaf or hard of hearing, the deafness in 37 children
was congenital, in 119 acquired, and in 21 doubtful. Of the cases of acquired deafness 61 resulted from
primary catarrhal or suppurative middle ear disease, 18 followed infectious fevers, 11 resulted from
congenital syphilis and 20 followed meningitis.
Schools for
deaf and
hard of
hearing
Special inquiries were made by Dr. Shrubsall in December in regard to nocturnal enuresis, which
had been found a source of trouble in connection with children in residential schools and also a source
of great difficulty in the camp school at Bushey Park, though care was taken to exclude children in
whose cases there was a history of this condition.
Nocturnal
Enuresis in
residential
schools
The causes suggested by the medical officers of the schools are—local irritation, which can often
be dealt with by operative measures ; dream states ; cold weather ; low intelligence ; lack of early
training ; laziness. A former medical officer of the Pentonville-road Place of Detention suggested, as
an additional cause in some cases, that it might be a deliberate act with the intention of avoiding being
sent to a ship, as it had become generally known to the boys that cases of incontinence were refused
admission to training ships and nautical schools. It is possible that this factor might act, consciously
or unconsciously, in certain cases when in residence at the schools.
The usual treatment in the schools is to deal with any cause of local irritation, e.g., by circumcision,
or to awaken the boys during the evening, sometimes on more than one occasion. Most of the
medical officers draw attention to the failure of ordinary medical treatment in persistent cases. A
special type of case is sometimes met at Ponton-road place of detention in girls who have been living an
immoral life and in whom the condition would seem to be due to bad habits or laziness. In these cases,
which are of a deliberate character, the superintendent has found that by waking the girls every hour
for two or three nights the habit is cured. This form of treatment is exceptionally needed and could
not be persisted in for any length of time. I understand, however, that owing to the care in the selection
of cases there have been practically no failures.
At Highbury Industrial School cases of enuresis are placed in a separate dormitory; in other
schools they are not separated from the others.
The number of suggested causes is so great, and the affliction is found under such diverse conditions
of intellectual or social status, as to suggest that the underlying factor may be more psychical
than physical. This conclusion has been definitely arrived at by physicians with special experience of
nervous children, such as Drs. Guthrie and Cameron. The latter has written a particularly valuable
paper on the topic, the essential features of which may be summarised as follows :—
The trouble is seldom serious in early childhood but becomes more marked when parents,
by their distress and admonitions keep the suggestion of possible bed wetting constantly before
the child's mind. When a child is removed to hospital for observation and so knows that
bed wetting is expected and will not be regarded as an offence but rather the contrary, the
obsession of fear is removed and the general experience is that the enuresis promptly stops
without other treatment. Anything which adds force to the fear of failure leads to a recurrence
so that it is not an uncommon experience for trouble to recur when a boy is sent to a boarding
school. Punishment adds to the trouble and it is commonly found that a cure at school is
very difficult unless the matter can be kept hidden from the other boys in the dormitory.
Sometimes the condition spreads so that there is also diurnal incontinence or even incontinence
of faeces. These peculiarities seem to Dr. Cameron to be only explicable by the assumption
that the lack of control is due to autosuggestion brought about originally by unwise action
of parents and later kept up by the sense of shame and the mental distress involved. He thinks
that the ordinary methods of treatment, operative, manipulative, educational or medicinal
and rewards or punishments only act by suggestion or as aids to the suggestion of cure. The
suggestion of failure acting on the child's mind must be changed and self-confidence restored.
Hypnotic suggestion, Dr. Cameron thinks, will usually make this one symptom disappear, but
will perpetuate rather than combat the cause, undue susceptibility to suggestion characteristic
alike of the little child and the older neuropathic person. He records a case of cure by
allowing a boy to wear a rubber urinal in bed, when it was found that its use was unnecessary
and that it could soon be given up, once the habit had been broken.
States of anxiety are in themselves a cause of excessive diuresis and in the normal individual
the desire for relief is often the more evident and urgent when there is doubt as to the possibility of such
a course. The fundamental anxiety in children detained in schools need not be solely as to the possibilities
of bed wetting, but may be re-inforced by a desire to escape from their surroundings and return
home or to a freer life. On this basis the freer the life and the more homelike the surroundings the
less would such factors be in action, hence possibly the better experience of the residential schools in
which the children could fully appreciate that residence was solely for their benefit. When a child who
is affected finds that another has in consequence received a satisfaction of his desires such as being
sent home, or a punishment, the unconscious action of the emotions of hope or fear would be propor
tionately increased. It should also be recognis:d that such data as are available with regard to the