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The arrangement by which the Metropolitan Asylums Board admits to a special
institution, on the direct nomination of Dr. Wells, all those children in whom mastoid
operation is the only means of cure has been continued. The change by which this
work is carried out at the Downs Hospital, Belmont, instead of at the Clevelandstreet
Infirmary, in London, has made it difficult to obtain a detailed account of
the year's working, but Dr. Wells reports that about 75 per cent, of the children
were discharged cured.
(d) Dental disease.—236,658 children were inspected by the school dentists,
43,928 more than in the year 1922. 166,454, or 70.3 per cent., were found with
defect. 95,332 children were treated at the treatment centres. These figures show
a great improvement as compared with the results obtained last year, and indeed
are the best yet recorded since dental inspection and treatment were begun.
Treatment of stammerers.
Tin six central classes for stammering children were continued throughout
the year. 266 children (184 boys and 82 girls) passed through the classes, of whom
133 were discharged cured. Only 7 relapses took place amongst the cured, and of
these 6 were again discharged without stammer.
More and more it becomes recognised that stammering is a pure psychosis.
Almost any treatment will cure a number of cases provided it helps to restore selfconfidence
in the child and to remove the fear of stammering which is the chief
cause. By pursuing a rational mode of treatment on this assumption, in place
of the former empiric methods, a greater degree of success is obtainable. Each
child requires individual investigation. The children are encouraged to confide
in their teacher, and from the relation of their dreams much is learnt.
A history of nervous instability either in the child himself or in the family is
found in the majority of cases. The larger number start before seven years of age,
and in most of these the stammer appears to be a retention of the repetition of
sounds which normally accompanies speech development. This repetition is more
pronounced among sensitive, highly-strung, children, whose understanding of the
spoken word is well in advance of their ability to express themselves in speech.
In several cases the stammer synchronises with the first term at school, either at