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3 or 5 years of age, although in a few it occurs when at 7 years old the child is transferred
from the infant department to the boys' school, no doubt a severe ordeal for
a nervous child. One parent attributed the stammer to the phonetic method of
teaching reading.
All cures are provisional, and the number of relapses recorded this year is
accounted for by the ability to follow up the cases further, owing to the earlier
age of treatment. Two boys relapsed on their voices breaking at puberty.
The prognosis in stammering depends upon (a) the teacher; (b) the period
between onset and treatment—the sooner after onset a case can be taken in hand
the better; (c) the intelligence of the child—intelligent co-operation between teacher
and patient is an absolute necessity and the child must be old enough to understand
this—in these classes no child is admitted before nine years of age; (d) the
physical condition of the child.
All physical defects, such as defective vision or teeth, unhealthy condition of
nose, throat or ear, must be attended to as soon as possible. Much time can be
wasted on a child mentally or physically incapable of receiving full benefit from
the course. Where a child is anaemic and generally run down a visit to one of the
Council's open-air residential schools greatly facilitates treatment.
The School Nursing Staff.
The importance of the work of the school nurses and the share of their work
in the success of the school medical service is not always appreciated at its full value.
A school child may come under the notice of the school doctor only three times,
during his school life of nine or eleven years, but every child in London passes under
the observation of the school nurse at least once in every school term, that is 27
or 33 times during his school life. This work is, therefore, of prime importance,
and, besides ensuring that the general standard of cleanliness and of freedom from
chronic infections is safeguarded, also ensures that children, silently suffering from
ailments that elude the watchful eyes of the teachers, are detected and brought
to the notice of the school doctors or referred directly to the treatment centres.
A sidelight on the importance of this work is given in the following account
by Dr. Chaikin of work in the East End in regard to the one particular of the discovery
of children suffering from ear discharge:—
" As is known, the school nurses 'discover' many cases of minor ailments
and of other conditions in school children in the course of their rota visits to the
schools. This report is intended to show the significance of their 'discovery' of
cases of otorrhoea—some not under treatment at all, and others where treatment
has been discontinued—during the four years 1920, 1921, 1922 and 1923, in so far
as the eastern division is concerned.
“The cases were reported to me on Form M.0.303 by the nurses who, at the
same time, sent the children to the treatment centres. Furthermore, the cases
were passed by me to the district organisers, who took steps to secure their being
followed -up. From the serious nature of middle ear disease, and from the numbers
reported, the importance of the nurse's work in continually searching out untreated
otorrhoea cases cannot be overestimated. The volume of the work is also noticeable
when it is borne in mind that it is carried out in the course of other duties.
" The following figures relating to otorrhoea cases reported on Form M.0.303,
are compiled from records kept by me during the several years :—1920—338; 1921
—403; 1922—251; 1923—420. The total, 1,412 in all, was made up of 542 senior
and 345 infant boys, and 318 senior and 207 infant girls, distributed as follows:—
Stepney, 525 (0.9 per cent.); Bethnal Green, 520 (2 per cent.); Poplar, 281 (0.8
per cent.); City of London, 86 (3 per cent.). The figures in brackets denote the
approximate percentage of the school child population.
The following facts may be noted :—(i.) There appears to be an annual fluctuation.
It looks as if 1922 had been a healthy year, and 1923 the least healthy.