View report page

109
1905, and, with the assistance of the Invalid Children's Aid Association, and the
school managers and, later, of the Care Committee organisation, a large number of
the children have secured treatment through the various voluntary hospitals. With
the introduction of the general school medical inspection, practically all crippled
children attending school came to notice, the chief difficulty in earlier days
being the delays necessitated by the numbers of children waiting for treatment
at the hospitals. With the inception of the Councils scheme for the treatment of
tuberculosis it may be taken that the provision is available for all children suffering
from crippling defects arising from that disease, either under the scheme or at
hospitals or institutions to which the parents may have taken them. A special
list of all children out of school for three months is kept, so that there is little chance
of any child escaping notice for prolonged periods. More recently arrangements
have been made for the diagnosis and treatment of poliomyelitis. The Ministry
of Health informed the local sanitary authorities of the assistance that can be
rendered by the Public Health Department in the matter of diagnosis in the early
stages, and a circular has been addressed to the medical officers of health of the,
metropolitan borough councils, pointing out that the Metropolitan Asylums Board,
at the request of the Council, have provided accommodation at Queen Mary's
Hospital, Carshalton, for the treatment of this disease, either at the second stage
(three months after onset), or discharged from the hospitals after undergoing
correctional operations. The Council's consulting orthopaedic surgeon and the
school doctors examining children in physically defective schools are aware of
these arrangements and have brought to notice cases in which they think further
treatment is desirable, which is always arranged subject to the consent of the
parents and hospital surgeon (if any) under whose care the child may happen to
be.
Tuberculosis and poliomyelitis between them constitute the bulk of the crippling
disorders of bones and joints, the residue consist chiefly of congenital deformities
and the after effects of rickets. Rickets appears to be diminishing in its incidence
and severity, and is no longer the serious problem that it was in former times
and is still in other areas. On the whole, in view of the fact that the Invalid
Children's Aid Association, in co-operation with the Council, follow up all cases
of crippling, give a large measure of convalescence, and render assistance in all
cases requiring orthopaedic instruments, the provision for dealing with deformities
appears to be adequate.
Many of these disabilities arise prior to school age, so that cases should now
come to notice more particularly through the schemes for maternity and child
welfare. In the recent circular the Ministry of Health have drawn the attention
of the borough medical officers to the facilities available, so that in increasing
numbers children are being dealt with before admission to special schools.
Apart from the diseases of the bones and joints, the most serious crippling
disorder is heart disease. Steps have recently been taken to follow up cases of
rheumatism with a view to averting, as far as possible, the conditions which lead
up to the development of heart disease. Through the agency of the Invalid Children's
Aid Association cases in the earlier stages have been sent for prolonged institutional
treatment to such a school as Hartfield.
Encephalitis lethargica has attracted increasing notice during the year, and the
records of cases have been investigated by Dr. Shrubsall. It has been the practice,
since the disease was made notifiable, to obtain from borough medical officers information
of the symptoms and other particulars in every case and to secure, as far
as possible, through the Children's Care organisation, reports on progress some
months after the acute stage. The chronic stages of the sequelae are of importanco
from the standpoints of education and after-care. They are characterised by various
degenerative changes, such as mental hebetude, which may slowly disappear, a
Encephalitis
lethargica
11809
h