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the patients come from extra-metropolitan areas or from other than elementary
schools. The chief problems according to the initial statements were " nervousness,"
"enuresis," "unmanageable behaviour," and "untruthfulness." Sixteen of the
fifty-four are described as having been cured or very greatly improved.
An important niche in the remedial facilities of East London is filled by the
undenominational child guidance clinic conducted by the Jewish Health Organisation
of Great Britain. This has now been established for over two years and is temporarily
housed at the Jews Free school, Bell-lane, E.1. The staff consists of two
psychiatrists and a psychologist giving part-time service, two psychiatric social
workers and voluntary assistants. It is open on two afternoons a week from 2-4
p.m. and two evenings from 5.30-7.30 p.m. It works in the closest co-operation
with the school service from which directly or indirectly some 70 per cent. of the
patients were referred. It is recognised as a school clinic and attendances are duly
recorded. The investigations are very thorough and a case conference at which
all angles of the problems are considered by the medical officers, psychologist and
social workers and to which interested parties are invited is held for each child.
The predominant type of problem has been either unexplained backwardness,
nervousness, enuresis, misbehaviour shown in a general lack of control and in a smaller
number of instances more personal difficulties such as habit spasms, night terrors,
sex troubles and the like. The average level of intelligence of the children attending
has shown a mental ratio of 99.4 per cent. or about the average of the general population,
but few have been so seriously retarded as to be on or below the borderlines
of mental deficiency. The average number of attendances per patient has been 8.
Some of the cases have been dealt with in co-operation with other agencies. The
psychiatrists in their report indicate that the average age of the children was between
eleven and twelve years and point out that the problems of adolescence are most
frequently found well before the age of puberty, during the period of the emergence
of self-consciousness and of the struggle to accept social values in behaviour. Many
cases pass relatively unnoticed until the problem reaches a sufficient degree of intensity
to force itself upon the parents or teachers or both. With the increase in
general interest and knowledge in such matters it is probable that, in increasing
measure, problems will be brought to light at an earlier date, when they can as a
rule be more readily resolved. In this task a series of lectures and conferences
arranged by the authorities of the centre for the voluntary workers, teachers and
others in the area has played an important and most useful part. The psychologist
to the centre draws attention to the frequency with which the problem proved
to be one of backwardness due not so much to lack of innate intelligence as to
interference by some neurosis. He finds that a problem baulks a neurotic child
either because of his excessive interest in its details to the consequent detriment of
the main issue or because of his extreme perfunctoriness with details. Idiosyncrasies
in intellectual adjustment have seemed to be traceable to fluctuations of interest,
attention and effort, rather than to lack of endowment. Special defects and
abilities have been rarely found. Dr. Miller and Dr. Burke point out that "Backwardness"
is not always due to an absolute retardation but to emotional causes which
produce not only disorder of social behaviour, but lack of attention, fear in facing
scholastic tasks, the fear of humiliation, and that functional paralysis of the will
which gives the appearance of stupidity to many of otherwise normal intelligence.
The officers of this clinic have found more help from the study of the child and
of environmental factors than from the mental history of other members of the
family. Some of the most promising results have been obtained from children who
have highly coloured mental family histories while a feeble constitution in the child
itself as observed in its physical and mental make up, is much more likely to give
early indications for a poor prognosis. The social workers here, as elsewhere, draw
attention to the advantage and often the necessity for certain children to spend
part of their holidays or even longer periods away from home. Arrangements for
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