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twenties in the care of the physically handicapped child, e.g. children with symptomless
cardiac defects being placed in special schools and left there indefinitely. Whether or
not is was true that the school health service adopted this over-cautious view, it most
certainly was true of some medical practitioners, and there are many adult neurotics
who are able to fall back on alleged cardiac disease diagnosed on the strength of a
systolic murmur found in childhood. A healthy distrust of repeating such mistakes
today sometimes leads medical practitioners who know little of ordinary schools and
less of special schools to tell parents that their child is quite fit to go to the former from
the general idea that, once a child has been admitted to a special school, he has been
in some way excluded from the ordinary community. In fact a handicapped child may
be very effectively excluded from the activities of other children in an ordinary school,
only to find his feet in a special school. Children can be very cruel to one another
and it is well to appreciate this possibility, but the code of behaviour in schools changes
with passing years and children of secondary school age are often more sympathetic
towards another child's problems than they were when they were only eight years
old. In fact it is wrong to generalise about the educational need of handicapped children ;
besides the degree of handicap that each possesses it is necessary to know as much as
possible of his intelligence and educational abilities—for many have missed months
or years of schooling in hospitals or at home when individual teaching has not been
maintained. In addition the child's social background and psychological attitude to
disability is important and some knowledge of the available schools is desirable. A
recommendation for education in a special school is an important decision but it is
never a life sentence, and should be regularly reviewed, for just as it is the aim in partially
deaf units to give auditory training to help a deaf child to take his place in the normal
environments of an ordinary school and a hearing world, so should it be the aim to
try to help a physically handicapped child to return from special to ordinary school as
soon as such a change would be of benefit.
In London the large numbers of special schools, day and boarding, provided by
the School Board before 1904 and by the County Council in the past 50 years have
made it much easier to provide special education for those thought to need it. The fall
in school population over this period has been accompanied by an even greater proportionate
fall in the numbers of places needed for the handicapped, particularly in
schools for the physically handicapped. This decline in numbers has however meant
that those in the special schools have generally more severe handicaps than previously
and the provision of special medical treatment inside the school is more urgently
required. In London, physiotherapy is provided at the departments of physical medicine
attached to numerous hospitals, and transport is provided between the school and the
hospitals. A recent survey showed that a great deal of educational time is wasted by
the children in travelling and in waiting in hospitals. Moreover the transport arrangements
become complex with children from one school going to three or even more
hospitals. In October, 1951, the Director of the Department of Physical Medicine at
King's College Hospital accepted responsibility for providing physiotherapy in a nearby
school for the physically handicapped and this has had a great effect on the school.
The question whether it may be possible to extend this to most or all of the other day
schools for physically handicapped children, with the co-operation of the teaching
hospitals that have schools of physiotherapy and of the regional hospital boards, is to
be explored in 1954. Speech therapy is also now provided in each of these schools but
the provision of physiotherapy and speech therapy on their own is insufficient. The
Ministry of Health circular 26/53, though it deals only with epileptic and spastic children,
underlines a need of all handicapped children—that careful assessment and reassessment
of their handicaps and abilities is required if they are to be able to take their proper
place in society. If there are fewer handicapped children in our schools the need for
help of those that remain is no less.