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in London. An educational assessment was carried out by an inspector of special
education, with the assistance of two teachers with experience of work in schools for
the physically handicapped, who interviewed the children receiving education.
Table (iv) shows the prevalence among 421,000 children aged 5-14 years, which
gives a rate of 1.181 per 1,000 and there is no significant difference in incidence between
the two sexes. Surveys have been carried out in other parts of the country from time to
time, but the results have ranged between 0.4 and 2.2. It is difficult to ascertain the extent
to which the different surveys were comparable, whether for example, ineducable
children (included in this survey) were included or excluded, but the general consensus
of opinion appears to be that in this country the prevalence lies between 1.0 and 2.0
per 1,000.
The smaller numbers found among the youngest children reflect the difficulty of
diagnosis in early life. In previous annual reports I have referred to the scheme of
research by Mrs. E. Collis and Dr. W. F. Dunham (under the aegis of the Medical
Research Council) among selected babies at maternity and child welfare centres, which
has the object of devising techniques for the earlier diagnosis of cerebral palsy amongst
infants. This research still continues.
One feature worthy of comment is the lower prevalence at ages 14.16 years—this
may possibly be due in part to slight cases leaving ordinary schools undetected. There
does seem to be a 'shortage' of cases in later life presumably due to assimilation among
normal young adults and possibly by death or admission to institutions. The Council
has agreed to the use of the school organisation by the British Council for the Welfare
of Spastics in a follow.up of cerebral palsied school leavers, which investigation may,
in due course, throw some light on this matter.
In Table (v) are given the numbers of the 722 children under 17 years of age by types
of cerebral palsy and degree of physical handicap. The nomenclature of cerebral palsy
is not well defined, and it is not easy to ensure that commonly used terms mean the
same thing to all users. The disadvantages of approaching a survey in this way were
clear, but seemed to be inherent in any inquiry covering both a large population and a
number of physicians with differing experience. An attempt was made to secure
uniformity by including in the survey form a note to the effect that, ' for the purposes
of this survey, spasticity should be interpreted as weakness of muscle power with
rigidity ; athetosis as complicated involuntary movement, and ataxia as inco.ordination
of movement'.
To complete the clinical picture so far as was necessary for the purposes of the
survey, data was sought on the number of handicaps other than limb involvement
occasioned by the cerebral palsy. Details by certain age groups are given in Table (vi),
which shows that about one.third of the children had no handicap other than limb
involvement, another third had one additional handicap and the remainder had more
than one additional handicap. The most common other defect was speech, followed by
ineducability and epilepsy. It should be noted that ' ineducability ' here is a clinical
impression in certain cases, not a formal 'ascertainment', hence the figure does not
agree with those shown in Table (viii), where numbers formally reported under
Section 57 of the Education Act, 1944, or dealt with under the Mental Deficiency Acts,
are quoted.
It is noticeable that only about 5 per cent. of these children are reported as having
hearing defects. Since the date of this survey, Dr. L. Fisch, of the Audiology Unit,
Royal National Throat, Nose and Ear Hospital, has examined children in schools for
the physically handicapped in London, and found that, of the 240 children examined,
16.7 per cent. had some degree of defective hearing in either one or both ears. Whilst
in some cases these defects would not have been sufficiently serious to affect a normal
child, Dr. Fisch emphasizes that even a slight degree of deafness in one ear is of serious
consequence to a cerebral palsied child who cannot, for example, easily move his head
or body so as to make use of the better ear.
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