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discharged from the Isolation Hospital were referred, and in some
cases the School Medical Officers or Teachers made a recommendation
regarding younger children in the family. The majority
came through the efforts of the Health Visitors. The early attendances
were small. In the first three months (until the end of
1935) the average attendance per session at Leyton Green Centre
was 3.5, and at Park House Centre 6.3; but during 1936 the numbers
increased considerably, and the average attendances for 1936
were 6.9 and 8.2 respectively.
At the first visit a detailed physical examination is made, but
emphasis is not laid on the physical examination. A discussion
on the child's diet, regularity of bowels, hours of sleep, any peculiarities
of behaviour, and observation and enquiry as to whether the
mother is allowing the child scope to develop mentally, focusses
the mother's attention on points she may have considered too trivial
to mention. The mother is accustomed to take her child to a
doctor for a "thorough examination" when he develops any
obvious physical ailment, but the idea of consulting a doctor to
make sure that the child's mental and physical development is
sound is novel to the majority. Another may bring a child
of 3 to 4 years to the clinic because he has a few urticarial
spots which alarm her. He has not been brought before
because" he has been getting on all right," but he has an
obvious lack of self-confidence, and enquiry may reveal that he
screams if the mother leaves him for a short time. The mother
explains his behaviour by describing him as "nervous" or "shy,"
but does not often realise that it is the lack of orderliness and security
in the child's immediate environment, or her own over-solicitous
care which is either producing or aggravating the child's symptoms.
This is where the nursery school or class does such valuable work
if the child can be removed from constant association with his
emotionally unstable parent at a sufficiently early age to prevent
permanent damage. Public opinion here is in advance of administrative
action. The mother may not realise the cause of the child's
unrest, but she is quick to appreciate the improvement in his
behaviour and general health when he attends a nursery class—
and the demand for admission to school greatly exceeds the supply
of accommodation. The more intelligent mother is ready to admit
that her knowledge of the needs of the young child's mind may not
be wide enough to provide suitable occupation for him throughout
the day.