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20
Orthoptics (Table 85)
Methods of Treatment.
Orthoptic treatment comprises:—
(1) restoring good visual acuity, by occluding the eye with the better vision;
(2) improving and developing binocular vision with the synoptophore, where the patient is trained to
superimpose two dissimilar pictures, such as the lion and the cage, fuse two similar pictures (the
child is taught to see one picture while adduction up to about +25° and about -5° are taught),
and to fuse slightly dissimilar pictures, using stereoscopic vision.
The child's accommodation is relaxed while using the synoptophore and he is trained for binocular
vision for distance. However, a large number of children squint mostly for close work, and therefore it is
very important to teach them to use binocular vision for near work. Picture books and reading exercises are
used to achieve this.
The close co-operation of the ophthalmic surgeon and orthoptist is essential in achieving good results
more particularly so in cases that need operation.
Results of Treatment.
The orthoptic cures were functional cures; single binocular vision has been restored with and without
glasses for all distances and directions of gaze. The cosmetic cures were very satisfactory in appearance; the
children have acquired equal (or as nearly as possible equal) visual acuity and have been taught to alternate,
so that their visual acuity does not deteriorate.
The observation cases were cures which are being watched closely before they are recorded as
discharges.
Audiometry (Tables 86 and 87)
Fewer children were tested in 1956 than in 1955 owing to the prolonged illness of the audiometer
operator in the early part of the year.
The children who failed the "sweep" test were given a more thorough second test; a few were then
found to have normal hearing and the remainder were referred to the Assistant Medical Officers at the Clinics
for further investigation of their defective hearing. Some children, after having wax removed, were found
to have normal hearing and others were found to be already under observation at a hospital or a private
doctor.
In some no action was needed at the time but a further test was recommended after a given period,
and children found to be suffering from enlarged tonsils and adenoids were referred for operation; one has
now had the operation and an improvement in hearing has been noted. The remainder were referred by
the Assistant Medical Officers to the County Council's Ear, Nose and Throat Specialist whose recommendations
are given in Table 87.
Handicapped Pupils (Tables 92, 93, and 94).
A new day special school for deaf pupils was opened at Heston in April; Willesden children who
had previously attended residential schools in various parts of the country or London Day Schools were transferred
to this new school.
Some physically handicapped children attending the Lower Place Day Special School and living in the
western part of Middlesex were transferred to a new day special school at Heston which opened after Easter.
This enabled all the children on the waiting list to be admitted and new cases can now be admitted within a
few days.
CHILD GUIDANCE
During the past year 145 cases were seen of which 96 were new cases. The waiting list by the
end of the year stood at 81 (Table 95).
An analysis of the main symptoms and reasons for referral of the new cases is shown in Table 96.
Owing to the work of the two part-time lay psychotherapists and the increase of medical sessions
from 4 to 7, some 30 children per week were receiving intensive psychotherapy and many more were being
supported by less frequent attendances. 9 maladjusted children were ascertained as in need of residential
schooling.
Links with some of the Infant and Maternity Welfare Centres and Day Nurseries were maintained
throughout the year by the Psychiatric Social Worker and the Psychiatrist. Joint conferences were held with
Assistant School Medical Officers and Health Visitors, Probation Officers, Welfare Officers, Speech Therapists
and others. The Centre was visited by groups of Health Visitors, Psychologists and Nurses as part of their
training schemes.
RHEUMATISM (Tables 97 and 98)
The Rheumatism Clinic was held on the third Tuesday of every month at the Willesden Health Clinic.
This clinic is situated centrally and deals with children referred from the three main clinics.
Rheumatism can be a serious disease requiring complete rest in bed, followed by convalescence for
several months. It can lead to permanent heart damage, interfere with children's normal activities, and
interrupt their school life. Some children are left physically handicapped and have to attend a special school
for years.