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43.
definite recessive mutants (such as cystic fibrosis of the
pancreas) when the risk is ¼, in the great majority of cases
the parents should be encouraged to try again. This is true
even when it is known that the defect (such as spina bifida,
or cleft palate) tends to occur in families; for the added
risk caused by this factor is small in comparison to the over
all risk of 1:40. and hardly increases it. True, the spina
bifida might occur again: but congenital heart disease could
occur instead, or a limb deformity, and the total hazard is
much the same, as though there had never been a defective baby.
The increased awareness of congenital defect has inspired
a fresh assessment of the causes of illness in neonates.
During the last 30 years, the idea that cerebral palsy is due
to brain injury at birth generally anoxic - has been steadily
gaining ground and is widely accepted. Nowadays many
paediatricians are wondering more and more whether in fact
such babies were not abnormal before they were born? It is
commonplace to find a 'spastic' child after what was apparently
a perfectly normal, non-traumatic birth; and it is possible
that abnormal labour (such as prematurity, or unusual presentation)
might be due to some flaw in the foetus. In other
words, the abnormal labour may be caused by 'cerebral palsy'
present before birth, rather than be a cause of this condition.
Certainly the increased prevalence of congenital deformity
(especially of the central nervous system) in the sibs of
spastic children is a hint against the theory of acquired
injury.
I should like to thank the School Health Officers who sent
the children to me. and the family doctors who permitted the
referral. I should also like to thank Dr. P. Tettmar. radiologist,
and Dr. W. Walther. pathologist, at Whipps Cross
Hospital, for kingly allowing me the use of their facilities.
DENTAL CLINIC
Mr. G.P.L. Taylor submits the following report on the work
of the School Dental Services:-
During 1961 only two full time dental surgeons were
employed but we have received valuable help from a number of
part time surgeons. This has enabled the department to inspect
and offer dental treatment to considerably more children than
in the preceding year.
The staffing difficulty seems likely to continue, and one
of the problems involved is to find a part time dental attendant