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Report of the Principal School Medical Officer for the Year 1967
107
CHILDREN WITH SPECIAL MEDICAL AND EDUCATIONAL PROBLEMS
Mention has been made in previous reports of the duty of the Local Education Authority to
ascertain which children in its area require special education. In the main, children present with a single
handicap which can be dealt with either by arranging special facilities in the ordinary school or providing,
if the numbers warrant this, a special class or school. Children with defined handicaps such as
partial sight, partial hearing, delicate, epilepsy and certain minor physical handicaps may often be
kept in an ordinary school, providing certain precautions are taken or suitable arrangements made,
and the disability is not gross. Educationally subnormal children are sufficiently numerous to be
grouped into special classes or given a special school.
There remains a small but important group of children who present with multiple handicaps, and
these do not always fit into the educational facilities available. Many of these children derive their
handicaps from congenital causes. A pregnant woman who contracts German measles or certain other
virus infections during the first three months of her pregnancy could possibly produce a child who
might suffer from partial or complete hearing loss, poor vision, mental retardation, microcephaly, or
heart disease, or any combination of these handicaps.
The decision which must be made is how to fit the individual child into the special educational
facilities available and this decision depends upon many factors, not least of which is what facilities the
Authority has to offer. If mental defect is the outstanding feature, clearly the training must be consistent
with the child's mental ability. If the child is able to benefit from education, then the decision must be
based on the child's capability in visual, auditory, and physical areas. For example, sub classes usually
can be provided in partially hearing classes for children who are also partially sighted, or partially
hearing children with limited academic ability can be dealt with in a school for educationally subnormal
children.
Where more than two handicaps occur in a child, the decision becomes more difficult. Many of
these children are referred to the school medical officers in the early months of life; accurate assessment
can only be achieved by the accumulation of evidence in the following years from parents, health
visitors, family doctors, consultants in the various fields of medicine, educational psychologists, education
officers, teachers, etc., and from this data a provisional plan prepared for the child's entry into
formal education at the appropriate age.
Advances in paediatric medicine and surgery are also posing problems for the School Medical
Officer. The treatment of spina bifida is an example. This condition is a developmental abnormality of
the spinal cord which frequently results in failure of the vertebrae to develop completely and close over
the cord. There is thus a protrusion of the coverings of the spinal cord through the vertebral arch, and
as these then lie immediately beneath the skin, the spinal cord is extremely vulnerable. The majority of
these children are affected in the lower part of the spine, with damage to the spinal cord and often
paralysis in the lower limbs and bladder.
In the absence of surgical treatment, a number of children would develop increasing cerebro-spinal
fluid pressure, resulting in the condition known as hydrocephalus; and, since the growing brain is the
part under greatest stress, the mental ability of the child deteriorates rapidly due to thinning and
destruction of brain tissue. Surgeons can now overcome this problem by inserting a drainage tube
incorporating a valve into one of the ventricles of the brain and allowing the excess fluid to escape into
the blood stream via a vein. The child's mental powers are preserved, although he may be left with
weakness or paralysis of his lower limbs and lack of function and bladder control. The increasing
number of children being saved in this way is bound to increase the number of places required in
schools for the physically handicapped.
A considerable part of the child's time in a school for physically handicapped children is spent in
physiotherapy and training in the use of aids to walking and movement, and preserving or increasing
the power to use groups of muscles. Apart from those with spina bifida, children suffering from cerebral
palsy, in all its varied forms, muscular dystrophy and polio paralysis—now, happily, becoming a
rarity—all need close and expert supervision of medical and teaching personnel.
Since the classes are small by comparison with ordinary schools, the teachers are able to devote
more time to individuals, and educational time is therefore not lost.
It is fortunate that there is a school for physically handicapped children in the borough, but the
indications are that the school will need to be expanded if we are to care for all the physically handicapped
children who will need special education in future.