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spine) in early adolescence, usually associated with some underlying disease. In its early and
treatable stages it can be discovered by careful examination and hence the need for all children
to be examined thoroughly at appropriate stages throughout their school career. Defects of the
feet rank fairly high in the proportion of all defects, being 6.4% in 1970. The majority of children
with these conditions have "flat feet" (flattening of the longitudinal arch), hallux valgus (big toe
is drawn over to the midline of the foot often over-riding the second and third toes). The former
is seen in all groups of pupils and can be remedied fairly easily with exercises and the help of the
physical education specialist is sought in school. The second condition is seen very frequently in
senior girls and represents the result of ill-fitting and unsuitable shoes. Fashion frequently dictates
the choice of clothing especially footwear, but fashion does not always consider the suitability
of the foot to fit its cover. Hence socks or stockings which are too small and shoes which tend
to mould the foot into their shape ruin many children's feet. Defective feet can produce a great
deal of misery now and in the future. It is very important that from the toddler stage onwards the
fitting of shoes should be made by appropriately trained staff and the use of inexperienced assistants
on a busy Saturday afternoon is to be deprecated. Time, care and moderate expense is necessary
to secure defect-free feet into old age.
DISEASES OF THE NERVOUS SYSTEM
These continue to be small in number accounting for nearly 0.5% of the total defects. Epilepsy
is the commonest condition usually of very mild character and allowing the child to be taught
in a normal environment under suitable therapy. These children do not as a rule present any great
problem to the teacher especially where he is aware of the condition, but every parent whose
child is liable to have fits, however minor, should take the headteacher and school doctor into his
confidence in order to prevent untoward episodes.
PSYCHOLOGICAL DEFECTS
The School Health Service is increasingly aware of psychological problems in school children
and this is reflected in the increasing number being referred for consultation to the Child Guidance
Clinic. Emotional difficulties can arise at any age but the chances of developing these increase
as the child approaches adolescence. Sometimes these difficulties are associated with environmental
circumstances and these may be altered by the various agencies to the child's advantage,
i.e. special classes or school or residential treatment in special school. Occasionally, however,
one is presented with a personality change derived from a mental illness of such severity that
immediate transfer to a psychiatric hospital is necessary for the child's security and treatment.
Here the position is little better than it was 5 years ago. The provision of hospital beds for acutely
mentally ill children is practically non-existent in the immediate neighbourhood of this Borough.
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