- Email: [email protected]
EDUCATING DEAF CHILDREN IN ORDINARY SCHOOLS
40
claiming a high rate of fetal loss among normal pregnancies due to the screening process.
stantiated reports
Departments of Medical Genetics, and Pathology, Royal Hospital for Sick Children, Glasgow G3 8SJ
M. A. FERGUSON-SMITH A. A. M. GIBSON
Department of Midwifery, Yorkhill and Associated Hospitals,
Glasgow
C. R. WHITFIELD
Radioimmunoassay Unit, Biochemistry Department, Royal Infirmary, Glasgow
J. G. RATCLIFFE
SIR,-The U.K. Collaborative Study’ stated that over 90% of infants with neural-tube defects are born to women who have not previously had affected children. This is being misinterpreted-for example, by Dr Chamberlain (Dec. 16, p. 1293)-as "some 10% of these [N.T.D.] births would have occurred in previously affected families who would be offered amniocentesis in the absence of a serum screening pro-
gramme". The proportion of index patients who, in large series, had a previously affected sib was for a very high incidence area 6%2 and in a low-incidence area 4%.3 It is better, therefore, to take 5% rather than 10% as the proportion of cases of spina bifida and anencephaly who will have had a previously affected sib. M.R.C. Clinical Genetics Unit, Institute of Child Health, London WC1N 1EH
cited out of context from our paper on maternal serand spontaneous abortion.’ He did so for the first time in his letter of Nov. 4 and although we pointed out the error in your correspondence columns of Nov. 18 he has not corrected it. Contrary to Mr Bennett’s statements, in both his letter and article, we demonstrated that women with a high serum-A.F.p. level were more likely to have a spontaneous abortion than were women with normal A.F.P. levels.
again
um-A.F.p.
I.C.R.F. Cancer Epidemiology and Clinical Trials Unit, Department of Regius Professor of Medicine, Radcliffe Infirmary, Oxford OX2 6HE
NICHOLAS WALD SHEILA BARKER HOWARD CUCKLE
Department of Human Genetics, Western General Hospital,
Edinburgh
DAVID BROCK
Nuffield Department of Obstetrics and Gynæcology, John Radcliffe Hospital, Oxford
GORDON STIRRAT
EDUCATING DEAF CHILDREN IN ORDINARY SCHOOLS
SIR,—In the light of Dr Dale’s paper5 your readers might be interested in a system which specialises in educating deaf and partially hearing children individually in ordinary schools in Scotland. Since 1961 professional oversight has been available from the Gateside Centre in Paisley, offering to heads of schools, classroom teachers, and parents a peripatetic service of information and support by which profoundly deaf children receive their education in ordinary schools. Individual programmes in speech and linguistic skills are planned for each child and daily tuition is given in the hearing school by trained teachers of the deaf. These lessons, of an hour’s duration, are supplemented 1. U.K. Collaborative
Study
There
on
Alpha-fetoprotein
Defects. Lancet, 1977, i, 1323. 2. Carter, C. O., David, P. A., Lawrence, K. M. 3. Carter, C. O., Evans, K. ibid. 1973,10, 209. 4. Wald, N., Barker, S., Cuckle, H., Brock, D. Obstet. Gynœc. 1977, 84, 357. 5. Dale, D. M. C. Lancet, 1978, ii, 884.
in
J.
Relation
to
Neural Tube
med. Genet. 1968,
5, 81.
115 children in
our
programme, 37 of whom have
deafness. All decisions on the child’s management and future education are taken by a panel consisting of the principal psychologist, the senior clinical medical officer, the otolaryngologist, and the head teacher of the school for the deaf, in consultation with the parents and others (e.g., child psychiatrists, paediatricians, and social workers). At the Gateside Centre there is a parent guidance programme, a diagnostic unit, and a pre-school nursery. Parents’ workshops are held regularly in the evenings. Courses in hearing schools, for teachers, who have deaf children in their classes, take place during term time. Of the pupils who have left our educational establishment over the past five years 2 have university degrees, and 10 attended further education colleges passing examinations in subjects ranging from business studies through mathematics to English and catering. Some students passed these subjects at 0 or A level standard. The remainder completed their secondary school courses and have since, despite their hearing loss, gained employment suitable to their age, aptitude, and ability". As far as we know no former pupil is unemployed. Argyll & Clyde Health Board, Paisley PA1 1DU
J. MORAG MACARTHUR
Gateside Centre for the Deaf
M. BURTON
SCREENING AND CERVICAL CANCER
SIR,—Macgregor and Teper’ should not really state that screening for cervical cancer has been done "particularly so" in Scotland and then not explain why the impact on mortality "differs remarkably little between England and Wales, and Scotland". A difference of 2 or 3 cases in the Tayside and Grampian figures could have reversed Macgregor and Teper’s conclusions,2 and in any case it was pointed out in 19663 that mortality had been falling in England and Wales ever since 1948-long before screening was introduced. Screening has been much more intensive in British Columbia than in more populous Ontario and Quebec4 or in New Zealand,5 and more intensive in New Zealand (since 1954) than in England and Wales or in Scotland. Nevertheless, the incidence of cervical cancer in British Columbia for 1969-71 was greater than that in Ontario and Quebec4 or in New Zealand;5 and New Zealand incidence and mortality figures are no better than those for England and Wales and Scotland cited by Macgregor and Teper. A greater question mark against the validity of the claims made for screening lies in the increasing mortality now being seen in women of 20-34, the most heavily screened group, in England and Wales and in New Zealand.5It is not sufficient to refer vaguely to cervical cancer as a parallel to venereal disease, or to imply that there is plenty of time after an atypical smear before "microinvasion" is reached, as Macgregor and Teper have done. Until this discrepancy has been properly explained their claims for the benefits of screening must be regarded with some scepticism. Postgraduate School of Obstetrics and Gynæcology University of Auckland, National Women’s Hospital, Auckland 3, New Zealand
G. H. GREEN
SIR The argument on screening techniques is polarising between those who passionately believe in it as a fundamental of preventive medicine and those who think that the money could be spent in other areas of patient care. We do not see this 1.
Macgregor, E., Teper, S. Lancet, 1978, ii, 774. Crombie, I. K. ibid. p. 1084. 3. Hammond, E. C., Siedman, H. Archs envir. Hlth, 1966, 13, 105. 4. Walton Report Can. med. Ass. J. 1976, 114, 1003. 5. Green, G. H. Br. J. Obstet. Gynœc. (in the press).
2.
J. H., Stirrat, G. M. Br. J.
are
profound hearing impairment. All deaf children go into ordinary school at five years of age irrespective of the degree of
C. O. CARTER K. A. EVANS
SIR,—MR Bennett, in his joint article (Dec. 16, p. 1296), has
by visits to parents.
claiming a high rate of fetal loss among normal pregnancies due to the screening process.
stantiated reports
Departments of Medical Genetics, and Pathology, Royal Hospital for Sick Children, Glasgow G3 8SJ
M. A. FERGUSON-SMITH A. A. M. GIBSON
Department of Midwifery, Yorkhill and Associated Hospitals,
Glasgow
C. R. WHITFIELD
Radioimmunoassay Unit, Biochemistry Department, Royal Infirmary, Glasgow
J. G. RATCLIFFE
SIR,-The U.K. Collaborative Study’ stated that over 90% of infants with neural-tube defects are born to women who have not previously had affected children. This is being misinterpreted-for example, by Dr Chamberlain (Dec. 16, p. 1293)-as "some 10% of these [N.T.D.] births would have occurred in previously affected families who would be offered amniocentesis in the absence of a serum screening pro-
gramme". The proportion of index patients who, in large series, had a previously affected sib was for a very high incidence area 6%2 and in a low-incidence area 4%.3 It is better, therefore, to take 5% rather than 10% as the proportion of cases of spina bifida and anencephaly who will have had a previously affected sib. M.R.C. Clinical Genetics Unit, Institute of Child Health, London WC1N 1EH
cited out of context from our paper on maternal serand spontaneous abortion.’ He did so for the first time in his letter of Nov. 4 and although we pointed out the error in your correspondence columns of Nov. 18 he has not corrected it. Contrary to Mr Bennett’s statements, in both his letter and article, we demonstrated that women with a high serum-A.F.p. level were more likely to have a spontaneous abortion than were women with normal A.F.P. levels.
again
um-A.F.p.
I.C.R.F. Cancer Epidemiology and Clinical Trials Unit, Department of Regius Professor of Medicine, Radcliffe Infirmary, Oxford OX2 6HE
NICHOLAS WALD SHEILA BARKER HOWARD CUCKLE
Department of Human Genetics, Western General Hospital,
Edinburgh
DAVID BROCK
Nuffield Department of Obstetrics and Gynæcology, John Radcliffe Hospital, Oxford
GORDON STIRRAT
EDUCATING DEAF CHILDREN IN ORDINARY SCHOOLS
SIR,—In the light of Dr Dale’s paper5 your readers might be interested in a system which specialises in educating deaf and partially hearing children individually in ordinary schools in Scotland. Since 1961 professional oversight has been available from the Gateside Centre in Paisley, offering to heads of schools, classroom teachers, and parents a peripatetic service of information and support by which profoundly deaf children receive their education in ordinary schools. Individual programmes in speech and linguistic skills are planned for each child and daily tuition is given in the hearing school by trained teachers of the deaf. These lessons, of an hour’s duration, are supplemented 1. U.K. Collaborative
Study
There
on
Alpha-fetoprotein
Defects. Lancet, 1977, i, 1323. 2. Carter, C. O., David, P. A., Lawrence, K. M. 3. Carter, C. O., Evans, K. ibid. 1973,10, 209. 4. Wald, N., Barker, S., Cuckle, H., Brock, D. Obstet. Gynœc. 1977, 84, 357. 5. Dale, D. M. C. Lancet, 1978, ii, 884.
in
J.
Relation
to
Neural Tube
med. Genet. 1968,
5, 81.
115 children in
our
programme, 37 of whom have
deafness. All decisions on the child’s management and future education are taken by a panel consisting of the principal psychologist, the senior clinical medical officer, the otolaryngologist, and the head teacher of the school for the deaf, in consultation with the parents and others (e.g., child psychiatrists, paediatricians, and social workers). At the Gateside Centre there is a parent guidance programme, a diagnostic unit, and a pre-school nursery. Parents’ workshops are held regularly in the evenings. Courses in hearing schools, for teachers, who have deaf children in their classes, take place during term time. Of the pupils who have left our educational establishment over the past five years 2 have university degrees, and 10 attended further education colleges passing examinations in subjects ranging from business studies through mathematics to English and catering. Some students passed these subjects at 0 or A level standard. The remainder completed their secondary school courses and have since, despite their hearing loss, gained employment suitable to their age, aptitude, and ability". As far as we know no former pupil is unemployed. Argyll & Clyde Health Board, Paisley PA1 1DU
J. MORAG MACARTHUR
Gateside Centre for the Deaf
M. BURTON
SCREENING AND CERVICAL CANCER
SIR,—Macgregor and Teper’ should not really state that screening for cervical cancer has been done "particularly so" in Scotland and then not explain why the impact on mortality "differs remarkably little between England and Wales, and Scotland". A difference of 2 or 3 cases in the Tayside and Grampian figures could have reversed Macgregor and Teper’s conclusions,2 and in any case it was pointed out in 19663 that mortality had been falling in England and Wales ever since 1948-long before screening was introduced. Screening has been much more intensive in British Columbia than in more populous Ontario and Quebec4 or in New Zealand,5 and more intensive in New Zealand (since 1954) than in England and Wales or in Scotland. Nevertheless, the incidence of cervical cancer in British Columbia for 1969-71 was greater than that in Ontario and Quebec4 or in New Zealand;5 and New Zealand incidence and mortality figures are no better than those for England and Wales and Scotland cited by Macgregor and Teper. A greater question mark against the validity of the claims made for screening lies in the increasing mortality now being seen in women of 20-34, the most heavily screened group, in England and Wales and in New Zealand.5It is not sufficient to refer vaguely to cervical cancer as a parallel to venereal disease, or to imply that there is plenty of time after an atypical smear before "microinvasion" is reached, as Macgregor and Teper have done. Until this discrepancy has been properly explained their claims for the benefits of screening must be regarded with some scepticism. Postgraduate School of Obstetrics and Gynæcology University of Auckland, National Women’s Hospital, Auckland 3, New Zealand
G. H. GREEN
SIR The argument on screening techniques is polarising between those who passionately believe in it as a fundamental of preventive medicine and those who think that the money could be spent in other areas of patient care. We do not see this 1.
Macgregor, E., Teper, S. Lancet, 1978, ii, 774. Crombie, I. K. ibid. p. 1084. 3. Hammond, E. C., Siedman, H. Archs envir. Hlth, 1966, 13, 105. 4. Walton Report Can. med. Ass. J. 1976, 114, 1003. 5. Green, G. H. Br. J. Obstet. Gynœc. (in the press).
2.
J. H., Stirrat, G. M. Br. J.
are
profound hearing impairment. All deaf children go into ordinary school at five years of age irrespective of the degree of
C. O. CARTER K. A. EVANS
SIR,—MR Bennett, in his joint article (Dec. 16, p. 1296), has
by visits to parents.