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Epilepsy in children of school age
HEALTH
PUBLIC
SOCIETY OF MEDICAL OFFICERS OF HEALTH
APRIL, 1948
No. 7. Vol. LXI.
CONTENTS PAGE
PAGI~
CORRESPONDENCE
EDITORIAL Epilepsy in Children of School Age A Stocktaking in American Public Health ............ T h e N u r s i n g Working Party's Report . . . . . . . . . . . . . . . . . . A " New Look " for Annual Reports . . . . . . . . . . . . . . . . . . Bronchial Carcinoma . . . . . . . . . . . . . . . . . . . . . . . . .
.
.
.
.
.
.
.
.
.
.
.
.
.
121 121 122 122 123
Nfinistty of Education Circular 146 (R. G a m l i n )
SPECIAL ARI"ICkES
REPORTS Policy in Dealing with Blind and Partially Sighted Persons
123 129 132 134
NEWS A N D
135
135
OBITUARY J. J. Clarke, L.R.C.P.I., L.B.A., D,P.H . . . . . . . . . . . . . . . . . . .
THE SOCIETY Mental Health in Relation to the Family. By C. O. Stallybrass, M.D,, D.P.H. Mental Subnormality in the Community. By D. H. H. Thomas, E.se., •VLR.e.S,, D.p./U . . . . . . . . . . . . . . . . . . Health at a World Jamboree. By"D. D. Payne~ M.D., D.P.I-I. . . . Observations Submitted by the Society on the Report of the Working Party .on Recruitment and T r a l n i n e of Nurses . . . . . . . . . . . . . . .
. . . . . . . . . . . .
136
OF MEDICAL OFFICERS OF HEALTH
Eastern Branch: Care of Premature Babies . . . . . . . . . ...... Home Counties B r a n c h : Relationship of a Large Hospital to the District Local Health Services . . . . . . . . . . . . . . . . . . . . . . . . Northern Branch . . . . . . . . . . . . . . . . . . . . . . . . . . . North-Western B r a n c h : Some Implications of Social Medicine Welsh Branch: After-history of Juvenile Rheumatism, and Chronic Rheumatism ... . . . . . . . . . . . . . . . . . . . . . . . . . . . Yorkshire Branch . . . . . . . . . . . . Maternity and Chiid" Wel'fare G r o u p : Replenishing of L o n d o n ' s " H e a l t i ~ Services, with Special Reference to Child Health . . . . . . . . . . . . Maternity and ChiId WeIfare G r o u p : Week-end Refresher Course, June 26th mad 27th . . . . . . . . . . . . . . . . . . . . . . . . . . .
136 136 137 137 138 138 139
viii
conference it was difficult to get a certain local education authority to realise the needs of the sub-normal epileptic in their suggestions for the establishment of a residential special Dr. P. Henderson of the Ministry of Education has m~d'e a school for epileptics. It is to be hoped tha.t, in planning for timely contribution to the study of the incidence of epilepsy the more generous provision for epileptics, committees will not in children in the Lancet of March 20th (1948, 1, 455). In look for invariably-go0d~'esuitsl Tl~elr duty is to give each a school population amounting to 1,700,000 school children child some sort of chance. If they fail to do this they are not (about one-third of the total school population of England and fulfilling either the letter or the spirit of the Education Act Wales) in various parts of the country speciaI information and the Regulations. Whole-hearted support can be given to Dr. Henderson's was secured through school medical officers and may be taken as a reliable index of the state of affairs throughout the country recommendations summarised towards the end of the article, as a whole. Of the 1,700,000 children surveyed, 519, or 0.3 but another plea may be a d d e d - t h a t is, for more accurate per 1,000 school population, were considered to be in need diagnosis. Kinnier Wilson wrote of " The Epilepsies " and insisted that " No such disease as epilepsy exists, or can exist. of special school education. T h i s figure is higher than the estimate of 0"2 per 1,000 given in the pamphlet of the Ministry In fact the epileptic fit is nothing else than a symptom." Much of the treatment of epilepsy nowadays is merely symptoon Special Educational Treatment, and is consiclerably higher than the present available special school accommodation matic, although many cases relieved of the symptoms lose (0'12 per 1,000). This information will be of great value their epilepsy or keep it under control. The epileptic personalto those L.E.A.s who in collaboration with adjacent areas are ity is awkward to deal with, but although epilepsy may someat present considering how they should fulfil the requirements times be associated with delinquency there is no evidence of unusual delinquency in epileptic children. A g a i n the danger of the Education Act and the Regulations. There is, however, more food for thought in the article than of epileptics to themselves or to others has been grossly this. Dr. Henderson pays high tribute to Manchester which exaggerated an.d~many epileptics may be encouraged to lead for 80 years has maintained a boarding school for epileptics a normal life without coming to any harm. By providing at Soss Moss. This authority has a high ascertainment rate suitable education for the epileptic child and an understanding (0"46 per 1,000), supporting the fact well known to experi- of the needs and after-care of the persistent epileptic adult enced S.M.O.s that the better the provision for certain types of the country will relieve their families of distressing problems Handicapped Pupils the more complete will be the ascertain- and will secure a place in industry for many who " are ment and indicating .that when such provision is lacking the known to be drifting about in the community in need of needs of a number of children will be overlooked. Again, medical a.cfvice or of help with their social problems " (Daiey). Dr. Henderson lightly observes that for m a n y years local The Society has recently been considering the dr_aft of a education authorities have found it increasingly difficult to memorandum on the subject of epilepsy in prepar£tion by the secure admission to special schools for children with an I.Q. of Ministry of Health and will give every support to any movement for a better understanding of our obligations to the less than 70. And yet the testing of an epileptic by the epileptic. ordinary intelligence tests is notoriously unsatisfactory. He may be ur~der the influence of ill-regulated medicaments; he may never have had regular education (and the most enthusi- A Stoektaking in, American Public Health astic supporters of mental testing cannot deny that such a child Sir Allen Daley, in his " Impressions of America " printed is badly handicapped by lack of schooling); he may come in our February issue, referred to the feast of oratory at the from a family in which there is little interest in academic general session of the American Public Health Association's subiects; he has not been taught how to think and he finds 75th annual meeting when the subject was " The Heritage of it difficult to do so. For these and perhaps other reasons the ~ # ~ - - T h e Seed of the Future." The notable addresses score sheet Often shows a scatter which is inexplicable to u ~ ' { ~ d ~ . ~ o n that occasion have now been printed in a special and we know that the only way of ascertaining his caDabilit/~ ~ e n ~ ' @ 4 t to the January, 1948, number of the American is to try him at school. But no school will have him ff ~Ls , [ ~ , n a l ~ P u b l i c Health (vol. 88, No. 1) with the general title examiner fails to produce a sufficiently high I.Q. I n a rec~Mt ' P~lSt~ffjIealth in Midstream."
EDITORIAL Epilepsy in Children of Sehool Age
PUBLIC
SOCIETY OF MEDICAL OFFICERS OF HEALTH
APRIL, 1948
No. 7. Vol. LXI.
CONTENTS PAGE
PAGI~
CORRESPONDENCE
EDITORIAL Epilepsy in Children of School Age A Stocktaking in American Public Health ............ T h e N u r s i n g Working Party's Report . . . . . . . . . . . . . . . . . . A " New Look " for Annual Reports . . . . . . . . . . . . . . . . . . Bronchial Carcinoma . . . . . . . . . . . . . . . . . . . . . . . . .
.
.
.
.
.
.
.
.
.
.
.
.
.
121 121 122 122 123
Nfinistty of Education Circular 146 (R. G a m l i n )
SPECIAL ARI"ICkES
REPORTS Policy in Dealing with Blind and Partially Sighted Persons
123 129 132 134
NEWS A N D
135
135
OBITUARY J. J. Clarke, L.R.C.P.I., L.B.A., D,P.H . . . . . . . . . . . . . . . . . . .
THE SOCIETY Mental Health in Relation to the Family. By C. O. Stallybrass, M.D,, D.P.H. Mental Subnormality in the Community. By D. H. H. Thomas, E.se., •VLR.e.S,, D.p./U . . . . . . . . . . . . . . . . . . Health at a World Jamboree. By"D. D. Payne~ M.D., D.P.I-I. . . . Observations Submitted by the Society on the Report of the Working Party .on Recruitment and T r a l n i n e of Nurses . . . . . . . . . . . . . . .
. . . . . . . . . . . .
136
OF MEDICAL OFFICERS OF HEALTH
Eastern Branch: Care of Premature Babies . . . . . . . . . ...... Home Counties B r a n c h : Relationship of a Large Hospital to the District Local Health Services . . . . . . . . . . . . . . . . . . . . . . . . Northern Branch . . . . . . . . . . . . . . . . . . . . . . . . . . . North-Western B r a n c h : Some Implications of Social Medicine Welsh Branch: After-history of Juvenile Rheumatism, and Chronic Rheumatism ... . . . . . . . . . . . . . . . . . . . . . . . . . . . Yorkshire Branch . . . . . . . . . . . . Maternity and Chiid" Wel'fare G r o u p : Replenishing of L o n d o n ' s " H e a l t i ~ Services, with Special Reference to Child Health . . . . . . . . . . . . Maternity and ChiId WeIfare G r o u p : Week-end Refresher Course, June 26th mad 27th . . . . . . . . . . . . . . . . . . . . . . . . . . .
136 136 137 137 138 138 139
viii
conference it was difficult to get a certain local education authority to realise the needs of the sub-normal epileptic in their suggestions for the establishment of a residential special Dr. P. Henderson of the Ministry of Education has m~d'e a school for epileptics. It is to be hoped tha.t, in planning for timely contribution to the study of the incidence of epilepsy the more generous provision for epileptics, committees will not in children in the Lancet of March 20th (1948, 1, 455). In look for invariably-go0d~'esuitsl Tl~elr duty is to give each a school population amounting to 1,700,000 school children child some sort of chance. If they fail to do this they are not (about one-third of the total school population of England and fulfilling either the letter or the spirit of the Education Act Wales) in various parts of the country speciaI information and the Regulations. Whole-hearted support can be given to Dr. Henderson's was secured through school medical officers and may be taken as a reliable index of the state of affairs throughout the country recommendations summarised towards the end of the article, as a whole. Of the 1,700,000 children surveyed, 519, or 0.3 but another plea may be a d d e d - t h a t is, for more accurate per 1,000 school population, were considered to be in need diagnosis. Kinnier Wilson wrote of " The Epilepsies " and insisted that " No such disease as epilepsy exists, or can exist. of special school education. T h i s figure is higher than the estimate of 0"2 per 1,000 given in the pamphlet of the Ministry In fact the epileptic fit is nothing else than a symptom." Much of the treatment of epilepsy nowadays is merely symptoon Special Educational Treatment, and is consiclerably higher than the present available special school accommodation matic, although many cases relieved of the symptoms lose (0'12 per 1,000). This information will be of great value their epilepsy or keep it under control. The epileptic personalto those L.E.A.s who in collaboration with adjacent areas are ity is awkward to deal with, but although epilepsy may someat present considering how they should fulfil the requirements times be associated with delinquency there is no evidence of unusual delinquency in epileptic children. A g a i n the danger of the Education Act and the Regulations. There is, however, more food for thought in the article than of epileptics to themselves or to others has been grossly this. Dr. Henderson pays high tribute to Manchester which exaggerated an.d~many epileptics may be encouraged to lead for 80 years has maintained a boarding school for epileptics a normal life without coming to any harm. By providing at Soss Moss. This authority has a high ascertainment rate suitable education for the epileptic child and an understanding (0"46 per 1,000), supporting the fact well known to experi- of the needs and after-care of the persistent epileptic adult enced S.M.O.s that the better the provision for certain types of the country will relieve their families of distressing problems Handicapped Pupils the more complete will be the ascertain- and will secure a place in industry for many who " are ment and indicating .that when such provision is lacking the known to be drifting about in the community in need of needs of a number of children will be overlooked. Again, medical a.cfvice or of help with their social problems " (Daiey). Dr. Henderson lightly observes that for m a n y years local The Society has recently been considering the dr_aft of a education authorities have found it increasingly difficult to memorandum on the subject of epilepsy in prepar£tion by the secure admission to special schools for children with an I.Q. of Ministry of Health and will give every support to any movement for a better understanding of our obligations to the less than 70. And yet the testing of an epileptic by the epileptic. ordinary intelligence tests is notoriously unsatisfactory. He may be ur~der the influence of ill-regulated medicaments; he may never have had regular education (and the most enthusi- A Stoektaking in, American Public Health astic supporters of mental testing cannot deny that such a child Sir Allen Daley, in his " Impressions of America " printed is badly handicapped by lack of schooling); he may come in our February issue, referred to the feast of oratory at the from a family in which there is little interest in academic general session of the American Public Health Association's subiects; he has not been taught how to think and he finds 75th annual meeting when the subject was " The Heritage of it difficult to do so. For these and perhaps other reasons the ~ # ~ - - T h e Seed of the Future." The notable addresses score sheet Often shows a scatter which is inexplicable to u ~ ' { ~ d ~ . ~ o n that occasion have now been printed in a special and we know that the only way of ascertaining his caDabilit/~ ~ e n ~ ' @ 4 t to the January, 1948, number of the American is to try him at school. But no school will have him ff ~Ls , [ ~ , n a l ~ P u b l i c Health (vol. 88, No. 1) with the general title examiner fails to produce a sufficiently high I.Q. I n a rec~Mt ' P~lSt~ffjIealth in Midstream."
EDITORIAL Epilepsy in Children of Sehool Age