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THE EPILEPTIC CHILD
140
THE
of Obstetricians and in 1929 and one of founded Gynaecologists its objects was to improve the standard of midwifery among general practitioners who wish to hold obstetric appointments in maternity hospitals, whether under voluntary or municipal management, and to act locally as obstetric consultants. The original intention of the college was to elect to its membership only those definitely established as consultants in obstetrics and to institute a diploma for the younger body of men, who desired some form of recognition. But as it was not found possible at that time to frame a diploma the membership was widened to include those who had held resident appointments in obstetrics and gynaecology, were prepared to submit records and commentaries of their cases, and to undergo an hour’s oral and clinical examination. Now, after over three years’ experience gained by the examination committee, the college has again been impressed with the fact that the present
British
of students in obstetrics is insufficient to fit them for responsible work in maternity services, and has decided to award a diploma to registered medical practitioners who have had special postgraduate training and experience in the subject and satisfy the examiners appointed by the college. The regulations for this diploma, which carries the letters D.C.O.G., are set out on p. 158 of our present issue. The membership of the college, being intended for those aspiring to special practice in obstetrics and gynaecology, demands a larger and wider experience than is possible for those entering family practice. Many candidates for the membership have, we understand, suffered rejection because they had insufficient training and experience, and for many of them it may be impossible, at the stage of their career which they have reached, to undergo further training and to hold further resident posts. They will however be suitable candidates for the diploma, and a special consideration is shown to those who have been engaged in practice for at least ten years.
training
THE D.C.O.G.
College
was
ANNOTATIONS THE EPILEPTIC CHILD
FOR financial reasons no new places are being in special schools at present. This makes it very desirable that the places should be used to the best advantage, and in a recent annual reportSir George Newman discusses the application of this principle to residential schools for epilepsy. The intelligence of epileptic children varies within wide limits, the social outlook for the lower grades being very poor. Imbecile children are by law excluded from certified schools for epileptics, but a recent review of the 605 children in the existing residential schools leads the chief medical officer to believe that something like 10 per cent. should be classified as ineducable, and a further 20 per cent. as feebleminded but educable. Both these groups will, or should, come under the segis of the Board of Control at the age of 16, if not earlier ; and if their places at special schools were occupied by children of more intelligence, the nation would be getting better value for its money. As a move in this direction Sir George Newman asks for the discharge of any children who are not benefiting by the instruction provided. This is taken to mean all cases with intelligence quotients of 50 or less, and some with quotients up to 55 or even 60. Then he would like a periodic review made of the remaining children, so that those whose intelligence is at a standstill or deteriorating The probationary period may not be overlooked. for feeble-minded children of doubtful educability should not exceed a year. And finally both school authorities and medical officers should select cases for admission with greater care. These suggestions will, we think, meet with general approval provided that something is done for the lower-grade children who are discharged or refused admission. The Education Acts evidently intend that the schools shall provide for all epileptic children above the grade of imbecile. If those below it are outside the purview of education authorities, they must be not merely notified to the Board of Control but dealt with adequately by local authorities under
provided
1 The Health of the School Child. Office. 1933.
Chap. VI.
H.M. Stat.
the Mental Deficiency Acts. In most cases supervision will not be enough ; institutional care will be required. Low-grade children, with frequent epileptic fits, can seldom be properly cared for in an ordinary household, and their presence is often seriously detrimental to others. It is now very difficult to find places for these children in suitable institutions, and to follow out the new policy without regard to this need must bring hardship to many children and unhappiness to many homes. A further proviso is that local education authorities will make greater efforts than heretofore to send brighter epileptic children to the residential schools. It would be foolish to empty the schools at the bottom without taking steps to ensure that they will be filled at the top. It is for school medical officers to make strong representations to authorities and parents-in suitable cases; upon them will depend the success or failure of the new policy. One statement in the report calls for criticism. The advantage of early admission is stressed, and the suggestion made that while there are waiting-lists no child should be admitted who is over 13. But, the this is hard on and view, surely boys long taking girls of good intelligence who develop epilepsy late in school life. These are precisely the cases which will get the most benefit out of institutional treatment. From the point of view both of the disease itself and of the mental condition the outlook for them is better than that for children whose epilepsy starts earlier in life. In other words they will get the best value out of the training as well as the treatment, and it seems hardly fair to handicap them because the complaint was inconsiderate enough not to appear earlier. THE USE OF SEDATIVE DRUGS BY MIDWIVES THE Central Midwives Board and the General Medical Council are exchanging views about the proposed new rule for the guidance of the midwife in her work. The original draft has been modified by the C.M.B. in the hope of meeting general acceptance, and the rule now runs : "A midwife must not on her own responsibility use any drug unless in the course of her obstetric training, whether
THE
of Obstetricians and in 1929 and one of founded Gynaecologists its objects was to improve the standard of midwifery among general practitioners who wish to hold obstetric appointments in maternity hospitals, whether under voluntary or municipal management, and to act locally as obstetric consultants. The original intention of the college was to elect to its membership only those definitely established as consultants in obstetrics and to institute a diploma for the younger body of men, who desired some form of recognition. But as it was not found possible at that time to frame a diploma the membership was widened to include those who had held resident appointments in obstetrics and gynaecology, were prepared to submit records and commentaries of their cases, and to undergo an hour’s oral and clinical examination. Now, after over three years’ experience gained by the examination committee, the college has again been impressed with the fact that the present
British
of students in obstetrics is insufficient to fit them for responsible work in maternity services, and has decided to award a diploma to registered medical practitioners who have had special postgraduate training and experience in the subject and satisfy the examiners appointed by the college. The regulations for this diploma, which carries the letters D.C.O.G., are set out on p. 158 of our present issue. The membership of the college, being intended for those aspiring to special practice in obstetrics and gynaecology, demands a larger and wider experience than is possible for those entering family practice. Many candidates for the membership have, we understand, suffered rejection because they had insufficient training and experience, and for many of them it may be impossible, at the stage of their career which they have reached, to undergo further training and to hold further resident posts. They will however be suitable candidates for the diploma, and a special consideration is shown to those who have been engaged in practice for at least ten years.
training
THE D.C.O.G.
College
was
ANNOTATIONS THE EPILEPTIC CHILD
FOR financial reasons no new places are being in special schools at present. This makes it very desirable that the places should be used to the best advantage, and in a recent annual reportSir George Newman discusses the application of this principle to residential schools for epilepsy. The intelligence of epileptic children varies within wide limits, the social outlook for the lower grades being very poor. Imbecile children are by law excluded from certified schools for epileptics, but a recent review of the 605 children in the existing residential schools leads the chief medical officer to believe that something like 10 per cent. should be classified as ineducable, and a further 20 per cent. as feebleminded but educable. Both these groups will, or should, come under the segis of the Board of Control at the age of 16, if not earlier ; and if their places at special schools were occupied by children of more intelligence, the nation would be getting better value for its money. As a move in this direction Sir George Newman asks for the discharge of any children who are not benefiting by the instruction provided. This is taken to mean all cases with intelligence quotients of 50 or less, and some with quotients up to 55 or even 60. Then he would like a periodic review made of the remaining children, so that those whose intelligence is at a standstill or deteriorating The probationary period may not be overlooked. for feeble-minded children of doubtful educability should not exceed a year. And finally both school authorities and medical officers should select cases for admission with greater care. These suggestions will, we think, meet with general approval provided that something is done for the lower-grade children who are discharged or refused admission. The Education Acts evidently intend that the schools shall provide for all epileptic children above the grade of imbecile. If those below it are outside the purview of education authorities, they must be not merely notified to the Board of Control but dealt with adequately by local authorities under
provided
1 The Health of the School Child. Office. 1933.
Chap. VI.
H.M. Stat.
the Mental Deficiency Acts. In most cases supervision will not be enough ; institutional care will be required. Low-grade children, with frequent epileptic fits, can seldom be properly cared for in an ordinary household, and their presence is often seriously detrimental to others. It is now very difficult to find places for these children in suitable institutions, and to follow out the new policy without regard to this need must bring hardship to many children and unhappiness to many homes. A further proviso is that local education authorities will make greater efforts than heretofore to send brighter epileptic children to the residential schools. It would be foolish to empty the schools at the bottom without taking steps to ensure that they will be filled at the top. It is for school medical officers to make strong representations to authorities and parents-in suitable cases; upon them will depend the success or failure of the new policy. One statement in the report calls for criticism. The advantage of early admission is stressed, and the suggestion made that while there are waiting-lists no child should be admitted who is over 13. But, the this is hard on and view, surely boys long taking girls of good intelligence who develop epilepsy late in school life. These are precisely the cases which will get the most benefit out of institutional treatment. From the point of view both of the disease itself and of the mental condition the outlook for them is better than that for children whose epilepsy starts earlier in life. In other words they will get the best value out of the training as well as the treatment, and it seems hardly fair to handicap them because the complaint was inconsiderate enough not to appear earlier. THE USE OF SEDATIVE DRUGS BY MIDWIVES THE Central Midwives Board and the General Medical Council are exchanging views about the proposed new rule for the guidance of the midwife in her work. The original draft has been modified by the C.M.B. in the hope of meeting general acceptance, and the rule now runs : "A midwife must not on her own responsibility use any drug unless in the course of her obstetric training, whether