Start
nshd_54_iwm
STRICTLY CONFIDENTIAL
OCTOBER 1954
SCHOOL NURSE'S INTERVIEW WITH MOTHER
NATIONAL SURVEY OF THE HEALTH AND DEVELOPMENT OF CHILDREN
INSTITUTE OF CHILD HEALTH (UNIVERSITY OF LONDON)
SOCIETY OF MEDICAL OFFICERS OF HEALTH and
POPULATION INVESTIGATION COMMITTEE
At the LONDON SCHOOL OF ECONOMICS

Ref. No.

Generic text

Name

Generic text

Address

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School

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FOR THOSE WHO HAVE MOVED

New Address

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L.E.A.

Generic text

School

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IF THE FAMILY HAS MOVED TO ANOTHER AUTHORITY PLEASE ENTER THE NEW ADDRESS AND THE NAMES OF THE NEW L.E.A. AND NEW SCHOOL IN THE SPACE PROVIDED. IF THE CHILD CANNOT BE TRACED PLEASE ENTER THE LAST ADDRESS AND ANY OTHER INFORMATION THAT MIGHT HELP US TO TRACE HIM. IN EITHER CASE RETURN THE FORM TO WHOMEVER HAS BEEN DELEGATED BY THE SCHOOL MEDICAL OFFICER TO RECEIVE IT.
Approach to the Mother
Remind her that in previous years she gave us most valuable information about herself and her child. We now want to find out what progress her child has made during the last year. All information she gives will, of course, be ABSOLUTELY CONFIDENTIAL.
Purpose of this inquiry
This child was enrolled at birth in a national survey which is being made by a Joint Committee of the Institute of Child Health, the Society of Medical Officers of Health and the Population Investigation Committee. The purpose of the present examination is to bring the medical and social history up to date, to obtain further information about the school absences, and to check information previously noted.
They are drawn from all social classes and during the first eight years of their lives only 8% of the original sample have been lost. The value of this inquiry depends on information being obtained for every possible survey child. The Joint Committee are therefore most anxious that this form should be completed.
How to fill in this form.
Five thousand Mothers scattered all over the country are being interviewed, and it is therefore important that the many hundreds of Health Visitors and School Nurses who are seeing them should record their findings in a comparable way. For this reason, and also to reduce the amount of clerical work, this form has been framed as a series of questions, many of which can be answered by one of several printed alternatives. All that is required is to put a circle round the number opposite the printed answer that most nearly describes your findings. If no alternative fits please write the answer in the space directly under the question. Similarly, if you feel that any printed answer, though applicable, does not fully explain your findings, we should be most grateful for any further information you can give us.
In order to ensure that this information is obtained in the same way by the many people taking part in the survey, it is important that the wording and order of this form should be adhered to.
COMPLETED FORMS SHOULD BE RETURNED TO THE SCHOOL MEDICAL OFFICER AND NOT DIRECTLY TO THE JOINT COMMITTEE.
RING THE CODE NUMBER OPPOSITE THE MOTHER'S ANSWER. IF NO ANSWER IS GIVEN, OR IF A QUESTION DOES NOT APPLY, STRIKE IT THROUGH.

Person interviewed.

1
Mother
*
Other, namely
Other

If mother not interviewed because she was ill, refused, etc., please give reasons.

Generic text
If this child has died, please state.

Date of death

Date of death

Cause of death (if known)

Generic text
(For all living children)

Where is this child now living ?

1
At home
2
With relatives
3
Adopted
4
Residential nursery
5
Ill in hospital
*
Elsewhere, namely
Other
I. ACCIDENTS

Last accident recorded. Type

Generic text

Last accident recorded. Age when injured ... yrs.

Age
(Since this accident, or since SEPTEMBER, 1953)

Has this child had an accident in which he was BURNT or SCALDED, BROKE A BONE, or was BADLY CUT or BRUISED ?

1
Yes
0
No
(If "yes")
qc_4_b == 1
Please give the following details about each accident starting with the earliest :
Type of injury (enter as BURN, SCALD, BROKEN BONE, CUT, etc.) Part or Parts injured Age when injured (in years and months) Treatment, Hosp. I.P., Hosp. O.P., Nursing Home, Own Home If treated in own home, who gave treatment (Doctor, Nurse, other) Details of any remaining scarring, disability or deformity
Generic textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric text Generic textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric text Generic textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric text Generic textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric text Generic textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric text Generic textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric text
First Accident: 1
Second: 2
Please give the following details about each accident starting with the earliest :
DETAILS of how each ACCIDENT OCCURRED (if burnt by fire, say whether electric, gas, open fire or stove) WHERE IT OCCURRED (Own Home, School, Street, etc.)
Generic textGeneric textGeneric textGeneric text Generic textGeneric textGeneric textGeneric text
First Accident: 1
Second: 2
II. INFECTIOUS DISEASES
Please give the following information about any attacks of WHOOPING COUGH, MEASLES, MUMPS or SCARLET FEVER this child has had since SEPTEMBER 1953.
Age at onset (years and months) Where treated Hosp. IP Hosp. OP Nursing Home Own Home If treated in own home who gave treatment ? (Doctor, Nurse, other)
Generic textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric text Generic textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric text Generic textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric text
Whooping Cough
Measles
Mumps
Scarlet Fever
(Attacks recorded in previous surveys are given in red.)
(For all those who have had whooping cough)
qc_5_a$1;1 != NULL

Was there any doubt that it was whooping cough ?

0
Doubtful
1
Certain

How long did the whooping cough last ? ... weeks

How many

Details of complications, if any

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III. ADMISSIONS TO HOSPITAL

Details of last Hospital Admission Recorded in this Survey. Illness

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Details of last Hospital Admission Recorded in this Survey. Hospital

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Details of last Hospital Admission Recorded in this Survey. Age

Age
(If nothing recorded there has been no admission before SEPTEMBER, 1953)

Has this child been an IN-PATIENT in a HOSPITAL or NURSING HOME since SEPTEMBER 1953 when he was 7 years 6 months old?

1
Yes
0
No
x
No answer
(If "yes")
qc_6_b == 1
Please give the following details about each admission:
Nature of illness Nature of operation performed (if any) Date of Admission
Generic textGeneric textGeneric dateGeneric textGeneric textGeneric dateGeneric textGeneric dateGeneric text Generic textGeneric textGeneric dateGeneric textGeneric textGeneric dateGeneric textGeneric dateGeneric text Generic textGeneric textGeneric dateGeneric textGeneric textGeneric dateGeneric textGeneric dateGeneric text
1
2
Please give the following details about each admission:
Name and Address of Hospital or Nursing Home Length of stay in Hospital or Nursing Home Name of Doctor or Specialist in Charge of Child
Generic textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric text Generic textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric text Generic textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric text
1
2
IV. SCHOOL CLINIC AND OUT-PATIENT DEPARTMENT ATTENDANCES

Has this child attended a School Clinic or Out-Patient Department of a Hospital since SEPTEMBER, 1953 ?

1
Yes
0
No
(If "yes")
qc_7_a == 1

Name of hospital or clinic

Generic text

Address

Generic text
This child's clinic attendances up to September 1953 are recorded in red below. Can you please give us the following information about each one of these, and ALSO ABOUT ANY THAT HAVE TAKEN PLACE SINCE SEPTEMBER, 1953, INCLUDING THOSE RECORDED IN 7 (a) and 7 (b) opposite.
Name of School Clinic or Out-Patient Dept. Reason for attending Date of FIRST attendance (month and year) Date of LAST attendance (month and year) (if still attending strike through) Number of attendances Present condition

1 - cured

2 - improved

3 - unchanged

4 - worse

How manyGeneric textGeneric textGeneric dateGeneric dateHow manyGeneric textGeneric date

1 - cured

2 - improved

3 - unchanged

4 - worse

Generic textGeneric dateGeneric dateGeneric dateGeneric textGeneric text

1 - cured

2 - improved

3 - unchanged

4 - worse

How manyGeneric textHow manyGeneric textGeneric dateGeneric date

1 - cured

2 - improved

3 - unchanged

4 - worse

1 - cured

2 - improved

3 - unchanged

4 - worse

Generic dateHow manyGeneric textGeneric textGeneric dateGeneric textGeneric textGeneric dateGeneric dateHow many

1 - cured

2 - improved

3 - unchanged

4 - worse

1 - cured

2 - improved

3 - unchanged

4 - worse

How manyGeneric textGeneric textGeneric dateGeneric dateHow manyGeneric textGeneric date

1 - cured

2 - improved

3 - unchanged

4 - worse

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1 - cured

2 - improved

3 - unchanged

4 - worse

How manyGeneric textHow manyGeneric textGeneric dateGeneric date

1 - cured

2 - improved

3 - unchanged

4 - worse

1 - cured

2 - improved

3 - unchanged

4 - worse

Generic dateHow manyGeneric textGeneric textGeneric dateGeneric textGeneric textGeneric dateGeneric dateHow many

1 - cured

2 - improved

3 - unchanged

4 - worse

1 - cured

2 - improved

3 - unchanged

4 - worse

How manyGeneric textGeneric textGeneric dateGeneric dateHow manyGeneric textGeneric date

1 - cured

2 - improved

3 - unchanged

4 - worse

Generic textGeneric dateGeneric dateGeneric dateGeneric textGeneric text

1 - cured

2 - improved

3 - unchanged

4 - worse

How manyGeneric textHow manyGeneric textGeneric dateGeneric date

1 - cured

2 - improved

3 - unchanged

4 - worse

1 - cured

2 - improved

3 - unchanged

4 - worse

Generic dateHow manyGeneric textGeneric textGeneric dateGeneric textGeneric textGeneric dateGeneric dateHow many

1 - cured

2 - improved

3 - unchanged

4 - worse

1 - cured

2 - improved

3 - unchanged

4 - worse

How manyGeneric textGeneric textGeneric dateGeneric dateHow manyGeneric textGeneric date

1 - cured

2 - improved

3 - unchanged

4 - worse

Generic textGeneric dateGeneric dateGeneric dateGeneric textGeneric text

1 - cured

2 - improved

3 - unchanged

4 - worse

How manyGeneric textHow manyGeneric textGeneric dateGeneric date

1 - cured

2 - improved

3 - unchanged

4 - worse

1 - cured

2 - improved

3 - unchanged

4 - worse

Generic dateHow manyGeneric textGeneric textGeneric dateGeneric textGeneric textGeneric dateGeneric dateHow many

1 - cured

2 - improved

3 - unchanged

4 - worse

1 - cured

2 - improved

3 - unchanged

4 - worse

How manyGeneric textGeneric textGeneric dateGeneric dateHow manyGeneric textGeneric date

1 - cured

2 - improved

3 - unchanged

4 - worse

Generic textGeneric dateGeneric dateGeneric dateGeneric textGeneric text

1 - cured

2 - improved

3 - unchanged

4 - worse

How manyGeneric textHow manyGeneric textGeneric dateGeneric date

1 - cured

2 - improved

3 - unchanged

4 - worse

1 - cured

2 - improved

3 - unchanged

4 - worse

Generic dateHow manyGeneric textGeneric textGeneric dateGeneric textGeneric textGeneric dateGeneric dateHow many

1 - cured

2 - improved

3 - unchanged

4 - worse

1 - cured

2 - improved

3 - unchanged

4 - worse

How manyGeneric textGeneric textGeneric dateGeneric dateHow manyGeneric textGeneric date

1 - cured

2 - improved

3 - unchanged

4 - worse

Generic textGeneric dateGeneric dateGeneric dateGeneric textGeneric text

1 - cured

2 - improved

3 - unchanged

4 - worse

How manyGeneric textHow manyGeneric textGeneric dateGeneric date

1 - cured

2 - improved

3 - unchanged

4 - worse

1 - cured

2 - improved

3 - unchanged

4 - worse

Generic dateHow manyGeneric textGeneric textGeneric dateGeneric textGeneric textGeneric dateGeneric dateHow many

1 - cured

2 - improved

3 - unchanged

4 - worse

1
2
3
4
(If nothing recorded in red there has been no clinic attendance before SEPTEMBER 1953.)
V. SCHOOL ABSENCES
The school absence record for this child shows that he was away from school for more than one week on the following occasions during the last year. Could you give us further information about these absences which are recorded in red below :
Period of Absence: From Period of Absence: To Reason for Absence If child was ill: Where treated Hospital I.P. Hospital O.P. Nursing Home Own Home If child was ill: If treated at home who gave treatment Doctor Chemist Nurse/Other Remarks
Generic textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric text Generic textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric text Generic textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric text Generic textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric text Generic textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric text Generic textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric text
1
2
3
4
5
6
VI. BED WETTING

Is this child dry by night ?

0
Never wet
1
Wet occasionally
2
Wet several nights a week
3
Wet every night
(If "wet")
qc_10_a == 1 || qc_10_a == 2 || qc_10_a == 3

How are you trying to get him dry ?

Generic text
VII. GENERAL HEALTH AND BEHAVIOUR

Are you in any way worried about this child's health ?

1
Yes
0
No
(If "yes")
qc_11_a == 1

Please give your reasons for worrying

Generic text

Are you in any way worried about this child's behaviour.

1
Yes
0
No
(If "yes")
qc_12_a == 1

Please give your reasons for worrying

Generic text

Are you in any way worried about this child's progress at school ?

1
Yes
0
No
(If "yes")
qc_13_a == 1

Please give your reasons for worrying.

Generic text
VIII. SCHOOLING

Have you met this child's present class teacher or head teacher ?

1
Yes, class teacher
2
Yes, head teacher
3
Yes, both
0
Neither
(If "yes")
qc_14_a == 1 || qc_14_a == 2 || qc_14_a == 3

Did you ever discuss this child's school progress with either of them ?

1
Yes, with class teacher
2
Yes, with head teacher
3
Yes, with both
0
No

Does this child's school have a Parent-Teacher association ?

1
Yes
0
No
2
Don't know
(If "yes")
qc_15_a == 1

Do you or your husband belong to it ?

1
Yes
0
No
x
No answer

Have you a particular school in mind for this child when he reaches the age of 11 ?

1
Yes
0
No
(If "yes")
qc_16_a == 1

Please give the name of this school

Generic text

(School Nurse please say whether school mentioned is-

1
Grammar School
2
Secondary Modern
3
Technical
4
Fee Paying

What are your reasons for wishing this child to go to this school ?

Generic text
(If no particular school in mind)
qc_16_a == 0

Which of the following types of school would you prefer him to go to ?

1
Grammar
2
Secondary Modern
3
Technical
4
Fee Paying
x
Don't know

What are your reasons for wishing him to go to this type of school ?

Generic text
(Ask all who wish their child to go to a Grammar School)
qc_16_b_i == 1 || qc_16_d == 1

If this child failed to get a place in a Grammar School, would you send him to :

1
Secondary Modern
2
Technical
3
Fee Paying
4
Don't know
(Ask all who prefer other than Grammar School)
qc_16_b_i >= 2 && qc_16_b_i <= 4 || qc_16_d >= 2 && qc_16_d <= 4

If this child were offered a place in a Grammar School, would you accept it ?

1
Yes
0
No
2
Don't know
(If "no")
qc_17_b == 0

What are your reasons for not wishing him to go to a Grammar School ?

Generic text
Please give the following information about the schools now attended by this child's brothers and sisters.
Name of Child Age (yrs.) Name of School Type of School

1 - Primary

2 - Grammar

3 - Sec. Mod.

4 - Technical

5 - Fee Paying

AgeGeneric textGeneric textAgeGeneric textGeneric text

1 - Primary

2 - Grammar

3 - Sec. Mod.

4 - Technical

5 - Fee Paying

Generic textAgeGeneric text

1 - Primary

2 - Grammar

3 - Sec. Mod.

4 - Technical

5 - Fee Paying

Generic textAge

1 - Primary

2 - Grammar

3 - Sec. Mod.

4 - Technical

5 - Fee Paying

Generic text

1 - Primary

2 - Grammar

3 - Sec. Mod.

4 - Technical

5 - Fee Paying

AgeGeneric textGeneric textAgeGeneric textGeneric text

1 - Primary

2 - Grammar

3 - Sec. Mod.

4 - Technical

5 - Fee Paying

Generic textAgeGeneric text

1 - Primary

2 - Grammar

3 - Sec. Mod.

4 - Technical

5 - Fee Paying

Generic textAge

1 - Primary

2 - Grammar

3 - Sec. Mod.

4 - Technical

5 - Fee Paying

Generic text

1 - Primary

2 - Grammar

3 - Sec. Mod.

4 - Technical

5 - Fee Paying

AgeGeneric textGeneric textAgeGeneric textGeneric text

1 - Primary

2 - Grammar

3 - Sec. Mod.

4 - Technical

5 - Fee Paying

Generic textAgeGeneric text

1 - Primary

2 - Grammar

3 - Sec. Mod.

4 - Technical

5 - Fee Paying

Generic textAge

1 - Primary

2 - Grammar

3 - Sec. Mod.

4 - Technical

5 - Fee Paying

Generic text

1 - Primary

2 - Grammar

3 - Sec. Mod.

4 - Technical

5 - Fee Paying

AgeGeneric textGeneric textAgeGeneric textGeneric text

1 - Primary

2 - Grammar

3 - Sec. Mod.

4 - Technical

5 - Fee Paying

Generic textAgeGeneric text

1 - Primary

2 - Grammar

3 - Sec. Mod.

4 - Technical

5 - Fee Paying

Generic textAge

1 - Primary

2 - Grammar

3 - Sec. Mod.

4 - Technical

5 - Fee Paying

Generic text
1
2
3
Are any of your children now attending classes or taking courses at a night school, university, training college or correspondence college ?
Name of Child Age (yrs.) Type of course or college attending Type of course or college attending: Other, namely

1 - Night Technical or Commercial: Part Time

2 - Night Technical or Commercial: Full Time

3 - Teachers Training College

4 - University

* - Other, namely

AgeGeneric textOtherAgeGeneric textOther

1 - Night Technical or Commercial: Part Time

2 - Night Technical or Commercial: Full Time

3 - Teachers Training College

4 - University

* - Other, namely

Generic textAgeOther

1 - Night Technical or Commercial: Part Time

2 - Night Technical or Commercial: Full Time

3 - Teachers Training College

4 - University

* - Other, namely

OtherAge

1 - Night Technical or Commercial: Part Time

2 - Night Technical or Commercial: Full Time

3 - Teachers Training College

4 - University

* - Other, namely

Generic text

1 - Night Technical or Commercial: Part Time

2 - Night Technical or Commercial: Full Time

3 - Teachers Training College

4 - University

* - Other, namely

AgeGeneric textOtherAgeGeneric textOther

1 - Night Technical or Commercial: Part Time

2 - Night Technical or Commercial: Full Time

3 - Teachers Training College

4 - University

* - Other, namely

Generic textAgeOther

1 - Night Technical or Commercial: Part Time

2 - Night Technical or Commercial: Full Time

3 - Teachers Training College

4 - University

* - Other, namely

OtherAge

1 - Night Technical or Commercial: Part Time

2 - Night Technical or Commercial: Full Time

3 - Teachers Training College

4 - University

* - Other, namely

Generic text

1 - Night Technical or Commercial: Part Time

2 - Night Technical or Commercial: Full Time

3 - Teachers Training College

4 - University

* - Other, namely

AgeGeneric textOtherAgeGeneric textOther

1 - Night Technical or Commercial: Part Time

2 - Night Technical or Commercial: Full Time

3 - Teachers Training College

4 - University

* - Other, namely

Generic textAgeOther

1 - Night Technical or Commercial: Part Time

2 - Night Technical or Commercial: Full Time

3 - Teachers Training College

4 - University

* - Other, namely

OtherAge

1 - Night Technical or Commercial: Part Time

2 - Night Technical or Commercial: Full Time

3 - Teachers Training College

4 - University

* - Other, namely

Generic text

1 - Night Technical or Commercial: Part Time

2 - Night Technical or Commercial: Full Time

3 - Teachers Training College

4 - University

* - Other, namely

AgeGeneric textOtherAgeGeneric textOther

1 - Night Technical or Commercial: Part Time

2 - Night Technical or Commercial: Full Time

3 - Teachers Training College

4 - University

* - Other, namely

Generic textAgeOther

1 - Night Technical or Commercial: Part Time

2 - Night Technical or Commercial: Full Time

3 - Teachers Training College

4 - University

* - Other, namely

OtherAge

1 - Night Technical or Commercial: Part Time

2 - Night Technical or Commercial: Full Time

3 - Teachers Training College

4 - University

* - Other, namely

Generic text
1
2
IX. PLAY AND HOBBIES

Has this child any hobby or special interest ?

1
Yes
0
No
(If "yes")
qc_19_a == 1

What is it ?

Generic text

Does he belong to any club or organisation outside school ?

1
Yes
0
No
(If "yes")
qc_20_a == 1

What organisation(s) does he belong to ?

Generic text
X. THE DWELLING

Type of dwelling.

1
Whole house or bungalow
2
Self-contained flat
3
Tenement
4
Unfurnished rooms
5
Furnished rooms
*
Other, namely
Other

Ownership of dwelling.

1
Council
2
Parents of the child
3
Relative
*
Other, namely
Other

Approximate age of dwelling.

1
Built before 1919
2
Built 1919-1939
3
Built since 1939
XI. THE HOUSEHOLD
Parents and their children living in this household.
Christian Name Sex Age: Years Age: Months
AgeAge in monthsGeneric textGeneric textAge in monthsGeneric textGeneric textAgeGeneric textAge in monthsGeneric textAgeGeneric textAge in monthsAgeGeneric text AgeAge in monthsGeneric textGeneric textAge in monthsGeneric textGeneric textAgeGeneric textAge in monthsGeneric textAgeGeneric textAge in monthsAgeGeneric text AgeAge in monthsGeneric textGeneric textAge in monthsGeneric textGeneric textAgeGeneric textAge in monthsGeneric textAgeGeneric textAge in monthsAgeGeneric text AgeAge in monthsGeneric textGeneric textAge in monthsGeneric textGeneric textAgeGeneric textAge in monthsGeneric textAgeGeneric textAge in monthsAgeGeneric text
1
2
3
4
5
6
7
8
Other members of the household (lodgers, relatives, domestics, etc.)
Relationship to mother of this child (e.g., mother-in-law, sister, lodger, etc.) Sex Approximate age
Generic textAgeGeneric textGeneric textAgeGeneric textAgeGeneric textGeneric text Generic textAgeGeneric textGeneric textAgeGeneric textAgeGeneric textGeneric text Generic textAgeGeneric textGeneric textAgeGeneric textAgeGeneric textGeneric text
1
2
3

Total in household. ... persons

How many
Total rooms occupied by all the members of the household listed in 22 (a) and (b).
Bedrooms Living rooms (include kitchen only if used as a living room, exclude scullery): Own living rooms Living rooms (include kitchen only if used as a living room, exclude scullery): Living rooms shared with other households Total
How manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow many How manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow many How manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow many How manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow many
1

Does this child sleep in a room by himself or in a room with others ?

1
By himself
2
With others
(If "with others")
qc_25_a == 2

Who else sleeps in his room ? (Please give names and ages).

Generic text

Does he sleep in own bed or with others ? (If with others, please give names and ages).

0
Own bed
*
With others, namely
Other
XII. THE MOTHER'S WORK

Have you been in paid work (either inside or outside the home) since SEPTEMBER 1952 when this child was six years six months old ?

1
Yes
*
No
(If "yes")
qc_26_a == 1
Please give the following details of each period of employment.
Exact nature of work Approximate hours per week Date of taking job Date of leaving job
How manyGeneric textGeneric dateGeneric dateGeneric textGeneric dateGeneric dateHow manyGeneric dateGeneric textGeneric dateHow manyGeneric dateGeneric textHow manyGeneric date How manyGeneric textGeneric dateGeneric dateGeneric textGeneric dateGeneric dateHow manyGeneric dateGeneric textGeneric dateHow manyGeneric dateGeneric textHow manyGeneric date How manyGeneric textGeneric dateGeneric dateGeneric textGeneric dateGeneric dateHow manyGeneric dateGeneric textGeneric dateHow manyGeneric dateGeneric textHow manyGeneric date How manyGeneric textGeneric dateGeneric dateGeneric textGeneric dateGeneric dateHow manyGeneric dateGeneric textGeneric dateHow manyGeneric dateGeneric textHow manyGeneric date
1
2
3
(The last employment recorded in this survey is entered in red.)
XIII. SUBSEQUENT PREGNANCIES
Please give the following details for each pregnancy since September, 1952 :-
Date of delivery (mth. and yr.) Sex of child Birth weight (to nearest 1/4 lb.) Result of delivery (live birth, stillbirth or miscarriage) If not surviving please give age at death
Generic textBirth weightGeneric dateGeneric textGeneric textGeneric textGeneric textGeneric textGeneric dateBirth weightGeneric textBirth weightGeneric textGeneric textGeneric dateGeneric dateBirth weightGeneric textGeneric textGeneric textGeneric textGeneric textBirth weightGeneric dateGeneric text Generic textBirth weightGeneric dateGeneric textGeneric textGeneric textGeneric textGeneric textGeneric dateBirth weightGeneric textBirth weightGeneric textGeneric textGeneric dateGeneric dateBirth weightGeneric textGeneric textGeneric textGeneric textGeneric textBirth weightGeneric dateGeneric text Generic textBirth weightGeneric dateGeneric textGeneric textGeneric textGeneric textGeneric textGeneric dateBirth weightGeneric textBirth weightGeneric textGeneric textGeneric dateGeneric dateBirth weightGeneric textGeneric textGeneric textGeneric textGeneric textBirth weightGeneric dateGeneric text Generic textBirth weightGeneric dateGeneric textGeneric textGeneric textGeneric textGeneric textGeneric dateBirth weightGeneric textBirth weightGeneric textGeneric textGeneric dateGeneric dateBirth weightGeneric textGeneric textGeneric textGeneric textGeneric textBirth weightGeneric dateGeneric text Generic textBirth weightGeneric dateGeneric textGeneric textGeneric textGeneric textGeneric textGeneric dateBirth weightGeneric textBirth weightGeneric textGeneric textGeneric dateGeneric dateBirth weightGeneric textGeneric textGeneric textGeneric textGeneric textBirth weightGeneric dateGeneric text
1
2
3
(The date of the last confinement noted is entered in red.)
(If now pregnant)

Expected date of delivery

Generic date
XIV. FAMILY HISTORY
(School Nurse - these questions on family history are of the greatest importance in this inquiry, and we hope that the answers to all of them can be obtained.)

Date of (first) marriage.

Generic date

What was your own occupation before marriage ?

Generic text

What is your husband's occupation now ?

Generic text
(If unemployed, ill, dead, etc., this information should relate to the last job.)

In what industry does he work ?

Generic text

Does he-

p
Earn a weekly wage?
q
Earn a monthly salary ?
r
Work for himself or employ less than 10 people ?
s
Employ 10 or more people ?

Is your OWN father-

1
Working
2
Retired
3
Dead

In what industry does (or did) he work ?

Generic text

Does (or did) he-

a
Work for himself ?
b
Work for an employer ?

Is your HUSBAND'S father

1
Working
2
Retired
3
Dead

In what industry does (or did) he work ?

Generic text

Does (or did) he

a
Work for himself?
b
Work for an employer?
INFORMATION GIVEN BY SCHOOL NURSE OR HEALTH VISITOR
(Please answer the following questions from your own knowledge. DO NOT ask the mother directly.)

Does this family possess any of the following ?

1
Telephone
2
Car
3
Television
0
None of these

Please state from your OWN KNOWLEDGE whether the parents of this child are-

1
Married & living together
2
Legally separated
3
Divorced
4
Permanently separated for other reasons
5
Widowed
*
Other, namely
Other

QUERIES ARISING FROM EARLIER SURVEYS

Long text

Date of Interview

Generic date

Length of Interview ... mins.

How many

Name of School Nurse or Health Visitor

Generic text
End

nshd_54_iwm

STRICTLY CONFIDENTIAL
OCTOBER 1954
SCHOOL NURSE'S INTERVIEW WITH MOTHER
NATIONAL SURVEY OF THE HEALTH AND DEVELOPMENT OF CHILDREN
INSTITUTE OF CHILD HEALTH (UNIVERSITY OF LONDON)
SOCIETY OF MEDICAL OFFICERS OF HEALTH and
POPULATION INVESTIGATION COMMITTEE
At the LONDON SCHOOL OF ECONOMICS
Ref. No.
Generic text
Name
Generic text
Address
Generic text
School
Generic text

FOR THOSE WHO HAVE MOVED

New Address
Generic text
L.E.A.
Generic text
School
Generic text
IF THE FAMILY HAS MOVED TO ANOTHER AUTHORITY PLEASE ENTER THE NEW ADDRESS AND THE NAMES OF THE NEW L.E.A. AND NEW SCHOOL IN THE SPACE PROVIDED. IF THE CHILD CANNOT BE TRACED PLEASE ENTER THE LAST ADDRESS AND ANY OTHER INFORMATION THAT MIGHT HELP US TO TRACE HIM. IN EITHER CASE RETURN THE FORM TO WHOMEVER HAS BEEN DELEGATED BY THE SCHOOL MEDICAL OFFICER TO RECEIVE IT.
Approach to the Mother
Remind her that in previous years she gave us most valuable information about herself and her child. We now want to find out what progress her child has made during the last year. All information she gives will, of course, be ABSOLUTELY CONFIDENTIAL.
Purpose of this inquiry
This child was enrolled at birth in a national survey which is being made by a Joint Committee of the Institute of Child Health, the Society of Medical Officers of Health and the Population Investigation Committee. The purpose of the present examination is to bring the medical and social history up to date, to obtain further information about the school absences, and to check information previously noted.
They are drawn from all social classes and during the first eight years of their lives only 8% of the original sample have been lost. The value of this inquiry depends on information being obtained for every possible survey child. The Joint Committee are therefore most anxious that this form should be completed.
How to fill in this form.
Five thousand Mothers scattered all over the country are being interviewed, and it is therefore important that the many hundreds of Health Visitors and School Nurses who are seeing them should record their findings in a comparable way. For this reason, and also to reduce the amount of clerical work, this form has been framed as a series of questions, many of which can be answered by one of several printed alternatives. All that is required is to put a circle round the number opposite the printed answer that most nearly describes your findings. If no alternative fits please write the answer in the space directly under the question. Similarly, if you feel that any printed answer, though applicable, does not fully explain your findings, we should be most grateful for any further information you can give us.
In order to ensure that this information is obtained in the same way by the many people taking part in the survey, it is important that the wording and order of this form should be adhered to.
COMPLETED FORMS SHOULD BE RETURNED TO THE SCHOOL MEDICAL OFFICER AND NOT DIRECTLY TO THE JOINT COMMITTEE.
RING THE CODE NUMBER OPPOSITE THE MOTHER'S ANSWER. IF NO ANSWER IS GIVEN, OR IF A QUESTION DOES NOT APPLY, STRIKE IT THROUGH.
Person interviewed.
1
Mother
*
Other, namely
Other
If mother not interviewed because she was ill, refused, etc., please give reasons.
Generic text
Date of death
Date of death
Cause of death (if known)
Generic text
(For all living children)
Where is this child now living ?
1
At home
2
With relatives
3
Adopted
4
Residential nursery
5
Ill in hospital
*
Elsewhere, namely
Other

I. ACCIDENTS

Last accident recorded. Type
Generic text
Last accident recorded. Age when injured ... yrs.
Age
(Since this accident, or since SEPTEMBER, 1953)
Has this child had an accident in which he was BURNT or SCALDED, BROKE A BONE, or was BADLY CUT or BRUISED ?
1
Yes
0
No

Please give the following details about each accident starting with the earliest :

Type of injury (enter as BURN, SCALD, BROKEN BONE, CUT, etc.) Part or Parts injured Age when injured (in years and months) Treatment, Hosp. I.P., Hosp. O.P., Nursing Home, Own Home If treated in own home, who gave treatment (Doctor, Nurse, other) Details of any remaining scarring, disability or deformity
Generic textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric text Generic textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric text Generic textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric text Generic textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric text Generic textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric text Generic textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric text
First Accident: 1
Second: 2

Please give the following details about each accident starting with the earliest :

DETAILS of how each ACCIDENT OCCURRED (if burnt by fire, say whether electric, gas, open fire or stove) WHERE IT OCCURRED (Own Home, School, Street, etc.)
Generic textGeneric textGeneric textGeneric text Generic textGeneric textGeneric textGeneric text
First Accident: 1
Second: 2

II. INFECTIOUS DISEASES

Please give the following information about any attacks of WHOOPING COUGH, MEASLES, MUMPS or SCARLET FEVER this child has had since SEPTEMBER 1953.

Age at onset (years and months) Where treated Hosp. IP Hosp. OP Nursing Home Own Home If treated in own home who gave treatment ? (Doctor, Nurse, other)
Generic textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric text Generic textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric text Generic textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric text
Whooping Cough
Measles
Mumps
Scarlet Fever
(Attacks recorded in previous surveys are given in red.)
Was there any doubt that it was whooping cough ?
0
Doubtful
1
Certain
How long did the whooping cough last ? ... weeks
How many
Details of complications, if any
Generic text

III. ADMISSIONS TO HOSPITAL

Details of last Hospital Admission Recorded in this Survey. Illness
Generic text
Details of last Hospital Admission Recorded in this Survey. Hospital
Generic text
Details of last Hospital Admission Recorded in this Survey. Age
Age
(If nothing recorded there has been no admission before SEPTEMBER, 1953)
Has this child been an IN-PATIENT in a HOSPITAL or NURSING HOME since SEPTEMBER 1953 when he was 7 years 6 months old?
1
Yes
0
No
x
No answer

Please give the following details about each admission:

Nature of illness Nature of operation performed (if any) Date of Admission
Generic textGeneric textGeneric dateGeneric textGeneric textGeneric dateGeneric textGeneric dateGeneric text Generic textGeneric textGeneric dateGeneric textGeneric textGeneric dateGeneric textGeneric dateGeneric text Generic textGeneric textGeneric dateGeneric textGeneric textGeneric dateGeneric textGeneric dateGeneric text
1
2

Please give the following details about each admission:

Name and Address of Hospital or Nursing Home Length of stay in Hospital or Nursing Home Name of Doctor or Specialist in Charge of Child
Generic textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric text Generic textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric text Generic textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric text
1
2

IV. SCHOOL CLINIC AND OUT-PATIENT DEPARTMENT ATTENDANCES

Has this child attended a School Clinic or Out-Patient Department of a Hospital since SEPTEMBER, 1953 ?
1
Yes
0
No
Name of hospital or clinic
Generic text
Address
Generic text

This child's clinic attendances up to September 1953 are recorded in red below. Can you please give us the following information about each one of these, and ALSO ABOUT ANY THAT HAVE TAKEN PLACE SINCE SEPTEMBER, 1953, INCLUDING THOSE RECORDED IN 7 (a) and 7 (b) opposite.

Name of School Clinic or Out-Patient Dept. Reason for attending Date of FIRST attendance (month and year) Date of LAST attendance (month and year) (if still attending strike through) Number of attendances Present condition

1 - cured

2 - improved

3 - unchanged

4 - worse

How manyGeneric textGeneric textGeneric dateGeneric dateHow manyGeneric textGeneric date

1 - cured

2 - improved

3 - unchanged

4 - worse

Generic textGeneric dateGeneric dateGeneric dateGeneric textGeneric text

1 - cured

2 - improved

3 - unchanged

4 - worse

How manyGeneric textHow manyGeneric textGeneric dateGeneric date

1 - cured

2 - improved

3 - unchanged

4 - worse

1 - cured

2 - improved

3 - unchanged

4 - worse

Generic dateHow manyGeneric textGeneric textGeneric dateGeneric textGeneric textGeneric dateGeneric dateHow many

1 - cured

2 - improved

3 - unchanged

4 - worse

1 - cured

2 - improved

3 - unchanged

4 - worse

How manyGeneric textGeneric textGeneric dateGeneric dateHow manyGeneric textGeneric date

1 - cured

2 - improved

3 - unchanged

4 - worse

Generic textGeneric dateGeneric dateGeneric dateGeneric textGeneric text

1 - cured

2 - improved

3 - unchanged

4 - worse

How manyGeneric textHow manyGeneric textGeneric dateGeneric date

1 - cured

2 - improved

3 - unchanged

4 - worse

1 - cured

2 - improved

3 - unchanged

4 - worse

Generic dateHow manyGeneric textGeneric textGeneric dateGeneric textGeneric textGeneric dateGeneric dateHow many

1 - cured

2 - improved

3 - unchanged

4 - worse

1 - cured

2 - improved

3 - unchanged

4 - worse

How manyGeneric textGeneric textGeneric dateGeneric dateHow manyGeneric textGeneric date

1 - cured

2 - improved

3 - unchanged

4 - worse

Generic textGeneric dateGeneric dateGeneric dateGeneric textGeneric text

1 - cured

2 - improved

3 - unchanged

4 - worse

How manyGeneric textHow manyGeneric textGeneric dateGeneric date

1 - cured

2 - improved

3 - unchanged

4 - worse

1 - cured

2 - improved

3 - unchanged

4 - worse

Generic dateHow manyGeneric textGeneric textGeneric dateGeneric textGeneric textGeneric dateGeneric dateHow many

1 - cured

2 - improved

3 - unchanged

4 - worse

1 - cured

2 - improved

3 - unchanged

4 - worse

How manyGeneric textGeneric textGeneric dateGeneric dateHow manyGeneric textGeneric date

1 - cured

2 - improved

3 - unchanged

4 - worse

Generic textGeneric dateGeneric dateGeneric dateGeneric textGeneric text

1 - cured

2 - improved

3 - unchanged

4 - worse

How manyGeneric textHow manyGeneric textGeneric dateGeneric date

1 - cured

2 - improved

3 - unchanged

4 - worse

1 - cured

2 - improved

3 - unchanged

4 - worse

Generic dateHow manyGeneric textGeneric textGeneric dateGeneric textGeneric textGeneric dateGeneric dateHow many

1 - cured

2 - improved

3 - unchanged

4 - worse

1 - cured

2 - improved

3 - unchanged

4 - worse

How manyGeneric textGeneric textGeneric dateGeneric dateHow manyGeneric textGeneric date

1 - cured

2 - improved

3 - unchanged

4 - worse

Generic textGeneric dateGeneric dateGeneric dateGeneric textGeneric text

1 - cured

2 - improved

3 - unchanged

4 - worse

How manyGeneric textHow manyGeneric textGeneric dateGeneric date

1 - cured

2 - improved

3 - unchanged

4 - worse

1 - cured

2 - improved

3 - unchanged

4 - worse

Generic dateHow manyGeneric textGeneric textGeneric dateGeneric textGeneric textGeneric dateGeneric dateHow many

1 - cured

2 - improved

3 - unchanged

4 - worse

1 - cured

2 - improved

3 - unchanged

4 - worse

How manyGeneric textGeneric textGeneric dateGeneric dateHow manyGeneric textGeneric date

1 - cured

2 - improved

3 - unchanged

4 - worse

Generic textGeneric dateGeneric dateGeneric dateGeneric textGeneric text

1 - cured

2 - improved

3 - unchanged

4 - worse

How manyGeneric textHow manyGeneric textGeneric dateGeneric date

1 - cured

2 - improved

3 - unchanged

4 - worse

1 - cured

2 - improved

3 - unchanged

4 - worse

Generic dateHow manyGeneric textGeneric textGeneric dateGeneric textGeneric textGeneric dateGeneric dateHow many

1 - cured

2 - improved

3 - unchanged

4 - worse

1
2
3
4
(If nothing recorded in red there has been no clinic attendance before SEPTEMBER 1953.)

V. SCHOOL ABSENCES

The school absence record for this child shows that he was away from school for more than one week on the following occasions during the last year. Could you give us further information about these absences which are recorded in red below :

Period of Absence: From Period of Absence: To Reason for Absence If child was ill: Where treated Hospital I.P. Hospital O.P. Nursing Home Own Home If child was ill: If treated at home who gave treatment Doctor Chemist Nurse/Other Remarks
Generic textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric text Generic textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric text Generic textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric text Generic textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric text Generic textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric text Generic textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric text
1
2
3
4
5
6

VI. BED WETTING

Is this child dry by night ?
0
Never wet
1
Wet occasionally
2
Wet several nights a week
3
Wet every night
How are you trying to get him dry ?
Generic text

VII. GENERAL HEALTH AND BEHAVIOUR

Are you in any way worried about this child's health ?
1
Yes
0
No
Please give your reasons for worrying
Generic text
Are you in any way worried about this child's behaviour.
1
Yes
0
No
Please give your reasons for worrying
Generic text
Are you in any way worried about this child's progress at school ?
1
Yes
0
No
Please give your reasons for worrying.
Generic text

VIII. SCHOOLING

Have you met this child's present class teacher or head teacher ?
1
Yes, class teacher
2
Yes, head teacher
3
Yes, both
0
Neither
Did you ever discuss this child's school progress with either of them ?
1
Yes, with class teacher
2
Yes, with head teacher
3
Yes, with both
0
No
Does this child's school have a Parent-Teacher association ?
1
Yes
0
No
2
Don't know
Do you or your husband belong to it ?
1
Yes
0
No
x
No answer
Have you a particular school in mind for this child when he reaches the age of 11 ?
1
Yes
0
No
Please give the name of this school
Generic text
(School Nurse please say whether school mentioned is-
1
Grammar School
2
Secondary Modern
3
Technical
4
Fee Paying
What are your reasons for wishing this child to go to this school ?
Generic text
Which of the following types of school would you prefer him to go to ?
1
Grammar
2
Secondary Modern
3
Technical
4
Fee Paying
x
Don't know
What are your reasons for wishing him to go to this type of school ?
Generic text
If this child failed to get a place in a Grammar School, would you send him to :
1
Secondary Modern
2
Technical
3
Fee Paying
4
Don't know
If this child were offered a place in a Grammar School, would you accept it ?
1
Yes
0
No
2
Don't know
What are your reasons for not wishing him to go to a Grammar School ?
Generic text

Please give the following information about the schools now attended by this child's brothers and sisters.

Name of Child Age (yrs.) Name of School Type of School

1 - Primary

2 - Grammar

3 - Sec. Mod.

4 - Technical

5 - Fee Paying

AgeGeneric textGeneric textAgeGeneric textGeneric text

1 - Primary

2 - Grammar

3 - Sec. Mod.

4 - Technical

5 - Fee Paying

Generic textAgeGeneric text

1 - Primary

2 - Grammar

3 - Sec. Mod.

4 - Technical

5 - Fee Paying

Generic textAge

1 - Primary

2 - Grammar

3 - Sec. Mod.

4 - Technical

5 - Fee Paying

Generic text

1 - Primary

2 - Grammar

3 - Sec. Mod.

4 - Technical

5 - Fee Paying

AgeGeneric textGeneric textAgeGeneric textGeneric text

1 - Primary

2 - Grammar

3 - Sec. Mod.

4 - Technical

5 - Fee Paying

Generic textAgeGeneric text

1 - Primary

2 - Grammar

3 - Sec. Mod.

4 - Technical

5 - Fee Paying

Generic textAge

1 - Primary

2 - Grammar

3 - Sec. Mod.

4 - Technical

5 - Fee Paying

Generic text

1 - Primary

2 - Grammar

3 - Sec. Mod.

4 - Technical

5 - Fee Paying

AgeGeneric textGeneric textAgeGeneric textGeneric text

1 - Primary

2 - Grammar

3 - Sec. Mod.

4 - Technical

5 - Fee Paying

Generic textAgeGeneric text

1 - Primary

2 - Grammar

3 - Sec. Mod.

4 - Technical

5 - Fee Paying

Generic textAge

1 - Primary

2 - Grammar

3 - Sec. Mod.

4 - Technical

5 - Fee Paying

Generic text

1 - Primary

2 - Grammar

3 - Sec. Mod.

4 - Technical

5 - Fee Paying

AgeGeneric textGeneric textAgeGeneric textGeneric text

1 - Primary

2 - Grammar

3 - Sec. Mod.

4 - Technical

5 - Fee Paying

Generic textAgeGeneric text

1 - Primary

2 - Grammar

3 - Sec. Mod.

4 - Technical

5 - Fee Paying

Generic textAge

1 - Primary

2 - Grammar

3 - Sec. Mod.

4 - Technical

5 - Fee Paying

Generic text
1
2
3

Are any of your children now attending classes or taking courses at a night school, university, training college or correspondence college ?

Name of Child Age (yrs.) Type of course or college attending Type of course or college attending: Other, namely

1 - Night Technical or Commercial: Part Time

2 - Night Technical or Commercial: Full Time

3 - Teachers Training College

4 - University

* - Other, namely

AgeGeneric textOtherAgeGeneric textOther

1 - Night Technical or Commercial: Part Time

2 - Night Technical or Commercial: Full Time

3 - Teachers Training College

4 - University

* - Other, namely

Generic textAgeOther

1 - Night Technical or Commercial: Part Time

2 - Night Technical or Commercial: Full Time

3 - Teachers Training College

4 - University

* - Other, namely

OtherAge

1 - Night Technical or Commercial: Part Time

2 - Night Technical or Commercial: Full Time

3 - Teachers Training College

4 - University

* - Other, namely

Generic text

1 - Night Technical or Commercial: Part Time

2 - Night Technical or Commercial: Full Time

3 - Teachers Training College

4 - University

* - Other, namely

AgeGeneric textOtherAgeGeneric textOther

1 - Night Technical or Commercial: Part Time

2 - Night Technical or Commercial: Full Time

3 - Teachers Training College

4 - University

* - Other, namely

Generic textAgeOther

1 - Night Technical or Commercial: Part Time

2 - Night Technical or Commercial: Full Time

3 - Teachers Training College

4 - University

* - Other, namely

OtherAge

1 - Night Technical or Commercial: Part Time

2 - Night Technical or Commercial: Full Time

3 - Teachers Training College

4 - University

* - Other, namely

Generic text

1 - Night Technical or Commercial: Part Time

2 - Night Technical or Commercial: Full Time

3 - Teachers Training College

4 - University

* - Other, namely

AgeGeneric textOtherAgeGeneric textOther

1 - Night Technical or Commercial: Part Time

2 - Night Technical or Commercial: Full Time

3 - Teachers Training College

4 - University

* - Other, namely

Generic textAgeOther

1 - Night Technical or Commercial: Part Time

2 - Night Technical or Commercial: Full Time

3 - Teachers Training College

4 - University

* - Other, namely

OtherAge

1 - Night Technical or Commercial: Part Time

2 - Night Technical or Commercial: Full Time

3 - Teachers Training College

4 - University

* - Other, namely

Generic text

1 - Night Technical or Commercial: Part Time

2 - Night Technical or Commercial: Full Time

3 - Teachers Training College

4 - University

* - Other, namely

AgeGeneric textOtherAgeGeneric textOther

1 - Night Technical or Commercial: Part Time

2 - Night Technical or Commercial: Full Time

3 - Teachers Training College

4 - University

* - Other, namely

Generic textAgeOther

1 - Night Technical or Commercial: Part Time

2 - Night Technical or Commercial: Full Time

3 - Teachers Training College

4 - University

* - Other, namely

OtherAge

1 - Night Technical or Commercial: Part Time

2 - Night Technical or Commercial: Full Time

3 - Teachers Training College

4 - University

* - Other, namely

Generic text
1
2

IX. PLAY AND HOBBIES

Has this child any hobby or special interest ?
1
Yes
0
No
What is it ?
Generic text
Does he belong to any club or organisation outside school ?
1
Yes
0
No
What organisation(s) does he belong to ?
Generic text

X. THE DWELLING

Type of dwelling.
1
Whole house or bungalow
2
Self-contained flat
3
Tenement
4
Unfurnished rooms
5
Furnished rooms
*
Other, namely
Other
Ownership of dwelling.
1
Council
2
Parents of the child
3
Relative
*
Other, namely
Other
Approximate age of dwelling.
1
Built before 1919
2
Built 1919-1939
3
Built since 1939

XI. THE HOUSEHOLD

Parents and their children living in this household.

Christian Name Sex Age: Years Age: Months
AgeAge in monthsGeneric textGeneric textAge in monthsGeneric textGeneric textAgeGeneric textAge in monthsGeneric textAgeGeneric textAge in monthsAgeGeneric text AgeAge in monthsGeneric textGeneric textAge in monthsGeneric textGeneric textAgeGeneric textAge in monthsGeneric textAgeGeneric textAge in monthsAgeGeneric text AgeAge in monthsGeneric textGeneric textAge in monthsGeneric textGeneric textAgeGeneric textAge in monthsGeneric textAgeGeneric textAge in monthsAgeGeneric text AgeAge in monthsGeneric textGeneric textAge in monthsGeneric textGeneric textAgeGeneric textAge in monthsGeneric textAgeGeneric textAge in monthsAgeGeneric text
1
2
3
4
5
6
7
8

Other members of the household (lodgers, relatives, domestics, etc.)

Relationship to mother of this child (e.g., mother-in-law, sister, lodger, etc.) Sex Approximate age
Generic textAgeGeneric textGeneric textAgeGeneric textAgeGeneric textGeneric text Generic textAgeGeneric textGeneric textAgeGeneric textAgeGeneric textGeneric text Generic textAgeGeneric textGeneric textAgeGeneric textAgeGeneric textGeneric text
1
2
3
Total in household. ... persons
How many

Total rooms occupied by all the members of the household listed in 22 (a) and (b).

Bedrooms Living rooms (include kitchen only if used as a living room, exclude scullery): Own living rooms Living rooms (include kitchen only if used as a living room, exclude scullery): Living rooms shared with other households Total
How manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow many How manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow many How manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow many How manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow many
1
Does this child sleep in a room by himself or in a room with others ?
1
By himself
2
With others
Who else sleeps in his room ? (Please give names and ages).
Generic text
Does he sleep in own bed or with others ? (If with others, please give names and ages).
0
Own bed
*
With others, namely
Other

XII. THE MOTHER'S WORK

Have you been in paid work (either inside or outside the home) since SEPTEMBER 1952 when this child was six years six months old ?
1
Yes
*
No

Please give the following details of each period of employment.

Exact nature of work Approximate hours per week Date of taking job Date of leaving job
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1
2
3
(The last employment recorded in this survey is entered in red.)

XIII. SUBSEQUENT PREGNANCIES

Please give the following details for each pregnancy since September, 1952 :-

Date of delivery (mth. and yr.) Sex of child Birth weight (to nearest 1/4 lb.) Result of delivery (live birth, stillbirth or miscarriage) If not surviving please give age at death
Generic textBirth weightGeneric dateGeneric textGeneric textGeneric textGeneric textGeneric textGeneric dateBirth weightGeneric textBirth weightGeneric textGeneric textGeneric dateGeneric dateBirth weightGeneric textGeneric textGeneric textGeneric textGeneric textBirth weightGeneric dateGeneric text Generic textBirth weightGeneric dateGeneric textGeneric textGeneric textGeneric textGeneric textGeneric dateBirth weightGeneric textBirth weightGeneric textGeneric textGeneric dateGeneric dateBirth weightGeneric textGeneric textGeneric textGeneric textGeneric textBirth weightGeneric dateGeneric text Generic textBirth weightGeneric dateGeneric textGeneric textGeneric textGeneric textGeneric textGeneric dateBirth weightGeneric textBirth weightGeneric textGeneric textGeneric dateGeneric dateBirth weightGeneric textGeneric textGeneric textGeneric textGeneric textBirth weightGeneric dateGeneric text Generic textBirth weightGeneric dateGeneric textGeneric textGeneric textGeneric textGeneric textGeneric dateBirth weightGeneric textBirth weightGeneric textGeneric textGeneric dateGeneric dateBirth weightGeneric textGeneric textGeneric textGeneric textGeneric textBirth weightGeneric dateGeneric text Generic textBirth weightGeneric dateGeneric textGeneric textGeneric textGeneric textGeneric textGeneric dateBirth weightGeneric textBirth weightGeneric textGeneric textGeneric dateGeneric dateBirth weightGeneric textGeneric textGeneric textGeneric textGeneric textBirth weightGeneric dateGeneric text
1
2
3
(The date of the last confinement noted is entered in red.)
Expected date of delivery
Generic date

XIV. FAMILY HISTORY

(School Nurse - these questions on family history are of the greatest importance in this inquiry, and we hope that the answers to all of them can be obtained.)
Date of (first) marriage.
Generic date
What was your own occupation before marriage ?
Generic text
What is your husband's occupation now ?
Generic text
(If unemployed, ill, dead, etc., this information should relate to the last job.)
In what industry does he work ?
Generic text
Does he-
p
Earn a weekly wage?
q
Earn a monthly salary ?
r
Work for himself or employ less than 10 people ?
s
Employ 10 or more people ?
Is your OWN father-
1
Working
2
Retired
3
Dead
In what industry does (or did) he work ?
Generic text
Does (or did) he-
a
Work for himself ?
b
Work for an employer ?
Is your HUSBAND'S father
1
Working
2
Retired
3
Dead
In what industry does (or did) he work ?
Generic text
Does (or did) he
a
Work for himself?
b
Work for an employer?

INFORMATION GIVEN BY SCHOOL NURSE OR HEALTH VISITOR

(Please answer the following questions from your own knowledge. DO NOT ask the mother directly.)
Does this family possess any of the following ?
1
Telephone
2
Car
3
Television
0
None of these
Please state from your OWN KNOWLEDGE whether the parents of this child are-
1
Married & living together
2
Legally separated
3
Divorced
4
Permanently separated for other reasons
5
Widowed
*
Other, namely
Other
QUERIES ARISING FROM EARLIER SURVEYS
Long text
Date of Interview
Generic date
Length of Interview ... mins.
How many
Name of School Nurse or Health Visitor
Generic text
Name

1954 School Nurse's Interview with Mother