Start
nshd_61_sd
STRICTLY CONFIDENTIAL
1960-61
EXAMINATION BY THE SCHOOL DOCTOR
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

Ref. No.

Generic text

Name

Generic text

Address

Generic text

School

Generic text
FOR THOSE WHO HAVE MOVED

New address

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.
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 children in this survey are representative of all births in England, Wales and Scotland in March 1946. They are drawn from all social classes and during the first fourteen years of their lives less than 10 per cent of the children in 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.
In order to ensure that these many medical histories are obtained in the same way it is important, when questioning the parent, 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
THE FOLLOWING EQUIPMENT IS NEEDED:- (a) Darning needle size No. 1 (Milwards Gold Seal) (b) black thread (Coates button thread, extra strong) (c) a pin (d) a penny (c) a pencil
It is hoped that the Mother and/or Father will be present at this examination
A. MEDICAL HISTORY
Put a circle round the code 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. If a question does not apply, strike it through.
SURVIVAL
If this child has died please state

Date of Death

Date of death
SOURCE OF INFORMATION
If this child is living but the form cannot be completed

please state the reason here:

Generic text

Parent or relative attending with child

1
Mother
2
Father
3
Both parents
0
Other person, namely
Other
ASTHMA

Has this child, DURING THE LAST YEAR, had an attack of asthma?

1
Yes
0
No
(If "yes".)
qc_4_a ==1

Do they occur?

4
Daily
3
Weekly
2
Monthly
1
Less often

How long do they last?

1
Minutes
2
Hours
3
One or more days

Has a doctor been consulted about his asthma?

1
Doctor consulted
0
No doctor consulted

Has the cause of the attacks been investigated?

1
Yes, at hospital
2
Yes, by family doctor
0
No investigation

What treatment is being given?

Generic text
TEETH
All Children

How many times has this child been seen by a dentist DURING THE LAST YEAR? ... times

How many
0
Not seen by a dentist
A. HEART

DURING THE LAST YEAR has this child been treated for heart trouble?

1
Yes
0
No
(If "yes".)
qc_6_a == 1

Name and address of hospital where treated? Name

Generic text

Name and address of hospital where treated? Address

Generic text

What treatment was given?

Generic text

Did this treatment lead to any restriction of his activities?

*
Yes, namely
0
No restriction of activities
Generic text
A. ABDOMEN
All Children

Has this child had any attacks of abdominal pain DURING THE LAST YEAR?

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

Was a doctor called in or was he taken to hospital?

1
Doctor called in
2
Taken to hospital
0
Neither
All Children

Has this child, DURING THE LAST YEAR, had recurrent attacks of vomiting (i.e. out of sorts at least 12 hours and at least one vomit)?

1
Yes
0
No
(If "yes".)
qc_8_a == 1

About how often does he have these attacks?

1
Less than once a month
2
More often

Are these attacks associated with any particular circumstances? If so please give details

Generic text
BEDWETTING
All Children

Is this child now dry by night?

0
Never wet
1
Wet occasionally
2
Wet several nights a week
3
Wet every night
(If "wet")
qc_9_a == 1 || qc_9_a == 2 || qc_9_a == 3

How are you trying to get him dry?

Generic text
MENSTRUATION
All Girls

Has this child started her periods?

1
Yes
0
No
Y
Does not apply
(If "yes".)
qc_10_a == 1

Are they regular or only occasional?

2
Regular
1
Occasional
0
No periods yet
Y
Does not apply

What was the date of onset of the FIRST period?

Generic date
0
No periods yet
Y
Does not apply

Did this child complain of abdominal discomfort during the three months preceding her first period?

1
Yes
0
No
Y
Does not apply

Does she now have pain or discomfort associated with menstruation?

1
Yes
0
No
Y
Does not apply
HEARING
All Children

Is this child hard of hearing sometimes, or all the time?

1
Sometimes deaf
2
Always deaf
0
Normal hearing
(If "sometimes deaf".)
qc_11_a == 1

Is he hard of hearing when he has colds?

1
Yes
0
No
FITS AND CONVULSIONS
All Children

Has this child, DURING THE LAST YEAR had a fit or convulsion or lost consciousness?

1
Yes, fits, etc.
0
No fit or convulsion
(If "fit or convulsion".)
qc_12_a == 1

How many fits or convulsions has he had DURING THE LAST YEAR? ... fits or convulsions

How many

Did they occur during an illness or while he was in normal health?

1
During an illness
2
While in normal health
IMMUNISATION AND CLINICS
All Children

Has this child had B.C.G. vaccination?

1
Yes
0
No

Has this child had poliomyelitis immunisation?

1
Yes
0
No

Has this child attended a school clinic or Out-Patient Department of a hospital DURING THE LAST YEAR?

1
Yes
0
No
(If "yes".)
qc_14 == 1
Please give the following details:-
Type of Clinic Reason for attendance Date of last attendance
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
3
GENERAL HEALTH
All Children

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

1
Yes
0
No
(If "yes".)
qc_15_a == 1

Please give your reasons for worrying

Generic text
All Children

Does this child show any problems of behaviour, adjustment, or conduct which are a cause of concern to you?

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

Please give details

Generic text

What treatment, if any, is being given for these behaviour problems?

0
No treatment
1
Child Guidance Clinic
*
Other, namely
Y
Does not apply
Other
B. EXAMINATION
THROAT AND TONSILS
All Children

Colour of pillars of fauces.

1
Congested
0
Not congested
Y
Not seen, child gags

Tonsils.

1
Present and intact
2
Remnants
0
Removed
Y
Not seen, child gags
(If tonsils present.)
qc_17_b ==1 || qc_17_b ==2

Size of tonsils.

1
Meet in mid line
2
Buried and atrophic
3
All other sizes

Crypts.

1
Contain pus
2
Do not contain pus
3
No crypts seen
4
Concretions

Tonsillar glands.

1
Palpable
0
Not palpable

In your opinion should this child's tonsils be removed?

1
Yes
0
No
2
Undecided
(If "yes".)
qc_17_f == 1

Please give your reasons

Generic text
BREAST DEVELOPMENT
All Children

Are there any signs of breast development?

1
Yes
0
No
Y
Does not apply
LUNGS
All Children

Are there any abnormal signs present in the lungs?

1
Abnormal signs present
0
No abnormality detected
(If "abnormal signs".)
qc_19 == 1

Please describe

Generic text
B. HEART
Please examine this child standing up and lying down.
All Children

Position of cardiac impulse

Generic text

Murmurs. Standing

0
No murmur heard
1
Murmur(s) heard

Murmurs. Lying

0
No murmur heard
1
Murmur(s) heard
(If "murmur(s)".)
qc_20_b_i == 1 || qc_20_b_ii == 1

Point of maximum intensity?

Generic text

Timing of the murmur?

Generic text

Is there a palpable thrill?

Generic text
If so,

where?

Generic text
All Children

Details of any other cardiac abnormalities not noted above

Generic text

Do you consider that this child shows any evidence of rheumatic heart disease?

1
Yes
0
No
2
Doubtful
(If "Yes".)
qc_20_d == 1

Please describe

Generic text
All Children

Are there any other manifestations of rheumatic disease?

Generic text

Do you consider that this child shows any evidence of congenital heart disease?

1
Yes
0
No
2
Doubtful
(If "Yes".)
qc_20_f == 1

Please describe

Generic text
B. ABDOMEN
All Children

Is there any abdominal distention?

1
Yes
0
No

As there any palpable masses?

0
No
1
Yes, liver palpable
2
Yes, spleen palpable
3
Yes, faeces palpable
*
Yes, other masses, namely
Other

Is there an impulse on coughing when a finger is inserted into the inguinal canal?

1
Yes
0
No

Is any pigmented pubic hair visible?

1
Yes, sparse
2
Yes, profuse
0
No

Is any axillary hair visible?

1
Yes
0
No
Boys Only

Development of genitalia

0
Infantile
1
*Early
2
**Advanced or complete
Y
Does not apply
*"early" increase in length of penis and width of glans with softening and slight enlargement of testes.
**"advanced" substantial enlargement of glans and penis plus testicular enlargement with pendulous and rugose scrotum.
CO-ORDINATION
All Children

Can this child hop on his right leg?

1
Yes
0
No

Can this child hop on his left leg?

1
Yes
0
No

Can this child thread a darning needle with his right hand?

1
Yes
0
No
(Darning needle Size 1 and Coates extra strong black thread.)

Can this child thread a darning needle with his left hand?

1
Yes
0
No
(If this child cannot thread a needle with left or right hand proceed as follows until he is successful.)
qc_22_c == 0 && qc_22_d == 0

Can this child pick up a pin? Right hand

1
Yes
0
No

Can this child pick up a pin? Left hand

1
Yes
0
No

Can this child pick up a penny? Right hand

1
Yes
0
No

Can this child pick up a penny? Left hand

1
Yes
0
No

Can this child pick up a matchstick? Right hand

1
Yes
0
No

Can this child pick up a matchstick? Left hand

1
Yes
0
No

Can this child pick up a pencil? Right hand

1
Yes
0
No

Can this child pick up a pencil? Left hand

1
Yes
0
No
All Children

Ask this child to tap as fast as he can the dorsum of his left hand with his right finger ... taps in 15 secs.

How many

Ask this child to tap as fast as he can the dorsum of his right hand with his left finger ... taps in 15 secs.

How many

With the child sitting, ask him to tap the ground as fast as he can with his right foot ... taps in 15 secs.

How many

With this child sitting, ask him to tap the ground as fast as he can with his left foot ... taps in 15 secs.

How many
MISCELLANEOUS
All Children

Skin.

0
No obvious abnormality
1
Septic spots or boils

Skin. Other abnormalities, namely

Other

Nails and fingers.

0
No abnormality
1
Bitten nails
2
Clubbed fingers
*
Other, namely
Other

Orthopaedic defects. Extremities

1
Knock knee
2
Valgus ankles
3
Hallux valgus
4
Painful flat feet

Orthopaedic defects. Extremities other namely

Other

Orthopaedic defects. Postural

5
Scoliosis
6
Kyphosis

Orthopaedic defects. Postural other namely

Other

Orthopaedic defects. Disease

7
Poliomyelitis

Orthopaedic defects. Disease other namely

Other

Orthopaedic defects. Congenital

Generic text

Orthopaedic defects. Other defect namely

Other

Orthopaedic defects.

0
No defect
(If any defect)
qc_25_vi != 0

Please give details of treatment

Generic text

Remarks on other abnormalities or deformities not reported above

Other
PHYSICAL MEASUREMENTS

Present weight. (In underpants or knickers only and WITHOUT SHOES. If this is impossible please list the clothes in which he was weighed ... ) ... st. ... lbs. ... ozs.

Generic text
st
lbs in stones
ozs in pounds

Scales used.

1
Beam balance
2
Spring balance

Present standing height. (WITHOUT SHOES.) ... ft. ... ins. (To nearest quarter inch.)

ft
ins in feet
1
Height measurer used
2
Measured against wall
["The most accurate results are obtained if heels, shoulders and buttocks touch an upright wall, and the child looks straight ahead so that the lower border of the orbit and the external auditory meatus are in the same horizontal plane. The child should be told to make himself as tall as possible without lifting his heels from the ground. A deep breath should be taken as this helps to bring him up to his maximum height." Report of C.M.O., Ministry of Education, 1950/51, p. 61.]
SPEECH
All Children

Has this child's voice broken?

0
Not yet broken
1
Starting to break
2
Completely broken
Y
Does not apply

Speech

0
No abnormality
1
Stammering
2
Dyslalia
*
Structural, namely
Generic text
(If "stammering," "dyslalia" or other defect.)
qc_29_b == 1 || qc_29_b == 2 || qc_29_b == *

Does this child, in your opinion, need speech therapy?

1
Yes
0
No
(If "yes".)
qc_29_c == 1

What arrangements have been made to give him speech therapy

Generic text
EYES
All Children

Squint.

0
Does not squint
1
Concomitant squint
2
Paralytic squint

Have glasses been supplied for this child?

1
Yes
0
No
(If "yes".)
qc_30_b == 1

Who refracted this child?

Generic text

Are glasses being worn to-day?

1
Yes
0
No
Visual acuity.
Without glasses With glasses
AcuityGeneric textAcuityGeneric text AcuityGeneric textAcuityGeneric text
Right eye
Left eye

Eye defects not noted above:

Generic text
EARS
All Children

External Auditory Meatus. Right

1
Mucoid discharge
2
Purulent discharge
3
Wax
0
Clear
*
Other, namely
Other

External Auditory Meatus. Left

1
Mucoid discharge
2
Purulent discharge
3
Wax
0
Clear
*
Other, namely
Other

Drums. Right

0
Intact
1
Indrawn
2
Perforated
3
Obscured by wax
*
Other conditions, namely
Other

Drums. Left

0
Intact
1
Indrawn
2
Perforated
3
Obscured by wax
*
Other conditions, namely
Other

What is your assessment of this child's hearing?

3
Average or good
2
Poor
1
Very poor
(If hearing is "poor".)
qc_32_c == 2 || qc_32_c == 1

Does he wear a hearing aid?

Generic text
ASSESSMENTS
All Children

Alertness and activity.

2
Average
3
Above average
1
Below average
0
Apathetic

Physical development.

1
Average
2
Superior
0
Inferior

Obesity.

1
Very obese
2
Obese
3
Average
4
Thin
5
Very thin

What does this child propose to do when he/she leaves school?

Generic text

Is there anything in this history or examination which, in your opinion, would make this choice of job unsuitable or undesirable?

1
Yes
0
No
(If "yes".)
qc_34_ii == 1

Please give your reasons for thinking this choice of job is unsuitable or undesirable

Generic text

CHECK ON PAST INFORMATION

Long text

Name of Doctor making examination

Generic text
1
School Doctor
2
Family Doctor

Date of examination

Generic date

Time taken for this examination

Time taken
End

nshd_61_sd

STRICTLY CONFIDENTIAL
1960-61
EXAMINATION BY THE SCHOOL DOCTOR
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
Ref. No.
Generic text
Name
Generic text
Address
Generic text
School
Generic text

FOR THOSE WHO HAVE MOVED

New address
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.
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 children in this survey are representative of all births in England, Wales and Scotland in March 1946. They are drawn from all social classes and during the first fourteen years of their lives less than 10 per cent of the children in 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.
In order to ensure that these many medical histories are obtained in the same way it is important, when questioning the parent, 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
THE FOLLOWING EQUIPMENT IS NEEDED:- (a) Darning needle size No. 1 (Milwards Gold Seal) (b) black thread (Coates button thread, extra strong) (c) a pin (d) a penny (c) a pencil
It is hoped that the Mother and/or Father will be present at this examination

A. MEDICAL HISTORY

Put a circle round the code 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. If a question does not apply, strike it through.

SURVIVAL

Date of Death
Date of death

SOURCE OF INFORMATION

please state the reason here:
Generic text
Parent or relative attending with child
1
Mother
2
Father
3
Both parents
0
Other person, namely
Other

ASTHMA

Has this child, DURING THE LAST YEAR, had an attack of asthma?
1
Yes
0
No
Do they occur?
4
Daily
3
Weekly
2
Monthly
1
Less often
How long do they last?
1
Minutes
2
Hours
3
One or more days
Has a doctor been consulted about his asthma?
1
Doctor consulted
0
No doctor consulted
Has the cause of the attacks been investigated?
1
Yes, at hospital
2
Yes, by family doctor
0
No investigation
What treatment is being given?
Generic text

TEETH

All Children
How many times has this child been seen by a dentist DURING THE LAST YEAR? ... times
How many
0
Not seen by a dentist

A. HEART

DURING THE LAST YEAR has this child been treated for heart trouble?
1
Yes
0
No
Name and address of hospital where treated? Name
Generic text
Name and address of hospital where treated? Address
Generic text
What treatment was given?
Generic text
Did this treatment lead to any restriction of his activities?
*
Yes, namely
0
No restriction of activities
Generic text

A. ABDOMEN

All Children
Has this child had any attacks of abdominal pain DURING THE LAST YEAR?
1
Yes
0
No
Was a doctor called in or was he taken to hospital?
1
Doctor called in
2
Taken to hospital
0
Neither
All Children
Has this child, DURING THE LAST YEAR, had recurrent attacks of vomiting (i.e. out of sorts at least 12 hours and at least one vomit)?
1
Yes
0
No
About how often does he have these attacks?
1
Less than once a month
2
More often
Are these attacks associated with any particular circumstances? If so please give details
Generic text

BEDWETTING

All Children
Is this child now 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

MENSTRUATION

Has this child started her periods?
1
Yes
0
No
Y
Does not apply
Are they regular or only occasional?
2
Regular
1
Occasional
0
No periods yet
Y
Does not apply
What was the date of onset of the FIRST period?
Generic date
0
No periods yet
Y
Does not apply
Did this child complain of abdominal discomfort during the three months preceding her first period?
1
Yes
0
No
Y
Does not apply
Does she now have pain or discomfort associated with menstruation?
1
Yes
0
No
Y
Does not apply

HEARING

All Children
Is this child hard of hearing sometimes, or all the time?
1
Sometimes deaf
2
Always deaf
0
Normal hearing
Is he hard of hearing when he has colds?
1
Yes
0
No

FITS AND CONVULSIONS

Has this child, DURING THE LAST YEAR had a fit or convulsion or lost consciousness?
1
Yes, fits, etc.
0
No fit or convulsion
How many fits or convulsions has he had DURING THE LAST YEAR? ... fits or convulsions
How many
Did they occur during an illness or while he was in normal health?
1
During an illness
2
While in normal health

IMMUNISATION AND CLINICS

Has this child had B.C.G. vaccination?
1
Yes
0
No
Has this child had poliomyelitis immunisation?
1
Yes
0
No
Has this child attended a school clinic or Out-Patient Department of a hospital DURING THE LAST YEAR?
1
Yes
0
No

Please give the following details:-

Type of Clinic Reason for attendance Date of last attendance
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
3

GENERAL HEALTH

All Children
Are you in any way worried about this child's health?
1
Yes
0
No
Please give your reasons for worrying
Generic text
All Children
Does this child show any problems of behaviour, adjustment, or conduct which are a cause of concern to you?
1
Yes
0
No
Please give details
Generic text
What treatment, if any, is being given for these behaviour problems?
0
No treatment
1
Child Guidance Clinic
*
Other, namely
Y
Does not apply
Other

B. EXAMINATION

THROAT AND TONSILS

All Children
Colour of pillars of fauces.
1
Congested
0
Not congested
Y
Not seen, child gags
Tonsils.
1
Present and intact
2
Remnants
0
Removed
Y
Not seen, child gags
Size of tonsils.
1
Meet in mid line
2
Buried and atrophic
3
All other sizes
Crypts.
1
Contain pus
2
Do not contain pus
3
No crypts seen
4
Concretions
Tonsillar glands.
1
Palpable
0
Not palpable
In your opinion should this child's tonsils be removed?
1
Yes
0
No
2
Undecided
Please give your reasons
Generic text

BREAST DEVELOPMENT

All Children
Are there any signs of breast development?
1
Yes
0
No
Y
Does not apply

LUNGS

All Children
Are there any abnormal signs present in the lungs?
1
Abnormal signs present
0
No abnormality detected
Please describe
Generic text

B. HEART

Please examine this child standing up and lying down.
All Children
Position of cardiac impulse
Generic text
Murmurs. Standing
0
No murmur heard
1
Murmur(s) heard
Murmurs. Lying
0
No murmur heard
1
Murmur(s) heard
Point of maximum intensity?
Generic text
Timing of the murmur?
Generic text
Is there a palpable thrill?
Generic text
where?
Generic text
All Children
Details of any other cardiac abnormalities not noted above
Generic text
Do you consider that this child shows any evidence of rheumatic heart disease?
1
Yes
0
No
2
Doubtful
Please describe
Generic text
All Children
Are there any other manifestations of rheumatic disease?
Generic text
Do you consider that this child shows any evidence of congenital heart disease?
1
Yes
0
No
2
Doubtful
Please describe
Generic text

B. ABDOMEN

All Children
Is there any abdominal distention?
1
Yes
0
No
As there any palpable masses?
0
No
1
Yes, liver palpable
2
Yes, spleen palpable
3
Yes, faeces palpable
*
Yes, other masses, namely
Other
Is there an impulse on coughing when a finger is inserted into the inguinal canal?
1
Yes
0
No
Is any pigmented pubic hair visible?
1
Yes, sparse
2
Yes, profuse
0
No
Is any axillary hair visible?
1
Yes
0
No
Development of genitalia
0
Infantile
1
*Early
2
**Advanced or complete
Y
Does not apply
*"early" increase in length of penis and width of glans with softening and slight enlargement of testes.
**"advanced" substantial enlargement of glans and penis plus testicular enlargement with pendulous and rugose scrotum.

CO-ORDINATION

All Children
Can this child hop on his right leg?
1
Yes
0
No
Can this child hop on his left leg?
1
Yes
0
No
Can this child thread a darning needle with his right hand?
1
Yes
0
No
(Darning needle Size 1 and Coates extra strong black thread.)
Can this child thread a darning needle with his left hand?
1
Yes
0
No
Can this child pick up a pin? Right hand
1
Yes
0
No
Can this child pick up a pin? Left hand
1
Yes
0
No
Can this child pick up a penny? Right hand
1
Yes
0
No
Can this child pick up a penny? Left hand
1
Yes
0
No
Can this child pick up a matchstick? Right hand
1
Yes
0
No
Can this child pick up a matchstick? Left hand
1
Yes
0
No
Can this child pick up a pencil? Right hand
1
Yes
0
No
Can this child pick up a pencil? Left hand
1
Yes
0
No
All Children
Ask this child to tap as fast as he can the dorsum of his left hand with his right finger ... taps in 15 secs.
How many
Ask this child to tap as fast as he can the dorsum of his right hand with his left finger ... taps in 15 secs.
How many
With the child sitting, ask him to tap the ground as fast as he can with his right foot ... taps in 15 secs.
How many
With this child sitting, ask him to tap the ground as fast as he can with his left foot ... taps in 15 secs.
How many

MISCELLANEOUS

All Children
Skin.
0
No obvious abnormality
1
Septic spots or boils
Skin. Other abnormalities, namely
Other
Nails and fingers.
0
No abnormality
1
Bitten nails
2
Clubbed fingers
*
Other, namely
Other
Orthopaedic defects. Extremities
1
Knock knee
2
Valgus ankles
3
Hallux valgus
4
Painful flat feet
Orthopaedic defects. Extremities other namely
Other
Orthopaedic defects. Postural
5
Scoliosis
6
Kyphosis
Orthopaedic defects. Postural other namely
Other
Orthopaedic defects. Disease
7
Poliomyelitis
Orthopaedic defects. Disease other namely
Other
Orthopaedic defects. Congenital
Generic text
Orthopaedic defects. Other defect namely
Other
Orthopaedic defects.
0
No defect
Please give details of treatment
Generic text
Remarks on other abnormalities or deformities not reported above
Other

PHYSICAL MEASUREMENTS

Present weight. (In underpants or knickers only and WITHOUT SHOES. If this is impossible please list the clothes in which he was weighed ... ) ... st. ... lbs. ... ozs.
Generic text
st
lbs in stones
ozs in pounds
Scales used.
1
Beam balance
2
Spring balance
Present standing height. (WITHOUT SHOES.) ... ft. ... ins. (To nearest quarter inch.)
ft
ins in feet
1
Height measurer used
2
Measured against wall
["The most accurate results are obtained if heels, shoulders and buttocks touch an upright wall, and the child looks straight ahead so that the lower border of the orbit and the external auditory meatus are in the same horizontal plane. The child should be told to make himself as tall as possible without lifting his heels from the ground. A deep breath should be taken as this helps to bring him up to his maximum height." Report of C.M.O., Ministry of Education, 1950/51, p. 61.]

SPEECH

All Children
Has this child's voice broken?
0
Not yet broken
1
Starting to break
2
Completely broken
Y
Does not apply
Speech
0
No abnormality
1
Stammering
2
Dyslalia
*
Structural, namely
Generic text
Does this child, in your opinion, need speech therapy?
1
Yes
0
No
What arrangements have been made to give him speech therapy
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EYES

All Children
Squint.
0
Does not squint
1
Concomitant squint
2
Paralytic squint
Have glasses been supplied for this child?
1
Yes
0
No
Who refracted this child?
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Are glasses being worn to-day?
1
Yes
0
No

Visual acuity.

Without glasses With glasses
AcuityGeneric textAcuityGeneric text AcuityGeneric textAcuityGeneric text
Right eye
Left eye
Eye defects not noted above:
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EARS

All Children
External Auditory Meatus. Right
1
Mucoid discharge
2
Purulent discharge
3
Wax
0
Clear
*
Other, namely
Other
External Auditory Meatus. Left
1
Mucoid discharge
2
Purulent discharge
3
Wax
0
Clear
*
Other, namely
Other
Drums. Right
0
Intact
1
Indrawn
2
Perforated
3
Obscured by wax
*
Other conditions, namely
Other
Drums. Left
0
Intact
1
Indrawn
2
Perforated
3
Obscured by wax
*
Other conditions, namely
Other
What is your assessment of this child's hearing?
3
Average or good
2
Poor
1
Very poor
Does he wear a hearing aid?
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ASSESSMENTS

All Children
Alertness and activity.
2
Average
3
Above average
1
Below average
0
Apathetic
Physical development.
1
Average
2
Superior
0
Inferior
Obesity.
1
Very obese
2
Obese
3
Average
4
Thin
5
Very thin
What does this child propose to do when he/she leaves school?
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Is there anything in this history or examination which, in your opinion, would make this choice of job unsuitable or undesirable?
1
Yes
0
No
Please give your reasons for thinking this choice of job is unsuitable or undesirable
Generic text
CHECK ON PAST INFORMATION
Long text
Name of Doctor making examination
Generic text
1
School Doctor
2
Family Doctor
Date of examination
Generic date
Time taken for this examination
Time taken
Name

1961 Examination by the School Doctor