Start
nshd_57_iwm
STRICTLY CONFIDENTIAL
JANUARY 1957
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. The children in this sample are representative of all births in England, Wales and Scotland. They are drawn from all social classes and during the first ten year 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 A QUESTION DOES NOT APPLY, STRIKE IT THROUGH.

Person interviewed.

1
Mother
*
Other, namely
Other text

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

Generic date

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 school
5
Ill in hospital
*
Elsewhere, namely
Other text
I. ACCIDENTS

Last accident recorded. Type

Generic text

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

Age in years
(Since this accident, or since OCTOBER, 1955)

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
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.)
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 OCTOBER 1955.
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)
Whooping Cough
Measles
Mumps
Scarlet Fever
(Attacks recorded in previous surveys are given in red.)
(For all those who have had whooping cough since October 1955)
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

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 the Survey. Age

Generic text
(If nothing recorded there has been no admission before OCTOBER, 1955)

Has this child been an IN-PATIENT in a HOSPITAL or NURSING HOME since OCTOBER 1955 ?

1
Yes
0
No
(If "yes")
qc_6_b == 1
Please give the following details about each admission including any accidents or infectious diseases noted in Sections I or II.
Nature of illness Nature of operation performed (if any) Date of Admission
1
2
Please give the following details about each admission including any accidents or infectious diseases noted in Sections I or II.
Name and Address of Hospital or Nursing Home Name of Doctor or Specialist in Charge of Child
1
2
IV. SCHOOL CLINIC AND OUT-PATIENT DEPARTMENT ATTENDANCES
(Include child guidance and all other clinics wherever held)

Details of last Clinic Attendance Recorded in this Survey. Name of Clinic

Generic text

Details of last Clinic Attendance Recorded in this Survey. Reason for attending

Generic text

Details of last Clinic Attendance Recorded in this Survey. Age

Generic text

Has this child attended a School Clinic or Out-Patient Department of a Hospital since OCTOBER 1955?

1
Yes
0
No
(If "yes")
qc_7_b == 1
Please give the following details about each Clinic attended.
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
2
V. SCHOOL ABSENCES
Please complete the information given below about the child's absences during the past year.
Information from School Absence Record: Period of Absence: From Information from School Absence Record: Period of Absence: To Information from School Absence Record: Reason for Absence Please give these additional details: If child was ill: Where treated Hospital I.P. Hospital O.P. Nursing Home Own Home Please give these additional details: If child was ill: If treated at home who gave treatement ? (Doctor Chemist Nurse, Other) Please give these additional details: Remarks
1
2
3
VI. SCHOOLING

During the last year have you or your husband met this child's class teacher or head teacher ?

3
Yes, both
1
Yes, class teacher
2
Yes, head teacher
0
Neither
(If "yes")
qc_9_a >= 1 && qc_9_a <= 3

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

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

Until what age do you want this child to stay at school ? ... years

Age in years

Do you have any specific ideas on the job you would like this child to do on leaving school ?

1
Yes
0
No
(If "yes")
qc_10_b == 1

What are they ?

Generic text

Which of the following types of school do you NOW wish your child to go to?

1
Grammar
2
Secondary modern
3
Technical
6
Comprehensive
4
Fee paying
*
Other, namely
Other text

Which of the following types of school do you NOW wish your child to go to? (Alternative answers for Scotland)

1
Senior Secondary
2
Junior Secondary
3
Fee paying
*
Other, namely
Other text

Have you changed your mind since this question was asked last year ?

1
Yes
0
No
(If "yes")
qc_11_b == 1

Why have you changed your mind

Generic text

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

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

Please give your reasons for worrying.

Generic text
VII. HOBBIES AND OUTSIDE INTERESTS

Has this child any hobby or special interest?

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

What is it?

Generic text

Does he belong to any club or organisation outside school?

1
Yes
0
No
(If "yes")
qc_14_a == 1

What organisation(s) does he belong to ?

Generic text

Does this child go to Church or Sunday School ?

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

What Church or Sunday School does he go to ?

1
Church of England
2
Roman Catholic
3
Non-conformist
*
Other, namely
Other text

At what time does this child go to bed at night ? ... p.m.

Generic time

At what time does this child get up in the morning ? ... a.m.

Generic time
VIII. GENERAL HEALTH AND BEHAVIOUR

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

1
Yes
0
No
("If yes")
qc_17_a == 1

Please give your reasons for worrying

Generic text

Has this child any habits such as thumb sucking, nail biting, nose picking, tics or general fidgetiness ?

0
No habits of this type
1
Sucks thumb
2
Bites nails
3
Picks nose
*
Other habits, namely
Other text

During the last year, have you or any member of your household ever had to go to this child because of his nightmares or disturbed sleep ?

0
Never
1
Occasionally
2
Several nights a week
3
Every night
IX. DOMESTIC HELP

Who helps you with the housework or children ? Regularly

1
Husband
2
This child
3
Other children
4
Grandparents
5
Other relations or friends
6
Paid help
0
Not helped at all

Who helps you with the housework or children ? Occasionally

1
Husband
2
This child
3
Other children
4
Grandparents
5
Other relations or friends
6
Paid help
0
Not helped at all
X. OCCUPATION OF PRESENT HUSBAND

What is your husband's occupation now ?

Generic text

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 ?

If you husband's work regularly keeps him away from home for 24 hours or more at a time, please give details.

Generic text
XI. SUBSEQUENT PREGNANCIES
Please give the following details for each pregnancy since October 1954:-
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
1
2
3
(If now pregnant)

Expected date of delivery

Generic text
XII. THE MOTHER'S WORK

Have you been in paid work (either inside or outside the home) since OCTOBER, 1955 ?

1
Yes
0
No
(If "yes")
qc_22_a == 1
Please give the following details of each period of employment.
Exact nature of work No. of days worked per week Time of leaving home Time of getting back home Date of taking job Date of leaving job
1
2
XIII. THE HOUSEHOLD AND DWELLING

Ownership of dwelling.

1
Council
2
Parents of the child
3
Relative
*
Other, namely
Other text
Parents and their children living in this household.
Christian Name Sex Age Years Age Months
1
2
3
4
5
6
7
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
1
2
3

Total in household. ... persons

How many?
Total rooms occupied by all the members of the household listed in 24 (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
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_26_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 text

Is your kitchen shared with another household?

1
Yes
0
No
Y
No kitchen

Is there a bathroom for your use ?

1
Yes
0
No

How do you obtain hot water ?

1
Running hot water
2
Gas or electric copper
3
Boiling kettles
*
Other, namely
Other text

Where does this child do his homework ?

1
In the living room with other members of the family
2
In a separate room
*
Elsewhere, namely
Other text

Does mother think that this dwelling lacks any essential amenities that would help you in bringing up your children ?

1
Yes
0
No
(If "yes",
qc_31 == 1

please give details)

Long text
INFORMATION GIVEN BY SCHOOL NURSE OR HEALTH VISITOR
(Please answer the following Questions from your own knowledge. DO NOT ask the mother directly.)

Is any member of this child's family or household known to have tuberculosis ?

1
Yes
0
No
X
Unknown
(If "yes")
qc_32_a == 1

Please state the name and the relationship Name

Generic text

Please state the name and the relationship Relationship

Generic text

Was B.C.G. Vaccination offered to this child and if so, was it accepted ?

1
Offered and accepted
2
Offered, not accepted
3
Not offered
X
Unknown
Y
Not applicable

Does this family possess any of the following ?

1
Telephone
2
Car
3
Television
0
None of these

Please give your assessment of the state of repair of the dwelling.

1
Average
2
Very good
3
Bad

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

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

Date of interview

Generic date

Length of Interview ... mins.

How many?

Name of School Nurse or Health Visitor

Generic text
End

nshd_57_iwm

STRICTLY CONFIDENTIAL
JANUARY 1957
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. The children in this sample are representative of all births in England, Wales and Scotland. They are drawn from all social classes and during the first ten year 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 A QUESTION DOES NOT APPLY, STRIKE IT THROUGH.
Person interviewed.
1
Mother
*
Other, namely
Other text
If mother not interviewed because she was ill, refused, etc., please give reasons.
Generic text
Date of death
Generic date
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 school
5
Ill in hospital
*
Elsewhere, namely
Other text

I. ACCIDENTS

Last accident recorded. Type
Generic text
Last accident recorded. Age when injured ... yrs.
Age in years
(Since this accident, or since OCTOBER, 1955)
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
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
First Accident 1
Second 2
qc_4_b == 1

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.)
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 OCTOBER 1955.

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)
Whooping Cough
Measles
Mumps
Scarlet Fever
(Attacks recorded in previous surveys are given in red.)
qc_5_a$1;1 != NULL
Was there any doubt that it was whooping cough ?
0
Doubtful
1
Certain
qc_5_a$1;1 != NULL
How long did the whooping cough last ? ... weeks
How many?
qc_5_a$1;1 != NULL
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 the Survey. Age
Generic text
(If nothing recorded there has been no admission before OCTOBER, 1955)
Has this child been an IN-PATIENT in a HOSPITAL or NURSING HOME since OCTOBER 1955 ?
1
Yes
0
No
qc_6_b == 1

Please give the following details about each admission including any accidents or infectious diseases noted in Sections I or II.

Nature of illness Nature of operation performed (if any) Date of Admission
1
2
qc_6_b == 1

Please give the following details about each admission including any accidents or infectious diseases noted in Sections I or II.

Name and Address of Hospital or Nursing Home Name of Doctor or Specialist in Charge of Child
1
2

IV. SCHOOL CLINIC AND OUT-PATIENT DEPARTMENT ATTENDANCES

(Include child guidance and all other clinics wherever held)
Details of last Clinic Attendance Recorded in this Survey. Name of Clinic
Generic text
Details of last Clinic Attendance Recorded in this Survey. Reason for attending
Generic text
Details of last Clinic Attendance Recorded in this Survey. Age
Generic text
Has this child attended a School Clinic or Out-Patient Department of a Hospital since OCTOBER 1955?
1
Yes
0
No
qc_7_b == 1

Please give the following details about each Clinic attended.

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
2

V. SCHOOL ABSENCES

Please complete the information given below about the child's absences during the past year.

Information from School Absence Record: Period of Absence: From Information from School Absence Record: Period of Absence: To Information from School Absence Record: Reason for Absence Please give these additional details: If child was ill: Where treated Hospital I.P. Hospital O.P. Nursing Home Own Home Please give these additional details: If child was ill: If treated at home who gave treatement ? (Doctor Chemist Nurse, Other) Please give these additional details: Remarks
1
2
3

VI. SCHOOLING

During the last year have you or your husband met this child's class teacher or head teacher ?
3
Yes, both
1
Yes, class teacher
2
Yes, head teacher
0
Neither
qc_9_a >= 1 && qc_9_a <= 3
Did you discuss this child's school progress with either or both of them ?
3
Yes, with both
1
Yes, with class teacher
2
Yes, with head teacher
0
No
Until what age do you want this child to stay at school ? ... years
Age in years
Do you have any specific ideas on the job you would like this child to do on leaving school ?
1
Yes
0
No
qc_10_b == 1
What are they ?
Generic text
Which of the following types of school do you NOW wish your child to go to?
1
Grammar
2
Secondary modern
3
Technical
6
Comprehensive
4
Fee paying
*
Other, namely
Other text
Which of the following types of school do you NOW wish your child to go to? (Alternative answers for Scotland)
1
Senior Secondary
2
Junior Secondary
3
Fee paying
*
Other, namely
Other text
Have you changed your mind since this question was asked last year ?
1
Yes
0
No
qc_11_b == 1
Why have you changed your mind
Generic text
Are you in any way worried about this child's progress at school?
1
Yes
0
No
qc_12_a == 1
Please give your reasons for worrying.
Generic text

VII. HOBBIES AND OUTSIDE INTERESTS

Has this child any hobby or special interest?
1
Yes
0
No
qc_13_a == 1
What is it?
Generic text
Does he belong to any club or organisation outside school?
1
Yes
0
No
qc_14_a == 1
What organisation(s) does he belong to ?
Generic text
Does this child go to Church or Sunday School ?
1
Yes
0
No
What Church or Sunday School does he go to ?
1
Church of England
2
Roman Catholic
3
Non-conformist
*
Other, namely
Other text
At what time does this child go to bed at night ? ... p.m.
Generic time
At what time does this child get up in the morning ? ... a.m.
Generic time

VIII. GENERAL HEALTH AND BEHAVIOUR

Are you in any way worried about this child's behaviour?
1
Yes
0
No
qc_17_a == 1
Please give your reasons for worrying
Generic text
Has this child any habits such as thumb sucking, nail biting, nose picking, tics or general fidgetiness ?
0
No habits of this type
1
Sucks thumb
2
Bites nails
3
Picks nose
*
Other habits, namely
Other text
During the last year, have you or any member of your household ever had to go to this child because of his nightmares or disturbed sleep ?
0
Never
1
Occasionally
2
Several nights a week
3
Every night

IX. DOMESTIC HELP

Who helps you with the housework or children ? Regularly
1
Husband
2
This child
3
Other children
4
Grandparents
5
Other relations or friends
6
Paid help
0
Not helped at all
Who helps you with the housework or children ? Occasionally
1
Husband
2
This child
3
Other children
4
Grandparents
5
Other relations or friends
6
Paid help
0
Not helped at all

X. OCCUPATION OF PRESENT HUSBAND

What is your husband's occupation now ?
Generic text
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 ?
If you husband's work regularly keeps him away from home for 24 hours or more at a time, please give details.
Generic text

XI. SUBSEQUENT PREGNANCIES

Please give the following details for each pregnancy since October 1954:-

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
1
2
3
Expected date of delivery
Generic text

XII. THE MOTHER'S WORK

Have you been in paid work (either inside or outside the home) since OCTOBER, 1955 ?
1
Yes
0
No
qc_22_a == 1

Please give the following details of each period of employment.

Exact nature of work No. of days worked per week Time of leaving home Time of getting back home Date of taking job Date of leaving job
1
2

XIII. THE HOUSEHOLD AND DWELLING

Ownership of dwelling.
1
Council
2
Parents of the child
3
Relative
*
Other, namely
Other text

Parents and their children living in this household.

Christian Name Sex Age Years Age Months
1
2
3
4
5
6
7

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
1
2
3
Total in household. ... persons
How many?

Total rooms occupied by all the members of the household listed in 24 (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
1
Does this child sleep in a room by himself or in a room with others ?
1
By himself
2
With others
qc_26_a == 2
Who else sleeps in his room ? (Please give names and ages).
Generic text
qc_26_a == 2
Does he sleep in own bed or with others ? (If with others, please give names and ages).
0
Own bed
*
With others, namely
Other text
Is your kitchen shared with another household?
1
Yes
0
No
Y
No kitchen
Is there a bathroom for your use ?
1
Yes
0
No
How do you obtain hot water ?
1
Running hot water
2
Gas or electric copper
3
Boiling kettles
*
Other, namely
Other text
Where does this child do his homework ?
1
In the living room with other members of the family
2
In a separate room
*
Elsewhere, namely
Other text
Does mother think that this dwelling lacks any essential amenities that would help you in bringing up your children ?
1
Yes
0
No
qc_31 == 1
please give details)
Long text

INFORMATION GIVEN BY SCHOOL NURSE OR HEALTH VISITOR

(Please answer the following Questions from your own knowledge. DO NOT ask the mother directly.)
Is any member of this child's family or household known to have tuberculosis ?
1
Yes
0
No
X
Unknown
qc_32_a == 1
Please state the name and the relationship Name
Generic text
qc_32_a == 1
Please state the name and the relationship Relationship
Generic text
Was B.C.G. Vaccination offered to this child and if so, was it accepted ?
1
Offered and accepted
2
Offered, not accepted
3
Not offered
X
Unknown
Y
Not applicable
Does this family possess any of the following ?
1
Telephone
2
Car
3
Television
0
None of these
Please give your assessment of the state of repair of the dwelling.
1
Average
2
Very good
3
Bad
Please state from your OWN KNOWLEDGE whether the parents of this child are-
1
Married &amp; living together
2
Legally separated
3
Divorced
4
Permanently separated for other reasons
5
Widowed
*
Other, namely
Other text
Date of interview
Generic date
Length of Interview ... mins.
How many?
Name of School Nurse or Health Visitor
Generic text
Name

Interview With Mother