Start
nshd_57_sd
STRICTLY CONFIDENTIAL
JANUARY 1957
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 At the LONDON SCHOOL OF ECONOMICS,
intro i

Ref. No.

Generic text
intro ii

Name

Generic text
intro iii

Address

Long text
intro iv

School

Generic text
FOR THOSE WHO HAVE MOVED
intro v

New Address

Long text
intro vi

L.E.A.

Generic text
intro vii

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 RECIEVE IT.
Purpose of this enquiry.
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. They are drawn from all social classes and during the first ten years of their lives only 8 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.
How to fill in this form.
Five thousand children scattered all over the country are being given this examination, and it is therefore important that the many hundreds of doctors who are examining them should record their findings in a comparable way. For this reason, and also to reduce the amount of clerical work, this examination 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. When a question does not apply it should be struck through. When either the Doctor or the Mother is unable to answer a question, this fact should be recorded in the space directly under the question.
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
It is hoped that the Mother &/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
1 a

Date of Death

Date of death
1 b

Cause of Death (if known)

Generic text
1 c

Address or Name of Hospital where death occurred

Generic text
SOURCE OF INFORMATION
2

If this child is living but the form cannot be completed please state the reason here :

Generic text
3

Parent or relative attending with child

1
Mother
2
Father
3
Both parents
*
Other person, namely
0
No one
Other
ASTHMA
4 a

Has this child, during the last year, had an attack of asthma?

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

How frequent are his asthmatic attacks?

Generic text
4 c

How long do they last? ... hours

How many
4 d

Has a doctor been consulted about his asthma?

1
Doctor consulted
0
No doctor consulted
4 e

Has the cause of the attacks been investigated?

1
Yes, at hospital
2
Yes, by family doctor
0
No investigation
4 f(i)

Name and address of hospital where investigated Name

Generic text
4 f(ii)

Name and address of hospital where investigated Address

Generic text
4 g

What treatment is being given?

Generic text
TEETH
5 a

How many times has this child been seen by a dentist during the last year? ... times

How many
0
A_HEART
6 a

During the last year, has this child been treated for heart trouble?

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

What treatment was given?

Generic text
6 c

Did this treatment lead to any restriction of his activities?

*
Yes, namely
0
No restriction of activities
Generic text
A_ABDOMEN
7 a

Has this child had any attacks of abdominal pain during the last year?

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

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

1
Doctor called in
2
Taken to hospital
0
Neither
8 a

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
8 b

About how often does he have these attacks?

1
Less than once a month
2
More often
8 c

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

Generic text
(All Children)
8 d

Has this child ever had jaundice or putty coloured stools?

1
Yes
0
No
(If "yes".)
qc_8_d == 1
8 d(i)

Please give details

Generic text
BEDWETTING
9 a

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
9 b

How are you trying to get him dry?

Generic text
MENSTRUATION
10

Has this child started her periods?

1
Yes
0
No
Y
Does not apply
HEARING
11 a

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
11 b

Is he hard of hearing when he has colds?

1
Yes
2
No
FITS AND CONVULSIONS
12 a

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
12 b

How many fits or convulsions has he had during the last year? ... fits and convulsions

How many
12 c

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

1
During an illness
2
While in normal health
GENERAL HEALTH
13 a

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

1
Yes
0
No
(If "yes".)
qc_13_a == 1
13 b

Please give your reasons for worrying

Generic text
X-RAY
14
Please give the following details of any X-rays (including mass miniature radiography) this child has ever had.
Approx. age Reason for X-ray Part X-rayed Approximate number of exposures
How manyGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textHow manyGeneric textGeneric textGeneric textHow manyGeneric textGeneric textHow manyGeneric text How manyGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textHow manyGeneric textGeneric textGeneric textHow manyGeneric textGeneric textHow manyGeneric text How manyGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textHow manyGeneric textGeneric textGeneric textHow manyGeneric textGeneric textHow manyGeneric text How manyGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textHow manyGeneric textGeneric textGeneric textHow manyGeneric textGeneric textHow manyGeneric text
1
2
3
B. EXAMINATION
15

Pulse rate at beginning of examination ... per minute

How many
THROAT AND TONSILS
16 a

Colour of pillars of fauces.

1
Congested
0
Not congested
Y
Not seen, child gags
16 b

Tonsils.

1
Present and intact
2
Remnants
0
Removed
Y
Not seen, child gags
(If tonsils present.)
qc_16_b == 1
16 c

Size of tonsils.

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

Crypts.

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

Tonsillar glands.

1
Palpable
0
Not palpable
16 f

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

1
Yes
0
No
2
Undecided
(If "yes".)
qc_16_f == 1
16 g

Please give your reasons

Generic text
TEETH
17 i

Please describe the condition of the FIRST PREMOLAR TEETH Number missing

How many
17 ii

Please describe the condition of the FIRST PREMOLAR TEETH Number filled

How many
17 iii

Please describe the condition of the FIRST PREMOLAR TEETH Number decayed, not filled

How many
17 iv

Please describe the condition of the FIRST PREMOLAR TEETH Number non-carious

How many
BREAST DEVELOPMENT
18

Are there any signs of breast development?

1
Yes
0
No
Y
Does not apply
LUNGS
19

Are there any abnormal signs present in the lungs?

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

Please describe

Generic text
B_HEART
Please examine this child standing up and lying down.
20 a

Position of cardiac impulse

Generic text
20 b(i)

Murmurs. Standing

0
No murmur heard
1
Murmur(s) heard
20 b(ii)

Murmurs. Lying

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

Point of maximum intensity?

Generic text
20 b(iv)

Timing of the murmur?

Generic text
20 b(v)

Is there a palpable thrill?

Generic text
20 b(vi)

If so, where?

Generic text
(All children.)
20 c

Details of any other cardiac abnormalities not noted above

Generic text
20 d

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
20 d(i)

Please describe

Generic text
20 e

Are there any other manifestations of rheumatic disease

Generic text
(All children.)
20 f

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
20 f(i)

Please describe

Generic text
B_ABDOMEN
21 a

Is there any abdominal distention?

1
Yes
0
No
21 b

Are there any palpable masses?

0
No
1
Yes, liver palpable
2
Yes, spleen palpable
3
Yes, foeces palpable
*
Yes, other masses, namely
Other
21 c

Is there any evidence of umbilical hernia?

1
Yes
0
No
21 d

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

1
Yes
0
No
21 e

Is any pigmented pubic hair visible?

1
Yes
0
No
21 f

Has this child been circumcised?

1
Yes
0
No
Y
Does not apply
22 a

Are both testicles in the scrotal sac?

1
Yes, both
2
Left only descended
3
Right only descended
4
Neither descended
Y
Question does not apply
(If "not descended")
qc_22_a == 2 || qc_22_a == 3 || qc_22_a == 4
22 b

Can the testicle(s) be drawn down into the scrotal sac?

1
Yes
0
No
MISCELLANEOUS
23 i

Lymphatic glands Neck (Exc. tonsillar glands)

1
Palpable
0
Not palpable
23 ii

Lymphatic glands Axilla

1
Palpable
0
Not palpable
23 iii

Lymphatic glands Groin

1
Palpable
0
Not palpable
24

Skin.

0
No obvious abnormality
1
Septic spots or boils
*
Other abnormalities, namely
Other
25

Nails and fingers.

*
No abnormality
1
Bitten nails
2
Clubbed fingers
*
Other, namely
Other
26

Orthopaedic defects.

0
None
1
Defect
(If "defect".)
qc_26 == 1
26 i

Please give details

Generic text
27

Remarks on other abnormalities or deformities not reported above

Generic text
28

Pulse rate at end of examination ... per minute.

How many
PHYSICAL MEASUREMENTS
29

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
ozs
29 i

Scales used.

1
Beam balance
2
Spring balance
30

Present standing height. (WITHOUT SHOES.) ... ft. ... ins.

(To nearest quarter inch.)

ft.
ins.
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
31 a

Speech.

0
No abnormality
1
Stammering
2
Dyslalia
*
Structural speech defect, namely
Generic text
(If "stammering", "dyslalia" or other defect.)
qc_31_a == 1 || qc_31_a == 2 || qc_31_a == *
31 b

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

1
Yes
0
No
(If "yes")
qc_31_b == 1
31 c

What arrangements have been made to give him speech therapy

Generic text
EYES
32 a

Squint.

0
Does not squint
1
Concomitant squint
2
Paralytic squint
32 b

Does this child wear glasses?

0
Yes
1
No
32 c
Visual acuity.
Without glasses With glasses
Generic textGeneric textGeneric textGeneric text Generic textGeneric textGeneric textGeneric text
Right eye
Left eye
32 d

Eye defects not noted above:

Generic text
EARS
33 a(i)

External Auditory Meatus. Right

1
Mucoid discharge
2
Purulent discharge
3
Wax
0
Clear
*
Other, namely
Other
33 a(ii)

External Auditory Meatus. Left

1
Mucoid discharge
2
Purulent discharge
3
Wax
0
Clear
*
Other, namely
33 b(i)

Drums. Right

0
Intact
1
Indrawn
2
Perforated
3
Obscured by wax
*
Other conditions, namely
Other
33 b(ii)

Drums. Left

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

What is your assessment of this child's hearing?

3
Average or good
2
Poor
1
Very poor
[If hearing is "poor")
qc_33_c == 2 || qc_33_c == 1
33 d

Does he wear a hearing aid?

Generic text
LATERALITY
34

Eye dominance

Give this child a white card (about 8" x 5") in the middle of which a hole approximately 1/2" in diameter has been cut. Ask him to stand several feet from you, to raise the card at arm's length, and to look at you through the hole, BOTH EYES BEING KEPT OPEN. Please note which eye you can see through the hole. Repeat three times.

1
Always right eye
2
Always left eye
3
Sometimes right, sometimes left
HANDS
35 a

Which hand does this child use to write with or draw with?

1
Right
2
Left
3
Either
35 b

Ask the child to pick up a ball placed directly in front of him, and to throw it as accurately as possible into a box. Note which hand is used. Repeat three times.

1
Always right hand
2
Always left hand
3
Sometimes right, sometimes left
ASSESSMENTS
36 a

Alertness and activity.

2
Average
3
Above average
1
Below average
0
Apathetic
36 b

Physical development.

1
Average
2
Superior
0
Inferior
outro i

CHECK ON PAST INFORMATION

Long text
outro ii

Name of Doctor making examination

Generic text
1
School Doctor
2
Family Doctor
outro iii

Date of Examination

Generic date
outro iv

Time taken for this interview

Generic time
End

nshd_57_sd

s_intro_i
STRICTLY CONFIDENTIAL
s_intro_ii
JANUARY 1957
s_intro_iii
EXAMINATION BY THE SCHOOL DOCTOR
s_intro_iv
NATIONAL SURVEY OF THE HEALTH AND DEVELOPMENT OF CHILDREN
s_intro_v
INSTITUTE OF CHILD HEALTH (UNIVERSITY OF LONDON) SOCIETY OF MEDICAL OFFICERS OF HEALTH and POPULATION INVESTIGATION COMMITTEE At the LONDON SCHOOL OF ECONOMICS,
intro i
Ref. No.
Generic text
intro ii
Name
Generic text
intro iii
Address
Long text
intro iv
School
Generic text

FOR THOSE WHO HAVE MOVED

intro v
New Address
Long text
intro vi
L.E.A.
Generic text
intro vii
School
Generic text
s_intro_vi
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 RECIEVE IT.
s_intro_vii
Purpose of this enquiry.
s_intro_viii
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. They are drawn from all social classes and during the first ten years of their lives only 8 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.
s_intro_ix
How to fill in this form.
s_intro_x
Five thousand children scattered all over the country are being given this examination, and it is therefore important that the many hundreds of doctors who are examining them should record their findings in a comparable way. For this reason, and also to reduce the amount of clerical work, this examination 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. When a question does not apply it should be struck through. When either the Doctor or the Mother is unable to answer a question, this fact should be recorded in the space directly under the question.
s_intro_xi
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.
s_intro_xii
COMPLETED FORMS SHOULD BE RETURNED TO THE SCHOOL MEDICAL OFFICER AND NOT DIRECTLY TO THE JOINT COMMITTEE
s_intro_xiii
It is hoped that the Mother &/or Father will be present at this examination

A. MEDICAL HISTORY

s_medicalhistory_i
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.
s_medicalhistory_ii
If a question does not apply, strike it through.

SURVIVAL

1 a
Date of Death
Date of death
If this child has died please state
1 b
Cause of Death (if known)
Generic text
If this child has died please state
1 c
Address or Name of Hospital where death occurred
Generic text
If this child has died please state

SOURCE OF INFORMATION

2
If this child is living but the form cannot be completed please state the reason here :
Generic text
3
Parent or relative attending with child
1
Mother
2
Father
3
Both parents
*
Other person, namely
0
No one
Other

ASTHMA

4 a
Has this child, during the last year, had an attack of asthma?
1
Yes
0
No
4 b
How frequent are his asthmatic attacks?
Generic text
(If "yes".)
4 c
How long do they last? ... hours
How many
(If "yes".)
4 d
Has a doctor been consulted about his asthma?
1
Doctor consulted
0
No doctor consulted
(If "yes".)
4 e
Has the cause of the attacks been investigated?
1
Yes, at hospital
2
Yes, by family doctor
0
No investigation
(If "yes".)
4 f(i)
Name and address of hospital where investigated Name
Generic text
4 f(ii)
Name and address of hospital where investigated Address
Generic text
4 g
What treatment is being given?
Generic text
s_teeth_i
TEETH
5 a
How many times has this child been seen by a dentist during the last year? ... times
How many
0

A_HEART

6 a
During the last year, has this child been treated for heart trouble?
1
Yes
0
No
6 b
What treatment was given?
Generic text
(If "yes".)
6 c
Did this treatment lead to any restriction of his activities?
*
Yes, namely
0
No restriction of activities
Generic text
(If "yes".)

A_ABDOMEN

7 a
Has this child had any attacks of abdominal pain during the last year?
1
Yes
0
No
7 b
Was a doctor called in or was he taken to hospital?
1
Doctor called in
2
Taken to hospital
0
Neither
(If "yes".)
8 a
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
8 b
About how often does he have these attacks?
1
Less than once a month
2
More often
(If "yes".)
8 c
Are these attacks associated with any particular circumstances? If so, please give details
Generic text
(If "yes".)
s_q8d
(All Children)
8 d
Has this child ever had jaundice or putty coloured stools?
1
Yes
0
No
8 d(i)
Please give details
Generic text
(If "yes".)

BEDWETTING

9 a
Is this child now dry by night?
0
Never wet
1
Wet occasionally
2
Wet several nights a week
3
Wet every night
9 b
How are you trying to get him dry?
Generic text
(If "wet")
s_menstruation_i
MENSTRUATION
10
Has this child started her periods?
1
Yes
0
No
Y
Does not apply

HEARING

11 a
Is this child hard of hearing sometimes, or all the time?
1
Sometimes deaf
2
Always deaf
0
Normal hearing
11 b
Is he hard of hearing when he has colds?
1
Yes
2
No
(If "sometimes deaf".)

FITS AND CONVULSIONS

12 a
Has this child, during the last year, had a fit or convulsion or lost consciousness?
1
Yes, fits, etc.
0
No fit or convulsion
12 b
How many fits or convulsions has he had during the last year? ... fits and convulsions
How many
(If "fit or convulsion".)
12 c
Did they occur during an illness or while he was in normal health?
1
During an illness
2
While in normal health
(If "fit or convulsion".)

GENERAL HEALTH

13 a
Are you in any way worried about this child's health?
1
Yes
0
No
13 b
Please give your reasons for worrying
Generic text
(If "yes".)
s_xray_i
X-RAY
14

Please give the following details of any X-rays (including mass miniature radiography) this child has ever had.

Approx. age Reason for X-ray Part X-rayed Approximate number of exposures
How manyGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textHow manyGeneric textGeneric textGeneric textHow manyGeneric textGeneric textHow manyGeneric text How manyGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textHow manyGeneric textGeneric textGeneric textHow manyGeneric textGeneric textHow manyGeneric text How manyGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textHow manyGeneric textGeneric textGeneric textHow manyGeneric textGeneric textHow manyGeneric text How manyGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textHow manyGeneric textGeneric textGeneric textHow manyGeneric textGeneric textHow manyGeneric text
1
2
3

B. EXAMINATION

15
Pulse rate at beginning of examination ... per minute
How many

THROAT AND TONSILS

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

TEETH

17 i
Please describe the condition of the FIRST PREMOLAR TEETH Number missing
How many
17 ii
Please describe the condition of the FIRST PREMOLAR TEETH Number filled
How many
17 iii
Please describe the condition of the FIRST PREMOLAR TEETH Number decayed, not filled
How many
17 iv
Please describe the condition of the FIRST PREMOLAR TEETH Number non-carious
How many
s_breastdevelopment_i
BREAST DEVELOPMENT
18
Are there any signs of breast development?
1
Yes
0
No
Y
Does not apply

LUNGS

19
Are there any abnormal signs present in the lungs?
1
Abnormal signs present
0
No abnormality detected
19 i
Please describe
Generic text
(If "abnormal signs".)

B_HEART

s_bheart_i
Please examine this child standing up and lying down.
20 a
Position of cardiac impulse
Generic text
20 b(i)
Murmurs. Standing
0
No murmur heard
1
Murmur(s) heard
20 b(ii)
Murmurs. Lying
0
No murmur heard
1
Murmur(s) heard
20 b(iii)
Point of maximum intensity?
Generic text
(If "murmur(s)".)
20 b(iv)
Timing of the murmur?
Generic text
(If "murmur(s)".)
20 b(v)
Is there a palpable thrill?
Generic text
(If "murmur(s)".)
20 b(vi)
If so, where?
Generic text
(If "murmur(s)".)
s_q20c
(All children.)
20 c
Details of any other cardiac abnormalities not noted above
Generic text
20 d
Do you consider that this child shows any evidence of rheumatic heart disease?
1
Yes
0
No
2
Doubtful
20 d(i)
Please describe
Generic text
(If "yes")
20 e
Are there any other manifestations of rheumatic disease
Generic text
(If "yes")
s_q20f
(All children.)
20 f
Do you consider that this child shows any evidence of congenital heart disease?
1
Yes
0
No
2
Doubtful
20 f(i)
Please describe
Generic text
(If "yes")

B_ABDOMEN

21 a
Is there any abdominal distention?
1
Yes
0
No
21 b
Are there any palpable masses?
0
No
1
Yes, liver palpable
2
Yes, spleen palpable
3
Yes, foeces palpable
*
Yes, other masses, namely
Other
21 c
Is there any evidence of umbilical hernia?
1
Yes
0
No
21 d
Is there an impulse on coughing when a finger is inserted into the inguinal canal?
1
Yes
0
No
21 e
Is any pigmented pubic hair visible?
1
Yes
0
No
21 f
Has this child been circumcised?
1
Yes
0
No
Y
Does not apply
22 a
Are both testicles in the scrotal sac?
1
Yes, both
2
Left only descended
3
Right only descended
4
Neither descended
Y
Question does not apply
22 b
Can the testicle(s) be drawn down into the scrotal sac?
1
Yes
0
No
(If "not descended")

MISCELLANEOUS

23 i
Lymphatic glands Neck (Exc. tonsillar glands)
1
Palpable
0
Not palpable
23 ii
Lymphatic glands Axilla
1
Palpable
0
Not palpable
23 iii
Lymphatic glands Groin
1
Palpable
0
Not palpable
24
Skin.
0
No obvious abnormality
1
Septic spots or boils
*
Other abnormalities, namely
Other
25
Nails and fingers.
*
No abnormality
1
Bitten nails
2
Clubbed fingers
*
Other, namely
Other
26
Orthopaedic defects.
0
None
1
Defect
26 i
Please give details
Generic text
(If "defect".)
27
Remarks on other abnormalities or deformities not reported above
Generic text
28
Pulse rate at end of examination ... per minute.
How many

PHYSICAL MEASUREMENTS

29
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
ozs
29 i
Scales used.
1
Beam balance
2
Spring balance
30
Present standing height. (WITHOUT SHOES.) ... ft. ... ins.
ft.
ins.
1
Height measurer used
2
Measured against wall
s_q30
["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

31 a
Speech.
0
No abnormality
1
Stammering
2
Dyslalia
*
Structural speech defect, namely
Generic text
31 b
Does this child, in your opinion, need speech therapy?
1
Yes
0
No
(If "stammering", "dyslalia" or other defect.)
31 c
What arrangements have been made to give him speech therapy
Generic text
(If "stammering", "dyslalia" or other defect.)
(If "yes")

EYES

32 a
Squint.
0
Does not squint
1
Concomitant squint
2
Paralytic squint
32 b
Does this child wear glasses?
0
Yes
1
No
32 c

Visual acuity.

Without glasses With glasses
Generic textGeneric textGeneric textGeneric text Generic textGeneric textGeneric textGeneric text
Right eye
Left eye
32 d
Eye defects not noted above:
Generic text

EARS

33 a(i)
External Auditory Meatus. Right
1
Mucoid discharge
2
Purulent discharge
3
Wax
0
Clear
*
Other, namely
Other
33 a(ii)
External Auditory Meatus. Left
1
Mucoid discharge
2
Purulent discharge
3
Wax
0
Clear
*
Other, namely
33 b(i)
Drums. Right
0
Intact
1
Indrawn
2
Perforated
3
Obscured by wax
*
Other conditions, namely
Other
33 b(ii)
Drums. Left
0
Intact
1
Indrawn
2
Perforated
3
Obscured by wax
*
Other conditions, namely
Other
33 c
What is your assessment of this child's hearing?
3
Average or good
2
Poor
1
Very poor
33 d
Does he wear a hearing aid?
Generic text
[If hearing is "poor")

LATERALITY

34
Eye dominance
1
Always right eye
2
Always left eye
3
Sometimes right, sometimes left

HANDS

35 a
Which hand does this child use to write with or draw with?
1
Right
2
Left
3
Either
35 b
Ask the child to pick up a ball placed directly in front of him, and to throw it as accurately as possible into a box. Note which hand is used. Repeat three times.
1
Always right hand
2
Always left hand
3
Sometimes right, sometimes left

ASSESSMENTS

36 a
Alertness and activity.
2
Average
3
Above average
1
Below average
0
Apathetic
36 b
Physical development.
1
Average
2
Superior
0
Inferior
outro i
CHECK ON PAST INFORMATION
Long text
outro ii
Name of Doctor making examination
Generic text
1
School Doctor
2
Family Doctor
outro iii
Date of Examination
Generic date
outro iv
Time taken for this interview
Generic time
Name

1957 Examination by the School Doctor