Start
nshd_52_iwm
STRICTLY CONFIDENTIAL
MARCH 1952
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

Name

(Surname first in block letters)

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 1946, 1948 and 1950 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 two years. 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. Details of health and development have been recorded at two yearly intervals during the pre-school years and it is hoped that, during the primary school period, a clinical examination will be made by the School Doctor each year and a record of illnesses made each term by the School Nurse. The aim of the present examination is to bring the medical and social history up to date, to check information previously noted, and to record the clinical state of the child. This will complete our information for the whole of the pre-school period.
The children in this sample are representative of all births in England, Wales and Scotland in March 1946. They are drawn from all social classes and during the first six years of their lives only 5% 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.
This form refers to the past medical history and to the home and family background of the child. A clinical examination form is being completed by the School Doctor. When following the future progress of this child a very much briefer record card will be used.
How to fill in this form.
Six 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. When a question does not apply it should be struck through. When either you 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 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
THIS INQUIRY REFERS THROUGHOUT TO THE CHILD BORN IN MARCH 1946. RING WITH A SOFT PENCIL THE CODE NUMBER OPPOSITE THE MOTHER'S ANSWER. IF NO ANSWER IS GIVEN RECORD THIS FACT UNDER THE QUESTION. IF A QUESTION DOES NOT APPLY, STRIKE IT THROUGH.
If this child has died please state

Date of death

Date of death

Cause of death (if known)

Generic text
(For all living children)

Parent or relative interviewed

1
Mother
2
Father
3
Both parents
*
Other person, namely
0
No one
Other
If mother not interviewed
qc_1_a != 1

please give reasons

Generic text
I. ACCIDENTS

Last accident recorded in 1950. Type ... Age when injured ... yrs.

Generic text
Age
0
No accident reported in first 4yrs. 3 mths. of life
(Since this accident, or since June 1950)

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_2_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 textAge (in years and months)Generic textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textAge (in years and months)Generic textGeneric textGeneric textGeneric textAge (in years and months)Generic textGeneric textGeneric textGeneric textAge (in years and months)Generic textGeneric textGeneric textGeneric textGeneric textGeneric textAge (in years and months)Generic textGeneric textGeneric textAge (in years and months)Generic textGeneric textGeneric textGeneric text Generic textGeneric textAge (in years and months)Generic textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textAge (in years and months)Generic textGeneric textGeneric textGeneric textAge (in years and months)Generic textGeneric textGeneric textGeneric textAge (in years and months)Generic textGeneric textGeneric textGeneric textGeneric textGeneric textAge (in years and months)Generic textGeneric textGeneric textAge (in years and months)Generic textGeneric textGeneric textGeneric text Generic textGeneric textAge (in years and months)Generic textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textAge (in years and months)Generic textGeneric textGeneric textGeneric textAge (in years and months)Generic textGeneric textGeneric textGeneric textAge (in years and months)Generic textGeneric textGeneric textGeneric textGeneric textGeneric textAge (in years and months)Generic textGeneric textGeneric textAge (in years and months)Generic textGeneric textGeneric textGeneric text Generic textGeneric textAge (in years and months)Generic textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textAge (in years and months)Generic textGeneric textGeneric textGeneric textAge (in years and months)Generic textGeneric textGeneric textGeneric textAge (in years and months)Generic textGeneric textGeneric textGeneric textGeneric textGeneric textAge (in years and months)Generic textGeneric textGeneric textAge (in years and months)Generic textGeneric textGeneric textGeneric text Generic textGeneric textAge (in years and months)Generic textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textAge (in years and months)Generic textGeneric textGeneric textGeneric textAge (in years and months)Generic textGeneric textGeneric textGeneric textAge (in years and months)Generic textGeneric textGeneric textGeneric textGeneric textGeneric textAge (in years and months)Generic textGeneric textGeneric textAge (in years and months)Generic textGeneric textGeneric textGeneric text Generic textGeneric textAge (in years and months)Generic textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textAge (in years and months)Generic textGeneric textGeneric textGeneric textAge (in years and months)Generic textGeneric textGeneric textGeneric textAge (in years and months)Generic textGeneric textGeneric textGeneric textGeneric textGeneric textAge (in years and months)Generic textGeneric textGeneric textAge (in years and months)Generic textGeneric textGeneric textGeneric text
First Accident since June 1950: 1
Subsequent Accidents: 2
Subsequent Accidents: 3
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 since June 1950: 1
Subsequent Accidents: 2
Subsequent Accidents: 3
II. INFECTIOUS DISEASES

Has this child been immunised against WHOOPING COUGH? If so, at what age? Immunised when ... mths.

Age in months
0
Not immunised
(Attacks recorded in previous surveys are entered in red.)
Has this child had WHOOPING COUGH, MEASLES, MUMPS OR SCARLET FEVER since June, 1950, when he was 4 yrs. 3 mths. old?
-

1 - Yes

0 - No

Whooping Cough
Measles
Mumps
Scarlet Fever
(If "yes.")
qc_3_b$1;1 == 1 || qc_3_b$1;2 == 1 || qc_3_b$1;3 == 1 || qc_3_b$1;4 == 1
Please give the following details:-
Age at onset (yrs. and mths.) Where treated Hosp. I.P. Hosp. O.P. Nursing Home Own Home If treated in own home who gave treatment (Doctor, Nurse, other)
Generic textAge (in years and months)Generic textGeneric textAge (in years and months)Generic textAge (in years and months)Generic textGeneric text Generic textAge (in years and months)Generic textGeneric textAge (in years and months)Generic textAge (in years and months)Generic textGeneric text Generic textAge (in years and months)Generic textGeneric textAge (in years and months)Generic textAge (in years and months)Generic textGeneric text
Whooping cough
Measles
Mumps
Scarlet fever
For all those who have had Whooping Cough.
qc_3_b$1;1 == 1

Was there any doubt that it was Whooping Cough?

0
Doubtful whooping cough
1
Certainly whooping cough

How long did the cough last? ... weeks

How many
III. HOSPITAL ADMISSIONS

Last hospital admission recorded in 1950. Illness ... Hospital ... Age on admission ... yrs.

Generic text
Generic text 2
Age
0
Not admitted to hospital during first 4 yrs. 3 mths. of life

Has this child been an IN-PATIENT in a hospital or nursing home since June, 1950, when he was 4 yrs. 3mths. old?

1
Yes
0
No
(If "yes.")
qc_4_b == 1
Please give the following information about each admission. (When a single illness involves more than one admission give information separately for each period in hospital.)

INCLUDE all illnesses, etc., even if recorded earlier on this form.

Nature of illness Operation (if any) Age on admission (in yrs. and mths.)
Generic textGeneric textAge (in years and months)Generic textGeneric textAge (in years and months)Generic textAge (in years and months)Generic text Generic textGeneric textAge (in years and months)Generic textGeneric textAge (in years and months)Generic textAge (in years and months)Generic text Generic textGeneric textAge (in years and months)Generic textGeneric textAge (in years and months)Generic textAge (in years and months)Generic text
1
2
3
Please give the following information about each admission. (When a single illness involves more than one admission give information separately for each period in hospital.)
Name and address of hospital or nursing home Hosp. Reg No. (if known) Length of stay in hosp. or nursing home (in days)
Generic textGeneric textHow long (in days)Generic textGeneric textHow long (in days)Generic textHow long (in days)Generic text Generic textGeneric textHow long (in days)Generic textGeneric textHow long (in days)Generic textHow long (in days)Generic text Generic textGeneric textHow long (in days)Generic textGeneric textHow long (in days)Generic textHow long (in days)Generic text
1
2
3
(For all children going to hospital.)

Have you noticed any differences in the behaviour of this child since he came back home?

1
Yes
0
No
(If "yes.")
qc_4_e == 1

Please give details:

Generic text
IV. OTHER CONDITIONS

Is this child frequently sick? If so, please say on what occasions.

0
Not frequently sick
1
Sick when travelling
2
Sick when excited
3
Sick when he over-eats
*
Sick on other occasions, namely
Other

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

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

Please give your reasons for worrying

Generic text

Remarks on any illnesses or disabilities not recorded above:

Long text
V. BLADDER & BOWEL TRAINING

Is this child dry by day?

0
Never wet
1
Sometimes wet

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_8_a == 1 || qc_8_b == 1 || qc_8_b == 2 || qc_8_b == 3

How are you trying to get him dry? Punishments, namely

Generic text

How are you trying to get him dry? Rewards if dry, namely

Generic text

How are you trying to get him dry? Special treatment, namely

Generic text
(If "dry.")
qc_8_a == 0 && qc 8_b ==0

How old was he when you left his napkins off at night? ... yrs. ... mths

Age
Months

How old was this child when you started to train him to be clean? ... mths. old

0
From birth
Age in months

At what age did he first gain control of his bowels? ...mths. old

Age in months

Have you had any trouble with his cleanliness since then?

1
Yes
0
No
(If "yes.")
qc_9_c == 1

How old was he when the trouble started? ... mths. old

Age in months

How long did it last? ... mths.

How many
9
Still sometimes dirty

How frequent are this child's motions?

1
More than once a day
2
Usually once a day
3
Usually less than once a day

Do you give this child laxatives?

2
Once a week or more often
1
Less than once a week
0
Never
(If "yes.")
qc_10_b == 2 || qc_10_b == 1

Why do you give him laxatives?

1
Hard stools
*
Other reason, namely
Other
VI. HABITS

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

0
No habits of this type
1
Sucks thumb
2
Bites nails
3
Picks nose
*
Other habits, namely
Other
(If "habits.")
qc_11_a == 1 || qc_11_a == 2 || qc_11_a == 3 || qc_11_a == *

How are you trying to cure him of these habits? Punishments, namely

Generic text

How are you trying to cure him of these habits? Rewards, namely

Generic text

How are you trying to cure him of thes habits? Special treatment, namely

Generic text

How are you trying to cure him of these habits?

0
Not trying to cure him

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

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

Please give your reasons for worrying

Generic text
VII. SLEEP AND PLAY

Has he any favourite toy which he takes to bed?

*
Yes, namely
0
None
Generic 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
(For those who have had to go to their child at night.)
qc_13_b == 1 || qc_13_b == 2 || qc_13_b == 3

Who usually goes to the child?

1
Mother
2
Father
*
Other person, namely
Other

What are this child's favourite toys?

Generic text

What are his favourite games?

Generic text

With whom does he usually play when not at school?

0
By himself
1
With brothers and sisters
2
With school fellows
*
With others, namely
Other
(If "by himself.")
qc_14_c == 0

Why does he play by himself?

1
From choice
2
No children living nearby
3
Shyness
*
Other reason, namely
Other
(All children.)

Where does he usually play when not at school? Summer

1
In the house
2
In the yard or garden
3
In the street
4
In park or open space
5
Elsewhere,

Where does he usually play when not at school? Winter

1
In the house
2
In the yard or garden
3
In the street
4
In park or open space
5
Elsewhere,
VIII. 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
IX. THE HOUSEHOLD
Parents and their children living in this household.

(Please start with the youngest and end with the oldest. INCLUDE THE PARENTS AND THIS CHILD).

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
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 17 (a) and (b) above.
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_19_a == 2

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

Generic text

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

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

Have you been in paid work (either inside or outside the home) since June, 1950, when this child was 4 yrs. 3 mths. old?

1
Yes
0
No
(If "yes.")
qc_20_a == 1
(The last employment noted in 1950 is entered in red.)
Please give the following details of each period of employment.
Exact nature of work Approx. hrs. 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

Who looked after this child while you were working?

Generic text

Were you satisfied with the care he received?

1
Yes
0
No
XI. SUBSEQUENT PREGNANCIES

Have you been pregnant since June, 1950, when this child was 4 yrs. 3 mths. old?

1
Yes
0
No
(If "yes.")
qc_21_a == 1
(The date of the last confinement noted in 1950 is entered in red.)
Please give the following details for each pregnancy:-
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
Age (in years and months)PoundsGeneric dateGeneric textGeneric textAge (in years and months)Generic textGeneric textGeneric datePoundsGeneric textPoundsGeneric textAge (in years and months)Generic dateGeneric datePoundsAge (in years and months)Generic textGeneric textGeneric textAge (in years and months)PoundsGeneric dateGeneric text Age (in years and months)PoundsGeneric dateGeneric textGeneric textAge (in years and months)Generic textGeneric textGeneric datePoundsGeneric textPoundsGeneric textAge (in years and months)Generic dateGeneric datePoundsAge (in years and months)Generic textGeneric textGeneric textAge (in years and months)PoundsGeneric dateGeneric text Age (in years and months)PoundsGeneric dateGeneric textGeneric textAge (in years and months)Generic textGeneric textGeneric datePoundsGeneric textPoundsGeneric textAge (in years and months)Generic dateGeneric datePoundsAge (in years and months)Generic textGeneric textGeneric textAge (in years and months)PoundsGeneric dateGeneric text Age (in years and months)PoundsGeneric dateGeneric textGeneric textAge (in years and months)Generic textGeneric textGeneric datePoundsGeneric textPoundsGeneric textAge (in years and months)Generic dateGeneric datePoundsAge (in years and months)Generic textGeneric textGeneric textAge (in years and months)PoundsGeneric dateGeneric text Age (in years and months)PoundsGeneric dateGeneric textGeneric textAge (in years and months)Generic textGeneric textGeneric datePoundsGeneric textPoundsGeneric textAge (in years and months)Generic dateGeneric datePoundsAge (in years and months)Generic textGeneric textGeneric textAge (in years and months)PoundsGeneric dateGeneric text
1
2
3
(If now pregnant.)

Expected date of delivery

Generic date
XII. SEPARATION FROM MOTHER

What is the longest time you have been separated from this child? ... days when he was ... mths. old

How many
How many 2
0
Never separated
(If "separated.")
qc_22_a != 0

Why were you separated from him?

Generic text

Was the child at home during this period of separation?

1
Yes
0
No
(If "yes.")
qc_22_c == 1
Who looked after him at home?
Relationship Sex Age
Generic textAgeGeneric textGeneric textAgeGeneric textAgeGeneric textGeneric text Generic textAgeGeneric textGeneric textAgeGeneric textAgeGeneric textGeneric text Generic textAgeGeneric textGeneric textAgeGeneric textAgeGeneric textGeneric text
1
2
(If not looked after at home.)
qc_22_c == 0

Where did he go to?

1
Grandparents
2
Other relative or friends
3
Hospital
4
Residential nursery
*
Elsewhere, namely
Other
XIII. EDUCATION OF FATHER & MOTHER
LAST School attended

Those educated in England and Wales? Mother

1
Senior Elementary
2
Central
3
Technical
4
Sec. Grammar or County
5
Public School
*
Other, namely
Other

Those educated in England and Wales? Father

1
Senior Elementary
2
Central
3
Technical
4
Sec. Grammar or County
5
Public School
*
Other, namely
Other

Those educated in Scotland? Type of School Mother

Generic text

Those educated in Scotland? Type of School Father

Generic text

At what age did you/your husband leave school? Mother ... yrs

Age

At what age did you/your husband leave school? Father ... yrs.

Age
Education after leaving School
After leaving school did you/your husband attend any classes or take any courses at a night school, technical school, university, training college or correspondence college?

(Include art, needlework, cookery, handicrafts, etc., as well as technical and academic education.)

-

0 - No further education

1 - Night, technical or commercial school: Full-time

2 - Night, technical or commercial school: Part-time

3 - Teacher's training college

4 - University: Full-time

5 - University: Part-time

6 - Correspondence college

Mother
Father

After leaving school did you/your husband attend any classes or take any course at a night school, technical school, university, training college or correspondence college? Other, namely

Other
(If education after leaving school)
qc_24_a$1;1 != 0 || qc_24_a$1;2 != 0 || qc_24_a_i != 0
(If education after leaving school)
Main subject studied Length of course Age when course finished Degrees, diplomas or certificates obtained
Generic 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 text Generic 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 text
Mother
Father
XIV. OCCUPATION OF PRESENT HUSBAND
(i.e. not necessarily the father of this child.)
(If unemployed, ill, dead, etc., this information should relate to the last job.)

What is your husband's occupation?

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

Generic text
XV. SCHOOL NURSE'S COMMENTS
WILL SCHOOL NURSES PLEASE FILL IN THIS SECTION FROM THEIR OWN KNOWLEDGE OF THE FAMILY

Is this child's clothing in a satisfactory or unsatisfactory state of repair?

1
Satisfactory
2
Unsatisfactory

Are this child's shoes satisfactory or unsatisfactory?

1
Satisfactory
*
Unsatisfactory because
Generic text
Please compare (c) the cleanliness of this child, and (d) the cleanliness of this home with the standard of others in your care.
-

1 - Average

2 - Among the most clean

3 - Among the least clean

Cleanliness of the child
Cleanliness of the home

Please give details of any special lack of facilities in this dwelling which makes it difficult for this Mother to bring up her child or manage her home.

Generic text

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

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

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

1
Average
2
Very good
3
Bad

PLEASE COMMENT FREELY ON THE STATE OF REPAIR OF THE DWELLING:-

Long text

Please comment on any questions which you feel may have been unreliably answered

Generic text
ALL QUESTIONS SHOULD BE ANSWERED (OR STRUCK THROUGH IF NOT APPLICABLE). PLEASE SEE THAT THIS HAS BEEN DONE.

Date of Interview

Generic date

Length of Interview ... mins.

How many

Name of School Nurse or Health Visitor

Generic text
End

nshd_52_iwm

STRICTLY CONFIDENTIAL
MARCH 1952
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
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 1946, 1948 and 1950 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 two years. 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. Details of health and development have been recorded at two yearly intervals during the pre-school years and it is hoped that, during the primary school period, a clinical examination will be made by the School Doctor each year and a record of illnesses made each term by the School Nurse. The aim of the present examination is to bring the medical and social history up to date, to check information previously noted, and to record the clinical state of the child. This will complete our information for the whole of the pre-school period.
The children in this sample are representative of all births in England, Wales and Scotland in March 1946. They are drawn from all social classes and during the first six years of their lives only 5% 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.
This form refers to the past medical history and to the home and family background of the child. A clinical examination form is being completed by the School Doctor. When following the future progress of this child a very much briefer record card will be used.
How to fill in this form.
Six 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. When a question does not apply it should be struck through. When either you 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 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
THIS INQUIRY REFERS THROUGHOUT TO THE CHILD BORN IN MARCH 1946. RING WITH A SOFT PENCIL THE CODE NUMBER OPPOSITE THE MOTHER'S ANSWER. IF NO ANSWER IS GIVEN RECORD THIS FACT UNDER THE QUESTION. IF A QUESTION DOES NOT APPLY, STRIKE IT THROUGH.
Date of death
Date of death
Cause of death (if known)
Generic text
(For all living children)
Parent or relative interviewed
1
Mother
2
Father
3
Both parents
*
Other person, namely
0
No one
Other
please give reasons
Generic text

I. ACCIDENTS

Last accident recorded in 1950. Type ... Age when injured ... yrs.
Generic text
Age
0
No accident reported in first 4yrs. 3 mths. of life
(Since this accident, or since June 1950)
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 textAge (in years and months)Generic textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textAge (in years and months)Generic textGeneric textGeneric textGeneric textAge (in years and months)Generic textGeneric textGeneric textGeneric textAge (in years and months)Generic textGeneric textGeneric textGeneric textGeneric textGeneric textAge (in years and months)Generic textGeneric textGeneric textAge (in years and months)Generic textGeneric textGeneric textGeneric text Generic textGeneric textAge (in years and months)Generic textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textAge (in years and months)Generic textGeneric textGeneric textGeneric textAge (in years and months)Generic textGeneric textGeneric textGeneric textAge (in years and months)Generic textGeneric textGeneric textGeneric textGeneric textGeneric textAge (in years and months)Generic textGeneric textGeneric textAge (in years and months)Generic textGeneric textGeneric textGeneric text Generic textGeneric textAge (in years and months)Generic textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textAge (in years and months)Generic textGeneric textGeneric textGeneric textAge (in years and months)Generic textGeneric textGeneric textGeneric textAge (in years and months)Generic textGeneric textGeneric textGeneric textGeneric textGeneric textAge (in years and months)Generic textGeneric textGeneric textAge (in years and months)Generic textGeneric textGeneric textGeneric text Generic textGeneric textAge (in years and months)Generic textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textAge (in years and months)Generic textGeneric textGeneric textGeneric textAge (in years and months)Generic textGeneric textGeneric textGeneric textAge (in years and months)Generic textGeneric textGeneric textGeneric textGeneric textGeneric textAge (in years and months)Generic textGeneric textGeneric textAge (in years and months)Generic textGeneric textGeneric textGeneric text Generic textGeneric textAge (in years and months)Generic textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textAge (in years and months)Generic textGeneric textGeneric textGeneric textAge (in years and months)Generic textGeneric textGeneric textGeneric textAge (in years and months)Generic textGeneric textGeneric textGeneric textGeneric textGeneric textAge (in years and months)Generic textGeneric textGeneric textAge (in years and months)Generic textGeneric textGeneric textGeneric text Generic textGeneric textAge (in years and months)Generic textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textAge (in years and months)Generic textGeneric textGeneric textGeneric textAge (in years and months)Generic textGeneric textGeneric textGeneric textAge (in years and months)Generic textGeneric textGeneric textGeneric textGeneric textGeneric textAge (in years and months)Generic textGeneric textGeneric textAge (in years and months)Generic textGeneric textGeneric textGeneric text
First Accident since June 1950: 1
Subsequent Accidents: 2
Subsequent Accidents: 3

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 since June 1950: 1
Subsequent Accidents: 2
Subsequent Accidents: 3

II. INFECTIOUS DISEASES

Has this child been immunised against WHOOPING COUGH? If so, at what age? Immunised when ... mths.
Age in months
0
Not immunised
(Attacks recorded in previous surveys are entered in red.)

Has this child had WHOOPING COUGH, MEASLES, MUMPS OR SCARLET FEVER since June, 1950, when he was 4 yrs. 3 mths. old?

-

1 - Yes

0 - No

Whooping Cough
Measles
Mumps
Scarlet Fever

Please give the following details:-

Age at onset (yrs. and mths.) Where treated Hosp. I.P. Hosp. O.P. Nursing Home Own Home If treated in own home who gave treatment (Doctor, Nurse, other)
Generic textAge (in years and months)Generic textGeneric textAge (in years and months)Generic textAge (in years and months)Generic textGeneric text Generic textAge (in years and months)Generic textGeneric textAge (in years and months)Generic textAge (in years and months)Generic textGeneric text Generic textAge (in years and months)Generic textGeneric textAge (in years and months)Generic textAge (in years and months)Generic textGeneric text
Whooping cough
Measles
Mumps
Scarlet fever
Was there any doubt that it was Whooping Cough?
0
Doubtful whooping cough
1
Certainly whooping cough
How long did the cough last? ... weeks
How many

III. HOSPITAL ADMISSIONS

Last hospital admission recorded in 1950. Illness ... Hospital ... Age on admission ... yrs.
Generic text
Generic text 2
Age
0
Not admitted to hospital during first 4 yrs. 3 mths. of life
Has this child been an IN-PATIENT in a hospital or nursing home since June, 1950, when he was 4 yrs. 3mths. old?
1
Yes
0
No

Please give the following information about each admission. (When a single illness involves more than one admission give information separately for each period in hospital.)

Nature of illness Operation (if any) Age on admission (in yrs. and mths.)
Generic textGeneric textAge (in years and months)Generic textGeneric textAge (in years and months)Generic textAge (in years and months)Generic text Generic textGeneric textAge (in years and months)Generic textGeneric textAge (in years and months)Generic textAge (in years and months)Generic text Generic textGeneric textAge (in years and months)Generic textGeneric textAge (in years and months)Generic textAge (in years and months)Generic text
1
2
3

Please give the following information about each admission. (When a single illness involves more than one admission give information separately for each period in hospital.)

Name and address of hospital or nursing home Hosp. Reg No. (if known) Length of stay in hosp. or nursing home (in days)
Generic textGeneric textHow long (in days)Generic textGeneric textHow long (in days)Generic textHow long (in days)Generic text Generic textGeneric textHow long (in days)Generic textGeneric textHow long (in days)Generic textHow long (in days)Generic text Generic textGeneric textHow long (in days)Generic textGeneric textHow long (in days)Generic textHow long (in days)Generic text
1
2
3
(For all children going to hospital.)
Have you noticed any differences in the behaviour of this child since he came back home?
1
Yes
0
No
Please give details:
Generic text

IV. OTHER CONDITIONS

Is this child frequently sick? If so, please say on what occasions.
0
Not frequently sick
1
Sick when travelling
2
Sick when excited
3
Sick when he over-eats
*
Sick on other occasions, namely
Other
Are you in any way worried about this child's health?
1
Yes
0
No
Please give your reasons for worrying
Generic text
Remarks on any illnesses or disabilities not recorded above:
Long text

V. BLADDER & BOWEL TRAINING

Is this child dry by day?
0
Never wet
1
Sometimes wet
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? Punishments, namely
Generic text
How are you trying to get him dry? Rewards if dry, namely
Generic text
How are you trying to get him dry? Special treatment, namely
Generic text
How old was he when you left his napkins off at night? ... yrs. ... mths
Age
Months
How old was this child when you started to train him to be clean? ... mths. old
0
From birth
Age in months
At what age did he first gain control of his bowels? ...mths. old
Age in months
Have you had any trouble with his cleanliness since then?
1
Yes
0
No
How old was he when the trouble started? ... mths. old
Age in months
How long did it last? ... mths.
How many
9
Still sometimes dirty
How frequent are this child's motions?
1
More than once a day
2
Usually once a day
3
Usually less than once a day
Do you give this child laxatives?
2
Once a week or more often
1
Less than once a week
0
Never
Why do you give him laxatives?
1
Hard stools
*
Other reason, namely
Other

VI. HABITS

Has this child any habits such as thumb sucking, nail biting, nose picking, tics or general fidgitiness?
0
No habits of this type
1
Sucks thumb
2
Bites nails
3
Picks nose
*
Other habits, namely
Other
How are you trying to cure him of these habits? Punishments, namely
Generic text
How are you trying to cure him of these habits? Rewards, namely
Generic text
How are you trying to cure him of thes habits? Special treatment, namely
Generic text
How are you trying to cure him of these habits?
0
Not trying to cure him
Are you in any way worried about this child's habits or behaviour?
1
Yes
0
No
Please give your reasons for worrying
Generic text

VII. SLEEP AND PLAY

Has he any favourite toy which he takes to bed?
*
Yes, namely
0
None
Generic 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
Who usually goes to the child?
1
Mother
2
Father
*
Other person, namely
Other
What are this child's favourite toys?
Generic text
What are his favourite games?
Generic text
With whom does he usually play when not at school?
0
By himself
1
With brothers and sisters
2
With school fellows
*
With others, namely
Other
Why does he play by himself?
1
From choice
2
No children living nearby
3
Shyness
*
Other reason, namely
Other
(All children.)
Where does he usually play when not at school? Summer
1
In the house
2
In the yard or garden
3
In the street
4
In park or open space
5
Elsewhere,
Where does he usually play when not at school? Winter
1
In the house
2
In the yard or garden
3
In the street
4
In park or open space
5
Elsewhere,

VIII. 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

IX. 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

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 17 (a) and (b) above.

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 his own bed or with others? (If with others please give names and ages.)
0
Own bed
*
With others, namely
Other

X. THE MOTHER'S WORK

Have you been in paid work (either inside or outside the home) since June, 1950, when this child was 4 yrs. 3 mths. old?
1
Yes
0
No
(The last employment noted in 1950 is entered in red.)

Please give the following details of each period of employment.

Exact nature of work Approx. hrs. 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
Who looked after this child while you were working?
Generic text
Were you satisfied with the care he received?
1
Yes
0
No

XI. SUBSEQUENT PREGNANCIES

Have you been pregnant since June, 1950, when this child was 4 yrs. 3 mths. old?
1
Yes
0
No
(The date of the last confinement noted in 1950 is entered in red.)

Please give the following details for each pregnancy:-

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
Age (in years and months)PoundsGeneric dateGeneric textGeneric textAge (in years and months)Generic textGeneric textGeneric datePoundsGeneric textPoundsGeneric textAge (in years and months)Generic dateGeneric datePoundsAge (in years and months)Generic textGeneric textGeneric textAge (in years and months)PoundsGeneric dateGeneric text Age (in years and months)PoundsGeneric dateGeneric textGeneric textAge (in years and months)Generic textGeneric textGeneric datePoundsGeneric textPoundsGeneric textAge (in years and months)Generic dateGeneric datePoundsAge (in years and months)Generic textGeneric textGeneric textAge (in years and months)PoundsGeneric dateGeneric text Age (in years and months)PoundsGeneric dateGeneric textGeneric textAge (in years and months)Generic textGeneric textGeneric datePoundsGeneric textPoundsGeneric textAge (in years and months)Generic dateGeneric datePoundsAge (in years and months)Generic textGeneric textGeneric textAge (in years and months)PoundsGeneric dateGeneric text Age (in years and months)PoundsGeneric dateGeneric textGeneric textAge (in years and months)Generic textGeneric textGeneric datePoundsGeneric textPoundsGeneric textAge (in years and months)Generic dateGeneric datePoundsAge (in years and months)Generic textGeneric textGeneric textAge (in years and months)PoundsGeneric dateGeneric text Age (in years and months)PoundsGeneric dateGeneric textGeneric textAge (in years and months)Generic textGeneric textGeneric datePoundsGeneric textPoundsGeneric textAge (in years and months)Generic dateGeneric datePoundsAge (in years and months)Generic textGeneric textGeneric textAge (in years and months)PoundsGeneric dateGeneric text
1
2
3
Expected date of delivery
Generic date

XII. SEPARATION FROM MOTHER

What is the longest time you have been separated from this child? ... days when he was ... mths. old
How many
How many 2
0
Never separated
Why were you separated from him?
Generic text
Was the child at home during this period of separation?
1
Yes
0
No

Who looked after him at home?

Relationship Sex Age
Generic textAgeGeneric textGeneric textAgeGeneric textAgeGeneric textGeneric text Generic textAgeGeneric textGeneric textAgeGeneric textAgeGeneric textGeneric text Generic textAgeGeneric textGeneric textAgeGeneric textAgeGeneric textGeneric text
1
2
Where did he go to?
1
Grandparents
2
Other relative or friends
3
Hospital
4
Residential nursery
*
Elsewhere, namely
Other

XIII. EDUCATION OF FATHER & MOTHER

LAST School attended
Those educated in England and Wales? Mother
1
Senior Elementary
2
Central
3
Technical
4
Sec. Grammar or County
5
Public School
*
Other, namely
Other
Those educated in England and Wales? Father
1
Senior Elementary
2
Central
3
Technical
4
Sec. Grammar or County
5
Public School
*
Other, namely
Other
Those educated in Scotland? Type of School Mother
Generic text
Those educated in Scotland? Type of School Father
Generic text
At what age did you/your husband leave school? Mother ... yrs
Age
At what age did you/your husband leave school? Father ... yrs.
Age
Education after leaving School

After leaving school did you/your husband attend any classes or take any courses at a night school, technical school, university, training college or correspondence college?

-

0 - No further education

1 - Night, technical or commercial school: Full-time

2 - Night, technical or commercial school: Part-time

3 - Teacher's training college

4 - University: Full-time

5 - University: Part-time

6 - Correspondence college

Mother
Father
After leaving school did you/your husband attend any classes or take any course at a night school, technical school, university, training college or correspondence college? Other, namely
Other

(If education after leaving school)

Main subject studied Length of course Age when course finished Degrees, diplomas or certificates obtained
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Mother
Father

XIV. OCCUPATION OF PRESENT HUSBAND

(i.e. not necessarily the father of this child.)
(If unemployed, ill, dead, etc., this information should relate to the last job.)
What is your husband's occupation?
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 your husband's work regularly keeps him away from home for 24 hours or more at a time, please give details.
Generic text

XV. SCHOOL NURSE'S COMMENTS

WILL SCHOOL NURSES PLEASE FILL IN THIS SECTION FROM THEIR OWN KNOWLEDGE OF THE FAMILY
Is this child's clothing in a satisfactory or unsatisfactory state of repair?
1
Satisfactory
2
Unsatisfactory
Are this child's shoes satisfactory or unsatisfactory?
1
Satisfactory
*
Unsatisfactory because
Generic text

Please compare (c) the cleanliness of this child, and (d) the cleanliness of this home with the standard of others in your care.

-

1 - Average

2 - Among the most clean

3 - Among the least clean

Cleanliness of the child
Cleanliness of the home
Please give details of any special lack of facilities in this dwelling which makes it difficult for this Mother to bring up her child or manage her home.
Generic text
Please state from your OWN KNOWLEDGE whether the parents of this child are:-
1
Married and living together
2
Legally separated
3
Divorced
4
Permanently separated for other reasons
5
Widowed
*
Other, namely
Other
Please give your assessment of the state of repair of the dwelling.
1
Average
2
Very good
3
Bad
PLEASE COMMENT FREELY ON THE STATE OF REPAIR OF THE DWELLING:-
Long text
Please comment on any questions which you feel may have been unreliably answered
Generic text
ALL QUESTIONS SHOULD BE ANSWERED (OR STRUCK THROUGH IF NOT APPLICABLE). PLEASE SEE THAT THIS HAS BEEN DONE.
Date of Interview
Generic date
Length of Interview ... mins.
How many
Name of School Nurse or Health Visitor
Generic text
Name

1952 School Nurse's Interview with Mother