Start
nshd_52_sd
STRICTLY CONFIDENTIAL
MARCH 1952
It is hoped that the Mother &/or Father will be present at this examination
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

Name

(Surname first in block letters)

Generic text
intro ii

Address

Generic text
intro iii

School

Generic text
FOR THOSE WHO HAVE MOVED
intro iv

New address

Generic text
intro v

L.E.A.

Generic text
intro vi

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.
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.
This form refers to the medical history and clinical examination only. Details of the home conditions and of certain past illnesses and accidents are being recorded by the School Nurse or Health Visitor on a separate sheet.
How to fill in this form.
Six 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
If this child has died please state
a

Date of Death

Date of death
b

Cause of Death (if known)

Generic text
If this child is living but the form cannot be completed
c

please state the reason here:

Generic text
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.
1

Parent or relative attending with child.

1
Mother
2
Father
3
Both parents
*
Other person, namely
0
No one
Other
COLDS, SORE THROAT, ETC.
2 a

Does this child breathe with his mouth open in the day time?

1
Yes
0
No
2 b

Does he snore at night?

2
Always snores
1
Sometimes snores
0
Never snores
2 c

How often has he had a snuffly or running nose during the last year?

3
Continually
2
Frequently (4 or more)
1
Occasionally (3 or less)
0
Never
2 d

Has he had a sore throat during the last year? If so, how many has he had? ... sore throats

How many
0
No sore throats
3 a

Do any members of the household (other than this child) have continual or repeated colds, sore throats, coughs or catarrh?

1
Yes, colds
2
Yes, sore throats
3
Yes, coughs
4
Yes, catarrh
0
No one
(If "yes.")
qc_3_a == 1 || qc_3_a == 2 || qc_3_a == 3 || qc_3_a == 4
3 b
Please say which members of the household suffer from them (giving names and ages).
Name Age State whether cold, sore throat, cough or catarrh
Generic textAgeGeneric textGeneric textAgeGeneric textAgeGeneric textGeneric text Generic textAgeGeneric textGeneric textAgeGeneric textAgeGeneric textGeneric text Generic textAgeGeneric textGeneric textAgeGeneric textAgeGeneric textGeneric text
1
2
3
4
TONSILS
4 a

Have this child's tonsils been removed?

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

Why were they removed?

Generic text
4 c

Has his condition been better, worse or unchanged since their removal?

1
Better
3
Worse
2
Unchanged
(If "better" or "worse.")
qc_4_c == 1 || qc_4_c == 3
4 d

Please say in what ways

Generic text
(If tonsils not removed.)
qc_4_a == 0
4 e

Has anyone suggested that his tonsils should be removed?

1
Yes, doctor
*
Yes, other person, namely
0
No
Other
If "yes."
qc_4_e == 1 || qc_4_e == *
4 f

Why was this suggested?

Generic text
4 g

Is he on a waiting list for tonsillectomy?

1
Yes
0
No
(If not on waiting list.)
qc_4_g == 0
4 h

Why is he not on a waiting list?

Generic text
COUGHS
5 a

Does this child ever have attacks of coughing when he has NOT got a cold?

2
Yes, continually
1
Yes, sometimes
0
No
(For those with coughs.)
qc_5_a == 2 || qc_5_a == 1
5 b

Has a doctor been consulted about his coughing?

1
Doctor consulted
0
No doctor consulted
5 c

When he coughs, is it at night only, in the day only, or both in the day and night?

1
Night only
2
Day only
3
Both day and night
6 a

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

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

How frequent are his asthmatic attacks?

Generic text
6 c

Has a doctor been consulted about his asthma?

1
Doctor consulted
0
No doctor consulted
6 d

Has the cause of the attacks been investigated?

1
Yes, at hospital
2
Yes, by family doctor
0
No investigation
(If "investigated.")
qc_6_d == 1 || qc_6_d == 2
6 e

What was the result of the investigation?

Generic text
6 f

What treatment is being given?

Generic text
A_TEETH
7 a

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

How many
0
Not seen by a dentist
7 b

How many of his teeth have been extracted? ... teeth

How many
0
None extracted
A_HEART
8 a

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

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

Did this treatment lead to any restriction of his activities?

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

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

1
Yes
0
No
(If "yes.")
qc_9_a == 1
9 b

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

1
Doctor callled in
2
Taken to hospital
0
Neither
10 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_10_a == 1
10 b

About how often does he have these attacks?

1
Less than once a month
2
More often
SPECIAL SENSES
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 deaf when he has colds?

1
Yes
2
No
(If "always deaf.")
qc_11_a == 2
11 c

When did you first suspect he was hard of hearing? At ... years old

Age
11 d

What made you suspect it?

Generic text
11 e

Has he been treated for deafness?

1
Yes
0
No
(If "yes.")
qc_11_e == 1
11 f

What treatment (Medical, Surgical or Educational) was given?

Long text
12 a

Has this child ever complained of earache?

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

How old was he when he first complained? ... years

Age
12 c

How many attacks of earache has he had during the last year?

1
Frequent (more than 2)
2
Occasional (2 or less)
0
None
13 a

Has this child ever had discharge of pus from his ears?

1
Yes
0
No
(If "yes.")
qc_13_a == 1
13 b
Please give the following details:-
Age at Attack Duration of Discharge in weeks Where treated Hos. I.P. Hos.O.P. Nursing Home Own Home If treated at home, who gave treatment (Doctor, Nurse, other)
AgeGeneric textGeneric textDuration (weeks)Generic textGeneric textDuration (weeks)AgeGeneric textGeneric textDuration (weeks)AgeDuration (weeks)Generic textAgeGeneric text AgeGeneric textGeneric textDuration (weeks)Generic textGeneric textDuration (weeks)AgeGeneric textGeneric textDuration (weeks)AgeDuration (weeks)Generic textAgeGeneric text AgeGeneric textGeneric textDuration (weeks)Generic textGeneric textDuration (weeks)AgeGeneric textGeneric textDuration (weeks)AgeDuration (weeks)Generic textAgeGeneric text AgeGeneric textGeneric textDuration (weeks)Generic textGeneric textDuration (weeks)AgeGeneric textGeneric textDuration (weeks)AgeDuration (weeks)Generic textAgeGeneric text
1
2
3
(Attacks recorded in earlier surveys are entered in red.)
14 a

Does this child squint or has he ever squinted?

3
Always squints
2
Sometimes squints
1
Used to squint
0
Never squints
(If "squint.")
qc_14_a == 3 || qc_14_a == 2 || qc_14_a == 1
14 b

How old was this child when squint was first noticed? ... years

Age
14 c

Has treatment been given and if so, what treatment?

0
No treatment given
*
Treatment given, namely
Generic text
FITS AND CONVULSIONS
15 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_15_a == 1
15 b

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

How many
15 c

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

1
During an illness
2
While in normal health
B. EXAMINATION
16

Pulse rate at beginning of examination ... per minute

How many
APPEARANCE
17 a

Hair colour.

1
Red
2
Blond
3
Light brown
4
Dark brown
5
Black
17 b

Skin colour.

1
Rosy cheeked
2
Pale
3
Swarthy
4
Freckled
*
Other, namely
Other
17 c

Eye colour.

1
Blue
2
Brown
3
Other
17 d

Nails and fingers.

0
No abnormality
1
Bitten nails
2
Clubbed fingers
*
Other, namely
Other
PHYSICAL MEASUREMENTS
Give measurements AS RECORDED by the apparatus used and as accurasely as these allow. (in most cases this will be to the nearest QUARTER POUND and to the nearest QUARTER INCH.)
18

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
Stones
Pounds in stone
Ounces in pound
18 i

Scales used.

1
Beam balance
2
Spring balance
19

Present standing height. (WITHOUT SHOES.) (If no height measurer is available and a ruler is used to mark the position of the top of the head, please make sure that this is level when viewed from the side.) ... ft. ... ins.

(To nearest quarter inch.)

Feet
Inches in foot
NASAL PASSAGES
20 a

Is there a nasal discharge?

1
Yes
0
No
(If "yes.")
qc_20_a == 1
20 b

Is it watery or mucopurulent?

1
Watery
2
Mucopurulent
(All children.)
20 c

Is there a postnasal discharge hanging down behind the uvula?

1
Yes
0
No
Y
Not seen, child gags
20 d

Are this child's nasal passages obstructed?

1
Yes, by adenoids
2
Yes, by catarrh
*
Other causes, namely
0
Not obstructed
Other
THROAT AND TONSILS
21 a

Colour of pillars of fauces.

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

Tonsils.

1
Present and intact
2
Remnants
0
Removed
Y
Not seen, child gags
(If tonsils present.)
qc_21_b == 1
21 c

Size of tonsils.

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

Crypts.

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

Tonsillar glands.

1
Palpable
0
Not palpable
21 f

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

1
Yes
0
No
2
Undecided
(If "yes.")
qc_21_f == 1
21 g

Please give your reasons

Generic text
B_TEETH
22 a

How many teeth have been filled in? ... teeth

How many
0
None filled
22 b

How many of his existing teeth are so carious that they require extraction? ... teeth

How many
0
None require extraction
X
Undecided
LUNGS
23

Are there any abnormal signs present in the lungs?

1
Abnormal signs present
0
No abnormality detected
(If "abnormal signs.")
qc_23 == 1
23 i

Please describe

Generic text
B_HEART
Please examine this child standing up and lying down.
24 a(i)

Rhythm Standing

0
Regular
1
Irregular
24 a(ii)

Rhythm Lying

0
Regular
1
Irregular
(If "irregular.")
qc_24_a_i == 1 || qc_24_a_ii == 1
24 a(iii)

Please describe the nature of the irregularity

Generic text
24 b(i)

Murmurs. Standing

0
No murmurs heard
1
Murmur(s) present
24 b(ii)

Murmurs. Lying

0
No murmurs heard
1
Murmur(s) present
(If "murmur(s).")
qc_24_b_i == 1 || qc_24_b_ii == 1
24 b(iii)

Please describe, giving timing and location

Generic text
(All children.)
24 c

Details of any other cardiac abnormalities not noted above

Generic text
B_ABDOMEN
25

Is there nay evidence of hernia or weakness of the inguinal canal?

1
Yes
0
No
(If "yes.")
qc_25 == 1
25 i

Please describe

Generic text
26

Is there any abnormality of the external genital organs?

1
Yes
0
No
(If "yes.")
qc_26 == 1
26 i

Please describe

Generic text
MISCELLANEOUS
27 i

Lymphatic glands Neck (Exc. tonsillar glands)

1
Palpable
0
Not palpable
27 ii

Lymphatic glands Axilla

1
Palpable
0
Not palpable
27 iii

Lymphatic glands Groin

1
Palpable
0
Not palpable
28

Skin

0
No obvious abnormality
1
Septic spots or boils
*
Other abnormalities, namely
Other
29

Orthopaedic defects

0
None
1
Defect
(If "defect.")
qc_29 == 1
29 i

Please give details

Generic text
30 a

Speech

0
No abnormality
1
Stammering
2
Dyslalia
*
Structural speech defect, namely
Generic text
(If "stammering," "dyslalia" or other defect.)
qc_30_a == 1 || qc_30_a == 2 || qc_30_a == *
30 b

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

1
Yes
0
No
30 c

Is he having, or have arrangements been made for him to have speech therapy?

1
Therapy being given
2
Arrangements made
0
No provision available
EARS
31 a(i)

External Auditory Meatus. Right

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

External Auditory Meatus. Left

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

Drums. Right

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

Drums. Left

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

What is your assessment of this child's hearing?

3
Average or good
2
Poor
1
Very poor
EYES
32 a

Squint.

1
Does not squint
0
Concomitant squint
2
Paralytic squint
32 b
Visual acuity.
Without glasses With glasses
Generic textGeneric textGeneric textGeneric text Generic textGeneric textGeneric textGeneric text
Right eye
Left eye
32 b(i)

If acuity not measured please state reason

Generic text
32 c

Eye defects not noted above:

Generic text
LATERALITY
33 a

Eye Dominance.

Give this child a white quarto sheet of paper in the middle of which a hole approximately one inch in diameter has been cut. Ask him to hold the paper close to his face and look through the hole at an object about six feet away. Please note whether he uses the left or the right eye. Repeat several times.

1
Uses right eye
2
Uses left eye
3
Uses either
0
Will not co-operate
33 b

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

1
Right hand
2
Left hand
3
Either hand
33 c

Footedness. Which foot does this child use to kick a ball?

(Give this child a ball to kick.)

1
Right foot
2
Left foot
3
Either foot
34

Remarks on other abnormalities or deformities not reported above

Generic text
35

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

How many
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
PARENTS' MEASUREMENTS
37
It would be of great value if the following information could be obtained about the parents of this child. It is realised that it may not be possible to get actual measurements in which case please give approximate figures.

*Cross out the one that does not apply.

Weight (in indoor clothes) ... st. Weight (in indoor clothes) ... lbs. Weight (in indoor clothes) * Height (deduct height of heels if measured in shoes) ... ft. Height (deduct height of heels if measured in shoes) ... ins. Height (deduct height of heels if measured in shoes) *

1 - actual

2 - estimate

1 - actual

2 - estimate

StonesPounds in stoneFeetInches in foot

1 - actual

2 - estimate

Pounds in stoneInches in foot

1 - actual

2 - estimate

StonesFeetInches in footFeetPounds in stoneStones

1 - actual

2 - estimate

1 - actual

2 - estimate

Pounds in stone

1 - actual

2 - estimate

StonesInches in footFeet

1 - actual

2 - estimate

1 - actual

2 - estimate

Feet

1 - actual

2 - estimate

StonesPounds in stoneInches in footPounds in stoneStonesFeetInches in foot

1 - actual

2 - estimate

1 - actual

2 - estimate

1 - actual

2 - estimate

1 - actual

2 - estimate

StonesPounds in stoneFeetInches in foot

1 - actual

2 - estimate

Pounds in stoneInches in foot

1 - actual

2 - estimate

StonesFeetInches in footFeetPounds in stoneStones

1 - actual

2 - estimate

1 - actual

2 - estimate

Pounds in stone

1 - actual

2 - estimate

StonesInches in footFeet

1 - actual

2 - estimate

1 - actual

2 - estimate

Feet

1 - actual

2 - estimate

StonesPounds in stoneInches in footPounds in stoneStonesFeetInches in foot

1 - actual

2 - estimate

1 - actual

2 - estimate

1 - actual

2 - estimate

1 - actual

2 - estimate

StonesPounds in stoneFeetInches in foot

1 - actual

2 - estimate

Pounds in stoneInches in foot

1 - actual

2 - estimate

StonesFeetInches in footFeetPounds in stoneStones

1 - actual

2 - estimate

1 - actual

2 - estimate

Pounds in stone

1 - actual

2 - estimate

StonesInches in footFeet

1 - actual

2 - estimate

1 - actual

2 - estimate

Feet

1 - actual

2 - estimate

StonesPounds in stoneInches in footPounds in stoneStonesFeetInches in foot

1 - actual

2 - estimate

1 - actual

2 - estimate

1 - actual

2 - estimate

1 - actual

2 - estimate

StonesPounds in stoneFeetInches in foot

1 - actual

2 - estimate

Pounds in stoneInches in foot

1 - actual

2 - estimate

StonesFeetInches in footFeetPounds in stoneStones

1 - actual

2 - estimate

1 - actual

2 - estimate

Pounds in stone

1 - actual

2 - estimate

StonesInches in footFeet

1 - actual

2 - estimate

1 - actual

2 - estimate

Feet

1 - actual

2 - estimate

StonesPounds in stoneInches in footPounds in stoneStonesFeetInches in foot

1 - actual

2 - estimate

1 - actual

2 - estimate

1 - actual

2 - estimate

1 - actual

2 - estimate

StonesPounds in stoneFeetInches in foot

1 - actual

2 - estimate

Pounds in stoneInches in foot

1 - actual

2 - estimate

StonesFeetInches in footFeetPounds in stoneStones

1 - actual

2 - estimate

1 - actual

2 - estimate

Pounds in stone

1 - actual

2 - estimate

StonesInches in footFeet

1 - actual

2 - estimate

1 - actual

2 - estimate

Feet

1 - actual

2 - estimate

StonesPounds in stoneInches in footPounds in stoneStonesFeetInches in foot

1 - actual

2 - estimate

1 - actual

2 - estimate

1 - actual

2 - estimate

1 - actual

2 - estimate

StonesPounds in stoneFeetInches in foot

1 - actual

2 - estimate

Pounds in stoneInches in foot

1 - actual

2 - estimate

StonesFeetInches in footFeetPounds in stoneStones

1 - actual

2 - estimate

1 - actual

2 - estimate

Pounds in stone

1 - actual

2 - estimate

StonesInches in footFeet

1 - actual

2 - estimate

1 - actual

2 - estimate

Feet

1 - actual

2 - estimate

StonesPounds in stoneInches in footPounds in stoneStonesFeetInches in foot

1 - actual

2 - estimate

1 - actual

2 - estimate
Mother
Father
37 a

Age of father ... years

Age
38

Estimate of the reliability of the medical history given by this mother.

1
Probably reliable
2
Probably unreliable
0
Undecided
CHECK OF PAST INFORMATION
39
THE FOLLOWING CONDITIONS WERE REPORTED IN EARLIER SURVEYS. PLEASE CHECK THEIR ACCURACY AND SUPPLY, IF POSSIBLE, THE ADDITIONAL INFORMATION ASKED FOR.
Condition Age when reported Additional information needed Doctor's comments
AgeGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textAgeGeneric textGeneric textGeneric textAgeGeneric textGeneric textAgeGeneric text AgeGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textAgeGeneric textGeneric textGeneric textAgeGeneric textGeneric textAgeGeneric text AgeGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textAgeGeneric textGeneric textGeneric textAgeGeneric textGeneric textAgeGeneric text AgeGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textAgeGeneric textGeneric textGeneric textAgeGeneric textGeneric textAgeGeneric text
1
2
3
ALL QUESTIONS SHOULD BE ANSWERED (OR CROSSED OUT IF NOT APPLICABLE). PLEASE CHECK THAT THIS HAS BEEN DONE
outro i

Name of Doctor making Examination

Generic text
outro ii

Date of Examination

Generic date
outro iii

Time taken for this interview

Time taken
End

nshd_52_sd

s_intro_i
STRICTLY CONFIDENTIAL
s_intro_ii
MARCH 1952
s_intro_iii
It is hoped that the Mother &/or Father will be present at this examination
s_intro_iv
EXAMINATION BY THE SCHOOL DOCTOR
s_intro_v
NATIONAL SURVEY OF THE HEALTH AND DEVELOPMENT OF CHILDREN
s_intro_vi
INSTITUTE OF CHILD HEALTH (UNIVERSITY OF LONDON) SOCIETY OF MEDICAL OFFICERS OF HEALTH
s_intro_vii
and POPULATION INVESTIGATION COMMITTEE At the LONDON SCHOOL OF ECONOMICS,
intro i
Name
Generic text
intro ii
Address
Generic text
intro iii
School
Generic text

FOR THOSE WHO HAVE MOVED

intro iv
New address
Generic text
intro v
L.E.A.
Generic text
intro vi
School
Generic text
s_intro_viii
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.
s_intro_ix
Purpose of this inquiry
s_intro_x
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.
s_intro_xi
This form refers to the medical history and clinical examination only. Details of the home conditions and of certain past illnesses and accidents are being recorded by the School Nurse or Health Visitor on a separate sheet.
s_intro_xii
How to fill in this form.
s_intro_xiii
Six 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_xiv
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_xv
COMPLETED FORMS SHOULD BE RETURNED TO THE SCHOOL MEDICAL OFFICER AND NOT DIRECTLY TO THE JOINT COMMITTEE
a
Date of Death
Date of death
If this child has died please state
b
Cause of Death (if known)
Generic text
If this child has died please state
c
please state the reason here:
Generic text
If this child is living but the form cannot be completed

A. MEDICAL HISTORY

s_q1_i
Put a circle round the code number opposite the printed answer that most nearly describes your findings.
s_q1_ii
If no alternative fits please write the answer in the space directly under the question.
1
Parent or relative attending with child.
1
Mother
2
Father
3
Both parents
*
Other person, namely
0
No one
Other

COLDS, SORE THROAT, ETC.

2 a
Does this child breathe with his mouth open in the day time?
1
Yes
0
No
2 b
Does he snore at night?
2
Always snores
1
Sometimes snores
0
Never snores
2 c
How often has he had a snuffly or running nose during the last year?
3
Continually
2
Frequently (4 or more)
1
Occasionally (3 or less)
0
Never
2 d
Has he had a sore throat during the last year? If so, how many has he had? ... sore throats
How many
0
No sore throats
3 a
Do any members of the household (other than this child) have continual or repeated colds, sore throats, coughs or catarrh?
1
Yes, colds
2
Yes, sore throats
3
Yes, coughs
4
Yes, catarrh
0
No one
3 b

Please say which members of the household suffer from them (giving names and ages).

Name Age State whether cold, sore throat, cough or catarrh
Generic textAgeGeneric textGeneric textAgeGeneric textAgeGeneric textGeneric text Generic textAgeGeneric textGeneric textAgeGeneric textAgeGeneric textGeneric text Generic textAgeGeneric textGeneric textAgeGeneric textAgeGeneric textGeneric text
1
2
3
4
(If "yes.")

TONSILS

4 a
Have this child's tonsils been removed?
1
Yes
0
No
4 b
Why were they removed?
Generic text
(If "yes.")
4 c
Has his condition been better, worse or unchanged since their removal?
1
Better
3
Worse
2
Unchanged
(If "yes.")
4 d
Please say in what ways
Generic text
(If "yes.")
(If "better" or "worse.")
4 e
Has anyone suggested that his tonsils should be removed?
1
Yes, doctor
*
Yes, other person, namely
0
No
Other
(If tonsils not removed.)
4 f
Why was this suggested?
Generic text
(If tonsils not removed.)
If "yes."
4 g
Is he on a waiting list for tonsillectomy?
1
Yes
0
No
(If tonsils not removed.)
4 h
Why is he not on a waiting list?
Generic text
(If tonsils not removed.)
(If not on waiting list.)

COUGHS

5 a
Does this child ever have attacks of coughing when he has NOT got a cold?
2
Yes, continually
1
Yes, sometimes
0
No
5 b
Has a doctor been consulted about his coughing?
1
Doctor consulted
0
No doctor consulted
(For those with coughs.)
5 c
When he coughs, is it at night only, in the day only, or both in the day and night?
1
Night only
2
Day only
3
Both day and night
(For those with coughs.)
6 a
Has this child, during the last year, had an attack of asthma?
1
Yes
0
No
6 b
How frequent are his asthmatic attacks?
Generic text
(If "yes.")
6 c
Has a doctor been consulted about his asthma?
1
Doctor consulted
0
No doctor consulted
(If "yes.")
6 d
Has the cause of the attacks been investigated?
1
Yes, at hospital
2
Yes, by family doctor
0
No investigation
(If "yes.")
6 e
What was the result of the investigation?
Generic text
(If "yes.")
(If "investigated.")
6 f
What treatment is being given?
Generic text
(If "yes.")
(If "investigated.")

A_TEETH

7 a
How many times has this child been seen by a dentist during the last year? ... times
How many
0
Not seen by a dentist
7 b
How many of his teeth have been extracted? ... teeth
How many
0
None extracted

A_HEART

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

A_ABDOMEN

9 a
Has this child had any attacks of abdominal pain during the last year?
1
Yes
0
No
9 b
Was a doctor called in or was he taken to hospital?
1
Doctor callled in
2
Taken to hospital
0
Neither
(If "yes.")
10 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
10 b
About how often does he have these attacks?
1
Less than once a month
2
More often
(If "yes.")

SPECIAL SENSES

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 deaf when he has colds?
1
Yes
2
No
(If "sometimes deaf")
11 c
When did you first suspect he was hard of hearing? At ... years old
Age
(If "always deaf.")
11 d
What made you suspect it?
Generic text
(If "always deaf.")
11 e
Has he been treated for deafness?
1
Yes
0
No
(If "always deaf.")
11 f
What treatment (Medical, Surgical or Educational) was given?
Long text
(If "always deaf.")
(If "yes.")
12 a
Has this child ever complained of earache?
1
Yes
0
No
12 b
How old was he when he first complained? ... years
Age
(If "yes.")
12 c
How many attacks of earache has he had during the last year?
1
Frequent (more than 2)
2
Occasional (2 or less)
0
None
(If "yes.")
13 a
Has this child ever had discharge of pus from his ears?
1
Yes
0
No
13 b

Please give the following details:-

Age at Attack Duration of Discharge in weeks Where treated Hos. I.P. Hos.O.P. Nursing Home Own Home If treated at home, who gave treatment (Doctor, Nurse, other)
AgeGeneric textGeneric textDuration (weeks)Generic textGeneric textDuration (weeks)AgeGeneric textGeneric textDuration (weeks)AgeDuration (weeks)Generic textAgeGeneric text AgeGeneric textGeneric textDuration (weeks)Generic textGeneric textDuration (weeks)AgeGeneric textGeneric textDuration (weeks)AgeDuration (weeks)Generic textAgeGeneric text AgeGeneric textGeneric textDuration (weeks)Generic textGeneric textDuration (weeks)AgeGeneric textGeneric textDuration (weeks)AgeDuration (weeks)Generic textAgeGeneric text AgeGeneric textGeneric textDuration (weeks)Generic textGeneric textDuration (weeks)AgeGeneric textGeneric textDuration (weeks)AgeDuration (weeks)Generic textAgeGeneric text
1
2
3
(If "yes.")
s_q13b
(Attacks recorded in earlier surveys are entered in red.)
(If "yes.")
14 a
Does this child squint or has he ever squinted?
3
Always squints
2
Sometimes squints
1
Used to squint
0
Never squints
14 b
How old was this child when squint was first noticed? ... years
Age
(If "squint.")
14 c
Has treatment been given and if so, what treatment?
0
No treatment given
*
Treatment given, namely
Generic text
(If "squint.")

FITS AND CONVULSIONS

15 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
15 b
How many fits or convulsions has he had during the last year? ... fits or convulsions
How many
(If "fit or convulsion.")
15 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.")

B. EXAMINATION

16
Pulse rate at beginning of examination ... per minute
How many

APPEARANCE

17 a
Hair colour.
1
Red
2
Blond
3
Light brown
4
Dark brown
5
Black
17 b
Skin colour.
1
Rosy cheeked
2
Pale
3
Swarthy
4
Freckled
*
Other, namely
Other
17 c
Eye colour.
1
Blue
2
Brown
3
Other
17 d
Nails and fingers.
0
No abnormality
1
Bitten nails
2
Clubbed fingers
*
Other, namely
Other

PHYSICAL MEASUREMENTS

s_q18
Give measurements AS RECORDED by the apparatus used and as accurasely as these allow. (in most cases this will be to the nearest QUARTER POUND and to the nearest QUARTER INCH.)
18
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
Stones
Pounds in stone
Ounces in pound
18 i
Scales used.
1
Beam balance
2
Spring balance
19
Present standing height. (WITHOUT SHOES.) (If no height measurer is available and a ruler is used to mark the position of the top of the head, please make sure that this is level when viewed from the side.) ... ft. ... ins.
Feet
Inches in foot

NASAL PASSAGES

20 a
Is there a nasal discharge?
1
Yes
0
No
20 b
Is it watery or mucopurulent?
1
Watery
2
Mucopurulent
(If "yes.")
s_q20c
(All children.)
20 c
Is there a postnasal discharge hanging down behind the uvula?
1
Yes
0
No
Y
Not seen, child gags
20 d
Are this child's nasal passages obstructed?
1
Yes, by adenoids
2
Yes, by catarrh
*
Other causes, namely
0
Not obstructed
Other

THROAT AND TONSILS

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

B_TEETH

22 a
How many teeth have been filled in? ... teeth
How many
0
None filled
22 b
How many of his existing teeth are so carious that they require extraction? ... teeth
How many
0
None require extraction
X
Undecided

LUNGS

23
Are there any abnormal signs present in the lungs?
1
Abnormal signs present
0
No abnormality detected
23 i
Please describe
Generic text
(If "abnormal signs.")

B_HEART

s_q24a
Please examine this child standing up and lying down.
24 a(i)
Rhythm Standing
0
Regular
1
Irregular
24 a(ii)
Rhythm Lying
0
Regular
1
Irregular
24 a(iii)
Please describe the nature of the irregularity
Generic text
(If "irregular.")
24 b(i)
Murmurs. Standing
0
No murmurs heard
1
Murmur(s) present
24 b(ii)
Murmurs. Lying
0
No murmurs heard
1
Murmur(s) present
24 b(iii)
Please describe, giving timing and location
Generic text
(If "murmur(s).")
s_q24c
(All children.)
24 c
Details of any other cardiac abnormalities not noted above
Generic text

B_ABDOMEN

25
Is there nay evidence of hernia or weakness of the inguinal canal?
1
Yes
0
No
25 i
Please describe
Generic text
(If "yes.")
26
Is there any abnormality of the external genital organs?
1
Yes
0
No
26 i
Please describe
Generic text
(If "yes.")

MISCELLANEOUS

27 i
Lymphatic glands Neck (Exc. tonsillar glands)
1
Palpable
0
Not palpable
27 ii
Lymphatic glands Axilla
1
Palpable
0
Not palpable
27 iii
Lymphatic glands Groin
1
Palpable
0
Not palpable
28
Skin
0
No obvious abnormality
1
Septic spots or boils
*
Other abnormalities, namely
Other
29
Orthopaedic defects
0
None
1
Defect
29 i
Please give details
Generic text
(If "defect.")
30 a
Speech
0
No abnormality
1
Stammering
2
Dyslalia
*
Structural speech defect, namely
Generic text
30 b
Does this child, in your opinion, need speech therapy?
1
Yes
0
No
(If "stammering," "dyslalia" or other defect.)
30 c
Is he having, or have arrangements been made for him to have speech therapy?
1
Therapy being given
2
Arrangements made
0
No provision available
(If "stammering," "dyslalia" or other defect.)

EARS

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

EYES

32 a
Squint.
1
Does not squint
0
Concomitant squint
2
Paralytic squint
32 b

Visual acuity.

Without glasses With glasses
Generic textGeneric textGeneric textGeneric text Generic textGeneric textGeneric textGeneric text
Right eye
Left eye
32 b(i)
If acuity not measured please state reason
Generic text
32 c
Eye defects not noted above:
Generic text

LATERALITY

33 a
Eye Dominance.
1
Uses right eye
2
Uses left eye
3
Uses either
0
Will not co-operate
33 b
Handedness. Which hand does this child use to write or draw with?
1
Right hand
2
Left hand
3
Either hand
33 c
Footedness. Which foot does this child use to kick a ball?
1
Right foot
2
Left foot
3
Either foot
34
Remarks on other abnormalities or deformities not reported above
Generic text
35
Pulse rate at end of examination. ... per minute.
How many

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

PARENTS' MEASUREMENTS

37

It would be of great value if the following information could be obtained about the parents of this child. It is realised that it may not be possible to get actual measurements in which case please give approximate figures.

Weight (in indoor clothes) ... st. Weight (in indoor clothes) ... lbs. Weight (in indoor clothes) * Height (deduct height of heels if measured in shoes) ... ft. Height (deduct height of heels if measured in shoes) ... ins. Height (deduct height of heels if measured in shoes) *

1 - actual

2 - estimate

1 - actual

2 - estimate

StonesPounds in stoneFeetInches in foot

1 - actual

2 - estimate

Pounds in stoneInches in foot

1 - actual

2 - estimate

StonesFeetInches in footFeetPounds in stoneStones

1 - actual

2 - estimate

1 - actual

2 - estimate

Pounds in stone

1 - actual

2 - estimate

StonesInches in footFeet

1 - actual

2 - estimate

1 - actual

2 - estimate

Feet

1 - actual

2 - estimate

StonesPounds in stoneInches in footPounds in stoneStonesFeetInches in foot

1 - actual

2 - estimate

1 - actual

2 - estimate

1 - actual

2 - estimate

1 - actual

2 - estimate

StonesPounds in stoneFeetInches in foot

1 - actual

2 - estimate

Pounds in stoneInches in foot

1 - actual

2 - estimate

StonesFeetInches in footFeetPounds in stoneStones

1 - actual

2 - estimate

1 - actual

2 - estimate

Pounds in stone

1 - actual

2 - estimate

StonesInches in footFeet

1 - actual

2 - estimate

1 - actual

2 - estimate

Feet

1 - actual

2 - estimate

StonesPounds in stoneInches in footPounds in stoneStonesFeetInches in foot

1 - actual

2 - estimate

1 - actual

2 - estimate

1 - actual

2 - estimate

1 - actual

2 - estimate

StonesPounds in stoneFeetInches in foot

1 - actual

2 - estimate

Pounds in stoneInches in foot

1 - actual

2 - estimate

StonesFeetInches in footFeetPounds in stoneStones

1 - actual

2 - estimate

1 - actual

2 - estimate

Pounds in stone

1 - actual

2 - estimate

StonesInches in footFeet

1 - actual

2 - estimate

1 - actual

2 - estimate

Feet

1 - actual

2 - estimate

StonesPounds in stoneInches in footPounds in stoneStonesFeetInches in foot

1 - actual

2 - estimate

1 - actual

2 - estimate

1 - actual

2 - estimate

1 - actual

2 - estimate

StonesPounds in stoneFeetInches in foot

1 - actual

2 - estimate

Pounds in stoneInches in foot

1 - actual

2 - estimate

StonesFeetInches in footFeetPounds in stoneStones

1 - actual

2 - estimate

1 - actual

2 - estimate

Pounds in stone

1 - actual

2 - estimate

StonesInches in footFeet

1 - actual

2 - estimate

1 - actual

2 - estimate

Feet

1 - actual

2 - estimate

StonesPounds in stoneInches in footPounds in stoneStonesFeetInches in foot

1 - actual

2 - estimate

1 - actual

2 - estimate

1 - actual

2 - estimate

1 - actual

2 - estimate

StonesPounds in stoneFeetInches in foot

1 - actual

2 - estimate

Pounds in stoneInches in foot

1 - actual

2 - estimate

StonesFeetInches in footFeetPounds in stoneStones

1 - actual

2 - estimate

1 - actual

2 - estimate

Pounds in stone

1 - actual

2 - estimate

StonesInches in footFeet

1 - actual

2 - estimate

1 - actual

2 - estimate

Feet

1 - actual

2 - estimate

StonesPounds in stoneInches in footPounds in stoneStonesFeetInches in foot

1 - actual

2 - estimate

1 - actual

2 - estimate

1 - actual

2 - estimate

1 - actual

2 - estimate

StonesPounds in stoneFeetInches in foot

1 - actual

2 - estimate

Pounds in stoneInches in foot

1 - actual

2 - estimate

StonesFeetInches in footFeetPounds in stoneStones

1 - actual

2 - estimate

1 - actual

2 - estimate

Pounds in stone

1 - actual

2 - estimate

StonesInches in footFeet

1 - actual

2 - estimate

1 - actual

2 - estimate

Feet

1 - actual

2 - estimate

StonesPounds in stoneInches in footPounds in stoneStonesFeetInches in foot

1 - actual

2 - estimate

1 - actual

2 - estimate
Mother
Father
37 a
Age of father ... years
Age
38
Estimate of the reliability of the medical history given by this mother.
1
Probably reliable
2
Probably unreliable
0
Undecided

CHECK OF PAST INFORMATION

39

THE FOLLOWING CONDITIONS WERE REPORTED IN EARLIER SURVEYS. PLEASE CHECK THEIR ACCURACY AND SUPPLY, IF POSSIBLE, THE ADDITIONAL INFORMATION ASKED FOR.

Condition Age when reported Additional information needed Doctor's comments
AgeGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textAgeGeneric textGeneric textGeneric textAgeGeneric textGeneric textAgeGeneric text AgeGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textAgeGeneric textGeneric textGeneric textAgeGeneric textGeneric textAgeGeneric text AgeGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textAgeGeneric textGeneric textGeneric textAgeGeneric textGeneric textAgeGeneric text AgeGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textAgeGeneric textGeneric textGeneric textAgeGeneric textGeneric textAgeGeneric text
1
2
3
s_q39
ALL QUESTIONS SHOULD BE ANSWERED (OR CROSSED OUT IF NOT APPLICABLE). PLEASE CHECK THAT THIS HAS BEEN DONE
outro i
Name of Doctor making Examination
Generic text
outro ii
Date of Examination
Generic date
outro iii
Time taken for this interview
Time taken
Name

1952 Examination by the School Doctor

Users Also Viewed
  INFB52
  1961 Head Teacher Questionnaire Dataset
  MEF
  RHO61

Other manifestations of rheumatic disease other than heart 1961
  TTLAN3