2. The provisions of the 1944 Act for the special educational treatment of handicapped pupils not only reflected a change in outlook which had been developing over the years, but helped to intensify that change. The duty laid upon local education authorities to provide special educational treatment was made part of their general duty, imposed by Section 8, to provide primary and secondary schools in sufficient variety to meet the different ages, abilities and aptitudes of the pupils attending them. In fulfilling this general duty local education authorities were required, in the words of Section 8(2)(c), to have regard -

to the need for securing that provision is made for pupils who suffer from any disability of mind or body by providing, either in special schools or otherwise, special educational treatment, that is to say, education by special methods appropriate for persons suffering from that disability.

4. Previously, handicapped children had been dealt with as a group entirely separate from their more fortunate fellows. The only special educational treatment recognised in the 1921 Act was education in a school "certified by the Board of Education as suitable" for the education of blind or deaf children or in a school or class similarly certified as suitable for defective or epileptic children. Under the 1944 Act the handicapped child was dealt with primarily as a child, to be provided with special educational treatment appropriate to any disability of mind or body from which he might be suffering. The fact that this might be given either in special schools "or otherwise" and that, in Section 33 of the Act, it was stipulated that where a child's disability was "not serious" the special educational treatment might be given in "any school" - i.e. not necessarily in a special school or even in a special class - served to emphasise that physical or mental handicap existed in all degrees, from the very slight to the serious; and that special educational treatment was not a matter of segregating the seriously handicapped from their fellows but of providing in each case the special help or modifications in regime or education suited to the needs of the individual child.

5. The different categories of handicap were not named in the 1944 Act, as they had been in the Act of 1921, but the Minister was required to make regulations "defining the several categories of pupils requiring special

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educational treatment and making provision as to the special methods appropriate for the education of pupils of each category". In the Regulations of 1945 and still more in those of 1953 which replaced them, the categories of handicap were defined in such a way as to follow the intention of the Act by the avoidance, so far as possible, of a rigid separation of the handicapped from the normal.

6. The change in outlook may perhaps most clearly be illustrated by quoting a passage from the Education Act 1921, which defines defective and epileptic children, and contrasting it with the definitions in the 1953 Regulations of educationally sub-normal, epileptic, physically handicapped and delicate pupils - the four categories most nearly corresponding to the "defective and epileptic" children of the 1921 Act. Those who have been accustomed to working against the changed background of recent years may well, on re-reading the following passage from the 1921 Act, find it difficult to believe that it was still the law of the land little more than ten years ago:

"55 (1) A local education authority shall, with the approval of the Board of Education, make arrangements for ascertaining -

(a) what children in their area, not being imbecile, and not being merely duII or backward, are defective, that is to say, what children by reason of mental or physical defect are incapable of receiving proper benefit from the instruction in the ordinary public elementary schools, but are not incapable by reason of that defect of receiving benefit from instruction in such special classes or schools as under this Part of this Act may be provided for defective children; and

(b) what children in their area are epileptic children, that is to say, what children, not being idiots or imbeciles, are unfit by reason of severe epilepsy to attend the ordinary public elementary schools."

14. The several categories of pupils requiring special educational treatment are hereby defined as follows:

(e) Educationally sub-normal pupils, that is to say, pupils who, by reason of limited ability or other conditions resulting in educational retardation, require some specialised form of education wholly or partly in substitution for the education normally given in ordinary schools.

(f) Epileptic pupils, that is to say, pupils who by reason of epilepsy cannot be educated under the normal regime of ordinary schools without detriment to themselves or other pupils.

(h) Physically handicapped pupils, that is to say, pupils not suffering solely from a defect of sight or hearing who by reason of disease or crippling defect cannot without detriment to their health or educational development be satisfactorily educated under the normal regime of ordinary schools.

(j) Delicate pupils, that is to say, pupils not falling under any other category in this Regulation, who by reason of impaired physical condition need a change of environment or cannot, without risk to their health or educational development, be educated under the normal regime of ordinary schools.

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7. The new approach to the problems of the education of the handicapped led to an increased realisation during the period under review that much could and should be done in the way of providing special educational treatment in the ordinary school. This subject was dealt with in a chapter on "Handicapped Children in Ordinary Schools" in the Report of the Chief Medical Officer of the Ministry of Education for 1952-53 (published in 1954), in which the opening paragraph states:

For the handicapped child the normal field of opportunity should be open to the fullest extent compatible with the nature and extent of his disability. The fact that he has a mental or physical handicap does not necessarily involve his withdrawal from a normal environment but, if he has to be withdrawn at all, the withdrawal should not be further or greater than his condition demands. Handicapped children have a deep longing to achieve as much independence as possible within the normal community instead of being surrounded by an atmosphere of disability, but their handicap carries with it, especially in older children, a danger of psychological and emotional disturbance, resulting from a sense of deprivation and frustration. This can often be countered by retaining them within the normal environment, or as much of it as their condition allows, provided that within it they are treated with understanding and given the fullest opportunities. In these circumstances many a child succeeds in developing his residual resources to an unexpected degree, thus becoming an asset to the community instead of being a burden to himself, his family and the state.

8. Notwithstanding the emphasis on keeping children, whenever possible, in the ordinary school, the period under review witnessed a rapid expansion of the special school system, since there was in 1945 a shortage of special schools for most categories of handicap. Between January 1946 and January 1955 the number of special schools increased from 528 to 743, the number of pupils in them from 38,499 to 58,034, and the number of full-time teachers from 2,434 to 4,381, increases of 41, 51 and 80 per cent respectively.

9. Particulars of the new special schools provided since the war are given in the following table:

[page 4]

Against this must be set the closure of 33 schools (21 day and 12 boarding), giving a net gain of 222 schools (52 day and 170 boarding). Of the new schools, 219 (73 day and 146 boarding) were provided by local education authorities, and 36 (all boarding) by voluntary bodies.

10. The following table shows the net additional special school places provided since the war:

11. In addition, accommodation for over 1,400 handicapped pupils has been provided since the war in approved boarding homes, from which they attend ordinary schools in the neighbourhood.

Two new boarding homes for maladjusted pupils, with accommodation for 55 in all, were opened during 1955. Of the 68 new homes, 57 were provided by local education authorities, with accommodation for 1,206, and 11, with accommodation for 204, by voluntary bodies and private persons.

12. Despite the increase of nearly 20,000 between 1946 and 1955 in the number of pupils in special schools, there were in January 1955, only some 7,000 more pupils than there were in March 1939, the last pre-war date for which figures are available; between then and January 1946 (the first post-war date for which there are statistics) the number of pupils in special schools had fallen from 51,152 to 38,499. Though much of this decline in numbers was immediately due to difficulties arising out of the war, notably to loss of premises and to evacuation, it reflected to a considerable extent a change in need due to changes in social conditions and in medical and educational theory and practice, and the special school places provided since the war do not therefore to any appreciable extent represent a return to the pre-war pattern of provision.

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13. A substantial part of the net decline between 1939 and 1946 in the number of special school pupils was accounted for by a fall of over 5,000 in the number of delicate children in day special schools, of some 2,000 in the number of pupils in special schools in hospitals and of some 800 in the number of blind and partially sighted pupils in day special schools. These particular losses have not been made good in the years since the war, for reasons which are discussed in the paragraphs below which deal with particular handicaps (see paragraphs 39, 81-84 and 90-92). On the other hand, there has been a marked increase in recent years in provision for the educationally sub-normal, for whom there was a serious shortage of special schools both before and after the war, for the deaf and partially deaf and (in boarding schools) for the severely crippled, including spastics (see paragraphs 40, 62, 71 and 72), and for the maladjusted, for whom little had been done before the war.

14. The rapid expansion of the special school system at a time when there were many other demands on the educational building programme was possible only by the widespread use of adapted premises, most of which had not been designed for school purposes. At the beginning of 1946 the Ministry, issued a circular* calling attention to the serious shortage of boarding school provision for educationally sub-normal and maladjusted children, and indicating that the need was so pressing that every expedient for providing new boarding schools should be considered. The possibility of buying and adapting large houses was mentioned as one way of tackling the problem. This suggestion was readily adopted and formed the basis of the expansion which followed. The response by authorities was undoubtedly due to a general consciousness of the need for more boarding special schools and of the difficulties caused by long waiting lists of children who could not be educated satisfactorily and who were becoming a grave social problem. Interest was further stimulated by the series of regional conferences held in 1946 and 1947, to which reference is made in paragraph 22.

15. The policy of adapting large houses was a timely one in the years immediately after the war, when a relatively large number of properties, many of which had been requisitioned during the war, were for sale. Although some proved to be less suitable than had at first been hoped, either because they needed costly repairs or extensive adaptation or were expensive to run or difficult to staff, on the whole the policy worked well and the great majority of the schools provided in this way have been satisfactory as schools and attractive as places to live in. Most of the 182 boarding schools opened since the war are in adapted houses (cf. the table in paragraph 9).

16. By 1952, however, it was becoming clear that this policy had spent its initial force, and that a change was necessary. The main emphasis during the "country house" period had necessarily been on boarding rather than on day schools, and the location of the schools had been determined by the availability of buildings. These schools had therefore proved more suitable for those handicaps which, owing to their relative infrequency, were dealt with on a regional or national basis. As a result, while much had been and was being done to deal with the deficiency of boarding school places for the partially sighted, deaf and partially deaf, severely crippled and epileptic, comparatively little had been done to tackle the biggest deficiency of all - that of places for the educationally sub-normal, particularly in day special schools. Moreover, the supply of suitable houses was becoming exhausted; and, with the improvements in school planning and building

*Circular 79, dated 1st January 1946.

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which were being evolved in the ordinary primary and secondary field and which could be applied to special schools, it was becoming more economical and satisfactory to build new schools than to adapt existing buildings.

17. The 1953 building programme showed this change. Previously, programmes had consisted almost exclusively of proposals for the adaptation of country houses and other suitable buildings, but the 1953 programme included several proposals for new day special schools for educationally sub-normal pupils in buildings designed for the purpose. This change was emphasised in Circular 276 issued in June 1954.

18. The change found little reflection in the new schools opened before the end of 1955 but appears clearly in the current building programmes. The following table shows new special schools in course of provision or in building programmes down to and including the 1956-57 programme:

Following are the net additional places to be provided by these new schools, by extensions to existing schools, also in current programmes, and by minor works:

These figures illustrate the swing from boarding to day provision and from adapted to new premises, as well as the predominant attention now being given to the needs of educationally sub-normal pupils.

19. Since, by the 1944 Act, the duty of a local education authority to provide special schools was made part of the general duty to provide primary and secondary schools, the authority's development plan for primary and secondary education had to include "particulars of the arrangements made and proposed to be made by the authority for meeting the needs ... of pupils who require special educational treatment". This was the first occasion on which authorities had been called upon to make a comprehensive review of their arrangements for educating the handicapped.

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20. In order to help them in this the Ministry published in 1946 a pamphlet - "Special Educational Treatment" - which was "intended both to supply answers to some of the questions asked by those who have to consider what provision should be made for handicapped children, and to afford some help and guidance to teachers who find handicapped children in the schools in which they work". The questions considered in the pamphlet were:

(i) What kinds of children required special educational treatment.

(ii) How they should be selected.

(iii) How many might be expected of each kind.

(iv) How and where the special educational treatment should be given.

(v) Who should give it and what preparation would be required for this work.

(vi) What results might be expected from it.

22. The Ministry also sought to help authorities by calling a series of regional conferences in 1946 and 1947, to which all the authorities in the region sent representatives and at which consideration was given to cooperation between authorities in the provision of special schools. The development plans contained a number of proposals arising from these conferences.

23. In some regions further conferences were held, after the 1946-47 series, on the initiative of the authorities, and in at least one region machinery for regional consultation was kept in being. By 1954 it was clear that it would be useful to have another series of regional conferences and to aim at standing arrangements in each region for inter-authority consultation. This suggestion was put to authorities in Circular 276, to which reference has already been made in paragraphs 7 and 17, and a series of conferences was held during the winter of 1954-55. It was hoped that by the establishment of regional machinery the changing pattern of special school requirements could be reviewed periodically between authorities and that by the pooling of knowledge and experience the fullest advantage might be taken of experiments and developments.

24. The increase in the number of children receiving special educational treatment, with the consequential increase in the number of teachers needed for their education, stimulated interest in the supply and training of teachers of handicapped pupils. It had long been felt by some - and not least by many of the teachers themselves - that, although a sense of vocation was essential to the successful teaching of handicapped children, this alone was insufficient and that training was needed in addition to that required for teaching normal children.

[page 8]

25. Although the McNair Committee, which in 1944 reported on the supply, recruitment and training of teachers and youth leaders, did not consider in detail the training of teachers of the handicapped, it stated in its report that "teachers in special schools should not feel themselves to be segregated from teachers in ordinary schools and they should participate fully in the arrangements which area training organisations may make for the benefit of practising teachers generally". The Committee's view was that special training for these teachers should be provided within the general training scheme, that it should be undertaken after a completed course of normal training and that "in general teachers should have had some experience of teaching normal children before taking a course to prepare them for work in special schools".

26. The only teachers of handicapped pupils who are at present required to obtain qualifications other than those which entitle them to the status of qualified teacher are teachers of blind, deaf and partially deaf children in special schools. Professional standards for these teachers were first insisted upon by the teachers themselves.

27. The training of teachers of the blind by experience, under guidance while serving in the schools, was instituted by the College of Teachers of the Blind, and the diploma awarded by this body was, after being recognised by the Board of Education, later made a compulsory requirement for all intending teachers of the blind, to be obtained within three years of taking up appointment. There is as yet no full-time training course for these teachers but the University of Birmingham intends to open one in the 1956-57 session.

28. The National College of Teachers of the Deaf similarly instituted a diploma, to be taken after a period of in-service training, and this has been recognised since 1910 as a qualification for teaching deaf children. In 1919 a full-time one-year training course was established by the Department of Education of the Deaf in the University of Manchester. This course, which opened with six students, can now admit up to 65 a year for service in England and Wales. Intending teachers of deaf or partially deaf children in special schools must either complete this course successfully or obtain the diploma of the National College of Teachers of the Deaf within three years of taking up appointment.

29. Although teachers of the remaining categories of handicapped pupils, whether serving in special schools or in other schools, are not required to obtain additional qualifications, there are a few training courses which they may take in order to equip themselves more fuIIy. Some one-year training courses have been established since 1950 - by the University of London Institute of Education, for teachers of educationally sub-normal children and maladjusted children (separate courses), and by the University of Birmingham Department of Education for teachers of educationally subnormal children. A one-year course on backward children for experienced serving teachers was started by the University of Leeds Institute of Education in 1955. Proposals for the establishment of further one-year courses had been received and were being considered at the end of 1955. A number of shorter courses are held every year both by the Ministry and by local education authorities and by voluntary bodies for teachers of most categories of handicap; these have proved to be particularly useful to teachers of long experience, and to those who find a longer course impracticable.

30. The trends of thought since the McNair Report was published were reflected in the Fourth Report of the National Advisory Council on the

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Training and Supply of Teachers, which was published in November 1954, and was concerned solely with the recruitment and training of teachers of handicapped pupils. The Report recommended, inter alia, that teachers wishing to enter special schools should, after experience in ordinary schools, and after some preliminary experience with handicapped children, take a full-time course of additional training, subject to exceptions for certain special categories of teachers. This recommendation applied to teachers of the blind, deaf and partially deaf as well as to others and would, if implemented, bring to an end the recognition hitherto accorded to in-service methods of training for these teachers.

31. The proposed one-year courses of full-time training for teachers of handicapped pupils other than the blind, deaf and partially deaf would deal with problems which are commonly found among children of all handicaps. Such courses would also probably include some bias towards the teaching of particular categories of handicapped children. There would in addition be a number of shorter courses for teachers of particular categories of handicap. It was recommended that a proportion of teachers in ordinary schools should take the same courses and obtain the same qualifications as teachers in special schools.

32. In a foreword to the Report, the Minister expressed the hope that it would be generally studied and discussed so that future developments in this work might be based upon a still wider interest in and understanding of tile needs of handicapped children and the training that is desirable for those in charge of their education. The Report was still under consideration at the end of 1955.

(a) Blind and Partially Sighted Pupils

33. In January 1946, there were 16 schools for the blind, 30 for the partially sighted and 14 which took pupils of both categories. At the beginning of 1955, the corresponding figures were 22, 27 and 3. These figures illustrate the principal development of the past decade in this particular field, namely the separation of the blind from the partially sighted. This step was among the recommendations of the Committee on the partially sighted which reported in 1934 but it was only after the war that it could be put into effect. Of the three schools still taking both categories, one was being reorganised and the other two had special reasons for continuing to provide both for blind and partially sighted pupils.

34. There was no general shortage of special school places for the blind, and the number of blind pupils in special schools showed no significant variation during the period under review. There is no reason in the long run to expect any marked change in the present incidence of blindness, which is a good deal lower than it was a generation ago. During the first half of the period, however, there was a substantial rise in the number of cases of retrolental fibroplasia among babies born prematurely, and between 1948 and 1952 especially there was a marked increase in the number of babies blinded from this cause. After the discovery, however, of a connection between the disease and the administration of oxygen to premature babies, there was a decline in its incidence and it is to be hoped that new cases of blindness from this cause will be few. There will be, however, a temporary problem for the blind schools in dealing with the resultant "bulge".

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35. While the period has not been one of expansion, there have been improvements in organisation, and special school provision for the blind is now both varied and comprehensive, ranging as it does from the Sunshine Homes (residential nursery schools) to secondary grammar and technical schools. An interesting development was the opening, in 1948, by the Royal National Institute for the Blind, of Condover Hall, a boarding school for blind children with other handicaps. Among the children at this school are a few suffering from both blindness and deafness; a combination of handicaps which presents almost insuperable obstacles to education in the normal sense. The attainments of these children must often remain very humble indeed but, with some of the more able ones, striking results have already been achieved in the small specialised unit where they are taught. One example is that of a girl who at the age of fourteen, when attending a grammar school, contracted tubercular meningitis, which left her both blind and deaf. After a period of 18 months at Condover Hall she passed the General Certificate of Education in three subjects at Ordinary level, and transferred to Chorleywood College to continue her course to Advanced level.

36. Within the schools there has been much steady progress. Many of them are old foundations with a history of honourable service going back to a period when their aim was first and foremost to provide an asylum for the blind person against the hazards of ordinary life. Much has been done to sweep away the last relics of the "institutional" character which some of the schools once possessed and to bring them into line with a newer and wider conception of education. Symptoms of this change are to be found in the expansion of braille libraries in the schools, the development of athletics and in a freer and more natural routine with more contacts with the outside world.

37. Similar changes have taken place in the vocational training of the blind. Under conditions of full employment, the great variety of modern industry and commerce offers the blind much wider opportunities for employment than in the past and the blind person of good intelligence is no longer restricted to a narrow range of sheltered employment. An enquiry among the blind schools about their school leavers during the school year 1954-55 showed that out of 128 only 28 had gone on to be trained in a traditional blind craft. Of the remainder, 31 were training to be shorthand typists, nine to be physiotherapists, two had gone to a university, two to a teachers' training college and 32 had entered or were proposing to enter ordinary open employment.

38. In 1951 a working party set up by the Minister of Labour and National Service investigated the facilities for the employment of the blind and the possibility of their development. It drew attention to the widening range of occupations open to blind persons under modern conditions and suggested the need for a new sort of training establishment for blind boys and girls over the age of 16 which would have the object of giving them further education and training and at the same time equipping them to make an appropriate choice of occupation. After discussion with the Minister of Labour and National Service, the Minister of Education asked the Royal National Institute for the Blind to undertake the provision and management of such an establishment, and they agreed to do so. It was expected that the first pupils would enter this centre early in 1956.

39. As shown in the table in paragraph 10, the number of day pupils in special schools for the partially sighted fell during the period. Some small

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schools were closed and more pupils received the special educational treatment they needed in ordinary day schools. On the other hand, there was an increase in the amount of boarding provision, and an interesting development was the opening in 1951 of a boarding special school for the partially sighted by the Warwickshire local education authority, at Exhall Grange, near Coventry. This school, with accommodation for 240 partially sighted pupils, was originally intended for those boys and girls from the Midlands whose visual defects made it impossible for them to attend ordinary schools and who did not live in areas where a day special school was available. In practice, however, it has drawn its pupils from a much wider area, a considerable number coming from the north of England; in 1955 about half the local education authorities in England were sending pupils there. So far as could be seen, the opening of this school had virtually made good the shortage of boarding special school places for the partially sighted.

(b) Deaf and Partially Deaf Pupils

40. The years which have elapsed since the end of the war have witnessed great advances in the education of the deaf. It has been, first and foremost, a period of rapid expansion. The need for this expansion arose not from any increase in the incidence of deafness but from a change of view about the age range for which the deaf schools should cater. Up to 1937 the lower age of compulsory school attendance for deaf children was seven years, and very few went to school before five. It is now accepted that some sort of special educational treatment should begin as soon as possible after the age of two. In consequence the number of deaf and partially deaf children attending special schools rose from 3,461 in 1946 to 5,206 in 1955. 12 new boarding schools have been opened.

41. While there has been no significant long term increase in the incidence of deafness, there have been two factors which have led to temporary increases. During 1940, a number of expectant mothers were affected by an epidemic of German measles and, as a result, there was a large increase in the number of babIes born deaf. In consequence the schools have had to deal with an exceptionally large age group born in that year. These children will be leaving school in the course of the next year and the ensuing reduction in numbers should afford the schools a welcome measure of relief. A second post war cause of deafness has been the use of streptomycin in cases of tubercular meningitis. This treatment saved the lives of many children who would otherwise have died but left a number of them deaf. This unfortunate after-effect has now been largely eliminated by the use of improved drugs.

42. During the course of this expansion of the deaf schools a start was made on the reorganisation of boarding schools to separate the deaf from the partially deaf, a policy recommended in 1938 by the Committee on the Partially Deaf, and two new boarding schools for the partially deaf have been opened by local education authorities at Tewin Water in Hertfordshire and Needwood in Staffordshire.

43. Two interesting developments by voluntary bodies - one at the beginning of the period, the other at the end - were the opening of the Mary Hare Special School as a grammar school for the deaf, and Burwood Park, a school for deaf boys which was provided by a very generous gift and whose aim is to offer a secondary education with a technical or art bias. The history of Mary Hare School, which at the end of 1955 was being enlarged to take over 100 boys and girls from all parts of the country,

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has shown that deaf pupils of the requisite intelligence are capable of following a grammar school course, notwithstanding the grave handicap which their disability imposes on them.

44. The post war development of deaf education has not, however, been simply a matter of numerical expansion. Recent advances in electronic engineering have put at the disposal of the teacher greatly improved amplifying equipment, in the form both of individual and group hearing aids, with the result that a large proportion even of children correctly classified as deaf are enabled to have some perception of sound, although it may be very limited. It is as yet too early to judge the full effects of this development, but it does not seem over-optimistic to hope that they may be far reaching.

45. The post war concentration on the education of young deaf children has led not only to extensions of special school provision and, in particular, the addition of nursery units to existing schools but also to new methods of approach in dealing with the under-fives. Through the co-operation and interest of workers in the National Health Service, it has been possible in some areas to lay the foundation of subsequent educational progress even before the children reach the age of two. Babies suspected of having a defect of hearing are referred to special clinics and, if the existence of a defect is confirmed, the mother is invited to attend the clinic and is given guidance on the best way to minimise her child's handicap. There is a possibility that this work may be much expanded by the training of health visitors to undertake both the detection of very young children whose hearing may be impaired, and also to give help and instruction to their parents. Several courses for health visitors on these lines have already been conducted at the Department of Education of the Deaf at Manchester University.

46. To match the great increase in the number of children attending special schools for the deaf and partially deaf the number of teachers working in these schools has increased from 356 in 1946 to 583 in 1955. Mention has already been made in paragraphs 28 and 45 of the Department of Education of the Deaf at Manchester University and it is appropriate at this point to pay tribute to the contribution which it has made, both by its role as a centre of research and by the great increase in its output of teachers who have completed the one-year course in the education of the deaf. The Manchester trained teachers have been supplemented by those who have qualified by obtaining the diploma of the National College of Teachers of the Deaf.

47. There has been an encouraging increase in public knowledge of and interest in the education of the deaf as shown, for instance, in the reception given to the films "Mandy" and "Thursday's Children". This interest has led naturally enough to criticisms; criticisms that the expansion of the schools has not been quick enough, that the schools do not concentrate sufficiently on the development of speech by oral methods or, from the opposite point of view, that they would do better to devote less attention to speech and more to non-oral methods of communication. These criticisms are a healthy sign; they emphasise that the education of the deaf is undergoing rapid change and development and that even after the demand for school places has been met, as it should be in the near future, there will be no cause for complacency but on the contrary a greater need to concentrate on outstanding problems.

(c) The Educationally Sub-normal

48. Mention has already been made of the shortage of special school places for the educationally sub-normal and of the steps which have been and are being taken to make it good (see paragraphs 14, 16 and 17).

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Throughout the period this has remained the most serious and intractable of the shortages of special school provision. Whereas the number of educationally sub-normal pupils in special schools increased from 15,483 to 22,895 in the five years from the end of 1949 to the end of 1954, the number of children for whom authorities were seeking special school places, most of whom were in the meantime in ordinary schools, varied little throughout the period and was indeed slightly higher at the end than at the beginning - 12,578 as compared with 12,489.

49. The explanation of the apparent steadiness in the size of this waiting list is that, while places remain short, demand tends to be governed by supply. Many authorities and their medical officers are reluctant to put children on their list unless there is reasonable hope of placing them, so that when a child is admitted to a special school and moves off the list there is often another child to add to it. Even at the end of 1955 it was impossible to forecast the amount of additional provision likely to be needed to make a significant impression on the apparent size of the waiting lists. As the figures in paragraph 18 show, however, there was a substantial number of additional places in course of provision or in the current building programmes and it is likely that the next two or three years will witness an appreciable improvement.

50. One sign of improvement has been that it has become less difficult to place the really troublesome educationally-sub-normal boy or girl, whose mental disability is complicated by behaviour difficulties and perhaps a record of delinquency. Until the last two or three years this was a problem which was frequently brought to the Ministry's attention; as recently as 1953 it was discussed by the local authority associations with the Ministry, following representations by the associations. But when it was further discussed at the regional meetings held in the winter of 1954-55 (see paragraph 23), the local education authorities' representatives did not seem to find it any longer so serious.

51. In no sphere of special educational treatment has the effect of the legal changes introduced by the 1944 Act been more marked than in the case of the educationally sub-normal. In the earlier days, the educationally sub-normal were officially described as "mentally defective" and were at times apt to be treated as outcasts from the educational system. This is no longer the case: they are now recognised as a large group of about 5-10 per cent of the school population, who need special help if they are to succeed at school and become useful members of the community. Most of this group can and should be taught in the ordinary schools and there is a growing interest in their problems among teachers. This in turn has led to an increasing tendency no longer to regard the educationally sub-normal pupils in special schools as rejects of the ordinary school but rather as needing help which the ordinary school cannot give.

52. The standard of premises and equipment for the new special schools has been at least as good as that for the ordinary primary and secondary schools. Some of the older day schools had been accommodated in the worst type of elementary school building, and the older boarding special schools often had amenities reminiscent of a Poor Law Institution. The new schools are less institutional in character; both they and the dormitories are smaller, since it has become more generally recognised that handicapped children do not thrive in large groups.

53. There have been signs of a growing appreciation among parents of what the special schools can do for their children. At one time they were

[page 14]

often regarded with hostility as places where children were "put away" but now parents are often more aware of what the special schools can do to develop the children's potentialities and restore their self-confidence, often after failure and frustration in the ordinary school.

(d) Epileptic Pupils

54. Epilepsy was long regarded as a mysterious affliction, sometimes attributed to possession by a devil, and it was not until the nineteenth century that it was studied scientifically. This led to an appreciation of the social and educational needs of those suffering from the disease and legislation at the end of the century empowered authorities to establish schools for epileptics. The first such school was approved in 1903 (St. Elizabeth's Roman Catholic School, Much Hadham). Between that date and 1946 six more schools were established, four of them by voluntary bodies in association with epileptic colonies (Lingfield, Maghull, Chalfont St. Peters and Colthurst House at the David Lewis Colony), and two by local education authorities (Soss Moss by Manchester local education authority and a small school in St. Faith's Hospital by the London County Council, since taken over by the Essex local education authority). In 1946 these special schools had accommodation for about 600 pupils, but waiting lists were long.

55. The history of special educational treatment for epileptics since the war reflects the changes which were taking place in the treatment of and attitude towards epileptics generally. First there were the great advances made in recent years in the diagnosis and medical treatment of epilepsy by the development of new techniques and in particular in the control of fits by the use of anti-convulsant drugs. Secondly there was a growing emphasis by doctors and others concerned with epileptics on the desirability of their living as normal a life as possible. This way of thinking, carried into the special schools, meant a fuller recognition that the aim of the school should be to prepare the child for return to the ordinary school wherever practicable. Thirdly there had been a growing appreciation among the enlightened public, and in particular among teachers, of the nature and significance of epilepsy. Teachers have become more willing to accept the responsibility of receiving the less severe cases, which form the great majority, into the ordinary schools. Encouraged and advised by school medical officers, they are prepared to face the possibility of fits in school and, in the comparatively rare cases where one occurs, to deal with it calmly and competently so that a minimum of disturbance or dismay is caused to the class.

56. These changes have had an effect on the demand for special school places. Such places are required only for children who, owing to the frequency or severity of fits or to behaviour difficulties, cannot be educated in the ordinary schools. Limited surveys carried out in a number of areas in 1947 indicated that the total national demand for special school places might be 1,500; a second similar survey in 1950-51 suggested a figure of 1,200. Subsequent experience however has shown that these estimates were too high. Since it was suspected that the facts mentioned in the preceding paragraph might be operating increasingly to reduce demand, it was decided in 1953 to make a detailed assessment of requirements. Local education authorities were asked to supply particulars of all epileptic children then awaiting places in special schools. Particulars of 143 children were returned and the survey showed that existing places and those being provided should suffice to meet the full need of about 900 places.

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(c) Maladjusted Pupils

57. Before the war little had been done to provide special educational treatment for maladjusted pupils and in 1945 the only facilities available for examining or teaching them were 79 child guidance clinics, some hostels which had been opened during the war for children who could not be billeted in ordinary households, a few independent boarding schools which catered specially for nervous or difficult children and two day schools provided by local education authorities originally for children who were retarded in their school work or were misfits in other ways. By the end of 1955 there were about 300 child guidance clinics, over 200 of them provided by local education authorities, 45 approved boarding homes (or "hostels") with 850 places, 32 boarding special schools (including some of the schools mentioned above which had begun as independent schools) with 1,100 places; three day special schools with 168 places and 17 part-time special classes. In addition, local education authorities were maintaining 1,062 maladjusted children in 158 independent boarding schools and providing education for seriously disturbed children in six children's departments of mental hospitals or other children's units.

58. As facilities increased, a clearer perception was gained of the functions of the various types of establishment and of the range of children for whom they could cater. To begin with, children were usually referred to child guidance clinics only if they were a nuisance at school or delinquent. Some of the children sent were merely educationally sub-normal and it is now realised that these need help of another type. On the other hand, as parents, doctors and teachers gained confidence in clinics, they began to refer more maladjusted children who were quiet and passive and, in general, to seek help at an earlier stage before a child's maladjustment had become pronounced. Clinics increasingly are concerned with prevention as well as cure and try to deal with children in the context of their homes, helping both parents and children. Boarding special schools have learned from experience the types of maladjusted children with whom they are successful and unsuccessful. Much more discrimination is now shown in selecting children for admission. It is increasingly recognised that the main function of these schools is not to provide instruction for difficult children away from home but to help children to become re-adjusted, and that every aspect of the life of the school community must play a part in this.

59. The staffing of the various types of establishment and the co-operation between them have also improved. In 1945 some child guidance clinics were run almost single-handed by a psychiatrist or a psychologist, whereas most are now served by a team consisting of a child psychiatrist, an educational psychologist and a psychiatric social worker. A start has been made in arranging training courses for teachers or house-staff working with maladjusted children. Child guidance teams work much more closely than before with the staff of hostels and special schools, providing psychiatric supervision and treatment for the children and helping to maintain contact with the parents.

60. Although much has been learned in recent years, this part of the education service is still in its early stages. In 1950 Mr. George Tomlinson, as Minister of Education, set up a Committee "to enquire into and report upon the medical, educational and social problems relating to maladjusted children, with reference to their treatment within the educational system". This Committee, whose* Report was published in November 1955, made a

*Report of the Committee on Maladjusted Children. H.M.S.O. 6s. 0d.

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comprehensive survey of the problem, and suggested ways in which the various types of treatment and methods of prevention might best be used and developed.

(f) Physically Handicapped Pupils

61. Physically handicapped pupils are defined as "pupils not suffering solely from a defect of sight or hearing who by reason of disease or crippling defect cannot, without detriment to their health or educational development, be satisfactorily educated under the normal regime of ordinary schools". The definition covers a wide variety of degree and type of handicap, including congenital and rheumatic heart disease, cerebral palsy (dealt with separately below in paragraphs 69-74), tuberculosis of the bones or joints, deformities or amputation of limbs, muscular dystrophy, haemophilia and the after effects of poliomyelitis as well as other less common or less severe conditions. Many of the less seriously handicapped can, with suitable modifications of the ordinary regime and with special help such as the provision of transport, be educated at ordinary schools. Others may need to attend the day special schools which exist in some urban areas. For some, boarding school education is necessary; this may be because there is no day special school within reach or because they are so seriously handicapped that only boarding education is practicable; for instance they may be unable to walk or may need special nursing care. Others again are so severely handicapped that they need to be educated at home. While the physically handicapped group includes children of average and above average intelligence, many of those who are attending special schools are very backward educationally, either because they have missed so much schooling through illness or for other reasons, and they may also have emotional difficulties because of their physical handicap.

62. Ten years ago there was no very precise estimate of the number of physically handicapped children likely to need special school places. London and most large county boroughs had already established one or more day schools, and there were in existence about a dozen boarding schools, mainly run by voluntary bodies, for children who either because of their handicap or for other reasons were unable to attend day schools. The waiting lists for these boarding schools were very long and there was a great need for places for very severely handicapped children. More places for such children was obviously a matter deserving priority, and both the voluntary bodies and local education authorities responded promptly. Many of the 25 boarding schools provided since the war have been for severely disabled children and it is now much easier to place this type of child.

63. Schools of this kind have their own problems and much useful experience has been gained in the last ten years. So far as the amelioration of the disabilities themselves is concerned, a feature of the period has been the increasing amount of physiotherapy provided by the schools as more trained physiotherapists became available. Great progress has also taken place in the supply of special equipment, much of it adapted to the individual pupil's needs.

64. The histories, abilities, and future prospects of the pupils at these schools vary widely. Some of the children have been crippled since babyhood, and so completely lack a background of normal experience. Others, such as those suffering from the after effects of poliomyelitis, have had to face the cruel shock of a totally unexpected disablement. While there are some who may, with suitable education and training, become completely or partially self-supporting, some will never be able to earn and a proportion

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will always be dependent upon others for their daily care. Each child must be considered as an individual. Many of the children are only too conscious of the problems presented by their future, and the school has the difficult task of encouraging a realistic attitude towards the handicap and the conditions which it must impose while training the children to be as independent as possible and giving them enduring interests in reading, music, crafts and hobbies.

65. Some of these young people have been able to achieve a surprising degree of independence. Some boys, mostly after special training, have been successfully placed in employment in a great variety of trades, including radio repairs. A girl unable to walk and expected to need sheltered workshop conditions is now, after training, steadily employed as a machinist in a factory which she reaches in her car. Another was able to go on to an ordinary grammar school and still another to a training college for teachers.

66. In 1950 it was decided to enquire into the number of physically handicapped children requiring education in special schools and information was sought from all local education authorities in England and Wales. The results suggested that day provision was reasonably adequate except in a few areas. About 600 to 700 additional boarding school places then seemed likely to be required. In 1954 it was thought timely to hold another and more detailed survey. Particulars were obtained from the local education authorities of all physically handicapped children recommended for special school education but not yet placed. The results of this inquiry were circulated to local education authorities. They showed that there were 203 children awaiting day school places. Eight hundred and fifty children had been recommended for boarding special school education; parental consent had been given in 525 cases and had been refused or not yet given in the remainder. After allowance had been made for probable refusals of parental consent, it appeared that the number of boarding school places likely to be available within the next two or three years would be sufficient to meet the needs of children suffering from all kinds of physical handicap, including cerebral palsy. Improvements in the school premises or the services provided were required in some instances, and guidance on this subject was promised to authorities by the Minister; this was under consideration at the end of the year.

67. Much thought has been given in recent years as to whether a secondary grammar school for physically handicapped pupils is required, comparable to those for blind and deaf children. In an attempt to assess the need for such a school, a survey was carried out by one of the Ministry's medical officers in association with H.M. Inspectors into the arrangements at present made for the secondary education of physically handicapped pupils in five selected areas. The report of this survey, a full account of which was given in the Report of the Chief Medical Officer for 1952-53, showed that considerable efforts were being made both by local education authorities and by teachers to enable children of grammar school calibre, some of them severely handicapped, to attend ordinary grammar schools and to profit as much as possible from the education there. Concessions granted to the children included extra time for taking the selection tests for those who had difficulty in writing, permission for children who had missed considerable schooling to take the test at a later age than normal, allocation to a school where the buildings were particularly suitable for a physically handicapped child or to a school nearer the child's home than would otherwise have been made available, the provision of special transport to school and special placing and other arrangements in school to minimise the child's

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difficulties. The conclusion from the survey was that, within the areas studied few or no children suited for grammar school education were not receiving it, though in the case of a few severely handicapped children education could not be given in school but had to be given through tuition at home. It was calculated that there were about seven children in the areas studied who would be suitable for a special grammar school. The national demand on a comparable scale might be for between 60 and 120 places.

68. Towards the end of 1955 the Governors of the Lord Mayor Treloar College, Alton, Hampshire (hitherto a vocational training establishment for older boys) decided to start, in addition to the vocational courses, some secondary school courses for abler and more gifted physically handicapped boys from the age of eleven including work leading to the General Certificate of Education. It is hoped that this project, which will be started on an experimental basis, may develop into a national grammar school course, allied with work of a secondary technical character. Meanwhile, some of the existing schools for the physically handicapped are on occasion able to make special arrangements for individual pupils.

Cerebral Palsy

69. Cerebral palsy is one of the commoner conditions found among physically handicapped pupils. It is dealt with separately here because of the public interest which has been shown in the subject in recent years, and also because considerable progress has been made in special educational treatment for cerebral palsied children. People suffering from this condition are commonly described as "spastics".

70. A great deal had been done in the U.S.A. immediately before 1945 to improve the lot of spastics and when the war ended informed circles in this country increasingly realised that more might be done here to help them. One of the first recommendations made by the Minister's Advisory Committee on Handicapped Children was that made in 1945 to the effect that "there was an urgent need for the setting up of a small but definite scheme for research into the medical and educational aspects of the problem of children suffering from cerebral palsy". The National Foundation for Educational Research in England and Wales was forthwith asked to undertake this research which led to the publication in 1951 of a survey by Miss M. I. Dunsdon entitled "The Educability of Cerebral Palsied Children".

71. Before 1947 spastic children had been educated in special schools for the physically handicapped generally. There were however some who, though possibly of average or nearly average intelligence, were too severely handicapped to be able to profit from the education given in these schools. St. Margaret's School, Croydon, the first special school solely for children suffering from this disease, was established in 1947. The opening of Carlson House, Birmingham, a day school, followed in 1948 and the opening of the Dame Hannah Rogers School, Ivybridge, another boarding school, in 1949. All three schools were established by voluntary bodies with encouragement and financial assistance from the Ministry of Education. They were experimental and their object was to find out what could be done by highly specialised education and treatment, including physiotherapy and speech therapy, to help children who were too severely handicapped to profit from the ordinary special schools and who might, perhaps, previously have been regarded as unsuitable for any school. Because of the demand for places, these specialised schools could, at first, admit only children whose intelligence appeared to be roughly within the normal range.

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72. Since 1949 five more special schools exclusively for spastic children have been opened, four by local education authorities (three boarding and one day), and one, a boarding school, by a voluntary body. These schools provide places for 220 children (about 90 day places and the remainder boarding). With these additional places the schools now seem to be able to provide for some children who would previously have been excluded on their relatively low standard of intelligence. The schools are kept small so that the children can be given individual attention.

73. The 1954 survey of physically handicapped children awaiting places in special schools showed that there were on the 1st October in that year 50 spastic children awaiting places in day schools and 435 recommended for places in boarding schools, parental consent having been given in 301 of the latter cases. This does not mean that all these children needed places in schools provided specially for spastic children, as many such children, if they are not too seriously handicapped, can very well be educated in the ordinary special schools for physically handicapped children, both boarding and day schools, and also in open air schools. Some schools have been able to arrange special spastic units and this is being done to an increasing extent where numbers justify it.

74. An inquiry made in January 1955 showed that at least 1,800 spastic children were attending special schools of one kind or another, excluding hospital schools. In addition to the arrangements in special schools, a number of small units have been set up in various parts of the country, sometimes in association with hospitals, where day special schools are impracticable. Spastic children, and particularly younger children, attend daily and obtain both education and treatment. There are also about 3,000 lightly handicapped spastic children who are being educated in ordinary schools; these children are entitled to the physiotherapy and speech therapy service of the Health Services.

(g) Pupils suffering from Speech Defects

75. The first local education authority to make special arrangements for children with speech difficulties was Manchester which in 1906 started special classes for stammerers, taken by specially trained teachers. By 1945, 70 local education authorities were employing speech therapists.

76. In 1945 two important changes took place which were to have major effects on the development of this service. There is no doubt that up to that time the recruitment of speech therapists had been retarded for want of an agreed syllabus of study or of a single recognised qualification and by the existence of two rival professional organisations. These two bodies, however, amalgamated in April 1945, and founded the College of Speech Therapists, which became the sole organising and examining body and channel of entry for speech therapists to the National Register of Medical Auxiliaries. The college instituted a common three-year syllabus and final examinations which were adopted by all the training schools in England and Scotland.

77. In the same year the duty of providing special educational treatment for children suffering from speech defects was first imposed on local education authorities by the Handicapped Pupils and School Health Service Regulations 1945. While the regulations could not immediately be fully implemented owing to the lack of qualified therapists, very substantial progress has been made. There were on 31st December 1954, 341 speech therapists employed full and part-time by local education authorities (the equivalent of 295 full-time therapists) compared with 205 (full-time equivalent 157) employed

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on 31st December 1949. The number of children with speech defects treated during the year ending 31st December 1954 was 44,840 compared with 25,098 in the year ending 31st December 1949.

78. A major problem was to build up as quickly as possible the supply of therapists, whose services were required not only in the school health service but also in hospitals and elsewhere. There were already six training schools, four in England and two in Scotland, and a seventh, in Leicester, was opened by the local education authority. These seven schools are now capable of training a total of about 80 speech therapists a year, and although the wastage through marriage is high it is hoped that there will, within a few years, be enough to meet all needs.

79. Moor House Special School, Oxted, was established in 1947 for children who require more highly specialised and concentrated treatment than the school speech clinics can provide. It deals mainly with severely aphasic children and with those who have serious speech defects, many with an organic cause. A team of workers which includes a neurologist, plastic surgeons, an ear, nose and throat surgeon, a psychiatrist, a psychologist and a dental surgeon, as well as speech therapists and teachers, work together with the object of fitting the children as soon as possible for return to an ordinary school. There is a close link with the Queen Victoria Hospital, East Grinstead, which has a plastic surgery unit, and about half the children in the school receive plastic surgery there.

(h) Delicate Pupils

80. Delicate pupils are normally provided with special educational treatment either in ordinary schools with suitable modifications of the school regime, in hospital if they are sick enough to require this, or in special schools for delicate children - often known as "open air" schools. The first "open air" school for delicate children in this country was opened by the London County Council in 1907, as an experiment and for the summer months only, but the results were so successful that in the next year three more schools were opened by the Council and three by other authorities. Growth in this type of provision, both day and boarding, continued up to 1914 and between the wars. At present there are rather more than 12,000 delicate children in open air day and boarding schools in England and Wales.

81. In the years since the first of these schools was opened, there have been great improvements in the health of school children generally, attributable in part to the improved economic position of large sections of the population and in part to the development of a comprehensive school health service, the provision of school meals and milk and improved conditions in the ordinary schools. In 1949 it was decided, therefore, that the time was opportune for a survey to be made by the Medical Officers of the Ministry of the function and conduct of open air schools, and a full report, which was of a character to stimulate thought about the nature and purpose of these schools, was published in "The Report of the Chief Medical Officer of the Ministry of Education for 1950 and 1951".* This was particularly critical of the over-spartan conditions prevalent in some of the schools; although these conditions had been accepted as beneficial to health during the early years of the "open air" school movement, they were no longer generally sanctioned by medical opinion. Since the issue of the report many improvements have been made.

*H.M.S.O. 1952. 5s. 0d.

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82. The survey showed that changes were taking place in the type of case dealt with in the open air schools. In the early days many of the children had been suffering from malnutrition and from tuberculosis. Now the chief ailments were respiratory defects - asthma or bronchitis being the most common - or debility due to illness or poor home conditions. In recent years an increased number of children had been admitted with nervous conditions and many were backward educationally. Features of the open air school were shown to be an emphasis on open air life with, for instance, many of the lessons out of doors, the close medical supervision of the children, plenty of good food and arrangements to ensure the necessary rest and sleep including mid-day rest periods when desirable. Most children stayed for eighteen months to two years in the day schools but for shorter periods in the residential schools.

83. The general conclusion drawn by the Medical Officers was that there was still a place for special schools for delicate children, particularly for those living in industrial areas, but that there did not seem to be much justification for expansion. One of the great merits of the open air schools was their small size, which enabled individual care and attention to be given.

84. Experience since the survey has confirmed that the function of the open air schools is changing. With purely physical debility becoming less of a problem, it has been found that this type of school is useful for children who, for various reasons, find life in the ordinary school too strenuous - for instance, asthmatic children or those who perhaps because of illness have missed a good deal of schooling and need special educational treatment in addition to the building up of their physical strength. The Minister's Committee on Maladjusted Children has suggested that a few maladjusted children may respond well in an open air school, provided that they are carefully selected. There has also been an increasing tendency to use day open air schools for physically handicapped children in areas where no day school exists specifically for them. In a number of open air schools special arrangements exist for the care and education of spastic children, often in special units. Provided that these children can be taught in small groups and can be given treatment, and provided that the long-term educational needs of the physically handicapped are not overlooked, such an arrangement may well be better for the children and more acceptable to the parents, at any rate during the early years, than sending them away to a boarding school.

Diabetic Pupils

85. In the Handicapped Pupils and School Health Service Regulations 1945, there was a separate category for diabetic pupils, but these children are now included in the general category of delicate pupils as defined in the School Health Service and Handicapped Pupils Regulations 1953. The problem of educating diabetic children is a comparatively recent one, because there was little prospect of survival for those with this disease until the discovery of insulin treatment in 1922. The use of insulin has, however, radically altered the life expectation of diabetics and it is estimated that there may now be nearly 2,000 diabetic school children in England and Wales. The great majority can obtain care and treatment while living at home, any necessary modification being made in the ordinary school regime. Some diabetic children, however, need other arrangements; some live in rural areas where there are no facilities for treatment; others live in homes where conditions are unfavourable to the maintenance of the strict regime

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which is necessary. For these children a number of hostels have been established, under the charge of trained nurses, from which it is possible to attend the local schools. The chief characteristics of the hostel regime are the modified diet, supervised injections of insulin and training in the diabetic way of life. The children are taught to become as self-reliant as possible by giving themselves injections, carrying out the necessary tests of urine, keeping a watch for and dealing with the early signs of hypoglycaemia (deficiency of blood sugar) and paying careful attention to their own general health. In other ways they are encouraged to lead as normal a life as possible.

86. The first hostel for diabetic children was set up by the London County Council in 1939, with the support of the Diabetic Association, as part of the evacuation scheme. The hostel always took most of its children from outside the London County Council's area, but the waiting list for its 60 places grew longer as the years passed. In 1947 representatives of the Diabetic Association and officers of the Ministry met to discuss the problem and it was decided to hold a survey with a view to estimating requirements. The conclusion was that a total of 130-150 hostel places might be required. The Church of England Children's Society and the National Children's Home and Orphanage were then approached by the Ministry and generously agreed to provide additional hostels. There are now six hostels with a total of about 150 places to which local education authorities can send diabetic children, and the need seems to be met.

87. There have also been arrangements in existence since 1952, with which the Diabetic Association are again connected, by which local education authorities have been able to arrange holidays by the sea or in the country for a limited number of diabetic children, who would probably otherwise, owing to dieting and other difficulties, not get a holiday away from home.

88. The duty of local education authorities to provide education for all children who are capable of benefiting from it applies to children in hospitals no less than to others. Authorities may establish special schools in hospitals, or, if the number of children is insufficient to justify this, they are empowered by Section 56 of the Education Act 1944, to provide individual or group tuition "otherwise than at school ".

89. The National Health Service Act 1946 safeguarded the existing arrangements for education in hospitals and facilitated their extension. Under Section 62 regional hospital boards and the boards of governors of teaching hospitals are empowered to arrange with a local education authority or voluntary organisation for the use as a special school of any premises forming part of the hospital.

90. During the last 20 years, the number of long-stay child patients in hospital has declined considerably. Teaching is now carried out in many more hospitals than before the war but the children being taught are a much greater mixture of short, medium and long-stay cases than previously, when long-stay cases predominated.

91. In 1939 there were 88 special schools in hospitals; by the end of 1947 there were 95. By January 1955, this number had increased to 120, of which 15 were maintained by voluntary bodies. These schools had 6,476 pupils on roll, compared with 7,414 pupils in the 88 hospital schools in 1939. In addition, however, to the pupils in hospital schools, there were in January 1955 1,425 children who were receiving individual or group tuition in hospitals.

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92. These figures are indicative both of the changed nature of the problem and of the increasing awareness among education and hospital authorities of the value of education for children who have to spend periods in hospital. It is significant that while, in former times, teachers were sometimes admitted to the wards only after much difficulty, the request for teaching is now often made in the first instance by the hospital staffs.

93. The changed conditions in hospitals have called for much adaptability on the part of the teachers. For children being taught in hospital, there is rarely a rigid organisation of classes, time-tables and terms. Admissions and discharges may cause frequent changes of companions, and teaching periods are inevitably interrupted by medical treatment. A wide variety of equipment is called for and may have to be specially adapted. Bed tables, for example, are normal and the teachers must have trolleys to move books and materials. The ingenuity of teachers in adapting equipment is illustrated by the fact that children are able to paint without damage to bed clothes.

94. Illness has no regard for age, ability or aptitude and it is usual to find a wide variety of all three among the children in the same hospital and even within the same ward or teaching group. In a hospital recently visited, the children in the care of one teacher varied in age from five to 17, covered a wide intelligence range and included a Belgian boy, a boy from an approved school and a boy from a well-known public school. It is clear that teaching in these circumstances calls for more flexibility than in any other type of school.

95. Hospital schools are usually staffed to meet the needs of the wide range of children and in many a specially qualified and experienced teacher is responsible for the boys and girls who are studying for the General Certificate of Education. It is common for this examination to be taken by pupils while in hospital. Some boys and girls, too, through advanced study in hospital have been able to go to a university. Some have developed special gifts like the boy who revealed in hospital an unexpected gift for music and is now hoping to become a professional violinist.

96. Arrangements for education are limited by the fact that the children are in hospital primarily for medical treatment. For the most part they must be taught in bed and sometimes are not able to make full use of their hands. It has long been appreciated, however, that education can have a therapeutic value, as well as helping to ensure that children who have to spend long periods in hospitals do not suffer by loss of schooling.

97. The success of a hospital special school or teaching group depends on close and continuous co-operation between hospital and teaching staffs. It is a tribute to those concerned that education is already accepted as an integral part in the life of so many hospitals.

98. Local education authorities have power "in extraordinary circumstances" to provide education for children otherwise than at school. This power is used mainly to provide tuition at home or elsewhere for handicapped children. Most of the children are too seriously handicapped to attend a special school. Some children may suffer from a combination of handicaps. Others may be awaiting entry to hospital or convalescent after hospital treatment or attending hospitals regularly as out-patients and temporarily unfit to attend ordinary or special schools. A steadily decreasing number are waiting for places in special schools to become available. There has been a very marked growth in recent years in home tuition, principally for

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children who are severely handicapped. Annual figures have been obtained from local education authorities only since 1949 but these show an increase from 780 in that year, including children receiving individual tuition in hospital (see also paragraphs 88 and 91 above), to 3,708 in December 1954, of whom 1,425 were in hospital and 2,283 at home or in small groups elsewhere. The large majority of handicapped children receiving education in this way fall within the category of the physically handicapped (1,533 in December 1954, exclusive of those in hospital), but there are a few within each category. The physically handicapped include many with severe crippling or multiple defects and some whose expectation of life is short.

99. Although some local education authorities employ teachers full-time for this work, most of the teachers are employed part-time. In some areas, particularly in rural districts where the homes are widely scattered and much travelling is involved, recruitment of suitable teachers is not easy. Married women who have left the ordinary service for family reasons have proved very useful. They are usually personally well suited by their own experience for this work with its intimate contacts with the home and the need for sympathetic handling of the possibly harassed mother. Retired teachers are also employed and people without teaching qualifications are sometimes able to undertake this work satisfactorily. For the most part the children are taught individually in their homes. Sometimes very small groups can be formed and gathered together in one of their homes or elsewhere. Where the home is unsuitable, premises can sometimes be hired nearby or a sympathetic neighbour may offer to lend her sitting room.

100. The amount of tuition given varies according to the age, ability and physical condition of the child. Five sessions per week of an hour or more duration is the usual maximum. The nature of the tuition obviously varies according to the child's background, abilities and the nature of his handicap. Although instruction in the basic skills of reading, writing and arithmetic is prominent, more cultural and aesthetic activities add much interest to the lives of these children. Music, art, crafts and literature are valuable and the children can be helped to listen intelligently to wireless programmes. One authority has provided the visiting teacher with a portable radio. The principle of steady work, whether the teacher is there or not, seems to have been generally accepted. In some areas teachers have taken children out on visits to places of interest, nature study visits, etc. Many children progress from home teaching to a boarding school, where they enjoy the companionship and stimulus of other children.

101. The real effectiveness of the service depends upon the devotion and skiIl of the teachers and there are many indications that these qualities are possessed by the teachers engaged in this work. Many of them become intimate friends of the family and maintain contacts with the children long after the tuition has ceased.

102. In this review an attempt has been made to show the principal changes in the education of the handicapped brought about as a result of the 1944 Act and how these changes are being applied to the special problems of each handicap. The general aim throughout is to provide each handicapped child with the education best suited to his age, ability and aptitude, and. so far as possible, to educate him in a normal environment and against a normal background. In this way handicapped children can best be helped to overcome their handicaps so far as they can, and to take their place after leaving school as members of the adult community.

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103. The record of what has been done since 1945 reflects the growing interest in the handicapped and of the need to give them every possible help to overcome their disabilities. It is a striking fact that local education authorities, at a time when they have been hard pressed in the primary and secondary field generally with the problem of providing school accommodation for the raising of the school age and to deal with the growth of the school population as a result of the rise in the birth rate after the war, should have been able to expand the special school system more rapidly than in any previous decade. Still more striking perhaps is the contribution made by voluntary bodies to these post-war developments. In this field, voluntary organisations clearly still have a big part to play in partnership with the Ministry and the local education authorities.