One appreciates how much has been achieved in these islands when one visits a developing Asian or African country where there is still a mass of untreated physical disease among children, including tuberculosis, diphtheria, typhoid, virulent measles, the tropical diseases, and severe malnutrition. But already in these countries there are doctors and educationists who recog nize that there are also boys and girls with emotional and behaviour problems, and with speech and language disorders, for whom there is no diagnostic, treatment, or special educa tional provision, and whose needs are submerged by the many with gross and grave physical illness. Recently I visited two of these countries, one in Africa the other in Asia, where there was only one psychiatrist in each. One of the countries had a single mental hospital with a nominal 700 beds for adults and children but, on average, 1,500 inpatients, more than half of whom had to lie on the stone floor of the wards. The other country had 100 psychiatric beds for an estimated population of about 12 million; patients, including children, who were considered to be refractory were sent to a home for the destitute. Though such conditions no longer exist in this country we have no cause for complacency. It must be emphasized that children wiith handicaps and disabilities do not often fall naturally into clear-cut separate categories. It is administratively convenient to have categories of handicapped children, but, in fact, many handicapped boys and girls have more than one disability; children with severe multiple handicaps, particularly those with grave defects of hearing and vision, present specially difficult problems to the medical, educational, and social services and, not least, to their parents. Parent counselling is vitally important but is outside the scope of this lecture. Though most schoolchildren with severe handicaps and dis abilities are in special schools quite a number attend the regular classes of ordinary schools, as do many children with less severe handicaps. There is still much to be learnt about what is the best educational provision that it is practicable to arrange for handicapped children, and the more closely the educational and medical services co-operate in this work the better it will be for the children and their parents. The official Ministerial policy is that No handicapped pupil should be sent to a special school who can be satisfactorily educated in an ordinary school. 21
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