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47
PUBLIC
HEALTH
SOCIETY OF MEDICAL OFFICERS OF HEALTH
AUGUST, 1947
No. II. Vol. LX. CONTENTS
PAGE
PAGE
EDITORIAL
Ministry of Health Circular 118/47 . . . . . . . . . . . . . . . . . . ]Poliomyelitis ........................... School Health ........................... Duncan of Liverpool ........................ The Cost of Motherhood ~. . . . . . . . . . . . . . . . . . . . . . .
BOOK
212 213 213 214 214
A. G. Morison, M.A., M,D., D.P.H J. E. Wilson, M.D., D.P.H. . . .
CORRESPONDENCE
Control of Smallpox: A Correction (W. H. Bradley) . . . . . . . . . . . . .
SPECIAL ARTICLES
Ascertainment of Visual Defect in Children. By D. D. Stenhouse Stewart, M . R . C . S . , L R . C . P . , D . O . M . S . . . . . . . . . . . . . . . . . . . 215 Care of the Aged. By E. D. Irvlne, M.D., D.P.H. . . . . . . . . . . . . 219 NEWS
AND
REPORTS
Medical Officers o[ Health Under the Act . . . . . . ......... The Maternity and Child Welfare Conference ............ Prevention and Treatment of Tuberculosis . . . . . . . . . . . . . . . 8th (London) Field Hygiene Company, R.A.M.C. (T.A.) . . . . . . . . .
222 223 223
228
EDITORIAL M i n i s t r y of H e a l t h C i r c u l a r 1 1 8 / 4 7
T h e issue of Circular 118/47,* d a t e d July 10th, to t h e local h e a l t h authorities c o n s t i t u t e d b y t h e N . H , S . Act, 1946, completes t h e guidance given b y t h e M i n i s t r y o n t h e p r e p a r a t i o n of p r o p o s a l s to b e m a d e u n d e r P a r t I I I . T h u s it covers care of m o t h e r s a n d y o u n g children, t h e m i d w i v e s service, h e a l t h visitors, h o m e nursing, a n d p r e v e n t i o n of illness, care a n d a f t e r - c a r e ; a n d contains p a r a g r a p h s w h i c h will affect t h e f u t u r e of large sections o f t h e p r e s e n t p u b l i c h e a l t h service. O n care of m o t h e r s a n d y o u n g children, t h e circular anticipates " considerable differences, some i m m e d i a t e , some growing w i t h t h e d e v e l o p m e n t of o t h e r parts of t h e N a t i o n a l H e a l t h Service," b e t w e e n t h e p r e s e n t M . & C.W. service a n d t h a t to b e p r o v i d e d u n d e r section 22 of the Act, the expectation t h a t in f u t u r e t h e services of a family d o c t o r will b e available to every m o t h e r a n d child. I t is t h o u g h t p r o b a b l e t h a t every e x p e c t a n t m o t h e r will consult h e r family d o c t o r (subject to regulations yet to b e m a d e ) a n d t h a t every general p r a c t i t i o n e r will have a n o p p o r t u n i t y of applying to a local professional c o m m i t t e e for recognition as a p r a c t i t i o n e r a p p r o v e d to practise midwifery. I n the course of time, according to t h e circular, the b u l k of the L. H. A. a n t e - n a t a l clinic staffs will b e G . P . obstetricians, b u t these clinics will still be n e e d e d for the regular and systematic supervision a n d for t h e education of p r e g n a n t w o m e n . T h e p r e s e n t ante-natal M . O . is expected to b e c o m e m o r e of a specialist b y a t t a c h m e n t to the obstetrical team, whilst t h e p r e s e n t M . & C.W. officer w h o s e m a i n interest is in child welfare should be encouraged to specialise in t h a t aspect b y participating in the work of t h e paediative d e p a r t m e n t s or O.P. d e p a r t m e n t s of c h i l d r e n ' s hospitals. I t is envisaged t h a t s u c h medical officers will be a p p o i n t e d j o i n t l y b y t h e L . H . A . a n d t h e Regional Board. T h i s scheme is indeed different from the situation of t o - d a y a n d n o one can complain t h a t t h e circular is n o t looking well ahead. T h e questions m a y b e asked, however, w h e n is it expected t h a t general practitioners will b e ready to u n d e r t a k e the preventive work of the p u b l i c h e a l t h service on any large scale, a n d w h e t h e r L . H . A . s have to estimate this factor in t h e i r " d e v e l o p m e n t plans " u n d e r p a r a g r a p h 8 of the circular ? T h e o t h e r section of the p u b l i c h e a l t h service w h i c h will be particularly affected b y t h e t r a n s f e r of functions u n d e r t h e A c t is t h e medical officers of h e a l t h of n o n - c o u n t y b o r o u g h s a n d c o u n t y districts. Regarding section 22 (4) t h e M i n i s t e r h a s d e c i d e d against m a k i n g regulations to impose s c h e m e s of divisional a d m i n i s t r a t i o n w i t h the same b o u n d a r i e s as those for education, a n d t h a t a b e t t e r way of achieving c o n t i n u i t y would b e to divide counties, w h e r e v e r this is practicable, into h e a l t h areas comprising g r o u p s of c o u n t y districts, each o f which. * H.M. Stationery Office, Price 6d.
REVIEW
An Introduction to Bacteriological Chemistry (C. G. Anderson) . . . . . .
THE
SOCIETY
223
OBITUARY .
.
.
.
.
.
.
.
.
.
.
..................
OF MEDICAL OFFICERS
.
.
.
.
22l
.
.
OF HEALTH
Northern Branch . . . . . . . . . . . . . . . . . . . . . . . . . . . West of England Branch . . . . . . . . . . . . . . . . . . . . . . . . Yorkshire Branch . . . . . . . . . . . . . . . . . . . . . . . . . . . County District Group . . . . . . . . . . . . . . . . . . . . . . . . Dental Officers' Group . . . . . . . . . . . . Maternity and Child Welfare Group ......... Navy, Army and Air Force Hygiene Group . . . . . . . . . . . . . . . North-Western M. & C.W. and School Health Sub-Groups . . . . . . . . . School Health Service Group . . . . . . . . . . . . . . . . . . . . .
.
224 224
224 224 224 225
225 227
226
227
228
w o u l d b e r e p r e s e n t e d on t h e s u b - c o m m i t t e e s of s t a t u t o r y h e a l t h c o m m i t t e e s t h a t would b e responsible for d a y - t o - d a y a d m i n i s t r a t i o n of n o t only child care services b u t of o t h e r P a r t I I I services also. I t is f u r t h e r suggested t h a t n o n - c o u n t y b o r o u g h s or large u r b a n districts " which, besides b e i n g ' e x c e p t e d d i s t r i c t s ' u n d e r t h e E d u c a t i o n Act, h o u s e a n u n u s u a l l y h i g h p r o p o r t i o n of t h e total population of t h e county, o r possess exceptionally well-developed public h e a l t h (including school health) services " should b e c o m e areas of h e a l t h a d m i n i s tration o n t h e i r own, u n d e r s u b - c o m m i t t e e s o f w h i c h h a l f or m o r e of t h e m e m b e r s w o u l d b e f r o m t h e b o r o u g h or district council. T h e b o r o u g h or district M . O . H , w o u l d t h e n , b y agreem e n t , b e a p p o i n t e d p a r t - t i m e to the C o u n t y Medical Officer's Staff. W e agree t h a t t h i s will b e t h e only m e t h o d of retaining local interest a n d knowledge w i t h i n t h e f r a m e w o r k of t h e Act, a n d t h a t t h e M i n i s t e r has b e e n well advised n o t to m a k e regulations w h i c h w o u l d limit decentralisation to existing e d u c a t i o n divisions and to child care services only. T h e r e is u n d e r t h e n e w suggestion a p r o s p e c t of responsible w o r k for a n u m b e r of c o u n t y district medical officers of health, who, it is suggested, should b e a p p o i n t e d as p a r t - t i m e divisional medical officers w i t h executive functions o n t h e staff of t h e c o u n t y M . O . H . I t will b e recalled, too, t h a t m i n o r h e a l t h authorities have, u n d e r section 20 (2) to receive copies of t h e c o u n t y council's proposals a n d can m a k e r e c o m m e n d a t i o n s direct to t h e M i n i s t e r for t h e i r modification. I n this connection, we t h o u g h t it of interest to publish, o n a n o t h e r page, a s u m m a r y of t h e discussion at t h e M . O . H . conference h e l d at t h e R.S.I. Congress i n J u n e last. R e g a r d i n g child life protection, the circular states t h a t in view of t h e f o r t h c o m i n g t r a n s f e r of central responsibility for " d e p r i v e d " c h i l d r e n to t h e H o m e Office, n o proposals n e e d b e m a d e to t h e M i n i s t e r of H e a l t h u n d e r Section 22 (3). I n the p a r a g r a p h referring to section 28, t h e M i n i s t e r directs t h a t a r r a n g e m e n t s shall b e m a d e for t h e purpose of p r e v e n t i n g tuberculosis a n d of the care a n d after-care of persons suffering f r o m tuberculosis. Proposals regarding o t h e r specific diseases are also invited. I n t h e interest of integration between t h e hospital and local a u t h o r i t y services affecting tuberculosis, t h e circular draws attention to t h e work o f tuberculosis officers in b o t h the preventive a n d curative fields u n d e r t h e p r e s e n t system, a n d suggests t h a t t h e i r a p p o i n t m e n t s as tuberculosis specialists u n d e r t h e A c t s h o u l d b e m a d e jointly, w h e r e they will b e engaged in b o t h parts of the service, b y the Regional Boards a n d L.H.A.s. W e recognise t h e difficulties f r o m t h e p o i n t of view of tuberculosis officers of serving two masters, b u t this appears to b e t h e only m e t h o d for definitely linking t h e clinical a n d sociological sides of tuberculosis work. T h e venereal disease service will b e entirely a d m i n i s t e r e d b y Regional Boards, b u t it is reeognised t h a t t h e M . O . H . o f t h e ~t.~al.th a u t h o r i t y will b e c o n c e r n e d in t h e epidemiological ~d/d;~ e s h o u l d have liked to have seen a m o r e definite s " l ~ j ~ t i ' ~ s to t h e supply of i n f o r m a t i o n to h e a l t h d e p a r t m e n t s oA t ~ e p ' ~ a l e n c e of V.D.
HEALTH
SOCIETY OF MEDICAL OFFICERS OF HEALTH
AUGUST, 1947
No. II. Vol. LX. CONTENTS
PAGE
PAGE
EDITORIAL
Ministry of Health Circular 118/47 . . . . . . . . . . . . . . . . . . ]Poliomyelitis ........................... School Health ........................... Duncan of Liverpool ........................ The Cost of Motherhood ~. . . . . . . . . . . . . . . . . . . . . . .
BOOK
212 213 213 214 214
A. G. Morison, M.A., M,D., D.P.H J. E. Wilson, M.D., D.P.H. . . .
CORRESPONDENCE
Control of Smallpox: A Correction (W. H. Bradley) . . . . . . . . . . . . .
SPECIAL ARTICLES
Ascertainment of Visual Defect in Children. By D. D. Stenhouse Stewart, M . R . C . S . , L R . C . P . , D . O . M . S . . . . . . . . . . . . . . . . . . . 215 Care of the Aged. By E. D. Irvlne, M.D., D.P.H. . . . . . . . . . . . . 219 NEWS
AND
REPORTS
Medical Officers o[ Health Under the Act . . . . . . ......... The Maternity and Child Welfare Conference ............ Prevention and Treatment of Tuberculosis . . . . . . . . . . . . . . . 8th (London) Field Hygiene Company, R.A.M.C. (T.A.) . . . . . . . . .
222 223 223
228
EDITORIAL M i n i s t r y of H e a l t h C i r c u l a r 1 1 8 / 4 7
T h e issue of Circular 118/47,* d a t e d July 10th, to t h e local h e a l t h authorities c o n s t i t u t e d b y t h e N . H , S . Act, 1946, completes t h e guidance given b y t h e M i n i s t r y o n t h e p r e p a r a t i o n of p r o p o s a l s to b e m a d e u n d e r P a r t I I I . T h u s it covers care of m o t h e r s a n d y o u n g children, t h e m i d w i v e s service, h e a l t h visitors, h o m e nursing, a n d p r e v e n t i o n of illness, care a n d a f t e r - c a r e ; a n d contains p a r a g r a p h s w h i c h will affect t h e f u t u r e of large sections o f t h e p r e s e n t p u b l i c h e a l t h service. O n care of m o t h e r s a n d y o u n g children, t h e circular anticipates " considerable differences, some i m m e d i a t e , some growing w i t h t h e d e v e l o p m e n t of o t h e r parts of t h e N a t i o n a l H e a l t h Service," b e t w e e n t h e p r e s e n t M . & C.W. service a n d t h a t to b e p r o v i d e d u n d e r section 22 of the Act, the expectation t h a t in f u t u r e t h e services of a family d o c t o r will b e available to every m o t h e r a n d child. I t is t h o u g h t p r o b a b l e t h a t every e x p e c t a n t m o t h e r will consult h e r family d o c t o r (subject to regulations yet to b e m a d e ) a n d t h a t every general p r a c t i t i o n e r will have a n o p p o r t u n i t y of applying to a local professional c o m m i t t e e for recognition as a p r a c t i t i o n e r a p p r o v e d to practise midwifery. I n the course of time, according to t h e circular, the b u l k of the L. H. A. a n t e - n a t a l clinic staffs will b e G . P . obstetricians, b u t these clinics will still be n e e d e d for the regular and systematic supervision a n d for t h e education of p r e g n a n t w o m e n . T h e p r e s e n t ante-natal M . O . is expected to b e c o m e m o r e of a specialist b y a t t a c h m e n t to the obstetrical team, whilst t h e p r e s e n t M . & C.W. officer w h o s e m a i n interest is in child welfare should be encouraged to specialise in t h a t aspect b y participating in the work of t h e paediative d e p a r t m e n t s or O.P. d e p a r t m e n t s of c h i l d r e n ' s hospitals. I t is envisaged t h a t s u c h medical officers will be a p p o i n t e d j o i n t l y b y t h e L . H . A . a n d t h e Regional Board. T h i s scheme is indeed different from the situation of t o - d a y a n d n o one can complain t h a t t h e circular is n o t looking well ahead. T h e questions m a y b e asked, however, w h e n is it expected t h a t general practitioners will b e ready to u n d e r t a k e the preventive work of the p u b l i c h e a l t h service on any large scale, a n d w h e t h e r L . H . A . s have to estimate this factor in t h e i r " d e v e l o p m e n t plans " u n d e r p a r a g r a p h 8 of the circular ? T h e o t h e r section of the p u b l i c h e a l t h service w h i c h will be particularly affected b y t h e t r a n s f e r of functions u n d e r t h e A c t is t h e medical officers of h e a l t h of n o n - c o u n t y b o r o u g h s a n d c o u n t y districts. Regarding section 22 (4) t h e M i n i s t e r h a s d e c i d e d against m a k i n g regulations to impose s c h e m e s of divisional a d m i n i s t r a t i o n w i t h the same b o u n d a r i e s as those for education, a n d t h a t a b e t t e r way of achieving c o n t i n u i t y would b e to divide counties, w h e r e v e r this is practicable, into h e a l t h areas comprising g r o u p s of c o u n t y districts, each o f which. * H.M. Stationery Office, Price 6d.
REVIEW
An Introduction to Bacteriological Chemistry (C. G. Anderson) . . . . . .
THE
SOCIETY
223
OBITUARY .
.
.
.
.
.
.
.
.
.
.
..................
OF MEDICAL OFFICERS
.
.
.
.
22l
.
.
OF HEALTH
Northern Branch . . . . . . . . . . . . . . . . . . . . . . . . . . . West of England Branch . . . . . . . . . . . . . . . . . . . . . . . . Yorkshire Branch . . . . . . . . . . . . . . . . . . . . . . . . . . . County District Group . . . . . . . . . . . . . . . . . . . . . . . . Dental Officers' Group . . . . . . . . . . . . Maternity and Child Welfare Group ......... Navy, Army and Air Force Hygiene Group . . . . . . . . . . . . . . . North-Western M. & C.W. and School Health Sub-Groups . . . . . . . . . School Health Service Group . . . . . . . . . . . . . . . . . . . . .
.
224 224
224 224 224 225
225 227
226
227
228
w o u l d b e r e p r e s e n t e d on t h e s u b - c o m m i t t e e s of s t a t u t o r y h e a l t h c o m m i t t e e s t h a t would b e responsible for d a y - t o - d a y a d m i n i s t r a t i o n of n o t only child care services b u t of o t h e r P a r t I I I services also. I t is f u r t h e r suggested t h a t n o n - c o u n t y b o r o u g h s or large u r b a n districts " which, besides b e i n g ' e x c e p t e d d i s t r i c t s ' u n d e r t h e E d u c a t i o n Act, h o u s e a n u n u s u a l l y h i g h p r o p o r t i o n of t h e total population of t h e county, o r possess exceptionally well-developed public h e a l t h (including school health) services " should b e c o m e areas of h e a l t h a d m i n i s tration o n t h e i r own, u n d e r s u b - c o m m i t t e e s o f w h i c h h a l f or m o r e of t h e m e m b e r s w o u l d b e f r o m t h e b o r o u g h or district council. T h e b o r o u g h or district M . O . H , w o u l d t h e n , b y agreem e n t , b e a p p o i n t e d p a r t - t i m e to the C o u n t y Medical Officer's Staff. W e agree t h a t t h i s will b e t h e only m e t h o d of retaining local interest a n d knowledge w i t h i n t h e f r a m e w o r k of t h e Act, a n d t h a t t h e M i n i s t e r has b e e n well advised n o t to m a k e regulations w h i c h w o u l d limit decentralisation to existing e d u c a t i o n divisions and to child care services only. T h e r e is u n d e r t h e n e w suggestion a p r o s p e c t of responsible w o r k for a n u m b e r of c o u n t y district medical officers of health, who, it is suggested, should b e a p p o i n t e d as p a r t - t i m e divisional medical officers w i t h executive functions o n t h e staff of t h e c o u n t y M . O . H . I t will b e recalled, too, t h a t m i n o r h e a l t h authorities have, u n d e r section 20 (2) to receive copies of t h e c o u n t y council's proposals a n d can m a k e r e c o m m e n d a t i o n s direct to t h e M i n i s t e r for t h e i r modification. I n this connection, we t h o u g h t it of interest to publish, o n a n o t h e r page, a s u m m a r y of t h e discussion at t h e M . O . H . conference h e l d at t h e R.S.I. Congress i n J u n e last. R e g a r d i n g child life protection, the circular states t h a t in view of t h e f o r t h c o m i n g t r a n s f e r of central responsibility for " d e p r i v e d " c h i l d r e n to t h e H o m e Office, n o proposals n e e d b e m a d e to t h e M i n i s t e r of H e a l t h u n d e r Section 22 (3). I n the p a r a g r a p h referring to section 28, t h e M i n i s t e r directs t h a t a r r a n g e m e n t s shall b e m a d e for t h e purpose of p r e v e n t i n g tuberculosis a n d of the care a n d after-care of persons suffering f r o m tuberculosis. Proposals regarding o t h e r specific diseases are also invited. I n t h e interest of integration between t h e hospital and local a u t h o r i t y services affecting tuberculosis, t h e circular draws attention to t h e work o f tuberculosis officers in b o t h the preventive a n d curative fields u n d e r t h e p r e s e n t system, a n d suggests t h a t t h e i r a p p o i n t m e n t s as tuberculosis specialists u n d e r t h e A c t s h o u l d b e m a d e jointly, w h e r e they will b e engaged in b o t h parts of the service, b y the Regional Boards a n d L.H.A.s. W e recognise t h e difficulties f r o m t h e p o i n t of view of tuberculosis officers of serving two masters, b u t this appears to b e t h e only m e t h o d for definitely linking t h e clinical a n d sociological sides of tuberculosis work. T h e venereal disease service will b e entirely a d m i n i s t e r e d b y Regional Boards, b u t it is reeognised t h a t t h e M . O . H . o f t h e ~t.~al.th a u t h o r i t y will b e c o n c e r n e d in t h e epidemiological ~d/d;~ e s h o u l d have liked to have seen a m o r e definite s " l ~ j ~ t i ' ~ s to t h e supply of i n f o r m a t i o n to h e a l t h d e p a r t m e n t s oA t ~ e p ' ~ a l e n c e of V.D.