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General and special hospitals of the London county council
_PUBLIC HEALTH THE JOURNAL OF
THE SOCIETY OF MEDICAL OFFICERS OF HEALTH. No. 5. Vol. XLVI.
FEBRUARY, 1938.
PUa*LIC HEALTH, the Official Organ o/ the Society o/ Medical Officers of Health, is prepared to receive a certain number of approved advertisements. Application should be made to the Executive Secretary o] the Society, at 1, Upper Montague
Street, Russell Square, London, W.C.1. Subscription price 31s. 6d. per annum, post ]tee in advance.
Single Copies, 2s, 6d. post ]ree.
Contents. EDITORIAL--
PAGIi
PAGE
G e n e r a l a n d Special H o s p i t a l s of the L o n d o n County Council . . . . . . . . . . . .
145
Artificial I m m u n i t y a g a i n s t D i p h t h e r i a
146
T h e R i s e of P r e v e n t i v e M e d i c i n e
...
......
D e n t i s t r y a nd M e d i c i n e . By G~NTLEY SMITH, L.M.S.S.A, LOND,~ H.D.D.~ R.C.S. EDIN.~ L.D.S. ENC . . . .... . . . . . . . . . . . . An American Letter . . . . . . . . . . . . . . .
163 166
147
Pneumoconiosis . . . . . . . . . . . . . . . Miners' Nystagrnus . . . . . . . . . . . .
148 148
C h a p i n , of P r o v i d e n c e
149
. . . . . . . . . . . .
SOCIETY OF MEDICAL OFFICERS OF H E A L T H - Council Meeting . . . . . . . . . . . Ordinary Meeting . . . . . . . . . . . T h e Metropolitan Branch ___ ...... T h e School M e d i c a l S e rvi c e G r o u p ...... T h e Yorkshire Branch . . . . . . . . . . . T h e North-Western Branch ......... The Tuberculosis Group ...... T h e M a t e r n i t y a nd C h i l d W e l f a r e G r o u p Yorkshire Sub-Group . . . . . . . . . . .
SPECIAL A R T I C L E S - Cancer as a P u b l i c H e a l t h P r o b l e m .
By ROBERT HUOrlES PARRY, M.B., D.P.H., M e d i c a l Officer of H e a l t h , C i t y a n d P o r t of Bristol ......
150
. . . ..~ .
168 170 170 172 172 173 174 175 175
Ut Ira Dicam.
(Being C o m m e n t s , apropos a n d otherwise, on S u n d r y M a t t e r s ) . . . . . . . . .
157
S o m e A s p e c t s of H o s p i t a l A d m i n i s t r a t i o n . By C . O . STALLYBRASS, M.D., D.P.H., Senior Assist a n t M e d i c a l Officer of H e a l t h , C i t y of L i v e r p o o l
159
T H E L I T E R A T U R E OF P R E V E N T I V E M E D I C I N E - T h e C r i t i c a l A ge of W o m a n ......... 176 T h e P r a c t i c e of B i r t h C o n t r o l . . . . . . . . . N e w H e a l t h for E v e r y m a n .........
176 176
Editorial. General and Special Hospitals of the London County Council. HE task imposed upon many authorities as a result of the coming into operation of the Local Government Act of 1929 must have been great. In few, if any, however, could it have been of the magnitude that had to be faced by the London County Council. Not by any means the least part of the burden was that to be borne by the health department, and the part played by Sir Frederick Menzies, the medical officer of health of the county, in this connection for long will lead to wondering comment and warm commendation from those who know the labour, worry and anxiety that must have been involved. In connection with the work he was calledupon to do, not the least in extent was that concerned with hospitals and the medical services generally that fell to pass from the hands of bodies due to disappear
T
into those of the London County Council. Already in his report for 193(i, Sir Frederick has written of the preliminaries and of the arrangements made and operated so that the actual transference should cause as little of disturbance as possible. That there was, in fact, nothing of disturbance at the dawning of the appointed day he has shown and London saw.
In the annual report of the London County Council for 1931 there appears a report* by Sir Frederick in which he shows how matters have gone in relation to the hospitals and general medical services since they came into the hands of the council; describes developments that have occurred, and that he hopes to * PUBLIC HEALTH--GENERAL AND SPECIAL HOSPITALS. Vol. IV (Part I) : No. 2935. London : P. S. King and Son, Ltd., 14, Great Smith Street, S.W.I. Price 2s. 6d.
146
PUBLIC
see made, and gives details not only with regard to the minutiae of management of institutions, staff, etc., but of the cases dealt with in various of the special hospitals from the clinical point of view. Some idea of the magnitude of the task carried out, as also of reporting upon it, may be gathered from a few of the figures quoted by Sir Frederick Menzies. In the hospital branch of the department, it is explained, there are two main sections, one dealing with general hospitals and the other with special hospitals. The former has responsibility for no fewer than 44 hospitals and institutions with a total bed accommodation of 27,553. In this same division provision is made also for medical instruction and training of nurses and midwives, and a number of other extremely important ancillary services. The special hospitals division is concerned with the management of 31 hospitals, of which 17 are for infectious diseases. The number of beds here reaches 13,390. In this division as in the other, there is provision for-teaching, particularly in the infectious diseases hospitals for the instruction of medical students and of candidates for the diploma in public health. As a contribution to teaching facilities in London this must have an immense value and is appreciated, it may be hoped, by those for whom it is provided. Amongst developments in the future it would appear that there is in the mind of Sir Frederick Menzies intention to provide teaching facilities additional to those already available in other hospitals and institutions. If this can be done, the effect on London as a teaching centre will be enormous. How enormous is to be gathered from the tables in the report showing the numbers and types of cases dealt with in the special hospitals, figures calculated to arouse feelings of acutest envy in the heart of even the least enthusiastic of clinical teachers. That the clinical material is not entirely neglected, and that opportunities for research that are offered are taken advantage of to as great an extent as other work permits, is shown in the report, which contains a list of quite respectable dimensions of investigations carried out in laboratories and elsewhere, and of books and papers published by members of the staff. In regard to staff, the information given as to grading shows not only that careful thought has been devoted to the subject, but that every effort has been made to show the fullest possible consideration for the individual members of the personnel, and to ensure that to each grade there should be tempted suitable and suitably
HEALTH.
FEBRU,XI~Y,
qualified people; that, in short, the medical service of the London County Council should be made, what it shows every indication of becoming : one worthy of serious consideration when the question of career and future is receiving attention from the medical graduate. In the report there is no reference to the step recently taken by the county council of notifying intention of terminating the appointment of the temporary consulting staff of the hospitals. Indeed, at the moment, apart from the fact of the notice, nothing definite in the way of announcement has been made as to what is proposed to be done. With an organisation s o immense, which in the main has been framed and moulded by other hands, difficulties in relation to such a matter as staffing inevitably must arise and must be faced; from the way others of the kind have already been dealt with, there appears little doubt that a fair and proper solution will be found. Evidence of this is to be found in the report for 1931 which, with regard to other matters and in other respects, constitutes a mine of interest and information worthy of investigation by others than persons having responsibilities connected with hospitals, municipal hospitals especially.
Artificial Immunity against Diphtheria. (170/Med.)recently issued I •byN thethememorandum Ministry of Health on this subject, as the memorandum itself in fact recognises, there is much that is already known and practised by the bulk of authorities. Nevertheless, it was wise of the Ministry to make the information so conveniently available, and more particularly to issue, in the form of a series of recommendations on the practice of active immunisation of children susceptible to diphtheria, a statement in accord with the findings of the conference of experts from different countries held in London in June, 1931, under the auspices of the Health Committee of the League of Nations. This shows that among children in this country a proportion which varies in different communities, but may be as high as 90 per cent., or as low as ll) per cent., is susceptible to diphtheria. It explains also that in order definitely to ascertain whether a child is susceptible or not, a preliminary (Schick) test should be made, and describes the method of its performance. With a view to determining whether there is any hypersensitiveness which requires to be taken into consideration if immunisation is to be proceeded with as
THE SOCIETY OF MEDICAL OFFICERS OF HEALTH. No. 5. Vol. XLVI.
FEBRUARY, 1938.
PUa*LIC HEALTH, the Official Organ o/ the Society o/ Medical Officers of Health, is prepared to receive a certain number of approved advertisements. Application should be made to the Executive Secretary o] the Society, at 1, Upper Montague
Street, Russell Square, London, W.C.1. Subscription price 31s. 6d. per annum, post ]tee in advance.
Single Copies, 2s, 6d. post ]ree.
Contents. EDITORIAL--
PAGIi
PAGE
G e n e r a l a n d Special H o s p i t a l s of the L o n d o n County Council . . . . . . . . . . . .
145
Artificial I m m u n i t y a g a i n s t D i p h t h e r i a
146
T h e R i s e of P r e v e n t i v e M e d i c i n e
...
......
D e n t i s t r y a nd M e d i c i n e . By G~NTLEY SMITH, L.M.S.S.A, LOND,~ H.D.D.~ R.C.S. EDIN.~ L.D.S. ENC . . . .... . . . . . . . . . . . . An American Letter . . . . . . . . . . . . . . .
163 166
147
Pneumoconiosis . . . . . . . . . . . . . . . Miners' Nystagrnus . . . . . . . . . . . .
148 148
C h a p i n , of P r o v i d e n c e
149
. . . . . . . . . . . .
SOCIETY OF MEDICAL OFFICERS OF H E A L T H - Council Meeting . . . . . . . . . . . Ordinary Meeting . . . . . . . . . . . T h e Metropolitan Branch ___ ...... T h e School M e d i c a l S e rvi c e G r o u p ...... T h e Yorkshire Branch . . . . . . . . . . . T h e North-Western Branch ......... The Tuberculosis Group ...... T h e M a t e r n i t y a nd C h i l d W e l f a r e G r o u p Yorkshire Sub-Group . . . . . . . . . . .
SPECIAL A R T I C L E S - Cancer as a P u b l i c H e a l t h P r o b l e m .
By ROBERT HUOrlES PARRY, M.B., D.P.H., M e d i c a l Officer of H e a l t h , C i t y a n d P o r t of Bristol ......
150
. . . ..~ .
168 170 170 172 172 173 174 175 175
Ut Ira Dicam.
(Being C o m m e n t s , apropos a n d otherwise, on S u n d r y M a t t e r s ) . . . . . . . . .
157
S o m e A s p e c t s of H o s p i t a l A d m i n i s t r a t i o n . By C . O . STALLYBRASS, M.D., D.P.H., Senior Assist a n t M e d i c a l Officer of H e a l t h , C i t y of L i v e r p o o l
159
T H E L I T E R A T U R E OF P R E V E N T I V E M E D I C I N E - T h e C r i t i c a l A ge of W o m a n ......... 176 T h e P r a c t i c e of B i r t h C o n t r o l . . . . . . . . . N e w H e a l t h for E v e r y m a n .........
176 176
Editorial. General and Special Hospitals of the London County Council. HE task imposed upon many authorities as a result of the coming into operation of the Local Government Act of 1929 must have been great. In few, if any, however, could it have been of the magnitude that had to be faced by the London County Council. Not by any means the least part of the burden was that to be borne by the health department, and the part played by Sir Frederick Menzies, the medical officer of health of the county, in this connection for long will lead to wondering comment and warm commendation from those who know the labour, worry and anxiety that must have been involved. In connection with the work he was calledupon to do, not the least in extent was that concerned with hospitals and the medical services generally that fell to pass from the hands of bodies due to disappear
T
into those of the London County Council. Already in his report for 193(i, Sir Frederick has written of the preliminaries and of the arrangements made and operated so that the actual transference should cause as little of disturbance as possible. That there was, in fact, nothing of disturbance at the dawning of the appointed day he has shown and London saw.
In the annual report of the London County Council for 1931 there appears a report* by Sir Frederick in which he shows how matters have gone in relation to the hospitals and general medical services since they came into the hands of the council; describes developments that have occurred, and that he hopes to * PUBLIC HEALTH--GENERAL AND SPECIAL HOSPITALS. Vol. IV (Part I) : No. 2935. London : P. S. King and Son, Ltd., 14, Great Smith Street, S.W.I. Price 2s. 6d.
146
PUBLIC
see made, and gives details not only with regard to the minutiae of management of institutions, staff, etc., but of the cases dealt with in various of the special hospitals from the clinical point of view. Some idea of the magnitude of the task carried out, as also of reporting upon it, may be gathered from a few of the figures quoted by Sir Frederick Menzies. In the hospital branch of the department, it is explained, there are two main sections, one dealing with general hospitals and the other with special hospitals. The former has responsibility for no fewer than 44 hospitals and institutions with a total bed accommodation of 27,553. In this same division provision is made also for medical instruction and training of nurses and midwives, and a number of other extremely important ancillary services. The special hospitals division is concerned with the management of 31 hospitals, of which 17 are for infectious diseases. The number of beds here reaches 13,390. In this division as in the other, there is provision for-teaching, particularly in the infectious diseases hospitals for the instruction of medical students and of candidates for the diploma in public health. As a contribution to teaching facilities in London this must have an immense value and is appreciated, it may be hoped, by those for whom it is provided. Amongst developments in the future it would appear that there is in the mind of Sir Frederick Menzies intention to provide teaching facilities additional to those already available in other hospitals and institutions. If this can be done, the effect on London as a teaching centre will be enormous. How enormous is to be gathered from the tables in the report showing the numbers and types of cases dealt with in the special hospitals, figures calculated to arouse feelings of acutest envy in the heart of even the least enthusiastic of clinical teachers. That the clinical material is not entirely neglected, and that opportunities for research that are offered are taken advantage of to as great an extent as other work permits, is shown in the report, which contains a list of quite respectable dimensions of investigations carried out in laboratories and elsewhere, and of books and papers published by members of the staff. In regard to staff, the information given as to grading shows not only that careful thought has been devoted to the subject, but that every effort has been made to show the fullest possible consideration for the individual members of the personnel, and to ensure that to each grade there should be tempted suitable and suitably
HEALTH.
FEBRU,XI~Y,
qualified people; that, in short, the medical service of the London County Council should be made, what it shows every indication of becoming : one worthy of serious consideration when the question of career and future is receiving attention from the medical graduate. In the report there is no reference to the step recently taken by the county council of notifying intention of terminating the appointment of the temporary consulting staff of the hospitals. Indeed, at the moment, apart from the fact of the notice, nothing definite in the way of announcement has been made as to what is proposed to be done. With an organisation s o immense, which in the main has been framed and moulded by other hands, difficulties in relation to such a matter as staffing inevitably must arise and must be faced; from the way others of the kind have already been dealt with, there appears little doubt that a fair and proper solution will be found. Evidence of this is to be found in the report for 1931 which, with regard to other matters and in other respects, constitutes a mine of interest and information worthy of investigation by others than persons having responsibilities connected with hospitals, municipal hospitals especially.
Artificial Immunity against Diphtheria. (170/Med.)recently issued I •byN thethememorandum Ministry of Health on this subject, as the memorandum itself in fact recognises, there is much that is already known and practised by the bulk of authorities. Nevertheless, it was wise of the Ministry to make the information so conveniently available, and more particularly to issue, in the form of a series of recommendations on the practice of active immunisation of children susceptible to diphtheria, a statement in accord with the findings of the conference of experts from different countries held in London in June, 1931, under the auspices of the Health Committee of the League of Nations. This shows that among children in this country a proportion which varies in different communities, but may be as high as 90 per cent., or as low as ll) per cent., is susceptible to diphtheria. It explains also that in order definitely to ascertain whether a child is susceptible or not, a preliminary (Schick) test should be made, and describes the method of its performance. With a view to determining whether there is any hypersensitiveness which requires to be taken into consideration if immunisation is to be proceeded with as