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The Emergence of the Health Visitor.
HE
EMERGENCE OF THE
HEALTH
VISITOR.
dark night ; indeed, this is much more year. When recognised early, recovery may be necessary than a standard form sense. In a good almost guaranteed in eight or ten weeks, if the light a candidate may pass all the usual tests with required treatment is duly carried out. Snellen’s types and the colour tests with Holmgren’s wools easily, but he might fail, deplorably if the The of the Health light were dim. The lantern test with the necessary Visitor. coloured glasses seems to be the best colour test for locomotive men and for sailors, but it would THREE classes of women have come to be very appear that more attention should be devoted to closely associated with the medical practitioner in the examination of light sense. his work as indispensable helpmates, whether on The promise of the President of the Board of the remedial or preventive side. In order of Trade, Sir AUCKLAND GEDDES, that a national emergence these are, of course, the midwifeeyesight test for railwaymen shall be established whose history goes back into the unknown ; the within a month comes none too soon. Indeed, it nurse-whose founder, in the modern sense of is regrettable that such a test was not established the title, was FLORENCE NIGHTINGALE ; and the long ago, instead of leaving a difficult matter to be health visitor-who scarcely existed before decided separately by each railway company, with the London County Council Act of 1908. The the result of the dissatisfaction recently manifested nurse’s work is purely remedial, to her both In the case of the patient and doctor alike turn in sickness; but on the North-Eastern Railway. Mercantile Marine, in which similar dissatisfaction medicine is becoming increasingly preventive, and used to exist, a Departmental Committee was set unless specially trained in the mechanism of health up by the Board of Trade in 1912 and its recom- the nurse may be as inadvertently dangerous to the mendations for a national test were adopted, with well child as she is mercifully helpful to the sick results that are said to be satisfactory. On this one. The midwife’s habitat is normal physiological committee two ophthalmologists held seats, and it function, and the Board which controls her strictly is essential that in deciding on the railway tests defines the variations from the normal which also, ophthalmologists should be brought into are her concern. The health visitor arose for consultation. One of the most important tests the purpose of advising on the proper nurture, is that for colour vision. As has been proved care, and management of young children, of by Dr. F. W. EDRIDGE-GREEN, the old Holmgren promoting cleanliness as the basis of health, and wool test is both inefficient and dangerous in that of carrying out (in the words of the Act of 1908) it rejects some who ought to be passed, while, on such other analogous duties as might be assigned to the other hand, a large number will pass it easily her. No one then could foresee to what extent whose future employment is dangerous. The wool these analogous duties might grow in ten years’ test has now been replaced by most, if not all, of time or be expected to devise in advance the the railway companies by some form of lantern training best suited to meet them. The Local test. This should be made compulsory, and no Government Board at that time regarded the full lantern should be used which has not means for nursing certificate or the diploma of the Central regulating the luminosity of the lights shown, as Midwives Board as satisfactory evidence of qualificaotherwise a man who cannot distinguish in a fog tion. Time has not justified this claim, and the between a red and a green light might be passed. most successful health visiting is now found The degree of visual acuity necessary for engine- to be done by women of good education with some drivers and firemen is a matter that certainly previous training in social science. To define and requires a uniform settlement. On one railway the promote the best type of training for the health present standard is 6/12 in the better eye, 6/18 in visitor has for some time been an objective of the the worse, without glasses. Is 6/12 good enough ? National Association for the Prevention of Infant Is not 6/18 an unnecessarily high standard for Mortality, and the scheme for training just issued the worse eye ? A man with 6/6 vision in one as Circular 4 (M. and C.W. 10) by the Ministry of eye and 6/60 only in the other would certainly Health may be regarded as the fruition of their have better vision with the two eyes than one labours. At the same time appear the draft regulawith 6/12 and 6/18 respectively. The only dis- tions (Cmd. 255, price ld.) of the Board of Educaadvantage that the former might be under wouldtion, laying down the conditions under which in be the possibility of getting a spark from thefuture grants will be made in aid of health visiting. engine in his better eye. The question of theBriefly, a good preliminary education and a course employment of spectacles should be answered, and of two years will be required of candidates a rough but efficient test for the visual fieldswithout previous special training, one year be devoted to theory and one to practice. In should be established to exclude any with such disease as retinitis pigmentosa, in which central 1the case of fully trained nurses, previous health ’’visitors, or those holding a vision may remain good till a late period. university degree or its The detection of tobacco amblyopia is a matter Eequivalent, one year’s training may be remitted. of very great importance at the present time, whencertificate will be granted after examination, this disease is more prevalent than formerly. Noand subsequent to a certain date, of which notice man should enter the railway service withoutiwill be given, no uncertificated appointment of being told the facts as to tobacco blindness and 1iealth visitor may be made by any local authority. the importance of taking early advice in case Ifurther details will be found in the documents to of gradual diminution of vision, which will vvhich a reference has been given. Restrictive in often save him from the necessity of having to form only, the regulations are a charter for the throw up his job. As toxic amblyopia is fairly aapproved health visitor which, by protecting her frequent even in those who smoke with modera- from unqualified competition, will afford a much tion, and as its characteristic symptom is the needed stimulus to the supply of the better class of early onset of a macular scotoma for green and vvsitor. The Ministry of Health was bound to red, it would seem necessary for engine-drivers and pprotect in this way one of its principal agents in watchmen to be tested for this complaint every six bhealth work, and has done well in making this months or so, and locomotive firemen at least every reform its first public action. on
a
Emergence
I
,
161
EMERGENCE OF THE
HEALTH
VISITOR.
dark night ; indeed, this is much more year. When recognised early, recovery may be necessary than a standard form sense. In a good almost guaranteed in eight or ten weeks, if the light a candidate may pass all the usual tests with required treatment is duly carried out. Snellen’s types and the colour tests with Holmgren’s wools easily, but he might fail, deplorably if the The of the Health light were dim. The lantern test with the necessary Visitor. coloured glasses seems to be the best colour test for locomotive men and for sailors, but it would THREE classes of women have come to be very appear that more attention should be devoted to closely associated with the medical practitioner in the examination of light sense. his work as indispensable helpmates, whether on The promise of the President of the Board of the remedial or preventive side. In order of Trade, Sir AUCKLAND GEDDES, that a national emergence these are, of course, the midwifeeyesight test for railwaymen shall be established whose history goes back into the unknown ; the within a month comes none too soon. Indeed, it nurse-whose founder, in the modern sense of is regrettable that such a test was not established the title, was FLORENCE NIGHTINGALE ; and the long ago, instead of leaving a difficult matter to be health visitor-who scarcely existed before decided separately by each railway company, with the London County Council Act of 1908. The the result of the dissatisfaction recently manifested nurse’s work is purely remedial, to her both In the case of the patient and doctor alike turn in sickness; but on the North-Eastern Railway. Mercantile Marine, in which similar dissatisfaction medicine is becoming increasingly preventive, and used to exist, a Departmental Committee was set unless specially trained in the mechanism of health up by the Board of Trade in 1912 and its recom- the nurse may be as inadvertently dangerous to the mendations for a national test were adopted, with well child as she is mercifully helpful to the sick results that are said to be satisfactory. On this one. The midwife’s habitat is normal physiological committee two ophthalmologists held seats, and it function, and the Board which controls her strictly is essential that in deciding on the railway tests defines the variations from the normal which also, ophthalmologists should be brought into are her concern. The health visitor arose for consultation. One of the most important tests the purpose of advising on the proper nurture, is that for colour vision. As has been proved care, and management of young children, of by Dr. F. W. EDRIDGE-GREEN, the old Holmgren promoting cleanliness as the basis of health, and wool test is both inefficient and dangerous in that of carrying out (in the words of the Act of 1908) it rejects some who ought to be passed, while, on such other analogous duties as might be assigned to the other hand, a large number will pass it easily her. No one then could foresee to what extent whose future employment is dangerous. The wool these analogous duties might grow in ten years’ test has now been replaced by most, if not all, of time or be expected to devise in advance the the railway companies by some form of lantern training best suited to meet them. The Local test. This should be made compulsory, and no Government Board at that time regarded the full lantern should be used which has not means for nursing certificate or the diploma of the Central regulating the luminosity of the lights shown, as Midwives Board as satisfactory evidence of qualificaotherwise a man who cannot distinguish in a fog tion. Time has not justified this claim, and the between a red and a green light might be passed. most successful health visiting is now found The degree of visual acuity necessary for engine- to be done by women of good education with some drivers and firemen is a matter that certainly previous training in social science. To define and requires a uniform settlement. On one railway the promote the best type of training for the health present standard is 6/12 in the better eye, 6/18 in visitor has for some time been an objective of the the worse, without glasses. Is 6/12 good enough ? National Association for the Prevention of Infant Is not 6/18 an unnecessarily high standard for Mortality, and the scheme for training just issued the worse eye ? A man with 6/6 vision in one as Circular 4 (M. and C.W. 10) by the Ministry of eye and 6/60 only in the other would certainly Health may be regarded as the fruition of their have better vision with the two eyes than one labours. At the same time appear the draft regulawith 6/12 and 6/18 respectively. The only dis- tions (Cmd. 255, price ld.) of the Board of Educaadvantage that the former might be under wouldtion, laying down the conditions under which in be the possibility of getting a spark from thefuture grants will be made in aid of health visiting. engine in his better eye. The question of theBriefly, a good preliminary education and a course employment of spectacles should be answered, and of two years will be required of candidates a rough but efficient test for the visual fieldswithout previous special training, one year be devoted to theory and one to practice. In should be established to exclude any with such disease as retinitis pigmentosa, in which central 1the case of fully trained nurses, previous health ’’visitors, or those holding a vision may remain good till a late period. university degree or its The detection of tobacco amblyopia is a matter Eequivalent, one year’s training may be remitted. of very great importance at the present time, whencertificate will be granted after examination, this disease is more prevalent than formerly. Noand subsequent to a certain date, of which notice man should enter the railway service withoutiwill be given, no uncertificated appointment of being told the facts as to tobacco blindness and 1iealth visitor may be made by any local authority. the importance of taking early advice in case Ifurther details will be found in the documents to of gradual diminution of vision, which will vvhich a reference has been given. Restrictive in often save him from the necessity of having to form only, the regulations are a charter for the throw up his job. As toxic amblyopia is fairly aapproved health visitor which, by protecting her frequent even in those who smoke with modera- from unqualified competition, will afford a much tion, and as its characteristic symptom is the needed stimulus to the supply of the better class of early onset of a macular scotoma for green and vvsitor. The Ministry of Health was bound to red, it would seem necessary for engine-drivers and pprotect in this way one of its principal agents in watchmen to be tested for this complaint every six bhealth work, and has done well in making this months or so, and locomotive firemen at least every reform its first public action. on
a
Emergence
I
,
161