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The health congress, Portsmouth, 1938
PUBLIC
HEALTH THE JOURNAL OF
THE SOCIETY OF MEDICAL OFFICERS OF HEALTH No. I1.
Vol. LI.
AUGUST, 1938
"Public Health "is the O3~dal Organ of the Society of Medical O~cers of Health and a suitable medium for the advertisement of o~cial appointments vacant in the health service. Space is also available for a certain number of approved commercial advertisements. Application shouM be made to the Executive Secretary of the Society, at 1, Thornhaugh Street, Russell Square, London, W.C.1. Telephone: Museum 1815. Telegrams: Epidauros, Westcent
Contents Editorial T h e Health Congress, Portsmouth, 1938 . . . . . . T h e General Practitioner and Child Welfare ... T h e Maternity & Child Welfare Conference, Bristol T h e Tuberculosis Conference ......... Examination of S p u t u m . . . . . . . . . . . . Milk and Nutrition . . . . . . . . . . . . . . . Adequate Lighting . . . . . . . . . . . . . . . T h e Cow and the Streptococcus . . . . . . . . .
PAGE 321 323 323 324 325 325 326 327
Special Articles National Health and Physical Fitness. By E. Ashworth Underwood, M.A., B.SC., M.D., D.P.H. T h e Selection of Cases for Psychiatric T r e a t m e n t in Guidance Clinics. By W. Mary Burbury, M.A.~ M.B.~ B.S., M.R.C.S., L.R.C.P., D.P.M . . . .
328
aa3
A Review of the Incidence of Diphtheria amongst those Actively I m m u n i s e d against the Disease in Southampton. By H. C. Maurice Williams, M.R.C.S., L.R.C.P., D.P.H., and A. Carling, B.M., B.CH.~ D.P.H . . . . . . . . . . . . . . . .
T h e New Emergency Obstetric Service in London. By P. M. G. Russell, M.B., M.C.O.G. .... . . Enuresis. By Robert Hutchinson, M.D., P.R.C.P., and Donald Winnicott, M.A., M.R.C.P. . . . . . .
Correspondence . . . . . . . . . . . . Book Reviews ................ News and Announcements A Public Health Convalescent H o m e ...... Ministry of Health D o c u m e n t s ......... Recent Appointments in the Public Health Service
Society of Medical Officers of Health Branch and Group Meetings ......... Provincial Meeting . . . . . . . . . . . . . . .
3a7 339 340 341 342 342 348 348 34a 347
Editorial The Health Congress, Portsmouth, 1938 The Annual Health Congress convened by the Royal Sanitary Institute is unique in attracting all types of professional officers in the health services, together with elected representatives of local authorities. This year's Congress, held at Portsmouth from July l lth to 16th, continued this tradition and provided many topical subjects o f importance for discussion by the delegates, who were slightly more in number than last year's
record figure. The papers and discussions will be published in succeeding issues of the journal of the Royal Sanitary Institute, and in the space available here we can only touch upon particular points of interest. On Monday, the Earl of Bessborough, President of the Congress, set a high standard in his opening address, in which he urged the importance of still further educating the people to take advantage of the lessons of public health and of the services at their disposal. Next day the section of Preventive Medicine, to which Sir Harold Pink, Chairman of the British Hospitals' Association, delivered a Presidential address, held an interesting discussion on " The Future of the General Hospital." The opener from the side of the publicly-owned hospitals was Dr. R. VeitchClark, of Manchester, who thought that the voluntary hospital could never die out because its individualism and power of unfettered development was part of the national psychology. From the side of the voluntary hospitals, Mr. C. E. A. Bedwell, House Governor of King's College Hospital, stressed the need for developing the preventive atmosphere in order to avoid excessive resort to hospitals; he suggested that the local authorities should concentrate upon the preventive and educational work of health centres and leave the voluntary hospitals to cope with curative work. This point was taken up by Dr. John Buchan (Bradford), who argued that there was already too much curative work for the voluntary hospitals to meet; the public demand for hospitalisation was no mere fad, and there was room for both voluntary and municipal hospitals without competition. On the same day, Sir Raymond Unwin delivered an inspiring address on Town-planning to the section of Architecture, Town-planning and Engineering. A paper by Mr. D. H. Thomson (Engineer to the Portsmouth Water Company) on Safeguarding of Water Supplies was also of interest in the light of recent events. Elsewhere Mr. W. R. McGrath (S.I., City of London, and President of the S.I.A.) addressed the conference of his colleagues on the current question of the value of terminal disinfection. The Sanitary Inspectors' Conference also discussed the Housing (Rural Workers) Act and the Housing Act, of 1936 ; much of the discussion centred on the problem of t h e " undesirable" tenant and how to deal with h i m 321
PUBLIC
HEALTH
The most crowded meeting on Wednesday was that of representatives of Local Authorities, who heard papers by the chief officials of Portsmouth on Air Raid Precautions. Portsmouth is particularly well forward in this work, which has become an additional and unavoidable local government function, and the demonstrations given the same evening were evidence of the careful planning and training which have been carried out in the city. On the same morning, Dr. James Fenton gave his Presidential address to a well-attended conference of Medical Officers of Health; in it he argued strongly that M.O.sH. should engage in health education of the people, and that they could do so without violating medical principles and traditions of professional conduct. The conference went on to discuss the campaign against rheumatism; Lord Horder spoke of the aims of the Empire Rheumatism Council, Dr. J. Alison Glover (Board of Education) dealt with rheumatic diseases from the point of view of central administration, and Dr. H. J. Rae (M.O.H., Aberdeen) from the point of view of the local authority. The latter suggested that local rheumatism clinics should be established jointly with orthopaedic and fracture clinics in view of the common basis of treatment. The discussion touched upon many aspects of research into and treatment of the rheumatic diseases, which are becoming more and more a province of public health activity. At the second meeting of the Sanitary Inspectors' Conference, Mr. C. J. Couch (Woolwich) described the work carried out in his borough towards discovering a satisfactory method 'of diffusion of heavy naphtha vapour as a means of disinfestation ; the problems now appears to have been overcome by the use of Egyptian cotton screens. The section of Tropical Hygiene provided an interesting meeting on Health Propaganda and the Hygiene of Indigenous Races in the Tropics," to which many distinguished speakers, headed by Sir Malcolm Watson, contributed. The morning of Thursday provided one of the most interesting meetings of the Conference in the section of Maternity and Child Welfare and School Hygiene," the subject for discussion was The Defects Found in School Entrants and the steps that might be taken to effect their remedy before the beginning of school life." Dr. J. Greenwood Wilson (M.O.H., Cardiff) pointed out that 100,000 children every year entered school unfit and urged that no mass production scheme in industry could tolerate such a proportion of failures. In the course of his paper he asked whether we were not too much obsessed by the idea of bigger and better clinics, and he pointed to the success of the Huddersfield system "
"
"
AUGUST where there were no welfare centres but every effort was concentrated upon home visitation; the percentage of school entrants at Huddersfield with defects requiring treatment was lower than the average for England and Wales. Mr. Myles Formby, F.R.C.S. (University College Hospital) dealt with the treatment of ear, nose and throat defects and urged that the position of tonsillectomy must be put on a scientific basis; surgery should be the last resort in any treatment and in dealing with tonsils and adenoids in children under five must be employed with great discrimination. Major-General J. P. Helliwell (Consulting Dental Surgeon to the L.C.C.) spoke on the prevention of dental diseases amongst children, with particular reference to the giving of cleansing food-stuffs and adequate conservative treatment. On the same day the section of Veterinary Hygiene discussed modern standards of meat inspection and the section of Hygiene of Food dealt with the food-manufacturer's contribution to public health. On Friday, Dr. Charles Porter (M.O.H., St. Marylebone) delivered his presidential address to the conference of Health Visitors, in which he dealt with the changes in the professional standard and type of entrant during his long public health experience; he thought that more women health officers should turn to sanitary inspection. The Conference then discussed the psychological problems of child welfare centres, Dr. Grace Calve1: (Children's Department, Tavistock Clinic) and Dr. Mildred Creak (Children's Department, Maudsley Hospital) giving interesting papers on " Behaviour and Nervous Disorders in Children attending M. and C.W. centres." Miss C. Hale (late Health Visitor and Superintendent of Welfare Centres, St. Marylebone) spoke on the problems and organisation of clinics for the pre-school child. The section of National Health Insurance heard an interesting paper by Dr. A. B. Walker (Department of Health for Scotland) on " The Duration of Incapacitating Sickness." The social side of the Congress was made unusually interesting by opportunities of seeing something of the work of the Navy as well as local public health undertakings. The hospitality of the Lord Mayor and Corporation was on a generous scale and particular congratulations are due to Dr. A. B. Williamson, M.O.H., Portsmouth, and Mr. L. C. Rogers, Chief Clerk; Portsmouth Health Department~ for the success of the local arrangements. Congratulations are also extended to Dr. Dudley Robinson and the Staff of the Royal Sanitary Institute, who displayed their usual competence in the handling of this great conference.
322
HEALTH THE JOURNAL OF
THE SOCIETY OF MEDICAL OFFICERS OF HEALTH No. I1.
Vol. LI.
AUGUST, 1938
"Public Health "is the O3~dal Organ of the Society of Medical O~cers of Health and a suitable medium for the advertisement of o~cial appointments vacant in the health service. Space is also available for a certain number of approved commercial advertisements. Application shouM be made to the Executive Secretary of the Society, at 1, Thornhaugh Street, Russell Square, London, W.C.1. Telephone: Museum 1815. Telegrams: Epidauros, Westcent
Contents Editorial T h e Health Congress, Portsmouth, 1938 . . . . . . T h e General Practitioner and Child Welfare ... T h e Maternity & Child Welfare Conference, Bristol T h e Tuberculosis Conference ......... Examination of S p u t u m . . . . . . . . . . . . Milk and Nutrition . . . . . . . . . . . . . . . Adequate Lighting . . . . . . . . . . . . . . . T h e Cow and the Streptococcus . . . . . . . . .
PAGE 321 323 323 324 325 325 326 327
Special Articles National Health and Physical Fitness. By E. Ashworth Underwood, M.A., B.SC., M.D., D.P.H. T h e Selection of Cases for Psychiatric T r e a t m e n t in Guidance Clinics. By W. Mary Burbury, M.A.~ M.B.~ B.S., M.R.C.S., L.R.C.P., D.P.M . . . .
328
aa3
A Review of the Incidence of Diphtheria amongst those Actively I m m u n i s e d against the Disease in Southampton. By H. C. Maurice Williams, M.R.C.S., L.R.C.P., D.P.H., and A. Carling, B.M., B.CH.~ D.P.H . . . . . . . . . . . . . . . .
T h e New Emergency Obstetric Service in London. By P. M. G. Russell, M.B., M.C.O.G. .... . . Enuresis. By Robert Hutchinson, M.D., P.R.C.P., and Donald Winnicott, M.A., M.R.C.P. . . . . . .
Correspondence . . . . . . . . . . . . Book Reviews ................ News and Announcements A Public Health Convalescent H o m e ...... Ministry of Health D o c u m e n t s ......... Recent Appointments in the Public Health Service
Society of Medical Officers of Health Branch and Group Meetings ......... Provincial Meeting . . . . . . . . . . . . . . .
3a7 339 340 341 342 342 348 348 34a 347
Editorial The Health Congress, Portsmouth, 1938 The Annual Health Congress convened by the Royal Sanitary Institute is unique in attracting all types of professional officers in the health services, together with elected representatives of local authorities. This year's Congress, held at Portsmouth from July l lth to 16th, continued this tradition and provided many topical subjects o f importance for discussion by the delegates, who were slightly more in number than last year's
record figure. The papers and discussions will be published in succeeding issues of the journal of the Royal Sanitary Institute, and in the space available here we can only touch upon particular points of interest. On Monday, the Earl of Bessborough, President of the Congress, set a high standard in his opening address, in which he urged the importance of still further educating the people to take advantage of the lessons of public health and of the services at their disposal. Next day the section of Preventive Medicine, to which Sir Harold Pink, Chairman of the British Hospitals' Association, delivered a Presidential address, held an interesting discussion on " The Future of the General Hospital." The opener from the side of the publicly-owned hospitals was Dr. R. VeitchClark, of Manchester, who thought that the voluntary hospital could never die out because its individualism and power of unfettered development was part of the national psychology. From the side of the voluntary hospitals, Mr. C. E. A. Bedwell, House Governor of King's College Hospital, stressed the need for developing the preventive atmosphere in order to avoid excessive resort to hospitals; he suggested that the local authorities should concentrate upon the preventive and educational work of health centres and leave the voluntary hospitals to cope with curative work. This point was taken up by Dr. John Buchan (Bradford), who argued that there was already too much curative work for the voluntary hospitals to meet; the public demand for hospitalisation was no mere fad, and there was room for both voluntary and municipal hospitals without competition. On the same day, Sir Raymond Unwin delivered an inspiring address on Town-planning to the section of Architecture, Town-planning and Engineering. A paper by Mr. D. H. Thomson (Engineer to the Portsmouth Water Company) on Safeguarding of Water Supplies was also of interest in the light of recent events. Elsewhere Mr. W. R. McGrath (S.I., City of London, and President of the S.I.A.) addressed the conference of his colleagues on the current question of the value of terminal disinfection. The Sanitary Inspectors' Conference also discussed the Housing (Rural Workers) Act and the Housing Act, of 1936 ; much of the discussion centred on the problem of t h e " undesirable" tenant and how to deal with h i m 321
PUBLIC
HEALTH
The most crowded meeting on Wednesday was that of representatives of Local Authorities, who heard papers by the chief officials of Portsmouth on Air Raid Precautions. Portsmouth is particularly well forward in this work, which has become an additional and unavoidable local government function, and the demonstrations given the same evening were evidence of the careful planning and training which have been carried out in the city. On the same morning, Dr. James Fenton gave his Presidential address to a well-attended conference of Medical Officers of Health; in it he argued strongly that M.O.sH. should engage in health education of the people, and that they could do so without violating medical principles and traditions of professional conduct. The conference went on to discuss the campaign against rheumatism; Lord Horder spoke of the aims of the Empire Rheumatism Council, Dr. J. Alison Glover (Board of Education) dealt with rheumatic diseases from the point of view of central administration, and Dr. H. J. Rae (M.O.H., Aberdeen) from the point of view of the local authority. The latter suggested that local rheumatism clinics should be established jointly with orthopaedic and fracture clinics in view of the common basis of treatment. The discussion touched upon many aspects of research into and treatment of the rheumatic diseases, which are becoming more and more a province of public health activity. At the second meeting of the Sanitary Inspectors' Conference, Mr. C. J. Couch (Woolwich) described the work carried out in his borough towards discovering a satisfactory method 'of diffusion of heavy naphtha vapour as a means of disinfestation ; the problems now appears to have been overcome by the use of Egyptian cotton screens. The section of Tropical Hygiene provided an interesting meeting on Health Propaganda and the Hygiene of Indigenous Races in the Tropics," to which many distinguished speakers, headed by Sir Malcolm Watson, contributed. The morning of Thursday provided one of the most interesting meetings of the Conference in the section of Maternity and Child Welfare and School Hygiene," the subject for discussion was The Defects Found in School Entrants and the steps that might be taken to effect their remedy before the beginning of school life." Dr. J. Greenwood Wilson (M.O.H., Cardiff) pointed out that 100,000 children every year entered school unfit and urged that no mass production scheme in industry could tolerate such a proportion of failures. In the course of his paper he asked whether we were not too much obsessed by the idea of bigger and better clinics, and he pointed to the success of the Huddersfield system "
"
"
AUGUST where there were no welfare centres but every effort was concentrated upon home visitation; the percentage of school entrants at Huddersfield with defects requiring treatment was lower than the average for England and Wales. Mr. Myles Formby, F.R.C.S. (University College Hospital) dealt with the treatment of ear, nose and throat defects and urged that the position of tonsillectomy must be put on a scientific basis; surgery should be the last resort in any treatment and in dealing with tonsils and adenoids in children under five must be employed with great discrimination. Major-General J. P. Helliwell (Consulting Dental Surgeon to the L.C.C.) spoke on the prevention of dental diseases amongst children, with particular reference to the giving of cleansing food-stuffs and adequate conservative treatment. On the same day the section of Veterinary Hygiene discussed modern standards of meat inspection and the section of Hygiene of Food dealt with the food-manufacturer's contribution to public health. On Friday, Dr. Charles Porter (M.O.H., St. Marylebone) delivered his presidential address to the conference of Health Visitors, in which he dealt with the changes in the professional standard and type of entrant during his long public health experience; he thought that more women health officers should turn to sanitary inspection. The Conference then discussed the psychological problems of child welfare centres, Dr. Grace Calve1: (Children's Department, Tavistock Clinic) and Dr. Mildred Creak (Children's Department, Maudsley Hospital) giving interesting papers on " Behaviour and Nervous Disorders in Children attending M. and C.W. centres." Miss C. Hale (late Health Visitor and Superintendent of Welfare Centres, St. Marylebone) spoke on the problems and organisation of clinics for the pre-school child. The section of National Health Insurance heard an interesting paper by Dr. A. B. Walker (Department of Health for Scotland) on " The Duration of Incapacitating Sickness." The social side of the Congress was made unusually interesting by opportunities of seeing something of the work of the Navy as well as local public health undertakings. The hospitality of the Lord Mayor and Corporation was on a generous scale and particular congratulations are due to Dr. A. B. Williamson, M.O.H., Portsmouth, and Mr. L. C. Rogers, Chief Clerk; Portsmouth Health Department~ for the success of the local arrangements. Congratulations are also extended to Dr. Dudley Robinson and the Staff of the Royal Sanitary Institute, who displayed their usual competence in the handling of this great conference.
322