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CEREBRAL PALSY
145 all are interested, and with the increasing emphasis on this whole field, both in preparation and in in-service training, there has been over the years an increasing awareness, ability, and sureness shown in the nurse’s work. For evidence of this one has only to glance through the old files and compare the sketchy history and sparse follow-up work of ten years ago with those of today. One cannot help but be struck by the growth in understanding, the sharpening of observation, and the increased competence ’of action, or in some cases the wise withholding of action.
This outline of the role of the public-health nurse in the mental-hygiene work of this agency would not be complete without some reference to group discussions. The more or less informal but regular " get-together " of a few people for the purpose of learning by discussion is being found effective in many fields. Arranging such discussion is not yet an established part of the public-health nurses’ role, but the few attempts that have been made are very promising. Three of our nurses have undertaken to " lead " such parent groups with very encouraging response. We do not refer here to talks to mothers or other groups, but a different, freer, more living and meaningful process in which the group itself is the teacher. The nurses and the parents who have taken part in these have attested to the real and lastingchange that takes place in such a setting. Of course the pitfalls on the nurse’s path as she tries to spread the knowledge of the normal, and help to prevent and correct the deviations from the normal are obvious. But through the mental-hygiene clinic, the regular conferences with the psychiatric social worker or the psychologist as her work progresses, and through her own experience, the nurse becomes aware of her own limitations and those of her agency, and learns to work productively within them. Some there are indeed who make so much of the dangers that they are blind to the possibilities. But no-one can deny that mental health is public health, and what public-health measure has not met with reactionary resistance? To safeguard against these dangers is one of the functions of the mental-
hygiene
division. SUMMARY
An account is given of the work of a mental-hygiene division in a public-health department. The organisation of the metropolitan health department is described. Its relationships with other agencies are shown. The composition of the mental-hygiene division is briefly sketched and the influence of its mental hygiene clinic is indicated. Examples are given of the ways in which the public-health nurse exercises her functions in mentalhygiene work (1) in the community, (2) in the schools, (3) in child-health centres, (4) in tuberculosis control, (,5) in the mental-hygiene clinic, and (6) in group discussions.
BACTERIAL GENETICS GENETICS have
increasing part in the study of bacteriological problems, and in order to outline the uses and techniques of the subject a colloquium was held in 14-17 by a group of interested bacterioloLondon on Dec. gists. While the range of the discussion was intentionally ,a medical bacteriologist may have thought that a disproportionate amount of time was spent in reviewing the genetics of bacteriophage and of Escherichia coli K 12 ; but this can be justified by the fact these organisms are JI1" most susceptible to detailed analysis. ljpr-ning- the colloquium, B. A. D. STOCKER gave an an
admirable review of bacterial transformation and transduction by phage, while W. HAYES did the same for the
genetics of Esch. coli K 12. other
lucidity.
(Unfortunately
did not maintain the This was partly because
speakers
same
some
many of the
standard of
participants
new material instead of discussing principles r such contributions tended to break the flow of the, meeting, and the informal air desirable in colloquia was lost.) Discussing the papers by Stocker and Hayes, J. L. JINKS spoke of the exclusion factor which he believes. to be an essential part of the mechanism of recombination in Esch. coli K12.
presented
A discussion on population changes was opened by CHARLOTTE AUERBACH, who emphasised that workers were sometimes not careful enough in their use of words :: for instance, "mutation" was used to mean both the act of producing a mutant and the mutant itself. She also pointed out the dangers in interpreting experiments in which selection of a mutant is involved. D. A. MITCHISON described some of the mechanisms which may
bring about large-scale changes in cultures, referring mainly to the antibiotics. J. YuDEiN sought to explain. some of these changes on clonal variation-a hypothesis that would require revision of some of our ideas of inheritance of bacterial characters. The genetics of bacteriophage was next discussedIn this field the fact that the result of crosses can be analysed is offset by our lack of knowledge of how the phages are reproduced ; at present no hypothesis of phage replication adequately fits all the known facts. However, ELINOR MCCLOY and NIEVILLE SYMONDS. described the main experimental facts in this field, while W. HAYES discussed the inheritance of prophage. Otherviruses were rather neglected ; but F. FULTON did give asatisfying account of the recombination between influenza strains, and he suggested that the virulence of these strains was best attributed to an inherited pattern ratherthan to any single character. The final session was devoted to some of the applications of bacterial genetics, including its possible uses. in the study of virulence. T. W. BURROWS described theimportance of growth factors in Pasteurella pestis strains,_ while L. F. HEWITT outlined the role of phages in thetoxogenicity of diphtheria. D. RowLEY put forward a scheme (still in the experimental stage) for analysing themouse virulence of Esch. coli strains. The organisers are to be congratulated on their attemptto introduce the study of genetics to a wider range of workers.
CEREBRAL PALSY AT the national congress of the Societa Italiana di Ginnastica Medica, held in Milan on Dec. 6-8, Dr. A. Cor.Li GRISONI (Milan) pointed out that there had been a distinct change in the approach to the infantile cerebral palsies. Formerly regarded as osteomuscular states, only partly amenable to static forms of treatment, they were
rapidly becoming recognised as neurophysiological conditions in the developing child, calling for a dynamic approach. Defective development should be evaluated from both physical and mental angles, in order to give a. prognosis of a child’s educability. Her fundamental principles of treatment could be grouped under three heads-physiotherapy, occupational therapy, and speech therapy-and suitable personnel were about to be trained in Italy for this work. Trainees with a -vocation must be selected and specially trained in precise techniques cf management. She felt that babies are best treated at home, children between 3 and 5 years at special day centres attached to hospitals, and older children at schools for handicapped children. She emphasised the importance of instructing parents in day-to-day care of their children, and remarked that even children barred by mental deficiency from ordinary education can be helped to some extent. Spastic children, she said, must first acquire complete relaxation ; then passive movements must be applied ; later passive-active movements must be carried out ;; and, lastly, active movements.
146 There was much to be done in the field of the infantile cerebral palsies, and neurologically based research should be encouraged. Dr. L. MASSIMO (Genoa) read, in translation, the commentary to an English film, previously shown in London This film, entitled The Rôle of Mental Function in Physical Activity, was prepared in the cerebral-palsy unit at Queen Mary’s Hospital for Children, Carshalton, and the associated parents’ advice clinic. The commentary out that cerebral pointed palsies may occur in mentally normal and in mentally deficient subjects, and that prognoses of ultimate compensation for these nonprogressive motor disorders rest on evaluation of the patient’smental function. The film first illustrated the role of mental function in ordinary everyday activities of intelligent adults who, having been born without arms, were effectively compensating for their missing limbs. The first, a mother of seven children, was shown doing housework and caring for her youngest child ; the second, a young man, was shown at work. The film then illustrated the development of mental function in normal babies, and showed the defective development of children with abnormalities of brain function. Four defective babies were shown during clinical testing for primary abnormalities of mental and motor function. The tests revealed that two of the babies had no motor disorder, and two had both mental
Public Health
appropriate
lively intelligence. The trend of the papers read and the films shown at this congress was towards a new approach to the infantile cerebral palsies-an approach based on neurophysiological study of infant development, recognition of mental abnormalities, and practical application of dynamic principles in techniques of diagnosis and of management of children with brain deficiencies. Mrs. Eirene Collis, C.P.T., of the cerebral-palsy unit at Queen Mary’s Hospital for Children, Carshalton, was awarded by the Italian Republic the stella della solidarietet italiana, for services to the children of Italy.
that the addition of colour to raw meat, game, poultry, fish, fruit, and vegetables should be prohibited (to the best of its knowledge such additions are not being made
Coloured Food Standards Committee has
THE Food recommendation by its that the Public Health
adopted a preservatives subcommittee1 (Preservatives, &c., in Food) Regulations, 1925-53, should be amended so as to permit the inclusion in foods of specified colours only. The subcommittee, whose chairman is Sir Charles Dodds, F.R.C.P., F.R.S., remarks that the practice of colouring food is by no means new. Pliny the elder, for instance, referred to the colouring of wine. But it is only in the past hundred years or so that this practice has been open to possible objection. About "
1850 the ‘‘ coal-tar dyes were discovered, and these have now largely replaced the natural colours previously used. In 1924 a departmental committee, appointed by the Minister of Health, recommended that the use of only specified colouring matters, regarded as non-injurious to health, should be allowed. But the Government of the day decided on a different approach ; and under the 1925 regulations the inclusion in food of certain colours then known to be harmful was prohibited. These were : antimony, arsenic, cadmium, chromium, copper, lead, mercury, and zincgamboge (a vegetable colouring-matter) ; and five coal-tar colours (picric acid, victoria yellow, aurine, manchester yellow, and "
"
aurantia). The present position is that the Food and Drugs (Milk, Dairies and Artificial Cream) Act, 1950, prohibits the addition of colouring matter to milk ; but otherwise any colours not specifically prohibited by the Public Health (Preservatives, in Food) Regulations, 1925-53, may be used in &c., foods- provided that such use does not contravene the provisions of sections 1 and 3 of the Food and Drugs Act, 1938.
The subcommittee observes that evidence has been colours a hazard to health ; in laboratory animals some have proved "
accumulating which indicates that coal-tar other than the five already prohibited may be
"’
carcinogenic. Without the addition of colour, saysthe subcommittee, many foods would havea drab unattractive appearance. If, therefore, there is enough evidence that the colours used have no deleterious effect on health, it sees no objection to their being used to replace natural colour lost in processing, to standardise appearance, or simply to render a food more attractive. But the report suggests 1. Food Standards Committee: Report H.M. Stationery Office. Pp. 27. 1s.
and motor limitations. These four babies were shown at later stages of development, and the correctness of the diagnose; thus demonstrated. The commentary emphasised the need for planning com. pensatory activitv for children with primary motor defect and demonstrated the results of planning in palsied children shown at play and in school. Those of normal intelligence showed achievements, within their motor limits. appropriate to their ages, and those with mental deficiencies failed in this respect. Finally, two brothers were shown, one normal and one with cerebral palsy. The boy with cerebral palsy showed activity which closely resembled that of his brother. He had been competently helped from an early age to use his defective motor function skilfully for expressing his
on
Colouring Matters.
in this country). , The report ends with a list of colours which, the subcommittee suggests, should be approved for inclusion in food. Representations on the subcommittee’s recommendations may be submitted, up till March 31, to the Joint Secretary, Preservative: Subcommittee, Ministry of Food, Horseferry Road, London, S.W.I.
Fish and
Great
Westminster Honse.
Chip Shops
In his report for 1953, Dr. T. R. Roberton, medical officer of health for Bootle, describes how his department has been improving the standard of hygiene in fish and chip shops in the borough. Generally the shops were well maintained, but one possible source of danger (and it is certainly not one that is confined to Bootle) was the improvised shed at the rear of .some premises, which was used for storing, cleaning, and peeling the potatoes and which was often an unsuitable place for the job. The report also refers to the wrapping of fish and chips in " an inadequate sheet of grease-proof paper " and then in newspaper ‘‘ the source of which was unknown." Proprietors were recommended to wrap the food completely in a suitable paper bag and to use " an external wrapping from an approved source."
Geography of General
Practices
Middlesbrough’s health department lately made a small survey to find out the extent to which the local family doctors’ practices overlapped geographically. In his report for 1953, Dr. E. C. Downer, medical officer of health for Middlesbrough tells how six streets were selected from different parts of the town ; only house* which some member of the department happened to be visiting officially were included in the inquiry. In one street, 18 families were attended by 17 different doctors ; in another, 25 families were attended by 19 doctors. Each street surveyed had 10 or more doctors covering from 12 to 26 families. " From this it will be seen," Dr. Downer comments, ’’ that in times of widespread illness or epidemics the general practitioners of the town have to motor all over the town to attend their patients.... An enormous amount of time must be spent by doctors at the wheel rather than at the bedside, and ... it is impossible to attach the district health visitor as closely to the doctors as one would wish. five or He suggests that, in the interests of economy, six doctors working in some form of group practice should be responsible for a large housing estate of ’‘
This outline of the role of the public-health nurse in the mental-hygiene work of this agency would not be complete without some reference to group discussions. The more or less informal but regular " get-together " of a few people for the purpose of learning by discussion is being found effective in many fields. Arranging such discussion is not yet an established part of the public-health nurses’ role, but the few attempts that have been made are very promising. Three of our nurses have undertaken to " lead " such parent groups with very encouraging response. We do not refer here to talks to mothers or other groups, but a different, freer, more living and meaningful process in which the group itself is the teacher. The nurses and the parents who have taken part in these have attested to the real and lastingchange that takes place in such a setting. Of course the pitfalls on the nurse’s path as she tries to spread the knowledge of the normal, and help to prevent and correct the deviations from the normal are obvious. But through the mental-hygiene clinic, the regular conferences with the psychiatric social worker or the psychologist as her work progresses, and through her own experience, the nurse becomes aware of her own limitations and those of her agency, and learns to work productively within them. Some there are indeed who make so much of the dangers that they are blind to the possibilities. But no-one can deny that mental health is public health, and what public-health measure has not met with reactionary resistance? To safeguard against these dangers is one of the functions of the mental-
hygiene
division. SUMMARY
An account is given of the work of a mental-hygiene division in a public-health department. The organisation of the metropolitan health department is described. Its relationships with other agencies are shown. The composition of the mental-hygiene division is briefly sketched and the influence of its mental hygiene clinic is indicated. Examples are given of the ways in which the public-health nurse exercises her functions in mentalhygiene work (1) in the community, (2) in the schools, (3) in child-health centres, (4) in tuberculosis control, (,5) in the mental-hygiene clinic, and (6) in group discussions.
BACTERIAL GENETICS GENETICS have
increasing part in the study of bacteriological problems, and in order to outline the uses and techniques of the subject a colloquium was held in 14-17 by a group of interested bacterioloLondon on Dec. gists. While the range of the discussion was intentionally ,a medical bacteriologist may have thought that a disproportionate amount of time was spent in reviewing the genetics of bacteriophage and of Escherichia coli K 12 ; but this can be justified by the fact these organisms are JI1" most susceptible to detailed analysis. ljpr-ning- the colloquium, B. A. D. STOCKER gave an an
admirable review of bacterial transformation and transduction by phage, while W. HAYES did the same for the
genetics of Esch. coli K 12. other
lucidity.
(Unfortunately
did not maintain the This was partly because
speakers
same
some
many of the
standard of
participants
new material instead of discussing principles r such contributions tended to break the flow of the, meeting, and the informal air desirable in colloquia was lost.) Discussing the papers by Stocker and Hayes, J. L. JINKS spoke of the exclusion factor which he believes. to be an essential part of the mechanism of recombination in Esch. coli K12.
presented
A discussion on population changes was opened by CHARLOTTE AUERBACH, who emphasised that workers were sometimes not careful enough in their use of words :: for instance, "mutation" was used to mean both the act of producing a mutant and the mutant itself. She also pointed out the dangers in interpreting experiments in which selection of a mutant is involved. D. A. MITCHISON described some of the mechanisms which may
bring about large-scale changes in cultures, referring mainly to the antibiotics. J. YuDEiN sought to explain. some of these changes on clonal variation-a hypothesis that would require revision of some of our ideas of inheritance of bacterial characters. The genetics of bacteriophage was next discussedIn this field the fact that the result of crosses can be analysed is offset by our lack of knowledge of how the phages are reproduced ; at present no hypothesis of phage replication adequately fits all the known facts. However, ELINOR MCCLOY and NIEVILLE SYMONDS. described the main experimental facts in this field, while W. HAYES discussed the inheritance of prophage. Otherviruses were rather neglected ; but F. FULTON did give asatisfying account of the recombination between influenza strains, and he suggested that the virulence of these strains was best attributed to an inherited pattern ratherthan to any single character. The final session was devoted to some of the applications of bacterial genetics, including its possible uses. in the study of virulence. T. W. BURROWS described theimportance of growth factors in Pasteurella pestis strains,_ while L. F. HEWITT outlined the role of phages in thetoxogenicity of diphtheria. D. RowLEY put forward a scheme (still in the experimental stage) for analysing themouse virulence of Esch. coli strains. The organisers are to be congratulated on their attemptto introduce the study of genetics to a wider range of workers.
CEREBRAL PALSY AT the national congress of the Societa Italiana di Ginnastica Medica, held in Milan on Dec. 6-8, Dr. A. Cor.Li GRISONI (Milan) pointed out that there had been a distinct change in the approach to the infantile cerebral palsies. Formerly regarded as osteomuscular states, only partly amenable to static forms of treatment, they were
rapidly becoming recognised as neurophysiological conditions in the developing child, calling for a dynamic approach. Defective development should be evaluated from both physical and mental angles, in order to give a. prognosis of a child’s educability. Her fundamental principles of treatment could be grouped under three heads-physiotherapy, occupational therapy, and speech therapy-and suitable personnel were about to be trained in Italy for this work. Trainees with a -vocation must be selected and specially trained in precise techniques cf management. She felt that babies are best treated at home, children between 3 and 5 years at special day centres attached to hospitals, and older children at schools for handicapped children. She emphasised the importance of instructing parents in day-to-day care of their children, and remarked that even children barred by mental deficiency from ordinary education can be helped to some extent. Spastic children, she said, must first acquire complete relaxation ; then passive movements must be applied ; later passive-active movements must be carried out ;; and, lastly, active movements.
146 There was much to be done in the field of the infantile cerebral palsies, and neurologically based research should be encouraged. Dr. L. MASSIMO (Genoa) read, in translation, the commentary to an English film, previously shown in London This film, entitled The Rôle of Mental Function in Physical Activity, was prepared in the cerebral-palsy unit at Queen Mary’s Hospital for Children, Carshalton, and the associated parents’ advice clinic. The commentary out that cerebral pointed palsies may occur in mentally normal and in mentally deficient subjects, and that prognoses of ultimate compensation for these nonprogressive motor disorders rest on evaluation of the patient’smental function. The film first illustrated the role of mental function in ordinary everyday activities of intelligent adults who, having been born without arms, were effectively compensating for their missing limbs. The first, a mother of seven children, was shown doing housework and caring for her youngest child ; the second, a young man, was shown at work. The film then illustrated the development of mental function in normal babies, and showed the defective development of children with abnormalities of brain function. Four defective babies were shown during clinical testing for primary abnormalities of mental and motor function. The tests revealed that two of the babies had no motor disorder, and two had both mental
Public Health
appropriate
lively intelligence. The trend of the papers read and the films shown at this congress was towards a new approach to the infantile cerebral palsies-an approach based on neurophysiological study of infant development, recognition of mental abnormalities, and practical application of dynamic principles in techniques of diagnosis and of management of children with brain deficiencies. Mrs. Eirene Collis, C.P.T., of the cerebral-palsy unit at Queen Mary’s Hospital for Children, Carshalton, was awarded by the Italian Republic the stella della solidarietet italiana, for services to the children of Italy.
that the addition of colour to raw meat, game, poultry, fish, fruit, and vegetables should be prohibited (to the best of its knowledge such additions are not being made
Coloured Food Standards Committee has
THE Food recommendation by its that the Public Health
adopted a preservatives subcommittee1 (Preservatives, &c., in Food) Regulations, 1925-53, should be amended so as to permit the inclusion in foods of specified colours only. The subcommittee, whose chairman is Sir Charles Dodds, F.R.C.P., F.R.S., remarks that the practice of colouring food is by no means new. Pliny the elder, for instance, referred to the colouring of wine. But it is only in the past hundred years or so that this practice has been open to possible objection. About "
1850 the ‘‘ coal-tar dyes were discovered, and these have now largely replaced the natural colours previously used. In 1924 a departmental committee, appointed by the Minister of Health, recommended that the use of only specified colouring matters, regarded as non-injurious to health, should be allowed. But the Government of the day decided on a different approach ; and under the 1925 regulations the inclusion in food of certain colours then known to be harmful was prohibited. These were : antimony, arsenic, cadmium, chromium, copper, lead, mercury, and zincgamboge (a vegetable colouring-matter) ; and five coal-tar colours (picric acid, victoria yellow, aurine, manchester yellow, and "
"
aurantia). The present position is that the Food and Drugs (Milk, Dairies and Artificial Cream) Act, 1950, prohibits the addition of colouring matter to milk ; but otherwise any colours not specifically prohibited by the Public Health (Preservatives, in Food) Regulations, 1925-53, may be used in &c., foods- provided that such use does not contravene the provisions of sections 1 and 3 of the Food and Drugs Act, 1938.
The subcommittee observes that evidence has been colours a hazard to health ; in laboratory animals some have proved "
accumulating which indicates that coal-tar other than the five already prohibited may be
"’
carcinogenic. Without the addition of colour, saysthe subcommittee, many foods would havea drab unattractive appearance. If, therefore, there is enough evidence that the colours used have no deleterious effect on health, it sees no objection to their being used to replace natural colour lost in processing, to standardise appearance, or simply to render a food more attractive. But the report suggests 1. Food Standards Committee: Report H.M. Stationery Office. Pp. 27. 1s.
and motor limitations. These four babies were shown at later stages of development, and the correctness of the diagnose; thus demonstrated. The commentary emphasised the need for planning com. pensatory activitv for children with primary motor defect and demonstrated the results of planning in palsied children shown at play and in school. Those of normal intelligence showed achievements, within their motor limits. appropriate to their ages, and those with mental deficiencies failed in this respect. Finally, two brothers were shown, one normal and one with cerebral palsy. The boy with cerebral palsy showed activity which closely resembled that of his brother. He had been competently helped from an early age to use his defective motor function skilfully for expressing his
on
Colouring Matters.
in this country). , The report ends with a list of colours which, the subcommittee suggests, should be approved for inclusion in food. Representations on the subcommittee’s recommendations may be submitted, up till March 31, to the Joint Secretary, Preservative: Subcommittee, Ministry of Food, Horseferry Road, London, S.W.I.
Fish and
Great
Westminster Honse.
Chip Shops
In his report for 1953, Dr. T. R. Roberton, medical officer of health for Bootle, describes how his department has been improving the standard of hygiene in fish and chip shops in the borough. Generally the shops were well maintained, but one possible source of danger (and it is certainly not one that is confined to Bootle) was the improvised shed at the rear of .some premises, which was used for storing, cleaning, and peeling the potatoes and which was often an unsuitable place for the job. The report also refers to the wrapping of fish and chips in " an inadequate sheet of grease-proof paper " and then in newspaper ‘‘ the source of which was unknown." Proprietors were recommended to wrap the food completely in a suitable paper bag and to use " an external wrapping from an approved source."
Geography of General
Practices
Middlesbrough’s health department lately made a small survey to find out the extent to which the local family doctors’ practices overlapped geographically. In his report for 1953, Dr. E. C. Downer, medical officer of health for Middlesbrough tells how six streets were selected from different parts of the town ; only house* which some member of the department happened to be visiting officially were included in the inquiry. In one street, 18 families were attended by 17 different doctors ; in another, 25 families were attended by 19 doctors. Each street surveyed had 10 or more doctors covering from 12 to 26 families. " From this it will be seen," Dr. Downer comments, ’’ that in times of widespread illness or epidemics the general practitioners of the town have to motor all over the town to attend their patients.... An enormous amount of time must be spent by doctors at the wheel rather than at the bedside, and ... it is impossible to attach the district health visitor as closely to the doctors as one would wish. five or He suggests that, in the interests of economy, six doctors working in some form of group practice should be responsible for a large housing estate of ’‘