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Health works of the London county council
PUBLIC HEALTH.
372
an inspiring speaker on official occasions, notably at the Congress dinner, deserve warm congratulations on a remarkably successful meeting.
Health Works of the London County Council. subjects dealt with in Volume II of T HtheE Annual Report of the London County Council for 1934" have reference to Public Health. In it there are discussed, in addition to public health generally, such matters as main drainage, housing, etc. Under the heading " Public Health, Transferred Services it is noted that there were in December, 1934, more than 40,000 beds in 75 hospitals (including some institutions in process of conversion into hospitals for the chronic sick). These are under the control of the Council's Hospitals and Medical Services Committee, which administers the services transferred to the Council from the late poor law authorities on April 1st, 1930, so far as they relate to the care of the sick in hospitals and domiciliary medical services. In this connection it is interesting to learn that the arrangements, begun in 1933, for giving instruction to medical students at the Council's hospitals, in association with the voluntary teaching hospitals, are being continued. That opportunities for special research work have also been afforded to medical practitioners in the Council's hospitals, from which, it has been shown more than once in this journal, contributions of value to. medical knowledge are coming in increasing numbers, may be noted too. The modernisation and improvement of hospital accommodation was continued during 1934, amongst other additions made being extra isolation blocks at certain of the infectious hospitals. The section of the report upon the London Ambulance Service contains a note showing that the vehicles of the general section of this service, which conveys patients to and from the Council's hospitals and mental hospitals, ran nearly 2,000,000 miles during the year, while the mileage of the accident section was more than 208,000. In the chapter on the non-transferred services the subjects reported upon include the special schemes for maternity and child welfare and for combating tuberculosis and "
*London: P. S. King & Son, Ltd, 14, Great Smith Street, S.W.I. Publication No. 3176. Price Is.
AUGUST,
venereal disease. In addition, there is reference to food protection works, the operation of the Midwives Acts, drainage bye-laws, etc. The remaining sections contain a volume of information with regard to main drainage and housing. Describing the London main drainage system, the report shows that this covered an area of nearly 160 square miles and served a population of more than 5} millions, including 1,161,000 outside the county boundary. Further, in 1934 there were about 400 miles of main, intercepting and storm relief sewers, and in that year more than 88,000 million gallons of sewage was pumped into the outfatl sewers at the five main stations. Reference is made to experiments in devising new methods of dealing with sewage, including a process " of causing the sludge, by digestion, to decompose and give off a gas which could be used for heating, lighting and power." A very important section of the report is that dealing with housing. Here reference is made to the negotiations between representatives of the Council and the Minister of Health which preceded the introduction of the measure which became the H o u s i n g Act of 1935. In January of 1934 the Council gave evidence before a Departmental Committee, set up by the Minister of Health, on Garden Cities and Satellite Towns, to the effect that owing to financial and industrial considerations the Council did not regard the setting up of satellite towns as a practicable or desirable contribution to London's housing problem. Statistics are given showing that by the end of 1934 more than 67,000 houses and flats had been erected by the Council, of which over 57,000 were erected in the post-war period. More than 5,800 people were displaced and rehoused during the year. In July, 1934, the Council reviewed the slum clearance question and adopted a programme for the three years from June, 1934, to June, 1937, which contemplated the commencement of operations on all the larger unhealthy areas (132 in number) capable of redevelopment by the erection of block dwellings. A number of the smaller unhealthy areas, not suitable for housing development, will be cleared at the same time as the larger areas and the remainder will be dealt with as and when additional housing accommodation is provided. Active co-operation, it i s noted, is
1936.
PUBLIC HEALTH.
being given by the metropolitan borough councils. During the year new types of flats with improved internal planning were approved, and new elevations designed on modern lines were adopted. During 1934, it is interesting to learn, the Council reviewed the rents charged on its estates, taking into account a new factor not previously considered, z,iz., that the income of the displaced slum dweller is lower than the average for a working-class family. As a result, reductions ranging from 6d. to 4s. 6d. a week were made in the rents of a number of block dwellings. A memorandum by the Comptroller of the Council (Mr. F. G. Bowers, c.m, C.B.E.) on the Council's housing accounts for the year ended March 31st, 1936, and one by the Council's Valuer (Mr. Frank Hunt, c.v.o.) on housing statistics and the management of the Council's housing estates during the same period, contain information likely to be of value to authorities and organisations concerned in and operating housing schemes.
The Maternity and Child Welfare Conference. I S Conference, held at Liverpool on T HJuly 1st, 2nd and 3rd, was attended by a large number of official representatives from all parts of the country. In his presidential address, Mr. Geoffrey Shakespeare, M.P., Parliamentary Secretary to the Ministry of Health, referred to the marked decline in infant mortality and the need for co-operation between the maternity and child welfare and school medical services in the extended care of the pre-school child. He also made brief reference to the Midwives Bill. The subject discussed at the opening session was " The Promotion of Maternal Welfare in relation to Child Health," when papers were read by Professor Leyland Robinson, Dr. Barbara Hirst and Miss Alden. Dame Janet Campbell was, unfortunately, prevented from being present but, in the paper on domiciliary midwifery which she had prepared, she held that a well-trained midwife, working under reasonable conditions and able to give proper time and attention to each patient, and not harassed by financial worries, was the first essential for sound domiciliary treatment whether or not the mother was attended by a doctor. Dr. Leyland Robinson dealt more especially with the influences of pre-natal work
373
upon foetal and neo-natal mortality, pointing out that the first month of life was the most dangerous period of youth and maturity and that the first half-hour of existence was probably tile most critical part of a life-time. In his opinion the failure to effect any improvement in the neo-natal death-rate in the main was the fact that many of the causes of foetal disease and death were either unknown or w-ere not amenable to the pre-natal methods which were at present available, and that as yet ante-natal care had not been applied in adequate fashion to those cases which were amenable to preventive treatment. Dr. Hirst discussed the question of the provision of rest and convalescence as factors in maternal welfare. In her view, in many towns there existed a definite need for some home or hospital to which infants and young" children could be admitted without delay, the criterion for admission being solely tile illness or the incapacity of the mother, and that any scheme which aimed at assistance for the mother would fall short of complete success unless, side by side with it, provision was also made for the care of the y o u n g children. In her paper on maternal welfare and the public, Dr. Charlotte I)ouglas, of the Department of tteatth for Scotland, expressed the opinion that efforts to care for the mother should start with the proper rearing of the girl infant : she said that at the present time it was an undoubted fact that, whilst as regards the future of the race it was the girls who were the most valuable members, the average mother lavished much more care on her sons than she did on her daughters. Mr. Edward Fuller, in dealing with the public health services and public opinion, stated that it was sometimes said by the cynics that the modern girt would rather have a car than a baby : he felt that a car was sometimes safer for the community, as a book of instructions was given with a new car, and the Minister of Transport required a driving test, but no licence was required before undertaking the responsibilities of parenthood. On the second day of the Conference, sessions were organised by the National Association of Day Nurseries, the Nursery School Association, the Invalid Children's .kid Association, and the Central Council for the Care of Cripples. At the last-named session the chair was taken by Dr. W . M. Frazer, Medical Officer of Health for Liverpool.
372
an inspiring speaker on official occasions, notably at the Congress dinner, deserve warm congratulations on a remarkably successful meeting.
Health Works of the London County Council. subjects dealt with in Volume II of T HtheE Annual Report of the London County Council for 1934" have reference to Public Health. In it there are discussed, in addition to public health generally, such matters as main drainage, housing, etc. Under the heading " Public Health, Transferred Services it is noted that there were in December, 1934, more than 40,000 beds in 75 hospitals (including some institutions in process of conversion into hospitals for the chronic sick). These are under the control of the Council's Hospitals and Medical Services Committee, which administers the services transferred to the Council from the late poor law authorities on April 1st, 1930, so far as they relate to the care of the sick in hospitals and domiciliary medical services. In this connection it is interesting to learn that the arrangements, begun in 1933, for giving instruction to medical students at the Council's hospitals, in association with the voluntary teaching hospitals, are being continued. That opportunities for special research work have also been afforded to medical practitioners in the Council's hospitals, from which, it has been shown more than once in this journal, contributions of value to. medical knowledge are coming in increasing numbers, may be noted too. The modernisation and improvement of hospital accommodation was continued during 1934, amongst other additions made being extra isolation blocks at certain of the infectious hospitals. The section of the report upon the London Ambulance Service contains a note showing that the vehicles of the general section of this service, which conveys patients to and from the Council's hospitals and mental hospitals, ran nearly 2,000,000 miles during the year, while the mileage of the accident section was more than 208,000. In the chapter on the non-transferred services the subjects reported upon include the special schemes for maternity and child welfare and for combating tuberculosis and "
*London: P. S. King & Son, Ltd, 14, Great Smith Street, S.W.I. Publication No. 3176. Price Is.
AUGUST,
venereal disease. In addition, there is reference to food protection works, the operation of the Midwives Acts, drainage bye-laws, etc. The remaining sections contain a volume of information with regard to main drainage and housing. Describing the London main drainage system, the report shows that this covered an area of nearly 160 square miles and served a population of more than 5} millions, including 1,161,000 outside the county boundary. Further, in 1934 there were about 400 miles of main, intercepting and storm relief sewers, and in that year more than 88,000 million gallons of sewage was pumped into the outfatl sewers at the five main stations. Reference is made to experiments in devising new methods of dealing with sewage, including a process " of causing the sludge, by digestion, to decompose and give off a gas which could be used for heating, lighting and power." A very important section of the report is that dealing with housing. Here reference is made to the negotiations between representatives of the Council and the Minister of Health which preceded the introduction of the measure which became the H o u s i n g Act of 1935. In January of 1934 the Council gave evidence before a Departmental Committee, set up by the Minister of Health, on Garden Cities and Satellite Towns, to the effect that owing to financial and industrial considerations the Council did not regard the setting up of satellite towns as a practicable or desirable contribution to London's housing problem. Statistics are given showing that by the end of 1934 more than 67,000 houses and flats had been erected by the Council, of which over 57,000 were erected in the post-war period. More than 5,800 people were displaced and rehoused during the year. In July, 1934, the Council reviewed the slum clearance question and adopted a programme for the three years from June, 1934, to June, 1937, which contemplated the commencement of operations on all the larger unhealthy areas (132 in number) capable of redevelopment by the erection of block dwellings. A number of the smaller unhealthy areas, not suitable for housing development, will be cleared at the same time as the larger areas and the remainder will be dealt with as and when additional housing accommodation is provided. Active co-operation, it i s noted, is
1936.
PUBLIC HEALTH.
being given by the metropolitan borough councils. During the year new types of flats with improved internal planning were approved, and new elevations designed on modern lines were adopted. During 1934, it is interesting to learn, the Council reviewed the rents charged on its estates, taking into account a new factor not previously considered, z,iz., that the income of the displaced slum dweller is lower than the average for a working-class family. As a result, reductions ranging from 6d. to 4s. 6d. a week were made in the rents of a number of block dwellings. A memorandum by the Comptroller of the Council (Mr. F. G. Bowers, c.m, C.B.E.) on the Council's housing accounts for the year ended March 31st, 1936, and one by the Council's Valuer (Mr. Frank Hunt, c.v.o.) on housing statistics and the management of the Council's housing estates during the same period, contain information likely to be of value to authorities and organisations concerned in and operating housing schemes.
The Maternity and Child Welfare Conference. I S Conference, held at Liverpool on T HJuly 1st, 2nd and 3rd, was attended by a large number of official representatives from all parts of the country. In his presidential address, Mr. Geoffrey Shakespeare, M.P., Parliamentary Secretary to the Ministry of Health, referred to the marked decline in infant mortality and the need for co-operation between the maternity and child welfare and school medical services in the extended care of the pre-school child. He also made brief reference to the Midwives Bill. The subject discussed at the opening session was " The Promotion of Maternal Welfare in relation to Child Health," when papers were read by Professor Leyland Robinson, Dr. Barbara Hirst and Miss Alden. Dame Janet Campbell was, unfortunately, prevented from being present but, in the paper on domiciliary midwifery which she had prepared, she held that a well-trained midwife, working under reasonable conditions and able to give proper time and attention to each patient, and not harassed by financial worries, was the first essential for sound domiciliary treatment whether or not the mother was attended by a doctor. Dr. Leyland Robinson dealt more especially with the influences of pre-natal work
373
upon foetal and neo-natal mortality, pointing out that the first month of life was the most dangerous period of youth and maturity and that the first half-hour of existence was probably tile most critical part of a life-time. In his opinion the failure to effect any improvement in the neo-natal death-rate in the main was the fact that many of the causes of foetal disease and death were either unknown or w-ere not amenable to the pre-natal methods which were at present available, and that as yet ante-natal care had not been applied in adequate fashion to those cases which were amenable to preventive treatment. Dr. Hirst discussed the question of the provision of rest and convalescence as factors in maternal welfare. In her view, in many towns there existed a definite need for some home or hospital to which infants and young" children could be admitted without delay, the criterion for admission being solely tile illness or the incapacity of the mother, and that any scheme which aimed at assistance for the mother would fall short of complete success unless, side by side with it, provision was also made for the care of the y o u n g children. In her paper on maternal welfare and the public, Dr. Charlotte I)ouglas, of the Department of tteatth for Scotland, expressed the opinion that efforts to care for the mother should start with the proper rearing of the girl infant : she said that at the present time it was an undoubted fact that, whilst as regards the future of the race it was the girls who were the most valuable members, the average mother lavished much more care on her sons than she did on her daughters. Mr. Edward Fuller, in dealing with the public health services and public opinion, stated that it was sometimes said by the cynics that the modern girt would rather have a car than a baby : he felt that a car was sometimes safer for the community, as a book of instructions was given with a new car, and the Minister of Transport required a driving test, but no licence was required before undertaking the responsibilities of parenthood. On the second day of the Conference, sessions were organised by the National Association of Day Nurseries, the Nursery School Association, the Invalid Children's .kid Association, and the Central Council for the Care of Cripples. At the last-named session the chair was taken by Dr. W . M. Frazer, Medical Officer of Health for Liverpool.