Infant Mortality in Gibraltar

PUBLIC HEALTH, September, 1946 welcomed, but so far none have stood the test of time. T h e most recent substance, streptomycin, an antibiotic isolated by Waksman, of Rutgers University, U.S.A., has been the subject of experiments in vitro, in guinea-pigs, and to a limited extent in human clinical trials by William H. Feldman, of the Mayo Foundation, University of Minnesota. Dr. Feldman has given an interim report of his work and results in the Harben Lectures of the Royal Institute of Public Health and Hygiene, and in a paper delivered to the Tuberculosis Association meeting at Oxford. T o state the matter in the most conservative form, this work appears to offer more hope of the finding of a satisfactory therapeutic substance than anything which has gone before. Dr. Feldman is modest in his claims, but those who have heard him speak could not help but feel like Keats, "watcher of the skies when a new planet swims into his ken." It is too soon to say more, the preparation of streptomycin in sufficient quantity and pure state is still a laborious and difficult matter, the results of tuberculosis experiments take a long time to assess, but we cannot help feeling that this research may well provide us with a weapon such as we have been seeking. The Oxford Institute of Social Medicine T h e Institute of Social Medicine, the first of its kind, was set up by its trustees, the Nuffield Provincial Hospitals Trust, on April 1st, 1943, when Prof. J. A. Ryle was appointed as Director and as Professor of Social Medicine in the University of Oxford ; but owing to the war its full operation did not begin until 1944, and its first full annual report covers the year 1945. Its activities have become well known to the public health service, whose community of purpose with that of the Institute is exemplified by the presence on its committee of Dr. G. C. Williams (M.O.H., City of Oxford). One investigation, a child health survey, is being carried out in full co-operation with the city health department; others relate to thyroid enlargement in school children, to skeletal and other physical characters in the earlier years of life which can be radiographically studied, and to still-births and neonatal mortality. A statistical analysis of the latter subject is in progress, and if this records " black spots " specific local surveys may be carried out in conjunction with the local health authorities concerned. O n the teaching side, medical students in the clinical period are given instruction in social medicine, in conjunction with hospital almoners. Post-graduate study is not at present feasible, but it will have been noticed that the Institute has assisted in the Society's refresher courses. T h e report sums up the methods appropriate to the advancement of social pathology as follows : (1) statistical studies of mortality and morbidity: for these co-operation with the Bureau of Health and Sickness Records is providing a new opportunity; (2) medico-social surveys: survey methods themselves are a matter for study, calling for collaboration between clinician, statistician, medical social workers and others; (3) the social experiment, such as t h a t described by M'Gonigle and Kirby in " Poverty and Public Health " (1936) : the possibility of engaging in such experiments in connection with rehousing schemes or during changes of working environment in industry, has been mooted. We foresee much useful future co-operation with the Oxford Institute and with the Bureau of Health and Sickness Records. I n f a n t Mortality i n Gibraltar T h e report of the Senior Medical Officer of the Colonial Secretary to Gibraltar showed that last year there were 600 children born to a population of 19,000 (roughly 34.8); of these 28 died, with an infant mortality rate of 32-9. Gibraltar suffers from great overcrowding, slum conditions and much ignorance. T h e infant welfare movement is in its infancy. It is, therefore, of some interest that such a low infantile mortality rate should occur. Dr. Procter suggests that this may be due to some or all of the following factors : - 1. T h e general use of dried milk (condensed or powdered). 2. T h e almost total lack of flies because of the absence of animals and good refuse collection and street cleansing. 3. T h e mildness of the climate during the winter. 4. T h e high level of food consumption in the Colony which must affect maternal stamina (the fat ration, for example, has been 14 oz. per head).

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OPPORTUNITIES FOR RESEARCH IN THE SCHOOL H E A L T H S E R V I C E * By H. M. COHsN, M.D., D.P.H.,

School Medical O~cer, City of Sheffield [Dr. Cohen, in his opening remarks, mentioned the list of special iuvestigations undertaken by School Medical Officers which used to appear in " The Health of the School Child." Dr. Cohen said he would like to draw attention to some work appearing since and bearing on aspects of the School Health Service which could be pursued. The subject of research had come very much to the forefront recently and in this connection the National Foundation for Educational Research was mentioned with some regret that the Society had not gained some representation on this foundation. Dr. Cohen then considered briefly the'philosophy underlying research in general, stressing that investigation in the various branches of the School Health Service need not necessarily be sensational where the knowledge gained may be but small, but in the aggregate of much help. Turning more specifically to the School Health Service, Dr. Cohen drew attention to Professor Ryle's recent exhortation that " the best opportunities and problems for research are those which confront school medical officers." Intelligence and epilepsy was then given as a subject of importance to school medical officers from the point of view of special educational treatment, and vocational guidance and the question of mental deterioration in idiopathic epilepsy might well be followed up: Intelligence and infant mortality" in problem families had recently been pursued and further investigation of the intelligence of the children of such families would be of benefit as the subject had become of increasing importance and as much light as possible was necessary to elucidate the issues involved. Nutritional status was particularly suited to investigation by the School Health Service. In this connection Dr. Cohen instanced the actu:~.l enquiries pursued by Dr. E. H. M. Milligan, a member of the Group. Dr. Cohen suggested the evaluation of basic standards so that districts and towns could be compared in the same way that certain investigations in industrial towns had been undertaken and such investigations as nutrition and sizes of a family. The Tuberculin Patch Test with correlation with mass miniature radiography could be profitably carried out. An investigation was also needed into the question of speech, left-handedness, and ocular dominance which Dr. Cohen briefly discussed. The acquisition of statistical method was further mentioned as an instrument in assessing studies efficiently. Dr. Cohen then described as follows some work which he had carried out in a group of children attending a school for educable mental defectives (the educationally sub-norma~) bearing out some of the points he had discussed.] Mental Deficiency and Soeio-Eeonomie Status I should like to deal briefly with an investigation which I undertook into the relationship between mental deficiency and socio-economic status. I n the endeavour to discover the relationship between intelligence and the social and economic status the problem of measuring the latter presented itself. It has been realised that there are differences existing amongst the homes in other social enquiries, but at first these have appeared qualitative and so apparently incapable of measurement. Later workers attempted comparison by means of single facts, such as the possession of a telephone or the n u m b e r of books'in the home library. Dr. Lawrence, to whom I shall refer again, in a recent investigation into the relationship between intelligence and inheritance, pointed out that the measurement of social class was difficult and that there was no known means of weighting various factors occurring in each home and combining these to form a reliable social index. Lawrence relied on a single factor, namely, occupation. All the occupations were grouped into five classes which gave five broad social strata. Sims, in America, has devised a score card for socio-economic status with 23 queries with an arbitrary weighting for each. Applying this standard to the present investigation, it was realised that information, in the great majority of cases, could be elicited for three of these queries only. It appears that the Sims score card is first of all applicable to American conditions, and a similar scale for this country would be very different in its items, and secondly that this scale covers a greater spread of social status. Typical questions on the Sims card are : ~ * Abstract of Presidential Address delivered to the School Medical Service Group, Society of Medical Officers of Health, London, January 25th, 1946.