- Email: [email protected]
Inter-departmental committee on nursing services
PUBLIC
HEALTH THE JOURNAL OF
T H E SOCIETY OF MEDICAL OFFICERS OF HEALTH No. 10.
Vol. LI.
JULY, 1938
Subscription 81s. 6d. per annum, post free, in advance Single copies 2s. 6d. post free.
"Public Health" is the Official Organ of the Society of Medical Officers of Health and a suitable medium for the advertisement of official appointments vacant in the health service. Space is also available for a certain number of approved commercial advertisements. Application should be made to the Executive Secretary of the Society, at 1, Thornhaugh Street, Russell Square, London, W.C.1. Telephone: Museum 181,5. Telegrams: Epidauros, Westcent
Contents Editorial I n t e r - D e p a r t m e n t a l C o m m i t t e e on N u r s i n g Services Venereal Diseases in Scandinavia and t h e U . S . A .... C o n s t r u c t i o n a n d M a i n t e n a n c e o f Special Hospitals I n q u i r i e s into A b o r t i o n . . . . . . . . . . . . O u t d o o r Medical A s s i s t a n c e in Newcastle . . . . . . Provincial M e e t i n g of the Society . . . . . . . . .
PAGE 287 288 289 291 292 292
Special Articles H o w D o W e Assess N u t r i t i o n ? By E. H. Wilkins, M.B., D.P.H . . . . . . . . . . . . . . . . T h e C h i l d K e p t A p a r t from his Parents, By Ethel Cassie, M.D., D.P.H T h e N u r s i n g Services. Evidence given by t h e Society to t h e I n t e r - D e p a r t m e n t a l C o m m i t t e e .
.
.
.
.
.
.
.
.
.
.
.
.
293 299 305
News and Announcements Specialist Service for Bristol C o r p o r a t i o n Hospitals R e c e n t A p p o i n t m e n t s in t h e Public Health Service
317 317
Obituary H. D ' A r c y Ellis, M.R.C.S, L.R.C.P., j.p G. G. B u c h a n a n , M.B., B.SC. (P.H.), D.P.H . . . . W . M. Fisher, L.D.S., R.C.S. (ENG.) . . . . . . . . . J. M a u r i c e H a r p e r , v.n., M.R,C.S., D.P.H . . . . . . . . J. F. Haines, M.D., M.CH., lq.U.I . . . . . . . . . . .
.
.
.
.
.
303 303 304 304 304
.
Society of Medical Officers of Health Branch Meetings
Book Reviews
. . . . . . . . . . . .
...
318
............
...
320
Editorial Inter-Departmental Committee on Nursing Services During the past month local authorities and all other bodies responsible for hospital management have received a questionnaire from the Committee appointed by the Ministers of Health and Education to consider the recruitment, training and conditions of service of nurses. This Society (whose evidence is printed on pages 305-316 of the present issue) realises the great difficulty in gathering the facts about the nursing profession, its sources of supply, the conditions under which it works in different types of area and institution and the extent to which the present shortage is overcome by using the services of untrained women whose occupational prospects are doubtful. The number of nurses registered is rapidly increasing from year to year and yet the shortage remains unabated. No one knows how many nurses the country needs or is likely to need in the near future. Until some such information is collected, it is impossible to say what proportion of nurses tan be derived from secondary schools; how many can be found in the " A streams" of senior schools; whether it will be necessary, as a permanent policy, to recruit women unable to pass such an examination as the test recently instituted by the General Nursing Council, which, incidentally, has caused great inconvenience to local authorities; and, in the latter case, whether such recruits should receive a modified form of training for nursing of the chronic sick or work in other types of hospital which are not training schools. The questionnaire is intended to elicit some of the information relevant to these points. The Society's sub-committee failed to get a complete response to its own questionnaire and other bodies representing local government have had a similar experience. The Lancet Commission had the same difficulty, both with voluntary and council hospitals. Although the Inter-Departmental Committee is understood to have restricted its enquiry only to such information as is absolutely necessary to elucidate the position its questionnaire is more detailed than anything of the kind hitherto issued. Matrons of smaller hospitals may think 9_87
PUBLIC HEALTH its completion a formidable task. Yet it is quite as important if not more so, to have reliable facts about small as about large hospitals. The Medical Officer of Health is in a key position to see that they are supplied. The problems of nursing are of first importance both to the medical and nursing sections of the public health and local government service, and the whole weight of our influence should be used to ensure that the outcome of the enquiry is a real national survey and not merely a series of samples.
Venereal Diseases in Scandinavia and the U.S.A. In the light of a recent discussion on the Control of Venereal Diseases, reported in our issue of February last,* members of the public health service will study with interest the material of a more precise character to be found in the report of a deputation sent by the Minister of Health to examine the systems of Scandinavia and Holland.t The members of the deputation were Col. Harrison and Mr. Dudley Ward of the Ministry, Dr. Ferguson of the Department of Health for Scotland and Dr. Margaret Rorke of the Royal Free Hospital. In Denmark and Sweden the law provides, broadly, for anonymous reporting, compulsory treatment, notification by name in the event of discontinuance of, or failure to apply for, treatment, free treatment at clinics and penalties for transmission of the disease. Further, in Sweden, the practitioner consulted by a patient, must endeavour to trace the source of infection and report him or her by name and address. In Norway, notification without identification is prescribed, with the further provision that the name and address shall be transmitted if the patient ceases treatment prematurely; it is a punishable offence to infect another person or expose him to infection; free treatment is afforded only for sailors. Generally, the campaign against venereal disease is less vigorous in Norway, but a law similar to that of the sister countries is withheld only for financial reasons. The Dutch system in all essential points is similar to our own, except that such free treatment as is afforded is not given out of public funds, while the non-statutory work of following up patients and contacts is perhaps receiving more attention than with us. The law in Denmark and Sweden seems to be actively operated. It is generally accepted and attempts to evade it appear to be relatively uncommon. In the early days of compulsion in * Public Health, 51, 135.
Ministry of Health: Reports on Pub. Health and Med. Subjects, No. 83. 1938. H.M. Stationery Office, 2s. 6d. 288
JULY Denmark, some measure of which dates from 1788, there was opposition, often violent. The Swedish law of 1918 was passed only after tong discussion and much resistance, partly due to the concurrent abolition of the regulation of prostitution. In both countries the medical profession and the people are now firmly convinced of its value. The deputation made as careful a comparison as possible of the decline in venereal diseases in these several countries and in Great Britain. The tables and charts contained in their report will repay careful examination. They conclude that a substantial measure of success in reducing the incidence of syphilis has been achieved in all five countries under varying law. None has been outstandingly successful in reducing gonorrh~ea. In their view, compulsory treatment is not a major factor influencing the results of anti-venereal methods. The only comments we would make on this report at present are (1) that perhaps too much weight is given to the equivocal estimates of incidence in Great Britain, based on attendances at clinics, (2) that, as .measured by congenital syphilis, our position is distinctly inferior, and it is a mere presumption that this is due to the lesser frequency of routine serum tests in pregnancy, and (3) that the long-term effect on individual cases of treatment completed under compulsion is not sufficiently stressed. The Report does, however, enable us to view the problem in better perspective. On May 25th, President Roosevelt signed an Act imposing additional duties on the United States Public Health Service in connection with the investigation and control of venereal diseases. Like other public health problems, venereal diseases are primarily the concern of State and local authorities, but federal intervention is not entirely new. In 1935, the Social Security Act made provision, among other things, for conditional grants from federal monies for improving local public health services, to be administered, in the first instance, through State health departments. Such grants are given under Regulations of 1936, made by the Surgeon-General, and depend partly on the nature of the programmes submitted to him by these departments, in which, no doubt, the measures proposed for the control of venereal diseases have received careful scrutiny. Under the new Act, appropriations are specifically earmarked for venereal diseases, not exceeding $3 million for the year ending June, 1939, $5 million for 1940, 87 million for 1941 and for each succeeding fiscal year such sum as ma3~ be necessary. Part of this money (unspecified) will be available for staffing the United States Public Health Service, for carrying out investigations and demonstrations and for the printing of reports,
HEALTH THE JOURNAL OF
T H E SOCIETY OF MEDICAL OFFICERS OF HEALTH No. 10.
Vol. LI.
JULY, 1938
Subscription 81s. 6d. per annum, post free, in advance Single copies 2s. 6d. post free.
"Public Health" is the Official Organ of the Society of Medical Officers of Health and a suitable medium for the advertisement of official appointments vacant in the health service. Space is also available for a certain number of approved commercial advertisements. Application should be made to the Executive Secretary of the Society, at 1, Thornhaugh Street, Russell Square, London, W.C.1. Telephone: Museum 181,5. Telegrams: Epidauros, Westcent
Contents Editorial I n t e r - D e p a r t m e n t a l C o m m i t t e e on N u r s i n g Services Venereal Diseases in Scandinavia and t h e U . S . A .... C o n s t r u c t i o n a n d M a i n t e n a n c e o f Special Hospitals I n q u i r i e s into A b o r t i o n . . . . . . . . . . . . O u t d o o r Medical A s s i s t a n c e in Newcastle . . . . . . Provincial M e e t i n g of the Society . . . . . . . . .
PAGE 287 288 289 291 292 292
Special Articles H o w D o W e Assess N u t r i t i o n ? By E. H. Wilkins, M.B., D.P.H . . . . . . . . . . . . . . . . T h e C h i l d K e p t A p a r t from his Parents, By Ethel Cassie, M.D., D.P.H T h e N u r s i n g Services. Evidence given by t h e Society to t h e I n t e r - D e p a r t m e n t a l C o m m i t t e e .
.
.
.
.
.
.
.
.
.
.
.
.
293 299 305
News and Announcements Specialist Service for Bristol C o r p o r a t i o n Hospitals R e c e n t A p p o i n t m e n t s in t h e Public Health Service
317 317
Obituary H. D ' A r c y Ellis, M.R.C.S, L.R.C.P., j.p G. G. B u c h a n a n , M.B., B.SC. (P.H.), D.P.H . . . . W . M. Fisher, L.D.S., R.C.S. (ENG.) . . . . . . . . . J. M a u r i c e H a r p e r , v.n., M.R,C.S., D.P.H . . . . . . . . J. F. Haines, M.D., M.CH., lq.U.I . . . . . . . . . . .
.
.
.
.
.
303 303 304 304 304
.
Society of Medical Officers of Health Branch Meetings
Book Reviews
. . . . . . . . . . . .
...
318
............
...
320
Editorial Inter-Departmental Committee on Nursing Services During the past month local authorities and all other bodies responsible for hospital management have received a questionnaire from the Committee appointed by the Ministers of Health and Education to consider the recruitment, training and conditions of service of nurses. This Society (whose evidence is printed on pages 305-316 of the present issue) realises the great difficulty in gathering the facts about the nursing profession, its sources of supply, the conditions under which it works in different types of area and institution and the extent to which the present shortage is overcome by using the services of untrained women whose occupational prospects are doubtful. The number of nurses registered is rapidly increasing from year to year and yet the shortage remains unabated. No one knows how many nurses the country needs or is likely to need in the near future. Until some such information is collected, it is impossible to say what proportion of nurses tan be derived from secondary schools; how many can be found in the " A streams" of senior schools; whether it will be necessary, as a permanent policy, to recruit women unable to pass such an examination as the test recently instituted by the General Nursing Council, which, incidentally, has caused great inconvenience to local authorities; and, in the latter case, whether such recruits should receive a modified form of training for nursing of the chronic sick or work in other types of hospital which are not training schools. The questionnaire is intended to elicit some of the information relevant to these points. The Society's sub-committee failed to get a complete response to its own questionnaire and other bodies representing local government have had a similar experience. The Lancet Commission had the same difficulty, both with voluntary and council hospitals. Although the Inter-Departmental Committee is understood to have restricted its enquiry only to such information as is absolutely necessary to elucidate the position its questionnaire is more detailed than anything of the kind hitherto issued. Matrons of smaller hospitals may think 9_87
PUBLIC HEALTH its completion a formidable task. Yet it is quite as important if not more so, to have reliable facts about small as about large hospitals. The Medical Officer of Health is in a key position to see that they are supplied. The problems of nursing are of first importance both to the medical and nursing sections of the public health and local government service, and the whole weight of our influence should be used to ensure that the outcome of the enquiry is a real national survey and not merely a series of samples.
Venereal Diseases in Scandinavia and the U.S.A. In the light of a recent discussion on the Control of Venereal Diseases, reported in our issue of February last,* members of the public health service will study with interest the material of a more precise character to be found in the report of a deputation sent by the Minister of Health to examine the systems of Scandinavia and Holland.t The members of the deputation were Col. Harrison and Mr. Dudley Ward of the Ministry, Dr. Ferguson of the Department of Health for Scotland and Dr. Margaret Rorke of the Royal Free Hospital. In Denmark and Sweden the law provides, broadly, for anonymous reporting, compulsory treatment, notification by name in the event of discontinuance of, or failure to apply for, treatment, free treatment at clinics and penalties for transmission of the disease. Further, in Sweden, the practitioner consulted by a patient, must endeavour to trace the source of infection and report him or her by name and address. In Norway, notification without identification is prescribed, with the further provision that the name and address shall be transmitted if the patient ceases treatment prematurely; it is a punishable offence to infect another person or expose him to infection; free treatment is afforded only for sailors. Generally, the campaign against venereal disease is less vigorous in Norway, but a law similar to that of the sister countries is withheld only for financial reasons. The Dutch system in all essential points is similar to our own, except that such free treatment as is afforded is not given out of public funds, while the non-statutory work of following up patients and contacts is perhaps receiving more attention than with us. The law in Denmark and Sweden seems to be actively operated. It is generally accepted and attempts to evade it appear to be relatively uncommon. In the early days of compulsion in * Public Health, 51, 135.
Ministry of Health: Reports on Pub. Health and Med. Subjects, No. 83. 1938. H.M. Stationery Office, 2s. 6d. 288
JULY Denmark, some measure of which dates from 1788, there was opposition, often violent. The Swedish law of 1918 was passed only after tong discussion and much resistance, partly due to the concurrent abolition of the regulation of prostitution. In both countries the medical profession and the people are now firmly convinced of its value. The deputation made as careful a comparison as possible of the decline in venereal diseases in these several countries and in Great Britain. The tables and charts contained in their report will repay careful examination. They conclude that a substantial measure of success in reducing the incidence of syphilis has been achieved in all five countries under varying law. None has been outstandingly successful in reducing gonorrh~ea. In their view, compulsory treatment is not a major factor influencing the results of anti-venereal methods. The only comments we would make on this report at present are (1) that perhaps too much weight is given to the equivocal estimates of incidence in Great Britain, based on attendances at clinics, (2) that, as .measured by congenital syphilis, our position is distinctly inferior, and it is a mere presumption that this is due to the lesser frequency of routine serum tests in pregnancy, and (3) that the long-term effect on individual cases of treatment completed under compulsion is not sufficiently stressed. The Report does, however, enable us to view the problem in better perspective. On May 25th, President Roosevelt signed an Act imposing additional duties on the United States Public Health Service in connection with the investigation and control of venereal diseases. Like other public health problems, venereal diseases are primarily the concern of State and local authorities, but federal intervention is not entirely new. In 1935, the Social Security Act made provision, among other things, for conditional grants from federal monies for improving local public health services, to be administered, in the first instance, through State health departments. Such grants are given under Regulations of 1936, made by the Surgeon-General, and depend partly on the nature of the programmes submitted to him by these departments, in which, no doubt, the measures proposed for the control of venereal diseases have received careful scrutiny. Under the new Act, appropriations are specifically earmarked for venereal diseases, not exceeding $3 million for the year ending June, 1939, $5 million for 1940, 87 million for 1941 and for each succeeding fiscal year such sum as ma3~ be necessary. Part of this money (unspecified) will be available for staffing the United States Public Health Service, for carrying out investigations and demonstrations and for the printing of reports,