- Email: [email protected]
Malnourished children
PUBLIC HEALTH,
47
D e c e m b e r , ~954
r a t h e r t h a n wait till a wholesale c h a n g e m i g h t iniraculousl~" occur, nIight it n o t be a good b e g i n n i n g to s t a r t s o m e e x p e n n i e n t a l clinics, where doctors t r a i n e d in m e n t a l h e a l t h , could assess a n d t r e a t e v e r y d a y p r o b l e m cases? Such a clinic, w i t h a flexible t i m e - t a b l e , less h a r r a s s e d b y n u m b e r s a n d f o r m s would give a n o p p o r t u n i t y to really c o m p r e h e n s i v e assessmerit of t o - d a y ' s p r o b l e m s a n d t w o }'ears" work written u p would p r o v i d e a m o s t useful p o i n t e r to w h a t f o r m f u t u r e m e n t a l h e a l t h clinics m i g h t take. Y o u r s faithfull',', H. Sv_~ox[,s, M.O., L.C.C.
pressing character face the health administrations of the countries of Europe. The public health aspects of cardiovascular disease and cancer, the new problems of food sanitation a r i s i n g p a r t i c u l a r l y f r o m t h e u s e o f p r e s e r v a t i v e s a n d a d d i t i v e s , t h e a d j u s t m e n t o f h e a l t h s e r v i c e s to a n a g e i n g p o p u l a t i o n m e all s u b j e c t s o n w h i c h W H O m i g h t u s e f u l l y f o c u s its a t t e n t i o n in t h e c o m i n g y e a r s .
CORRESPONDENCE
Clinical A s s i s s t a n t S t . G,zorge's H o s p i t a l C h i l d G u i d a n c e Clinic.
MV-N'!AL I-1EALTP! IN PUBLIC t~-LALTH PRACTICE
S I R , - - D r . M a c Q u e e n ' s a d m i r a b l y far-seeing article in y o u r last issue t o u c h e s on e x t r e m e l y vital points. F o r y e a r s t h e r e h a s been a g r o w i n g c o n v i c t i o n t h a t a d u l t n e r v o u s disorders h a v e a h i s t o r y f a r back in t h e i n d i v i d u a l ' s p a s t a n d t h a t of his p a r e n t s ' t~ast. It was also felt, t h a t child neuroses h a v e b e g u n w i t h s y m p t o m s h a r d l y d i s t i n g u i s h a b l e f r o m t h e " norreal " d i s t u r b a n c e s of d e v e l o p m e n t . As w i t h all o t h e r diseases, p r e v e n t i o n w o u l d h a v e to t a c k l e t h e d i s e a s e - t o - b e a t a s t a g e w h e n t h e earliest d i s t u r b a n c e shows. No one in t h e whole H e a l t h Service is in as good a position as t h e C~inic Medical Officer for recognising t h e s t r a i n s a n d stresses in a f a m i l y relationships, p r o v i d e d h e is able to see it. U n t o r t u n a t o t y , i n s i g h t into m e n t M m a k e - u p , c h a r a c t e r traits a n d e n s u i n g difficulties, j u s t as m u c h as l i n k i n g t h e p r e s e n t slight s e e m i n g s y m p t o m w i t h h i s f u t u r e cousin of m a l a d j u s t m e n t or a b e r r a t i o n , is a discipline w h i c h h a s t o be l e a r n t like a n y other. It is n e x t to impossible for s o m e o n e t h o r o u g h l y t r a i n e d in p h y s i c a l m e t h o d s , a n d w i t h o u t f u ~ h e r knowledge, to p e r f o r m t h e t a s k of h e l p i n g t h e m o t h e r to see where h e r contlicts w i t h t h e child are l e a d i n g t h e m both. T h e r e are y e a r l y s~tatistics dealing w i t h all f o r m s of p u b lic h e a l t h work, b u t , as f a r as I know, t h e r e is n o w r i t t e n record of t h e v a r i o u s t y p e s of p r o b l e m s m e t w i t h in clinic practice. E q u a l l y a really u~eful g u i d e e x p l a i n i n g t h e interaction of i n s t i n c t u a l forces a n d their v i c i s s i t u d e s a n d a t w h a t p o i n t a difficulty b e c o m e s a disease, is needed. T h a t public h e a l t h clinics m i g h t in t h e f u t u r e b e c o m e m e n t a l h e a l t h clinics s e e m s a n a c c e p t e d possibility. B u t
W h i t e Poplars, Alton .Road, R o e h a m p t o n , S.W.15. November 6 l h , x954. MALNOURISHED CHILDREN
G t R , - - A few p o i n t s in t h e v e r y i n t e r e s t i n g article '" Stress Disorders in Chitdlaood,'" b y Dr. R o n a l d M a c K e i t h (p. I27, S e p t e m b e r , I954), calI for c o m m e n t . , I t would be a g r a v e m i s t a k e to a s s u m e t h a t m a l n u t r i t i o n is no longer a p r o b l e m in L o n d o n , even t h o u g h it be less t h a n in t h e " H u n g r y T h i r t i e s . " N u t r i t i o n clinics do n o t now in f a c t n o r m a l l y deal w i t h enuresis a t all. Moreover, m a n y cases of m a l n a t r i t i o n are m o r e a p p r o p r i a t e l y dealt w i t h b y o t h e r m e a n s , e.g. advice b y t h e school doctor on diet a n d m a n a g e m e n t , a r e c u p e r a t i v e h o l i d a y , or t r a n s f e r to a n o p e n air school. I t is s e l d o m t h a t tl~ere is n o t a s'ubstantial ~ a i t i n g list for open air schools. I n I952 t h e general condition of chitdren e x a m i n e d in L o n d o n schools was classified t h u s : Good Fair Poor 50.5% 47.I% 2,4% S u c h a s s e s s m e n t s are, of course, subjec~cive a n d p r o b a b l y t e n d to err o n the generous side. N e v e r t h e l e s s , 4 9 . 5 % were classifiel as less t h a n " G o o d . " T h e r e are still considerable pools of ill-nourished children w h o s e diets are defective in p r o t e i n s a n d excessive in c a r b o h y d r a t e s . I n m a n y families no cooked b r e a k f a s t is provided- a n d t h e child ieaves for school on a basis of t o a s t a n d tea, or a p l a t e of cereal o u t
Keeping in touch with the man on the spot
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a c t i v i t i e s a n d a p p l y i n f o r m a t i o n r e c e i v e d f r o m t h e m . T h e sets a r e v e r s a t i l e a n d adaptable, robust, carefully engineered miniature units, extremely ] in numerous
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PUBLIC HEALTH,
48 of a p a c k e t . S u c h c h i l d r e n c a n o f t e n be identified a t a glance. Disraeli's~ '" T w o N a t i o n s " are still all t o o e v i d e n t - on n u t r i t i o n a l s t a n d a r d s , if no other, Y o u r s faithfully, GEOFFREY G. ~HERRIFF, M.B., D.P.FI. i, Vicarage Gate, London, W.8. October
25th,
1954 .
A TRIBUTE TO STELLA CHURCHILL Dr. Stclla Churchill, w h o died in M e n t o n e o n S e p t e m b e r i 6 t h , a t t h e a g e of 7 I, w a s u n t i l h e r h e a l t h b r o k e d o w n a n a c t i v e a n d well-beloved m e m b e r of fi~e Society of Medical Officers of H e a l t h . A g r a d u a t e in 1917 f r o m t h e L o n d o n School of Medicine for , W g t n e n , s h e s e r v e d as A . M . O . H . in B e n n o n d s e y , a n d f r o m i92o-24 as d e p u t y M . O . H . St. P a n c r a s , betore e n t e r i n g local politics a n d s e r v i n g as a m e m b e r of t h e L.C.C. f r o m 1925-32. I n h e r professional career s h e t u r n e d to p s y c h i a t r y , b e i n g a m e m b e r of t h e staff of t h e T a v i s t o c k Clinic for i o year~ f r o m 1936. Stella Churchill h a d m u c h to do w i t h t h e d e v e l o p m e n t o f t h e p r e s e n t h i g h influence a n d prestige of t h e M a t e r n i t y a n d Child W e l f a r e G r o u p in t h e Society. W e a r e p a r t i c u l a r l y glad, therefore, to h a v e t h e o p p o r t u n i t y of p u b l i s h i n g t h e ~[ollowing personal t r i b u t e f r o m o n e of h e r friends w h o was a n o t h e r of t h e f o u n d e r m e m b e r s of t h e G r o u p : - " M u c h was a c c o m p l i s h e d d u r i n g t h e e a r l y t h i r t i e s in vision a n d i m a g i n a t i o n to p r e p a r e for t h e y e a r s of c o n s t r u c t i o n a n d for e n s u i n g s y s t e m s of ' social m e d i c i n e . ' Many who s o u n d e d t h e - e a r l y c l a r i o n calls h a v e passed. I n r e c e n t weeks we m o u r n t w o i m p o r t a n t w o m e n Btelta Churchill a n d D a m e Janet Campbell. I t is of Stella t h a t I w o u l d write, a n d in 'a p e r s o n a l sense, as s h e was m y friend. N o m a t t e r zthat t h a t privilege was s h a r e d b y a vasCc a n d v a r i e d c o m p a n y , it was n o n e t h e less peculiar a n d i n t i m a t e . O n e d i d n o t h a v e t o see Stella f r e q u e n t l y t o be a s s u r e d of t h e living w a r m t h of h e r h u m a n i t y or t h e reality of t h e ' s p a r k ' t h a t fired h e r e v e r y c o n t a c t , w h e t h e r with p e r s o n s or ideas. T h a t s h e i m p r e s s e d so m a n y w i t h h e r lovableness a n d h e r s a g a c i t y - s h e w h o could be s a r d o n i c - - w a s in no s m a l l degree d u e to h e r c a p a c i t y for living o t h e r p e o p l e ' s exoeriences, for a b s o r b i n g a n d profiting b y t h e m , as b y h e r own. " W e m e t in t h e Society in t h e e a r l y ' t w e n t i e s w h e n a h a n d f u l of ve~.turers joined to t r y ou*c t h e c h a n c e s of a M a t e r n i t y a n d Child W e l f a r e G r o u p , first s u c h oflmhoot, if I r e m e m b e r r i g h t l y , of t h e p a r e n t b o d y . ' G r o u p ' is a word in g r e a t f a v o u r n o w a d a y s . I q u e s t i o n if. as a rule it conn o t e s a n y t h i n g p o s s e s s i n g s u c h marl~ed resilience, s u c h a m p l i t u d e a n d s p r y n e s s in m i d d l e life as t h i s first child of t h e Society. Stella was a l r e a d y a ' figure,' r e m a r k a b l e a m o n g u s as a n a c t i n g M . O . H . , h e r chief a t St. P a n c r a s b e i n g al~sent a b r o a d o n p r o l o n g e d sick leave. Small a n d slight, l e w i s h of feature, w i t h tin5? h a n d s a n d feet, s h e h a d b o t h presence a n d v i v a c i t y , wits a n d i m p e r t u r b a b l e bonh o m i e t o i m p r e s s a t t h e i r o w n level t h e a d m i n i s * r a t i v e ' bosses ' w h o s o m e t i m e s p e n e t r a t e d o u r junior, m a i n l y female r a n k s . I n t h o s e earlier y e a r s t h e G r o u p r a n to s u b - C o m m i t tees which, w i t h r e p r e s e n t a t i v e s f r o m t h e p a r e n t Society, t h e M i n i s t r y , t h e ]3.M.A., t h e R o y a l Society of Medicine a n d o t h e r a u g u s t bodies, considered s u c h s u b j e c t s as t h e introd u c t i o n of m a t e r n a l a n d child h y g i e n e i n t o t h e m e d i c a l curr i c u l u m a n d t h e a l i g n m e n t of M. a n d C . W . clinics a n d o t h e r services, s u c h as h o m e visiting, w i t h t h e h o s p i t a l services. Stella w i t h h e r b r o a d views, clear delivery a n d a b i l i t y to weigh personalities r a p i d l y a n d accurately, contributed g r e a t l y in t h e s e discussions. M o t h e r of a p a i r of t e e n a g e c h i l d r e n (one of w h o m l a t e r p r e s e n t e d h e r w i t h h e r b u n c h of beloved g r a n d c h i l d r e n ) , k e e n l y e n g a g e d in s i n g l e - p a r e n t u p b r i n g i n g , s h e was e q u a l l y v a l u a b l e to t h e G r o u p in its m o r e d o m e s t i c sessions, providing, w h e n o u r n u m b e r s were
D e c e m b e r , 1954
small, t h e elixir of f i l s t - h a n d experience a n d cooling s p r a y s of c o m m o n s e n s e . "' W i d e as was h e r c o m p r e h e n s i o n , a n d c o n s t a n t a n d catholic h e r s t u d y . Stella was n e v e r a c a d e m i c : in f a c t one m i g h t s a y t h a t s t e r e o t y p e s lines of t h o u g h t a n d c o n d u c t bored her. A f t e r a d e c a d e in t h e P u b l i c H e a l t h Service she seized a c o n v e n i e n t o p p o r t u n i t y - - o n b e c o m i n g financially i n d e p e n d e n t - - t o t h r o w off t h e s h a c k l e s a n d b l a z e h e r own trails: b u t alway~ in t h e direction of w a k e n i n g t h e public to b e t t e r ideas of h e a l t h . R e s i g n i n g h e r a p p o i n t m e n t she o p e n e d h e r own clinic in S.E. L o n d o n : t h e n c e f o r w a r d , o p e r a t i n g on a p e r s o n a l w a v e - l e n g t h , q u i e t l y p l u g g e d t h e e t h e r with t h e t e n e t s of h e r f a i t h in Society i~_~eetings, in a n d t h r o u g h political c a n d i d a t u r e , local g o v e r n m e n t service, b r o a d c a s t i n g , lectures, articles, books. M u c h of h e r credo, r e p r e s e n t a t i v e of a n a d v a n c e d sociology, h a s now b e c o m e law. If we record our t h a n k s for a m e a s u r e of social medicine, we s h o u l d n o t forget Stella, ~ h o preachec~ in t h e hedgercw~ as well as ill t h e s a n c t u a r i e s . A p u n g e n t speaker, h e r voice r a s p i n g alr:~ost, in c o n t r a s t w i t h h e r serene m a n n e r , she held h e r a u d i e n c e s in h e r h a n d : a n d n o t l e a s t in afterd i n n e r speaking, where a m o n g experts, she excelled. N o t often does a w o m a n c o m m a n d s u c h wit, c h a r m , influence w i t h o u t a h i n t of t r a i t o r coyness, or c o n c e i t . 9 " T h r o u g h t h e ' t h i r t i e s Stella c o u t i n u e d to a t t e n d m e e t ings of t h e Society. s e r v i n g as G r o u p Vice-President a n d PreMdent a n d as a m e m b e r of Council. A n a l y s e d b y J u n g , she decided to t a k e up p s y c h i a t r i c practice. B u t only a year or t w o ago r e n e w e d h e r G r o u p c o n t a c t s b y offering h e r be~autiful h o u s e in R e g e n t ' s P a r k for a R e c e p t i o n g i v e n t o child h e a l t h specialists ~isiting f r o m W e s t e r n a n d E a s t e r n E u r o p e . "' N o personal record of Stella w o u l d r i n g t r u e t h a t failed to describe h e r i n t e n s e courage. A t a n early G r o u p P r o v i n cial M e e t i n g s h e t u r n e d u p h a g g a r d , weak, e m a c i a t e d , w i t h blue lips. Smiling she said t h a t she h a d diabetes, b u t t h a t insulin was available. T h r o u g h t h i r t y y e a r s s h e c o n t i n u e d h e r d e p e n d e n c e o n insulin a n d w i t h o t h e r doctors p r o c l a i m e d t h e fact, in t h e D i a b e t i c L e a g u e m e m b e r s h i p , to help others. I n h e r late sixties she suffered a c a r collision. H e r r i g h t t h i g h f r a c t u r e d , s h e was rescued f r o m i m m i n e n t c o m a b y a t e l e p h o n e call f r o m L o n d o n . T h e r e a f t e r laid for e i g h t m o n t h s in a M i d l a n d s h o s p i t a l w i t h h e r leg in s u s p e n s i o n . R e t u r n ing exceedingly lame, w i t h several inches s h o r t e n i n g , s h e decided t h a t s h e would n o t h a v e a limp. B y ~heer doggedness she o v e r c a m e or concealed it, a n d t o o k a g a i n to swimruing. T h i s year, a f t e r a coronary, s h e w e n t for h e r u s u a l I t a l i a n h o l i d a y : a n d died quietly, u n o b s e r v e d , a t t h e end of a full d a y . " H o w feeble t h e s e few recollections of S t e l l a - - t h e inw a r d l y rich, t h e erect, t h e u r b a n e . She w a s a s t a u n c h friend, a j o y o u s c o m r a d e , a r a d i a n t hostess, a f~ithful p a t r o n (of m a n v arts a n d artists), a priestess in t h e c a u s e of a wider c h a r i t y . W h a t could colleagues wish m o r e ? " M.E.
NORTH WESTERN BRANCH Dr. A. V. S t o c k s ( M . O . H Eccles M . B . , a n d I r l a m U . D . , a n d Div. M.O. L a n c a s h i r e ) . H e n . S e c r e t a r y . . Dr. J. J. G. B u r n e t t (M.O.H. PrestoJi C.B.). A n o r d i n a r y m e e t i n g o5 t h e B r a n c h w a s held in M a n c h e s t e r . on F r i d a y , N o v e m b e r 5th, w h e n 30 m e m b e r ~ at-tended. Dr. J. B. M. D a v i e s (Dep. M . O . H . , Liverpool) reviewed c o m p r e h e n s i v e l y t h e W e l f a r e Services e n v i s a g e d for t h e h a n d i c a p p e d a d u l t . A keen d i s c u s s i o n e n s u e d in which, i n t e r a l i a , Drs. Yule, W a r r e n , J o n e s a n d H i I d i t c h joined, t h e l a t t e r e x p r e s s i n g t h e t h a n k s of t h e a s s e m b l e d m e m b e r s to t h e speaker. A request from the Manchester Regional Hospital Board's W o r k i n g P a r t y for t h e B r a n c h ' s views on t h e a d v i s a b i l i t y of e s t a b l i s h i n g hostels for c e r t a i n m e n t a l defectives n o t in need of h o s p i t a l t r e a t m e n t w a s considered. I t was decided to i n v i t e t h e R e g i o n a l A d v i s e r on P s y c h i a t r y to enlarge on t h e s u g g e s *ions n l a d e a t a l a t e r c o n v e n i e n t m e e t i n g of t h e b r a n c h . I t was resolved, on t h e proposi{ion of t h e P r e s i d e n t , t h a t t h e c o n g r a t u l a t i o n s of t h e m e e t i n g be e x t e n d e d to Dr. Metcalfe B r o w n on his elections as C h a i r m a n of t h e Council of t h e Society. President:
* Usual published announcement.
47
D e c e m b e r , ~954
r a t h e r t h a n wait till a wholesale c h a n g e m i g h t iniraculousl~" occur, nIight it n o t be a good b e g i n n i n g to s t a r t s o m e e x p e n n i e n t a l clinics, where doctors t r a i n e d in m e n t a l h e a l t h , could assess a n d t r e a t e v e r y d a y p r o b l e m cases? Such a clinic, w i t h a flexible t i m e - t a b l e , less h a r r a s s e d b y n u m b e r s a n d f o r m s would give a n o p p o r t u n i t y to really c o m p r e h e n s i v e assessmerit of t o - d a y ' s p r o b l e m s a n d t w o }'ears" work written u p would p r o v i d e a m o s t useful p o i n t e r to w h a t f o r m f u t u r e m e n t a l h e a l t h clinics m i g h t take. Y o u r s faithfull',', H. Sv_~ox[,s, M.O., L.C.C.
pressing character face the health administrations of the countries of Europe. The public health aspects of cardiovascular disease and cancer, the new problems of food sanitation a r i s i n g p a r t i c u l a r l y f r o m t h e u s e o f p r e s e r v a t i v e s a n d a d d i t i v e s , t h e a d j u s t m e n t o f h e a l t h s e r v i c e s to a n a g e i n g p o p u l a t i o n m e all s u b j e c t s o n w h i c h W H O m i g h t u s e f u l l y f o c u s its a t t e n t i o n in t h e c o m i n g y e a r s .
CORRESPONDENCE
Clinical A s s i s s t a n t S t . G,zorge's H o s p i t a l C h i l d G u i d a n c e Clinic.
MV-N'!AL I-1EALTP! IN PUBLIC t~-LALTH PRACTICE
S I R , - - D r . M a c Q u e e n ' s a d m i r a b l y far-seeing article in y o u r last issue t o u c h e s on e x t r e m e l y vital points. F o r y e a r s t h e r e h a s been a g r o w i n g c o n v i c t i o n t h a t a d u l t n e r v o u s disorders h a v e a h i s t o r y f a r back in t h e i n d i v i d u a l ' s p a s t a n d t h a t of his p a r e n t s ' t~ast. It was also felt, t h a t child neuroses h a v e b e g u n w i t h s y m p t o m s h a r d l y d i s t i n g u i s h a b l e f r o m t h e " norreal " d i s t u r b a n c e s of d e v e l o p m e n t . As w i t h all o t h e r diseases, p r e v e n t i o n w o u l d h a v e to t a c k l e t h e d i s e a s e - t o - b e a t a s t a g e w h e n t h e earliest d i s t u r b a n c e shows. No one in t h e whole H e a l t h Service is in as good a position as t h e C~inic Medical Officer for recognising t h e s t r a i n s a n d stresses in a f a m i l y relationships, p r o v i d e d h e is able to see it. U n t o r t u n a t o t y , i n s i g h t into m e n t M m a k e - u p , c h a r a c t e r traits a n d e n s u i n g difficulties, j u s t as m u c h as l i n k i n g t h e p r e s e n t slight s e e m i n g s y m p t o m w i t h h i s f u t u r e cousin of m a l a d j u s t m e n t or a b e r r a t i o n , is a discipline w h i c h h a s t o be l e a r n t like a n y other. It is n e x t to impossible for s o m e o n e t h o r o u g h l y t r a i n e d in p h y s i c a l m e t h o d s , a n d w i t h o u t f u ~ h e r knowledge, to p e r f o r m t h e t a s k of h e l p i n g t h e m o t h e r to see where h e r contlicts w i t h t h e child are l e a d i n g t h e m both. T h e r e are y e a r l y s~tatistics dealing w i t h all f o r m s of p u b lic h e a l t h work, b u t , as f a r as I know, t h e r e is n o w r i t t e n record of t h e v a r i o u s t y p e s of p r o b l e m s m e t w i t h in clinic practice. E q u a l l y a really u~eful g u i d e e x p l a i n i n g t h e interaction of i n s t i n c t u a l forces a n d their v i c i s s i t u d e s a n d a t w h a t p o i n t a difficulty b e c o m e s a disease, is needed. T h a t public h e a l t h clinics m i g h t in t h e f u t u r e b e c o m e m e n t a l h e a l t h clinics s e e m s a n a c c e p t e d possibility. B u t
W h i t e Poplars, Alton .Road, R o e h a m p t o n , S.W.15. November 6 l h , x954. MALNOURISHED CHILDREN
G t R , - - A few p o i n t s in t h e v e r y i n t e r e s t i n g article '" Stress Disorders in Chitdlaood,'" b y Dr. R o n a l d M a c K e i t h (p. I27, S e p t e m b e r , I954), calI for c o m m e n t . , I t would be a g r a v e m i s t a k e to a s s u m e t h a t m a l n u t r i t i o n is no longer a p r o b l e m in L o n d o n , even t h o u g h it be less t h a n in t h e " H u n g r y T h i r t i e s . " N u t r i t i o n clinics do n o t now in f a c t n o r m a l l y deal w i t h enuresis a t all. Moreover, m a n y cases of m a l n a t r i t i o n are m o r e a p p r o p r i a t e l y dealt w i t h b y o t h e r m e a n s , e.g. advice b y t h e school doctor on diet a n d m a n a g e m e n t , a r e c u p e r a t i v e h o l i d a y , or t r a n s f e r to a n o p e n air school. I t is s e l d o m t h a t tl~ere is n o t a s'ubstantial ~ a i t i n g list for open air schools. I n I952 t h e general condition of chitdren e x a m i n e d in L o n d o n schools was classified t h u s : Good Fair Poor 50.5% 47.I% 2,4% S u c h a s s e s s m e n t s are, of course, subjec~cive a n d p r o b a b l y t e n d to err o n the generous side. N e v e r t h e l e s s , 4 9 . 5 % were classifiel as less t h a n " G o o d . " T h e r e are still considerable pools of ill-nourished children w h o s e diets are defective in p r o t e i n s a n d excessive in c a r b o h y d r a t e s . I n m a n y families no cooked b r e a k f a s t is provided- a n d t h e child ieaves for school on a basis of t o a s t a n d tea, or a p l a t e of cereal o u t
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48 of a p a c k e t . S u c h c h i l d r e n c a n o f t e n be identified a t a glance. Disraeli's~ '" T w o N a t i o n s " are still all t o o e v i d e n t - on n u t r i t i o n a l s t a n d a r d s , if no other, Y o u r s faithfully, GEOFFREY G. ~HERRIFF, M.B., D.P.FI. i, Vicarage Gate, London, W.8. October
25th,
1954 .
A TRIBUTE TO STELLA CHURCHILL Dr. Stclla Churchill, w h o died in M e n t o n e o n S e p t e m b e r i 6 t h , a t t h e a g e of 7 I, w a s u n t i l h e r h e a l t h b r o k e d o w n a n a c t i v e a n d well-beloved m e m b e r of fi~e Society of Medical Officers of H e a l t h . A g r a d u a t e in 1917 f r o m t h e L o n d o n School of Medicine for , W g t n e n , s h e s e r v e d as A . M . O . H . in B e n n o n d s e y , a n d f r o m i92o-24 as d e p u t y M . O . H . St. P a n c r a s , betore e n t e r i n g local politics a n d s e r v i n g as a m e m b e r of t h e L.C.C. f r o m 1925-32. I n h e r professional career s h e t u r n e d to p s y c h i a t r y , b e i n g a m e m b e r of t h e staff of t h e T a v i s t o c k Clinic for i o year~ f r o m 1936. Stella Churchill h a d m u c h to do w i t h t h e d e v e l o p m e n t o f t h e p r e s e n t h i g h influence a n d prestige of t h e M a t e r n i t y a n d Child W e l f a r e G r o u p in t h e Society. W e a r e p a r t i c u l a r l y glad, therefore, to h a v e t h e o p p o r t u n i t y of p u b l i s h i n g t h e ~[ollowing personal t r i b u t e f r o m o n e of h e r friends w h o was a n o t h e r of t h e f o u n d e r m e m b e r s of t h e G r o u p : - " M u c h was a c c o m p l i s h e d d u r i n g t h e e a r l y t h i r t i e s in vision a n d i m a g i n a t i o n to p r e p a r e for t h e y e a r s of c o n s t r u c t i o n a n d for e n s u i n g s y s t e m s of ' social m e d i c i n e . ' Many who s o u n d e d t h e - e a r l y c l a r i o n calls h a v e passed. I n r e c e n t weeks we m o u r n t w o i m p o r t a n t w o m e n Btelta Churchill a n d D a m e Janet Campbell. I t is of Stella t h a t I w o u l d write, a n d in 'a p e r s o n a l sense, as s h e was m y friend. N o m a t t e r zthat t h a t privilege was s h a r e d b y a vasCc a n d v a r i e d c o m p a n y , it was n o n e t h e less peculiar a n d i n t i m a t e . O n e d i d n o t h a v e t o see Stella f r e q u e n t l y t o be a s s u r e d of t h e living w a r m t h of h e r h u m a n i t y or t h e reality of t h e ' s p a r k ' t h a t fired h e r e v e r y c o n t a c t , w h e t h e r with p e r s o n s or ideas. T h a t s h e i m p r e s s e d so m a n y w i t h h e r lovableness a n d h e r s a g a c i t y - s h e w h o could be s a r d o n i c - - w a s in no s m a l l degree d u e to h e r c a p a c i t y for living o t h e r p e o p l e ' s exoeriences, for a b s o r b i n g a n d profiting b y t h e m , as b y h e r own. " W e m e t in t h e Society in t h e e a r l y ' t w e n t i e s w h e n a h a n d f u l of ve~.turers joined to t r y ou*c t h e c h a n c e s of a M a t e r n i t y a n d Child W e l f a r e G r o u p , first s u c h oflmhoot, if I r e m e m b e r r i g h t l y , of t h e p a r e n t b o d y . ' G r o u p ' is a word in g r e a t f a v o u r n o w a d a y s . I q u e s t i o n if. as a rule it conn o t e s a n y t h i n g p o s s e s s i n g s u c h marl~ed resilience, s u c h a m p l i t u d e a n d s p r y n e s s in m i d d l e life as t h i s first child of t h e Society. Stella was a l r e a d y a ' figure,' r e m a r k a b l e a m o n g u s as a n a c t i n g M . O . H . , h e r chief a t St. P a n c r a s b e i n g al~sent a b r o a d o n p r o l o n g e d sick leave. Small a n d slight, l e w i s h of feature, w i t h tin5? h a n d s a n d feet, s h e h a d b o t h presence a n d v i v a c i t y , wits a n d i m p e r t u r b a b l e bonh o m i e t o i m p r e s s a t t h e i r o w n level t h e a d m i n i s * r a t i v e ' bosses ' w h o s o m e t i m e s p e n e t r a t e d o u r junior, m a i n l y female r a n k s . I n t h o s e earlier y e a r s t h e G r o u p r a n to s u b - C o m m i t tees which, w i t h r e p r e s e n t a t i v e s f r o m t h e p a r e n t Society, t h e M i n i s t r y , t h e ]3.M.A., t h e R o y a l Society of Medicine a n d o t h e r a u g u s t bodies, considered s u c h s u b j e c t s as t h e introd u c t i o n of m a t e r n a l a n d child h y g i e n e i n t o t h e m e d i c a l curr i c u l u m a n d t h e a l i g n m e n t of M. a n d C . W . clinics a n d o t h e r services, s u c h as h o m e visiting, w i t h t h e h o s p i t a l services. Stella w i t h h e r b r o a d views, clear delivery a n d a b i l i t y to weigh personalities r a p i d l y a n d accurately, contributed g r e a t l y in t h e s e discussions. M o t h e r of a p a i r of t e e n a g e c h i l d r e n (one of w h o m l a t e r p r e s e n t e d h e r w i t h h e r b u n c h of beloved g r a n d c h i l d r e n ) , k e e n l y e n g a g e d in s i n g l e - p a r e n t u p b r i n g i n g , s h e was e q u a l l y v a l u a b l e to t h e G r o u p in its m o r e d o m e s t i c sessions, providing, w h e n o u r n u m b e r s were
D e c e m b e r , 1954
small, t h e elixir of f i l s t - h a n d experience a n d cooling s p r a y s of c o m m o n s e n s e . "' W i d e as was h e r c o m p r e h e n s i o n , a n d c o n s t a n t a n d catholic h e r s t u d y . Stella was n e v e r a c a d e m i c : in f a c t one m i g h t s a y t h a t s t e r e o t y p e s lines of t h o u g h t a n d c o n d u c t bored her. A f t e r a d e c a d e in t h e P u b l i c H e a l t h Service she seized a c o n v e n i e n t o p p o r t u n i t y - - o n b e c o m i n g financially i n d e p e n d e n t - - t o t h r o w off t h e s h a c k l e s a n d b l a z e h e r own trails: b u t alway~ in t h e direction of w a k e n i n g t h e public to b e t t e r ideas of h e a l t h . R e s i g n i n g h e r a p p o i n t m e n t she o p e n e d h e r own clinic in S.E. L o n d o n : t h e n c e f o r w a r d , o p e r a t i n g on a p e r s o n a l w a v e - l e n g t h , q u i e t l y p l u g g e d t h e e t h e r with t h e t e n e t s of h e r f a i t h in Society i~_~eetings, in a n d t h r o u g h political c a n d i d a t u r e , local g o v e r n m e n t service, b r o a d c a s t i n g , lectures, articles, books. M u c h of h e r credo, r e p r e s e n t a t i v e of a n a d v a n c e d sociology, h a s now b e c o m e law. If we record our t h a n k s for a m e a s u r e of social medicine, we s h o u l d n o t forget Stella, ~ h o preachec~ in t h e hedgercw~ as well as ill t h e s a n c t u a r i e s . A p u n g e n t speaker, h e r voice r a s p i n g alr:~ost, in c o n t r a s t w i t h h e r serene m a n n e r , she held h e r a u d i e n c e s in h e r h a n d : a n d n o t l e a s t in afterd i n n e r speaking, where a m o n g experts, she excelled. N o t often does a w o m a n c o m m a n d s u c h wit, c h a r m , influence w i t h o u t a h i n t of t r a i t o r coyness, or c o n c e i t . 9 " T h r o u g h t h e ' t h i r t i e s Stella c o u t i n u e d to a t t e n d m e e t ings of t h e Society. s e r v i n g as G r o u p Vice-President a n d PreMdent a n d as a m e m b e r of Council. A n a l y s e d b y J u n g , she decided to t a k e up p s y c h i a t r i c practice. B u t only a year or t w o ago r e n e w e d h e r G r o u p c o n t a c t s b y offering h e r be~autiful h o u s e in R e g e n t ' s P a r k for a R e c e p t i o n g i v e n t o child h e a l t h specialists ~isiting f r o m W e s t e r n a n d E a s t e r n E u r o p e . "' N o personal record of Stella w o u l d r i n g t r u e t h a t failed to describe h e r i n t e n s e courage. A t a n early G r o u p P r o v i n cial M e e t i n g s h e t u r n e d u p h a g g a r d , weak, e m a c i a t e d , w i t h blue lips. Smiling she said t h a t she h a d diabetes, b u t t h a t insulin was available. T h r o u g h t h i r t y y e a r s s h e c o n t i n u e d h e r d e p e n d e n c e o n insulin a n d w i t h o t h e r doctors p r o c l a i m e d t h e fact, in t h e D i a b e t i c L e a g u e m e m b e r s h i p , to help others. I n h e r late sixties she suffered a c a r collision. H e r r i g h t t h i g h f r a c t u r e d , s h e was rescued f r o m i m m i n e n t c o m a b y a t e l e p h o n e call f r o m L o n d o n . T h e r e a f t e r laid for e i g h t m o n t h s in a M i d l a n d s h o s p i t a l w i t h h e r leg in s u s p e n s i o n . R e t u r n ing exceedingly lame, w i t h several inches s h o r t e n i n g , s h e decided t h a t s h e would n o t h a v e a limp. B y ~heer doggedness she o v e r c a m e or concealed it, a n d t o o k a g a i n to swimruing. T h i s year, a f t e r a coronary, s h e w e n t for h e r u s u a l I t a l i a n h o l i d a y : a n d died quietly, u n o b s e r v e d , a t t h e end of a full d a y . " H o w feeble t h e s e few recollections of S t e l l a - - t h e inw a r d l y rich, t h e erect, t h e u r b a n e . She w a s a s t a u n c h friend, a j o y o u s c o m r a d e , a r a d i a n t hostess, a f~ithful p a t r o n (of m a n v arts a n d artists), a priestess in t h e c a u s e of a wider c h a r i t y . W h a t could colleagues wish m o r e ? " M.E.
NORTH WESTERN BRANCH Dr. A. V. S t o c k s ( M . O . H Eccles M . B . , a n d I r l a m U . D . , a n d Div. M.O. L a n c a s h i r e ) . H e n . S e c r e t a r y . . Dr. J. J. G. B u r n e t t (M.O.H. PrestoJi C.B.). A n o r d i n a r y m e e t i n g o5 t h e B r a n c h w a s held in M a n c h e s t e r . on F r i d a y , N o v e m b e r 5th, w h e n 30 m e m b e r ~ at-tended. Dr. J. B. M. D a v i e s (Dep. M . O . H . , Liverpool) reviewed c o m p r e h e n s i v e l y t h e W e l f a r e Services e n v i s a g e d for t h e h a n d i c a p p e d a d u l t . A keen d i s c u s s i o n e n s u e d in which, i n t e r a l i a , Drs. Yule, W a r r e n , J o n e s a n d H i I d i t c h joined, t h e l a t t e r e x p r e s s i n g t h e t h a n k s of t h e a s s e m b l e d m e m b e r s to t h e speaker. A request from the Manchester Regional Hospital Board's W o r k i n g P a r t y for t h e B r a n c h ' s views on t h e a d v i s a b i l i t y of e s t a b l i s h i n g hostels for c e r t a i n m e n t a l defectives n o t in need of h o s p i t a l t r e a t m e n t w a s considered. I t was decided to i n v i t e t h e R e g i o n a l A d v i s e r on P s y c h i a t r y to enlarge on t h e s u g g e s *ions n l a d e a t a l a t e r c o n v e n i e n t m e e t i n g of t h e b r a n c h . I t was resolved, on t h e proposi{ion of t h e P r e s i d e n t , t h a t t h e c o n g r a t u l a t i o n s of t h e m e e t i n g be e x t e n d e d to Dr. Metcalfe B r o w n on his elections as C h a i r m a n of t h e Council of t h e Society. President:
* Usual published announcement.