Maternity and Child Welfare Group

107

PUBLIC H E A L T H , .June, t945 e m p l o y i n g bodies w i t h i n the s c h e m e ; (b) by setting u p effective m a c h i n e r y , s u c h as s t a t u t o r y tribunals to w h i c h all m a t t e r s o f d i s p u t e w h e t h e r financial, related to range and t e r m s o f service, or complaints o f m i s c o n d u c t , i n c o m p e t e n c e , or negligence m a y be referred by either part ; (c) b y e x t e n d i n g security o f t e n u r e to all medical officers o f health of local authorities."

WELSH BRANCH President: Dr. H. It_ T i g h e (M.O.H., Swansea C.B.). Hon. Secretary: Dr. G. M c K i m T h o m a s (M.O.H., Cardiff R.D.). A m e e t i n g of t h e W e l s h B r a n c h was h e l d at Cardiff on Febr u a r y 17th. T w e n t y m e m b e r s a n d n i n e visitors were present. Invitations h a d been e x t e n d e d to t h e m e m b e r s of t h e Cardiff Division of the B.M.A. a n d t h e Cardiff Medical Society. T h e m i n u t e s of the m e e t i n g held on J a n u a r y 6th were~ approved. T h e subject of the m e e t i n g was t h e prevention o£ surgical a n d other infections in hospital wards. T h e o p e n i n g speaker, was Dr V. D. Allison, D e p u t y Senior M.O., Ministry of Health, who dealt with t h e non-surgical side of t h e s u b j e c t T h e second paper ~vas given by Dr. J. Gough, L e c t u r e r in Pathology', W e I s h National SchooI of Medicine, who spoke on t h e surgical aspect. Both papers were of g r e a t interest a n d contained m u c h useful a n d valuable information. T h a t this was so was s h o w n b y "the n u m b e r of m e m b e r s who took part in the s u b s e q u e n t discussion, a n y points raised b e i n g suitably dealt with b y t h e speakers. A h e a r t y vote of t h a n k s was accorded to Drs. Allison a n d G o u g h for their i l l u m i n a t i n g addresses.

A t a special m e e t i n g o f t h e B r a n c h at Cardiff o n April 14th, t h e P r e s i d e n t and 14 m e m b e r s were present. T h e m i n u t e s of the m e e t i n g held on Feb. 17th were read, confirmed a n d signed by the President. T h e m e e t i n g considered t h e " revised D r a f t of Salary Scale," t h e m a i n b o d y of w h i c h was approved, b u t several r e c o m m e n d a t i o n s were m a d e w h i c h were to be s u b m i t t e d to t h e Society for their consideration. T h e P r e s i d e n t and i7 m e m b e r s were p r e s e n t at a m e e t i n g at Cardiff o n April 2Ist. T h e m i n u t e s of t h e m e e t i n g h e l d o n April 14th were read, approved, a n d signed b y the President. T h e B r a n c h passed a resolution s u p p o r t i n g t h e n o m i n a t i o n of Prof. J'ohnstone Jervis as P r e s i d e n t of t h e Society for t h e Session 1945-46. Dr. A. T r e v o r Jones, o f the W e l s h B o a r d o f H e a l t h , read a paper on co-ordination o f a hospital service. H e reviewed t h e E m e r g e n c y Hospital S c h e m e , and o b s e r v e d h o w t h e services had developed far b e y o n d t h e original ideas a n d had given a great s t i m u l u s to hospitals o f all categories w i t h i n t h e scheme. T h e i n t e r c h a n g e of c o n s u l t a n t s a n d n u r s i n g staff h a d b e e n of benefit to all, as h a d t h e e q u i p m e n t provided by t h e G o v e r n m e n t to m a n y o f t h e hospitals. T h e Blood T r a n s f u s i o n Service h a d worked Well, a n d a good deal of knowledge had been acquired as a result. T h e organised t r a n s p o r t r u n by central m a n a g e m e n t h a d been very effective. The consultant advisors h a d c o n t r i b u t e d greatly to t h e t r e a t m e n t afforded in s o m e o f the smaller hospitals, a n d in his opinion t h e regular visits .had done m o r e to raise s t a n d a r d s o f work t h a n formal w r i t t e n instructions. Reliable ease records were very i m p o r t a n t to a successful working. I t was desirable t h a t w h e r e any extensions to a hospital were considered all t h e hospital authorities in t h e area s h o u l d be i n f o r m e d o f t h e proposals in order to avoid duplication of services. T h e p a t h o logical service h a d been greatly e x t e n d e d a n d there was satisfaction with the improvements and developments. A n interesting discussion followed a n d t h e P r e s i d e n t proposed a vote of thanks to D r . T r e v o r Jones.

M A T E R N I T Y A N D CHILD W E L F A R E GROUP T h e A m m a l G e n e r a l NIeeting a n d Social M e e t i n g of the above G r o u p will be held at t h e Sesame C l u b , 49, G r o s v e n o r Street, L o n d o n , W.1, on T h u r s d a y , J u n e 28th, at 8 p . m . A m e e t i n g o f t h e G r o u p was held in L o n d o n on April 13th, w h e n 23 m e m b e r s and guests attended. T h e President, in t h e chair, i n t r o d u c e d M i s s Elizabeth D e n b y , HON. A.R.I.B.A., w h o spoke on bad h o u s i n g a n d rehousing. S l u m people, s h e said, could be f o u n d in a n y s t r a t u m of society, and therefore s l u m dwellers were n o t always s l u m people. She defined s l u m people as those w h o could n o t m a n a g e to keep a good h o m e in a bad e n v i r o n m e n t . "It was often forgotten that on n e w estates t h e rents" and r u n n i n g costs were higher, and that t h e old s l u m f u r n i t u r e transferred to a n e w h o u s e or flat looked o u t o f place. T h e s e things t e n d e d to discourage t h e r e h o u s e d after their first e x c i t e m e n t in t h e n e w h o m e . A really n e w e n v i r o n m e n t , she t h o u g h t , o u g h t to be given to people w h o kept a s l u m h o m e well, and s l u m people s h o u l d be given reconditioned old . h o u s e s w h i c h could be redecorated frequently. T h e m o s t appropriate w a y of i m p r o v i n g a bad area was b y p u t t i n g in n u r s e r y schools a n d clubs. C h i l d r e n were m o s t adaptable a n d teachable, and h a d t h e power, by example,

of t e a c h i n g t h e i r parents. T h e easiest w a y to raise the sell-respect o f p a r e n t s was indirectly t h r o u g h t h e child, a n d t h e nursery, school could become a social c e n t r e w h e r e p a r e n t s could m e e t ; o r d e r and discipline were t h u s gradually i n c r e a s e d in their family life. A n e i g h b o u r h o o d w h i c h h a d b e e n s t a r v e d of a n y kind of culture could be e n l i g h t e n e d by a well-rmx club, a n d the first consideration s h o u l d be beauty. O n e could see how t h e self-respect of t h e m e m b e r s increased w i t h the i n t r o d u c t i o n o f colour, m u s i c , a n d reading. M i s s D e n b y deprecated the t e n d e n c y to build large blocks of flats for families. People w i t h o u t families s h o u l d h a v e w e l l - p l a n n e d blocks, w i t h self-working lifts, while families s h o u l d have houses with gardens. C o n t r a r y to t h e usual belief, this s c h e m e w a s less expensive and no m o r e e x t r a v a g a n t with land. A f t e r an i n t e r e s t i n g discussion D r . K a t h e r i n e H i r s t proposed a vote of t h a n k s to the speaker.

M I D L A N D M A T E R N I T Y A N D CHILD W E L F A R E SUB-GROUP A m e e t i n g of this s u b - g r o u p was held o n M a r c h 17th, 1945, at Birmingham. T h i r t y - t h r e e m e m b e r s attended, a n d Dr. Dickson presided. T h e m e m b e r s were shown r o u n d t h e b a b y block of the Children's Hospital, B i r m i n g h a m . Dr. W i n i f r e d Y o u n g t h e n delivered a m o s t instructive a n d interesting address, illustrated b y l a n t e r n slides, on gastro-enteritis and d e h y d r a t i o n in infants. Dr. Y o u n g stated t h a t when i n f a n t s Were suffering from gastro-enteritis a knowledge of ~the intricacies o f their water m e t a b o l i s m became a l l - i m p 0 r t a n t ; {he prevention and the relief of d e h y d r a t i o n were the m o s t difficult problems o f treatment. In i n f a n c y the excretory f u n c t i o n of t h e kidney was still in t h e development stage, a n d a b a b y was able to r e g u l a t e his salt a n d water m e t a b o l i s m only if there was e n o u g h water available for excretion. A full-term b a b y Container[ 75 to 80% of water; an a d u l t only 60 to 65%. F u r t h e r m o r e , 65% of t h e body water was extracellular in infancy, b u t .only 28% in adults. Ex~ perience h a d shown t h a t a baby required n m c h more fluid per k i l o g r a m m e of body weight t h a n a n adult, a n d t h a t even on a basis of surface area t h e fluid i n t a k e o u g h t to be higher. T h e urine volumes, too, were considerably larger. Urea a n d m i n e r a l clearances were always low at birth, a n d t h e y d i m i n i s h e d if the m i n u t e v o l u m e s were small. T h e y were lower in p r e m a t u r e t h a n in full-term newborn .infants, b u t t h e y increased towards adult level d u r i n g t h e first year of life. P r e m a t u r e i n f a n t s were very liable to oedema, a n d their low m i n e r a l clearances were the explanation of this. A n y i n f a n t who was short of water was likely to suffer from r e n a l failure. T h e , i n f a n t fed on cow's milk suffered sooner t h a n t h e breast-fed b a b y because h i s food contained more protein a n d salt. A n i n f a n t needed more w a t e r whenever the o u t p u t b y t h e skin; lungs, or bowel was increased, because his urine v o l u m e s m u s t n o t be allowed t o fall. E x t r a water should be given if a b a b y was feverish, b u t salt m u s t be g i v e n as well if he was suffering from diarrhoea a n d vomiting. If the dehydration h a d been mild, a solution of glucose up to 3% of h i s b o d y weight was" given at once ; a n d if severe, 6'7% of his b o d y weight. T h e solution was generally a m i x t u r e of 0;9% NaCI 4- 5% glucose in equal parts. E n o u g h . water m u s t be giveh to establish a free flow of urine, a n d b o t h the d e h y d r a t i o n afl~t oliguria should be relieved in a few hours. It m i g h t be possible t o ' d o th~s in an i n f a n t w h o was not v o m i t i n g b y g i v i n g h i m fluids b y m o u t h , b u t the i n t r a v e n o u s route was f r e q u e n t l y t h e only one b y which t h e depleted' b o d y fluids could be restored in time, a n d was easily the m o s t comfortable for t h e ~patient. A c c u r a t e c h a r t i n g of t h e o u t p u t by all r o u t e s was essentml in order to estimate t h e day-today requirements. T h e t h a n k s of t h e Sub-group was accorded to Dr. Y o u n g for h e r most interesting address. SOUTHERN BRANCH President : D r . Catherine A v e r y ( M . O . H . , W i n c h e s t e r R.D.C,). Hon. Secretary: Dr. H. C. M a u r i e e Williams, o.B.E. ( M . O . H . , Southampton). A m e e t i n g w a s held at an A m e r i c a n Depot, P o r t s m o u t h , o n M a r c h 27th. T h e r e were p r e s e n t t h e P r e s i d e n t a n d 11 m e m b e r s . T h e m i n u t e s of t h e m e e t i n g held on J a n u a r y 5th were approved as correct a n d signed by t h e C h a i r m a n . T h e P r e s i d e n t reported the d e a t h of Dr. C. F. Pedley, of B o u r n e m o u t h , w h o h a d been a m e m b e r of t h e ' S o c i e t y for m a n y years. It was resolved t h a t an expression of s y m p a t h y be sent on b e h a l f o f the B r a n c h to his widow. Captain H . S. Friedlander, Medical Corps, U . S . A r m y (Assistant M . O . , Child H y g i e n e Division, N e w York City Del~ertment o f H e a l t h ) gave a m o s t interesting talk on medical practice i n ' ~ n e r i c a , a n d outlined t h e m e t h o d s of qualification a n d practice in A m e r i c a as c o m pared w i t h t h o s e in this country. As C a p t a i n F r i e d l a n d e r also holds a British medical qualification, he was able to illustrate t h e differences