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NATIONAL CONFERENCE ON MATERNITY AND CHILD WELFARE
39 pensary and the school authorities would be essential. Among other measures for detecting early infection might be a wider use of the sedimentation and other blood tests. An application of these methods to children might help to show the dividing line between infection and disease in childhood, without which a " knowledge of " infection only was of comparatively little practical value.. Dr. L. S. T.. BURRELL (London) pointed out the terms to distinguish between necessity for with tuberculosis with and those infected persons without clinical disease. The term " pre-tuberculous " was a bad one, but if used at all, it should be applied only to those with a negative tuberculin test. Those with a positive test were already infected, and in such persons certain signs or symptoms might develop which experience showed would render the individual liable to become consumptive, even when clinical and radiological examination revealed no active disease. The importance of examining children was chiefly to detect this stage of latent tuberculosis. It was a matter of the greatest difficulty to determine whether or not a child had a lesion which might develop into active disease, and which therefore needed treatment. The child might be in danger either because it already had some lesion, or because it was in contact with infection. Examination should therefore have the double object of discovering any lesion present and of determining whether the child was in sufficiently close contact with infection to render it liable to develop tuberculosis. The second of these objects was by far the more important since it aimed at prevention rather than cure. It was not only easy to overlook a tuberculous lesion which was present, but it was even more easy to imagine one when the child was weakly or undernourished. Weakly children did need treatment, and since to treat them in a sanatorium or preventorium was as good as any other method, it mattered little whether or not their disability was due to tuberculosis or not. What did matter was that the strong children should not be neglected, because they were equally susceptible to tuberculosis. Adults rather than children should be examined in an infected household, to discover a possible source of infection ; and any child, robust or delicate, was in grave danger of being infected or reinfected if he remained in contact with a case of open tuberculosis. Dr. H. MIDGLEY TURNER (Sheffield) said that children who attended for periodic examination at a tuberculosis dispensary could be divided broadly into three classes : (1) notified cases of tuberculosis ; (2) infected children without symptoms or signs of active disease, who were still exposed to known sources of infection ; (3) children not yet infected, but exposed to a known source of infection. The purpose of examination in the first group was to assess the general health, to ascertain that there was no evidence of toxic absorption, to examine carefully for any change in the local signs of disease in the system known to be infected, and to note whether spread to other lymphatic systems had occurred. In the second group the object was to seek any subjective or objective evidence that the -child was being adversely affected by the tuberculous infection, and, if so, to localise and treat the lesion. In group 3, examination was directed towards observing the reactions of the child when infection occurred, and taking steps where necessary to begin treatment. The aim, therefore, of systematic examination of children was to detect the earliest evidence of clinical disease, remembering that the examination must be
finding
mainly on the child’s lymphatic system. Sputum-positive pulmonary tuberculosis in the child was relatively uncommon. concentrated
OPEN-AIR SCHOOLS
J. THOMAS and Dr. NOEL BARDSWELL (London County Council) described the growth of the open-air movement in schools in London, and the remarkable improvement, physical and mental, in the children attending such schools. Two principles of exceptional importance in this work were, first, the necessity for constant vigilance to see that in all ways complete sanatorium conditions were preserved, and insidious attempts to introduce heating firmly resisted ; and, secondly, the necessity for an ample supply of good nourishing food. Dr. RALPH WILLIAMS (Board of Education) said that the day and residential open-air school had definite places in the prevention of tuberculosis, providing treatment for the child in the early and non-infectious stages of the disease, and for the delicate contact. Such schools were centres for the teaching of hygiene and were a useful means of educating the public. The design of the open-air school had also had a valuable effect on the planning of ordinary school buildings. Councillor STEWART REID (Glasgow) and Alderman T. HAMBLETT (St. Helens) also discussed the principles upon which open-air schools were designed, and urged the adoption of such principles by ordinary schools-a measure which they thought would go a long way towards eradicating tuberculosis, not only in childhood but also in later life. School feeding was also probably one of the most important functions they had to perform. Dr.
C.
NATIONAL CONFERENCE ON MATERNITY AND CHILD WELFARE THE CHILD FROM TWO TO FIVE
THE first day’s sessions of this conferencewere held in the London County Hall, Westminster, on July lst, under the chairmanship of Mr. SOMERVILLE HASTINGS (chairman of the hospitals and medical services committee, L.C.C.). After a short opening speech by Lord SNELL (chairman of the L.C.C.), the presidential address was delivered by Sir KINGSLEY WOOD, Minister of Health. He said that satisfaction with the steady progress made in child welfare must be tempered by our failure to improve the toll of maternal mortality. There had been a consistent reduction in deaths, among infants and among children between the ages of one and five years, largely brought about by the work of health visitors in the homes, and that of infant welfare centres. There had been a gradual decline in the percentage of children entering school in need of medical treatment. Few areas now failed to provide the essential features of a progressive child welfare service, but there was evidence than an inadequate number of toddlers were benefiting by it. The remedy lay in instruction of the public and arousing of public interest. It was impossible to emphasise too strongly the importance of better housing ; if we could eliminate the majority of slums within the next five years, our generation would have given one of the greatest contributions to the health of the people ever made. The, distressing fact that maternal mortality had not declined was a matter of grave concern and a blot 1 Organised on behalf of the National Council for Maternity and Child Welfare and a number of constituent bodies by the National Association for the Prevention of Infant Mortality.
,
40
lasting were the results of illness was carefully organised Convalescence privation. to ensure that children who had been really ill were sent to homes where skilled care was available. The home conditions to which children returned were most important ; homes were visited and advice was of areas where, in the last ten years, the mean of the maternal mortality-rate had been above the given. In connexion with new housing schemes average for the country as a whole. About half it would be a good thing if mothers could be helped with their budgeting and cooking. Provision of of these areas had already been visited, and when the convalescence for young children was an urgent was were to be examined the inquiry complete findings and one which should be recognised by every in need the medical of the by ministry department local authority. consultation with Sir Comyns Berkeley, and it was Dr. LESLIE HOUSDEN spoke on the main causes hoped that much might be learned from this piece of ill-health in the children of poor homes. These of research. he considered to be emotional unrest and unhappiness Mr. SOMERvILLE HASTINGS emphasised the importance of the age-period of two to five years. A number (often due to over-large families), parental ignorance, of diseases and affections which might last poor feeding, lack of routine and discipline, and life had their origin in that period. Dental decay, absence of fresh air and sunshine. He recommended tuberculosis, rheumatism, deafness, and nasal disease simple education in non-technical language, inculcating a spirit of assurance and a belief that the new-born were among such complaints, and any disease at that age was liable to leave a scar on the constitution. baby is generally healthy and only requires a mother’s Dr. G. F. MCCLFARY reported on the results of an care to keep it so. The right course, he thought, the National was to on the teaching of mothercraft concentrate investigation promoted by Society for the Prevention of Infant Mortality. An inquiry before marriage and to interfere as little as possible form had been issued to 514 local authorities in Great afterwards. Britain and Northern Ireland, who were asked to Dr. ALAN MONCRIEFF urged the recognition of indicate what measures were employed in their areas convalescent homes as an essential part of the national to promote the physical and mental welfare of children health services. Some conditions in young children from two to five years of age. Replies were received demanded convalescence if they were to be comfrom 369 authorities, and the measures most generally pletely cured. Chronic lung disease would largely adopted were found to be supervision of toddlers disappear if children suffering from measles or in centres and by health visiting, provision of food whooping-cough could have a long period of conof minor and valescence. The same applied to tonsillectomy and treatment ailments, (chiefly milk), orthopaedic and dental clinics. Little provision had chronic digestive disorders, and it was important that convalescent homes should take children earlier been made for child guidance clinics, day nurseries, playrooms, and playgrounds, and-particularly deplor- after acute illnesses. The length of stay must be able-only 62 nursery schools, with accommodation adequate, three weeks being regarded as an absolute for about 5000 children, had been established and minimum. (To be concluded) officially recognised, in the whole of England and Wales. The chief obstacle in promoting the welfare of children between two and five was said to be parental ignorance and apathy in 96 out of 159 MEDICINE AND THE LAW replies. Other causes were stated to be bad housing, poverty and unemployment, and financial stringency. Dr. McCleary said a study of the replies left him with Inquest on Human Arm Prohibited the impression that the most urgent needs were more nursery schools and an extensive development of 1’sr our issue of June l5th our correspondent from instruction in parentcraft. Australia described the unusual medico-legal problem Dr. ETHEL CASSIE (Medical Officer for Maternity associated with the discovery of a human arm in and Child Welfare, Birmingham) said she was not the body of a shark on the Coogie beach. The story convinced that a really good beginning had been is carried further in the Times of June 25th, where a made. The proportion of toddlers attending centres, message from Sydney describes the intervention of even when special sessions were arranged for them, the Supreme Court of New South Wales to stop the was disappointingly small, and some local authorities inquest on the ground that a human arm does not were content if these children received one visit constitute a body. It is understood that a man a year from a health visitor, while the majority named James Smith has been missing in circumwere not seen more than twice a year. She thought stances suggesting the possible theory that he was systematic medical inspection and home visiting murdered and that his body was disposed of by the first necessities. throwing it to the sharks. The arm has been identiDr. G. F. STILL (National Institute for the Prevention fied by tattoo marks and fingerprints as the arm of of Infant Mortality) presided over the afternoon James Smith. Medical evidence indicated that it session, when’ the subject for discussion was Facilities was apparently severed from a dead body. A man for Convalescent Treatment of the Child under Five has been charged with the murder of Smith. At the Years. instance of the accused the Supreme Court was asked HOGARTH (Divisional Medical to grant an order prohibiting the inquest from proDr. MARGARET Officer, L.C.C.) said that the London County Council ceeding. Mr. Justice Halse Rogers granted a proarranged holidays for about 6000 children a year, hibition. His decision, he said, was based solely on but many of these were not strictly convalescent, the question of what constitutes a body; a coroner and the accommodation for children under five was is obliged to view a body to assist him in reaching a very small. The toddler was nobody’s child, falling verdict, and an arm is not a body; if the inquest between the Ministry of Health and the Board of proceeded, separate limbs, found in the jurisdictions Education. This was very unfortunate in view of of different coronerships, might be the subject of the great importance of the early years ; the younger separate inquests.
good health record of the country. Maternal mortality was a complex problem and did not admit of any simple solution. An investigation was being carried out by medical officers of the Ministry of Health, who were studying conditions in a number on
the
throughout
-.
-
-
M
--
the child the
or
more
finding
mainly on the child’s lymphatic system. Sputum-positive pulmonary tuberculosis in the child was relatively uncommon. concentrated
OPEN-AIR SCHOOLS
J. THOMAS and Dr. NOEL BARDSWELL (London County Council) described the growth of the open-air movement in schools in London, and the remarkable improvement, physical and mental, in the children attending such schools. Two principles of exceptional importance in this work were, first, the necessity for constant vigilance to see that in all ways complete sanatorium conditions were preserved, and insidious attempts to introduce heating firmly resisted ; and, secondly, the necessity for an ample supply of good nourishing food. Dr. RALPH WILLIAMS (Board of Education) said that the day and residential open-air school had definite places in the prevention of tuberculosis, providing treatment for the child in the early and non-infectious stages of the disease, and for the delicate contact. Such schools were centres for the teaching of hygiene and were a useful means of educating the public. The design of the open-air school had also had a valuable effect on the planning of ordinary school buildings. Councillor STEWART REID (Glasgow) and Alderman T. HAMBLETT (St. Helens) also discussed the principles upon which open-air schools were designed, and urged the adoption of such principles by ordinary schools-a measure which they thought would go a long way towards eradicating tuberculosis, not only in childhood but also in later life. School feeding was also probably one of the most important functions they had to perform. Dr.
C.
NATIONAL CONFERENCE ON MATERNITY AND CHILD WELFARE THE CHILD FROM TWO TO FIVE
THE first day’s sessions of this conferencewere held in the London County Hall, Westminster, on July lst, under the chairmanship of Mr. SOMERVILLE HASTINGS (chairman of the hospitals and medical services committee, L.C.C.). After a short opening speech by Lord SNELL (chairman of the L.C.C.), the presidential address was delivered by Sir KINGSLEY WOOD, Minister of Health. He said that satisfaction with the steady progress made in child welfare must be tempered by our failure to improve the toll of maternal mortality. There had been a consistent reduction in deaths, among infants and among children between the ages of one and five years, largely brought about by the work of health visitors in the homes, and that of infant welfare centres. There had been a gradual decline in the percentage of children entering school in need of medical treatment. Few areas now failed to provide the essential features of a progressive child welfare service, but there was evidence than an inadequate number of toddlers were benefiting by it. The remedy lay in instruction of the public and arousing of public interest. It was impossible to emphasise too strongly the importance of better housing ; if we could eliminate the majority of slums within the next five years, our generation would have given one of the greatest contributions to the health of the people ever made. The, distressing fact that maternal mortality had not declined was a matter of grave concern and a blot 1 Organised on behalf of the National Council for Maternity and Child Welfare and a number of constituent bodies by the National Association for the Prevention of Infant Mortality.
,
40
lasting were the results of illness was carefully organised Convalescence privation. to ensure that children who had been really ill were sent to homes where skilled care was available. The home conditions to which children returned were most important ; homes were visited and advice was of areas where, in the last ten years, the mean of the maternal mortality-rate had been above the given. In connexion with new housing schemes average for the country as a whole. About half it would be a good thing if mothers could be helped with their budgeting and cooking. Provision of of these areas had already been visited, and when the convalescence for young children was an urgent was were to be examined the inquiry complete findings and one which should be recognised by every in need the medical of the by ministry department local authority. consultation with Sir Comyns Berkeley, and it was Dr. LESLIE HOUSDEN spoke on the main causes hoped that much might be learned from this piece of ill-health in the children of poor homes. These of research. he considered to be emotional unrest and unhappiness Mr. SOMERvILLE HASTINGS emphasised the importance of the age-period of two to five years. A number (often due to over-large families), parental ignorance, of diseases and affections which might last poor feeding, lack of routine and discipline, and life had their origin in that period. Dental decay, absence of fresh air and sunshine. He recommended tuberculosis, rheumatism, deafness, and nasal disease simple education in non-technical language, inculcating a spirit of assurance and a belief that the new-born were among such complaints, and any disease at that age was liable to leave a scar on the constitution. baby is generally healthy and only requires a mother’s Dr. G. F. MCCLFARY reported on the results of an care to keep it so. The right course, he thought, the National was to on the teaching of mothercraft concentrate investigation promoted by Society for the Prevention of Infant Mortality. An inquiry before marriage and to interfere as little as possible form had been issued to 514 local authorities in Great afterwards. Britain and Northern Ireland, who were asked to Dr. ALAN MONCRIEFF urged the recognition of indicate what measures were employed in their areas convalescent homes as an essential part of the national to promote the physical and mental welfare of children health services. Some conditions in young children from two to five years of age. Replies were received demanded convalescence if they were to be comfrom 369 authorities, and the measures most generally pletely cured. Chronic lung disease would largely adopted were found to be supervision of toddlers disappear if children suffering from measles or in centres and by health visiting, provision of food whooping-cough could have a long period of conof minor and valescence. The same applied to tonsillectomy and treatment ailments, (chiefly milk), orthopaedic and dental clinics. Little provision had chronic digestive disorders, and it was important that convalescent homes should take children earlier been made for child guidance clinics, day nurseries, playrooms, and playgrounds, and-particularly deplor- after acute illnesses. The length of stay must be able-only 62 nursery schools, with accommodation adequate, three weeks being regarded as an absolute for about 5000 children, had been established and minimum. (To be concluded) officially recognised, in the whole of England and Wales. The chief obstacle in promoting the welfare of children between two and five was said to be parental ignorance and apathy in 96 out of 159 MEDICINE AND THE LAW replies. Other causes were stated to be bad housing, poverty and unemployment, and financial stringency. Dr. McCleary said a study of the replies left him with Inquest on Human Arm Prohibited the impression that the most urgent needs were more nursery schools and an extensive development of 1’sr our issue of June l5th our correspondent from instruction in parentcraft. Australia described the unusual medico-legal problem Dr. ETHEL CASSIE (Medical Officer for Maternity associated with the discovery of a human arm in and Child Welfare, Birmingham) said she was not the body of a shark on the Coogie beach. The story convinced that a really good beginning had been is carried further in the Times of June 25th, where a made. The proportion of toddlers attending centres, message from Sydney describes the intervention of even when special sessions were arranged for them, the Supreme Court of New South Wales to stop the was disappointingly small, and some local authorities inquest on the ground that a human arm does not were content if these children received one visit constitute a body. It is understood that a man a year from a health visitor, while the majority named James Smith has been missing in circumwere not seen more than twice a year. She thought stances suggesting the possible theory that he was systematic medical inspection and home visiting murdered and that his body was disposed of by the first necessities. throwing it to the sharks. The arm has been identiDr. G. F. STILL (National Institute for the Prevention fied by tattoo marks and fingerprints as the arm of of Infant Mortality) presided over the afternoon James Smith. Medical evidence indicated that it session, when’ the subject for discussion was Facilities was apparently severed from a dead body. A man for Convalescent Treatment of the Child under Five has been charged with the murder of Smith. At the Years. instance of the accused the Supreme Court was asked HOGARTH (Divisional Medical to grant an order prohibiting the inquest from proDr. MARGARET Officer, L.C.C.) said that the London County Council ceeding. Mr. Justice Halse Rogers granted a proarranged holidays for about 6000 children a year, hibition. His decision, he said, was based solely on but many of these were not strictly convalescent, the question of what constitutes a body; a coroner and the accommodation for children under five was is obliged to view a body to assist him in reaching a very small. The toddler was nobody’s child, falling verdict, and an arm is not a body; if the inquest between the Ministry of Health and the Board of proceeded, separate limbs, found in the jurisdictions Education. This was very unfortunate in view of of different coronerships, might be the subject of the great importance of the early years ; the younger separate inquests.
good health record of the country. Maternal mortality was a complex problem and did not admit of any simple solution. An investigation was being carried out by medical officers of the Ministry of Health, who were studying conditions in a number on
the
throughout
-.
-
-
M
--
the child the
or
more