North-Western Branch

1939 medicines and the effects of recent developments on the status of the family doctor, the speaker described in some detail the B.M.A. proposals for a General Medical Service for the Nation, as given in the handbook of the Association, published in November, 1988. He stressed the importance of a unification of the control of all health services, both centrally and locally, and the fusion of the National Health Insurance scheme with private practice. Dr. Potter also dealt with the alternative proposals for immediate extensions of Insurance benefits : - (a) By an increase in the scope of the benefits to those already insured, or (b) By extending the existing benefits to the dependents of insured persons, and expressed himself in favour of giving priority to the latter. In announcing that the address was open for discussion the President pointed out that the next item on the Agenda was the consideration of the B.M.A. Scheme itself and suggested that the two items should be taken together. The following speakers joined in the debate : Drs. Sharpley, Griffin, Robinson, Cookson, Paul and Jolly. The chief objections raised to the scheme were that it only provided for families with an income limit of £250 per annum and several speakers felt that this was too low. Dr. Paul then moved and Dr. Sharpley seconded that the B.M.A. Scheme be accepted in principle as a basis for a National Scheme. This was carried nem. con. The President then proposed a very cordial vote of thanks to Dr. Potter for consenting to come to Birmingham at such short notice and for his interesting address. In his reply Dr. Potter agreed that an income limit of £250 was not fundamental to the scheme, but that it was desirable to commence with the existing limit when introducing extensions to the Insurance scheme. The fifth meeting of the session was held at the Medical Institute, 154, Great Charles Street, Birmingham, on Thursday, March 2nd, 1989, at 5.80 p.m. The President was in the chair and 17 members attended.

Education of Deaf Children. Dr. J. R. Mitchell (School Medical Officer, Birmingham) read a paper on the Education of Deaf Children. After referring to the powers and duties of Education Authorities to provide special educational facilities for deaf children, the speaker stated that the spoken word was the only reliable test for this defect, provided that it could be applied uniformly. He then went on to describe the gramophone audiometer as a means of determining hearing defects. In Birmingham 48,000 school children had been tested with this instrument, of whom 2,700 had failed on re-testing. After suitable treatment, 700 of these were restored to normal hearing capacity and a further 800 were so much improved as to be able to continue the ordinary school curriculum with special facilities (i.e., Grade 2A), leaving a residue of 1,200 who required to be educated as deaf children. For this latter class, special examinations were necessary by an aural specialist who should have the assistance of a pure tone audiometer for determining the type of deafness and the possibility of supplying the child with some form of hearing aid. The gramo-

PUBLIC HEALTH phone audiometer method of group testing was not reliable in an infants' department and could not be applied to Mental Defectives, as it was also a test of intelligence. In infants' departments mouth breathers should always be suspected of deafness and should be tested individually. Dr. Auden referred to Ewing's discovery of high frequency deafness and said he had found that irritability and head nodding in young children were symptoms of aural trouble. After Dr. Mitchell had answered questions put to him by several members of his audience, the President moved that a very hearty vote of thanks be accorded to him for his most interesting and instructive talk. This was carried unanimously.

Salaries P~licy. The Branch next considered the question of admission of former offenders against Salaries policy. After the resolution outlined by the General Purposes Committee of the Society had been discussed, the following amendment was proposed and carried without dissention : - " That the Council of the Society, after consultation with the Branch concerned, should exercise its discretion in respect of the eligibility for re-election of members of the Society who have been called upon to resign or have been expelled under the powers given by Article 11, after a period of ten years from the time of the offence ; and that the same attitude should be taken in regard to applications for membership from those who have not at any time been members of the Society and would not have been considered acceptable owing to a similar offence, or from those who have submitted resignations after the commission of an offence before the completion of the procedure under Article 11." Owing to the lateness of the hour, it was decided to defer further consideration of the Salaries of whole-time Public Health Medical Officers until the next session.

NORTH-WESTERN BRANCH. President : Dr. R. M. Galloway (M.O.H., Bolton C.B.). Hon. Secretary: Dr. J. E. Spenee (M.O.H., Eccles M.B.). An ordinary meeting of the Branch was held in Reeces Restaurant, Liverpool, on Friday, January 18th, 1989, the President occupying the chair, when 18 members were present. Apologies were received from eight members. A letter from Dr. Grahame, of Burnley, relating to the subscription paid by members of the Society to the British Medical Association was read and it was resolved to submit it to the Council of the Society for consideration. It was resolved to convene a special meeting of the Branch on Friday, January 27th, 1989, to consider the British Medical Association's proposals for a Complete Medical Service. The President then introduced Dr. A. O. Ross, M.B., D.P.H., who gave an extremely interesting and informative paper on " Venereal Disease in Young Persons " which it is hoped will be published shortly in P ~ r l c HEALTH. A vote of thanks to Dr. Ross was proposed by Dr. T. W. N. Barlow and seconded by Dr. Stallybrass, 217

PUBLIC HEALTH Dr. Downer, Dr. Glover and the President also took part in the discussion to which Dr. Ross replied. An ordinary meeting of the Branch was held in the Manchester Limited Restaurant, on Friday, February 10th, 1989. The President occupied the chair and 28 members were present. The minutes of the last meeting were confirmed.

Child Guidance. A very interesting paper was given on " Child Guidance " by Dr. Mary Burbury, who in the course of her remarks stressed the following principal features : The function of the Child Guidance Clinic is to re-adjust the emotional life of the child. In childhood, the outlet for the emotions is in play, and this is why play therapy is such an important part of the treatment. The methods of treatment adopted are :-I. Suggestion. (a) Indirect ; (b) Direct--Hypnotism. II. Persuasion and Re-assurance. This is more important in relation to the parents, but can also be used with the children themselves. II. Play Therapy. This is the counterpart of analytic treatment in adults. It is analgoous to Bio-ehemistry, which consists of reduction and synthesis. Emotional disturbances can be said to be due to a failure of synthesis. In the child, play represents fantasy life ; it expresses in its play what it thinks and feels but is unable to express in actual life. Play is observed and interpreted by the psychologist and the knowledge gained used in treatment by suggestion and re-assurance. Dr. Zilihi, of Vienna, a close associate of Adler, followed and gave an interesting r~sum~ of the work done by Adler in establishing Child Guidance Clinics throughout Vienna. Dr. Stallybrass, in proposing the vote of thanks, emphasised the importance of never teaching the child fear. He also considered it important to educate the child at an early age to have a sense of its social duties and be a good citizen. This he thought, might have an advantageous effect upon the incidence of child crime. The vote of thanks, seconded by Dr. Lobban, was carried with acclamation. Dr. N. F. Smith and Dr. E. Downer and the President also took part in the discussion and Dr. Burbury briefly replied to the various points raised by the speakers. An ordinary meeting of the Branch was held in the Manchester Limited Restaurant, on Friday, March 10th, 1989, the President occupying the chair. Twenty members and friends were present. The minutes of the last meeting having been confirmed the Hon. Secretary reported that Dr. J. B. Yeoman had recently retired from the post of Medical Officer of Health of the North-West Cheshire Combined Districts, and was eligible for election as a fully paid life members. It was resolved that the Council be requested to elect Dr. Yeoman a fully paid life member of the Society. The President then introduced Dr. A. R. Somerford who gave an extremely interesting and instructive 218

APRIL address on " Common Skin Infections in Children," dealing with general dermatitis, impetigo, scabies, ringworm, alopecia, warts, infantile eczema and congenital syphilis. The address was followed by a discussion in which Dr. A. C. Crawford, Dr. Spence and the President joined and a vote of thanks to Dr. Somerford proposed by Dr. Crawford and seconded by Dr. Bennett was carried unanimously. SOUTHERN BRANCH.

President : Dr. G. Chesney (Dep. M.O.H., Poole M.B.). Hon. Secretary : Dr. G. E. B. Payne (Dep. M.O.H., Southampton C.B.). A meeting of the Branch was held at 1, East Park Terrace, Southampton, on February 8rd, 1989. Owing to the absence of the President Dr. Croft Watts took the chair ; t2 other members attended. Dr. Croft Watts, on behalf of the Branch, requested the Secretary to convey to the President their regrets at his illness and to wish him a speedy recovery. The minutes of the previous meeting, having been circulated, were signed by the Chairman. A Mobile First-Aid Post. No cases were discussed, but Dr. H. C. MaurieeWilliams had on view a single-decker bus which had been converted to be used as a mobile First-Aid Unit. The bus had been stripped and was fitted with an operating table, and a calor gas heater supplying hot water to the hand basin. The water supply was from a 20-gallon tank on the roof. The windows were protected by movable metal sheets. A most interesting discussion followed the inspection of this Unit. Dr. H. C. Maurice-Williams discussed the provisions of the Young Persons (Employment) Act, 1988, and the manner in which he was administering the Act in the County Borough of Southampton. Work of Southampton Birth-Control Clinic. Mr. R. Knowlton, F.R.C.S., then gave an address entitled " Some Aspects of the Work of a Birth Control Clinic." He said that the birth control clinic of which he was in charge was organised by the Southampton County Borough Council, and he adhered strictly to the Ministry of Health's Circular. He sai:l the intention of the lecture was not to deal individually with each type of contraceptive, but rather with the results of treatment advised and the intelligence of the persons who sought advice. The clinic was instituted over three years ago, and since that time about 200 persons had attended, and accurate records are available of 186 persons treated, of whom 40 did not return. Mr. Knowlton thought that 40 defaulters was high, considering the efficient " follow-up-system." In the following table, Mr. Knowlton has classed the intelligence of the women attending as: (a) Good, (b) Average, (c) Fair, and (at) Poor to Hopeless. The mental grading has not been by intelligence tests, but by the behaviour of the persons at the time of instruction. Of the 96 cases attending regularly, the average number of pregnancies for the three year groups is one pregnancy per 4.1 women. He further said that failure