- Email: [email protected]
Ordinary meeting, September 22nd
PUBLIC
178 c e r n e d b u t p r e s e n t e d m e r e l y an extension of existing facilities a n d of p r e s e n t practice. Dr. H a r d i n g c o n c l u d e d by posing t h e q u e s t i o n w h e t h e r p r e v e n t i v e m e n t a l h e a l t h s h o u l d really b e t h e f u n c t i o n of the P u b l i c H e a l t h Service. H e r e m i n d e d t h e m e e t i n g of t h e t r a d i t i o n a l f u n c t i o n of the service in " filling the gaps " a n d expressed t h e hope t h a t t h e service w o u l d once a g a i n a d z p t itself to the n e e d s of the c o m m u n i t y . I n t h e discussion w h i c h followed, Dr. F a n n y Wride, psychiatrist in o n e of t h e L . C . C . ' s child g u i d a n c e clinics, said t h a t she h a d h a d some experience of this work from b o t h aspects. F o r two years after the special clinic at H o l b o r n was set up, she c o n t i n u e d to do one session a week at the Welfare Centre, w h e r e she had a n excellent H e a l t h Visitor for this type of work, a n d they tried to work o n the basis suggested in t h e report. Nevertheless, s h e soon f o u n d t h a t she was obliged to refer cases to t h e special clinic because t h e r e was n o time to deal w i t h t h e m in t h e Welfare Centre. S h e completely agreed with t h e theoretical concepts in t h e report. She w o u l d e m p h a s i s e p a r a g r a p h 11 (c), t h o u g h she usually stated it s i m p l y t h u s : " T h e attitudes of parents t o w a r d s t h e i r c h i l d r e n are influenced b y t h e i r own early experiences, particularly by t h e i r u n c o n s c i o u s a t t i t u d e towards t h e s e experiences w h i c h t h e y repeat or to w h i c h t h e y react w h e n similar situations arise in c o n n e c t i o n w i t h t h e i r c h i l d r e n . " S h e emphasised, too, t h e s t a t e m e n t at t h e e n d of this p a r a g r a p h t h a t such cases r e q u i r e d " assistance " of a m o r e skilled a n d specialised kind. T h e s e are the cases t o w a r d s w h i c h t h e i r efforts have b e e n directed. D u r i n g the 10 years since records had b e e n kept, they h a d h a d 760 cases t h r o u g h h e r clinic. S h e agreed t h a t doctors, health visitors a n d p a r e n t s s h o u l d b e i n c l u d e d in schemes for the d i s s e m i n a t i o n of psychological knowledge, b u t stressed t h a t it was a slow a n d laborious process. S h e challenged t h e s t a t e m e n t that n o C h i l d G u i d a n c e Clinic h a d p r o v i d e d a preventive service. I n t h e H o l b o r n Clinic t h e y did n o t give advice b u t tried to help the m o t h e r to see w h a t h e r p r o b l e m was a n d so e n a b l e h e r to c h a n g e h e r attitude, conscious a n d u n c o n s c i o u s , towards t h e child. T h e s c h e m e p u t forward was a useful educative a p p r o a c h b u t n o t a s u b s t i t u t e for a psychiatric service, a n d n e v e r could be. T h e case conference b e t w e e n the C . W . C e n t r e staff a n d t h e psychiatric c o n s u l t a n t s could n o t b e a n a d e q u a t e s u b s t i t u t e for the direct interview w i t h t h e case. She did n o t agree t h a t t h e r e were n o t at p r e s e n t e n o u g h specialists qualified to staff a n ideal psychiatric service, at any rate in L o n d o n . T h e difficulties w e r e o t h e r t h a n lack of m a n - p o w e r . T h e p r i n c i p l e of voluntary selection of candidates for t r a i n i n g i n this s c h e m e was a good one in theory, b u t t h o u g h m a n y of the m o r e able a n d intuitive w o u l d come forward, so w o u l d t h e severely neurotic. Selection m i g h t b e c o m e invidious. S h e asked h o w did one tell a psychiatrically u n t r a i n e d p e r s o n to recognise u n c o n s c i o u s anxiety ? Presumably t h r o u g h s y m p t o m formation, b u t a s y m p t o m m i g h t m e a n one of m a n y things, a n d h o w could a n y o n e i n t e r p r e t secondh a n d w i t h confidence. T h i s was t h e crux of t h e p r o b l e m , o n w h i c h the s c h e m e will s t a n d or fall. W h i l s t she agreed in theory w i t h all t h a t h a d b e e n said a b o u t t h e close liaison b e t w e e n all workers, medical a n d lay, in t h e welfare centre, in practice it s o m e t i m e s did n o t work. S o m e h e a l t h visitors r e s p o n d e d a n d c o u l d take full p a r t in t h e w o r k / o t h e r s , because of t h e i r o w n p r o b l e m s , were q u i t e u n a b l e to do so. S h e agreed w i t h the r e c o m m e n d a t i o n s a b o u t t r a i n i n g for D . P . H . and D . C . H . , particularly the latter. S h e f o u n d doctors in p o s t - g r a d u a t e t r a i n i n g responsive a n d e n t h u s i a s t i c a n d several followed u p t h e interest aroused b y a visit to t h e clinic a n d f u r t h e r private discussion. T o s u m up, she would say t h a t the s c h e m e was a good o n e if it was p u t forward as a m e a n s to give increased k n o w ledge and awareness of the emotional factors i n early h u m a n relationships a n d child d e v e l o p m e n t . B u t it w o u l d not, in any m e a s u r a b l e t i m e be an a d e q u a t e s u b s t i t u t e for t h e expan-
HEAL;I'H,
August,
i955
sion of s c h e m e s such as were already in operation in Divisions 1 a n d 3. D r . Morris, paediatrician, w e l c o m e d the r e p o r t b u t d e p l o r e d t h e o m i s s i o n o f a paediatrician f r o m the S t u d y G r o u p . D r . D o r o t h y F. Egan stressed the i m p o r t a n c e of c o n d u c t i n g research into t h e success of t h e s c h e m e right f r o m the beginning. I n his reply Dr. B o w l b y said that he was m u c h e n c o u r a g e d b y t h e interest t h e proposals h a d aroused. A l t h o u g h Dr. W r i d e h a d far m o r e experience in this field than he had, he was n o t so pessimistic of w h a t could be achieved. Dr. M a c k e n z i e and Mrs. Irvine, of t h e T a v i s t o c k Clinic, h a d h a d over a year's experience of a regular weekly case conference w i t h public h e a l t h p e r s o n n e l in St. M a r y l e b o n e a n d b o t h sides felt it h a d b e e n fruitful. O n l y f u r t h e r experience in o t h e r centres would tell us w h e t h e r we were on the right lines or not. M e a n w h i l e , it n m s t be recognised that t h e plan was still e x p e r i m e n t a l a n d n o t suitable as yet for wide application. D r . H a r d i n g also replied briefly and, referring to Dr. M o r r i s ' s point, said that it had b e e n essential, in the i n t e r e s t of c o n s t r u c t i v e work, to keep d o w n the n u m b e r of m e m b e r s of t h e G r o u p . Dr. J. A. Scott, Medical Officer of Health, C o u n t y of L o n d o n , p r o p o s e d a vote of t h a n k s a n d in so doing r e m i n d e d Dr. M o r r i s t h a t medical officers a t t e n d i n g child welfare clinics were i n d e e d paediatricians in t h e i r o w n right, as far as the n o r m a l d e v e l o p m e n t of y o u n g c h i l d r e n was concerned.
Society of Medical Officers of Health NOTICES
ORDINARY MEETING, SEPTEMBER 22nd Notice is hereby given that an Ordinary Meeting of the Scciety will be held in the Apothecaries' Hall, Blackfriarsl Lane, Ludgate Circus, London, E.C.4, at 5.30 p.m., on Thursday, September 22nd, 1955. The business of the meeting will include the installation of Dr. Charles F. White, O.B.E., Medical Officer of Itealth, City of London, as President of the Society for the session 1955-56. Dr. White will deliver his presidential address to the meeting. Full agenda, with the names of candidates for election to membership on September 22nd, will be included with the September issue of PUBLIC HEALTH. J u l y 29th, 19,55.
S. R. BRAGG, A d m i n i s t r a t i v e O(licer.
MATERNITY A N D CHILD WELFARE GROUP The first meeting of the session 1955-56 will take the form of.. a Cocktail Party to be held at the London School of Hygiene and Tropical Medicine, Keppel Street, Gower Street, W.C.1, at 6.30 p.m. on Friday, October 7th, 1955. At 7.30 p.m. Dr. Catherine M. Gray, Assistant Medical Officer, M. & C.W., Leeds C.B.. will be installed as President of the Group for the session. REPORTS
MIDLAND BRANCH President : Dr. J. W. Pickup (C.M.O.H., TVorcestershire). Hon. S e c r e t a r y : Dr. W. R. Martine (Adlinin. and M.O.H.
(Gen. Purposes), Birmingham). The fourth meeting of the session was held at Lancaster Street Welfare Centre, Birmingham, on Thursday, February 3rd, 1955, at 3.0 p.m. The President was in the chair and 34 members attended. Prophylaxis by Inoculation Papers on this subject were given by Dr. L. B. Holt, St. Mary's Hospital Laboratory, and Miss M. Barr, Wellcome Research Laboratories. Dr. Holt opened with comment upon the variability of the earlier preparations of A P T and t h e development at St. Mary's Hospital of PTAP, which had a higher antigenic potency than APT, and stated that all other laboratories could now produce a product with the same high antigenic efficiency. The Ministry of Health had instituted field trials in 1949 to determine the ability of P T A P to prevent diphtheria as distinct from its ability to induce production of a,tti-toxin ; their report
178 c e r n e d b u t p r e s e n t e d m e r e l y an extension of existing facilities a n d of p r e s e n t practice. Dr. H a r d i n g c o n c l u d e d by posing t h e q u e s t i o n w h e t h e r p r e v e n t i v e m e n t a l h e a l t h s h o u l d really b e t h e f u n c t i o n of the P u b l i c H e a l t h Service. H e r e m i n d e d t h e m e e t i n g of t h e t r a d i t i o n a l f u n c t i o n of the service in " filling the gaps " a n d expressed t h e hope t h a t t h e service w o u l d once a g a i n a d z p t itself to the n e e d s of the c o m m u n i t y . I n t h e discussion w h i c h followed, Dr. F a n n y Wride, psychiatrist in o n e of t h e L . C . C . ' s child g u i d a n c e clinics, said t h a t she h a d h a d some experience of this work from b o t h aspects. F o r two years after the special clinic at H o l b o r n was set up, she c o n t i n u e d to do one session a week at the Welfare Centre, w h e r e she had a n excellent H e a l t h Visitor for this type of work, a n d they tried to work o n the basis suggested in t h e report. Nevertheless, s h e soon f o u n d t h a t she was obliged to refer cases to t h e special clinic because t h e r e was n o time to deal w i t h t h e m in t h e Welfare Centre. S h e completely agreed with t h e theoretical concepts in t h e report. She w o u l d e m p h a s i s e p a r a g r a p h 11 (c), t h o u g h she usually stated it s i m p l y t h u s : " T h e attitudes of parents t o w a r d s t h e i r c h i l d r e n are influenced b y t h e i r own early experiences, particularly by t h e i r u n c o n s c i o u s a t t i t u d e towards t h e s e experiences w h i c h t h e y repeat or to w h i c h t h e y react w h e n similar situations arise in c o n n e c t i o n w i t h t h e i r c h i l d r e n . " S h e emphasised, too, t h e s t a t e m e n t at t h e e n d of this p a r a g r a p h t h a t such cases r e q u i r e d " assistance " of a m o r e skilled a n d specialised kind. T h e s e are the cases t o w a r d s w h i c h t h e i r efforts have b e e n directed. D u r i n g the 10 years since records had b e e n kept, they h a d h a d 760 cases t h r o u g h h e r clinic. S h e agreed t h a t doctors, health visitors a n d p a r e n t s s h o u l d b e i n c l u d e d in schemes for the d i s s e m i n a t i o n of psychological knowledge, b u t stressed t h a t it was a slow a n d laborious process. S h e challenged t h e s t a t e m e n t that n o C h i l d G u i d a n c e Clinic h a d p r o v i d e d a preventive service. I n t h e H o l b o r n Clinic t h e y did n o t give advice b u t tried to help the m o t h e r to see w h a t h e r p r o b l e m was a n d so e n a b l e h e r to c h a n g e h e r attitude, conscious a n d u n c o n s c i o u s , towards t h e child. T h e s c h e m e p u t forward was a useful educative a p p r o a c h b u t n o t a s u b s t i t u t e for a psychiatric service, a n d n e v e r could be. T h e case conference b e t w e e n the C . W . C e n t r e staff a n d t h e psychiatric c o n s u l t a n t s could n o t b e a n a d e q u a t e s u b s t i t u t e for the direct interview w i t h t h e case. She did n o t agree t h a t t h e r e were n o t at p r e s e n t e n o u g h specialists qualified to staff a n ideal psychiatric service, at any rate in L o n d o n . T h e difficulties w e r e o t h e r t h a n lack of m a n - p o w e r . T h e p r i n c i p l e of voluntary selection of candidates for t r a i n i n g i n this s c h e m e was a good one in theory, b u t t h o u g h m a n y of the m o r e able a n d intuitive w o u l d come forward, so w o u l d t h e severely neurotic. Selection m i g h t b e c o m e invidious. S h e asked h o w did one tell a psychiatrically u n t r a i n e d p e r s o n to recognise u n c o n s c i o u s anxiety ? Presumably t h r o u g h s y m p t o m formation, b u t a s y m p t o m m i g h t m e a n one of m a n y things, a n d h o w could a n y o n e i n t e r p r e t secondh a n d w i t h confidence. T h i s was t h e crux of t h e p r o b l e m , o n w h i c h the s c h e m e will s t a n d or fall. W h i l s t she agreed in theory w i t h all t h a t h a d b e e n said a b o u t t h e close liaison b e t w e e n all workers, medical a n d lay, in t h e welfare centre, in practice it s o m e t i m e s did n o t work. S o m e h e a l t h visitors r e s p o n d e d a n d c o u l d take full p a r t in t h e w o r k / o t h e r s , because of t h e i r o w n p r o b l e m s , were q u i t e u n a b l e to do so. S h e agreed w i t h the r e c o m m e n d a t i o n s a b o u t t r a i n i n g for D . P . H . and D . C . H . , particularly the latter. S h e f o u n d doctors in p o s t - g r a d u a t e t r a i n i n g responsive a n d e n t h u s i a s t i c a n d several followed u p t h e interest aroused b y a visit to t h e clinic a n d f u r t h e r private discussion. T o s u m up, she would say t h a t the s c h e m e was a good o n e if it was p u t forward as a m e a n s to give increased k n o w ledge and awareness of the emotional factors i n early h u m a n relationships a n d child d e v e l o p m e n t . B u t it w o u l d not, in any m e a s u r a b l e t i m e be an a d e q u a t e s u b s t i t u t e for t h e expan-
HEAL;I'H,
August,
i955
sion of s c h e m e s such as were already in operation in Divisions 1 a n d 3. D r . Morris, paediatrician, w e l c o m e d the r e p o r t b u t d e p l o r e d t h e o m i s s i o n o f a paediatrician f r o m the S t u d y G r o u p . D r . D o r o t h y F. Egan stressed the i m p o r t a n c e of c o n d u c t i n g research into t h e success of t h e s c h e m e right f r o m the beginning. I n his reply Dr. B o w l b y said that he was m u c h e n c o u r a g e d b y t h e interest t h e proposals h a d aroused. A l t h o u g h Dr. W r i d e h a d far m o r e experience in this field than he had, he was n o t so pessimistic of w h a t could be achieved. Dr. M a c k e n z i e and Mrs. Irvine, of t h e T a v i s t o c k Clinic, h a d h a d over a year's experience of a regular weekly case conference w i t h public h e a l t h p e r s o n n e l in St. M a r y l e b o n e a n d b o t h sides felt it h a d b e e n fruitful. O n l y f u r t h e r experience in o t h e r centres would tell us w h e t h e r we were on the right lines or not. M e a n w h i l e , it n m s t be recognised that t h e plan was still e x p e r i m e n t a l a n d n o t suitable as yet for wide application. D r . H a r d i n g also replied briefly and, referring to Dr. M o r r i s ' s point, said that it had b e e n essential, in the i n t e r e s t of c o n s t r u c t i v e work, to keep d o w n the n u m b e r of m e m b e r s of t h e G r o u p . Dr. J. A. Scott, Medical Officer of Health, C o u n t y of L o n d o n , p r o p o s e d a vote of t h a n k s a n d in so doing r e m i n d e d Dr. M o r r i s t h a t medical officers a t t e n d i n g child welfare clinics were i n d e e d paediatricians in t h e i r o w n right, as far as the n o r m a l d e v e l o p m e n t of y o u n g c h i l d r e n was concerned.
Society of Medical Officers of Health NOTICES
ORDINARY MEETING, SEPTEMBER 22nd Notice is hereby given that an Ordinary Meeting of the Scciety will be held in the Apothecaries' Hall, Blackfriarsl Lane, Ludgate Circus, London, E.C.4, at 5.30 p.m., on Thursday, September 22nd, 1955. The business of the meeting will include the installation of Dr. Charles F. White, O.B.E., Medical Officer of Itealth, City of London, as President of the Society for the session 1955-56. Dr. White will deliver his presidential address to the meeting. Full agenda, with the names of candidates for election to membership on September 22nd, will be included with the September issue of PUBLIC HEALTH. J u l y 29th, 19,55.
S. R. BRAGG, A d m i n i s t r a t i v e O(licer.
MATERNITY A N D CHILD WELFARE GROUP The first meeting of the session 1955-56 will take the form of.. a Cocktail Party to be held at the London School of Hygiene and Tropical Medicine, Keppel Street, Gower Street, W.C.1, at 6.30 p.m. on Friday, October 7th, 1955. At 7.30 p.m. Dr. Catherine M. Gray, Assistant Medical Officer, M. & C.W., Leeds C.B.. will be installed as President of the Group for the session. REPORTS
MIDLAND BRANCH President : Dr. J. W. Pickup (C.M.O.H., TVorcestershire). Hon. S e c r e t a r y : Dr. W. R. Martine (Adlinin. and M.O.H.
(Gen. Purposes), Birmingham). The fourth meeting of the session was held at Lancaster Street Welfare Centre, Birmingham, on Thursday, February 3rd, 1955, at 3.0 p.m. The President was in the chair and 34 members attended. Prophylaxis by Inoculation Papers on this subject were given by Dr. L. B. Holt, St. Mary's Hospital Laboratory, and Miss M. Barr, Wellcome Research Laboratories. Dr. Holt opened with comment upon the variability of the earlier preparations of A P T and t h e development at St. Mary's Hospital of PTAP, which had a higher antigenic potency than APT, and stated that all other laboratories could now produce a product with the same high antigenic efficiency. The Ministry of Health had instituted field trials in 1949 to determine the ability of P T A P to prevent diphtheria as distinct from its ability to induce production of a,tti-toxin ; their report