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Services Hygiene Group
PUBLIC HEALTH, July, 1949
220 other aids to walking such as the walking chair, parallel bars and tetrapods for the use of toddlers. Also, they were shown the spring suspension apparatus of Mrs. Guthrie Smith. I n the Occupational Therapy department, they were taken round the handcraft and carpentry sections. • Afterwards, Mr. B. O'Neill, F.R.C.S., spoke on chest diseases in childhood, illustrated by X-ray plates and of the m o d e r n methods o f treatment of pulmonary tuberculosis. Before leaving the Group were entertained to tea by the matron of the hospital. Course Dinner O n Saturday evening a dinner was held at the Great Northern Hotel. T h e Past-President, Dr. Benham, was in the chair. Alderman Beevers, Mrs. Naylor, Prof. and Mrs. Craig, Dr. Davies and Dr. Gray were guests of the Group. Dr. Hirst proposed the toast of the City of Leeds, coupled with the Guests, to which Alderman Beavers replied. Ante-natal Care O n Sunday morning, at the Maternity Hospital, Prof. Claye, Professor of Obstetrics to the University of Leeds, addressed the G r o u p as follows: To-day, ante-natal supervision can be regarded as being largely a psychological preparation for labour. T h e reason, for instance, that many mothers behave badly during labour or refuse to breastfeed their babies is because their psychological approach to it is wrong. T h e preparation for labour, as expounded by Dr. Read Dick, has certainly proved a most helpful teaching, though it m u s t be understood that drugs are still necessary in a certain n u m b e r of eases and are used even by him. Classes for ante-natal exercises should begin early in pregnancy. T h e y should aim to encourage the mother to develop muscular control and should preferably be taken by someone who is to be present at the confinement. Approximately six weeks before the baby is due the phenomenon of labour should be explained to the m o t h e r taking care to avoid the use of the word " p a i n " and to use the word " c o n t r a c t i o n " in its place. W h e n the mother first attends the ante-natal clinic a complete medical examination should b e carried out, and this examination should include a blood examination for the haemoglobin level, the Wasserman reaction and the Rhesus factor. Private doctors also should be circularised concerning the importance of determining the Rhesus factor. T h i s test is of very doubtful benefit to the baby. I n cases of hydrops faetalis the chance of recovery is nil. Some cases of icterus gravis may recover with blood transfusion b u t about 15% of those that recover will be left with neurological trouble. Haemolytic anaemia in the new b o r n wilt usually recover with iron-therapy alone. T h e real importance of this examination is to ensure that a Rhesus-negative woman is transfused with Rhesusnegative blood to avoid sensitising her to the Rh factor and jecpardising her chances of a successful pregnancy in the future. T h e 34th week is perhaps the best time to spot and deal with a malpresentation. Few breeches turn spontaneously after the 84th week though many will do so before that date. By the 36th week version becomes more difficult. If version is unsuccessful without an anaesthetic, another attempt should be made with an anaesthetic. T h e r e is always a danger of separation of the placenta from this manipulation b u t statistics show that the stillbirth rate following version is only 2% while that from breech delivery remains at 15%. I t is still impossible in the majority of cases to state the reason for malpresentation. T h e patient should again be examined at the 36th week to make certain that the head fits the pelvic brim. Failure to engage may be due to contracted pelvis, to turnout or to placenta praevia, b u t the commonest cause is a persistent occipiti-posterior position. I f the head is not engaged an attempt should be made to push it down into the pelvic cavity. If this is unsuccessful in the recumbent position, stand the patient up and see if the force of gravity will make it descend. If still unsuccessful, examine under art anaesthetic or by radiographic pelvimetry. Following coffee and biscuits, members divided into two groups. One group were given a demonstration of high rupture of the membranes using a Drew-Smythe catheter, followed by a talk on pre-eclamptic toxaemia by Prof. Claye. T h e other group went to the labour wards and were shown a case of toxaemia and a case of post-maturity by Mr. B. L. Jeafferson, who also spoke on toxaemia of pregnancy. M e m b e r s of the Group are greatly indebted to Dr. Gray, Senior Assistant Medical Officer of Leeds, who was responsible for the detailed arrangements of a very successful week-end. T h e Editor again regrets that several Branch and Group reports have had to be held over.
President:
SERVICES HYGIENE GROUP Dr. H. D. Chalke, o.n.e. (Divl. M.O., L.C.C., Lt..
Col., R.A.M.C. [T.A.]). Hon. Secretary: Dr. G. M. Frizelle, T.D. (Sub-Dean, London School of Hygiene & Tropical Medicine). The Pioneer Health Centre, Peekham. T h e Group met on April 29th, 1949, at 7.30 p.m. at the Pioneer Health Centre, Peckham: T h e President was supported by about 30 members. T h e Medical Director, Dr. Innes H. Pearse, who was introduced by Brigadier J. W. Scharff, gave a highly interesting talk on the history, aims and activities of the Health Centre. T h i s was followed by a tour of the building--including a welcome visit to the excellent cafeteria--during which the members of the Group were enabled to witness the normal evening activities of the centre. T h e President thanked Dr. Pearse for her interesting and instructive address, and for the hospitality which had been extended to the Group. He remarked on the interest which members had shown in this visit, as was evidenced by the good attendance and the fact that many had travelled long distances for the occasion. Dr. Pearse, Brig. Scharff, and a representative of one of the families, answered a large n u m b e r of questions, and it was not until a late hour that this most enjoyable and illuminating visit was concluded. Visit to the Royal Navy at Portsmouth. Some 34 members of the Group, led by the President, visited Portsmouth on Saturday, June l l t h , by kind invitation of their fellow member, Surg.-Capt. A. W. McRurie, R.N., who is Naval Medical Officer of Health, Portsmouth Command. T h e party arrived in the forenoon and was first conducted over a modern submarine (H.M.S. Auriga) lying in Haslar Creek. T h e amount of living and working sFaee , the " Schnorkel " for air supply to the crew and diesel engines while the boat runs submerged and the escape arrangements, were points of special interest. T h e next visit was to the escape training apparatus in the submarine shore establishment (H.M.S. Dolphin), whence members adjourned to lunch as guests of the officers' mess at the R.N. Hospital, Haslar. After lunch, when the President had expressed warm thanks to Surg.-Capt. McRorie and the mess, the party returned by motorboat across the harbour to the Royal Dockyard, where a visit was paid to H . M . battleship Duke of York in the graving dock with especial reference to the sick bay. Thence to the ever-glorious H.M.S. Victory, where a seaman guide gave an excellent running commentary. NORTH-WESTERN M. & C.W. AND SCHOOL H.S. SUB-GROUPS President: Dr. H. G. M. Bennett (A.D.M.O., Lancashire). Hon. Secretary : Dr. J. S. G. Burnett (M.O.H., Preston C.B.). T h e annual meeting of the sub-groups was held at Biddulph Orthopaedic Hospital on Friday, May 20th, at 2.30 p.m., w h e n 25 members attended, including one past-President of the Society and three past-Presidents of the North-Western Branch. Sir Harry Plait demonstrated orthopaedic cases of clinical interest, and provocatively stimulated m u c h discussion amongst many who had been members of his resident staff in years past. T h e group was then conducted by the Matron over the extensive and lovely grounds of the hospital. T h e following elections to office were made for the session 19491950 : President: Dr. J. E. Spence. Vice-President : Dr. H. G. M. Bennett. Hon. Seoetary : Dr. E. M. Jenkins. Committee: Drs. M. E. Cliff, S. C. Gawne, J. T. C. Keddie, M. Sproul, E. H. Walker and G. E. Wilkinson. Representatives on the School Health Service Group : Drs. E. M. Jenkins and G. E. Wilkinson. Representatives on the M. & C.W. Group: Drs. M. Sproul and J. T. C. Keddie. It was resolved (a) that the President and Hon. Secretary of the North-West Branch of the Society of Medical Officers of Health be ex-o~cio members of the Sub-Groups Committee ; (b) that the number of annually elected members of the Committee be increased from six to eight ; and that (c) Drs. B. M. Butters and W. A. Kane be elected to the two vacancies created by the preceding resolution. PubIi© H e a l t h is the Official Organ of the Society of Medicat Officers of Health and a suitable medium for the advertisement of official appointments vacant in the health service. Space is also available for a certain n u m b e r of approved commercial advertisements. Application should be made to the Executive Secretary of the Society, at Tavistock House South, Tavistock Square, W.C.I. Subscription 3Is. 6d. per annum, post free, in advance. Single copies 2s. 6d. post free. Official classified advertisements are charged at 2s. per line or part of a line. Minimum charge 16s. Telephone: Euston 3923. Telegrams : Epidauros, Westeent
220 other aids to walking such as the walking chair, parallel bars and tetrapods for the use of toddlers. Also, they were shown the spring suspension apparatus of Mrs. Guthrie Smith. I n the Occupational Therapy department, they were taken round the handcraft and carpentry sections. • Afterwards, Mr. B. O'Neill, F.R.C.S., spoke on chest diseases in childhood, illustrated by X-ray plates and of the m o d e r n methods o f treatment of pulmonary tuberculosis. Before leaving the Group were entertained to tea by the matron of the hospital. Course Dinner O n Saturday evening a dinner was held at the Great Northern Hotel. T h e Past-President, Dr. Benham, was in the chair. Alderman Beevers, Mrs. Naylor, Prof. and Mrs. Craig, Dr. Davies and Dr. Gray were guests of the Group. Dr. Hirst proposed the toast of the City of Leeds, coupled with the Guests, to which Alderman Beavers replied. Ante-natal Care O n Sunday morning, at the Maternity Hospital, Prof. Claye, Professor of Obstetrics to the University of Leeds, addressed the G r o u p as follows: To-day, ante-natal supervision can be regarded as being largely a psychological preparation for labour. T h e reason, for instance, that many mothers behave badly during labour or refuse to breastfeed their babies is because their psychological approach to it is wrong. T h e preparation for labour, as expounded by Dr. Read Dick, has certainly proved a most helpful teaching, though it m u s t be understood that drugs are still necessary in a certain n u m b e r of eases and are used even by him. Classes for ante-natal exercises should begin early in pregnancy. T h e y should aim to encourage the mother to develop muscular control and should preferably be taken by someone who is to be present at the confinement. Approximately six weeks before the baby is due the phenomenon of labour should be explained to the m o t h e r taking care to avoid the use of the word " p a i n " and to use the word " c o n t r a c t i o n " in its place. W h e n the mother first attends the ante-natal clinic a complete medical examination should b e carried out, and this examination should include a blood examination for the haemoglobin level, the Wasserman reaction and the Rhesus factor. Private doctors also should be circularised concerning the importance of determining the Rhesus factor. T h i s test is of very doubtful benefit to the baby. I n cases of hydrops faetalis the chance of recovery is nil. Some cases of icterus gravis may recover with blood transfusion b u t about 15% of those that recover will be left with neurological trouble. Haemolytic anaemia in the new b o r n wilt usually recover with iron-therapy alone. T h e real importance of this examination is to ensure that a Rhesus-negative woman is transfused with Rhesusnegative blood to avoid sensitising her to the Rh factor and jecpardising her chances of a successful pregnancy in the future. T h e 34th week is perhaps the best time to spot and deal with a malpresentation. Few breeches turn spontaneously after the 84th week though many will do so before that date. By the 36th week version becomes more difficult. If version is unsuccessful without an anaesthetic, another attempt should be made with an anaesthetic. T h e r e is always a danger of separation of the placenta from this manipulation b u t statistics show that the stillbirth rate following version is only 2% while that from breech delivery remains at 15%. I t is still impossible in the majority of cases to state the reason for malpresentation. T h e patient should again be examined at the 36th week to make certain that the head fits the pelvic brim. Failure to engage may be due to contracted pelvis, to turnout or to placenta praevia, b u t the commonest cause is a persistent occipiti-posterior position. I f the head is not engaged an attempt should be made to push it down into the pelvic cavity. If this is unsuccessful in the recumbent position, stand the patient up and see if the force of gravity will make it descend. If still unsuccessful, examine under art anaesthetic or by radiographic pelvimetry. Following coffee and biscuits, members divided into two groups. One group were given a demonstration of high rupture of the membranes using a Drew-Smythe catheter, followed by a talk on pre-eclamptic toxaemia by Prof. Claye. T h e other group went to the labour wards and were shown a case of toxaemia and a case of post-maturity by Mr. B. L. Jeafferson, who also spoke on toxaemia of pregnancy. M e m b e r s of the Group are greatly indebted to Dr. Gray, Senior Assistant Medical Officer of Leeds, who was responsible for the detailed arrangements of a very successful week-end. T h e Editor again regrets that several Branch and Group reports have had to be held over.
President:
SERVICES HYGIENE GROUP Dr. H. D. Chalke, o.n.e. (Divl. M.O., L.C.C., Lt..
Col., R.A.M.C. [T.A.]). Hon. Secretary: Dr. G. M. Frizelle, T.D. (Sub-Dean, London School of Hygiene & Tropical Medicine). The Pioneer Health Centre, Peekham. T h e Group met on April 29th, 1949, at 7.30 p.m. at the Pioneer Health Centre, Peckham: T h e President was supported by about 30 members. T h e Medical Director, Dr. Innes H. Pearse, who was introduced by Brigadier J. W. Scharff, gave a highly interesting talk on the history, aims and activities of the Health Centre. T h i s was followed by a tour of the building--including a welcome visit to the excellent cafeteria--during which the members of the Group were enabled to witness the normal evening activities of the centre. T h e President thanked Dr. Pearse for her interesting and instructive address, and for the hospitality which had been extended to the Group. He remarked on the interest which members had shown in this visit, as was evidenced by the good attendance and the fact that many had travelled long distances for the occasion. Dr. Pearse, Brig. Scharff, and a representative of one of the families, answered a large n u m b e r of questions, and it was not until a late hour that this most enjoyable and illuminating visit was concluded. Visit to the Royal Navy at Portsmouth. Some 34 members of the Group, led by the President, visited Portsmouth on Saturday, June l l t h , by kind invitation of their fellow member, Surg.-Capt. A. W. McRurie, R.N., who is Naval Medical Officer of Health, Portsmouth Command. T h e party arrived in the forenoon and was first conducted over a modern submarine (H.M.S. Auriga) lying in Haslar Creek. T h e amount of living and working sFaee , the " Schnorkel " for air supply to the crew and diesel engines while the boat runs submerged and the escape arrangements, were points of special interest. T h e next visit was to the escape training apparatus in the submarine shore establishment (H.M.S. Dolphin), whence members adjourned to lunch as guests of the officers' mess at the R.N. Hospital, Haslar. After lunch, when the President had expressed warm thanks to Surg.-Capt. McRorie and the mess, the party returned by motorboat across the harbour to the Royal Dockyard, where a visit was paid to H . M . battleship Duke of York in the graving dock with especial reference to the sick bay. Thence to the ever-glorious H.M.S. Victory, where a seaman guide gave an excellent running commentary. NORTH-WESTERN M. & C.W. AND SCHOOL H.S. SUB-GROUPS President: Dr. H. G. M. Bennett (A.D.M.O., Lancashire). Hon. Secretary : Dr. J. S. G. Burnett (M.O.H., Preston C.B.). T h e annual meeting of the sub-groups was held at Biddulph Orthopaedic Hospital on Friday, May 20th, at 2.30 p.m., w h e n 25 members attended, including one past-President of the Society and three past-Presidents of the North-Western Branch. Sir Harry Plait demonstrated orthopaedic cases of clinical interest, and provocatively stimulated m u c h discussion amongst many who had been members of his resident staff in years past. T h e group was then conducted by the Matron over the extensive and lovely grounds of the hospital. T h e following elections to office were made for the session 19491950 : President: Dr. J. E. Spence. Vice-President : Dr. H. G. M. Bennett. Hon. Seoetary : Dr. E. M. Jenkins. Committee: Drs. M. E. Cliff, S. C. Gawne, J. T. C. Keddie, M. Sproul, E. H. Walker and G. E. Wilkinson. Representatives on the School Health Service Group : Drs. E. M. Jenkins and G. E. Wilkinson. Representatives on the M. & C.W. Group: Drs. M. Sproul and J. T. C. Keddie. It was resolved (a) that the President and Hon. Secretary of the North-West Branch of the Society of Medical Officers of Health be ex-o~cio members of the Sub-Groups Committee ; (b) that the number of annually elected members of the Committee be increased from six to eight ; and that (c) Drs. B. M. Butters and W. A. Kane be elected to the two vacancies created by the preceding resolution. PubIi© H e a l t h is the Official Organ of the Society of Medicat Officers of Health and a suitable medium for the advertisement of official appointments vacant in the health service. Space is also available for a certain n u m b e r of approved commercial advertisements. Application should be made to the Executive Secretary of the Society, at Tavistock House South, Tavistock Square, W.C.I. Subscription 3Is. 6d. per annum, post free, in advance. Single copies 2s. 6d. post free. Official classified advertisements are charged at 2s. per line or part of a line. Minimum charge 16s. Telephone: Euston 3923. Telegrams : Epidauros, Westeent