The London County Council Hospitals: Research

PUBLIC HEALTH THE JOURNAL OF

THE SOCIETY OF MEDICAL OFFICERS OF HEALTH. MARCH, 1986. Subscription price 31s. 6d. per annum, post free, in advance. Single copies, 2s. 6d. post free. No. 6.

Vol. X L I X .

"Public Health" Is the Official Organ of the Society of Medical Officers of Health and a suitable medium for the advertisement of official appointments vacant in the health service. Space is available also for a certain number of approved commercial advertisements. Application should be made to the Executive Secretary of the Society, at 1, Thornhaugh Street, Russell Square, London, W.C.1.

Contents. EDITORIAL-T h e L o n d o n C o u n t y Council Hospitals ,.. T h e Central Midwives Board . . . . . . . . . Physical Education . . . . . . . . . . . . Diphtheritic Infections . . . . . . . . . . . . Standardisation of Vitamin A . . . . . . . . . Water Pollution . . . . . . . . . Pathological Specimens I~y Post::: ... Bacteriological Examination of Water "Supplies British Medical Films . . . . . . . . . . . . T h e Care of the Cripple . . . . . . . . . . . . British Rainfall, 1934 . . . . . . . . . . . . L o n d o n Health Services . . . . . . . . . . . . Certification of Blindness ......... Obituary . . . . . . . . . . . . . . . . . .

PACE 193 196 197 198 198 199

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200 200 201 201 202 202 202

SPECIAL ARTICLES-Psychology in Relation

to Public Health. By HErmY WmSON, M.D., M.R.C.P., Physician, T h e Institute of Medical P s y c h o l o g y ; Fellow in Psychiatry, L o n d o n Child Guidance Clinic; and S. W. SAVAGE, M.D., D.P.n., D e p u t y County Medical Officer of Health, Buckinghamshire ... Ut lta Dicam. (Being C o m m e n t s , apropos and otherwise, on S u n d r y Matters) . . . . . . . . . . Parental Vaccination and T r a n s m i s s i b l e I m m u n i t y . By JAMES BENNETT, M.R.C.S., L.R.C.P. (LOND.), D.P.H., Medical Officer of Health, W a r r i n g t o n Rural District, and G o l b o r n e and L y r n m U r b a n Districts ; Public Vaccinator, W a r r i n g t o n C o u n t y Borough . . . . . . . . . . . . . . .

PAGE Conservative T r e a t m e n t of Chronic Mastoid Disease. By ALEXIS TUMARKIN, M.B., F.R.C.S. (EDIN.), D.L.O. (LORD.), H o n o r a r y Aurist, Bootie General Hospital . . . . . . . . . . . . . . . . . .

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SOCIETY OF MEDICAL OFFICERS OF HEALTH-Council Meeting . . . . . . . . . . . . Ordinary Meeting ............. T h e N o r t h - W e s t e r n Branch . . . . . . T h e Yorkshire Branch . . . . . . . . . . . . T h e Midland Branch . . . . . . . . . . . . T h e S o u t h e r n Branch . . . . . . . . . . . . T h e Fever Hospital Medical Service G r o u p .... T h e Maternity and Child Welfare G r o u p ... T h e W e l s h Branch . . . . . . . . . . . .

224 23I 232 233 233 234 234 235 236

THE LITERATURE OF PREVENTIVE MEDICINE--

203 214

T h e W o r k of the Sanitary E n g i n e e r ...... Balanced Meals with Calorie Values . . . . . . Vitamins in T h e o r y and Practice ...... T h e T h e o r y and Practice of Anaesthesia ... Hygiene and Public Health ......... T h e L a w of H o u s i n g . . . . . . . . . . . . Australian Sanitary Engineering Practice ... Prognosis . . . . . . . . . . . . . . . . . . I n the Annual R e p o r t s

216

Correspondence

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. . . . . . . . . . . .

237 237 237 237 238 238 238 238 239

...

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Editorial. The London County Council Hospitals: Research. NE of the duties of the London County Council in taking over, under the Local Government Act of 1929, the hospitals of the late poor law authorities and the laboratories attached to them was to supply a report annually on the work of these hospitals and laboratories during the previous year. These reports cover such topics as improvements and enlargements, number of patients admitted, treated and discharged, and the financial side of running such hospitals. In such a huge organisation as the hospital service of the Council, comprising as it does general hospitals, sanatoria and hospitals for infectious diseases and other special purposes, a great variety of cases of sickness--many o~.~ which no other hospitals are prepared to d ~ :

O

with--is provided for. There is, therefore, a vast amount of material available from which much can be learned. Moreover, there are on the Council's staff persons admirably fitted to carry out research and to advance the treatment of disease. W i t h a generosity not always conspicuous amongst local authorities where matters of this kind are concerned, the London County Council from the very beginning made provision for allowing members of the staff to take advantage of opportunities for carrying out research. Further, they provided full facilities for publication of results, and annually during the last four or five years a section of the annual report of the Council has been devoted to this purpose, appearing under the title of " Public Health ~edical Supplement to the Report on the Hxo~ital Services." In the medical supple-

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ment for 1934" there is contained a collection of papers, reports and annotations, a number of which may be counted scientific contributions not only of interest but of importance and certain to react beneficially to the investigators as well as to sufferers, whether in the Council's hospitals or elsewhere. The field covered by the contributions is, naturally perhaps, wide and varied and classification is not too easy. In the publication the arrangement followed is one adopted a year or two ago of grouping papers, reports, etc., under the heads of special hospitals, special units and general hospitals, the chemical branch having a separate heading for itself. In the special hospitals group the communications from isolation hospitals are naturally most numerous. In addition, however, notes from tuberculosis hospitals and sanatoria and establishments for rheumatic children are given a place. Amongst special units making contribution are that for puerperal fever, the radium centre and clinic, the goitre clinic, the maternity wards, and the clinics for diabetes and pernicious anaemia. From the general hospitals the reports, notes and papers deal with interesting cases, surgical as well as medical. That there must have been a good deal of selection done, not only in this but in the other branches, is certain, and j u d g i n g from the general high standard of excellence of the contributions it must have been carried out most carefully. In the special hospitals group of papers, since they treat of such subjects as purpura h~emorrhagica and scarlet fever, food poisoning caused by B. dysenterice, the use of the Drinker respirator, vulvovaginal diphtheria, gastric lavage in tuberculous children--to quote only a few--every one has a wide importance. The paper on gastric lavage in tuberculous children, by Dr. Fish of H i g h W o o d Hospital, is a preliminary report only, but as it appears to indicate that by this method real assistance in detecting the presence of tubercle bacilli can be obtained, it is worth noting. The paper on the Drinker respirator, descriptive of its use and assessing its value in the case of diphtheria, empyema and pulmonary collapse, is also noteworthy. Of reports from special u n i t s calling for mention are those of Dr. Joe on the work done in relation to puerperal * London: P. S. King & Son, Ltd., 14, Great Smith Street, S.W.1. Publication No. 3156. Price 5s.

MARCH,

fever. These contain a close analysis of the cases dealt with and full particulars of 14 deaths occurring amongst 166 cases of puerperal sepsis admitted for treatment. In present circumstances the notes on work done at the radium centre for carcinoma of the uterus at Lambeth Hospital and tile radiotherapeutic clinic also at that hospital by Sir Comyns Berkeley, Dr. Stebbing and others, are of real moment. Equally so are the reports from the goitre and diabetic clinics. Dr. Y o u n g ' s report of the work done at the latter especially may be noted on account of the fulness of the information given with regard to the type of diet in use at St. Peter's Hospital and tile method devised for its measurement by patients, particularly those in poor circumstances. An important contribution in the special unit group is that by Dr. Letitia Fairfield on maternal deaths in the Council's hospitals. That there has been a very great advance made in relation to maternity work in the various institutions since they were taken over by the London County Council cannot be doubted. It is certainly revealed in this as in other reports that have been issued with regard to work done. In 1934 the total number of births taking place in the hospitals was 13,253, an increase of 1,336 on the numbers for the previous year. The number of deaths of women confined in the hospitals after the twenty-eighth week of pregnancy was 66. Ttiis gives a death-rate of 5"1. As a maternal mortality, having regard to what it includes, this must be counted small. By way of conclusion to very full and skilful analysis of the figures and facts, Dr. Fairfield submits the following, which will probably receive general acceptance: " The close enquiries undertaken into every maternal death in the Council's hospitals show that no obvious or easily eliminated cause for a high mortality rate exists. There is very rarely any evidence of failure of ante-natal care, of avoidable sepsis, of unnecessary interference, or of failure to provide efficient obstetrical aid at the proper time. Samples of the many and diverse obstetrical problems which defy easy and automatic solution are now being dealt with. A steady improvement of staffing, accommodation and organisation, as well as loyal co-operation on the part of the patient, offer the only possibility of a further reduction in the mortality rate." Amongst contributions from the general hospitals group may be

1,q:16.

PUBLIC HEALTH.

men|i0ned those of Mr. Waters of Sl. Stephen's Hospital on abdominal actinomycosis, and of Mr. Gillies (Hackney) and Major Sinclair (St. James'), the former on fractures of the nec[~ of the femur, and the latter on end results of fractures. From the chemical branch two contributions were regarded as worthy of inclusion in the report: one by Mr. Coste on atmospheric pollution, and the other descriptive of an investigation carried out bv Mr. Shelbourn and Mr. Bennett, at the request of the Chief Officer of the Fire Brigade, into possilSle dangers from inhaling phosgene gas in connection with the use of fire extinguishers of the carbon-tetrachloride type. As already mentioned, there must have been very close and careful selection made of papers prepared by members of the Council's staff. An indication of the amount of work this involved may be gathered from the fact that, in addition to those included in the report, there is a long list of others which, no doubt because they were crowded out, had to be publisheTd elsewhere. The references to these are quite full, so that the information they contain will be readily accessible, though possibly less so than those included in this interesting and most valuable supplement to the general report on the hospital services.

Mental Hospitals and Mental Deficiency. Because they also are, in a sense, supplementary or, possibly, rather complementary to this report, those on Mental Hospitals and Mental Deficiency, and Hospital Finance, may appropriately be referred to here. In a series of three chapters and some four appendices the former* gives a volume of most useful information with regard to the extremely extensive mental services provided by the Council. Historically it is interesting to note that on January 1st, 1890, that body and the Metropolitan Asylums Board together were providing institutional accommodation for 15,670 mental patients. On January 1st, 1935, the Council, which took over the functions of the Metropolitan Asylums Board in 1930, was providing beds for 83,62i mental patients and shouldering double the responsibility of 1890. This does not mean that there is any substantial increase in the incidence of mental derangement in the London population. Largely it has resulted from change in policy * Publication No. 3148. Price ls.

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and outlook. The Mental Deficiency Act, 1913, for example, placed upon tile Council the duty of ascertaining and providing for mentally defective persons who before that date had been dealt with--if at all--in the chronic wards of mental hospitals, or (not very suitably) as cases of chronic harmless insanity by the Metropolitan Asylums Board. Since then, further, a mental deficiency service, supplementing the provision made for the assistance of the mentally deranged, has been organised and developed. On December 31st, 1934, the Council's mental hospitals committee were responsible for the care of 37,236 persons suffering from mental disorder or defect, including defectives under supervision in their own homes or under statutory guardianship. The report, which is very rich in statistical information, contains a number of figures of sufficient general interest to be worth quoting. During 1934, for instance, 3,621 persons suffering from mental disorder were admitted to London county mental hospitals. The percentage of direct admissions to the total population of the administrative county of London as at the 1931 census was 0"07. The number of deaths of patients in such hospitals during 1934 is the lowest recorded since 1898. There are more patients between the ages of 45 and 54 years than in any other age-group. This applies both in respect of the total patient population and of direct admissions during the year to the county mental hospitals. On March 31st, 1935, there were 741 patients in the hospitals whose mental disability was due to, or aggravated by, military service during the Great W a r and who were therefore classified as "service" patients. On December 31st, 1934, there were in residence at the mental hospitals 665 alien patients, of whom more than one-third were Russian subjects. Tile unique work done at Maudsley Hospital, where only voluntary patients suffering from early mental or nervous disorder are received, is worthy of comment. During 1934, 3,32.5 out-patients were treated at the hospital and a further 1,302 at the psychiatric clinics, established as " limbs " of Maudsley Hospital, at three of the Council's general hospitals north of the Thames. Between 1914 (when the Mental Deficiency Act, 1913, came into operation) and Decemkier 31st, 1934, 17,950 cases of mental defect were notified to tl{e Council as a local mental deficiency authority. The