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THE REORGANISATION OF THE SCHOOL MEDICAL STAFF IN LONDON.
1205
THE REORGANISATION OF THE SCHOOL MEDICAL STAFF IN LONDON.
Public Health. ANNUAL REPORTS OF MEDICAL OFFICERS OF HEALTH.
IN order to meet the view of the Board of Education that the efficiency of the school medical service may suffer unless more variety is introduced into the work of school medical officers, and to comply with a suggestion that in certain respects the arrangements for medical inspection were capable of improvement, the London County Council has decided to divide the county into five districts instead of four, the staff of each division to be under the control of a divisional officer and to consist of a nucleus of permanent medical assistants, the remainder of the staff consisting partly of full-time temporary medical assistants appointed for three years only and partly of temporary part-time medical inspectors. The Board of Education suggested that the duties of the permanent officers might be extended to include further examination of visual defects, public’ health work, including investigations of infectious diseases in schools, medical inspection of children in secondary schools, scholarship candidates, &c., work in connexion with special schools, research and laboratory work, and some share in the working of the administrative arrangements. Furthermore, in order to earn the full 50 per cent. grant towards the cost of medical inspeotion and treatment, the Board requires that provision should be made for completing the scheme of re-inspection of children found defective, including the continuous observation of tuberculous children, for special examinations in connexion with visual and aural defects and cases requiring nursing treatment, and for more complete control of outbreaks of infectious disease. The Education Committee proposed that, as from April 1st, 1914, there should be five divisional medical officers at a commencing salary of E500 a year, rising by annual increments of
and resolved :(a) That Mr. J. G. Forbes, Mr. A. W. Sikes, and Mr. F. W. Higgs, medical assistants in the public health department, be designated "divisional medical officers." (b) That Mr. F. C. Lewis (B450). a medical assistant in the public health department, be promoted to be a divisional medical officer at the commencing salary of .B500 a year, rising by annual increments of B25 to B600 a year. (c) That the salary ( £ 400 a year since September, 1913) of Mr. T. J. T. MeHattie, a medical assistant in the public health department, be increased to JE425 a year. (d) That Dr. A. R. Cowell, Dr. H. F. Marris, Dr. R. H. Norman, Dr. W. J. M. Slowan, and Dr. A. G. Wells be appointed medical assistants in the public health department, each at a commencing salary of B425 a year; Mr. L. R. Tosswill, Dr. Mabel Russell, and Dr. F. T. H. Wood to be medical assistants, each at a commencing salary of £ 400 a year, rising in both instances by :E25 a year to .E500 a year. (e) That the services of Miss Ruth Balmer. Mr. E. J. Boome, Mr. Cresswell Burrows, Mr. A. M. Davies, Miss J. G. Duncan, Miss M. G. Edis, Miss M. C. Macdonald, Miss E. M. MeVail. Mr. E. F. Palgrave, and Mr. 0. H. Peters be temporarily retained for a period not exceeding three years as medical assistants in the public health department, each at a salary at the rate of B400 a year. (f) That the services of Dr. C. F. Hadfield, Miss Rose Jordan, DrF. S. Langmead, Mr. E. J. Morton, Mr. E. B. Smith, and Dr. Oliver R. Williamson be retained for a period not exceeding two years as quarter-time school doctors, each at a salary at the rate of 2132 a year. Permission has been given for the school organisation to be used in connexion with investigations which Mrs. Frances Wood desires to carry out in certain schools with the object of ascertaining whether there was any correlation between the home environment of a child and its mental ability and physical characteristics. The work is to be carried out in the statistical laboratory of the Lister Institute of Preventive Medicine under the direction of Mr. Major
Greenwood, jun. 1
THE LANCET,
August 2nd, 1913,
p. 339.
County of Durham.-Dr. T. Eustace Hill’s last annual report contains as usual a variety of interesting information. The shire of Durham, which includes a large mining population, continues to increase the number of its inhabitants, which is In 1912 the number of now estimated at about 952,000. births was 29,671 and the deaths 13,111, giving a 11 natural increase" of births over deaths of 16,560. It is true that the birth-rate shows a tendency to fall-for 1912 it was 31 - 2, as compared with 36’ 9 in 1891-5-and that, notwithstanding a steady simultaneous fall in the general death-rate, the proportionate 11 natural increase " is now somewhat less than formerly ; but even on present figures the Durham rate, if it obtained throughout the country, would occasion serious problems of over-population. The county has an excess of males : 100 to every 95’5 5 females, as against 106’8 8 females in the case of England and Wales ; the preponderance is notable at all ages after 15, and no doubt signifies a large amount of female emigration as well as of male immigration. A relatively high infant mortality rate accompanies the high birth-rate, but this also has fallen conspicuously in recent years, and for 1912 was no higher than 106 per 1000 births, as compared with 95 per 1000 for England and Wales. The rural districts of Durham have a higher infant death-rate than the urban ; but it has to be remembered that many of the so-called rural districts contain large aggregations of population living under urban conditions. Last year the adoption of the Notification of Births Act was made obligatory all over the county at the instance of the county council, but in the period reviewed in this report this Act was operative in six districts only. For these districts the county council appointed and maintained health visitors and nurses, and the complete scheme now contemplated will entail the appointment of 40 such visitors, on the basis of 1 to every 25,000 persons. It is proposed that the health visitors should also undertake the duties of visiting persons suffering from tuberculosis and of following up school children ascertained to be suffering from physical defects requiring attention or treatment. A notable decline has taken place in the mortality from, and prevalence of, enteric fever, in regard to which the county of Durham formerly had an unenviable pre-eminence. This must in large measure be attributed to progress in the matter of sewage and improved watersupplies, and the efforts which have been made to abolish the insalubrious middens which are so characteristic of many of the towns and villages in the county. Progress, though slow, is being made in replacing by properly constructed covered drains the objectionable open channels which are so frequently used in the colliery villages for the conveyance of slop-water and waste-water, while in Stockton and other places the local authorities have at length decided on an active policy of systematic conversion of midden privies to water closets. Much, however, has still to be done to mitigate the nuisances caused by the insanitary practice of depositing house refuse and midden contents on the footpaths and roadways to await the uncertain arrival of the scavengers’ carts, to get the roads in new neighbourhoods properly made up, and generally to prevent the numerous causes of soil pollution which obtain in the mining villages and elsewhere. It is to the credit of the county council and its medical officer of health that in Durham a very active policy has been pursued for many years in regard to the improvement of housing conditions. Dr. Hill gives some specimens of useful forms for recording the results of inspection of working-class property, and shows that as a whole the various districts in the county have substantial housing improvements to their credit. The report gives a detailed account of a long-standing dispute between the county authorities and the district council of Benfieldside on the question whether the old type of miner’s cottage can be made reasonably fit for human habitation by any method short of rebuilding the upper storey and raising the roof. The Local Government Board, as a result of a test case, endorsed the county view that the raising of the roofs so that the upper rooms have an average height of 8 feet would be desirable, but was unable to rule out alternative improvements, such as the provision of dormer windows and
THE REORGANISATION OF THE SCHOOL MEDICAL STAFF IN LONDON.
Public Health. ANNUAL REPORTS OF MEDICAL OFFICERS OF HEALTH.
IN order to meet the view of the Board of Education that the efficiency of the school medical service may suffer unless more variety is introduced into the work of school medical officers, and to comply with a suggestion that in certain respects the arrangements for medical inspection were capable of improvement, the London County Council has decided to divide the county into five districts instead of four, the staff of each division to be under the control of a divisional officer and to consist of a nucleus of permanent medical assistants, the remainder of the staff consisting partly of full-time temporary medical assistants appointed for three years only and partly of temporary part-time medical inspectors. The Board of Education suggested that the duties of the permanent officers might be extended to include further examination of visual defects, public’ health work, including investigations of infectious diseases in schools, medical inspection of children in secondary schools, scholarship candidates, &c., work in connexion with special schools, research and laboratory work, and some share in the working of the administrative arrangements. Furthermore, in order to earn the full 50 per cent. grant towards the cost of medical inspeotion and treatment, the Board requires that provision should be made for completing the scheme of re-inspection of children found defective, including the continuous observation of tuberculous children, for special examinations in connexion with visual and aural defects and cases requiring nursing treatment, and for more complete control of outbreaks of infectious disease. The Education Committee proposed that, as from April 1st, 1914, there should be five divisional medical officers at a commencing salary of E500 a year, rising by annual increments of
and resolved :(a) That Mr. J. G. Forbes, Mr. A. W. Sikes, and Mr. F. W. Higgs, medical assistants in the public health department, be designated "divisional medical officers." (b) That Mr. F. C. Lewis (B450). a medical assistant in the public health department, be promoted to be a divisional medical officer at the commencing salary of .B500 a year, rising by annual increments of B25 to B600 a year. (c) That the salary ( £ 400 a year since September, 1913) of Mr. T. J. T. MeHattie, a medical assistant in the public health department, be increased to JE425 a year. (d) That Dr. A. R. Cowell, Dr. H. F. Marris, Dr. R. H. Norman, Dr. W. J. M. Slowan, and Dr. A. G. Wells be appointed medical assistants in the public health department, each at a commencing salary of B425 a year; Mr. L. R. Tosswill, Dr. Mabel Russell, and Dr. F. T. H. Wood to be medical assistants, each at a commencing salary of £ 400 a year, rising in both instances by :E25 a year to .E500 a year. (e) That the services of Miss Ruth Balmer. Mr. E. J. Boome, Mr. Cresswell Burrows, Mr. A. M. Davies, Miss J. G. Duncan, Miss M. G. Edis, Miss M. C. Macdonald, Miss E. M. MeVail. Mr. E. F. Palgrave, and Mr. 0. H. Peters be temporarily retained for a period not exceeding three years as medical assistants in the public health department, each at a salary at the rate of B400 a year. (f) That the services of Dr. C. F. Hadfield, Miss Rose Jordan, DrF. S. Langmead, Mr. E. J. Morton, Mr. E. B. Smith, and Dr. Oliver R. Williamson be retained for a period not exceeding two years as quarter-time school doctors, each at a salary at the rate of 2132 a year. Permission has been given for the school organisation to be used in connexion with investigations which Mrs. Frances Wood desires to carry out in certain schools with the object of ascertaining whether there was any correlation between the home environment of a child and its mental ability and physical characteristics. The work is to be carried out in the statistical laboratory of the Lister Institute of Preventive Medicine under the direction of Mr. Major
Greenwood, jun. 1
THE LANCET,
August 2nd, 1913,
p. 339.
County of Durham.-Dr. T. Eustace Hill’s last annual report contains as usual a variety of interesting information. The shire of Durham, which includes a large mining population, continues to increase the number of its inhabitants, which is In 1912 the number of now estimated at about 952,000. births was 29,671 and the deaths 13,111, giving a 11 natural increase" of births over deaths of 16,560. It is true that the birth-rate shows a tendency to fall-for 1912 it was 31 - 2, as compared with 36’ 9 in 1891-5-and that, notwithstanding a steady simultaneous fall in the general death-rate, the proportionate 11 natural increase " is now somewhat less than formerly ; but even on present figures the Durham rate, if it obtained throughout the country, would occasion serious problems of over-population. The county has an excess of males : 100 to every 95’5 5 females, as against 106’8 8 females in the case of England and Wales ; the preponderance is notable at all ages after 15, and no doubt signifies a large amount of female emigration as well as of male immigration. A relatively high infant mortality rate accompanies the high birth-rate, but this also has fallen conspicuously in recent years, and for 1912 was no higher than 106 per 1000 births, as compared with 95 per 1000 for England and Wales. The rural districts of Durham have a higher infant death-rate than the urban ; but it has to be remembered that many of the so-called rural districts contain large aggregations of population living under urban conditions. Last year the adoption of the Notification of Births Act was made obligatory all over the county at the instance of the county council, but in the period reviewed in this report this Act was operative in six districts only. For these districts the county council appointed and maintained health visitors and nurses, and the complete scheme now contemplated will entail the appointment of 40 such visitors, on the basis of 1 to every 25,000 persons. It is proposed that the health visitors should also undertake the duties of visiting persons suffering from tuberculosis and of following up school children ascertained to be suffering from physical defects requiring attention or treatment. A notable decline has taken place in the mortality from, and prevalence of, enteric fever, in regard to which the county of Durham formerly had an unenviable pre-eminence. This must in large measure be attributed to progress in the matter of sewage and improved watersupplies, and the efforts which have been made to abolish the insalubrious middens which are so characteristic of many of the towns and villages in the county. Progress, though slow, is being made in replacing by properly constructed covered drains the objectionable open channels which are so frequently used in the colliery villages for the conveyance of slop-water and waste-water, while in Stockton and other places the local authorities have at length decided on an active policy of systematic conversion of midden privies to water closets. Much, however, has still to be done to mitigate the nuisances caused by the insanitary practice of depositing house refuse and midden contents on the footpaths and roadways to await the uncertain arrival of the scavengers’ carts, to get the roads in new neighbourhoods properly made up, and generally to prevent the numerous causes of soil pollution which obtain in the mining villages and elsewhere. It is to the credit of the county council and its medical officer of health that in Durham a very active policy has been pursued for many years in regard to the improvement of housing conditions. Dr. Hill gives some specimens of useful forms for recording the results of inspection of working-class property, and shows that as a whole the various districts in the county have substantial housing improvements to their credit. The report gives a detailed account of a long-standing dispute between the county authorities and the district council of Benfieldside on the question whether the old type of miner’s cottage can be made reasonably fit for human habitation by any method short of rebuilding the upper storey and raising the roof. The Local Government Board, as a result of a test case, endorsed the county view that the raising of the roofs so that the upper rooms have an average height of 8 feet would be desirable, but was unable to rule out alternative improvements, such as the provision of dormer windows and