Yorkshire Branch

82

PUBLIC H E A L T H , April, 1945

T h e C o u n c i l o f S e v e n B e l i e f s is a b o d y o f s e r i o u s - m i n d e d men and women who believe that the preservation of our race is i m p o r t a n t f o r t h e w e l f a r e o f m a n k i n d . C o n s e q u e n t l y it views with dismay the tendency towards an ageing and diminishi n g p o p u l a t i o n , a n d is d e s i r o u s o f i n v e s t i g a t i n g t h e c a u s e s a n d finding remedies for this tendency. The Council believes t h a t o n e o f t h e m o s t i m p o r t a n t f a c t o r s is a l o w e r i n g o f t h e noble calling of motherhood. In the present state of our c i v i l i s a t i o n n o t all w o m e n c a n b e c o m e m o t h e r s , a n d t h o s e w h o s e b i o l o g i c a l a n d s o c i a l c o n d i t i o n s d o n o t p r e c l u d e it, receive scanty encouragement: Small families, the necessity to earn a living, or the desire to achieve an individual career, prevent many girls from learning the domestic arts which are fundam e n t a l f o r t h e s u c c e s s o f f a m i l y life. M a n y y o u n g m a r r i e d c o u p l e s a r e u n w i l l i n g to f a c e t h e r e s p o n s i b i l i t y o f p a r e n t h o o d , either from purely selfish motives or for fear of being overw h e l m e d b y social o r e c o n o m i c d i s a s t e r t h r o u g h n o f a u l t o f their own. Those who want children and have faith in the future may well be daunted by the obstacles which modern h o u s i n g c o n d i t i o n s a n d t h e lack o f d o m e s t i c h e l p p l a c e in t h e w a y o f r e a r i n g a f a m i l y , s o t h a t t h e m o t h e r o f s i x is n o w m o r e o f t e n r e g a r d e d b y h e r s i s t e r s as a n o b j e c t o f p i t y r a t h e r t h a n o f e n v y . I n s p i t e o f all t h i s a w o m a n ' s p r i m a r y u r g e is still to become a wife and mother, equal partner with her husband i n t h e j o y s a n d t r i a l s o f f a m i l y life. T h e r e a r e s i g n s t h a t a t t h i s late h o u r t h e n a t i o n is b e g i n n i n g t o realise t h a t its c o n tinued existence depends on the production of conditions in w h i c h f a m i l y life c a n f l o u r i s h a n d t h e d i g n i t y o f m o t h e r h o o d b e maintained. T h e C o u n c i l o f S e v e n B e l i e f s is s t r i v i n g t o s t r e s s the urgency of the matter by publishing Dr. Grantly Dick R e a d ' s a d d r e s s o n " T h e I m p o r t a n c e o f M o t h e r h o o d in t h e Post-\Var World." T h i s p a m p h l e t will b e u s e f u l t o all t h o s e who hold the same views and seek help in expressing them. It may be obtained from the Headquarters of the Council, 34, S u s s e x P l a c e , L o n d o n , W . 2 , p r i c e 6 d . n e t , p o s t a g e l d .

OBITUARY F. A. SItARPE, l~i.D., D.P.YL M e m b e r s of t h e Public H e a l t h Service a n d m a n y in other walks of life will have h e a r d w i t h deep regret of t h e s u d d e n d e a t h of Dr. F. A. Sharpe at his h o m e n e a r Preston on F e b r u a r y 2tst, at t h e age of 63. A native of Leicestershire, Frederick A u g u s t u s Sharpe h a d a successful career at Guy's, from where h e qualified M.B., B.S. i n 1905. H e took t h e D.P.H. of Leeds in 1907, a n d t h e M.D. of LOndon (State Medicine) in 1910. Like m a n y others who have d i s t i n g u i s h e d themselves in h e a l t h a d m i n i s t r a t i o n he served h i s early apprenticeship with Brindley, of D e r b y ; and, after appointm e n t s as M.O.H. of Chesterfield a n d of Barnsley, h e c a m e to Preston a q u a r t e r of a c e n t u r y ago. Here his efficiency a n d c h a r m i n g personality won h i m t h e respect a n d affection not only of his Council, b r o t h e r officials, a n d staff of t h e d e p a r t m e n t w h i c h h e so ably controlled, b u t also of t h e general public. Sharpe was a m a n of h i g h g i f t s ; h e was cultured, widely read, adaptable and, above all, endowed with an i n h e r e n t sense of fairness a n d kindliness. H e possessed a keen sense of h m n o u r a n d a ready t o n g u e , w h i c h was a source of c o n s t a n t joy" to his i n t i m a t e friends. M e m b e r s of t h e Society of Medical Officers of H e a l t h will long r e m e m b e r his m a s t e r y of debate, h i s gift of s u m m i n g up involved discussions, a n d h i s own i n i m i t a b l e way of d i s a r m i n g criticism or of reconciling conflicting points of view. Such ability m a d e h i m a most acceptable President of t h e N o r t h - W e s t e r n Branch of t h e Society a n d a valued m e m b e r of t h e Council of t h e p a r e n t body. His later years were clouded b y t h e d e a t h in action of a m u c h loved son, a C a p t a i n in a n A i r b o r n e U n i t of the R.A.M.C. Deep t h o u g h his friends knew his sorrow to be, it was typical t h a t h e carried on with his c u s t o m a r y cheerfulness a n d energy, to die as h e would h a v e wished, in harness. Sharpe leaves b e h i n d h i m n o t h i n g b u t a h o s t of h a n p y m e m o r i e s wl~ich will ever live in t h e m i n d s of those who, llke t h e writer, were privileged to enjoy his r e f r e s h i n g friendship. H e is survived a n d m o u r n e d by a widow, son a n d d a u g h t e r . H i s f u n e r a l service was attended" b y civic chiefs a n d officials of the town w h i c h h e h a d served so faithfully, b y m a n y of his general nractitioner a n d nublic h e a l t h colleagues, a n d by his m a s o n i c brethren.

T h e M i n i s t r y of Supply a n n o u n c e s that, on t a k i n g up a n o t h e r g o v e r n m e n t a p p o i n t m e n t , Mr. ~. B. H u t c h i n g s h a s resigned his post as Principal Director of Salvage a n d Recovery.

SOCIETY

OF

MEDICAL OFFICERS YORKSHIRE BRANCH

OF

HEALTH

P r e s i d e n t : Dr. J. A. Fraser (C.M.O., N o r t h Riding). H o n . S e c r e t a r y : Dr. J. M. Gibson (M.O.H., Huddersfield).

A n o r d i n a r y m e e t i n g of t h e Yorkshire B r a n c h was h e l d in Leeds on D e c e m b e r 29th, 1944, at w h i c h 20 m e m b e r s were present. T h i s was preceded by a m e e t i n g of t h e Council, at w h i c h seven m e m b e r s were present. A t t h e o r d i n a r y meeting, Dr. J. J. Jervis reported t h a t t h e Hon. Secretary, Dr. J. M. Gibson, h a d been appointed C h a i r m a n of t h e General Purposes C o m m i t t e e of t h e Council of t h e Society. It was resolved t h a t a record be m a d e in the m i n u t e s , expressing t h e satisfaction of the m e m b e r s of the B r a n c h with this appointm e n t , which, as t h e President stated, t h e y regarded as a tribute to Dr. Gibson's services, not o n l y as Secretary of t h e Yorkshire Branch, b u t also on t h e Council of t h e Society. T h e m i n u t e s of the m e e t i n g h e l d on D e c e m b e r 1st, 1944, were approved. T h e President welcomed two n e w m e m b e r s , Dr. M. E. Willcock, School M.O.H., Leeds, a n d Mr. K. G. Penney, School Dentist, Sheffield. I n f o r m a t i o n was received t h a t M a j o r E. H. T o m l i n , R.A.MqC., a n d Mr. K. G. Penney, L.D.S., h a d been accepted as m e m b e r s of tire Society, a n d would be a t t a c h e d to t h e Yorkshire Branch. A discussion followed u p o n t h e suggested scale of salaries for medical officers in the Public H e a l t h Service; a n d t h e following r e c o m m e n d a t i o n s were agreed u p o n : (1) T h a t medical officers of m e n t a l deficiency institutions s h o u l d be either included in Group IV of t h e Scale, or specially m e n tioned as included with t h e M e n t a l Hospitals Group. (2) T h a t where a medical officer is s u p e r i n t e n d e n t of one hospital a n d medical officer of a n o t h e r institution, consideration s h o u l d be given to the total n u m b e r of patients or beds u n d e r t h e medical officer's care. (3) T h a t officers who h a v e served a local a u t h o r i t y for a considerable n u m b e r of years should be g r a n t e d a greater allowance t h a n 1/120th for each year of non-contributory service. (4) T h a t for purooses of s u p e r a n n u a t i o n war service shmfld be regarded as equivalent to service with a local" authority, a n d be counted, therefore, either as c o n t r i b u t o r y or n o n - c o n t r l b u t o r y service according to circumstances. (5) T h a t all m e d i c a l officers a l r e a d y employed should be placed in t h e appropriate position on t h e Scale corresponding to t h e i r previous service. (This would appear to be in lieu of VII(3).) (6) T h a t there should be some s a f e g u a r d to protect medical officers of h e a l t h of c o u n t y districts in t h e event of t h e s e districts c e a s i n g to be a u t o n o m o u s h e a l t h authorities. (7) T h a t as t h e scales outlined are those we hone to secure, it m i g h t be advisable to s u b m i t s o m e w h a t h i g h e r scales in t h e first i n s t a n c e to allow for " b a r g a i n i n g . " Prof. J. W. M c L e o d read a p a p e r on t h e " V i " p h a g e t y p i n g of B. ty!)hosus.

A brief s u m m a r y was m a d e of t h e original work of Craigie a n d Yen on Vi p h a g e t r u i n g of t h e t v n h o i d bacillus. Felix's work with Pitt on distinguisblr~g the Vi a n t i g e n i c components of the t v n h o i d bacillus was also reviewed, a n d his later work with 1M[iss Callow on t h e ar)plication of Crai~ie a n d Yen's m e t h o d s to a similar t~ming of t h e P a r a B. bacilIus. T h e value of these m e t h o d s in following out t h e aetiologlcal c h a i n in cases of infection with bacilli of t h e enteric group was also discussed a n d i l l u s t r a t e d f r o m t h e papers of K i n g a n d Bradley A n ordinary m e e t i n g of t h e Yorkshire B r a n c h was h e l d in Leeds on J a n u a r y 26th. T w e n t y m e m b e r s were present. T h i s was preceded b y a m e e t i n g of t h e Councit, at w h i c h n i n e m e m b e r s were present. A t the ordinary m e e t i n g the m i n u t e s of the last meeting, h e l d on D e c e m b e r 29th, 1944. were approved. T h e m e e t i n g w h i c h followed was regarded as a n " o p e n day." Dr, J. J. B u c h a n wondered w h a t progress h a d been m a d e in regard to t h e provision of h o m e helps ' i n cases of sickness or infirmity, as sanctioned recently b y t h e M i n i s t r y of H e a l t h . M e m bers disclosed t h a t a l t h o u g h s c h e m e s b a d been approved in m o s t areas, no h o m e helps h a d so far been available. Dr. E. D, Irvine, of Shipley, reoorted t h a t in response to an aOvertlsement h e h a d received anplications from persons with Civil N u r s i n g Reserve training, who s e e m e d to regard t h e service as one of nursing. Dr. J. M. Gibson suggested t h a t w h e n c o m m u n i c a t i o n s were received f r o m n o n - m e m b e r s of t h e Society of Medical Officers of H e a l t h t h e o p n o r t u n l t y s h o u l d be t a k e n to point out t h e advantages of m e m b e r s h i p . Dr. J. J. B u e h a n referred to t h e nresent prevalence of infantile diarrhoea in several institutions in t h e W e s t a n d East R i d i n g s of Yorkshire. T h i s was regarded as an infectious type of dysentery,

t~3

PUBLIC H E A L T H , April, 1945 b u t n o p a t h o g e n i c o r g a n i s m s h a d been isolated. T h e r e h a d been a few deaths a m o n g babies. Dr. D. D. P a y n e asked w h a t action s h o u l d be t a k e n p n receipt of a notification of Sonne dysentery. It was generally agreed t h a t i n q u i r y . s h o u l d. . be m a d e r e g a r d i n g t h e source of infection. , a n d t h a t d i s m f e c t m n of personal clothing s h o u l d be c a r r m d o u t ; b u t unless t h e h a n d l i n g o£ food were involved, extensive bacteriological e x a m h m t i o n s s e e m e d unnecessary. Dr. P a y n e asked if it was considered safe for patients suffering f r o m p u l m o n a r y tuberculosis to. borrow books f r o m a public library. It was agreed t h a t this p r a c n c e s h o u l d be condemned, a n d t h a t patients in a s a n a t o r i u m s h o u l d have a library at ,the s a n a t o r i u m for their own use. Dr. P a y n e also a s k e d if all crockery at a s a n a t o r i u m s h o u l d be boiled. It was agreed by t h e m e m b e r s t h a t this was advisable, unless all patients were provided with individual utensils. Dr. Gibson referred to difficulties in dealing with t h e illegitimate c h i l d r e n of coloured soldiers. A t p r e s e n t t h e only redress is b y m e a n s of a paternity order t h r o u g h t h e court, b u t t h e circumstances are u s u a l l y s u c h t h a t procedure of this k i n d is impossible. Dr. Irvine said t h a t paedlatricians could be appointed b y a local a u t h o r i t y to advise upon the t r e a t m e n t of children seen either at clinics or at hospitals, b u t a p p a r e n t l y t h e M i n i s t r y could n o t sanction a n a r r a n g e m e n t w h i c h i n c l u d e d h o m e visits. H e felt t h a t p e r m i s s o n for this service s h o u l d be sought. H e also called attention to t h e difficulty he h a d experienced in trying to control a n o u t b r e a k of p e m p h i g u s n e o n a t o r u m . T h i s difficulty was s h a r e d b y others present, a n d ~he futility of t r y i n g to check s u c h an outbreak b y t h e swabbing of contacts was emphasised. It was resolved t h a t t h e Council of t h e Society be a s k e d for a legal opinion u p o n t h e position of a medical officer or of a n u r s e who contracts a n illness a t t r i b u t a b l e ,to e m p l o y m e n t , a n d suffers p e r m a n e n t disability therefrom. F u r t h e r , t h a t if compensation in s u c h circumstances is either arbitrary, or d e p e n d e n t upon a verdict obtained t h r o u g h t h e L a w Courts, a n effort s h o u l d be m a d e to secure some m e a s u r e of protection, similar to t h a t g r a n t e d to m e m b e r s of t h e Police Force u n d e r t h e Police Regulations. It was resolved t h a t t h e Council of t h e Society be requested to call t h e a t t e n t i o n of t h e M i n i s t r y of H e a l t h to t h a t fact t h a t (a) large sections of th'e n u r s i n g profession are n o t adequately represented u p o n t h e General N u r s i n g Council, a n d (b) t h e refusal of t h e General N u r s i n g Council to recognise t h e Tuberculosis Certificate as a qualification for inclusion on t h e Register is a h a n d i c a p to t h e efficiency of the tuberculosis service. MATERNITY AND CHILD WELFARE GROUP A Clinical Course, a t t e n d e d b y 51 m e m b e r s of t h e M a t e r n i t y a n d C h i l d W e l f a r e Group, was h e l d at t h e Central Middlesex C o u n t y Hospital on October 28th. Diabetics and P r e g n a n c y Dr. A v e r y Jones t h e n gave a n a d d r e s s o n diabetes a n d pregnancy. A m e r i c a n work, h e said, s u g g e s t e d t h a t diabetes was inherited as a M e n d e l i a n recessive. If one p a r e n t was diabetic a n d t h e o t h e r not, t h e c h i l d r e n h a d no greater t e n d e n c y to diabetes t h a n normal, b u t if the second p a r e n t h a d diabetic relatives, there was a 10% risk of diabetes developing before t h e age of 50. If both p a r e n t s were diabetics, in time p r o b a b l y all the children would become so. T h e disease was not itself transmitted, b u t only a t e n d e n c y towards i t ; studies in identical twins h a d shown wide variations in t h e age of o n s e t ; e n v i r o n m e n t a l factors m i g h t pull t h e trigger. D e v e l o p m e n t of obesity was a n i m p o r t a n t factor. Dr. Jones said t h a t m o d e r n diets enabled t h e patient to lead n o r m a l lives. It was essential to t e a c h t h e diabetic all a b o u t his illness, for it was only w i t h his full co-operation a n d u n d e r s t a n d i n g t h a t t h e best results could be achieved. Dr. M a r y B i g b y said t h a t in t h e days before insulin, p r e g n a n c y occurring in a diabetic p a t i e n t resulted in a m a t e r n a l mortality of 27% d u r i n g p r e g n a n c y , labour a n d t h e p u e r p e r i u m , a n d a f u r t h e r 23% in t h e n e x t two years, a n d a foetal m o r t a l i t y of 41%. Since insulin h a d been used t h e m a t e r n a l m o r t a l i t y h a d been reduced to 2% a n d t h e foetal to 37%; A t Central M i d d l e s e x C o u n t y Hospital a series of eleven cases h a d been collected in t h e past two y e a r s ; there was a foetal m o r t a l i t y of 18% with no m a t e r n a l deaths. T h e diabetic risks were ketosls, h y p o g l y c a e m i a , particularly in l a b o u r a n d t h e early, p u e r p e r i u m , a n d sepsis f r o m vulvitis. T h e chief obstetric risk in p r e g n a n c y was t h e increased f r e q u e n c y of toxaemia, noted particularly b y A m e r i c a n writers, Priscilla W h i t e (1942) findi n g it in 42%. L a ~ r e n e e a n d Oakley f o u n d t o x a e m i a in only 10% of cases, a n d at t h e Central M i d d l e s e x there was only one case with true t o x a e m i a a n d one with h y p e r t e n s i o n t h r o u g h o u t pregnancy. T h e foetal risks were: (I) large babies, u p to 12 lb. or m o r e ; (2) p r e m a t u r e d e a t h of t h e foetus i n u t e r o ; (3) h y d r a m n i o s with a t t e n d a n t risks of malpresentation, etc.; (4)

neo-natal

death, possibly due to over

development

of pancreas

zn u t e r o c a u s i n g n y p o g i y c a e m i a ; (5) foetal abnormalities.

Dr, B i g b y descnDea the m a n a g e m e n t of diabetics as follows. T h e c a r b o h y d r a t e allowance s h o u l d be increased to 250 to 300 g r a m m e s b y t h e f o u r t h to fifth m o n t h to allow for t h e loss of s u g a r in the urine due to lowered renal threshold, a n d t h e calorie vatue be increased to 2,000 ,to 2,500. T h e insulin r e q u i r e m e n t s m i g h t increase in t h e second trimester a n d even m o r e in t h i r d trimester. T h e y should be j u d g e d b y blood s u g a r a n d n o t u r i n a r y sugar. T h e u s u a l diet was given as long as possible, t h e n glucose 20 to 30 g r a m m e s two-hourly, a n d in every case 30 g r a m m e s at the onset of t h e second stage. If ketosis were present even more m i g h t be re~tuired. T h e insulin r e q u i r e m e n t s were u s u a l l y considerably decreased in labour, a n d even m o r e so in the p u e r p e r i u m . Careful supervision t h r o u g h o u t p r e g n a n c y was essential, particular watch b e i n g kept for t o x a e m i a ; blood pressure a n d u r i n e were tested f o r t n i g h t l y until the 32rid week, a n d t h e n weekly. P r e m a t u r e delivery at 36 to 38 weeks was advisable to prevent over-large i n f a n t s a n d foetal d e a t h i n u t e r o n e a r term. T h e m e t h o d s available were Caesarean section a n d surgical induction of labour. Nine live babies h a d been delivered at t h e Central Middlesex, eight following surgical i n d u c t i o n at 36 to 37 weeks p r e g n a n c y , a n d one s p o n t a n e o u s labour at 32 weeks in t h e t o x a e m i c patient ; t h e latter's b a b y weighed 5 lb. 4 oz., a n d t h e o~hers 5 lb. 6 oz. to 8 lb. 4 oz. T h e r e were n o n e o - n a t a l deaths. O n e p a t i e n t h a d foetal d e a t h i n u t e r o at 33 weeks p r e g n a n c y a n d one miscarried at 22 weeks. In m a n a g i n g ~the baby, to p r e v e n t hypoglycaemia~ glucose, 1 d r a c h m in 1 oz. water, was given two-hourly for 24 h o u r s , a n d t h e n t h r e e - h o u r l y a n d extra fluids ; a n d breas,t feeding: was started as soon as possible. Lactation, however, tended to be very poor. P y l o r i c Stenosis Dr. J. Sakula reviewed t h e last ten years' experience at t h e Central M i d d l e s e x County" Hospital of cases of congenital pyloric stenosis. F o r t y cases h a d all been treated surgically. The earliest onset was at one week, t h e latest at six weeks, t h e average being three weeks. V o m i t i n g was always t h e first s y m p t o m , a n d 39 ,out of 40 patients h a d projectile vomiting. F e e d i n g was freq u e n t l y c h a n g e d ; on a d m i s s i o n o n l y 25 of t h e 40 i n f a n t s were still b e i n g breast fed. Over 50% were below birth weight w h e n a d m i t t e d ; in t h r e e t h e loss in w e i g h t was m o r e t h a n 2 lb. Constipation was present in 80% of cases. O n e x a m i n a t i o n .the child was wasted, b u t active a n d h u n g r y . Visible peristalsis was seen in all cases, b u t t h e t u m o u r was felt in only seven of t h e 40. Diagnosis was relatively simple a n d s h o u l d be m a d e on purely clinical g r o u n d s w i t h o u t x - r a y e x a m i n a t i o n . T h e operation, for which t h e child h a d to be in good condition, was a modification of t h e original R a m s t e d t . Most of t h e children did well, a n d t h e average stay in hospital was 17 days. The average g a i n in weight d u r i n g this t i m e w a s 12 oz. T h e r e were four d e a t h s t h r e e f r o m gastro-enteritis a n d one doubtful, a rate of 10%. Mr. T. G. I. J a m e s also read a p a p e r on this subject, in w h i c h he amplified s o m e of t h e theories of pathogenesis a n d t h e n reviewed t h e history of t h e operation. Penicillin for Breast A b s c e s s L a d y Florey, in a paper on penicillin in breast abscess, said t h a t f r o m N o v e m b e r , 1943, to May, 1944--the 'six m o n t h s of the year w h e n sepsis was more p r e v a l e n t - - 3 3 cases of breast abscess were treated at t h e Central Middlesex Hospital, 17 of w h i c h received penicillin b y various techniques, t h e o t h e r 16 b e i n g treated b y c u r r e n t m e t h o d s . T h e average h e a l i n g t i m e in t h e cases .given penicillin was 14 d a y s - - v a r y i n g f r o m 7 to 30; in t h e others, in w h i c h t h e t r e a t m e n t was s u l p h a t h i a z o l e or s u l p h a m e z a t h i n e 20 to 30 g r a m m e s , stitboestrol, a n d e v e n t u a l incision a n d drainage, it averaged 33 days, with a variation of 14 to 61. T h e penicillin-treated cases, w h e n in t h e acutely s p r e a d i n g stage, were f o u n d to respond best to a 24- to 72-hour course of t h r e e - h o u r l y i n t r a m u s c u l a r injections of t5,000 units. T h i s was followed by aspiration, or expression t h r o u g h a sinus, a n d instillation of penicillin solution (500 u n i t s per c.cm.) for some days till the p u s was sterile. Only in one very l a r g e a n d well 1ocalised abscess was incision indicated ; a n d in this evacuation followed b y suture a n d i n t u b a t i o n for c o n t i n u e d local tre~tmen~ gave a satisfactory r e s u l t . One a d d e d a d v a n t a g e in t h e penicillin-treated series was t h a t t h e m o t h e r s were able to suckle ~heir babies on both breasts at t h e end of t h e treatment, w h i c h was f o u n d to be effective witho u t stilboestrol. Caesarean Section Mr. J. M a c V i n e said t h a t over a period of ten years 143 Caesarean sections h a d been p e r f o r m e d a t t h e Central M i d d l e s e x Hospital, 50% d u r i n g t h e last three years. T h e m a i n indications for it were: (1) ~isproportaon; (2) p r t m a r y uterine m e r n a w i t h rigid