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PUBLIC HEALTH SERVICES

LONDON COUNTY COUNCIL.

ANNUAL REPORT OF THE MEDICAL OFFICER

OF HEALTH FOR 1930.

(Concluded from p. 162.)

EX-POOR-LAW HOSPITALS.

AT the end of 1930 the general hospital service.comprised 27 acute hospitals, 13 hospitals andinstitutions for the chronic sick, 2 convalescent

hospitals, and 2 colonies for sane epileptics. Theacute hospitals suffer from noisy surroundings,insufficiency of isolation wards, and lack of meansfor the classification of patients. Ultimately somewill have to be replaced by more modern buildings.In the past some of these ex-poor-law hospitals havebeen overcrowded at a time when others had emptybeds, owing to the legal obligation to provide treat-ment without delay for destitute persons. These

hospitals could not, like voluntary hospitals, selecttheir patients and close their doors when their bedswere full, there has not been convalescent accommo-dation available for them, and the bed space perpatient was generally too low. The demand forhospital accommodation increases, and will increasemore rapidly, now that the pauper restriction hasbeen removed. There have also to be consideredthe need for more adequate provision for the so-calledmiddle class, and the large increase in street casualtiesin recent years. Sir F. Menzies pays a tribute to the

splendid work done by these poor-law hospitals,although there was much variation in the policypursued by the various boards of guardians. The

problem now, put quite briefly, he says, is to find thebest scheme for the prevention and treatment oidisease of the people of London. The classificationof the many types of patients is a big task. Foi

example, some require dormitories, day-rooms, andwork-places ; others dormitories and dining-roomssome must have their meals in the wards, and ther(are sick children, maternity patients, and the blincand mental patients to be considered. At the tim(of writing the report a comprehensive survey (outlinecin a previous article) was in progress in order t(evolve a scheme for the better utilisation of th(accommodation.

DISTRICT MEDICAL SERVICES.

These have been continued as before, pendingreview and consideration of the best system. Thertare 126 medical relief districts in the county, and 108of the district medical officers are part-time practitioners under no medical supervision except ir

Hackney, where the eight medical officers act unde’the supervision of the medical superintendent of thehospital. In the remaining 18 districts, the districmedical officer is a whole-time official acting unde:the supervision of the medical superintendent of th,hospital, and usually also a medical officer of th,

hospital. In most of these ex-poor-law hospitals aout-patient department has arisen to deal wit]casualties, after-care of former in-patients, and provision of antenatal and postnatal care for maternit-cases. For instance, out of 29 hospitals, 27 providfor casualties, 24 for the after-care of former in

patients, and 20 have antenatal clinics. It i

suggested that in the future the scope of these outpatient departments will be extended.

MATERNITY AND INFANCY.

The quality of maternity accommodation in thetransferred general hospitals varies from a fullyequipped maternity block with 36 beds and 3 labourwards to quite primitive conditions. The wards atone hospital have been closed, and all maternitywards are being surveyed with a view to gradualimprovement. The demand for maternity beds is

increasing. The response from the patients to theestablishment of antenatal clinics is remarkable, andthese clinics have the advantage of being under thesame roof as X ray and other departments. Beforetransfer, obstetrical consultants had been appointedto 9 of the hospitals, and the extension of this pro-vision is being considered as part of the generalquestion of supplying consultants for the council’shospitals.The healthy children under 3 years in the Council’s

care at the end of the year numbered 706, of whom442 were separated from their parents. Thesechildren require different accommodation in the firstyear of life, in the second year of life, and in thethird year, when they are becoming more active andindependent At the present time each nurseryaccommodates all three groups.

MENTAL.

The late boards of guardians had observation wardsfor mental patients in 21 hospitals and institutions.These wards on the whole fell short of the minimumstandard for good classification and efficient treatment.Only 5 of the hospitals had a complete unit withtwo wards, day-room, airing court, and paddedcells. In future schemes the aim will be to have

larger and more efficient units. At present only2 of the hospitals with mental wards have a mentalspecialist as consultant. Since September, 1930,trained mental welfare workers have been acting ashome-visitors for two of these hospitals. X rayapparatus is or will be installed in most of the hospitals,and during the year Dr. Stanley Melville, who hasbeen appointed consulting radiologist, has made acareful review of the plant in use. His reportemphasises the fact that nowadays the radiologistat each hospital should be adequately trained andexperienced in this special work.

ADMINISTRATION.

It is expected to effect considerable economies inthe purchase of medical supplies, and a sample room

. has been set aside in the County Hall, where thecontract standard samples and samples of instruments

; are available for inspection. Unusual and expensiveinstruments will also be kept in the sample room

. and be available for loan to the hospitals.Special accommodation has been set aside for

children suffering from chicken-pox, whooping-cough,; mumps, and measles, and in order to deal with a: long waiting-list of school-children needing operations; for enlarged tonsils and adenoids arrangements haveB been made for these children to be operated upon in

certain of the general hospitals. As regards con-

i valescent accommodation, there are now available- 500 beds at Queen Mary’s Hospital, Sidcup, which

was opened by Princess Mary in July, 1930; 320beds at St. Benedict’s Hospital, formerly known as

- Tooting Home ; and the Council have acquiredHeatherwood Hospital, Ascot (136 children’s beds),

- from the United Services Fund, along with its

obligation to the children of ex-Service men.

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The hours of awakening patients at the 28 generalhospitals were found to vary considerably. At tenof them patients were awakened at or before 5 A.M.It is now proposed that the awakening hour shouldnot be before 6 A.M., and that all hospitals shouldbe raised to this standard as staff becomes available.Incidentally, the report shows that the settlementof standard conditions for the various grades of nurseshas already had its effect in increasing the applicationsfor entry as probationers in the Council’s service.The creation of a nursing staff common to the wholeof the Council’s hospitals has provided wide facilitiesfor training and experience and opportunities forpromotion more extensive than those in anycomparable service.

EX-M.A.B. HOSPITALS.

Sir F. Menzies points out that when the specialhospitals were transferred from the M.A.B., theCouncil took over a highly organised system of

hospitals, the administration of which had, as a

result of a natural process of development over along period of years, been coordinated, and that allthat was necessary was to adapt the methods underwhich they had been administered to the Council’ssystem, a comparatively simple process. Amongstthe research work in progress at the infectioushospitals are a trial of vitamin A concentrate in theprevention of secondary infections, such as middle-ear disease, under the supervision of Prof. S. J.Cowell; a trial of the aspiration method of treatinglaryngeal diphtheria, and the study of the heartin diphtheria by means of the electrocardiograph.Convalescent serum is in successful use for theprevention of measles, and encouraging results arereported from the treatment of parkinsonian caseswith the dried extract of stramonium (U.S.A.pharmacopoeia). Cases of acute poliomyelitis are sentto the Western Hospital, and the absence of anyepidemic prevalence during the year is indicatedby the fact that only five cases were admitted.Small-pox cases admitted to the " River hospitals "numbered 6170, of whom 19 died. Nine babies wereborn in hospital; 35 babies not suffering from

small-pox were admitted with variolous mothers,and five mothers not suffering from small-pox withvariolous babies. During the year four cases ofacute encephalomyelitis occurred, of which one onlyhad been recently vaccinated. Mr. M. S. Mayou,F.R.C.S., reports that 196 babies and 113 motherswere admitted to St. Margaret’s Hospital forophthalmia neonatorum. The number of damagedeyes was less, but still "far too many." Some casesare admitted with the cornea damaged by too strongnitrate of silver or perchloride of mercury. Manymidwives visited the institution during the year,but not a single medical student. Mr. Mayou deploresthe absence of the latter.

SYPHILITIC MOTHERS.

Mr. John Adams, F.R.C.S., reports on the workof Thavies’ Inn V.D. Hospital. Three patients wereconfined of macerated babies a few days after admis-sion. All babies born from syphilitic mothers weredischarged with a negative Wassermann test, exceptfour, who left within a month. Of the latter, twohad out-patient treatment and became negative, andthe other two were lost sight of. Many childrenborn of syphilitic mothers have been under observa-tion since 1917, and had blood tests from time totime. All have appeared healthy, and none hasshown any signs of syphilis.

TUBERCULOSIS.

Dr. James Watt, chief medical officer, tuberculosis.service, reports that 3228 cases of pulmonary tuber--culosis were admitted to the hospitals, and thatthe average duration of stay was longer than in theprevious year. He states that in other countriesthe duration of stay in hospital is 50 per cent. longerthan in England. The recognition during the lastten years of the poor after-results of sanatoriumtreatment, he says, has led to a revision of methods.A much larger proportion of cases are being treatedby surgical methods, and when it is more widelyrecognised that thoracoplasty, generally reserved forhopeless cases, gives as high a proportion of casesalive after five years, as ordinary sanatorium treat-ment can give for all cases, early and advanced, it iscertain to be used more extensively. He also refersto the promising results obtained from the injectionof gold salts, and to the need for further researchas to the action of this remedy and the best dosage.He recommends the institution of out-patient clinicsat certain of the Council’s hospitals for the continuanceof pneumothorax treatment. The immediate resultsof treatment on discharge from Pinewood and KingGeorge V. Sanatorium were apparently satisfactory,but, if we are to judge by past experience, 50 per cent.of the patients will die within five years, and only 25per cent. be fit for work. It may be, he thinks, we-have paid too much attention in the past to the

disappearance of symptoms and physical signs, andtoo little to X ray pictures of the condition of healingof the lungs.

INFECTIOUS DISEASE

IN ENGLAND AND WALES DURING THE WEEK ENDED

FEB. 6TH, 1932.

Notifications.-The following cases of infectiousdisease were notified during the week :-Small-pox,57 (last week 49) ; scarlet fever, 1485 ; diphtheria,1015 ; enteric fever, 36 ; pneumonia, 1742 ; puerperalfever, 55 ; puerperal pyrexia, 99 ; cerebro-spinalfever, 48 ; acute poliomyelitis, 6 ; acute polio-encephalitis, 4 ; encephalitis lethargica, 7 ; continuedfever, 1 ; dysentery, 20 ; ophthalmia neonatorum, 91.No case of cholera, plague, or typhus fever was notifiedduring the week.The number of cases in the Infectious Hospitals of the

London County Council on Feb. 9th-10th was as follows :Small-pox, 105 under treatment, 4 under observation (lastweek 110 and 3 respectively) ; scarlet fever, 1199 ;diphtheria, 1502 ; enteric fever, 10 ; measles, 905 ; whooping-cough, 334 ; puerperal fever, 13 (plus 10 babies), encephalitislethargica, 220 ; poliomyelitis, 4 ; " other diseases," 241.At St. Margaret’s Hospital there were 15 babies (plus 9

mothers) with ophthalmia neonatorum.

Deaths.-In 117 great towns, including London,there was no death from small-pox or enteric fever,44 (15) from measles, 7 (1) from scarlet fever, 50 (11)from whooping-cough, 36 (7) from diphtheria, 53 (8)from diarrhoea and enteritis under two years, and278 (81) from influenza. The figures in parenthesesare those for London itself.

The reported deaths from influenza are still falling, butthe total deaths for the year so far amount to 1732 against1126 for the corresponding period of 1931. Of the greattowns Birmingham again stands highest with 12 deathsfrom influenza, Manchester following with 8, Croydon,Bradford, Sheffield, and Swansea, each with 6. Manchesterreported 11 deaths from measles, Stoke-on-Trent 5.Whooping-cough accounted for 4 deaths at Liverpool,3 at Manchester.

The number of stillbirths notified during the week was273 (corresponding to a rate of 41 per 1000 births),including 41 in London.