[Report of the Medical Officer of Health for London County Council 1958].

  • London County Council (London, England). County of London.
Date:
1959
Catalogue details

Licence: Attribution-NonCommercial 4.0 International (CC BY-NC 4.0)

Credit: [Report of the Medical Officer of Health for London County Council 1958]. Source: Wellcome Collection.

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    and health visitors would become trained to a point where they would no longer need to work with the support of a child psychiatrist, may need to be modified and a con tinuous service through permanent case conferences may take its place. (r) Early diagnosis of congenital deajness—Medical officers working in child welfare clinics see 88 per cent, of infants born in the County (page 142 above), and thus have a unique opportunity to screen babies for congenital handicaps. This is perhaps peculiarly true of congenital deafness. In 1957 Mr. J. C. Ballantyne, f.r.c.S., consultant otologist to the Council, and Dr. Mary Sheridan, m.d., d.c.h., medical officer, Ministry of Health, were invited to train medical officers in screening tests of the hearing of young children. Some 30 medical officers have attended these courses and by the end of 1959 it is expected that all medical officers in the Council's service will have had the opportunity of studying these techniques. The importance of the standardisation of tests has not been overlooked. Every maternity and child welfare centre has been equipped with the 'Stycar' testing set designed by Dr. Sheridan. Medical officers have been asked to train health visitors not only to refer babies known to be at risk but also to help to carry out screening tests at the centre. All cases of suspected deafness are being referred to the divisional otologist or to Mr. Ballantyne. The youngest child for whom a hearing aid and auditory training have so far been prescribed was four months of age. In the 10 years under review the infant mortality rate in the County has fallen from 31 per 1,000 in 1948 to 23 per 1,000 in 1958. This figure compares favourably with the national figure of 26 per 1,000. Much work however remains to be done. The application of the newly discovered tests for errors of metabolism may help us to tackle the problem of hereditary and familial diseases. Screening tests for the early diagnosis of congenital handicaps are being developed to meet the needs of the handicapped child under two years of age. In the field of preventive mental health only the first steps have been taken. Peri-natal mortality remains a challenge. Domiciliary midwifery The domiciliary midwifery service underwent no fundamental change as a result of the coming into force of the National Health Service Act, 1946, except that it became a free service. The Council had employed salaried midwives since 1938 and had entered into agreements with hospitals and district nursing associations to continue district practice. This structure of the service has been maintained through the last ten years and remains centrally administered. In 1949 there were 16,090 home confinements—5,573 more than in 1958. The number reached its lowest level in 1955. The decline in the general birth rate up to and including 1955 relieved the pressure on hospital beds and the proportion of domiciliary confinements fell, staff being reduced accordingly: from 1956 onwards the birth rate has risen but although there has been an absolute increase in domiciliary confine ments these still represent a smaller proportion of total births. In 1949 the Council's 140 directly employed midwives carried a case-load of 58. In 1957, in spite of new responsibihties in ante-natal care 87 midwives carried a case-load of 71. The lower case load in 1949 is perhaps explained by the fact that the Council's policy then was to offer an alternative choice of midwife to each mother so that Council midwives practised in the same areas as midwives employed in district nursing associations and hospital districts. Shortage of woman power now makes this pohcy impracticable Ante-natal services The main changes brought about by the Act nave been the closer integration ot the domiciliary midwifery services with the maternity and child welfare, home help and other health services; with the general practitioner service through the maternity medical services and with the hospital maternity and paediatric units. All midwives, including most of those employed in District Nursing Associations, now do their ante-natal work in the centres. There are the obvious advantages of the better facilities than could be provided formerly in the home of the midwife and the fact that the midwife is brought 146