652

Lawlor, Solomon, M.B., 1918(1).Lawrenson, Harman F., M.D., 1887(1).Leavy, Edward P., F.R.C.S., 1890(1).Lee, Daniel, M.B., 1885(E).Lehane, William, M.B., 1916(1).Leigh-Barlow, Vivian H., L.R.C.P. & S.,

1927(S).Lemass-Boland (Mrs.), Alice M. (formerly

Lemass), M.B., 1925(1).Lennon, John, L.R.C.P. & S., 1930(1).Leslie, James S., M.R.C.S., 1915(E).Leslie, William, M.B., 1926(E).Lewellyn, John W., M.R.C.S., 1902(E).Lewin, Jessie A., M.B., 1904(E).Lindow, Albert, M.R.C.S., 1886(E).Lindsay, Crawford A., M.B., 1926(E).Lipschitz, Alexander, L.R.C.P. & S.,

1927(S).Lloyd, John T., M.R.C.S., 1904(E).Lodge, Hilda, M.B., 1921(E).

Loewenthal, Leonard J. A., M.B., 1925(E).Long, Edwin W., M.R.C.S., 1880(E).Longford (Mrs.), Geraldine N., M.R.C.S.,

1924(E).Loots, Johannes H’., M.B., 1930(E).Lopez, Vincent J., M.R.C.S., 1930(E).Loubser, Cornelius J. N., M.B., 1924(1).

Louis, Francis, F.R.C.S., 1922(E).Louisson, Maurice G., M.R.C.S., 1904(E).Lovett, Margaret E., M.B., 1926(E).Lucas, Stanley A., M.R.C.S., 1898(E).Lum, Kim S., L.R.C.P. & S., 1926(E).Lundie, Francis R., F.R.C.S., 1927(1).Lunn, Elsa P., M.R.C.S., 1924(E).Lush, John S., M.R.C.S., 1876(E).Lwin, Teong K., M.B., 1918(S).Lydon, Francis L., M.B., 1924(1).Lynch, Francis J., L.R.C.P., 1881(1).Lynch, William W., M.R.C.S., 1901(E).Lyons, John F., L.R.C.P. & S., 1915(1).Lyons, Thomas, M.B., 1929(1).Lysaght, Arthur C., M.R.C.S., 1925(E).

McCullagh, John, M.D., 1880(1).McCullough, William W., M.B., 1928(1).McIlwaine, Alfred L., M.B., 1918(S).Macnamara, John W. U., M.D., 1879(1).Malone, William A., L.R.C.P. & S.,

1916(I).Mead, Rivis, M.B., 1883(E).Metzger, George N., M.B., 1917(E).

Naganathan, Elangai M. V., M.R.C.S.,1929(E).

O’Carroll, Christopher J., L.R.C.P. & S.,1916(1).

Parbury, Frederic D., M.R.C.S., 1902(E).Parsons, Charles W., 1LR.C.S., 1883(E).Pickard, Lawrence N., L.’ù1.8., 1919(Col).Precope, John, M.R.C.S., 1913(E).

Rattray, Malcolm J., M.R.C.S., 1907(E).Roland, Bartholomew, M.B., 1926(1).

Shepherd, Richard le F., lBI.B., 1886(S).Short, Richard C., ILB., 1927(1).Slimon, James G., 1T.B., 1929(S).Stonehill, Gerald, M.R.C.S., 1928(E).Sumner, Theodotus J., M.B., 1923(S).

Taylor, William 1., M.RC.S., 1900(E).

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Walker, Sydney R., M.R.C.S., 1897(E).Warren, William E., M.D., 1873(1).Worthington, Mary, M.B., 1929(E).

PUBLIC HEALTH SERVICES

The Economics of Voluntary Work -

SPECULATION is busy on the contents of theexpected report on economy in public services.Curtailment in the activities of any particular depart-ment will no doubt be preceded by careful considera-tion and will follow an ordered and regulated method.Action is complicated by the fact that many of thesocial services had their origin in voluntary organisa-tions which have become assimilated in greater orless degree with the public health authority. An

outstanding example of what can be done by voluntarywork on a large scale is to be found in London, wherethe movement for maternal and infant welfare wasinitiated by voluntary effort and still employs verylarge numbers of volunteers, with an almost incrediblesaving, not only in official salaries, but in expenditureon poverty and destitution which almost alwaysaccompanies ill-health amongst the poor, and whichwould otherwise be added to the already heavyburden of the ratepayer. In the social work arisingout of the school medical service there is an army of5-6000 men and women, unpaid officials workingunder 150 trained organisers, and saving the Londonratepayers many thousands of pounds yearly. Thefollowing-up of children who require treatment or

special observation, for example, is carried out bythe school care organisation, which is largely composedof volunteers whose work is coordinated by trainedworkers. Miss Helen Nussey, writing in the annual ’report for 1931 of the school medical officer to the ’Council, remarks : 1

" When the Council decided to give an opportunity for;the cooperation of the private citizen in work for thecommunity by delegating to children’s care committees 1certain of its duties, the trail had already been blazed by Ivoluntary workers who had banded, together to work forchildren in the poorest schools... "The care committees undertake three importantduties : (1) They see that no child in need of food isunprovided for ; (2) that no child found by theschool doctor to need treatment fails to receive it ; eand (3) that no child leaves school in ignorance Iof the possibilities the district offers of suitable e

employment, further education, and social recreation. tThese workers, coming into contact with the home r

conditions of school-children and their parents, are c

the means of preventing a large load of chronic c

invalidism, with its corollary of destitution andState relief, by arranging for the early treatment of Pdisease and effects. From their contact with a wider rienvironment they can also very often readjust a

employment to the individual and, in some instances,are able to find work for the unemployed by bringingemployer and employee together. ,

In addition to the devotion of individual voluntaryworkers, the Council, of course, receives the help ofvoluntary organisations, such as the S.P.C.C., theI.C.A.A., and the special departments at variousvoluntary hospitals. During the past year theShaftesbury Society offered their camp schoolin Epping Forest to be used for parties ofchildren from day schools for the mentallydefective ; the success of this experiment has alreadybeen noted in our columns. Another example of

organised voluntary effort appears in the specialdental centre at Hackney Wick, maintained by theManor Charitable Trust. Intensive work has beencarried out there during the year in connexion withchildren from two of the Council’s schools ; a dentalhygienist is attached to this clinic, and a follow-upsystem of letters and visits to parents who refusetreatment has resulted in a very low percentage offinal refusals. The report of Mr. A. T. Pitts of anindependent inspection of children from the Wickclinic and children attending the usual dental centresof the Council, indicates clearly that the childrenfrom the Wick clinic showed a better dental condi-tion-testimony to the value of voluntary effort.When curtailment of social services is being considered,it is to be hoped that there will be no discouragementof such work, but that a concerted effort will be madeto stimulate an interest in the public health servicesamongst understanding people with time to spare.The example of London might well be followed byprovincial areas where resources of this nature:emain untapped.

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SCHOOL MEDICAL REPORTS

County of LeicesterTHE county authorities are evidently shrewd

economists, neither lavish nor blindly cheese-paring.- jike others they realise they are obliged to limitxpenditure, however reluctantly. For example,he senior dentist, Mr. Percy Ashton, regrets that aelative inadequacy of his staff has led to a lesseningf the conservative work and an increase of extractionsf permanent teeth."Until such time as every school in the county is

periodically visited and every child receives systematicreatment, the number of permanent teeth extracted willemain comparatively high. The committee are fullylive to this fact and only the present financial situation

653

stands in the way of the completion of the scheme. Thatthe present scheme has extended slowly is perhaps all forthe best, as this tends to promote a- desire on the part ofthose areas not included to partake of the benefits of acomplete dental service." "

Throughout his report Dr. J. A. Fairer indicatesthat the education committee are getting good valuefor their outlay. Routine work is being carriedout efficiently, and the encouragement given toresearch fosters enthusiasm. The examples of suchwork in the present report have not been cut downon the plea of the cost of printing. They includea note on myopia which amplifies an Ealing reporton the same subject by recording 38 obstinate casesof blepharitis cured by correction of minor refractiveerrors. Dr. Constance Walters thinks the chronicinflammation is kept up by the strain of accommoda-tion, and it is apt to occur with hypermetropia oftwo dioptres or less, because it is in these cases thataccommodation will give normal vision, and thereforethe strain is maintained. An investigation by Dr.David Anderson deals with the relation betweenscarlet fever and other defects, especially enlargedtonsils and adenoids. Analysing the records of1520 children he deduces that enlarged tonsils and/oradenoids increase the liability to scarlet fever, andthat scarlet fever tends to cause enlarged tonsilsand/or adenoids, or at least to make a pre-existingenlargement more permanent. A thoughtful dis-cussion by Dr. K. Cowan on the orthopaedic schemeas a preventive service concludes :-

" The scheme should embrace all departments of thehealth services of the area-maternity and child welfareschools, tuberculosis, &c.-and all the agencies of ascertain-ment in each department should be coordinated undera single control. A much greater return will be obtainedfrom expenditure on an organisation for prevention than uponthat for treatment, and a higher proportion of the moneyallocated for orthopaedics might with benefit be divertedfor this purpose. At the best the treatment of cripplingdefects is an expensive burden upon the local authority.The only means of alleviating this burden is concentrationof effort on prevention, and in all phases of the orthopaedicscheme the essence of prevention is early ascertainment."

In the aggregate of these contributions there is anaddition to our knowledge of real economic value.

Wiltshire

There is in this county no open-air school in thestrict sense, but part of the Marlborough publicassistance institution has just been opened as con-valescent accommodation for children, and it isstated, " this provision has already been the meansof re-establishing health for many children who wereotherwise drifting into chronic disability." Rheumaticheart clinics are active in the county, and whenit is remembered that rheumatic and heart affectionscause more loss of working time in the industrialworld than strikes, it is evident that this work is ofeconomic value. Direct proof of a good returnis given in an investigation by Dr. Janet McKay ofthe after-history of 82 cases treated at the BathOrthopaedic Hospital between 1924 and 1931. Theresults were :-

School Overcases. school age.

Cured ....... 7 .... 7Much improved...... 9 .... 24Improved ...... 11 .... 20Stationary ...... 2 .... 2

Total...... 29 .... 53

The classification errs on the side of modesty andthe real value is brought out by studying the detailswhich show the practical changes brought about.Few of the cases would have had educational orindustrial capacity without treatment, whereas nowall the children are attending school and all theadolescents have been working except those markedstationary, which comprise 2 cases of spasticparalysis, 1 of them hopelessly mentally deficient,and 2 cases where treatment was refused. Only

8 of the 53 adolescents have-to wear any appliance,and one of these is an artificial limb for a case ofsarcoma of the tibia. -

MENTAL HOSPITAL REPORTS

The WEST SUSSEX COUNTY MENTAL HOSPITAL atCHICHESTER housed 932 patients on Dec. 31st last.Of the 186 admissions during the year, 29 were

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voluntary, but no temporary patients were received.The hospital is not at present overcrowded. Therecovery-rate was 36-5 per cent. and the death-rate5-6 per cent. Apart from a few cases of influenza,the health was good. The handicraft departmentcontinues to provide occupation for patients whocannot be interested in any other way. Parole beyondthe estate was given to 16 men and 12 women, andwithin the grounds to 20 men and 26 women. Fivemale and four female wards are administered on theopen-door principle. An out-patient clinic has beenstarted at the Royal West Hospital at Chichester,in addition to that at the Worthing Hospital. Duringthe year four attendants and eight nurses passed thefinal examination of the R.M.P.A., and two nursesbecame State registered.The ISLE OF WIGHT COUNTY MENTAL HOSPITAL at

WHITECROFT had 329 patients in residence on

Feb. 3rd, 1932. The recovery-rate for the year was40 per cent. and the death-rate 9-56 per cent. Apartfrom three cases of erysipelas, there was no seriousinfectious disease. The occupational therapy depart-ment continues to flourish, and the open-door systemis to be adopted. The dental clinic continues to dosatisfactory work, and three clinical rooms fortherapeutic conversation have been established. Thecommittee hope to establish an out-patient clinic atRyde before long, and in the meantime the medicalsuperintendent sees at the hospital any case referredto him by medical practitioners.At the CITY OF CARDIFF MENTAL HOSPITAL there

were 777 patients resident on Jan. lst, 1932 ; of these123 were voluntary and 11 were temporary. Therecovery-rate for the year was 41-6 per cent., and thedeath-rate 10-6 per cent. The general health wasgood, the only infectious or germ-borne diseases beingfive cases of tuberculosis. The medical superintendentwelcomes the new Act which allows the admissionof voluntary patients, and cites the case of a manwho had invariably suffered three months’ miseryat home before a minimum period of six months inhospital during his attacks, but who presented himselfas a voluntary patient at the very outset of the nextattack after the Act, and was discharged recoveredin three months. The value of team work is alsostressed, an illustrative case cited being the recoveryof a patient with a toxic psychosis after pus hadbeen drained from the nasal sinuses by the rhinologistand a vaccine had been prepared by the pathologist.The out-patient clinic continues to do good work ;the total attendances during 1931 were 865. A largenumber of patients have been admitted to the hospitalfrom the clinic on a voluntary basis. A social workerwas appointed in May, and her work has proved ofthe utmost value. Further developments havetaken place in the occupational therapy department,and two discharged patients have been appointedvoluntary assistants to the occupational therapyofficer. Of the male patients 78 per cent., and of thefemale 87 per cent., are employed in useful tasks.A considerable output of research from the laboratoryis recorded. Among the results are that the inter-ference of narcotics with the oxidation of glucose orlactic acid is directly related to their hypnotic power,and that sulphur therapy is worth a trial in schizo-phrenia. Radiographic examinations of the sinuseswere made in 26 cases during the year, and 47 otherpatients were examined by X rays for various reasons.The dentist attended fortnightly. Short leave ofabsence was granted to 171 patients on 1226 occasions.Of the nursing staff 18 men and 34 women areregistered or certificated.