INTERNATIONAL
NEWS
AND
REPORTS
NEWS FROM ENGLAND
ALAN MONCRIEFF,
M.D.,
Corresponding EditorCHILD HEALTH IN GREAT BRITAIN
A report* published for the Socialist Medical Association of Great Britain regards reductions in
mortality in the last 50 years as mainly due to improved living standards, the first fruits of a social
revolution. For major causes of death and disability, however, there are still class differences of over 100% due to environmental and therefore removable handicaps. Improved medical services
are important, but secondary. Since children now form only 20% of the population, economic
neces-sity as well as social justice demand that protection and encouragement of child health should be-come an absolute priority in national service. New legislation (education, insurance, health) pro-vides a framework in which rapid exploitation of 20th century science is possible, and the report is emphatic that it is the positive and preventive obligations of child health service which are of
primary importance. Remedial services still require large developments, but preoccupation with them must not obscure the fact that the need for doctors, nurses and hospitals can be steadily re-duced by good nurture.
The first needs, therefore, are good food, houses and schools, physical culture and the happy
employment of leisure. Class differences in stature and physique can be abolished by food supple-ments to primary school children: food rationing, food subsidies and free school meals have pre-vented deterioration in child health during the economic stress of war and postwar years. The report
urges more rapid provision for meals for all school children, better family endowment, state control of milk production and distribution and increase rather than reduction of food subsidies. Better training of doctors and nurses in lactation would increase the number of women who can nurse
their infants. Physical training in secondary schools is given by gymnasts, but not in primary schools where it is of even greater importance: development of physique is only second to good food in
protecting against disease. Organized games, holiday camps and good play centers in cities are required; more children of poor physique should go to residential open-air schools.
Opportunity for research into the methods of health service itself and the technics of education in bodily and mental hygiene is provided by the reorganization of administration into larger units, and
should be a responsibility not only of university centers but also of county health departments and regional hospital boards. The report is critical of the fact that administrative responsibility
for developing child health service remains divided between several ministries, regional and county authorities. Advisory committees composed largely of health workers (doctors, nurses, social workers) are required at all levels of organization: service for children demands good team work. The large administrative organization is dangerous unless provision is made for effective semi-autonomous
units in which parents, teachers and health workers can contribute to policy.
School services especially need reform, both in the content of their programmes and in order to give increased opportunity for individual initiative to staff. Organization of teams consisting of
full-time health officers, family doctors, health visitors and social workers are recommended, to serve
child populations of 2500 to 5000, from birth to adolescence; each team should be based on a health center. The needs of child health service demand a new and more carefully devised scheme of training for health workers, including doctors, whose economic and professional status is overdue
for reform.
Remedial medicine must not be divorced from positive health service. In each medical specialty and within each administrative region, a programme of work and organization is needed, and should e worked out largely through advisory committees so that the needs of preventive medicine are
* Child Health: Survey and Proposals, published for the Socialist Medical Association, London,
Today and Tomorrow Publications, Ltd., 1949.
INTERNATIONAL NEWS AND REPORTS 535
brought constantly to the notice of medical specialists. Greater use should be made of technical assistants in ophthalmology, dentistry, orthopedics and otorhinology, and in the teaching of hygiene;
the essentials are suggested for a programme of work in each field. Pediatric hospital service, apart
from university centers, is still largely undeveloped; pediatric departments should form part of
large general hospitals, undertake postgraduate teaching and provide essential contacts between hospitals, family doctors and child health staff. Home consultation should diminish the need for
hospital admissions.
- Tuberculosis, it is maintained, could be eradicated in a few years if the need were regarded as
urgent and the country’s conscience not lulled by statistical evidence to show that tuberculosis is
“controlled.” Over 3000 children die of it annually and the seeds of adult tuberculosis are sown in many thousands more, themselves to infect the next generation. The reforms advocated are (a) con-centration on the provision of hospital beds for all open’ cases, with strict enforcement of
notifica-tion; (b) nationalization of the milk industry; (c) tuberculin testing of all children; (d) exploitation of BCG vaccine for all children known to be at risk.
Services for disabled, mentally defective and maladjusted children are also considered in the report, which ends by summarizing the conclusions of the committee of’ doctors, nurses, dentists, opticians, etc., appointed by the Association, in the form of 32 recommendations.
DUNCAN G. LEYS, M.D.
UNIVERSITY OF LIVERPOOL: DEPARTMENT OF CHILD HEALTH
A lectureship in diseases of infants and children was established in 1882 at University College,
Liverpool (subsequently the University of Liverpool) but it was not until 194k that the University Department of Child Health was opened under the direction of the Professor of Child Health. This development was made possible by collaboration between the University, the City Council
(repre-senting prophylactic paediatrics and in control of Alder Hey Children’s Hospital) and the Royal Liverpool Children’s Hospital (“voluntary” hospital), and the scheme was designed to promote further cooperation between these various interests for the study of preventive and curative
paedi-atrics, and for more comprehensive teaching and research. The fundamental changes in hospital management which took place on July 5, 1948, when the National Health Service came into operation, have not interfered with the basic idea of the scheme, and in the Department of Child Health the
University is now linked with the City Council (for prophylactic paediatrics), with the Liverpool Regional Hospital Board (Alder Hey Children’s Hospital and the neonatal unit at Mill Road Hospital), and with the Board of Governors (Royal Liverpool Children’s Hospital and the neonatal
unit of the Liverpool Maternity Hospital).
The staff of the Department consists of the Professor of Child Health, the First and Second
Assistants, a Senior Lecturer and a Lecturer in Child Health (both full time) , four Lecturers and
Assistant Lectures in Clinical Paediatrics, two Lecturers in Clinical (Preventive) Paediatrics, two secretaries, together with Medical Registrars, etc.
The administrative offices of the Department are at Alder Hey Children’s Hospital and include two lecture theatres, two research laboratories, library, pathologic museum and photographic room,
in addition to the necessary rooms for the use of members of the staff and two secretaries. The
pro-fessorial clinical unit at Alder Hey Hospital consists of two wards each containing 14 single cubicles (chiefly for infants) and two wards (one male and one female) each of 30 beds, for children up to the age of 15 years. The hospital is a large general hospital for children, admitting about 7,000
patients annually, and all are available for teaching purposes. They include a full range of medical,
general surgical, orthopaedic and “special” paediatric cases ( such as ear, nose and throat, ophthalmic,
plastic surgery and primary tuberculosis).
At the City Branch of the Royal Liverpool Children’s Hospital-also a general hospital for
children-there are 68 surgical and 68 medical beds (28 under the charge of the Professor). At the Heswall Branch (of which Sir Robert Jones and Dr. Charles Macalister were the chief founders;
it is situated in the country about 10 miles from Liverpool and provides good facilities for open-air
536 INTERNATIONAL NEWS AND REPORTS
Tuition to Medical Students
The teaching of undergraduate medical students takes place mainly at the Royal Liverpool
Chil-dren’s Hospital, which is situated conveniently near to the University Medical School.
Between 70 and 80 students are given instruction in clinical paediatrics each year ; the teaching is given both by the professorial team and by the nonprofessorial teaching staff. Approximately 10
students are allocated to each “clinical unit’ ‘ and receive instruction for one month from the
pro-fessorial ‘‘unit” and one month from the nonprofessorial “unit.” During this two month period
ap-proximately 76 hours are spent in the hospital wards and 58 hours in the outpatient departments,
including child welfare clinics and school clinics. It has not been possible, so far, to arrange for students to have a period of residence in hospital. Fifteen academic lectures in paediatrics are given
during the year and in addition eight clinical lectures are attended by each student during his
two-monthly period of clinical paediatrics. Instruction in neonatal paediatrics is given to students during their (residential) period of clinical obstetrics at the Liverpool Maternity Hospital and Mill Road Hospital.
In the final MB. examination there is no separate paper in Child Health but two of the 10 compulsory questions in medicine are on paediatric subjects and the clinical examination includes
paediatrics cases.
Tuition to Postgraduate
This is given chiefly at Alder Hey Childrens Hospital and includes:
1. A ward round, followed by a lecture, one morning each week throughout the year at Alder Hey Children’s Hospital. This class is attended by postgraduates studying for . higher degrees or
diplomas (M.R.C.P. and D.C.H.), school medical officers and child welfare officers,
2. Full time three week refresher courses in paediatrics held twice yearly. These are intended
primarily for doctors in the area of the Liverpool Regional Hospital Board who are engaged in
preventive and curative paediatrics, but other applicants are accepted up to a total number of 20
per course. The Ministries of Health and Education have recognized these courses for ‘‘grant”
purposes.
3. Courses for general practitioners in the area from time to time.
4. A teaching round once weekly at the Liverpool Maternity Hospital at which problems of
neonatal paediatrics are discussed and clinical cases are demonstrated.
5. Tuition to a small number of postgraduates, mostly from overseas, who work in the Depart. ment for periods of 3 to 12 months.
For the degree of M.D. (Liverpool) a candidate may elect to take Child Health as a special
subject.
Courses of instruction in child care, etc., are given by members of the Department to school teachers, foster mothers and other workers in the fields of paediatrics and social medicine, and a course of 24 lectures is given each year to students taking the University Diploma in Child Care.
Research
The Department was one of the original centres selected by the Medical Research Council for the clinical trials of streptomycin in tuberculosis; this work continues and has been enlarged to include a wider study of tuberculosis in infancy. A study, also on behalf of the Medical Research Council, was concerned with the chemoprophylaxis of childhood rheumatism, and a survey of ward infection has been carried out on behalf of the British Paediatric Association. A full time research worker, appointed by the Medical Research Council, is at present studying infections in infancy, with
special reference to diarrhoea and vomiting. Three ‘Cow and Gate” scholars have worked in the
Department during the past year and have studied breastfeeding, rheumatic infection in childhood and congenital disorders of the urinary tract. Another of these scholars has begun work upon
con-valescence in childhood.
