London's Pulse: Medical Officer of Health reports 1848-1972

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London County Council 1934

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

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The average number of visits to all general nursing cases is 23.6 as compared
with 63.9 for the Council's cases. The latter figure is, however, reduced to 33.9
if diabetic cases are excluded. It should also be borne in mind that among the
Council's cases the proportion of chronic cases is no doubt higher than among
patients nursed outside the Council's arrangements, their chronicity being in most
cases the ultimate factor bringing them under the care of the Council.
The considerably higher proportion of females requiring nursing attention has
been commented upon in previous years. There is no doubt that, apart from the
fact that the incidence of sickness is higher in females than in males, women elect
to remain at home when ill rather than be removed to hospitals, even when the
illness is serious. Also the district nurse is very often only called in to male patients
when the attention required is beyond the resources of the female members of the
In the case of diabetics the average number of visits is about the same for
each sex. At the same time the investigation brings out the well-known selective
incidence of the disease—six females being affected to one male.
The following table shows the number of patients and visits in the six selected
districts classified as far as possible under "acute" and "chronic " conditions :—

Classification of L.C.C. cases, acute or chronic, in six selected districts.

Nursing association.Acute.Chronic.Unclassified.Total.
CasesVisits.Average no. of visits.Cases.Visits.Average no. of visits.CasesVisits.Average no. of visits.Cases.No. of visits.Average no.ofvisits.
East London (South)501,45029.010621,995207.5510020016123,545146.2
Metropolitan (St. Pancras)2575630.2242,535105.64458114.5533,74970.7
Metropolitan (Bedford-place)53954180615,96497.723417.01166,95259.9
North London5873612.6695,28776.61146141.91386,48446.9
South London1142,20919.3793,10639.3829637.02015,61127.9
Woolwich and Plumstead931,08918.1675,35179.86325.31667,07242.6
Total for selected districts3937,79419.840644,238108.9361,38138.383553,41363.9
Total L.C.C. cases for whole or London3,134172,91355.1

It will be observed that the average number of visits (63.9) is higher than that
for the whole of London (55.1). This is accounted for, in part, by the fact that the
incidence of diabetes is proportionately high amongst the Jewish population served
by the East London Nursing Association.
From the above table it is apparent that acute cases seldom last more than
three weeks, some possibly requiring more than one visit a day in the beginning.
Chronic cases on the other hand averaged 108.9 visits each. These chronic cases,
most of whom are in receipt of permanent relief, require prolonged nursing treatment,
and, although no nurse may continue to attend a case except under medical
instructions, it was felt that there should be a definite limit to the period during
which a nurse should continue visiting without the attendance of a doctor. District
medical officers have accordingly been informed that they should visit personally,
as frequently as the circumstances of the case require and in every case not less
frequently than once a month, every patient whom they have placed under the
care of a district nurse.