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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Attention has been drawn from time to time to cases leaving the Council's
hospitals, still requiring nursing treatment and reported to the local nursing associations,
either by the patients' friends or by voluntary charitable agencies or found
by the district nurses themselves on their daily rounds. These cases were frequently
patients who had taken their own discharge contrary to the advice of the medical
The whole question of district nursing was discussed with a deputation from
the Metropolitan Federation of District Nursing Associations following representations
which had been made by that body. It was decided that, in order to secure
continuity of nursing treatment, patients, who are discharged from the Council's
hospitals or who take their discharge against medical advice and who still require
nursing treatment, should be referred to the local district nursing organisations so
that they could arrange for a nurse to visit. Medical superintendents were also
asked to communicate with the patients' private doctor or the district medical
officer previously in charge of the case, stating that nursing services appeared to
be necessary, and informing him that as a matter of urgency the local nursing
association had been informed.
In the case of a patient not previously under a district medical officer, who
appeared to be financially unable to obtain the services of a private doctor, the
relieving officer is informed in addition to the nursing association in order to ensure
medical attention.
Where, however, the patient continues to receive medical treatment in the
out-patient department of the hospital (this does not include patients attending
the medical out-relief station), any nursing treatment required is given at the hospital
and not by the district nurse. In this way divided medical responsibility is obviated.
During the past year there has been a pronounced increase in the number of
diabetic patients receiving treatment under the Council's scheme. This increase is
attributable to two causes : (a) the more widespread use of insulin in the treatment
of the disease with a resulting increase in demands for nursing service in its administration
; and (b) the increasing advantage taken of the fact that patients
unable to pay the full cost of insulin treatment can obtain such treatment by way
of medical relief by applying to the relieving officer. Such patients immediately
come within the category of patients entitled to home nursing services under the
Council's scheme. This has had the effect of transferring to the Council's medical
care a considerable number of patients from voluntary hospitals, notwithstanding
the fact that the Council is prepared, in suitable cases, to defray the cost of insulin
supplied at voluntary hospitals to necessitous persons.
From the chronic nature of the disease, it is inevitable that the yearly increase
in the number of cases will be maintained until a saturation point is reached when
new cases will be balanced by a proportionate number of cases falling out.
The majority of cases are referred to the district nurses by the Council's medical
officers. In the east of London where, from the nature of the population, the
largest numbers are concentrated, patients attend the medical out-relief stations.
In St. George-in-the-East hospital and in the medical out-relief station in Vallanceroad
adjoining St. Peter's hospital, special clinics are held weekly for patients
suffering from this disease. The clinic at Vallance-road is a particularly good
example of a diabetic clinic. Patients are carefully instructed in the importance
of suitable diet, and a diet table is issued to each patient based on sugar calculation,
which is done at frequent intervals. The educational part of the work is by no
means the least important, and the district nurses' services are requisitioned to
administer insulin, and to instruct patients how to give it themselves. In St.
George-in-the-East particular attention is paid to instruction of patients by district
nurses in the administration of insulin. In this connection, it is considered that
still further use might be made of the services of these nurses in educating patients
in regard to the effect of diet upon the disease. The remarkably large incidence
of diabetes in East London demonstrated in the table below undoubtedly presents
a problem to be tackled, especially in view of the increasing numbers.