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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31
The position as regards the Hostel is somewhat different. The majority of
the inmates are not of the " habitual casual " type, and it was felt that any steps
which would assist in preventing them from drifting into that mode of life would
be of considerable value. The period of stay at the Hostel is on an average twelve
days, but on occasions it extends to as long as four weeks. It was accordingly
decided that arrangements should be made for the systematic medical examination
of all persons admitted to the Hostel. This arrangement was put into operation
in October, 1934, and rendered unnecessary the continuance of the monthly
examinations.
It was also considered desirable to systematise the procedure for the treatment
of sick casuals. The cases requiring action fall into three categories :—
(1) Inmates suffering from various minor ailments, such as slightly sore
feet, which are likely to be cured during the time the man is detained in the
casual ward. It was felt that these should be treated in the ward itself.
(2) Inmates suffering from (a) minor ailments which cannot be healed
within the period of detention, but which do not call for admission to hospital,
and (b) defective teeth, need for surgical apparatus, or some defect apart from
illness, such as defective vision. It was arranged that these inmates should be
offered admission to the appropriate institution, and that, if out-patient hospital
treatment were necessary, the master and medical officer of the institution
would make the necessary arrangements for the inmate to be sent to the
appropriate hospital.
(3) Inmates suffering from definite illness or requiring operative treatment.
These patients were to be offered admission to the appropriate general hospital.
Experience has shown that, for the purpose of the temporary treatment of
acute emergencies and of trivial ailments, it is essential for the medical officer to
have at his disposal a small supply of drugs, stock mixtures and dressings. Suitable
arrangements were made accordingly.
A survey of the casual wards revealed the fact that in a number of cases the
accommodation at the disposal of the medical officer for the examination of patients
was inadequate or unsuitable, and that certain necessary equipment was lacking.
These matters have all received attention.
The arrangements for treatment in the case of inmates of the Hostel are
similar in the main to those in force at the casual wards. There is, however, a need
for better facilities for treatment on the premises for simple minor ailments, owing
to the fact that the sojourn of inmates at the Hostel is considerably longer than at
the casual wards. Accordingly, arrangements are being made for the provision of
an adequately equipped consulting room at which the services of a district nurse
will be available when required.
The number of casuals examined at the twelve monthly inspections in 1934,
including inspections at the Hostel up to September, ranged from 349 at the December
examination to 549 at the February examination. The total number of casuals
who slept in the wards on the nights preceding the twelve examinations was 7,494.
A certain number of casuals inevitably escape examination, as they take their
discharge at an early hour in the morning. The number actually examined was
5,408 (73 per cent.). This total includes a considerable number of re-examinations
of persons seen at previous examinations.
As in 1933, the most prevalent defects were found to be skin complaints,
hernia, heart disease, varicose veins, defective teeth and bronchitis. Of the casuals
examined 66.5 per cent. were noted as having good nutrition, while the majority
of the remainder were noted as having fair nutrition.
The reports of the medical officers also revealed a high standard of personal
cleanliness among the casuals.
Attention was drawn to the fact that the washing rooms of the casual wards,
which are excellently equipped, contained no fixed foot baths with hot and cold
water, such as are installed in all the common lodging houses. It had been found
that foot baths to which the patients have access are an important feature in
keeping the feet in good condition, and are highly appreciated by the inmates. A