View report page

DIVISION 3, comprising the boroughs of Finsbury, Holborn and Islington
Dr. W. G. Harding reports:
Phenylketonuria— A pilot survey was conducted to establish the practicability of routine
testing of all infants for phenylketonuria and the amount of extra effort by health visiting
staff which would be required. The survey was based on two child welfare centres, the
Province of Natal, Holborn and East Islington.
The children tested were those born during a six months period to mothers resident in
the areas of the two welfare centres or who moved into the areas. Testing was by application
of paper strips impregnated with reagents ('Phenistix') made available by the manufacturer.
Two tests were carried out; the first as early as possible after the tenth day of
life and the second about five weeks after the first. Health visitors were told to carry out
the tests as far as possible during the course of their normal contact with mother and child
at home or in the clinic. Arrangements were made for urine showing a doubtful test result
to be retested in a hospital biochemical laboratory.
Of 582 births referred to the two centres, tests were carried out on 530 infants. In the
Province of Natal centre area 90 per cent. of the first tests were completed by the end of the
third week of life and in the East Islington area, a larger and more difficult one, the
corresponding figure was 75 per cent. Overall, 36 babies (6.8 per cent.) could not be tested
until they were at least seven weeks old and no second test was arranged for them; others
left the area after the first test and 458 were available for the second test.
Only three doubtful results were found, but on retesting the urines were found to be
normal. The majority of the tests were carried out without difficulty, either at home or
in the centres, but special arrangements for additional home visits or centre appointments
had to be made in some instances. For the first tests 222 special home visits were made
and for the second tests 169.
Altogether 129 infants out of 530 needed one or more special home visits for the first
test and 107 out of 458 needed at least one special visit for the second test, a total of 391
extra visits. A hard core of 85 infants—well below 10 per cent. of all—required between
two and eight special visits, amounting to a total of 239. The most frequent reasons for
special visits were the absence of a wet napkin or failure to keep an appointment. It was
estimated that if all infants born in the county were to be tested once only some 17,000
additional visits would be necessary, equivalent to the time of approximately two wholetime
health visitors. With an incidence of phenylketonuria as low as between one in 25,000
to 50,000 and bearing in mind the many other important tasks performed by health
visitors, it could be argued that special visits should not be devoted to this sole purpose.
Equally it could be argued that, because the consequences of non-detection are so serious,
every effort should be made to ensure that no case is missed.
A more economical case-finding routine would be the follow-up of families of known
cases, comprising not only the testing of live siblings of diagnosed cases but also blood
tests of any further siblings shortly after birth. The search on these lines should be extended
into the next generation and as far as first cousins. Such selective testing would need a
national register of all 'high risk' families, with the attendant problems of exchange of
information between authorities concerned.
A full account of this pilot screening survey was published in 'The Medical Officer' of
21 June, 1961 (CVI, 51-53).
Maternity beds—The difficulties in obtaining maternity beds, especially for patients in
social need of hospital confinement, continued throughout 1961 and in many instances
beds were secured only through the Emergency Bed Service when labour commenced.
Fortunately, the helpful arrangement described in last year's report, whereby the Royal
Free hospital allocated ten beds directly to our welfare centres for cases in urgent social
need, continued.
100