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16
While on the subject of school children I may say that the school medical
work is carried out by a staff entirely separate from the health department staff,
the work of medical inspection being in the hands of a staff of 52 part-time medical
officers under a Director of Hygiene, who is an officer of the School Committee
of the Council. Each school doctor is required to visit the schools in his district
each morning and also to examine each child in the schools once a year. In addition
to the doctors there are 62 school nurses each with a district and responsible for
the oversight of some 2,000 children. In regard to maternity and child welfare
work I found that much reliance was placed on voluntary effort, though by means
of what are called "Health Centres" an attempt is made to bring all the voluntary
agencies together and into co-operation with the Health Department. At the
moment only one such centre has been established, and under the direction of one
of the medical inspectors of the department, a Dr. Wilinsky, is doing excellent
work. Under one roof I found an infant clinic and a dental clinic in operation,
and also accommodation for tuberculosis and district nurses, used bv them as a
sort of headquarters, as it is also by the inspector of the district.
Maternity work in Boston, as in the States, or such of them as I have visited,
I have found very interesting. In the South a very great part of the work is
done by coloured midwives, who in the main are intensely ignorant and illiterate,
there being no provision for the training of midwives, and a great unwillingness
to provide for training. In New Bedford there are again many midwives,
mostly Portuguese and largely employed and kept under close supervision.
In Boston no one but a medical practitioner may repcrt a birth, which is taken to
mean that no one but a medically qualified person may attend a woman in labour.
Despite all this it is believed that many women do practise midw ifery and that many
women have none but a woman to attend to them, though the reports of births,
in accordance with the law, are made by medical practitioners.
In Boston I visited a most beautiful and modern maternity hospital. In this
as in another maternity hospital I visited in New Bedford, I saw none of the herding
together of mothers and babies in one ward with a nurse sitting by the fire
making the baby comfortable. Instead, I found separate wards for mothers and
babies, and adjoining the babies' ward a room in which all washing, etc., of the
babies was done. The question of whether or not they ever had diarrhoea amongst
mothers, babies, and members of the staff, though it trembled on my lips, I did not
dare to ask. In any case, I know quite well that they never have it.
Indeed, diarrhoea amongst infants is becoming less and less in cities in the
United States and this they ascribe, as they ascribe also the reduction in the amount
of tuberculosis of glands and bowels, to the fact that nearly 98 per cent. of all
milk sold is pasteurized.
This last piece of information which I had received from others I had confirmed
at the Children's Hospital in Boston, which again is a most beautiful building.
Like the Maternity Hospital it is in the neighbourhood of the Harvard University
Medical School, which I had the opportunity of visiting on more than one occasion.
The public health school in the University I also visited and found amazingly
well equipped. Here, as in Baltimore, there appears to be no lack of money for
research, and in practically every room in the building I found people engaged in
trying to solve some problem or other in connection with the causation or prevention
of disease. The number of students, American students particularly, in the school
is small, the public health service not being attractive and so much less remunerative
than private practice.
While on the subject of institutions I should like to refer to a visit paid to the
Forsyth Dental Infirmary. This is, I imagine, the largest establishment in the
world entirely given over to dental and nose and throat work, and is intended
exclusively for the use of children. In the main room there are something like
160 dental chairs with an equal number of dentists or "dental hygienists," the