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Work of the Health Visitors.
The work undertaken by the Health Visiting Staff is very varied, but may with advantage be
described under three headings :—
(i.) Maternity and Child Welfare.
(ii.) School Medical Service.
(iii.) Infectious Diseases.
For purposes of visiting Willesden is divided into districts each containing as far as possible
an equal amount of work. Each Health Visitor has charge of a district with an approximate population
of 8,558, and it is usual for her to have about 1,000 cases under observation at any one time. In
her district she acts as Health Visitor and School Nurse, and is responsible for the family, whether it
be for an infectious disease, a school child, a mother or a baby. This arrangement minimises the time
spent in travelling and, what is always desirable, reduces official visits to the home to a minimum.
Her duties may be described in more detail as follows :—
A. Maternity and Child Welfare Service.
(1) Expectant Mothers.—Expectant Mothers whom the Health Visitors come to know of are
visited in their homes and advised regarding the general hygiene and management of pregnancy,
including the special care of the teeth. They are advised to seek ante-natal care from their own
medical man or at one of the ante-natal clinics. The Health Visitor must also be in a position to
explain to the patient, if desired, what arrangements are made by the Council for confinement cases ,
viz., Hospital Provision or Home Provision (including midwife and home help).
(2) Children under 5 years.—Notified births are visited on the 11th day, when, presumably,
the doctor or midwife has finished with the case. If the child is healthy and the parents raise no
objection a visit every 3 months is paid during the first year, a visit every 6 months during the second
year and a visit every 12 months from the second to the fifth year. If the child is ailing the visits
are paid as often as may be necessary or possible. Advice is given to the mother on the feeding of
the baby. The importance of breast feeding is explained and encouraged wherever possible. Where
the child has to be artificially fed advice is given on the necessity for cleanly utensils, suitable storage
of milk and precautions necessary for the prevention of summer diarrhoea which takes such a toll of
infant life. Suitable clothing for the child and the necessity for fresh air and open windows are
subjects which receive attention during these visits.
(3) The Nursing Mother.—In addition to the supervision of the baby the Health Visitor gives
attention to the mother herself. She advises regarding the care of the breasts, teeth and general
hygiene, and gives helpful advice regarding the weaning of the child at the necessary time.
(4) Still Births and Deaths of Children under 5 Years.—Special visits and inquiries are made
into these cases to ascertain if possible whether the condition was preventible, and thus to throw more
light on what further steps may be taken to reduce infantile mortality.
B. School Medical Service.
(1) Medical Inspections.—Some days before a medical inspection the Health Visitor pays a
preliminary visit to the school during which she weighs and measures the children due for examination,
inspects their scalps, body and clothing for cleanliness, and tests their vision. On the day of the
inspection she attends with the doctor and prepares the children for his inspection.
(2) " Following-up " in the Homes.—All defects found at Medical or Dental Inspections are
communicated to the parents, and it is the Health Visitors' duty to follow up these cases later and
ascertain if the necessary treatment has been obtained. If nothing has been done she again explains
the necessity to the parent and advises how they may best set about getting the condition attended to.
(3) Cleanliness Inspections.—As far as possible the Health Visitor carries out a cleanliness
inspection weekly at each school and brings to the attention of the parent any abnormal condition
which may be found.
(4) Cases Specially Referred by the Head Teacher.—The Health Visitor also endeavours to visit
every department of her school once a week so that the Head Teacher may have an opportunity of
bringing to her notice any child she thinks requires medical attention.
(5) Attendance at Court.—From time to time Health Visitors are required to attend the Court
with reference to verminous cases prosecuted under Section 87 of the Education Act, 1921.
C. Infectious Diseases.
(1) Investigation into the Source of an Infectious Disease.—Infectious Diseases are classified
as Notifiable {e.g., Scarlet Fever, Diphtheria, Typhoid, etc.) and Non-notifiable (e.g., Mumps, Measles,
Chicken Pox, etc.). The former are notified to the Medical Officer of Health by a medical practitioner,
the latter come to the knowledge of the Health Department usually through the School Teacher,
Attendance Officer or Parent. In either case, on receipt of such a notification the Health Visitor
visits the home and makes certain inquiries which deal chiefly with the history of the disease and the
possible source of infection.
(2) Prevention of Spread of Disease.—Where necessary the Health Visitor makes arrangements
for the patient to be removed to Hospital and gives instructions about disinfection. The sanitary
conditions and overcrowding or otherwise in the house are important matters for her supervision.
Contacts must be isolated, and if these are school children the Health Visitor must arrange for their
exclusion and re-admission to schoool, as the case demands. When a patient suffering from an
infectious disease is being nursed at home the Health Visitor must see that suitable isolation is maintained
and at the end of the period of infection must make arrangements for disinfection.