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P.S.—With regard to the provision of 20 beds at Kingsbury, it should be noted :
(1) That the maternity beds there provided are practically constantly full, and that there
is no space to allow for the fluctuations in admissions of maternity cases.
(2) That it has also been suggested that beds should be available at Kingsbury for the
tions on tonsils and adenoids and deflected nasal septum for which the Council are
responsible. (Note.—There were 552 such operations in 1930—106 in children under 5,
and 446 in school children.)
(3) That in connection with heart cases, some provision should be made for education while
in hospital.
It might, therefore, appear to the Committee desirable to consider the provision of beds with
the other Committees concerned.
In the meantime, however, it might be desirable to proceed with the establishment of the
Rheumatism Supervisory Centre as outlined above.
May, 1931. G. F. B.
APPENDIX I.
VARICOSE ULCERS.
MEMORANDUM BY THE MEDICAL OFFICER OF HEALTH.
The Health Committee at its last meeting had before them a letter from Dr. Haldin-Davis,
the Council's Dermatologist, dated the 26th March, 1931, and instructed me to report further on
the matter.
Varicose Ulcers are frequent amongst working class women especially those who have borne
children. Varicose ulcers constitute a distressing and painful condition and hitherto healing of the
ulcers could only be successfully accomplished by a prolonged stay in bed, aided by other measures.
The method of treatment referred to by Dr. Haldin-Davis in his letter enables healing of the ulcer
to proceed while the patient goes about his or her usual avocation.
I have consulted with Dr. Haldin-Davis as to the provision which might be made to give
opportunities for this treatment in Willesden. As a tentative measure Dr. Haldin-Davis is prepared
to see patients at the ordinary sessions at which he now comes to Willesden, namely, Wednesday and
Thursday each week at Health Centres (1) and (3). It is not easy to say exactly how many patients
will attend, but in any case such a tentative arrangement will enable information to be obtained.
If provision is made by which these arrangements may become operative after the summer holidays,
I would suggest that the sum of £100 would cover all the expenses likely to be incurred.
GEORGE F. BUCHAN,
Medical Officer of Health.
June, 1931.
52, Harley Street,
W. 1.
26th March, 1931.
Dear Dr. Buchan,
I should like to call your attention to the advances recently made in the treatment of varicose
ulcer. As is well known ulceration of the leg, as a rule associated with varicose veins, is one of
the most disabling and painful of the chronic but non-fatal complaints which affect the working
population. These ulcers often last for many years, are always productive of a great degree of disability
and in many cases absolutely debar those who suffer from them from doing work. The public
hospitals (i.e., the institutions up till recently known as infirmaries) are always full of them, but
the economic loss to the community by no means ends with the cases incarcerated in these buildings.
Every medical man who is familiar with the out-patient departments of the hospitals all over the
country can testify to the frequency with which patients suffering from "bad leg" throng the clinics.
He will also admit, or he would have admitted until lately, the difficulty of treating them successfully.
Owing to the unsatisfactory nature of these cases, and the difficulties of treatment they are not
welcome patients and they are commonly relegated by those in charge of the clinics to the care of
their assistants and frequently they fall into the hands of nurses and even of quite unqualified quacks.
Within recent years however very important progress has been made in the treatment of this
affliction. Largely owing to the work of Mr. Dickson Wright, a young London surgeon, we have
learnt actually to cure ulcers of the leg without confining the patient to bed. In the past, bed has
always been considered absolutely essential to their successful treatment and this has been one of
the chief difficulties in dealing with these patients because there could never be a sufficient number
of beds available for a sufficient time. Three months is a quite ordinary period for a bed to be