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mothers in the homes by Health Visitors while in 1936, there were 9,098 such visits made. I refer
particularly to this work as the clinic attendances of expectant mothers take up much more time
than the average run of clinic attendances and special provision has got to be made for such women.
In addition, it has to be remembered that the operation of the Midwives Act, 1936, and the contemplated
extension of the Maternity Hospital will both have the effect of further increasing these already large
attendances.
4. Tuberculosis Visits.—2,523 such visits were made by Health Visitors in 1936 and none in
1930. These visits practically take up the time of one Health Visitor. Generally speaking a Health
Visitor can make something between 4,000 and 5,000 visits per annum taking one visit with another,
but a tuberculosis visit takes more time than the average visit and 2,523 visits to tuberculous patients,
as I have said above, means practically the time of one Health Visitor.
5. Infant Life Protection.—This is a service which was not provided for in 1930 as it did not
come into operation until after Health Centre (3) was built. There were paid in 1936 2,405 visits
in connection with infant life protection and, again, this takes up the time of practically one Health
Visitor for the same reason as 2,523 visits to tuberculous patients take up the time of one Health
Visitor.
6. Inspection of Midwives and Inspection of Nursing Homes.—This has also been undertaken
by the Council since 1930 without any increase in staff for this work.
7. Then, again since 1930, and more particularly within the last two or three years, there has
been a large demand on the department, which is rapidly increasing, for the medical inspection and
the cleanliness inspection of children about to be sent away for country holidays and school journeys.
In 1936, 830 children received such medical inspection and at least three cleanliness inspections before
departure and some of these children had also to be cleansed at the clinic.
8. In addition, there are some minor matters all of which represent an increase to an overburdened
staff: e.g., the examination of children under the Employment of Children in Entertainment
Rules; the medical examination of staff for admission to the Superannuation scheme; the treatment
of varicose ulcers (958 attendances in 1936) and diphtheria immunisation (1,032 attendances in 1936).
It will also be remembered that when the matter was under consideration about a year ago it was
generally considered desirable that there should be a medical examination of children nearer the
school leaving period than 12 years of age with the view of assisting in the choice of employment but
this examination has not been undertaken.
It will be appreciated that it has only been possible to encompass the foregoing work by cutting
down work in other directions or not urging clinic attendances. For example, breathing exercises
are very necessary after the removal of Tonsils and Adenoids. Such exercises are only available at
Health Centre (1) and Health Centre (3). Some of the mothers in the Willesden Green area do not
send their children for these exercises and a Health Visitor is sent to enquire the reason why. When
the mother states it is too far the matter is left at that and she is not pressed to make her child attend
because, in fact, if she is induced to send the child and subsequently the child fails to attend, a further
visit by the Health Visitor is necessary to ascertain the cause of the second or subsequent failure.
The basis of the proposed extension of Health Centre (2) so far as medical work is concerned, is
the addition of one whole-time Medical Officer. At the present time there are two such Medical Officers
engaged at Health Centre (2) and the average number of cases that they saw during the whole of 1936
was 41 and 30 per session respectively. It is certain that where a doctor is seeing an average of 30
cases per session these cases are not receiving sufficient attention. Some authorities make a limit of
25 as the number to be seen at one infant welfare session and probably this figure is correct as,
obviously, 30 cases in a 2½-hours session means that one case is dealt with every five minutes which is
a very short time when it is remembered that an expectant mother seldom occupies the time of a doctor
for less than 15 minutes. The additional doctor would, therefore, have to deal with approximately
4,000 children between 1 and 5 years resident in Clinic (2) area and also relieve to some extent the
existing doctors of their excess of work.
I think it would be well to note that the work to be done in respect of existing services is greater
than the above average numbers of cases seen by the doctors now employed indicate, because as a
result of the pressure of attendances doctors do not now see many cases who would nevertheless be
seen and profit by a medical consultation were time available. This is shown by the fact that the
doctors in the employ of the Council saw in 1930, the cases under their observation 65 per cent, of the
occasions on which they attended but in 1935, this percentage had fallen to 49 per cent.
Having regard to the above considerations, it will, I think, be noted that neither the plans
nor estimates which have been submitted are beyond the requirements of the area served by Health
Centre (2).
(Incidentally, it should be observed that the doctor at Health Centre (1) in 1936 saw 27 cases
on the average per session and the two doctors at Health Centre (3) saw 29 and 34, respectively, on
the average.)