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All held the certificate of the Central Midwives Board. The Superintendent of domiciliary midwives
is also Non-Medical Supervisor of Midwives, and undertakes the necessary visiting and investigation
appropriate to the Council's Statutory responsibilities in this area.
CONGENITAL MALFORMATIONS
The Registrar General requires information concerning children who are discovered at the
time of their birth to have an obvious congenital malformation. Regular returns are forwarded to
the Registrar General based upon information received from local midwives at the time that the
birth is notified to this Department in accordance with the Notification of Births Act, 1907. A total
of 82 babies with congenital conditions were notified in 1970.
PHENYLKETONURIA
This disease of the metabolism has been known for many years. It is hereditary and detectable
shortly after birth. If untreated it leads to irreversible brain damage and mental subnormality.
A simple urine test has been used successfully for routine screening of all babies. However, this
is not always reliable before 4-6 weeks of age, and even by this time the brain may be damaged.
A blood test (Guthrie test) has now been developed which can be done after the 6th day of life.
It is more accurate than the urine test, but requires laboratory facilities, which have now been
provided on a regional basis throughout the country. Early in 1970 the Guthrie blood test was
introduced in Hillingdon as a routine screening procedure.
The test is carried out on the 6th day of life by the midwife either in hospital or at home and
involves pricking the baby's foot to obtain drops of blood of a specified size. These are collected
on a special filter paper which is then posted to the regional centre for processing. Sometimes the
result is unsatisfactory for technical reasons and the test has to be repeated.
There were no cases of phenylketonuria detected in the Borough during the year.
CHILD HEALTH CENTRES
A change in title from Child Welfare Clinic to Child Health Centre emphasises the radical
re-appraisal which is currently being undertaken of the clinical work which Local Authorities
now undertake amongst babies and young children. Formerly such clinics were much concerned
with the child's nutrition, relatively minor medical conditions and orthopaedic abnormalities.
As such the clinic attracted some criticism from other medical colleagues who considered that
such work was unnecessary.
The relief of parental anxiety concerning the development of children is still a valid use of
the time of both doctors and the health visitors. The valuable sociological studies of John and
Elizabeth Newson indicate that parents are sometimes bewildered by the developmental progress
of their children, and are glad to receive appropriate advice which is not often available outside
the Child Health Centre. Similarly a number of physical changes concomitant with developmental
maturity may be confused with abnormality so that skilled re-assurance should be available.
Thus the Child Health Centre should provide a service for the education of parents both
on an individual and on a group basis. The immunisation of children is also an essential part of
the work. In addition to the immunisation schemes which have been available for many years,
programmes to immunise against measles and german measles are being introduced. Although
measles vaccination in this area has been available for some years the community protection
levels are insufficient to eliminate the disease, and significant numbers of cases are still being
reported. A vigorous campaign particularly directed towards children most at risk of complications
from measles should be led from child health centres whether organised by the Local Authority
or by individual general practitioners. The variety of immunising agents and the various contraindications
to their use constitutes a special branch of knowledge which can all too easily be
overlooked.
In order to advise parents about the developmental progress of their children, both doctors
and health visitors must be skilled in the techniques of developmental paediatrics and the early
detection of significant handicaps. This process of re-orientation has been continuing for some
years, but is now being rapidly accelerated. A programme to ensure that each full time medical
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