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29
health of the mother in pregnancy and the normality or otherwise of her
labour. Genetic factors may also be involved.
The problem with observation registers at present is that 40% of
children born with handicap, or subsequently developing handicap, do
not fall into the group deserving special surveillance because of these
factors.
Observation registers require much skilled professional time in
determining "at risk" factors and administering the register, and it may
well be argued that with this high percentage of children falling outside
the register, careful thorough examination of all children would be more
satisfactory both clinically and administratively.
This is not intended to be a condemnation of all observation
registers as it is quite apparent that for research purposes alone the
idea of the observation register should be continued in certain areas,
though not universally applied.
Whatever the fate of these registers, I am convinced they are responsible
for an enormous generation of interest in the early diagnosis
of handicap, and a radical change in the function of infant welfare
centres.
All children aged approximately seven months can now have their
hearing tested by Health Visitors trained for this purpose.
To avoid lengthy travelling by the parent this service is now provided
at 7 centres throughout the Borough and it is hoped that early
in 1969 4 more premises will be available for these appointments.
Births
In 1968 there were 3,533 live births in the Borough and the illegitimacy
rate was 7.5%. Close liaison exists with all midwives and maternity
units in the area for the immediate notification of all births where some
form of congenital abnormality is present or is suspected. Arrangements
are made for the follow up of these cases by Health Visitors, or by
direct approach to the Paediatrician in charge of the case so that full
details can be forwarded to the Registrar General or in the case of
residents outside the Borough to the responsible Health Authority.
73 such cases were reported in 1968, details of which are given in
Appendix 10.
The Observation
Register
Dr. Joan M. Pooley, M.B., B.S., D.C.H., Senior Assistant Medical
Officer reports as follows:-