Publ. Hlth, Lond. (1975) 89, 137-140
History of Former Groups and Branches* {a} History of the Activities of the Maternal and Child Health Group of the Society of C o m m u n i t y Medicine J. Davies M.B., B,S., M.F.C.M.
Principal Physician Child Health, City and East London Area Health
Authority
The Maternal and Child Health Group was created to promote the exchange of ideas amongst those engaged in this sphere of medicine, to maintain co-operation with other branches of preventive medicine, to arrange meetings in London and other parts of the country, to extend interest in maternal and child health by the formation of sub-groups and to promote the interests of all doctors concerned with this work. The aims of the Society itself in advancing education were also to be realized by the organization of lectures, study days, postgraduate weekends and courses and links maintained with other professional bodies such as the British Medical Association and the British Paediatric Association. The group has also represented the Society on a number of outside bodies, consistently submitting comments to Government bodies, committees and working parties. In 1856 the Metropolitan Association of Medical Officers was founded, this becoming the Association of Medical Officers of Health in 1869 and the Society of Medical Officers of Health in 1873. The affairs of the Society were relatively uneventful until activities began to increase in 1906. The new constitution in 1919 allowed the formation of functional groups of doctors, and, in 1922, the Maternal and Child Welfare Group was established. There was considerable re-orientation following the war years and the group formulated a scheme for the conduct of child welfare centres. Subject matter and details of the work which has been undertaken over the years, together with that of other Groups, are part of the Society's records and will be held at some central point. Because of this they will not be itemized in chronological order in this short history which deals with the most important of them from about 1948. It is interesting that, at this time and during the early 1950s, the executive committee, on behalf of the group, was considering the training of health visitors and district nurses and their relationship with general practitioners and was also very concerned with the scope of the work in child welfare clinics, so called at that time, progressing to an analysis of the actual work carried out. The group also represented the Society on the organizing committee on the Survey of Child Development and also on the following bodies: the General Council of the National Association of Maternal and Child Welfare and the British Council for the Care of Spastics. Nineteen hundred and fifty-six was memorable as being the centenary year of the foundation of the Society of Medical Officers of Health, and various subjects were under consideration during the rest of the fifties. The following must be cited: the use of day nurseries; *In spite of the efforts of the Society it has only been possible to obtain the following summaries of two groups.
138
History of former groups and branches
the follow-up of children placed for adoption or in residential nurseries; child neglect; illegitimacy; the welfare, as opposed to the medical and nursing care, of children in hospitals. In 1957 the outstanding work was a draft memorandum on the future of the maternity services for submission to the Cranbrook Committee and the Report on Confidential Enquiries into Maternal Deaths. In 1958 a memorandum was prepared for submission to Council on the prevention of break up of families. The four most important reports commented on during the 1960s were as follows: that of the Sheldon Committee; comments which were submitted to the Department of Education and Science on the education and training of mentally handicapped children; and on certain aspects of the education of blind and partially sighted children; and finally the Quirk Committee of Enquiry into Speech Therapy Services. A great deal of time was of course devoted to the Seebohm Report and Green Paper at the end of 1968. A presidential address was devoted to the expanding role of the health visitor in 1961 and, during 1965, the role of men in health visiting was considered, together with medical staffing in clinics. Child neglect was a very pressing problem at this time and the group became involved, too, with mothers and babies during the lying-in period, with the follow-up of babies placed for adoption or in residential nurseries, together with a survey of illegitimate children which culminated in a memorandum to Council on the prevention of family break-up in December 1968. A great deal of the group's work has of course pertained to child health centres and the developmental paediatric training of doctors. Their job satisfaction and the updating of their work has been a recurring activity over the years. In 1954 a sub-committee compiled a fact-finding questionnaire to ascertain how many doctors are sponsored by their authorities to attend study days and courses and also the frequency, with which they attend. Until 1956 the educational activities of the Society had been confined to refresher courses, largely for the benefit of junior, clinically orientated doctors. These have, over the years, made developmental paediatrics and the detection of handicapping conditions, together with their management, a subspeciality. However, it was now beginning to be felt that courses to interest these, together with the more senior doctors, would beneficially combine the expertise and experience of the latter with the fresh clinical ideas of the former. A sub-committee was set up to consider co-operation with the School Health Group in the organization of such courses. This reorientation was perhaps particularly relevant at the time of the 100th anniversary of the Society when it was taking stock of its full scope and function. Even in the early 1950s the artificial division between the pre-school and school phases of childhood was being criticized. A memorandum on child welfare centres was prepared by the group and published in the British Medical Journal in May 1955. In May 1967 a steering committee was formed from group representatives and from the General Purposes Committee to organize developmental paediatric courses, following a grant from the Spastics Society. Later in 1968, of course, this was replaced by the Developmental Paediatrics Courses Sub-Committee. Consideration was also given to the emotional disorders which may only come to light at our centres and the manner in which these are dealt with. The study day theme in November 1970 posed the question: "Child Health Specialist: Community Physician--Which?", when the future role of our clinical doctors was considered at length. It was now being realized that more should be done to establish joint appointments in the community and within the hospital precincts, the latter both in outpatient departments and in assessment centres. Time was also devoted to discussing this
History of former groups and branches
139
topic in May 1971, following a refresher course in Oxford, and it was also felt that community health teams, with the attachment of health visitors to group practices, should be increased. At this time comments were also submitted to the 0-5 group, i.e. the pre-school enquiry under the chairmanship of Professor Eric Stroud. During the early 1970s one-parent families were considered. In June 1973 a meeting was held with the chief medical officer of the Department of Health and Social Services to discuss the future role of clinically orientated doctors. The record card used in child health centres--the so-called '46 was originally designed by this group in 1959 as an aid in orientating doctors who conducted developmental paediatric examinations at key ages during the first five years of life. In 1961 a sub-committee was elected to consider record-keeping, and minor amendments were subsequently suggested, the new compilation being initially used in a pilot survey in certain London boroughs, in Southampton and in Buckinghamshire. The amended card became generally available in 1968. A booklet which was initially called Maternal and Child Welfare Guide, was also a group compilation. It was financed by the group with income from its continued sale being donated to the Society's developmental fund. This became The Doctor and the Child Welfare Centre in 1966 and was finally updated in 1973 to The Work of the Child Health Doctor in the Community and was included as part of the group's evidence to the Court Committee. An ad hoe working party had been set up with members of the School Health Group to formulate ideas for submission here. The group's president attended a Department of Health and Social Security conference on the at-risk register concept during the early 1970s when certain decisions were made. Screening of all pre-school age children was to be aimed at and it was felt that some of this work could be delegated to trained health visitors. Serial screening procedures in infants and young children were considered in 1972. During this period views were also given on a number of other topics, the most important being the Asa Briggs Committee Report on Nursing. Interest was also shown in the relationship child psychiatry had with general paediatrics and adult psychiatry. Assistance was given to the British Paediatric Association in the compilation of a memorandum. The widening split, with paediatric psychiatrists based in hospital and educational psychologists with the education authorities, was becoming very apparent when the desire for complete teamwork was felt to be so important. The role of psychologists in the health service, it was felt, needed clarifying. The management of diabetic children and children who have a long stay in hospital were two topics considered at this time. It was decided during the early 1950s that lectures, study days and courses would be coordinated and advertised by Society headquarters to ensure that groups avoided similarities of theme or clashing dates. It was also decided that refresher courses would be yearly events. Subject matter has always been up to date and a wide variety of themes over the years has included topical subjects, administration and purely clinical matters. For instance, from about 1969, monthly lectures have been arranged around a theme, commencing with, developmental paediatrics, and continuing with, the handicapped child, adoption, metabolism and nutrition, and most recently priorities in the health care of children. The final study day was devoted to sudden death in infancy, a subject being researched extensively at this time (1974). The group's work has also centred on what has more recently been called social obstetrics and which, over the years, has included consideration of antenatal, post-natal and midwifery problems, cervical cytology and well-women clinics, family planning and the
140
History of former groups and branches
epidemiology of venereal diseases. Discussion was also devoted to the Report on Confidential Enquiries into Maternal Deaths (1957), the Peel Report on Domiciliary Midwifery and Maternity Bed Needs. Cervical cytology screening and the recall scheme were considered in 1972 and 1973 and comments were made on active management of labour in 1974. Oral evidence was also given to the Lane Committee which considered the working of the Abortion Act. The group was concerned with family planning training during 1969 and 1972 and in November 1969 a study day devoted to some of these aspects of social obstetrics was mounted. A second study day pertaining to the same subject took place in November 1971 when the brief was extended to include the epidemiology of sexually transmitted diseases, contraception, social aspects of termination of pregnancy, modern maternity units, well-women clinics and unified maternity services. In 1969 the group partook in a working party set up to compile a new family planning record card. It is interesting that a recommendation for a change in the name of the group was initially under consideration even in 1952. In December 1968, following the Sheldon Report, it was felt that the change was now appropriate and necessary. The replacement of "maternal and child health", with "maternity and child welfare", was suggested at the Annual General Meeting in 1969 and the sanction of Council for this change was received in November of that year. A bar, bearing the altered name, was added to the presidential insignia at this time, being the gift of the president of that particular year. Even in 1956 the arbitrary division of childhood into pre-school and school phases was considered to be outmoded. An address entitled, "Why Not a Child Health Service", was indeed given during that year. However, it was not until 1970 that a recommendation for closer collaboration between the Maternal and Child Health and School Health Groups of the Society was made. It was felt that this would be achieved by joint meetings and joint refresher courses. In 1972 efforts were restarted towards integration and, at this time, there was one active joint sub-committee, that pertaining to audiology. The culmination, of course, has been the fusion of these two groups to form the Obstetrics, Child and Youth Health Committee, effective from October 1974 and one of five specialist committees of the Society.
New Appointment Miss Norma Brodie Batley, SRN, HV Tutor Cert., has been appointed director-designate of the Council for the Education and Training of Health Visitors and takes up her new post on 1 March 1975. Formerly a health visitor tutor, she has been since 1963 with the Department of Education and Science as one of Her Majesty's inspectors of schools--only the second nurse to have held such a post. Miss Batley succeeds Miss E. E. Wilkie, OBE, BA, SRN, HV Tutor Cert., who is retiring and who was appointed chief professional adviser to the Council for the Training of Health Visitors in 1963 and has been its director since the name was changed in 1972 to the Council for the Education and Training of Health Visitors.
History of Former Groups and Branches* {a} History of the Activities of the Maternal and Child Health Group of the Society of C o m m u n i t y Medicine J. Davies M.B., B,S., M.F.C.M.
Principal Physician Child Health, City and East London Area Health
Authority
The Maternal and Child Health Group was created to promote the exchange of ideas amongst those engaged in this sphere of medicine, to maintain co-operation with other branches of preventive medicine, to arrange meetings in London and other parts of the country, to extend interest in maternal and child health by the formation of sub-groups and to promote the interests of all doctors concerned with this work. The aims of the Society itself in advancing education were also to be realized by the organization of lectures, study days, postgraduate weekends and courses and links maintained with other professional bodies such as the British Medical Association and the British Paediatric Association. The group has also represented the Society on a number of outside bodies, consistently submitting comments to Government bodies, committees and working parties. In 1856 the Metropolitan Association of Medical Officers was founded, this becoming the Association of Medical Officers of Health in 1869 and the Society of Medical Officers of Health in 1873. The affairs of the Society were relatively uneventful until activities began to increase in 1906. The new constitution in 1919 allowed the formation of functional groups of doctors, and, in 1922, the Maternal and Child Welfare Group was established. There was considerable re-orientation following the war years and the group formulated a scheme for the conduct of child welfare centres. Subject matter and details of the work which has been undertaken over the years, together with that of other Groups, are part of the Society's records and will be held at some central point. Because of this they will not be itemized in chronological order in this short history which deals with the most important of them from about 1948. It is interesting that, at this time and during the early 1950s, the executive committee, on behalf of the group, was considering the training of health visitors and district nurses and their relationship with general practitioners and was also very concerned with the scope of the work in child welfare clinics, so called at that time, progressing to an analysis of the actual work carried out. The group also represented the Society on the organizing committee on the Survey of Child Development and also on the following bodies: the General Council of the National Association of Maternal and Child Welfare and the British Council for the Care of Spastics. Nineteen hundred and fifty-six was memorable as being the centenary year of the foundation of the Society of Medical Officers of Health, and various subjects were under consideration during the rest of the fifties. The following must be cited: the use of day nurseries; *In spite of the efforts of the Society it has only been possible to obtain the following summaries of two groups.
138
History of former groups and branches
the follow-up of children placed for adoption or in residential nurseries; child neglect; illegitimacy; the welfare, as opposed to the medical and nursing care, of children in hospitals. In 1957 the outstanding work was a draft memorandum on the future of the maternity services for submission to the Cranbrook Committee and the Report on Confidential Enquiries into Maternal Deaths. In 1958 a memorandum was prepared for submission to Council on the prevention of break up of families. The four most important reports commented on during the 1960s were as follows: that of the Sheldon Committee; comments which were submitted to the Department of Education and Science on the education and training of mentally handicapped children; and on certain aspects of the education of blind and partially sighted children; and finally the Quirk Committee of Enquiry into Speech Therapy Services. A great deal of time was of course devoted to the Seebohm Report and Green Paper at the end of 1968. A presidential address was devoted to the expanding role of the health visitor in 1961 and, during 1965, the role of men in health visiting was considered, together with medical staffing in clinics. Child neglect was a very pressing problem at this time and the group became involved, too, with mothers and babies during the lying-in period, with the follow-up of babies placed for adoption or in residential nurseries, together with a survey of illegitimate children which culminated in a memorandum to Council on the prevention of family break-up in December 1968. A great deal of the group's work has of course pertained to child health centres and the developmental paediatric training of doctors. Their job satisfaction and the updating of their work has been a recurring activity over the years. In 1954 a sub-committee compiled a fact-finding questionnaire to ascertain how many doctors are sponsored by their authorities to attend study days and courses and also the frequency, with which they attend. Until 1956 the educational activities of the Society had been confined to refresher courses, largely for the benefit of junior, clinically orientated doctors. These have, over the years, made developmental paediatrics and the detection of handicapping conditions, together with their management, a subspeciality. However, it was now beginning to be felt that courses to interest these, together with the more senior doctors, would beneficially combine the expertise and experience of the latter with the fresh clinical ideas of the former. A sub-committee was set up to consider co-operation with the School Health Group in the organization of such courses. This reorientation was perhaps particularly relevant at the time of the 100th anniversary of the Society when it was taking stock of its full scope and function. Even in the early 1950s the artificial division between the pre-school and school phases of childhood was being criticized. A memorandum on child welfare centres was prepared by the group and published in the British Medical Journal in May 1955. In May 1967 a steering committee was formed from group representatives and from the General Purposes Committee to organize developmental paediatric courses, following a grant from the Spastics Society. Later in 1968, of course, this was replaced by the Developmental Paediatrics Courses Sub-Committee. Consideration was also given to the emotional disorders which may only come to light at our centres and the manner in which these are dealt with. The study day theme in November 1970 posed the question: "Child Health Specialist: Community Physician--Which?", when the future role of our clinical doctors was considered at length. It was now being realized that more should be done to establish joint appointments in the community and within the hospital precincts, the latter both in outpatient departments and in assessment centres. Time was also devoted to discussing this
History of former groups and branches
139
topic in May 1971, following a refresher course in Oxford, and it was also felt that community health teams, with the attachment of health visitors to group practices, should be increased. At this time comments were also submitted to the 0-5 group, i.e. the pre-school enquiry under the chairmanship of Professor Eric Stroud. During the early 1970s one-parent families were considered. In June 1973 a meeting was held with the chief medical officer of the Department of Health and Social Services to discuss the future role of clinically orientated doctors. The record card used in child health centres--the so-called '46 was originally designed by this group in 1959 as an aid in orientating doctors who conducted developmental paediatric examinations at key ages during the first five years of life. In 1961 a sub-committee was elected to consider record-keeping, and minor amendments were subsequently suggested, the new compilation being initially used in a pilot survey in certain London boroughs, in Southampton and in Buckinghamshire. The amended card became generally available in 1968. A booklet which was initially called Maternal and Child Welfare Guide, was also a group compilation. It was financed by the group with income from its continued sale being donated to the Society's developmental fund. This became The Doctor and the Child Welfare Centre in 1966 and was finally updated in 1973 to The Work of the Child Health Doctor in the Community and was included as part of the group's evidence to the Court Committee. An ad hoe working party had been set up with members of the School Health Group to formulate ideas for submission here. The group's president attended a Department of Health and Social Security conference on the at-risk register concept during the early 1970s when certain decisions were made. Screening of all pre-school age children was to be aimed at and it was felt that some of this work could be delegated to trained health visitors. Serial screening procedures in infants and young children were considered in 1972. During this period views were also given on a number of other topics, the most important being the Asa Briggs Committee Report on Nursing. Interest was also shown in the relationship child psychiatry had with general paediatrics and adult psychiatry. Assistance was given to the British Paediatric Association in the compilation of a memorandum. The widening split, with paediatric psychiatrists based in hospital and educational psychologists with the education authorities, was becoming very apparent when the desire for complete teamwork was felt to be so important. The role of psychologists in the health service, it was felt, needed clarifying. The management of diabetic children and children who have a long stay in hospital were two topics considered at this time. It was decided during the early 1950s that lectures, study days and courses would be coordinated and advertised by Society headquarters to ensure that groups avoided similarities of theme or clashing dates. It was also decided that refresher courses would be yearly events. Subject matter has always been up to date and a wide variety of themes over the years has included topical subjects, administration and purely clinical matters. For instance, from about 1969, monthly lectures have been arranged around a theme, commencing with, developmental paediatrics, and continuing with, the handicapped child, adoption, metabolism and nutrition, and most recently priorities in the health care of children. The final study day was devoted to sudden death in infancy, a subject being researched extensively at this time (1974). The group's work has also centred on what has more recently been called social obstetrics and which, over the years, has included consideration of antenatal, post-natal and midwifery problems, cervical cytology and well-women clinics, family planning and the
140
History of former groups and branches
epidemiology of venereal diseases. Discussion was also devoted to the Report on Confidential Enquiries into Maternal Deaths (1957), the Peel Report on Domiciliary Midwifery and Maternity Bed Needs. Cervical cytology screening and the recall scheme were considered in 1972 and 1973 and comments were made on active management of labour in 1974. Oral evidence was also given to the Lane Committee which considered the working of the Abortion Act. The group was concerned with family planning training during 1969 and 1972 and in November 1969 a study day devoted to some of these aspects of social obstetrics was mounted. A second study day pertaining to the same subject took place in November 1971 when the brief was extended to include the epidemiology of sexually transmitted diseases, contraception, social aspects of termination of pregnancy, modern maternity units, well-women clinics and unified maternity services. In 1969 the group partook in a working party set up to compile a new family planning record card. It is interesting that a recommendation for a change in the name of the group was initially under consideration even in 1952. In December 1968, following the Sheldon Report, it was felt that the change was now appropriate and necessary. The replacement of "maternal and child health", with "maternity and child welfare", was suggested at the Annual General Meeting in 1969 and the sanction of Council for this change was received in November of that year. A bar, bearing the altered name, was added to the presidential insignia at this time, being the gift of the president of that particular year. Even in 1956 the arbitrary division of childhood into pre-school and school phases was considered to be outmoded. An address entitled, "Why Not a Child Health Service", was indeed given during that year. However, it was not until 1970 that a recommendation for closer collaboration between the Maternal and Child Health and School Health Groups of the Society was made. It was felt that this would be achieved by joint meetings and joint refresher courses. In 1972 efforts were restarted towards integration and, at this time, there was one active joint sub-committee, that pertaining to audiology. The culmination, of course, has been the fusion of these two groups to form the Obstetrics, Child and Youth Health Committee, effective from October 1974 and one of five specialist committees of the Society.
New Appointment Miss Norma Brodie Batley, SRN, HV Tutor Cert., has been appointed director-designate of the Council for the Education and Training of Health Visitors and takes up her new post on 1 March 1975. Formerly a health visitor tutor, she has been since 1963 with the Department of Education and Science as one of Her Majesty's inspectors of schools--only the second nurse to have held such a post. Miss Batley succeeds Miss E. E. Wilkie, OBE, BA, SRN, HV Tutor Cert., who is retiring and who was appointed chief professional adviser to the Council for the Training of Health Visitors in 1963 and has been its director since the name was changed in 1972 to the Council for the Education and Training of Health Visitors.
