OPENING BUSINESS SESSION.

Otago Witness, Issue 3804, 8 February 1927, Page 27

OPENING BUSINESS SESSION.

SEVERAL SUBJECTS DISCUSSED The opening business session of the Australasian Medical Congress was commenced on Friday morning in the new block of the Medical School, when there was a discussion on the subject of goitre at a combined meeting of the sections of medi-~ cine, surgery, pathology, preventive medicine, and radiology. Professot'Hercus (Dunedin) and Dr Harvey Sutton (Sydney) dealt with the incidence of goitre and with its causation and methods of prevention. Professor Drennan (Dunedin) dealt with the pathology of various . forms of goitre and the relation of the different causative factors. Dr R. R. Stawell (Melbourne) read a paper on the medical treatment of goitre and dealt with some detail on the value •of medicine in getting rid of the enlargement of the gland. 'Dr Carrick Robertson (Auckland) gave a paper on the surgical treatment of the disease, and Dr C. C. Anderson (Dunedin) dealt with the treatment by means of Xrays. In the section of ophthalmology Dr Brook Lewis (Adelaide) dealt in a technical manner with the changes in file eye accompanying certain forms of goitre. The president of the ophthalmology section. Dr A. M. Morgan (Adelaide) spoke on the causes of certain forms of squint. MEDICAL SERVICES IN THE FIELD. A paper dealing with medical services in the field, with special reference to the battle of Messines, was read by Colonel F.. : yA. Maguire, D. 5.0., A.A.M.C., deputy

Director of Medical Services, Second Military District, Australian Military Forces. The writer stated, that medical service in the field was based oh the principle of rapid evacuation of the sick and wounded. The efficiency with which this system was. organised and administered greatly affected the mobility and morale of the army. The main requirements for field work might be summarised--as follows : —Rapid evacuation, the provision. of warmth, an ample supply .of hot fluids, and the gentle handling of patients. The work of. the medical services in the field called for good staff work, ample supplies, and thorough training of the personnel. Dr Maguire added that the battle of Messines stood out as a perfect example of a "set piece.” Plans were laid for it many months ahead, so that preparations could be developed on an elaborate scale. . There was a definite set objective, limited . in extent, involving the seizure and holding of a piece of enemy country and a straightening out of the line. There was no intention of a general advance following;the battle, so there was no need for a general . scheme for rapid advance or a pursuit battle. Some new factors were introduced into the medical services at the battle of Messines. Mustard gas was encountered for the first time, and it had to be studied and met by new means of defence. But most of the gas. casualties were from phosgen. Oxygen apparatus was supplied to each C.M.D.S., and special provision was made for treating gas casualties. Dr Maguire referred to the excellent and careful work done by the staff in connection with the evacuation. Geneial Sir Donald M'Gavin (Wellington) said he considered that the main dressing stations of jthe corps had. been unnecessary at Messines, as everything necessary could have been done from the advanced dressing stations. The positions of the main dressing stations had been vulnerable, and had involved a lot of extra handling, but he thought their institution 'would have been advisable if the carrying to the casualty clearing stations had been too long ; or the long distance shelling had been too heavy. The only delay experienced had been at Westtock farm, where cars had waited as long to be unloaded as it would have taken them to have gone to Bailleau and back. He considered that the advantages of previous knowledge and a set objective had made the arrangements excellent. With regard to the question whether ambulance cars should go to the front line he estimated that the exposure of the wounded to shell fire was much the less with the ambulance than it was with hand carriage. The proportion was one to 32.' He submitted that it was more important to keep the roads in good condition than to maintain lines of railways, which were easily put out of commission. He spoke very favourably of body shields which had saved many lives, although some of the men had discarded them. They had noticed that the khaki covering had often prevented wounds after the steel ' plate had been penetrated. Lieutenant-colonel Hardie Neil (Auckland) said he regarded the medical organisation at Messines as practically perfect. The only defect, in his opinion, was the lack of facilities for treating abdominal wounds. He had made the suggestion that these facilities should be provided, but some time elapsed before his suggestion was adopted. Ho also referred to the methods of splinting a fractured thigh, which resulted in. a very considerable reduction in the mortality. Colonel J. S. Purdy. (Sydney) said he thought that the arrangement at Messines which deserved the greatest praise was the pooling of the stretcher-bearers of the three field ambulances, the officer commanding the forward area collaborating with the officer commanding the transport and also with the officer commanding the main dressing station. The lessening of fatigue divided the stretch-bearers so that half the men were at rest at any given time. They experienced great difficulty at the “Charing Cross” advanced dressing station with soldiers who had been gassed. This was due to the fact that the men had not been properly instructed in the use of gas masks. The late arrival of the officer concerned had resulted in a very late, burial of the dead. Lieutenant Colonel A. D. Carbery (Wellington) advocated the establsihment of a corps -of main dressing stations as a relay between the advanced stations and the casualty clearance stations. One of the advantages was the regulation of the flow of wounded to the casualty clearing stations, where the work done was limited by the capacity of the operating teams. Nearly one-third of the men reaching the casualty clearing stations required operations. He thought that the sorting of the various types of casualties should be done at the rhain dressing stations. In the second place the requirements of urgent surgery such as the arresting of haemorrhage and emergency amputations, were best carried out at the main dressing stations, while restorative measures for shock, such as blood transfusion, the application of warmth, and rest, should be carried out at such places. He thought that the injection of serum against tetanus. slwuld be carried out at the main dressing stations because the necessary clerical recording and notification could be carried out more easily there than elsewhere. D. B. Smythe, adjutant general New South Wales staff corps, said that where an area was being covered by enemy fire, but where individual targets were not being aimed at, it would be better to get the wounded away in cars, but where the fire was being directed at individuals it would be better to employ stretcherbearers, because ambulances provided a much more conspicuous target. Major General G. W. Barber, directorgeneral of medical service of the Commonwealth, said that experience gained at Messines had been invaluable to him. as he had based his orders on the knowledge lie had gained there, the Battle of Amiens, on the Hindenberg line. He agreed with Sir Donald M’Gavin that in certain circumstances the main dressing stations should be abolished. PUBLIC HEALTH NURSES. Dr M. H. Watt (Deputy-director General of the Department of Health of New Zealand) read a paper in which he dealt with the functions of public health nurses. He pointed out that public health nurses might be employed by the Government, by a local body, by voluntary organisations, or by private employers. Her duties might cover ante-natal care, maternity, and infant welfare, including the supervision of midwives, the inspection of maternity hospitals, child welfare; including the pre-school and school ages, industrial hygiene, the control

of communicable diseases, and the education of the public in preventive medicine, lie thought that her most important functions were to insure the well-being of ‘the mother during pregnacy, and the health of the child during infancy, and the pre-school and school ages. He gave some details with regard to the method of training public health nurses, and particularly pointed out that hospital training in itself was not sufficient preparation for this work, and that a further period of specialised training was essential. ' Public health nursing was of very recent origin, and he was loath to lay down any hard and fast rule for the work. Two views were held with regard to the . public health nurse. One was that she should try to cover the whole range of duties referred to above, and the other was that she should limit herself to some speciality. He pointed out that' district nurses worked amongst the Maoris as community nurses, combining bedside care and health teaching. On the other hand there were ante-natal nurses, Plunket nurses, and school nurses, who were specialists. In NewZealand there were eight nurses who acted as inspectors, 32 school nurses, six antenatal nurses, who were employed by the Department of Health, and 115 Plunket nurses, who were employed by the Plunket Societies. All these were specialists, and m addition there were 51 district nurses, who were generalised. He said that the generalised system had certain obvious advantages, and was particularly well adapted for rural areas, being economical in regard to both money arid effort. A discussion took place in the afternoon on the paper. Dr Harvey Sutton, chief local officer of the Department of Education, New South Wales, dealt with the school nurse from the community point of view. He said that in New South Wales and Victoria the school nurse was an assistant—a home visitor or health visitor whose duty it was to follow up children found defective at a school medical examination. The nurse formed a personal link between the medical service and the home. The nurse interviewed the mother, explained the report, insisted that the child should be treated for its defect, and where facilities for treatment were not available, collected children in parties and took them to a hospital. Where the people were badly off she made arrangements for the supply of necessarysmall apparatus. In the metropolitan area of Sydney there were 150,000 public school children. These were divided into six districts, and one nurse and one medical officer were allotted to each district. The nurse’s efforts had practically doubled the amount of treatment that had been in evidence before there had been school nurses. This meant a considerable avoidance of wastage for carelessness, ignorance, or neglect on the part of parents. Generally speaking, 40 per cent, of the parents took action aftea- inv stigation within three months. Of those who had not responded within three months the nurses obtained effective results in between 20 and 40 per cent. so that the total was raised to from 60 to 80 per cent. Other duties that the nurse undertook were to visit a school just before the school doctor’s visit in order to see that everything was in order, and she carried out a certain amount of sight-testing by means of visual charts. If she found any suspicious signs of disease or defect she referred the child to the medical officer. The nurse undertook the “clean” survey’s, looking for lice, ring worm, skin diseases, ear trouble, diseased or decayed teeth, discharging ears, and dirty clothing, and she reported on all these matters. In the third place the nurses made a certain amount .. of • social investigation and dealt in her report on the amount of milk available for the child, the question of malnutrition or the evidence of venereal disease so that if any of these things were there steps might be taken to remove them. She acted as an assistant in the swabbing for diphtheria and in the “schick” test for diphtheria; in the inoculation for typhoid fever and the vaccination against smallpox and influenza. She acted as an assistant to the doctor in his lectures to the girl children in regard to infant care and home nursing. Dr Sutton gave an account of the training the school nurse underwent, and described the standard of efficiency demanded before a nurse was allowed to take over her responsible duties.Dr Ada Paterson, Director of School Medical Resources, New. Zealand, said that they had 12 school medical officers and 3k school nurses in New Zealand. If possible, a school medical officer had two nurses, one of whom went ahead and made a preparatory survey. Dr Paterson maintained that the result of this arrangement was that treatment results were brought up to 80 per cent, of efficiency, and in certain areas even up to 90 per cent, efficiency. The personality of the nurse counted for much. Training was essential, but a nurse should not be too long in qualifying, although the wider the scope of the training the better. She thought that New Zealand was in a better position than New South Wales, in that the Health Department controlled the whole of the activities in New Zealand whereas in New South Wales they were split up between the Health Department arid the Education Department. Dr Paterson said she liked the proposal ot cadet nurses, who would be taken after the completion of their training. Dr Gertrude Halley, chief school medical officer of South Australia, claimed that a doctor could examine 20 to 30 more children every day if he had the assistance of a nurse. She pointed out the value of nurses following up the school visit to see if the treatment Were being followed. By this method they would get very much better results. Dr P. T. S. Cherry, Port Adelaide, wanted to know from Dr Sutton whether it was true that 37* per cent, of Australian children were defective. He thought that the search for a septic focus in children had been very much overdone, and he did not agree with the wholesale cutting out of tonsils. He considered that many of the children contracted disease after they had started attending school. In his opinion the visit of the school nurse into the private house was resented. He also wanted to know whether any prohibition was exercised on the admission of children who had been in contact with infectious disease in the school, or outside, in places of amusement. He had noticed that in some cases schools were closed but the kinemas were kept open. . Dr Sutton, in reply, said it was true that 30 per cent, of the medical defectives were found in the school children, but he pointed out that this percentage, included visual defectives. In one high school in

Sydney, with 420 boys, 111 had been operated on for the' removal of tonsils or adenoids. That was the standard of the profession before the department took over the control, and he claimed that his department could not further alter the standard the profession had set. It must follow it. The school nurse went to the home to help, and she had no legal powers, but with tact she got there, and collected all the opinions she needed. In New South Wales contacts were prohibited from attending the picture shows, but he admitted that the law was very difficult to enforce. He wanted to have a small committee appointed to discuss the matter of the training of the school and public health nurses.