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T h e splendid parenta l response to BCG protect ion of the i r infants is due to the in te res ted co-operat ion of the Staff of the Hospi ta l . Almost 4,000 of the 4,881 l ive bi r ths have been vacc ina ted .

I t is a pleasure to t hank the Master, Medical, Nurs ing and Almoner Staffs for the helpful assistance t h e y have given to the Tuberculosis Prevent ion Service dur ing the year.

X - R A Y D E P A R T M E N T

(From 1st J anua ry , 1963 to 31st December , 1963)

DR. C. L. MCDONOGH

TABLE A

Uterus and Contents (see Table B) . . . . . . . . . 295 Placental site . . . . . . . . . . . . . . . . . . 14 Pelvimetry . . . . . . . . . . . . . . . . . . . . . 220 Salpingogram ... . . . . . . . . . . . . . . . 27 Straight urinary tract . . . . . . . . . . . . . . . 11 I.V.P . . . . . . . . . . . . . . . . . . . ... 28 Lungs and heart . . . . . . . . . . . . . . . . . . 143 Miscellaneous . . . . . . . . . . . . . . . . . . 61 Babies (see Table C) . . . . . . . . . . . . . . . . . . 719

TOTAL ... 1,518

TABLE B Normal foetus (vertex) . . . . . . . . . . . . . . . . 149 Twins ... " (breech presenting~ 26

. . . . . . . . . . . . . . . . . . . . . 64 Dead foetus . . . . . . . . . . . . . . . . . . . . . 22 Anencephalic . . . . . . . . . . . . . . . . . . . . . 12 Hydrocephaiic . . . . . . . . . . . . . . . . . . . 5 Malpresentation . . . . . . . . . . . . . . . . . . 15 No evidence of pregnancy . . . . . . . . . . . . . . . 2

TABLE C

BABIES Lungs and heart . . . . . . . . . . . . . . . . . . 293 Barium meal . . . . . . . . . . . . . . . . . . II Long bones . . . . . . . . . . . . . . . . . . . . . 56 Plain abdomen . . . . . . . . . . . . . . . 29 Skull . . . . . . . . . . . . . . . . . . . . . ... 185 Shoulder girdle . . . . . . . . . . . . . . . . . . 21 I.V.P. or I.M.P . . . . . . . . . . . . . . . . ... 6 Congenital abnormality . . . . . . . . . . . . . . . 110 Miscellaneous . . . . . . . . . . . . . . . . . . 8

SOCIAL S E R V I C E D E P A R T M E N T

MIss ELEANOR HOLMES

The year under review has been a difficult one for the Depar tmen t . Exigencies outside the Hosp i ta l made it necessary for m y colleague and mysel f to t ake leave in excess of the annual mon th each. The problem of find- ing locum almoners has been more acute than ever, in fact , for a lmost a m o n t h of the 1963 leave, we have had to funct ion wi thou t a locum. This resul ted in a serious backlog of work, for even a t no rmal t imes, it has been impossible to cope adequa te ly wi th the work of the Depar tmen t . Wi th the

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increased turnover of patients in the Hospital and the greater apprecia- tion of our function, our present staff of two almoners and one clerk has proved to be quite inadequate. An additional clerk is an urgent necessity, and if this is not possible, we will have to give thought to re-orientating ourselves to the situation and eliminating certain duties.

Out of 4,966 new patients interviewed (4,656 materni ty and 310 gynae- cological) 2,676 were found to be in need of our services.

The needs of 1,703 patients recorded in our Statistical Register (1,591 materni ty and 112 gynaecological) came to our notice as follows:--

(a) D u r i n g r o u t i n e i n t e r v i e w . . . . . . . . . . . . 760 (b) M a d e a p p l i c a t i o n t h e m s e l v e s . . . . . . . . . 436 (v) Re fe r r ed b y m e m b e r s of H o s p i t a l s t a f f 348 (d) R e f e r r e d b y i n d i v i d u a l s o r o r g a n i s a t i o n s o u t s i d e t i le

H o s p i t a l . . . . . . . . . . . . . . . . . . 159

T h e f o l l o w i n g a n a l y s i s s h o w s t h a t t h e n e e d s of t h e s e p a t i e n t s cou ld be d i v i d e d a s fo l lows : - -

(a) M a t e r i a l . . . . . . . . . . . . . . . . . . . . . 488 (b) F a m i l y . . . . . . . . . . . . . . . . . . . . . 97 (c) P e r s o n a l . . . . . . . . . . . . . . . . . . . . . 300 (d) E m o t i o n a l .. . 47 (e) A c o m b i n a t i o n of t w o o r m o r e of t h e s e f a c t o r s .. . 771

The apparent more stable economic situation and the improving standard of living in this country has given rise to more expectation by our patients of certain facilities and amenities of life. This has been noted in the desire of many patients, from the less educated and less well-to-do strata of society, to have semi-private accommodation. This has not always had a happy result, sometimes due to the insecurity of the patients themselves in endeav- outing to "keep up with the Joneses ", and also, when for some medical or obstetric reason the stay in hospital becomes protracted and financially impossible, many such patients have felt that to transfer to a general ward would cause "loss of face".

In spite of the increasing affluence of our society, there were still many patients attending the Hospital who were found to exist at near starvation level, some, on account of sickness, unemployment or alcoholism of the breadwinner; others, through mismanagement of adequate income, usually caused by poor mental powers, and/or insufficient education. The latter category of patient often came from a disturbed or problem family back- ground.

Unemployment, Disability and Maternity Benefits increased on 7th January 1963. On 1st November 1963, Children's Allowance also increased and the first child in the family became eligible; heretofore, only families with two or more children, under 16 years, were entitled to this allowance. These benefit increases were largely offset by the Government's introduction of a 2�89 % Turnover Tax on 1st November 1963. In practice, this tax frequently worked out at an even higher percentage. The cost of living was further inflated, in that, prior to the introduction of the Turnover Tax, some manu- facturers and businesses had increased the prices of many essential household commodities on the apparent pretext that this new Tax would prove costly to administer.

As noted in our report of last year, the housing situation had become grave, due to insufficient forethought by the authorities in providing housing for emigrants returning to work in Ireland as a result of the improved employment situation. The collapse of the two 18th century Dublin houses in June, 1963, causing loss of life, led to many more dwellings being con- demned as dangerous, the tenants of such dwellings being given priority in re-housing, and it must be borne in mind that the average Georgian tenement

9

dwelling housed 7-8 families. There were not sufficient facilities even to re-house all of these dispossessed tenants and others already on the waiting list no longer had any priority. The system of dwellings by draw for "newly- weds" had to be eliminated. A great number of our patients and their families were forced to live with relations, often in small Corporation houses, which were frequently found to house two or three families, sometimes with 10-20 people living in the same house. Some families had to split up and go to different relatives. An army barracks and the Mendicity Institution were used for those who had nowhere to go, but proved to be under- standably unpopular. The strain of the situation on expectant mothers, and those with young children was great, and there was so little we could do, except to help them to come to terms with an intolerable situation, which we could only hope would be of short duration. In the emergency, the Dublin Corporation Housing Welfare Officers were assigned to help with allocations, and had to neglect their very necessary social work with tenants, and to date, they are still being overwhelmed by tenants in difficulty over re-housing, a problem which one feels should be dealt with entirely by the Allocations Branch of the Dublin Corporation Housing Department.

The criterion that local authori ty dwellings were provided for the "working- classes" has been a very unfair one for the ratepayers of Dublin and elsewhere in the country, for many families, occupying such houses at subsidised rents, could afford to rent or purchase their own houses (approximately 10,000 families pay the maximum differential rent, and even this top rent is an unecononuc figure). A more realistic approach and proper means test should considerably ease the housing problem for the local authorities. It is well known that numerous "white collar" citizens, who are in a less affluent financial position than many manual workers, must provide housing for themselves.

The rents of privately owned flats and houses have greatly increased due part ly to heavy demand. The majority of these rents has been raised to a figure considerably above the percentage of income which could be considered as economic for the tenant.

The publicity and acceptance of guidance on family planning by Church and lay authorities in cases of economic hardship and family illness, have given rise to an increasing number of our patients asking for such advice and no longer having feelings of guilt in doing so.

In the OUT PATIENT DEPARTMENT we had 50 patients expecting illegitimate babies, 46 of these were single, 2 married and 2 widows. The youngest was 14�89 years and the oldest 43 years. 25% were teenage. Seven married later in the pregnancy. Of the total, 25 were delivered in hospital; 3 delivered on District; 17 relerred elsewhere for confinement (special homes, etc.); 5 not delivered in 1963.

In the INTERN DEPARTMENT, 60 such patients were delivered. Of these, 35 were unbooked, 3 were private patients. Fifty-seven were single and 3 were married women. The youngest was 14 years and eldest 43 years. 28% were teenage. One married following discharge from Hospital. Fifteen of these patients are known to have kept their babies, the majority of the re- mainder decided on adoption, except in a few instances where on account of hereditary factors or the baby's unsuitability, institutional care had to be resorted to.

Occupations of the girls ranged from various domestic categories, factory workers and those of no occupation who helped at home, to clerks, shop assistants and university students. Occupations of putative fathers included one "unable to work", labourers, soldiers, a policeman, an artist, business men, and university students.

The most pressing problem in dealing with the mother of an illegitimate child occurred with those who came into hospital unbooked. The time factor

7O

militated against working out a solution, for the days immediately after confinement are, with any patient, a time of emotional upheaval, and this is naturally greater in the unmarried mother. There is a dual problem, viz:-- what seems best for the baby? what seems best for the mother? The mother's decision is of the utmost importance, firstly, if her decision is not satisfactory to herself she may feel frustrated, and unhappier than she already is, and perhaps in time repeat her pattern of behaviour in having a further illegit- imate pregnancy--In any event, the repercussions will not be good. Secondly, it must be remembered that whatever the circurnstances she is the legal guardian of the child. Her decision will be influenced by the society in which she lives, and it is for us to see that inadvisable pressures from well-meaning relatives, employers and others are not too great. It is here that some very delicate casework must be practised in helping the patient to come to a wise decision for both herself and her child.

In the Maternity and Gynaecological sect:ons we have continued to deal with a proportion of patients who feel unable to cope with their personal difficulties and environments. A great number of these patients have benefited tremendously from the services of our Psychiatrist. Others have had problems of a nature that we ourselves could provide the necessarycase work service, for example: immature patients, where self-analysis and perseverance is absent and where they have to be helped in managing their problems; also patients who have a normal depression resulting from trouble or some family difficulty.

The appointment of a Dietitian for a few hours each week has helped to fill a long felt need, for we have always been aware of a great number of patients who need special advice on diet and the budgeting entailed.

The demand for beds continues unabated, and our weekly consultation with the Chief Assistant is a tremendous help in solving some of these difficulties. Fewer patients than ever wished to remain at home, in fact those who wished domiciliary confinement were usually those most unsuited for it, due to high multiparity and overcrowded home conditions. Many who had every convenience and a relative to help and were suitable obstetric- ally, were too nervous to stay at home. Over the years it has become obvious that even with good facilities, unless both the patient and her husband have suitably placid temperaments, domiciliary confinement will not be accept- able. The need for Home helps continues, not only for those who have their confinements at home, but also for the patient discharged from hospital after confinement.

In the Paediatric Unit and Nursery we have depended on the staff for referral of social problems, but pressure of work has prevented us from giving as much time to these sections as we would wish.

During the year we had two Social Science students, from Trinity College and University College, who completed part of their field work training in the Department. Lectures were given to post-graduates, social science students and student midwives.

Without the many statutory and voluntary bodies and individuals outside the hospital it would be impossible for us to function, for almoners, as well as being members of the hospital team treating patients, also act as liaison between the Hospital and voluntary and statutory organisations which are geared to help with many of the difficulties that arise for our patients.

Our thanks are due to the great number of people who have co-operated with us and helped our patients during the year. Within the hospital, the Infant Clothing Fund Committee and the Linen Guild and S~maritan Fund Committee have continued their generous help with clothing for needy mothers and babies, as has Mrs. H. P. Mayne, who over the years has never forgotten to send us beautiful hand sewn garments. Our Annual Dance had a most fruitful financial result, and the Samaritan Fund became solvent

once more. We are very grateful to the Dance Committee for their hard work resulting in such a successful effort.

Our appreciation goes to members of staff in the hospital for their co- operation and support throughout the year.

STATISTICS OF T H E SOCIAL SERVICE DEPARTMENT

Total number of new patients interviewed . . . . . . . . . . . . 4,966 , . . . . . . . assisted . . . . . . . . . . . . . . . 2,676

STATUTORY HELP :

Pat ients helped th rough Matern i ty and Child Welfare Service ... 410 ,, referred to H o m e Assistance Officers .., 18 . . . . . . Tuberculosis Officers, Medical Officers of

Hea l th and Dispensary Medical Officers ... 17 . . . . . . Municipal Hous ing Authori t ies . . . . . . 34 . . . . . . other S t a t u t o r y agencies . . . . . . . . . 190

VOLUNTARY HELP : Pa t ien ts referred to Catholic Social Service Dining rooms ... 280

,, Ambulance Service 57 ,, helped th rough Samar i t an Funr and Linen Guild, and

I n f a n t Clothing F u n d . . . . . . 903 ,, referred to o ther vo lun ta ry agencies . . . . . . . . . 524

ACTION TAKEN : Pa t ien ts visited and followed up . . . . . . . . . . . . . . . 390

,, who received ex t ra n o u r i s h m e n t or special diet help ... 644 . . . . . . clothing . . . . . . . . . . . . . . . 539 . . . . bedding . . . . . . . . . . . . . . . 33

sent to convalescent homes . . . . . . . . . . . . 10 Mothers for w h o m lodgings were found . . . . . . . . . . . . 14 Babies 13 Families for wllom insti ' tut ional 'care was arranged w]~ilst m o t h e r in

hospi ta l . . . . . . . . . 52

NATURE OF WORK : Pat ien ts for w h o m the pract ice of social casework to a ma jo r degree

was necessary . . . . . . 151 ,, who needed special advice or guidance . . . . . . . . . 739 ,, whose need was therapeut ic in terviewing . . . . . . 500 ,, who needed suppor t ive help and reassurance . . . . . . 747

Social reports (writ ten or verbal) . . . . . . . . . . . . . . . 259 Minor services carried ou t . . . . . . . . . . . . . . . . . . 678

DEPARTMENT OF PAEDIATRICS

DR. P . C. D . MACCLANCY AND DR. E . E . DOYLE

During the year under review all sections of the Department are in a position to report a satisfactory year 's work. As will be seen from reading through the report, our admission figures to the Nursery and Paediatric Unit show a slight reduction; however, there have been times when so many infants have been in the department at one time, that our resources have been strained to the utmost. The problems of suitable accommodation for infants born with hopeless congenital defects, and the well infants of the ill mothers in hospital, are still awaiting satisfactory solutions.