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The health organisation of the League of Nations in 1926 and 1927
19~8.
PUBLIC HEALTH.
reasonable amounts paid by the midwife to other midwives employed to attend such patients confined during her period of suspension as were actually entered in her books as having engaged her prior to the date of suspension. It is recognised, however, that cases may occasionally arise in which it is necessary to suspend a midwife for a prolonged period. Any such case will need to be dealt with by reference to the special circumstances, and the whole of the facts should be placed before tile Minister before the authority commit themselves to the payment of compensation.
The Health Organisation of The League of Nations in 1926 and 1927. O little is known of the health activities Nations that a done, issued in the form of a Supplement to the general Information Pamphlet, cannot fail to be of value and interest. Sir George Buchanan, of the Ministry of Health, most are aware, is an original and very active member of the Health Committee of the League ; it is less well known, however, that so also is the head of the United States Public Health Service, and that the health authorities of the Union of Soviet Socialist Republics have participated in the principal branches of work, thus showing that medicine is above all distinctions of race, creed orpolitics, and forms a common bond between them, however divergent otherwise. The membership is indeed world wide, and all parts of the eastern and western hemispheres are represented. The co-ordination, by community of personnel and otherwise, between the League's Health Committee and the Office International d'Hygi&ne Publique, which acts as its official Advisory Council, has been made even closer than before, and notifications required by the International Sanitary Convention of 1926, to be sent to the Office are now transmitted bv way o f the League's various I3ureaux, e.g., that at Singapore, which collects all information for Ihe Far East as far south as New Zealand, and east to Panama. The Epidemiological Intelligence Service now receives and redistributes, through its Bureaux, by telegraph, cable and wireless, information relating to no less than 75 per cent of the world's population. New Bureaux are proposed for Australasia and Africa~ t h e
S of the League of description of the work
163
farmer at Melbourne and the latter at Algiers. \Veekly, monthly, and annual epidemiological reports are also issued from Geneva. The last-named shows, i¢zter alia, tile spread and fluctuations during the year of the principal infectious diseases throughout the world. Liaison with national health administrations is effected by means of interchanges of health officers, medical and engineering, in various parts of the world, and of the part played by the Society of Medical Officers of Health in this country high appreciation is expressed. International public health courses are arranged; last year in Paris and in London; that in Rio de Janeiro is to have permanent standing for Latin America; one in Buenos Ayres is to be a permanent school for doctors and nurses in connection with infant mortality. A number of scholarships are also provided for the study of special subjects. The standardisation of sera and biological products has made considerable progress, notably in connection with anti-tetanus and anti-dysenteric sera, and investigations upon tuberculin, and scarlet fever diagnosis and treatment are proceeding. Insulin and pituitary extract have now universal standards, as also digitalis, by biological test. Blood groups have been the subject of an investigation. Tile determination of blood groups is a recent discovery of great,value for physiological studies, as well as for the treatment and diagnosis of disease. As applications of tile discovery which have attracted popular attention may be mentioned its use in criminology (identification of blood stains, etc.); also in the transfusion of- blood, in which certain donors' blood may be actually harmful. Small-pox and vaccination ; the alleged connection between vaccination and encephalitis lethargica; c2mcer, sleeping sickness, and malaria, have also been subjects of particular investigation, and courses of training in connection with the last-named have been, or are being, set up in Hamburg, London, Paris, and Rome. The study of the esters of opium has also been continued. Encouragement has been given to the opening of new schools of hygiene, notably in Central Europe, and to frequent meetings ibetween their directors. An investigation that may produce results of considerable ~mportance is that into the .working of v.a~qious National Health Insurance
16~
PUBLIC HEALTH.
Schemes, with special reference to the question of overlapping with other services, such as child welfare, public health, hospitals, etc. Further, an investigation into the causes of dead births and infantile deaths, urban ~nd rural, is in progress in a number of European countries, and this is being extended to South America, where infant mortality is a grave problem. Leprosy is also being studied in Latin America. From the foregoing it will be seen that the League's Health Committee has not been idle. It has only a small budget, something like ~60,000, but this is supplemented considerably by the Rockefeller Trust. There are many problems which cannot be solved parochially, and in all of these the League finds a wonderful field for effort. As it commands many of the finest scientific workers in the world, its efforts bid fair to have a great effect upon the world's health.
The International Continuation Course, 1927. O the participants in the International T Course on Public Health, held in London, at the end of last year, it would not be at all surprising to learn that the outstanding memory was one of clays full of arduous lectures, and of taskmasters entirely without p i t y . That their feelings are definitely not of this type would appear from the note on the course written b y one of the members, Dr. Spranger, of Friedeberg, Germany, which it is a privilege to be allowed to reproduce. In a group of enthusiasts, Dr. Spranger was conspicuous on account of the anxiety he displaYed to permit of no opportunity to escape him of acquiring knowledge of the rather involved system of English health administration, and of seeing as many as possible of the activities of health departments and officers. During his comparatively short stay he made a host of friends in the service, and" by these, particularly, Spranger's note on the impressions he received will be read with interest : - I hope to be able to give a note with regard to the International Course on Public Health held in London, from November 3rd to December 15th, 1927, under the auspices of the League of Nations, not only from my own point of view, but also in the n a m e of the other participants, because we all felt like one great family at the end of this, in every way, most wonderfuI course. T h e a r r a n g e m e n t s had been m a d e by the Ministry of Health and the Society of Medical Officers of Health, whose Executive Secretary, Mr, Elliston, worked out the
MARC~,
different a r r a n g e m e n t s , and was a friend to all participants by the kind and helpful advice he was always ready to give. T h e p r o g r a m m e consisted of lectures by prominent British and foreign authorities on public health and medical science, which were mostly delivered at the H o u s e of the Society, a n d were followed by discussions or appropriate demonstrations. Visits to institutions of public health interest completed the rich p r o g r a m m e of the course. Delegates of Brazil, Czecho-Slovakia, France, Germany, Great Britain and Crown Colonies, H u n g a r y , Iceland, the Netherlands, Norway, Sweden, Switzerland, the United States of America, and Yugoslavia were participants. T h e fact that the course was only being held in London gave the possibility to study p u n i c health administration and the perfect welfare work of the Metropolis the more intensively. Nevertheless, we have seen, too, a great deal of public health work in the vicinity, visiting the wonderful Cripples' Hospital at Alton, and studying rural hygiene in Bedfordshire under the guidance of Professor Kenwood. T h e introductory lecture of Sir George N e w m a n on the historical development of the administration and practice of public health in England gave us an idea of the high spirit which governs British public health work, and all the lectures that followed were based on the same spirit, the wide field of pubtlc health administration and of welfare w o r k being explained to us in lectures by m a n y distinguished British public health authorities. A great m a n y m o s t interesting visits to institutions of hygienic importance illustrated the matters dealt with in the lectures. It is impossible to point out in a few lines all we saw, but most interesting were the welfare and treatment centres of the Metropolis, the Metropolitan W a t e r Board, London's excellent milk supply, the food inspection in L o n d o n ' s Port, the M u s e u m of the School of Hygiene and Tropical Medicine, and the Royal Sanitary Institute. A special feature of this international course was the fact that lectures by foreign authorities were delivered besides the lectures of e m i n e n t British lecturers. W e heard Prof. Debrg fi'om Paris, Prof. E m e r s o n from New York, Dr. Foramitti from Vienna, Prof. F r i e d e m a n n from Berlin, Prof. Giglioli from Florence, and m a n y others. Lectures by Sir George B u c h a n a n , Dr. F. G. Boudreau, and Dr. N o r m a n W h i t e described the health work of the League of Nations, so that we did not only get a thorough knowledge of British public health work, but an idea of international hygiene in general, too. A point which gave a special note to the course, and which is worth mentioning, is the fact that not only non-Brltish colleagues were participants, but also British delegates from Northern Ireland, from Scotland, and from the Crown Colonies, m a k i n g us non-British delegates feel quite at home at once. T h e kind advice of these British colleagues w a s a great help and enabled us to get still deeper into the different topics treated in the lectures. I think it would be worth delegating to evei-y international interchange course of the League one or more representatives of the country visited as participants. T h e experience of our London course in this direction was excellent, and I hope that the exchange of knowledge between the British and the other participant,~ was profitable to both. Out of the multitude of things we heard and saw it m a y be permitted to me to'pick out those which impressed themselves strongest on m y mind, and to say a few words on the er~cellent open air training of the pro-tuberculous child, on the wonderful solution of the problem of housing in the
PUBLIC HEALTH.
reasonable amounts paid by the midwife to other midwives employed to attend such patients confined during her period of suspension as were actually entered in her books as having engaged her prior to the date of suspension. It is recognised, however, that cases may occasionally arise in which it is necessary to suspend a midwife for a prolonged period. Any such case will need to be dealt with by reference to the special circumstances, and the whole of the facts should be placed before tile Minister before the authority commit themselves to the payment of compensation.
The Health Organisation of The League of Nations in 1926 and 1927. O little is known of the health activities Nations that a done, issued in the form of a Supplement to the general Information Pamphlet, cannot fail to be of value and interest. Sir George Buchanan, of the Ministry of Health, most are aware, is an original and very active member of the Health Committee of the League ; it is less well known, however, that so also is the head of the United States Public Health Service, and that the health authorities of the Union of Soviet Socialist Republics have participated in the principal branches of work, thus showing that medicine is above all distinctions of race, creed orpolitics, and forms a common bond between them, however divergent otherwise. The membership is indeed world wide, and all parts of the eastern and western hemispheres are represented. The co-ordination, by community of personnel and otherwise, between the League's Health Committee and the Office International d'Hygi&ne Publique, which acts as its official Advisory Council, has been made even closer than before, and notifications required by the International Sanitary Convention of 1926, to be sent to the Office are now transmitted bv way o f the League's various I3ureaux, e.g., that at Singapore, which collects all information for Ihe Far East as far south as New Zealand, and east to Panama. The Epidemiological Intelligence Service now receives and redistributes, through its Bureaux, by telegraph, cable and wireless, information relating to no less than 75 per cent of the world's population. New Bureaux are proposed for Australasia and Africa~ t h e
S of the League of description of the work
163
farmer at Melbourne and the latter at Algiers. \Veekly, monthly, and annual epidemiological reports are also issued from Geneva. The last-named shows, i¢zter alia, tile spread and fluctuations during the year of the principal infectious diseases throughout the world. Liaison with national health administrations is effected by means of interchanges of health officers, medical and engineering, in various parts of the world, and of the part played by the Society of Medical Officers of Health in this country high appreciation is expressed. International public health courses are arranged; last year in Paris and in London; that in Rio de Janeiro is to have permanent standing for Latin America; one in Buenos Ayres is to be a permanent school for doctors and nurses in connection with infant mortality. A number of scholarships are also provided for the study of special subjects. The standardisation of sera and biological products has made considerable progress, notably in connection with anti-tetanus and anti-dysenteric sera, and investigations upon tuberculin, and scarlet fever diagnosis and treatment are proceeding. Insulin and pituitary extract have now universal standards, as also digitalis, by biological test. Blood groups have been the subject of an investigation. Tile determination of blood groups is a recent discovery of great,value for physiological studies, as well as for the treatment and diagnosis of disease. As applications of tile discovery which have attracted popular attention may be mentioned its use in criminology (identification of blood stains, etc.); also in the transfusion of- blood, in which certain donors' blood may be actually harmful. Small-pox and vaccination ; the alleged connection between vaccination and encephalitis lethargica; c2mcer, sleeping sickness, and malaria, have also been subjects of particular investigation, and courses of training in connection with the last-named have been, or are being, set up in Hamburg, London, Paris, and Rome. The study of the esters of opium has also been continued. Encouragement has been given to the opening of new schools of hygiene, notably in Central Europe, and to frequent meetings ibetween their directors. An investigation that may produce results of considerable ~mportance is that into the .working of v.a~qious National Health Insurance
16~
PUBLIC HEALTH.
Schemes, with special reference to the question of overlapping with other services, such as child welfare, public health, hospitals, etc. Further, an investigation into the causes of dead births and infantile deaths, urban ~nd rural, is in progress in a number of European countries, and this is being extended to South America, where infant mortality is a grave problem. Leprosy is also being studied in Latin America. From the foregoing it will be seen that the League's Health Committee has not been idle. It has only a small budget, something like ~60,000, but this is supplemented considerably by the Rockefeller Trust. There are many problems which cannot be solved parochially, and in all of these the League finds a wonderful field for effort. As it commands many of the finest scientific workers in the world, its efforts bid fair to have a great effect upon the world's health.
The International Continuation Course, 1927. O the participants in the International T Course on Public Health, held in London, at the end of last year, it would not be at all surprising to learn that the outstanding memory was one of clays full of arduous lectures, and of taskmasters entirely without p i t y . That their feelings are definitely not of this type would appear from the note on the course written b y one of the members, Dr. Spranger, of Friedeberg, Germany, which it is a privilege to be allowed to reproduce. In a group of enthusiasts, Dr. Spranger was conspicuous on account of the anxiety he displaYed to permit of no opportunity to escape him of acquiring knowledge of the rather involved system of English health administration, and of seeing as many as possible of the activities of health departments and officers. During his comparatively short stay he made a host of friends in the service, and" by these, particularly, Spranger's note on the impressions he received will be read with interest : - I hope to be able to give a note with regard to the International Course on Public Health held in London, from November 3rd to December 15th, 1927, under the auspices of the League of Nations, not only from my own point of view, but also in the n a m e of the other participants, because we all felt like one great family at the end of this, in every way, most wonderfuI course. T h e a r r a n g e m e n t s had been m a d e by the Ministry of Health and the Society of Medical Officers of Health, whose Executive Secretary, Mr, Elliston, worked out the
MARC~,
different a r r a n g e m e n t s , and was a friend to all participants by the kind and helpful advice he was always ready to give. T h e p r o g r a m m e consisted of lectures by prominent British and foreign authorities on public health and medical science, which were mostly delivered at the H o u s e of the Society, a n d were followed by discussions or appropriate demonstrations. Visits to institutions of public health interest completed the rich p r o g r a m m e of the course. Delegates of Brazil, Czecho-Slovakia, France, Germany, Great Britain and Crown Colonies, H u n g a r y , Iceland, the Netherlands, Norway, Sweden, Switzerland, the United States of America, and Yugoslavia were participants. T h e fact that the course was only being held in London gave the possibility to study p u n i c health administration and the perfect welfare work of the Metropolis the more intensively. Nevertheless, we have seen, too, a great deal of public health work in the vicinity, visiting the wonderful Cripples' Hospital at Alton, and studying rural hygiene in Bedfordshire under the guidance of Professor Kenwood. T h e introductory lecture of Sir George N e w m a n on the historical development of the administration and practice of public health in England gave us an idea of the high spirit which governs British public health work, and all the lectures that followed were based on the same spirit, the wide field of pubtlc health administration and of welfare w o r k being explained to us in lectures by m a n y distinguished British public health authorities. A great m a n y m o s t interesting visits to institutions of hygienic importance illustrated the matters dealt with in the lectures. It is impossible to point out in a few lines all we saw, but most interesting were the welfare and treatment centres of the Metropolis, the Metropolitan W a t e r Board, London's excellent milk supply, the food inspection in L o n d o n ' s Port, the M u s e u m of the School of Hygiene and Tropical Medicine, and the Royal Sanitary Institute. A special feature of this international course was the fact that lectures by foreign authorities were delivered besides the lectures of e m i n e n t British lecturers. W e heard Prof. Debrg fi'om Paris, Prof. E m e r s o n from New York, Dr. Foramitti from Vienna, Prof. F r i e d e m a n n from Berlin, Prof. Giglioli from Florence, and m a n y others. Lectures by Sir George B u c h a n a n , Dr. F. G. Boudreau, and Dr. N o r m a n W h i t e described the health work of the League of Nations, so that we did not only get a thorough knowledge of British public health work, but an idea of international hygiene in general, too. A point which gave a special note to the course, and which is worth mentioning, is the fact that not only non-Brltish colleagues were participants, but also British delegates from Northern Ireland, from Scotland, and from the Crown Colonies, m a k i n g us non-British delegates feel quite at home at once. T h e kind advice of these British colleagues w a s a great help and enabled us to get still deeper into the different topics treated in the lectures. I think it would be worth delegating to evei-y international interchange course of the League one or more representatives of the country visited as participants. T h e experience of our London course in this direction was excellent, and I hope that the exchange of knowledge between the British and the other participant,~ was profitable to both. Out of the multitude of things we heard and saw it m a y be permitted to me to'pick out those which impressed themselves strongest on m y mind, and to say a few words on the er~cellent open air training of the pro-tuberculous child, on the wonderful solution of the problem of housing in the