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The milk and dairies order
236
PUBLIC HEALTH.
as our small group of Health Officers from all over the world lived together in London on the best of terms, renewing old friendships~ and making new friends, likewise we have carried home w i t h us that~ spirit of international understanding, on the creation of which the Public H e a l t h men, on account of their position, and uniformity of their aims, are likely to have great influence. I n conclusion, I wish to express the Unanimous and heartiest thanks of all to the representatives of t h e Health Section of the League of Nations, to all the Public Health Authorities and Agencies in London, and to all Londoners who have taken such a great interest in making this Interchange a
Success.
'
Pioneers in Preventive Medicine.* GEORGE N E W M A N , in his oration to the Hunterian Society traces in his usual masterly manner the influence which John Hunter exercised on his colleagues and pupils, especially in regard to preventive medicine. He claims Hunter as one of its founders on the ground that Hunter taught the importance of a proper understanding and reliance upon the laws of nature as they concern all forms and conditions of life. His teaching inaugurated exact observation in place of the empiricism which has previously obtained. The resuk was that a great impetus was given to the study of epidemic disease. Sir Geoi'ge has Collected references to some 350 private practitioners including medical men in the Services who carried out such investigations in all parts of the Kingdom. Among these we find John Haygarth of Chester, one of the first to'distinguish different kinds of fever by their periods of incubation, and to suggest their notification. He was the first to insist on the need for isolation, a p r a c t i c e begun in Chester in 1783. John Huxham of Plymouth, introduced new methods of investigation into the contamination of food supplies, and demonstrated that the Endemical Colic of Devonshire was due to lead being used in the vats and cider presses. Thomas Percival and John Ferrar both of Manchester, investigated the conditions in the cotton millswhich may be claimed as the beginning from which factory legislation originated. In obstetrics we have William
S
IR
*The Private Practitioner as Pioneer in Preventive Medicine. Being the Annum Oration of the Hunterian Society: 1926. By Sir George Newman, K.C.B., M.D., D.C.L. Ox.ford University Press, London: Humphrey Milford. pp. 47, Price ls. net.
MAY,
Smellie and Charles White, the latter an advocate of the need for maternity homes and for ante-nataI supervision. He attributed puerperal sepsis to the effects of mismanagement in the aqeoucheur or nurses, or else from the patient's own imprudence. He laid down rules for the rnanagement of pregnant and lying-in women, and claimed that by following these he had never lost a case by puerperal fever. Fothergill, Lettsom, Armstrong, Wells, and Willan were among the leaders recommending the advantage of affording medical treatment, homely advice and personal hygiene to the great mass of the people. It was the beginning of a movement which reduced child mortality, under five years, from 74 per cent. of children born in 1730-49 to its present-day level of 13 per cent. Edward Jenner was a resident pupil of John Hunter for two years and they were in constant communication for many years afterwards. Sir George combats the idea that the public medical services are designed to exclude the private practitioner ; on the contrary, the aim is to bring him into an organised scheme of national preventive medicine in which he has many opportunities to use the legacy of the past to its highest advantage.
The Milk and Dairies Order. HE Milk and Dairies (Consolidation) Act, which came into operation in September of last year, is, so to speak, more or less a skeleton requiring such Order o r Orders under Section I to clothe it with flesh and give it life. A Milk and Dairies Order, which has now been laid in draft before the Houses of Parliament, will come into operation on July 1st, of this year, and it depends on the manner in which Local Authorities, and particularly County Councils, perform their duties under it, whether that life will be crowned with success. Since the Act was passed in 19'15~, the general public has become more and more insistent in its demand for a clean and wholesome milk supply and while a number of progressive milk producers have recognised the demand and have tried to meet it, there remains a large number on whose minds the necessity for care in milk production can only be impressed by the threat of compuIsion. It is desirable, however, that education should g o hand in hand with compulsory measures, for want of knowledge, and not simply perversity or self-interest, is often the cause of inactivity on the part of the farmer. Moreover, he should be taught, especially by
T
1926.
PUBLIC HEALTH.
those societies and associations which are always ready to protect his interests, that an improvement in the general quality of milk must assuredly result in an increased consumption, and so ultimately benefit him financially. The Order is divided into five Parts, embracing thirty-seven Articles, and, it must be admitted, constitutes a great step forward in milk legislation. It is unnecessary to consider all the five Parts into which the Order is divided, but attention may be drawn to a few of the more notable provisions. By the first Article the requirements relating to the construction of cowsheds and the provision of water supplies for dairies in use on September 1st, 1925, are not to apply until a period of six months elapses after notice is served by the Sanitary Authority ; the compulsory cooling of milk does not come into operation until January 1st, 1927; and the employment of churns and receptacles which can be readily cleansed, the marking of the churns and the use of suitable lids are not to be compulsory until July 1st, 1928. Part IV of the Order, relating to the health and inspection of cattle is to be enforced by County Councils and County Borough Councils. It may be conceded that County Councils will carry out those duties entrusted to them in a better manner than would Rural District Councils, yet it is unfortunate that Article 7 is not more definite in insisting on the inspection of cattle being made twice, or at least once in each year. Useful provisions° are made for the prevention of the spread of infectious disease by means of milk. An employee must notify the dairyman of the occurrence of infectious disease i n any member of his household, and" the dairyman in turn has to notify the Medical Officer of Health of the district. The Medical Officer of Health is empowered to stop the sale of milk in his district for a period of 24 hours (renewable for a further period) if he is in possession of evidence that infectious disease is being caused by its consumption, and, further, the Medical Officer of Health can inspect employees at a dairy when there is danger of the transmission of infectious disease by an actual case of the disease or by a contact, and can exclude from the handling of milk or vessels persons likely to cause the spread of infectious disease. These are very necessary and valuable powers, and if properly used should do much to protect the public. Altogether, the Act, with the far-reaching provisions in this Order, provided the Local Authorities accept their responsibilities and faith-
237
fully meet them, should be the means of assuring in the course of a few years a wholesome and safe milk supply. Ancillary to the provisions of this Order are the Public Health (Imported Milk) Regulations, 1926, which come into operation on January 1st, 1927, and which place imported milk under control, and afford the consumer some protection from the importation of an unsatisfactory foreign product.
The Removal of Infirm Persons from Insanitary Premises. HE Select Committee on Local Legislation reporting upon Bills approved in the last Session of Parliament, calls attention to the powers which have been given to Bradford Corporation. These introduce a new legal principle, the working of which will be watched with interest. It allows the medical officer of the Corporation, upon a written certificate that any person is aged, infirm, or physically incapacitated, and resides in premises which are insanitary owing to any neglect on the part of the occupier, and after thorough inquiry and consideration has shown the necessity in the public interest and in the interest of the persons concerned, to apply to a court of summary jurisdiction which, upon oral proof, may make an erder for the removal of such person to a proper institution. One sympathises with these people struggling to maintain their independence, but unable to keep either themselves or their rooms in a dec6nt condition, often though not always, unable to afford assistance or as not infrequently happens unwilling to allow relatives or friends to assist, but the conditions which result become offensive and a danger to their neighbours. It is very difficult to persuade such persons to go into an institutio.n voluntarily, but this would be rendered easier if one had power to compel as a final resort.
T
Societe Internationale de Medicins Hygienistes. of the B ECAUSE produced as a
feeling of friendship result of the Interchanges amongst the members of the pBrticular groups and between them and the members of the health service in the countries visited, it was inevitable that there should arise a desire that the contact established should be continued. As a method of maintaining that contact there was only one that appeared possible, and that was the formation of a society
PUBLIC HEALTH.
as our small group of Health Officers from all over the world lived together in London on the best of terms, renewing old friendships~ and making new friends, likewise we have carried home w i t h us that~ spirit of international understanding, on the creation of which the Public H e a l t h men, on account of their position, and uniformity of their aims, are likely to have great influence. I n conclusion, I wish to express the Unanimous and heartiest thanks of all to the representatives of t h e Health Section of the League of Nations, to all the Public Health Authorities and Agencies in London, and to all Londoners who have taken such a great interest in making this Interchange a
Success.
'
Pioneers in Preventive Medicine.* GEORGE N E W M A N , in his oration to the Hunterian Society traces in his usual masterly manner the influence which John Hunter exercised on his colleagues and pupils, especially in regard to preventive medicine. He claims Hunter as one of its founders on the ground that Hunter taught the importance of a proper understanding and reliance upon the laws of nature as they concern all forms and conditions of life. His teaching inaugurated exact observation in place of the empiricism which has previously obtained. The resuk was that a great impetus was given to the study of epidemic disease. Sir Geoi'ge has Collected references to some 350 private practitioners including medical men in the Services who carried out such investigations in all parts of the Kingdom. Among these we find John Haygarth of Chester, one of the first to'distinguish different kinds of fever by their periods of incubation, and to suggest their notification. He was the first to insist on the need for isolation, a p r a c t i c e begun in Chester in 1783. John Huxham of Plymouth, introduced new methods of investigation into the contamination of food supplies, and demonstrated that the Endemical Colic of Devonshire was due to lead being used in the vats and cider presses. Thomas Percival and John Ferrar both of Manchester, investigated the conditions in the cotton millswhich may be claimed as the beginning from which factory legislation originated. In obstetrics we have William
S
IR
*The Private Practitioner as Pioneer in Preventive Medicine. Being the Annum Oration of the Hunterian Society: 1926. By Sir George Newman, K.C.B., M.D., D.C.L. Ox.ford University Press, London: Humphrey Milford. pp. 47, Price ls. net.
MAY,
Smellie and Charles White, the latter an advocate of the need for maternity homes and for ante-nataI supervision. He attributed puerperal sepsis to the effects of mismanagement in the aqeoucheur or nurses, or else from the patient's own imprudence. He laid down rules for the rnanagement of pregnant and lying-in women, and claimed that by following these he had never lost a case by puerperal fever. Fothergill, Lettsom, Armstrong, Wells, and Willan were among the leaders recommending the advantage of affording medical treatment, homely advice and personal hygiene to the great mass of the people. It was the beginning of a movement which reduced child mortality, under five years, from 74 per cent. of children born in 1730-49 to its present-day level of 13 per cent. Edward Jenner was a resident pupil of John Hunter for two years and they were in constant communication for many years afterwards. Sir George combats the idea that the public medical services are designed to exclude the private practitioner ; on the contrary, the aim is to bring him into an organised scheme of national preventive medicine in which he has many opportunities to use the legacy of the past to its highest advantage.
The Milk and Dairies Order. HE Milk and Dairies (Consolidation) Act, which came into operation in September of last year, is, so to speak, more or less a skeleton requiring such Order o r Orders under Section I to clothe it with flesh and give it life. A Milk and Dairies Order, which has now been laid in draft before the Houses of Parliament, will come into operation on July 1st, of this year, and it depends on the manner in which Local Authorities, and particularly County Councils, perform their duties under it, whether that life will be crowned with success. Since the Act was passed in 19'15~, the general public has become more and more insistent in its demand for a clean and wholesome milk supply and while a number of progressive milk producers have recognised the demand and have tried to meet it, there remains a large number on whose minds the necessity for care in milk production can only be impressed by the threat of compuIsion. It is desirable, however, that education should g o hand in hand with compulsory measures, for want of knowledge, and not simply perversity or self-interest, is often the cause of inactivity on the part of the farmer. Moreover, he should be taught, especially by
T
1926.
PUBLIC HEALTH.
those societies and associations which are always ready to protect his interests, that an improvement in the general quality of milk must assuredly result in an increased consumption, and so ultimately benefit him financially. The Order is divided into five Parts, embracing thirty-seven Articles, and, it must be admitted, constitutes a great step forward in milk legislation. It is unnecessary to consider all the five Parts into which the Order is divided, but attention may be drawn to a few of the more notable provisions. By the first Article the requirements relating to the construction of cowsheds and the provision of water supplies for dairies in use on September 1st, 1925, are not to apply until a period of six months elapses after notice is served by the Sanitary Authority ; the compulsory cooling of milk does not come into operation until January 1st, 1927; and the employment of churns and receptacles which can be readily cleansed, the marking of the churns and the use of suitable lids are not to be compulsory until July 1st, 1928. Part IV of the Order, relating to the health and inspection of cattle is to be enforced by County Councils and County Borough Councils. It may be conceded that County Councils will carry out those duties entrusted to them in a better manner than would Rural District Councils, yet it is unfortunate that Article 7 is not more definite in insisting on the inspection of cattle being made twice, or at least once in each year. Useful provisions° are made for the prevention of the spread of infectious disease by means of milk. An employee must notify the dairyman of the occurrence of infectious disease i n any member of his household, and" the dairyman in turn has to notify the Medical Officer of Health of the district. The Medical Officer of Health is empowered to stop the sale of milk in his district for a period of 24 hours (renewable for a further period) if he is in possession of evidence that infectious disease is being caused by its consumption, and, further, the Medical Officer of Health can inspect employees at a dairy when there is danger of the transmission of infectious disease by an actual case of the disease or by a contact, and can exclude from the handling of milk or vessels persons likely to cause the spread of infectious disease. These are very necessary and valuable powers, and if properly used should do much to protect the public. Altogether, the Act, with the far-reaching provisions in this Order, provided the Local Authorities accept their responsibilities and faith-
237
fully meet them, should be the means of assuring in the course of a few years a wholesome and safe milk supply. Ancillary to the provisions of this Order are the Public Health (Imported Milk) Regulations, 1926, which come into operation on January 1st, 1927, and which place imported milk under control, and afford the consumer some protection from the importation of an unsatisfactory foreign product.
The Removal of Infirm Persons from Insanitary Premises. HE Select Committee on Local Legislation reporting upon Bills approved in the last Session of Parliament, calls attention to the powers which have been given to Bradford Corporation. These introduce a new legal principle, the working of which will be watched with interest. It allows the medical officer of the Corporation, upon a written certificate that any person is aged, infirm, or physically incapacitated, and resides in premises which are insanitary owing to any neglect on the part of the occupier, and after thorough inquiry and consideration has shown the necessity in the public interest and in the interest of the persons concerned, to apply to a court of summary jurisdiction which, upon oral proof, may make an erder for the removal of such person to a proper institution. One sympathises with these people struggling to maintain their independence, but unable to keep either themselves or their rooms in a dec6nt condition, often though not always, unable to afford assistance or as not infrequently happens unwilling to allow relatives or friends to assist, but the conditions which result become offensive and a danger to their neighbours. It is very difficult to persuade such persons to go into an institutio.n voluntarily, but this would be rendered easier if one had power to compel as a final resort.
T
Societe Internationale de Medicins Hygienistes. of the B ECAUSE produced as a
feeling of friendship result of the Interchanges amongst the members of the pBrticular groups and between them and the members of the health service in the countries visited, it was inevitable that there should arise a desire that the contact established should be continued. As a method of maintaining that contact there was only one that appeared possible, and that was the formation of a society