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The ministries of health bill
Public Health THE
JOURNAL
OF
The Society of Medical Officers of Health. DECEMBER,
No, 3,
Subscription price, 2IS. per annum, post free advance. Single copies, Is. 8d. post free.
in
CONTENTS. PAG]~
EDITORIAL-The New President of the L.G.B . . . . . . .
25 25
The Ministries of Health Bill . . . . . . . . .
SPE(~IAL ARTIOLES--
Maternity Nursing. (By G. F. Buckan, ~LD., D.P.H., M.O.H. Willesden) . . . . . . . . . "' Sanatorium Benefit " : Is it a FaihLre ? (By W. H. Dickinson, M.D., D.P.H., Tuberculosis Officer, Newcastle-on-Tyne) . . . . . . . . . CORRESPONDENOE-From Dr. E. 2VI. Smith, M.O.H., York ..From '" Another M.O.H." -. . . . . . . . NOTES~
Notification of Whooping Cough ...... Typhoid Fever at Aberdeen . . . . . . . . . M.O.H. Salaries . . . . . . . . . . . . . . . Medical Candidates for Parliament ...... influenza Epidemic ............ Prevention of Venereal Disease .........
27
32 33 34 26 31 3z, 36 32 33 33
SOCIETY OF MEDICAL OFFICERS OF H E A L T H Proceedings of the Society of M.O.H . . . . . . . 34-36
bit0riaf. T H E N E W P R E S I D E N T OF T H E LOCAL G O V E R N M E N T BOARD. We offer our congratulations to Sir Auckland Geddes, M.B., Ch.B., the first medical President of the Local Government Board, on his appointment to this high post of State, and wish him a long and successful term of office. T H E M I N I S T R I E S OF H E A L T H BILL. our issue of F e b r u a r y tast we urged t h a t the I N most pressing of all public health reforms was the passing of the half-a-dozen or so clauses required for the abolition of Boards of Guardians, together with the distribution of their work among the Councils of Counties, County Boroughs, and t h e larger Urban Districts, in accordance with the recommendation of the Special Committee
1918,
VOL. XXXII.
appointed b y the Ministry of Reconstruction. No action was, however, taken by the Government to deal with this most pressing reform, and the omission to clear away this obstacle to all progress has, as we predicted in our issue of August last, again brought disaster upon the Ministries of Health Bill. The hesitation of the Government to deal effectively with the obsolete Poor Law and Boards of Guardians has enabled Friendly Societies and Trades Unions to object Successfully to what they regard as a sham Health Ministry which would merge both National Health Insurance and Public Health Service in what would be, virtually, a Poor Law Department. Evidently the supporters of the Bill which has now been dropped hoped to get it through without much opposition, because the Poor L a w was not referred to, but they forgot apparently t h a t a much more effective and vigorous opposition will always be raised against the association of public health and insurance work with the Poor Law. The abolition of the Poor Law will, whenever it is undertaken, involve a struggle. Vested interests always die hard, but if an effective Ministry of Health is to be sent up, it is evident t h a t the battle against the Poor Law should be fought and won before a real Health Ministry can be formed. I t is altogether unfair to set up a ministry the first work of which would be a struggle against Poor Law interests. This struggle should be finished before a Ministry of Health commences its existence. I t would then be able to devote its attention immediately to its proper work. The actual views of the great Friendly Societies were recently expressed by Mr. W. H. Hayes, Grand Master of the Manchester Unity of Oddfellows, in a letter published in the Manchester Guardian. Mr. Hayes says : - " T h e Friendly Societies which were in existence a century before State insurance evolved approved societies have some claim to know what the mass of the people think of the Poor Law. They are also t h e strongest supporters for the establishment of a Ministry of Health, and for this reason they do not desire t h a t the Ministry shall be suspect from the day of its birth, as it certainly will be if it should be in any way connected with the
26
PUBLIC HEALTH.
administration of pauper relief, whether it be outdoor or indoor relief. " The methods adopted by the (misnamed) ' guardians ' of the poor, under the direction of the Local Government Board, are so detested that if the Ministry of Health have to administer the Poor Law it will inevitably" be regarded merely as the embodiment of pauper relief in another form. " The Friendly Societies exist because men desired to be free of the dread of the workhouse and all that the workhouse stands for. To ignore this feeling is to court failure. If the reform of the Poor Law is not possible simultaneously with the setting up of a Ministr);'of Health, then the Local Government Board should be left to administer it until it can be reformed. But what politicians should be aware of is that the feeling of detestation of the administration of the Poor Law is so real and so deep that it will provoke people to regard any authority which may administer its provisions as being the same thing under another name." The suggestion t h a t the break-up of the Poor Law and the division of its work among existing authorities present profound difficulties which could only be overcome by several years' hard work, does not appeal to practical administrators, who know quite well that no real difficulties stand in the way. Before the war our theoretical politicians advanced the same objections against the nationalisation of the railways and mines, but in practice these changes were accomplished with ease and without delay when once decided upon. I t is extremely doubtful whether, even if it were practicable, the construction of a Ministry of Health, without the previous abolition of the Poor Law, would produce an effect which could be compared in any way with the beneficial effects which would follow the adoption of the recommendations of the Poor Law Commit.tee of the Ministry of Reconstruction, with or without a Ministry of Health. By adopting these recommendations the whole aspect of public health administration would be changed and, without any creation of a Ministry of Health, the public health work in this country would in a few years be transformed. I t is now, unforttmately, only too certain t h a t the coming of peace will find us without a Ministry of Health, with our National I-Iealth Insurance system cracking at all points, and without any effective and unified organization of the preventive and curative aspects of disease. The return from abroad and the dispersion all over the country of millions of soldiers, will inevitably plunge public health administration into new dangers and difficulties, and to meet these we are maintaining our wasteful duplicate institutions and overlapping medical services.
D~C~rB~R,
The Bill which was recently introduced into Parliament, possesses, in the eyes of medical officers of health, the only body of administrative medical officers in the country, several vital defects which it behoves the Society of Medical Officers of Health to see remedied in the new Bill when it appears. It is doubtful whether the Bill as it stands would secure any real advance in public health organization. The most glaring instances of lack of co-ordination in health work are afforded by the separate control of the medical inspection and treatment of children and the supervision of the health of workers in factories by the Board of Education and the Home Office respectively. No real advance on public health can be made until both these spheres of activity are included in the general health work of the country, both centrally and locally, but the former is only made a possibility in the Bill, while the latter is left out of the Bill altogether. The newly-constituted medical work of the Ministry of Pensions is already affording illustrations, all over the countw, of the need for unification, but here again the Bill fails to deal effectively with the problem, and only makes such unification a future possibility. Still another obvious defect in the Bill is the provision for putting the work of the Medical Research Committee under the Privy Council. Surely the Ministry of Health is the proper body to deal with medical research, if such research is to be applied to those problems the solution of which is likely to result in the improvement of the national health. The establishment and the exact position t)f consultative councils as part of the machinery of the Ministry has been the subject of considerable discussion and criticism. If the position is to be similar to that of the advisory committees of the Insurance Commission, such councils are not likely to be of any practical use, and means must be contrived whereby such bodies, if created, can approach Parliament direct and also possess entire freedom as regards publication of their views.
NOTIFICATION OF WHOOPING COUGH. The Glasgow City Council recentty considered a recommendation by the Public Health Committee that a special meeting of the Council be convened for the purpose of considering, and if so resolved, ordering that the Infectious Disease Notification Act shall apply to whooping cough in the area for a period of three years. I t was decided by 52 votes to 20, that the minute be remitted back to the Committee.
JOURNAL
OF
The Society of Medical Officers of Health. DECEMBER,
No, 3,
Subscription price, 2IS. per annum, post free advance. Single copies, Is. 8d. post free.
in
CONTENTS. PAG]~
EDITORIAL-The New President of the L.G.B . . . . . . .
25 25
The Ministries of Health Bill . . . . . . . . .
SPE(~IAL ARTIOLES--
Maternity Nursing. (By G. F. Buckan, ~LD., D.P.H., M.O.H. Willesden) . . . . . . . . . "' Sanatorium Benefit " : Is it a FaihLre ? (By W. H. Dickinson, M.D., D.P.H., Tuberculosis Officer, Newcastle-on-Tyne) . . . . . . . . . CORRESPONDENOE-From Dr. E. 2VI. Smith, M.O.H., York ..From '" Another M.O.H." -. . . . . . . . NOTES~
Notification of Whooping Cough ...... Typhoid Fever at Aberdeen . . . . . . . . . M.O.H. Salaries . . . . . . . . . . . . . . . Medical Candidates for Parliament ...... influenza Epidemic ............ Prevention of Venereal Disease .........
27
32 33 34 26 31 3z, 36 32 33 33
SOCIETY OF MEDICAL OFFICERS OF H E A L T H Proceedings of the Society of M.O.H . . . . . . . 34-36
bit0riaf. T H E N E W P R E S I D E N T OF T H E LOCAL G O V E R N M E N T BOARD. We offer our congratulations to Sir Auckland Geddes, M.B., Ch.B., the first medical President of the Local Government Board, on his appointment to this high post of State, and wish him a long and successful term of office. T H E M I N I S T R I E S OF H E A L T H BILL. our issue of F e b r u a r y tast we urged t h a t the I N most pressing of all public health reforms was the passing of the half-a-dozen or so clauses required for the abolition of Boards of Guardians, together with the distribution of their work among the Councils of Counties, County Boroughs, and t h e larger Urban Districts, in accordance with the recommendation of the Special Committee
1918,
VOL. XXXII.
appointed b y the Ministry of Reconstruction. No action was, however, taken by the Government to deal with this most pressing reform, and the omission to clear away this obstacle to all progress has, as we predicted in our issue of August last, again brought disaster upon the Ministries of Health Bill. The hesitation of the Government to deal effectively with the obsolete Poor Law and Boards of Guardians has enabled Friendly Societies and Trades Unions to object Successfully to what they regard as a sham Health Ministry which would merge both National Health Insurance and Public Health Service in what would be, virtually, a Poor Law Department. Evidently the supporters of the Bill which has now been dropped hoped to get it through without much opposition, because the Poor L a w was not referred to, but they forgot apparently t h a t a much more effective and vigorous opposition will always be raised against the association of public health and insurance work with the Poor Law. The abolition of the Poor Law will, whenever it is undertaken, involve a struggle. Vested interests always die hard, but if an effective Ministry of Health is to be sent up, it is evident t h a t the battle against the Poor Law should be fought and won before a real Health Ministry can be formed. I t is altogether unfair to set up a ministry the first work of which would be a struggle against Poor Law interests. This struggle should be finished before a Ministry of Health commences its existence. I t would then be able to devote its attention immediately to its proper work. The actual views of the great Friendly Societies were recently expressed by Mr. W. H. Hayes, Grand Master of the Manchester Unity of Oddfellows, in a letter published in the Manchester Guardian. Mr. Hayes says : - " T h e Friendly Societies which were in existence a century before State insurance evolved approved societies have some claim to know what the mass of the people think of the Poor Law. They are also t h e strongest supporters for the establishment of a Ministry of Health, and for this reason they do not desire t h a t the Ministry shall be suspect from the day of its birth, as it certainly will be if it should be in any way connected with the
26
PUBLIC HEALTH.
administration of pauper relief, whether it be outdoor or indoor relief. " The methods adopted by the (misnamed) ' guardians ' of the poor, under the direction of the Local Government Board, are so detested that if the Ministry of Health have to administer the Poor Law it will inevitably" be regarded merely as the embodiment of pauper relief in another form. " The Friendly Societies exist because men desired to be free of the dread of the workhouse and all that the workhouse stands for. To ignore this feeling is to court failure. If the reform of the Poor Law is not possible simultaneously with the setting up of a Ministr);'of Health, then the Local Government Board should be left to administer it until it can be reformed. But what politicians should be aware of is that the feeling of detestation of the administration of the Poor Law is so real and so deep that it will provoke people to regard any authority which may administer its provisions as being the same thing under another name." The suggestion t h a t the break-up of the Poor Law and the division of its work among existing authorities present profound difficulties which could only be overcome by several years' hard work, does not appeal to practical administrators, who know quite well that no real difficulties stand in the way. Before the war our theoretical politicians advanced the same objections against the nationalisation of the railways and mines, but in practice these changes were accomplished with ease and without delay when once decided upon. I t is extremely doubtful whether, even if it were practicable, the construction of a Ministry of Health, without the previous abolition of the Poor Law, would produce an effect which could be compared in any way with the beneficial effects which would follow the adoption of the recommendations of the Poor Law Commit.tee of the Ministry of Reconstruction, with or without a Ministry of Health. By adopting these recommendations the whole aspect of public health administration would be changed and, without any creation of a Ministry of Health, the public health work in this country would in a few years be transformed. I t is now, unforttmately, only too certain t h a t the coming of peace will find us without a Ministry of Health, with our National I-Iealth Insurance system cracking at all points, and without any effective and unified organization of the preventive and curative aspects of disease. The return from abroad and the dispersion all over the country of millions of soldiers, will inevitably plunge public health administration into new dangers and difficulties, and to meet these we are maintaining our wasteful duplicate institutions and overlapping medical services.
D~C~rB~R,
The Bill which was recently introduced into Parliament, possesses, in the eyes of medical officers of health, the only body of administrative medical officers in the country, several vital defects which it behoves the Society of Medical Officers of Health to see remedied in the new Bill when it appears. It is doubtful whether the Bill as it stands would secure any real advance in public health organization. The most glaring instances of lack of co-ordination in health work are afforded by the separate control of the medical inspection and treatment of children and the supervision of the health of workers in factories by the Board of Education and the Home Office respectively. No real advance on public health can be made until both these spheres of activity are included in the general health work of the country, both centrally and locally, but the former is only made a possibility in the Bill, while the latter is left out of the Bill altogether. The newly-constituted medical work of the Ministry of Pensions is already affording illustrations, all over the countw, of the need for unification, but here again the Bill fails to deal effectively with the problem, and only makes such unification a future possibility. Still another obvious defect in the Bill is the provision for putting the work of the Medical Research Committee under the Privy Council. Surely the Ministry of Health is the proper body to deal with medical research, if such research is to be applied to those problems the solution of which is likely to result in the improvement of the national health. The establishment and the exact position t)f consultative councils as part of the machinery of the Ministry has been the subject of considerable discussion and criticism. If the position is to be similar to that of the advisory committees of the Insurance Commission, such councils are not likely to be of any practical use, and means must be contrived whereby such bodies, if created, can approach Parliament direct and also possess entire freedom as regards publication of their views.
NOTIFICATION OF WHOOPING COUGH. The Glasgow City Council recentty considered a recommendation by the Public Health Committee that a special meeting of the Council be convened for the purpose of considering, and if so resolved, ordering that the Infectious Disease Notification Act shall apply to whooping cough in the area for a period of three years. I t was decided by 52 votes to 20, that the minute be remitted back to the Committee.