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Welsh Branch
P U B L I C H E A L T H , June, 1944
106 4. T h a t the Chief Executive Officer of the Joint Authority should be primarily an administrator, preferably a medical officer with administrative experience and qualifications. 5. T h a t both Central and Local Health Services Committees and other advisory bodies should contain members who have had practical experience in the Public Health Service. 6. T h a t the various services involved in a comprehensive scheme for a National Health Service should be closely integrated through the medical staff serving various authorities and services. 7. T h a t there should be a system of suitable advisory panels to operate at all stages of the service where professional appointments have to be made. 8. T h a t in the legislation resulting from the consideration of the White Paper provision should be made for adequate compensation to be payable to any member of the existing Public Health Services who may suffer loss of remuneration consequent on alteration of his duties, and that such provision should include, for superannuation purposes, the addition of years of service in respect of the student period.
WELSH BRANCH
President: Dr. J. Greenwood Wilson (M.O.H., Cardiff). Hon. Secretary : Dr. G. M c K i m Thomas (M.O.H., Cardiff R.D.). A meeting of the Branch was held at Cardiff on M a r c h 18th. T h e President, 16 members and 13 visitors were present. Dr. W. H. Bradley, Medical Officer, Ministry of Health, spoke to the meeting about recent clinical and field investigations into jaundice, and afterwards, upon the request of the President, talked about epidemic nausea and vomiting. There was a full discussion, followed by a vote of thanks to the speaker.
MIDLAND MATERNITY A N D CHILD WELFARE SUB-GROUP A clinical meeting of this group was held in the Cancer Department of the Queen Elizabeth Hospital, Selly Oak, on M a r c h 18th. Dr. Findlay presided. Twenty-six members were present. Mr. Baron Rose, chairman of the Cancer Research Committee, a m e m b e r of the Radium Commission and honorary surgeon to the Queen Elizabeth Hospital, gave an interesting address on cancer research. Clinical research, he said, was being carried out at the University a!a_d all the results were co-ordinated and correlated by the Cancer Research Committee. T h e Cancer Act of 1940 was m the process of becoming law, and in the Midlands alone there would be 5,000-6,000 cases annually to be dealt with. At present the Committee were working out a plan for implementing this Act and were experiencing difficulty in finding the necessary accommodation. M a n y patients seen for the first time were found to be inoperable, mainly because the patient had been too frightened to seek advice, or because the case had been wrongly diagnosed. Treatment was by surgery, radiotherapy, or both. Cases for surgical treatment were selected by the surgeon in consultation with the radio-therapist and possibly a physician. NORTH-WESTERN
BRANCH
President : Dr. J. E. Spence (M.O.H., Eceles). Hon. Secretary: Dr. W. C. V. Brothwood (Deputy C.M.O.H., Lancashire). A meeting took place at Manchester on M a r c h 24th. T h e President and 62 members and visitors were present. Dr. C. Metcalfe Brown opened a discussion on the White Paper. After a n u m b e r of speakers had taken part, the matter was referred for consideration to a Committee of eleven. On April 13th the President and 40 members considered the report of the Committee, after which the Branch's observations were formulated as follows. T h e Branch in general welcomes proposals for the establishment of a comprehensive service, b u t views some of those contained in the White Paper with grave concern. 1. T h e administrative arrangements envisaged are such that they can be properly administered only by whole-time medical officers who have present experience of administration in the public health service of local authorities. Further, whatever system of administration is established, it is of paramount importance that the chief executive officer shall be such a medical officer. T h e Branch notes with concern the absence of any adequate acknowledgment of the part which has been played by medical officers of health and other public health medical officers in building up the health services of the comatry. They are disquieted by the vague and meagre reference to the future status of these officers. In particular, they deplore the absence of any clear expression of intention to utilise the experience gained by them in directing and controlling medical services. 2. T h e proven benefits of preventive medicine are such that it is a matter for regret that no adequate reference is ma~le to it. In all branches of medicine which have been confided to the public
health services--e.g., infectious diseases, tuberculosis, the prevention of infantile mortality, and the provision of hospitals--very great progress has been made, a fact which is amply attested by statistics. 3. T h e Branch considers that the school medical service and the child welfare service should be merged centrally and locally in a unified child health service, the local administration of which should lie with local public health authorities, acting through their wholetime public health medical officers. In no other way can the integration of the environmental and curative services be achieved. In the Branch's opinion, it is a fundamental administrative defect that the White Paper proposals will effect a breach between the hospital and consultant services on the one hand, and the domiciliary maternity and child health services on the other. 4. T h e Branch considers that the industrial health services should be integrated with the new health services. 5. It is the Branch's view that medical officers of infectious diseases hospitals and public health laboratories should work in close association not only with each other, but also with others who may be engaged in field work. 6. T h e Branch considers that by whatever means the public health authority establishes a domiciliary nursing service, whether it be directly or indirectly, control of the service should be exercised by the medical officer of health. 7. With regard to administrative areas, the Branch considers t h a t for the purposes of planning and formulation of general policy large areas with adequate financial resources are necessary, b u t that it is equally important that for the maintenance of local interest and efficiency of administration there should be a large measure of delegated powers to existing authorities, and that in the exercise of these powers they should be advised by medical officers who are responsible for the detailed administration of the districts concerned, so that the whole of the medical services can be co-ordinated. In suitable cases within the existing county areas, executive powers in respect of certain medical and health services, including school medical and maternity and child welfare, should be exercised by county districts or by suitable combinations of such districts. Further, suitable public health services not dealt with by the White Paper should be administered by those county districts or combination of county districts which are referred to in the previous paragraph. T h e Branch also considered a memorandum prepared by the Medical Officer ot County Districts in the North-XNest, and expressed themselves as being in general agreement with the opinions expressed. T h e Illuminating Engineering Society, 82, Victoria Street, London, S.W.1, is preparing a series of pamphlets on lighting reconstruction. T h e first three of these have just been issued at a price of ls. each, 9s. a dozen, or £ 3 per hundred. They are designed to be of use to Government departments, local authorities, borough engineers, architects, and others concerned with the lighting of public and private buildings. T h e pamphlet, Principles of Good Lighting deals in non-technical language with the broad principles of illumination and with such faults as glare and abrupt contrasts. The Lighting of Pvblic Buildings briefly reviews the problems of lighting long corridors, public halls, picture galleries and museums, libraries, places of amusement such as swimming baths and skating rinks, and hospitals. Floodlighting is also dealt with. T h e third pamphlet, The Lighting of Schools considers the problems of lighting classrooms and lecture theatres. T h e problem of partially sighted children is discussed, and a table given of values of illumination considered to be adequate for the various parts of a school building. T h e pamphlets are short and necessarily lacking in detail, but they give a basis of right principle upon which planners can work. T h e Royal Institute of International Affairs has issued at the price of Is. a 35-page pamphlet entitled .4 Reading List for Relief Workers. This is a useful bibliography arranged under the general headings of " Health and Hygiene," " Nutrition, Food and Agriculture," " W e l f a r e of Children and Young People," and " Displaced Persons " (i.e., the refugee and the occupational). There is a general list of reading matter relating to relief during and after the last war and, as a background to the present conditions, suggested books on Belgium, Czechoslovakia, France, Greece, Italy, the Netherlands, Norway, Poland, and Yugoslavia. T h e booklet may be obtained from Chatham House, St. James's Squarg, London, S.W.1.
Subscription 3D. 6d. per annum, post flee, in adcgmce. Single copies 2s. 6d. post free. °' Public Health " is the O ~ a l Organ o[ the Society o/Medical Officers of Health and a suitable medium for the advertisement of o~cial a4~pointments t~cant in the health service. Space is also available ]or a certain number o] approved commercial advertisemeats. Application should be made to the Executive Secretary of the Society, at Ta~istoch House South, Tat,istock Square, W.C.I. Telephone: Euston 3923. Telegrams: Epid~ros, Westcent.
106 4. T h a t the Chief Executive Officer of the Joint Authority should be primarily an administrator, preferably a medical officer with administrative experience and qualifications. 5. T h a t both Central and Local Health Services Committees and other advisory bodies should contain members who have had practical experience in the Public Health Service. 6. T h a t the various services involved in a comprehensive scheme for a National Health Service should be closely integrated through the medical staff serving various authorities and services. 7. T h a t there should be a system of suitable advisory panels to operate at all stages of the service where professional appointments have to be made. 8. T h a t in the legislation resulting from the consideration of the White Paper provision should be made for adequate compensation to be payable to any member of the existing Public Health Services who may suffer loss of remuneration consequent on alteration of his duties, and that such provision should include, for superannuation purposes, the addition of years of service in respect of the student period.
WELSH BRANCH
President: Dr. J. Greenwood Wilson (M.O.H., Cardiff). Hon. Secretary : Dr. G. M c K i m Thomas (M.O.H., Cardiff R.D.). A meeting of the Branch was held at Cardiff on M a r c h 18th. T h e President, 16 members and 13 visitors were present. Dr. W. H. Bradley, Medical Officer, Ministry of Health, spoke to the meeting about recent clinical and field investigations into jaundice, and afterwards, upon the request of the President, talked about epidemic nausea and vomiting. There was a full discussion, followed by a vote of thanks to the speaker.
MIDLAND MATERNITY A N D CHILD WELFARE SUB-GROUP A clinical meeting of this group was held in the Cancer Department of the Queen Elizabeth Hospital, Selly Oak, on M a r c h 18th. Dr. Findlay presided. Twenty-six members were present. Mr. Baron Rose, chairman of the Cancer Research Committee, a m e m b e r of the Radium Commission and honorary surgeon to the Queen Elizabeth Hospital, gave an interesting address on cancer research. Clinical research, he said, was being carried out at the University a!a_d all the results were co-ordinated and correlated by the Cancer Research Committee. T h e Cancer Act of 1940 was m the process of becoming law, and in the Midlands alone there would be 5,000-6,000 cases annually to be dealt with. At present the Committee were working out a plan for implementing this Act and were experiencing difficulty in finding the necessary accommodation. M a n y patients seen for the first time were found to be inoperable, mainly because the patient had been too frightened to seek advice, or because the case had been wrongly diagnosed. Treatment was by surgery, radiotherapy, or both. Cases for surgical treatment were selected by the surgeon in consultation with the radio-therapist and possibly a physician. NORTH-WESTERN
BRANCH
President : Dr. J. E. Spence (M.O.H., Eceles). Hon. Secretary: Dr. W. C. V. Brothwood (Deputy C.M.O.H., Lancashire). A meeting took place at Manchester on M a r c h 24th. T h e President and 62 members and visitors were present. Dr. C. Metcalfe Brown opened a discussion on the White Paper. After a n u m b e r of speakers had taken part, the matter was referred for consideration to a Committee of eleven. On April 13th the President and 40 members considered the report of the Committee, after which the Branch's observations were formulated as follows. T h e Branch in general welcomes proposals for the establishment of a comprehensive service, b u t views some of those contained in the White Paper with grave concern. 1. T h e administrative arrangements envisaged are such that they can be properly administered only by whole-time medical officers who have present experience of administration in the public health service of local authorities. Further, whatever system of administration is established, it is of paramount importance that the chief executive officer shall be such a medical officer. T h e Branch notes with concern the absence of any adequate acknowledgment of the part which has been played by medical officers of health and other public health medical officers in building up the health services of the comatry. They are disquieted by the vague and meagre reference to the future status of these officers. In particular, they deplore the absence of any clear expression of intention to utilise the experience gained by them in directing and controlling medical services. 2. T h e proven benefits of preventive medicine are such that it is a matter for regret that no adequate reference is ma~le to it. In all branches of medicine which have been confided to the public
health services--e.g., infectious diseases, tuberculosis, the prevention of infantile mortality, and the provision of hospitals--very great progress has been made, a fact which is amply attested by statistics. 3. T h e Branch considers that the school medical service and the child welfare service should be merged centrally and locally in a unified child health service, the local administration of which should lie with local public health authorities, acting through their wholetime public health medical officers. In no other way can the integration of the environmental and curative services be achieved. In the Branch's opinion, it is a fundamental administrative defect that the White Paper proposals will effect a breach between the hospital and consultant services on the one hand, and the domiciliary maternity and child health services on the other. 4. T h e Branch considers that the industrial health services should be integrated with the new health services. 5. It is the Branch's view that medical officers of infectious diseases hospitals and public health laboratories should work in close association not only with each other, but also with others who may be engaged in field work. 6. T h e Branch considers that by whatever means the public health authority establishes a domiciliary nursing service, whether it be directly or indirectly, control of the service should be exercised by the medical officer of health. 7. With regard to administrative areas, the Branch considers t h a t for the purposes of planning and formulation of general policy large areas with adequate financial resources are necessary, b u t that it is equally important that for the maintenance of local interest and efficiency of administration there should be a large measure of delegated powers to existing authorities, and that in the exercise of these powers they should be advised by medical officers who are responsible for the detailed administration of the districts concerned, so that the whole of the medical services can be co-ordinated. In suitable cases within the existing county areas, executive powers in respect of certain medical and health services, including school medical and maternity and child welfare, should be exercised by county districts or by suitable combinations of such districts. Further, suitable public health services not dealt with by the White Paper should be administered by those county districts or combination of county districts which are referred to in the previous paragraph. T h e Branch also considered a memorandum prepared by the Medical Officer ot County Districts in the North-XNest, and expressed themselves as being in general agreement with the opinions expressed. T h e Illuminating Engineering Society, 82, Victoria Street, London, S.W.1, is preparing a series of pamphlets on lighting reconstruction. T h e first three of these have just been issued at a price of ls. each, 9s. a dozen, or £ 3 per hundred. They are designed to be of use to Government departments, local authorities, borough engineers, architects, and others concerned with the lighting of public and private buildings. T h e pamphlet, Principles of Good Lighting deals in non-technical language with the broad principles of illumination and with such faults as glare and abrupt contrasts. The Lighting of Pvblic Buildings briefly reviews the problems of lighting long corridors, public halls, picture galleries and museums, libraries, places of amusement such as swimming baths and skating rinks, and hospitals. Floodlighting is also dealt with. T h e third pamphlet, The Lighting of Schools considers the problems of lighting classrooms and lecture theatres. T h e problem of partially sighted children is discussed, and a table given of values of illumination considered to be adequate for the various parts of a school building. T h e pamphlets are short and necessarily lacking in detail, but they give a basis of right principle upon which planners can work. T h e Royal Institute of International Affairs has issued at the price of Is. a 35-page pamphlet entitled .4 Reading List for Relief Workers. This is a useful bibliography arranged under the general headings of " Health and Hygiene," " Nutrition, Food and Agriculture," " W e l f a r e of Children and Young People," and " Displaced Persons " (i.e., the refugee and the occupational). There is a general list of reading matter relating to relief during and after the last war and, as a background to the present conditions, suggested books on Belgium, Czechoslovakia, France, Greece, Italy, the Netherlands, Norway, Poland, and Yugoslavia. T h e booklet may be obtained from Chatham House, St. James's Squarg, London, S.W.1.
Subscription 3D. 6d. per annum, post flee, in adcgmce. Single copies 2s. 6d. post free. °' Public Health " is the O ~ a l Organ o[ the Society o/Medical Officers of Health and a suitable medium for the advertisement of o~cial a4~pointments t~cant in the health service. Space is also available ]or a certain number o] approved commercial advertisemeats. Application should be made to the Executive Secretary of the Society, at Ta~istoch House South, Tat,istock Square, W.C.I. Telephone: Euston 3923. Telegrams: Epid~ros, Westcent.