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Annual dinner
1925.
PUBLIG. H E A L T H .
Presidential Address.--Dr. Buchan then delivered the A d d r e s s on " M e t h o d s of P r e v e n t i o n in D i p h t h e r i a and Scarlet F e v e r , " which is rep r o d u c e d in full in Public Health, N o v e m b e r , 1925. A vote of t h a n k s to the P r e s i d e n t was moved by Dr. E u s t a c e Hill, seconded by Prof. H. R. K e n w o o d , and c a r r i e d by acclamation. The m e e t i n g then adjourned.
ANNUAL
DINNER.
The A n n u a l D i n n e r of the Society was held at the Piccadilly Hotel, London, on F r i d a y , O c t o b e r 16th. A record n u m b e r .of m e m b e r s and g u e s t s were received by the P r e s i d e n t and Mrs. Buchan, and the plan of the tables will be found on p a g e s 40-41. The P r e s i d e n t , h a v i n g p r o p o s e d the h e a l t h of the K i n g , the t o a s t of " T h e S o c i e t y " w a s g i v e n by Sir H. K i n g s l e y W o o d , M . P . , P a r l i a m e n t a r y S e c r e t a r y , M i n i s t r y of Health, w h o said : - " I e s t e e m it a g r e a t privilege to be p r e s e n t at thls g a t h e r i n g t o - n l g h t and to have the h o n o u r of p r o p o s i n g the health of the Society. I should like first to say how highly Mr. Neville C h a m b e r l a i n and myself value the w o r k which is b e i n g done by Medical Officers of H e a l t h up and down the country. I w a s careful this e v e n i n g to a s k the C h a i r m a n w h e t h e r the relationships of the Society with the M i n i s t r y of H e a l t h were perfectly cordial. It is a wise precaution when you represent the M i n i s t r y of Health, and he tells me t h a t the relationships are of the best. I can confirm that, and I desire on behalf of t h a t d e p a r t ment especially to t h a n k the Medical Officers of H e a l t h for their loyal co-operation t h r o u g h o u t the p a s t year. If t h e r e is one m a t t e r to which I would like p a r t i c u l a r l y to refer it is the g r e a t a s s i s t a n c e which this Society has rendered t h e G o v e r n m e n t and the S t a t e in connection with the i n t e r c h a n g e which has t a k e n place d u r i n g the y e a r of Medical Officers from a b r o a d . I do not t h i n k I should be e x a g g e r a t i n g the position if I say t h a t but for the w o r k of the Society, the influence for g o o d which has no d o u b t followed the visit t o this land of so m a n y public officers connected with health adm i n i s t r a t i o n in other countries, would have been impossible, and I a m very g r a t e f u l indeed to the Society for all its efforts in t h a t direction. T h e Society and its m e m b e r s have also done a g r e a t deal in f u r t h e r i n g the very s u b s t a n t i a l p r o g r e s s which has u n d o u b t e d l y been m a d e in health
45
affairs d u r i n g the last few years. I a m inclined to think s o m e t i m e s t h a t we live in a s o m e w h a t pessimistic age. If I d a r e say so to g e n t l e m e n w h o are connected with the medical profession, I should say t h a t it was a new and s o m e w h a t fashionable c o m p l a i n t - - p e s s i m i t i s - - a n d highly infectious. I think it has t w o m a r k e d s y m p t o m s . In the first place, it p a r t i c u l a r l y a t t a c k s certain people when they m a k e public speeches in tfiis country, and my friend Sir Alfred M o n d is in g r e a t d a n g e r of g e t t i n g it. T h e o t h e r s y m p t o m of the complaint is t h a t the p a t i e n t is a p t to fall in a fit when he sees a m e m b e r of the present G o v e r n m e n t ; but at any rate, so f a r as o u r health p r o g r e s s is concerned in this country, no one can be pessimistic. M a y I venture to recall to you the really wonderful p r o g r e s s t h a t has been made - - p r o g r e s s due to a v e r y l a r g e e x t e n t to the w o r k of the n a t i o n ' s health officers? i find, for instance, t a k i n g as a very g o o d test the d e a t h r a t e in this country, t h a t in 1870 the death rate was 21, whilst in 1924 it w a s 12. In the same period, if you t a k e a n o t h e r v e r y sensitive index of national health, the infantile m o r t a l i t y rate, you will find that it has been b r o u g h t down from 149 p e r 1,000 to 75. In 1 8 7 5 - - n o t so l o n g ago--enteric fever accounted for 370 d e a t h s in each million; last year t h a t 370 had fallen to 12. T h e tuberculosis rate is declining and with increasing velocity. In 1847--a stili p e r h a p s l o n g e r period a g o - - t h e d e a t h r a t e per million from c o n s u m p t i o n w a s 3,189. In 1875 it was 2,313, and in 1924 it had fallen to 801, a really r e m a r k a b l e achievem e n t ; and so far as small-po× is concerned, a n a t i o n a l scourge some y e a r s a g o , I a m a s s u r e d on the best a u t h o r i t y t h a t the only people who have it to-day are the people w h o wish to have it. T h e r e f o r e there has been s o m e t h i n g like a revolution in medicine, and p r o b a b l y the g r e a t e s t w a t c h w o r d which either the M i n i s t r y of H e a l t h or this Society could have in c o n j u n c t i o n with its w o r k would be the single w o r d ' P r e v e n t i o n . ' T h a t , at any rate, is the ideal which I t h i n k everyone who is a c q u a i n t e d with health affairs is e n d e a v o u r i n g to attain at the p r e s e n t time. I s u p p o s e t h a t so f a r as future policy is concerned one of the most desirable t h i n g s is to link up our health agencies in each locality. It is an e x t r a o r d i n a r y t h i n g at the p r e s e n t m o m e n t t h a t in almost every a d m i n i s t r a t i v e unit t h e r e are some nine individuals or units. T h e r e is the Medical Officer and his A s s i s t a n t , the Medical Officer for Child W e l f a r e , the School doctor, the T u b e r c u l o s i s Officer, the Specialist in certain diseases, the C e r t i f y i n g F a c t o r y S u r g e o n , the
46
PUBLfC HEALTH'.
P o o r Law doctor, and the I n s u r a n c e practitioner, and I nearly d r a g g e d i n - - w h e n I saw Col. S t a n l e y - - t h e P e n s i o n s ' doctor. I t h i n k everyone here who is interested in Public H e a l t h affairs m u s t a g r e e t h a t one of o u r first principles m u s t be co-ordination and c o - o p e r a t i o n a m o n g s t all those individuals or units who, no doubt, a r e each fulfilling an i m p o r t a n t p a r t in our Public H e a l t h a d m i n i s t r a t i o n . I also v e n t u r e to s u g g e s t t h a t in connection with t h a t a d m i n i s t r a t i o n we w a n t to do n o t h i n g which will interfere with individual responsibility, g o o d c h a r a c t e r and thrift. I have a g r e a t a d m i r a t i o n for every medical prac{itioner in the country, g u t I believe t h a t a f t e r all the first and the b e s t person to t a k e care of the children are their f a t h e r s a n d m o t h e r s , and I hope we shall do n o t h i n g to u n d e r m i n e that responsibility. In conclusion, I hope the Society will continue, as it has done in t h e p a s t , to do all in its power to e n c o u r a g e medical researcfl. I believe a l o n g t h a t line lies a g r e a t deal of progress. T h e r e is, a f t e r all, a g r e a t d a n g e r of b e i n g i m m e r s e d in the r o u t i n e of t h e w o r k we do, and occasionally our duties a r e so g r e a t t h a t we have not time to t a k e s t o c k a n d to see w h e t h e r the w o r k we are d o i n g is a c h i e v i n g tile end in view. I have g r e a t p l e a s u r e in c o u p l i n g this t o a s t with t h a t of y o u r new P r e s i d e n t . I cong r a t u l a t e him upon his election t o w h a t is, I suppose, the h i g h e s t office a m o n g s t Medical Officers of H e a l t h in this c o u n t r y . H e has had a considerable experience in different p a r t s of the country, and I feel t h a t w h i l s t you h a v e honoured him, his accession to the P r e s i d e n t i a l C h a i r will be of g r e a t benefit to the S o c i e t y . " T h e P r e s i d e n t (Dr. G e o r g e F. Buchan), who, on rising, was g r e e t e d with a c c l a m a t i o n , in his reply said : " O n behalf of the Society of M e d i c a l Officers of H e a l t h , I have to t h a n k Sir K i n g s l e y W o o d for the v e r y kind m a n n e r in which he has proposed the toast. I a m p r o u d t o - n i g h t to reply for the Society. I a m conscious t h a t this is not a Society which, like some of t h e older medical societies in London, has b e h i n d it a l o n g series of ancient t r a d i t i o n s , for it w a s f o u n d e d only some 69 years ago, b u t I realise t h a t it is a society which has p l a y e d a g r e a t p a r t in the dev e l o p m e n t of t h a t p r a c t i c e of m e d i c i n e and will continue to play an even g r e a t e r p a r t in tt~e future. Sixty-nine y e a r s a g o , the S o c i e t y was for Medical Officers of H e a l t h only, b u t the Public H e a l t h a d m i n i s t r a t i o n of this ccmntry has altered very g r e a t l y since those days~ and the Society has m a d e chae#ges from t i m e t o time to
NOVEMBER,
meet the c h a n g e s in the medical w o r k of health authorities. So t h a t t o - d a y the Society c o m p r i s e s every kind of medical officer employed by a u t h o r i t i e s - - c i v i l , military, naval or aerial ; central or l o c a l ; h o m e or c o l o n i a l - - s o long as the medical officer is p r i m a r y concerned with the p r a c tice of Public H e a l t h either on land or sea or under the sea or in the air. D u r i n g these 69 y e a r s since the e s t a b l i s h m e n t of the Society, we have h a d our successes. It is true we cannot d e m o n s t r a t e with all the a r t of the physician or s u r g e o n the p a t i e n t s w h o have r e a c t e d to our skill and t r e a t ment, but, in a d d i t i o n to the evidence of Sir K i n g s l e y W o o d , t h e statistical records o~ the R e g i s t r a r - G e n e r a l show, I think, t h a t we have saved m a n y lives, and t h a t o t h e r s have lived h e a l t h i e r and l o n g e r lives on account of our efforts. T h e s e a c h i e v e m e n t s have resulted from the w o r k of the r a n k and file of Medical Officers of H e a l t h . It is quite a m i s t a k e g e n e r a l l y to s u p p o s e t h a t a n y t h i n g s u b s t a n t i a l is achieved by brilliant l e a d e r s h i p alone, t h o u g h t h a t is essential e n o u g h , and just a s our E m p i r e has been won and built up by o r d i n a r y c o m m o n men who have set the cause a b o v e the prize, so the successes of Public H e a l t h in this c o u n t r y have been achieved by e v e r y - d a y Medical Officers of H e a l t h whose first c o n s i d e r a t i o n has been the public health a n d the public interest. T h e r e is at the p r e s e n t time a g r e a t e r d e m a n d for health t h a n ever before, and this d e m a n d has its e x p r e s s i o n in the i n c r e a s i n g a t t e n t i o n which is given by y o u n g people to o u t d o o r life. If the d e m a n d for more health is to be met it is n e c e s s a r y t h a t medical officers should be equipped for the task. A f t e r 69 y e a r s of w o r k , I t h i n k it m a y safely be s t a t e d t h a t we have succeeded in r e m o v i n g all the g r o s s c a u s e s of ill-health, and now in o r d e r to increase l o n g e v i t y we shall have to w o r k intensively on the causes which remain. This implies s t u d y a n d - - I was g l a d to h e a r f r o m S i r K i n g s l e y W o o d - - r e s e a r c h , and the application of the findings of research in the a r e a s of the local authorities. Of course, the necessary research for the elucidation of the o u t s t a n d i n g p r o b l e m s of public health c a n n o t be u n d e r t a k e n w i t h o u t money, a n d we shall have to look to the n a t i o n a l and local chancellors of the exchequer for t h a t p a r t i c u l a r c o m m o d i t y , for wlaen all is said and done, it has to be reallsed t h a t health is p u r c h a s able. In a n y case, I feel sure t h a t if the w o r k e r s in public health h a v e to achieve even b e t t e r results in the f u t u r e than they have done in the past, it will be n e c e s s a r y for local authorities to t a k e an i n t e r e s t in the research w o r k which is
1925.
PUBLIC HI~'ALTH.
necessary for the problems of preventive medicine. To secure the best health in the future it will be necessary also to give close attention to the training of the medical officer of health, and we are particularly pleased to have with us to-night Sir Alfred Mond, who is the presiding genius of the new School of Hygiene and Tropical Medicine now on its way in London, and the primary function of which must be to turn out practitioners of public health who will preach the gospel of prevention to the ends of the earth. The training of the medical officer of health has its bearing, too, on the training of the doctor, who, in his turn, must be a worker for the maintenance of the national health. The education, in fact, of the doctor of the future must be based on the conception of the prevention rather than the cure of disease, and I know it is one of the most earnest desires of our most distinguished Chief Medical Officer of the Ministry (Sir George Newman) that preventive ideas should permeate the whole medical curriculum from an early stage. I feel myself that an undergraduate medical student should not be able to receive his medical degree unless he has had some opportunity of inspecting and reporting on the medical work which is done by his Town Council for the community, so that he may understand the trend of modern public health in relation to his future practice of medicine. He would then in practice become a health doctor rather than a disease doctor, and the community and his patients would reap a corresponding benefit. England has been in the van of public health work for many years, and this Society is especially anxious that every effort should be made to maintain that place. Other nations are wakening up to the importance of public health, and during the past three years or so this Society has organised, on behalf of the League of Nations and the Ministry of Health, demonstrations of English public health methods to international groups of health officers, while some few of the Fellows of this Society have gone abroad to see public health work in other countries. It is very gratifying to the Society {that these demonstrations in this country of the work of the English public health service have been so highly appreciated by the foreign and colonial medical officers who have taken part and have testified to the high state of development and the scientific administration of public health in England. Abroad it is true there have been some picturesque public health successes in respect of Mediterranean Fever and Yellow Fever and the control of Malaria and Hookworm disease, but these represent more particularly
47
pieces of outstanding research which have not yet been utilised to the full to establish abroad a scientific administration for the application of the principles of preventive medicine generally to the health of the communities. This may be seen from the high death rates and infantile mortality rates which unfortunately still prevail in many foreign countries. It is to be hoped that as a result of this international interchange of health officers which has been inaugurated, general public health administration may be set up and extended both at home and abroad, so that not only England but the world may become more and more healthy. I do not think that I have anything more to say. I am delighted to have had the honour to reply to this toast, and I am delighted to think t~at you, who are representatives of central and local government and the general medical profession, show by your presence here to-night that you realise that health is a matter of public concern which knows no party and no territory. In England there has been continuous public health progress since the first great public health enactment of 1875, and I am sure that with the results achieved constantly before us one does not require to be an idealist to realise that with intensive and concerted action better and better health can yet be enjoyed in England. If I were asked to-night to treat the case for better health I would prescribe a mixture containing all of the following ingredients : the early training of the doctor in the preventive idea, the still better training of the medical officer of health, the education of the public in health, the systematic provision by local authorities of opportunities for research into t~e main causes of sickness and death, the application of the findings of research, and last, but not least, complete understanding, harmonious co-operation and implicit confidence--real team work in f a c t - between the general practitioners of medicine, medical officers of health, and the men and women of the nation." Dr. W. J. Howarth, C.B.E., in proposing "The Guests" said that their a n n u a l ' g a t h e r i n g s were always charaeterised by the presence of visitors from the many professions associated with that which they represented, and of members of various learned societies, but he did not remember in his experience such a large number of distinguished guests, and it would take all the evening to recount their qualities and the distinguished part they had played in the present-day history of this country. He extended a cordial welcome to visitors from Willesden, the local authority which it was the privilege of their President to serve. It gave the Society an opportunity of t
48
PUBLIC HE)ILTH.
being able to show to those visitors the esteem in which its President and their officer was held by his colleagues. The representatives of the County Councils Association and Municipal Corporations Association and of the Rural Councils they also warmly welcomed. The gentlemen who represented these bodies were entitled to their sincere thanks and appreciation forthe patience and forbearance they had displayed during the recent years in matter of mutual interest. Their annual gatherings would seem strange without the presence of their respected executive chief, Sir George Newman, and it was to be regretted that Sir Arthur Robinson was unable to be present with them. It always seemed to them that Sir George radiated a spirit of freshness, always urged them on to do the impossible, but they were perfectly satisfied because they felt that whatever he decided was for the benefit of the State as a whole. For the first time they had the pleasure of entertaining Sir Walter Fletcher who, since he had taken charge of the Research Department of the Privy Council had improved, if that were possible, his own reputation, and had in the palm of his hand the making of a hundred reputations, and it was interesting to note that research work was a hard, gruelling process, and compared very badly with the fireworks that resulted from short cuts in science. Sir Walter could be assured that if at any time he felt he would like to call upon the Society or its individual members to assist him in any matter of research he had only to say so, and there would be ready helpers. They were honoured by the presence of representatives of the Royal Society of Medicine. Sir St. Clair Thomson everyone knew. His writings were well known and his present office was not the first Presidency of distinction that he had held. Dr. H'owarth welcomed also Dr. Brackenbury and Dr. Cox of the British Medical Association, and regretted that Prof. Bolam was not there. They had with them,~ too, representatives of the Services. General Leishman and his work were closely associated with public health, for as time went on the medical work in the Army ran more and more parallel with the work in which they were engaged. Sir Squire Sprigge everybody was delighted to see; he was generous in the space he gave the public health service in his journal, and impartial in any squabbles that arose. More than that they could not ask. The British Parliament was well represented by the four distinguished Members present, Sir Alfred Mond, Col. Fremantle, Col. Stanley, and Mr. Viant, and
NOVEMBER,
to them, on behalf of the Society, he extended a very hearty welcome. Concluding, Dr. Howarth said that there were 45,000,000 people in the British Isles : did there exist in the knowledge of anyone present a similar area of land with such a congested population where the sickness rate was so low and the date of death longer deferred? He thought not. The Ministry of Health might to a certain extent depend upon their loyalty and energies, but success as a whole, undoubtedly depended upon the wisdom of those who were in office in that department. That wisdom in the past had been of a high order, and long might it continue so to be. Coupled with the toast were the names of Sir Alfred Mond, Sir Arthur Chapman and Sir St. Clair Thomson. The Rt. Hon. Sir Alfred Mond, Bart., P.C., M.P., in response, said that he was very glad indeed to be asked to the dinner that night. He remembered on former occasions when he had had the honour of representing the Ministry of Health attending a dinner of that character, and could then testify to the important r61e played by medical officers of health in national health and welfare. He had only one grievance against Slr Kingsley Wood, and that was the invention of a new disease, and the claiming of himself as a victim. Sir Alfred stated that he looked upon himself as an optimist, and got rather tired when told that they were a C.3. nation, for that could be proved statistically to be absolute nonsense. Vast progress had been made in this country, and how far they stood ahead to-day could only be appreciated after a visit to foreign countries. Maternity and Child Welfare, for example, could be taken and compared with similar work done in any country in Europe. The medical officer of Health, to his mind, was a most remarkable man, with an encyclopaedic knowledge. Guardian of the public health and servant of the public, his work was frequently checked by financial considerations and baulked by the very people he wanted to help. No one realised the difficulties with which all who laboured in the public health service were faced, and it was greatly to their credit that they did not allow themselves to be discouraged. Undoubtedly their influence was becoming stronger; people were receiving more education, and their interest in health problems was increasing, and by the co-operation of all, progress would be made. Referring to the new School of Hygiene, to which the President had made reference, Sir Alfred said that he had been glad at being asked to take a part in its creation. Undoubtedly the future work of the school would
1925.
PUBLIC HEALTH.
have a great influence not only in this country, but throughout the whole British Empire. He had been happy to be present amongst them that evening, and delighted to be brought into contact with such a large number of members of what was one of the greatest services in the country. Sir Arthur Chapman, Chairman, County Councils Association, expressed great pleasure in being privileged to respond to the toast proposed in such felicitous terms by Dr. Howarth. His first duty obviously was to convey thanks for the generosity shown them, and by their presence there to assure the Society of the very great importance they attached to, and the deep interest they took in its activities. After more than 30 years of public life he could not fail to recall the miraculous change in public opinion. The provision of certain social services out of public funds for those who were the less fortunate members of the community, had brought about a change of outlook that had been of great benefit to the country. In contemplating all that had been achieved in the past, and all that was being done at the present time to prolong life and prevent disease, he had no hesitation in saying that in no department of social service had the development been more marked than it had been in the Public Health Service. Great surprises were yet in store, and the future would reveal great discoveries in science. With better education the people of the country, the working-classes especially, would no longer be willing to live herded together in insanitary dwellings. Parliament would be compelled by public opinion to attend more and more to health matters, and local authorities in their turn would be obliged by statute to make new regulations and to spend more money. Medical Officers of Health as a result would be called upon to perform new and often disagreeable duties. Obliged to put into force regulations which would interfere with vested interests, they would require and would be entitled to claim from the local authorities all the assistance they could possibly give, and it followed necessarily that the relationship between the local authority and the medical officer of health would need to be of the friendliest. Sir St. Clair Thomson, M.D., F . R . C . P . , F . R . C . S . , President, Royal Society of Medicine, in a speech ab6undlng in humorous anecdotes, also thanked the Society for its hospitality. A series of songs by Mr. George Baker contributed to the success of the evening. DR. C. H. B. THOMPSON has been appointed medical officer of health to the Central Board of Health, Fiji.
49
METROPOLITAN
BRANCH.
The Metropolitan Branch opened the session 1925-26 on October 2nd last with a Meeting at the House of the Society. The chair was occupied by Dr. Charles Porter, the re-elected President. The proceedings of the meeting of the Council of the Branch, heId earlier in the afternoon, were reported and approved. The Branch unanimously agreed to the recommendation of the Council that Dr. Annis and Dr. Middleton Hewat be re-appointed as Honorary Auditors for the ensuing session. The Honorary Secretary submitted a letter received from Dr. C. W. Hutt, Medical Officer of Health for Holborn, suggesting that the duties connected with the supervision of widows and children receiving benefit under the Widows, Orphans and Old Age Contributory Pensions Bill should be entrusted to local authorities in London who have the necessary machinery available for this work. In view of the fact that the Bill had become an Act since the receipt of this letter, and that Officers to carry out this work are being appointed by the Ministry of Health, it was decided that no useful purpose could be served by taking action in regard to the matter. The Branch considered the Housing Act, 1925, and resolved to intimate to the Metropolitan Boroughs Standing Joint Committee and the London County Council, their opinion that ByeLaws respecting houses let in lodgings, provided for under section 6 of the Act, should be made without delay. During a discussion of the Public Health (Preservatives in Food) Regulations, 1925, attention was drawn to the campaign now being undertaken by traders in foodstuffs to secure some alteration or amendment which would allow the addition of preservatives to certain articles of food which is prohibited by the Regulations. It was resolved to communicate with tile Council of the Society suggesting that their Food SubCommittee be asked to watch the campaign and to advise the Council of the Society to take such action as might be indicated. The Branch gave considerations to the Public Health Act, 1925, the Milk and Dairies (Consolidation) Act, 1915, the Public Health (Prevention of Tuberculosis) Regulations, 1925, and the Housing Consolidated' Regulations, 1925, and decided that these measures called for no special action by the Branch.
PUBLIG. H E A L T H .
Presidential Address.--Dr. Buchan then delivered the A d d r e s s on " M e t h o d s of P r e v e n t i o n in D i p h t h e r i a and Scarlet F e v e r , " which is rep r o d u c e d in full in Public Health, N o v e m b e r , 1925. A vote of t h a n k s to the P r e s i d e n t was moved by Dr. E u s t a c e Hill, seconded by Prof. H. R. K e n w o o d , and c a r r i e d by acclamation. The m e e t i n g then adjourned.
ANNUAL
DINNER.
The A n n u a l D i n n e r of the Society was held at the Piccadilly Hotel, London, on F r i d a y , O c t o b e r 16th. A record n u m b e r .of m e m b e r s and g u e s t s were received by the P r e s i d e n t and Mrs. Buchan, and the plan of the tables will be found on p a g e s 40-41. The P r e s i d e n t , h a v i n g p r o p o s e d the h e a l t h of the K i n g , the t o a s t of " T h e S o c i e t y " w a s g i v e n by Sir H. K i n g s l e y W o o d , M . P . , P a r l i a m e n t a r y S e c r e t a r y , M i n i s t r y of Health, w h o said : - " I e s t e e m it a g r e a t privilege to be p r e s e n t at thls g a t h e r i n g t o - n l g h t and to have the h o n o u r of p r o p o s i n g the health of the Society. I should like first to say how highly Mr. Neville C h a m b e r l a i n and myself value the w o r k which is b e i n g done by Medical Officers of H e a l t h up and down the country. I w a s careful this e v e n i n g to a s k the C h a i r m a n w h e t h e r the relationships of the Society with the M i n i s t r y of H e a l t h were perfectly cordial. It is a wise precaution when you represent the M i n i s t r y of Health, and he tells me t h a t the relationships are of the best. I can confirm that, and I desire on behalf of t h a t d e p a r t ment especially to t h a n k the Medical Officers of H e a l t h for their loyal co-operation t h r o u g h o u t the p a s t year. If t h e r e is one m a t t e r to which I would like p a r t i c u l a r l y to refer it is the g r e a t a s s i s t a n c e which this Society has rendered t h e G o v e r n m e n t and the S t a t e in connection with the i n t e r c h a n g e which has t a k e n place d u r i n g the y e a r of Medical Officers from a b r o a d . I do not t h i n k I should be e x a g g e r a t i n g the position if I say t h a t but for the w o r k of the Society, the influence for g o o d which has no d o u b t followed the visit t o this land of so m a n y public officers connected with health adm i n i s t r a t i o n in other countries, would have been impossible, and I a m very g r a t e f u l indeed to the Society for all its efforts in t h a t direction. T h e Society and its m e m b e r s have also done a g r e a t deal in f u r t h e r i n g the very s u b s t a n t i a l p r o g r e s s which has u n d o u b t e d l y been m a d e in health
45
affairs d u r i n g the last few years. I a m inclined to think s o m e t i m e s t h a t we live in a s o m e w h a t pessimistic age. If I d a r e say so to g e n t l e m e n w h o are connected with the medical profession, I should say t h a t it was a new and s o m e w h a t fashionable c o m p l a i n t - - p e s s i m i t i s - - a n d highly infectious. I think it has t w o m a r k e d s y m p t o m s . In the first place, it p a r t i c u l a r l y a t t a c k s certain people when they m a k e public speeches in tfiis country, and my friend Sir Alfred M o n d is in g r e a t d a n g e r of g e t t i n g it. T h e o t h e r s y m p t o m of the complaint is t h a t the p a t i e n t is a p t to fall in a fit when he sees a m e m b e r of the present G o v e r n m e n t ; but at any rate, so f a r as o u r health p r o g r e s s is concerned in this country, no one can be pessimistic. M a y I venture to recall to you the really wonderful p r o g r e s s t h a t has been made - - p r o g r e s s due to a v e r y l a r g e e x t e n t to the w o r k of the n a t i o n ' s health officers? i find, for instance, t a k i n g as a very g o o d test the d e a t h r a t e in this country, t h a t in 1870 the death rate was 21, whilst in 1924 it w a s 12. In the same period, if you t a k e a n o t h e r v e r y sensitive index of national health, the infantile m o r t a l i t y rate, you will find that it has been b r o u g h t down from 149 p e r 1,000 to 75. In 1 8 7 5 - - n o t so l o n g ago--enteric fever accounted for 370 d e a t h s in each million; last year t h a t 370 had fallen to 12. T h e tuberculosis rate is declining and with increasing velocity. In 1847--a stili p e r h a p s l o n g e r period a g o - - t h e d e a t h r a t e per million from c o n s u m p t i o n w a s 3,189. In 1875 it was 2,313, and in 1924 it had fallen to 801, a really r e m a r k a b l e achievem e n t ; and so far as small-po× is concerned, a n a t i o n a l scourge some y e a r s a g o , I a m a s s u r e d on the best a u t h o r i t y t h a t the only people who have it to-day are the people w h o wish to have it. T h e r e f o r e there has been s o m e t h i n g like a revolution in medicine, and p r o b a b l y the g r e a t e s t w a t c h w o r d which either the M i n i s t r y of H e a l t h or this Society could have in c o n j u n c t i o n with its w o r k would be the single w o r d ' P r e v e n t i o n . ' T h a t , at any rate, is the ideal which I t h i n k everyone who is a c q u a i n t e d with health affairs is e n d e a v o u r i n g to attain at the p r e s e n t time. I s u p p o s e t h a t so f a r as future policy is concerned one of the most desirable t h i n g s is to link up our health agencies in each locality. It is an e x t r a o r d i n a r y t h i n g at the p r e s e n t m o m e n t t h a t in almost every a d m i n i s t r a t i v e unit t h e r e are some nine individuals or units. T h e r e is the Medical Officer and his A s s i s t a n t , the Medical Officer for Child W e l f a r e , the School doctor, the T u b e r c u l o s i s Officer, the Specialist in certain diseases, the C e r t i f y i n g F a c t o r y S u r g e o n , the
46
PUBLfC HEALTH'.
P o o r Law doctor, and the I n s u r a n c e practitioner, and I nearly d r a g g e d i n - - w h e n I saw Col. S t a n l e y - - t h e P e n s i o n s ' doctor. I t h i n k everyone here who is interested in Public H e a l t h affairs m u s t a g r e e t h a t one of o u r first principles m u s t be co-ordination and c o - o p e r a t i o n a m o n g s t all those individuals or units who, no doubt, a r e each fulfilling an i m p o r t a n t p a r t in our Public H e a l t h a d m i n i s t r a t i o n . I also v e n t u r e to s u g g e s t t h a t in connection with t h a t a d m i n i s t r a t i o n we w a n t to do n o t h i n g which will interfere with individual responsibility, g o o d c h a r a c t e r and thrift. I have a g r e a t a d m i r a t i o n for every medical prac{itioner in the country, g u t I believe t h a t a f t e r all the first and the b e s t person to t a k e care of the children are their f a t h e r s a n d m o t h e r s , and I hope we shall do n o t h i n g to u n d e r m i n e that responsibility. In conclusion, I hope the Society will continue, as it has done in t h e p a s t , to do all in its power to e n c o u r a g e medical researcfl. I believe a l o n g t h a t line lies a g r e a t deal of progress. T h e r e is, a f t e r all, a g r e a t d a n g e r of b e i n g i m m e r s e d in the r o u t i n e of t h e w o r k we do, and occasionally our duties a r e so g r e a t t h a t we have not time to t a k e s t o c k a n d to see w h e t h e r the w o r k we are d o i n g is a c h i e v i n g tile end in view. I have g r e a t p l e a s u r e in c o u p l i n g this t o a s t with t h a t of y o u r new P r e s i d e n t . I cong r a t u l a t e him upon his election t o w h a t is, I suppose, the h i g h e s t office a m o n g s t Medical Officers of H e a l t h in this c o u n t r y . H e has had a considerable experience in different p a r t s of the country, and I feel t h a t w h i l s t you h a v e honoured him, his accession to the P r e s i d e n t i a l C h a i r will be of g r e a t benefit to the S o c i e t y . " T h e P r e s i d e n t (Dr. G e o r g e F. Buchan), who, on rising, was g r e e t e d with a c c l a m a t i o n , in his reply said : " O n behalf of the Society of M e d i c a l Officers of H e a l t h , I have to t h a n k Sir K i n g s l e y W o o d for the v e r y kind m a n n e r in which he has proposed the toast. I a m p r o u d t o - n i g h t to reply for the Society. I a m conscious t h a t this is not a Society which, like some of t h e older medical societies in London, has b e h i n d it a l o n g series of ancient t r a d i t i o n s , for it w a s f o u n d e d only some 69 years ago, b u t I realise t h a t it is a society which has p l a y e d a g r e a t p a r t in the dev e l o p m e n t of t h a t p r a c t i c e of m e d i c i n e and will continue to play an even g r e a t e r p a r t in tt~e future. Sixty-nine y e a r s a g o , the S o c i e t y was for Medical Officers of H e a l t h only, b u t the Public H e a l t h a d m i n i s t r a t i o n of this ccmntry has altered very g r e a t l y since those days~ and the Society has m a d e chae#ges from t i m e t o time to
NOVEMBER,
meet the c h a n g e s in the medical w o r k of health authorities. So t h a t t o - d a y the Society c o m p r i s e s every kind of medical officer employed by a u t h o r i t i e s - - c i v i l , military, naval or aerial ; central or l o c a l ; h o m e or c o l o n i a l - - s o long as the medical officer is p r i m a r y concerned with the p r a c tice of Public H e a l t h either on land or sea or under the sea or in the air. D u r i n g these 69 y e a r s since the e s t a b l i s h m e n t of the Society, we have h a d our successes. It is true we cannot d e m o n s t r a t e with all the a r t of the physician or s u r g e o n the p a t i e n t s w h o have r e a c t e d to our skill and t r e a t ment, but, in a d d i t i o n to the evidence of Sir K i n g s l e y W o o d , t h e statistical records o~ the R e g i s t r a r - G e n e r a l show, I think, t h a t we have saved m a n y lives, and t h a t o t h e r s have lived h e a l t h i e r and l o n g e r lives on account of our efforts. T h e s e a c h i e v e m e n t s have resulted from the w o r k of the r a n k and file of Medical Officers of H e a l t h . It is quite a m i s t a k e g e n e r a l l y to s u p p o s e t h a t a n y t h i n g s u b s t a n t i a l is achieved by brilliant l e a d e r s h i p alone, t h o u g h t h a t is essential e n o u g h , and just a s our E m p i r e has been won and built up by o r d i n a r y c o m m o n men who have set the cause a b o v e the prize, so the successes of Public H e a l t h in this c o u n t r y have been achieved by e v e r y - d a y Medical Officers of H e a l t h whose first c o n s i d e r a t i o n has been the public health a n d the public interest. T h e r e is at the p r e s e n t time a g r e a t e r d e m a n d for health t h a n ever before, and this d e m a n d has its e x p r e s s i o n in the i n c r e a s i n g a t t e n t i o n which is given by y o u n g people to o u t d o o r life. If the d e m a n d for more health is to be met it is n e c e s s a r y t h a t medical officers should be equipped for the task. A f t e r 69 y e a r s of w o r k , I t h i n k it m a y safely be s t a t e d t h a t we have succeeded in r e m o v i n g all the g r o s s c a u s e s of ill-health, and now in o r d e r to increase l o n g e v i t y we shall have to w o r k intensively on the causes which remain. This implies s t u d y a n d - - I was g l a d to h e a r f r o m S i r K i n g s l e y W o o d - - r e s e a r c h , and the application of the findings of research in the a r e a s of the local authorities. Of course, the necessary research for the elucidation of the o u t s t a n d i n g p r o b l e m s of public health c a n n o t be u n d e r t a k e n w i t h o u t money, a n d we shall have to look to the n a t i o n a l and local chancellors of the exchequer for t h a t p a r t i c u l a r c o m m o d i t y , for wlaen all is said and done, it has to be reallsed t h a t health is p u r c h a s able. In a n y case, I feel sure t h a t if the w o r k e r s in public health h a v e to achieve even b e t t e r results in the f u t u r e than they have done in the past, it will be n e c e s s a r y for local authorities to t a k e an i n t e r e s t in the research w o r k which is
1925.
PUBLIC HI~'ALTH.
necessary for the problems of preventive medicine. To secure the best health in the future it will be necessary also to give close attention to the training of the medical officer of health, and we are particularly pleased to have with us to-night Sir Alfred Mond, who is the presiding genius of the new School of Hygiene and Tropical Medicine now on its way in London, and the primary function of which must be to turn out practitioners of public health who will preach the gospel of prevention to the ends of the earth. The training of the medical officer of health has its bearing, too, on the training of the doctor, who, in his turn, must be a worker for the maintenance of the national health. The education, in fact, of the doctor of the future must be based on the conception of the prevention rather than the cure of disease, and I know it is one of the most earnest desires of our most distinguished Chief Medical Officer of the Ministry (Sir George Newman) that preventive ideas should permeate the whole medical curriculum from an early stage. I feel myself that an undergraduate medical student should not be able to receive his medical degree unless he has had some opportunity of inspecting and reporting on the medical work which is done by his Town Council for the community, so that he may understand the trend of modern public health in relation to his future practice of medicine. He would then in practice become a health doctor rather than a disease doctor, and the community and his patients would reap a corresponding benefit. England has been in the van of public health work for many years, and this Society is especially anxious that every effort should be made to maintain that place. Other nations are wakening up to the importance of public health, and during the past three years or so this Society has organised, on behalf of the League of Nations and the Ministry of Health, demonstrations of English public health methods to international groups of health officers, while some few of the Fellows of this Society have gone abroad to see public health work in other countries. It is very gratifying to the Society {that these demonstrations in this country of the work of the English public health service have been so highly appreciated by the foreign and colonial medical officers who have taken part and have testified to the high state of development and the scientific administration of public health in England. Abroad it is true there have been some picturesque public health successes in respect of Mediterranean Fever and Yellow Fever and the control of Malaria and Hookworm disease, but these represent more particularly
47
pieces of outstanding research which have not yet been utilised to the full to establish abroad a scientific administration for the application of the principles of preventive medicine generally to the health of the communities. This may be seen from the high death rates and infantile mortality rates which unfortunately still prevail in many foreign countries. It is to be hoped that as a result of this international interchange of health officers which has been inaugurated, general public health administration may be set up and extended both at home and abroad, so that not only England but the world may become more and more healthy. I do not think that I have anything more to say. I am delighted to have had the honour to reply to this toast, and I am delighted to think t~at you, who are representatives of central and local government and the general medical profession, show by your presence here to-night that you realise that health is a matter of public concern which knows no party and no territory. In England there has been continuous public health progress since the first great public health enactment of 1875, and I am sure that with the results achieved constantly before us one does not require to be an idealist to realise that with intensive and concerted action better and better health can yet be enjoyed in England. If I were asked to-night to treat the case for better health I would prescribe a mixture containing all of the following ingredients : the early training of the doctor in the preventive idea, the still better training of the medical officer of health, the education of the public in health, the systematic provision by local authorities of opportunities for research into t~e main causes of sickness and death, the application of the findings of research, and last, but not least, complete understanding, harmonious co-operation and implicit confidence--real team work in f a c t - between the general practitioners of medicine, medical officers of health, and the men and women of the nation." Dr. W. J. Howarth, C.B.E., in proposing "The Guests" said that their a n n u a l ' g a t h e r i n g s were always charaeterised by the presence of visitors from the many professions associated with that which they represented, and of members of various learned societies, but he did not remember in his experience such a large number of distinguished guests, and it would take all the evening to recount their qualities and the distinguished part they had played in the present-day history of this country. He extended a cordial welcome to visitors from Willesden, the local authority which it was the privilege of their President to serve. It gave the Society an opportunity of t
48
PUBLIC HE)ILTH.
being able to show to those visitors the esteem in which its President and their officer was held by his colleagues. The representatives of the County Councils Association and Municipal Corporations Association and of the Rural Councils they also warmly welcomed. The gentlemen who represented these bodies were entitled to their sincere thanks and appreciation forthe patience and forbearance they had displayed during the recent years in matter of mutual interest. Their annual gatherings would seem strange without the presence of their respected executive chief, Sir George Newman, and it was to be regretted that Sir Arthur Robinson was unable to be present with them. It always seemed to them that Sir George radiated a spirit of freshness, always urged them on to do the impossible, but they were perfectly satisfied because they felt that whatever he decided was for the benefit of the State as a whole. For the first time they had the pleasure of entertaining Sir Walter Fletcher who, since he had taken charge of the Research Department of the Privy Council had improved, if that were possible, his own reputation, and had in the palm of his hand the making of a hundred reputations, and it was interesting to note that research work was a hard, gruelling process, and compared very badly with the fireworks that resulted from short cuts in science. Sir Walter could be assured that if at any time he felt he would like to call upon the Society or its individual members to assist him in any matter of research he had only to say so, and there would be ready helpers. They were honoured by the presence of representatives of the Royal Society of Medicine. Sir St. Clair Thomson everyone knew. His writings were well known and his present office was not the first Presidency of distinction that he had held. Dr. H'owarth welcomed also Dr. Brackenbury and Dr. Cox of the British Medical Association, and regretted that Prof. Bolam was not there. They had with them,~ too, representatives of the Services. General Leishman and his work were closely associated with public health, for as time went on the medical work in the Army ran more and more parallel with the work in which they were engaged. Sir Squire Sprigge everybody was delighted to see; he was generous in the space he gave the public health service in his journal, and impartial in any squabbles that arose. More than that they could not ask. The British Parliament was well represented by the four distinguished Members present, Sir Alfred Mond, Col. Fremantle, Col. Stanley, and Mr. Viant, and
NOVEMBER,
to them, on behalf of the Society, he extended a very hearty welcome. Concluding, Dr. Howarth said that there were 45,000,000 people in the British Isles : did there exist in the knowledge of anyone present a similar area of land with such a congested population where the sickness rate was so low and the date of death longer deferred? He thought not. The Ministry of Health might to a certain extent depend upon their loyalty and energies, but success as a whole, undoubtedly depended upon the wisdom of those who were in office in that department. That wisdom in the past had been of a high order, and long might it continue so to be. Coupled with the toast were the names of Sir Alfred Mond, Sir Arthur Chapman and Sir St. Clair Thomson. The Rt. Hon. Sir Alfred Mond, Bart., P.C., M.P., in response, said that he was very glad indeed to be asked to the dinner that night. He remembered on former occasions when he had had the honour of representing the Ministry of Health attending a dinner of that character, and could then testify to the important r61e played by medical officers of health in national health and welfare. He had only one grievance against Slr Kingsley Wood, and that was the invention of a new disease, and the claiming of himself as a victim. Sir Alfred stated that he looked upon himself as an optimist, and got rather tired when told that they were a C.3. nation, for that could be proved statistically to be absolute nonsense. Vast progress had been made in this country, and how far they stood ahead to-day could only be appreciated after a visit to foreign countries. Maternity and Child Welfare, for example, could be taken and compared with similar work done in any country in Europe. The medical officer of Health, to his mind, was a most remarkable man, with an encyclopaedic knowledge. Guardian of the public health and servant of the public, his work was frequently checked by financial considerations and baulked by the very people he wanted to help. No one realised the difficulties with which all who laboured in the public health service were faced, and it was greatly to their credit that they did not allow themselves to be discouraged. Undoubtedly their influence was becoming stronger; people were receiving more education, and their interest in health problems was increasing, and by the co-operation of all, progress would be made. Referring to the new School of Hygiene, to which the President had made reference, Sir Alfred said that he had been glad at being asked to take a part in its creation. Undoubtedly the future work of the school would
1925.
PUBLIC HEALTH.
have a great influence not only in this country, but throughout the whole British Empire. He had been happy to be present amongst them that evening, and delighted to be brought into contact with such a large number of members of what was one of the greatest services in the country. Sir Arthur Chapman, Chairman, County Councils Association, expressed great pleasure in being privileged to respond to the toast proposed in such felicitous terms by Dr. Howarth. His first duty obviously was to convey thanks for the generosity shown them, and by their presence there to assure the Society of the very great importance they attached to, and the deep interest they took in its activities. After more than 30 years of public life he could not fail to recall the miraculous change in public opinion. The provision of certain social services out of public funds for those who were the less fortunate members of the community, had brought about a change of outlook that had been of great benefit to the country. In contemplating all that had been achieved in the past, and all that was being done at the present time to prolong life and prevent disease, he had no hesitation in saying that in no department of social service had the development been more marked than it had been in the Public Health Service. Great surprises were yet in store, and the future would reveal great discoveries in science. With better education the people of the country, the working-classes especially, would no longer be willing to live herded together in insanitary dwellings. Parliament would be compelled by public opinion to attend more and more to health matters, and local authorities in their turn would be obliged by statute to make new regulations and to spend more money. Medical Officers of Health as a result would be called upon to perform new and often disagreeable duties. Obliged to put into force regulations which would interfere with vested interests, they would require and would be entitled to claim from the local authorities all the assistance they could possibly give, and it followed necessarily that the relationship between the local authority and the medical officer of health would need to be of the friendliest. Sir St. Clair Thomson, M.D., F . R . C . P . , F . R . C . S . , President, Royal Society of Medicine, in a speech ab6undlng in humorous anecdotes, also thanked the Society for its hospitality. A series of songs by Mr. George Baker contributed to the success of the evening. DR. C. H. B. THOMPSON has been appointed medical officer of health to the Central Board of Health, Fiji.
49
METROPOLITAN
BRANCH.
The Metropolitan Branch opened the session 1925-26 on October 2nd last with a Meeting at the House of the Society. The chair was occupied by Dr. Charles Porter, the re-elected President. The proceedings of the meeting of the Council of the Branch, heId earlier in the afternoon, were reported and approved. The Branch unanimously agreed to the recommendation of the Council that Dr. Annis and Dr. Middleton Hewat be re-appointed as Honorary Auditors for the ensuing session. The Honorary Secretary submitted a letter received from Dr. C. W. Hutt, Medical Officer of Health for Holborn, suggesting that the duties connected with the supervision of widows and children receiving benefit under the Widows, Orphans and Old Age Contributory Pensions Bill should be entrusted to local authorities in London who have the necessary machinery available for this work. In view of the fact that the Bill had become an Act since the receipt of this letter, and that Officers to carry out this work are being appointed by the Ministry of Health, it was decided that no useful purpose could be served by taking action in regard to the matter. The Branch considered the Housing Act, 1925, and resolved to intimate to the Metropolitan Boroughs Standing Joint Committee and the London County Council, their opinion that ByeLaws respecting houses let in lodgings, provided for under section 6 of the Act, should be made without delay. During a discussion of the Public Health (Preservatives in Food) Regulations, 1925, attention was drawn to the campaign now being undertaken by traders in foodstuffs to secure some alteration or amendment which would allow the addition of preservatives to certain articles of food which is prohibited by the Regulations. It was resolved to communicate with tile Council of the Society suggesting that their Food SubCommittee be asked to watch the campaign and to advise the Council of the Society to take such action as might be indicated. The Branch gave considerations to the Public Health Act, 1925, the Milk and Dairies (Consolidation) Act, 1915, the Public Health (Prevention of Tuberculosis) Regulations, 1925, and the Housing Consolidated' Regulations, 1925, and decided that these measures called for no special action by the Branch.