- Email: [email protected]
Appendix C Committee on Air Pollution
PUBLIC
HEALTH,
A u g u s t , 1954
122. S c h o o l H e a l t h S e r v i c e . - (a) T h e question of t h e n e e d to refer m a t t e r s relating to the School H e a l t h Service to g r o u p s other t h a n t h e School H e a l t h Service g r o u p was carefully considered a n d it Was agreed that there was no necessity to change t h e p r e s e n t procedure. (b) It was reported that the British Medical Association h a d h a d its attention called to a p r o b l e m arising in connection with alleged n o n - c o o p e r a t i o n b e t w e e n t h e School H e a l t h Service and General Practitioners with regard to the referal of children by t h e School Health Service to c o n s u l t a n t s a n d specialists. It was resoh'ed that t h e Medical Officer of H e a l t h in q u e s t i o n be informed that t h e existing arrangemerits in his area were n o t in accordance with t h e agreem e n t b e t w e e n the Society and t h e B . M . A . , a n d that therefore t h e Society w o u l d s u p p o r t a n y action taken by t h e Public H e a l t h C o m m i t t e e of that organisation. 123. C o n f e r e n c e o n V e n e r e a l D i s e a s e s . - - I t was reported that a letter, dated 26th F e b r u a r y , f r o m the B.M.A. h a d invited the Society to appoint representatives to attend a Conference on Venereal Diseases. A f t e r consultation w i t h t h e C h a i r m a n , t h e following m e m b e r s h a d been invited to r e p r e s e n t t h e S o c i e t y : Drs. E. B. Argles, L. M e r e d i t h Davis, F. Hall, R. C. M. Pearson, J. S. Logan, T . R u d d o c k West. Representatives of t h e Public H e a l t h C o m m i t t e e a n d Venereologists G r o u p C o m m i t t e e of the B.M.A. also a t t e n d e d t h e Conference, t o g e t h e r with representatives of the Medical Society for the S t u d y of Venereal Diseases. T h e C o m m i t t e e h a d before it the M i n u t e s o f t h e Conference, a n d it was resolved to approve t h e r e c o m m e n d e d Joint S t a t e m e n t of Policy as follows : (1) Social work s h o u l d be an integral part of t h e V.D. Service - - t h i s principle h a s b e e n expressed b y a large majority of p h y sicians in charge of V.D. Clinics. [2) T h e Staff of every clinic s h o u l d be s u c h as to e n s u r e that social work can be u n d e r t a k e n b y a suitably experienced person or p e r s o n s w h o s h o u l d r e m a i n attached to t h e s a m e clinic or clinics w i t h o u t b e i n g c h a n g e d m o r e f r e q u e n t l y t h a n is absolutely necessary. (3) Social work u n d e r t a k e n at t h e clinic s h o u l d i n c l u d e interviewing patients at t h e clinic, s e c u r i n g t h e attendance, b y visit or otherwise, of contacts, i.e. p e r s o n s k n o w n or believed to be sources of venereal infection, a n d securing t h e r e - a t t e n d a n c e of p e r s o n s w h o have d i s c o n t i n u e d t r e a t m e n t p r e m a t u r e l y . (4) Staff elagaged on social work s h o u l d carry o u t their duties in the area served b y t h e clinic w i t h o u t strict regard to local a u t h o r i t y boundaries. (5) T h e cost of p r o v i d i n g staff for social work in t h e V.D. service m i g h t , in certain c i r c u m s t a n c e s , be a p p o r t i o n e d b e t w e e n t h e hospital a u t h o r i t y a n d t h e local h e a l t h a u t h o r i t y concerned, on an agreed basis. W h e r e m o r e t h a n one local a u t h o r i t y is concerned, the cost m i g h t well be shared according to population. (6) W i t h t h e object of securing full co-operation between venereologists a n d medical officers of h e a l t h in t h e p r e v e n t i o n of venereal diseases, a r r a n g e m e n t s should be m a d e w h e r e possible for venereologists in charge of clinics to be attached to t h e public health d e p a r t m e n t s of t h e local health authorities of t h e areas served by their clinics ; a n d that the p r o c e d u r e described in parag r a p h 6 of M i n i s t r y of H e a l t h circular 5/48, for protecting medical officers e n g a g e d in V.D. work f r o m actions for s l a n d e r etc. be applied to venereologists attached to public health d e p a r t m e n t s for the above purpose. (7) (i) W i t h t h e object of securing a f u r t h e r d i m i n u t i o n in t h e incidence of congenital syphilis, every effort s h o u l d be m a d e in hospitals, ante-natal clinics, a n d general practice : (a) to extend t h e practice of t e s t i n g p r e g n a n t patients for venereal disease, n o t only in their first b u t also in s u b s e quent pregnancms ; (b) to seek t h e co-operation of the c o n s u l t a n t venereologist in a n y ease of d o u b t . (ii) Special attention s h o u l d be given to t h e i m p o r t a n c e of avoiding delay in r e p o r t i n g the results of tests. 124. ]VIental I l l n e s s a n d M e n t a l D e f i c i e n c y . - - A letter, dated 27th F e b r u a r y , invited the Society to s u b m i t evidence to t h e Royal C o m m i s s i o n on t h e L a w Relating to M e n t a l Illnes~ a n d M e n t a l Deficiency. It was resolved that t h e following be appointed a S u b - C o m m i t t e e to prepare evidence in this c o n n e c t i o n : Drs. H. K. Cowan, F. Hall, J. S. Logan, A. A. E. N e w t h , E. M. Jenkins and L l y w e l y n Roberts. 125. A c c i d e n t s i n t h e H o m e . - - A letter, dated 15th M a r c h , f r o m Dr. J. B. S. M o r g a n , in his capacity as H o n . Secretary of t h e Sheffield P r e - L i a i s o n C o m m i t t e e , was referred to t h e M a t e r nity a n d Child Welfare G r o u p . 126. R e g i s t r a r G e n e r a l ' s Q u a r t e r l y R e t u r n . - - I t was reported that a letter, dated 25th M a r c h , f r o m t h e Registrar General i n f o r m e d t h e Society that it was p r o p o s e d to d i s c o n t i n u e Publica-
187 tion of the Quarterly Figures of Population, Births, D e a t h s and M a r r i a g e s in Counties, Great T o w n s , and Smaller Toxx ns, xxhich at p r e s e n t appeared in T a b l e s IV, V and "VI of the Quarterly R e t u r n . It was resoh'ed that no objections be raised to the proposals. 127. V i s i t o f B r i t i s h D o c t o r s to t h e U . S . S . R . - ~ It was reported that a letter h a d been received from t h e Society for Cultural Relations avith t h e U.S.S_R. referring to an invitation for twenty British medical m e n and w o m e n to \~isit the Soviet U n i o n in S e p t e m b e r this year. T h e letter invited the Society to forward s o m e n a m e s for consideration by the organising committee. It was resolved that the invitation be left over for the consideration of t h e Council. 128. C e r t i f i c a t e of F e v e r N u r s i n g . - - A letter, dated 30th M a r c h , f r o m t h e E d u c a t i o n Officer, G e n e r a l N u r s i n g Council, forwarded for :the c o m m e n t s of the Society a copy of the s u g g e s t e d revised syllabus of subjects for e x a m i n a t i o n s for the Certificate of F e v e r N u r s i n g . It was resoh'ed that t h e m a t t e r be referred to the F e v e r G r o u p , with power to act. 129. C o m m i t t e e P r o c e d u r e . It was resoh'ed to recommend that t h e Officers of the Society be appointed a Sub C o m m i t t e e to consider t h e q u e s t i o n of C o m m i t t e e procedure, with special reference to t h e confidentiality of r e c o m m e n d a t i o n s to the Council, m a d e by the General P u r p o s e s C o m m i t t e e , a n d to the s u g g e s t i o n b y the Editor of Public H e a l t h that in future the M i n u t e s of t h e General P u r p o s e s C o m m i t t e e and of t h e Council should n o t be p u b l i s h e d in full in Public Health, b u t that an abbreviated report o f t h e b u s i n e s s transacted at t h e m e e t i n g s s h o u l d appear shortly after t h e M e e t i n g s . 130. R e p r e s e n t a t i o n . - - A . Handicapped Children.--A letter, dated 28th F e b r u a r y , from Dr. S i m o n Y u d k i n , invited t h e Society to a p p o i n t a representative to a Conference to be held at C h u r c h H o u s e , W e s t m i n s t e r , on Saturday, 8 t h M a y , at w h i c h w o u l d be considered t h e p r o b l e m of children suffering f r o m m e n t a l or bodily handicap. It was resolved t h a t Dr. A. A. E. N e w t h be a p p o i n t e d t h e Society's representative on this occasion. B. T h e following were appointed representatives of the Society : i. B.S.I. Sub-committee--Examination a n d P h y s i o t h e r a p y C o u c h e s . Dr. A. A. E. N e w t h . ii. Central Council for Health Education--Council 1954/55. Dr. E. K . M a c d o n a l d a n d D r . H . C. M a u r i c e Williams. iii. Registered Plumbers Association--Council, N o t t i n g h a m , J u n e 4th. Dr. William D o d d . iv. Regional Housing and Planning Conference--London Region, W e d n e s d a y , 26th M a y . Dr. F. M. May. T h e r e being no other b u s i n e s s the m e e t i n g closed at approxim a t e l y 12.55 p . m . APPENDIX C
COMMITTEE
ON AIR POLLUTION
Introduction
T h e Society of Medical Officers of H e a l t h have pleasure in s u b m i t t i n g a m e m o r a n d u m to the C o m m i t t e e on Air Pollution. N o a t t e m p t has been m a d e to include all the possible considerations w h i c h the Society could b r i n g before the notice of the C o m m i t t e e , for it is k n o w n that t h e C o m m i t t e e have received evidence f r o m a n u m b e r of bodies (particularly t h e National S m o k e A b a t e m e n t Society) with w h i c h m e m b e r s of the Society find t h e m selves, speaking generally, in broad agreement. It is intended, therefore, that t h e Society's evidence shall be brief. T h e Society offers its fullest co-operation in a t t e m p t i n g to p r e v e n t a n d to deal with p r o b l e m s of air pollution. In particular t h e Society wishes to state that medical officers of health arc p r i m arily responsible u n d c r the Sanitary Officers' Regulations (Article 17) 1935, " to keep themselves i n f o r m e d on all matters . . . likely to affect t h e p u b l i c health in the district a n d be prepared to advise t h e local a u t h o r i t y on a n y s u c h m a t t e r . " F o r m a n v years the Society collectively, and its m e m b e r s individually, l~a,:e striven against great difficulties to b r i n g a b o u t a cleaner a t m o s p h e r e and t h e y will do all in their power n o w a n d in t h e future to assist t h e C o m m i t t e e in every possible way. Legislation
T h e Society considers there is n e e d for a consolidation fo legislation on the subject of air pollution ; that it should be simple a n d clear in e n f o r c e m e n t and a d m i n i s t r a t i o n a n d that it s h o u l d be n a t i o n w i d e in extent. It is s u g g e s t e d that s m o k e is a social n u i s a n c e a n d that it should be regarded, by the very fact of. its existence, as a legal nuisance. Subject to provisos that a slight emission of s m o k e of less t h a n 2 R i n g l e m a n n (and for certain periods of lighting up, soot-blowing a n d " excepted " processes) s m o k e s h o u l d be regarded as a legal n u i s a n c e i n d e p e n d e n t of its colour, d e n s i t y or duration.
188 T h e r e is need for simplification a n d clarification of t h e law relating to s m o k e f r o m locomotives. Industrial Aspects It is r e c o m m e n d e d that an attack be m a d e first on industrial smoke. M a n y firms are co-operating by t h e installation of m o d e r n e q u i p m e n t . I n this connection it m a y be pointed o u t that while it is u n d e r s t o o d that t h e installation of n e w p l a n t is s u b j e c t to tax relief, efficient m a i n t e n a n c e of s u c h plant is not. It is felt that those firms w h i c h seek to i m p r o v e their existing plant b y alterations s h o u l d receive s o m e tax relief. W i t h regard to t h e " excepted " processes, it will be recognised that the p r e s e n t list is o u t of date a n d the Society will s u p p o r t t h e call for a complete review of all the processes regarded as " excepted." T h e Society recognises the value of alkali inspectorate a n d w o u l d w e l c o m e an increase in t h e n u m b e r of s u c h inspectors. It is s u g g e s t e d that this inspectorate, whilst based on central h e a d quarters, s h o u l d have regional offices in the largest centres of population, so that t h e advice of these inspectors could be m o r e readily available. A decisive increase will be necessary in the scale of p r e s e n t m e a s u r e s for the training of staff, s u c h as stokers, w i t h t h e object of l e s s e n i n g industrial smoke. S o m e i n d u c e m e n t of a material k i n d s h o u l d be offered to m e n w h o successfully u n d e r t a k e s u c h a course a n d are g r a n t e d a certificate, A t p r e s e n t t h e rewards vary widely f r o m nil u p w a r d s . T h e Soei'ety is greatly c o n c e r n e d over t h e gaseous a n d particulate matter emitted f r o m p o w e r station c h i m n e y s controlled by the British Electricity A u t h o r i t y . It records its alarm at the building o f so m a n y p o w e r stations in areas w h e r e there is a large p o p u l a tion. T h e Society is far f r o m satisfied t h a t t h e m e a s u r e s in u s e for precipitating t h e particulate m a t t e r are as efficient as they s h o u l d be, whilst even greater concern is expressed over the possible h a r m f u l effects of t h e wide d i s s e m i n a t i o n of gasses s u c h as oxides of s u l p h u r . It is n o t e d that t h e e m i s s i o n of s u l p h u r dioxide can be as h i g h as t e n million cubic feet p e r day a n d t h e Society earnestly h o p e s t h a t the C o m m i t t e e ' s r e c o m m e n d a t i o n s will lead to t h e a b a t e m e n t of w h a t m i g h t be a serious d a n g e r to health. Domestic Smoke T h e Society r e c o m m e n d s that t h e C o m m i t t e e will favourably consider i n d u c e m e n t s to t h e householder, w h e t h e r in m u n i c i p a l l y or privately o w n e d houses, to use m o d e m appliances (where these are n o t already installed) a n d to t h e use of smokeless fuel. It reeognises t h a t m u c h education of t h e public is n e e d e d to this e n d a n d it pledges itself t h a t it will do all in its p o w e r to f u r t h e r this end. It is appreciated, however, that m u c h will d e p e n d on r e d u c i n g the price a n d i m p r o v i n g t h e reactivity a n d o t h e r qualities of smokeless fuels. T h e Society believes in the i m p l e m e n t a t i o n a n d extension of policy of smokeless zones a n d has h e a r d f r o m its m e m b e r s favourable reports of t h e w o r k i n g of the " condition of t e n a n c y " clause in Council estates, w h e r e b y smokeless fuel only is b u r n t . T h e Society wishes to reinforce the evidence of o t h e r bodies in r e q u e s t ing t h a t there be provision for smokeless zone p o w e r s in general legislation. Research T h e Society u r g e s strongly the necessity of research into m a n y aspects of air pollution. It deplores t h e ignorance of f u n d a m e n t a l facts in p r e s e n t knowledge. It w o u l d u r g e that t h e help o f U n i v e r s i t y D e p a r t m e n t s be engaged in carrying o u t f u r t h e r research on the effect of t h e various pollutants u p o n h u m a n and animal h e a l t h a n d u p o n agriculture. It w o u l d p o i n t o u t that a b o d y s u c h as t h e M e d i c a l R e s e a r c h Council m i g h t well initiate research into the differential incidence of respiratory disease and m o r t a l i t y in various centres of population t h r o u g h o u t the country. It is noted, for instance, t h a t the incidence of chronic bronchitis appears to be over f o u r t i m e s as h i g h in s o u t h - e a s t L a n c a s h i r e as in c o u n t r y areas. It s u g g e s t s that ~reas be chosen w h e r e t h e r e is a h i g h rate of a t m o s p h e r i c pollution as c o m p a r e d with control areas of low or m i n i m a l pollution. It suggests that research (both retrospective a n d prospective) in vital statistics m i g h t yield valuable results. Lastly, t h e Society is m u c h c o n c e r n e d w i t h the i m p l e m e n t a t i o n of t h e r e c o m m e n d a t i o n s w h i c h t h e C o m m i t t e e will make, r e m e m b e r i n g t h e fate of several previous reports. It e a m e s t l y h o p e s that t h e r e c o m m e n d a t i o n s of t h e C o m m i t t e e on A i r Pollution will be effective a n d acceptable. It r e c o m m e n d s that a p e r m a n e n t d e p a r t m e n t be instituted, possibly as a section~of t h e M i n i s t r y of H o u s i n g a n d Local G o v e r n m e n t , w h i c h will be c h a r g e d w i t h t h e task of carrying o u t a n d e x t e n d i n g t h e C o m m i t t e e ' s r e c o m m e n d a tions on this m o s t i m p o r t a n t aspect of e n v i r o n m e n t a l hygiene.
PUBLIC
HEALTH,
A u g u s t , 1954
DENTAL OFFICERS GROUP President: Mr. S. B. N e w t o n , L.D.S. H o n . S e c r e t a r y : Mr. J. F. A. S m y t h , L.D.S. (P.S.D.O.), Gloucestershire. An E x t r a o r d i n a r y General M e e t i n g of t h e G r o u p was held in t h e Old L i b r a r y , B . M . A . H o u s e , L o n d o n , on S a t u r d a y , M a r c h 2oth, I95. t. I n 7the a b s e n c e of t h e P r e s i d e n t , t h e Vice-President, Mr. K . C. B. W e b s t e r , presided a n d was s u p p o r t e d b y t e n o t h e r m e m b e r s a n d visitors. The Hon. S e c r e t a r y i e a d t h e notice c o n v e n i n g t h e m e e t i n g a n d r e a d t h r o u g h t h e p r o p o s e d Group R u l e s as revised b y a special s u b - c o m n f i t t e e a n d a p p r o v e d b y t h e Group Council. The C h a i r m a n e x p l a i n e d t h a t the a l t e r a t i o n s were m i n o r ones a n d b r o u g h t t h e G r o u p R u l e s up to date. T h e only significant c h a n g e was t h e p r o p o s a l t h a t t h e ?title of t h e G r o u p s h o u l d be altered to "' D e n t a l G r o u p '" O n t h e proposition of Mr. S m y t h s e c o n d e d b y Mr. R u b r a , t h e n e w rules were agreed to by t h e u n a n i m o u s v o t e of t h o s e m e m b e r s present. A m e e t i n g of t h e G r o u p was held a t B . M . A . House, on t h e a f t e r n o o n of S a t u r d a y , M a r c h 20th, w h e n in t h e absence of t h e P r e s i d e n t o w i n g to illness, Mr. K. C. B. W e b s t e r occupied t h e chair. I n all, t h e r e was a n a t t e n d a n c e of 1~ m e m b e r s a n d visitors. O b i t u a r y . - - T h e C h a i r m a n s p o k e of t h e m a n y years of d e v o t e d service given ?to t h e Society, a n d to t h e cause of P u b l i c H e a l t h in general, b y t h e late Sir George Elliston. H e h a d been a sancere friend of t h e G r o u p a n d it was largely owing to his efforts t h a t t h e School D e n t i s t s ' Society was a m a l g a m a t e d w i t h t h e Society of Medical Officers' of H e a l t h in ~92r. T h e m e e t i n ~ stood in silence a s a t o k e n of respect for his m e m o r y . M i n u t e s . - - T h e M i n u t e s of t h e p r e v i o u s General Meeting were read, a p p r o v e d a n d signed. Apologies for a b s e n c e were received front t h e P r e s i d e n t (Mr. S. B. Newton), Miss Forrest, Messrs. Fletcher, R o b e r t s o n , Dinsdale, Duffield, F l e m i n g , Sykes a n d J. Y o u n g . Acrylic Filling Materials T h e C h a i r m a n t h e n i n t r o d u c e d Mr. G. A. M o r r a n t , B.D.S., D.D.S., H e a d of t h e D e p a r t m e a t of C o n s e r v a t i v e D e n t i s t r y a t t h e E a s t m a n D e n t a l H o s p i t a l , a n d called u p o n h i m to s p e a k o n t h e a b o v e subject. Mr. M o r r a n t , w h o i l l u s t r a t e d his ~talk t h r o u g h o u t w i t h a series of excellent l a n t e r n slides, said t h a t in t h e l a b o r a t o r y acrylic resins for artificial d e n t u r e s were processed b y th~ a p p l i c a t i o n of h e a t a n d p r e s s u r e for a considerable t i m e . F o r direct fillings in t h e m o u t h , s u c h a t e c h n i q u e was impossible a n d t h e principle e m p l o y e d was to use m o n o n l e r p l u s p o l y m e r t o g e t h e r w i t h a n a c t i v a t o r . It w a s n e c e s s a r y a t t h e s a m e t i m e to find s o m e m e t h o d of controlling s h r i n k a g e . T h e r e w a s t h r e e t y p e s oI acrylic filling materials. Type I (amino-peroxide) c o n t a i n e d a t e r t i a r y a m i n e in t h e m o n o m e r a n d h y d r o g e n peroxide in t h e p o l y m e r . T h e first of t h e s e m a t e r i a l s was i n t r o d u c e d into this c o u n t r y following r e s e a r c h work in G e r m a n y . T h e a c t i v a t o r was fry t h e liquid, a n d polymer~sation s : a r t e d a t t h e periphery, a n d as a r e s u l t serious s h r i n k a g e took place. F u r t h e r m a t e r i a l s followed, u s i n g a n a r o m a t i c a m i n e . T h e s e s e t more q u i c k l y , b u t p r e s s u r e applied b y a :~pecial f o r m of c l a m p was r e q u i r e d a n d discolouration occurred a f t e r a s h o r t t i m e in t h e m o u t h . Another material usinff a trepal ester in t h e m o n o m e r a p p e a r e d less Iiable to discolouration. T y p e II acrylics used a s u l p h u r i c acid a c t i v a t o r , b u t as t h i s was u n s t a b l e a n d affected b y m o i s u t r e it was p u t u p in a n oily silicone base. T h e colour s t a b i l i t y in t h i s t y p e of m a t e r i a l was m u c h grea~er. T y p e I I I (Sulphur-peroxide) u s e d a l a u r y l m e r c a p t a n activ a t o r p u t u p in t a b l e t f o r m w i t h b e n z o y l peroxide in t h e polymer. T h e a d v a n t a g e of t h i s • was t h a t it was less affected b y m o i s t u r e , a n d t h e t e c h n i q u e for its use was to soak t h e t a b l e t of a c t i v a t o r in a few drops of m o n o m e r a n d t h e n to a d d t h e powder, m i x i n g t h e m t o g e t h e r on a slab. A silicone barrier c r e a m was p r o v i d e d for use w i t h cellulose a c e t a t e strips. R e c e n t l y a neyr T y p e I m a t e r i a l h a d b e e n i n t r o d u c e d . It h a d been believed t h a t t h e diseolouration in this t y p e of acrylic h a d b e e n d u e to i m p u r i t i e s in t h e tertiary a m i n e a g d claims were ~ow m a d e t o h a v e prodk~ced a colour stable filling material. Mr. M o r r a n t said t h a t control of s h r i n k a g e could be considered u n d e r two h e a d i n g s ; t e c h n i q u e , a n d t h e use of adhesives. O n e ;technique was a us,e of p r e s s u r e applied wKh t h e finger or b y m e a n s of a c l a m p or c o m p o s i t i o n m a t r i x . For Type I the brush method had been advocated. A fine
HEALTH,
A u g u s t , 1954
122. S c h o o l H e a l t h S e r v i c e . - (a) T h e question of t h e n e e d to refer m a t t e r s relating to the School H e a l t h Service to g r o u p s other t h a n t h e School H e a l t h Service g r o u p was carefully considered a n d it Was agreed that there was no necessity to change t h e p r e s e n t procedure. (b) It was reported that the British Medical Association h a d h a d its attention called to a p r o b l e m arising in connection with alleged n o n - c o o p e r a t i o n b e t w e e n t h e School H e a l t h Service and General Practitioners with regard to the referal of children by t h e School Health Service to c o n s u l t a n t s a n d specialists. It was resoh'ed that t h e Medical Officer of H e a l t h in q u e s t i o n be informed that t h e existing arrangemerits in his area were n o t in accordance with t h e agreem e n t b e t w e e n the Society and t h e B . M . A . , a n d that therefore t h e Society w o u l d s u p p o r t a n y action taken by t h e Public H e a l t h C o m m i t t e e of that organisation. 123. C o n f e r e n c e o n V e n e r e a l D i s e a s e s . - - I t was reported that a letter, dated 26th F e b r u a r y , f r o m the B.M.A. h a d invited the Society to appoint representatives to attend a Conference on Venereal Diseases. A f t e r consultation w i t h t h e C h a i r m a n , t h e following m e m b e r s h a d been invited to r e p r e s e n t t h e S o c i e t y : Drs. E. B. Argles, L. M e r e d i t h Davis, F. Hall, R. C. M. Pearson, J. S. Logan, T . R u d d o c k West. Representatives of t h e Public H e a l t h C o m m i t t e e a n d Venereologists G r o u p C o m m i t t e e of the B.M.A. also a t t e n d e d t h e Conference, t o g e t h e r with representatives of the Medical Society for the S t u d y of Venereal Diseases. T h e C o m m i t t e e h a d before it the M i n u t e s o f t h e Conference, a n d it was resolved to approve t h e r e c o m m e n d e d Joint S t a t e m e n t of Policy as follows : (1) Social work s h o u l d be an integral part of t h e V.D. Service - - t h i s principle h a s b e e n expressed b y a large majority of p h y sicians in charge of V.D. Clinics. [2) T h e Staff of every clinic s h o u l d be s u c h as to e n s u r e that social work can be u n d e r t a k e n b y a suitably experienced person or p e r s o n s w h o s h o u l d r e m a i n attached to t h e s a m e clinic or clinics w i t h o u t b e i n g c h a n g e d m o r e f r e q u e n t l y t h a n is absolutely necessary. (3) Social work u n d e r t a k e n at t h e clinic s h o u l d i n c l u d e interviewing patients at t h e clinic, s e c u r i n g t h e attendance, b y visit or otherwise, of contacts, i.e. p e r s o n s k n o w n or believed to be sources of venereal infection, a n d securing t h e r e - a t t e n d a n c e of p e r s o n s w h o have d i s c o n t i n u e d t r e a t m e n t p r e m a t u r e l y . (4) Staff elagaged on social work s h o u l d carry o u t their duties in the area served b y t h e clinic w i t h o u t strict regard to local a u t h o r i t y boundaries. (5) T h e cost of p r o v i d i n g staff for social work in t h e V.D. service m i g h t , in certain c i r c u m s t a n c e s , be a p p o r t i o n e d b e t w e e n t h e hospital a u t h o r i t y a n d t h e local h e a l t h a u t h o r i t y concerned, on an agreed basis. W h e r e m o r e t h a n one local a u t h o r i t y is concerned, the cost m i g h t well be shared according to population. (6) W i t h t h e object of securing full co-operation between venereologists a n d medical officers of h e a l t h in t h e p r e v e n t i o n of venereal diseases, a r r a n g e m e n t s should be m a d e w h e r e possible for venereologists in charge of clinics to be attached to t h e public health d e p a r t m e n t s of t h e local health authorities of t h e areas served by their clinics ; a n d that the p r o c e d u r e described in parag r a p h 6 of M i n i s t r y of H e a l t h circular 5/48, for protecting medical officers e n g a g e d in V.D. work f r o m actions for s l a n d e r etc. be applied to venereologists attached to public health d e p a r t m e n t s for the above purpose. (7) (i) W i t h t h e object of securing a f u r t h e r d i m i n u t i o n in t h e incidence of congenital syphilis, every effort s h o u l d be m a d e in hospitals, ante-natal clinics, a n d general practice : (a) to extend t h e practice of t e s t i n g p r e g n a n t patients for venereal disease, n o t only in their first b u t also in s u b s e quent pregnancms ; (b) to seek t h e co-operation of the c o n s u l t a n t venereologist in a n y ease of d o u b t . (ii) Special attention s h o u l d be given to t h e i m p o r t a n c e of avoiding delay in r e p o r t i n g the results of tests. 124. ]VIental I l l n e s s a n d M e n t a l D e f i c i e n c y . - - A letter, dated 27th F e b r u a r y , invited the Society to s u b m i t evidence to t h e Royal C o m m i s s i o n on t h e L a w Relating to M e n t a l Illnes~ a n d M e n t a l Deficiency. It was resolved that t h e following be appointed a S u b - C o m m i t t e e to prepare evidence in this c o n n e c t i o n : Drs. H. K. Cowan, F. Hall, J. S. Logan, A. A. E. N e w t h , E. M. Jenkins and L l y w e l y n Roberts. 125. A c c i d e n t s i n t h e H o m e . - - A letter, dated 15th M a r c h , f r o m Dr. J. B. S. M o r g a n , in his capacity as H o n . Secretary of t h e Sheffield P r e - L i a i s o n C o m m i t t e e , was referred to t h e M a t e r nity a n d Child Welfare G r o u p . 126. R e g i s t r a r G e n e r a l ' s Q u a r t e r l y R e t u r n . - - I t was reported that a letter, dated 25th M a r c h , f r o m t h e Registrar General i n f o r m e d t h e Society that it was p r o p o s e d to d i s c o n t i n u e Publica-
187 tion of the Quarterly Figures of Population, Births, D e a t h s and M a r r i a g e s in Counties, Great T o w n s , and Smaller Toxx ns, xxhich at p r e s e n t appeared in T a b l e s IV, V and "VI of the Quarterly R e t u r n . It was resoh'ed that no objections be raised to the proposals. 127. V i s i t o f B r i t i s h D o c t o r s to t h e U . S . S . R . - ~ It was reported that a letter h a d been received from t h e Society for Cultural Relations avith t h e U.S.S_R. referring to an invitation for twenty British medical m e n and w o m e n to \~isit the Soviet U n i o n in S e p t e m b e r this year. T h e letter invited the Society to forward s o m e n a m e s for consideration by the organising committee. It was resolved that the invitation be left over for the consideration of t h e Council. 128. C e r t i f i c a t e of F e v e r N u r s i n g . - - A letter, dated 30th M a r c h , f r o m t h e E d u c a t i o n Officer, G e n e r a l N u r s i n g Council, forwarded for :the c o m m e n t s of the Society a copy of the s u g g e s t e d revised syllabus of subjects for e x a m i n a t i o n s for the Certificate of F e v e r N u r s i n g . It was resoh'ed that t h e m a t t e r be referred to the F e v e r G r o u p , with power to act. 129. C o m m i t t e e P r o c e d u r e . It was resoh'ed to recommend that t h e Officers of the Society be appointed a Sub C o m m i t t e e to consider t h e q u e s t i o n of C o m m i t t e e procedure, with special reference to t h e confidentiality of r e c o m m e n d a t i o n s to the Council, m a d e by the General P u r p o s e s C o m m i t t e e , a n d to the s u g g e s t i o n b y the Editor of Public H e a l t h that in future the M i n u t e s of t h e General P u r p o s e s C o m m i t t e e and of t h e Council should n o t be p u b l i s h e d in full in Public Health, b u t that an abbreviated report o f t h e b u s i n e s s transacted at t h e m e e t i n g s s h o u l d appear shortly after t h e M e e t i n g s . 130. R e p r e s e n t a t i o n . - - A . Handicapped Children.--A letter, dated 28th F e b r u a r y , from Dr. S i m o n Y u d k i n , invited t h e Society to a p p o i n t a representative to a Conference to be held at C h u r c h H o u s e , W e s t m i n s t e r , on Saturday, 8 t h M a y , at w h i c h w o u l d be considered t h e p r o b l e m of children suffering f r o m m e n t a l or bodily handicap. It was resolved t h a t Dr. A. A. E. N e w t h be a p p o i n t e d t h e Society's representative on this occasion. B. T h e following were appointed representatives of the Society : i. B.S.I. Sub-committee--Examination a n d P h y s i o t h e r a p y C o u c h e s . Dr. A. A. E. N e w t h . ii. Central Council for Health Education--Council 1954/55. Dr. E. K . M a c d o n a l d a n d D r . H . C. M a u r i c e Williams. iii. Registered Plumbers Association--Council, N o t t i n g h a m , J u n e 4th. Dr. William D o d d . iv. Regional Housing and Planning Conference--London Region, W e d n e s d a y , 26th M a y . Dr. F. M. May. T h e r e being no other b u s i n e s s the m e e t i n g closed at approxim a t e l y 12.55 p . m . APPENDIX C
COMMITTEE
ON AIR POLLUTION
Introduction
T h e Society of Medical Officers of H e a l t h have pleasure in s u b m i t t i n g a m e m o r a n d u m to the C o m m i t t e e on Air Pollution. N o a t t e m p t has been m a d e to include all the possible considerations w h i c h the Society could b r i n g before the notice of the C o m m i t t e e , for it is k n o w n that t h e C o m m i t t e e have received evidence f r o m a n u m b e r of bodies (particularly t h e National S m o k e A b a t e m e n t Society) with w h i c h m e m b e r s of the Society find t h e m selves, speaking generally, in broad agreement. It is intended, therefore, that t h e Society's evidence shall be brief. T h e Society offers its fullest co-operation in a t t e m p t i n g to p r e v e n t a n d to deal with p r o b l e m s of air pollution. In particular t h e Society wishes to state that medical officers of health arc p r i m arily responsible u n d c r the Sanitary Officers' Regulations (Article 17) 1935, " to keep themselves i n f o r m e d on all matters . . . likely to affect t h e p u b l i c health in the district a n d be prepared to advise t h e local a u t h o r i t y on a n y s u c h m a t t e r . " F o r m a n v years the Society collectively, and its m e m b e r s individually, l~a,:e striven against great difficulties to b r i n g a b o u t a cleaner a t m o s p h e r e and t h e y will do all in their power n o w a n d in t h e future to assist t h e C o m m i t t e e in every possible way. Legislation
T h e Society considers there is n e e d for a consolidation fo legislation on the subject of air pollution ; that it should be simple a n d clear in e n f o r c e m e n t and a d m i n i s t r a t i o n a n d that it s h o u l d be n a t i o n w i d e in extent. It is s u g g e s t e d that s m o k e is a social n u i s a n c e a n d that it should be regarded, by the very fact of. its existence, as a legal nuisance. Subject to provisos that a slight emission of s m o k e of less t h a n 2 R i n g l e m a n n (and for certain periods of lighting up, soot-blowing a n d " excepted " processes) s m o k e s h o u l d be regarded as a legal n u i s a n c e i n d e p e n d e n t of its colour, d e n s i t y or duration.
188 T h e r e is need for simplification a n d clarification of t h e law relating to s m o k e f r o m locomotives. Industrial Aspects It is r e c o m m e n d e d that an attack be m a d e first on industrial smoke. M a n y firms are co-operating by t h e installation of m o d e r n e q u i p m e n t . I n this connection it m a y be pointed o u t that while it is u n d e r s t o o d that t h e installation of n e w p l a n t is s u b j e c t to tax relief, efficient m a i n t e n a n c e of s u c h plant is not. It is felt that those firms w h i c h seek to i m p r o v e their existing plant b y alterations s h o u l d receive s o m e tax relief. W i t h regard to t h e " excepted " processes, it will be recognised that the p r e s e n t list is o u t of date a n d the Society will s u p p o r t t h e call for a complete review of all the processes regarded as " excepted." T h e Society recognises the value of alkali inspectorate a n d w o u l d w e l c o m e an increase in t h e n u m b e r of s u c h inspectors. It is s u g g e s t e d that this inspectorate, whilst based on central h e a d quarters, s h o u l d have regional offices in the largest centres of population, so that t h e advice of these inspectors could be m o r e readily available. A decisive increase will be necessary in the scale of p r e s e n t m e a s u r e s for the training of staff, s u c h as stokers, w i t h t h e object of l e s s e n i n g industrial smoke. S o m e i n d u c e m e n t of a material k i n d s h o u l d be offered to m e n w h o successfully u n d e r t a k e s u c h a course a n d are g r a n t e d a certificate, A t p r e s e n t t h e rewards vary widely f r o m nil u p w a r d s . T h e Soei'ety is greatly c o n c e r n e d over t h e gaseous a n d particulate matter emitted f r o m p o w e r station c h i m n e y s controlled by the British Electricity A u t h o r i t y . It records its alarm at the building o f so m a n y p o w e r stations in areas w h e r e there is a large p o p u l a tion. T h e Society is far f r o m satisfied t h a t t h e m e a s u r e s in u s e for precipitating t h e particulate m a t t e r are as efficient as they s h o u l d be, whilst even greater concern is expressed over the possible h a r m f u l effects of t h e wide d i s s e m i n a t i o n of gasses s u c h as oxides of s u l p h u r . It is n o t e d that t h e e m i s s i o n of s u l p h u r dioxide can be as h i g h as t e n million cubic feet p e r day a n d t h e Society earnestly h o p e s t h a t the C o m m i t t e e ' s r e c o m m e n d a t i o n s will lead to t h e a b a t e m e n t of w h a t m i g h t be a serious d a n g e r to health. Domestic Smoke T h e Society r e c o m m e n d s that t h e C o m m i t t e e will favourably consider i n d u c e m e n t s to t h e householder, w h e t h e r in m u n i c i p a l l y or privately o w n e d houses, to use m o d e m appliances (where these are n o t already installed) a n d to t h e use of smokeless fuel. It reeognises t h a t m u c h education of t h e public is n e e d e d to this e n d a n d it pledges itself t h a t it will do all in its p o w e r to f u r t h e r this end. It is appreciated, however, that m u c h will d e p e n d on r e d u c i n g the price a n d i m p r o v i n g t h e reactivity a n d o t h e r qualities of smokeless fuels. T h e Society believes in the i m p l e m e n t a t i o n a n d extension of policy of smokeless zones a n d has h e a r d f r o m its m e m b e r s favourable reports of t h e w o r k i n g of the " condition of t e n a n c y " clause in Council estates, w h e r e b y smokeless fuel only is b u r n t . T h e Society wishes to reinforce the evidence of o t h e r bodies in r e q u e s t ing t h a t there be provision for smokeless zone p o w e r s in general legislation. Research T h e Society u r g e s strongly the necessity of research into m a n y aspects of air pollution. It deplores t h e ignorance of f u n d a m e n t a l facts in p r e s e n t knowledge. It w o u l d u r g e that t h e help o f U n i v e r s i t y D e p a r t m e n t s be engaged in carrying o u t f u r t h e r research on the effect of t h e various pollutants u p o n h u m a n and animal h e a l t h a n d u p o n agriculture. It w o u l d p o i n t o u t that a b o d y s u c h as t h e M e d i c a l R e s e a r c h Council m i g h t well initiate research into the differential incidence of respiratory disease and m o r t a l i t y in various centres of population t h r o u g h o u t the country. It is noted, for instance, t h a t the incidence of chronic bronchitis appears to be over f o u r t i m e s as h i g h in s o u t h - e a s t L a n c a s h i r e as in c o u n t r y areas. It s u g g e s t s that ~reas be chosen w h e r e t h e r e is a h i g h rate of a t m o s p h e r i c pollution as c o m p a r e d with control areas of low or m i n i m a l pollution. It suggests that research (both retrospective a n d prospective) in vital statistics m i g h t yield valuable results. Lastly, t h e Society is m u c h c o n c e r n e d w i t h the i m p l e m e n t a t i o n of t h e r e c o m m e n d a t i o n s w h i c h t h e C o m m i t t e e will make, r e m e m b e r i n g t h e fate of several previous reports. It e a m e s t l y h o p e s that t h e r e c o m m e n d a t i o n s of t h e C o m m i t t e e on A i r Pollution will be effective a n d acceptable. It r e c o m m e n d s that a p e r m a n e n t d e p a r t m e n t be instituted, possibly as a section~of t h e M i n i s t r y of H o u s i n g a n d Local G o v e r n m e n t , w h i c h will be c h a r g e d w i t h t h e task of carrying o u t a n d e x t e n d i n g t h e C o m m i t t e e ' s r e c o m m e n d a tions on this m o s t i m p o r t a n t aspect of e n v i r o n m e n t a l hygiene.
PUBLIC
HEALTH,
A u g u s t , 1954
DENTAL OFFICERS GROUP President: Mr. S. B. N e w t o n , L.D.S. H o n . S e c r e t a r y : Mr. J. F. A. S m y t h , L.D.S. (P.S.D.O.), Gloucestershire. An E x t r a o r d i n a r y General M e e t i n g of t h e G r o u p was held in t h e Old L i b r a r y , B . M . A . H o u s e , L o n d o n , on S a t u r d a y , M a r c h 2oth, I95. t. I n 7the a b s e n c e of t h e P r e s i d e n t , t h e Vice-President, Mr. K . C. B. W e b s t e r , presided a n d was s u p p o r t e d b y t e n o t h e r m e m b e r s a n d visitors. The Hon. S e c r e t a r y i e a d t h e notice c o n v e n i n g t h e m e e t i n g a n d r e a d t h r o u g h t h e p r o p o s e d Group R u l e s as revised b y a special s u b - c o m n f i t t e e a n d a p p r o v e d b y t h e Group Council. The C h a i r m a n e x p l a i n e d t h a t the a l t e r a t i o n s were m i n o r ones a n d b r o u g h t t h e G r o u p R u l e s up to date. T h e only significant c h a n g e was t h e p r o p o s a l t h a t t h e ?title of t h e G r o u p s h o u l d be altered to "' D e n t a l G r o u p '" O n t h e proposition of Mr. S m y t h s e c o n d e d b y Mr. R u b r a , t h e n e w rules were agreed to by t h e u n a n i m o u s v o t e of t h o s e m e m b e r s present. A m e e t i n g of t h e G r o u p was held a t B . M . A . House, on t h e a f t e r n o o n of S a t u r d a y , M a r c h 20th, w h e n in t h e absence of t h e P r e s i d e n t o w i n g to illness, Mr. K. C. B. W e b s t e r occupied t h e chair. I n all, t h e r e was a n a t t e n d a n c e of 1~ m e m b e r s a n d visitors. O b i t u a r y . - - T h e C h a i r m a n s p o k e of t h e m a n y years of d e v o t e d service given ?to t h e Society, a n d to t h e cause of P u b l i c H e a l t h in general, b y t h e late Sir George Elliston. H e h a d been a sancere friend of t h e G r o u p a n d it was largely owing to his efforts t h a t t h e School D e n t i s t s ' Society was a m a l g a m a t e d w i t h t h e Society of Medical Officers' of H e a l t h in ~92r. T h e m e e t i n ~ stood in silence a s a t o k e n of respect for his m e m o r y . M i n u t e s . - - T h e M i n u t e s of t h e p r e v i o u s General Meeting were read, a p p r o v e d a n d signed. Apologies for a b s e n c e were received front t h e P r e s i d e n t (Mr. S. B. Newton), Miss Forrest, Messrs. Fletcher, R o b e r t s o n , Dinsdale, Duffield, F l e m i n g , Sykes a n d J. Y o u n g . Acrylic Filling Materials T h e C h a i r m a n t h e n i n t r o d u c e d Mr. G. A. M o r r a n t , B.D.S., D.D.S., H e a d of t h e D e p a r t m e a t of C o n s e r v a t i v e D e n t i s t r y a t t h e E a s t m a n D e n t a l H o s p i t a l , a n d called u p o n h i m to s p e a k o n t h e a b o v e subject. Mr. M o r r a n t , w h o i l l u s t r a t e d his ~talk t h r o u g h o u t w i t h a series of excellent l a n t e r n slides, said t h a t in t h e l a b o r a t o r y acrylic resins for artificial d e n t u r e s were processed b y th~ a p p l i c a t i o n of h e a t a n d p r e s s u r e for a considerable t i m e . F o r direct fillings in t h e m o u t h , s u c h a t e c h n i q u e was impossible a n d t h e principle e m p l o y e d was to use m o n o n l e r p l u s p o l y m e r t o g e t h e r w i t h a n a c t i v a t o r . It w a s n e c e s s a r y a t t h e s a m e t i m e to find s o m e m e t h o d of controlling s h r i n k a g e . T h e r e w a s t h r e e t y p e s oI acrylic filling materials. Type I (amino-peroxide) c o n t a i n e d a t e r t i a r y a m i n e in t h e m o n o m e r a n d h y d r o g e n peroxide in t h e p o l y m e r . T h e first of t h e s e m a t e r i a l s was i n t r o d u c e d into this c o u n t r y following r e s e a r c h work in G e r m a n y . T h e a c t i v a t o r was fry t h e liquid, a n d polymer~sation s : a r t e d a t t h e periphery, a n d as a r e s u l t serious s h r i n k a g e took place. F u r t h e r m a t e r i a l s followed, u s i n g a n a r o m a t i c a m i n e . T h e s e s e t more q u i c k l y , b u t p r e s s u r e applied b y a :~pecial f o r m of c l a m p was r e q u i r e d a n d discolouration occurred a f t e r a s h o r t t i m e in t h e m o u t h . Another material usinff a trepal ester in t h e m o n o m e r a p p e a r e d less Iiable to discolouration. T y p e II acrylics used a s u l p h u r i c acid a c t i v a t o r , b u t as t h i s was u n s t a b l e a n d affected b y m o i s u t r e it was p u t u p in a n oily silicone base. T h e colour s t a b i l i t y in t h i s t y p e of m a t e r i a l was m u c h grea~er. T y p e I I I (Sulphur-peroxide) u s e d a l a u r y l m e r c a p t a n activ a t o r p u t u p in t a b l e t f o r m w i t h b e n z o y l peroxide in t h e polymer. T h e a d v a n t a g e of t h i s • was t h a t it was less affected b y m o i s t u r e , a n d t h e t e c h n i q u e for its use was to soak t h e t a b l e t of a c t i v a t o r in a few drops of m o n o m e r a n d t h e n to a d d t h e powder, m i x i n g t h e m t o g e t h e r on a slab. A silicone barrier c r e a m was p r o v i d e d for use w i t h cellulose a c e t a t e strips. R e c e n t l y a neyr T y p e I m a t e r i a l h a d b e e n i n t r o d u c e d . It h a d been believed t h a t t h e diseolouration in this t y p e of acrylic h a d b e e n d u e to i m p u r i t i e s in t h e tertiary a m i n e a g d claims were ~ow m a d e t o h a v e prodk~ced a colour stable filling material. Mr. M o r r a n t said t h a t control of s h r i n k a g e could be considered u n d e r two h e a d i n g s ; t e c h n i q u e , a n d t h e use of adhesives. O n e ;technique was a us,e of p r e s s u r e applied wKh t h e finger or b y m e a n s of a c l a m p or c o m p o s i t i o n m a t r i x . For Type I the brush method had been advocated. A fine