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General Purposes Committee
182
THE SOCIETY OF MEDICAL OFFICERS OF HEALTH
P U B L I C H E A L T H , July, 1942
Representation of the Society.--The following were elected to represent the Society: B.M.A. Council--Prof. R. M. F. Picken and Dr. T. N. V. Ports. B.M.A. Representative Body--Drs. G , F. Buchan, J. W. Hunter, J. Fenton and J. M. Gibson. National Milk COUNCIL M E E T I N G Publicity Council--Dr. T. Oar. Central Council for the Care of A meeting of the Council was held at Tavistock House, Tavistock • Cripples--Dr. D. H. Geffen. Central Midwives B o a r d q D r . J. J. Square, London, W.C.1, on May 15th, 1942, with the President Buchan. Joint Committee for Matters Concerning the Midwifery (Sir Alexander Macgregor) in the chair. Profession--Dr. T. Ors. There were present: Drs. J. S. Anderson, Cyril Banks, H, Dismissal of a County Medical Officer of Health.--Dr. J. A. Charles Stanley Banks, G. F. Buchan, J. J. Buchan, H. W. Catto, J. A. reported the final steps in connection with the sanction of the Charles, J. Fenton, J. Ferguson, D. H. Geffen, J. M. Gibson, A. G. Ministry of Health for the dismissal of a county medical officer of Glass, C. E. Herington, J. W. Hunter, Sir Wilson Jameson, Drs. health. After some discussion of various matters arising out of R. Iq. H. Jolly, A. W. Johns, G. Lilico, T. Orr, Prof. R. M. F. the inquiry which might affect the future status and responsibilities Picken, Drs. T. N. V. Ports, E. Virginia Saunders-Jacobs; F. A. of medical officers of health, it was stated that attention had been Sharpe, J. A. Stirling, J. A. Struthers, R. Sutherland, Mr. A. Gordon drawn to these matters in the proper quarter. T h e Council decided Taylor, Drs. E. W. Caryl Thomas, FI..G. Trayer, E. Ward, H. to put on record their appreciation of the great services rendered Gibbons W a r d , H. C. Mauriee Williams, and F. T. H . Wood. by Dr. J. A. Charles and Dr. Charles Hill (B.M.A.) during the Apologies for absence were received from Sir Francis Fremantle, various stages of the inquiry, and of the attendance of the President Dr." J. E. Spence, and Dr. C. F. White. to give evidence. In opening the meeting the President expressed the pleasure of T h e Council then adjourned. the Council at Capt. Elliston's return to his duties as acting Executive Secretary after his recent operation. He added that they were GENERAL PURPOSES COMMITTEE deeply indebted to Lieut. G. L. C. Elliston, mN.v.a., for securing I. A meeting of the General Purposes Committee was held at compassionate leave so that he could attend to the Society's affairs Tavistock House, Tavistoek Square, London, W.C.1, on May 15th, during the absence of his deputy. 1942. S i r Henry Brackeubury.--The President referred to the loss Present.--Dr. Cyril Banks (chairman), Drs. J. S. Anderson, sustained by the Society b y the death of Sir Henry Brackenbury, G. F. Buchan, J. J. Buehan, J. A. Charles, James Fenton, J. Ferguson, who for so many years was a representative of the B.M.A. on the R. H. H. Jolly, Gordon Lilieo, Sir Alexander Macgregor, Prof. Council. They would all remember Sir Henry as a valued friend R. M. F. Pieken, Drs. T. N. V. Putts, E. Virginia Saunders-Jacobs, of the Public Health Service. A vote of condolence with the family J. A. Stifling, R. Sutherland, E. Ward, H. Gibbons Ward, H. C. was passed by the Council, the members standing in a silent tribute. Report of the General Purposes Committee.--Dr. Cyril Banks Mauriee Williams, and F. T. H. Wood. 2. Minutes of the meeting held February 20th, 1942 (printed (chairman) reported the business transacted by this Committee in PUBLIC HEALTH, April, 1942) were confirmed and signed. earlier in the day, as recorded above. T h e Council approved and 3. Medical Superintendents' Society.--A deputation from this adopted the report with the exception of the paragraph in reference Society (Dr. Peter Edwards, Dr. H. A. Kidd, Dr. Stanley Banks, to the compulsory notification of scabies. It was agreed that the and Dr. Ernest C. Hadley) attended to submit suggestions for coletter in this. connection from the U r b a n District Councils Assooperation with the Society of Medical Officers of Health. After an ciation should be referred back to the Committee for further exchange of information regarding the respective constitutions of consideration. the two bodies, it was agreed that the Committee recommend the T h e Council elected Sir Alexander Macgregor, Dr. Cyril Banks, Council to appoint a small committee to meet representatives of the Dr. J. Ferguson, Dr. J. b e n t o n and Dr. J. A. Charles to meet repreMedical Superintendents' Society to consider whether and how sentatives of the Medical Superintendents' Society to consider closer relations could be established between the Societies. possibilities of co-operation between the two bodies. 4. Salary Cuts.---Correspondence was reported from the British Dr. Vynne Borland.~The Council accepted with great regret Medical Association and the British Dental Association in reference the resignation of Dr. Borland owing to ill health, and expressed to the continuation for senior medical and dental officers of the their good wishes for his early recovery. It was agreed that the salary reductions enforced by a county council under the Geddes Metropolitan Branch should fill the vacancy on the Council caused economy scheme of 1921. Although the salaries offered by the by Dr. Borland's retirement. Central Councilfor Health Education.--Owing to pressure of work county council for new appointments have complied with t h e Askwith scale, it has been decided by the professional associations in connection with educational schemes arising out of war condithat advertisements for future vacancies will not be accepted for tions, the Central Council had asked the Society to select repretheir journals while the Geddes cuts are still retained for senior sentatives who could be relied upon for frequent attendance. Present officers. members able to comply with this request were Drs. W. A. Daley, 5. Scabies Order, 1941.--The Borough Medical Officers C o m James Fenton, J. Macmillan, T. Orr, R. P~ Garrow, Maitland mittee submitted a summary of replies to a questionnaire as to t h e Radford, Ernest Ward and Mr. J. F. Pilbeam, L:D.S. This left six vacancies. It was agreed that two of these should be reserved for treatment of scabies by hospitals, chemists and doctors, from 22 metropolitan medical officers of health as follows : ~ representatives to be elected by the Association of County Medical Treatment in Hospitals.~The views expressed are that in most boroughs Officers on the understanding that such representatives would be there, is adequate co-operation between hospitals and the public health usually available for attendance at meetings. T h e remaining four department. Seven replies, however, state that cases are at times treated vacancies were filled by ballot from a list of members nominated without the knowledge of the department, and in three of these it is .stated that this, however, refers to a few cases only, but m two cases it ts eonstdered by the Branches. Three members--viz., Drs. J. F. Galloway, that it amounts to a considerable number. D. H. Geffen, and G. Macdonald--were elected outright but for Treatment by Chemists.--Most of the replies are indefinite,about the extent the fourth place there was equal voting for Drs. J. Greenwood of this practice. In two cases, however, defimte opinion ts expressed that a considerable number of persons attend and receive treatment from chemistt. Wilson, J. W. Hunter, and Hugh Paul. It was agreed that each of A few replies state that the majority of such cases probably eventually reach them should be asked to notify his readiness t u serve and whether the public health department, as a result of unsatisfactory treatment. he could conveniently attend the frequent meetings. Replies to Treatment by Doctors.--Mnst of the revlies have stated that cases are generally referred by doctors to the public health departments, but in clime eases this inquiry would be considered by the President, Dr. Cyril Banks the replies'iodicate that this is not by any means always the case, andin three and the Executive Secretary, and their final selection for the fourth cases tt is stated that there are probably a considerable number of exceptions. vacancy reported to C o u n c i l In most cases the opinion has been expressed that treatment by chemists or doctors without co-operation of the public health departments may be T h e Central Council desire that the Executive SecreUary of the regarded generally as ur~atisfactory. Society or his deputy should continue to serve as liaison officer T h e Borough Medical Officers Committee further reported that between the two bodies. I~aflets and Directions for National Dried Milk.--As requested after consultation with the Secretary of the Pharmaceutical Society by Council, the Maternity and Child Welfare Group submitted a they recommended ( 1 ) t h a t a letter should be addressed to the Pharmaceutical ~ournal indicating the pernicious nature of scabies draft leaflet, based on the collective experience of their members, and how essential a thorough treatment is, and advising chemists for distribution to mothers and nurses with supplies of the National Dried Milk. T h e Council thanked the Group for their help in to direct any sufferers with whom they come in contact to the public this matter and agreed that the draft should be forwarded to the facilities available for t r e a t m e n t ; and (2) that a pamphlet should be prepared suitable for distribution to the public through chemists' Ministry of Food and the Ministry of Health. President for Session 1942-43.--On the unanimous nomination of shops. T h e recommendations Were approved for adoption by the Council, and it was agreed to ask the Central Council for Health the Branches the Council decided to recommend Dr. Cyril Banks for election as President of the Society for the session 1942-43. Education to prepare and distribute a suitable pamphlet. T h e following report from the British Association of Dermatology Vice-Presidents and Hon. Treasurer for Session 1942-43.--Sir Alexander Macgregor, Dr. F. T . H. Wood and Dr. James Fenton and SypJailology was also considered : were elected Vice-Presidents of the Society for the Session 1942-43. The sub-committees appointed by the Executive Covaaeila of the British Association of Dermatology and Syphilology and the Society of Medical Dr. G. F. Buchan was re-elected Hun. Treasurer.
183
P U B L I C H E A L T H , July, 1942 Officers of Health to consider the present epidemic of scabies met on two occasions at the Royal Society of Medicine. At the first me.etin~ h.eld on
March 20th, 1942, there were present : Dr. MacCormac (in the chair), Dr. Gray, Dr. Semon and Dr. Barber (Secretary), representing the British A n o eiation of Dermatology and syphilology." Dr. F e n t o n , D r . ~Begg end Dr. Bacon, representing the Society of Medical Officers of Health ~ and Lt.-Col. McKenna and Dr. Mellanby, who were invited to attend. At the second meeting herd on April 10th, 1942, the same members of the two sub-committees were present, end Dr. Buchan was also able to attend. Sir Alexander Macgregor could not, unfortunately~be present at either meeting. After considerable discussion, the following proposals were agreed upon :
(1) Notif~ation.--That scabies should be made a nottfi.able disease. (2) Prol~t~tda.MThat steps should be taken to give Instruction Dy means cr suitable methods of propaganda in the nature, mode of spread, symptoms, and principles of prevention and treatment of the disease. (3) Treatment.That owing to the existing shortage of fats, which makes the use of sulphur ointments undesirable, an emulsion of benzyl benzoate should be employed for routine treatmont~viz., benzyl benzoate 25"0, lanette wax 2 0, water to 100'0--and that this emulsion should be applied either on two successive days or on two occasions at an interval of a week. When p.o?mblethe first application should be preceded by a hot hath, in which the skin of the body and limbs should be thoroughly lathered with soap. (4) Disinf~tatioa.-That whenever possible some method of dlsinfestlng the garments and bedclothing should be provided, or that the unclergarments and sheets at any rate should be thoroughly washed at the termination of treatment. (5) Treatmerit Ccntres.--That an adequate number of properly equipped treatment and cleansing stations shouldbe established. The number of those at present available is far too few, and it was agreed that, if scabies is made notifiable, it is essential that full facilities for treatment near thepatient's home should at once be provided. These treatment centres should be equipped with baths, or at least shower-baths, some form of apparatus for disinfestmg the clothing, and an adequate number of trained personnel. It was rcallsed, however, that the provision of a large number of new treatment centres throughout the country would be difficult or impossible under present conditions. It was therefore recommended that, owing to the extreme ur~.ency of the scabies problem, all existing cleansing stations should be made avmlable both for children and adults, and that the gas-decontaminatlon centres should also be utilised for the purpose. Simple apparatus for disinfesting the clothing could doubtless be imprOvised where necessary. (6) Follo~-up System.-That at all treatment centres the patients should be urged to present themselves again for medical inspection one month after their treatment.
Further letters were reported from the U r b a n District Councils Association and others asking whether the Society would be likely to reconsider their decision that the general compulsory notification of scabies was not desirable. T h e C o m m i t t e e decided that their decision m u s t stand until there was adequate provision for treatment of the disease. 6. War-time Increases of Salaries.--The Committee considered replies from the Branches and Groups in reference to the desirability or otherwise of recommending increases of public health salaries during the war. T h e replies showed a preponderance of opinion that a revision of salaries should not be pressed at the present time, but that any war bonus awarded to the staffs of local authorities should be extended to all medical officers, whole-time or pa~'t-time. It was agreed to forward a recommendation to this effect to the Public Health Committee of the British Medical Association, with w h o m the inquiry originated. 7. Scientific Liaison with U . S . S . R . - - D r . E. H. R. Smithard reported his attendance on behalf of the Society at a meeting called by the Ministry of Information to consider scientific liaison with the U.S.S.R. After speeches by Mr. Ernest Thurtle, M.P., Parliamentary Secretary, Ministry of Information, Sir John Russell, F.R.S., and others it wa s agreed nem. con. that a small committee should be elected to organise the desired liaison and to consider ways and means. T h e Committee extended thanks to Dr. Smithard for his report. 8. Proposed /lmalgamation of Tuberculosis Organisations.--A scheme for the establishment of a General Council, by the National Association for the Prevention of Tuberculosis to include within its organisation the Joint Tuberculosis Council and the Tuberculosis Association, was forwarded for the observations of the Society. It was agreed that the scheme would m e a n economy in working and avoidance of duplication and overlapping in the work of the bodies concerned, and that it should be supported, provided that the Society of Medical Officers of Health was given adequate representation on the General Council. 9. White HospitalCoats.--A letter was received from Dr. Cecil B. Hogg (M.O.H., Kettering) asking the Society to press for the a m e n d m e n t of the C o n s u m e r Rationing Order (No. 8), 1941, to e x e m p t from coupon requirements white coats required for fever hospitals and clinics. As this matter has recently been fully ventilated in the House of C o m m o n s and in letters to the Board of Trade, it was agreed that further action would serve no useful purpose for the time being. 10. The Nutrition Society.--A letter from Dr. Leslie J. Harris reported that the Nutrition Society is particularly anxious to interest health departments in its activities and has already enrolled a n u m b e r of medical officers of health in its m e m b e r s h i p . T h e i r immediate wish was to co-opt a representative of the Society on their Council. In reply to this invitation it was agreed to nominate Dr. G. F. Buchan. I 1. Physical Education.--The Federation of Societies of Teachers in Physical Education, representing approximately 3,500 m e n and women teachers of the subiect, wrote expressing their desire to co-operate with the medical profession in order to consider and
discuss questions concerning the health and physique of school children. The Federation suggested the formation of a joint committee with representatives of the Society for this purpose. It was agreed to accept this invitation, and the following were recommended for election by the Council to represent the Society--via., Dr. Oscar Holden (Croydon), Dr. E. Virginia Saunders-Jacobss Dr. R. Suthcrland, and Dr. H. C. Mauricc Williams. 12. Tuberculosis Hospital Accommodation.--The Association of Municipal Corporations invited observations from the Society on a representation from the Stoke-on-Trent City Council urging the provision of additional hospital accommodation for the treatment of persons suffering, from tuberculosis. T h e Tuberculosis Group of the Society strongly endorsed the opinion of the Stoke-on-Trent Council, and it was agreed that the Association of Municipal Corporations should be advised that increased hospital accommodation for tuberculosis cases was urgently necessary a n d that provision should be made therein for proper, specialist "treatment of the disease. 13. Matters Deferred.--Owing to pressure of other business, consideration of correspondence from the Maternity and Child Welfare Group, the Midland Branch and Dr. G. E. B. Payne (M.O.H., Acton) in reference to wartime nurseries, was postponed until the next meeting of the Committee. Also postponed was a m e m o r a n d u m on the p a y m e n t of expenses for attendance at Group m e e t ings, and correspondence from the Yorkshire Branch regarding security of tenure of office for all medical officers. T h e meeting then adjourned. METROPOLITAN
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A joint meeting of the above branches was held on February 13th at Tavistock House, 62 m e m b e r s being present. WHOOPING COUGH PROPHYLAXIS A n address on whooping-cough prophylaxis was given by D r . I. H. Maclean, of the Inoculation D e p a r t m e n t of St. M a r y ' s Hospital. He said that, in c o m p u t i n g results of whooping-cough prophylaxis, all experiences before 1936, at which date Phase I vaccines first became generally available in this country, should be discarded. In his experience, during the last 5 years all b u t 3 of 28 field trials of pertussis vaccine h a d been favourable. Kendrick and Eldering had concluded " that there was a reduction of 60% in the risk of attack in the vaccinated group and an eight-fold increase in the probability of escaping from known exposures " : this had been substantiated by nearly all other trials. A b o u t 70% complete protection from known exposures could be expected, as against a 10-20 % escape rate in controls according to the type of exposure and the severity of the epidemic concerned. In institutions, where exposure was prolonged and heavy, there were more failures in the vaccinated group than among those in street and household exposure. T h e 3 unfavourable trials were in institutions, but there were at least 7 reports from residential children's homes where the protection was found to be up to the 70% standard. Prophylaxis in pertussis was less efficient than in diphtheria. Pertussis, with its explosive cough, its long incubation period, and absence of institutional isolation, gave an exposure to infection of from 5 to 6 weeks, whereas in diphtheria there was less intensive exposure of only 2 to 5 days. T h e i m m u n i t y in pertussis was antibacterial ; in diphtheria it was antitoxic. T h e dosage used in immunisation was i m p o r t a n t : in U.S.A. the Saner method, with 6 injections amounting to a total dose of 80,000 to 160,000 million organisms, was widely practised. D r . Maclean had found that good protection could be obtained by a total of 16,000 to 20,000 million, split up into four spaced doses. If this dosage were too c u m b e r s o m e to use in clinics, good results could be obtained with a dose of 20,000 million given in two properly spaced injections. T h i s was a great convenience, especially as both doses of pertussis vaccine could be combined with the two doses of diphtheria prophylactic (A.P.T.) and spaced at one m o n t h ' s i n t e r v a l Dr. Maclean stressed, however, that this two-dose i m munisation had not had an extensive trial and experience m i g h t alter these views: M a n y day nurseries were now opening, and if they had a perm a n e n t population they would be ideal for field trials of pertussia vaccine. T h e experiments would have to be properly controlled, and the results collected by a central authority. Although pertussis was a war-time problem, it was probably premature to r e c o m m e n d mass immuniaation. Dr. Rawlinson stressed the value of the " boosting " dose, which should follow the normal course, b u t at a m u c h later date. D r . Struthers pleaded for standardisation of research in nurseries and other communities. Dr. Maclean replied, stating that reaction to inoculations varies within wide limits. T h e Medical Research Council had prepared a scheme for immuniaation of the population, b u t this was not in all
THE SOCIETY OF MEDICAL OFFICERS OF HEALTH
P U B L I C H E A L T H , July, 1942
Representation of the Society.--The following were elected to represent the Society: B.M.A. Council--Prof. R. M. F. Picken and Dr. T. N. V. Ports. B.M.A. Representative Body--Drs. G , F. Buchan, J. W. Hunter, J. Fenton and J. M. Gibson. National Milk COUNCIL M E E T I N G Publicity Council--Dr. T. Oar. Central Council for the Care of A meeting of the Council was held at Tavistock House, Tavistock • Cripples--Dr. D. H. Geffen. Central Midwives B o a r d q D r . J. J. Square, London, W.C.1, on May 15th, 1942, with the President Buchan. Joint Committee for Matters Concerning the Midwifery (Sir Alexander Macgregor) in the chair. Profession--Dr. T. Ors. There were present: Drs. J. S. Anderson, Cyril Banks, H, Dismissal of a County Medical Officer of Health.--Dr. J. A. Charles Stanley Banks, G. F. Buchan, J. J. Buchan, H. W. Catto, J. A. reported the final steps in connection with the sanction of the Charles, J. Fenton, J. Ferguson, D. H. Geffen, J. M. Gibson, A. G. Ministry of Health for the dismissal of a county medical officer of Glass, C. E. Herington, J. W. Hunter, Sir Wilson Jameson, Drs. health. After some discussion of various matters arising out of R. Iq. H. Jolly, A. W. Johns, G. Lilico, T. Orr, Prof. R. M. F. the inquiry which might affect the future status and responsibilities Picken, Drs. T. N. V. Ports, E. Virginia Saunders-Jacobs; F. A. of medical officers of health, it was stated that attention had been Sharpe, J. A. Stirling, J. A. Struthers, R. Sutherland, Mr. A. Gordon drawn to these matters in the proper quarter. T h e Council decided Taylor, Drs. E. W. Caryl Thomas, FI..G. Trayer, E. Ward, H. to put on record their appreciation of the great services rendered Gibbons W a r d , H. C. Mauriee Williams, and F. T. H . Wood. by Dr. J. A. Charles and Dr. Charles Hill (B.M.A.) during the Apologies for absence were received from Sir Francis Fremantle, various stages of the inquiry, and of the attendance of the President Dr." J. E. Spence, and Dr. C. F. White. to give evidence. In opening the meeting the President expressed the pleasure of T h e Council then adjourned. the Council at Capt. Elliston's return to his duties as acting Executive Secretary after his recent operation. He added that they were GENERAL PURPOSES COMMITTEE deeply indebted to Lieut. G. L. C. Elliston, mN.v.a., for securing I. A meeting of the General Purposes Committee was held at compassionate leave so that he could attend to the Society's affairs Tavistock House, Tavistoek Square, London, W.C.1, on May 15th, during the absence of his deputy. 1942. S i r Henry Brackeubury.--The President referred to the loss Present.--Dr. Cyril Banks (chairman), Drs. J. S. Anderson, sustained by the Society b y the death of Sir Henry Brackenbury, G. F. Buchan, J. J. Buehan, J. A. Charles, James Fenton, J. Ferguson, who for so many years was a representative of the B.M.A. on the R. H. H. Jolly, Gordon Lilieo, Sir Alexander Macgregor, Prof. Council. They would all remember Sir Henry as a valued friend R. M. F. Pieken, Drs. T. N. V. Putts, E. Virginia Saunders-Jacobs, of the Public Health Service. A vote of condolence with the family J. A. Stifling, R. Sutherland, E. Ward, H. Gibbons Ward, H. C. was passed by the Council, the members standing in a silent tribute. Report of the General Purposes Committee.--Dr. Cyril Banks Mauriee Williams, and F. T. H. Wood. 2. Minutes of the meeting held February 20th, 1942 (printed (chairman) reported the business transacted by this Committee in PUBLIC HEALTH, April, 1942) were confirmed and signed. earlier in the day, as recorded above. T h e Council approved and 3. Medical Superintendents' Society.--A deputation from this adopted the report with the exception of the paragraph in reference Society (Dr. Peter Edwards, Dr. H. A. Kidd, Dr. Stanley Banks, to the compulsory notification of scabies. It was agreed that the and Dr. Ernest C. Hadley) attended to submit suggestions for coletter in this. connection from the U r b a n District Councils Assooperation with the Society of Medical Officers of Health. After an ciation should be referred back to the Committee for further exchange of information regarding the respective constitutions of consideration. the two bodies, it was agreed that the Committee recommend the T h e Council elected Sir Alexander Macgregor, Dr. Cyril Banks, Council to appoint a small committee to meet representatives of the Dr. J. Ferguson, Dr. J. b e n t o n and Dr. J. A. Charles to meet repreMedical Superintendents' Society to consider whether and how sentatives of the Medical Superintendents' Society to consider closer relations could be established between the Societies. possibilities of co-operation between the two bodies. 4. Salary Cuts.---Correspondence was reported from the British Dr. Vynne Borland.~The Council accepted with great regret Medical Association and the British Dental Association in reference the resignation of Dr. Borland owing to ill health, and expressed to the continuation for senior medical and dental officers of the their good wishes for his early recovery. It was agreed that the salary reductions enforced by a county council under the Geddes Metropolitan Branch should fill the vacancy on the Council caused economy scheme of 1921. Although the salaries offered by the by Dr. Borland's retirement. Central Councilfor Health Education.--Owing to pressure of work county council for new appointments have complied with t h e Askwith scale, it has been decided by the professional associations in connection with educational schemes arising out of war condithat advertisements for future vacancies will not be accepted for tions, the Central Council had asked the Society to select repretheir journals while the Geddes cuts are still retained for senior sentatives who could be relied upon for frequent attendance. Present officers. members able to comply with this request were Drs. W. A. Daley, 5. Scabies Order, 1941.--The Borough Medical Officers C o m James Fenton, J. Macmillan, T. Orr, R. P~ Garrow, Maitland mittee submitted a summary of replies to a questionnaire as to t h e Radford, Ernest Ward and Mr. J. F. Pilbeam, L:D.S. This left six vacancies. It was agreed that two of these should be reserved for treatment of scabies by hospitals, chemists and doctors, from 22 metropolitan medical officers of health as follows : ~ representatives to be elected by the Association of County Medical Treatment in Hospitals.~The views expressed are that in most boroughs Officers on the understanding that such representatives would be there, is adequate co-operation between hospitals and the public health usually available for attendance at meetings. T h e remaining four department. Seven replies, however, state that cases are at times treated vacancies were filled by ballot from a list of members nominated without the knowledge of the department, and in three of these it is .stated that this, however, refers to a few cases only, but m two cases it ts eonstdered by the Branches. Three members--viz., Drs. J. F. Galloway, that it amounts to a considerable number. D. H. Geffen, and G. Macdonald--were elected outright but for Treatment by Chemists.--Most of the replies are indefinite,about the extent the fourth place there was equal voting for Drs. J. Greenwood of this practice. In two cases, however, defimte opinion ts expressed that a considerable number of persons attend and receive treatment from chemistt. Wilson, J. W. Hunter, and Hugh Paul. It was agreed that each of A few replies state that the majority of such cases probably eventually reach them should be asked to notify his readiness t u serve and whether the public health department, as a result of unsatisfactory treatment. he could conveniently attend the frequent meetings. Replies to Treatment by Doctors.--Mnst of the revlies have stated that cases are generally referred by doctors to the public health departments, but in clime eases this inquiry would be considered by the President, Dr. Cyril Banks the replies'iodicate that this is not by any means always the case, andin three and the Executive Secretary, and their final selection for the fourth cases tt is stated that there are probably a considerable number of exceptions. vacancy reported to C o u n c i l In most cases the opinion has been expressed that treatment by chemists or doctors without co-operation of the public health departments may be T h e Central Council desire that the Executive SecreUary of the regarded generally as ur~atisfactory. Society or his deputy should continue to serve as liaison officer T h e Borough Medical Officers Committee further reported that between the two bodies. I~aflets and Directions for National Dried Milk.--As requested after consultation with the Secretary of the Pharmaceutical Society by Council, the Maternity and Child Welfare Group submitted a they recommended ( 1 ) t h a t a letter should be addressed to the Pharmaceutical ~ournal indicating the pernicious nature of scabies draft leaflet, based on the collective experience of their members, and how essential a thorough treatment is, and advising chemists for distribution to mothers and nurses with supplies of the National Dried Milk. T h e Council thanked the Group for their help in to direct any sufferers with whom they come in contact to the public this matter and agreed that the draft should be forwarded to the facilities available for t r e a t m e n t ; and (2) that a pamphlet should be prepared suitable for distribution to the public through chemists' Ministry of Food and the Ministry of Health. President for Session 1942-43.--On the unanimous nomination of shops. T h e recommendations Were approved for adoption by the Council, and it was agreed to ask the Central Council for Health the Branches the Council decided to recommend Dr. Cyril Banks for election as President of the Society for the session 1942-43. Education to prepare and distribute a suitable pamphlet. T h e following report from the British Association of Dermatology Vice-Presidents and Hon. Treasurer for Session 1942-43.--Sir Alexander Macgregor, Dr. F. T . H. Wood and Dr. James Fenton and SypJailology was also considered : were elected Vice-Presidents of the Society for the Session 1942-43. The sub-committees appointed by the Executive Covaaeila of the British Association of Dermatology and Syphilology and the Society of Medical Dr. G. F. Buchan was re-elected Hun. Treasurer.
183
P U B L I C H E A L T H , July, 1942 Officers of Health to consider the present epidemic of scabies met on two occasions at the Royal Society of Medicine. At the first me.etin~ h.eld on
March 20th, 1942, there were present : Dr. MacCormac (in the chair), Dr. Gray, Dr. Semon and Dr. Barber (Secretary), representing the British A n o eiation of Dermatology and syphilology." Dr. F e n t o n , D r . ~Begg end Dr. Bacon, representing the Society of Medical Officers of Health ~ and Lt.-Col. McKenna and Dr. Mellanby, who were invited to attend. At the second meeting herd on April 10th, 1942, the same members of the two sub-committees were present, end Dr. Buchan was also able to attend. Sir Alexander Macgregor could not, unfortunately~be present at either meeting. After considerable discussion, the following proposals were agreed upon :
(1) Notif~ation.--That scabies should be made a nottfi.able disease. (2) Prol~t~tda.MThat steps should be taken to give Instruction Dy means cr suitable methods of propaganda in the nature, mode of spread, symptoms, and principles of prevention and treatment of the disease. (3) Treatment.That owing to the existing shortage of fats, which makes the use of sulphur ointments undesirable, an emulsion of benzyl benzoate should be employed for routine treatmont~viz., benzyl benzoate 25"0, lanette wax 2 0, water to 100'0--and that this emulsion should be applied either on two successive days or on two occasions at an interval of a week. When p.o?mblethe first application should be preceded by a hot hath, in which the skin of the body and limbs should be thoroughly lathered with soap. (4) Disinf~tatioa.-That whenever possible some method of dlsinfestlng the garments and bedclothing should be provided, or that the unclergarments and sheets at any rate should be thoroughly washed at the termination of treatment. (5) Treatmerit Ccntres.--That an adequate number of properly equipped treatment and cleansing stations shouldbe established. The number of those at present available is far too few, and it was agreed that, if scabies is made notifiable, it is essential that full facilities for treatment near thepatient's home should at once be provided. These treatment centres should be equipped with baths, or at least shower-baths, some form of apparatus for disinfestmg the clothing, and an adequate number of trained personnel. It was rcallsed, however, that the provision of a large number of new treatment centres throughout the country would be difficult or impossible under present conditions. It was therefore recommended that, owing to the extreme ur~.ency of the scabies problem, all existing cleansing stations should be made avmlable both for children and adults, and that the gas-decontaminatlon centres should also be utilised for the purpose. Simple apparatus for disinfesting the clothing could doubtless be imprOvised where necessary. (6) Follo~-up System.-That at all treatment centres the patients should be urged to present themselves again for medical inspection one month after their treatment.
Further letters were reported from the U r b a n District Councils Association and others asking whether the Society would be likely to reconsider their decision that the general compulsory notification of scabies was not desirable. T h e C o m m i t t e e decided that their decision m u s t stand until there was adequate provision for treatment of the disease. 6. War-time Increases of Salaries.--The Committee considered replies from the Branches and Groups in reference to the desirability or otherwise of recommending increases of public health salaries during the war. T h e replies showed a preponderance of opinion that a revision of salaries should not be pressed at the present time, but that any war bonus awarded to the staffs of local authorities should be extended to all medical officers, whole-time or pa~'t-time. It was agreed to forward a recommendation to this effect to the Public Health Committee of the British Medical Association, with w h o m the inquiry originated. 7. Scientific Liaison with U . S . S . R . - - D r . E. H. R. Smithard reported his attendance on behalf of the Society at a meeting called by the Ministry of Information to consider scientific liaison with the U.S.S.R. After speeches by Mr. Ernest Thurtle, M.P., Parliamentary Secretary, Ministry of Information, Sir John Russell, F.R.S., and others it wa s agreed nem. con. that a small committee should be elected to organise the desired liaison and to consider ways and means. T h e Committee extended thanks to Dr. Smithard for his report. 8. Proposed /lmalgamation of Tuberculosis Organisations.--A scheme for the establishment of a General Council, by the National Association for the Prevention of Tuberculosis to include within its organisation the Joint Tuberculosis Council and the Tuberculosis Association, was forwarded for the observations of the Society. It was agreed that the scheme would m e a n economy in working and avoidance of duplication and overlapping in the work of the bodies concerned, and that it should be supported, provided that the Society of Medical Officers of Health was given adequate representation on the General Council. 9. White HospitalCoats.--A letter was received from Dr. Cecil B. Hogg (M.O.H., Kettering) asking the Society to press for the a m e n d m e n t of the C o n s u m e r Rationing Order (No. 8), 1941, to e x e m p t from coupon requirements white coats required for fever hospitals and clinics. As this matter has recently been fully ventilated in the House of C o m m o n s and in letters to the Board of Trade, it was agreed that further action would serve no useful purpose for the time being. 10. The Nutrition Society.--A letter from Dr. Leslie J. Harris reported that the Nutrition Society is particularly anxious to interest health departments in its activities and has already enrolled a n u m b e r of medical officers of health in its m e m b e r s h i p . T h e i r immediate wish was to co-opt a representative of the Society on their Council. In reply to this invitation it was agreed to nominate Dr. G. F. Buchan. I 1. Physical Education.--The Federation of Societies of Teachers in Physical Education, representing approximately 3,500 m e n and women teachers of the subiect, wrote expressing their desire to co-operate with the medical profession in order to consider and
discuss questions concerning the health and physique of school children. The Federation suggested the formation of a joint committee with representatives of the Society for this purpose. It was agreed to accept this invitation, and the following were recommended for election by the Council to represent the Society--via., Dr. Oscar Holden (Croydon), Dr. E. Virginia Saunders-Jacobss Dr. R. Suthcrland, and Dr. H. C. Mauricc Williams. 12. Tuberculosis Hospital Accommodation.--The Association of Municipal Corporations invited observations from the Society on a representation from the Stoke-on-Trent City Council urging the provision of additional hospital accommodation for the treatment of persons suffering, from tuberculosis. T h e Tuberculosis Group of the Society strongly endorsed the opinion of the Stoke-on-Trent Council, and it was agreed that the Association of Municipal Corporations should be advised that increased hospital accommodation for tuberculosis cases was urgently necessary a n d that provision should be made therein for proper, specialist "treatment of the disease. 13. Matters Deferred.--Owing to pressure of other business, consideration of correspondence from the Maternity and Child Welfare Group, the Midland Branch and Dr. G. E. B. Payne (M.O.H., Acton) in reference to wartime nurseries, was postponed until the next meeting of the Committee. Also postponed was a m e m o r a n d u m on the p a y m e n t of expenses for attendance at Group m e e t ings, and correspondence from the Yorkshire Branch regarding security of tenure of office for all medical officers. T h e meeting then adjourned. METROPOLITAN
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A joint meeting of the above branches was held on February 13th at Tavistock House, 62 m e m b e r s being present. WHOOPING COUGH PROPHYLAXIS A n address on whooping-cough prophylaxis was given by D r . I. H. Maclean, of the Inoculation D e p a r t m e n t of St. M a r y ' s Hospital. He said that, in c o m p u t i n g results of whooping-cough prophylaxis, all experiences before 1936, at which date Phase I vaccines first became generally available in this country, should be discarded. In his experience, during the last 5 years all b u t 3 of 28 field trials of pertussis vaccine h a d been favourable. Kendrick and Eldering had concluded " that there was a reduction of 60% in the risk of attack in the vaccinated group and an eight-fold increase in the probability of escaping from known exposures " : this had been substantiated by nearly all other trials. A b o u t 70% complete protection from known exposures could be expected, as against a 10-20 % escape rate in controls according to the type of exposure and the severity of the epidemic concerned. In institutions, where exposure was prolonged and heavy, there were more failures in the vaccinated group than among those in street and household exposure. T h e 3 unfavourable trials were in institutions, but there were at least 7 reports from residential children's homes where the protection was found to be up to the 70% standard. Prophylaxis in pertussis was less efficient than in diphtheria. Pertussis, with its explosive cough, its long incubation period, and absence of institutional isolation, gave an exposure to infection of from 5 to 6 weeks, whereas in diphtheria there was less intensive exposure of only 2 to 5 days. T h e i m m u n i t y in pertussis was antibacterial ; in diphtheria it was antitoxic. T h e dosage used in immunisation was i m p o r t a n t : in U.S.A. the Saner method, with 6 injections amounting to a total dose of 80,000 to 160,000 million organisms, was widely practised. D r . Maclean had found that good protection could be obtained by a total of 16,000 to 20,000 million, split up into four spaced doses. If this dosage were too c u m b e r s o m e to use in clinics, good results could be obtained with a dose of 20,000 million given in two properly spaced injections. T h i s was a great convenience, especially as both doses of pertussis vaccine could be combined with the two doses of diphtheria prophylactic (A.P.T.) and spaced at one m o n t h ' s i n t e r v a l Dr. Maclean stressed, however, that this two-dose i m munisation had not had an extensive trial and experience m i g h t alter these views: M a n y day nurseries were now opening, and if they had a perm a n e n t population they would be ideal for field trials of pertussia vaccine. T h e experiments would have to be properly controlled, and the results collected by a central authority. Although pertussis was a war-time problem, it was probably premature to r e c o m m e n d mass immuniaation. Dr. Rawlinson stressed the value of the " boosting " dose, which should follow the normal course, b u t at a m u c h later date. D r . Struthers pleaded for standardisation of research in nurseries and other communities. Dr. Maclean replied, stating that reaction to inoculations varies within wide limits. T h e Medical Research Council had prepared a scheme for immuniaation of the population, b u t this was not in all