Joint Tuberculosis Council

1941 Dr. E, an elderly general practitioner, has given his life on the Home Front. The bomb which killed him destroyed his home and all his possessions. His reduced practice, situated in a relatively vulnerable area, is unsaleable. The Medical War Relief Fund could not undertake to contribute towards the maintenance of his widow for the remainder of her life, but it gave her a substantial sum to meet immediate necessities and also assisted her to obtain a very satisfactory pension from another organisation. She has left the Committee of the Fund in no doubt as to her gratitude. Dr. F was killed by a bomb when on duty at a first-aid post. Other bombs seriously damaged his residence and his surgery. The widow will receive a pension of £1 17s. 8d. per week from the Government, and there will be little addition to this even if it is possible to sell the practice when the surgery has been repaired. Mrs. F has no relatives who can assist her financially, and she cannot at present undertake remunerative work as there are children to be cared for. The Medical War Relief Fund has granted her a gift which will be paid in annual instalments over a period of five years. The money has been handed to the Royal Medical Benevolent Fund for administration, and this body will therefore be able to maintain contact with the family and advise Mrs. F if at a later date additional help is required for the completion of the children's education. AIMS AND CONSTITUTION OF THE FUND It might happen to any one of us, though we are not all exposed to equal risks. It would be good to know that there would be help for our wives and children if they should be numbered among the unfortunate; to know that our colleagues had created a fund to which they could appeal without humiliation, a fund which we ourselves had helped to establish, a fund that could come to the rescue in a manner worthy of a generous profession. It is to achieve this object that the Medical War Relief Fund has been instituted, and the above cases illustrate the work that is being done. The purpose of the Fund is defined as the temporary assistance of registered medical practitioners and their dependants who find themselves in financial straits as a direct result of war conditions. Applicants must be " registered members of the medical profession, British subjects domiciled in England, Scotland, Wales, the Isle of Man, the Channel Islands and Northern Ireland, and such of their dependants as the Committee may determine." Assistance takes the form of a gift or a loan free of interest, or may be given partly as a gift and partly as a loan. The Fund is administered by a Committee representative of the British Medical Association, the Royal Colleges, and the Royal Medical Benevolent Fund. The cost of administration is very small, and it has not been necessary to acquire special office accommodation ol to appoint a special staff. The Honorary Treasurer and Honorary Secretary of the Fund are officials of the British Medical Association and the cost of their work, which includes much correspondence connected with the collection of subscriptions, is defrayed by the Association. A Distribution Sub-committee has been appointed to consider applications and vote awards. The Royal Medical Benevolent Fund was invited to

PUBLIC HEALTH nominate a number of the members of the Sub-committee and tile Secretary of that body acts as Seei'etary of the Sub-committee. MORE SUPPORT NEEDED The subscription lists already published show that many individual practitioners, B.M.A. Branches and Divisions, Local Medical War Committees, Local Medical and Panel Committees and other professional organisations have responded to the appeal in a magnificent way. At the end of March, 1941, the contributions exceeded £20,000 and more than £4,000 had already been expended since the date of the first awards --that is, during a period of four and a half months. Further subscriptions will certainly be needed, for the number of applicants is increasing and will doubtless continue to increase as the war goes on. Every member of the profession is asked to send a contribution, however modest. Collections are being made in many areas, but any practitioner who has not received a local appeal may send his subscription to the Honorary Treasurer of the Medical War Relief Fund at B.M.A. House, Tavistoek Square, W.C.1. Cheques should be made payable to the Medical War Relief Fund. Doctors will not fail to discharge their responsibilities, whatever the risk, and it seems inevitable that many of them will suffer. Is it not both a duty and a privilege to ensure that in their hour of need they will be able to echo the words of one who has been helped by the Fund and say that they too are " proud of their profession " ?

JOINT TUBERCULOSIS COUNCIL A meeting of the Joint Tuberculosis Council was held at the London School of Hygiene and Tropical Medicine on March 1st, 1941. There was a good attendance of members. It was decided that the next meeting of the Council should be held in London, if possible, on Saturday, May 17th, 1941. The Honorary Secretary (Dr. J. B. McDougall) reported that there had been a good response to the inquiries addressed to Deans of Medical Schools with reference to the teaching of students in tuberculosis during war-time. Most schools had made arrangements directly or indirectly with local authorities for students to attend tuberculosis dispensaries or sanatoria in the near neighbourhood of their temporary residence. The following Officers were appointed for 1941: Chairman, Dr. D. A. Powell; Vice-Chairmen, Drs. James Watt and Ernest Powell; Hon. Auditor, Dr. D. P. Sutherland; Hon. Treasurer, Dr. G. Jessel; Hon. Secretary, Dr. J. B. McDougall. Dr. G. Lissant Cox introduced the subject of the co-ordination of tuberculosis services of local authorities in a memorandum which had been circulated previously to the Council. The first part of this memorandum is published at p. 188 of the present issue ; the second part will appear next month. Tuberculosis in War-Time In the unavoidable absence of the Convener of the Committee (Dr. James Watt) the Council considered a memorandum prepared by Dr. F. R. G. Heaf on

.MAY

PUBLIC HEALTH tuberculosis in shelters. It was resolved that in view of the urgency of the subject the memorandum be sent to the Standing Advisory Committee and to the Society of Medical Officers of Health. The following recommendations by Dr. F. R. G. Heaf were accepted by the Council :-1. That the tuberculous person shall not lack adequate air-raid protection because of the nature of his disability. 2. That the healthy person frequenting public shelters shall not thereby incur greater risk of contracting tuberculosis than in normal life. 8. That the recommendations of the Horder Committee be carried out as soon as possible. 4. That the provision of special shelter accommodation for the tuberculous in densely poptilated areas be encouraged. 5. That extra accommodation be provided for segregation of the open cases not needing treatment in hostels or in industrial settlements, the distinction between treatment and segregation being thus emphasised. 6. That the present educational campaign be extended and anti-tuberculosis propaganda be given more attention by official bodies. 7. That a special effort be made to examine more frequently contacts of known tuberculous cases using Anderson shelters and that such contacts be assured of adequate nourishment. 8. That all children be removed from Anderson shelters used by tuberculous persons. 9. That no tuberculous person be allowed to use a school shelter. 10. That individuals using public shelters and presenting symptoms of pulmonary tuberculosis be persuaded to undergo an X-ray examination. 11. That compulsory powers should be available if persuasion fails. 12. That every effort be made to prevent the spread of catarrhal infections. 18. That spitting be vigorously suppressed. 14. The presence or history of tuberculous disease must not be used as a means of gaining privileges which have no relation to the problem of preventing spread of infection and thereby allowing people to obtain special advantages over their fellows. Many of these recommendations can only be applied during periods of comparative quiet. When bombing is intense little can be done in segregating the tuberculous. It is therefore essential that action is taken whilst it is possible to enforce regulations so that a certain adherence to order and routine may be expected in times of extreme emergency.

andum (Circular 2323) on the allocation of man power between civilian and military services, a slightly abridged version of which is printed below. The steady expansion of the Armed Forces at home and overseas has led to a growing need for doctors in the medical branches of the Royal Navy, the Army and the Royal Air Force, which has recently been examined by the Ministers concerned in relation to the medical needs of the civilian community. This examination has made it apparent that further special measures are necessary on allhands if the limited numbers of doctors available are to be employed to the best advantage on work which as a whole much exceeds that falling on members of the profession in time of peace. SERVICE NEEDS: Accordingly, the three Service Departments are reviewing all their medical establishments, and it is hoped thereby to reduce in a number of ways the further calls that would otherwise have to be made on the doctors remaining in civilian practice in this country. The needs of the different theatres of war, however, are so great that such calls will still have to be made from time to time, which will be met as hitherto from practitioners liable to military service, through the machinery of the Central Medical War Committee appointed to advise the Government on these matters. REVIEW OF EMERGENCY MEDICAL SERVICE The Minister for his part is reviewing the Emergency Medical Service with the intention of releasing for the Armed Forces a number of whole-time and part-time members now enrolled in it, (i) by reducing the present strength of the Service and (ii) by replacing, in addition, a number of British members by the enrolment of foreign practitioners admitted tO practice under the Medical Register (Temporary Registration) Orders. REVIEW OF OTHER HOSPITAL STAFFS

In the view of the Government, hospital authorities should take all possible steps in the same directions in ~eladon to their own medical staffs. The Central Medical War Committee is inviting them to review the existing establishments of A, B2 and B1 resident posts with a view to considering the possibility of reducing them, and the Minister emphasises that this recommendation has his support and urges hospital authorities to extend their review to any senior posts outside these three categories. In addition to savings in staff secured in this way, hospital authorities have been asked to consider favourably the employment of foreign practitioners recently facilitated by the Medical Register (Temporary Registration) Orders, so as to release the British practitioners they replace for service with the Armed Forces. In the case of doctors of enemy nationality certain restricMEDICAL MAN POWER tions apply (see Public Health, April, 1941, p. 116). ALLOCATION BETWEEN CIVILIAN AND The Principal Regional Medical Officers of the MILITARY SERVICE Ministry have been instructed to consult, on both the In December of last year the Robinson Committee measures referred to in this paragraph, with Medical was appointed at the request of the Central Medical Officers of Health administering the principal municipal War Committee to consider the situation created by hospitals. The Hospital and Group Officers of the the demands of the fighting services for medical per- Ministry have been instructed similarly to approach sonnel and the effect of this on those left in civil prac- voluntary hospitals included in the Emergency Hospital tice. The Ministry of Health has now issued a memor- Scheme, and authorities administering institutions

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