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MATERNAL MORTALITY AND NUTRITION
MATERNAL MORTALITY AND NUTRITION
96
Committee from
other
committees
of
the
local
authority, such as the Public Health Committee. It appeared to him that in the long run better progress was likely to be secured in the conditions of local government which actually prevailed by accepting the fact that there must be the closest possible connexion between the various organs of government in the shape of the committees of a local authority. Sir Arthur referred to the presence of Lord Macmillan, whose outstanding services on the Royal Commission on Lunacy and Mental Disorder were in the minds of all of them, and had resulted in the passing of the Mental Treatment Act of 1930, some of the results of which he had previously mentioned. He closed by bringing the best wishes of the Minister of Health to the service of mental health and to the Royal Medico-Psychological Association. Sir William Collins, in submitting the toast of the Middlesex County Council, claimed as an old municipal hack, more acquaintance with the County of London, its Lieutenancy and its County Council than with Middlesex, though he had a nodding and neighbourly acquaintance with that county. He recalled the Local Government Act of 1888 when London was dealt with as an incident in rural administration, and the new County of London was largely carved out of ’the side of Middlesex. While the population of the County of London, he said, had been falling since 1901, that of Middlesex had grown from half a million to one and three quarter millions, a reminder that the County of Middlesex is becoming largely a dormitory for London, and the " green belt" of which many dreamt 40 years ago as the boundary of the County of London cannot now be realised, though possibly some such belt might be established around Greater London. When he was elected to the L.C.C. in 1892 and served on the asylums committee, two things, he said, impressed him particularly. One was the need of more thorough research into the pathology of insanity, and the other was the need for pensions for the asylums officers. With regard to the first he had endeavoured to promote research by inaugurating the laboratory at Claybury with the late Sir Frederick Mott as pathologist, while in 1909 he introduced into the House of Commons a Bill which became eventually the Asylums Officers Superannuation Act. In coupling with the toast the name of Mr. Alderman Button, the chairman of the Middlesex County Council, a body which had just promised 100,000 to the University of London, he recalled the fact that Mr. Button sat for a time in the House of Commons but was now pursuing the interests of both physical and mental health in the serener atmosphere of
municipal life. The toast was replied to by Mr. Alderman Howard Button, who referred to Middlesex as the county, save Rutland, with the smallest acreage, and an enormous population. The county was responsible for the conduct of two admirable mental hospitals, those at Shenley and Springfield, though the institutions were actually in
Buckinghamshire.
The toast of the visitors was proposed by Dr. W. GMasefield, who said that the assembly of guests was very representative, including visitors from Belgium, Denmark, France, Holland, and the United States of America. all of whom were in the charge of the members of the Association, on " a purely voluntary basis." The toast was replied to by Lord MacmillanL and Lord Wakefield. Dr. Robert Hutchison, president of the Royal-
Society of Medicine, proposed the toast of prosperity the Royal Medico-Psychological Association. coupling it with the name of Dr. Worth, who briefly replied.
to
MATERNAL MORTALITY AND NUTRITION A
NEW
INQUIRY
THE People’s League of Health has established a committee to consider the nutrition of expectant and nursing mothers in relation to maternal mortality and
morbidity. At an inaugural luncheon held at Claridge’s Hotel, London, on July 5th, Dr. C. 0. HAWTHORNE, chairman of the council of the League, said that its reports were intended to inform and arouse public opinion and official action. The immediate object of the new committee was to study the question of food in relation to the health of the mother and to inquiry what part was played by quantitative or qualitativeerrors of diet in the pathetic chapter on maternal mortality and morbidity. The solution of this graveproblem would not be found in emotional appeals orin exaggerated statements, and still less in panic. Lord HoRDER, welcoming the enterprise, declared his belief that the core of the problem of maternal mortality and morbidity did not lie in any shortcomings of the doctor or midwife, and that the orientation of study should be shifted in the direction of thefitness of the mother to bear her child. Other attemptsto solve the problem had failed, but this one had not
been tested. The word nutrition must be read in the widest possible sense. Probably physical fitness, mental fitness, and biochemical fitness all contributed to the nutrition of the expectant and nursing mother. Prof. JAMES YOUNG also commended the object of the League in this matter, but at the same timeemphasised the importance of the obstetric aspect of the problem. Much maternal mortality had its origin in the ineffective standards of service brought to bear on the practical application of the subject. Theinvestigations in Rochdale were extremely relevant;: until recently this area had had the highest maternal mortality in the country but, as the result of a com-paratively simple effort to improve the obstetricservice, the mortality had come down in the most, gratifying and dramatic manner. There was in addition a large group of conditions operating adversely, for example, the toxaemias and metabolic disturbances. There was strong evidence that some defect in thediet of the mother might be operating. The possibility could not be eliminated that in death from’ puerperal sepsis after normal labour there might besome factor determined by inadequacy of nutrition during pregnancy. Many conditions of pregnancy were directly related to diet, as, for example, thecondition of the teeth. Nor must the child be forgotten ; the condition of the mother had a great effect on the teeth and bones of the child and in this way the obstetric welfare of the third generation might be affected. Dr. R. VEITCH CLARK suggested that the relation-ship between nutrition and pregnancy was probably biochemical; the word " nutrition " must be taken in its widest possible sense. He was not satisfied that there was any relation between maternal mortality and morbidity and the amount of food taken. Even the establishment of definite negatives would be a contribution of no little consequence.
MEDICINES AND SURGICAL APPLIANCES
Mr. VICTOR BONNEY advocated the election of
a
subcommittee for research ; the services of people with both knowledge and time were essential for success.-Miss OLGA NETHERSOLE reported that the Royal College of Physicians of London at its next meeting would consider the appointment of a representative on the new committee.-DAME LOUISE MCILROY said that the investigation would entail two or three years’ hard work, and the workers would probably find themselves up against some unknown quality in the patient herself.-Sir COMYNS BERKELEY observed that the subject was very complex. A list of members of the committee follows. Asterisks denote that they are members in an advisory capacity small
logists. Dr. LETITIA FAIRFIELD, a senior medical officer of the Public Health Department, London County Council. Prof. AMY ’FLEMING, F.C.O.G., director of the obstetrical and gynaecological unit, Royal Free Hospital, London. Prof. W. M. FRAZER, M.D., medical officer of health for Liverpool. Dr. JOHN Guv, medical officer of health for Edinburgh. Sir LEONARD HILL, M.B., F.R.S., late director of applied physiology, National Institute of Medical Research. *Mr. EARDLEY HOLLAND, F.R.C.P., obstetric and surgeon to the London Hospital. Prof. J. JOHNSTONE JERVIS, M.D., medical officer of health for Leeds. Dr. R. C. JEWESBURY, physician in charge of children’s department, St. Thomas’s Hospital, London. *Colonel P. S. LELEAN, F.R.C.S., professor of public health in the University of Edinburgh. Dr. HELEN MACKAY, physician to the Queen’s Hospital for Children. *Sir ROBERT MCCARRISON, F.R.C.P., past director, Nutritional Research Pasteur Institute, Coonor, India. Dr. A. S. M. MACGREGOR, medical officer of health for
gynaecological
Glasgow (corresponding member). Dame LouisE McILROY, F.C.O.G., late professor of obstetrics and gynaecology. University of London. *Mrs. IAN MURRAY, Ph.D., of the University of Glasgow. Dr. ELWiN H. NASH, medical officer of health for Heston and Isleworth. *Sir JOHN BoYD ORR, M.D., F.R.S., director of the Rowett Research Institute, Aberdeen. Dr. THOMAS ORR, medical officer of health for Ealing. Dr. W. H. F. OxLEY, hon. medical officer, East End Maternity Hospital, London. Dr. ERIC PRITCHARD, paediatrician to Queen Charlotte’s Maternity Hospital, London.
BILL
97
Dr. H. J. RAE, principal medical officer of health for Aberdeen. *Sir JOHN ROBERTSON, M.D., late medical officer of health for Birmingham. Dr. G. W. THEOBALD, consulting obstetrician and gynaecologist, St. Mary Abbots Hospital, Kensington. Sir PENDRILL VARRIER-JONES, F.R.C.P., director of
Papworth Village Settlement, Cambridge. Miss JEAN WISHART, matron, Queen Mary’s Maternity Home, Hampstead. Prof. JAMES YOUNG, F.C.O.G., professor of obstetrics and gynaecology at the British Postgraduate Medical School, London.
MEDICINES AND SURGICAL APPLIANCES (ADVERTISEMENT) BILL
only. Sir_CoMNS BERKELEY, F.R.C.P., consulting obstetric and gynaecological surgeon to the Middlesex Hospital, London. Mr. VICTOR BONNEY, F.R.C.S., gynaecological surgeon to the Middlesex Hospital. Dr. J. J. BucHAN, medical officer of health for Bradford. *Dr. W. L. BURGESS, medical officer of health for Dundee. Prof. F. J. BROWNE, F.C.O.G., director of the obstetrical unit, University College Hospital, London. *Prof. E. P. CATHCART, M.D., F.R.S., regius professor of physiology in the University of Glasgow. Dr. R. VEITCH CLARK, medical officer of health for Manchester. Miss M. L. CLARK, L.L.A. *Dr. G. P. CROWDEN, reader in industrial physiology at the London School of Hygiene and Tropical Medicine. Prof. S. LYLE CUMMINS, M.D., David Davies professor of tuberculosis, Welsh National School of Medicine. *Sir HENRY DALE, F.R.C.P., F.R.S., director of the National Institute for Medical Research, Hampstead. *Prof. L. S. P. DAVIDSON, M.D., regius professor of medicine, University of Aberdeen. *Prof. J. C. DRUMMOND, D.Sc., professor of biochemistry at University College, London. *Dr. J. S. FAiRBAiRN, consulting obstetrical physician and gynaecologist to St. Thomas’s Hospital, London; president of the College of Obstetricians and Gynmco-
(ADVERTISEMENT)
DEPUTATION TO THE MINISTER OF HEALTH
Kingsley Wood, the Minister of Health, who accompanied by Sir Edward Campbell, received deputation on July 4th from the Parliamentary
Sir was a
Committee on Food and Health. The speakers were Lord Mamhead, Captain G. S. Elliston, Sir John Pybus, and Sir Francis Fremantle. The associations represented were :Advertising Association; Association of Municipal Corporations ; British Medical Association; County Councils Association ; Institute of Incorporated Practi. tioners in Advertising; Newspaper Society ; Periodical Trade Press and Weekly Newspaper Proprietors’ Association, Limited; National Association of Insurance Committees ; Pharmaceutical Society of Great Britain; National Pharmaceutical Union; Surgical Instrument Manufacturers’ Association Incorporated ; Society of Medical Officers of Health; Parliamentary Medical Committee ; and Parliamentary Committee on Food and Health.
Lord MAMHEAD, in introducing the deputation, recalled the fact that the Parliamentary Committee on Food and Health had first been constituted at a meeting held in 1911 and called by Dr. Addison, Lord Bledisloe, and others. It had always been a non-party and a lay body. Captain ELLISTON said that the committee had had in preparation for some time the draft of a Bill to control the advertisement of medicines and surgical appliances. A Select Committee of the House of Commons, the appointment of which arose out of action taken by the Parliamentary Committee, investigated the question in 1912-14 and reported in favour of legislation. Several endeavours had been made since then to introduce legislation, but it had not been possible to make progress with a Bill. One of the difficulties had been that, in the past, it had been impossible to secure the agreement of the many interests concerned. The present Bill had been discussed with all the important interests affected, and a measure of agreement, never previously attained, had now been reached. The principal objects of the Bill were :
(1) To prohibit the advertisement of medicines, surgical appliances, or forms of treatment as effective for the cure or prevertion of certain specified ailments, such as cancer and consumption, and (2) To prohibit the publication of invitations to members of the public to obtain the diagnosis or treatment of these ailments by correspondence. The Bill also contained clauses safeguarding the interests of those concerned, including newspapers and religious organisations. Sir JOHN PYBUS, speaking as president of the Advertising Association, said that the Bill, if it were
legitimate
96
Committee from
other
committees
of
the
local
authority, such as the Public Health Committee. It appeared to him that in the long run better progress was likely to be secured in the conditions of local government which actually prevailed by accepting the fact that there must be the closest possible connexion between the various organs of government in the shape of the committees of a local authority. Sir Arthur referred to the presence of Lord Macmillan, whose outstanding services on the Royal Commission on Lunacy and Mental Disorder were in the minds of all of them, and had resulted in the passing of the Mental Treatment Act of 1930, some of the results of which he had previously mentioned. He closed by bringing the best wishes of the Minister of Health to the service of mental health and to the Royal Medico-Psychological Association. Sir William Collins, in submitting the toast of the Middlesex County Council, claimed as an old municipal hack, more acquaintance with the County of London, its Lieutenancy and its County Council than with Middlesex, though he had a nodding and neighbourly acquaintance with that county. He recalled the Local Government Act of 1888 when London was dealt with as an incident in rural administration, and the new County of London was largely carved out of ’the side of Middlesex. While the population of the County of London, he said, had been falling since 1901, that of Middlesex had grown from half a million to one and three quarter millions, a reminder that the County of Middlesex is becoming largely a dormitory for London, and the " green belt" of which many dreamt 40 years ago as the boundary of the County of London cannot now be realised, though possibly some such belt might be established around Greater London. When he was elected to the L.C.C. in 1892 and served on the asylums committee, two things, he said, impressed him particularly. One was the need of more thorough research into the pathology of insanity, and the other was the need for pensions for the asylums officers. With regard to the first he had endeavoured to promote research by inaugurating the laboratory at Claybury with the late Sir Frederick Mott as pathologist, while in 1909 he introduced into the House of Commons a Bill which became eventually the Asylums Officers Superannuation Act. In coupling with the toast the name of Mr. Alderman Button, the chairman of the Middlesex County Council, a body which had just promised 100,000 to the University of London, he recalled the fact that Mr. Button sat for a time in the House of Commons but was now pursuing the interests of both physical and mental health in the serener atmosphere of
municipal life. The toast was replied to by Mr. Alderman Howard Button, who referred to Middlesex as the county, save Rutland, with the smallest acreage, and an enormous population. The county was responsible for the conduct of two admirable mental hospitals, those at Shenley and Springfield, though the institutions were actually in
Buckinghamshire.
The toast of the visitors was proposed by Dr. W. GMasefield, who said that the assembly of guests was very representative, including visitors from Belgium, Denmark, France, Holland, and the United States of America. all of whom were in the charge of the members of the Association, on " a purely voluntary basis." The toast was replied to by Lord MacmillanL and Lord Wakefield. Dr. Robert Hutchison, president of the Royal-
Society of Medicine, proposed the toast of prosperity the Royal Medico-Psychological Association. coupling it with the name of Dr. Worth, who briefly replied.
to
MATERNAL MORTALITY AND NUTRITION A
NEW
INQUIRY
THE People’s League of Health has established a committee to consider the nutrition of expectant and nursing mothers in relation to maternal mortality and
morbidity. At an inaugural luncheon held at Claridge’s Hotel, London, on July 5th, Dr. C. 0. HAWTHORNE, chairman of the council of the League, said that its reports were intended to inform and arouse public opinion and official action. The immediate object of the new committee was to study the question of food in relation to the health of the mother and to inquiry what part was played by quantitative or qualitativeerrors of diet in the pathetic chapter on maternal mortality and morbidity. The solution of this graveproblem would not be found in emotional appeals orin exaggerated statements, and still less in panic. Lord HoRDER, welcoming the enterprise, declared his belief that the core of the problem of maternal mortality and morbidity did not lie in any shortcomings of the doctor or midwife, and that the orientation of study should be shifted in the direction of thefitness of the mother to bear her child. Other attemptsto solve the problem had failed, but this one had not
been tested. The word nutrition must be read in the widest possible sense. Probably physical fitness, mental fitness, and biochemical fitness all contributed to the nutrition of the expectant and nursing mother. Prof. JAMES YOUNG also commended the object of the League in this matter, but at the same timeemphasised the importance of the obstetric aspect of the problem. Much maternal mortality had its origin in the ineffective standards of service brought to bear on the practical application of the subject. Theinvestigations in Rochdale were extremely relevant;: until recently this area had had the highest maternal mortality in the country but, as the result of a com-paratively simple effort to improve the obstetricservice, the mortality had come down in the most, gratifying and dramatic manner. There was in addition a large group of conditions operating adversely, for example, the toxaemias and metabolic disturbances. There was strong evidence that some defect in thediet of the mother might be operating. The possibility could not be eliminated that in death from’ puerperal sepsis after normal labour there might besome factor determined by inadequacy of nutrition during pregnancy. Many conditions of pregnancy were directly related to diet, as, for example, thecondition of the teeth. Nor must the child be forgotten ; the condition of the mother had a great effect on the teeth and bones of the child and in this way the obstetric welfare of the third generation might be affected. Dr. R. VEITCH CLARK suggested that the relation-ship between nutrition and pregnancy was probably biochemical; the word " nutrition " must be taken in its widest possible sense. He was not satisfied that there was any relation between maternal mortality and morbidity and the amount of food taken. Even the establishment of definite negatives would be a contribution of no little consequence.
MEDICINES AND SURGICAL APPLIANCES
Mr. VICTOR BONNEY advocated the election of
a
subcommittee for research ; the services of people with both knowledge and time were essential for success.-Miss OLGA NETHERSOLE reported that the Royal College of Physicians of London at its next meeting would consider the appointment of a representative on the new committee.-DAME LOUISE MCILROY said that the investigation would entail two or three years’ hard work, and the workers would probably find themselves up against some unknown quality in the patient herself.-Sir COMYNS BERKELEY observed that the subject was very complex. A list of members of the committee follows. Asterisks denote that they are members in an advisory capacity small
logists. Dr. LETITIA FAIRFIELD, a senior medical officer of the Public Health Department, London County Council. Prof. AMY ’FLEMING, F.C.O.G., director of the obstetrical and gynaecological unit, Royal Free Hospital, London. Prof. W. M. FRAZER, M.D., medical officer of health for Liverpool. Dr. JOHN Guv, medical officer of health for Edinburgh. Sir LEONARD HILL, M.B., F.R.S., late director of applied physiology, National Institute of Medical Research. *Mr. EARDLEY HOLLAND, F.R.C.P., obstetric and surgeon to the London Hospital. Prof. J. JOHNSTONE JERVIS, M.D., medical officer of health for Leeds. Dr. R. C. JEWESBURY, physician in charge of children’s department, St. Thomas’s Hospital, London. *Colonel P. S. LELEAN, F.R.C.S., professor of public health in the University of Edinburgh. Dr. HELEN MACKAY, physician to the Queen’s Hospital for Children. *Sir ROBERT MCCARRISON, F.R.C.P., past director, Nutritional Research Pasteur Institute, Coonor, India. Dr. A. S. M. MACGREGOR, medical officer of health for
gynaecological
Glasgow (corresponding member). Dame LouisE McILROY, F.C.O.G., late professor of obstetrics and gynaecology. University of London. *Mrs. IAN MURRAY, Ph.D., of the University of Glasgow. Dr. ELWiN H. NASH, medical officer of health for Heston and Isleworth. *Sir JOHN BoYD ORR, M.D., F.R.S., director of the Rowett Research Institute, Aberdeen. Dr. THOMAS ORR, medical officer of health for Ealing. Dr. W. H. F. OxLEY, hon. medical officer, East End Maternity Hospital, London. Dr. ERIC PRITCHARD, paediatrician to Queen Charlotte’s Maternity Hospital, London.
BILL
97
Dr. H. J. RAE, principal medical officer of health for Aberdeen. *Sir JOHN ROBERTSON, M.D., late medical officer of health for Birmingham. Dr. G. W. THEOBALD, consulting obstetrician and gynaecologist, St. Mary Abbots Hospital, Kensington. Sir PENDRILL VARRIER-JONES, F.R.C.P., director of
Papworth Village Settlement, Cambridge. Miss JEAN WISHART, matron, Queen Mary’s Maternity Home, Hampstead. Prof. JAMES YOUNG, F.C.O.G., professor of obstetrics and gynaecology at the British Postgraduate Medical School, London.
MEDICINES AND SURGICAL APPLIANCES (ADVERTISEMENT) BILL
only. Sir_CoMNS BERKELEY, F.R.C.P., consulting obstetric and gynaecological surgeon to the Middlesex Hospital, London. Mr. VICTOR BONNEY, F.R.C.S., gynaecological surgeon to the Middlesex Hospital. Dr. J. J. BucHAN, medical officer of health for Bradford. *Dr. W. L. BURGESS, medical officer of health for Dundee. Prof. F. J. BROWNE, F.C.O.G., director of the obstetrical unit, University College Hospital, London. *Prof. E. P. CATHCART, M.D., F.R.S., regius professor of physiology in the University of Glasgow. Dr. R. VEITCH CLARK, medical officer of health for Manchester. Miss M. L. CLARK, L.L.A. *Dr. G. P. CROWDEN, reader in industrial physiology at the London School of Hygiene and Tropical Medicine. Prof. S. LYLE CUMMINS, M.D., David Davies professor of tuberculosis, Welsh National School of Medicine. *Sir HENRY DALE, F.R.C.P., F.R.S., director of the National Institute for Medical Research, Hampstead. *Prof. L. S. P. DAVIDSON, M.D., regius professor of medicine, University of Aberdeen. *Prof. J. C. DRUMMOND, D.Sc., professor of biochemistry at University College, London. *Dr. J. S. FAiRBAiRN, consulting obstetrical physician and gynaecologist to St. Thomas’s Hospital, London; president of the College of Obstetricians and Gynmco-
(ADVERTISEMENT)
DEPUTATION TO THE MINISTER OF HEALTH
Kingsley Wood, the Minister of Health, who accompanied by Sir Edward Campbell, received deputation on July 4th from the Parliamentary
Sir was a
Committee on Food and Health. The speakers were Lord Mamhead, Captain G. S. Elliston, Sir John Pybus, and Sir Francis Fremantle. The associations represented were :Advertising Association; Association of Municipal Corporations ; British Medical Association; County Councils Association ; Institute of Incorporated Practi. tioners in Advertising; Newspaper Society ; Periodical Trade Press and Weekly Newspaper Proprietors’ Association, Limited; National Association of Insurance Committees ; Pharmaceutical Society of Great Britain; National Pharmaceutical Union; Surgical Instrument Manufacturers’ Association Incorporated ; Society of Medical Officers of Health; Parliamentary Medical Committee ; and Parliamentary Committee on Food and Health.
Lord MAMHEAD, in introducing the deputation, recalled the fact that the Parliamentary Committee on Food and Health had first been constituted at a meeting held in 1911 and called by Dr. Addison, Lord Bledisloe, and others. It had always been a non-party and a lay body. Captain ELLISTON said that the committee had had in preparation for some time the draft of a Bill to control the advertisement of medicines and surgical appliances. A Select Committee of the House of Commons, the appointment of which arose out of action taken by the Parliamentary Committee, investigated the question in 1912-14 and reported in favour of legislation. Several endeavours had been made since then to introduce legislation, but it had not been possible to make progress with a Bill. One of the difficulties had been that, in the past, it had been impossible to secure the agreement of the many interests concerned. The present Bill had been discussed with all the important interests affected, and a measure of agreement, never previously attained, had now been reached. The principal objects of the Bill were :
(1) To prohibit the advertisement of medicines, surgical appliances, or forms of treatment as effective for the cure or prevertion of certain specified ailments, such as cancer and consumption, and (2) To prohibit the publication of invitations to members of the public to obtain the diagnosis or treatment of these ailments by correspondence. The Bill also contained clauses safeguarding the interests of those concerned, including newspapers and religious organisations. Sir JOHN PYBUS, speaking as president of the Advertising Association, said that the Bill, if it were
legitimate