- Email: [email protected]
Membership of the tuberculosis group
84
PUBLIC HEALTH, March, 1946
*:entral colleagues. Political m a c h i n a t i o n s , t h e g r e a t e r influence o f older a n d m o r e senior d e p a r t m e n t s of State, t h e T r e a s u r y , national medical organisations, t h e i n n u m e r a b l e n a t i o n a l v o l u n t a r y organisafions, t h e d e p a r t m e n t a l , research, social a n d o t h e r considerations are j u s t some of t h e i r troubles. L o c a l a d m i n i s t r a t i o n h a s to h a v e r e g a r d for political or council rulings, the F i n a n c e C o m m i t t e e , m a i n t e n a n c e of relations w i t h other d e p a r t m e n t s a n d officials, general p r a c t i t i o n e r s , t h e v o l u n t a r y organisations a n d o t h e r committees. T o t r a n s l a t e a circular so t h a t it will fit in w i t h the p a t t e r n of local e n v i r o n m e n t a n d c u s t o m is n o t always quite so simple a n d s t r a i g h t f o r w a r d as m i g h t a p p e a r to L o n d o n , n o r c a n we resort to passing m e m o r a n d a , as is d o n e in the Civil Service. Closer w e l d i n g of t h e m e d i c a l t e a m e n g a g e d in central a n d local h e a l t h g o v e r n m e n t s h o u l d n o t b e impossible, a n d w o u l d be all the b e t t e r for t h e h e a l t h services a d m i n i s t r a t i o n . T h e local g o v e r n m e n t control m u s t remain, because m a n y p a r t s of o u r h e a l t h servmes include so m u c h of an e n v i r o n m e n t a l nature. T o q u o t e once again t h o s e far-seeing m e m b e r s of t h e 1869 C o m m i s s i o n : - " The principle of local self-government has been generally recognised as of the essence of our national vigour. Local administration under oentral superintendence is the distinguishing factor of our government. Whatever concerns the whole nation must be dealt with nationally, while whatever concerns only a district must be dealt with by the district." A n y social service, a n d especially a h e a l t h service, d e p e n d s m u c h m o r e u p o n t h e personal qualities of t h e a d m i n i s t r a t o r s t h a n u p o n t h e s t r u c t u r e of t h e m e c h a n i s m . I n this respect a n a d m i n i s t r a t i v e m e d i c a l service h a s a n excellent f o u n d a t i o n because of t h e individualistic t r a i n i n g a n d outlook of t h e doctors, w h o c o m e into a n a d m i n i s t r a t i v e m a c h i n e later t h a n most. W e are apt to look at t h e case first a n d t h e rule second, a n d m a y we always c o n t i n u e to do so w h a t e v e r t h e f u t u r e set-up of t h e a d m i n i s t r a t i v e m a c h i n e . T h e m e d i c a l officer carries out t h e policy i n d i c a t e d b y t h e local council in accorda n c e w i t h his professional o p i n i o n ; h e works w i t h his chief official colleagues in a local g o v e r n m e n t team, h e works w i t h his professional colleagues in general practice in a medical team, w i t h his colleagues in t h e local a n d n e i g h b o u r i n g h e a l t h services a n d w i t h his colleagues of t h e M i n i s t r y in a n a d m i n i s trative team. H i s experience is a n a l l - r o u n d one, a n d one w h i c h can be v e r y v a l u a b l e to t h e c o m m u n i t y . T h i s s h o u l d b e recognised a n d u s e d in t h e f u t u r e as one of t h e specialist b r a n c h e s of m e d i c i n e a n d n o t b e r e g a r d e d p r i m a r i l y as qualification to control others. A n e n d e a v o u r has b e e n m a d e to s h o w h o w medical officers, r a t h e r b y usage t h a n b y p l a n n i n g , h a v e b e c o m e fitted into constantly developing local a n d central h e a l t h a d m i n i s t r a t i o n . T h e process has b e e n long a n d complicated. H i s position is complicated b y so m a n y external a n d n o n - m e d i c a l elements, a n d particularly b y p r o c e d u r e a n d political expediency. Refere n c e to these latter two obstacles calls to m i n d B a c o n ' s definition of Medicine, in his A d v a n c e m e n t of Learning : " M e d i c i n e is a science, w h i c h h a t h b e e n as we b a v e said, m o r e professed t h a n l a b o u r e d a n d yet m o r e l a b o u r e d t h a n advanced, the l a b o u r having been, in m y j u d g m e n t , r a t h e r in circle t h a n in progression." F o r t u n a t e l y for p r e v e n t i v e m e d i c i n e n o t all t h e p r o g r e s s i o n h a s b e e n in circle, because t h e c e n t r i f u g a l forces in t h e f o r m of t h e medical staffs have b e e n able, f r o m t i m e to time, to o v e r c o m e t h e restraining c e n t r i p e t a l forces of political a n d b u r e a u c r a t i c procedure. I t is in t h e r e g u l a t i o n of t h e b a l a n c e of these two sets of f o r c e s - - t h e professional a n d t h e g o v e r n m e n t a l - - t h a t the f u t u r e of t h e n a t i o n a l h e a l t h service will d e p e n d . I f t h e former, t h e professional or centrifugal, is too m u c h in t h e ascendancy t h e r e will b e a t e n d e n c y for t h e p r o fession to go off o n a t a n g e n t of s y n d i c a l i s m ; if t h e latter forces, t h e lay g o v e r n m e n t a l or centripetal, prevail for too long t h e n progression will n o t b e so free a n d will t e n d to revert to B a c o n ' s " circle." I n conclusion, I q u o t e t h e t h o u g h t e x p r e s s e d b y one of t h e first m e d i c a l officers of h e a l t h - - S i r J o h n S i m o n - - i n his English S a n i t a r y Institutions : - " Our Science, which is becoming more and more able to preserve and strengthen to men their gift of life, would indeed
offer but a joyless task to its administrators if they had not in hope that the lives they endeavour to maintain would be lives of growing worth and happiness; and in proportion as we medical workers have to recognise that ours is only a divisional and preparatory labour, so much the more ~ardently must we wish God-speed to those who are specialists in the later divisions."
BOOK R E V I E W Human Behaviour and Its Relation to Industry. CAMERON a n d H . G . Ross. 1944. M o n t r e a l : W a t t e r s , L t d . pp. 204. Price u n s t a t e d .
By D. E. Plow &
T h i s book deals w i t h different aspects of t h e b e h a v i o u r of n o r m a l i n d i v i d u a l s in i n d u s t r y a n d m a l a d j u s t m e n t s of t h e i n d u s t r i a l worker. T h e following f o r m t h e subject m a t t e r of 12 lectures g i v e n at M c G i l l U n i v e r s i t y in 1 9 4 4 : M e d i c i n e i n I n d u s t r y ; D e v e l o p m e n t of t h e I n d i v i d u a l a n d h o w h e meets Situations; Motivations and Incentives; The Indiv i d u a l in t h e I n d u s t r i a l C o m m u n i t y ; W o m e n a n d I n d u s t r y ; P e r s o n n e l Selection a n d J o b A s s i g n m e n t ; J o b s M i s f i t s ; A b s e n t e e i s m ; W a r - t i m e P r e s s u r e a n d Its E f f e c t s ; O r g a n isation of I n d u s t r i a l M e n t a l H e a l t h a n d t h e R e l a t i o n of H e a l t h to Behaviour. T h e g r o u n d covered is extensive a n d the views expressed are t h o s e of p e r s o n s well qualified to speak. T h e book w o u l d have b e e n b e t t e r for careful editing a n d is a n e x a m p l e of t h e d i s a d v a n t a g e of p r i n t i n g t h e spoken w o r d w i t h o u t drastic c u t t i n g ; it is, however, r e c o m m e n d e d to all i n t e r e s t e d in industrial health.
MEMBERSHIP OF THE TUBERCULOSIS GROUP (The following memorandum, addressed to medical officers of health of authorities with tuberculosis staffs, is printed in the journal in view of the current difficulties of circularisation and as part of the campaign for recruitment of new members.) T h e view has been expressed by the Committee of the Tuberculosis Group of the Society that the strength of the Society as a whole, and of the Tuberculosis Group in particular, is impaired because too many tuberculosis officers and sanatorium medical officers are not Fellows of the Society and members of the Group. T h e reason for this may be that they are unaware that the Society exists, or that they fail to see any advantage in belonging to it. It is to the advantage of all that such a state of affairs should be remedied, and I would be grateful, therefore, if you would try to persuade any members of your tuberculosis staff who are not Fellows to join the Society. T h e Tuberculosis Service has many problems of a varied administrative and clinical nature. These difficulties must be resolved if the service is to achieve maximum efficiency and to hold the confidence of the general practitioners and the respect of consultants in other branches of medicine, as well as that of the public. Tuberculosis officers also have their own individual problems, which are often capable of solution by the combined experience of their fellow workers. T h e Tuberculosis Group Committee is actively engaged on all these matters on behalf both of the Society and of individual members of the Group. It has taken part, either directly or through its members, on the Joint Tuberculosis Council, in such matters as salaries, Memo. 266/T, remuneration for reports under Memo 146/T, facilities for postgraduate study, sanatorium staff problems, and similar items of interest to members as a whole, as well as advising members on individual problems which they have referred tO the Committee. The Hon. Secretary keeps a list of suitable persons for locum tenens though at present the n u m b e r available is very small, and the undersigned would be grateful for the names of any retired or otherwise available experienced men or women. Sub-Groups have been formed in the Metropolitan and Midland districts for clinical and other meetings. T h e Tuberculosis Group collaborates with the other departmental groups of the Society in all matters affecting the welfare of departmental officers as a whole. T h e Hon. Secretary will be only too glad to supply any further information, and hopes he may have your support and help in strengthening the Tuberculosis Group, for its own benefit and that of the Public Health Service as a whole. R. L. MIDGLEY, Hawkmoor Sanatorium, Hon. Secretary. Bovey Tracy, Devon.
PUBLIC HEALTH, March, 1946
*:entral colleagues. Political m a c h i n a t i o n s , t h e g r e a t e r influence o f older a n d m o r e senior d e p a r t m e n t s of State, t h e T r e a s u r y , national medical organisations, t h e i n n u m e r a b l e n a t i o n a l v o l u n t a r y organisafions, t h e d e p a r t m e n t a l , research, social a n d o t h e r considerations are j u s t some of t h e i r troubles. L o c a l a d m i n i s t r a t i o n h a s to h a v e r e g a r d for political or council rulings, the F i n a n c e C o m m i t t e e , m a i n t e n a n c e of relations w i t h other d e p a r t m e n t s a n d officials, general p r a c t i t i o n e r s , t h e v o l u n t a r y organisations a n d o t h e r committees. T o t r a n s l a t e a circular so t h a t it will fit in w i t h the p a t t e r n of local e n v i r o n m e n t a n d c u s t o m is n o t always quite so simple a n d s t r a i g h t f o r w a r d as m i g h t a p p e a r to L o n d o n , n o r c a n we resort to passing m e m o r a n d a , as is d o n e in the Civil Service. Closer w e l d i n g of t h e m e d i c a l t e a m e n g a g e d in central a n d local h e a l t h g o v e r n m e n t s h o u l d n o t b e impossible, a n d w o u l d be all the b e t t e r for t h e h e a l t h services a d m i n i s t r a t i o n . T h e local g o v e r n m e n t control m u s t remain, because m a n y p a r t s of o u r h e a l t h servmes include so m u c h of an e n v i r o n m e n t a l nature. T o q u o t e once again t h o s e far-seeing m e m b e r s of t h e 1869 C o m m i s s i o n : - " The principle of local self-government has been generally recognised as of the essence of our national vigour. Local administration under oentral superintendence is the distinguishing factor of our government. Whatever concerns the whole nation must be dealt with nationally, while whatever concerns only a district must be dealt with by the district." A n y social service, a n d especially a h e a l t h service, d e p e n d s m u c h m o r e u p o n t h e personal qualities of t h e a d m i n i s t r a t o r s t h a n u p o n t h e s t r u c t u r e of t h e m e c h a n i s m . I n this respect a n a d m i n i s t r a t i v e m e d i c a l service h a s a n excellent f o u n d a t i o n because of t h e individualistic t r a i n i n g a n d outlook of t h e doctors, w h o c o m e into a n a d m i n i s t r a t i v e m a c h i n e later t h a n most. W e are apt to look at t h e case first a n d t h e rule second, a n d m a y we always c o n t i n u e to do so w h a t e v e r t h e f u t u r e set-up of t h e a d m i n i s t r a t i v e m a c h i n e . T h e m e d i c a l officer carries out t h e policy i n d i c a t e d b y t h e local council in accorda n c e w i t h his professional o p i n i o n ; h e works w i t h his chief official colleagues in a local g o v e r n m e n t team, h e works w i t h his professional colleagues in general practice in a medical team, w i t h his colleagues in t h e local a n d n e i g h b o u r i n g h e a l t h services a n d w i t h his colleagues of t h e M i n i s t r y in a n a d m i n i s trative team. H i s experience is a n a l l - r o u n d one, a n d one w h i c h can be v e r y v a l u a b l e to t h e c o m m u n i t y . T h i s s h o u l d b e recognised a n d u s e d in t h e f u t u r e as one of t h e specialist b r a n c h e s of m e d i c i n e a n d n o t b e r e g a r d e d p r i m a r i l y as qualification to control others. A n e n d e a v o u r has b e e n m a d e to s h o w h o w medical officers, r a t h e r b y usage t h a n b y p l a n n i n g , h a v e b e c o m e fitted into constantly developing local a n d central h e a l t h a d m i n i s t r a t i o n . T h e process has b e e n long a n d complicated. H i s position is complicated b y so m a n y external a n d n o n - m e d i c a l elements, a n d particularly b y p r o c e d u r e a n d political expediency. Refere n c e to these latter two obstacles calls to m i n d B a c o n ' s definition of Medicine, in his A d v a n c e m e n t of Learning : " M e d i c i n e is a science, w h i c h h a t h b e e n as we b a v e said, m o r e professed t h a n l a b o u r e d a n d yet m o r e l a b o u r e d t h a n advanced, the l a b o u r having been, in m y j u d g m e n t , r a t h e r in circle t h a n in progression." F o r t u n a t e l y for p r e v e n t i v e m e d i c i n e n o t all t h e p r o g r e s s i o n h a s b e e n in circle, because t h e c e n t r i f u g a l forces in t h e f o r m of t h e medical staffs have b e e n able, f r o m t i m e to time, to o v e r c o m e t h e restraining c e n t r i p e t a l forces of political a n d b u r e a u c r a t i c procedure. I t is in t h e r e g u l a t i o n of t h e b a l a n c e of these two sets of f o r c e s - - t h e professional a n d t h e g o v e r n m e n t a l - - t h a t the f u t u r e of t h e n a t i o n a l h e a l t h service will d e p e n d . I f t h e former, t h e professional or centrifugal, is too m u c h in t h e ascendancy t h e r e will b e a t e n d e n c y for t h e p r o fession to go off o n a t a n g e n t of s y n d i c a l i s m ; if t h e latter forces, t h e lay g o v e r n m e n t a l or centripetal, prevail for too long t h e n progression will n o t b e so free a n d will t e n d to revert to B a c o n ' s " circle." I n conclusion, I q u o t e t h e t h o u g h t e x p r e s s e d b y one of t h e first m e d i c a l officers of h e a l t h - - S i r J o h n S i m o n - - i n his English S a n i t a r y Institutions : - " Our Science, which is becoming more and more able to preserve and strengthen to men their gift of life, would indeed
offer but a joyless task to its administrators if they had not in hope that the lives they endeavour to maintain would be lives of growing worth and happiness; and in proportion as we medical workers have to recognise that ours is only a divisional and preparatory labour, so much the more ~ardently must we wish God-speed to those who are specialists in the later divisions."
BOOK R E V I E W Human Behaviour and Its Relation to Industry. CAMERON a n d H . G . Ross. 1944. M o n t r e a l : W a t t e r s , L t d . pp. 204. Price u n s t a t e d .
By D. E. Plow &
T h i s book deals w i t h different aspects of t h e b e h a v i o u r of n o r m a l i n d i v i d u a l s in i n d u s t r y a n d m a l a d j u s t m e n t s of t h e i n d u s t r i a l worker. T h e following f o r m t h e subject m a t t e r of 12 lectures g i v e n at M c G i l l U n i v e r s i t y in 1 9 4 4 : M e d i c i n e i n I n d u s t r y ; D e v e l o p m e n t of t h e I n d i v i d u a l a n d h o w h e meets Situations; Motivations and Incentives; The Indiv i d u a l in t h e I n d u s t r i a l C o m m u n i t y ; W o m e n a n d I n d u s t r y ; P e r s o n n e l Selection a n d J o b A s s i g n m e n t ; J o b s M i s f i t s ; A b s e n t e e i s m ; W a r - t i m e P r e s s u r e a n d Its E f f e c t s ; O r g a n isation of I n d u s t r i a l M e n t a l H e a l t h a n d t h e R e l a t i o n of H e a l t h to Behaviour. T h e g r o u n d covered is extensive a n d the views expressed are t h o s e of p e r s o n s well qualified to speak. T h e book w o u l d have b e e n b e t t e r for careful editing a n d is a n e x a m p l e of t h e d i s a d v a n t a g e of p r i n t i n g t h e spoken w o r d w i t h o u t drastic c u t t i n g ; it is, however, r e c o m m e n d e d to all i n t e r e s t e d in industrial health.
MEMBERSHIP OF THE TUBERCULOSIS GROUP (The following memorandum, addressed to medical officers of health of authorities with tuberculosis staffs, is printed in the journal in view of the current difficulties of circularisation and as part of the campaign for recruitment of new members.) T h e view has been expressed by the Committee of the Tuberculosis Group of the Society that the strength of the Society as a whole, and of the Tuberculosis Group in particular, is impaired because too many tuberculosis officers and sanatorium medical officers are not Fellows of the Society and members of the Group. T h e reason for this may be that they are unaware that the Society exists, or that they fail to see any advantage in belonging to it. It is to the advantage of all that such a state of affairs should be remedied, and I would be grateful, therefore, if you would try to persuade any members of your tuberculosis staff who are not Fellows to join the Society. T h e Tuberculosis Service has many problems of a varied administrative and clinical nature. These difficulties must be resolved if the service is to achieve maximum efficiency and to hold the confidence of the general practitioners and the respect of consultants in other branches of medicine, as well as that of the public. Tuberculosis officers also have their own individual problems, which are often capable of solution by the combined experience of their fellow workers. T h e Tuberculosis Group Committee is actively engaged on all these matters on behalf both of the Society and of individual members of the Group. It has taken part, either directly or through its members, on the Joint Tuberculosis Council, in such matters as salaries, Memo. 266/T, remuneration for reports under Memo 146/T, facilities for postgraduate study, sanatorium staff problems, and similar items of interest to members as a whole, as well as advising members on individual problems which they have referred tO the Committee. The Hon. Secretary keeps a list of suitable persons for locum tenens though at present the n u m b e r available is very small, and the undersigned would be grateful for the names of any retired or otherwise available experienced men or women. Sub-Groups have been formed in the Metropolitan and Midland districts for clinical and other meetings. T h e Tuberculosis Group collaborates with the other departmental groups of the Society in all matters affecting the welfare of departmental officers as a whole. T h e Hon. Secretary will be only too glad to supply any further information, and hopes he may have your support and help in strengthening the Tuberculosis Group, for its own benefit and that of the Public Health Service as a whole. R. L. MIDGLEY, Hawkmoor Sanatorium, Hon. Secretary. Bovey Tracy, Devon.