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Mental health of the nation, 1946
PUBLIC HEALTH, January, 1948
52 confirming, the sequence, was, for various reasons, disappointingly incomplete•) The authors refer to previous surveys by F o x and Bortin4 and Aycock and Ingalls2 (who have also made a similar enquiry, with comparable results, in poliomyelitis), both of which, like their own, included infected mothers delivered of normal infants. F o r the sake of completeness they h a v e combined the results of the three surveys and these m a y be summarized as follows. Of 76 pregnant w o m e n infected with rubella during the first three t r i m e s t e r s (not months), 16 bore defective infants and ten aborted, or the infant was still-bern. T h u s in about a third of the pregnancies the infant was either lost or defective. I n half the abnormal pregnancies the mother was infected with rubella _during the first trimester compared with 14% during the second and third trimesters respectively. Ober el at., point out that, with the exception of Aycock and Ingalls, no previous observers h a v e referred to abortions and still-births although these are as large in number as defective children, and t h e y recommend that in all cases careful autopsies should be performed.
that facilitates cleanliness, to keep t h e m free from infestation and, regarding their employees, to facilitate their personal cleanliness, to take precautions against infections and, if any are reported or observed, to notify the M . O . H . T h e e m ployees, on their side, undertake to maintain a high standardof personal cleanliness, both of body and clothing, and to sup port their employers' efforts to keep a good standard in the premises and to notify their employers if they are suffering from, or in contact with, an infectious or contagious disease. I n a s m u c h as certain requirements necessitate building or other forms of alteration, a period o f four m o n t h s has been given before the scheme actually comes into operation, but Dr. Belam is hopeful that after that time, the conditions u n d e r which food is prepared or sold in G u i l d f o r d will set an example for other areas. H e states that firms are already very sensitive to any possibility of infection arising among their staffs, especially in connection with poliomyelitis and scarlet fever, and this feeling is being fostered by lectures from the Central Council for Health Education, T h e results of the full operation of this scheme will be awaited with great interest.
REFERENCES
FRANKLIN H. ToP. " Handbook of Communicable Diseases," 2nd edition. St. Louis (1947) and London. pp. 464. 2 AYcocK, W. I3., and INGALLS, T. H. (1946.) Am. ]. reed. Sci., 212, 366. 30BER, R. E., HORTON, J. M., and F E E M S T E R , R. F. (1947.) Am. ]. Publ. Hlth., 37, 1328. ' F o x , M. J., and BORTIN, M. M. (1946.) ]. Am. reed. Ass., 130, 568.
• 1
G u i l d f o r d ' s I n i t i a t i v e in F o o d H y g i e n e O u r necessarily very brief reference, in reporting the conference for F o o d and Drink Infections in our N o v e m b e r issue (page 20), to the scheme instituted by G u i l d f o r d Borough Council to raise the local standards in food practice calls for some amplification, and we are indebted to Dr. F. A. Belam ( M . O . H . , Guildford) for further information on what has been done or is proposed, in his town. T h e story begins with a special investigation carried out in 1946 u n d e r the C h i e f Sanitary Inspector (Mr. J. A. Perry) into the methods of manufacture, handling and distribution of all classes of foodstuffs. T h e survey involved 317 food premises (including 42 concerned with making or selling icecream, 16 dairy farms and dairies, 48 cafrs or restaurants, 30 butchers or cooked m e a t shops, 76 general stores and confectioners, e t c . ) - - a n interesting fact alone in a town of only some 46,000 population, though it is, of course, the shopping centre for a fairly populous surrounding area. T h e results showed many deficiencies. T o take one example : of 48 car& and restaurants, 16 had no sanitary accommodation or washing facilities for customers and three had no separate a c c o m m o d a tion for sexes, and in the snack-bar type of caf~ food was produced in most unsatisfactory conditions. In these and m a n y other food-handling premises there was lack of sanitary provision to enable staff to maintain p r o p e r personal cleanlin e s s ; heating and structure were inadequate in many. O f three Government-controlled slaughterhouses in Guildford, of which two are in regular use, it was reported that conditions were most unsatisfactory on account of bad situation of buildings, inadequate lairage, slaughtering and hanging accommodation, excessive numbers of animals slaughtered and insufficient staff, so that a good standard of meat inspection could only be maintained with the greatest difficulty. After consideration of these findings, a special sub-committee r e c o m m e n d e d to the Council that all possible steps be taken to raise the standard of conditions u n d e r which food is prepared and distributed and that a " G u i l d f o r d Hygienic F o o d T r a d e r s ' G u i l d " be set up. T h i s was accepted, and the G u i l d has now been formed u n d e r an advisory committee comprising the chairman of the Borough Health Committee, four other Borough councillors, and 13 representatives of the trades concerned. T h e essence of the scheme is observance by m e m b e r s of codes of practice which have been agreed for the various types of premises. U n d e r the codes, the employers undertake, in addition to conforming with statutory requiremerits, to maintain their premises and e q u i p m e n t in a way
The National Diet w o publish in our correspondence columns, on page 66, an eloquent r i p o s t e - - u n d e r the title " ' D y i n g E n g l a n d ' or ' The Birth of a Nation '? " - - t o the recent vote at a debate of the Hunterian Society, reported in the B.M.J. ( N o v e m b e r 29th, page 882) and. L a n c e t ( N o v e m b e r 22nd, page 768), when a majority of about three to one d e c i d e d that " our present diet is undermining the health of the nation•" W e consider that our correspondent has completely made out his case that the general distribution of foodstuffs in Britain is now more equitable t h a n before the war or ever before, that the nutrition of the priority classes is almost certainly at a better level, and that the signs of actual deficiencies in the diet are lacking. But there are certain reservations in our m i n d which prevent accepting the opinion that the national diet as a whole is truly adequate both in q u a n t i t y and variety, when we recall such points as the honest view expressed b y some observers that the fats allowance is dangerously low, the demands b y certain h e a v y workers and university students for additional food, and the state of lonely old people, as recently revealed in Croydon. R e g a r d i n g the members of the Hunterian Society, it is fair, too, to observe that men in practice, who are in contact with patients every day, are entitled to draw conclusions from their observations, although it should also be remembered that they m a y be confusing with under-nutrition the effects of other present-day troubles such as overwork, the strain on women of obtaining rations and the anxieties which m a n y people are suffering both as to their own and the country's economic future and as to the international complications. Sir J a c k D r u m m o n d himself has, in a letter to T h e T i m e s of D e c e m b e r 29th, expressed anxiety lest the present concurrent rationing of both bread and potatoes m a y threaten the reserve of calorie intake. Regarding the unanswered point in his last sentence, our co;respondent will find some evidence in the survey reported in the C a n a d i a n P u b l i c H e a l t h J o u r n a l for November,* which found that, a m o n g 12,848 Canadians of 18 years upwards, 17% were 10% or more above average weight for height, age and sex (18% amongst those over 40) and urged that " overweight in older persons is a nutritional abnormality caused by the consumption of too m u c h food, that it has been generally disregarded in nutrition education and that it needs the vigorous attention of health officials "! M e n t a l H e a l t h of the Nation, 1946 The 33rd annual report of the Board of Control, t the last to be issued in this form, clearly illustrates the w a y in which the importance of early treatment of mental illness has been realised b y the public• The n u m b e r of admissions to mental McHEm~v, E. W., CRAWFORD,R., and B A R K E R , L. (1947.) " T h e Heights and Weights of a Canadian Group." Can. ]. Pub. Hlth., 38, 437. t 33rd Annual Report of the Board of Control for the Year 1946. Part I. Pp. 40. H.M. Stationery Office. Price 9d.
PUBLIC HEALTH, January, 1948 hospitals each year has been steadily increasing, and the figure was 85,585 in 1946 compared with 27,437 in 1938: of these about 18,000 were voluntary admissions in 1946 (9,600 in 1938). This is held to show that the public now appreciate that a mental hospital is a place where effective treatment is possible and are ready to seel~ it early. The n u m b e r of discharges in 1946 was 25,326, the highest ever recorded, representing 71'2% of the direct admissions--the average for the prevtous five years was 67'1%. At the end of the y e a r there were 146,444 persons under treatment, of w h o m the majority were in public mental hospitals. There was an aggregate of overcrowding of 13"1% on the basis of the recognised bed space owing to the diversion of 10,417 beds to war-time services, and to staff shortage in the case of 3,080 beds. The Board are anxious about a breakdown in institutional provision unless some way is found through the present building shortages of material and labour. ]~egarding treatment, the Board note that some form of physical treatment is used in every mental hospital to supplement psycho-therapy and other methods. The Board's administrative function has already been transferred to the Minister of Health, and c o m m e n t i n g on this the report states: " The Board of Control welcome the integration of the Mental H e a l t h Service with the National Health Service. T h e y h a v e long held the view that further progress in the treatment of mental illness would depend largely upon the closer association of psychiatry with general medicine, and the breaking down of that isolation by which the treatment of mental illness has so often been handicapped. We believe that in the development of the integrated service there are invaluable opportunities for expanding the scope and increase the efficiency of the Mental Health S e r v i c e . " Members of the Society will note that Dr. W. Rees Thomas, Senior Medical Commissioner of the Board, has kindly undertaken to address a general meeting of the Society on Thursday, F e b r u a r y 19th, at 5.30 p.m., on the scope of the future Mental Health Service and the part to be played by the local health authorities. A n A m e r i c a n A w a r d to the Ministries o f F o o d a n d H e a l t h Sir Wilson Jameson attended the 7 5 t h annual meeting of the American Public Health Association in October last, in order to receive on behalf of the Ministries of F o o d and H e a l t h a Lasker Group Award " for the unprecedented p r o g r a m m e of food distribution in Great Britain during the war with resulting improvement in the health of the p e o p l e . " The awards, in the form of statuettes of the " Winged Victory " of Samothrace, are provided by the Albert and Mary Lasker Foundation, and are made either to individuals or groups for outstanding work in medical research or health administration. The award to the British Ministries is the first to be given to a foreign country. The citation r e a d s : " L o n g before the World War II, the Medical Research Council and the health authorities of Great Britain had been active in promoting research and in spreading knowledge of nutrition among the people. In 1937 an Advisory Committee on Nutrition was set up by "the British Ministry of ~Iealth which undertook a survey of the national diet, The background had therefore been developed before the outbreak of the war for the first large-scale application of the science of nutrition to the population of the United Kingdom. A separate Ministry of Food was established with wide executive powers over the production and rationing of foods, the purchase of foods from abroad and the education of the public in the proper use of available foods. By the effective employment of its great powers, the Ministry of Food, in consultation with the Ministry of Health and with the advice (on all matters which might affect the health of the people) of a Standing Committee under the chairmanship, of the Chief Medical Officer, succeeded to a remarkable degree m providing a diet for all the workers of the country in conformity with their physiological requirement, irrespective of income. Although almost all other environmental factors which might influence the public health deteriorated under the stress of war, the public health in Great Britain was maintained and in many respects improved, The rates of infantile, neo-natal and maternal mortality and of stillbirths all reached the lowest levels in the history of the country. The incidence of anaemia and dental caries declined, the rate of growth of school children improved, progress was made in the control of tuberculosis, and the general
53 state of nutrition of the population as a whole was up to or an improvement upon pre-war standards. In the opinion of the Lasker Awards Committee, this has been one of the greatest demonstrations in public health administration that the world has ever seen, The Lasker Awards Committee of the American Public Health Association therefore takes great satisfaction in recommending awards for scientific and administrative achievement to the British Ministries of Food and Health and to the four great leaders in this historic enterprise, Lord Woolton, Sir.Jack Drummond, Sir Wilson Jameson arid Sir John Boyd Orr." The four persons n a m e d above h a v e each received a leather=bomtd volume containing the citation illuminated and inscribed by hand. While attending the meeting of the A . P . H . A . , Sir Wilson read a paper on Britain's war-time food scheme (printed in the A m e r i c a n J o u r n a l o f P u b l i c H e a l t h , November, 1947) which gave a lucid s u m m a r y of the planning and results from the health aspect of this great national undertaking. S a f e T r e a t m e n t o f Milk United Dairies, Ltd., h a v e done a useful service in enlisting the aid of St. Mary's Hospital Incubation D e p a r t m e n t to carry out a series of tests on bulked milk before and after pasteurisation b y the H . T . S . T . process. The results were given in a letter by the chief chemist of the firm published in the B r i t i s h M e d i c a l J o n r n a l of D e c e m b e r 6th (page 927) and show that 129. samp.les of raw milk taken in 1945 and 1946 gave a positive guinea-pig test for tubercle bacilli: the 129 sample of H . T . S . T . pasteurised, milk corresponding to the above raw were all negative in the test and also passed the official phosphatase test. In a leading article in the same issue, the B . M . J . refers to the troubles encountered in the phosphatase test and suggest t h a t health authorities should ask for guineapig inoculation tests to be carried out in a proportion of 5% of the pasteurised and heat-treated milks that they submit for examination in order to be sure that the process is working efficiently. Another interesting document which refers to safety of milk was published in the M u n i c i p a l R e v i e w for N o v e m b e r (page 389). This is the m e m o r a n d u m prepared by the public health committee of the Association of Municipal Corporations for submission to the Williams Committee set up by the Minister of F o o d in October, 1946, to report on the distribution Of liquid milk from the producer to the consumer. On milk designations, the m e m o r a n d u m recommends that wide publicity should be given to the true meanings of the special designations, so that consumers m a y choose intelligently which type they wish to try and m a y realise that " Accredited," as m u c h as raw milk, should be boiled before giving it to y o u n g children; and later that there are strong reasons for believing that heat-treatment should now be m a d e compulsory and universal, should be imposed by law and not left to depend merely on financial considerations. T h e terms of Defence Regulation 55G, which give the Minister discretion to autborise any person to sell milk as " heat-treated " with the sole check of the methylene blue and phosphatase tests, are referred to, and the criticism is made that the Minister appears to be prepared to authorise " flash " pasteurisation, with all its uncertainty and lack of temperature-recording, as heat treatment along with the properly controlled pasteurising methods. The m e m o r a n d u m , therefore, urges t h a t all " heat-treated '" milk (with the possible exception of " Sterilised " ) should be sold as " pasteurised," after treatment b y the " holder " or H . T . S . T . methods prescribed by the Milk (Special Designations) Orders, 1935-46, and no other. C h a n g i n g I n c i d e n c e a n d M o r t a l i t y in T u b e r c u l o s i s One of the most remarkable features about the epidemiological picture of tuberculosis in this country has been the m o u n t i n g notification rate, which from 1939 to 1945 has risen from 110 to 120 per 100,000. Strangely enough, this has been associatec~ with an equally striking drop in the mortality figures, viz., 60 to 55 per 100,000 during the same period. It is interesting to speculate on the precise reasons for these r e m a r k a b l y diverse trends in this national disease. During the recent discussions staged b y the H u n t e r i a n Society at the Apothecaries Hall in London, Dr. Franklin Bicknell suggested that the rising notification trends were the sequel to the
52 confirming, the sequence, was, for various reasons, disappointingly incomplete•) The authors refer to previous surveys by F o x and Bortin4 and Aycock and Ingalls2 (who have also made a similar enquiry, with comparable results, in poliomyelitis), both of which, like their own, included infected mothers delivered of normal infants. F o r the sake of completeness they h a v e combined the results of the three surveys and these m a y be summarized as follows. Of 76 pregnant w o m e n infected with rubella during the first three t r i m e s t e r s (not months), 16 bore defective infants and ten aborted, or the infant was still-bern. T h u s in about a third of the pregnancies the infant was either lost or defective. I n half the abnormal pregnancies the mother was infected with rubella _during the first trimester compared with 14% during the second and third trimesters respectively. Ober el at., point out that, with the exception of Aycock and Ingalls, no previous observers h a v e referred to abortions and still-births although these are as large in number as defective children, and t h e y recommend that in all cases careful autopsies should be performed.
that facilitates cleanliness, to keep t h e m free from infestation and, regarding their employees, to facilitate their personal cleanliness, to take precautions against infections and, if any are reported or observed, to notify the M . O . H . T h e e m ployees, on their side, undertake to maintain a high standardof personal cleanliness, both of body and clothing, and to sup port their employers' efforts to keep a good standard in the premises and to notify their employers if they are suffering from, or in contact with, an infectious or contagious disease. I n a s m u c h as certain requirements necessitate building or other forms of alteration, a period o f four m o n t h s has been given before the scheme actually comes into operation, but Dr. Belam is hopeful that after that time, the conditions u n d e r which food is prepared or sold in G u i l d f o r d will set an example for other areas. H e states that firms are already very sensitive to any possibility of infection arising among their staffs, especially in connection with poliomyelitis and scarlet fever, and this feeling is being fostered by lectures from the Central Council for Health Education, T h e results of the full operation of this scheme will be awaited with great interest.
REFERENCES
FRANKLIN H. ToP. " Handbook of Communicable Diseases," 2nd edition. St. Louis (1947) and London. pp. 464. 2 AYcocK, W. I3., and INGALLS, T. H. (1946.) Am. ]. reed. Sci., 212, 366. 30BER, R. E., HORTON, J. M., and F E E M S T E R , R. F. (1947.) Am. ]. Publ. Hlth., 37, 1328. ' F o x , M. J., and BORTIN, M. M. (1946.) ]. Am. reed. Ass., 130, 568.
• 1
G u i l d f o r d ' s I n i t i a t i v e in F o o d H y g i e n e O u r necessarily very brief reference, in reporting the conference for F o o d and Drink Infections in our N o v e m b e r issue (page 20), to the scheme instituted by G u i l d f o r d Borough Council to raise the local standards in food practice calls for some amplification, and we are indebted to Dr. F. A. Belam ( M . O . H . , Guildford) for further information on what has been done or is proposed, in his town. T h e story begins with a special investigation carried out in 1946 u n d e r the C h i e f Sanitary Inspector (Mr. J. A. Perry) into the methods of manufacture, handling and distribution of all classes of foodstuffs. T h e survey involved 317 food premises (including 42 concerned with making or selling icecream, 16 dairy farms and dairies, 48 cafrs or restaurants, 30 butchers or cooked m e a t shops, 76 general stores and confectioners, e t c . ) - - a n interesting fact alone in a town of only some 46,000 population, though it is, of course, the shopping centre for a fairly populous surrounding area. T h e results showed many deficiencies. T o take one example : of 48 car& and restaurants, 16 had no sanitary accommodation or washing facilities for customers and three had no separate a c c o m m o d a tion for sexes, and in the snack-bar type of caf~ food was produced in most unsatisfactory conditions. In these and m a n y other food-handling premises there was lack of sanitary provision to enable staff to maintain p r o p e r personal cleanlin e s s ; heating and structure were inadequate in many. O f three Government-controlled slaughterhouses in Guildford, of which two are in regular use, it was reported that conditions were most unsatisfactory on account of bad situation of buildings, inadequate lairage, slaughtering and hanging accommodation, excessive numbers of animals slaughtered and insufficient staff, so that a good standard of meat inspection could only be maintained with the greatest difficulty. After consideration of these findings, a special sub-committee r e c o m m e n d e d to the Council that all possible steps be taken to raise the standard of conditions u n d e r which food is prepared and distributed and that a " G u i l d f o r d Hygienic F o o d T r a d e r s ' G u i l d " be set up. T h i s was accepted, and the G u i l d has now been formed u n d e r an advisory committee comprising the chairman of the Borough Health Committee, four other Borough councillors, and 13 representatives of the trades concerned. T h e essence of the scheme is observance by m e m b e r s of codes of practice which have been agreed for the various types of premises. U n d e r the codes, the employers undertake, in addition to conforming with statutory requiremerits, to maintain their premises and e q u i p m e n t in a way
The National Diet w o publish in our correspondence columns, on page 66, an eloquent r i p o s t e - - u n d e r the title " ' D y i n g E n g l a n d ' or ' The Birth of a Nation '? " - - t o the recent vote at a debate of the Hunterian Society, reported in the B.M.J. ( N o v e m b e r 29th, page 882) and. L a n c e t ( N o v e m b e r 22nd, page 768), when a majority of about three to one d e c i d e d that " our present diet is undermining the health of the nation•" W e consider that our correspondent has completely made out his case that the general distribution of foodstuffs in Britain is now more equitable t h a n before the war or ever before, that the nutrition of the priority classes is almost certainly at a better level, and that the signs of actual deficiencies in the diet are lacking. But there are certain reservations in our m i n d which prevent accepting the opinion that the national diet as a whole is truly adequate both in q u a n t i t y and variety, when we recall such points as the honest view expressed b y some observers that the fats allowance is dangerously low, the demands b y certain h e a v y workers and university students for additional food, and the state of lonely old people, as recently revealed in Croydon. R e g a r d i n g the members of the Hunterian Society, it is fair, too, to observe that men in practice, who are in contact with patients every day, are entitled to draw conclusions from their observations, although it should also be remembered that they m a y be confusing with under-nutrition the effects of other present-day troubles such as overwork, the strain on women of obtaining rations and the anxieties which m a n y people are suffering both as to their own and the country's economic future and as to the international complications. Sir J a c k D r u m m o n d himself has, in a letter to T h e T i m e s of D e c e m b e r 29th, expressed anxiety lest the present concurrent rationing of both bread and potatoes m a y threaten the reserve of calorie intake. Regarding the unanswered point in his last sentence, our co;respondent will find some evidence in the survey reported in the C a n a d i a n P u b l i c H e a l t h J o u r n a l for November,* which found that, a m o n g 12,848 Canadians of 18 years upwards, 17% were 10% or more above average weight for height, age and sex (18% amongst those over 40) and urged that " overweight in older persons is a nutritional abnormality caused by the consumption of too m u c h food, that it has been generally disregarded in nutrition education and that it needs the vigorous attention of health officials "! M e n t a l H e a l t h of the Nation, 1946 The 33rd annual report of the Board of Control, t the last to be issued in this form, clearly illustrates the w a y in which the importance of early treatment of mental illness has been realised b y the public• The n u m b e r of admissions to mental McHEm~v, E. W., CRAWFORD,R., and B A R K E R , L. (1947.) " T h e Heights and Weights of a Canadian Group." Can. ]. Pub. Hlth., 38, 437. t 33rd Annual Report of the Board of Control for the Year 1946. Part I. Pp. 40. H.M. Stationery Office. Price 9d.
PUBLIC HEALTH, January, 1948 hospitals each year has been steadily increasing, and the figure was 85,585 in 1946 compared with 27,437 in 1938: of these about 18,000 were voluntary admissions in 1946 (9,600 in 1938). This is held to show that the public now appreciate that a mental hospital is a place where effective treatment is possible and are ready to seel~ it early. The n u m b e r of discharges in 1946 was 25,326, the highest ever recorded, representing 71'2% of the direct admissions--the average for the prevtous five years was 67'1%. At the end of the y e a r there were 146,444 persons under treatment, of w h o m the majority were in public mental hospitals. There was an aggregate of overcrowding of 13"1% on the basis of the recognised bed space owing to the diversion of 10,417 beds to war-time services, and to staff shortage in the case of 3,080 beds. The Board are anxious about a breakdown in institutional provision unless some way is found through the present building shortages of material and labour. ]~egarding treatment, the Board note that some form of physical treatment is used in every mental hospital to supplement psycho-therapy and other methods. The Board's administrative function has already been transferred to the Minister of Health, and c o m m e n t i n g on this the report states: " The Board of Control welcome the integration of the Mental H e a l t h Service with the National Health Service. T h e y h a v e long held the view that further progress in the treatment of mental illness would depend largely upon the closer association of psychiatry with general medicine, and the breaking down of that isolation by which the treatment of mental illness has so often been handicapped. We believe that in the development of the integrated service there are invaluable opportunities for expanding the scope and increase the efficiency of the Mental Health S e r v i c e . " Members of the Society will note that Dr. W. Rees Thomas, Senior Medical Commissioner of the Board, has kindly undertaken to address a general meeting of the Society on Thursday, F e b r u a r y 19th, at 5.30 p.m., on the scope of the future Mental Health Service and the part to be played by the local health authorities. A n A m e r i c a n A w a r d to the Ministries o f F o o d a n d H e a l t h Sir Wilson Jameson attended the 7 5 t h annual meeting of the American Public Health Association in October last, in order to receive on behalf of the Ministries of F o o d and H e a l t h a Lasker Group Award " for the unprecedented p r o g r a m m e of food distribution in Great Britain during the war with resulting improvement in the health of the p e o p l e . " The awards, in the form of statuettes of the " Winged Victory " of Samothrace, are provided by the Albert and Mary Lasker Foundation, and are made either to individuals or groups for outstanding work in medical research or health administration. The award to the British Ministries is the first to be given to a foreign country. The citation r e a d s : " L o n g before the World War II, the Medical Research Council and the health authorities of Great Britain had been active in promoting research and in spreading knowledge of nutrition among the people. In 1937 an Advisory Committee on Nutrition was set up by "the British Ministry of ~Iealth which undertook a survey of the national diet, The background had therefore been developed before the outbreak of the war for the first large-scale application of the science of nutrition to the population of the United Kingdom. A separate Ministry of Food was established with wide executive powers over the production and rationing of foods, the purchase of foods from abroad and the education of the public in the proper use of available foods. By the effective employment of its great powers, the Ministry of Food, in consultation with the Ministry of Health and with the advice (on all matters which might affect the health of the people) of a Standing Committee under the chairmanship, of the Chief Medical Officer, succeeded to a remarkable degree m providing a diet for all the workers of the country in conformity with their physiological requirement, irrespective of income. Although almost all other environmental factors which might influence the public health deteriorated under the stress of war, the public health in Great Britain was maintained and in many respects improved, The rates of infantile, neo-natal and maternal mortality and of stillbirths all reached the lowest levels in the history of the country. The incidence of anaemia and dental caries declined, the rate of growth of school children improved, progress was made in the control of tuberculosis, and the general
53 state of nutrition of the population as a whole was up to or an improvement upon pre-war standards. In the opinion of the Lasker Awards Committee, this has been one of the greatest demonstrations in public health administration that the world has ever seen, The Lasker Awards Committee of the American Public Health Association therefore takes great satisfaction in recommending awards for scientific and administrative achievement to the British Ministries of Food and Health and to the four great leaders in this historic enterprise, Lord Woolton, Sir.Jack Drummond, Sir Wilson Jameson arid Sir John Boyd Orr." The four persons n a m e d above h a v e each received a leather=bomtd volume containing the citation illuminated and inscribed by hand. While attending the meeting of the A . P . H . A . , Sir Wilson read a paper on Britain's war-time food scheme (printed in the A m e r i c a n J o u r n a l o f P u b l i c H e a l t h , November, 1947) which gave a lucid s u m m a r y of the planning and results from the health aspect of this great national undertaking. S a f e T r e a t m e n t o f Milk United Dairies, Ltd., h a v e done a useful service in enlisting the aid of St. Mary's Hospital Incubation D e p a r t m e n t to carry out a series of tests on bulked milk before and after pasteurisation b y the H . T . S . T . process. The results were given in a letter by the chief chemist of the firm published in the B r i t i s h M e d i c a l J o n r n a l of D e c e m b e r 6th (page 927) and show that 129. samp.les of raw milk taken in 1945 and 1946 gave a positive guinea-pig test for tubercle bacilli: the 129 sample of H . T . S . T . pasteurised, milk corresponding to the above raw were all negative in the test and also passed the official phosphatase test. In a leading article in the same issue, the B . M . J . refers to the troubles encountered in the phosphatase test and suggest t h a t health authorities should ask for guineapig inoculation tests to be carried out in a proportion of 5% of the pasteurised and heat-treated milks that they submit for examination in order to be sure that the process is working efficiently. Another interesting document which refers to safety of milk was published in the M u n i c i p a l R e v i e w for N o v e m b e r (page 389). This is the m e m o r a n d u m prepared by the public health committee of the Association of Municipal Corporations for submission to the Williams Committee set up by the Minister of F o o d in October, 1946, to report on the distribution Of liquid milk from the producer to the consumer. On milk designations, the m e m o r a n d u m recommends that wide publicity should be given to the true meanings of the special designations, so that consumers m a y choose intelligently which type they wish to try and m a y realise that " Accredited," as m u c h as raw milk, should be boiled before giving it to y o u n g children; and later that there are strong reasons for believing that heat-treatment should now be m a d e compulsory and universal, should be imposed by law and not left to depend merely on financial considerations. T h e terms of Defence Regulation 55G, which give the Minister discretion to autborise any person to sell milk as " heat-treated " with the sole check of the methylene blue and phosphatase tests, are referred to, and the criticism is made that the Minister appears to be prepared to authorise " flash " pasteurisation, with all its uncertainty and lack of temperature-recording, as heat treatment along with the properly controlled pasteurising methods. The m e m o r a n d u m , therefore, urges t h a t all " heat-treated '" milk (with the possible exception of " Sterilised " ) should be sold as " pasteurised," after treatment b y the " holder " or H . T . S . T . methods prescribed by the Milk (Special Designations) Orders, 1935-46, and no other. C h a n g i n g I n c i d e n c e a n d M o r t a l i t y in T u b e r c u l o s i s One of the most remarkable features about the epidemiological picture of tuberculosis in this country has been the m o u n t i n g notification rate, which from 1939 to 1945 has risen from 110 to 120 per 100,000. Strangely enough, this has been associatec~ with an equally striking drop in the mortality figures, viz., 60 to 55 per 100,000 during the same period. It is interesting to speculate on the precise reasons for these r e m a r k a b l y diverse trends in this national disease. During the recent discussions staged b y the H u n t e r i a n Society at the Apothecaries Hall in London, Dr. Franklin Bicknell suggested that the rising notification trends were the sequel to the