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Midland Branch
1942 consultants would visit cases in the home if required by the family doctor. Spaced around there would be subsidiary health centres, staffed by groups of doctors, from which the district nurses and health visitors would also work. I n the transition period Mr. Hastings would have ali the clinical health services, including the school medical service and the medical section of National Health Insurance, taken over by the public health commgttees, in each area. Whilst anxious to safeguard the interests of existing insurance practitioners, he would oppose the extension of the panel system. Such practices should not be bought and sold, but the most suitable doctor should be appointed to carry out the work. He would like to see the institution of specialist consultation clinics by local authorities made compulsory and the law amended to permit these specialists to be called out to the patient's home by the family doctor at the expense of the local,authority. An important measure for the provision of good heahh services by the local authorities was to make the Acts of Parliament dealing with the personal health services compulsory instead of merely permissive. Mr. Hastings welcomed the announced survey of the hospital service. It was desirable to get rid of the competition between the voluntary and municipal hospitals ; after a space of years all hospitals would probably come under the control of committees composed of elected representatives of the community. I n his view this was the proper solution. ~_ATERNITY AND CHILD WELFARE Dr. Marjorie Back (A.M.O.H., Middlesex C.C.) gave a lucid survey of the place of maternity and child welfare work in medical planning. Dr. Back said that it would not be difficult to combine a national maternity and child welfare service in the excellent scheme just outlined by Mr. Somerville Hastings. It was very desirable that the meeting should have a practical outcome and that the future of the maternity and child welfare movement should be assured. T h e Maternity and Child Welfare Act gave the authorities a wide charter, but was it wide enough ? Should the work still be limited to the care of expectant and nursing mothers, or should it be expanded to take in all women of child-hearing age .~ Should the ban on domiciliary medical service be removed ? Dr. Beck agreed with Mr. Somerville Hastings in hoping that the permissive character of the Act would be made compulsory. T h e aim of any maternity a n d child welfare scheme should be to teach the art of parent-craft and to provide the means whereby the knowledge could be put into practice. The present powers of the local authorities were not fully utilised, but that should not prevent them from looking forward to possible alterations or extensions. T h e B.M.A. scheme for a general medical service for the nation, published in 1938, put forward a general practitioner service through an extension of the N.H.I. scheme and a reorganisation of the public assistance domiciliary service. Dr. Back agreed with Mr. Somerville Hastings in disliking a national scheme which included only a section of the population. It would seem better to make a family doctor available to all in the community in the same way as elementary education was provided for every child. The Ministry of Health Report in 1920 did not deal with maternity and child welfare in detail, but at that time maternity and child welfare schemes were only just coming into force. The Report envisaged a scheme not unlike that of Mr. Hastings but carried out by general practitioners instead of wholetime medical officers. Into such a scheme it would not be difficult to institute an
PUBLIC HEALTH effective maternity and child welfare service much on the present lines. Other possibilities might arise. The end of the war might see a complete State medical service in a socialised state. Another possibility was that the result of the increased hospitalisation of mothers during the war emergency would create after the war a public demand for institutional confinement. Dr. Back drew attention to the overcrowding of centres and to the employment of personnel without adequate specialised knowledge or whose knowledge had become out of date; this problem might be dealt with by more refresher courses. The inability of mothers to carry, out advice owing to poverty and bad housing conditions was a social and economic problem but nevertheless demanded a solution. The removal of the children in the 2 to 5 year old group from the maternity and child welfare scheme when they were admitted to nursery schools was a pity, and the counter-suggestion that all- medical care of school children should be removed from the Board of Education and given to the Ministry of Health deserved consideration. Dr. Back stressed the importance of the training of health visitors and pleaded for a closer liaison between the educational and treatment services, represented by the clinic doctor and the general practitioner. Many people took part in the subsequent discussion. Among them Dr. Maitland Radford paid a tribute to the administrative ability shown in the scheme of Mr. Somerville Hastings. MIDLAND BRANCH President: Dr. Ethel Cassie, O.B.E. (Senior A.M.O., M. & C.W., Birmingham). Hon. Secretary: Dr. R. H. H. Jolly (M.O.H., Wolverhampton C.B.): The second meeting of the session was held at Birmingham on November 6th, 1941, at 3 p.m. T h e minutes of the previous meeting were read and confirmed. T h e Hon. Treasurer, Dr. Gibbons Ward, presented the balance sheet for 1940-41 and the annual statement of accounts. These were received and adopted. It was unanimously agreed that Dr. J. Cowie, on his retirement from the post of Medical Officer of Health, Burton-on-Trent, should be recommended for fullypaid life membership of the Society. Dr. Cowie joined the Society in 1914 and was President of the Midland Branch in 1915. MEDICAL PLANNING Dr. A. Massey, in a discussion on " M e d i c a l Planning," said that the two alternative methods of dealing with the problem were by means of a root-and-branch reform, or by way of the evolution of existing services. As the present system was wasteful of man power and restricted the equipment and amenities available, he thought that the domiciliary practice of the future should be conducted from a district health centre, and that it should provide an increased scientific interest to those engaged in it. These health centres might be linked up with school medical work and with tuberculosis and V.D. clinics. He pointed out that an increasing proportion of the income of the general practitioner was derived" from public funds, and this meant a greater control over his services. This increase in the public service of the doctor might be brought about by an extension of the scope of National Health Insurance work, or there might be an out-and-out national medical service. He considqred that the new industrial medical service was b.eing built on wrong lines and that it should be linked with the general public health services. 111
PUBLIC HEALTH Dr. A. Beauchamp, Hon. Secretary of the Birmingham Division of the B.M.A., after admitting that a large proportion of general practitioners would prefer a State medical service to existing conditions, enumerated some of the faults and advantages of the present system of private and panel practice. He then outlined the following scheme as an alternative to a State medical service. Practice areas of a suitable size "should be defined in all urban areas, each with its own primary health centre at which the equipment would be adequate but not elaborate. From this centre all general practitioners' services, the school medical service, the maternity and child welfare service, immunisation, public assistance medical service, and industrial medicine would be conducted. Each centre would be linked with a district hospital, and all the medical officers attached to the centre would be members of the staff. They would be entitled to call in consultants as necessary. Groups of primary health centres would be linked with a secondary health centre, which would deal mainly with cases of tuberculosis, venereal disease, and mental defects and disorders. Existing general hospitals, voluntary and m u n i cipal, would continue, but their out-patient work would be diminished by the above scheme. Dr. Beauchamp proposed to liquidate general practices by means of deferred annuities and to pay doctors a fixed salary. Everybody would be entitled to attend the health centres, but they would be charged a fee graduated in accordance with their means. The third speaker was Mr. Fauset Welsh, F.R.C.S., who called for a spirit of devotion and not of greed. T h e difficulty was to combine freedom to the individual doctor or hospital with a reasonable amount of order. Regional p l a n n i n g , as well as national planning, was necessary for the future treatment of the sick. Dr. Cassie emphasised the value of teaching hospitals, and thought it would be an advantage to include m u n i cipal hospitals in teaching schemes. She considered that medical degrees should be national and not regional. A lively discussion followed, a~ad in replying Dr. Masse), said that at this stage broad principles alone could,be considered.
EASTERN BRANCH President: Dr. V. F. Soothill (M.O.H., Norwich C.B.). Hon. Secretary: Dr. J. W. Hunter (M.O.H. & S.M.O., Ipswich C.B.). A meeting of the Eastern Branch was held at Scole on November Ist, 1941, at 3 p.m. The minutes of the previous meeting were submitted and signed by the chairman. It was agreed that the Branch should forward to the Acting Executive Secretary of the Society observations on Medical Planning, and the Hon. Secretary was requested to represent the Branch on the Central C o m mittee. It was suggested that w h e n any Agenda was circulated in regard to the Central Committee the Branch should have an opportunity of discussing this before the Central meeting. Several points were brought forward in regard to post-war medical planning. A discussion on the various aspects of the control, prevention and treatment of scabies followed. In this connection it was resolved to forward to the Council a resolution stating that the Eastern Branch advocates that all facilities--for example, cinema, wireless, Press, etc.--should be used for propaganda on a national basis directed by the Ministry of Health. 112
FEBRUARY NORTHERN BRANCH President: Dr. G. Hurrell (T.O., Newcastle-upon-Tyne). Hon. Secretary: Dr. J. A. Charles (M.O.H., Newcastleupon-Tyne). A meeting of the Branch was held at Newcastle-uponT y n e on November 22nd, 1941. The minutes of the annual meeting were read, confirmed, and signed by the chairman. The Hon. Secretary informed the members that he had received from the Hon. Secretary of the County Borough M.Os.H. Group copies of correspondence which had passed between him and the Hon. Secretary of the Association of County Medical Officers of Health regarding the activities of the Nuffield Trust. This matter had been raised at the Council Meeting on November 21st, and it was felt that the Nuffield T r u s t activities would begin to diminish as and when the Ministry of Health stated more clearly the Government's views on the subject of hospital re-organisation after the war. Dr. Grant was nominated to serve as the representative of the Northern Branch on the Medical Planning Committee of the Society. Dr. A. E. W. McLachlan then delivered an address on the present position as regards venereal disease.
YORKSHIRE BRANCH President : Dr. J. F. Galloway (M.O.H., Dewsbury C.B.). Hon. Secretary: Dr. R. Sutherland (M.O.H.I Brighouse M.B.). An ordinary meeting of the Branch was held at Leeds on November 28th at 2.30 p.m. A letter was read from the Secretary of the Yorkshire Council for Further Education inviting the Branch to nominate a representative to serve upon the County Advisory Committee on Food Education. The Secretary was nominated as the Branch's representative. After consideration of a letter from Dr. D. D. Payne, Medical Officer of Health, Harrogate, it was resolved that the Secretary should write to the Secretary of the Society asking that the Society should inform the British Medical Association that it wishes to dissociate itself from a resolution which was passed at a special conference of representatives of Home Divisions of the British Medical Association held at the B.M.A. House on September 1l t h and 12th. The resolution concerned was as follows : - 14. Medical Planning. Proposed by North Staffs (A. V. Campbell), and resolved (by 68 to 65) : That in the opinion of this meeting all representatives of the Ministry of Health and Ministry of Labour be excluded from all meetings of the Medical Planning Commission until the ultimate meeting of the Commission at which the final findings of the Commission will be discussed. It was also decided that the resolution passed at the same B.M.A. meeting urging the employment of parttime instead of whole-time medical officers wherever practicable in the various local government services should be referred for consideration to the Medical Planning Sub-Committee of the Branch. Dr. Dick, Medical Superintendent of St. James' Hospital, described to the meeting the new extensions to the hospital. He then conducted the members through the new wing.
PUBLIC HEALTH effective maternity and child welfare service much on the present lines. Other possibilities might arise. The end of the war might see a complete State medical service in a socialised state. Another possibility was that the result of the increased hospitalisation of mothers during the war emergency would create after the war a public demand for institutional confinement. Dr. Back drew attention to the overcrowding of centres and to the employment of personnel without adequate specialised knowledge or whose knowledge had become out of date; this problem might be dealt with by more refresher courses. The inability of mothers to carry, out advice owing to poverty and bad housing conditions was a social and economic problem but nevertheless demanded a solution. The removal of the children in the 2 to 5 year old group from the maternity and child welfare scheme when they were admitted to nursery schools was a pity, and the counter-suggestion that all- medical care of school children should be removed from the Board of Education and given to the Ministry of Health deserved consideration. Dr. Back stressed the importance of the training of health visitors and pleaded for a closer liaison between the educational and treatment services, represented by the clinic doctor and the general practitioner. Many people took part in the subsequent discussion. Among them Dr. Maitland Radford paid a tribute to the administrative ability shown in the scheme of Mr. Somerville Hastings. MIDLAND BRANCH President: Dr. Ethel Cassie, O.B.E. (Senior A.M.O., M. & C.W., Birmingham). Hon. Secretary: Dr. R. H. H. Jolly (M.O.H., Wolverhampton C.B.): The second meeting of the session was held at Birmingham on November 6th, 1941, at 3 p.m. T h e minutes of the previous meeting were read and confirmed. T h e Hon. Treasurer, Dr. Gibbons Ward, presented the balance sheet for 1940-41 and the annual statement of accounts. These were received and adopted. It was unanimously agreed that Dr. J. Cowie, on his retirement from the post of Medical Officer of Health, Burton-on-Trent, should be recommended for fullypaid life membership of the Society. Dr. Cowie joined the Society in 1914 and was President of the Midland Branch in 1915. MEDICAL PLANNING Dr. A. Massey, in a discussion on " M e d i c a l Planning," said that the two alternative methods of dealing with the problem were by means of a root-and-branch reform, or by way of the evolution of existing services. As the present system was wasteful of man power and restricted the equipment and amenities available, he thought that the domiciliary practice of the future should be conducted from a district health centre, and that it should provide an increased scientific interest to those engaged in it. These health centres might be linked up with school medical work and with tuberculosis and V.D. clinics. He pointed out that an increasing proportion of the income of the general practitioner was derived" from public funds, and this meant a greater control over his services. This increase in the public service of the doctor might be brought about by an extension of the scope of National Health Insurance work, or there might be an out-and-out national medical service. He considqred that the new industrial medical service was b.eing built on wrong lines and that it should be linked with the general public health services. 111
PUBLIC HEALTH Dr. A. Beauchamp, Hon. Secretary of the Birmingham Division of the B.M.A., after admitting that a large proportion of general practitioners would prefer a State medical service to existing conditions, enumerated some of the faults and advantages of the present system of private and panel practice. He then outlined the following scheme as an alternative to a State medical service. Practice areas of a suitable size "should be defined in all urban areas, each with its own primary health centre at which the equipment would be adequate but not elaborate. From this centre all general practitioners' services, the school medical service, the maternity and child welfare service, immunisation, public assistance medical service, and industrial medicine would be conducted. Each centre would be linked with a district hospital, and all the medical officers attached to the centre would be members of the staff. They would be entitled to call in consultants as necessary. Groups of primary health centres would be linked with a secondary health centre, which would deal mainly with cases of tuberculosis, venereal disease, and mental defects and disorders. Existing general hospitals, voluntary and m u n i cipal, would continue, but their out-patient work would be diminished by the above scheme. Dr. Beauchamp proposed to liquidate general practices by means of deferred annuities and to pay doctors a fixed salary. Everybody would be entitled to attend the health centres, but they would be charged a fee graduated in accordance with their means. The third speaker was Mr. Fauset Welsh, F.R.C.S., who called for a spirit of devotion and not of greed. T h e difficulty was to combine freedom to the individual doctor or hospital with a reasonable amount of order. Regional p l a n n i n g , as well as national planning, was necessary for the future treatment of the sick. Dr. Cassie emphasised the value of teaching hospitals, and thought it would be an advantage to include m u n i cipal hospitals in teaching schemes. She considered that medical degrees should be national and not regional. A lively discussion followed, a~ad in replying Dr. Masse), said that at this stage broad principles alone could,be considered.
EASTERN BRANCH President: Dr. V. F. Soothill (M.O.H., Norwich C.B.). Hon. Secretary: Dr. J. W. Hunter (M.O.H. & S.M.O., Ipswich C.B.). A meeting of the Eastern Branch was held at Scole on November Ist, 1941, at 3 p.m. The minutes of the previous meeting were submitted and signed by the chairman. It was agreed that the Branch should forward to the Acting Executive Secretary of the Society observations on Medical Planning, and the Hon. Secretary was requested to represent the Branch on the Central C o m mittee. It was suggested that w h e n any Agenda was circulated in regard to the Central Committee the Branch should have an opportunity of discussing this before the Central meeting. Several points were brought forward in regard to post-war medical planning. A discussion on the various aspects of the control, prevention and treatment of scabies followed. In this connection it was resolved to forward to the Council a resolution stating that the Eastern Branch advocates that all facilities--for example, cinema, wireless, Press, etc.--should be used for propaganda on a national basis directed by the Ministry of Health. 112
FEBRUARY NORTHERN BRANCH President: Dr. G. Hurrell (T.O., Newcastle-upon-Tyne). Hon. Secretary: Dr. J. A. Charles (M.O.H., Newcastleupon-Tyne). A meeting of the Branch was held at Newcastle-uponT y n e on November 22nd, 1941. The minutes of the annual meeting were read, confirmed, and signed by the chairman. The Hon. Secretary informed the members that he had received from the Hon. Secretary of the County Borough M.Os.H. Group copies of correspondence which had passed between him and the Hon. Secretary of the Association of County Medical Officers of Health regarding the activities of the Nuffield Trust. This matter had been raised at the Council Meeting on November 21st, and it was felt that the Nuffield T r u s t activities would begin to diminish as and when the Ministry of Health stated more clearly the Government's views on the subject of hospital re-organisation after the war. Dr. Grant was nominated to serve as the representative of the Northern Branch on the Medical Planning Committee of the Society. Dr. A. E. W. McLachlan then delivered an address on the present position as regards venereal disease.
YORKSHIRE BRANCH President : Dr. J. F. Galloway (M.O.H., Dewsbury C.B.). Hon. Secretary: Dr. R. Sutherland (M.O.H.I Brighouse M.B.). An ordinary meeting of the Branch was held at Leeds on November 28th at 2.30 p.m. A letter was read from the Secretary of the Yorkshire Council for Further Education inviting the Branch to nominate a representative to serve upon the County Advisory Committee on Food Education. The Secretary was nominated as the Branch's representative. After consideration of a letter from Dr. D. D. Payne, Medical Officer of Health, Harrogate, it was resolved that the Secretary should write to the Secretary of the Society asking that the Society should inform the British Medical Association that it wishes to dissociate itself from a resolution which was passed at a special conference of representatives of Home Divisions of the British Medical Association held at the B.M.A. House on September 1l t h and 12th. The resolution concerned was as follows : - 14. Medical Planning. Proposed by North Staffs (A. V. Campbell), and resolved (by 68 to 65) : That in the opinion of this meeting all representatives of the Ministry of Health and Ministry of Labour be excluded from all meetings of the Medical Planning Commission until the ultimate meeting of the Commission at which the final findings of the Commission will be discussed. It was also decided that the resolution passed at the same B.M.A. meeting urging the employment of parttime instead of whole-time medical officers wherever practicable in the various local government services should be referred for consideration to the Medical Planning Sub-Committee of the Branch. Dr. Dick, Medical Superintendent of St. James' Hospital, described to the meeting the new extensions to the hospital. He then conducted the members through the new wing.