- Email: [email protected]
Naval, Military and Air Force Group
~922.
PUBLIC
for an i n t e r e s t i n g p a p e r on " D i p h t h e r i a C a r r i e r s a n d their connection with Clinical D i p h t h e r i a , " which w a s followed by a keen discussion in which m a n y of the m e m b e r s t o o k p a r t .
THE EASTERN
BRANCH.
THE BRANCH.
This Branch has hitherto m e t only once a year, but efforts will be m a d e to revise interest in the affairs of the Society. The a r e a is l a r g e and poorly served for locomotion (train services), and so it is difficult to secure a l a r g e a t t e n d a n c e at any individual place, but by h a v i n g r e g u l a r m o n t h l y m e e t i n g s it m i g h t be m a d e possible for all m e m b e r s to g e t to at least three or four meeti n g s a year. N o w t h a t several School Medical Officers, T u b e r c u l o s i s Officers, Dentists, etc., have become m e m b e r s it m a y be possible to secure a l a r g e r a t t e n d a n c e if m e e t i n g s are held on S a t u r d a y s . Vgith a view to test this a m e e t i n g will be held shortly, and the P r e s i d e n t wilt invite m e m b e r s to p a r t a k e of tea at the close of the meeting. SALARIES.
A t t e m p t s have been m a d e in some S a n i t a r y D i s t r i c t s and U n i o n s to lower the salaries of officials, including District M . O . H . or P o o r - l a w M.O. In some instances such reductions have been accepted w i t h o u t c o m m e n t ; in others refused or r e a s o n s a s k e d f o r - - t h e only reason given b e i n g the need for n a t i o n a l economy !
NAVAL, THE
APRIL
MILITARY AND AIR GROUP.
FORCE
MEETING,
A M e e t i n g of this Group w a s held at l, U p p e r M o n t a g u e Street, Russell Square, on the 7th April, 1922, at w h i c h . a p a p e r on " T u b e r c u l o s i s as a Disease o f the Services " was read by P r o "fessor $2 Lyle Cummins, C.B., C . M . G . , M.B. T h e paper, which was of g r e a t interest and value, w a s followed, by a short discussion. MajorGe~eral Sir ~ r . G. Macphm'son, K.C.~.I~G.f~'fJK, A. M . S . , t o o k the chair. TUBERCULOSIS
IN THE SERVICES.
The following is a s u m m a r y of the paper by P r o f e s s o r S. Lyle Cummins, C.B., C . M . G . , M . B . , on " T u b e r c u l o s i s as a D i s e a s e of the S e r v i c e s . " C h a r t s were exhibited which showed a steady decline of the tuberculosis m o r t a l i t y and inv a l i d i n g rate in the Services to. a l m o s t v a n i s h i n g point. This raises the question : - -
HEALTH.
259
ts T u b e r c u l o s i s a disease which need not be worried a b o u t in the Services? T h e a n s w e r is " N o ! " for it m u s t not be f o r g o t t e n t h a t a l t h o u g h it produc~s little effect upon the Services H e a l t h figures d u r i n g P e a c e yet d u r i n g W a r , and as an a f t e r m a t h of W a r it is a really g r e a t factor. In this relation it is well to b e a r in mind two facts, firstly, t h a t our R e g u l a r F o r c e s a r e but the skeleton of o u r W a r A r m y , the bulk of the l a t t e r c o a t i n g from the factory, the mines, etc., on the o u t b r e a k of hostilities, and coincident general m o b i t i s a t i o n ; secondly, t h a t as a result of the stress and s t r a i n of active service, a n d perltaps no less also the reaction of s u b s e q u e n t Peace, some 60,000 pensions have a l r e a d y been g r a n t e d for this disease. The next f u n d a m e n t a l question for consideration is :--Is T u b e r c u l o s i s in the Services " caused by " the c o n d i t i o n s of the life, or " a w a k e n e d " by them ? The L e c t u r e r considered that it is " a w a k e n e d , " and he cited the a u t h o r i t y of F i s h b u r g , whom he quoted as h a v i n g written : " P h t h i s i s is a disease o c c u r r i n g in p e r s o n s who have been infected with T u b e r c l e Bacilli m a n y y e a r s before the o u t b r e a k of the d i s e a s e " - - : of Opie, w h o f o u n d T u b e r c u lous A b d o m i n a I g l a n d s in 27 p e r cent. of P . M . cases of d e a t h from causes o t h e r t h a n Tb. in British soldiers : of himself who found 75 per cent. of soldiers clinically free from T b . , positive to the Von P i r q u e t test with 5 per cent. Old T u b e r cutin, s u p p o r t i n g this finding with the findings of Baldwin and Z i n s s e r t h a t the tuberculin test, when positive, proves actual infection with the tubercle bacillus. W i t h reference to special conditions, which m a y a p p e r t a i n to life in the Services, it w a s pointed out t h a t m o d e r n views consider t h a t t r a u m a of the chest such as p e n e t r a t i n g w o u n d s (unless the missile h a p p e n s actually to p a s s t h r o u g h a t u b e r culous focus), or g a s w o u n d s have little or no effect r e Tb, b u t that ~extensiv~ contusions are very m i s c h i e v o u s ; {hat climate, p e r se, ,has no specific effect, and t h a t it only affects the incidence ~g qt' affectS' that of m a n y o t h e r diseases. S u m m i n g up we must consider : - 1. T h a t T u b e r c u l o s i s in the Services calls for m o s t careful control, t h o u g h it is not, g e n e r a l l y s p e a k i n g , acquired d u r i n g life in the Services. 2. T h a t a l t h o u g h the bulk of our recruits are from industrial a r e a s m a n y individuals are from rural communities. T h e s e l a t t e r p r o v i d i n g relatively v i r g i n soil with consequent absence of acquired immunity.
26o
PUBLIC
3. Careful preliminary examination can, and does, weed out diagnosable cases, i.e. cases in the " open " dangerous condition. 4:. That acute and mass infection is absent from the Services. 5. That hygienic conditions of life in the Services are good. The Lecturer suggested that more general research was required, and advocated the training and employment of a few Specialist Tuberculosis Medical Officers, though deprecating any suggestion of Service Sanatoria. Major-General W. W. O. Beverldge, C.B., C. B.E., D.S.O., Lieut.-Colonel Sylvester Bradley, Dr. Nankivell joined in the discussion which followed, and Major-General Sir W. G. Macpherson, K.C.M.G., C.B., summed up from the chair.
SOCIETY
OF
MEDICAL HEALTH.
OFFICERS
OF
COUNCIL MEETING. A Meeting of the Council was held at the house of the Society on Friday, May 19th, 1922. The President (Dr. W. J. Howarth) was in the chair, and there were present : Professors Kenwood and Kerr, Lieut.-Cols. Herbert Jones, F. E. Fremantle,M.P., and Caldwell Smith, Drs. G. F. Buchan, Charles Porter, Snell, J. J. Buchan, Kirkhope, Duncan Forbes, Joseph, W~heatIey, Clements, Peyton, Pearce, Eustaee Hill, Auden, Nash, Gibbons Ward, Stocks, McMaster, Wilshaw, Sanders, Evans, Ewart and Veitch Clark. The minutes of the last meeting having been approved and signed, letters of apology were read from Dr. Edmund Smith and Dr. J. F. Blackett. Correspondence.--(1) From the British Medical Association suggesting a conference to discuss the relationship between the Association and the Society and the whole question of the best methods of co-operation between the two bodies : the B.M.A. representatives to be the officers of the Association, namely, the President, the Chairman of Council, the Chairman of Representative Meetings, and the Treasurer, together with the Chairmen of the Public Health, MedicoPolitical, Insurance Acts and Organisation Committee. R e s o l v e d that the suggested conference be approved and that the Society of Medical Officers of Health be represented by Drs. Howarth, Eustace Hill, Herbert Jones, Snell, G. F. Buchan, Veitch Clark, Lyster, and Kirkhope.
HEALTH.
JUNE,
(2) From the British Medical Association regarding (a) vaccinations by unqualified persons during the small-pox epidemic in Glasgow, (b) the fees paid to general practitioners in Glasgow for visits required by the M.O.H. R e s o l v e d that the letter be referred to the Scottish Branch of the Society for their observations. (3) From the B.M.A. in reference to the decision of a Local Authority that their Medical Officer of Health should report to the Coroner deaths from diphtheria where there had been negligent delay on the part of parents or doctors. The President reported that he had discussed the letter with the M.O.H. concerned, and was satisfied that his connection with the above decision was strictly regular, and that he could be relied upon to act with intelligence and discretion in giving effect to the decision. (d) From a Medical Officer of Health regarding- the requirement of his Local Authority that reports of the Health Department should be submitted to the Town Clerk. It was agreed that the Yorkshire Branch of the Society be asked to submit their observations on special local circumstances referred to in the letter. (5) From a School Medical Officer suggesting further action in regard to the memorandum recently circulated by the Association of Directors of Education referring to school medical work. It was agreed that the letter be referred to the School Medical Group for their observations and recommendations. (6) From the British Medical Association in reference to Tuberculosis appointments in a N . W . county, and asking for a definition by the Society • of the status of an Assistant Tuberculosis Officer. The letter was referred to the Salaries Committee. (7) From the National Milk Publicity Council inviting the Society to elect a representative to serve on the executive of that b o d y : R e s o l v e d that Dr. YVheatley be e!ected. (8) From the National Association for the Prevention of Infant Mortality askin~ the Society to nominate representatives.to join a deputation to the Minister of Health to ask for the promotion of legislation called for in the final report of the Smoke Abatement Committee, and for the enforcement of the present law with regard to smoke. R e s o l v e d that Drs. Sanders and Ewart be elected to represent the Society. B . M . A . Annual M e e t i n g . - - I t was agreed that Dr. A. K. Chalmers (President of the Public Health Section), Dr. R. J. Reeee, C.B., and Prof. Harold Kerr, O.B.E. (Vice-Presidents, P.A.
PUBLIC
for an i n t e r e s t i n g p a p e r on " D i p h t h e r i a C a r r i e r s a n d their connection with Clinical D i p h t h e r i a , " which w a s followed by a keen discussion in which m a n y of the m e m b e r s t o o k p a r t .
THE EASTERN
BRANCH.
THE BRANCH.
This Branch has hitherto m e t only once a year, but efforts will be m a d e to revise interest in the affairs of the Society. The a r e a is l a r g e and poorly served for locomotion (train services), and so it is difficult to secure a l a r g e a t t e n d a n c e at any individual place, but by h a v i n g r e g u l a r m o n t h l y m e e t i n g s it m i g h t be m a d e possible for all m e m b e r s to g e t to at least three or four meeti n g s a year. N o w t h a t several School Medical Officers, T u b e r c u l o s i s Officers, Dentists, etc., have become m e m b e r s it m a y be possible to secure a l a r g e r a t t e n d a n c e if m e e t i n g s are held on S a t u r d a y s . Vgith a view to test this a m e e t i n g will be held shortly, and the P r e s i d e n t wilt invite m e m b e r s to p a r t a k e of tea at the close of the meeting. SALARIES.
A t t e m p t s have been m a d e in some S a n i t a r y D i s t r i c t s and U n i o n s to lower the salaries of officials, including District M . O . H . or P o o r - l a w M.O. In some instances such reductions have been accepted w i t h o u t c o m m e n t ; in others refused or r e a s o n s a s k e d f o r - - t h e only reason given b e i n g the need for n a t i o n a l economy !
NAVAL, THE
APRIL
MILITARY AND AIR GROUP.
FORCE
MEETING,
A M e e t i n g of this Group w a s held at l, U p p e r M o n t a g u e Street, Russell Square, on the 7th April, 1922, at w h i c h . a p a p e r on " T u b e r c u l o s i s as a Disease o f the Services " was read by P r o "fessor $2 Lyle Cummins, C.B., C . M . G . , M.B. T h e paper, which was of g r e a t interest and value, w a s followed, by a short discussion. MajorGe~eral Sir ~ r . G. Macphm'son, K.C.~.I~G.f~'fJK, A. M . S . , t o o k the chair. TUBERCULOSIS
IN THE SERVICES.
The following is a s u m m a r y of the paper by P r o f e s s o r S. Lyle Cummins, C.B., C . M . G . , M . B . , on " T u b e r c u l o s i s as a D i s e a s e of the S e r v i c e s . " C h a r t s were exhibited which showed a steady decline of the tuberculosis m o r t a l i t y and inv a l i d i n g rate in the Services to. a l m o s t v a n i s h i n g point. This raises the question : - -
HEALTH.
259
ts T u b e r c u l o s i s a disease which need not be worried a b o u t in the Services? T h e a n s w e r is " N o ! " for it m u s t not be f o r g o t t e n t h a t a l t h o u g h it produc~s little effect upon the Services H e a l t h figures d u r i n g P e a c e yet d u r i n g W a r , and as an a f t e r m a t h of W a r it is a really g r e a t factor. In this relation it is well to b e a r in mind two facts, firstly, t h a t our R e g u l a r F o r c e s a r e but the skeleton of o u r W a r A r m y , the bulk of the l a t t e r c o a t i n g from the factory, the mines, etc., on the o u t b r e a k of hostilities, and coincident general m o b i t i s a t i o n ; secondly, t h a t as a result of the stress and s t r a i n of active service, a n d perltaps no less also the reaction of s u b s e q u e n t Peace, some 60,000 pensions have a l r e a d y been g r a n t e d for this disease. The next f u n d a m e n t a l question for consideration is :--Is T u b e r c u l o s i s in the Services " caused by " the c o n d i t i o n s of the life, or " a w a k e n e d " by them ? The L e c t u r e r considered that it is " a w a k e n e d , " and he cited the a u t h o r i t y of F i s h b u r g , whom he quoted as h a v i n g written : " P h t h i s i s is a disease o c c u r r i n g in p e r s o n s who have been infected with T u b e r c l e Bacilli m a n y y e a r s before the o u t b r e a k of the d i s e a s e " - - : of Opie, w h o f o u n d T u b e r c u lous A b d o m i n a I g l a n d s in 27 p e r cent. of P . M . cases of d e a t h from causes o t h e r t h a n Tb. in British soldiers : of himself who found 75 per cent. of soldiers clinically free from T b . , positive to the Von P i r q u e t test with 5 per cent. Old T u b e r cutin, s u p p o r t i n g this finding with the findings of Baldwin and Z i n s s e r t h a t the tuberculin test, when positive, proves actual infection with the tubercle bacillus. W i t h reference to special conditions, which m a y a p p e r t a i n to life in the Services, it w a s pointed out t h a t m o d e r n views consider t h a t t r a u m a of the chest such as p e n e t r a t i n g w o u n d s (unless the missile h a p p e n s actually to p a s s t h r o u g h a t u b e r culous focus), or g a s w o u n d s have little or no effect r e Tb, b u t that ~extensiv~ contusions are very m i s c h i e v o u s ; {hat climate, p e r se, ,has no specific effect, and t h a t it only affects the incidence ~g qt' affectS' that of m a n y o t h e r diseases. S u m m i n g up we must consider : - 1. T h a t T u b e r c u l o s i s in the Services calls for m o s t careful control, t h o u g h it is not, g e n e r a l l y s p e a k i n g , acquired d u r i n g life in the Services. 2. T h a t a l t h o u g h the bulk of our recruits are from industrial a r e a s m a n y individuals are from rural communities. T h e s e l a t t e r p r o v i d i n g relatively v i r g i n soil with consequent absence of acquired immunity.
26o
PUBLIC
3. Careful preliminary examination can, and does, weed out diagnosable cases, i.e. cases in the " open " dangerous condition. 4:. That acute and mass infection is absent from the Services. 5. That hygienic conditions of life in the Services are good. The Lecturer suggested that more general research was required, and advocated the training and employment of a few Specialist Tuberculosis Medical Officers, though deprecating any suggestion of Service Sanatoria. Major-General W. W. O. Beverldge, C.B., C. B.E., D.S.O., Lieut.-Colonel Sylvester Bradley, Dr. Nankivell joined in the discussion which followed, and Major-General Sir W. G. Macpherson, K.C.M.G., C.B., summed up from the chair.
SOCIETY
OF
MEDICAL HEALTH.
OFFICERS
OF
COUNCIL MEETING. A Meeting of the Council was held at the house of the Society on Friday, May 19th, 1922. The President (Dr. W. J. Howarth) was in the chair, and there were present : Professors Kenwood and Kerr, Lieut.-Cols. Herbert Jones, F. E. Fremantle,M.P., and Caldwell Smith, Drs. G. F. Buchan, Charles Porter, Snell, J. J. Buchan, Kirkhope, Duncan Forbes, Joseph, W~heatIey, Clements, Peyton, Pearce, Eustaee Hill, Auden, Nash, Gibbons Ward, Stocks, McMaster, Wilshaw, Sanders, Evans, Ewart and Veitch Clark. The minutes of the last meeting having been approved and signed, letters of apology were read from Dr. Edmund Smith and Dr. J. F. Blackett. Correspondence.--(1) From the British Medical Association suggesting a conference to discuss the relationship between the Association and the Society and the whole question of the best methods of co-operation between the two bodies : the B.M.A. representatives to be the officers of the Association, namely, the President, the Chairman of Council, the Chairman of Representative Meetings, and the Treasurer, together with the Chairmen of the Public Health, MedicoPolitical, Insurance Acts and Organisation Committee. R e s o l v e d that the suggested conference be approved and that the Society of Medical Officers of Health be represented by Drs. Howarth, Eustace Hill, Herbert Jones, Snell, G. F. Buchan, Veitch Clark, Lyster, and Kirkhope.
HEALTH.
JUNE,
(2) From the British Medical Association regarding (a) vaccinations by unqualified persons during the small-pox epidemic in Glasgow, (b) the fees paid to general practitioners in Glasgow for visits required by the M.O.H. R e s o l v e d that the letter be referred to the Scottish Branch of the Society for their observations. (3) From the B.M.A. in reference to the decision of a Local Authority that their Medical Officer of Health should report to the Coroner deaths from diphtheria where there had been negligent delay on the part of parents or doctors. The President reported that he had discussed the letter with the M.O.H. concerned, and was satisfied that his connection with the above decision was strictly regular, and that he could be relied upon to act with intelligence and discretion in giving effect to the decision. (d) From a Medical Officer of Health regarding- the requirement of his Local Authority that reports of the Health Department should be submitted to the Town Clerk. It was agreed that the Yorkshire Branch of the Society be asked to submit their observations on special local circumstances referred to in the letter. (5) From a School Medical Officer suggesting further action in regard to the memorandum recently circulated by the Association of Directors of Education referring to school medical work. It was agreed that the letter be referred to the School Medical Group for their observations and recommendations. (6) From the British Medical Association in reference to Tuberculosis appointments in a N . W . county, and asking for a definition by the Society • of the status of an Assistant Tuberculosis Officer. The letter was referred to the Salaries Committee. (7) From the National Milk Publicity Council inviting the Society to elect a representative to serve on the executive of that b o d y : R e s o l v e d that Dr. YVheatley be e!ected. (8) From the National Association for the Prevention of Infant Mortality askin~ the Society to nominate representatives.to join a deputation to the Minister of Health to ask for the promotion of legislation called for in the final report of the Smoke Abatement Committee, and for the enforcement of the present law with regard to smoke. R e s o l v e d that Drs. Sanders and Ewart be elected to represent the Society. B . M . A . Annual M e e t i n g . - - I t was agreed that Dr. A. K. Chalmers (President of the Public Health Section), Dr. R. J. Reeee, C.B., and Prof. Harold Kerr, O.B.E. (Vice-Presidents, P.A.