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OBSTETRICS IN GENERAL PRACTICE
1250
Everyone knew that doctors attached great importance to a proper medical history of a case, and they were really at a loss if they had not got it. If it were necessary to change the provisions of the Bill in order
that these medical histories would be not be made available in any other way, the case would be very strong, but even then there would be considerable objections. He believed that quite a large number of schoolchildren-many more than one was inclined to think at first sight;-indeed he had heard it estimated at 50 per cent., though that could not be true in all cases-went to work in areas different from those in which they had grown up as school-children and that would make the working of this scheme, if it was still to be based on the educational medical system, rather difficult. In any case, however, he thought they must realise that these medical histories could be made available. There were elaborate provisions in Subsection (9) of Clause 92 for making available those medical histories which were really important. Therefore he did not think that the case was so strong as was suggested, and he did not think to make
sure
available, and if they could
that they ought to take the view that the doctors under the education system were more likely to do the work better than the examining surgeons were doing it to-day. They were practical doctors who had had considerable experience of industry, and he thought that the Committee would be ill-advised to make such a change as had been suggested. The clause was ordered to stand part of the Bill. FEES OF EXAMINING SURGEONS
On Clause 120, Mr. VIANT moved to provide that the Home Office should be charged with the expenditure in connexion with this part of the Act.-Mr. LLOYD said he thought it was a reasonable view to take that these medical examinations were on a similar basis to the other precautionary measures which occupiers were required to take, and of which they had to bear the expense, and he saw no reason why they should be relieved of this particular expense. The amendment was withdrawn and the clause was ordered to stand part of the Bill. The Committee adjourned until May 25th.
CORRESPONDENCE OBSTETRICS IN GENERAL PRACTICE
of THE LANCET SIR,—I am in agreement with your leading article of May 8th that the proposals contained in the recent report by the Ministry of Health on maternal mortality and morbidity are revolutionary. You leave one doubting, however, whether you approve or disapprove of the revolution. On balance, I To the Editor
conclude that you approve, as I do. For many years I have advocated the recommendations contained To put it very simply, operative in the report. obstetrics should be placed on a plane with surgery and the surgical specialties-only experts should deal with it. By experts I include not only pure obstetric specialists but those general practitioners who, by post-graduate training and the interest they take in obstetrics, have qualified to practise this special branch of medicine and surgery. My criticism of the report is that it does not define and detail how the obstetric service is to be organised. I did so in 1931 and included my scheme in " Maternal Mortality and Morbidity : a Study of their Problems published by E. and S. Livingstone in 1933. We are now going to have expert municipal midwives. Their work should be directly associated with the antenatal clinics of ,local authorities ; this would of their give those centres very definite supervision work and lessen the number of " inspectors," or supervisors " as the Minister of Health prefers to designate them, necessary for the service. The medical staff of the antenatal clinics should be well-trained and experienced obstetricians and they should act as consultants to the municipal midwives when they require advice or assistance. Further, the obstetricians of the antenatal clinics should be on the staff of the local maternity hospitals and act as assistants to the medical director or directors of the hospitals. At present in many antenatal clinics of local authorities the medical staffing is unsatisfactory, because the individuals doing the work are engaged only in the antenatal care of pregnant women-they have nothing to do with the supervision of women in parturition or during the puerperium. In many large cities, and certainly in all in which there is a teaching school, pure obstetric specialists are to hand. In some these would have to be intro"
as has been done in a few instances. In small cities and towns specially well-trained family practitioners should be enlisted into the service. It is unfortunate in some respects that obstetrics in common with so many other departments of medicine has to be removed from the province of the family practitioner. But as you point out " occasional obstetrics is even more dangerous than occasional motoring " ; possibly " may be " should be substituted for " is." One word more. I think it would be preferable if in the further developments of the service construction were made from the centre or the institution rather than the periphery. It is impossible to predict to what extent institutional treatment may extend. As a simple example-a number of us think that all primigravidee should receive institutional treatment in their first confinement. I am, Sir, yours faithfully, J. M. MUNRO KERR.
duced,
MEDICAL PEACE CAMPAIGN
of THE LANCET SIR,-The death early in April of Dr. Cecile Booysen, the secretary of the Medical Peace Campaign, has been a great loss to her colleagues. It was chiefly through her inspiration and energy that the work of such a campaign was conceived and initiated. As we, who were closely associated with her, interpret her thought, it was that our profession has a duty to strive for the prevention of all human suffering and pain by penetrating to their causes and removing them. If war came to be outside the medical purview, one of the main sources of such suffering would be eliminated. A calm, scientific approach is needed and the profession as a whole should be urged constantly to debate the problems associated with war and its causation much as it debates the aetiology and prevention of disease. It is in this spirit that her work will be carried forward. We do not anticipate spectacular results, for the point of view will require discussion among our colleagues before it is likely to receive full accept. ance. But primarily it is this discussion that we wish To the Editor
to initiate and foster. An account of the activities of the Campaign up to date will be found in the three bulletins that have so far been issued ; but we feel that our activities
Everyone knew that doctors attached great importance to a proper medical history of a case, and they were really at a loss if they had not got it. If it were necessary to change the provisions of the Bill in order
that these medical histories would be not be made available in any other way, the case would be very strong, but even then there would be considerable objections. He believed that quite a large number of schoolchildren-many more than one was inclined to think at first sight;-indeed he had heard it estimated at 50 per cent., though that could not be true in all cases-went to work in areas different from those in which they had grown up as school-children and that would make the working of this scheme, if it was still to be based on the educational medical system, rather difficult. In any case, however, he thought they must realise that these medical histories could be made available. There were elaborate provisions in Subsection (9) of Clause 92 for making available those medical histories which were really important. Therefore he did not think that the case was so strong as was suggested, and he did not think to make
sure
available, and if they could
that they ought to take the view that the doctors under the education system were more likely to do the work better than the examining surgeons were doing it to-day. They were practical doctors who had had considerable experience of industry, and he thought that the Committee would be ill-advised to make such a change as had been suggested. The clause was ordered to stand part of the Bill. FEES OF EXAMINING SURGEONS
On Clause 120, Mr. VIANT moved to provide that the Home Office should be charged with the expenditure in connexion with this part of the Act.-Mr. LLOYD said he thought it was a reasonable view to take that these medical examinations were on a similar basis to the other precautionary measures which occupiers were required to take, and of which they had to bear the expense, and he saw no reason why they should be relieved of this particular expense. The amendment was withdrawn and the clause was ordered to stand part of the Bill. The Committee adjourned until May 25th.
CORRESPONDENCE OBSTETRICS IN GENERAL PRACTICE
of THE LANCET SIR,—I am in agreement with your leading article of May 8th that the proposals contained in the recent report by the Ministry of Health on maternal mortality and morbidity are revolutionary. You leave one doubting, however, whether you approve or disapprove of the revolution. On balance, I To the Editor
conclude that you approve, as I do. For many years I have advocated the recommendations contained To put it very simply, operative in the report. obstetrics should be placed on a plane with surgery and the surgical specialties-only experts should deal with it. By experts I include not only pure obstetric specialists but those general practitioners who, by post-graduate training and the interest they take in obstetrics, have qualified to practise this special branch of medicine and surgery. My criticism of the report is that it does not define and detail how the obstetric service is to be organised. I did so in 1931 and included my scheme in " Maternal Mortality and Morbidity : a Study of their Problems published by E. and S. Livingstone in 1933. We are now going to have expert municipal midwives. Their work should be directly associated with the antenatal clinics of ,local authorities ; this would of their give those centres very definite supervision work and lessen the number of " inspectors," or supervisors " as the Minister of Health prefers to designate them, necessary for the service. The medical staff of the antenatal clinics should be well-trained and experienced obstetricians and they should act as consultants to the municipal midwives when they require advice or assistance. Further, the obstetricians of the antenatal clinics should be on the staff of the local maternity hospitals and act as assistants to the medical director or directors of the hospitals. At present in many antenatal clinics of local authorities the medical staffing is unsatisfactory, because the individuals doing the work are engaged only in the antenatal care of pregnant women-they have nothing to do with the supervision of women in parturition or during the puerperium. In many large cities, and certainly in all in which there is a teaching school, pure obstetric specialists are to hand. In some these would have to be intro"
as has been done in a few instances. In small cities and towns specially well-trained family practitioners should be enlisted into the service. It is unfortunate in some respects that obstetrics in common with so many other departments of medicine has to be removed from the province of the family practitioner. But as you point out " occasional obstetrics is even more dangerous than occasional motoring " ; possibly " may be " should be substituted for " is." One word more. I think it would be preferable if in the further developments of the service construction were made from the centre or the institution rather than the periphery. It is impossible to predict to what extent institutional treatment may extend. As a simple example-a number of us think that all primigravidee should receive institutional treatment in their first confinement. I am, Sir, yours faithfully, J. M. MUNRO KERR.
duced,
MEDICAL PEACE CAMPAIGN
of THE LANCET SIR,-The death early in April of Dr. Cecile Booysen, the secretary of the Medical Peace Campaign, has been a great loss to her colleagues. It was chiefly through her inspiration and energy that the work of such a campaign was conceived and initiated. As we, who were closely associated with her, interpret her thought, it was that our profession has a duty to strive for the prevention of all human suffering and pain by penetrating to their causes and removing them. If war came to be outside the medical purview, one of the main sources of such suffering would be eliminated. A calm, scientific approach is needed and the profession as a whole should be urged constantly to debate the problems associated with war and its causation much as it debates the aetiology and prevention of disease. It is in this spirit that her work will be carried forward. We do not anticipate spectacular results, for the point of view will require discussion among our colleagues before it is likely to receive full accept. ance. But primarily it is this discussion that we wish To the Editor
to initiate and foster. An account of the activities of the Campaign up to date will be found in the three bulletins that have so far been issued ; but we feel that our activities