Panel doctors' pay

3°

PUBLIC HEALTH.

universal dentat supervision we c a n n o t , with. our p r e s e n t knowledge, give the p{~blic an)" g u a r a n t e e that the next g e n e r a t i o n will not require iust as m u c h work as this one. C o n s i d e r i n g the size and complexity of the problem, there is a pitifully small a m o u n t of accurate knowledge about it. All that can be said is that we believe certain t h i n g s to be true. \~.'e believe that if we could persuade the public to c h a n g e their m e t h o d s of diet, to alter their p i e s e n t neglect of the teeth, to cleanse their teeth regularly, a n d to have r e g u l a r dental supervision from an early age, we should b r i n g a b o u t a n i m p r o v e m e n t in the dental condition of the race, but the evidence upon which these beliefs are based is negligible. A study of the work of i n v e s t i g a t i o n that has been done by school dentists and those associaled with them shows that the evidence is extrao r d i n a r i l y contradictory and variable. The relationships between dental disease a n d social position, b r e a s t feeding, mouth b r e a t h i n g , and a v a r i e t y of similar subjects have not led to any .convincing result up to the present. E v e n upon such a f u n d a m e n t a l point as the effect, if any, of .dental disease upon the vitality and g e n e r a l health and development of the child, there is practically no evidence. I n fact, Dr. Priesttey, of Staffordshire, a most careful investigator, was unable to find any g r e a t difference between the health and development of the average child and t h a t of the child with a perfect denture. The differences were so small that in the second year of his i n v e s t i g a t i o n Dr. Priestley made this astonishi n K remark, " The possession of perfectly sound .dentures seems to confer unexpectedly small •a d v a n t a g e s . " W e have no desire to belittle the i m p o r t a n c e of sound dentures, and we have no h e s i t a t i o n in r a n g i n g ourselves on the side of those who believe in the i m p o r t a n c e of sound ,dentures as a m a t t e r c o n c e r n i n g public health, b u t we are e n d e a v o u r i n g now to illustrate the be"witdering condition of the small world of dental ~'esearch at the present time. At C a m b r i d g e the i m p o r t a n t claim was made in 1912 that o r g a n i s e d dental t r e a t m e n t had resulted, after five y e a r s ' work, in a s u b s t a n t i a l decrease ol .dental caries discovered on the first e x a m i n a t i o n .of the school child. No less t h a n nine )..ears ago it was claimed that, after five y e a r s ' school dentistry in that town, children of five )'ears of age were a p p e a r i n g at the school, without any previous dental t r e a t m e n t , with better teeth t h a n the five year olds of 1907, a n d the s u g g e s t i o n was made that this decrease a m o n g s t these y o u n g s t e r s

Novu~BEr~,

was due to the .fact t h a t . t h e tre'atment of the older brothers and slstfrs had rendered their s u r r o u n d inks at home iess contagious. Nine ) e a r s ago it looked, therefore, as if an a m a z i n g confirmation of all theories as to the i m p o r t a n c e of dental treatment had been obtained, and its publication in the A n n u a l Report of the Chief Medical Officer of the Board of E d u c a t i o n appeared to give us just the proof we w a n t e d , ~ a n d we felt confident that the next issue of that report would c o n t a i n further valuable information. U n f o r t u n a t e l y , these expectations were not realised and, so far as we are ~ble to trace, there has been no further reference to this matter. At the present time there are three main theories in connection with the p r e v e n t i o n of dental caries. T h e first is that p r e v e n t i o n would be achieved by a l t e r i n g the diet of the public and of the children in particular, in other words, by i n t r o d u c i n g into the food more t o o t h - c l e a n i n g m a t e r i a l ; the second is that a similar result would be achieved by r e g u l a r c l e a n s i n g of the teeth by t o o t h - b r u s h e s ; the third is that a c o m b i n a t i o n of the two methods is necessary. If the Committee which has been appointed to investigate this subject is able to obtain the necessary s u p p o r t from the Ministry of Health they have a wonderful opportunity to prove or disprove these theories. Large i n s t i t u t i o n s c o n t a i n i n g children of atl ages shouId be selected and should be put under very strict supervision. In one g r o u p of i n s t i t u t i o n s the diet could be c h a n g e d in the way recommended by those who favour the first t h e o r y ; in a n o t h e r g r o u p tooth-brush care of the teeth should be made a m a t t e r of perfect discipIine; in a n o t h e r g r o u p neither of these factors shouId be specially emphasised, while in a fourth g r o u p special a t t e n t i o n m i g h t be given to thorough dental supervision in the w a y of conservative dentistry. An experiment of this kind carried over a series of years i n i n s t i t u t i o n s which would lend themselves to observation, b e i n g carried out for ten or mo?e" y e a r s 'of a child's life, should lead to some definite result and should enable these tbeories to be p u t to the practical test. Nothing" less wilt be of any re~l value. P A N E L D O C T O R S ' PAY. The struggle between the Ministry of Health and the medical profession over" the reduction of the panel p a y m e n t from l l s . to 9s. 6d. per head has been short but not sharp. After m a n y declarations of defiance the panel doctors have given way a n d have accepted the reduction. One wonders whether in the future it will be possible to resist

PUBLIC HEALTH.

I92~.

similar reductions b e i n g m a d e more or less cont i n u o u s l y until the p a y m e n t per head reaches the old F r i e n d l y S o c i e t y p a y m e n t . D u r i n g the .war when ever}" kind of r e m u n e r a t i o n was increased a n d when l a r g e w a r bonuses were b e i n g given to civil s e r v a n t s and others the small and a l t o g e t h e r i n a d e q u a t e stnn p a i d to d o c t o r s for the notification of infectious d i s e a s e s w a s singled out for reduction, and this w a s accepted with a p p a r e n t complacency by the profession. I t is not s u r p r i s i n g , therefore, now t h a t there is a tendency for w a r bonuses a n d for w a g e s to g o down, that the medical p r o f e s s i o n has been selected as a victim once more. A little more than twelve m o n t h s a g o the British Medical Association w a s asked by the Society of Medical Officers of H e a l t h for its definite s u p p o r t for a c a m p a i g n for increased rem u n e r a t i o n for whole-time medical officers of health. T h e expected and desired s u p p o r t eras not f o r t h c o m i n g . P o s s i b l y some of those w h o o p p o s e d this request of the Society have by now realised t h a t the existence of a g r o s s l y u n d e r p a i d w h o l e - t i m e public medical service in this c o u n t r y wili always be the chief f a c t o r in p r e v e n t i n g a n y g e n e r a l increase in medical r e m u n e r a t i o n and in i n c r e a s i n g the p r o b a b i l i t y of d e c r e a s e in the same. U n d o u b t e d l y the m o s t serious a r g u m e n t in f a v o u r of r e d u c i n g the p r e s e n t panel p a y m e n t is the fact t h a t the a v e r a g e p a n e l p r a c t i t i o n e r w o r k i n g whole time receives m o r e than double the salary of the a v e r a g e w h o l e - t i m e medical officer of health, and this inequality wiI1 continue to be an active factor in future possible reductions of panel p a y m e n t s until the p a n e l p a y m e n t reaches the sum of 5s, 6d. as c o m p a r e d with the p r e s e n t eleven shillings. S o o n e r or later the British Medical A s s o c i a t i o n wilt be compelled to reatise the fact t h a t the best w a y to a s s u r e p r o p e r r e m u n e r a t i o n for all medical services is to secure for all whole-time medical officials a r a t e of r e m u n e r a t i o n at least equat to the_ possib!g income m a d e bv any p r a c t i t i o n e r wor,Mng W h o l e ' t i m e a t the panel rate which they c o n s i d e r to be desirable. FALSE ECONOMY. T h e efforts which, are n o w b e i n g made by the M i n i s t r y of H e a l t h to effect a reduction in exp e n d i t u r e on public health and social m a t t e r s , r e s u l t i n g in economies which are microscopical c o m p a r e d with t h o s e which are possible in connection with the g r e a t items of national expenditure, are b e g i n n i n g to be r e s e n t e d by the g e n e r a l public. In the c a s e of the s u p p l y of milk by Local A u t h o r i t i e s the M i n i s t r y has p r e s u m a b l y come to

3~

the conclusion t h a t it has g o n e too far, and it has now w i t h d r a w n its t h r e a t to reduce the g r a n t . W e have no d o u b t t h a t in m a n y o t h e r directions the M i n i s t r y will discover t h a t it is m a k i n g a m i s t a k e in p l a y i n g for political k u d o s and ~isking the loss of p o p u l a r app'roval. One of the l a t e s t efforts w a s t h e B o a r d of C o n t r o l circular a b o u t r e d u c i n g expenditure, p r e s u m a b l y issued at the d i c t a t e s of the Ministry. In a recent case broffght up on r e m a n d at the W e s t m i n s t e r Police C o u r t u n d e r the Mental Deficiency Act, Mr. L e e m i n g for the L.C.C. p o i n t e d out t h a t that body had been requested by the Board of Control to deal with no additional cases beyond a very close e s t i m a t e of e×penditure for the c u r r e n t year, which e s t i m a t e had now been p r a c t i c a l l y e x h a u s t e d . The medical w i t n e s s said that there w a s no chance for the.' d e f e n d a n t unless .<,he were cared for in a p r o p e r institution, and the p r o b a t i o n officer said t h a t no o r d i n a r y home would t a k e such a case. A f t e r h e a r i n g the evidence, the M a g i s t r a t e (Mr. C h a p m a n ) o r d e r e d a further r e m a n d with the r e m a r k t h a t a d a n g e r o u s situation w a s created, and t h a t it w a s very false economy. " THE

HOSPITAL AND HEALTH REVIEW."

A f t e r thirty-five y e a r s ' existence as a w e e k l y n e w s p a p e r " T h e H o s p i t a l , " e s t a b l i s h e d and cond u c t e d by the late Sir H e n r y B u r d e t t , K . C . B . , , h a s become a m o n t h l y journal under the title of " T h e H o s p i t a l a n d H e a l t h R e v i e w . " T h e new m o n t h l y will c o n t a i n hospital news and criticisms as before, but it will e n l a r g e its o r i g i n a l sphere of interest by d i s c u s s i n g , in addition to institutional m a t t e r s , the m u l t i f o r m activities of public health. The h o s p i t a l s are b e c o m i n g more and m o r e centres for the t e a c h i n g a n d p r a c t i c e of health, and in consequence, their activities t a k e on a new and w i d e r p e r s p e c t i v e vahich can best be p r e s e n t e d .~n m o n t h l y reviews, wherein the whole m o v e m e n t cal) be b r o u g h t into one focus. The first n u m b e r . o f the new series w a s p u b tished on O c t o b e r 21st and c o n t a i n s special a t t r a c t i o n s in the w a y of an article by Dr. "vV. S a v a g e , M . O . H . for S o m e r s e t s h i r e , o n " ' T o x i c i t y of P u t r i d F o o d , " a n d also the first of a series of articles on " N o t a b l e E p i d e m i c s , " by Dr. A. T. Nankivell, M . O . H . , H o r n s e y , in a d d i t i o n to several a t t r a c t i v e f e a t u r e s of special interest to the' medical officer of health.

DR. JAMES ARTHUR HARGREAVES, medical officer of health for tile W e t h e r b y rural district, has been a p p o i n t e d to the Commission of the P e a c e for the \ V e s t R i d i n g of Yorkshire.