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Presidential address to the society of medical officers of health
1938
PUBLIC HEALTH
Presidential Address to the Society of Medical Officers of Health.* By E. H. T. NASH,M.R.C.S., M.R.C.P., D.P.H.
Medical Officer of Health, Borough of Heston and Isleworth. in the country put in for an advance on his salary, which was definitely below the standard for a town of the size he served and was refused, but as a sop to their Council's conscience they gave him authority to take premium pupils. The result was that the thing became a scandal as on one occasion there were four candidates for a junior post, every one of them bearing a glowing testimonial from the M.O.H. in question as to their suitability for the post for which they were applying. Needless to say it did not help the candidates as their superlative claims to fame cancelled out one another. The position in the early days was in some respects extraordinary. Manchester made itself prominent, I almost said famous. Niven, at that time one of the best known and most capable M.Os.H. in this or any other country, came into prominence on the salary question by reason of the difference in the salary which he received as compared to the Chief Constable. The attitude the authorities took up was that Niven was only in charge of a small, in fact very small, but highlyskilled staff, whereas the Chief Constable was in command of a large number of policemen and the salaries were based on the principle of " counting knobs." In other words, it put it up to the M.O.H. that unless he had a staff which would be abnormally and uneconomically large his chance of his salary being brought into accord with the prominence and responsibility of his Department was not likely to be materially increased. Things went on fairly welt until the outbreak of war and then trouble ensued again, not so much at the outbreak of war as during the post-war period. The way in which women were rushed through the Universities in order to relieve the men produced its own difficulties when things quietened down after the War. It must be borne in mind that the conditions under which the Scottish graduates came on to the market were very different from those which applied in the rest of Great Britain. The Carnegie Trust Scholarships and their Bursaries, together with the Scottish economy, made possible the qualification of a large number of women, particularly daughters of the Manse and other professional people with small incomes to whom the grant made just the difference of a medical qualification, were a very important and difficult factor in the situation. To some * Delivered to an Ordinary Meeting of the Society at of these people who had come from homes where the Society's house, Friday, October 28th, 1938. economy was of necessity the order of the day,
" I could not love thee, dear, so much, Loved I not honour more." --LoVELACE. I had other thoughts for a Presidential Address than these which I am putting before the meeting to-day, but recent events have made me feel that it is not inappropriate in a President who is retiring immediately from the service to say something, particularly to the younger members, with regard to the service, its status and its honour. I may possibly be excused in another way for taking up this subject as I was the first Medical Officer of Health, who, as an assistant, for want of a better word, " struck " against the inadequate salary offered by the authority he was then serving when promotion at an inadequate salary was offered. I was at the time an Assistant Medical Officer to the County Borough of Derby in the capacity of Medical Superintendent of the Isolation Hospital. When the Education (Administrative Provisions) Act came out in 1907 the Corporation of Derby tried to advertise for an Assistant Medical Officer at a salary of£200 a year. This was banned by the British Medical Journal, and the Lancet also came into line and refused the advertisement. Ultimately the Council capitulated, but as one of the Senior Aldermen said, he did not mind paying £250 a year, which was the minimum salary settled by the British Medical Association, but he was " d a m n e d " if he liked paying it with a pistol put to his head. This was the first occasion in which a medical officer had struck for the adequate salaries agreed upon. As far as I was concerned at the time, it was a very serious matter indeed to me as I had come into the Public Health Service late ; I had a wife and five children, and it was imperative that my promotion should be rapid. Had I not taken the attitude I did it would have opened the door to a flood of appointments at £200 a year, which I maintain was entirely forestalled, by reason of the action I took, and the salary agreed upon was standardised without opposition. In the early days difficulties arose in several directions. It must be borne in mind that the Town Councils had at that time without any opposition, the ability to pay what salary it liked. One of the best known Medical Officers of Health
29
PUBLIC HEALTH an income even below the standard fixed by the B.M.A. was comparative wealth. For example, in one of the largest towns in England, in the Midlands, an appointment for an Assistant Medical Officer which was advertised below the salary scale was blacklisted. The School Medical Officer happened to be a fellow student and personal friend of mine and I got information with regard to the situation that existed. There were thirteen candidates for the post. As he put it, " twelve Scotch women graduates and a senile, alcoholic Englishman." One of the women was appointed and ostracised by the rest of the professional staff. This Council, like others, got the bit between their teeth and although ardent trade unionists themselves, objected to another trade union as they liked to call the B.M.A., having any say in what they paid their officers. Things got very acute and a number of appointments were taken by the Scottish women, particularly, below the salary scale. At the Liverpool meeting of the Royal Sanitary Institute, I had a long talk with Dr. Ivens, as she was then, who was at the time the President of the Medical Women's Federation, on the situation. The position was so serious that she at "once took steps to bring it to an end. We arranged to call a round table conference to talk things out and I agreed to take six representatives of the Public Health Service, of whom two should be Assistant Medical Officers, and she arranged to bring six representatives of the Medical Women's Federation. We dined together at a house loaned by one of her women colleagues. The other members on our side were Dr. George Buchan, Mr. George Etliston, Dr. Ruddock-West (now County Medical Officer of Norfolk), my Deputy, Dr. Roberts and one other doctor. We had a long discussion as to the best method or methods of getting over the difficulty. The women felt their pride was hurt. Ultimately, the women agreed to start a fund and to finance these blacklegs into general practice. Some little while ago I was informed that with one excpetion who was still paying off the loan slowly, every single one of the women to whom money was advanced to settle them in practice had repaid the amount loaned to them and from that day to this there has been an absence of the distressing condition whereby the women were underselling the male members of the profession. I had another very difficult experience which was illuminating in that in the area where I was at the time a Scottish graduate had come in as an assistant to a firm consisting of three partners. The partners had not taken the trouble to insist on the 30
NOVEMBER usual agreement with the doctor that he should not practice within a certain restricted area. The position became unfortunate by reason of difficulty between one partner and the Assistant due to the fact that the Assistant had discovered, whilst acting for one of the partners on holiday, that a patient who had been told he had some persistent dyspeptic trouble was suffering from gastric crises occurring in a definitely marked case of locomotor ataxy. When the partner returned from his holidays trouble ensued and the Assistant left and started up in opposition in the district. This, as can be easily understood, lead to difficulties at once and things became acute until I intervened. I ultimately got in touch with him and found a man who was all on edge, all prickles, unapproachable and with no contact or sympathy with his fellow medical men. I found it extremely difficult to catch him as he definitely avoided me. However, as I had no car at that time of my own, Dr. Ruddock°West volunteered to help. He came over early and fetched me, and I got to the man's house before he had time to make a get-away. We had a long heart-to-heart talk and finally I got the address of his people. I wrote to the father, who was a professional man and also to his mother. His father, as a professional man, took up the attitude that he ought to throw in his hand and do the honourable thing. The mother, on the other hand, was very sore at what she felt was a grave injustice to her son who had now started to make his way in the world. The unfortunate medical man was torn between the opinions expressed in the two letters and at the time was very definitely taking up the attitude that he did not care two hoots for anybody and was going his own way, being inclined to follow the advice of his mother, who was not concerned in the least with whether the thing was honourable or not. The position was very difficult. Eventually I got him to see that honour demanded that he should leave the district, which he did, disposing of the patients he had obtained apart from the practice and referring the others back. I never felt happier in my life than I did on the day I was able to shake him by the hand and tell him he could now hold his head high amongst his fellows as a man of honour. I invited him to my own house as an honoured guest and made him feel that here was a harbour where he could find peace and anchorage in his troubles if he wanted to. Ultimately, when he threw in his hand, I got him to come down to a meeting of the local division of the B.M.A., and there I introduced him to the members and when he came in the whole meeting stood to greet him and shake him by the hand. As far as I was concerned, it was a
1938 meeting pregnant with the deepest emotions, for here was an outcast who had come back to the fold and all the other members regarded him now as one of them--a man of honour, a man they were glad to know. The after history was not as happy. He finally got into a practice as an assistant in the East End of London and wrote to me lamenting the fact that he had done the right thing. As he said, " Here the men amongst whom I work seem to have no regard of the high principles which seem to actuate you and your progress in life, and are not above doing dirty tricks to one another, and in a very large number of cases the only dominating factor in their life seems to be money." This was a very disheartening thing after what one had done. At the same time, I felt that at the back of it all the man had something which he could carry through life which would enable him to hold his head high amongst his professional brethren. A few years ago, the M.O.H.-ship of an important authority fell vacant. The local authority advertised the post at a salary below the agreed scale. This meant, of course, that the post had to be blacklisted and the advertisement refused by the medical journals. The authority persisted in advertising and a small body of men applied, contrary to the appeals of the Society and the B.M.A. When certain facts were brought to their knowledge the local authority saved its face by making a temporary appointment at a salary substantially over that which they offered. Ultimately the post was advertised at a salary agreeable to the Askwith Scale and a man of very high standing was appointed. I tried my utmost to get things straightened out. One of my sons was home on leave and had an open car. I am never likely to forget driving back across a wide, open space with the rain puring into the sides of the car and of getting thoroughly soaked on the journey. One of the most extraordinary things which emerged out of this was the mistaken idea of the important people on the County Council with regard to the functions of the B.M.A. and it was most gratifying to see the immediate " volte face " when they appreciated that we as an Association, would not tolerate for a minute any action by any of our members which was in any way derogatory to the Service to which we belong. From that moment, the whole atmosphere changed and co-operation was the order of the day. Latterly in the north there have, unfortunately, been difficulties and more members of the Society have been asked to resign for accepting appointments in a town where the assistant medical officers' salaries were still under the agreed scale.
PUBLIC HEALTH The position has become very difficult and I want to say at once that I appreciate to the full the difficulty of the man in the position of Deputy, whose chief has been promoted elsewhere and whose turn for promotion has arrived and who is offered by the Council, who feel because they have got him there they need not pay him the same salary as paid to his predecessor, a salary which is below the agreed scale, as he is put in a most difficult position. The salary offered may be a considerable advance on what he is getting but at the same time it is below the agreed scale. It is very. difficult indeed to label a man in that position as a " blackleg" and yet every time this sort of thing happens trouble is bound to ensue. I am bound to say that it is extraordinary to me that certain Councils will break through the agreed scales when they think they have the officer in their power and can force a decrease in the salary scale. Speaking generally, one is glad to report that Councils up and down the country do treat their officers with that respect to which we feel entitled. Of course, we are bound to admit that it is not every officer who is a model of tact and industry, or even morality, and should they suddenly disappear as a result of any of these things, it is not for us to interfere in the just reward of their shortcomings. One of the great difficulties is the differentiation between the salaries offered to different officers. I am at a loss to understand why, for instance, electrical engineers should enjoy salaries in advance of their colleagues whose training and standing is in no way less than theirs. The ideal system seems to me to be the one where the principal officers, with the exception of the Town Clerk, are all on the same salary scale, the Town Clerk drawing £100 a year more in recognition of his post as Chief Administrative Officer. So long as there are differences so long will there be friction within the house. If there is one thing more than another which is important to my mind it is that there should be peace and a good spirit between those of us who are working for local authorities. At the same time there must be between local authorities and their officers a sense of trust and perfect confidence that there will be nothing but honourable dealings between them and the public. The Corrupt Practices Act, unfortunately, is still needed, i have done my best to keep the honour of the Society of Medical Officers of Health untarnished. I have failed in some respects, but I have been able to do something towards the end I have been striving for. The position at the present time is difficult. There must be a far greater liaison between ourselves and the B.M.A. It is true and very heartening that the contact is becoming closer 31
PUBLIC HEALTH and closer as the days go by, but it should be impossible for a medical officer of health who has been asked to resign from this Society to be sent up to the representative body by his division as a fit and proper person to represent the practitioners of that area or to hold office in that Division. It is up to those of us who are old in the service to see that those with whom we come into contact, particularly our own staff, do retain that high sense of integrity which should, and must, be the standard for all our members. T h e r e are many who have not stood the stress of temptation. Possibly having been through the mill I am in a position to speak, and to speak feelingly. I have done my best to keep the profession at the high pitch which is its due and also to render to my professional brethren any assistance that I possibly could to make our profession, in whatever branch I have been, a united service of medical men no matter what the line of country is which they are pursuing. Finally, may I instance what was to me nothing but the following out of the principles I have adopted, but which had far-reaching effect in the years that followed. I was a young man only recently in practice in the N o r t h and pushed into the job of Secretary to the local medical society. I was rung up one day about 2 o'clock by a housekeeper of a bachelor doctor whom I did not know personally as he had been more or less an invalid since I had come to the district. She said that he had gone away and his locum had not turned up and there were a n u m b e r of people waiting in the surgery. I knew he had a friend on the far side of the district, about as far on the opposite side as I was on my side. I offered, if he would take all the practice on his side of the doctor's house, to take all the practice on my side on the condition that the doctor was not to be told until he returned that his locum had not turned up so that his convalescence should not be interfered with. At the end of six months, he returned from Italy, and we handed over to him a list of the patients we had seen on his behalf together with the accounts which were due for that attendance. Personally, I made a friend for life but I would ask no less of any member of the profession in a case of need, and if we live up to that ideal I do not think much will go wrong with our professional relations. I end as I began. Our outlook on life is summed up in the quotation : - " I could not love thee, dear, so much Loved I not honour more." :32
NOVEMBER VOTE OF THANKS.
Captain G. S. Elliston, M.P. (Consultant Secretary and Member of Council of the Society) said that it gave him very great pleasure to have the opportunity of moving a hearty vote of thanks to the President for his Address. He said that he had first known the President when he was a young House Surgeon at the Ipswich Hospital under his (Captain Elliston's) father, and he felt that Dr. Nash had never lost that youthful enthusiasm and energy which he had shown at that time. He said also that he was pleased to move the vote of thanks as he himself had been so actively interested in the campaign for better salaries, which had been the main subject of the President's Address. He would like~to make one comment on this campaign, which was the impression he had retained of how few medical officers had been disloyal to the policy of the profession during the difficult times after the War. Dr. A. T. W. Powell, M.C. (M.O.H., Walthamstow, and President of the Home Counties Branch) said that he was very glad and honoured to second the vote of thanks. As one of the younger medical officers of health, he had always admired Dr. Nash's enterprise and enthusiasm, which he thought were an example to others. He himself would like to refer particularly to Dr. Nash's work in diphtheria immunisation, which he thought was one of the most useful and most important factors in public health at the present time. The proposition was then put to the meeting and carried by acclamation. Dr. Nash briefly returned thanks for the reception of his Address.
THE ANNUAL DINNER. Members are reminded that the Annual Dinner is to be held this year on Friday, November 18th, at the Piccadilly Hotel, London, at 7.10 for 7.30 p.m. Tickets, 12s. 6d. exclusive of wines. Dr. Robert Hutchison, President of the Royal College of Physicians will propose the toast of the Society; and other distinguished guests have accepted invitations to be present. The Dinner will also be the occasion of congratulating Sir William Savage on the honour of knighthood, the recently-appointed King's Honorary Physicians (Sir Arthur MacNahy, Sir Frederick Menzies, Dr. A. S. M. Macgregor and Dr. J. C. Bridge), and Dr. James Fenton (Immediate Past-President) on his C.B.E. The toast list is to be a short one, and arrangements are being made for members and their ladies who so wish to proceed to the hotel ballroom for the cabaret and dancing. Members are asked to make early application for tickets for themselves and their guests (price 12s. 6d., exclusive of wines; after November 16th, 15s.) to the Executive Secretary, 1, Thornhaugh Street, Russell Square, W.C.1. The names of guests should be sent'in with applications for tickets for inclusion on the table plan.
PUBLIC HEALTH
Presidential Address to the Society of Medical Officers of Health.* By E. H. T. NASH,M.R.C.S., M.R.C.P., D.P.H.
Medical Officer of Health, Borough of Heston and Isleworth. in the country put in for an advance on his salary, which was definitely below the standard for a town of the size he served and was refused, but as a sop to their Council's conscience they gave him authority to take premium pupils. The result was that the thing became a scandal as on one occasion there were four candidates for a junior post, every one of them bearing a glowing testimonial from the M.O.H. in question as to their suitability for the post for which they were applying. Needless to say it did not help the candidates as their superlative claims to fame cancelled out one another. The position in the early days was in some respects extraordinary. Manchester made itself prominent, I almost said famous. Niven, at that time one of the best known and most capable M.Os.H. in this or any other country, came into prominence on the salary question by reason of the difference in the salary which he received as compared to the Chief Constable. The attitude the authorities took up was that Niven was only in charge of a small, in fact very small, but highlyskilled staff, whereas the Chief Constable was in command of a large number of policemen and the salaries were based on the principle of " counting knobs." In other words, it put it up to the M.O.H. that unless he had a staff which would be abnormally and uneconomically large his chance of his salary being brought into accord with the prominence and responsibility of his Department was not likely to be materially increased. Things went on fairly welt until the outbreak of war and then trouble ensued again, not so much at the outbreak of war as during the post-war period. The way in which women were rushed through the Universities in order to relieve the men produced its own difficulties when things quietened down after the War. It must be borne in mind that the conditions under which the Scottish graduates came on to the market were very different from those which applied in the rest of Great Britain. The Carnegie Trust Scholarships and their Bursaries, together with the Scottish economy, made possible the qualification of a large number of women, particularly daughters of the Manse and other professional people with small incomes to whom the grant made just the difference of a medical qualification, were a very important and difficult factor in the situation. To some * Delivered to an Ordinary Meeting of the Society at of these people who had come from homes where the Society's house, Friday, October 28th, 1938. economy was of necessity the order of the day,
" I could not love thee, dear, so much, Loved I not honour more." --LoVELACE. I had other thoughts for a Presidential Address than these which I am putting before the meeting to-day, but recent events have made me feel that it is not inappropriate in a President who is retiring immediately from the service to say something, particularly to the younger members, with regard to the service, its status and its honour. I may possibly be excused in another way for taking up this subject as I was the first Medical Officer of Health, who, as an assistant, for want of a better word, " struck " against the inadequate salary offered by the authority he was then serving when promotion at an inadequate salary was offered. I was at the time an Assistant Medical Officer to the County Borough of Derby in the capacity of Medical Superintendent of the Isolation Hospital. When the Education (Administrative Provisions) Act came out in 1907 the Corporation of Derby tried to advertise for an Assistant Medical Officer at a salary of£200 a year. This was banned by the British Medical Journal, and the Lancet also came into line and refused the advertisement. Ultimately the Council capitulated, but as one of the Senior Aldermen said, he did not mind paying £250 a year, which was the minimum salary settled by the British Medical Association, but he was " d a m n e d " if he liked paying it with a pistol put to his head. This was the first occasion in which a medical officer had struck for the adequate salaries agreed upon. As far as I was concerned at the time, it was a very serious matter indeed to me as I had come into the Public Health Service late ; I had a wife and five children, and it was imperative that my promotion should be rapid. Had I not taken the attitude I did it would have opened the door to a flood of appointments at £200 a year, which I maintain was entirely forestalled, by reason of the action I took, and the salary agreed upon was standardised without opposition. In the early days difficulties arose in several directions. It must be borne in mind that the Town Councils had at that time without any opposition, the ability to pay what salary it liked. One of the best known Medical Officers of Health
29
PUBLIC HEALTH an income even below the standard fixed by the B.M.A. was comparative wealth. For example, in one of the largest towns in England, in the Midlands, an appointment for an Assistant Medical Officer which was advertised below the salary scale was blacklisted. The School Medical Officer happened to be a fellow student and personal friend of mine and I got information with regard to the situation that existed. There were thirteen candidates for the post. As he put it, " twelve Scotch women graduates and a senile, alcoholic Englishman." One of the women was appointed and ostracised by the rest of the professional staff. This Council, like others, got the bit between their teeth and although ardent trade unionists themselves, objected to another trade union as they liked to call the B.M.A., having any say in what they paid their officers. Things got very acute and a number of appointments were taken by the Scottish women, particularly, below the salary scale. At the Liverpool meeting of the Royal Sanitary Institute, I had a long talk with Dr. Ivens, as she was then, who was at the time the President of the Medical Women's Federation, on the situation. The position was so serious that she at "once took steps to bring it to an end. We arranged to call a round table conference to talk things out and I agreed to take six representatives of the Public Health Service, of whom two should be Assistant Medical Officers, and she arranged to bring six representatives of the Medical Women's Federation. We dined together at a house loaned by one of her women colleagues. The other members on our side were Dr. George Buchan, Mr. George Etliston, Dr. Ruddock-West (now County Medical Officer of Norfolk), my Deputy, Dr. Roberts and one other doctor. We had a long discussion as to the best method or methods of getting over the difficulty. The women felt their pride was hurt. Ultimately, the women agreed to start a fund and to finance these blacklegs into general practice. Some little while ago I was informed that with one excpetion who was still paying off the loan slowly, every single one of the women to whom money was advanced to settle them in practice had repaid the amount loaned to them and from that day to this there has been an absence of the distressing condition whereby the women were underselling the male members of the profession. I had another very difficult experience which was illuminating in that in the area where I was at the time a Scottish graduate had come in as an assistant to a firm consisting of three partners. The partners had not taken the trouble to insist on the 30
NOVEMBER usual agreement with the doctor that he should not practice within a certain restricted area. The position became unfortunate by reason of difficulty between one partner and the Assistant due to the fact that the Assistant had discovered, whilst acting for one of the partners on holiday, that a patient who had been told he had some persistent dyspeptic trouble was suffering from gastric crises occurring in a definitely marked case of locomotor ataxy. When the partner returned from his holidays trouble ensued and the Assistant left and started up in opposition in the district. This, as can be easily understood, lead to difficulties at once and things became acute until I intervened. I ultimately got in touch with him and found a man who was all on edge, all prickles, unapproachable and with no contact or sympathy with his fellow medical men. I found it extremely difficult to catch him as he definitely avoided me. However, as I had no car at that time of my own, Dr. Ruddock°West volunteered to help. He came over early and fetched me, and I got to the man's house before he had time to make a get-away. We had a long heart-to-heart talk and finally I got the address of his people. I wrote to the father, who was a professional man and also to his mother. His father, as a professional man, took up the attitude that he ought to throw in his hand and do the honourable thing. The mother, on the other hand, was very sore at what she felt was a grave injustice to her son who had now started to make his way in the world. The unfortunate medical man was torn between the opinions expressed in the two letters and at the time was very definitely taking up the attitude that he did not care two hoots for anybody and was going his own way, being inclined to follow the advice of his mother, who was not concerned in the least with whether the thing was honourable or not. The position was very difficult. Eventually I got him to see that honour demanded that he should leave the district, which he did, disposing of the patients he had obtained apart from the practice and referring the others back. I never felt happier in my life than I did on the day I was able to shake him by the hand and tell him he could now hold his head high amongst his fellows as a man of honour. I invited him to my own house as an honoured guest and made him feel that here was a harbour where he could find peace and anchorage in his troubles if he wanted to. Ultimately, when he threw in his hand, I got him to come down to a meeting of the local division of the B.M.A., and there I introduced him to the members and when he came in the whole meeting stood to greet him and shake him by the hand. As far as I was concerned, it was a
1938 meeting pregnant with the deepest emotions, for here was an outcast who had come back to the fold and all the other members regarded him now as one of them--a man of honour, a man they were glad to know. The after history was not as happy. He finally got into a practice as an assistant in the East End of London and wrote to me lamenting the fact that he had done the right thing. As he said, " Here the men amongst whom I work seem to have no regard of the high principles which seem to actuate you and your progress in life, and are not above doing dirty tricks to one another, and in a very large number of cases the only dominating factor in their life seems to be money." This was a very disheartening thing after what one had done. At the same time, I felt that at the back of it all the man had something which he could carry through life which would enable him to hold his head high amongst his professional brethren. A few years ago, the M.O.H.-ship of an important authority fell vacant. The local authority advertised the post at a salary below the agreed scale. This meant, of course, that the post had to be blacklisted and the advertisement refused by the medical journals. The authority persisted in advertising and a small body of men applied, contrary to the appeals of the Society and the B.M.A. When certain facts were brought to their knowledge the local authority saved its face by making a temporary appointment at a salary substantially over that which they offered. Ultimately the post was advertised at a salary agreeable to the Askwith Scale and a man of very high standing was appointed. I tried my utmost to get things straightened out. One of my sons was home on leave and had an open car. I am never likely to forget driving back across a wide, open space with the rain puring into the sides of the car and of getting thoroughly soaked on the journey. One of the most extraordinary things which emerged out of this was the mistaken idea of the important people on the County Council with regard to the functions of the B.M.A. and it was most gratifying to see the immediate " volte face " when they appreciated that we as an Association, would not tolerate for a minute any action by any of our members which was in any way derogatory to the Service to which we belong. From that moment, the whole atmosphere changed and co-operation was the order of the day. Latterly in the north there have, unfortunately, been difficulties and more members of the Society have been asked to resign for accepting appointments in a town where the assistant medical officers' salaries were still under the agreed scale.
PUBLIC HEALTH The position has become very difficult and I want to say at once that I appreciate to the full the difficulty of the man in the position of Deputy, whose chief has been promoted elsewhere and whose turn for promotion has arrived and who is offered by the Council, who feel because they have got him there they need not pay him the same salary as paid to his predecessor, a salary which is below the agreed scale, as he is put in a most difficult position. The salary offered may be a considerable advance on what he is getting but at the same time it is below the agreed scale. It is very. difficult indeed to label a man in that position as a " blackleg" and yet every time this sort of thing happens trouble is bound to ensue. I am bound to say that it is extraordinary to me that certain Councils will break through the agreed scales when they think they have the officer in their power and can force a decrease in the salary scale. Speaking generally, one is glad to report that Councils up and down the country do treat their officers with that respect to which we feel entitled. Of course, we are bound to admit that it is not every officer who is a model of tact and industry, or even morality, and should they suddenly disappear as a result of any of these things, it is not for us to interfere in the just reward of their shortcomings. One of the great difficulties is the differentiation between the salaries offered to different officers. I am at a loss to understand why, for instance, electrical engineers should enjoy salaries in advance of their colleagues whose training and standing is in no way less than theirs. The ideal system seems to me to be the one where the principal officers, with the exception of the Town Clerk, are all on the same salary scale, the Town Clerk drawing £100 a year more in recognition of his post as Chief Administrative Officer. So long as there are differences so long will there be friction within the house. If there is one thing more than another which is important to my mind it is that there should be peace and a good spirit between those of us who are working for local authorities. At the same time there must be between local authorities and their officers a sense of trust and perfect confidence that there will be nothing but honourable dealings between them and the public. The Corrupt Practices Act, unfortunately, is still needed, i have done my best to keep the honour of the Society of Medical Officers of Health untarnished. I have failed in some respects, but I have been able to do something towards the end I have been striving for. The position at the present time is difficult. There must be a far greater liaison between ourselves and the B.M.A. It is true and very heartening that the contact is becoming closer 31
PUBLIC HEALTH and closer as the days go by, but it should be impossible for a medical officer of health who has been asked to resign from this Society to be sent up to the representative body by his division as a fit and proper person to represent the practitioners of that area or to hold office in that Division. It is up to those of us who are old in the service to see that those with whom we come into contact, particularly our own staff, do retain that high sense of integrity which should, and must, be the standard for all our members. T h e r e are many who have not stood the stress of temptation. Possibly having been through the mill I am in a position to speak, and to speak feelingly. I have done my best to keep the profession at the high pitch which is its due and also to render to my professional brethren any assistance that I possibly could to make our profession, in whatever branch I have been, a united service of medical men no matter what the line of country is which they are pursuing. Finally, may I instance what was to me nothing but the following out of the principles I have adopted, but which had far-reaching effect in the years that followed. I was a young man only recently in practice in the N o r t h and pushed into the job of Secretary to the local medical society. I was rung up one day about 2 o'clock by a housekeeper of a bachelor doctor whom I did not know personally as he had been more or less an invalid since I had come to the district. She said that he had gone away and his locum had not turned up and there were a n u m b e r of people waiting in the surgery. I knew he had a friend on the far side of the district, about as far on the opposite side as I was on my side. I offered, if he would take all the practice on his side of the doctor's house, to take all the practice on my side on the condition that the doctor was not to be told until he returned that his locum had not turned up so that his convalescence should not be interfered with. At the end of six months, he returned from Italy, and we handed over to him a list of the patients we had seen on his behalf together with the accounts which were due for that attendance. Personally, I made a friend for life but I would ask no less of any member of the profession in a case of need, and if we live up to that ideal I do not think much will go wrong with our professional relations. I end as I began. Our outlook on life is summed up in the quotation : - " I could not love thee, dear, so much Loved I not honour more." :32
NOVEMBER VOTE OF THANKS.
Captain G. S. Elliston, M.P. (Consultant Secretary and Member of Council of the Society) said that it gave him very great pleasure to have the opportunity of moving a hearty vote of thanks to the President for his Address. He said that he had first known the President when he was a young House Surgeon at the Ipswich Hospital under his (Captain Elliston's) father, and he felt that Dr. Nash had never lost that youthful enthusiasm and energy which he had shown at that time. He said also that he was pleased to move the vote of thanks as he himself had been so actively interested in the campaign for better salaries, which had been the main subject of the President's Address. He would like~to make one comment on this campaign, which was the impression he had retained of how few medical officers had been disloyal to the policy of the profession during the difficult times after the War. Dr. A. T. W. Powell, M.C. (M.O.H., Walthamstow, and President of the Home Counties Branch) said that he was very glad and honoured to second the vote of thanks. As one of the younger medical officers of health, he had always admired Dr. Nash's enterprise and enthusiasm, which he thought were an example to others. He himself would like to refer particularly to Dr. Nash's work in diphtheria immunisation, which he thought was one of the most useful and most important factors in public health at the present time. The proposition was then put to the meeting and carried by acclamation. Dr. Nash briefly returned thanks for the reception of his Address.
THE ANNUAL DINNER. Members are reminded that the Annual Dinner is to be held this year on Friday, November 18th, at the Piccadilly Hotel, London, at 7.10 for 7.30 p.m. Tickets, 12s. 6d. exclusive of wines. Dr. Robert Hutchison, President of the Royal College of Physicians will propose the toast of the Society; and other distinguished guests have accepted invitations to be present. The Dinner will also be the occasion of congratulating Sir William Savage on the honour of knighthood, the recently-appointed King's Honorary Physicians (Sir Arthur MacNahy, Sir Frederick Menzies, Dr. A. S. M. Macgregor and Dr. J. C. Bridge), and Dr. James Fenton (Immediate Past-President) on his C.B.E. The toast list is to be a short one, and arrangements are being made for members and their ladies who so wish to proceed to the hotel ballroom for the cabaret and dancing. Members are asked to make early application for tickets for themselves and their guests (price 12s. 6d., exclusive of wines; after November 16th, 15s.) to the Executive Secretary, 1, Thornhaugh Street, Russell Square, W.C.1. The names of guests should be sent'in with applications for tickets for inclusion on the table plan.