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Smoke abatement
4,~ River'Lee and returned as sewage to the River Stort, which is a tributary of the Lee. The River Lee is a small river from which the Metropolitan Water Board dra~s water for the supply of over 1,000,000 of the people of London. It receives a number of sewage effluents, but the circumstance of their discharge has, in the past, been such that the river has been fully capable of overcoming this added pollution by its natural biological agencies and a study of the reports of the Director of Water Examination, Metropolitan Water Board, shows that the water received at the Board's works has been quite suitable for converting into a safe and acceptable domestic supply. In recent years, however, there has been considerable deterioration in the quality of the water in the River Lee owing to the advancing industrialisation in its watershed, and evidence was given at the public inquiry to the effect that the average biological oxygen demand of the river between April and June, 1946, was 4.8 parts per million, which is to say that it was higher than the highest level to which the Royal Commission on Sewage Disposal considered that this figure should be brought ; and that on four of the eleven occasions when this was estimated the water received at the works of the Metropolitan Water Board fell into the category described by the Royal Commission on Sewage Disposal as " bad or polluted rivers." It was also shown in evidence that the proposals of the Ministry will affect the river in two ways. They will deprive it of an uncertain but possibly large volume of pure water which now reaches it as springs from the chalk and will contribute to it an additional 12 m.g.p.d, of sewage effluent. It was estimated that, should the present proposals in regard to Stevenage alone be carried out, the river would, during periods of low flow, contain over 70% of sewage effluent, and, should the Harlow proposal materialise, this figure would be increased to over 800/0. T h e discharge of such quantities of sewage effluent into the River Lee would be contrary to the principles so clearly laid down by the Ministry of Health. We know of no cases in which so heavily polluted a water has been used in this country as a source of a domestic water supply and we fear that a precedent may be created which may well undo the great contribution which has been made to the health of the people of this country by adherence to long-established principles. This cannot be regarded as a parochial matter and it is the concern of all whose business it is to conserve and advise regarding the health of the people. We are perhaps less intimately concerned with the aesthetic aspect of this case but we venture to believe that the average citizen would receive with considerable repugnance the knowledge that his drinking water consisted almost entirely of purified sewage derived from a neighbouring community. Not the least astonishing evidence given at this inquiry was that which claimed that the situation of these towns had been decided upon the highest level without even the most superficial inquiry as to what might be their effect upon the water supplies to neighbouring communities. The Minister of Town and Country Planning has since written to the authorities concerned, stating that the plan for the development of Stevenage as a new satellite town is to be proceeded with. Regarding the aspects of water supply and sewage disposal, he has undertaken to maintain close contact with the Ministry of Health and the statutory undertakers at every stage of the development. We can only hope that a dangerous precedent and an unjustifiable risk to the people of London will be avoided by giving full weight to the factor brought out by Col. Mackenzie's evidence. Smoke Abatement " There's no smoke without fire " might have been the slogan for the thirteenth conference of the National Smoke Abatement Society (Brighton, October 24th-26th) judging from the fervour of the 400 delegates in attacking all possible sources of atmospheric pollution, both industrial and domestic. (One speaker, however, started his paper with the words: " Smoke--Britain can make it.") At the opening session, an encouraging message was received from Mr. Herbert Morrison, as the Minister responsible for the Department of
PUBLIC HEALTH, December, 1940 Scientific and Industrial Research, in which he urged that the public resentment of smoke from industrial chimneys must be increased and aimed not only at the factory chimney but at the ordinary smoking domestic chimney, " until public opinion will insist that smoke is anti-social and not to be tolerated." The feeling in the air that the'long years of campaigning against this evil are at last bearing fruit was well expressed ny Sir George Elliston when he said in his Presidential address : " The main task of the Society is not to dwell as formerly upon the ravages of atmospheric pollution, now universally recognised as a national waste, but the more constructive work as to how this pollution can be diminished most effectively and in the shortest possible time. Our policy is no longer a counsel of perfection ; it has now become a necessity on the lowest economic grounds alone. There is little use in the Ministry of Fuel and Power and other Ministries lamenting the shortage of coal for every purpose, industrial, domestic and export, when .we scatter no less than two and a half million tons of it unburnt'into the air to cause damage to our buildings and possessions, which with other costs conservative authorities have estimated at £ 2 , 0 0 0 , 0 0 0 per week . . . . We are in effect employing 10,000 miners to produce smoke and a far greater number of other people in cleaning up and making good all the damage it does." The note of optimism throughout the conference was, however, balanced by a sense of frustration that the general recognition of the evil and of its remedies is baulked in action by the shortages of smokeless fuels and appliances for burning them. Two of the resolutions passed at the close of the meetings illustrate the trend of views expressed. That this Conference of the National Smoke Abatement Society requests H.M. Government as a matter of extreme urgency to give a higher priority to the production of efficient domestic solid fuelburning appliances, and that the payment of subsidy to housing authorities be conditional on the installation of such appliances as soon as they are available. That this Conference of the National Smoke Abatement Society extends its good wishes to the National Coal Board and is gratified to learn that a progressively increasing production of smokeless fuels is to be the forefront of its programme, and trusts that, in the interests of both fuel efficiency and smoke prevention, an early start wiU be made towards the complete disuse of bituminous coat for all dome sti¢ purposes. The view was often expressed that district heating would be the overall answer to the domestic problems of smoke abatement, of conservation of fuel, of relieving the housewife of the drudgery of fuel carrying and stoking fires and ovens, and of revolutionising the comfort standards of British home life. The representative of one minor authority (Urmston U.D.C.) announced that a scheme had already begun to operate in his area, providing continuous hot-water and space heating of bungalow-type houses for a rental of three shillings weekly. Eventually the same service would be extended to a total of 1,300 houses as they were completed ; the charge for a house of 1,000 sq. ft. would be 5s. to 5s. 6d. per week. Prof. Tylecote, of Manchester, on the other hand, reported that his city's ambitious scheme to provide district heating for 8,000 houses at Wythenshawe was held up only by the failure, so far, of the Ministry of Health to approve its execution, presumably on account of the high capital cost involved. On the industrial side, the N.S.A.S. submitted for discussion suggested nev/ legislation to cover prior approval by local authorities of fuel burning installations, bye-laws as to their maintenance and operation, and training and registration of firemen. There was a general feeling that the calling of stoker must be recognised as a skilled one and paid accordingly if the standard of efficient combustion was to be raised. Other resolutions passed by the Conference called on the Ministry of Fuel and Power and the Central Electricity Board to take immediate steps to control the emission of smoke, sulphur and grit from certain electricity generating stations; and on local authorities generally to support the work of the N~S.A.S. by becoming subscribing members, so that it could become a complete clearing house and information bureau as to progress in smoke abatement. Congratulations are due to
PUBI,1C HEALTH, December, 1946 the N.S.A.S., especially to its chairman (Mr. Charles Gaudy), Executive Committee, and secretary (Mr. Arnold Marsh, M.SC.), on a most stimulating conference. On another page of this issue appears the memorandum of evidence submitted by the Society of Medical Officers of Health to the sub-committee of the Minister of Health's Central Housing Advisory Committee which is considering the methods of domestic heating to be adopted in the postwar housing schemes. It will be a retrograde step if old fashioned, wasteful and smoke-producing fires and ovens are fitted to new houses on grounds of expediency or of temporary difficulty in obtaining modem equipment; we hope that medical officers of health will make their voices heard. FamUies in Trouble~ A useful addition to the study of problem families comes under the above title from the pen of C. G. Tomlinson, Senior Admmlstratzve Officer of the Borough of Luton health department. One family in Luton in every 200 falls into this class, a little higher than the figure recorded by Savage in Herefordshire and half that found by Wofinden in Rotherham. The report emphasises again the lack of any true definition of the problem family, each such family presenting a unique complex of features. All have in common one characteristic, that of incapacity to improve their condition without outside help. In comparison with-the relatively small numbers involved, the importance of problem families in the national life is disproportionately high and they present a challenge to public health authorities which calls for determined action. At a time when the scope of the work of the public health department is being assailed from many directions here is a new public health field upon which medical officers of health might embark with some of that vigorous pioneering spirit which has characterised their efforts in the past. The Curtis Committee finds the public health department insufficiently qualified to deal with the social problems arising from homelessness in children. Let us show this public spirited but misguided body of experts that public health departments can go one better and seek to prevent the " homeless" by raising the social standards of the problem families from which a large fraction of such children are derived. Tomlinson suggests that the first step must be for health authorities to ascertain and record such families. When this is done the first attack on the problems presented by each individual family should be through the health visitors ; this will obviously call for an increase in establishments if the work is to be taken seriously. Over and above this some form of special social worker will be needed, someone who in the words of a recent leader in T h e L a n c e t " can take off his (or more probably her) coat and get down to the restitution of civilised conditions." The Norwich City Council appear to have appointed such persons under the name of " home advisers " : it is recorded that they have had " to scrub floors inches deep in indescribable filth, to clean little children who have never known a wash, much less a bath; then to teach dull, uncomprehending mothers the very rudiments of mending and cooking and cleaning." Tomlinson suggests that such a caseworker can handle about 15 cases at a time and he appears to favour their appointment by voluntary organisations in the first place. The Quakers, through the Pacifist Service Units (working in Manchester and Liverpool), have set an example. This is a point which clearly must depend on local circumstances; where such an arrangement is possible, no 'doubt it would have advantages but many authorities will surely have to appoint and supervise their own " home advisers." Tomlinson also emphasises the need for more nursery schools in areas where problem families are concentrated. This is dearly most desirable but he does not mention the equally desirable use of day nurseries for this purpose, With the change over of wartime nurseries to peacetime functions, it is to be hoped that priority for admission will be given to children on public health grounds and the younger members of the problem families should be found particularly eligible. * Gibbs, Bamforth & Co. (Luton), Ltd. (1946. Pp. 43. Price 3s. 6d.)
49 Both in the nursery school and the day nursery the teaching of good habits of living may have a profound effect, not only on the infants themselves but also through example on the parents, particularly when the mother and father can be persuaded to interest themselves in the nursery and discuss their problems with the matron or teacher.
Education Act, 1944---Section 48(3) In reply to enquiries arising from the report under the above heading printed in our issue of October last, page 22, the Ministry of Education have confirmed the general accuracy of the report but indicate that I I - - C o n t r i b u t i o n s b e t w e e n L o c a l E d u c a t i o n A u t h o r i t i e s - - s h o u l d be amended. The words, " e.g., when away from home on holiday " on lines 4 and 5 of that paragraph, should be deleted, as the power under which one authority may recoup another for treatment given in these particular circumstances does not derive from Section 106 of the 1944 Act. ,Evidently the report of the discussion on the Education Act ~iven on page 11 of PUnLIC HEALTHfor October, 1945, is correct. There the Ministry's representatives are reported as saying that, supposing that a Derbyshire child had an accident while staying at Boumemouth, the former authority would have to accept financial responsibility for the treatment given at Bournemouth. This was interpreted as meaning that the Derbyshire authority should reimburse the Boumemouth authority for the cost of treatment which it provided. If the Boumemouth local education authority actually provided the treatment in one of their own clinics or otherwise, they would naturally expect the Derbyshire authority to reimburse them, but this would not fall under Section 106 of the Education Act, 1944. A more common case would be one in which the child is treated in a municipal or voluntary hospital and the public health authority or the governors of the voluntary hospital would claim reimbursement from the local education authority of the child's home area. Health and Social Legislation in the U.S.A. It was a great and unexpected pleasure to the Council of the Society to have the opportunity on November 15th of meeting Dr. Thomas Parran, the Surgeon-General of the United States Public Health Service, who was paying a brief visit to this country. Dr. Parran gave a most interesting informal account of recent developments in the U.S.A., including mention of the matters reported below, and said that in many respects his country was still looking to Great Britain in regard to the development of social medicine. Dr. George Buchan, who introduced him, and our President, Sir Allen Daley, who thanked him for his informative speech, both laid stress on the value of our contacts with American public health, The leading article in the A m e r i c a n J o u r n a l o f P u b l i c H e a l t h for October gives a review of legislative changes during the life of the 79th Congress which affords an interesting comparison with some features of our National Health Service Act. Whereas we are moving toward a system whereby local fimctions in relation to health are transferred from local to central governing bodies, the American position is fundamentally different in that there are interposed, between the counties and municipalities and the Federal Government, States with independent legislatures and administration which cling tenaciously to their autonomy. The Federal Health Service has therefore to act largely by liberal a d h o c subsidy of approved programmes prepared by the States. The following description of the situation in America should be read in the light of that fundamental difference from our governmental structure. In the view of the A . J . P . H . , the contributions of the 74th Congress in the domestic field: were disappointing and the House of Representatives in particular was " markedly subservient to private vested interests." A Bill for a National Science Foundation passed the Senate but died in the Interstate and Commerce Committee of the House. Another Bill, for a national housing programme, likewise passed the Senate but was held tip by filibustering tactics in the House Committee on Banking and Currency. The House Ways and Means Committee " completely emasculated " a Bill for extending social .qeeurity benefits.
PUBLIC HEALTH, December, 1940 Scientific and Industrial Research, in which he urged that the public resentment of smoke from industrial chimneys must be increased and aimed not only at the factory chimney but at the ordinary smoking domestic chimney, " until public opinion will insist that smoke is anti-social and not to be tolerated." The feeling in the air that the'long years of campaigning against this evil are at last bearing fruit was well expressed ny Sir George Elliston when he said in his Presidential address : " The main task of the Society is not to dwell as formerly upon the ravages of atmospheric pollution, now universally recognised as a national waste, but the more constructive work as to how this pollution can be diminished most effectively and in the shortest possible time. Our policy is no longer a counsel of perfection ; it has now become a necessity on the lowest economic grounds alone. There is little use in the Ministry of Fuel and Power and other Ministries lamenting the shortage of coal for every purpose, industrial, domestic and export, when .we scatter no less than two and a half million tons of it unburnt'into the air to cause damage to our buildings and possessions, which with other costs conservative authorities have estimated at £ 2 , 0 0 0 , 0 0 0 per week . . . . We are in effect employing 10,000 miners to produce smoke and a far greater number of other people in cleaning up and making good all the damage it does." The note of optimism throughout the conference was, however, balanced by a sense of frustration that the general recognition of the evil and of its remedies is baulked in action by the shortages of smokeless fuels and appliances for burning them. Two of the resolutions passed at the close of the meetings illustrate the trend of views expressed. That this Conference of the National Smoke Abatement Society requests H.M. Government as a matter of extreme urgency to give a higher priority to the production of efficient domestic solid fuelburning appliances, and that the payment of subsidy to housing authorities be conditional on the installation of such appliances as soon as they are available. That this Conference of the National Smoke Abatement Society extends its good wishes to the National Coal Board and is gratified to learn that a progressively increasing production of smokeless fuels is to be the forefront of its programme, and trusts that, in the interests of both fuel efficiency and smoke prevention, an early start wiU be made towards the complete disuse of bituminous coat for all dome sti¢ purposes. The view was often expressed that district heating would be the overall answer to the domestic problems of smoke abatement, of conservation of fuel, of relieving the housewife of the drudgery of fuel carrying and stoking fires and ovens, and of revolutionising the comfort standards of British home life. The representative of one minor authority (Urmston U.D.C.) announced that a scheme had already begun to operate in his area, providing continuous hot-water and space heating of bungalow-type houses for a rental of three shillings weekly. Eventually the same service would be extended to a total of 1,300 houses as they were completed ; the charge for a house of 1,000 sq. ft. would be 5s. to 5s. 6d. per week. Prof. Tylecote, of Manchester, on the other hand, reported that his city's ambitious scheme to provide district heating for 8,000 houses at Wythenshawe was held up only by the failure, so far, of the Ministry of Health to approve its execution, presumably on account of the high capital cost involved. On the industrial side, the N.S.A.S. submitted for discussion suggested nev/ legislation to cover prior approval by local authorities of fuel burning installations, bye-laws as to their maintenance and operation, and training and registration of firemen. There was a general feeling that the calling of stoker must be recognised as a skilled one and paid accordingly if the standard of efficient combustion was to be raised. Other resolutions passed by the Conference called on the Ministry of Fuel and Power and the Central Electricity Board to take immediate steps to control the emission of smoke, sulphur and grit from certain electricity generating stations; and on local authorities generally to support the work of the N~S.A.S. by becoming subscribing members, so that it could become a complete clearing house and information bureau as to progress in smoke abatement. Congratulations are due to
PUBI,1C HEALTH, December, 1946 the N.S.A.S., especially to its chairman (Mr. Charles Gaudy), Executive Committee, and secretary (Mr. Arnold Marsh, M.SC.), on a most stimulating conference. On another page of this issue appears the memorandum of evidence submitted by the Society of Medical Officers of Health to the sub-committee of the Minister of Health's Central Housing Advisory Committee which is considering the methods of domestic heating to be adopted in the postwar housing schemes. It will be a retrograde step if old fashioned, wasteful and smoke-producing fires and ovens are fitted to new houses on grounds of expediency or of temporary difficulty in obtaining modem equipment; we hope that medical officers of health will make their voices heard. FamUies in Trouble~ A useful addition to the study of problem families comes under the above title from the pen of C. G. Tomlinson, Senior Admmlstratzve Officer of the Borough of Luton health department. One family in Luton in every 200 falls into this class, a little higher than the figure recorded by Savage in Herefordshire and half that found by Wofinden in Rotherham. The report emphasises again the lack of any true definition of the problem family, each such family presenting a unique complex of features. All have in common one characteristic, that of incapacity to improve their condition without outside help. In comparison with-the relatively small numbers involved, the importance of problem families in the national life is disproportionately high and they present a challenge to public health authorities which calls for determined action. At a time when the scope of the work of the public health department is being assailed from many directions here is a new public health field upon which medical officers of health might embark with some of that vigorous pioneering spirit which has characterised their efforts in the past. The Curtis Committee finds the public health department insufficiently qualified to deal with the social problems arising from homelessness in children. Let us show this public spirited but misguided body of experts that public health departments can go one better and seek to prevent the " homeless" by raising the social standards of the problem families from which a large fraction of such children are derived. Tomlinson suggests that the first step must be for health authorities to ascertain and record such families. When this is done the first attack on the problems presented by each individual family should be through the health visitors ; this will obviously call for an increase in establishments if the work is to be taken seriously. Over and above this some form of special social worker will be needed, someone who in the words of a recent leader in T h e L a n c e t " can take off his (or more probably her) coat and get down to the restitution of civilised conditions." The Norwich City Council appear to have appointed such persons under the name of " home advisers " : it is recorded that they have had " to scrub floors inches deep in indescribable filth, to clean little children who have never known a wash, much less a bath; then to teach dull, uncomprehending mothers the very rudiments of mending and cooking and cleaning." Tomlinson suggests that such a caseworker can handle about 15 cases at a time and he appears to favour their appointment by voluntary organisations in the first place. The Quakers, through the Pacifist Service Units (working in Manchester and Liverpool), have set an example. This is a point which clearly must depend on local circumstances; where such an arrangement is possible, no 'doubt it would have advantages but many authorities will surely have to appoint and supervise their own " home advisers." Tomlinson also emphasises the need for more nursery schools in areas where problem families are concentrated. This is dearly most desirable but he does not mention the equally desirable use of day nurseries for this purpose, With the change over of wartime nurseries to peacetime functions, it is to be hoped that priority for admission will be given to children on public health grounds and the younger members of the problem families should be found particularly eligible. * Gibbs, Bamforth & Co. (Luton), Ltd. (1946. Pp. 43. Price 3s. 6d.)
49 Both in the nursery school and the day nursery the teaching of good habits of living may have a profound effect, not only on the infants themselves but also through example on the parents, particularly when the mother and father can be persuaded to interest themselves in the nursery and discuss their problems with the matron or teacher.
Education Act, 1944---Section 48(3) In reply to enquiries arising from the report under the above heading printed in our issue of October last, page 22, the Ministry of Education have confirmed the general accuracy of the report but indicate that I I - - C o n t r i b u t i o n s b e t w e e n L o c a l E d u c a t i o n A u t h o r i t i e s - - s h o u l d be amended. The words, " e.g., when away from home on holiday " on lines 4 and 5 of that paragraph, should be deleted, as the power under which one authority may recoup another for treatment given in these particular circumstances does not derive from Section 106 of the 1944 Act. ,Evidently the report of the discussion on the Education Act ~iven on page 11 of PUnLIC HEALTHfor October, 1945, is correct. There the Ministry's representatives are reported as saying that, supposing that a Derbyshire child had an accident while staying at Boumemouth, the former authority would have to accept financial responsibility for the treatment given at Bournemouth. This was interpreted as meaning that the Derbyshire authority should reimburse the Boumemouth authority for the cost of treatment which it provided. If the Boumemouth local education authority actually provided the treatment in one of their own clinics or otherwise, they would naturally expect the Derbyshire authority to reimburse them, but this would not fall under Section 106 of the Education Act, 1944. A more common case would be one in which the child is treated in a municipal or voluntary hospital and the public health authority or the governors of the voluntary hospital would claim reimbursement from the local education authority of the child's home area. Health and Social Legislation in the U.S.A. It was a great and unexpected pleasure to the Council of the Society to have the opportunity on November 15th of meeting Dr. Thomas Parran, the Surgeon-General of the United States Public Health Service, who was paying a brief visit to this country. Dr. Parran gave a most interesting informal account of recent developments in the U.S.A., including mention of the matters reported below, and said that in many respects his country was still looking to Great Britain in regard to the development of social medicine. Dr. George Buchan, who introduced him, and our President, Sir Allen Daley, who thanked him for his informative speech, both laid stress on the value of our contacts with American public health, The leading article in the A m e r i c a n J o u r n a l o f P u b l i c H e a l t h for October gives a review of legislative changes during the life of the 79th Congress which affords an interesting comparison with some features of our National Health Service Act. Whereas we are moving toward a system whereby local fimctions in relation to health are transferred from local to central governing bodies, the American position is fundamentally different in that there are interposed, between the counties and municipalities and the Federal Government, States with independent legislatures and administration which cling tenaciously to their autonomy. The Federal Health Service has therefore to act largely by liberal a d h o c subsidy of approved programmes prepared by the States. The following description of the situation in America should be read in the light of that fundamental difference from our governmental structure. In the view of the A . J . P . H . , the contributions of the 74th Congress in the domestic field: were disappointing and the House of Representatives in particular was " markedly subservient to private vested interests." A Bill for a National Science Foundation passed the Senate but died in the Interstate and Commerce Committee of the House. Another Bill, for a national housing programme, likewise passed the Senate but was held tip by filibustering tactics in the House Committee on Banking and Currency. The House Ways and Means Committee " completely emasculated " a Bill for extending social .qeeurity benefits.