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The Annual Luncheon
PUBLIC HEALTH, July, 1947
206 •T H E
ANNUAL
LUNCHEON
S p e e c h e s by the President and the Minister of H e a l t h
T h e A n n u a l L u n c h e o n of the Society was held at the PiccadiUy Hotel, W.1, on Friday, J u n e 20th, 1947, t h e change from t h e usual S e p t e m b e r date b e i n g due to the P r e s i d e n t ' s forthc o m i n g visit to t h e U n i t e d States for the congress of the A m e r i c a n Public H e a l t h Association. Before l u n c h e o n the P r e s i d e n t (Sir Allen Daley, M.D., F.n.c.e., D.P.n.) a n d L a d y Daley received a b o u t 120 m e m b e r s a n d guests. A f t e r t h e d r i n k i n g of the loyal toast, the President, welcoming the guests, said : T h i s is the a n n u a l festival of t h e b a c k - r o o m boys of the public health service ; and in a b a c k - r o o m boy o n e envisages a p e r s o n w h o is seldom seen a n d seldom heard, b u t w h o does all the real work. (Hear, hear.) But these backroom boys, however, on this a n n u a l occasion p r e s e n t themselves to t h e i r lords a n d m a s t e r s - - t h e M i n i s t e r of H e a l t h a n d his principal officers, to t h e i r employers, the local authorities, and to the leaders of o u r profession, o n w h o m also we are anxious to make a very good impression. (Laughter.) T h e r e f o r e , it is essential t h a t we should give the impression t h a t we are industrious, a n d c o n s e q u e n t l y as the clock approaches t h r e e o'clock we will say, " Sorry, we m u s t go n o w ; we usually get only t w e n t y m i n u t e s for l u n c h " (laughter) a n d t h a t we m u s t keep an a p p o i n t m e n t , or a t t e n d a c o m m i t t e e or do some of the m a n y o t h e r t h i n g s w h i c h c o n s u m e o u r time. I a m telling you these confidential m a t t e r s in o r d e r to explain h o w it is t h a t the Council of the Society limits the speeches m a d e on its b e h a l f on these occasions to one only, n a m e l y t h a t of the President. B u t we m u s t r e m e m b e r t h a t we are all busy people these days, a n d n o t less b u s y since M r . A n e u r i n Bevan took u p his p r e s e n t office, a n d to such good effect t h a t his n a m e is a h o u s e h o l d w o r d - - t h o u g h n o t all can p r o n o u n c e it (laughter) - - t h r o u g h o u t the l e n g t h a n d b r e a d t h of this land. Also, in o r d e r t h a t we can portray ourselves as harassed a n d o v e r - w o r k e d officials we deprive ourselves of the privilege a n d t h e pleasure of hearing speeches f r o m o u r guests o t h e r t h a n the M i n i s t e r h i m s e l f ; and it would be a poor reward for o u r d i s t i n g u i s h e d guests w h o have b e e n so good n a t u r e d as to come a n d j o i n us at l u n c h to-day, if we were to keep t h e m b e y o n d t h e time w h e n they have to go elsewhere for o t h e r a n d u r g e n t pressing engagements. O u r guests m a y be divided into four categories. F i r s t of all t h e r e are o u r medical guests a n d o u r local authorities guests, t h e n t h e ladies, a n d t h e n the M i n i s t e r a n d officers of G o v e r n ment departments. W i t h regard to o u r medical guests we welcome here the Presidents of the t h r e e Royal Colleges (applause) w h o have always b e e n very good friends to the public h e a l t h services. T h e n we have the M a s t e r of the Society of Apothecaries, t h a t ancient medical f o u n d a t i o n to w h i c h I personally a m i n d e b t e d for a r e c e n t kindness. T h e n we h a v e Sir H u g h Lett, the P r e s i d e n t of the British M e d i c a l Association, a n d we are very h a p p y to see his n a m e i n c l u d e d in the recent B i r t h d a y H o n o u r s as receiving the h i g h h o n o u r of K n i g h t C o m m a n d e r of the Victorian Order. (Applause.) N e x t we have t h e P r e s i d e n t of the Royal Society of Medicine, w h e r e t h e r e is a strong section of epidemiology ; a n d we welcome Prof. L u c a s K e e n e , P r e s i d e n t of the Medical W o m e n ' s F e d e r a t i o n w h i c h is growing in s t r e n g t h a n d in n u m b e r s , a n d w h i c h contains a large n u m b e r of those w h o work in the public h e a l t h service. W e welcome Dr. Charles Hill, the Secretary of the British Medical Association, whose bluff geniality a n d h o m e l y m a x i m s broadcast to the n a t i o n have m a d e such an i m p o r t a n t c o n t r i b u t i o n to public h e a l t h - - i n fact, h e m i g h t be one of ourselves. ( L a u g h t e r . ) T h e n we welcome t h e editors of the medical journals, a n d we t h a n k t h e m for giving us in t h e i r pages an o p p o r t u n i t y of reading of recent advances in medical k n o w l e d g e ; a n d we t h a n k t h e m , too, for p u b l i s h i n g the results of o u r labours. N o w we come to the C h a i r m a n of the Central M i d w i v e s ' Board, M r . A r n o l d Walker, at w h o s e feet I sit a n d learn s o m e t h i n g a b o u t obstetrics, in r e t u r n for w h i c h I give h i m a little guidance in the art of administration. A n d t h e n t h e r e is Sir W i l s o n J a m e s o n , w h o is one of ourselves t h o u g h a guest to-day, a n d we regard ourselves as extremely f o r t u n a t e t h a t at this j u n c t u r e h e occupies t h e h i g h office of C h i e f Medical Officer of the
M i n i s t r i e s of H e a l t h a n d Education. H e is t r u s t e d a n d respected b y all parties. A n d t h e n we come to m y second g r o u p - - t h e local authorities. M o s t of us are e m p l o y e d b y local authorities, a n d strange as it m a y seem to those w h o g a t h e r their opinions f r o m the pages of the controversial Press, either medical or lay, we are h a p p y in the o p p o r t u n i t y for congenial work w h i c h we have w i t h those local authorities, a n d we are contented, b y a n d large, w i t h o u r lot. (Laughter.) I n fact, we would n o t desire to have to fight for a living in c o m p e t i t i o n w i t h o u r fellows, n o r even, M r . Minister, to be nationalised. But, ladies a n d gentlemen, because I a m within a very few years n o w of the time w h e n I m u s t relinquish the reins of office I a m in a perfectly free position to express t h e t r u t h as I see it in regard to local authorities. A n d w i t h o u t any fear of b e i n g m i s u n d e r s t o o d , because I seek n o f u r t h e r a d v a n c e m e n t - - n o t even financial ( l a u g h t e r ) - - I do say t h a t I feel as one w h o has w o r k e d in local g o v e r n m e n t for 36 years t h a t we o u g h t to pay a t r i b u t e to t h e local authorities. (Hear, hear.) A n d I can tell t h e m t h a t in t h e medical officers of health they have very firm supporters, as indeed they are "true friends and s u p p o r t e r s of us, a n d we do t h a n k t h e m for all they have done a n d for all the help they have given us in o u r work. Indeed, I know very m a n y instances w h e r e the m u t u a l respect w h i c h exists between a committee a n d its officers has ripened into real affection. W e welcome, therefore, as representatives of the local authorities, the C h a i r m e n of the G e n e r a l Purposes a n d Public H e a l t h C o m m i t t e e s of the Association of M u n i c i p a l Corporations and t h e i r Secretary, the C h a i r m e n of the M e t r o p o l i t a n B o r o u g h s J o i n t Committee, a n d of the U r b a n District Councils Association, and the P r e s i d e n t of the Association of E d u c a t i o n Committees. T h e n there is a n o t h e r Association w h i c h is r e p r e s e n t e d h e r e - - s o m e p e r h a p s would call it an a u t h o r i t y - b u t w h e n e v e r G o v e r n m e n t d e p a r t m e n t s desire to consult the associations of local authorities they also consult this o t h e r body, w h i c h is k n o w n as the L.C.C. N o w I seldom hear praise of this b o d y (laughter) t h o u g h I m u s t say I was v e r y gratified a few m o n t h s ago to read some praise of it in n o less a position t h a n t h e editorial pages of the British Medical Journal - - b u t t h a t was quite exceptional. It is surprising t h a t so m a n y people are interested in the work of this body, t h a t one constantly reads in the newspapers advice as to h o w m u c h b e t t e r the writer of a letter or the m a k e r of a speech could carry out some projected project or some projected plan t h a n this L.C.C. - - i n fact, Mr. Minister, it seems to m e t h a t like your own M i n i s t r y it has few or no friends ; b u t like your own d e p a r t m e n t , Sir, it is very curious t h a t those w h o have an intimate knowledge of the work of those two bodies, t h a t those w h o work for them, are very loyal supporters of t h e m , a n d c a n n o t u n d e r s t a n d these constant carpings a n d criticisms. I have the h o n o u r to have served the L.C.C., a n d from a very intimate knowledge I can say t h a t I t h i n k these criticisms are very far off the mark. B u t I a m personally extremely gratified a n d appreciative to those m e m b e r s of the L o n d o n C o u n t y Council w h o are here to-day for t h e i r great kindness in coming to do us honour. T h e n we have the representatives of the learned clerks. W e have Sir P a r k e r Morris, the H o n o r a r y Clerk to the M e t r o p o l i t a n B o r o u g h s S t a n d i n g C o m m i t t e e , a n d M r . H o w a r d Roberts, the Clerk of t h e L o n d o n C o u n t y Council. T h e y are the people to w h o m we go w h e n we are trying to get r o u n d the law (laughter) a n d w h e n we have discovered deficiencies or gaps in the laws w h i c h have b e e n left b y those august assemblies w h i c h are so well r e p r e s e n t e d here. W e are very h o n o u r e d at h a v i n g so m a n y ladies w h o have come to grace o u r board. I a m very sorry for the wives of medical officers of h e a l t h - - t h e y sit d e m u r e l y while we are engrossed in o u r reports a n d o u r files ; they listen s y m p a t h e t i c ally w h e n we u n l o a d u p o n t h e m o u r frustrations, a n d they help a n d encourage us in o u r periods of depression. W e give t h e m here a very w a r m welcome. A n d n o w we come to the G o v e r n m e n t d e p a r t m e n t s ; here I would like to m e n t i o n first the U n d e r - S e c r e t a r y of the M i n i s t r y of Education, w h o deals w i t h the special services a n d w i t h w h o m we have always h a d the m o s t h a p p y relations. A n d t h e n we have t h e M i n i s t e r a n d his principal officers--I h a v e already m e n t i o n e d Sir W i l s o n Jameson. W e also have Sir
PUBLIC HEALTH, July, 1947 William Douglas and Sir A r t h u r R u c k e r - - w e know t h e m as very able m e n of wide experience, and we know that they have given m u c h deep thought and hard work to first planning and now the organisation of this new health service in which we are all so interested. W e should like to thank them for their approachability, and for listening always so patiently when we take our difficulties to them, and for the way in which they try to help us to overcome them. And now, finally, ladies and gentlemen, we come to the Minister himself, our principal guest. (Applause.) H e is a colourful personality (laughter) and a master of the cut and thrust of debate. He has an unerring faculty for discovering the weak points in an argument and discomforting his critics. H e combines in a very unusual way the courage of the lion and the gentleness of the lamb. (Laughter.) W e are very gratified that he has come to-day. We know that in the negotiations which are now taking place with the accredited representatives of the medical profession he does not perhaps see altogether eye to eye with t h e m on every point ; on some of those matters we, as whole-time public health officers, perhaps are inclined to stand a little aloof, and we enjoy a ringside view of the contest; but there are other matters in which we are vitally concerned. T h e r e is one fact which gives us great confidence and we have confidence because we know, that sinking all questions of personal likes and dislikes and prejudices, the Minister brings to a solution of the various problems the same m i n d as we ourselves would take to these problems, namely by asking himself always what is in the best interests of the sick and suffering of this country and what will conduce most to the promotion of the health and happiness of the people of this country. And, therefore, for these reasons we honour and respect him, and we have confidence in him. I give you the toast of Our Guests, coupled with the name of the Right Honourable Mr. Aneurin Bevan, the Minister of Health. T h e M i n i s t e r o n M . O . H . s in t h e N a t i o n a l H e a l t h S e r v i c e
T h e Minister of Health (the Rt. Hon. Aneurin Bevan, P.c., M.P.) said : I rise to speak as a front-room boy (laughter) again manipulated by the back-room boys ; and this, I think, is the second or third occasion on which I have addressed the luncheon assembly of the Medical Officers of Health. Sir Allen Daley has proposed the toast of T h e Guests in a speech which we expected of h i m - - a speech full of eloquence and full of sly innuendo (laughter) barbed by knowledge, and delivered with intention. (Laughter.) H e has said that I am sometimes confused with a colleague of mine, and that many people find it difficult to pronounce m y Christian n a m e - - b u t I can assure him that when they did find that difficulty they found no difficulty in finding a substitute. (Laughter.) A n d the Public Relations D e p a r t m e n t of the Ministry has informed me that the substitutes are not always flattering to me. T h e task which I have to perform is a peculiarly difficult one, because I have to respond on behalf of the guests and at the same time to propose the toast of the Society. T h e second task is e a s y - - t h e first task is difficult ; perhaps not so difficult for me to do it as difficult for the guests to say themselves what I am going to say. I can see Dr. Charles Hill looking not so m u c h up against it as frustrated. (Laughter.) However, the President of the Royal College o f Surgeons has left to keep another appointment, and therefore I shall not make any reference whatsoever to Sir Alfred W e b b Johnson, of w h o m I have the greatest respect and fear. L o r d M o r a n is here ; and we have r e c e i v e d - - I have received, and the G o v e r n m e n t have received from the three Royal Colleges advice, sagacious advice, and guidance in a very difficult situation ; and I am happy to report that the discussions which are taking place with the representatives of the medical profession are being conducted in a diminuendo of acrimony. (Laughter.) A n d we are all hoping that before very long we shall be able to produce the details of the National Health Scheme in a form which will c o m m e n d itself to every branch of the medical profession. (Hear, hear.) Because I am sure that no matter how m u c h we press our own sectional c l a i m s - - a n d we all of us have obligations in that r e g a r d - - t h o s e who are representatives of different branches of the profession have their duties to perform
207 to those they represent ; nevertheless, we are all of us, when we are pressing those claims, conscious of the over-riding interests and claims of the c o m m u n i t y as a whole. A n d I have no doubt that before very m a n y months are over we shall be able to present to the country a scheme which will command universal approval and universal enthusiastic support. Of course, I cannot expect that the Medical Officers of Health would receive the original scheme with an outburst of spontaneous enthusiasm. After all, it was a very painful operation which was being performed. T h e Medical Officers of Health spent their early years in dealing with epidemics and with the environmental conditions leading to disease, and later on they branched out, with very m u c h more success than is generally admitted, into the clinical fields. Although very many c l a i m s - and justifiable claims--are made for the voluntary hospital system it must never be forgotten that the Medical Officers of Health inherited the poor law system and they had to try and adapt the ugly infirmaries of the past to modern hospital requirements. A n d whenever people are inclined to make odious comparisons between the standard of some of the voluntary hospitals and of the municipal hospitals it must always be r e m e m b e r e d that the Medical Officers of Health had the past to live down, and had very adverse circumstances to overcome. A n d in the hospital field they have indeed won very great distinction. It was, therefore, a painful operation when it was decided that the hospitals were to be taken away from the municipal authorities and organised into a national scheme. F o r a time when I went around the country and I m e t Medical Officers of Health I was not always greeted with the amiability that a Welshman naturally looks for (laughter) and I had no English stoicism to fall back upon. However, I did always keep in m i n d the fact that what was m y chief concern was to try and lay down the principles of a good health service which would command the admiration of the earth and the support of the people of Great Britain. A n d I think we have accomplished it. I do not think, Sir Allen, that the Medical Officers of Health have any reason to believe that their functions in the future are going to be less important than they were in the past. O n the contrary, the Medical Officers of Health are going to be very important links between the Regional Boards, between the Health Committees and the local Medical Committees and the Executive Councils responsible for the general public s e r v i c e - a very important link indeed. It has been pointed o u t - - I think it was pointed out at T o r q u a y - - t h a t on paper it looks as though the health service has some very serious crevasses--that one part of it is separated from another. Well, the Medical Officers of Health are going to be the bridges that will carry you over from one side of the precipice to the other, and both locally and functionally they will be able to bring about the unification in practice of a scheme which superficially looks divided. A n d I would m u c h rather have unity in practice and superficial schisms than superficial unity and muddle in practice. A n d therefore I am confident that the Medical Officers of Health are not at the end of an epoch, but at the beginning of an epoch ; they are not at the beginning of an epoch of declining usefulness, but on the contrary, I believe that their value is going to expand, and their importance is going to grow, and that they are going to achieve new distinction. I am also anxious to point out on occasions such as this that the therapeutical side of medicine always receives plenty of prominence, plenty of admiration. N e w discoveries are made in practice, fantastically successful operations are performed and prima donnas arise in the medical profession (laughter) and command the admiration of an admiring public, and very heavy fees. A n d I do not grudge them t h a t - - n o t at all ; but we ought to pay tribute to the very high level of British medicine on the preventive side. A n d the vital statistics that are now being issued year by year all have an increasingly pleasant story to tell, reflecting not only upon therapeutical medicine but upon the Medical Officers of Health in the public health service of Great Britain. (Hear, hear.) T h e rise in the birth-rate, the fall in the maternal mortality rate, the fall in the death-rate, the increasing health of the population--all these are due not only to the benefactions of an e n l i g h t e n e d G o v e r n m e n t
208 (laughter) b u t are also d u e to t h e exertions t h a t have been m a d e by a c e n t u r y of Medical Officers of Health. A n d therefore I pay m y t r i b u t e to t h e m , a n d I a m sure t h a t w h e n I do so I a m speaking o n b e h a l f of all the guests w h o are here this afternoon. (Hear, hear.) Very often the least p r o m i n e n t is t h e m o s t i m p o r t a n t ; a n d t h a t applies to politics as well as to any o t h e r b r a n c h : a n d c o n s e q u e n t l y I w o u l d say on b e h a l f of o u r guests h o w very h a p p y we are to b e here, a n d h o w m u c h we appreciate y o u r hospitality, a n d h o w m u c h we look forward to an e x p a n d i n g field of interest a n d a m b i t i o u s e n d e a v o u r for t h e Medical Officers of H e a l t h of G r e a t Britain. I give you the toast of T h e Society of Medical Officers of Health. Reply by the President T h e President, in reply, said : T h i s m u s t b e a serious speech because it is a response to the toast of t h e Society of Medical Officers of Health, of w h i c h I am, at the m o m e n t , the President. W e are very grateful to you, M r . Minister, for y o u r e n c o u r a g i n g words. W e have n o w h a d 90 years of existence as a Society, a n d it is 100 years since t h e first Medical Officer of H e a l t h was a p p o i n t e d in this c o u n t r y ; a n d we are very grateful to you for i n d i c a t i n g to us t h a t those years have n o t b e e n wasted. O n e p o i n t I m i g h t p e r h a p s m e n t i o n now. W e have t h r e e Royal C o l l e g e s - - w e have a Royal Medical Psychological A s s o c i a t i o n - - w e have a Royal Sanitary Institute, a Royal I n s t i t u t e of Public H e a l t h a n d H y g i e n e - - w e have two Royal Colleges of Nurses, a n d we have a Royal College of M i d w i v e s ; a n d p e r h a p s it m i g h t n o t b e too m u c h to expect t h a t possibly we m i g h t have a Royal Society of Medical Officers of Health, particularly in view of the rosy future w h i c h is b e i n g o p e n e d to us. It is n o good blinking the fact t h a t some of o u r m e m b e r s were, a n d possibly still are, filled w i t h inspissated gloom with regard to the future, b u t I share, Sir, your o p t i m i s m in the future, or at all events I a m n o t so pessimistic as some of m y colleagues. But a very great deal does d e p e n d o n w h a t h a p p e n s in the n e x t twelve m o n t h s . W e are setting s t a n d a r d s for t h e future of public health w h i c h will remain u n c h a n g e d for some decades, a n d it is very i m p o r t a n t , therefore, in m y view t h a t n o steps should be taken, even in order to m e e t some t e m p o r a r y difficulty, as a t e m p o r a r y e x p e d i e n t - - e i t h e r o n o u r part, or you, Sir, on y o u r p a r t - - w h i c h would make the retracing of our steps difficult. But time is going on a n d I will n o t keep you m u c h longer, t h o u g h t h e r e are two or three things w h i c h p e r h a p s one m i g h t take this o p p o r t u n i t y of saying w i t h regard to the future of the public h e a l t h service. T h e first is t h a t it m u s t be a service w h i c h is attractive to m e n of h i g h quality. (Hear, hear.) T h e public h e a l t h services of this c o u n t r y have done w e l l - - a n d I t h i n k they have d o n e so well in the past because we have b e e n able to attract people of t h a t quality ; a n d it is no gogd j u s t paying lip service to t h e slogan t h a t p r e v e n t i o n is b e t t e r t h a n C u r e - - w e m u s t really in o u r b o n e s feel it, a n d we m u s t b r i n g into o u r practice a c o n c e n t r a t e d e n t h u s i a s m for t h a t idea. Secondly, h a v i n g got these y o u n g m e n of h i g h quality into the service we m u s t make quite sure t h a t they have the facilities for doing t h e i r work properly, a n d m a k e sure t h a t they have the material available. It is an old bee in m y b o n n e t t h a t w i t h regard to the p r e v e n t i o n of disease we only have exact k n o w ledge w i t h regard to the notifiable infectious diseases. W e m u s t have in this n e w scheme some m e t h o d b y w h i c h we have u p - t o - d a t e knowledge of all the diseases a n d all the m o r b i d i t y w h i c h occurs in the c o m m u n i t i e s w h i c h we serve. (Hear, hear.) W e m u s t have access to t h e facts, a n d t h e n we can relate t h e m to p r e v e n t a b l e causes, w h e t h e r they be social, industrial or w h a t e v e r t h e y m a y be. A n e w t e r m is b e i n g c o i n e d - - s o c i a l m e d i c i n e - - i n regard to public h e a l t h - - o r preventive medicine, w h i c h in its wider corollary m e a n s t h e relationship of disease to all forms of social a n d economic life. We, f r o m o u r health offices, can obtain i n f o r m a t i o n w i t h r e g a r d to these m a t t e r s w h i c h will be of service to those in t h e h o s p i t a l s ~ w e are to b e the after-care a u t h o r i t y a n d we m u s t have a very close link w i t h the hospitals. T h e a l m o n e r is the link b e t w e e n the clinician a n d the social service,
PUBLIC HEALTH, July, 1947 a n d we w a n t to m a k e quite sure t h a t in t h e n e w h e a l t h service she will have h e r part in the public h e a l t h service. A n d thirdly, the public h e a l t h service m u s t be s u p p o r t e d by a good hospital service, a n d b y a good general practitioner service. A n d so far as the hospital service is c o n c e r n e d in m y view the key to a good hospital service---or at least w h a t is n e e d e d in order t h a t it m a y b e c o m e a n d r e m a i n g o o d - - i s n o t doctors, because we can p r o d u c e t h e doctors ; it is nurses. A n d , M r . Minister, it is going to be o n e of your great troubles, in m y view, to obtain an adequate supply of efficient nurses. We, as you have m e n t i o n e d , have h a d some experience w i t h regard to hospital work. F e v e r hospitals have b e e n the responsibility of m e d i c a l officers of h e a l t h for 70 y e a r s - - t u b e r c u l o s i s dispensaries for 30 or 40, a n d general hospitals of all sorts for t h e last 17 or 18. W e have learnt m u c h a b o u t the a d m i n i s t r a tion of h o s p i t a l s - - p a r t i c u l a r l y of the a d m i n i s t r a t i o n of a hospital service ; a n d we will gladly place at y o u r disposal t h e result of our experience. T h e r e are, as you said, Sir, t h r e e pillars in this n e w h e a l t h service, a n d as yqu so rightly say, t h e y m u s t act as a team ; inter-locking b e t w e e n the various sections is going to be very c l o s e - - m a t e r n i t y work, child welfare, school medicine, t u b e r c u losis, epidemiology, a n d so o n - - a l l are linked t o g e t h e r a n d all c o n c e r n e d m u s t work closely t o g e t h e r as a team. W e k n o w t h a t we will get s u p p o r t f r o m o u r local authorities, a n d we k n o w t h a t we will get s u p p o r t f r o m the M i n i s t r y a n d its officers, a n d f r o m the hospitals. A n d therefore we may, I think, look forward w i t h confidence to b e i n g able to repeat o u r t r i u m p h s - - a n d I t h i n k t h a t o u r c o n t r i b u t i o n s in t h e field of epidemiology w h i c h o u r predecessors h a n d l e d were t r i u m p h s - - a n d I a m confident t h a t we will have e q u a l success, spectacular success let us hope, in these w i d e r conceptions w h i c h are n o w o p e n i n g before us. O u r objectives o n all sides are the s a m e - - t h e f o u n d a t i o n of a good h e a l t h service has b e e n laid in the past h u n d r e d years a n d we shall b u i l d u p o n t h a t s o u n d foundation. You, M r . Minister, are the architect of the s u p e r s t r u c t u r e . Y o u drew the r o u g h sketch plan, if I m a y call it so, for this n e w edifice a n d it was a p p r o v e d by P a r l i a m e n t : a n d it is n o w the d u t y of you a n d your officers a n d the local authorities a n d t h e i r officers to p r e p a r e detailed drawings, estimate the quantities a n d to build the s t r u c t u r e itself. I f the plan is r i g h t - - a n d we do believe it is right in its essentials, t h o u g h p e r h a p s t h e r e are details o n w h i c h we w o u l d like to see i m p r o v e m e n t ; you can rely o n us to see t h a t we o n o u r side p u t o u r very best into it. A n d one last w o r d - - l e t us express t h e h o p e t h a t o u r successors in a n o t h e r h u n d r e d years' time will be able to look back w i t h the same satisfaction t h a t we can look b a c k on the p a s t h u n d r e d years. A n d I see no reason w h y they s h o u l d n o t be able to d o so.
A n d let us conclude finally b y saying t h a t we m u s t see to it that we pass o n the t o r c h of public health, a n d see to it t h a t it illuminates w i t h increasing b r i g h t n e s s a n d g a t h e r i n g s t r e n g t h the whole field of medicine, a n d so ensure t h a t the health and, in consequence, the happiness of the people t h a t we s e r v e - the people of this c o u n t r y - - w i l l attain the m a x i m u m possible. I t h a n k you. ( L o n g applause.) The guests of the Society were: The Right Hon. Aneurin Bey;m, P.c., M.P., Minister of Health; Lord Moran, M.C., M.D., e.mc.e. ; Sir Alfred Webb-Johnson, Bt., K.C.V.O., D.S.O., P.R.C.S., Mr. William Gilliatt, M.D., F.Ji.C.S., Sir Hugh Lett, Bt., K.C.V.O., F.R.C.S., President, Dr. Charles Hill, Secretary, and Dr. A. V. Kelynack, Asst. Secretary of the British Medical.Association; Sir Maurice Cassidy, K.C.V.O., V.R.C.P., President, R.S.M. ; Dr. C. Thackray Parsons, Master, Society of Apothecaries; the Lady Nathan, j.e., Chairman, London County Council; Lord Latham, j.P., F.C.I.S., Leader of the London County Council; Alderman Sir Miles Mitchell, j.P., Prof. F. E. Tylecote and Mr. G. H. Banwell, Association of Municipal Corporations; Sir S. Gurney Dixon, M.D., Chairman, Association of Education Committees; Mr. Arnold Walker, F.R.C.S., F.R.C.O.O., Chairman, Central Midwives Board; Sir Wilson Jameson, K.C.B., F.R.C.p., Chief Medical Officer, Sir William S. Douglas, K.C.B., Secretary, and Sir Arthur Rucker, K.C.M.G., Deputy Secretary, Ministry of Health; Mr. N. D. Bosworth Smith, C.B., Under-Secretary, Ministry of Education; Dr. John Dale, O.B.E., Melbourne University; Dr. Harvey Flack, Deputy Editor, Britisl~ Medical Journal; Dr. E. ClaytonJones, The Lancet. Apologies for inability to attend were received
PUBLIC H E A L T t t , July, 1947
209
[toni the President and Secretary, C.C.A., the Presidents, U.D.C.A. and R.D.C.A., the Chairman o[ Council and Secretary, ll.b.l., and the President, B.D.A. T h e President's personal guests were Messrs. Reginald Stamp, L.C.C., W. R. Owen, l.e., L.C.C., Mrs. Mary Ormerod, B.A., L.C.C., Mr..]. R. Howard-Roberts, O.B.E., Clerk to the L.C.C., Dr. and Mrs. Raymond Dalcy aud Miss Doreen Dale},, M.R.C.O.G., F.R.C.S.E. Amongst members of the Society present were: Dr. F. Hall, c.~.E., President-elect; Dr. G. F. Buchan, Chairman of Council; Dr. R. H. It. Jolly, . Vice-President ; Dr. James Fenton, O.B.E., Hon. Treasurer ; Dr. Charles Porter, Past Presideut ; Dr. A. F. Adamson, President, Home Counties B r a n c h ; Dr. Eric Ward, President, Southern B r a n c h ; Dr. C. Hamilton Hogben, President, IVl.& C.W. G r o u p ; Mr. K. C. B. Webster, President, Dental Officers' G r o u p ; Dr. J. M. Gibson, Chairman, General Purposes Committee; Sir Frederick Menzies, K.B.E., t.'.mc.P. (formerly M.O.H., L.C.C.), and Sir George Elliston, m.c., j.P. (Honorary Fellow). A special apology for absence was received from Dr. George Macdonald, President, Metropolitan Branch.
CORRESPONDENCE SMAI,LPOX: ~'IE'ruon OF SPREAD AND PREVI~NTiON
T o the Editor of PUBLIC HEALTH Sir,--Dr. Stallybrass's letter in your issue of April is valuable both from its information based ()it experience and interesting for his view~ on aerial spread. As you have opened your pages for other views I should like to make a few remarks on this wide subject. The five modes of infection for consideration are given by l)r. Stallybrass, viz., (It contact, direct or indirect; (2) fomites; (3) tties; (4) actual scabs; (5) droplets and droplet nuclei. Dr. Stallybrass admits (1) and (2) are proven but one thing he will not admit is that it may be transmitted by " aerial convection." But what is direct or indirect contact ? Does aerial spread not play a part in every case of such ? When we know of infections with a common cold, influenza, measles and all of the allied virus diseases and in which the virus exists in the nasopharynx even before the disease has shown symptoms, there can, I think, be no doubt about aerial spread of smallpox. The question to what extent and how far the spread by the air can occur is a different question which no one has settled and obviously nmst depend to some extent upon meteorlogical condilions, and the three cases he has quoted are possibly explained by such conditions being favourable to spread far. I am, however, in agreement with him that infection by air over a long distance has not been proved and is unlikely when other means are generally operative. Dr. Stallybrass will admit that the smell of smallpox (variola major and haemorrhagic cases), is intense and characteristic. In India where 1 had to deal with thousands of cases (in hospital and houses), I have been able to diagnose smallpox from its smell in the winding passages on the ground floor before seeing the case in the upper ttoor. This proves aerial spread. It is the custom of certain secIs on abont the ninth day to have a " Puga " or feast to drive away the evil spirit of " Matha " (smallpox), bv the relations and children coming around the patient x~ith smallpox ([ have seen this often)! It cannot be denied that persons confing to such a rotma get the disease through the air, m~d in some cases the door of the room opens on to a side street ! Often in these cases ventilation of rooms is excluded. You cannot cxcludc droplet infection nor infection by scab.s. If you do your fomitcs nmst go, and I do not agree to this. So long as we havc an unvaccinated cmnnnmitv you cannot exchtde this as a nte;ms ot: spread since vaccinated" persons with mild symptoms or treated its chicken-pox may h a r b o u r the virus in their nasopharynx, and thus spread to the unvaccinated. Our sheet-anchor is vaccinatim~, (primary in infants and re;,cination at ten years of a g e - - a n d in an epidemic even of those m'er 30 years). I was vaccinated primarily in infancy and was well vaccinated (four marks) when seeing the cases in Belvedere Hospital, Glasgow. T h a t vaccination of many years ago has stood me well to date. At that epidemic our Professor got only one typical smallpox on his forehead and was kept in the hospital as a patient ! For the prevention of aerial dissemination from th 9 pox I have used ti-ncture of iodine painted on each spot both in smallpox and chickenpox, and it undoubtedly aborts the pox and will prevent " pitting marks in smallpox." A. G. NEWFLI,,
Medical Officer o[ Health. Blvti~. May 29th, 1947.
OBITUARY j o a n PERC~ laTv, ~.n., CH.B. reraN.), n.e.n. The death occurred suddenly on May 25th o[ Dr. J. P. Lilt, medical officer of health and school medical officer for the borough of I , y t h a m St. Annes since t924. Dr. Litt graduated from Edinburgh University with distinction in 1910, took the M.D. in 1913 and the D.P.H. in 1914. His first public health experience was in the 1914-18 war, in which he rose to the rank of Major, R.A.M.('. On return from the Far East hc was appointed to L y t h a m St. Annes, where he was an efficient and popular officer, and did much to advance the well-being of the population, especially amongst the children. He rejoined the R.A.M.C. during the recent war and became A.D.H., Southern Command, retiring with the rank of Colonel. His death at the age of 59 will be m u c h regretted by ~oileagncs in North-Western Branch, of which he had been a keen member since 1922. Great sympathy will be felt for his widow and five children, of w h o m the eldest son is studying medicine at Edinburgh. JO~IN WILSON MmLER, M.B., CH.B. (GLAS.), D.P.H. The news of the death on May 2nd at the age of 62 of Dr. J. W. Miller, who only recently resigned his appointment as medical officer of health ~[or the metropolitan boro'ugh of Lewisham owing to ill-health, has been learned with regret by his many friends, especially in the Metropolitan Branch of the Society. He qualified at Glasgow University in 1907 and took the D.P.H. in 1910. After holding posts in the Glasgow city fever hospital and as senior A.M.O.H. and T.0. in Lanarkshire, and a period in the R.A.M.C., he was appointed in 1918 as deputy medical officer of health, Lewi, ham, where he was in charge of the first London nnuficipal maternity home, and succeeded to the M.O.H.-ship in 1937. The strain of civil defence service in addition to the day-to-day work of his department was severe and eventually necessitated his retirement. He was a Fellow of the Society from 1911 and was about to be elected a life member on the recommendation of the Metropolitan Branch at the time of his death. Sincere sympathy is extended to his widow on her loss. GEORGE SMITH BANKS, M.B., CH.B. (EDiN.), D.P.II.
We record with regret the death on May 9th at the age of 67 of Dr. G. S. Banks, formerly regional tuberculosis officer for the city and county of Aberdeen and for Kincardineshire. He graduated at Edinburgh in 1905, took the D.P.H. in 1909 and became A.M.O.H. and R.M.O. of the city hospital, Aberdeen. The M.O.H. (Prof. Matthew Hay) organised a tuberculosis scheme tinder which Dr. Banks in 1911 started the first dispensary in Aberdeen and the first wards for tuberculosis cases; and the latter in 1902 was appointed T.O. for the city. In 1928 when the regional scheme of health services centred on Aberdeen came into operation, Banks was appointed to the post which he held until his retirement. He was a leading figure in the first generation of tuberculosis workers under the local authorities and played a prominent part in the work of bodies associated with that field. He had been a member of the Society ,since 1909 and was elected a Life Fellow on the recommendation of the Scottish Branch last year.
SOCIETY
OF
M E D I C A L O F F I C E R S OF REPORTS OF MEETINGS NORTH-WESTERN BRANCH
HEALTH
President: Dr. C. Metcalfe Brown (M.O.H., Manchestel C.B.). Hon. Secretary: Dr. J. E. Spence (M.O.H., Eccles M.B.). The Annual Meeting of the Branch was held at Baguley Sanatorium on Friday, May 23rd, 1947. The President occupied the chair and 28 members were present. T h e Hon. Treasurer's report and andited balance sheet for the year 1946-47 was presented together with Dr. Wood's apology for absence and was adopted. A letter from Dr. Wood tendering his rcsignation from the office of Treasurer which he has held sim'c 1937, owing to his impending retirement from the public heahh service, was read and was accepted with regret. The Hon. Secrctory was requested to convey to Dr. Wood the thanks of the Branch for his services as Treasurer and their hope that he may enjoy m a n y h a p p y years in retirement. The Annual Report of the Hon. Secretary was read and adopted. The President proposed that Dr. W. C. V. Brothwood, Deputy County Medical Officer fox Lancashire, be elected President for the ensuing year. This was seconded by Dr. Burnett and carried unanimously. Dr. Keddie then proposed, and Dr. Brown seconded, that Dr. R. M. Galloway be elected Hon. Treasurer and this proposition was carried unanimously. Dr. Galloway briefly thanked the tnembers. The following/officers were also e l e c t e d : - Hon. Secretary: Dr. J. E. Spence.
206 •T H E
ANNUAL
LUNCHEON
S p e e c h e s by the President and the Minister of H e a l t h
T h e A n n u a l L u n c h e o n of the Society was held at the PiccadiUy Hotel, W.1, on Friday, J u n e 20th, 1947, t h e change from t h e usual S e p t e m b e r date b e i n g due to the P r e s i d e n t ' s forthc o m i n g visit to t h e U n i t e d States for the congress of the A m e r i c a n Public H e a l t h Association. Before l u n c h e o n the P r e s i d e n t (Sir Allen Daley, M.D., F.n.c.e., D.P.n.) a n d L a d y Daley received a b o u t 120 m e m b e r s a n d guests. A f t e r t h e d r i n k i n g of the loyal toast, the President, welcoming the guests, said : T h i s is the a n n u a l festival of t h e b a c k - r o o m boys of the public health service ; and in a b a c k - r o o m boy o n e envisages a p e r s o n w h o is seldom seen a n d seldom heard, b u t w h o does all the real work. (Hear, hear.) But these backroom boys, however, on this a n n u a l occasion p r e s e n t themselves to t h e i r lords a n d m a s t e r s - - t h e M i n i s t e r of H e a l t h a n d his principal officers, to t h e i r employers, the local authorities, and to the leaders of o u r profession, o n w h o m also we are anxious to make a very good impression. (Laughter.) T h e r e f o r e , it is essential t h a t we should give the impression t h a t we are industrious, a n d c o n s e q u e n t l y as the clock approaches t h r e e o'clock we will say, " Sorry, we m u s t go n o w ; we usually get only t w e n t y m i n u t e s for l u n c h " (laughter) a n d t h a t we m u s t keep an a p p o i n t m e n t , or a t t e n d a c o m m i t t e e or do some of the m a n y o t h e r t h i n g s w h i c h c o n s u m e o u r time. I a m telling you these confidential m a t t e r s in o r d e r to explain h o w it is t h a t the Council of the Society limits the speeches m a d e on its b e h a l f on these occasions to one only, n a m e l y t h a t of the President. B u t we m u s t r e m e m b e r t h a t we are all busy people these days, a n d n o t less b u s y since M r . A n e u r i n Bevan took u p his p r e s e n t office, a n d to such good effect t h a t his n a m e is a h o u s e h o l d w o r d - - t h o u g h n o t all can p r o n o u n c e it (laughter) - - t h r o u g h o u t the l e n g t h a n d b r e a d t h of this land. Also, in o r d e r t h a t we can portray ourselves as harassed a n d o v e r - w o r k e d officials we deprive ourselves of the privilege a n d t h e pleasure of hearing speeches f r o m o u r guests o t h e r t h a n the M i n i s t e r h i m s e l f ; and it would be a poor reward for o u r d i s t i n g u i s h e d guests w h o have b e e n so good n a t u r e d as to come a n d j o i n us at l u n c h to-day, if we were to keep t h e m b e y o n d t h e time w h e n they have to go elsewhere for o t h e r a n d u r g e n t pressing engagements. O u r guests m a y be divided into four categories. F i r s t of all t h e r e are o u r medical guests a n d o u r local authorities guests, t h e n t h e ladies, a n d t h e n the M i n i s t e r a n d officers of G o v e r n ment departments. W i t h regard to o u r medical guests we welcome here the Presidents of the t h r e e Royal Colleges (applause) w h o have always b e e n very good friends to the public h e a l t h services. T h e n we have the M a s t e r of the Society of Apothecaries, t h a t ancient medical f o u n d a t i o n to w h i c h I personally a m i n d e b t e d for a r e c e n t kindness. T h e n we h a v e Sir H u g h Lett, the P r e s i d e n t of the British M e d i c a l Association, a n d we are very h a p p y to see his n a m e i n c l u d e d in the recent B i r t h d a y H o n o u r s as receiving the h i g h h o n o u r of K n i g h t C o m m a n d e r of the Victorian Order. (Applause.) N e x t we have t h e P r e s i d e n t of the Royal Society of Medicine, w h e r e t h e r e is a strong section of epidemiology ; a n d we welcome Prof. L u c a s K e e n e , P r e s i d e n t of the Medical W o m e n ' s F e d e r a t i o n w h i c h is growing in s t r e n g t h a n d in n u m b e r s , a n d w h i c h contains a large n u m b e r of those w h o work in the public h e a l t h service. W e welcome Dr. Charles Hill, the Secretary of the British Medical Association, whose bluff geniality a n d h o m e l y m a x i m s broadcast to the n a t i o n have m a d e such an i m p o r t a n t c o n t r i b u t i o n to public h e a l t h - - i n fact, h e m i g h t be one of ourselves. ( L a u g h t e r . ) T h e n we welcome t h e editors of the medical journals, a n d we t h a n k t h e m for giving us in t h e i r pages an o p p o r t u n i t y of reading of recent advances in medical k n o w l e d g e ; a n d we t h a n k t h e m , too, for p u b l i s h i n g the results of o u r labours. N o w we come to the C h a i r m a n of the Central M i d w i v e s ' Board, M r . A r n o l d Walker, at w h o s e feet I sit a n d learn s o m e t h i n g a b o u t obstetrics, in r e t u r n for w h i c h I give h i m a little guidance in the art of administration. A n d t h e n t h e r e is Sir W i l s o n J a m e s o n , w h o is one of ourselves t h o u g h a guest to-day, a n d we regard ourselves as extremely f o r t u n a t e t h a t at this j u n c t u r e h e occupies t h e h i g h office of C h i e f Medical Officer of the
M i n i s t r i e s of H e a l t h a n d Education. H e is t r u s t e d a n d respected b y all parties. A n d t h e n we come to m y second g r o u p - - t h e local authorities. M o s t of us are e m p l o y e d b y local authorities, a n d strange as it m a y seem to those w h o g a t h e r their opinions f r o m the pages of the controversial Press, either medical or lay, we are h a p p y in the o p p o r t u n i t y for congenial work w h i c h we have w i t h those local authorities, a n d we are contented, b y a n d large, w i t h o u r lot. (Laughter.) I n fact, we would n o t desire to have to fight for a living in c o m p e t i t i o n w i t h o u r fellows, n o r even, M r . Minister, to be nationalised. But, ladies a n d gentlemen, because I a m within a very few years n o w of the time w h e n I m u s t relinquish the reins of office I a m in a perfectly free position to express t h e t r u t h as I see it in regard to local authorities. A n d w i t h o u t any fear of b e i n g m i s u n d e r s t o o d , because I seek n o f u r t h e r a d v a n c e m e n t - - n o t even financial ( l a u g h t e r ) - - I do say t h a t I feel as one w h o has w o r k e d in local g o v e r n m e n t for 36 years t h a t we o u g h t to pay a t r i b u t e to t h e local authorities. (Hear, hear.) A n d I can tell t h e m t h a t in t h e medical officers of health they have very firm supporters, as indeed they are "true friends and s u p p o r t e r s of us, a n d we do t h a n k t h e m for all they have done a n d for all the help they have given us in o u r work. Indeed, I know very m a n y instances w h e r e the m u t u a l respect w h i c h exists between a committee a n d its officers has ripened into real affection. W e welcome, therefore, as representatives of the local authorities, the C h a i r m e n of the G e n e r a l Purposes a n d Public H e a l t h C o m m i t t e e s of the Association of M u n i c i p a l Corporations and t h e i r Secretary, the C h a i r m e n of the M e t r o p o l i t a n B o r o u g h s J o i n t Committee, a n d of the U r b a n District Councils Association, and the P r e s i d e n t of the Association of E d u c a t i o n Committees. T h e n there is a n o t h e r Association w h i c h is r e p r e s e n t e d h e r e - - s o m e p e r h a p s would call it an a u t h o r i t y - b u t w h e n e v e r G o v e r n m e n t d e p a r t m e n t s desire to consult the associations of local authorities they also consult this o t h e r body, w h i c h is k n o w n as the L.C.C. N o w I seldom hear praise of this b o d y (laughter) t h o u g h I m u s t say I was v e r y gratified a few m o n t h s ago to read some praise of it in n o less a position t h a n t h e editorial pages of the British Medical Journal - - b u t t h a t was quite exceptional. It is surprising t h a t so m a n y people are interested in the work of this body, t h a t one constantly reads in the newspapers advice as to h o w m u c h b e t t e r the writer of a letter or the m a k e r of a speech could carry out some projected project or some projected plan t h a n this L.C.C. - - i n fact, Mr. Minister, it seems to m e t h a t like your own M i n i s t r y it has few or no friends ; b u t like your own d e p a r t m e n t , Sir, it is very curious t h a t those w h o have an intimate knowledge of the work of those two bodies, t h a t those w h o work for them, are very loyal supporters of t h e m , a n d c a n n o t u n d e r s t a n d these constant carpings a n d criticisms. I have the h o n o u r to have served the L.C.C., a n d from a very intimate knowledge I can say t h a t I t h i n k these criticisms are very far off the mark. B u t I a m personally extremely gratified a n d appreciative to those m e m b e r s of the L o n d o n C o u n t y Council w h o are here to-day for t h e i r great kindness in coming to do us honour. T h e n we have the representatives of the learned clerks. W e have Sir P a r k e r Morris, the H o n o r a r y Clerk to the M e t r o p o l i t a n B o r o u g h s S t a n d i n g C o m m i t t e e , a n d M r . H o w a r d Roberts, the Clerk of t h e L o n d o n C o u n t y Council. T h e y are the people to w h o m we go w h e n we are trying to get r o u n d the law (laughter) a n d w h e n we have discovered deficiencies or gaps in the laws w h i c h have b e e n left b y those august assemblies w h i c h are so well r e p r e s e n t e d here. W e are very h o n o u r e d at h a v i n g so m a n y ladies w h o have come to grace o u r board. I a m very sorry for the wives of medical officers of h e a l t h - - t h e y sit d e m u r e l y while we are engrossed in o u r reports a n d o u r files ; they listen s y m p a t h e t i c ally w h e n we u n l o a d u p o n t h e m o u r frustrations, a n d they help a n d encourage us in o u r periods of depression. W e give t h e m here a very w a r m welcome. A n d n o w we come to the G o v e r n m e n t d e p a r t m e n t s ; here I would like to m e n t i o n first the U n d e r - S e c r e t a r y of the M i n i s t r y of Education, w h o deals w i t h the special services a n d w i t h w h o m we have always h a d the m o s t h a p p y relations. A n d t h e n we have t h e M i n i s t e r a n d his principal officers--I h a v e already m e n t i o n e d Sir W i l s o n Jameson. W e also have Sir
PUBLIC HEALTH, July, 1947 William Douglas and Sir A r t h u r R u c k e r - - w e know t h e m as very able m e n of wide experience, and we know that they have given m u c h deep thought and hard work to first planning and now the organisation of this new health service in which we are all so interested. W e should like to thank them for their approachability, and for listening always so patiently when we take our difficulties to them, and for the way in which they try to help us to overcome them. And now, finally, ladies and gentlemen, we come to the Minister himself, our principal guest. (Applause.) H e is a colourful personality (laughter) and a master of the cut and thrust of debate. He has an unerring faculty for discovering the weak points in an argument and discomforting his critics. H e combines in a very unusual way the courage of the lion and the gentleness of the lamb. (Laughter.) W e are very gratified that he has come to-day. We know that in the negotiations which are now taking place with the accredited representatives of the medical profession he does not perhaps see altogether eye to eye with t h e m on every point ; on some of those matters we, as whole-time public health officers, perhaps are inclined to stand a little aloof, and we enjoy a ringside view of the contest; but there are other matters in which we are vitally concerned. T h e r e is one fact which gives us great confidence and we have confidence because we know, that sinking all questions of personal likes and dislikes and prejudices, the Minister brings to a solution of the various problems the same m i n d as we ourselves would take to these problems, namely by asking himself always what is in the best interests of the sick and suffering of this country and what will conduce most to the promotion of the health and happiness of the people of this country. And, therefore, for these reasons we honour and respect him, and we have confidence in him. I give you the toast of Our Guests, coupled with the name of the Right Honourable Mr. Aneurin Bevan, the Minister of Health. T h e M i n i s t e r o n M . O . H . s in t h e N a t i o n a l H e a l t h S e r v i c e
T h e Minister of Health (the Rt. Hon. Aneurin Bevan, P.c., M.P.) said : I rise to speak as a front-room boy (laughter) again manipulated by the back-room boys ; and this, I think, is the second or third occasion on which I have addressed the luncheon assembly of the Medical Officers of Health. Sir Allen Daley has proposed the toast of T h e Guests in a speech which we expected of h i m - - a speech full of eloquence and full of sly innuendo (laughter) barbed by knowledge, and delivered with intention. (Laughter.) H e has said that I am sometimes confused with a colleague of mine, and that many people find it difficult to pronounce m y Christian n a m e - - b u t I can assure him that when they did find that difficulty they found no difficulty in finding a substitute. (Laughter.) A n d the Public Relations D e p a r t m e n t of the Ministry has informed me that the substitutes are not always flattering to me. T h e task which I have to perform is a peculiarly difficult one, because I have to respond on behalf of the guests and at the same time to propose the toast of the Society. T h e second task is e a s y - - t h e first task is difficult ; perhaps not so difficult for me to do it as difficult for the guests to say themselves what I am going to say. I can see Dr. Charles Hill looking not so m u c h up against it as frustrated. (Laughter.) However, the President of the Royal College o f Surgeons has left to keep another appointment, and therefore I shall not make any reference whatsoever to Sir Alfred W e b b Johnson, of w h o m I have the greatest respect and fear. L o r d M o r a n is here ; and we have r e c e i v e d - - I have received, and the G o v e r n m e n t have received from the three Royal Colleges advice, sagacious advice, and guidance in a very difficult situation ; and I am happy to report that the discussions which are taking place with the representatives of the medical profession are being conducted in a diminuendo of acrimony. (Laughter.) A n d we are all hoping that before very long we shall be able to produce the details of the National Health Scheme in a form which will c o m m e n d itself to every branch of the medical profession. (Hear, hear.) Because I am sure that no matter how m u c h we press our own sectional c l a i m s - - a n d we all of us have obligations in that r e g a r d - - t h o s e who are representatives of different branches of the profession have their duties to perform
207 to those they represent ; nevertheless, we are all of us, when we are pressing those claims, conscious of the over-riding interests and claims of the c o m m u n i t y as a whole. A n d I have no doubt that before very m a n y months are over we shall be able to present to the country a scheme which will command universal approval and universal enthusiastic support. Of course, I cannot expect that the Medical Officers of Health would receive the original scheme with an outburst of spontaneous enthusiasm. After all, it was a very painful operation which was being performed. T h e Medical Officers of Health spent their early years in dealing with epidemics and with the environmental conditions leading to disease, and later on they branched out, with very m u c h more success than is generally admitted, into the clinical fields. Although very many c l a i m s - and justifiable claims--are made for the voluntary hospital system it must never be forgotten that the Medical Officers of Health inherited the poor law system and they had to try and adapt the ugly infirmaries of the past to modern hospital requirements. A n d whenever people are inclined to make odious comparisons between the standard of some of the voluntary hospitals and of the municipal hospitals it must always be r e m e m b e r e d that the Medical Officers of Health had the past to live down, and had very adverse circumstances to overcome. A n d in the hospital field they have indeed won very great distinction. It was, therefore, a painful operation when it was decided that the hospitals were to be taken away from the municipal authorities and organised into a national scheme. F o r a time when I went around the country and I m e t Medical Officers of Health I was not always greeted with the amiability that a Welshman naturally looks for (laughter) and I had no English stoicism to fall back upon. However, I did always keep in m i n d the fact that what was m y chief concern was to try and lay down the principles of a good health service which would command the admiration of the earth and the support of the people of Great Britain. A n d I think we have accomplished it. I do not think, Sir Allen, that the Medical Officers of Health have any reason to believe that their functions in the future are going to be less important than they were in the past. O n the contrary, the Medical Officers of Health are going to be very important links between the Regional Boards, between the Health Committees and the local Medical Committees and the Executive Councils responsible for the general public s e r v i c e - a very important link indeed. It has been pointed o u t - - I think it was pointed out at T o r q u a y - - t h a t on paper it looks as though the health service has some very serious crevasses--that one part of it is separated from another. Well, the Medical Officers of Health are going to be the bridges that will carry you over from one side of the precipice to the other, and both locally and functionally they will be able to bring about the unification in practice of a scheme which superficially looks divided. A n d I would m u c h rather have unity in practice and superficial schisms than superficial unity and muddle in practice. A n d therefore I am confident that the Medical Officers of Health are not at the end of an epoch, but at the beginning of an epoch ; they are not at the beginning of an epoch of declining usefulness, but on the contrary, I believe that their value is going to expand, and their importance is going to grow, and that they are going to achieve new distinction. I am also anxious to point out on occasions such as this that the therapeutical side of medicine always receives plenty of prominence, plenty of admiration. N e w discoveries are made in practice, fantastically successful operations are performed and prima donnas arise in the medical profession (laughter) and command the admiration of an admiring public, and very heavy fees. A n d I do not grudge them t h a t - - n o t at all ; but we ought to pay tribute to the very high level of British medicine on the preventive side. A n d the vital statistics that are now being issued year by year all have an increasingly pleasant story to tell, reflecting not only upon therapeutical medicine but upon the Medical Officers of Health in the public health service of Great Britain. (Hear, hear.) T h e rise in the birth-rate, the fall in the maternal mortality rate, the fall in the death-rate, the increasing health of the population--all these are due not only to the benefactions of an e n l i g h t e n e d G o v e r n m e n t
208 (laughter) b u t are also d u e to t h e exertions t h a t have been m a d e by a c e n t u r y of Medical Officers of Health. A n d therefore I pay m y t r i b u t e to t h e m , a n d I a m sure t h a t w h e n I do so I a m speaking o n b e h a l f of all the guests w h o are here this afternoon. (Hear, hear.) Very often the least p r o m i n e n t is t h e m o s t i m p o r t a n t ; a n d t h a t applies to politics as well as to any o t h e r b r a n c h : a n d c o n s e q u e n t l y I w o u l d say on b e h a l f of o u r guests h o w very h a p p y we are to b e here, a n d h o w m u c h we appreciate y o u r hospitality, a n d h o w m u c h we look forward to an e x p a n d i n g field of interest a n d a m b i t i o u s e n d e a v o u r for t h e Medical Officers of H e a l t h of G r e a t Britain. I give you the toast of T h e Society of Medical Officers of Health. Reply by the President T h e President, in reply, said : T h i s m u s t b e a serious speech because it is a response to the toast of t h e Society of Medical Officers of Health, of w h i c h I am, at the m o m e n t , the President. W e are very grateful to you, M r . Minister, for y o u r e n c o u r a g i n g words. W e have n o w h a d 90 years of existence as a Society, a n d it is 100 years since t h e first Medical Officer of H e a l t h was a p p o i n t e d in this c o u n t r y ; a n d we are very grateful to you for i n d i c a t i n g to us t h a t those years have n o t b e e n wasted. O n e p o i n t I m i g h t p e r h a p s m e n t i o n now. W e have t h r e e Royal C o l l e g e s - - w e have a Royal Medical Psychological A s s o c i a t i o n - - w e have a Royal Sanitary Institute, a Royal I n s t i t u t e of Public H e a l t h a n d H y g i e n e - - w e have two Royal Colleges of Nurses, a n d we have a Royal College of M i d w i v e s ; a n d p e r h a p s it m i g h t n o t b e too m u c h to expect t h a t possibly we m i g h t have a Royal Society of Medical Officers of Health, particularly in view of the rosy future w h i c h is b e i n g o p e n e d to us. It is n o good blinking the fact t h a t some of o u r m e m b e r s were, a n d possibly still are, filled w i t h inspissated gloom with regard to the future, b u t I share, Sir, your o p t i m i s m in the future, or at all events I a m n o t so pessimistic as some of m y colleagues. But a very great deal does d e p e n d o n w h a t h a p p e n s in the n e x t twelve m o n t h s . W e are setting s t a n d a r d s for t h e future of public health w h i c h will remain u n c h a n g e d for some decades, a n d it is very i m p o r t a n t , therefore, in m y view t h a t n o steps should be taken, even in order to m e e t some t e m p o r a r y difficulty, as a t e m p o r a r y e x p e d i e n t - - e i t h e r o n o u r part, or you, Sir, on y o u r p a r t - - w h i c h would make the retracing of our steps difficult. But time is going on a n d I will n o t keep you m u c h longer, t h o u g h t h e r e are two or three things w h i c h p e r h a p s one m i g h t take this o p p o r t u n i t y of saying w i t h regard to the future of the public h e a l t h service. T h e first is t h a t it m u s t be a service w h i c h is attractive to m e n of h i g h quality. (Hear, hear.) T h e public h e a l t h services of this c o u n t r y have done w e l l - - a n d I t h i n k they have d o n e so well in the past because we have b e e n able to attract people of t h a t quality ; a n d it is no gogd j u s t paying lip service to t h e slogan t h a t p r e v e n t i o n is b e t t e r t h a n C u r e - - w e m u s t really in o u r b o n e s feel it, a n d we m u s t b r i n g into o u r practice a c o n c e n t r a t e d e n t h u s i a s m for t h a t idea. Secondly, h a v i n g got these y o u n g m e n of h i g h quality into the service we m u s t make quite sure t h a t they have the facilities for doing t h e i r work properly, a n d m a k e sure t h a t they have the material available. It is an old bee in m y b o n n e t t h a t w i t h regard to the p r e v e n t i o n of disease we only have exact k n o w ledge w i t h regard to the notifiable infectious diseases. W e m u s t have in this n e w scheme some m e t h o d b y w h i c h we have u p - t o - d a t e knowledge of all the diseases a n d all the m o r b i d i t y w h i c h occurs in the c o m m u n i t i e s w h i c h we serve. (Hear, hear.) W e m u s t have access to t h e facts, a n d t h e n we can relate t h e m to p r e v e n t a b l e causes, w h e t h e r they be social, industrial or w h a t e v e r t h e y m a y be. A n e w t e r m is b e i n g c o i n e d - - s o c i a l m e d i c i n e - - i n regard to public h e a l t h - - o r preventive medicine, w h i c h in its wider corollary m e a n s t h e relationship of disease to all forms of social a n d economic life. We, f r o m o u r health offices, can obtain i n f o r m a t i o n w i t h r e g a r d to these m a t t e r s w h i c h will be of service to those in t h e h o s p i t a l s ~ w e are to b e the after-care a u t h o r i t y a n d we m u s t have a very close link w i t h the hospitals. T h e a l m o n e r is the link b e t w e e n the clinician a n d the social service,
PUBLIC HEALTH, July, 1947 a n d we w a n t to m a k e quite sure t h a t in t h e n e w h e a l t h service she will have h e r part in the public h e a l t h service. A n d thirdly, the public h e a l t h service m u s t be s u p p o r t e d by a good hospital service, a n d b y a good general practitioner service. A n d so far as the hospital service is c o n c e r n e d in m y view the key to a good hospital service---or at least w h a t is n e e d e d in order t h a t it m a y b e c o m e a n d r e m a i n g o o d - - i s n o t doctors, because we can p r o d u c e t h e doctors ; it is nurses. A n d , M r . Minister, it is going to be o n e of your great troubles, in m y view, to obtain an adequate supply of efficient nurses. We, as you have m e n t i o n e d , have h a d some experience w i t h regard to hospital work. F e v e r hospitals have b e e n the responsibility of m e d i c a l officers of h e a l t h for 70 y e a r s - - t u b e r c u l o s i s dispensaries for 30 or 40, a n d general hospitals of all sorts for t h e last 17 or 18. W e have learnt m u c h a b o u t the a d m i n i s t r a tion of h o s p i t a l s - - p a r t i c u l a r l y of the a d m i n i s t r a t i o n of a hospital service ; a n d we will gladly place at y o u r disposal t h e result of our experience. T h e r e are, as you said, Sir, t h r e e pillars in this n e w h e a l t h service, a n d as yqu so rightly say, t h e y m u s t act as a team ; inter-locking b e t w e e n the various sections is going to be very c l o s e - - m a t e r n i t y work, child welfare, school medicine, t u b e r c u losis, epidemiology, a n d so o n - - a l l are linked t o g e t h e r a n d all c o n c e r n e d m u s t work closely t o g e t h e r as a team. W e k n o w t h a t we will get s u p p o r t f r o m o u r local authorities, a n d we k n o w t h a t we will get s u p p o r t f r o m the M i n i s t r y a n d its officers, a n d f r o m the hospitals. A n d therefore we may, I think, look forward w i t h confidence to b e i n g able to repeat o u r t r i u m p h s - - a n d I t h i n k t h a t o u r c o n t r i b u t i o n s in t h e field of epidemiology w h i c h o u r predecessors h a n d l e d were t r i u m p h s - - a n d I a m confident t h a t we will have e q u a l success, spectacular success let us hope, in these w i d e r conceptions w h i c h are n o w o p e n i n g before us. O u r objectives o n all sides are the s a m e - - t h e f o u n d a t i o n of a good h e a l t h service has b e e n laid in the past h u n d r e d years a n d we shall b u i l d u p o n t h a t s o u n d foundation. You, M r . Minister, are the architect of the s u p e r s t r u c t u r e . Y o u drew the r o u g h sketch plan, if I m a y call it so, for this n e w edifice a n d it was a p p r o v e d by P a r l i a m e n t : a n d it is n o w the d u t y of you a n d your officers a n d the local authorities a n d t h e i r officers to p r e p a r e detailed drawings, estimate the quantities a n d to build the s t r u c t u r e itself. I f the plan is r i g h t - - a n d we do believe it is right in its essentials, t h o u g h p e r h a p s t h e r e are details o n w h i c h we w o u l d like to see i m p r o v e m e n t ; you can rely o n us to see t h a t we o n o u r side p u t o u r very best into it. A n d one last w o r d - - l e t us express t h e h o p e t h a t o u r successors in a n o t h e r h u n d r e d years' time will be able to look back w i t h the same satisfaction t h a t we can look b a c k on the p a s t h u n d r e d years. A n d I see no reason w h y they s h o u l d n o t be able to d o so.
A n d let us conclude finally b y saying t h a t we m u s t see to it that we pass o n the t o r c h of public health, a n d see to it t h a t it illuminates w i t h increasing b r i g h t n e s s a n d g a t h e r i n g s t r e n g t h the whole field of medicine, a n d so ensure t h a t the health and, in consequence, the happiness of the people t h a t we s e r v e - the people of this c o u n t r y - - w i l l attain the m a x i m u m possible. I t h a n k you. ( L o n g applause.) The guests of the Society were: The Right Hon. Aneurin Bey;m, P.c., M.P., Minister of Health; Lord Moran, M.C., M.D., e.mc.e. ; Sir Alfred Webb-Johnson, Bt., K.C.V.O., D.S.O., P.R.C.S., Mr. William Gilliatt, M.D., F.Ji.C.S., Sir Hugh Lett, Bt., K.C.V.O., F.R.C.S., President, Dr. Charles Hill, Secretary, and Dr. A. V. Kelynack, Asst. Secretary of the British Medical.Association; Sir Maurice Cassidy, K.C.V.O., V.R.C.P., President, R.S.M. ; Dr. C. Thackray Parsons, Master, Society of Apothecaries; the Lady Nathan, j.e., Chairman, London County Council; Lord Latham, j.P., F.C.I.S., Leader of the London County Council; Alderman Sir Miles Mitchell, j.P., Prof. F. E. Tylecote and Mr. G. H. Banwell, Association of Municipal Corporations; Sir S. Gurney Dixon, M.D., Chairman, Association of Education Committees; Mr. Arnold Walker, F.R.C.S., F.R.C.O.O., Chairman, Central Midwives Board; Sir Wilson Jameson, K.C.B., F.R.C.p., Chief Medical Officer, Sir William S. Douglas, K.C.B., Secretary, and Sir Arthur Rucker, K.C.M.G., Deputy Secretary, Ministry of Health; Mr. N. D. Bosworth Smith, C.B., Under-Secretary, Ministry of Education; Dr. John Dale, O.B.E., Melbourne University; Dr. Harvey Flack, Deputy Editor, Britisl~ Medical Journal; Dr. E. ClaytonJones, The Lancet. Apologies for inability to attend were received
PUBLIC H E A L T t t , July, 1947
209
[toni the President and Secretary, C.C.A., the Presidents, U.D.C.A. and R.D.C.A., the Chairman o[ Council and Secretary, ll.b.l., and the President, B.D.A. T h e President's personal guests were Messrs. Reginald Stamp, L.C.C., W. R. Owen, l.e., L.C.C., Mrs. Mary Ormerod, B.A., L.C.C., Mr..]. R. Howard-Roberts, O.B.E., Clerk to the L.C.C., Dr. and Mrs. Raymond Dalcy aud Miss Doreen Dale},, M.R.C.O.G., F.R.C.S.E. Amongst members of the Society present were: Dr. F. Hall, c.~.E., President-elect; Dr. G. F. Buchan, Chairman of Council; Dr. R. H. It. Jolly, . Vice-President ; Dr. James Fenton, O.B.E., Hon. Treasurer ; Dr. Charles Porter, Past Presideut ; Dr. A. F. Adamson, President, Home Counties B r a n c h ; Dr. Eric Ward, President, Southern B r a n c h ; Dr. C. Hamilton Hogben, President, IVl.& C.W. G r o u p ; Mr. K. C. B. Webster, President, Dental Officers' G r o u p ; Dr. J. M. Gibson, Chairman, General Purposes Committee; Sir Frederick Menzies, K.B.E., t.'.mc.P. (formerly M.O.H., L.C.C.), and Sir George Elliston, m.c., j.P. (Honorary Fellow). A special apology for absence was received from Dr. George Macdonald, President, Metropolitan Branch.
CORRESPONDENCE SMAI,LPOX: ~'IE'ruon OF SPREAD AND PREVI~NTiON
T o the Editor of PUBLIC HEALTH Sir,--Dr. Stallybrass's letter in your issue of April is valuable both from its information based ()it experience and interesting for his view~ on aerial spread. As you have opened your pages for other views I should like to make a few remarks on this wide subject. The five modes of infection for consideration are given by l)r. Stallybrass, viz., (It contact, direct or indirect; (2) fomites; (3) tties; (4) actual scabs; (5) droplets and droplet nuclei. Dr. Stallybrass admits (1) and (2) are proven but one thing he will not admit is that it may be transmitted by " aerial convection." But what is direct or indirect contact ? Does aerial spread not play a part in every case of such ? When we know of infections with a common cold, influenza, measles and all of the allied virus diseases and in which the virus exists in the nasopharynx even before the disease has shown symptoms, there can, I think, be no doubt about aerial spread of smallpox. The question to what extent and how far the spread by the air can occur is a different question which no one has settled and obviously nmst depend to some extent upon meteorlogical condilions, and the three cases he has quoted are possibly explained by such conditions being favourable to spread far. I am, however, in agreement with him that infection by air over a long distance has not been proved and is unlikely when other means are generally operative. Dr. Stallybrass will admit that the smell of smallpox (variola major and haemorrhagic cases), is intense and characteristic. In India where 1 had to deal with thousands of cases (in hospital and houses), I have been able to diagnose smallpox from its smell in the winding passages on the ground floor before seeing the case in the upper ttoor. This proves aerial spread. It is the custom of certain secIs on abont the ninth day to have a " Puga " or feast to drive away the evil spirit of " Matha " (smallpox), bv the relations and children coming around the patient x~ith smallpox ([ have seen this often)! It cannot be denied that persons confing to such a rotma get the disease through the air, m~d in some cases the door of the room opens on to a side street ! Often in these cases ventilation of rooms is excluded. You cannot cxcludc droplet infection nor infection by scab.s. If you do your fomitcs nmst go, and I do not agree to this. So long as we havc an unvaccinated cmnnnmitv you cannot exchtde this as a nte;ms ot: spread since vaccinated" persons with mild symptoms or treated its chicken-pox may h a r b o u r the virus in their nasopharynx, and thus spread to the unvaccinated. Our sheet-anchor is vaccinatim~, (primary in infants and re;,cination at ten years of a g e - - a n d in an epidemic even of those m'er 30 years). I was vaccinated primarily in infancy and was well vaccinated (four marks) when seeing the cases in Belvedere Hospital, Glasgow. T h a t vaccination of many years ago has stood me well to date. At that epidemic our Professor got only one typical smallpox on his forehead and was kept in the hospital as a patient ! For the prevention of aerial dissemination from th 9 pox I have used ti-ncture of iodine painted on each spot both in smallpox and chickenpox, and it undoubtedly aborts the pox and will prevent " pitting marks in smallpox." A. G. NEWFLI,,
Medical Officer o[ Health. Blvti~. May 29th, 1947.
OBITUARY j o a n PERC~ laTv, ~.n., CH.B. reraN.), n.e.n. The death occurred suddenly on May 25th o[ Dr. J. P. Lilt, medical officer of health and school medical officer for the borough of I , y t h a m St. Annes since t924. Dr. Litt graduated from Edinburgh University with distinction in 1910, took the M.D. in 1913 and the D.P.H. in 1914. His first public health experience was in the 1914-18 war, in which he rose to the rank of Major, R.A.M.('. On return from the Far East hc was appointed to L y t h a m St. Annes, where he was an efficient and popular officer, and did much to advance the well-being of the population, especially amongst the children. He rejoined the R.A.M.C. during the recent war and became A.D.H., Southern Command, retiring with the rank of Colonel. His death at the age of 59 will be m u c h regretted by ~oileagncs in North-Western Branch, of which he had been a keen member since 1922. Great sympathy will be felt for his widow and five children, of w h o m the eldest son is studying medicine at Edinburgh. JO~IN WILSON MmLER, M.B., CH.B. (GLAS.), D.P.H. The news of the death on May 2nd at the age of 62 of Dr. J. W. Miller, who only recently resigned his appointment as medical officer of health ~[or the metropolitan boro'ugh of Lewisham owing to ill-health, has been learned with regret by his many friends, especially in the Metropolitan Branch of the Society. He qualified at Glasgow University in 1907 and took the D.P.H. in 1910. After holding posts in the Glasgow city fever hospital and as senior A.M.O.H. and T.0. in Lanarkshire, and a period in the R.A.M.C., he was appointed in 1918 as deputy medical officer of health, Lewi, ham, where he was in charge of the first London nnuficipal maternity home, and succeeded to the M.O.H.-ship in 1937. The strain of civil defence service in addition to the day-to-day work of his department was severe and eventually necessitated his retirement. He was a Fellow of the Society from 1911 and was about to be elected a life member on the recommendation of the Metropolitan Branch at the time of his death. Sincere sympathy is extended to his widow on her loss. GEORGE SMITH BANKS, M.B., CH.B. (EDiN.), D.P.II.
We record with regret the death on May 9th at the age of 67 of Dr. G. S. Banks, formerly regional tuberculosis officer for the city and county of Aberdeen and for Kincardineshire. He graduated at Edinburgh in 1905, took the D.P.H. in 1909 and became A.M.O.H. and R.M.O. of the city hospital, Aberdeen. The M.O.H. (Prof. Matthew Hay) organised a tuberculosis scheme tinder which Dr. Banks in 1911 started the first dispensary in Aberdeen and the first wards for tuberculosis cases; and the latter in 1902 was appointed T.O. for the city. In 1928 when the regional scheme of health services centred on Aberdeen came into operation, Banks was appointed to the post which he held until his retirement. He was a leading figure in the first generation of tuberculosis workers under the local authorities and played a prominent part in the work of bodies associated with that field. He had been a member of the Society ,since 1909 and was elected a Life Fellow on the recommendation of the Scottish Branch last year.
SOCIETY
OF
M E D I C A L O F F I C E R S OF REPORTS OF MEETINGS NORTH-WESTERN BRANCH
HEALTH
President: Dr. C. Metcalfe Brown (M.O.H., Manchestel C.B.). Hon. Secretary: Dr. J. E. Spence (M.O.H., Eccles M.B.). The Annual Meeting of the Branch was held at Baguley Sanatorium on Friday, May 23rd, 1947. The President occupied the chair and 28 members were present. T h e Hon. Treasurer's report and andited balance sheet for the year 1946-47 was presented together with Dr. Wood's apology for absence and was adopted. A letter from Dr. Wood tendering his rcsignation from the office of Treasurer which he has held sim'c 1937, owing to his impending retirement from the public heahh service, was read and was accepted with regret. The Hon. Secrctory was requested to convey to Dr. Wood the thanks of the Branch for his services as Treasurer and their hope that he may enjoy m a n y h a p p y years in retirement. The Annual Report of the Hon. Secretary was read and adopted. The President proposed that Dr. W. C. V. Brothwood, Deputy County Medical Officer fox Lancashire, be elected President for the ensuing year. This was seconded by Dr. Burnett and carried unanimously. Dr. Keddie then proposed, and Dr. Brown seconded, that Dr. R. M. Galloway be elected Hon. Treasurer and this proposition was carried unanimously. Dr. Galloway briefly thanked the tnembers. The following/officers were also e l e c t e d : - Hon. Secretary: Dr. J. E. Spence.