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The ministry of health in 1934–35
PUBLIC HEALTH THE JOURNAL OF
THE SOCIETY OF MEDICAL OFFICERS OF HEALTH. No. 1. Vol. XLIX.
OCTOBER, 1985.
PUBLIC HEALTH, the Official Organ of the Society o f Medical Officers of Health, is prepared
to receive a certain number of approved advertisements. Application should be made to the Executive Secretary of the Society, at 1, Thornhaugh Street, Russell Square, London, W.C.1. Subscription price 31s. 6,t. per annum, post free, in advance. Single copies, 2s. 6d. post free.
Contents. PAGE
PAGE
EDITORIAL---
Ut Ita Dicam.
The M i n i s t r y of H e a l t h in 1934-35
......
1
Conso lidation of P u b l i c H e a l t h Acts
......
3
T h e Central Council for H e a l t h E d u c a t i o n
..,
4 5
F u m i g a t i o n s with l t y d r o g e n C y a n i d c . . . . . .
5
Obituary . . . . . . . . . . . . . . . . . .
(Being C o m m e n t s , a propos a nd otherwise, on S u n d r y M a t t e r s ) . . . . . . . . .
20
SOCIETY OF MEDICAL OFFICERS OF HEALTH-Council M e e t i n g . . . . . . . . . . . . . . . 22 B r a n c h a n d G r o u p El e c t i ons
.........
T h e M e t r o p o l i t a n B ra nc h
.........
The Maternity and Child Welfare Group
27 29 ...
30
THE LITERATURE OF PREVENTIVE MEDICINE-Epidemics a nd C r o w d Diseases . . . . . . . . . 32
SPECIAL ARTICLES--The M e d i c a l Officer's Practice of H o u s i n g .
A S h o r t I i i s t o r y of T a l m u d i c M e d i c i n e
By
A N e w A n g l e on H e a l t h . . . . . . . . . . . .
HUGII A. EAWCETT, M.R.C.S.~ L.R.C.P.~ D,P.H.~
...
32 32
D.T.M. & n., P r i n c i p a l A s s i s t a n t M e d i c a l Officer, In t he A n n u a l R e p o r t s
L o n d o n C o u n t y Council . . . . . . . . . . . .
. . . . . . . . . . . .
32
Editorial. The Ministry of Health in 1934-35. S an introduction to the Annual A the Ministry of Health for
Report of 1934-35" nothing could be more appropriate in this year of Jubilee than the summary given of the main developments during the period of the King's reign in the field of public health. In this there is reference to the establishment of the Ministry itself : and an account of the progress made in relation to National Health and Pensions Insurance, and in respect of the organisation of local government and some of the major services of local government entrusted to the Ministry. Even though couched in the language of the * C m d . 4 978. 5s. 6d, n e t .
H.M.
Stationery
Office.
Price
official publication, the description given of the developments in these connections is most .impressive. As evidence of progress in the various directions along which movement has ,taken place, in addition to facts that are unassailable, figures, some of them of an almost staggering immensity, are quoted. In relation to insurance, for example, it is mentioned that in the last ten years of record no less a sum than one hundred and fifty million pounds had been disbursed in the statutory sickness and maternity benefits, and over ninety millions in medical benefit. On public health it is shown that whereas the expenditure in 1910-11 was twelve million pounds, in 1932-33 it reached forty-six millions, the amount spent on housing in the same period having gone up from one to
PUBLIC HEALTH. thirty-nine million pounds. On new supplies of water in the period 1922-32 the capital expenditure amounted to approximately twentyfour-and-a-half million pounds. As a result of the spending of money on housing by the authorities and others, the eight million houses existing at the armistice has been increased by more than two-and-a-half millions of new houses, and in regard to slum clearance and slum replacement, remarkable progress has been made. No less remarkable has been the progress made on the side of personal health services, and in relation to tuberculosis and maternity and child welfare, the two most important of these, overwhelming proof of progress is submitted side by side with evidence of a strong desire to establish, further and spend money upon schemes for the benefit of the blind, on mental treatment and mental deficiency, public assistance, and the furtherance of medical education. As the Minister points out, expenditure on public health is generally held to be, and is defended as being: a long term investment. Even so, however, as the summary shows, already quite useful d i v i d e n d s have been received and continue to come in from the monies invested within even comparatively recent times. These are in the form of lives saved, and to show how considerable this has been, figures such as these are quoted: a standardised death-rate fallen from 13.2 in 1910 to 9"3 in 1934 ; an infant mortality rate of 105 in 1910 reduced to 64 in 1933; and a decrease in deaths from pulmonary and nonpulmonary tuberculosis from 988 and 439 per million respectively in 1910 to 639 and 160 in 1933. That these figures and the contents of the summary must be a source of gratification to His Majesty may be believed. It may be believed also that in the remainder of the report, which treats in the main of the work done and' results attained in the period 1934-35, there will be found reasons for pleasure and for pride also Amongst the contents there is given a general account of the position in relation to public health revealed as a result of the survey recently completed. Like the extremely concise and attractively written general survey of the health organisation of the country as a whole, which appeared in the report for 1933-34, this account is full of interest and cannot fail to prove useful to all who desire to understand or find it necessary to try to explain to others how matters stand in regard to health organisation in the metropolis. As a result of ihe coming into operation of the
OCTOBER,
Local Government Act, 1929, considerable simplification has resulted, and from the statements made in the report it appears that the machine is working satisfactorily and giving results that warrant the paying of compliments, unexpectedly warm, having regard to the fact that the report is that of the Ministry of Health, to the Medical Officer of the London County Council. Reporting upon surveys generally, the Ministry is in a position to claim that good progress is being made. Nor does it appear necessary for the Ministry to make any comment that is unfavourable in regard to any of the areas surveyed during the year. Indeed, there is little that can be counted as unfavourable said with with regard to health works or progress during the year under review. In regard to health services directed to the prevention of disease, the statements submitted show that the schemes and methods operated, in the majority of instances, are very effective. Tuberculosis has, of course, reacted in a marked manner to the efforts directly or indirectly brought to bear upon it, and the fact that additions were and are being made to the sanatorium provision particularly, suggests that local authorities are determined to continue their efforts and are encouraged by the improvements that have taken place and the attainment in 1934 of the lowest death-rate (763 per million) ever recorded in this country. The degree of improvement and the progress made in relation to the venereal diseases is less easy to judge than in the case of tuberculosis. Even here, however, such figures as there are provide encouragement to continue, at least, the practice of the methods now in vogue. The decrease in the number of new cases of syphilis in 1934 was approximately 7"5 per cent. compared with 1933. That in gonorrhoea the decrease should be lower--2.3 per cent.--is not unexpected or unusual, corresponding as it does, more or less, with the results obtained in other countries. Amongst the infectious diseases in which a decline is reported, smallpox is the most important, only 179 cases being notified--the smallest number since 1918. The situation in regard to pneumonia was also better, both cases and deaths being fewer, the former by over 13,000 and the latter by nearly 10,000. Increases are noted in the case of diphtheria and scarlet fever. One effect of the greater prevalence of diphtheria is claimed to have been additions to the number of authorities making provision of facilities for artificial immunisation against the
i .m~-,.
PUBLIC
disease. As a sign of progress and change it may be noted that the Ministry finds it necessary to introduce reference to the sanitary control of aerial navigation and to mention that the medical officer of health in many cases is now aerodrome medical officer, " so as to give him specific control of the medical and sanitary arrangements." In relation to welfare activities the report contains reference to extraordinarily good work done on behalf of the blind, and the deaf and dumb, as well as under the older establisked schemes for mothers and cMldren. So far as the latter are concerned, note is made of increases in tee demand for maternity beds in institutions and of the numbers of children under one year of age attending centres. Unfortunately, it is impossible .yet to record any improvement in " t h e obstinate and difficult: problem, the reduction of the rate of maternal mortality," though the infant mortality rate continues to fall and in 1934 a record low figure of 59 was reached. The discussion under the head of " Other Health Services" dwells mainly on questions relating to inspection and supervision of food, the work done in relation to milk and under the legal provisions relating to the sale of food and drugs. In regard to nutrition the only reference is to the work of the advisory committee and the joint conference with the physiologists representing the British Medical Association Committee. On local government officers the report has mention of the fact that during the year the appointments of 67 medical officers of health were approved and that out of a total of 1,080 medical officers, 415 do not engage in private practice. The total of sanitary inspectors is not given, though it is noted that of 267 appointed during the year 262 will give whole time to public duties. Referring to these and other officers and servants in another section (Local Government and Local Finance) the report indicates that approximately a quarter of a million have been brought within the Superannuation Act and that the total estimated annual cost to local authorities in respect of these is about two-and-a-half million pounds. In this section there is, of course, discussion of a large number of matters of real moment, as there is also in the sections dealing with Housing and Town Planning; Administration of the Poor L a w ; National Health Insurance and Contributory Pensions, and the very important part devoted exclusively to the work of the
HEALTH.
a
Welsh Board of Health. A number of these actually call for quotation and comment that unfortunately cannot be made here. In referring to the introductory summary of the Minister some note was made of what was said as to progress in relation to housing. In the year under review noteworthy contribution was made to the improvements that have taken place. The number of clearance areas declared was 3,029 with a population of 194,668, and of orders confirmed there were 1,988, involving the displacement of 101,676 persons. Of improvement areas declared there were only 42. The total number of local authorities who have declared such areas is 49. In regard to the general hoase-building situation it is noticed that the total number of houses built during the year under review was 291,983, of which 286,050 were erected by private enterprise. It is recognised, as already hinted, that in what is written here nothing like justice has been done to the report o f the Ministry as a piece of work. It is admitted also that much less of praise has been offered than actually is due to those responsible for t h e preparation of the report and for the work done and the results achieved. The report itself, however, has little or nothing to say of individuals and individual contributions of any sort. Even of Sir George Newman and Sir Arthur Robinson, to whom public health and preventive medicine owe so much, there is no mention. Partly, no doubt, this is because the resignation of these distinguished civil servants did not take effect within the period reviewed and it will be in a subsequent report that some attempt will be made to express appreciation of the wonderful services rendered by them not only in the year 1934-35 but throughout the period of their connection with the Ministry.
Consolidation of Public Health Acts. O M time to time over a number of years, F Rhints from more or less authoritative and well-informed sources that progress was being" made in the direction of the consolidation of public health legislation have been received. Recently these have been becoming more and more definite, so that it did not cause any great amount of surprise when the other day, following a suggestion given by Sir Harry Pritchard, in the course of an address to the Law Society, that the work of the committee concerned with the matter, of which he is a member, was nearly completed, a statement
THE SOCIETY OF MEDICAL OFFICERS OF HEALTH. No. 1. Vol. XLIX.
OCTOBER, 1985.
PUBLIC HEALTH, the Official Organ of the Society o f Medical Officers of Health, is prepared
to receive a certain number of approved advertisements. Application should be made to the Executive Secretary of the Society, at 1, Thornhaugh Street, Russell Square, London, W.C.1. Subscription price 31s. 6,t. per annum, post free, in advance. Single copies, 2s. 6d. post free.
Contents. PAGE
PAGE
EDITORIAL---
Ut Ita Dicam.
The M i n i s t r y of H e a l t h in 1934-35
......
1
Conso lidation of P u b l i c H e a l t h Acts
......
3
T h e Central Council for H e a l t h E d u c a t i o n
..,
4 5
F u m i g a t i o n s with l t y d r o g e n C y a n i d c . . . . . .
5
Obituary . . . . . . . . . . . . . . . . . .
(Being C o m m e n t s , a propos a nd otherwise, on S u n d r y M a t t e r s ) . . . . . . . . .
20
SOCIETY OF MEDICAL OFFICERS OF HEALTH-Council M e e t i n g . . . . . . . . . . . . . . . 22 B r a n c h a n d G r o u p El e c t i ons
.........
T h e M e t r o p o l i t a n B ra nc h
.........
The Maternity and Child Welfare Group
27 29 ...
30
THE LITERATURE OF PREVENTIVE MEDICINE-Epidemics a nd C r o w d Diseases . . . . . . . . . 32
SPECIAL ARTICLES--The M e d i c a l Officer's Practice of H o u s i n g .
A S h o r t I i i s t o r y of T a l m u d i c M e d i c i n e
By
A N e w A n g l e on H e a l t h . . . . . . . . . . . .
HUGII A. EAWCETT, M.R.C.S.~ L.R.C.P.~ D,P.H.~
...
32 32
D.T.M. & n., P r i n c i p a l A s s i s t a n t M e d i c a l Officer, In t he A n n u a l R e p o r t s
L o n d o n C o u n t y Council . . . . . . . . . . . .
. . . . . . . . . . . .
32
Editorial. The Ministry of Health in 1934-35. S an introduction to the Annual A the Ministry of Health for
Report of 1934-35" nothing could be more appropriate in this year of Jubilee than the summary given of the main developments during the period of the King's reign in the field of public health. In this there is reference to the establishment of the Ministry itself : and an account of the progress made in relation to National Health and Pensions Insurance, and in respect of the organisation of local government and some of the major services of local government entrusted to the Ministry. Even though couched in the language of the * C m d . 4 978. 5s. 6d, n e t .
H.M.
Stationery
Office.
Price
official publication, the description given of the developments in these connections is most .impressive. As evidence of progress in the various directions along which movement has ,taken place, in addition to facts that are unassailable, figures, some of them of an almost staggering immensity, are quoted. In relation to insurance, for example, it is mentioned that in the last ten years of record no less a sum than one hundred and fifty million pounds had been disbursed in the statutory sickness and maternity benefits, and over ninety millions in medical benefit. On public health it is shown that whereas the expenditure in 1910-11 was twelve million pounds, in 1932-33 it reached forty-six millions, the amount spent on housing in the same period having gone up from one to
PUBLIC HEALTH. thirty-nine million pounds. On new supplies of water in the period 1922-32 the capital expenditure amounted to approximately twentyfour-and-a-half million pounds. As a result of the spending of money on housing by the authorities and others, the eight million houses existing at the armistice has been increased by more than two-and-a-half millions of new houses, and in regard to slum clearance and slum replacement, remarkable progress has been made. No less remarkable has been the progress made on the side of personal health services, and in relation to tuberculosis and maternity and child welfare, the two most important of these, overwhelming proof of progress is submitted side by side with evidence of a strong desire to establish, further and spend money upon schemes for the benefit of the blind, on mental treatment and mental deficiency, public assistance, and the furtherance of medical education. As the Minister points out, expenditure on public health is generally held to be, and is defended as being: a long term investment. Even so, however, as the summary shows, already quite useful d i v i d e n d s have been received and continue to come in from the monies invested within even comparatively recent times. These are in the form of lives saved, and to show how considerable this has been, figures such as these are quoted: a standardised death-rate fallen from 13.2 in 1910 to 9"3 in 1934 ; an infant mortality rate of 105 in 1910 reduced to 64 in 1933; and a decrease in deaths from pulmonary and nonpulmonary tuberculosis from 988 and 439 per million respectively in 1910 to 639 and 160 in 1933. That these figures and the contents of the summary must be a source of gratification to His Majesty may be believed. It may be believed also that in the remainder of the report, which treats in the main of the work done and' results attained in the period 1934-35, there will be found reasons for pleasure and for pride also Amongst the contents there is given a general account of the position in relation to public health revealed as a result of the survey recently completed. Like the extremely concise and attractively written general survey of the health organisation of the country as a whole, which appeared in the report for 1933-34, this account is full of interest and cannot fail to prove useful to all who desire to understand or find it necessary to try to explain to others how matters stand in regard to health organisation in the metropolis. As a result of ihe coming into operation of the
OCTOBER,
Local Government Act, 1929, considerable simplification has resulted, and from the statements made in the report it appears that the machine is working satisfactorily and giving results that warrant the paying of compliments, unexpectedly warm, having regard to the fact that the report is that of the Ministry of Health, to the Medical Officer of the London County Council. Reporting upon surveys generally, the Ministry is in a position to claim that good progress is being made. Nor does it appear necessary for the Ministry to make any comment that is unfavourable in regard to any of the areas surveyed during the year. Indeed, there is little that can be counted as unfavourable said with with regard to health works or progress during the year under review. In regard to health services directed to the prevention of disease, the statements submitted show that the schemes and methods operated, in the majority of instances, are very effective. Tuberculosis has, of course, reacted in a marked manner to the efforts directly or indirectly brought to bear upon it, and the fact that additions were and are being made to the sanatorium provision particularly, suggests that local authorities are determined to continue their efforts and are encouraged by the improvements that have taken place and the attainment in 1934 of the lowest death-rate (763 per million) ever recorded in this country. The degree of improvement and the progress made in relation to the venereal diseases is less easy to judge than in the case of tuberculosis. Even here, however, such figures as there are provide encouragement to continue, at least, the practice of the methods now in vogue. The decrease in the number of new cases of syphilis in 1934 was approximately 7"5 per cent. compared with 1933. That in gonorrhoea the decrease should be lower--2.3 per cent.--is not unexpected or unusual, corresponding as it does, more or less, with the results obtained in other countries. Amongst the infectious diseases in which a decline is reported, smallpox is the most important, only 179 cases being notified--the smallest number since 1918. The situation in regard to pneumonia was also better, both cases and deaths being fewer, the former by over 13,000 and the latter by nearly 10,000. Increases are noted in the case of diphtheria and scarlet fever. One effect of the greater prevalence of diphtheria is claimed to have been additions to the number of authorities making provision of facilities for artificial immunisation against the
i .m~-,.
PUBLIC
disease. As a sign of progress and change it may be noted that the Ministry finds it necessary to introduce reference to the sanitary control of aerial navigation and to mention that the medical officer of health in many cases is now aerodrome medical officer, " so as to give him specific control of the medical and sanitary arrangements." In relation to welfare activities the report contains reference to extraordinarily good work done on behalf of the blind, and the deaf and dumb, as well as under the older establisked schemes for mothers and cMldren. So far as the latter are concerned, note is made of increases in tee demand for maternity beds in institutions and of the numbers of children under one year of age attending centres. Unfortunately, it is impossible .yet to record any improvement in " t h e obstinate and difficult: problem, the reduction of the rate of maternal mortality," though the infant mortality rate continues to fall and in 1934 a record low figure of 59 was reached. The discussion under the head of " Other Health Services" dwells mainly on questions relating to inspection and supervision of food, the work done in relation to milk and under the legal provisions relating to the sale of food and drugs. In regard to nutrition the only reference is to the work of the advisory committee and the joint conference with the physiologists representing the British Medical Association Committee. On local government officers the report has mention of the fact that during the year the appointments of 67 medical officers of health were approved and that out of a total of 1,080 medical officers, 415 do not engage in private practice. The total of sanitary inspectors is not given, though it is noted that of 267 appointed during the year 262 will give whole time to public duties. Referring to these and other officers and servants in another section (Local Government and Local Finance) the report indicates that approximately a quarter of a million have been brought within the Superannuation Act and that the total estimated annual cost to local authorities in respect of these is about two-and-a-half million pounds. In this section there is, of course, discussion of a large number of matters of real moment, as there is also in the sections dealing with Housing and Town Planning; Administration of the Poor L a w ; National Health Insurance and Contributory Pensions, and the very important part devoted exclusively to the work of the
HEALTH.
a
Welsh Board of Health. A number of these actually call for quotation and comment that unfortunately cannot be made here. In referring to the introductory summary of the Minister some note was made of what was said as to progress in relation to housing. In the year under review noteworthy contribution was made to the improvements that have taken place. The number of clearance areas declared was 3,029 with a population of 194,668, and of orders confirmed there were 1,988, involving the displacement of 101,676 persons. Of improvement areas declared there were only 42. The total number of local authorities who have declared such areas is 49. In regard to the general hoase-building situation it is noticed that the total number of houses built during the year under review was 291,983, of which 286,050 were erected by private enterprise. It is recognised, as already hinted, that in what is written here nothing like justice has been done to the report o f the Ministry as a piece of work. It is admitted also that much less of praise has been offered than actually is due to those responsible for t h e preparation of the report and for the work done and the results achieved. The report itself, however, has little or nothing to say of individuals and individual contributions of any sort. Even of Sir George Newman and Sir Arthur Robinson, to whom public health and preventive medicine owe so much, there is no mention. Partly, no doubt, this is because the resignation of these distinguished civil servants did not take effect within the period reviewed and it will be in a subsequent report that some attempt will be made to express appreciation of the wonderful services rendered by them not only in the year 1934-35 but throughout the period of their connection with the Ministry.
Consolidation of Public Health Acts. O M time to time over a number of years, F Rhints from more or less authoritative and well-informed sources that progress was being" made in the direction of the consolidation of public health legislation have been received. Recently these have been becoming more and more definite, so that it did not cause any great amount of surprise when the other day, following a suggestion given by Sir Harry Pritchard, in the course of an address to the Law Society, that the work of the committee concerned with the matter, of which he is a member, was nearly completed, a statement