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THE NEW PUBLIC HEALTH BILL.
669 cent. in this series-they may possibly be due to demonstrable inequality in the movements of the two sides of the chest. But in all cases they are believed to be of pleural origin, due to abnormalities in the supply,
distribution,
or
removal of the natural
KINGSLEY WOOD
was
able to state
on
Friday
last
that, if Mr. WOME-RSLEY’s Bill were placed upon the the Government would produce a further I statute-book, Bill, probably in 1926, and’ would then I, amending
lubricating
propose consolidation of the whole law.
Meanwhile Mr. WOMERSLEY’s Bill should be transudate of the membranes. They may coexist with tuberculosis or silicosis, but are not specially regarded as a valuable instalment. Its prospects must indicative or prognostic of these diseases. But they not be obstructed. Like every other Bill, it is open to the other hand, obscure the auscultatory criticism. Those who fear the extravagances of munituberculosis, and it is of paramount impor- cipal socialism have already noted Clause 61, whereby tance, therefore, that all labour recruits presenting this local authorities which possess slaughter-houses or may,
signs
on
of
condition should be submitted to X ray examination. markets are to be allowed also to possess refrigerators, While this investigation is of immediate importance and to make reasonable charges for cold storage. to the Rand mining industry, its general significance Critics on the other side will complain that the Bill should not be lost sight of. Until it is possible to does not go far enough. Those who care to pick up record physical signs in the same way as it is possible a modern Local Act and to scan the elaborate clauses to record a pulse tracing, or to demonstrate abnor- which the ingenuity of Parliamentary agents has malities in the renal secretion, every physician must multiplied, can make a list of the fashionable projudge for himself the degree and extent of abnormal visions which Mr. WoMERSLEY’s Bill omits to include. pulmonary and cardiac sounds. He must establish He would, for example, allow local authorities to put for himself the standards by comparison with up drinking fountains, but not to put up seats for the
weary. He includes clauses for dealing with disease in common lodging-houses, and clauses against offensive trades, against nuisance from occupation of tents and vans in unsuitable places, and against verminous premises, articles, and persons. He does not include other clauses which are common form in modern local legislation-the power to close Sunday schools in times of epidemics, the power to regulate ice-cream manufacture and sale, the power to make for better inspection of meat, and the power by-laws THE NEW PUBLIC HEALTH BILL. to prohibit persons from selling food who are sufferA MONTH ago the Minister of Health announced in ing from advanced tuberculosis. Criticism on these answer to a question in Parliament that he hoped to lines, however, is neither fair nor reasonable. The introduce a Public Health Acts Amendment Bill on Bill, neatly as much of it is drafted, will doubtless be the lines of the legislation of 1890 and 1907, embodying improved in Committee ; but it is better to obtain a for the benefit of the whole country various provisions legislative instalment in the form of the greatest at present contained only in local legislation. The common measure of agreement than to lose the Bill by Government Bill is known to be in an advanced stage concentrating on points of difference. The general of preparation, but there is scant hope of its intro- scheme of the Bill is permissive. This fact in itself duction this Session. Fortunately a private Member’s should disarm hostility. Bill, drafted with a similar object, has turned to good account the opportunity of a Friday afternoon debate ; at the end of last week it secured an agreed second HIGH MATERNAL MORTALITY: reading with the assent of all parties, the support of RESOLUTIONS BY THE MIDWIVES’ the Association of Municipal Corporations, and the of INSTITUTE. the Health. Mr. WoMERSLEY’s of Ministry blessing Bill, the terms of which are outlined this week by our AT the last annual general meeting of the MidParliamentary Correspondent, will do three excellent wives’ Institute the following resolutions were things. It will lighten the burdens of progressively- passed :minded ratepayers, who will no longer have to pay the 1. That there should be a post-mortem examination, by a pathologist, on every woman who dies in heavy cost of promoting special legislation to obtain duly appointed the public health facilities which other local authorities childbirth, unless otherwise disallowed by a competent official. If the post-mortem examination did not reveal the enjoy; it will ensure a measure of administrative exact cause of death, the coroner should be communicated uniformity throughout England and Wales ; and it with and further medical investigation should be made. will save valuable Parliamentary time. We have more 2. That the Ministry of Health should be asked for than once commented on the repeated recommenda- uniformity in the notification of births card, which should tions in the annual reports of the Local Legislation have a special place for the name of the person who actually delivers the woman. Committee in favour of the passing of such a Bill. One 3. That the Ministry of Health be asked to request the other admirable consequence will be the fact that the medical officers of health in their annual reports of puerperal way will thus be cleared for the re-casting of our public mortality to distinguish between those cases in which a health law into a single, orderly, comprehensive, and midwife was engaged, and those cases in which a doctor was comprehensible code,-a matter which the then engaged to attend. Minister of Health admitted to be of urgent importThe objects of the three resolutions will commend ance two years ago. It is almost inconceivable to themselves to our readers. First, the desirability of think that our principal legislation on the subject was an autopsy to clear up the pathology of an unexpected, passed as long ago as 1875, and that it has undergone unusual, or sudden event is common to the whole no substantial revision in the past half century, though practice of medicine ; secondly, infringements of the both the central and the local authorities have been Midwives Act should be provided against ; and, any connexion between high mortality and altered, though research has enlarged our powers of thirdly, the working of that Act should be made clear. At and a preventing disease, though constant increase in the facts demanded by the third resolution public interest has made acceptable a general improve- present can be ascertained only from certain of the annual ment in health standards. It is gratifying that Sir reports of medical officers of health.
which he may determine the significance of physical signs. He is, in fact, himself the variable, the experimental, or instrumental error in the observation of his patient, and it is only by careful and controlled work that he can so reduce the margin of error as to raise his technique from an art to a science.
distribution,
or
removal of the natural
KINGSLEY WOOD
was
able to state
on
Friday
last
that, if Mr. WOME-RSLEY’s Bill were placed upon the the Government would produce a further I statute-book, Bill, probably in 1926, and’ would then I, amending
lubricating
propose consolidation of the whole law.
Meanwhile Mr. WOMERSLEY’s Bill should be transudate of the membranes. They may coexist with tuberculosis or silicosis, but are not specially regarded as a valuable instalment. Its prospects must indicative or prognostic of these diseases. But they not be obstructed. Like every other Bill, it is open to the other hand, obscure the auscultatory criticism. Those who fear the extravagances of munituberculosis, and it is of paramount impor- cipal socialism have already noted Clause 61, whereby tance, therefore, that all labour recruits presenting this local authorities which possess slaughter-houses or may,
signs
on
of
condition should be submitted to X ray examination. markets are to be allowed also to possess refrigerators, While this investigation is of immediate importance and to make reasonable charges for cold storage. to the Rand mining industry, its general significance Critics on the other side will complain that the Bill should not be lost sight of. Until it is possible to does not go far enough. Those who care to pick up record physical signs in the same way as it is possible a modern Local Act and to scan the elaborate clauses to record a pulse tracing, or to demonstrate abnor- which the ingenuity of Parliamentary agents has malities in the renal secretion, every physician must multiplied, can make a list of the fashionable projudge for himself the degree and extent of abnormal visions which Mr. WoMERSLEY’s Bill omits to include. pulmonary and cardiac sounds. He must establish He would, for example, allow local authorities to put for himself the standards by comparison with up drinking fountains, but not to put up seats for the
weary. He includes clauses for dealing with disease in common lodging-houses, and clauses against offensive trades, against nuisance from occupation of tents and vans in unsuitable places, and against verminous premises, articles, and persons. He does not include other clauses which are common form in modern local legislation-the power to close Sunday schools in times of epidemics, the power to regulate ice-cream manufacture and sale, the power to make for better inspection of meat, and the power by-laws THE NEW PUBLIC HEALTH BILL. to prohibit persons from selling food who are sufferA MONTH ago the Minister of Health announced in ing from advanced tuberculosis. Criticism on these answer to a question in Parliament that he hoped to lines, however, is neither fair nor reasonable. The introduce a Public Health Acts Amendment Bill on Bill, neatly as much of it is drafted, will doubtless be the lines of the legislation of 1890 and 1907, embodying improved in Committee ; but it is better to obtain a for the benefit of the whole country various provisions legislative instalment in the form of the greatest at present contained only in local legislation. The common measure of agreement than to lose the Bill by Government Bill is known to be in an advanced stage concentrating on points of difference. The general of preparation, but there is scant hope of its intro- scheme of the Bill is permissive. This fact in itself duction this Session. Fortunately a private Member’s should disarm hostility. Bill, drafted with a similar object, has turned to good account the opportunity of a Friday afternoon debate ; at the end of last week it secured an agreed second HIGH MATERNAL MORTALITY: reading with the assent of all parties, the support of RESOLUTIONS BY THE MIDWIVES’ the Association of Municipal Corporations, and the of INSTITUTE. the Health. Mr. WoMERSLEY’s of Ministry blessing Bill, the terms of which are outlined this week by our AT the last annual general meeting of the MidParliamentary Correspondent, will do three excellent wives’ Institute the following resolutions were things. It will lighten the burdens of progressively- passed :minded ratepayers, who will no longer have to pay the 1. That there should be a post-mortem examination, by a pathologist, on every woman who dies in heavy cost of promoting special legislation to obtain duly appointed the public health facilities which other local authorities childbirth, unless otherwise disallowed by a competent official. If the post-mortem examination did not reveal the enjoy; it will ensure a measure of administrative exact cause of death, the coroner should be communicated uniformity throughout England and Wales ; and it with and further medical investigation should be made. will save valuable Parliamentary time. We have more 2. That the Ministry of Health should be asked for than once commented on the repeated recommenda- uniformity in the notification of births card, which should tions in the annual reports of the Local Legislation have a special place for the name of the person who actually delivers the woman. Committee in favour of the passing of such a Bill. One 3. That the Ministry of Health be asked to request the other admirable consequence will be the fact that the medical officers of health in their annual reports of puerperal way will thus be cleared for the re-casting of our public mortality to distinguish between those cases in which a health law into a single, orderly, comprehensive, and midwife was engaged, and those cases in which a doctor was comprehensible code,-a matter which the then engaged to attend. Minister of Health admitted to be of urgent importThe objects of the three resolutions will commend ance two years ago. It is almost inconceivable to themselves to our readers. First, the desirability of think that our principal legislation on the subject was an autopsy to clear up the pathology of an unexpected, passed as long ago as 1875, and that it has undergone unusual, or sudden event is common to the whole no substantial revision in the past half century, though practice of medicine ; secondly, infringements of the both the central and the local authorities have been Midwives Act should be provided against ; and, any connexion between high mortality and altered, though research has enlarged our powers of thirdly, the working of that Act should be made clear. At and a preventing disease, though constant increase in the facts demanded by the third resolution public interest has made acceptable a general improve- present can be ascertained only from certain of the annual ment in health standards. It is gratifying that Sir reports of medical officers of health.
which he may determine the significance of physical signs. He is, in fact, himself the variable, the experimental, or instrumental error in the observation of his patient, and it is only by careful and controlled work that he can so reduce the margin of error as to raise his technique from an art to a science.