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The Official Status of Public Health.
1802
grasped the situation. Ostensibly they have accorded to the President of the Board of Trade an additional stipend of .E3000 because the constitution over which he presides "is obsolete" and they "do not recommend its continuance and their reason for thus regarding it is that it is a Board of an amusingly heterogeneous composition. They "
THE LANCET.
understand,
too, that the Board of Trade "never meets." notwithstanding this it is impossible to discover from the report what changes the committee contemplates in order that the Board of Trade may become less But
LONDON: SATURlJA 1’; JUNE 25, 1904.
The Official Status of Public Health.
obsolete and the only ray of light which we can throw upon the situation is that contained in Section 13 which states that "in order to indicate more clearly the functions of the Board of Trade it might be deemed desirable to give
WITHIN the last year several of our Government departments have been weighed in the balance and one at least has been found wanting and consigned to the melting-pot. And now attention has been turned to two other Government departments-the Board of Trade and the Local Government Board, neither of which at present ranks as a first-class department in the hierarchy of Government. This has been regarded by some as an anomaly, and is so far as the Local Government Board is concerned
its head the title of Minister of Commerce and Industry.’" We regret that we can afford our readers no further information concerning the working of this new public body but we can nowhere discover the precise uniform which the head of the department of State is to wear. The report embodies the suggestion that in contrast with the Board of Trade the Local Government Board is a real Board-quite a modern institution which meets periodically in the same fashion as the new Army Board. It would, we fear, puzzle the secretary of the commission to furnish the
considered by THE LANCET, and the Chancellor of the Exchequer in the summer of 1903 appointed a committee, of which’ Lord JERSEY was made chairman, to consider "the position and duties of the Board of Trade and the Local Government Board and whether any, and if so what, alterations should be made in the so
date of the
last, or of any, meeting of the Local Government "Board."Further, no change in the constitution of the
......
constitution and status of those offices; also whether in the interests of administrative efficiency any re-arrangement of duties between those and other Government departments is desirable." A reference of this comprehensive nature would seem to carry with it the obligation to make a searching and detailed investigation into the working of each of the important offices concerned. But the members of the committee did not take this view and, as if anxious to be rid of the business, they elected to assume that the reference applied "primarily to the constitution of the departments as exemplified " by the position of their political chiefs." As the result of this limited conception of its duty to the public the committee has presented a report which in our view will become historical by virtue of its incomplete and imperfect character. Had one of the medical inspectors of the Local Government Board been given the reference and had he sent in the report in question there would, we imagine, have been a vacancy in the department. As the sum total of its labours, the committee in a report
which
less than four page?, inclusive of the preamble, recommends that the President of the Board of Trade should receive L5000 per annum instead of .f:2000 and that he should become in effect a Secretary of State, while with regard to Mr. WALTER LONG, the President of the Local Government Board, the recommendation is that he should receive .f:3000 in place of .E2000 and that as regards status he should remain as he is. The committee further recommends that the Permanent Secretary and the Parliamentary Secretary in the case of each department should receive a substantial increase in their emoluments. The reasons which have influenced the committee in leaving the central public health office practically as it is are a little difficult to understand and the members will forgive us if we question whether they themselves have quite covers
’
Local Government Board is recommended since "it consists entirely of members of the Cabinet." It therefore comes to this : that a committee has taken nearly a year to decide that the Board of Trade and the Local Government Board
practically as they are and that the staff of departments, with the exception of the three most prominent officials in each, is amply recompensed for the increasing duties which the committee is apparently satisfied have been imposed upon each department within are
to remain
each of their
recent years. Clearly the
as
for
treats with scant
committee, public health, and it
constituted, has no regard courtesy the
of Sir MICHAEL FOSTER that the duties of the regard to public health should be separated from the other duties of the Board and intrusted to a distinct staff under the direction of a Parliamentary Secretary and of a Permanent Secretary for Public Health. The proposal was advocated by Sir MICHAEL FOSTER because, in his view, the staff of the medical department had not time "to look adequately ahead,"but the committee has apparently satisfied itself "that the questions connected with public health which come before the Board (other than those which require the personal consideration of the President) would not be sufficiently numerous to occupy the time of an additional Parliamentary Secretary." Clearly the committee has no conception of the importance of expansion and initiative. With the question of the alleged degeneration of the masses prominently to the front; with the need for more central interference in connexion with backward local authorities and the control of our foodsupplies ; with diseases such as measles, whooping-cough, infantile diarrhoea, and syphilis practically untouched, this committee writes a report in which the work of the medical department is not so much as mentioned and where no reference whatever is made to that little army of expey
suggestion
Local Government Board with
1803 officers who for the last quarter of a century thrcughout England and Wales have brought credit to the Board and have kept it in touch with the public. We do not gather,
however, that Mr. BALFOLTR is disposed to treat the report at all
and
doae in committee. It is in the committees and not in the Council itself that most decisions are arrived at and rare, indeed, is it for the recommendations of a special committee to be rejected. The importance and the number of the
may therefore hope that Mr. LONG committees render it absolutely necessary that all members will succeed in diverting the recommendations of the of the Council should bear their fair share of the burden committee from his own department. Certainly he knows and this is only possible if each member of the Council is the needs of his department far better than does this very willing to attend regularly the committees of which he is a member. It is not enough that a councillor should attend perfunctory committee. punctually the eleven regular meetings of the Council ; he should also be willing and able tu attend the committee The of of meetings. The time required for this is very great and in the Election of Members cise of office.bearers, the President and the Vice-Presidents, who are ex-oficio members of all committees the time of Council. devoted to the service of the College must be enormous and ON Thursday, July 7th, the Fellows of the Royal College in the case of a surgeon in a large practice the pecuniary of Surgeons of England will have an opportunity of par- sacrifice may well be very great. It is only fair that some ticipating in the election of three members of the Council. of the representatives of the Fellows on the Council should
seriously
we
Royal College England:
Under the
Surgeons
present regulations whereby
rare for a surgeon from a able to devote the necessary time This practical to the numerous committee meetings. impossibility of fulfilling all the duties of a councillor
Fellows may vote
be
provincial surgeons provincial town to be
through the post the act of voting is extremely simple and merely requires the writing of a few words and the cost of a ld. stamp, yet so apathetic are the Fellows of the College that only 50 per cent. of them care to take the small amount of trouble needed to sign and to post the voting paper. Whether they are inclined to favour reform in the affairs of the College or are advocates of- the maintenance of the status quo we should have imagined that they would think it worth while to endeavour by voting for suitable candidates to support the views which they hold. Be the explanation what it may the fact remains that only every other Fellow cares to vote at all. Few, indeed, vote personally ; for some years past less than 20 Fellows have attended the actual election, so that the President and the scrutineers carry on their arduous labours of verifying and counting the votes in In
(and
almost
an
considering it is often
value)
empty
by
no means
doubtless often prevents provincial Fellows from allowing themselves to be nominated for the Council. At the present election there are three vacancies and of these has been caused by the death of Mr. T. R. In the Council as now constituted JESSOP of Leeds.
one
members representing the provincial W. MAYO ROBSON of Leeds, Mr. F. RICHARDSON CROSS of Bristol, and Dr. J. WARD COUSINS of Portsmouth, and as Mr. MAYO ROBSON has since his election become domiciled in London he can hardly be looked upon as a provincial Fellow. The Council contains 24 members and a sixth of the whole number, or four seats, may be reasonably said to be a fair
there
candidatesitor the
are
Fellows.
room.
the claims of the
but it is
Council
l’ruponlOli
easy to estimate their relative
only
it should be remarked that it is almost essential
three
Mr.
A.
lor
tue
be reached if
:
J) ell0Ws.
-Lius numoer
will
of the vacant seats is filled by a There is only one provincial candidate, one
Fellow. Mr. H. GILBERT BARLING of Birmingham. He obtained his Fellowship in 1881 and he is surgeon to the Birmingham General Hospital and professor of surgery at the University of Birmingham. From his standing Mr. BARLING should
provincial
that the members of that august body should have had much experience in the teaching as well as in the practice of surgery, for most of the work that the Council has to perform is connected with the teaching and the examining of students and therefore a post on the teaching staff of a medical school is almost a sine qud non. But it is by no means essential that the councillor should always remain on the teaching staff ; it is sufficient that he has been connected with it. There is also need that the Council should be in touch with those in practice and it would be especially advantageous if it could keep closely in touch with those in general practice. Now no small proportion of the Fellows are gentlemen who are in general practice and it would be of the greatest benefit, not only to the Council but also to the Fellows and Members of the College and to the profession at large, if some Fellow in general practice would allow himself to be nominated as a candidate for a seat on the Council. There should be no difficalty in finding a suitable Fellow and several names at once suggest themselves. Should such a candidate appear we feel sure that he would receive the support of many Fellows. It is hardly known to those outside the immediate circle of the Council how much of the work of that body is5
pruvinuitti
make
a
valuable addition to the Council and we think that probability be elected but his election will mainly on the votes of the provincial Fellows who
he will in all
depend can
Thus insure his success at the poll if they choose. left with only two vacancies for six London candi-
we are
dates.
These are, in order of
seniority,
Mr. 0. H. GOLDING-
BIRD, Mr. HARRISON CRIPPS, Mr. FREDERIC S. EVE, Mr. W. BRUCE CLARKE, Mr. A. A. BOWLBY, and Mr. J. BLAND. SUTTON. Mr. GOLDING. BIRD obtained the Fellowship in 1874. He is surgeon to Guy’s Hospital and is a member of the Examining Board of the College. He has done much for surgery. Mr. CRiPPS took the Fellowship in 1875. He is surgeon to St. Bartholomew’s Hospital and is well known for his work on the diseases of the rectum. Mr. EvE obtained his Fellowship in 1878. He is surgeon to the London Hospital and was formerly pathological curator at the College. Mr. BRUCE CLARKE is surgeon to St. Bartholomew’s Hospital, having taken his Fellowship in He has evinced an interest in the affairs of the 1879.
grasped the situation. Ostensibly they have accorded to the President of the Board of Trade an additional stipend of .E3000 because the constitution over which he presides "is obsolete" and they "do not recommend its continuance and their reason for thus regarding it is that it is a Board of an amusingly heterogeneous composition. They "
THE LANCET.
understand,
too, that the Board of Trade "never meets." notwithstanding this it is impossible to discover from the report what changes the committee contemplates in order that the Board of Trade may become less But
LONDON: SATURlJA 1’; JUNE 25, 1904.
The Official Status of Public Health.
obsolete and the only ray of light which we can throw upon the situation is that contained in Section 13 which states that "in order to indicate more clearly the functions of the Board of Trade it might be deemed desirable to give
WITHIN the last year several of our Government departments have been weighed in the balance and one at least has been found wanting and consigned to the melting-pot. And now attention has been turned to two other Government departments-the Board of Trade and the Local Government Board, neither of which at present ranks as a first-class department in the hierarchy of Government. This has been regarded by some as an anomaly, and is so far as the Local Government Board is concerned
its head the title of Minister of Commerce and Industry.’" We regret that we can afford our readers no further information concerning the working of this new public body but we can nowhere discover the precise uniform which the head of the department of State is to wear. The report embodies the suggestion that in contrast with the Board of Trade the Local Government Board is a real Board-quite a modern institution which meets periodically in the same fashion as the new Army Board. It would, we fear, puzzle the secretary of the commission to furnish the
considered by THE LANCET, and the Chancellor of the Exchequer in the summer of 1903 appointed a committee, of which’ Lord JERSEY was made chairman, to consider "the position and duties of the Board of Trade and the Local Government Board and whether any, and if so what, alterations should be made in the so
date of the
last, or of any, meeting of the Local Government "Board."Further, no change in the constitution of the
......
constitution and status of those offices; also whether in the interests of administrative efficiency any re-arrangement of duties between those and other Government departments is desirable." A reference of this comprehensive nature would seem to carry with it the obligation to make a searching and detailed investigation into the working of each of the important offices concerned. But the members of the committee did not take this view and, as if anxious to be rid of the business, they elected to assume that the reference applied "primarily to the constitution of the departments as exemplified " by the position of their political chiefs." As the result of this limited conception of its duty to the public the committee has presented a report which in our view will become historical by virtue of its incomplete and imperfect character. Had one of the medical inspectors of the Local Government Board been given the reference and had he sent in the report in question there would, we imagine, have been a vacancy in the department. As the sum total of its labours, the committee in a report
which
less than four page?, inclusive of the preamble, recommends that the President of the Board of Trade should receive L5000 per annum instead of .f:2000 and that he should become in effect a Secretary of State, while with regard to Mr. WALTER LONG, the President of the Local Government Board, the recommendation is that he should receive .f:3000 in place of .E2000 and that as regards status he should remain as he is. The committee further recommends that the Permanent Secretary and the Parliamentary Secretary in the case of each department should receive a substantial increase in their emoluments. The reasons which have influenced the committee in leaving the central public health office practically as it is are a little difficult to understand and the members will forgive us if we question whether they themselves have quite covers
’
Local Government Board is recommended since "it consists entirely of members of the Cabinet." It therefore comes to this : that a committee has taken nearly a year to decide that the Board of Trade and the Local Government Board
practically as they are and that the staff of departments, with the exception of the three most prominent officials in each, is amply recompensed for the increasing duties which the committee is apparently satisfied have been imposed upon each department within are
to remain
each of their
recent years. Clearly the
as
for
treats with scant
committee, public health, and it
constituted, has no regard courtesy the
of Sir MICHAEL FOSTER that the duties of the regard to public health should be separated from the other duties of the Board and intrusted to a distinct staff under the direction of a Parliamentary Secretary and of a Permanent Secretary for Public Health. The proposal was advocated by Sir MICHAEL FOSTER because, in his view, the staff of the medical department had not time "to look adequately ahead,"but the committee has apparently satisfied itself "that the questions connected with public health which come before the Board (other than those which require the personal consideration of the President) would not be sufficiently numerous to occupy the time of an additional Parliamentary Secretary." Clearly the committee has no conception of the importance of expansion and initiative. With the question of the alleged degeneration of the masses prominently to the front; with the need for more central interference in connexion with backward local authorities and the control of our foodsupplies ; with diseases such as measles, whooping-cough, infantile diarrhoea, and syphilis practically untouched, this committee writes a report in which the work of the medical department is not so much as mentioned and where no reference whatever is made to that little army of expey
suggestion
Local Government Board with
1803 officers who for the last quarter of a century thrcughout England and Wales have brought credit to the Board and have kept it in touch with the public. We do not gather,
however, that Mr. BALFOLTR is disposed to treat the report at all
and
doae in committee. It is in the committees and not in the Council itself that most decisions are arrived at and rare, indeed, is it for the recommendations of a special committee to be rejected. The importance and the number of the
may therefore hope that Mr. LONG committees render it absolutely necessary that all members will succeed in diverting the recommendations of the of the Council should bear their fair share of the burden committee from his own department. Certainly he knows and this is only possible if each member of the Council is the needs of his department far better than does this very willing to attend regularly the committees of which he is a member. It is not enough that a councillor should attend perfunctory committee. punctually the eleven regular meetings of the Council ; he should also be willing and able tu attend the committee The of of meetings. The time required for this is very great and in the Election of Members cise of office.bearers, the President and the Vice-Presidents, who are ex-oficio members of all committees the time of Council. devoted to the service of the College must be enormous and ON Thursday, July 7th, the Fellows of the Royal College in the case of a surgeon in a large practice the pecuniary of Surgeons of England will have an opportunity of par- sacrifice may well be very great. It is only fair that some ticipating in the election of three members of the Council. of the representatives of the Fellows on the Council should
seriously
we
Royal College England:
Under the
Surgeons
present regulations whereby
rare for a surgeon from a able to devote the necessary time This practical to the numerous committee meetings. impossibility of fulfilling all the duties of a councillor
Fellows may vote
be
provincial surgeons provincial town to be
through the post the act of voting is extremely simple and merely requires the writing of a few words and the cost of a ld. stamp, yet so apathetic are the Fellows of the College that only 50 per cent. of them care to take the small amount of trouble needed to sign and to post the voting paper. Whether they are inclined to favour reform in the affairs of the College or are advocates of- the maintenance of the status quo we should have imagined that they would think it worth while to endeavour by voting for suitable candidates to support the views which they hold. Be the explanation what it may the fact remains that only every other Fellow cares to vote at all. Few, indeed, vote personally ; for some years past less than 20 Fellows have attended the actual election, so that the President and the scrutineers carry on their arduous labours of verifying and counting the votes in In
(and
almost
an
considering it is often
value)
empty
by
no means
doubtless often prevents provincial Fellows from allowing themselves to be nominated for the Council. At the present election there are three vacancies and of these has been caused by the death of Mr. T. R. In the Council as now constituted JESSOP of Leeds.
one
members representing the provincial W. MAYO ROBSON of Leeds, Mr. F. RICHARDSON CROSS of Bristol, and Dr. J. WARD COUSINS of Portsmouth, and as Mr. MAYO ROBSON has since his election become domiciled in London he can hardly be looked upon as a provincial Fellow. The Council contains 24 members and a sixth of the whole number, or four seats, may be reasonably said to be a fair
there
candidatesitor the
are
Fellows.
room.
the claims of the
but it is
Council
l’ruponlOli
easy to estimate their relative
only
it should be remarked that it is almost essential
three
Mr.
A.
lor
tue
be reached if
:
J) ell0Ws.
-Lius numoer
will
of the vacant seats is filled by a There is only one provincial candidate, one
Fellow. Mr. H. GILBERT BARLING of Birmingham. He obtained his Fellowship in 1881 and he is surgeon to the Birmingham General Hospital and professor of surgery at the University of Birmingham. From his standing Mr. BARLING should
provincial
that the members of that august body should have had much experience in the teaching as well as in the practice of surgery, for most of the work that the Council has to perform is connected with the teaching and the examining of students and therefore a post on the teaching staff of a medical school is almost a sine qud non. But it is by no means essential that the councillor should always remain on the teaching staff ; it is sufficient that he has been connected with it. There is also need that the Council should be in touch with those in practice and it would be especially advantageous if it could keep closely in touch with those in general practice. Now no small proportion of the Fellows are gentlemen who are in general practice and it would be of the greatest benefit, not only to the Council but also to the Fellows and Members of the College and to the profession at large, if some Fellow in general practice would allow himself to be nominated as a candidate for a seat on the Council. There should be no difficalty in finding a suitable Fellow and several names at once suggest themselves. Should such a candidate appear we feel sure that he would receive the support of many Fellows. It is hardly known to those outside the immediate circle of the Council how much of the work of that body is5
pruvinuitti
make
a
valuable addition to the Council and we think that probability be elected but his election will mainly on the votes of the provincial Fellows who
he will in all
depend can
Thus insure his success at the poll if they choose. left with only two vacancies for six London candi-
we are
dates.
These are, in order of
seniority,
Mr. 0. H. GOLDING-
BIRD, Mr. HARRISON CRIPPS, Mr. FREDERIC S. EVE, Mr. W. BRUCE CLARKE, Mr. A. A. BOWLBY, and Mr. J. BLAND. SUTTON. Mr. GOLDING. BIRD obtained the Fellowship in 1874. He is surgeon to Guy’s Hospital and is a member of the Examining Board of the College. He has done much for surgery. Mr. CRiPPS took the Fellowship in 1875. He is surgeon to St. Bartholomew’s Hospital and is well known for his work on the diseases of the rectum. Mr. EvE obtained his Fellowship in 1878. He is surgeon to the London Hospital and was formerly pathological curator at the College. Mr. BRUCE CLARKE is surgeon to St. Bartholomew’s Hospital, having taken his Fellowship in He has evinced an interest in the affairs of the 1879.