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The place of the medical officer of health in research
PUBLIC
HEALTH,
June,
z955
(12) A s c h e m e devised on t h e lines indicated at t h e p e r i p h e r y would, w i t h t h e m o s t economical use of medical m a n p o w e r , b r i n g to t h e service of t h e work t h e doctors b e s t e q u i p p e d b y t h e i r training, experience a n d knowledge of local conditions a n d w o u l d p r o v i d e t h e m o s t efficient link w i t h t h e related local services. I t w o u l d enable m a n a g e m e n t s w h o are desirous of m a i n t a i n i n g private services so to do a n d it would f o r m a u n i t w o r k i n g in direct association w i t h w h a t e v e r central organisation is devised to oversee t h e national pattern.
T H E PLACE O F THE MEDICAL OFFICER OF H E A L T H I N RESEARCH* I n c o n s i d e r i n g t h e place of t h e M e d i c a l Officer of H e a l t h in research, a n d t h e f u n c t i o n s of t h e R e s e a r c h C o m m i t t e e itself, two m a t t e r s are i n v o l v e d in a d d i t i o n to t h e p r i m a r y i s s u e : (a) a consideration of w h a t s h o u l d p r o p e r l y b e r e g a r d e d as research ; (b) t h e research actually u n d e r t a k e n b y executive public h e a l t h d e p a r t m e n t s in r e c e n t years a n d t h e factors w h i c h have d e t e r m i n e d its v o l u m e . F o r c o n v e n i e n c e in d r a f t i n g a n d b e c a u s e m o s t o f t h e p r o b l e m s c o n s i d e r e d c o n c e r n t h e M e d i c a l Officer of H e a l t h , we h a v e referred in m o s t places in t h e report only to t h e M . O . H . a n d t h e local h e a l t h d e p a r t m e n t . It should, h o w ever, b e u n d e r s t o o d t h a t like p r o b l e m s arise f o r m e d i c a l officers in t h e Services a n d c e n t r a l g o v e r n m e n t d e p a r t m e n t s a n d for D e p a r t m e n t a l M e d i c a l Officers in local g o v e r n m e n t , m a n y of w h o m are m e m b e r s of t h e Society. W i t h suitable modifications in w o r d i n g o u r o b s e r v a t i o n s apply to t h e m equally.
I n v e s t i g a t i o n a Part o f the M.O.H.'s O r d i n a r y D u t i e s I t is an accepted part of t h e M . O . H . ' s d u t y to i n f o r n l h i m s e l f a b o u t a wide range of p r o b l e m s related to h e a l t h a n d disease i n his area. F o r this p u r p o s e h e m a k e s investigations of o n e sort or a n o t h e r a l m o s t w i t h o u t i n t e r m i s s i o n . S u c h investigations afford a good i n d i c a t i o n of t h e M . O . H . ' s field of specialisation, b u t c a n n o t as a rule b e classed as research. N o h a r d a n d fast line can b e d r a w n b e t w e e n t h e o r d i n a r y investigations carried out b y every M . O . H . a n d research proper, b u t a n u m b e r of practical tests can b e applied. Broadly, investigations u n d e r t a k e n b y t h e M . O . H . as a p u b l i c h e a l t h p r a c t i t i o n e r have implications w h i c h t e n d to b e local r a t h e r t h a n general. T h e y t e n d to be c o n c e r n e d r a t h e r w i t h i m m e d i a t e practical p r o b l e m s of a d m i n i s t r a t i o n t h a n w i t h m o r e f u n d a m e n t a l or l o n g - t e r m objectives, a n d t h e y are n o t i n t e n d e d p r i m a r i l y to add to t h e existing b o d y of systematised knowledge. As a rule these investigations are p u b l i s h e d only in reports i n t e n d e d primarily for t h e M.O.H.'s own Authority. P o i n t for point, researches p r o p e r have converse characteristics. T h e distinction is i m p o r t a n t because investigations a n d enquiries n o t a m o u n t i n g to research can usually be p l a n n e d a n d u n d e r t a k e n w i t h o u t any q u e s t i o n of outside help or special authorisation b y t h e local a u t h o r i t y concerned. S u c h investigations, w h i c h c o n s t i t u t e t h e great b u l k of investigations b y local h e a l t h d e p a r t m e n t s , are c o n s e q u e n t l y unlikely to c o n c e r n t h e Society's R e s e a r c h , C o m m i t t e e . Types of Research T h e r e is n o t h i n g to p r e c l u d e t h e M . O . t t . f r o m taking p a r t in research in any field of m e d i c i n e , b u t in practice h e is in p r e s e n t circumstances less likely to u n d e r t a k e researches b a s e d on specialised laboratory t e c h n i q u e s t h a n t ~ p u r s u e studies in t h e field. T h e direct investigation of physical factors affecting h e a l t h a n d disease--e.g., p r o b l e m s of bacteriology, virology, applied physiology a n d e x p e r i m e n t a l p s y c h o l o g y - - u s u a l l y requires w e l I - e q u i p p e d laboratories a n d specialised t e c h n i q u e s n o longer p r o v i d e d w i t h i n t h e f r a m e work of h e a l t h d e p a r t m e n t s in Britain. * A report by the Research Committee, Society of Medical Officers of Health, adopted by the Council "of the Society on May 13th, 19,55.
I n v e s t i g a t i o n s into s u c h m a t t e r s as air pollution, the heating a n d v e n t i l a t i o n of dwellings, a n d s a n i t a w p r o c e d u r e s , still provide f r u i t f u l fields of e n q u i r y a n d have p e r h a p s b e e n u n d u l y neglected in r e c e n t years. W i t h o u t u n d e r e s t i m a t i n g t h e i r i m p o r t a n c e , however, it seems clear that t h e M . O . H . ' s u n i q u e area of research is the c o n m m n i t y in its total setting. S o m e researches in this field have objectives w h i c h are p r i m a r i l y a d m i n i s t r a t i v e . T h e y include : - (1) T h e a s s e s s m e n t of medical care a n d social needs. (2) So-called o p e r a t i o n a l investigations. (3) Evaluative investigations. E x a m p l e s of investigations u n d e r each of these h e a d i n g s will readily o c c u r to a n y o n e familiar w i t h p r e s e n t - d a y p u b l i c h e a l t h a n d welfare services. T h e a s s e s s m e n t of m e d i c a l care a n d social n e e d s includes for i n s t a n c e s u c h familiar p r o b l e m s as t h e medical a n d n u r s i n g s u p e r v i s i o n of t h e sick child, a n d t h e special needs of h a n d i c a p p e d p e r s o n s a n d t h e aged a n d infirm. T h e expression " operational i n v e s t i g a t i o n s '~ refers p a r t i c u l a r l y to studies d e s i g n e d to m e a s u r e t h e efficiency of existing services such, for instance, as studies of t h e way in w h i c h h o m e n u r s i n g services, h o m e help services, infant welfare services or day n u r s e r i e s are b e i n g used. Evaluative investigations include particularly field trials, s u c h as t h e r e c e n t w h o o p i n g c o u g h i m n m n i s a t i o n trials a n d t h e controlled trials o f a n t i g e n s a g a i n s t poliomyelitis n o w in progress in t h e U . S . A . T h e y include also i n v e s t i g a t i o n s w i t h a m o r e a d m i n i s t r a t i v e flavour such, for instance, as studies to m e a s u r e t h e efficacy of a h e a l t h e d u c a t i o n a l or p u b l i c i t y campaign, or the v a l u e of s u c h p r o c e d u r e s as r o u t i n e school medical inspection, h e a l t h visiting for this or t h a t purpose, or t h e r o u t i n e u s e of medical staff in i n f a n t welfare work. T o some e x t e n t the classification is arbitrary, b u t it is useful for d i s t i n g u i s h i n g i m p o r t a n t sectors of research w h i c h are of special interest to executive h e a l t h d e p a r t m e n t s . O f t e n investigations in these classes are a n a t u r a l p a r t fo t h e M . O . H . ' s o r d i n a r y duties, b u t in t h e i r m o r e e l a b o r a t e f o r m s they can b e r e g a r d e d as t r u e research. O t h e r investigations w i t h i n t h e p r o v i n c e of p u b l i c hOalth are clearly deliberate research projects, e m b r a c i n g o n t h e o n e h a n d investigations of an a n t h r o p o m e t r i c n a t u r e a n d o n t h e other, e n q u i r i e s into t h e mass aspects of h e a l t h a n d disease. S o m e of t h e investigations in these g r o u p s have for t h e i r objective to state t h e i n c i d e n c e or p r e v a l e n c e of particular diseases or disabilities i n a particular age g r o u p or s e g m e n t of t h e population. Others, c o m m o n l y s u b s u m e d u n d e r the h e a d i n g of epidemiological studies, seek to elucidate aetiological questions b y d i s c o v e r i n g the e n v i r o n m e n t a l associations of disease. I t will n o t escape a t t e n t i o n t h a t t h e c o m p l e t e a s c e r t a i n m e n t of conditions in local c o m m u n i t i e s often requires t h a t clinical data m u s t b e m a d e available b y medical care services in t h e area, e.g., G e n e r a l P r a c t i t i o n e r s a n d Medical Staffs of t h e Regional H o s p i t a l Boards. All t h e investigations m e n t i o n e d d e p e n d on field surveys at some point, a n d usually involve t h e use of statistical m e t h o d s . I t is in t h e s e areas t h a t t h e M . O . H . can m o s t obviously m a k e a special c o n t r i b u t i o n to medical or socialm e d i c a l r e s e a r c h - - a n d this is e q u a l l y t r u e w h e t h e r t h e M . O . H . i s ' w o r k i n g alone or in collaboration w i t h others. It is obviously a d v a n t a g e o u s if t h e M . O . H . h a d a recognised status in the medical care services. T h e various investigations u n d e r t a k e n b y the M . O s . H . alad t h e staffs of h e a l t h d e p a r t m e n t s can also be d i s t i n g u i s h e d for t h e p r e s e n t p u r p o s e a c c o r d i n g to t h e i r alternative m o d e s of origin--i.e. : - (1) Projects initiated w i t h i n the. local h e a l t h d e p a r t m e n t itself.*
* ]~I.Os.tt. are not infrequently asked by a colleague, often another M.O.H. who is undertaking an investigation in his own area, to follow up families who have moved. \Ve have not given work of this kind a separate heading, hut we recognise its value and importance
x46 (2) Projects which owe their inception to central authorities, permanent or ad hoc research bodies, or to other bodies of a national or regional character. (3) T h e Committee can assist officers who initiate research by approaching suitable bodies to invite their collaboration with the Society or its members. Whilst the Committee would like to play an active part in the conduct of enquiries in the field, because of the lack of adequate facilities it is quite impossible to do so. (4) T h e Committee's main function will be to act as a clearing house--i.e., it is a suitable body for scrutinising and co-ordinating requests for help by M.Os.H. in the conduct of investigations initiated by national or other bodies. This applies especially when the collaboration of several medical officers in different parts of the country is solicited. We are satisfied that the Committee has already proved useful in this way. (5) As a rule, there would be no advantage in involving the Committee when a research project requires collaboration between an academic department or other body and one M.O.H. only. T h e Committee could, however, be the more useful generally if it were kept informed of any s u c h arrangements. (6) We do not think the Committee can do much directly to stimulate an increase in the volume of research coming out of local health departments. T h e y might, however, do so indirectly in several ways :w(a) By forging links between the public health service on the one hand and academic departments and the general practitioner service on the other. We think, for instance, that a representative of the College of General Practitioners, should be invited to serve on the Research Committee and also that it should be suggested to the College that they might consider the nomination of a member of the public health service to their local faculties. (b) By encouraging M.Os.H. to provide opportunities for M.Os. in health departments to undertake longterm studies. This would not only add to the prestige • of the public health service but would give an added interest to the work o f the Assistant M.O. (c) By drawing the attention of those concerned to ,the difficulties and obstacles referred to earlier in our report, and to any arising in the future. (7) Finally, we repeat that although the Committee can help medical officers in the ways we have suggested, no Committee can provide a substitute for individual initiative. T h i s applies with equal force to research projects in which the health department is associated with other bodies, such as Service Departments, T h e Ministry of National Insurance, general practitioners and so forth. So far as enquiries initiated locally are concerned, the M.O.H. should suggest lines of research to medical officers in his Department, encourage them to pursue investigations and help with their planning. T o do these things should be regarded as a natural extension of the M.O.H.'s primary duties.
O r g a n i s a t i o n of the R e s e a r c h C o m m i t t e e ' s W o r k We make the following suggestions which we think should be taken into account in organising the Committee's work. (1) T h e Committee as at present constituted is, in our view, too big to meet regularly for the purpose of dealing with purely routine enquiries. (2) It should meet--as required--to receive reports and to discuss matters of general policy. (3) It would be an advantage to appoint a small Advisory Panel consisting of, say, three or four members, to whom the Medical Secretary could refer questions, either indivitually or collectively as the occasion arose. (4) T h e Secretariat of the Society should deal with routine enquiries and maintain records of projects brought to its attention. (5) T h e report finally approved by the Council should be publicised to members of the Society and to University
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~955
Departments. It would be an advantage if the co-operation of University Dep~rtments on the basis of the report could be invited by the President acting with the authority of the Society. Projects requiring investigation on a nation-wide scale and projects for investigating differences between representative areas in different parts of the country also almost inevitably fall into the second category. We recall here that the Research Committee was originally set up because of the large number of requests for assistance that were received from the organisers of research projects, and it was considered that large-scale enquiries which needed the help of Public Health Departments, should be actively co-sponsored by the Society. A review of the enquiries considered by the Research Committee since its appointment in 1951 shows that most of the problems referred to it fall under the second heading above, i.e., instructed by outside bodies. T h e y have included : - (a) Poliomyelitis and Inoculations--referred by Ministry of Health and M.R.C. (b) Infant Morbidity and Mortality--referred by the Department of Preventive Medicine, Welsh National School. (c) Child Development--referred by Joint Committee, Population Investigation Committee and Institute of Child Health. (d) T h e Future of Child Welfare Clinics--referred by M.C.W. Group. (e) T h e Effects of Work during Pregnancy--referred by National Birthday Tr u st Fund. (f) Retrolental Fibroplasia--referred by Ministry of Health. (g) O t h e r : Survey of Illegitimate C h i l d r e n , District Nursing Records, Contamination of Bathing Beaches, A Cancer Enquiry, Milkless Babies and .Breast Cancer. R e s e a r c h A c t i v i t i e s o f L o c a l H e a l t h Authorities i n R e c e n t Years Although a great many local investigations are always in progress, the small volume of research work published in recent years requires explaining. T h e situation should be viewed first of all against a background of wider changes. Social-medical research was running at an unusually high level in the immediate post-war period and especially at the time the Society's Committee was established. Since then the volume has assumed more modest, but probably more normal proportions. The development of academic departments of social .medicine and social science at many Universities and extensions of the research activities of the General Register Office arid the Medical Research Council in post-war years have also tended to limit the area of independent investigations open to local health departments. T h e operation of these factors is not, however, the whole explanation. Research requires a combination of vision, will and means, which has apparently been relatively tess common in public health departments during the post-war period, than in earlier years. All true research involves the vision to see what is needed, the will to pursue distant objectives and access to the instruments and facilities appropriate to the task in hand. Younger members of the service may require assistance in preparing the results of their work in suitable form for publication. It cannot be expected that more than a fraction of doctors in any branch of medicine will have the personal qualities and the" opportunities needed to initiate elaborate investigations and carry them to completion. For a number of reasons the present period is probably one of unusual difficulty in the public health field. Since the National Health Service Act became operative the M.O.H. has not had access to clinical data in many fields where such data was previously available to him. A generation ago the M.O.H. had a training in sanitary and laboratory sciences which matched the outstanding problems of the time. T h e important unsolved problems now facing the M.O.H. require a different technical training
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HEALTH,
June,
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- - a n e x p e r t n e s s in t h e u s e of statistical m e t h o d s , field s u r v e y t e c h n i q u e s a n d t h e analytical p r o c e d u r e s u n d e r l y i n g h m n a n genetic theory. T h e s e subjects have n o t h a d a p r o m i n e n t place i n D . P . H . courses for m o r e t h a n a few years, a n d in c o n s e q u e n c e n o t every s e n i o r m a n in t h e ranks of public h e a l t h is practised in t h e i r u s e as r e s e a r c h tools. I t is t h e case, m o r e o v e r , t h a t n o m o r e t h a n a h a n d f u l of local h e a l t h d e p a r t m e n t s yet e m p l o y t h e services of a statistical officer, or deploy t h e m e c h a n i c a l devices for coding, c o u n t i n g a n d s o r t i n g operations w h i c h are n e e d e d for large-scale enquiries. Insfances of Local A u t h o r i t i e s failing to s u p p o r t t h e M . O . H . w i s h i n g to u n d e r t a k e r e s e a r c h m u s t b e rare. N o n e has b e e n b r o u g h t to o u r notice, n o r have we any evidence t h a t financial obstacles have affected t h e situation to any c o n s i d e r a b l e extent. F o r m o s t of t h e research work initiated w i t h i n t h e d e p a r t m e n t t h e M . O . H . usually has access to t h e resources h e n e e d s w i t h o u t t h e q u e s t i o n of additional e x p e n d i t u r e arising. ( W e except f r o m this s t a t e m e n t t h e p r o v i s i o n of a suitably e q u i p p e d statistical section to w h i c h we r e f e r r e d earlier.) T h e t e n d e n c y for academic d e p a r t m e n t s a n d research bodies to a p p o i n t p e r s o n s to p e r m a n e n t or l o n g - t e r m posts to supervise or c o n d u c t research has, we t h i n k , b e e n a n o t h e r factor c o n t r i b u t i n g to t h e decline in t h e v o l u m e of researches initiated in local h e a l t h d e p a r t m e n t s . I t is a factor w h i c h operates in two ways. It t e n d s to d e n y t h e necessary postd i p l o m a e x p e r i e n c e to m e n w h o will e n t e r t h e executive services, a n d increases t h e risk of field research b e c o m i n g to b e r e g a r d e d as t h e exclusive b u s i n e s s of t h e w h o l e - t i m e specialist. A n y staffing a r r a n g e m e n t s w h i c h would facilitate ,interchange b e t w e e n a c a d e m i c a n d executive fields would clearly b e beneficial. W e t h i n k also t h a t m o r e M . O s . H . w o u l d b e likely to u n d e r t a k e research work if t h e d i p l o m a courses indicated to a greater extent t h a n at p r e s e n t t h e gaps in k n o w l e d g e w h i c h local h e a l t h d e p a r t m e n t s m i g h t help to close.
Finally, we w o u l d stress t h a t successful large-scale investigations in t h e field often require at some stage t h e collaboration of academic d e p a r t m e n t s or research institutes. T h e M . O . H . , like his colleagues in o t h e r b r a n c h e s Of medicine, has in the past t e n d e d to an i n d i v i d u a l i s m w h i c h is s o m e t i m e s out of k e e p i n g w i t h t h e r e q u i r e m e n t s of t h e m o d e r n world. I t s h o u l d b e realised that m o s t investigations initiated and c o n d u c t e d exclusively by a local h e a l t h d e p a r t m e n t in isolation c a n n o t b e m o r e t h a n pilot enquiries, i m p o r t a n t as they are. It is only rarely t h a t elaborate investigations can be p l a n n e d a n d u n d e r t a k e n w i t h o u t t e a m - w o r k of a high o r d e r a n d the r i g h t links to e n s u r e this have n o t yet b e e n forged in m o r e t h a n a few areas. T h e s e also are facts w h i c h any realistic appraisal of t h e p r e s e n t status of t h e local h e a l t h d e p a r t m e n t in research m u s t take into account.
F u n c t i o n s o f the R e s e a r c h C o m m i t t e e W e are n o w in a position to suggest w h a t t h e A d v i s o r y C o m m i t t e e can be expected to do a n d w h a t it c a n n o t h o p e to do. F i r s t of all we wish to state t h a t o u r r e - e x a m i n a t i o n of t h e C o m m i t t e e ' s f u n c t i o n s a n d a review of t h e work it has d o n e since its i n c e p t i o n in 1951 has satisfied us o n t h r e e p o i n t s : - (1) T h e C o m m i t t e e ' s aims as originally declared are fundamentally sound. (2) T h e C o m m i t t e e has in fact served t h e p u r p o s e s intended. (3) So far as we can foresee, its f u t u r e role will n o t b e greatly dissimilar f r o m t h e role it has already fulfilled. W e have r e a c h e d t h e following particular c o n c l u s i o n s about the Committee's functions :-(1) T h o u g h it can o f t e n r e n d e r valuable help in ways m e n t i o n e d later, t h e C o m m i t t e e c a n n o t in o u r view i n i t i a t e research or play an active p a r t in t h e c o n d u c t of e n q u i r i e s a n d investigations. N e i t h e r can it, w i t h o u t i n c u r r i n g i m p l i e d
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PUBLIC HEALTH, June,
responsibilities which will be difficult to discharge, make specific suggestions to individuals for research or encourage individuals to undertake research work. T h e Society of Medical Officers of Health has neither the staff nor the resources to undertake these activities. (2) Only in a limited sense can the Committee advise individual medical officers about investigations initiated by them. It cannot proffer technical advice, but it can advise them about investigations known to be going on elsewhere-and thus help avoid needless duplication. In some instances, it can offer general guidance on ways and means. It might also sometimes be instrumental in putting an individual medical officer of health in touch with a person or an institution which is able to give assistance of a technical nature. THE M A Y COUNCIL MEETING
(Concluded from page 130). supervision o f the conduct of the visiting parents would be necessary. (c) T h e wearing of protective clothing by visitors and the application to them of the routine measures for the prevention of the spread of infection which are applicable to nursing staff engaged in.cubicle nursing. T h i s would necessarily include the proper use of adequate ablution facilities. (d) T h e visitation of some cases of infectious disease should not be permitted at all, e.g., smallpox and some types of cases of intestinal infection. (e) Visiting should be limited in general to parents and guardians, and children of school age or under should not be permitted to visit, except in very exceptional circumstances. 4. It is considered essential that the ultimate decision on the question of pemlitting visits by relatives must depend on the individual circumstances in relation to each patient in infectious diseases hospitals and must remain with the medical officers of the hospital. T h e possible risk of a visitor becoming a carrier and taking the infection to other children at home (e.g., diphtheria, scarlet fever, poliomyelitis) must be fully considered in relation to the individual home and family circumstances." Food ana~ Drugs Amendment Act, 1954.--The Council endorsed the action of the General Purposes Committee in deciding to make no comment on the proposals of the Ministry of Food regarding (a) the Mineral Oil in Food Order, and (b) Butter, Margarine and Margarine Cheese Regulations. T h e Ministry proposed, under (a) to recommend an amendment to the Order so that the requirements should not include chewing compounds which had not more than 12.5% of microcrystalline wax of a statutory specification of purity. T h e proposals, under (b), had been .drawn up after consideration of representations by interested bodies, including the Society of Medical Officers of Health. Centenary Year President.--The Council then dealt formally with the question of the election of a President for the Centenary Year of the Society. Only one nomination had been received, namely, that of Dr. Charles F. White, Medical Officer of Health of the City of London, by the "Metropolitan Branch supported by all other Branches and Groups. In accordance with the Articles of Association, therefore, Dr. Charles White's name was forwarded to the Ordinary Meeting following for formal election. Election of Officers.--The following other officers for the Session 1955-56 were elected : Chairman of CounciL--Dr. C. Metcalfe Brown. Three Vice-Presidents.--Dr. J. M. Gibson, Dr. Andrew Topping and Dr~ Jean M. Mackintosh. Honorary Treasurer.--Dr. C. E. E. Herington. B.M,A. Public Health Committee.--The Council appointed Drs. Llywelyn Roberts and H. M. Cohen as its representatives to serve on the Public Health Committee of the B.M.A. for the ensuing year.
1955
National Medical Manpower Committee.--It was resolved that Dr. H. D. Chalke be nominated for membership of the National Medical Manpower Committee for the ensuing three years. Food Hygiene.--The Council considered the announcement of the Ministry of Agriculture, Fisheries and Food, that they had appointed a Food Hygiene Advisory Council. Its membership would provide that 11 members would represent the public, three the trades, and three the workers in the trades. It appeared that there was no intention to appoint a representative to express a medical or technical opinion. It was agreed that a letter be addressed to the Minister in this connection, in support of action already taken by the British Medical Association. Recruitment to Medical Profession.--The Council appointed the President, Chairman of Council, Chairman of General Purposes Committee and Professor C. Fraser Brockington a Committee to prepare evidence for the Committee set up by the Ministry of Health : " T o estimate, on a long-term basis and with due regard to all relevant considerations, the number of medical practitioners likely to be engaged in all branches of the profession in the future, and the consequential intake of medical students required." Refresher Courses for Midwives.--A letter was received from the Royal College of Midwives referring to the fact that the Refresher Courses arranged by the Royal College had been approved by the Board to meet the requirements of the Board that attendance at refresher courses by midwives would be compulsory after December 31st, 1957. It was resolved that the Royal College of Midwives be informed that the Society was quite confident that the courses arranged by them would meet the l~eeds of midwives and did not Wish to offer advice or suggestions at this stage.
The Editor regrets that pressure on space necessitates the holding over of the report of the Ordinary Meeting of the Society of May 13th and of a number of reports of Branch and Group Meeting's. The Medical Whitley Council Committee C has issued M.D.C. Circular No. 24 dated June 1st, 1955, to all local authorities. It accepts the recent Award by the Industrial Court, and recommends that it be put into effect as from January 1st, 1955. It also deals with scales for Deputy M.O.H.s and Divisional or Area M.P.s.
SOCIETY OF MEDICAL OFFICERS OF HEALTH Medical Secretary The Society of Medical Officers of Health invite applications for the post of Medical Secretary (part-time). The salary offered is within the scale ~75o to ~I,OOO. Applications endorsed "Medical Secretary," and containing full details of the applicant's profesional career should be forwarded to the undersigned, and must be received not later than July ist. MEDICAL SECRETARY.
Tavistock House South, Tavistock Square, W.C.I.
Society o[ Medical O~cers of Health.
MEDICAL RESEARCH COUNCIL Require a medically-qualified man or woman, about 30 years of age, for work in tiaeir headquarters office concerned with administrative aspects of research. Organizing ability and clarity of expression in speecix and writing are desirable qualities, and some resarch experience, although not essent i a l would be an advantage. Salary ~I,285 (linked with age 3o) rising to ~2,IOO. Possibility of promotion to higher posts. Superannuation--F.S.S.U. Appointment probationary for two yea~s; if probation served satisfactorily appointment will be permanent.---Apply by letter (full details education, experience and names and addresses of two or more professional referees) to Establishment Officer of the Council, 38 , Old Queen Street, \Vestminster, S.W.I.
HEALTH,
June,
z955
(12) A s c h e m e devised on t h e lines indicated at t h e p e r i p h e r y would, w i t h t h e m o s t economical use of medical m a n p o w e r , b r i n g to t h e service of t h e work t h e doctors b e s t e q u i p p e d b y t h e i r training, experience a n d knowledge of local conditions a n d w o u l d p r o v i d e t h e m o s t efficient link w i t h t h e related local services. I t w o u l d enable m a n a g e m e n t s w h o are desirous of m a i n t a i n i n g private services so to do a n d it would f o r m a u n i t w o r k i n g in direct association w i t h w h a t e v e r central organisation is devised to oversee t h e national pattern.
T H E PLACE O F THE MEDICAL OFFICER OF H E A L T H I N RESEARCH* I n c o n s i d e r i n g t h e place of t h e M e d i c a l Officer of H e a l t h in research, a n d t h e f u n c t i o n s of t h e R e s e a r c h C o m m i t t e e itself, two m a t t e r s are i n v o l v e d in a d d i t i o n to t h e p r i m a r y i s s u e : (a) a consideration of w h a t s h o u l d p r o p e r l y b e r e g a r d e d as research ; (b) t h e research actually u n d e r t a k e n b y executive public h e a l t h d e p a r t m e n t s in r e c e n t years a n d t h e factors w h i c h have d e t e r m i n e d its v o l u m e . F o r c o n v e n i e n c e in d r a f t i n g a n d b e c a u s e m o s t o f t h e p r o b l e m s c o n s i d e r e d c o n c e r n t h e M e d i c a l Officer of H e a l t h , we h a v e referred in m o s t places in t h e report only to t h e M . O . H . a n d t h e local h e a l t h d e p a r t m e n t . It should, h o w ever, b e u n d e r s t o o d t h a t like p r o b l e m s arise f o r m e d i c a l officers in t h e Services a n d c e n t r a l g o v e r n m e n t d e p a r t m e n t s a n d for D e p a r t m e n t a l M e d i c a l Officers in local g o v e r n m e n t , m a n y of w h o m are m e m b e r s of t h e Society. W i t h suitable modifications in w o r d i n g o u r o b s e r v a t i o n s apply to t h e m equally.
I n v e s t i g a t i o n a Part o f the M.O.H.'s O r d i n a r y D u t i e s I t is an accepted part of t h e M . O . H . ' s d u t y to i n f o r n l h i m s e l f a b o u t a wide range of p r o b l e m s related to h e a l t h a n d disease i n his area. F o r this p u r p o s e h e m a k e s investigations of o n e sort or a n o t h e r a l m o s t w i t h o u t i n t e r m i s s i o n . S u c h investigations afford a good i n d i c a t i o n of t h e M . O . H . ' s field of specialisation, b u t c a n n o t as a rule b e classed as research. N o h a r d a n d fast line can b e d r a w n b e t w e e n t h e o r d i n a r y investigations carried out b y every M . O . H . a n d research proper, b u t a n u m b e r of practical tests can b e applied. Broadly, investigations u n d e r t a k e n b y t h e M . O . H . as a p u b l i c h e a l t h p r a c t i t i o n e r have implications w h i c h t e n d to b e local r a t h e r t h a n general. T h e y t e n d to be c o n c e r n e d r a t h e r w i t h i m m e d i a t e practical p r o b l e m s of a d m i n i s t r a t i o n t h a n w i t h m o r e f u n d a m e n t a l or l o n g - t e r m objectives, a n d t h e y are n o t i n t e n d e d p r i m a r i l y to add to t h e existing b o d y of systematised knowledge. As a rule these investigations are p u b l i s h e d only in reports i n t e n d e d primarily for t h e M.O.H.'s own Authority. P o i n t for point, researches p r o p e r have converse characteristics. T h e distinction is i m p o r t a n t because investigations a n d enquiries n o t a m o u n t i n g to research can usually be p l a n n e d a n d u n d e r t a k e n w i t h o u t any q u e s t i o n of outside help or special authorisation b y t h e local a u t h o r i t y concerned. S u c h investigations, w h i c h c o n s t i t u t e t h e great b u l k of investigations b y local h e a l t h d e p a r t m e n t s , are c o n s e q u e n t l y unlikely to c o n c e r n t h e Society's R e s e a r c h , C o m m i t t e e . Types of Research T h e r e is n o t h i n g to p r e c l u d e t h e M . O . t t . f r o m taking p a r t in research in any field of m e d i c i n e , b u t in practice h e is in p r e s e n t circumstances less likely to u n d e r t a k e researches b a s e d on specialised laboratory t e c h n i q u e s t h a n t ~ p u r s u e studies in t h e field. T h e direct investigation of physical factors affecting h e a l t h a n d disease--e.g., p r o b l e m s of bacteriology, virology, applied physiology a n d e x p e r i m e n t a l p s y c h o l o g y - - u s u a l l y requires w e l I - e q u i p p e d laboratories a n d specialised t e c h n i q u e s n o longer p r o v i d e d w i t h i n t h e f r a m e work of h e a l t h d e p a r t m e n t s in Britain. * A report by the Research Committee, Society of Medical Officers of Health, adopted by the Council "of the Society on May 13th, 19,55.
I n v e s t i g a t i o n s into s u c h m a t t e r s as air pollution, the heating a n d v e n t i l a t i o n of dwellings, a n d s a n i t a w p r o c e d u r e s , still provide f r u i t f u l fields of e n q u i r y a n d have p e r h a p s b e e n u n d u l y neglected in r e c e n t years. W i t h o u t u n d e r e s t i m a t i n g t h e i r i m p o r t a n c e , however, it seems clear that t h e M . O . H . ' s u n i q u e area of research is the c o n m m n i t y in its total setting. S o m e researches in this field have objectives w h i c h are p r i m a r i l y a d m i n i s t r a t i v e . T h e y include : - (1) T h e a s s e s s m e n t of medical care a n d social needs. (2) So-called o p e r a t i o n a l investigations. (3) Evaluative investigations. E x a m p l e s of investigations u n d e r each of these h e a d i n g s will readily o c c u r to a n y o n e familiar w i t h p r e s e n t - d a y p u b l i c h e a l t h a n d welfare services. T h e a s s e s s m e n t of m e d i c a l care a n d social n e e d s includes for i n s t a n c e s u c h familiar p r o b l e m s as t h e medical a n d n u r s i n g s u p e r v i s i o n of t h e sick child, a n d t h e special needs of h a n d i c a p p e d p e r s o n s a n d t h e aged a n d infirm. T h e expression " operational i n v e s t i g a t i o n s '~ refers p a r t i c u l a r l y to studies d e s i g n e d to m e a s u r e t h e efficiency of existing services such, for instance, as studies of t h e way in w h i c h h o m e n u r s i n g services, h o m e help services, infant welfare services or day n u r s e r i e s are b e i n g used. Evaluative investigations include particularly field trials, s u c h as t h e r e c e n t w h o o p i n g c o u g h i m n m n i s a t i o n trials a n d t h e controlled trials o f a n t i g e n s a g a i n s t poliomyelitis n o w in progress in t h e U . S . A . T h e y include also i n v e s t i g a t i o n s w i t h a m o r e a d m i n i s t r a t i v e flavour such, for instance, as studies to m e a s u r e t h e efficacy of a h e a l t h e d u c a t i o n a l or p u b l i c i t y campaign, or the v a l u e of s u c h p r o c e d u r e s as r o u t i n e school medical inspection, h e a l t h visiting for this or t h a t purpose, or t h e r o u t i n e u s e of medical staff in i n f a n t welfare work. T o some e x t e n t the classification is arbitrary, b u t it is useful for d i s t i n g u i s h i n g i m p o r t a n t sectors of research w h i c h are of special interest to executive h e a l t h d e p a r t m e n t s . O f t e n investigations in these classes are a n a t u r a l p a r t fo t h e M . O . H . ' s o r d i n a r y duties, b u t in t h e i r m o r e e l a b o r a t e f o r m s they can b e r e g a r d e d as t r u e research. O t h e r investigations w i t h i n t h e p r o v i n c e of p u b l i c hOalth are clearly deliberate research projects, e m b r a c i n g o n t h e o n e h a n d investigations of an a n t h r o p o m e t r i c n a t u r e a n d o n t h e other, e n q u i r i e s into t h e mass aspects of h e a l t h a n d disease. S o m e of t h e investigations in these g r o u p s have for t h e i r objective to state t h e i n c i d e n c e or p r e v a l e n c e of particular diseases or disabilities i n a particular age g r o u p or s e g m e n t of t h e population. Others, c o m m o n l y s u b s u m e d u n d e r the h e a d i n g of epidemiological studies, seek to elucidate aetiological questions b y d i s c o v e r i n g the e n v i r o n m e n t a l associations of disease. I t will n o t escape a t t e n t i o n t h a t t h e c o m p l e t e a s c e r t a i n m e n t of conditions in local c o m m u n i t i e s often requires t h a t clinical data m u s t b e m a d e available b y medical care services in t h e area, e.g., G e n e r a l P r a c t i t i o n e r s a n d Medical Staffs of t h e Regional H o s p i t a l Boards. All t h e investigations m e n t i o n e d d e p e n d on field surveys at some point, a n d usually involve t h e use of statistical m e t h o d s . I t is in t h e s e areas t h a t t h e M . O . H . can m o s t obviously m a k e a special c o n t r i b u t i o n to medical or socialm e d i c a l r e s e a r c h - - a n d this is e q u a l l y t r u e w h e t h e r t h e M . O . H . i s ' w o r k i n g alone or in collaboration w i t h others. It is obviously a d v a n t a g e o u s if t h e M . O . H . h a d a recognised status in the medical care services. T h e various investigations u n d e r t a k e n b y the M . O s . H . alad t h e staffs of h e a l t h d e p a r t m e n t s can also be d i s t i n g u i s h e d for t h e p r e s e n t p u r p o s e a c c o r d i n g to t h e i r alternative m o d e s of origin--i.e. : - (1) Projects initiated w i t h i n the. local h e a l t h d e p a r t m e n t itself.*
* ]~I.Os.tt. are not infrequently asked by a colleague, often another M.O.H. who is undertaking an investigation in his own area, to follow up families who have moved. \Ve have not given work of this kind a separate heading, hut we recognise its value and importance
x46 (2) Projects which owe their inception to central authorities, permanent or ad hoc research bodies, or to other bodies of a national or regional character. (3) T h e Committee can assist officers who initiate research by approaching suitable bodies to invite their collaboration with the Society or its members. Whilst the Committee would like to play an active part in the conduct of enquiries in the field, because of the lack of adequate facilities it is quite impossible to do so. (4) T h e Committee's main function will be to act as a clearing house--i.e., it is a suitable body for scrutinising and co-ordinating requests for help by M.Os.H. in the conduct of investigations initiated by national or other bodies. This applies especially when the collaboration of several medical officers in different parts of the country is solicited. We are satisfied that the Committee has already proved useful in this way. (5) As a rule, there would be no advantage in involving the Committee when a research project requires collaboration between an academic department or other body and one M.O.H. only. T h e Committee could, however, be the more useful generally if it were kept informed of any s u c h arrangements. (6) We do not think the Committee can do much directly to stimulate an increase in the volume of research coming out of local health departments. T h e y might, however, do so indirectly in several ways :w(a) By forging links between the public health service on the one hand and academic departments and the general practitioner service on the other. We think, for instance, that a representative of the College of General Practitioners, should be invited to serve on the Research Committee and also that it should be suggested to the College that they might consider the nomination of a member of the public health service to their local faculties. (b) By encouraging M.Os.H. to provide opportunities for M.Os. in health departments to undertake longterm studies. This would not only add to the prestige • of the public health service but would give an added interest to the work o f the Assistant M.O. (c) By drawing the attention of those concerned to ,the difficulties and obstacles referred to earlier in our report, and to any arising in the future. (7) Finally, we repeat that although the Committee can help medical officers in the ways we have suggested, no Committee can provide a substitute for individual initiative. T h i s applies with equal force to research projects in which the health department is associated with other bodies, such as Service Departments, T h e Ministry of National Insurance, general practitioners and so forth. So far as enquiries initiated locally are concerned, the M.O.H. should suggest lines of research to medical officers in his Department, encourage them to pursue investigations and help with their planning. T o do these things should be regarded as a natural extension of the M.O.H.'s primary duties.
O r g a n i s a t i o n of the R e s e a r c h C o m m i t t e e ' s W o r k We make the following suggestions which we think should be taken into account in organising the Committee's work. (1) T h e Committee as at present constituted is, in our view, too big to meet regularly for the purpose of dealing with purely routine enquiries. (2) It should meet--as required--to receive reports and to discuss matters of general policy. (3) It would be an advantage to appoint a small Advisory Panel consisting of, say, three or four members, to whom the Medical Secretary could refer questions, either indivitually or collectively as the occasion arose. (4) T h e Secretariat of the Society should deal with routine enquiries and maintain records of projects brought to its attention. (5) T h e report finally approved by the Council should be publicised to members of the Society and to University
PUBLIC HEALTH, June,
~955
Departments. It would be an advantage if the co-operation of University Dep~rtments on the basis of the report could be invited by the President acting with the authority of the Society. Projects requiring investigation on a nation-wide scale and projects for investigating differences between representative areas in different parts of the country also almost inevitably fall into the second category. We recall here that the Research Committee was originally set up because of the large number of requests for assistance that were received from the organisers of research projects, and it was considered that large-scale enquiries which needed the help of Public Health Departments, should be actively co-sponsored by the Society. A review of the enquiries considered by the Research Committee since its appointment in 1951 shows that most of the problems referred to it fall under the second heading above, i.e., instructed by outside bodies. T h e y have included : - (a) Poliomyelitis and Inoculations--referred by Ministry of Health and M.R.C. (b) Infant Morbidity and Mortality--referred by the Department of Preventive Medicine, Welsh National School. (c) Child Development--referred by Joint Committee, Population Investigation Committee and Institute of Child Health. (d) T h e Future of Child Welfare Clinics--referred by M.C.W. Group. (e) T h e Effects of Work during Pregnancy--referred by National Birthday Tr u st Fund. (f) Retrolental Fibroplasia--referred by Ministry of Health. (g) O t h e r : Survey of Illegitimate C h i l d r e n , District Nursing Records, Contamination of Bathing Beaches, A Cancer Enquiry, Milkless Babies and .Breast Cancer. R e s e a r c h A c t i v i t i e s o f L o c a l H e a l t h Authorities i n R e c e n t Years Although a great many local investigations are always in progress, the small volume of research work published in recent years requires explaining. T h e situation should be viewed first of all against a background of wider changes. Social-medical research was running at an unusually high level in the immediate post-war period and especially at the time the Society's Committee was established. Since then the volume has assumed more modest, but probably more normal proportions. The development of academic departments of social .medicine and social science at many Universities and extensions of the research activities of the General Register Office arid the Medical Research Council in post-war years have also tended to limit the area of independent investigations open to local health departments. T h e operation of these factors is not, however, the whole explanation. Research requires a combination of vision, will and means, which has apparently been relatively tess common in public health departments during the post-war period, than in earlier years. All true research involves the vision to see what is needed, the will to pursue distant objectives and access to the instruments and facilities appropriate to the task in hand. Younger members of the service may require assistance in preparing the results of their work in suitable form for publication. It cannot be expected that more than a fraction of doctors in any branch of medicine will have the personal qualities and the" opportunities needed to initiate elaborate investigations and carry them to completion. For a number of reasons the present period is probably one of unusual difficulty in the public health field. Since the National Health Service Act became operative the M.O.H. has not had access to clinical data in many fields where such data was previously available to him. A generation ago the M.O.H. had a training in sanitary and laboratory sciences which matched the outstanding problems of the time. T h e important unsolved problems now facing the M.O.H. require a different technical training
PUBLIC
HEALTH,
June,
i955
r47
- - a n e x p e r t n e s s in t h e u s e of statistical m e t h o d s , field s u r v e y t e c h n i q u e s a n d t h e analytical p r o c e d u r e s u n d e r l y i n g h m n a n genetic theory. T h e s e subjects have n o t h a d a p r o m i n e n t place i n D . P . H . courses for m o r e t h a n a few years, a n d in c o n s e q u e n c e n o t every s e n i o r m a n in t h e ranks of public h e a l t h is practised in t h e i r u s e as r e s e a r c h tools. I t is t h e case, m o r e o v e r , t h a t n o m o r e t h a n a h a n d f u l of local h e a l t h d e p a r t m e n t s yet e m p l o y t h e services of a statistical officer, or deploy t h e m e c h a n i c a l devices for coding, c o u n t i n g a n d s o r t i n g operations w h i c h are n e e d e d for large-scale enquiries. Insfances of Local A u t h o r i t i e s failing to s u p p o r t t h e M . O . H . w i s h i n g to u n d e r t a k e r e s e a r c h m u s t b e rare. N o n e has b e e n b r o u g h t to o u r notice, n o r have we any evidence t h a t financial obstacles have affected t h e situation to any c o n s i d e r a b l e extent. F o r m o s t of t h e research work initiated w i t h i n t h e d e p a r t m e n t t h e M . O . H . usually has access to t h e resources h e n e e d s w i t h o u t t h e q u e s t i o n of additional e x p e n d i t u r e arising. ( W e except f r o m this s t a t e m e n t t h e p r o v i s i o n of a suitably e q u i p p e d statistical section to w h i c h we r e f e r r e d earlier.) T h e t e n d e n c y for academic d e p a r t m e n t s a n d research bodies to a p p o i n t p e r s o n s to p e r m a n e n t or l o n g - t e r m posts to supervise or c o n d u c t research has, we t h i n k , b e e n a n o t h e r factor c o n t r i b u t i n g to t h e decline in t h e v o l u m e of researches initiated in local h e a l t h d e p a r t m e n t s . I t is a factor w h i c h operates in two ways. It t e n d s to d e n y t h e necessary postd i p l o m a e x p e r i e n c e to m e n w h o will e n t e r t h e executive services, a n d increases t h e risk of field research b e c o m i n g to b e r e g a r d e d as t h e exclusive b u s i n e s s of t h e w h o l e - t i m e specialist. A n y staffing a r r a n g e m e n t s w h i c h would facilitate ,interchange b e t w e e n a c a d e m i c a n d executive fields would clearly b e beneficial. W e t h i n k also t h a t m o r e M . O s . H . w o u l d b e likely to u n d e r t a k e research work if t h e d i p l o m a courses indicated to a greater extent t h a n at p r e s e n t t h e gaps in k n o w l e d g e w h i c h local h e a l t h d e p a r t m e n t s m i g h t help to close.
Finally, we w o u l d stress t h a t successful large-scale investigations in t h e field often require at some stage t h e collaboration of academic d e p a r t m e n t s or research institutes. T h e M . O . H . , like his colleagues in o t h e r b r a n c h e s Of medicine, has in the past t e n d e d to an i n d i v i d u a l i s m w h i c h is s o m e t i m e s out of k e e p i n g w i t h t h e r e q u i r e m e n t s of t h e m o d e r n world. I t s h o u l d b e realised that m o s t investigations initiated and c o n d u c t e d exclusively by a local h e a l t h d e p a r t m e n t in isolation c a n n o t b e m o r e t h a n pilot enquiries, i m p o r t a n t as they are. It is only rarely t h a t elaborate investigations can be p l a n n e d a n d u n d e r t a k e n w i t h o u t t e a m - w o r k of a high o r d e r a n d the r i g h t links to e n s u r e this have n o t yet b e e n forged in m o r e t h a n a few areas. T h e s e also are facts w h i c h any realistic appraisal of t h e p r e s e n t status of t h e local h e a l t h d e p a r t m e n t in research m u s t take into account.
F u n c t i o n s o f the R e s e a r c h C o m m i t t e e W e are n o w in a position to suggest w h a t t h e A d v i s o r y C o m m i t t e e can be expected to do a n d w h a t it c a n n o t h o p e to do. F i r s t of all we wish to state t h a t o u r r e - e x a m i n a t i o n of t h e C o m m i t t e e ' s f u n c t i o n s a n d a review of t h e work it has d o n e since its i n c e p t i o n in 1951 has satisfied us o n t h r e e p o i n t s : - (1) T h e C o m m i t t e e ' s aims as originally declared are fundamentally sound. (2) T h e C o m m i t t e e has in fact served t h e p u r p o s e s intended. (3) So far as we can foresee, its f u t u r e role will n o t b e greatly dissimilar f r o m t h e role it has already fulfilled. W e have r e a c h e d t h e following particular c o n c l u s i o n s about the Committee's functions :-(1) T h o u g h it can o f t e n r e n d e r valuable help in ways m e n t i o n e d later, t h e C o m m i t t e e c a n n o t in o u r view i n i t i a t e research or play an active p a r t in t h e c o n d u c t of e n q u i r i e s a n d investigations. N e i t h e r can it, w i t h o u t i n c u r r i n g i m p l i e d
METAFILTRATION THE METAFILTRATION COMPANY LIMITED, BELGRAVE ROAD, HOUNSLOW, MIDDLESEX •~
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148
PUBLIC HEALTH, June,
responsibilities which will be difficult to discharge, make specific suggestions to individuals for research or encourage individuals to undertake research work. T h e Society of Medical Officers of Health has neither the staff nor the resources to undertake these activities. (2) Only in a limited sense can the Committee advise individual medical officers about investigations initiated by them. It cannot proffer technical advice, but it can advise them about investigations known to be going on elsewhere-and thus help avoid needless duplication. In some instances, it can offer general guidance on ways and means. It might also sometimes be instrumental in putting an individual medical officer of health in touch with a person or an institution which is able to give assistance of a technical nature. THE M A Y COUNCIL MEETING
(Concluded from page 130). supervision o f the conduct of the visiting parents would be necessary. (c) T h e wearing of protective clothing by visitors and the application to them of the routine measures for the prevention of the spread of infection which are applicable to nursing staff engaged in.cubicle nursing. T h i s would necessarily include the proper use of adequate ablution facilities. (d) T h e visitation of some cases of infectious disease should not be permitted at all, e.g., smallpox and some types of cases of intestinal infection. (e) Visiting should be limited in general to parents and guardians, and children of school age or under should not be permitted to visit, except in very exceptional circumstances. 4. It is considered essential that the ultimate decision on the question of pemlitting visits by relatives must depend on the individual circumstances in relation to each patient in infectious diseases hospitals and must remain with the medical officers of the hospital. T h e possible risk of a visitor becoming a carrier and taking the infection to other children at home (e.g., diphtheria, scarlet fever, poliomyelitis) must be fully considered in relation to the individual home and family circumstances." Food ana~ Drugs Amendment Act, 1954.--The Council endorsed the action of the General Purposes Committee in deciding to make no comment on the proposals of the Ministry of Food regarding (a) the Mineral Oil in Food Order, and (b) Butter, Margarine and Margarine Cheese Regulations. T h e Ministry proposed, under (a) to recommend an amendment to the Order so that the requirements should not include chewing compounds which had not more than 12.5% of microcrystalline wax of a statutory specification of purity. T h e proposals, under (b), had been .drawn up after consideration of representations by interested bodies, including the Society of Medical Officers of Health. Centenary Year President.--The Council then dealt formally with the question of the election of a President for the Centenary Year of the Society. Only one nomination had been received, namely, that of Dr. Charles F. White, Medical Officer of Health of the City of London, by the "Metropolitan Branch supported by all other Branches and Groups. In accordance with the Articles of Association, therefore, Dr. Charles White's name was forwarded to the Ordinary Meeting following for formal election. Election of Officers.--The following other officers for the Session 1955-56 were elected : Chairman of CounciL--Dr. C. Metcalfe Brown. Three Vice-Presidents.--Dr. J. M. Gibson, Dr. Andrew Topping and Dr~ Jean M. Mackintosh. Honorary Treasurer.--Dr. C. E. E. Herington. B.M,A. Public Health Committee.--The Council appointed Drs. Llywelyn Roberts and H. M. Cohen as its representatives to serve on the Public Health Committee of the B.M.A. for the ensuing year.
1955
National Medical Manpower Committee.--It was resolved that Dr. H. D. Chalke be nominated for membership of the National Medical Manpower Committee for the ensuing three years. Food Hygiene.--The Council considered the announcement of the Ministry of Agriculture, Fisheries and Food, that they had appointed a Food Hygiene Advisory Council. Its membership would provide that 11 members would represent the public, three the trades, and three the workers in the trades. It appeared that there was no intention to appoint a representative to express a medical or technical opinion. It was agreed that a letter be addressed to the Minister in this connection, in support of action already taken by the British Medical Association. Recruitment to Medical Profession.--The Council appointed the President, Chairman of Council, Chairman of General Purposes Committee and Professor C. Fraser Brockington a Committee to prepare evidence for the Committee set up by the Ministry of Health : " T o estimate, on a long-term basis and with due regard to all relevant considerations, the number of medical practitioners likely to be engaged in all branches of the profession in the future, and the consequential intake of medical students required." Refresher Courses for Midwives.--A letter was received from the Royal College of Midwives referring to the fact that the Refresher Courses arranged by the Royal College had been approved by the Board to meet the requirements of the Board that attendance at refresher courses by midwives would be compulsory after December 31st, 1957. It was resolved that the Royal College of Midwives be informed that the Society was quite confident that the courses arranged by them would meet the l~eeds of midwives and did not Wish to offer advice or suggestions at this stage.
The Editor regrets that pressure on space necessitates the holding over of the report of the Ordinary Meeting of the Society of May 13th and of a number of reports of Branch and Group Meeting's. The Medical Whitley Council Committee C has issued M.D.C. Circular No. 24 dated June 1st, 1955, to all local authorities. It accepts the recent Award by the Industrial Court, and recommends that it be put into effect as from January 1st, 1955. It also deals with scales for Deputy M.O.H.s and Divisional or Area M.P.s.
SOCIETY OF MEDICAL OFFICERS OF HEALTH Medical Secretary The Society of Medical Officers of Health invite applications for the post of Medical Secretary (part-time). The salary offered is within the scale ~75o to ~I,OOO. Applications endorsed "Medical Secretary," and containing full details of the applicant's profesional career should be forwarded to the undersigned, and must be received not later than July ist. MEDICAL SECRETARY.
Tavistock House South, Tavistock Square, W.C.I.
Society o[ Medical O~cers of Health.
MEDICAL RESEARCH COUNCIL Require a medically-qualified man or woman, about 30 years of age, for work in tiaeir headquarters office concerned with administrative aspects of research. Organizing ability and clarity of expression in speecix and writing are desirable qualities, and some resarch experience, although not essent i a l would be an advantage. Salary ~I,285 (linked with age 3o) rising to ~2,IOO. Possibility of promotion to higher posts. Superannuation--F.S.S.U. Appointment probationary for two yea~s; if probation served satisfactorily appointment will be permanent.---Apply by letter (full details education, experience and names and addresses of two or more professional referees) to Establishment Officer of the Council, 38 , Old Queen Street, \Vestminster, S.W.I.