The report of the consultative council

Public Health THE JOURNAL OF

The Society of Medical Officers of Health. No.

10.

J U L Y , 1920.

Subscriptio~z ])rice, 21s. p e r a m , u m , p o s t f r e e i,z gdvalzce. Sillgle copies, Is. 8d., p o s t free.

CONTENTS.

EDITORIAL--

PAOE

The Report of the Consultative Council

...

155

SPECIAL ARTICLE-Civil Sanitary Work in Mesopotamia (By F. T. H. Wood, O.B.E., M.D., B,S., B.Sc., D.P.H., A s s i s t a n t Medical Officer of Health, Bir~.rd~zghc~.m, late Health Q~qcer (Civil), Bcrsrah) . . . . . . . . . . . . . . .

159

Some Observations on Mental Deficients (/)y

A . H. Newton, M.B., Ch.B., Assistant School Medical Oj~qce¢ for the City of Cove~try) . . . . . : ............ 165 $OCIETY OF MEDICAL OFPICER$ OF HEALTH--

Notices ...... ............ SpeciaI Council Meeting . . . . . . . . . . . . Ordinary Meeting . . . . . . . . . . . . . . . Metropolitan Branch ............ Meeting of Tuberculosis Officers ...... The Tuberculosis Group . . . . . . . . . . . . The Angus Memorial Fund ......... OBITUARY-Dr. J. A. Codd, M.O.I-t., xeVolverhampton ... NOTEB-Arsenical Poisoning at Haslemere ......

Prevention of Venereal Disease . . . ... . . . The Public Health Service Assurance Guild ... Small-Pox . . . . . . . . . . . . . . . . . .

157 170 170 171 172 172 174 158 158 158 173 174

(Kditorial. THE

REPORT

OF THE

CONSULTATIVE

COUNCIL. feeling a f t e r reading the interim T H Er e p first o r t of the Consultative Council to the t

Ministry of H e a l t h is one of thankfulness that none of the n o m i n a t i o n s made to this Council by the Society of Medical Officers of H e a l t h was a c c e p t e d by the Ministry of Health. The Society of Medical Officers of Health, by this f o r t u n a t e happening, is relieved entirely f r o m all responsibility for the report, and is free to criticise it and to advise the public generally upon its r e c o m m e n d a t i o n s . The r e p o r t is unnecessarily discursive and full of v a g u e repetitions, and could easily have

VOL. XXXIII.

been reduced in size to one or two pages, with a c o r r e s p o n d i n g increase in its value and clarity. At a r e c e n t Council meeting a distinguished m e m b e r of the Society s u m m e d up the r e p o r t as " T h e beatification of the general practitioner and the canonisation of the consultant." The vague n a t u r e of the r e p o r t is perhaps the general impression given by it, but a possible key to its reading is afforded by some of the r e m a r k s made b y L o r d D a w s o n in his presidential address to the Section of S t a t e Medicine in the Brussels C o n g r e s s in M a y last. In this a d d r e s s he refers to the c o n s t a n t and s t e a d y increase in the work provided and supervised by health d e p a r t m e n t s of large Authorities t h r o u g h o u t the c o u n t r y in the way of provision, open to all citizens, irrespective of their economic position, in connection with the medical inspection and t r e a t m e n t of school children, the diagnosis and free treatment of tuberculosis, the diagnosis and free t r e a t m e n t of venereal diseases, and the various points of activity in c o n n e c t i o n with m a t e r n i t y and child welfare. L o r d D a w s o n proceeds to say that " i t is easy to see t h a t extension of these old h o c services would soon e m b r a c e a large part of medical practice. It is a state medical service by instalments, a l m o s t by stealth, and before we go f u r t h e r it would be well to take stock of the position and define our policy." He also points out that underlying t h e provision of these medical services is the public opinion that the health of the people, like the education of the people, is of s u p r e m e i m p o r t a n c e to the Si:ate ; that the best m e a n s of maintaining health and curing disease should be made available to all citizens; and that the cost being beyond the capacity of most citizens to provide, must be partly or wholly b o r n e by public funds. W e a g r e e entirely.

r56

PUBLIC HEALTH.

When, however, Lord Dawson says that these health services have been instituted " almost by stealth," he probably means that until recently he was quite unaware of t h e extent to which such services had, as the result

of p@ular demand and the progressive tSolicy of large public bodies, been instituted. Apparently he is still ignorant of the working of these services, because he describes them as " i s o l a t e d units of effort tending to be aloof from the medical practice and doctors of t h e i r district." The report aims at providing the general practitioner with such expert assistance as will enable him to c a r r y on his work under conditions likely to be successful. With this aim everyone will be in sympathy. The proposal to transfer the whole of the poor law medical work to the Health Authority will also receive almost universal support. The only serious point for doubt arises when one considers the practicability of the proposed methods for attaining these ideals. It is not too much to say that every point involving practical difficulty is lightly skimmed over. Areas of administration, local authorities, payments of practitioners and consultants, &c., are all difficulties which are evaded in the report. The report expresses no final opinion on the subject of the constitution of local authorities, b e i n g undecided as to whether this should be an existing authority or one specially appointed " a d hoc." The formation of an ad hoc authority upsets the whole idea upon which the Ministry of Health was founded, for no ad hoc authority to which would be delegated the provision of medical services would be the Local Health Authority. Such an authority could not be the rating authority, and there are obvious disadvantages in the creation of a new irresponsible spending authority. The establishment of the Ministry of Health was due entirely to a universal desire for consolidation of health services, and the implied proposal to set up a new authority for health purposes is perhaps the most amazing part of the report. This new health authority is to have a large proportion of non-elected members. The non-elected or co-opted member is not, as a general rule, a conspicuously helpful member of the existing bodies~ and there is no

JULY,

doubt that the improvements in the public health service have been brought about largely by the directly elected element. The report outlines a chaos of committees and sub-committees partly elective, but largely non-elective, with committees dealing with special subjects, each in their turn with special co-opted members, and at the back of it the medical advisory council, composed presumably of general practitioners. One searches in vain for any consideration of the mass of the g e n e r a l public who will form the patients, and it is reasonable to suggest that the whole of the report is framed without any regard to the express desires and wishes of the general public so far as such desires and wishes can be interpreted by the methods of progress of the large public bodies during the past 10 or 15 years. The report, moreover, lays great stress on the principle of co-option, and advisory committees. \Ve think we foresee the time when this principle wilt not only be worn threadbare, but will, as it almost is at present, be reduced to an absurdity. It is obviously advantageous that those elected to an authority and appointed to committees should be interested in efficient local government. We do not think that they need necessarily be experts in the work of their. several committees ; we do not think that the chairman of an electricity committee need be an electrician, the chairman of the housing committee a builder, the chairman of a sanitary committee a medical man, or the chairman of the cemeteries committee a grave digger. A local authority is provided with expert advisers of every sort and cannot be advised properly by irresponsible co-opted members of committees. Medical practitioners c0-opted upon a local body inevitably and naturally have quite a different view point from that of the medieat officer of health. The M.O.H. views everything from the point of the patient and the public good, whereas medical practitioners view it from the point of view of professional interest. As regards the nature of the medical services paid for by local authorities, it is now a generally accepted principle, based .on the substantial foundation of accumulated experience, that the health services of a district, when paid

I92o.

PUBLIC

for by public funds, should be carried out by whole-time medical officers. The British Medical Association has, moreover, after many years' fighting on behalf of the part-time employment of general practitioners, recently definitely deprecated the establishment of general practitioner clinics under the aegis of the State. Lord Dawson, however, re-opens the whole controversy and states that " i t is a most important principle that the health services of a'district should, wherever possible, be staffed on a part-time basis by the doctors practising in that district," and this principle pervades the whole of the report. The popularity of hospitals, and more particularly of the services provided by the health departments of the large locaI authorities (tuberculosis dispensaries, maternity and infant welfare centres, school clinics, etc.), shews that without doubt on the average the public think more highly of the whole-time men. Also experience has shown that, on the whole, their work is on a higher level. To the primary centre the whole of the existing clinical and communal work now carried on by heatth autlmrities would be transferred (maternity a n d infant welfare, medical inspection of school children and their treatment, diagnosis and t r e a t m e n t of tuberculosis, etc.). This would remove at one sweep most of the work of the who!e-time staffs of medical officers of health. The Annual Representative Meeting of the B r i t i s h M e d i c a l Association gave the afternoon of June 26th to consideration of the proposals originated by the Memorandum of the Society of Medical Officers of Health on the remuneration of medical officers by local authorities. Dr. G. F. Buchan and Dr. W. J. Howarth attended on behalf of the society. After a prolonged discussion the meeting agreed nero. con. that a substantial increase on the general lines indicated in the society's scale is needed in all p u n i c health salaries, and " T h a t a Conjoint Committee of the British Medical Association and the Society of Medical Officers of Health be formed to take charge of the case for improvement in the salaries of medical officers in the public health services and to report to the Councils of the British Medical Association and of t h e Society of Medical Officers of Health as to any steps that mayt:b~ necessary to this end.'

I57

HEALTH.

SOCIETY OF MEDICAL OFFICERS OF HEALTH. NOTICES. A special meeting of the Society will be held at the Queen's Hotel, Birmingham, on Tuesday, July 20th, at 6 p.m. The only business will be the election to membership of a large number of candidates who must other~ wise await admission to the Society until the Annual Meeting in October next. As the Cotmcil will meet immediately after, a quormn is assured, so that members who have other engagements need feel under no obligation to attend. A meeting of the Council will be held at the Queen's Hotel, Birmingham, on Tuesday, July 20th, at 6.15 p.m., to receive the report of the special committee appointed to examine the recommendations o f the Consultative Council on Medical and Allied Services to the Ministry of Health. Tuberculosis officers are asked to maim a note of the meeting to be held at 1, Upper Montague Street, Russell Square, W.C. 1, oll Saturday, July 17th, at 11 a.m., when the Tuberculosis Group within the Society of Medical Officers of Health will be inaugurated. Dr. F. N. Kay Menzies will preside, and it is hoped that there will be a good attendance as much important business must be transacted. F u r t h e r details wilt be found on page 172. The A n n u a l S u m m e r Meeting of the Northern Branch will be held at the Town Hall, Carlisle, at 12.45 p.m., an Friday, 9th July, 1920. T h e r e wilt be luncheon immediately after the meeting at the Crown and Mitre Hotel, and in the afternoon a motor drive, followed by tea, has been arranged. The approximate costs will be :--Lunch, 3/6; motor drive, 5/6; and tea, 1/6. The Northern Branch has now a large membership in the north western counties, and the S u m m e r Meeting has been arranged in Carlisle for the special purpose of providing an opportunity for the eastern and western members to m e e t . It is hoped that as many as possible wilt turn out, not merely to ensure i'~pleasurable day, but as a m a t t e r of principle.