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Yorkshire Branch
PUBLIC HEALTH, April, 1950 out. Both responsibilities are included in the term "administration " in regard to local authority services. On the other hand, an administrative decision by a government department is usually transmitted elsewhere for execution. Such is Ihe case even under the National Health Service Act, for the bodies who actually provide the services are the Regional Hospital Board, Local Health Authority and Executive Council. Besides, the second part (execution) carries as much responsibility as, and is more difficult than, the first part and it is our contention that these dual functions cannot and shouhl not be separated. The technical knowledge necessary to formulate a scheme is necessary for its efficient execution. There are three fields where medical administration has already proved, its worth and in which we contend it should be m a i n t a i n e d : - 1. In medical officers of health of local authorities. 2. In senior administrative medical officers of Regional Hospital Boards. 3. In administrative heads of hospitals. In regard to the British Medical Association itself, its present method needs no commendation from us, for it has already gained a world-wide i'eputation. One can hardly imagine that the profession would tolerate a lay administrator or a town clerk to administer this great organisationl 1. In regard to the post of medical officer of health the B.M.A., with the full backing of the profession, has always supported the contention that he is the administrative chief of his department, responsible to the local authority direct and not through any other officer. There is sufficient statutory protection for him in this regard that a change cannot easily be brought about. It is not within the ambit of this memorandum to discuss the possibility of regionalisation of the public health service or of its becoming a direct State civil service--as long as the profession remains wide awake to the importance of the medical officer of health having executive as well as advisory function,s. His training has been brought up to date by the revision of the Diploma in Public Health which is a statutory qualification required for a medical officer of health before he can be appointed to a post. 2. Senior administrative medical offÉcers were appointed to be chief administrative officers of regional hospital boards. It was fairly obvious that only qualified medical men with aptitude for and experience in hospital planning and .administration could possibly be appointed chief officers to these newly created bodies. There are, of course, many other duties which can well be carried out by laymen--usually secretarial in character although often wrongly termed administrative. There will also be on the S.A.M.O.'s staff people specially trained in accountancy and as committee secretaries and records officers, etc., but the overriding executive authority must naturally rest with the senior medical administrator, who alone understands the main purpose of the service--which is to provide an efficient hospital and specialist service. At Hospital Management Committee level instances have already occurred of lay secretaries issuing instructions on medical
matters.
In our opinion the success of the administrator depends mainly on his knowledge of tlae work or service to be administered. To have a competent basic knowledge of medicine reqnires a period of study and hospital experience of some ten years. For the present appointments of medical administrators other than M.O.H.s no special qualification other than medical training and experience in hospital administratio~ has been demanded, but it may be that additional qualification after a period of special training should be recommended for all future applicants for such posts and for the deputyships. This is a matter to which the Society proposes to give further consideration and report. 3. In regard to medical superintendents, no further evidence is necessary regarding their importance than that " prepared by a Special Sub-committee and approved unanimously by the Central Consultants and Specialists Committee for Scotland." (See B.M.I. Supplement, July 23rd, 1939, p. 54.) " In the Government's proposed terms and conditions of service for hospital medical staff it is stated that the objective will be to reduce to a minimum the time to be given by medical staff to administrative duties. It is our opinion that, the number of doctors concerned in medical administration being small, no important benefit would accrne to the clinical side of the National Health Service if the numbers employed as medical superintendents declined, and that per contra the retention of the medical superintendent as the executive head of the hospital would bring to the Service greater advantages in efficient and smooth administration. Holding this opinion, we consider that the Government's objective, as stated, is not the right one. In any case we believe it to be wrong in principle and unwise in practice to determine in this oblique fashion what should be determined directly and on merit~namely, the future of the medical superintendent."
141 As in the case of the senior administrative medical officer, so with the medical superintendents--it is essential that new recruits into the service shall be specially qualified to undertake the duties. It is always a good thing to bear in mind that the purpose of an organised medical service is to fight disease and to maintain health. The special training and experience of the qualified medical person makes him suitable to take a guiding and leading part in this struggle. A good leader will at all times gather round him a team trained and suited for the task before him. So with preventive and clinical medicine--the captain should be a doctor, but his success will depend also upon his ability to direct operations and see them executed. YORKSHB~
BR&NCH
President: Dr. C. Fraser Brockington (C.M.O.H., West Riding). Hon. ,Secretary: Dr. J. M. Gibson (M.O.H., Huddersfield C.B.). The annual meeting of the Branch was held in the Civic Hall, Leeds, on Friday, June 24th, 1949. This was preceded by a meeting of the Council, at which six members were present. At the annual meeting twenty-three members were present. Nomination for Presidency.~The Honorary Secretary reported that he had received a letter from Dr. C. B. Crane asking that her name should be withdrawn from the list of nominations for the office of President, owing to pressure of other work. Election of Ol~cers.--The election of officers for the 1949-1950 session then took place. The following is a list of the officers elected : President: Dr. C. Fraser Brockington. Vice.Presidents: Drs. A. L. Taylor and D. D. Payne. Honorary Secretary and Treasurer: Dr. John M. Gibson. Council of the Branch: Drs. E. C. Benn, C. B. Crane, I. G. Davies, J. Douglas, W. G. Evans, J. A. Fraser, H. M. Holt, E. D. Ir~ine and J. Wood Wilson. British Medical Association Branch Council: Drs. C. Fraser Brockington, E. D. Irvine, A. L. Taylor and John M. Gibson. Council of the Society: Drs. C. Fraser Brockington and John M. Gibson. Tuberculosis Group Committee: Drs. H. Vallow and J. Wood Wilson. Honorary Auditors: Drs. H. M. Holt and J. Wood Wilson. British Medical Association--Yorkshire Branch.--The Honorary Secretary reported upon the meeting of the Yorkshire Branch of the Britsh Medical Association held on Sunday, May 29th, 1949, and made special reference to a report which had been prepared by a Special Sub-Committee on Obstetric Services. In that report it had been recommended to the Branch C o u n c i l : - (i) That the applications of all general practitioners to be placed on General Practitioner Obstetrician Lists 8hould be ~ccepted up till the end of the present year. (it) From January Ist, 1950, new applicants applying to be placed on the List should be required to have the following qualifications to enable them to have their names added to the l i s t : - (a) One of the higher obstetric qualifications, or (b) Post-graduate hospital experience in obstetric work for a reasonable period (no definite recommendation is made regardingj the length of this at present), or (c) Have attended at least 50 confinements in the previous three years. It was further r e c o m m e n d e d : - That the Obstetric List should be revised every five years. In the discussion which took place at the Branch Council objection was taken to the number 50 included in item (c), the opinion of the majority being that 50 over a period of three years was too high a figure. After full discussion this clause (it) (c) had been omitted altogether. Some Impressions of Tuberculosis in Tropical Countries Dr. W. Santon Gilmour, o.mE. (M.S., Killingbeck Sanatorium) began his address by emphasising that tuberculosis was an infectious disease, and in the public health interest it was important that the disease must be attacked from that angle; also, we must remember that the human subject with tuberculosis in the sputum was the source which kept the disease going. He then dealt with the reaction of various communities to the disease--some had gained a fairly high degree of protection due to immunisation by contact over centuries. In such a community we found a high rate of infection, but a relatively low rate of di~ase as such; also that there was more likely to be a greater proportion of chronic disease rather than actute infection. In areas where this has not been the case, and the population has not been immunised accordingly, the disease when introduced progresses rapidly. Tuberculosis had been called the " W h i t e Man's Disease," and, in years past, it had, no doubt, been more prevalent amongst the
142 white race t h a n a m o n g s t t h e black. A s a result of this, w h e n t h e disease was introduced a m o n g s t t h e black population, it spread rapidly in t h e way indicated. W e should r e m e m b e r , however, t h a t colour was not t h e deciding factor. T h e spread of infection here was simply a n indication of t h e general rule t h a t a low infection rate m e a n t a comparatively higlx disease rate. T h e d e a t h rate from t h e disease m i g h t be low, b u t t h e m o r t a l i t y rate a m o n g s t those infected was h i g h . In these days of extensive travel it was not o f t e n t h a t tuberculosis f o u n d a virgin soil, b u t in some countries t h e r e was quite a close approach to this---for example, in t h e W e s t Indies, slaves f r o m t h e W e s t Coast of Africa were introduced in large n u m b e r s a b o u t one h u n d r e d years ago. M a n y m o v e d to small villages a n d m i x e d with the white population f r o m t h e West. Mortality figures m o u n t e d , as a result. In u r b a n areas we f o u n d t h a t t h e percentage of persons who h a d been infected at some period of their lives with iuberculosis a p p r o x i m a t e d the figure of 9 0 % - - i n c o u n t r y districts this was m u c h lower. Dr. G i l m o u r t h e n dealt with various areas w h i c h he h a d visited, a n d showed h o w t h e general re-action to infection indicated b y h i m above was f o u n d in these areas, a n d t h e e x t e n t of t h e disease t h r o u g h o u t these countries follwed the course indicated above. In Central A m e r i c a there h a d been a g r o u p of I n d i a n s w h i c h constituted almost virgin s o i l - - h e r e the disease h a d spread like a n acute p n e u m o n i c disease. In China, on t h e other h a n d , w h i c h was a generally u r b a n i s e d c o m m u n i t y , there was a h i g h prevalence o f disease a c c o m p a n i e d b y a h i g h resistance, particularly in t h e cities a n d large towns. In U g a n d a , Central Africa, there were several tribes w h i c h a p p r o x i m a t e d to virgin soil, so far as tuberculosis was concerned. Cross-sections of the p o p u l a t i o n h a d been t a k e n a n d the t u b e r c u l i n test applied. It was f o u n d t h a t t h e h i g h e s t d e g r e e of i m m u n i t y was f o u n d a m o n g s t the " c a t t l e " groups, t h a t is to say, a m o n g s t those who were closely associated with cattle. It was well k n o w n t h a t tuberculosis was prevalent a m o n g s t t h e cattle in this part, a n d it would appeal t h a t t h e i n h a b i t a n t s h a d become partially i m m u n i s e d b y d r i n k i n g their milk. A m o n g s t those people not intimately associated with cattle, particularly amo.ngst the slave group in t h e South, infection m e a n t a severe reaction and, usually, death. Here there was a very low s t a n d a r d of living. A t t e n t i o n was b e i n g called to this g r o u p of people at present, as m a n y were employed b y t h e g r o u n d - n u t staff. It was obvious t h a t t h e y h a d n o t got e n o u g h i m m u n i t y to w i t h s t a n d infection, a n d he asked t h e question, " W h a t can be done to help these people?" T h e Colonies were mostly self-supporting, b u t t h e y h a d not e n o u g h m o n e y to tackle this problem. T h e one solution t h a t seemed possible at t h e m o m e n t was t h e use of B.C.G. vaccine. T h e President t h a n k e d Dr. G i l m o u r for his paper a n d t h e interesting account w h i c h he h a d g i v e n of his very wide experience of the tuberculosis problem in various parts of t h e world. It would appear from his r e m a r k s t h a t long experience of t h e infection in a c o m m u n i t y seems the only w a y to c o m b a t it, unless some d r u g could be discovered which would have a direct b e a r i n g o n t h e subject. It was a long d r a w n battle for a c o m m u n i t y waiting to b u i l d up its resistance. Dr. T a y l o r wondered if, in addition to t h e h e r d i m m u n i t y , there was some valuable genetic factor in a population w h i c h m i g h t m a k e some f/tmilies more liable to infection t h a n others. Dr. Holt called attention to t h e similarity between the position in U g a n d a a n d t h a t of this c o u n t r y one h u n d r e d years ago. Dr. Proctor, who h a d spent 20 years in K e n y a , pointed o u t t h a t tuberculosis was one of t h e principal social problems of t h a t country. It seemed strange t h a t a considerable a m o u n t of m o n e y could be f o u n d to c o m b a t leprosy, b u t not to deal with tuberculosis, a l t h o u g h t h e latter was b y far t h e m o r e serious problem. He h o p e d t h a t t h e use of B.C.G. vaccine m i g h t prove to be helpful, as it was almost impossible in countries like T a n g a n y i k a to improve conditions u n d e r present circumstances. Dr. Battersby pointed o u t t h a t tuberculosis could not be tackled as a single problem i n eastern countries, for often it was simply a t e r m i n a l disease, b e i n g associated with such diseases as malaria, p n e u m o n i a , a n d kala azar. Dr. H y n d referred to t h e poor results obtained b y surgical interference in the course of t r e a t m e n t in countries, like Nairobi a n d Kenya. I n his own experience h e h a d f o u n d t h a t s u r g e r y instead of h e l p i n g h a s t e n e d t h e end. Dr. T u r n e r supported t h e views of Dr. Battersbv t h a t tuberculosis was often closely associated with other diseases." He h a d f o u n d t h a t in M a l a y a there h a d been a drop in t h e disease w h e n m e a s u r e s tto control t h e spread of m a l a r i a were introduced. Dr. E v a n s asked t h e very pertinent question, " I f thberculosis is reduced as a result of various measures, will racial i m m u n i t y lessen to such a n extent t h a t t h e disease will a g a i n become a menace?" In reply, Dr. G i i m o u r agreed t h a t if we were to eradicate tuberculosis altogether, we would certainly lose o u r i m m u n i t y . T h a t state h a d almost been reached in certain parts of A m e r i c a at t h e
P U B L I C H E A L T H , April, 1950 present t i m e - - h e n c e the necessity for finding some vaccination of t h e B.C.G. type, w h i c h will give effective i m m u n i s a t i o n . B.C.G. vaccination was b e i n g carried o u t on a large scale in certain parts t o - d a y - - f o r example, a m o n g s t t h e Red I n d i a n s in America. It was too soon yet to forecast the results, b u t t h e protection given up to date h a d been reported in one source as "terrific." He agreed with Dr. Procter t h a t economics h a d a lot to do with t h e spread of infection. T h e low rate of tuberculosis a m o n g s t the " c a t t l e " race in U g a n d a w h i c h h e h a d referred to could be quite well accounted for by t h e fact t h a t t h e y received better food, e.g., m i l k a n d milk products, t h a n t h e other race, w h i c h lived on carb o h y d r a t e s only. H e h a d r e c o m m e n d e d t h e use of B.C.G. vaccine in U g a n d a for imported labour. A t t h e same time h e h a d emphasised t h a t all labourers m u s t be h o u s e d properly a n d adequately fed. A vote of t h a n k s was accorded to Dr. G i l m o u r on t h e m o t i o n of Dr. W o o d Wilson, who said h e h a d n o t only given a masterly s u m m a r y of t h e present-day position r e g a r d i n g tuberculosis, b u t h a d given also some indication of w h a t c a n be done in t h e future.
N O R T H - W E S T E R N M. & C.W. A N D SCHOOL ELS. President: Dr. J. E. Spence (M.O.H., Eccles M.B., Divl. M.O., Lancashire).
Hon. Secretary: Dr. E. M, J e n k i n s (Chief A.S.M.O., M a n c h e s t e r C.B.). A c o m m i t t e e m e e t i n g was h e l d at the Public H e a l t h D e p a r t m e n t , T o w n Hall, Manchester, on Friday, N o v e m b e r 4th, 1949, at 4.15 p.m. Present: Drs. Bennett, Butters, Cliff, Spence, Wilkinson, J~nkins. Consideration was given to the p r o g r a m m e for t h e e n s u i n g session. T h e n followed a general m e e t i n g of t h e sub-groups, a t t e n d e d b y ten m e m b e r s T h e retiring President, Dr. H. C,. M. Bennett, introduced with a few very apt r e m a r k s the new President, Dr. J. E. Spence, who was d u l y installed. Dr. B e n n e t t r e m i n d e d t h e G r o u p t h a t Dr. Spence h a d been Secretary of t h e m a i n N o r t h - W e s t e r n B r a n c h for 17 years, a n d was responsible for f o u n d i n g t h e Sub-Group some years before t h e last war. Dr. Spence t h e n gave a talk on his work in t h e Public H e a l t h Service d u r i n g t h e past 37 years (to be p u b l i s h e d in o u r n e x t issue). H e related m a n y interesting experiences a n d explained how t h e work of t h e School H e a l t h Service was carried on in t h e most difficult conditions in t h e early years of its i n a u g u r a t i o n . A vote of t h a n k s to t h e retiring President was proposed by Dr. Wilkinson a n d carried u n a n i m o u s l y . It was agreed t h a t representatives of the G r o u p on t h e m a i n Group Councils should be asked from time to t i m e to give a n account of t h e business c o n d u c t e d at t h e Council meetings.
UNIVERSITY OF IX)NDON A. H. Bvcoa'T SCHOLARSHmS, 1950 Application is invited f r o m registered Medical Practitioners who are at present in, or i n t e n d to enter, t h e Public H e a l t h Service, for t h e above Scholarships. T h r e e Scholarships are offered, each of t h e value of a b o u t £100, tenable at t h e L o n d o n School of H y g i e n e a n d Tropical Medicine for one year for t h e course for t h e A c a d e m i c P o s t g r a d u a t e D i p l o m a in Public H e a l t h . Application m u s t be m a d e b y M a y 1st. Application f o r m s a n d f u r t h e r particulars m a y be obtained f r o m t h e A c a d e m i c Registrar, University of London, Senate House, W.C.I.
P u b U e H e a l t h is t h e Official O r g a n of t h e Society of Medical Officers of H e a l t h a n d a suitable m e d i u m for t h e a d v e r t i s e m e n t of official a p p o i n t m e n t s v a c a n t in t h e h e a l t h service. Space is also available for a certain n u m b e r of approved commercial advertisements. Application should be m a d e to t h e Executive Secretary of t h e Society, at Tavistock H o u s e South, Tavistock Square, W.C.I. Subscription 3Is. 6d. per a n n u m , post free, in advance. Single copies 2s. 6d. post free. Official classified advertisements are c h a r g e d at 2s. 6d. per line or part of a line. M i n i m u m c h a r g e 15s, Telephone : E u s t o n 3923.
T e l e g r a m s : Epidauros, Westcent.
matters.
In our opinion the success of the administrator depends mainly on his knowledge of tlae work or service to be administered. To have a competent basic knowledge of medicine reqnires a period of study and hospital experience of some ten years. For the present appointments of medical administrators other than M.O.H.s no special qualification other than medical training and experience in hospital administratio~ has been demanded, but it may be that additional qualification after a period of special training should be recommended for all future applicants for such posts and for the deputyships. This is a matter to which the Society proposes to give further consideration and report. 3. In regard to medical superintendents, no further evidence is necessary regarding their importance than that " prepared by a Special Sub-committee and approved unanimously by the Central Consultants and Specialists Committee for Scotland." (See B.M.I. Supplement, July 23rd, 1939, p. 54.) " In the Government's proposed terms and conditions of service for hospital medical staff it is stated that the objective will be to reduce to a minimum the time to be given by medical staff to administrative duties. It is our opinion that, the number of doctors concerned in medical administration being small, no important benefit would accrne to the clinical side of the National Health Service if the numbers employed as medical superintendents declined, and that per contra the retention of the medical superintendent as the executive head of the hospital would bring to the Service greater advantages in efficient and smooth administration. Holding this opinion, we consider that the Government's objective, as stated, is not the right one. In any case we believe it to be wrong in principle and unwise in practice to determine in this oblique fashion what should be determined directly and on merit~namely, the future of the medical superintendent."
141 As in the case of the senior administrative medical officer, so with the medical superintendents--it is essential that new recruits into the service shall be specially qualified to undertake the duties. It is always a good thing to bear in mind that the purpose of an organised medical service is to fight disease and to maintain health. The special training and experience of the qualified medical person makes him suitable to take a guiding and leading part in this struggle. A good leader will at all times gather round him a team trained and suited for the task before him. So with preventive and clinical medicine--the captain should be a doctor, but his success will depend also upon his ability to direct operations and see them executed. YORKSHB~
BR&NCH
President: Dr. C. Fraser Brockington (C.M.O.H., West Riding). Hon. ,Secretary: Dr. J. M. Gibson (M.O.H., Huddersfield C.B.). The annual meeting of the Branch was held in the Civic Hall, Leeds, on Friday, June 24th, 1949. This was preceded by a meeting of the Council, at which six members were present. At the annual meeting twenty-three members were present. Nomination for Presidency.~The Honorary Secretary reported that he had received a letter from Dr. C. B. Crane asking that her name should be withdrawn from the list of nominations for the office of President, owing to pressure of other work. Election of Ol~cers.--The election of officers for the 1949-1950 session then took place. The following is a list of the officers elected : President: Dr. C. Fraser Brockington. Vice.Presidents: Drs. A. L. Taylor and D. D. Payne. Honorary Secretary and Treasurer: Dr. John M. Gibson. Council of the Branch: Drs. E. C. Benn, C. B. Crane, I. G. Davies, J. Douglas, W. G. Evans, J. A. Fraser, H. M. Holt, E. D. Ir~ine and J. Wood Wilson. British Medical Association Branch Council: Drs. C. Fraser Brockington, E. D. Irvine, A. L. Taylor and John M. Gibson. Council of the Society: Drs. C. Fraser Brockington and John M. Gibson. Tuberculosis Group Committee: Drs. H. Vallow and J. Wood Wilson. Honorary Auditors: Drs. H. M. Holt and J. Wood Wilson. British Medical Association--Yorkshire Branch.--The Honorary Secretary reported upon the meeting of the Yorkshire Branch of the Britsh Medical Association held on Sunday, May 29th, 1949, and made special reference to a report which had been prepared by a Special Sub-Committee on Obstetric Services. In that report it had been recommended to the Branch C o u n c i l : - (i) That the applications of all general practitioners to be placed on General Practitioner Obstetrician Lists 8hould be ~ccepted up till the end of the present year. (it) From January Ist, 1950, new applicants applying to be placed on the List should be required to have the following qualifications to enable them to have their names added to the l i s t : - (a) One of the higher obstetric qualifications, or (b) Post-graduate hospital experience in obstetric work for a reasonable period (no definite recommendation is made regardingj the length of this at present), or (c) Have attended at least 50 confinements in the previous three years. It was further r e c o m m e n d e d : - That the Obstetric List should be revised every five years. In the discussion which took place at the Branch Council objection was taken to the number 50 included in item (c), the opinion of the majority being that 50 over a period of three years was too high a figure. After full discussion this clause (it) (c) had been omitted altogether. Some Impressions of Tuberculosis in Tropical Countries Dr. W. Santon Gilmour, o.mE. (M.S., Killingbeck Sanatorium) began his address by emphasising that tuberculosis was an infectious disease, and in the public health interest it was important that the disease must be attacked from that angle; also, we must remember that the human subject with tuberculosis in the sputum was the source which kept the disease going. He then dealt with the reaction of various communities to the disease--some had gained a fairly high degree of protection due to immunisation by contact over centuries. In such a community we found a high rate of infection, but a relatively low rate of di~ase as such; also that there was more likely to be a greater proportion of chronic disease rather than actute infection. In areas where this has not been the case, and the population has not been immunised accordingly, the disease when introduced progresses rapidly. Tuberculosis had been called the " W h i t e Man's Disease," and, in years past, it had, no doubt, been more prevalent amongst the
142 white race t h a n a m o n g s t t h e black. A s a result of this, w h e n t h e disease was introduced a m o n g s t t h e black population, it spread rapidly in t h e way indicated. W e should r e m e m b e r , however, t h a t colour was not t h e deciding factor. T h e spread of infection here was simply a n indication of t h e general rule t h a t a low infection rate m e a n t a comparatively higlx disease rate. T h e d e a t h rate from t h e disease m i g h t be low, b u t t h e m o r t a l i t y rate a m o n g s t those infected was h i g h . In these days of extensive travel it was not o f t e n t h a t tuberculosis f o u n d a virgin soil, b u t in some countries t h e r e was quite a close approach to this---for example, in t h e W e s t Indies, slaves f r o m t h e W e s t Coast of Africa were introduced in large n u m b e r s a b o u t one h u n d r e d years ago. M a n y m o v e d to small villages a n d m i x e d with the white population f r o m t h e West. Mortality figures m o u n t e d , as a result. In u r b a n areas we f o u n d t h a t t h e percentage of persons who h a d been infected at some period of their lives with iuberculosis a p p r o x i m a t e d the figure of 9 0 % - - i n c o u n t r y districts this was m u c h lower. Dr. G i l m o u r t h e n dealt with various areas w h i c h he h a d visited, a n d showed h o w t h e general re-action to infection indicated b y h i m above was f o u n d in these areas, a n d t h e e x t e n t of t h e disease t h r o u g h o u t these countries follwed the course indicated above. In Central A m e r i c a there h a d been a g r o u p of I n d i a n s w h i c h constituted almost virgin s o i l - - h e r e the disease h a d spread like a n acute p n e u m o n i c disease. In China, on t h e other h a n d , w h i c h was a generally u r b a n i s e d c o m m u n i t y , there was a h i g h prevalence o f disease a c c o m p a n i e d b y a h i g h resistance, particularly in t h e cities a n d large towns. In U g a n d a , Central Africa, there were several tribes w h i c h a p p r o x i m a t e d to virgin soil, so far as tuberculosis was concerned. Cross-sections of the p o p u l a t i o n h a d been t a k e n a n d the t u b e r c u l i n test applied. It was f o u n d t h a t t h e h i g h e s t d e g r e e of i m m u n i t y was f o u n d a m o n g s t the " c a t t l e " groups, t h a t is to say, a m o n g s t those who were closely associated with cattle. It was well k n o w n t h a t tuberculosis was prevalent a m o n g s t t h e cattle in this part, a n d it would appeal t h a t t h e i n h a b i t a n t s h a d become partially i m m u n i s e d b y d r i n k i n g their milk. A m o n g s t those people not intimately associated with cattle, particularly amo.ngst the slave group in t h e South, infection m e a n t a severe reaction and, usually, death. Here there was a very low s t a n d a r d of living. A t t e n t i o n was b e i n g called to this g r o u p of people at present, as m a n y were employed b y t h e g r o u n d - n u t staff. It was obvious t h a t t h e y h a d n o t got e n o u g h i m m u n i t y to w i t h s t a n d infection, a n d he asked t h e question, " W h a t can be done to help these people?" T h e Colonies were mostly self-supporting, b u t t h e y h a d not e n o u g h m o n e y to tackle this problem. T h e one solution t h a t seemed possible at t h e m o m e n t was t h e use of B.C.G. vaccine. T h e President t h a n k e d Dr. G i l m o u r for his paper a n d t h e interesting account w h i c h he h a d g i v e n of his very wide experience of the tuberculosis problem in various parts of t h e world. It would appear from his r e m a r k s t h a t long experience of t h e infection in a c o m m u n i t y seems the only w a y to c o m b a t it, unless some d r u g could be discovered which would have a direct b e a r i n g o n t h e subject. It was a long d r a w n battle for a c o m m u n i t y waiting to b u i l d up its resistance. Dr. T a y l o r wondered if, in addition to t h e h e r d i m m u n i t y , there was some valuable genetic factor in a population w h i c h m i g h t m a k e some f/tmilies more liable to infection t h a n others. Dr. Holt called attention to t h e similarity between the position in U g a n d a a n d t h a t of this c o u n t r y one h u n d r e d years ago. Dr. Proctor, who h a d spent 20 years in K e n y a , pointed o u t t h a t tuberculosis was one of t h e principal social problems of t h a t country. It seemed strange t h a t a considerable a m o u n t of m o n e y could be f o u n d to c o m b a t leprosy, b u t not to deal with tuberculosis, a l t h o u g h t h e latter was b y far t h e m o r e serious problem. He h o p e d t h a t t h e use of B.C.G. vaccine m i g h t prove to be helpful, as it was almost impossible in countries like T a n g a n y i k a to improve conditions u n d e r present circumstances. Dr. Battersby pointed o u t t h a t tuberculosis could not be tackled as a single problem i n eastern countries, for often it was simply a t e r m i n a l disease, b e i n g associated with such diseases as malaria, p n e u m o n i a , a n d kala azar. Dr. H y n d referred to t h e poor results obtained b y surgical interference in the course of t r e a t m e n t in countries, like Nairobi a n d Kenya. I n his own experience h e h a d f o u n d t h a t s u r g e r y instead of h e l p i n g h a s t e n e d t h e end. Dr. T u r n e r supported t h e views of Dr. Battersbv t h a t tuberculosis was often closely associated with other diseases." He h a d f o u n d t h a t in M a l a y a there h a d been a drop in t h e disease w h e n m e a s u r e s tto control t h e spread of m a l a r i a were introduced. Dr. E v a n s asked t h e very pertinent question, " I f thberculosis is reduced as a result of various measures, will racial i m m u n i t y lessen to such a n extent t h a t t h e disease will a g a i n become a menace?" In reply, Dr. G i i m o u r agreed t h a t if we were to eradicate tuberculosis altogether, we would certainly lose o u r i m m u n i t y . T h a t state h a d almost been reached in certain parts of A m e r i c a at t h e
P U B L I C H E A L T H , April, 1950 present t i m e - - h e n c e the necessity for finding some vaccination of t h e B.C.G. type, w h i c h will give effective i m m u n i s a t i o n . B.C.G. vaccination was b e i n g carried o u t on a large scale in certain parts t o - d a y - - f o r example, a m o n g s t t h e Red I n d i a n s in America. It was too soon yet to forecast the results, b u t t h e protection given up to date h a d been reported in one source as "terrific." He agreed with Dr. Procter t h a t economics h a d a lot to do with t h e spread of infection. T h e low rate of tuberculosis a m o n g s t the " c a t t l e " race in U g a n d a w h i c h h e h a d referred to could be quite well accounted for by t h e fact t h a t t h e y received better food, e.g., m i l k a n d milk products, t h a n t h e other race, w h i c h lived on carb o h y d r a t e s only. H e h a d r e c o m m e n d e d t h e use of B.C.G. vaccine in U g a n d a for imported labour. A t t h e same time h e h a d emphasised t h a t all labourers m u s t be h o u s e d properly a n d adequately fed. A vote of t h a n k s was accorded to Dr. G i l m o u r on t h e m o t i o n of Dr. W o o d Wilson, who said h e h a d n o t only given a masterly s u m m a r y of t h e present-day position r e g a r d i n g tuberculosis, b u t h a d given also some indication of w h a t c a n be done in t h e future.
N O R T H - W E S T E R N M. & C.W. A N D SCHOOL ELS. President: Dr. J. E. Spence (M.O.H., Eccles M.B., Divl. M.O., Lancashire).
Hon. Secretary: Dr. E. M, J e n k i n s (Chief A.S.M.O., M a n c h e s t e r C.B.). A c o m m i t t e e m e e t i n g was h e l d at the Public H e a l t h D e p a r t m e n t , T o w n Hall, Manchester, on Friday, N o v e m b e r 4th, 1949, at 4.15 p.m. Present: Drs. Bennett, Butters, Cliff, Spence, Wilkinson, J~nkins. Consideration was given to the p r o g r a m m e for t h e e n s u i n g session. T h e n followed a general m e e t i n g of t h e sub-groups, a t t e n d e d b y ten m e m b e r s T h e retiring President, Dr. H. C,. M. Bennett, introduced with a few very apt r e m a r k s the new President, Dr. J. E. Spence, who was d u l y installed. Dr. B e n n e t t r e m i n d e d t h e G r o u p t h a t Dr. Spence h a d been Secretary of t h e m a i n N o r t h - W e s t e r n B r a n c h for 17 years, a n d was responsible for f o u n d i n g t h e Sub-Group some years before t h e last war. Dr. Spence t h e n gave a talk on his work in t h e Public H e a l t h Service d u r i n g t h e past 37 years (to be p u b l i s h e d in o u r n e x t issue). H e related m a n y interesting experiences a n d explained how t h e work of t h e School H e a l t h Service was carried on in t h e most difficult conditions in t h e early years of its i n a u g u r a t i o n . A vote of t h a n k s to t h e retiring President was proposed by Dr. Wilkinson a n d carried u n a n i m o u s l y . It was agreed t h a t representatives of the G r o u p on t h e m a i n Group Councils should be asked from time to t i m e to give a n account of t h e business c o n d u c t e d at t h e Council meetings.
UNIVERSITY OF IX)NDON A. H. Bvcoa'T SCHOLARSHmS, 1950 Application is invited f r o m registered Medical Practitioners who are at present in, or i n t e n d to enter, t h e Public H e a l t h Service, for t h e above Scholarships. T h r e e Scholarships are offered, each of t h e value of a b o u t £100, tenable at t h e L o n d o n School of H y g i e n e a n d Tropical Medicine for one year for t h e course for t h e A c a d e m i c P o s t g r a d u a t e D i p l o m a in Public H e a l t h . Application m u s t be m a d e b y M a y 1st. Application f o r m s a n d f u r t h e r particulars m a y be obtained f r o m t h e A c a d e m i c Registrar, University of London, Senate House, W.C.I.
P u b U e H e a l t h is t h e Official O r g a n of t h e Society of Medical Officers of H e a l t h a n d a suitable m e d i u m for t h e a d v e r t i s e m e n t of official a p p o i n t m e n t s v a c a n t in t h e h e a l t h service. Space is also available for a certain n u m b e r of approved commercial advertisements. Application should be m a d e to t h e Executive Secretary of t h e Society, at Tavistock H o u s e South, Tavistock Square, W.C.I. Subscription 3Is. 6d. per a n n u m , post free, in advance. Single copies 2s. 6d. post free. Official classified advertisements are c h a r g e d at 2s. 6d. per line or part of a line. M i n i m u m c h a r g e 15s, Telephone : E u s t o n 3923.
T e l e g r a m s : Epidauros, Westcent.