503

and as members of the same profession." When politi-cians got together, friction of various kinds was likelyto arise, but doctors in their assemblies " are not primarilyconcerned about who is going to do a thing, but that thething is going to be done." It did not matter to thedoctor whether the patient were black or white, brownor yellow, Communist or Fascist. " There is in medicinea catholic interest and dedication to the welfare ofmankind, a concern for the individual, quite indepen-dently of his social group, his inheritance, origin, or

destination. It is therefore of supreme importance thatthe organisation which has been born today should’

‘

have a successful inauguration and be continuallysustained by the enthusiasm of its founders and thosewho come after them." Dr. J. A. PRIDHAM and Dr. P:GLORIEux replied.The council of the British Medical Association also

gave a dinner at which the presidents of the three RoyalColleges were present. On the last afternoon of their

stay the delegates, at the invitation of Sir Alfred Webb-Johnson, paid a visit to Middlesex Hospital.

ROYAL COLLEGE OF OBSTETRICIANS AND

GYNÆCOLOGISTS

MR. BEVAN’S LETTER ON MATERNITY SERVICES

AT a dinner held in London on Sept. 27 Lord WooLTON,proposing The College, spoke of the distinction betweenbeing governed by public opinion-by the trust we havein one another-and being governed by edict and legis-lation. However high its own standards, the Governmenthad perhaps something to learn in this connexion fromthe Royal Colleges, whose lack of specific powers madethem all the more powerful. As a friend of Blair-Bell,founder of the college-" a great dynamic force con-stantly searching out new things "-Lord Woolton wasglad to see that the dream had come true.Recalling how, many years ago, he and his wife started

one of the first maternity clinics, and the first antenatalclinic, in the North of England, Lord Woolton said thatwhen he became Minister of Food he regarded it as anopportunity to do something to’ raise the standard ofmaternal and infant life, and in this he had been fortunatein having the help of Lord Horder and Sir JackDrummond. By directing cod-liver oil, orange juice,and other supplements to pregnant and nursing mothers"I think we did something." No Minister could goahead of the general sense of the public without beingcalled an idealist, but as soon as he declared his policyof putting children first, Lord Woolton had ceased toget abusive letters about rationing : ’’ the public thoughtI was right." There could be no wiser expenditure ofpublic money than on preserving child life.Mr. EARDLEY HOLLAND, responding as president, said

that the college had grown rapidly in its 17 years and washoping soon to receive a royal charter. Two-fifths of itsexistence had been in the difficult years of war, in whichits members, unlike physicians and surgeons, had usuallyhad to turn to different tasks. But the membership,which before the war was 580, was now 775. No less thana quarter of the fellows and a third of the members livedand worked in the Dominions, and the college was veryproud of its Dominion fellows, many of whose depart-ments were second to none in this country, and wantedthem to have more part in its work. It was to hold anexamination in Australia next year, and Sir WilliamFletcher Shaw, his predecessor as president, was evennow on his way to Australia to make arrangements.Being still young, the college had still to work its way tofame by the quality of its work, and among the manysubjects being discussed by its committees were popula-tion problems, human fertility, analgesia in childbirth,neonatal mortality, maternity hospitals, and the socialand economic aspects of the maternity service. For theRoyal Commission on Population it had undertaken aquestionary of considerable difficulty, and in 1944 it hadissued a memorandum on a National Maternity Servicewhich already seemed to have influenced the planningof a service and the Government’s Bill.

During the last few years, Mr. Holland continued,there had been a great change of outlook on obstetricpractice. The " new obstetrics " must be practised ona broad national basis and was concerned with the socialand economic factors. Obstetrics had, moreover, becomea form of " precision practice " very different from theold. With blood-grouping, tests for rhesus factor, andradiological examination becoming matters of routine,and with new techniques against infection and shock,obstetrics had been completely transformed in the lastten years. As the techniques became more precise thestandards of accomplishment must be raised among allwho did midwifery-whether midwives, general practi-tioners, or specialists. This year the council had decidedto double the period of training required of candidatesfor membership. While the college believed that thegeneral practitioner should play a most important partin the maternity service, it maintained that only practi-tioners with postgraduate training or special experienceshould be considered capable of going to the aid of themidwife in difficulties.The National Health Service Bill would become law

in a very short time, after which " we shall have to getround a sort of peace conference table, but with morehope in our hearts than in Paris." In April, 1948, hefelt sure,

" we shall, like loyal citizens, carry out the will

of the people and do our best to make the finest maternityservice in the world." In time it should be possible tosecure throughout the country an even distribution ofthose techniques now waiting to be used. The college’smemorandum had laid emphasis on coordination betweenthe various bodies which under the Bill would beresponsible for the maternity service. The Minister hadsaid that perfect coordination could be assured byadministrative action, and in answer to a request forfuller information had sent him a letter which said :

We have always envisaged that in staffing their antenatalclinics local authorities must enlist the cooperation of theregional board, and that this will be done by appointingone of the hospital obstetricians as officer in charge of eachof the local antenatal clinics. This would enable theobstetrician to determine whether the mother will ultimatelyrequire admission to hospital (and to take the necessarysteps accordingly) or whether she can be left to the care ofthe midwife, with the facilities of the hospital or the servicesof an obstetrician or experienced general practitioneralways available in the background. This arrangementwould ensure also that the social services of the local

authority in the shape of the health visitors would be at thedisposal of the obstetrician in the clinic, and similar servicewill of course be at his disposal by arrangement with thelocal authority in the hospital. But above all we mustremember that the general practitioner is one of the chiefcoordinators of the service. He is the manager whoproduces for the benefit of his patient all the facilitieswhich the National Health Service can offer. He will have econtacts with all the working parties of the machine-thehospital, the clinic, the health centre, and the services ofthe local authority-and will personally know the men andwomen who staff them.We have still a good deal to do in planning out the

precise details of the organisation, but these are the mainlines along which it will be developed.

Royal colleges, said the president in conclusion, setthe standards -of specialist practice -and therefore of allpractice. " The college spirit in medicine is precious, isunique, and is peculiarly British, and its flame must never .

die down " ; but the colleges must continue to makeprogress : their power and prestige now depended not onprivileges but on cultural and even spiritual qualities." Many of us believe that instead of working in completeisolation, like independent sovereign States, the collegeswill come to work more and more closely together," andit was essential that they should achieve unity andharmony. It was essential too-though the day might befar distant-that they should come together geographic-ally. His own college would in any case soon be forced tomove house because in more ways than one it had grownout of the premises given it by its founder.

Mr. A. A. GEMMELL proposed The Guests, whom heincluded in the definition of the college as " a fraternitywith a common purpose." Among those he mentioned was

504

Mr. Victor Bonney, admitted to the fellowship earlierin the day. Without going so far as to apply the parableof the lost sheep, Mr. Gemmell admitted that " thereis more joy in our ranks because he has joined us thanthere would be over any other man.

"

Sir HUGH LETT, president of the British MedicalAssociation. in reply, said that today no-one would bebold enough to put the question " is your college reallynecessary ? " Before the college was founded the situa-tion of surgery, medicine, and obstetrics recalled theold-fashioned bicycle in which there were two big wheelsand a little one which ran behind without anybodynoticing. In the last few years obstetrics and gynaecology ’had advanced so rapidly that it was essential to have abody like the college not only to lead developments butto speak with authority. Medicine was not only a greatprofession ; it was the ideal profession’: no other callingoffered such opportunities for development and pursuitof the finest ideals. The ideals often met with disappoint-ment in practice, but it had been well said that the joyof an ideal lies in its pursuit. ’-

After touching on the risk of dividing medicine intospecialties, which might lead the doctor to overlook thewhole of the patient, Sir Hugh spoke of the danger thatpeople in certain departments of medicine should regardthemselves as the profession. It was of the greatestimportance at this time that the profession should feelitself united and express its voice in such a way as toimpress those -in authority. Unity must be securedbetween the colleges themselves and between the collegesand other professional organisations. The work of the.colleges was a special academic work, for which theywere particularly fitted, but other things could be done

- only by such a body as the British Medical Association.One could not always be sure that the " will of thepeople " would bring about the good of the patient.Medicine should speak with one voice on what it believedto be in the best interests of the people as well as of theprofession. -

SCOTLAND

(FROM OUR OWN CORRESPONDENT) ’

THE University of Edinburgh is planning a con-

siderable extension of its premises. For many yearsnow the accommodation in the university buildings hasbeen wholly inadequate, and in the period after the warof 1914-18 new departments were built on the southside of the city some distance away from the old univer-sity buildings and from the medical school. As a resultthe university was scattered rather widely over the citywith a consequent loss of corporate sense and muchinconvenience to all concerned. The present plan hasbeen prepared for the university by Dr. Holden in con-sultation with Sir Patrick Abercrombie and Mr. Plum-

_ stead, the town planning officer for Edinburgh. PrincipalSir John Fraser publicly described the plans some weeksago and emphasised the urgency of beginning to putthem into effect. The Edinburgh town council has nowexpressed its general approval, at least in principle, ofthe first stage of the development, and Sir John Falconer,the lord provost, has given the scheme for the formationof’a university precinct his blessing.

It is intended that almost the whole area between thepresent old university buildings in the South Bridge atone end, and George Square and the Meadows at theother, should become a university area. without inter-fering with the principal traffic routes which pass throughthis part of the city. The plan foresees the constructionof teaching buildings on all sides of George Square withuniversity hostel accommodation in Buccleuch Place andits neighbourhood. It is intended to develop the medicalschool by extending its buildings from the present NewQuadrangle in Teviot Place backwards to include thenorth side of George Square. This will mean a greatincrease in accommodation for the various departmentsof the medical school. It is understood that the newbuilding programme will not involve the abandonmentof the buildings at West Mains Road, which are mainlyoccupied by departments of the faculty of science, butthe arts and other faculties still accommodated in theold university buildings in South Bridge have been in ahopelessly cramped situation, and the provision of addi-tional and better premises for these faculties is an

urgent matter. ’

Public Health

Prospects in Industrial MedicineA CONFERENCE held at Leeds last summer 1 reviewed

the difficulty of giving medical care to people workingin small factories-some 53% of the whole industrialpopulation. Accidents and disease are commoner inthese small factories, as Dr. C. G. Kirkland pointed out.He suggested that a mobile corps might be formed forfactories, to take the doctor to the job. Dr. J. VaughanJones thought the care of people in these smaller factoriescould not be left to voluntary effort. In one or twoplaces-at Bedford, and at Cray in Essex—small firmshave grouped themselves together to provide medicalcare for workers, but such schemes he believes are notlikely to become widespread : the interests of smallfirms are too diverse. He upheld the view of the Leedsjoint council that industrial medicine should be a

statutory service, regionally planned. The statutoryprinciple was supported by nearly all the speakers.Many doctors felt that because they were paid by thefirm they were at a disadvantage with workers, whosuspected them of being " gaffer’s " men, more interestedin production than in the health of the producers.

Discussing the organisation of a statutory service,Dr. G. F. Keatinge said it would not do to put theresponsibility of medical supervision on the existingexamining surgeons, because they can only give a limited amount of time to the work ; besides, their approach ispersonal instead of being environmental and occupa-tional. He thought that a corps of specialists inindustrial medicine should be formed, to be calledoccupational health officers. They would be the nextlink in the chain after the school medical officer, super-vising conditions for the worker from his entry toindustry to the end of his working life.

Many speakers noted that while the industrial medicalofficer can recommend alterations in working conditions,he has at present no authority to demand them. As aState servant he would be able to insist that workshopswere maintained at the statutory level ; though, as Dr.N. J. Cochran remarked, this might limit him, too : an

intelligent doctor employed by the firm could suggestimprovements beyond the statutory level.

It was generally agreed that industrial health researchfalls short in scope, speed, and operation.

The General Register OfficeThe branches of the office which were evacuated to

Blackpool at the beginning of the war have now returnedto Somerset House, London. The Registrar-General anda small staff remained at Somerset House throughoutthe war, but the general work of the office has beencarried out at Blackpool. The records of births, deaths,and marriages were arranged and indexed there andthen sent to Somerset House to be kept in the vaults.The whole of the office is now housed in London, except apart of the statistical branch and the whole of the CentralNational Registration Office which remain at Southport.

Infectious Disease in England and WalesWEEK ENDED SEPT. 21

Notifications.-Smallpox, 0 ; ; scarlet fever, 853 ;whooping-cough, 1610; diphtheria, 240; paratyphoid,17 ; typhoid, 13 ; measles (excluding rubella), 1208 ;pneumonia (primary or influenzal), 312 ; cerebrospinalfever, 36 ; poliomyelitis, 28 ; polio-encephalitis, 3;encephalitis lethargica, 1 ; dysentery, 66 ; puerperalpyrexia, 106; ophthalmia neonatorum, 69. No case ofcholera, plague, or typhus was notified during the week.

Deaths.—In 126 great towns there were no deathsfrom scarlet fever, 1 (1) from an enteric fever, 1 (0) frommeasles, 6 (0) from whooping-cough, 3 (2) from diph-theria, 38 (3) from diarrhoea and enteritis under twoyears, and 5 (1) from influenza. The figures in paren-theses are those for London itself.The number of stillbirths notified during the week was

266 (corresponding to a rate of 30 per thousand totalbirths), including 41 in London.1. Industrial Medicine. Report of Conference held in Leeds on

June 20, 1946, by the Leeds Joint Council on Industrial Medicine,the Burton-on-Trent Advisory Council on Industrial Medicine,and the Derby Advisory Council on Industrial Health.