1122

Special Articles.THE PEOPLE’S LEAGUE OF HEALTH.

FIRST INTERNATIONAL CONGRESSAT WEMBLEY.

THis congress was opened by Viscount Burnham,the President, at Wembley on May 21st. ThePresident said that the League had done muchpioneer work in educating the public as to healthmatters. Much of the success of Public Health Actsdepended upon the support of public opinion. Whenin Jamaica last year he saw how much the officersof public health were hampered and obstructed by theapathy and ignorance of the multitude. Greatthings had, however, already been done in combatingtropical diseases.

The TIollsing SectiOI/.Mr. Neville Chamberlain. M.P.. who presided over

the Housing Section, also pointed out that progress inpublic health depended upon public opinion. AllGovernments in this country followed, but did not lead.Housing was a problem of old countries and especiallyof the industrial towns of old countries. It was alegacy from the population of 100 years ago whobuilt houses according to the standard of that time.It was a pity no one had yet invented paper houses.Houses were at present built to last 80 years, andwould be out of date long before that time. It wasnot only rehousing that was necessary, but redishi-bution of the population. The housing questiontherefore was bound up intimately with the transportsystem, and housing reformers needed to exercisemuch forethought.Mr. James Stewart (Parliamentary Under-Secretary

for Health in Scotland), referring to the paper housesdescribed in Bellamy’s " Looking Backward," saidthat 80 years was much too long a life for a house.His experience of wooden houses in America wasthat they were quite warm and comfortable. Heagreed with Mr. Chamberlain that the housingproblem was not entirely the result of the capitalistsystem, but that it was rather due to the generalignorance of our forefathers. For instance, the homesof the aristocracy which had been converted intoGovernment offices were wanting in light and air.Money spent in housing would bring a return, butrather resembled capital invested in commercialenterprise, which did not earn dividends at once. As anative of Glasgow he was appalled by the percentagesof the population living in homes of one and two roomsrespectively. He believed that much of the tuber-culosis in Glasgow was due to housing conditions.220,000 a year were spent in efforts to cure tuber-culosis -mostly futile. Better housing would not onlymean less tuberculosis, but less expenditure on widowsand orphans, on the sick poor, on voluntary hospitals,and on the results of crime and intemperance.Housing had become the sport of politicians. Thereshould be a whole-hearted effort of all parties to finda remedy. He agreed with Mr. Chamberlain thatredistribution was necessary. He hoped for smallertowns and cities. The intelligent use of electric powerwould help in this direction. If we did not solvethe housing problem we were dootned as a nation.

Dr. John Hobertson (M.O,H., Birmingham) saidthat many English towns had the evils of back-to-back houses to put against the tenements of Glasgow.The back-to-back houses were mostly three-roomedand did allow the children to get out, and for thatreason were infinitely preferable to the Glasgow flatsystem. He was hopeful about town-planning, buturged that if town-planning were to be successfulprovision must be made for the recreation of thepopulation at every age. If the number of housesper acre were limited there would be open-airspace for the baby and the toddler in the gardenunder the eye of the mother. Small school-children

! needed playgrounds near their homes. For childrenfrom 8 to 10 years special accommodation wasneeded in the parka ; from 11 to 12 playing fields :from 11 onwards larger playing fields. After 25! recreation could usually be paid for. Allotmentswere essential, and at present were too far from thehomes and were held on too precarious a tenure.No town in the country had yet made adequateprovision for the recreation of its population. Heestimated that eight acres were needed per thousandof the population : five for games, two for allot-ments, and one for parks for the elders. This openspace might in the future be provided on each sideof the main arterial roads, which the noise of thetraffic would render unsuitable for housing sites.

Dr. F. E. Wynne (1T.O.I1., Sheffield) said thathousing had become such a burden on rates and taxesthat local authorities had been obliged to select goodtenants. This was wrong. The evacuation of slumsshould be the first charge on housing. Sickness anddisability caused by bad housing cost more than thesubsidies to housing. There was no difficulty in

showing that the bad conditions in the slums causedhigh death- and disease-rates. An area in Sheffieldwhich was condemned bv Dr. Robertson had notbeen dealt with yet. lie thought this was not atime for rigid adherence to ideals and that everyhousing scheme should in :lude some very cheaptemporary houses. It was true that the tenantsfrom the old slums might make these into new slums,but he thought this could be prevented by a combina-tion of firm administration and Octavia Hill methods.

Dr. Leonard Hill pleaded for geeater simplicityin houses. As long as one got plenty of open air andsunshine the house was a matter of little importance.The new houses were already out of date accordingto modern hygiene. He suggested that the localauthority should secure areas and allow persons whowanted houses to erect their own free of any restric-tion. The local authority would only need to providepure water and arrange for the careful disposal ofthe sewage and exereta.

Food Seciion.Sir «’. Arbuthnot Lane. in opening the proceedings

of the Food Section, said that he would like to seethe food experts present at the congress arrange adietary which tz ould give rise to three or four motionsin the 21 hours. The baby, during its napkin stage,was the only member of our community sensiblytreated. After babyhood a system of regulatedconstipation was taught.

Prof. E. Mellanhy pointed out that practicallyevery child of 5 had decayed teeth and that ricketswas a very common disease. Cereals were the chiefcause and oatmeal was the worst cereal. We musteat cereals, but forhmately we were able to antagonisethe bad effects of the cereals by an adequate supplyof foods containing the fat-soluble A-vitamin. Cod-liver oil was the best source of this vitamin andmilk had a better effect than butter. Sunshine inviutne of the ultra-violet rays would also antagonisethe bad effects of cereals, but was not efficacious ifthe diet were very bad. A small daily dose ofcod-liver oil was beneficial during the winter whensunshine was scarce.

Prof. R. II. A. Plimmer dealt with the variouskinds of protein. He explained why one proteinwas more valuable than another in promoting growthand nutrition. The protein of cereals alone was notsufficient, but the protein of cereals and green-leavedvegetables combined might suflice for a strictvegetarian.

Prof. J. C. Drummond dealt with the great valueof milk as a food. He instanced the bad effects ofthe scarcity of milk on the children of Central Europe,and the wonderfully good results obtained by providingill-nourished school-children in America, with an extrapint of milk per dav. The experiments in Americawere being continued, but up to now it appeared thatthe improvement produced by the milk was out of allproportion to its caloric value and way probably

1123

attributable to the vitamin-content of the milk.Research was now in progress as to the effects of

pasteurisation and desiccation on milk, and up to thepresent it would appear that the food value of theseforms of milk. if properly prepared, was much thesame as that of untreated milk.As the result of the discussion which followed the

reading of the papers, a resolution was adoptedrectuesting the Council of the People’s League ofHealth to appoint a special committee to draw upfor popular use a pamphlet of instructions as to thedietary necessary to promote good nutrition and health.

Air, Liqht, and lValer.The second day’s proceedings of the congress were

of equal interest. In the morning the memberslistened to an exposition of the latest views as to thevalue of light and air by well-known authoritiesunder the presidency of Sir Henry Gauvain. Dr.Fortescue Fox put in a plea for the systematic studyand organisation of British spa treatment, andinstanced the value of such treatment for chronicrheumatism and breakdown in middle life. Thechief event of this section was Dr. A. Rollier’sfascinating and suggestive paper on the r6le of thesun. The paper described the methods adopted atLeysin, their preventive application to debilitatedchildren in the "Sun" School at Cergnat, and thepossibilities of applying these principles in everydaylife ; and was illustrated by lantern slides showingthe wonderful results obtained in the treatment oftuberculous cripples.

Some Overseas and Other Diseases.Sir Leonard Rogers dealt with leprosy. There were

probably more than 2,000,000 lepers in the world.In spite of the success of modern treatment bychaulmoogra oil, he estimated that only one-tenthof the lepers in British Dominions were receivingtreatment. Segregation had not been appliedscientifically and perhaps 75 per cent. of the lepersat present segregated were non-infectious.

Dr. George Low, in discussing flariasis, showed thatthe mosquito (Culexfatigansl, which acted as the inter-mediate host of the causal worm, was more easilyextirpated than the malaria mosquito. Culex fatigans,like stegomyia, the vector of yellow fever, had domesticha,bits and was found in water-barrels, &c., near

dwellings. In the NATest Indies both these mosquitoeswere tackled sinmxltaneously. In many British,colonies anti-mosquito measures were still not Iconducted with sufficient energy. ,

Dr. P. R. Manson-Bahr described the modernusage of antimony preparations, arsenical derivatives,bismuth, quinine, Bayer "205," and emetine in thetreatment of kala-azar, bilharziasis, trypanosomiasis,yaws, malaria, dysentery, liver abscess, and othertropical scourges.

Dr. Andrew Balfour wound up with a paper onvermin and their relation to disease, using the term" vermin " in a wide sense. It may be confidentlysaid that, at the close of the session, none of theaudience disagreed with Dr. Balfour’s pronouncementthat our efforts to destroy vermin are too half-hearted,and that our interest in the promotion of researchis altogether inadequate when compared with thegreatness of our responsibility.

.1.11 ental Hygiene.At the morning session of May 23rd the Conference

settled down to discuss the hygiene of the mind,under the presidency of Sir Courtauld Thomson.

Dr. Farquhar Buzzard insisted that the term" nerves

" must go. It was a term invented for ourdeception because we did not like talking about ourminds. Medical opinion was unanimous that hopefor future improvement lay in the prevention andearly detection of disorders of function. Why shoulda man confess without a blush to having a disorderof the liver, perhaps the result of over-eating or

over-drinking, and his brother be afraid to admita disorder of the mind, caused by overwork or anxiety.If the term " nerves " were abolished and the

prejudice about the use of the word " mental "

disappeared, they would have taken the biggeststep forward in the promotion of mental hygiene.

Sir Frederick Mott strongly advocated the establish-ment throughout the country of more hospitals likethe Maudsley, and pointed out that the study andtreatment of early cases would be much more usefulif the law could be so altered that patients could bedetained for more than 24 hours, even against their wish.

Dr. H. Crichton Miller said there was no hard-and-fast differentiation between sane and insane. Some

asylum cases are curable, many uncertified cases ofmental breakdown can be saved, and a very greatproportion of both might be prevented. Much researchis still called for, but much of our present knowledgeis not applied, partly because public opinion is noteducated and partly because the necessary fundsare not available. We need greatly increased personnelin our asylums, more research into individual cases,and more chairs in our mental schools which willattract the best brains in the alienist world. Perhapsmore important still we need conditions for the treat-ment of minor mental disorders which will secure thecoordination of specialised medical skill for individualcases. Such a vision needed great financial support.

Dr. R. G. Rows said the recognition of the fact thatthe delinquent was made, not born, would put an endto the feeling of helplessness and hopelessness andjustify the hope that change of environment andeducation of parents and child would do much toprevent delinquency.On the following day Prof. George M. Robertson

contributed an interesting paper on the Hospitalisa-tion of the Asylum, and confirmed the views of otherspeakers as to the need for an increased medical staffin asylums, more research, and more careful studyof individual cases. He advocated several changescalculated to make asylums more like hospitals,such as the admission of all voluntary cases, whetherthey can pay or not, the temporary notification ofcases by two medical men in lieu of certification,and the more frequent revision of legally detainedcases.

Industrial Hygiene.i At the afternoon session of May 23rd the hygieneof industry was considered. Sir Thomas Oliverpresided, and the speakers included Prof. E. L. Collis,Dr. C. S. Myers, Director of the National Institute ofIndustrial Psychology, and Dr. F. Shufflebotham.

Dr. Myers pointed out that industrial psychologyis concerned in alleviating the strain arising fromdefective arrangements of hours of work and rest,or from rare or too frequent changes of work ; fromwaste of energy due to unsystematic training,unnecessary and unrhythmical movements, needlessstanding and stooping, &c. ; from inefficient illumina-tion, excessive vibration, humidity and temperature,&c. ; and from unfitness for the occupation adopted.The hygienic value of industrial psychology wasclearly reflected in the diminished sickness records,the increased output, and the greater happiness ofthe workers, obtained by its application.

In his paper on lead poisoning among potteryworkers Dr. Shufflebotham pointed out that acutecases of lead poisoning had been wiped out by theHome Office regulations, but that chronic cases stilloccurred and were very unfairly treated under theWorkmen’s Compensation Act. The monthly examina-tions by the factory surgeons had acted beneficiallyto leadworkers, but the power to suspend workerswho might have been engaged in this occupation for30 or 40 years, presumably because they were sufferingfrom lead poisoning, was a manifest injustice.

Dr. Ralph C. Matson, Director of the NationalTuberculosis Association, -U.S.A., described a typicalAmerican intensive health experiment, by means ofwhich the population of Framingham, Massachusetts,numbering 17,000, had been provided, after a studyof the conditions, with an up-to-date organisation,where practically none existed before, to the greatbenefit of the residents and industrial workers, and

1124

with a lowering of 16 per cent. in the general death-rate and about 50 per cent. in the mortality fromtuberculosis and among infants.

Legislation on Health Matters.Lines of progress for the future and desirable

legislative changes were the theme for the last sessionon Saturday, May 24th, Miss Margaret Bondfield,M.P., presiding. In opening the session Miss Bondfieldsaid that although legislative changes must come theywould have little effect in raising the standard ofhealth unless the people were roused to the importanceof obeying the laws and seeing that they were strictlyadministered. No matter what the legislativechanges, there would always be room for voluntaryeffort. Amongst the legislative changes requiredwere amendments of the Midwives Act, powers for ’’

the registration and inspection of maternity homes, !and power for the compulsory removal to hospitalof persons who were a danger to others. Referringto the House of Commons debate on the maintenanceof the blind, Miss Bondfield said more could be doneat childbirth and in early infancy to prevent blindness-a much more sensible policy.

Prof. W. E. Dixon made out a strong case for thestandardisation of drugs.

Dr. C. J. Bond pressed the need for an institutionalbranch of a unified health service, coordinating thework of all institutions dealing with both mind andbody. He wanted State aid in such a way as toretain the present voluntary and local management.The interests of the Ministries of Education and Healthshould be fused, the teaching of personal, sex, andsocial hygiene should become part of our educationalsystem, and the Ministries of Health and Educationshould cooperate to secure the education of exceptionalchildren.

Dr. F. E. Fremantle, M.P., emphasised the role ofthe individual. Voluntary effort should be encouragedon insurance principles. Laws should be so suppleas not to stifle voluntary help and effort.

Resolutions.Resolutions were passed in favour of :—

1. Establishment of an adequate hospital andinstitutional service instead of the present partialand incoordinated service, so frequently curtailedby lack of funds.

2. Action to be taken by the Ministry of Health withregard to the supply of wholemeal or standard breadand the education of the public as to the disadvantagesof bread made from highly refined flour.

3. Prohibition of the unnecessary addition ofpreservatives to food.

4. Need for the extension of legislative control toinfant foods consisting partly or mainly of starch.

5. Powers for the protection of children from theinfection of advanced cases of tuberculosis, eitherby the removal of the children or of the infectingcase from the home.The Conference terminated with votes of thanks to

all who had helped to promote its success. Miss OlgaNethersole is certainly to be congratulated in havingassembled a large body of medical speakers, eacheminent in his own particular line. The proceedings ofthe Conference will be published in book form inorder to reach a wider circle.

SOUTH LONDON HOSPITAL FOR WOMEN. - OnMay 22nd the new wing of the hospital at South Side,Clapham Common, was opened by the Duchess of York.The Mayor of W’andsworth referred to the hospital, whichwas opened by the Queen in 1916, as an example of theefficacy of women’s work and paid a special tribute toLady Cowdray’s full-hearted support as its chairman.Upwards of 50 purses, containing a total of some £1100,were presented to the Duchess of York by representativebodies and citizens of South London towards the cost ofthe new wing which has been furnished throughout, includingtheatre equipment, by an anonymous donor. The wingprovides accommodation for 38 additional patients and isexpected to lessen substantially the waiting list, on which atpresent some 600 rames stand. To defray the cost of thenecessary building alterations another JE6000 are needed.

THE DIFFICULTIES OF INSURANCEPRACTICE.

THREE OFFICIAL INQUIRIES.

WE print below summaries of the reports of threeInquiry Committees appointed by the Minister ofHealth since the beginning of the year. Each com-mittee was appointed to investigate a representationmade by an Insurance Committee that the con-

tinuance on the panel of an insurance doctor wouldbe prejudicial to the efficiency of the medical serviceof the insured.The facts only are summarised which the Inquiry

Committee found to be proved by the evidence sub-mitted to them. The decision given by the Ministerafter considering the report of the Committee isappended to each case.

I.-I,nadeqttate Deputising Arrangements : IrregularCertificatioii.

-Ile)i2bers of the Committee : -Alr. E. H. Tindal Atkinson,C.B.E., Barrister-at-Lam (Chairman), Dr. J. Divine, Dr.Alex Forbes.

The doctor had been in insurance practice since1912 ; for several years he had practised in a townwith a population of 44,000. He had over 1600insured persons on his list. He had two consultingrooms, one at his own residence and one at a neigh-bouring smaller town.With regard to the specific charges made in the

representation of the Insurance Committee, theInquiry Committee found the following facts to beproved :-

1. The doctor left home on August 4th for a shortholiday, returning on the 9th. During his absencehis house and consulting rooms were closed and noarrangements were made with any other doctor forthe treatment of his insured patients. The localmedical officer of health, Dr. A. B., had consentedat the doctor’s request to attend two of his patients(one of whom was an insured person), but had notbeen asked to exercise any general supervision overthe needs of the insured patients, neither could hehave done so owing to his public duties. The Insur-ance Committee received no complaints from anyinsured persons as to want of attention during thedoctor’s absence.At the hearing the doctor produced a notice

which stated that he was absent until August 9th,and that cases of emergency could be referred toDr. A. B. or to another doctor. This notice, hestated, was affixed to the door of the consulting roomduring his absence, but the Insurance Committee con-tended that this notice had never been exhibited.

2. Before going on his holiday the doctor signedintermediate certificates for eight insured personson his list, the certificate in each case stating thathe had examined the patient on a date when he was,in fact, away. The causes of incapacity were mostlyailments involving some probability of continuance.On his return the doctor issued a first certificate toan insured person, antedating it one day before hisreturn.

3. The doctor had also issued insurance prescrip-tions to 16 persons not on his list ; two of these werecases of urgency not admitting of inquiry, and inthe other cases there had been some mistake as tonames, initials, or identity. The doctor also issuedprescriptions to three persons who were on his dis-pensing list, and in one case he issued 14 post-datedprescriptions to a patient resident two miles from hishouse.

4. The doctor’s wife owned shop premises adjoin-ing the doctor’s residence, which were let to an

insurance chemist, C. D. A disagreement, whichdeveloped into a personal quarrel, arose between thedoctor and the chemist in connexion with the renewalof the tenancy. After the date of the notice to