■April i. 



[920J 



NATURE 



•51 



Public Health and Welfare. 



T^ HE forty-eighth Annual Report of the Local 

 ^ Government Board, containing the report of the 

 Medical Department for 19 18-19, is noteworthy in 

 many respects. It is the last of what may justly 

 be called a famous series; it is addressed, not, like its 

 predecessors, to the President of the Board, but to 

 the Minister of Health, and its introduction is written 

 by the First Medical Officer of the Ministry of Health. 

 Its contents are noteworthy too, dealing with matters 

 that no one probably even ten years ago would have 

 dreamed of seeing referred to in the Board's report, 

 and with subjects that the early Medical Officers of 

 the Board never thought of in relation to the work 

 of the Board. I 



The introduction, written by Sir George Newman, 

 takes the form of an interesting little historical note 

 on the origin and growth of the Medical Department 

 of the Local Government Board. To Sir John Simon, 

 who was the first Medical Officer, to Dr. Seaton, who 

 succeeded him, to Sir George Buchanan, to Sir 

 Richard Thorne Thorne, to Sir William Power, and 

 to Sir Arthur Newsholme, the last of the famous line, 

 he pays due tribute. They were all great men in the 

 eyes of the Public Health Service, but Sir John Simon 

 was the greatest of them all. As the English Parlia- 

 ment is the mother of Parliaments, so English public 

 health is the mother of all public health, and this is 

 due almost entirely to Sir John Simon. That the 

 English public health organisation is what it is to-day, 

 the finest in the world and adopted as the model by 

 every civilised nation, is largely thanks to him. This 

 Sir George Newman acknowledges. He recognises 

 also the greatness of the task before the new Ministry, 

 and admits, though many hard things have been said 

 of it, that the Local Government Board did work of 

 tremendous value to the country and the people, and, 

 " with all its limitations of machinery, proved itself 

 a body in search of truth and having humanitarian 

 ends." One precious possession it gave was the gift 

 of method — "a method formulated by practice and 

 experience, which consists of a combination of 

 scientific work and common-sense administration, both 

 associated with a wide and comprehensive vision." 

 As to the future medical plans of the Ministry Sir 

 George Newman has little to say except that steps 

 have been taken to reorganise the medical arrange- 

 ments by enlarging the staff and differentiating its 

 functions. For the report itself Dr. G. S. Buchanan, 

 Dr. R. J. Reece, and the Medical Inspectors of the 

 Board are responsible, the first-named providing a 

 general survey, as well as dealing, like each of his 

 colleagues, with certain of the special conditions or 

 subjects he was called upon to investigate during the 

 year. 



The bulk of the articles included relate to epidemic 

 disease, and the outstanding feature of the year in 

 this connection having been the pandemic of influenza, ' 

 not unnaturally much space is devoted to this disease, 

 the duty of reporting upon it being imposed upon Dr. 

 Carnwath, who acted as secretary of the special com- 

 mittce set up to investigate the subject. This report 

 contains an admirable and concise description of the 

 outbreaks experienced here, and contains much most 

 useful information with regard to the natural historv | 

 of the disease. Reference is made to a number of 

 investigations, bacteriological and epidemiological, 

 carriedout in various parts of the country dunnjf the 

 epidemic. So far as the former are concerned, it 

 cannot, as Dr. Carnwath states, "vet be stated that 

 unequivocal conclusions have been reached." Serious 

 doubt, however, was cast upon the claims of the 



bacillus of Pfeiffer, which for vears had been held 



be the causative organism, to continue to be so I 

 NO. 2631, VOL. 105] 



regarded. So far as epidemiological investigations 

 were concerned, attention is directed to those carried 

 out m Leicester by Dr. Arnold, one of the Medical 

 inspectors, and in certain public schools by Dr. Mac- 

 ewen, also a Medical Inspector. In Leicester Dr. 

 Arnold made more or less of a general inquiry with 

 the view of eliciting information as to age incidence 

 while in the schools Dr. Macewen went into the 

 question of immunity in influenza. Neither inves- 

 tigator appeared to succeed in obtaining any informa- 

 tion of practical value. 



For a section of the report dealing with epidemic 

 diseases associated specially with war conditions Dr. 

 Buchanan is responsible; while Dr. Reece and Dr. 

 MacNalty treat of encephalitis lethargica, the condi- 

 tion which the Press at first insisted upon regarding 

 as botulism, and now persistently and, for some reason 

 or other, jocularly refers to as "sleeping sickness." 

 Of the war-diseases those specially dealt with are 

 typhus and trench fever, malaria and dysentery. 

 The fact that the first two are louse-borne diseases is 

 stressed, and in regard to malaria it is pointed out 

 that, though a few cases of indigenous origin have been 

 brought to light, only in Kent was there any consider- 

 able spread of the disease. In the report on encephalitis 

 lethargica Dr. Reece deals with prevalence, and Dr. 

 MacNalty with the general features, of the disease. 

 By both observers a number of references are made 

 to instances of multiple cases in families and institu- 

 tions, but both quite definitely hesitate to class the 

 condition as infective. Dr. Ma'cNalty's explanation of 

 the sporadic distribution, that it belongs to the group 

 of maladies, including such conditions as cerebro- 

 spinal fever (spotted fever) and acute poliomyelitis 

 (infantile paralysis), in which the agent is present 

 commonly in the body and inactive until immunity 

 breaks down, is one likely to be generally accepted. 



Apart from reports upon diseases, there are some 

 others dealing with more General matters. Of these, 

 two calling for special reference are that by Dr. 

 Wheaton on maternity and child welfare, and that on 

 the work of the inspectors of food by Dr. MacFadden. 

 Both chronicle advances and improvements. Dr. 

 Wheaton shows that there is a steady increase in 

 enthusiasm for welfare work amongst local authorities, 

 as evidenced by the appointment of more and more 

 health visitors and by the establishment of more and 

 more centres^ consultations, creches, and day nurseries. 

 The work of the food inspectors on behalf of the Army 

 and the people. Dr. MacFadden states, v^-as carried out 

 with great activity, and, if it did nothing more, 

 showed many openings for reforms. Of two im- 

 portant, long-overdue reforms, one has relation to the 

 inspection of home-killed meat, which is inadequately 

 done, because only just over a hundred local authori- 

 ties have established public abattoirs, and much 

 slaughtering is still done in private slaughterhouses. 

 The other matter calling for attention is the super- 

 vision of places where food is prepared or stored. In 

 most districts there are many places in which food is 

 dealt with where the conditions are undoubtedly very 

 bad. From time to time such places are discovered 

 and efforts made to deal with them, but, as Dr. 

 MacFadden shows, proper supervision is impossible 

 for the reason that the powers granted by the Health 

 Acts are inadequate and unsuitable for controlling 

 them, and, more important still, the local inspectors 

 are too few in number and too much overloaded with 

 work of other kinds. 



The whole report is exceedingly interesting, and in 

 no sense inferior to those of former years. As it was 

 the last of the series, no doubt those responsible for 

 it desired to see it maintain the high level of excel- 

 lence already attained, and they have succeeded. 



