1087

The Ministry of Health.

THE LANCET.

LONDON: SATURDAY, MAY 21, 1921.

AT the end of last week Sir ALFRED MOND, on thevote to meet expenses in connexion with the

Ministry of Health, made a statement in respect ofthe present position and future intentions of hisdepartment, which has produced an excellent effectboth within and without the House of Commons.

For although the -sum asked for was a very largeone, the explanation of huge work ahead of theMinistry of Health led to an agreement to the votewithout any damaging criticism, while the publiclearned that the Ministry has been, and is, workingalong definite lines to promote and correlate effortsin behalf of the public health. Considering thevague and various attacks that have been made onthe Ministry of Health for political purposes fromits quite early days, this may be regardedas a very healthy state of affairs ; as the publicignorance, which has been exploited by irrespon-sible public statements, disappears, the real

economy of spending money in the prevention ofdisease will become clear.The Minister of Health began by pointing out

the perfect absurdity of drawing any comparisonbetween the estimates in connexion with the LocalGovernment Board in and before 1914 and thoseof the Ministry of Health at the present moment.All such comparisons have been transparentnonsense to those who know, and remember, howthe Ministry of Health came into being, and whatnumerous activities it represents other than thoseof the old Local Government Board. Nor is thisthe whole story. New programmes of work, con-sidered by neither the old Local Government Boardnor by any of the departments whose functionshave been transferred to the Ministry of Health,have been added to the designs of the Ministry,while the administration of the National InsuranceCommission, which was dislocated by the warbefore it had received proper trial of its possi-bilities, has called for large reconsideration. Andif comparisons between the numbers and spheresof work of the medical staff of the old LocalGovernment Board and that of the new Ministry ofHealth cannot be drawn, it becomes waste of timeto debate whether that medical staff, whenalluded to as " medical officers," implies only"medical officers " as distinct from " medicalinspectors," or implies the medical staff as a whole.In the House of Commons Dr. ADDISON stated,during the debate, that under the Local Govern-ment Board in 1918 there were already 38 medicalofficers. The statement was perfectly true, and nota person ought to have been deceived into thinkingthat he meant 38 heads of groups and sub-groups,under whom medical inspectors worked. He wasclearly including the " medical inspectors " under

the term " medical officers," as is always done inconversation.The actual figures, which can be fairly com-

pared in order to show the relative position ofthe headquarters staff of the Ministry of Health in1918 and to-day, are as follows :-

1918. 19,21.Medical Officer ...... 1 Chief Medical Officer... IAssistant Medical Officers 5 Senior Medical Officers... 6Medical ]Inspectors ...... 23 Medical Officers-

General......... 43 ) Med. Inspectors of Food 5 Food............ 5 50Med. Inspectors Poor-law 2 Poor-law ......... 2) lMed. Bacteriologists ... 2 Med. Bacteriologists ... 2:

38Insurance Medical Officers 8

46 59

Here is Sir ALFRED MOND’S statement on thematter, and it will be seen that it tallies both withthe facts and with Dr. ADDISON’S figures:-On April lst, 1919, the number of pensionable

medical men in the Local Government Board andthe Insurance Commission of England and Wales-was 46; the number at present in the Ministryis 59, or a difference of 13, distributed as

follows: Maternity and child welfare, 2; tubercu-

losis, 2; venereal disease, 2; port isolation hos-pitals, 3 ; statutory medical services and intelligencework, 3 ; and work taken over from the Home Office,1. These are additional functions to the workwhich is being looked after by the medical staff ofthe Ministry of Health, apart from the newly estab-lished regional officers. There are no less than1800 sanitary authorities which look to the Ministryfor guidance, 114 port authorities, 646 Poor-lawunions, 1029 isolation hospitals for infectious diseases,and 4220 public vaccination districts which have to beinspected. There are a vast number of maternitycentres and tuberculosis sanatoriums to which the

Ministry give grants and which also have to be

inspected. ’

This statement, which will be found in our Parlia-mentary Correspondent’s report, should be remem-bered, when, in the future, the wholesale cuttingdown of the members of the medical staff of the-Ministry of Health is under discussion on thescore of economy. Colonel FREMANTLE, duringthe debate in the House of Commons, alluded to-" a canard going round the press that the Ministryof Health inherited from the Local GovernmentBoard a staff of only four medical officers." He hassince written to the Times, where the unfortunateannouncement was made editorially in the courseof a plea for economy, giving much the same

comparative figures as those we print above. All

advocacy of economy is welcome to-day, but its basisshould be correct.Three expressions of opinion and intention came

from the Minister of Health, which revealed to theHouse of Commons a story of strenuous industryHe claimed that in spite of difficulties the depart-ment had succeeded in making a reduction of overf:3,OOO,OOO in the estimates of this year as comparedwith last year, while considerable progress hadbeen made with housing schemes. And here he

pointed out-what is now well known-that somelocal authorities have exaggerated local wants-The national need is grave enough without suchtroublesome errors. Secondly, in reply to pointsraised principally by Sir WATSON CHEYNE, Sir-ALFRED MOND stated that there was no inten-tion on the part of the Government to starta State Medical Service, although an endeavourwas being made to improve the existing panel

1088

systems in certain directions. We may hopethat one of these directions will be the encourage-ment of all movements on the part of the

Approved Societies to assist in the support ofthe voluntary hospitals. It was announced, on thevery afternoon that the Minister of Health was

speaking, that a number of beds in the LondonHospital would have to be closed, and the Ministerallowed that the position of these great charitieswas giving his department cause for anxiety;but recent action by the Approved Societiesshould have an encouraging influence here.These Societies have discussed with the British

Hospitals Association the possibility of providinginstitutional treatment for their members, whoform so large a section of the panel patients,in return for contributions on an agreed per-centage basis, and if the voluntary system can

be supported in this way on any general planthe relief to the charities should be greatand promptly felt. Lastly, Sir ALFRED MONDdefended the policy of the Government in respectto venereal disease,, a policy directed towardsofficial propaganda, but also towards the pro-motion of treatment. While he stated that herefused to accede to any demand to regard the

question from a merely medical point of view, it iswell known that a comprehensible policy in respectof the control of venereal disease, taking note ofthe therapeutic side, will shortly claim publicattention. There is nothing new about such a

policy, but for various reasons it has not been

pressed forward by the Ministry, and medical menwill agree that it is difficult, dangerous, and some-times wrong for a Government department to laydown from the centre rules which cover therapeuticdetails. Indeed, it can be argued that a Govern-ment department acting along such lines would be"

prescribing by correspondence," the mischief ofwhich has been sufficiently illustrated by countlesscharlatans. Further, the Ministry of Health isbound to take into consideration the freedom ofopinion of the local authorities working beneathits Eegis. For this reason the Ministry can

hardly go further in the definite treatment of Ivenereal disease than to acquiesce in freedomof action on the part of those who representthe ratepayers. But medical men have learntwith pleasure that, in view of the prevalence ofvenereal disease, the Ministry proposes to offer

public advice, pointing out the duty which lies onall individuals infected to take measures to purifythemselves. It need hardly be added that thosemeasures must be sufficient and must be prompt,or they will only constitute an imitation of

protection. The duty of the Ministry is to helpthose who desire to help themselves; and theduty of the local authorities is to come promptlyto a decision as to the methods which can be

employed to such an end.

Prague as a Health Focus.HEALTH conditions in Prague under imperial

rule left much to be desired. It was difficult toobtain a trained nurse. In the large part of thetown the drainage was inadequate, and the roughstone-paved streets in the older quarters were notkept free from garbage. Things are apparentlyimproving. Set in the very midst of the Europeanstorm circle, the Czecho-Slovak Republic enjoysnone the less some measure of the peace essential for

any organised health effort. A number of voluntaryhealth and social organisations have long existedin the Republic without any contact between eachother, and now, at a meeting called by the Czecho-Slovak Red Cross, representatives of nine of themost active of these organisations have arrangedto meet on a council in whose deliberations

public health and social effort shall have their

fitting place. Each organisation will preserveits independence, the council meeting four timesa year for joint deliberation. A central officewith a part-time secretary in the building of theRed Cross provides for the collection and circula-tion of information. The generosity of the Inter-national Health Board of the Rockefeller Foundationhas made it possible to open this office at once onan experimental basis.At the same time the Ministry of Public Health

and Physical Education is making every effortto mobilise all forces against the spread of infec-tious diseases. This is a measure of wiseprecaution, although the general situation inSlovakia itself is not alarming. Neither thetyphus epidemic nor the small-pox epidemic whichwere anticipated for the spring fulfilled the

gloomy promise, and of the latter only scatteredfoci persist in Slovakia. No cholera has beenreported. The Ministry has at its disposal a

mobile column to fight epidemics, consisting offour motor-cars, one containing a laboratory, a

second to accommodate personnel, a third for

transport of patients, and a fourth containingdisinfecting plant. Four nurses are attachedto the unit, the chauffeurs are trained disinfectors,and a physician is in charge of the whole. Theunit will at first operate in Slovakia along with asanitary train lent by the American Red Cross tothe Government. Proceedings will be made easierlater by the passage into law of a Bill now beforethe Assembly for the administration of localhealth under a national service of officers. Themeasure was deemed necessary in order to securean adequate medical and public health service forSlovakia, where the peasants are ignorant and

greatly in need of medical and health servicesalthough unable to support their health officer

locally. The nationalisation of some two thousandpart-time health officers will increase the budgetof the Ministry of Health by about 50 millioncrowns, but it will make it possible for the Ministryto send to Slovakia young Czech doctors who other-wise would not go there because they could notsupport themselves by private practice.At the Ministry itself a new section has been

organised for the study and reform of public healthactivities. The first task of this section will be todemonstrate the value of statistics and publichealth education in the programme of a would bemodern State. The section has two chiefs, oneof them being Prof. SELSKAR M. GUNN, technicaladviser to the Ministry, who represents theRockefeller Board; the other Mr. KOLINSKY, whoreturned recently from a study trip to Englandand the United States under the auspicesof the same Foundation. The personnel of thissection will chiefly consist of doctors who have

spent a year studying public health adminis-tration in the United States. An advisory boardconsisting of prominent men in the field of publichealth in Czecho-Slovakia has been attached to thesection. The whole movement will be watchedwith sympathetic interest by the neighbours of theRepublic, near or remote, who would like to see