A Basis for Discussion.

  1. During the last war and in the immediate post-war period, more lives were lost from disease than in four years fighting on the battlefields.  The present war, involving the whole of the civilian population as well as the armed forces will prove an even greater menace to the lives and health of the people.  Thous­ands now spend the greater part of their time outside of working hours in the tubes and shelters, in conditions which tend to the outbreak of epidemics.
  2. Most of the commoner infections which may develop into epidemics, such as influenza, diphtheria, scarlet fever, cerebro-spinal meningitis, polio-myelitis, and tuberculosis are airborne. Others, such as impetigo, scabies and verminous infestation, are spread by direct contact,  Others again such as diarrhoea and vom­iting, typhoid and dysentery, are spread by the contamination of food, water and feeding utensils, due to faulty sanitary arrangements.
  3. In each instance the most important single factor predisposing to an epidemic is overcrowding.  This is the crux of the problem, according to the Horder report, and in the correct solution of it lies the key to the whole situation.
  4.      The Horder report  regards dispersal as the key to the problem of overcrowding, but overcrowding is not solved by dispersal, but by increased accommodation.  An Anderson shelter may be as over­crowded, relatively, as a Tube platform, and the disadvantages of Anderson and surface shelters, under present conditions of cold and damp, outweigh any advantages they may have.  Overcrowding in shel­ters is only a part of the whole picture of overcrowding in poor conditions of ventilation, due to the black-out, which exist in the factories, in trains and buses, and in the homes of the people. The solution of the problems created by large numbers of workers living together for many hours in unhealthy factories and shelters lies, not in dispersal, but in increased accommodation and in the improvement of hygienic conditions in these places by an efficient and comprehensive health service which can deal effectively with all aspects of prevention and cure.
  5. To meet the requirements of safety, shelters must afford the maximum degree of protection against bombs, with the minimum risk of disease. 
  6. In order to do this, they must conform to certain public health requirements.  Ventilation, sanitation and warmth are essential.  Sleep is necessary for the maintenance of health and  working capacity, and sound sleep requires a sense of securityfrom danger, freedom from the noise of bombs and gunfire, and facilities for lying down in some degree of comfort.
  7. The S.M.A. is well aware that many, if not all, of the following proposals have been voiced before.  Some of them, but not the most important one, the building of bomb-proof shelters, are embodied in the Horder report, which the Government claims to have accepted.  This acceptance has so far reached the stage of recommendations to local authorities, and ‘an appropriate circular on this point is to be issued as soon as possible’.  (B.M.J. November 23rd, 1940.)  This may well result in indefinite delay, as the local authorities, whilst accepting the recommendations, are unable to implement them without the necessary authority and financial support of the Government.
  8. The S.M.A, is of the opinion that the people’s health and safety should be the first care of the Government, for with­ out the people it can neither bring the war to a successful con­clusion, nor achieve the promised reconstruction after the war. The S.M.A. therefore supports the calling of the People’s Convention, to be held in Manchester on January 12th 1941, whose aim is the establishment of a People’s Government, truly representative of the whole people, whose first care will be the people’s health and safety.

The Socialist Medical Association therefore puts forward the following proposals as the Association’s accepted policy for the protection of health in shelters;-

A. 1. Immediate provision by the Government of adequate num­bers of bomb-proof shelters, such as the Haldane type, which achieve dispersal by accommodating small numbers of people in separate sections of a large shelter, whilst at the same time providing adequate ventilation, sanitation and medical supervision,

2. Until such shelters are built, the Government shall forthwith take over all bomb-proof shelters, whether private or commercial, and open them to the public to relieve the overcrowd­ing of shelters already in use.

B.      The Borough Councils, through their Medical Officers of Health, shall be made responsible for all shelters in their area, and shall be given facilities by the Government to make the following provisions:-

  1. Adequate sanitary equipment, with the extra staff required for proper cleaning and disinfection of the shelters.
  2. Regular inspection of the shelters by the M.O.H. and his staff.
  3. First-aid posts with a staff of trained nurses and a doctor in attendance or on call, with adequate equipment for examination, and beds for isolation.
  4. Free inoculation against typhoid and diphtheria.
  5. Reservation of certain shelters for tuberculous persons still at work.
  6. Sleeping bunks and bedding, kept clean and free from infection, stored in the shelter and issued each night.
  7.  Washing facilities, including where possible showers for those who come straight to the shelter from work.
  8. Mobile canteens serving hot meals and a properly bal­anced diet, as well as refreshments, for those who are unable to obtain them during the day; and the provision of sufficient quan­tities of milk, as a protective food, for all those requiring it, including those who under the existing scheme can obtain it free or cheap.

C.      The co-operation of those using the shelter shall be secured by means of committees elected by the shelter-users, in

  • order to ensure the smooth working and the adequate supervision

  • of the provision made.

November 1940

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