MAY, 1934

The Official Organ of the Socialist Medical Association

PRICE THREE PENCE

VIEWPOINT

ONCE more “The Socialist Doctor” presents the view of those who are striving for a new and better form of medical service in this country. The events of the past few months give this issue an added importance. On another page we offer congratulations to those of our members who have been elected to the new London County Council, and give some indication of the changes that are likely to take place in the work of our largest municipal medical service. For the moment we want to ask our readers to consider what that may mean to the ideal for which the Socialist Medical Service stands.

In our consideration of the steps to be followed in reaching a State Medical Service which will be free and available to all we have always discussed the problem on a national basis. The advent of a Labour administration in a large area in which there are 80,000 hospital beds under one authority enables us to look at the question from an entirely new point of view. The L.C.C. can so organise and improve the municipal hospitals of London that they may quickly come to be regarded as the real leaders of medical care in the Metropolis. A populace which learns to regard its own rate-maintained hospitals as the correct and best places to go to for major medical attention will soon demand that the whole of its medical service is provided and controlled by the local authority. The L.C.C. has the machinery and the means to meet this demand, and a few years may give us the beginnings of a real medical service for the working class in London.

From this point of view it may be necessary for the S.M.A. to reconsider its programme. Our final aim we know, and none of us will rest until we have a complete socialised medical service; but through the L.C.C. we may reach it by a route we have not adequately explored.

NUTRITION NEEDS PLANNING

by Dr. Leslie J. Harris (Nutritional Laboratory, Cambridge).

INTEREST in the subject of nutrition is at present almost universal, and opinion as to the needs of the community and the presence of under-nourishment among the working classes varies enormously. Nevertheless, there are certain facts which are indisputable and which demand free publicity. From these basic facts readers can be left safely to draw their own conclusions.

I am thinking primarily of those diseases, mainly “deficiency diseases,” for which modern medical science has now found the remedy- remedies of which there is no inherent shortage in nature, but of which man is nevertheless still kept deprived, solely because of the stupidity and ignorance of a society which fails to apply its knowledge, or to make proper use of its available resources.

In America a good deal of attention has been given by research workers to a disease whose very name is unfamiliar to most in this country-pellagra. Its cause is an impoverished diet. The means of preventing it, by making good the dietary deficiency, have yet been known for some years. Yet the latest returns from Washington show that the number of certificates for deaths from pellagra in the course of the year (1930) was no less than 7,146… 7,146 deaths recorded in a year from a preventable disease, known definitely and beyond dispute to be due to under-feeding and at a time when food is being burned and thrown into the sea. This seems lunacy indeed , and one can understand the despairing scientists at long last venturing to suggest that scientific principles might after all be given at least a trial in the sociological field, so that his discovery need not be so much sheer waste.

Xerophthalmia is a disease (of the eye), caused by a lack of vitamin A. In India permanent and total blindness is very common, and it is an accepted fact that its chief cause is this xerophthalmia. What an opportunity for scientific planning the Continent of India offers- work in which the medical scientist must play his full part, if the planning is to be worthwhile. One further instance only need be cited to show the scale of the problem in India: In many regions in the South of India, where the staple diet consists of polished rice, nearly all pregnant women suffer from beriberi (ie, vitamin B deficiency), and the number of premature births is three times greater than it is in the North (where a more suitable diet is customary), and the death-rate of young infants many times greater.

In Egypt, 62 per cent of the Fellahin, or small farmer class, still have pellagra, despite all the scientific work that has been done on the question! In parts of China, adult rickets (osteomalacia), almost unknown in Europe, is universal among mothers; while in congested city areas in India, such as Lahore, over 50 per cent of children of school age were found to have late or “juvenile” rickets.

It is no use to suppose that the simple solution of a return to the natural life (whatever that may be) is enough to solve nutritional difficulties, for, malnutrition of the most devastating type may and does occur among many primitive races. Again, correct nutrition cannot be left to instinct. It has to be taught. This conclusion is sometimes questioned, but not, I think by those well acquainted with the full facts. For example, clinical experience shows us that in this Northern climate of ours, most babies are bound to develop some degree of rickets unless given some artificial anti-rachatic treatment. Instinct does not come to our aid by telling the babe to demand cod-liver oil! Again, little of the essential green vegetables and fruits are to be found among our own natural resources in this country during the winter months, and the eradication of scurvy in adults, and that later development, the habit of the daily dose of orange juice for all infants, with the accompanying eradication of “scurvy rickets,” is due not to the natural “instinct” of men, or to any return to a “natural life,” but to experience and to education combined with the amenities or, if you prefer to call it so, the “artificialities of modern transport.”

It is useful to look back and see how much has been already accomplished, not in any spirit of self-satisfaction, but to give us confidence of how much is possible. At the beginning of the century severe rickets was well nigh universal in many quarters, and there resulted thousands of cases of permanent crippling and deformity for life. We have changed all that now. “Fulminating” rickets is rare. Mild rickets, however, has not yet been wiped out, though it easily could be. Official figures from the Ministry of Health show that from a survey carried out in 1928, no less than 87 per cent, of elementary school children in London (five years old) had evidence of rickets. Now, repeated clinical tests show conclusively that no child need have rickets, for whenever a sufficient dose of vitamin D is given, rickets is prevented completely. All that is lacking here is medical education; the findings of the experts need to be more fully recognised and acted upon.

Perhaps the most hopeful record (if we do not allow it to blind us to the need for further progress) is the fall in the infant death rate. You will recall that it has been halved in the first twenty years of the century, dropping from 150 per thousand in 1901, to eighty in 1921.

Again compare a picture of any group of elementary school children of thirty or forty years ago, and you cannot dispute the remarkable change for the better in the corresponding group of to-day. The year-by-year improvement in physique can be seen from the reports of the Ministry of Education. In 1927 the average five-year-old child was no less than four pounds heavier than the corresponding child in 1921, and half-an-inch taller. A good achievement for a short space of six years.

But now, if we accept the axiom that Governments are responsible for the welfare and health of their citizens, it seems to me that there can be no halfway house in the process of amelioration. The very first call on the administration must inevitably be the health of the individual; and we should no longer tolerate the position which we know to-day, in which the means of health, although known and recognised, are still beyond the means of many. How anomalous, by this criterion, was the appeal recently heard over the wireless for leprosy, in which the speaker told us that the bulk of the vast numbers of lepers in India still cannot be cured—not because of any lack of knowledge, but rather because of shortage of money ! What an astounding sidelight on our civilisation will this appear to our more enlightened descendants.

But I err in tending to see the mote only in my neighbour’s eye, and, after all, charity begins at home. When we consider what might be done, and what little has been done, have we in this country so much to be proud of? We know from large-scale and carefully-controlled clinical experiments carried out in orphan asylums and in other institutions, among elementary school children up and down the country, what wonderful improvements result in physique, health, and good spirits when extra milk is added to the child’s diet. Yet how many school children in this country are able to receive the full amount of milk which modern science demonstrates to be desirable?

I will probably be expected to express an opinion of the recent differences between the Ministry of Health and the British Medical Association. To me, however, these differences appear relatively unimportant. The British Medical Association give us their minimum 3,400 calories, which includes a small necessary margin for waste. The Ministry allows 3,000 calories, not providing for waste, but admitting elsewhere that it exists, The difference, therefore, is virtually non-existent. What seems much more to the point is the demonstrable and admitted fact that many working-class people have not available even the limited sum needed for this bare sustenance allowance, and that after paying rent only, and making no allowance for such elemental necessities as clothes and coal. I think attention might be concentrated on this essential point, rather than on the relatively small differences between the two bodies. It deserves to be pointed out, moreover, that the scales which have been put forward seem to be based on the rather unnatural assumption that the un­employed person possesses so perfect a knowledge of dietetics and nutrition that he is to be able to choose his dietary constituents to the best (or meanest) possible physiological advantage (as well as in the cheapest market).

As to the difference in the protein allowance, between the 37 g. of the Ministry of Health, or the 50 g. of the British Medical Association, it is probably sufficient to remark that the War Office considers it necessary to provide for its soldiers on a basis not of 37 g., or even 50 g., but of 62.7 g., and that the Ministry itself allows every child under sixteen years of age in its Poor-Law homes, one pint of milk per day, and finds that an allowance of 43. 6d-per child per week is necessary, even when contracting for groups of two hundred of more. In addition, there is a danger that local authorities may forget that in many areas, and according to the season, food prices may tend to be appreciably higher than the basis taken by the British Medical Association Committee.

I believe that this problem of extensive malnutrition is becoming so widely appreciated, and so many varied organisations and committees of all political complexions are now interested, that there is every likelihood that some alleviation will be made. What seems to me to be most important is that detailed health programmes should be drawn up by the technicians—detailed plans made and held in readiness, which could then be put into effect without unnecessary delay as soon as a sympathetic administration feels that the time is ripe for a further big move forward in the service of the Public Health.

DIET IN PREGNANCY

THE problem of nutrition has rightly come to be regarded as a matter of increasing public interest, in view of its effect on the population generally; and in any consideration of this problem, the nutrition of the pregnant woman demands special attention. The pregnant woman is at the same time mother and child, and errors of diet or malnutrition may affect both the present and the next generation. It is generally assumed that the pregnant woman is not in a condition of illness; that she is passing through a normal physiological stage, and that her mode of life and diet need not he different from that of the normal, healthy woman. This point of view is to a large extent correct, and psychologically, it is desirable for a pregnant woman not to regard herself as an invalid. The expectant mother should eat just what any other woman should eat who would preserve full health and vigour, and should be assured of a diet which is adequate as regards fuel value, protein content, mineral content, and richness in vitamins.

During the first four months of pregnancy a woman’s metabolic rate is not appreciably altered, but after the fourth month, the more rapid development of the foetus calls for a gradually increasing calorie intake. Her fuel requirements gradually increase until the end of the ninth month, when her calorie intake should be about 20 per cent, higher than at the beginning of pregnancy.

If the woman is of normal weight at the beginning of pregnancy she should be permitted, because of the growth of the product of conception, to gain about fifteen pounds during this period; if she is under weight, some addition to her own body tissue should be permitted. If she is very much over weight, a gradual reduction may be accomplished, but this should be done with great care lest there be a deficiency in the necessary dietary elements.

The pregnant woman is now building new tissues, and therefore her need for protein increases at a higher ratio than her total fuel requirements. The mother, in case of need, breaks down her own tissue in order to secure the amino-acids necessary for the building up of the foetal tissues, and it is only when starvation is extreme that the foetus suffers. Therefore, for the conservation of her own body tissues as well as for the infant, the expectant mother should have an adequate protein intake. Meat is of the greatest value because it provides the requisite ammo-acids; the same applies to eggs. Milk is of great value because of the excellence of its protein.

Lack of mineral elements in the mother’s diet may cause the foetus incalculable harm. Calcium, phosphorus, iron, as well as small quantities of iodine and other elements, are essential. The mother will to some extent draw on her own store of ash material in order to supply her infant, but the result is often to produce in herself dental caries and other bony defects. When her diet is especially poor in mineral elements the child must also suffer. Milk is especially rich in ca­cium; it is, however, lacking in iron, which must be obtained from meat, eggs, and green vegetables.

The anaemia of pregnancy may in part be due to decreased acid production in the gastric mucosa, and this may require attention in addition to ensuring the supply of iron.

Vitamin deficiency in diet is disastrous to the offspring. The human body is built to store small quantities of vitamin A, but it does not seem able to store the other vitamins. Even vitamin A is finally exhausted unless the diet makes good the daily loss. Viatmin B is needed in large amounts, and vitamin C is equally important. Since bone development is vitally dependent on vitamin D, the expectant mother should be assured, an adequate supply of this factor. With an insufficient supply of vitamins, the foetus develops poorly, and the infant comes into the world a ready victim of disease.

After the fourth month of pregnancy, the diet should be gradually increased in amount until 20 per cent, more calories have been added. This means that the expectant mother of sedentary habits and of average size should take somewhere between 2,500 and 3,000 calories. Milk, for the reasons noted, should form a large part of the diet. The woman should, take at least one quart of milk each day. Milk products such as cheese, custards, butter­milk, &c., may in part be substituted. She should take each day liberal helpings of salads and green vegetables, such as spinach, lettuce, cabbage, cauliflower, peas, and beans. Fruit is also very necessary. To ensure the necessary protein intake of about 100 grammes, a liberal helping of meat and one or two eggs should be eaten daily. Cereals, preferably from whole grain with cream, should be a daily habit, A liberal amount of bread and butter should be eaten, and some preserves such as honey, marmalade, &c. Fats, in the form of butter, cream, and bacon, should be given in amounts sufficient to bring the fuel value of the diet to the required figure.

It is a common belief that the weight of the baby is influenced by the mother’s diet. This does not appear to be borne out by recorded observations. There is a marked tendency in pregnancy to eat too much and too frequently, partly because women find that the nausea of morning sickness and the heartburn of the later stages of pregnancy are both relieved by taking food, and partly because there is a common belief that extra food is required by the foetus. Adequate nourishment is essential, but over­feeding must not be indulged in. Water must be taken freely, and stimulants should be avoided.

Attention must be paid to the digestive organs. Fear, anxiety, and exhaustion influence the digestion, and they should be guarded against. The avoidance of constipation is obviously of the first importance. It is essential that the woman be given simple, easily-digested food, and that it be eaten at regular intervals.

The medical profession may lay down these standards, but it is clear to any observer that the poor women cannot comply with them in present conditions. She has many sources of worry and anxiety, and her mode of life does not allow of adequate rest. On the question of diet, it is a well-known fact that the more frugally people live, the more they are forced to subsist on grain products. Such a diet, even if it supplies the sufficient energy and protein, is faulty because of the poor quality of its protein and because it fails to supply sufficient calories and vitamins. Such a diet is beyond the reach of the vast number of poor women. The state of pregnancy is admittedly of vital importance to the race, and it should be the duty of the community to ensure to every pregnant woman the adequate nourishment and care essential for the well-being of herself and her child. O.W.-T.

ANNUAL GENERAL MEETING

THE annual general meeting of the Socialist Medical Association will be held on Sunday, May 13th, at 12, Park Crescent, W.I. (by kind permission of Dr. Hector Munro). The agenda is a very full one, and will afford ample scope for those who wish to put forward their views on various aspects of the association’s policy. Here are the main items:—

11a.m. to 1 p.m. — Report of Executive Committee. Balance Sheet. Election of Officers and Executive Committee. Report on “A National Maternity Service.”

1 p.m. to 2-30 p.m.—Luncheon Interval.

2-30 p.m. to 4-30 p.m.—Discussion on “Municipal Hospitals — Their Present Scope and Possible Development,” to be opened by Mr. Somerville Hastings.

4-30 p.m. to 5 p.m.—Tea interval.

5 p.m.—Public Lecture by Dr. Middleton Martin (Medical Officer of Health, Gloucestershire) on ” The Gloucestershire Scheme.”

SOMEDA

ONCE more the annual dinner and. dance of the association comes round. This time Someda is to be held at the Cafe Royal, W.I, the reception to be at 6-30 p.m. Dinner will be served at 7 p.m., and the association’s guests will be the Right Hon. J. R. Clynes and the Right Hon. Herbert Morrison. Dancing will go on till midnight, and there will be a cabaret. Tickets, which can be obtained from Dr. Edith Summerskill, 152, Harley-street. W.I, are I2s. 6d. each.

Those who attended Someda last year will remember that it was one of the social events of the season, and the committee promise that this year’s function will be even better. A big muster of members is wanted, and they are asked to bring as many friends as possible. Tickets should be applied for early as there has already been a big demand.

SIGNPOSTS

WE have not yet reached that stage in a periodical’s development when publishers rush to have their books noticed in its columns. There are, however, a number of books being published which either record facts about present medical services or may give guidance in the development of a socialised medical service. We shall give a brief note of those that appear of interest or importance.

” Red Medicine,” by Sir Arthur Newsholme and John A. Kingsbury (Heinemann), 10s. 6d., is an account of Russian public health administration as it has been developed by the Soviet. It is a well-written record of an extensive tour, and gives an indication of how the medical service of the U.S.S.R. is being modernised and socialised.

We have received from an unknown source four small booklets published in America by the Workers’ Rational Living Library. Dealing with such subjects as Sex and Health, Mental Health, Shall We Eat Flesh? and so on, these booklets are an attempt, and a fairly successful one, to put medical subjects forward in language easily understood by the layman. They also advocate a complete change in the capitalist system of medical service.

A large number of our members are interested in the control of Patent Medicines, and to them we recommend “100,000,000 Guinea Pigs,” by A. Kallet and F. J. Schlink (Vanguard. 2 dollars). The guinea pigs are the citizens of the U.S.A., and the book is an exposure of popular remedies, many sold in large quantities in this country.

M. D.

HOW ARE THE CHILDREN?

THE question of whether a child can be fed on a sum of 2s. or 3s. per week or not is one that can be considered from many angles. It may be discussed from the theoretical aspect by counting the cost of a diet giving an adequate caloric value. It may be considered from the statistics available for the cost as it works out in private homes and in institutions. It may also be discussed from the aspect of obvious results, from the effect on the health of children whose parents cannot have more than a bare minimum with which to provide food.

The reports of Medical Officers of Health on this subject would appear to vary enormously. Some report no deterioration in the nutrition of children, others report exactly the reverse, and a good many more report nothing at all. Amid all this welter of all shades of opinion, of varying accuracy, varying conditions, and varying degrees of accuracy of observation, how are we to proceed to separate the wheat from the chaff? What standards of comparison have we by means of which the findings of one set of observers may be checked against another set of observations by different observers in a different district?

Unfortunately, the biological sciences, and medicine in particular, have not yet reached the stage of expressing biological properties with mathematical exactitude. The physical condition of an individual at any given moment cannot be reduced to a set of precise formulae. The height and weight, of course, give some indication of the state of nourishment, but their use is limited. Apart from such measurements, the estimation of malnutrition depends very largely upon personal factors, that is to say, upon the training of the observer, his previous experience, his social and political outlook, and the extent to which his attention is concentrated upon the particular question of the state of nourishment of the individual.

Further, the observer must necessarily be influenced by what he has come to regard in his own mind as the average, or rather the normal. If he has been working in a poor district for some time, he will quite naturally and unconsciously tend to accept lower standards of what constitutes the normal than an observer in a good-class community, such as a Medical Officer to a public school, where the majority of the children come from well-to-do homes.

Though we therefore cannot compare nutritional states with exactitude, there are good grounds for belief that malnutrition and chronic undernutrition must be of commoner occurrence than is generally acknowledged. First, it seems probable that the proportion of children suffering from these conditions is found to be greater or less partly according to the state of awareness which may happen to exist in the medical staff of the particular locality; hence there should be a wide survey under agreed standards. Secondly, if it is agreed that minor rachitic deformities, the presence of widespread dental decay and the tendency to catarrhal disorders, and numerous septic skin lesions are all too frequently evidence of some nutritional defect, either past or present, then these defects must certainly be extremely widespread. This view is confirmed by what little work has been done in this respect. Thus, in America, Emerson found that children of good-class families averaged 4.6 defects per child, whilst the hospital class child averaged 6.8 defects, almost 50 per cent, more; and reports in this country show that while 60 per cent, or more of poorly-nourished children suffer from various defects, this figure may be halved in the case of well-nourished children. Thirdly, since we know that the minimum institutional cost of feeding a child is not less than 4s. 6d. per head per week, and the milk-bill alone for each child, assuming one pint per day at 3d. per pint, is 1s. 9d. per week, there must be many thousands of families where the children cannot be fed to such nutritional levels.

Hence the points to be aimed at are the greater use and dissemination of such information on nutrition as already exists, the stimulation of further inquiries, and a much wider distribution of free milk and meals in a planned, directed, and purposive effort to direct is an upward trend towards the optimum for the greatest possible number.

Caractacus.

L.C.C. GETS TO WORK.

Better Hospitals for London.

THE victory of Labour at the London County Council elections has meant big changes in the whole policy of that body, and no organisation is playing a bigger part in the shaping of this change than is the S.M.A. At the last election eight members and one associate stood in the Labour interest.

The following were elected :—

Mr. William Bennett, who is an associate, and Mr. G. P. Blizard, who acted as secretary of the committee responsible for the production of “A Socialised Medical Service,” were appointed as aldermen.

Mr. Hastings has been appointed chairman of the Hospitals and Medical Services Committee, with Dr. Rickards as chairman and Dr. Brook as vice-chairman of the Hospital Management Sub-committee, and Dr. Gillison as vice-chairman of the Planning and Development Sub-committee. Dr. Rickards has been appointed chairman of the Establishment Committee, and Dr. Brook chairman of the Committee for Welfare of the Blind.

Dr. Winch has been co-opted a member of the Hospitals and Medical Services Committee, and Dr. Samuel a member of the Mental Hospitals Committee, while many members of the association have been invited to serve on hospital committees.

Drastic alterations will require to be made in the whole L.C.C. policy, and it is certain that there will be an entirely different attitude at the County Hall on the development of the municipal hospitals. The leader of the Labour Party (Mr. Herbert Morrison) has already declared:—

We are going to remodel the hospitals. We are going to see that the municipal hospital is just as good, and even better, than the voluntary hospital, so that the citizens of London of all classes will be proud and happy to use the medical services of the hospital attached to the Council.

Mr. Somerville Hastings (president, Socialist Medical Association) is chairman of the committee that will formulate and carry out this new policy, and all members not only wish him success, but will, we feel sure, be ready to give him every assistance they can. A general discussion on municipal hospitals, which Mr. Hastings will open, is to be held at the annual general meeting, and it is hoped that many useful and practical suggestions will be forthcoming from members.

SOCIALISM AND PUBLIC HEALTH

by Somerville Hastings, M.S., F.R.C.S. (Chairman of Hospitals and Medical Services Committee, L.C.C.)

IT is sometimes useful to blow one’s trumpet, especially when, one can legitimately do so, and I verily believe the Public Health Services of this country are the very best in the world. The general standard of hospital accommodation in Sweden seemed to me far superior to anything we have in this country; the public provision for the medical treatment of the individual in his home in Russia, where well developed, struck me as infinitely better than anything we have here; but our English system of sanitation, of prevention and control of infectious disease, and of Public Health generally is, I believe, unsurpassed throughout the world.

During the last half-century there has been a steady and continuous improvement in our people’s health and a corresponding reduction in mortality rates. It is a little doubtful, perhaps, how long this improvement will continue to be seen, for the privations necessitated by the world crisis and the economy campaign must have had an adverse effect on the national physique and resistance to disease. Still, we have this to our credit, that during the last half-century the expectation of life for the average citizen has been increased by some twelve to fifteen years. Now if we look round carefully for the causes of this decreased mortality, we shall find that it is due much more to diseases which we have prevented than to those that we have cured. By careful supervision of our water supply we have almost completely wiped out those terrible epidemics of typhoid fever that we had in the past; by instruction given in our maternity and child-welfare centres we have to a large extent disposed of those attacks of infantile diarrhoea that used to be such a menace to child life; by notification, isolation, and disinfection we have been able to reduce both the incidence and mortality of infectious disease.

The history of Public Health legislation and administration in this country during the last fifty years is for the Socialist both inspiring and convincing. It is the story of how people who did not believe in Socialism and did not want it were compelled to adopt it to obtain not only efficiency, but any results at all, because private enterprise invariably let them down whenever they depended on it.

And people are beginning to ask why should not the principles that have served us so well in connection with preventive medicine be applied to clinical medicine also? If Socialism has been so effective in preventing disease, why should it not help us to cure it as well? And it is not only members of the Labour Party who are asking this. No one would describe Mr. Neville Chamberlain as a Socialist, yet it was he who, in 1929, realising that private enterprise had failed completely to provide for the hospital needs of the nation, carried through Parliament the Local Government Act which not only permits, but actually encourages local authorities to organise their own municipal hospitals, to which every citizen of the district has an equal right of entry.

How can we expect improved results in the treatment of disease when we adopt our present individualistic, disorganised, and utterly chaotic methods for dealing with it. Take the death-rate of mothers in child-birth, for instance. During the last quarter-of-a-century, in spite of a rapid and continuous fall in the infantile mortality rate, the maternal mortality figures have hardly decreased at all. There are literally dozens of agencies all attempting to deal with this important problem, and each one is working with but little or no co-ordination with all the rest. In not a few boroughs in London there are connected with maternity work private doctors and midwives, private maternity charities, one or more voluntary hospitals each with its own maternity ward, a London County Council hospital with similar wards, and a special maternity hospital run by the borough. How can you expect the death-rate of the mothers to decrease under conditions such as these? The same unification and co­ordination that has been so successful in the prevention of disease must also be adopted for its cure; in other words, we must apply the principles of Socialism to every aspect of disease if the best results are to be obtained.

TELL US

WHAT do you really think of “The Socialist Doctor”? Do you like its size, its print, its make-up? Would you like more advertisements, or do you not read them? Do you think our news of the S.M.A. adequate? Would you propose some other type of article? Do tell us. We really want to know your views on all those matters. The editor’s address is 74, Brim Hill, London, N.2.

FIVE SHILLINGS

Minimum Adequate Allowance for Children

THE one point in arguments on malnutrition on which public opinion is fairly well unanimous is that the allowance of 2s. to the children of an unemployed person is hopelessly inadequate. What has not been agreed upon is the amount which really is necessary. Some are prepared to take the opinion of the British Medical Association Nutrition Committee, whose figure for a child between two and three years is 3s. 1d. Others rightly point to the report published by the Ministry of Health on “Diet in Poor-Law Children’s Homes,” which showed that the recommended diet costs 4s. 3d. There are other sets of figures based on the theoretical calorie need, but arguments can be produced to show that all of these could be altered in one direction or another.

What actually is the cost of feeding a child? Every committee that has considered the problem has stressed the fact that allowance must be made for the ignorance of the mother, for bad marketing and household waste. Theoretical consideration will not allow an accurate estimation of these factors, and the only way in which a true figure can be reached is by getting careful notes from working-class mothers. Many mothers now keep their children to a carefully-regulated diet, which does not vary from week to week, and which can, therefore, be exactly ascertained.

“Reynolds’s Illustrated News,” the co-operative Sunday paper, recently held a competition for the photograph of the “bonniest” baby, each picture to be accompanied by exact figures of the child’s age, weight, and weekly diet. By the kindness of the editor of that journal, we have had submitted some hundreds of these diets, and a careful analysis yields some revealing figures. It should be emphasised that the photo graphs, weight, and age-cards, &c., indicated that the babies were well nourished and healthy in every way.

The diets were carefully scrutinised, and a selection made of these cards in which the diet appeared adequate without extravagance, rich in vitamins, and embodying at least one pint of milk per day. In this group the average cost per week was, for children one year and under, 4s. 9d. and for children from one to two years, 4s. 9¼ d. A small group of children, from two to three years, gave an average of 4s.11½d.

A certain number of diets appeared less well-balanced, but, as the children were of at least average weight, must be considered adequate. Adding these to the former group, the children up to one year cost 4s. 7½d., and in the second year, 4s. 10d. Taking all the diets together, the average is 4s. 9d.

Statistically, it will be said, the group analysed is too small to be of significance, but the variation was very slight. The highest figure was one of 8s., and quite a number about 7s. a week included one shilling for such unnecessary items as proprietary meat extracts.

None of the mothers included anything for cooking, and they were not asked to include any sum for clothes, heating, &c. From reading the diets and analysing the figures, one is prepared to state that a child cannot be given a diet adequate in every detail at a cost of less than 4s. 9d. per week. A nation which tries to rear its future citizens on less will find itself in later years populated by people who have never had a chance to build a strong, healthy, and disease-resisting bodies.

D. S. M.

AMERICA NEEDS A NEW HEALTH SERVICE

WHILE contending forces are struggling for supremacy in the American business world, quite a large section of the community is taking a very active interest in the need for reorganising the medical services of that country. A writer in the “Journal of the American Medical Association,” early this year, stated that “at least 100,000 persons in the United States sorely need hospital care, but are not getting it. Why? The answer seems to be that only two-thirds of the beds are in use!” He adds, however, as a less satirical reason, that only 2-5ths per cent, of those attending hospital clinics are able to pay the fees.

For such reasons, meetings of the medical profession, and of social workers generally, are being held everywhere to discuss what can be done, and the American Academy of Political and Social Science has passed a resolution that America needs “a socialised health service that is adequate, effective, easily available, and cheap, if not gratuitous.”

It is an interesting point that the London correspondent of the “Journal of the American Medical Association” goes out of his way, week by week, to produce arguments, based on English experience, against the National Health Insurance Acts, and against the whole idea of a socialised medical service. He constantly reiterates that there is really no support for such a scheme in this country, shutting his eyes to such phenomena as the new L.C.C.

Nevertheless, American opinion is gradually being built up in favour of either an insurance system or a complete free service, and the director of the Milbank Research Fund has declared “that some insurance system should be developed—providing every type of medical service to every member of the family of people having incomes below an amount sufficient to guarantee medical service in every contingency.” A campaign in favour of this is being carried on with considerable vigour, and in the “Lancet” of April 28th details are given of definite proposals for such a service. It is proposed to cover all families having an income less than £600 per annum, and to give a complete medical service, including hospital treatment and special examinations. General practitioners who come into the scheme are to be paid 30s. per insured person, and the contributions are to be paid by the insured according to ability to pay. It is insisted that, while there should be a joint committee of lay people and doctors to deal with complaints, the professional service and personnel should be under professional control.

It is too early yet to say what the medical profession will say to this, but when the situation in America becomes clearer it may be that one of the results of the depression will be some form of State organisation of the medical services of the American Continent.

M.O.H.

MOVEMENTS

THE past three months have been particularly busy ones for the executive of the S.M.A., and there can be no question that advances have been made in many ways. Apart from the L.C.C. elections and the resultant need for so many of our leading members to give their whole time and energy to the Public Health Services of that Council, a great variety of other work has been done. Three special committees have been at work, and their work should do much to clarify our views on certain aspects of medical service.

The committee on “A National Maternity Service” has completed its work, and a copy of their final scheme is being circulated to members. It is largely on the lines originally submitted by Dr. Esther Rickards, but has been modified to meet the views of the conference held last November, and has been amplified, chiefly by the addition of some statistics. This final memorandum will be submitted to the A.G.M-, and if passed will become the accepted policy of the association.

A committee has also been meeting to discuss the cost of a State Medical Service, and an immense amount of detailed matter has been considered. This is a very big problem, and certain figures have proved difficult to get, but the work is progressing, and it is hoped that at an early date a report will be available.

The third committee has been formed to consider disease in relation to social and economic factors, and have begun on the subject of nutrition. Already the ground has been cleared, but it is obvious that a large number of problems are involved, and the committee proposes to tackle each by asking one of its members to prepare a paper on the subject.

The Executive Council have had other questions of urgent importance before them. The treatment of our medical colleagues by the Austrian Government caused the Executive to pass an emergency resolution, which was forwarded to the Austrian Minister in London. The resolution said:—

“That the Socialist Medical Association desires to record its emphatic protest against the action of the Austrian Government—

(1) In the arrest and imprisonment of Professor Dr. J. Tandler, who has rendered world-renowned service to the promotion of Public Health and Social Welfare.

(2) In the discharge merely for their political opinions of doctors employed by the State or municipalities.

(3) In seeking to compel Austrian doctors who have treated the wounded to disclose the names of their patients, contrary to the accepted international code of medical ethics, and imprisoning those who have been unwilling to give this information.”

In addition to this action every member of the association received a letter from Mr. Somerville Hastings drawing attention to the treatment of Socialist doctors in Austria, and asking that a resolution against this should be moved at every B.M.A. branch. This action had some effect, and Professor Tandler has since been released.

The Executive Council has also appealed for funds, to be sent through a secret channel, for the assistance of Austrian doctors who have been victimised, and a sum of £16 has already been sent for this purpose. Money has also been voted for the provision of some surgical instruments to a victim of Italian Fascism living on one of the islands to which Socialists are exiled. This action was taken at the request of the Socialist Workers’ National Health Council, and Dr. O. Watts-Tobin took considerable trouble in arranging the details.

The Socialist Workers’ National Health Council has been carrying out a programme of Health Education Tours. They have also brought out a cyclo-styled periodical, “The Fight for Life.” A copy has been sent to us with a request to advise our members to read it, and they may find interest in doing so. The January issue contains an attack on the policy of the S.M.A. and the labour Party; an attack based on a complete misunderstanding of that policy.

The last meeting of the London and Home Counties Branch of the S.M.A., held on March 14th at 43, Devonshire Street, was particularly interesting. The speaker was Sir Ambrose Woodall, who gave an address on the history, development, and present position of the Manor House Hospital, of which he is superintendent. He also spoke on its possible place in a State Medical Service, and this gave rise to a very lengthy discussion, in which everyone present took part. The general feeling of the meeting was that while the Manor House Hospital has done wonderful work and has shown the need for a special industrial diseases hospital it could not, in its present form, have any place in a State Medical Service. This was one of the best meetings of the London and Home Counties branch, and it is hoped that next season will be full of equally interesting discussions.

ON-LOOKER.

MILK

MILLIONS of gallons of it! Yet we don’t use nearly enough of it in this country. It is generally agreed that in Great Britain we use much less per head each year than any other country. A lengthy report has just been issued dealing with the consumption in Scotland, and this confirms the backward position of the country as a whole. It is shown that the amount of milk was a little less than 0.5 pint per person per day. The consumption varied greatly in different districts, but even the highest did not reach the figure for the United States, which in 1926 was just over one pint per day. An increase in our daily consumption would not only mean a big improvement in the position of farmers, but, as numerous experiments and observations show, a big advance in the health of the nation.

This is only one of the problems offered by the milk question, and the Socialist movement, and the Socialist Medical Association in particular, will have to decide what it is going to do about the production, distribution, and control of milk in this country. The report quoted above mentions that it was found that in nearly all towns the largest proportion of the milk was handled by the co-operative societies. Are we to organise the milk supply through the already existing machinery of the Co-operative Movement or, as has been suggested in some quarters, through a new national and municipal organisation?

More important, from the medical point of view, is the question of how milk should be produced to prevent its being, as it can and is, one of the worst of disease-carriers. Should pasteurisation be made compulsory or should we go all out for a complete elimination of disease among milk cattle and their attendants? The latter would be a lengthy and. expensive business, and while tuberculosis can probably be got rid of, other conditions, such as Br. Abortus infection, are difficult of elimination, and there will always be some bacterial contamination of even the best milk. This is particularly the case with the milk supply of large towns, and in these cases, pasteurisation seems to be the best method of ensuring safety. One thing must be insisted on, namely, that all milk sold should be subject to the closest bacteriological and chemical control.

D. P. H.

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