MAY 1936

The Official Organ of the Socialist Medical Association

Price three pence

ACTIVITIES

WE have heard a number of complaints that the Socialist Medical Association is not playing a sufficiently active part in the medical and political affairs of the moment. The complaint has probably arisen from the rather small number of public meetings which have been held in London during the winter, but this was entirely due to such circumstances as the election, and a large number of our members who are engaged in public affairs are unable to give up much more of their time for meetings.

Despite this there has never been a time when the association has been more active, although the work has been confined to a comparatively small number of members. The Executive has met regularly, and lengthy agendas covering a wide variety of topics have been before the meetings. In addition, the Scientific Committee has had a number of problems before it and have completed one very important report to the executive which will shortly be published. This deals with the possibility of protecting the general public against gas attacks from the air, and the conclusions are summarised on another page. The question of nutrition has also engaged that Committee, and much work has been done in collecting facts and figures on the subject.

The most successful activity of the Association during the winter was undoubtedly the joint meeting with the Inter-Hospitals Socialist Society, which brought forth a very large audience and led to an increase in membership of both bodies taking part in the meeting.

The influence of the Association does not stop at the activities which it carries on officially, for a large number of our members who hold important positions on Local Authorities, in particular the London County Council, continue to exercise an important influence over Public Health policies generally.

THE SOCIALIST DOCTOR

Plans are being made for enlarging the size and scope of this publication so that it can be issued with regularity and may reach a wider public. To assist these plans the Editor will welcome ideas, criticism and contributions on any medical or political subject. These should be addressed “care of” The Socialist Medical Association, Kern House, 36-38, Kingsway, London, W.C.2.

A MIDWIFE MATERNITY SERVICE

ABOUT a year ago the S.M.A. published a scheme which it considered the most suitable for a National Maternity Service in this country. The basis of that scheme was the use of midwives for the conduct of normal cases in their own homes, which was considered the ideal, provided the service had an efficient personnel, readily available consultants, and suitable hospitals for emergency cases. A service such as that report suggested has now been brought a stage nearer by a Bill which the Minister of Health has presented to the House of Commons.

This Midwives’ Bill, if, as seems likely, it is passed in substantially the form which has been published, will make it compulsory for every Local Authority to formulate and put into operation a Maternity Service scheme providing a sufficient number of mid-wives for all births in the district. So far as the Bill as a whole is concerned, the chief criticism is that it does not go far enough, but in so far as it makes the provision of full-time midwives compulsory it is definitely a step towards a National Maternity Service.

The special sub-committee of the S.M.A. has considered the Bill and have reported to the Executive on a number of points which require clarification and in a few instances amendment. Important points, such as the provision of Home Helps, the length of time that the midwives are to remain in attendance, and the possibility that present existing voluntary nursing organisations may be given too large a part in the final scheme have all been criticised. The Bill reads as though the Ministry could force a Local Authority to consult or work with a voluntary organisation of which it totally disapproved. It requires also to be made clear that the local authority midwives must be available over the whole area, even if already served by a voluntary organisation, so that the latter is not given a monopoly.

The sub-committee also emphasise that the assessment of fees to be paid by them, using the midwives’ name, should be done by the local welfare committees, and must not be placed under Public Assistance. It is also advisable that the authorities should publish the scales they adopt for remittance of fees.

Perhaps the greatest benefit that would come from the putting into operation of this Bill would be that it prohibits the employment, as midwives, of those who are entirely unqualified for the work. It is also a good thing to see that the Local Authority must provide midwives with opportunity for refresher courses at frequent intervals. This may create a precedent which will have repercussions in all branches of the public medical service. While, as we have said, the Bill is in no way a full maternity service, it does provide a scheme which should do much to improve the standard of midwifery among the poorer classes and to make uniform throughout the country the standard of the midwives engaged in the service.

SOMEDA

(Socialist Medical Association)

ANNUAL DANCE

at

Suffolk Galleries, Suffolk Street, Haymarket W

On Saturday May 23rd

8-30-1 Ticket 2/6

AGRICULTURE & THE NEW OUTLOOK ON NUTRITION

NOT so many years ago it was mainly Socialists who asserted that there could be any possible connection between poverty and ill-health. As time went on and knowledge was accumulated about vitamins, minerals, calorie requirements and so forth, and the deficiency diseases and their causes became more clearly defined, so the consequences of food shortage of different varieties were recognised to have very definite and severe effects in many parts of the world. It was said, and still is being said in influential medical circles that the nutrition of the people generally is satisfactory, and that apart from a small unfortunate percentage there is no occasion for worry. Official statistics are readily produced to demonstrate that even in the distressed areas nobody is really starving, and that since the death-rate is gradually falling and the expectation of life increasing, that the health situation is really quite satisfactory.

The next stage in the development of a new outlook in nutrition took place when it was recognised that there is really no sharp dividing line between a state of perfect health and a definite disease-state due to a dietary deficiency, but that there might also exist various intermediate stages. An individual might be neither positively ill nor positively well; but if circumstances changed slightly for the worse, or if a mild infection occurred then such an individual was likely to go down sooner, be more liable to complications, and take longer to recover than a previously healthy person. There is a good deal of evidence pointing to a close relationship between nutrition and that no man’s land of chronic debility. Such effects are difficult to measure accurately, and had the whole problem been purely and simply one of health alone, it is possible that it might not have had all the attention that many governments in various country have recently devoted to it.

It has recently, however, become very obvious that poverty in the midst of plenty affects not only those in the state of poverty, but if there is also too much of the plenty, then the producers of the surplus will suffer accordingly. This position is becoming plainer every day, since the possibilities of world food production are rapidly rising, and it is now a simple matter to transport food from one end of the earth to the other and deliver it in good condition. The perishable foodstuffs—butter, fruit and meat—are no longer so perishable, and agricultural countries and the agricultural communities in many countries can now produce not only for their own and neighbouring urban populations, but can effectively compete in the world market to a degree immensely greater than ever before. The tendency toward the economic self-sufficiency of each state has also stimulated food production, and it is therefore only natural that in attempting to increase consumption generally, that some attention should be paid to the possibilities of an increase in the individual food consumption. Agricultural economic interests and national health interests begin to meet on a common basis.

The development of these interests is being organised in a perfectly conscious and deliberate manner, and it is either a sign of the times or else a happy coincidence that a medical man should occupy the post of Minister of Agriculture.

In 1934 the Health Committee of the League of Nations decided to make a general report on Nutrition, and Drs. Burnet and Aykroyd conducted a series of enquiries in Britain, France, United States, Norway, Sweden, Denmark and Russia on the nutrition policies of these countries. They state quite definitely, “Nutrition is put forward, not only as a physiological problem, but also as an economic, agricultural, industrial and commercial problem.” Burnet and Aykroyd’s report was used as a basis of discussion at the Sixteenth Assembly of the League of Nations in September, 1935, and Mr. Bruce of Australia (as the representative of a large food-exporting country) in opening the discussion stressed “the necessity for marrying agriculture and public health in the interests of the latter; of increasing the consumption of protective foods as a remedy for malnutrition and the agricultural crisis, and of changing the incidence of State protective subsidies so that they shall serve to increase consumption rather than to restrict production.”

Among the points which emerged from the discussion the following are significant:

1)An increase of food production supplies the Government with further means of increasing the Public health.

2)This constitutes a direct and practical means of attacking the problem of agricultural surpluses and the consequent fall in prices.

The Health Committee of the League appointed a Commission of Experts to consider the whole problem of nutrition, and among the United Kingdom representatives appointed was Sir John Boyd Orr, the Director of the Rowett Institute of Research on Animal Nutrition at Aberdeen. He has just published a report entitled “Food, Health and Income,” which, in his own words, is a survey of the adequacy of diet in relation to income.

He divides the population of this country into six income groups. Ten per cent, of the people, or about 4 1/2 millions, are estimated to spend on food an average of only 4s. per head per week, and another 20 per cent, not more than 6s. per head; ten per cent, only are estimated as having more than 14s. per head to spend on food. An important fact which he points out is that the poorest tenth of the population consists in the main of families in which there is a disproportionate number of children or other dependents per earner, and he estimates that between 20 and 25 per cent, of all the children in the country are in this lowest income group.

A large series of family budgets were obtained from different areas. The budgets ranged from very poor families spending less than 2s. per head weekly. on food up to families with an income of £2,000 per annum; as might be expected, many interesting facts emerged. The consumption of flour and potatoes was found to be practically unchanged throughout the different income level groups, but the amount spent on the protective foodstuffs varied directly with the income. Thus in Group I, the poorest, the consumption of milk (including condensed milk) per head per week was found to be 1.8 pints, and in Group II 2.7 pints, whilst in Groups V and VI, spending 12s. per head and over on food, the weekly milk consumption was 5 pints. Similarly, the consumption of meat, eggs, fish, vegetables apart from potatoes, and fruit all rose directly with the income; the expenditure on the last-named part of the diet for instance, rose from 2 1/2d. per head per week in Group I to Is. 8d. in Group VI.

Again, as one might also expect, the amount spent on condensed milk and margarine decreases considerably as we pass from the lower to the higher income groups.

To what extent are these dietary differences between the different income groups of significance so far as the health and physique of the population is concerned? Do those in Group VI spend excessively, that is unnecessarily, on diet, or does Group I spend too little? Before answering these questions we must have some conception of a standard of health to aim at, and Sir John Orr adopts the physiological ideal of a state of well-being which is such that no improvement can be effected by a change of diet. The dietary requirements from this point of view are covered quite satisfactorily by the standards compiled by Stiebeling for the Government Bureau of Home Economics, U.S.A., and as they have been tested against the age and sex distribution of this country, and no significant difference has been found, it was possible to compare the average diets of each income group with the Stiebeling standards. On this basis the diet of Group I (that is of 4 1/2 million people) is inadequate for perfect health, being deficient in calorie value, protein, fat, vitamins A and C, calcium, phosphorus, and iron. Group II is adequate only in total protein and total fat, and it is not until we reach Group V, spending 12s. per head weekly on food, that there is an ample safety-margin with the doubtful exception of calcium, whilst in Group VI the standard requirements are exceeded in every case.

Next, what are the nutritional differences in the population at the different income levels, and are the theoretical differences in accordance with what might be expected owing to the dietary variations? Generally speaking the answer is yes. In order to achieve full growth, children require a diet fairly rich in first-class protein, minerals and vitamins, and if this is not forthcoming there will be a slowing down of the rate of growth and perhaps some definite evidence of deficiency diseases. In “Food, Health and Income” some figures are quoted, illustrating the differences in physique of the public school and student class as contrasted with Council school boys and older boys at work. The latter are shorter than the former at all ages. We also have evidence of deficient Vitamin D in the high incidence of rachitic signs found at special enquiries, e.g., 87.5 per cent, of 1,638 unselected children showed such evidence in 1931; haemo­globin surveys in school and pre-school children show an increasing percentage of anaemic children as we descend the economic ladder.

The tale in adults is very similar. We may mention the well-known Aberdeen investigation of 1933, when out of 1,000 women falling within the income Groups I, II and III, fifty per cent, were found to be anaemic, and 15 per cent, severely anaemic. The incidence and mortality of Tuberculosis has also been found to be directly affected by changes in the diet. On the other hand, it has been demonstrated quite clearly and almost decisively that an improvement in feeding results in an increased rate of growth in the young, better physique in adults, and increased longevity and lessened liability to many illnesses which do not appear to be at first sight directly concerned with diet. McCarrison in particular has done much valuable work with animals, and the validity of his results applied to man is not seriously disputed.

Sir John Orr finally draws the interesting conclusion that “as income increases, disease and death-rate decrease, children grow more quickly, adult stature is greater, and general health and physique improve.” To what extent must the diets of the poorer groups be altered to ensure their reaching an adequate standard? The increase required will be mainly with the more expensive foodstuffs—milk, eggs, butter, fruit, vegetables and meat, and if their consumption-rate is increased by 12 to 25 per cent., then the dietary standard of Group IV will be reached.

This will mean an average expenditure of 10s. per head per week on food alone to ensure a mere adequacy without an ample safety margin, which increases the average cost per head at current prices to 14s.

Why should anyone be expected to live on a lower food standard so long as the farming community is forced to concern itself with the question of excessive food production? The problem is clear, and all we need is the will to solve it.

CARACTACUS.

ANNUAL GENERAL MEETING

THE Annual General Meeting of the Socialist Medical Association has never yet been a dull affair, and that to be held on May 24th of this year promises to be at least as interesting as any that has gone before. The meeting is to be held at the Royal Hotel, Woburn Place, Russell Square, W.C.I, and business will commence at 11 a.m. There will be the usual routine business, and a lengthy discussion is expected on the recommendation of the Executive Committee to make drastic alterations in the constitution of the Association. These alterations, it will be pointed out, have been made necessary by developments in the work of the association, and it is hoped that if they are carried, the association will be strengthened.

A large number of notices of motion have been given, and these will probably occupy the whole of the afternoon session. It is to be moved that the association favours the legalisation of the voluntary sterilisation of those suffering from certain diseases and defects, the resolution being on the usual lines on this subject. This is a point which the association has not previously discussed, but since its operation would require legislation and has already met with some political opposition, the association will require to consider it fully and come to a decision on it. Similarly with the motion on voluntary euthanasia.

The whole question of the association’s attitude as a part of the socialist movement towards war will be brought out in a discussion on two motions, one relating to war as a whole and the other dealing with defence against air raids. Together these resolutions cover a very wide range of subjects on which it is unlikely that the association will find itself unanimous, and a very lively discussion is anticipated.

By the time these resolutions have been dealt with the meeting will certainly be ready for the next item of business, an interval for tea. This is to be followed at 5 o’clock by a lecture on “State Hospitals and Medical Education.” The lecturer is Colonel A. H. Proctor, M.B., M.S., Dean of the British Post-Graduate Medical School, Hammersmith. This lecture should not only be informative, but should assist the members of the association to formulate their ideas on the future of medical education. The subject has been much discussed in the past few years, and it is one on which the association will be expected to have a policy when changes are proposed.

THE ANNUAL REPORT

THE Annual General Meeting will be asked to receive the Executive’s annual report which this year has many interesting features. Many members will welcome the approach that has been made to the Labour Party with regard to the constant happening that the Labour Party annual conference is unable, for lack of time, to discuss many resolutions on the agenda. Among these have been on more than one occasion, the resolutions submitted by the S.M.A. It is therefore suggested that in future regional conferences should be held prior to the national conference so that the whole country will have a chance to discuss these resolutions.

Members will also be interested in the resolution passed by the executive to the effect that, in view of certain actions taken by the M.P.U., members of the S.M.A. cannot be recommended to join that body.

The A.G.M. will also be asked to endorse the executive’s view that the domiliciary treatment of the sick poor should be by the “free choice” method.

GAS ATTACKS

Is There Any Protection?

THE Scientific Sub-Committee has spent a considerable time on the subject of gas warfare, its possible effect on the civilised population, and the question of whether any protection is possible. They have been assisted by experts who have studied the question very completely and have drawn up their conclusions in a pamphlet which will shortly be published by Messrs. Lawrence and Wishart (cost 6d.).

The pamphlet sets out in full what is known of the effects of gas and what types of gas are likely to be used. The methods of protection that have been suggested are then discussed, and certain conclusions are drawn. The first conclusion of importance is that ail raiders are certain to get through to large towns no matter what defence is used, and that they will use a combination of all the known weapons, high explosive, fire and gas, in order to cause the maximum amount of damage, injury and demoralisation. The only efficient protection against these weapons are respirators and gas and bomb­proof self-contained dugouts. This latter point is one which will impress those who care to read the pamphlet and those local authorities who are keen to make preparation for defence against gas must be asked to give this solution full consideration. The cost would be high, but if properly carried out, such shelters would certainly protect those who made use of them.

The pamphlet goes on to criticise the defences that have been proposed officially. The difficulty of making in private houses a gas-proof room, which would at the same time be safe from high explosive and fire, is pointed out, and figures are given to show, how completely impossible this procedure would be for the hundreds of thousands of people who live in single and two-roomed houses. In drawing up the pamphlet, the Committee have adhered to scientific facts and arguments, and feel compelled to point out that it would be by a combination of different types of gas that the maximum effect would be obtained.

Attention is also drawn to the difference between the type of air raid which was experienced in the last war and an air raid in which highly dangerous gases would be employed in quantities that would cover a very large area. In a final conclusion, the Committee considered that if the public are not aware of the real danger that lies in a modern gas attack, then the panic following such an attack would be much greater than would be the case if the dangers had been realised.

This pamphlet takes a quite dispassionate view of the subject, but there is no escaping the conclusion that gas is a potential danger to a very large proportion of the population of cities, and that it must be condemned by everyone and no efforts spared to prevent its use.

D. S. M.

MALNUTRITION

Interest in the nutritional question continues unabated and is likely to cause discussion in medical and political circles for a long time. The Committee against Malnutrition continues its work and the S.M.A. are keeping in close touch with it. Members of the S.M.A. have received copies of the bulletin issued by the committee and many subscribe to it. This is a valuable publication for those who want the latest facts about the occurrence of malnutrition and about proposals for dealing with the situation. It is issued from 19 Eagle St., London, W.C.1.

PATENT MEDICINE ADVERTISING.

THERE is a great need for both the medical profession and the socialist organisations, who believe that the consumer should be protected against unscrupulous exploiters to pay more attention to the ever-growing menace of patent medicine advertising. The volume of this is in no way diminishing, and month by month it appears to become more clever than ever, and to engender in the public a fear of ill-health, which cannot have anything but bad psychological results. Much of it also implies that the medical profession cannot or will not help those who suffer from a large variety of chronic illnesses. It is somewhat paradoxical that those who are in no way deluded by false advertising in other fields and who see through most of the tricks of the capitalist are nevertheless just as easily taken in by patent medicine advertising as are the uneducated.

The whole business of selling patent and proprietary remedies can be condemned on many grounds and these were most adequately summarised by a select committee of the House of Commons which investigated the question in 1914 and published a voluminous report. That committee took evidence from all sides and was able to quote many examples of preparations that were worthless and as many that were dangerous. Many changes to the present laws governing the sale of patent medicines were proposed but the war prevented these even being discussed. An effort was made by Mr. Somerville Hastings to introduce a bill that would have made considerable alterations but this was not proceeded with.

To some extent the dangerous type of patent and proprietary medicine is restricted by the new poison regulations coming into force this month but in the past the manufacturers have hardly been inconvenienced by such regulations as the results obtained by these remedies depends as much on the advertising as on the chemical content.

Danger may be removed from some preparations but the advertising, which gives the trade such a hold over our national newspapers will continue.

The Medical and Surgical Appliances (Advertisement) Bill, which was recently before the House of Commons, was a measure which had the support of many bodies with differing interests. It was a very mild bill, aiming only at the prevention of the very worst type of advertisement and leaving many loop-holes for those who cared to take advantage of them. From reading the Bill and the support which it had one would have imagined that it would have been unopposed in the House of Commons, but nevertheless its rejection was moved by Sir Arnold Wilson, and the House showed so little interest in it that it was finally talked out because a quorum of members could not be found. The Socialist Medical Association must give a lead in this matter as in so many others to those Labour Members of Parliament who are not sufficiently well informed on this matter as to realise that practically all advertisements of the type which were pro­hibited by this Bill are essentially a fraud on those who believe in them.

D. P. H. .

JOIN THE S.M.A.

Literature, Application Form, etc., from Dr. Charles Brook, Kern House, 36-38, Kingsway, London, W.C.2.

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