1185

UNEMPLOYMENT AND HEALTH

To the Editor of THE LANCET

SiR,—I have read with considerable interest theleading article in your issue of Nov. 12th entitledUnemployment and Health. There can be no doubtthat there are at the present time a good manyindividuals who find it an exceedingly difficult taskto obtain sufficient of the necessities of life to main-tain their health and vigour. This is especially thecase with townspeople with large families, who arecompelled to pay relatively large sums for theiraccommodation, owing to the refusal of owners andagents to let rooms to people with children. Themedical officer of health for Hammersmith in hisannual report for 1931 examines the budgets of agood many working-class families, both employedand unemployed, and finds that when rents are paidthere is in many cases a very small surplus left toprovide food, clothing, and other necessities of life.Amongst the unemployed this may be, according tohis statements, as little as 2s. 8d., 2s. 4d., Is. lld.,or even Is. 7d. per head, and amongst the employedmay come down as low as 3s. 8d. or 2s. 9d. There isno reason to suppose that conditions are exceptionalin the Hammersmith district, and there can be nodoubt that the reduction of the standard of lifewhich is necessitated by conditions such as theabove is liable to cause definite deterioration in bothphysical fitness and resistance to disease.Even with prices as low as they are to-day a suffi-

ciency of food of the right sort implies a considerableweekly expenditure. Dr. G. P. Crowden 1 regards7s. a week as the minimum cost of the food necessaryfor a labouring man. Dr. Caradog Jones, as theresult of a social survey carried out under the auspicesof the University of Liverpool, puts it at 6s. 3d.The members of the Advisory Committee on Nutritionof the Ministry of Health, in a report on the Dietsin Poor-law Children’s Homes (1932), state that thefood that they recommend for such children willcost 4s. 6d!. per week, provided that all provisionsare bought at contract prices. Now it must beevident that if the above statements are correct a

good many families have not at the present timesufficient coming in week by week, after the rent ispaid, to provide themselves with a sufficiency offood, even if we assume that nothing is being spenton cleansing, warming, lighting, clothing, and othernecessities. It must of course be admitted that incases of unemployment of short duration, previoussavings in money or kind may be drawn upon andsome amount of assistance from relations and friendslooked for. But’ the present prolonged period of

unemployment, the impoverishment of those around,and the application of the means test, make theseadventitious sources of income negligible in manycases, with the result that the family has to dependentirely upon unemployment benefit or publicassistance relief which, as has already been shown,are entirely insufficient to keep their recipients inphysiological health.Because the members of the medical profession

can alone be fully cognisant of the importance ofthe issues involved, it is, I think, both their privilegeand their duty to do their best to protect their fellow-countrymen, and especially the children of thenation, from that physical degeneration which iscertain to follow a deficiency of the right sort offood. It is of the greatest importance that the

1 The Minimum Cost of Physiologically Adequate Diets for Working-class Families, THE LANCET, 1932, i., 899.

standard of our national stock shall be maintained,-and it is the object of this letter to urge upon mycolleagues the necessity for dealing with every caseof malnutrition due to poverty that comes beforetheir notice by reference with a brief note to therelieving officer, as this official is bound by Act of-Parliament to provide nourishment when ’this is-needed.-I am, Sir, yours faithfully,

SOMERVILLE HASTINGS.Devonshire-street, W., Nev. 22nd, 1932.

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SOMERVILLE HASTINGS.

FESTINA LENTE

To the Editor of THE LANCET

SIR,-I spoke rather quickly when I had the_honour of addressing the Harveian Society on.

Nov. 9th, and it would take too long to draw attentionto the many places where I should like to elucidate’your industrious reporter’s record (Nov. 19th, p. 1109),but I must crave your indulgence to make just onereference. I was talking of Wheelhouse’s operation,and deploring the fact that many of the youngersurgeons seemed to be so hasty in giving up theeffort to find the proximal urethra,. and were ready foran excuse for making a suprapubic opening eitherfor the purpose of retrograde catheterisation or for:establishing drainage by that route. I told myaudience that in an experience of over 30 years.:1 had only once had to fall back on a suprapubicin such circumstances, but went on to state that

many times the perineal operation was tedious and.taxed one’s resource and patience sorely. To meet.such eventualities I suggested that it should only beapproached calmly and without hurry, and that thesurgeon should make up his mind that he would notbe rattled into adopting some expedient that mightbe more facile than prudent.To give point to my remark I told them of an

occasion when the late C. B. Lockwood came to.Newcastle to deliver a lecture on amputation before*one of the medical societies. He related how a friendof his had written to him confessing that he hadnever done any surgery, but that he contemplated-commencing his career by an amputation at thehip-joint, and begging Lockwood to give him a littleadvice. Before entering into technical detailsLockwood told his friend that the most importantthing was to approach the operation in a suitable,frame of mind, and he recommended by way ofpreparation that he should take care to have a goodnight’s sleep and a hearty breakfast! His replyhas always struck me as most apt, and I have

frequently borne it in mind, and have quite commonlyreferred to it in all seriousness. This advice by. agreat surgeon, whose teaching I constantly admire,.might well be borne in mind, but one must beprepared for the type of person who requires trephiningto enable him to see a jqke, even when meant to,

convey an important lesson.I am, Sir, yours faithfully,

G. GREY TURNER.Newcastle-upon-Tyne, Nov. 21st, 1932.

G. GREY TURNER.

QUEEN ALEXANDRA HOSPITAL FOR OFFICERS.-The thirteenth annual reunion dinner of this hospitalwas held on Nov. 18th, with Lord Melchett in the chair.Over 40 of the former patients and members of the staffwere present. Major W. B. Binnie responded to the toastof the Former Patients, proposed by the chairman, and thetoast of Our Guest (the Rt. Hon. J. C. C. Davidson, whosefather, the late Sir James Mackenzie Davidson, was con-sulting radiologist to the hospital) was proposed by Mr.Herbert Paterson.