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commission’s endorsement of the prepayment principleand Federal matching grants to States (on the basis ofrelative wealth and need), but emphasises the desperateneed for prompt action among the rural population ofAmerica. Dr. Hinsey concurred in the financial recom-mendations only if free choice of health personnel andfreedom of type of practice were maintained, and asystem of remuneration mutually satisfactory to membersof the health professions and the public could be devised.The United States has no unified central health depart-
ment, and the report reveals some of the reasons forthis. They include opposition by the Veterans Adminis-tration and the Department of Defense, which fear thedangers to their medical services, and " the zealousnessof some of its partisans to give this Department a biggerbite than it can possibly chew in its formative years."The recommendation is brief and to the point : it isthat " the Congress establish a Department of Healthand Security." Dr. Hinsey again dissented as heconsidered that the matter required further study.Mr. Graham and Dr. Russel V. Lee felt that thereshould be a Department of Health with cabinet statusbut had doubts on extending its function beyond healthactivities.
The report next turns to special aspects of healthservice, including the expansion of programmes ofdisease detection, and especially multiple screening ;a bold attack on chronic disease to be promoted by thehealth departments ; and the development of home-careservices. Research into mental illness must be giventop priority, and prevention of accidents a high priority.Also " less time should be spent on perfunctory annualexaminations of school children as they are too oftenperformed today," and more time devoted to carefulhealth screening and follow-up.The report examines the special problems of industrial
workers and rural people, including the deplorableconditions of migratory labourers. The problems of
ageing, the veterans, the rural Negro, and the Indiansare all carefully considered : and the difficulties of
drafting doctors, dentists, and veterinarians into thearmed forces (obviously a sore point) are recommendedfor further study.
PROPOSED HEALTH COMMISSION
Finally comes the recommendations that :1. The Congress establish a Federal Health Commission.2. Comparable bodies be established in State and local
The Health Commission is to fill the rôle of constantcritic and evaluator with an absolutely free hand, whilethe Federal health department would be primarilyan administrative organ of government. The healthcommissioners should receive no salaries ; not more thanhalf the members should be professional health workers,and no member should be an officer or employee ofeither Federal or State government. The commissionshould have the power to hold public hearings, and shouldmake an annual report to the President and the Congresson the health status and health needs of the American
people, including recommendations for legislation when-ever this is indicated.
As to the total cost of the recommendations, theFederal government at present spends just over 1000million dollars each year on civilian health activities.The health programme outlined in this report wouldrequire an annual Federal expenditure of approximately1000 million dollars more.
Prevention of Misuse of DrugsIN the House of Lords on Feb. 12. the EARL of ONSLOW,
moving the second reading of the Therapeutic Substances(Prevention of Misuse) Bill, said that its main objectwas to empower the Minister concerned to regulate theuse of new drugs. This applied particularly to isoniazid,a cheap product, which at the moment did not comewithin the scope of the 1947 Act, and could, if used forself-medication, do great harm. The other purpose ofthe Bill was to allow the Minister and his colleagues byregulation to permit the use of certain of these drugs,particularly at the moment penicillin, in the feeding ofpigs and table poultry.Lord AMULREE thought that if penicillin was to be fed
to pigs, it must be supplied by a veterinary surgeon;otherwise people might buy it for themselves. He alsosuggested that the Royal Veterinary College should beconsulted about any regulations to be made under theBill when it became an Act. Lord HADEN-GUEST wasdoubtful whether it was necessary to add the veterinarysurgeons to the two well-qualified bodies-the Agricul-tural Research Council and the Medical Research Council-under whose advice the supervision of the giving ofpenicillin was to be.
Replying to the debate, the EARL of ONSLOW said theA.R.C. and the M.R.C. were satisfied that penicillin fedto pigs in this form could do no harm. The quantitywas so small that it could not affect the consumers ofthe pig meat. The penicillin would be fed in one of twoways ; either in a compound food, where the makerswould have to put on the compound a statement of whathad been included in it ; or in a special mixture-sodiluted that it was impossible to extract the penicillinfor use in other ways-which the farmer would then beable to mix in his own feeding-stuffs. He was quitesatisfied with the assurance that there could not beanything harmful in the admixture in the feeding-stuffsfor either poultry or pigs.
QUESTION TIMEHealth Services Charges
Mr. ARTHUR BLENKINSOP asked the Minister of Healththe number and cost of prescriptions issued, dental treatmentprovided, and appliances issued, for which charges wereimposed under the National Health Service Act, 1952, forNovember and December, 1952. compared with the figures forNovember and December, 1951.-Mr. IAIN MACLEOD replied :The following are the figures for England and Wales :
Mr. BLENKINSOP asked the Minister what financial savinghe estimated would result from the charges imposed underthe Health Service Act, 1952 ; how much of this saving resultedfrom a faU in use of the services concerned ; and how the
savings compared with the estimates originally given.-Mr. MACLEOD replied : The estimated amount of the chargespaid, or to be paid, in 1952-53 by patients in England andWales under the 1952 Health Service Act is about £2 million.In addition, while figures to enable a complete estimate to bemade are not available, the reduction in the demand fordental treatment and for hospital appliances for which chargesare made compared with the previous year is estimated toshow a saving of about f: 13/4 million. Comparisons cannotusefully be made with estimates framed in the expectationthat the charges would operate for a full year and beforemodifications in the original proposals were made.
Bone-conduction Hearing-aidsIn answer to a question Mr. MACLEOD said that a first
consignment of bone-conduction hearing-aids had alreadybeen sent to the hospitals which distribute aids.
Flour-improversMr. D. W. WADE asked the Minister of Food what progress
had been made in the investigations into the existing methodsof treatment of flour ; and whether he would give an assurancethat the process of agenisation would be abandoned.-Major GWILYM LLOYD GEORGE replied : These complex andimportant investigations into possible alternatives to ageneas a flour-improver are requiring considerably more time thanwas originally thought necessary. They are being pursuedwith all possible speed, but it would be premature to take anyaction until they are completed. One or two possiblealternatives have been presented, but it is obvious that
very careful research must be undertaken before either canbe accepted.
Health Service Resignations in ScotlandSir THOMAS MooRE asked the Secretary of State for Scotland
whether he was aware of the public concern in Ayrshire inregard to the efficiency of the National Health Service, withparticular reference to the shortage of trained medical andsurgical consultants.-Mr. JAMES STUART replied : Ifthe hon. member will let me have particulars of anydeficiencies brought to his notice, I shall be glad to considerthem.
Sir THOMAS MOORE: While welcoming the Minister’ssuggestion, is he aware that there has been a disturbingnumber of resignations lately, especially amongst consultants ;and is he satisfied that the West of Scotland Regional Boardis adequately and effectively dealing with this unsatisfactorysituation ? Mr. STUART: I am assured that the regionalboard are taking proper steps to replace those who haveresigned.
Mr. A. C. MANUEL: Is the Secretary of State aware thatin the West of Scotland, and in Ayrshire in particular, sincethe inauguration of the National Health Service we have hada better full-time consultant service than ever previouslyexisted ; and that the doctors generally have expressedto me their satisfaction at the better service now
In England NowA Running Commentary by Peripatetic Correspondents
LEISURE, like the conversation that goes with it, isdying ; and we are hastening its end. In our fathers’day a whole section of society was dedicated to itspursuit ; and none thought a whit the worse of a man forbelonging to the leisured classes. But today the veryword leisure bears a sting of reproach. Braving publicopinion, the Chelsea Clinical Society last week met tohear from three distinguished speakers-a writer, a
surgeon and a broadcaster-how we might win our
way back to the Pursuit of Leisure. Mr. John Betjemanwould have none of this. By speaking for only threeminutes he slyly implied that he was making way forothers better qualified to talk, and his brief words werelargely directed to showing that no stigma of leisurecould be applied to him ; if, he declared, he liked whathe did he wouldn’t want any leisure. Leisure was aninvention ; and here presumably he meant that likeother inventions-the safety-pin, the steam engine, andeven television-it could be eradicated if only we turnedour minds to the task. A similar personal disclaimercame from Mr. Gilbert Harding-the Mr. Harding whoin other fields has spoken bravely. Only Sir HeneageOgilvie stood his ground ; but it was carefully chosenmedical ground on which he spoke well of leisure as acounterpoise to work. The lesson seems to be thatthis word is now taboo except in the consulting-room ;and we should thank the members of the Chelsea ClinicalSociety for setting aside some of their less hurried hoursto establish this.
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The study of man’s reaction to changing environmentis now a popular pastime. I have been making anunofficial pilot study of my reaction as a householder tothe august body which now runs the local hospital.The bureaucratic mills grind slowly, but with an air of
majestic purpose. The first victims were some moderate-sized houses in which the ci-devant bourgeoisie onceraised happy families. These were smartly converted intostaff quarters and maternity units, so that our ratherordinary neighbourhood has now a busy professional air.Starched white caps and scarlet-lined cloaks charm theeye in the daytime and ambulance noises make mynights hideous. After a suitable interval a nursing-homewas drawn into the net. This raised a generous amountof heat, even assuming atomic proportions, but the deedwas not undone and the opposing forces have withdrawnto regroup.But now a bureaucratic shaft has found a target right
in the middle of our domestic hearth. Our invaluabledaily help has decided to throw off the shackles of privateenterprise and give her services exclusively to the
hospital. It would take the genius of Milton to describethe despair with which we contemplate the future of ourfast’dwindling paradise, and my pilot study has turneda bit introspective....
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During the recent gales our sanatorium was sooncut off from electricity and water. On the firstmorning of the storm we were approached by a
delegation from the patients’ club, who, apparentlyunconcerned about their own welfare, wanted to knowwhat was to happen to their tropical fish. We answered,civilly enough, that we were rather busy just then, andquickly retreated to our quarters to consult our smallmedical reference library. The fish, some three dozen ofassorted species with their young, lived in a tank in aremoter part of the sanatorium property ; and the
fixity of their internal medium was controlled by a deviceof science, worked by electricity. The problem was ofkeeping the temperature of the tank above 750 Fahrenheitunder the prevailing chilly conditions. Coal fires in thehospital numbered two, and the tank could not be moved.On going through our literature, we found we had
mislaid Dr. Bernard’s paper ; other oracles we hadconsulted in the past could give us no guidance. Oureyes fell on our stone hot-water jar which lay on thefloor, where it had been blown out of the hands of a maid-servant earlier that morning. By applying the lateMr. Archimedes’s principle, two hot-water jars were