scotland

1
1310 service-so much material had been collected that it was found impossible to digest it in time for the conference. The work of this section will, therefore, be continued into next year. In only one instance did a serious dispute arise over the work of the preliminary committees. The subcommittee of the section dealing with reorganisa- tion of the federal health- service recommended that the maternity and infancy work be taken from the Labour Department (Children’s Bureau, under Miss Grace Abbott), and transferred to the public health service. Miss Abbott, herself a member of this sub- committee, wrote a minority report in which she said that " the conception of the unity of the child and the value of having the discipline and techniques of the social, medical, statistical, and other related sciences associated in the scientific study was advocated by the conference of 1909 and enthusiastically approved by President Roosevelt and, in turn, by Congress .... There is ample evidence that this plan of unified approach has greatly increased public interest in all the problems of children and child life. To remove the health, work from the Children’s Bureau would not merely remove one section of the Bureau’s activities ; it would destroy it as a Children’s Bureau." This minority report, in the haste of assembling material for the conference, was omitted from the printed volume of preliminary committee reports. But the omission came to the attention of representatives of women’s organisations in the conference, and overnight a remarkably strong protest movement against the majority recommenda- tion made itself manifest. The attempt of the majority of the committee to ignore this protest movement and even to prevent it from becoming I, vocal merely added to its momentum. It was an I astonishing spectacle to see the surgeon-general of I the public health service rebuking a leading sociologist for introducing remarks on social welfare in a section on public health matters, and one which gave some force to Miss Abbott’s previous arguments. Good sense ultimately prevailed, and the disputed recom- mendation was referred to a continuation committee, which was instructed to bring in a unanimous report. The conclusion of this same subcommittee that " the creation of a new department with a cabinet officer for the direction of federal health activities is not essential at present to the accomplishment of the objectives to be proposed " passed the conference without exciting any comment. Nor was there any overt criticism of the recommendation that federal grants in aid of health be continued and increased. I If the American Medical Association was represented its representatives raised no voice of protest against this continuation of the functions of the late Shephard- Towner Act. It is possible that the excitement over the work of the Children’s Bureau prevented discussion upon these other important matters. SCOTLAND. (FROM OUR OWN CORRESPONDENT.) NEW REMEDIES AND OPERATIONS. IN a recent address to the Pharmaceutical Society in Edinburgh Dr. Ralph Stockman, professor in materia medica and therapeutics in the University of Glasgow, dealt with some very practical points. He said it had to be admitted that the profession owed the introduction of some good remedies to manufacturing chemists, and these deserved gratitude also for furnishing reliable preparations of proved and attested remedies mostly in a convenient and pleasant form. There their legitimate function ceased and the role of teacher of pharmacology and therapeutics did not appertain to them. Infant foods and artificial foods generally had a dubious record from the point of view of therapeutic activities. The same might be said of treatment by serums and vaccines and also the development of endocrinology, which had furnished medicine with invaluable remedies. A weakness in the medical curriculum was the very large amount of mere description on the teaching side and an almost equal amount of mere memorising on the student side, with a minimum of those disciplines, such as mathematics or physics, which tend to develop reasoning power. This was inherent in biological studies and possibly unavoid- able in medicine, but possibly not. It was essential to ensure that during studentship some actual experience in treatment was available. It had sometimes crossed his mind that therapeutic practice might be stabilised intra-professionally by imitating the procedure of their legal confreres and establishing a medical court with medical judges, solicitors, advocates, and juries. Before these courts, with their experienced personnel, highly trained in weigh- ing the law of evidence, new drugs, new treat- ments, and new operations might be summoned to appear and show reasons for their existence and practice. Some such filter or buffer would be of incalculable benefit to the medical profession and a protection to the public at large. ALCOHOL AND THE LAW. In his Henderson lecture on Alcohol and Behaviour Prof. Sydney Smith said that under the new Road Act it was an offence to drive a car while " under the influence of alcohol, to such an extent as to be incapable of proper control of such vehicle." We knew, he said, that any quantity of alcohol diminished the control, and as this loss was gradually progressive, it was impossible to fix any exact point at which a person became incapable of driving a car. The question of diagnosis was thus going to be very difficult. Even when we knew the amount that a person had drunk we were not much further forward, for the effect of drink was not only different in different individuals, but varied enormously in the same individual at different times. Prof. Sydney Smith also emphasised the fall in the consumption of alcohol in Great Britain. The annual consumption of beer had, he said, diminished to half, and the consumption of whisky to about a quarter, of the amount used in 1900. In the present year this fall was continuing. With this fall in alcohol consumption there had been a similar diminu- tion in arrests for drunkenness, from about 200,000 in 1900 to 60,000 in 1928. The lecturer pointed out that although drunkenness had progressively diminished, sexual crimes had progressively increased. Thus, in the period 1900-04 there were about 1400 cases of rape and other sexual crimes annually, whereas in 1929 there were over 3000 similar cases. There seemed to be little correlation between drunkenness and the more serious crimes of violence and sexual crimes, but it bore a close relation to minor violence, neglect of children, and similar offences. Moderate indulgence in alcohol did not appear statistically to prejudice the expectation of life, but this finding should be accepted with some reserve.

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Page 1: SCOTLAND

1310

service-so much material had been collected thatit was found impossible to digest it in time for theconference. The work of this section will, therefore,be continued into next year.

In only one instance did a serious dispute ariseover the work of the preliminary committees. Thesubcommittee of the section dealing with reorganisa-tion of the federal health- service recommended thatthe maternity and infancy work be taken from theLabour Department (Children’s Bureau, under MissGrace Abbott), and transferred to the public healthservice. Miss Abbott, herself a member of this sub-committee, wrote a minority report in which shesaid that " the conception of the unity of the childand the value of having the discipline and techniquesof the social, medical, statistical, and other relatedsciences associated in the scientific study was advocatedby the conference of 1909 and enthusiasticallyapproved by President Roosevelt and, in turn, byCongress .... There is ample evidence that thisplan of unified approach has greatly increased publicinterest in all the problems of children and child life.To remove the health, work from the Children’sBureau would not merely remove one section of theBureau’s activities ; it would destroy it as a Children’sBureau."

This minority report, in the haste of assemblingmaterial for the conference, was omitted from theprinted volume of preliminary committee reports.But the omission came to the attention of

representatives of women’s organisations in theconference, and overnight a remarkably strongprotest movement against the majority recommenda-tion made itself manifest. The attempt of the

majority of the committee to ignore this protestmovement and even to prevent it from becoming I,vocal merely added to its momentum. It was an Iastonishing spectacle to see the surgeon-general of Ithe public health service rebuking a leading sociologistfor introducing remarks on social welfare in a sectionon public health matters, and one which gave someforce to Miss Abbott’s previous arguments. Goodsense ultimately prevailed, and the disputed recom-mendation was referred to a continuation committee,which was instructed to bring in a unanimous report.The conclusion of this same subcommittee that" the creation of a new department with a cabinetofficer for the direction of federal health activitiesis not essential at present to the accomplishment ofthe objectives to be proposed " passed the conferencewithout exciting any comment. Nor was there anyovert criticism of the recommendation that federalgrants in aid of health be continued and increased. IIf the American Medical Association was representedits representatives raised no voice of protest againstthis continuation of the functions of the late Shephard-Towner Act. It is possible that the excitement overthe work of the Children’s Bureau prevented discussionupon these other important matters.

SCOTLAND.

(FROM OUR OWN CORRESPONDENT.)

NEW REMEDIES AND OPERATIONS.

IN a recent address to the Pharmaceutical Societyin Edinburgh Dr. Ralph Stockman, professor inmateria medica and therapeutics in the Universityof Glasgow, dealt with some very practical points.He said it had to be admitted that the professionowed the introduction of some good remedies to

manufacturing chemists, and these deserved gratitudealso for furnishing reliable preparations of provedand attested remedies mostly in a convenient andpleasant form. There their legitimate functionceased and the role of teacher of pharmacology andtherapeutics did not appertain to them. Infantfoods and artificial foods generally had a dubiousrecord from the point of view of therapeutic activities.The same might be said of treatment by serums andvaccines and also the development of endocrinology,which had furnished medicine with invaluableremedies. A weakness in the medical curriculumwas the very large amount of mere description onthe teaching side and an almost equal amount ofmere memorising on the student side, with a minimumof those disciplines, such as mathematics or physics,which tend to develop reasoning power. This wasinherent in biological studies and possibly unavoid-able in medicine, but possibly not. It was essentialto ensure that during studentship some actualexperience in treatment was available. It hadsometimes crossed his mind that therapeutic practicemight be stabilised intra-professionally by imitatingthe procedure of their legal confreres and establishinga medical court with medical judges, solicitors,advocates, and juries. Before these courts, withtheir experienced personnel, highly trained in weigh-ing the law of evidence, new drugs, new treat-

ments, and new operations might be summoned toappear and show reasons for their existence and

practice. Some such filter or buffer would be ofincalculable benefit to the medical profession anda protection to the public at large.

ALCOHOL AND THE LAW.

In his Henderson lecture on Alcohol and BehaviourProf. Sydney Smith said that under the new RoadAct it was an offence to drive a car while " under theinfluence of alcohol, to such an extent as to beincapable of proper control of such vehicle." Weknew, he said, that any quantity of alcohol diminishedthe control, and as this loss was gradually progressive,it was impossible to fix any exact point at which aperson became incapable of driving a car. Thequestion of diagnosis was thus going to be verydifficult. Even when we knew the amount that aperson had drunk we were not much further forward,for the effect of drink was not only different in differentindividuals, but varied enormously in the same

individual at different times.Prof. Sydney Smith also emphasised the fall in

the consumption of alcohol in Great Britain. Theannual consumption of beer had, he said, diminishedto half, and the consumption of whisky to about aquarter, of the amount used in 1900. In the presentyear this fall was continuing. With this fall inalcohol consumption there had been a similar diminu-tion in arrests for drunkenness, from about 200,000in 1900 to 60,000 in 1928. The lecturer pointed outthat although drunkenness had progressivelydiminished, sexual crimes had progressively increased.Thus, in the period 1900-04 there were about 1400cases of rape and other sexual crimes annually,whereas in 1929 there were over 3000 similar cases.There seemed to be little correlation betweendrunkenness and the more serious crimes of violenceand sexual crimes, but it bore a close relation tominor violence, neglect of children, and similaroffences. Moderate indulgence in alcohol did not

appear statistically to prejudice the expectation oflife, but this finding should be accepted with somereserve.