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A CROSS-SECTION OF THE PUBLIC HEALTH

THE LANCET

LONDON: SATURDAY, SEPTEMBER 22, 1934

IN his annual report 1 to the Minister of Health,which appeared on Wednesday last, Sir GEORGENEWMAN remarks that the high standard of recentyears is being well maintained. Unemployment,undernourishment, and preventable malady andaccident seem, he says, to be the unavoidableconcomitant of current civilisation in Western

Europe in the present day, and we must not assumethat our continued good national health can whollypreclude the effects of such conditions falling uponcertain sections of the population. Yet we are

suffering less than other nations, and as a wholethe health of the unemployed and their dependents"is not suffering seriously or generally." Sir GEORGEis quite definite on this point, although he sees fitto reprint a striking paragraph from his last year’ssurvey of the physical effect of unemployment,in which he spoke of the possibility of risk ofmental instability in the adult man and prolongedundernourishment of women and children. These

words, he adds, seem equally true to-day and are, ]indeed, confirmed by the data he records. Amongmen in three localities-Tyneside, South Lancs, ]and East London-ill-health of a neurasthenic

type is on the increase. The commonest ill-effectof unemployment is a slowness of recovery-reactionafter illness, and in the older age-periods somegeneral incapacity for work. Women in the Northof England seem to be suffering from anaemia asthe indirect result of unemployment, but in SouthWales there is said to be an " almost total absence "of malnutrition. These findings are based on thepersonal experience of 66 regional medical officersof the Ministry, all of whom have themselves hadlong and varied personal experience of generalpractice ; 25 of these officers have personallyobserved no ill-effects whatever from unemploy-ment, another 25 ascribe certain minor conditionsonly to unemployment, no more than 16 reportsubstantial ill-effects, and these limited to certaindefinite areas. But having said this, Sir GEORGEinsists that it is necessary to check actual andverified data by the evidence of history. He hasfound since CHADWICK’S classical report of 1842ample records of the social and medical conditionof the people, invaluable as a plumb-line forevaluating experience. Problems raised in the’forties were answered by reform of local govern-ment and poor-law, and of many external conditionsof living ; the 1904 report on physical deteriorationled to public services such as school feeding, schoolmedical supervision, industrial welfare, care of

1 On the State of the Public Health. Annual Report of theChief Medical Officer of the Ministry of Health for the year 1933.H.M. Stationery Office. Pp. 295. 4s. 6d.

maternity and childhood, health and unemploymentinsurance. This profound change has proved tobe the defence of national health in the last fewyears of economic depression. The defence mayhave been imperfect but it has proved substantial.

Apart from this searching study of unemploy-ment, Sir GEORGE reacts sharply to the reiteratedassertion of physical deterioration of our race-

although he admits that deaths attributed to cancerare increasing, that a large proportion of fatalillness is due to heart disease, that year by yearthere is a higher percentage of apparently prevent-able deaths from accident, that large numbers ofchildren still enter school physically and mentallydefective, that the physical condition of recruitsfor the army leaves much to be desired, thatmaternal mortality is not reduced, and that thenutrition of the people is not so good as it shouldbe. Some of these topics are dealt with in thereport, although he disclaims the possibility of a"

complete periodic assize " to measure the nation’shealth. The greatest improvement in mortalityover the past three-quarters of a century has beenrecorded at the ages of 1 to 5 years, and that in

spite of the fact that there has been little directintervention at this age. On the other hand, theboy and girl leaving school at 14 too often declinein physical standard during the next few years,the strain of industrial life coming, it may be, tooearly upon them. To meet this, Sir GEORGEremarks, the time may have come for some

subsidising or constructive action by the Stateitself. The general nutrition of the people he findsbetter to-day than at any past period. Happilythey are learning to like the " protective foods "such as milk, eggs, fish, fruit, and fresh vegetablesof which there has been an enormously increasedconsumption. The situation, he remarks, does notcall for the imposition of a standard dietary.Tuberculosis remains an anxious problem in itseffect on women between 15 and 25 years of age,who do not share in the general decline of disease.In a final paragraph Sir GEORGE NEWMAN dealsfrankly with the arrest of maternal mortality ator about 4 deaths per 1000 births during the lasttwenty years. Clearly, he says, we must await theslow but sure reaction of the effect of educationon each of the five groups-school girls, potentialmothers, prospective husbands, midwives, andmedical practitioners ; but he again draws publicattention (on p. 262 of the report) to the countiesand towns which are chiefly responsible for thecontinuance of an exceptionally high maternal

mortality, and on the following page he sets outfor comparison the ten-year averages of theQueen’s Institute and some of the lying-in hospitalsand institutions whose death-rate is only a quarterof the general experience. Control of detail, heremarks, is the master-key to the whole problem.

These are but a sample of subjects dealt within a survey which every thoughtful citizen shouldread for himself-in spite of the 264 closely writtenpages, not including the 30 pages of appendices.It is unfortunate that the price of the review shouldbe treble what it was in 1920 and still rising.