PUBLIC HEALTH

Dominion, Volume 11, Issue 266, 30 July 1918, Page 7

PUBLIC HEALTH

» INCREASE OF INFECTIOUS DISEASE BETTER ORGANISATION NEEDED NOW-JfiOT AFTER THE WAR (By Dr. Edgar "NVhitaker.) 'During n time of national distress and Zander tho collective mind of tho public' Is receptive, and tho average understanding more highly keyed and attentive to jonstructivo planning than in n time of jioaco and plenty. Wo have had occasion to draw tho attention of the public t!o Hid proposed expenditure of our Hospital Board, with a view to maintain- . iing <i careful scrutiny upon tho financial side of tho undertakings. We here draw si parallel boUeen tho money annually spent by the Dominion in hospital upkeep and the results apparently obtained. Tho flzures in Ilia 1918 Tear Book 101 l us that "the expenditure ou hospitals and. charitable aid lias risen from -£1f19,«;i in 1885-G to £631,501 in 1915-16." '.['lie figures for the present financial year miusl bo well outsida .£IOO,OOO. Tho needs of tho Dominion havo be£onio during tho last tliroo years so urgent that it is surely time to take stock of our national = assets, and to seek out the best: way of ensuring the most careful nurturing of our possibilities. The Journal ol tho Department of Pu.blio Health for January, 1018, shows that •luring tho past yoaV there havo been 10,753 persons suH'erins from infectious discsaeb-'ICOD more than in tho preceding twelvo mouths. The figures for this year ulouo must nearly equal that number—in seven month-'. Thus, more than ono ill every ten of the wholo population inw.an infectious disease eacli day. A Precipice. Let lis put tho matter in another way. Wo will take tho well-known illustration of a precipice over which a certain number of the. population is liable to fall unless protected by measures taken by somebody else to prevent it. Let us call it fhe Precipice of Sickness. Along tho edge of that precipice a small body of men is always working to maintain a fence strong enough to withstand thu pressure put upon it by the natural increase of population. That body of Jiien, the Department; of Public Health, is allowed .£IO,(WU to keep that fence in order. But down below, stretching as far :is the eyo can reach, farther, indeed, than the limits of the horizon, row upon row of tine buildings can bo seen; operating theatres, surgical, medical and infectious wards rise tier on tier; men and women bustio about in Tied Cross ambulances'; X-ray apparatuses hiss out their messages ot' broken comminuted tones; motor-ears hurry busy doctors to and from the maimed survivors of the precipitous fall over the edge of danger into the carefully-administered arrangements, costing .C7CO,COO a year, made and paid for by au elected- Minister of Health, popularly-chosen hospital boards, ami an unenlightened public. 11l round figures, J33 is spent in this .Dominion a day in prcventivo measures,' and ,£2OOO a day in treating diseases that actually occur. Thosi/ aro merely tho figures for public hospitals. Health Districts, We need, therefore, make no excuse for referring to the present working of th» Department of Public Health. Tlie Honourable tho Minister, in a statement recently published in this paper, said, "It.has been evident for some time past ■> that the present health districts tiro far too large. There aro only four covering the whole Dominion. The longer I aui In office the more apparent becomes to mo the necessity for the development of , the public health, work of Hie Government." He also states tliat it would be a -wise and proper business to split up tho big districts and place speciallytrained officers in charge of tho artificial-ly-created local districts—"when special-ly-trained ollicci's are availably." That is tho matter upon which we- here offer an opinion. Tf we take a map of Now Zealand and strike off three oblique lines, so as to divide it equally, each of the four parts wilt contain, onu ui: the capital cities, and ail area of many thousand square miles. That is the present arrangement. Ono specially-trained officer and two or three lay assistants as inspectors havo charge of each area, one specially-trained oiliecr is above them in each area, and ono supermini controls tho entire outfit. That is the . Department of Public Health. _ Tho further step which the Minister is taking now, and proposes to. take in the future, is to subsidise students at the medical schools, so that they may find an incentive to take a course of oils year (l-oally nine months) in bacteriology and public, health in order that they may in due timo bncomo ono of the specially-trained men eligible for the Department. That, we agree, is n very -wiso and proper plan. But it lias Home devastating drawbacks, and tho public should clearly understand what they are. .Although tho Minister can offer tli© bursary (which is a polite term fir giving the public's money away foi a specific purpose), nothing on earth can compel the student who wins that bursary, and the degree in public health, to

enter tho shnclilos of tho Department. 11' ho has ordinary nmbition, if ho lias tho tenderest spark of real capacity, ho will always bo- able to win more as a frco. man in tho open market. A Timo of Stress. That is not tho greatest drawback. The plain fact is thai wo cuunot culculato or measure anything now in terms of peace. AVheii peaco comw it canliot bo a nioro return of tho conditions of 1913. It must moan swell ft time of strc.-s, fiiii'h uncertiiin, quick-changing phases of varying employment as can best respond to tho oscillations ;nd replacements of all tho avenue-.; of supply and demand ol a world, in reconstruction. Compared to the years which can bo immediately envisaged. this Dominion is now enjoying tranquillity and industrial pence ami c«so. Money is plentiful in comparison, and tho public mind is stirring and alei t t/> rapid changes. To fay that wo will tnko such and such a step ' after tho war" is merely to writo ourselves down as lioness unci helpless citizens. \\o must do far moro than that. Wo must each ono of lis look positively at exist ins evils and anachronisms and help lay solid foundations for their removal or betterment.

Tho Growing Child. \ Tho chief asset of our country is the growing child. "What aro the chief lactors about: this terrible increase of in- . fectious disease? Children and tho places where children gather—schools ( and P lc " turo. houses, and tho homes of parents. Is'cuo of those factors is under tho direct care or control of the OciKirUneut ol Ptfjlio Health or of hospital boardd or medical men—tho bodies trained to meet tho diseases at tho bottom of tho piucipice! If parents want advice ou sanitary matters. they havo no ono to ro > to, unless they pay for it for their children. It children want to avoid meeting other infectious children at school, they must keep away. They aro at lengthy periods superficially overhauled in school by lady doctors whoso advico 23 universally ignored because of tho expense. School buildings aro both insanitary and m* suflicieutj because committees havo neither money to spend Hor expert advice ob to how to t>peml it if they had it. The parenU of infectious children cannot by tho laws of tho country bo made to isolate those children, and not do so, bccauso of the expense. Tho , wholo argument is surrounded by tho ! question of expense—and yet at least £1,000,000 is spent annually by the pcoplo of this country upon the present disorganisation! Thesw matters aro not beyond remedy. We havo no need to sit down under them like tho people of Jsrael and of tho wilderaess with tho plagues of boils and flies. The charm of those times* is that they were so long ago, and so uncivilised. They had no hospital hoards or cleverlytrained doctors and bacteriologists. When their children died they called it fate. Wo call it anicrior-polio-meuingo-myeu-tis, ami seriously question tho amplitude of their opsonic iudex--as well as spending the aforesaid million. Times have changed and wo can intelligently adopt a reniedv. The Remedy? What is the remedy? The remedy lies ill a general recognition of tho importance of preventive medicine—strengthening the protecting edge at tho top of the PrtHpiee of Sickness and gradually erasing a concrete plan along the lop ot' it. Tho first essential must be to insist upon a broadening, out of the general duties and powers of the .Authority Kir Public Health. 'That Department must voluntarily delegate some definite authority to uic'dicn! men all over the country wiiling and competent to undertake sanitarv supervision. Wo must here accept a little of England's foresight in these matters; their methods might well too amalgamated with our own. livery town in England of over 20,001) inhabitants must have a medical man in charge of it who has the diploma of Public Health. Everv town of less than that population must have a local medical man, engaged by the urban authority;, to accept resnonsib'lify for the public health of that area. The whole of this vast mcctmnism is {<overned by tho President of the Local Government Board in London, t tlio sends, when necessary, his own hHi.y-traineil supervisors to investigate -uu take control in the case of grave epidemic or outbreak of new disease in ally ouarter. . Remarkable Results. The immediate results aro extraordinary. The niiblio is intimately protected" and advised by medical men tliev know, precautions can liie recommended and put in foTce, the schools, .secular nml religions, are a 'thief part of each sanitary area,.and as such have In maintain a fixed proportion of Hour space for a. fixed mimiber of pupils and take regular measures for disinfection; theatres Mid places of amusement have to live np to a good .standard. .Investigation and action are practically simultaneous. Every one pound -pent saves ton twenty to I he individual. The less readily-seen re-, suits are emiallv remarkable. The most lwjful national' statistics arc annually obtained ou sanitary matters; a progressive spirit of emulation is and maintained between the areas; the highly I rained simen-isoi;; have to show how highly trained Ihey are, with the result that they are gciini-ally the cleverest men in the country. ' Sanitary control should filler upwards from an enlighteni-d public, through inspectors, to a locally trained man with a medical degiree. From that medical man i-.'-imiisiliLi/.y should full upon highly trained doctors skilled in public health, who should visit at stated intervals and, in times of special urgency or danger, take full charge, of any district. Making

I one chain, in which each link takes tho 1 full pull of tho full load, according to its station. A Fair Deal tor the Children. To talk about what wo aro going to do "after the war" is onu kind of vanity. In the meanwhile tho children of our country mo not getting a fair deal. To go from a clean home in tho morning into an overcrowded, catarrhaHy-infccled schoolroom is not n fair deal. To buy discing in shops and second-hand sales, lo,iuhoU' it 1 rom public, towels, or recei'vo it from a bug-ridden accommodation house is not a. fair deal. To spoon-feed medical with a btiirsarv in tho vain hope, that in a, nebulous future thev may give some aid may give some people consolation; bill it does not prevent infectious disease. Hospital boards all over tho country are doing their plain duly in this matter. They are (responsible for tho outlay and provision of accommodation for tho increasing number of prevontiblo disease?. 'J hey are tho only elected representatives cf tho people who have a direct say in public health matters. It appears that local bodies have begun to uako up about those things. It is in their power to revolutionise the preventive measures against disease in this country. The Minister, we believe, will listen to them in this matter. Reverse for one single year tho monetary amounts wa havo mentioned. Spend tor ono yeftr tho sum of £700,000 upon an intelligent provention of disease and £10,000 upon treatment of it. Could wa not look upon tho future of our country with equanimity? EDO All WHITAKEU, L.8.C.P., Loud., M.R.C.S., Eng. Opthalmic. Surgeon, P.N. Public Hos- [ pital, member of P.N. Hospital Board, • mid hou. medical adviser to iior- ' ough Council.