BOOKS OF THE DAY

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The Building of a Nation's Health (W. T. Wells)... ... 22 The Needs of Youth (The Headmaster of Stowe)... ... 23 National Reserves (Honor Croome) ... 24 Poems and Dramas of Fulke Greville (Edward Sack-

vine -West ...

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The Criminal in Society (Mark Bonney)

25

The Dukes of Portland (Christopher Hobhouse)

26

Fiction (Kate O'Brien)

27

Current Literature ...

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A CENTURY OF PUBLIC HEALTH

By W. T. WELLS

FEW items of news during the past few weeks have been calculated to cheer those who have read or heard them. Perhaps the most striking exception to the depressing rule has been the fact that of the 200,003 and more young men of twenty who have been medically examined for the purposes of conscription 85 per cent. have been found to be of first- grade physique. And perhaps even more heartening than this national average is the fact that in one at least of the Special Areas that average has been exceeded. Here, it seems, is the final answer to the infinitely tedious speeches which most of us have had to endure in which the " burden of the social services " was the constant refrain. Five per cent. of a man's income, it may be felt, is a not unreasonable proportion to pay in order to ensure a constant supply of young men fit to protect the property from which that income is drawn. While for those whose politics are not ruled by their pockets the causes for satisfaction are clearly immense.

Sir George Newman, who for twenty-eight years was Chief Medical Officer to the Board of Education and for the last sixteen of them, from 1919 to 5935, held the same position under the Ministry of Health, has written a book which is equally valuable for its analysis of the steps by which our present system of public health has been built and for its recognition of the gaps which remain to be filled, of the ground which must yet be gained. It seems, in truth, to transport the reader into another world, and in more than one sense. On the one hand, in this world which Sir George creates, the raucous commonplaces of a half-educated Vien- nese house-painter seem not only ridiculous, but also irrele- vant. On the other, the record of selfless and largely unrewarded labour which the book contains is calculated to make the homme moyen sensuel despair at the pettiness of his personal pursuits and of his cherished ambitions. For what a record it is! Shaftesbury, reading The Times one morning in the autumn of 1832 an account of the evidence laid before Sadler's Committee of the conditions under which children worked, and thenceforth devoting his life to the cause of children's welfare ; Chadwick, who, in spite of some rather questionable work as Poor Law Commissioner, has earned the undying gratitude of posterity by his sensational exposure of working-class conditions of life which led to the first Public Health Act of 1848 ; John Simon, whose frequent reports and personal persuasiveness at length brought home to Governments and public alike the need of co-ordination of public health policy ; Morant, in a sense the creator both of our modern public education and of the Ministry of Health.

These are some of the great names. A vast host of humbler workers, some paid, others unpaid, have toiled in the same field, and contributed to the same results. There have been unknown medical officers, obscure district nurses, and voluntary workers on Care Committees ; timid spinsters venturing into rough streets, and wearied married women mounting innumerable stairs, to make sure that Tommy is sent to the dentist or Joan given a glass of milk. They have incurred the bitter hostility of greedy employers, parsimonious ratepayers and bad parents. Shaftesbury expressed the feel- ings which they must all have experienced at one time or another when he wrote in his diary, explaining the causes of the failure of the Board of Health, of which he was chairman:

" Its sin is unpardonable activity. . . . We roused all the Dis- senters by our Burial Board ; the Parliamentary agents are our

The Building of a Nation's Health. By Sir George Newman, G.B.E., K.C.B., M.D., P.R.C.P. (Macmillan. 21s.) sworn enemies ; the civil engineers, because we have selected able men to carry into effect the new principles ; the College of Physicians, because of our independent action in dealing with the cholera, when we proved that many a Poor Law medical officer knew more than all the fashionable doctors of London ; all the Boards of Guardians, because we exposed their reluctance to relieve the suffering poor in the days of the epidemic ; the Treasury besides, for the subalterns there hated Chadwick ; then come the water companies, whom we laid bare, and devised a method of supply which altogether superseded them ; the Com- missioners of Sewers, for our plans and principles were the reverse of theirs . . Thus after five years of intense and unrewarded labour I am turned off like a piece of lumber."

The Board of Health went, but the work continued ; after an interval when Simon worked under the Privy Council the Local Government Board was formed. From 1850-1890 these bodies were " laying the foundations of sanitation—clean- liness, drainage, sewerage, water supplies and removal of nuisances." At the same time, and with the help of the Registrar-General's department, a great work of fact-finding was carried on.

The workers of the nineteenth century, finding overwhelm- ing evils around them, tended to concentrate on the prevention of evil as their aim: the creation of a sanitary environment and the restriction of working hours, first for children, and then for women. After • 1875 this movement reached its height :

La new duties followed each other rapidly. Moreover, the idea of ' quarantine' came to be interpreted as `hospital isola- tion,' public vaccination must be pressed forward, hospital ac- commodation must be extended, industrial diseases prevented, the food supply must be controlled and increased, and poverty must somehow or other be reduced."

Collectivism began to be in the air, but it did not get far beyond " gas and water Socialism." With the dawn of the new century a new and more positive attitude began to prevail. As Sir George Newman puts it-

" . the centre of gravity' of public health government has

moved from the importance and effect upon mankind of a sanitary envircnment to the uncharted liabilities and obligations inborn in the nature of man's body itself."

In other words, not only the suppression of abuse, but also

the discovery and achievement of man's capacities, and the creation of new values in his life, became the aim. The advance of medical science, together with the quickening of the social conscience, made this possible. It was, in its nature, a twofold process, partly physiological and partly educational. Its essential technique was, and is, the co-opera- tion of the doctor with the schoolmaster through the assistance of the expert administrator. In operating Balfour's Education Act of 1902 it soon became evident that differences in health could make the ideal of educational opportunity an empty farce. School feeding and the school medical service followed from this perception, while on the other hand Lloyd George's adaptation of the German social insurance system to British needs made it possible for a medical profession, now enabled to co-operate on reasonable terms in the public service, to work for the maintenance in the adult community of a condi- tion of positive health.

There have been immense achievements since the economic tyrannies of the cholera-ridden "hungry. forties." But with a population, a far too great proportion of which is under- nourished, with a maternal mortality rate which includes 45 per cent. of preventable cases, and with an alarming prevalence of tuberculosis among the children of the poor, there is no room for complacency. We are simply on the threshold of opportunity. It remains to be seen whether war or economic policy will make us stop at that, or whether we shall go forward into a new world of social health and happiness.