96 MATERNAL MORTALITY AND NUTRITION

Committee from other committees of the local

authority, such as the Public Health Committee.It appeared to him that in the long run betterprogress was likely to be secured in the conditionsof local government which actually prevailed byaccepting the fact that there must be the closestpossible connexion between the various organsof government in the shape of the committeesof a local authority.

Sir Arthur referred to the presence of LordMacmillan, whose outstanding services on the RoyalCommission on Lunacy and Mental Disorder werein the minds of all of them, and had resulted in thepassing of the Mental Treatment Act of 1930, someof the results of which he had previously mentioned.He closed by bringing the best wishes of the Ministerof Health to the service of mental health and to theRoyal Medico-Psychological Association.

Sir William Collins, in submitting the toast ofthe Middlesex County Council, claimed as an oldmunicipal hack, more acquaintance with the Countyof London, its Lieutenancy and its County Councilthan with Middlesex, though he had a nodding andneighbourly acquaintance with that county. Herecalled the Local Government Act of 1888 whenLondon was dealt with as an incident in ruraladministration, and the new County of London waslargely carved out of ’the side of Middlesex. Whilethe population of the County of London, he said,had been falling since 1901, that of Middlesex hadgrown from half a million to one and three quartermillions, a reminder that the County of Middlesex isbecoming largely a dormitory for London, and the" green belt" of which many dreamt 40 years agoas the boundary of the County of London cannotnow be realised, though possibly some such belt

might be established around Greater London. Whenhe was elected to the L.C.C. in 1892 and served onthe asylums committee, two things, he said, impressedhim particularly. One was the need of more thoroughresearch into the pathology of insanity, and theother was the need for pensions for the asylumsofficers. With regard to the first he had endeavouredto promote research by inaugurating the laboratoryat Claybury with the late Sir Frederick Mott as

pathologist, while in 1909 he introduced into theHouse of Commons a Bill which became eventuallythe Asylums Officers Superannuation Act. In coupl-ing with the toast the name of Mr. Alderman Button,the chairman of the Middlesex County Council,a body which had just promised 100,000 to the

University of London, he recalled the fact thatMr. Button sat for a time in the House of Commonsbut was now pursuing the interests of both physicaland mental health in the serener atmosphere of

municipal life.The toast was replied to by Mr. Alderman Howard

Button, who referred to Middlesex as the county, saveRutland, with the smallest acreage, and an enormouspopulation. The county was responsible for the conductof two admirable mental hospitals, those at Shenleyand Springfield, though the institutions were actuallyin Buckinghamshire.The toast of the visitors was proposed by Dr. W. G-

Masefield, who said that the assembly of guests wasvery representative, including visitors from Belgium,Denmark, France, Holland, and the United Statesof America. all of whom were in the charge of themembers of the Association, on " a purely voluntarybasis." The toast was replied to by Lord Macmillanand Lord Wakefield.

Dr. Robert Hutchison, president of the Royal

Society of Medicine, proposed the toast of prosperityto the Royal Medico-Psychological Association.coupling it with the name of Dr. Worth, who brieflyreplied.

MATERNAL MORTALITY AND

NUTRITIONA NEW INQUIRY

THE People’s League of Health has established acommittee to consider the nutrition of expectant andnursing mothers in relation to maternal mortality andmorbidity.At an inaugural luncheon held at Claridge’s Hotel,

London, on July 5th, Dr. C. 0. HAWTHORNE,chairman of the council of the League, said that itsreports were intended to inform and arouse publicopinion and official action. The immediate object ofthe new committee was to study the question of foodin relation to the health of the mother and to inquirywhat part was played by quantitative or qualitative-errors of diet in the pathetic chapter on maternalmortality and morbidity. The solution of this grave-problem would not be found in emotional appeals or-in exaggerated statements, and still less in panic.Lord HoRDER, welcoming the enterprise, declared

his belief that the core of the problem of maternalmortality and morbidity did not lie in any short-comings of the doctor or midwife, and that the orienta-tion of study should be shifted in the direction of the-fitness of the mother to bear her child. Other attempts-to solve the problem had failed, but this one had notbeen tested. The word nutrition must be read in thewidest possible sense. Probably physical fitness,mental fitness, and biochemical fitness all contributedto the nutrition of the expectant and nursing mother.

Prof. JAMES YOUNG also commended the objectof the League in this matter, but at the same time-emphasised the importance of the obstetric aspect ofthe problem. Much maternal mortality had its

origin in the ineffective standards of service brought tobear on the practical application of the subject. The-

investigations in Rochdale were extremely relevant ;:until recently this area had had the highest maternalmortality in the country but, as the result of a com--paratively simple effort to improve the obstetric-service, the mortality had come down in the most,gratifying and dramatic manner. There was in addi-tion a large group of conditions operating adversely,for example, the toxaemias and metabolic disturbances.There was strong evidence that some defect in the-diet of the mother might be operating. The possi-bility could not be eliminated that in death from’puerperal sepsis after normal labour there might be-some factor determined by inadequacy of nutritionduring pregnancy. Many conditions of pregnancywere directly related to diet, as, for example, the-condition of the teeth. Nor must the child be for-

gotten ; the condition of the mother had a greateffect on the teeth and bones of the child and in thisway the obstetric welfare of the third generationmight be affected.

Dr. R. VEITCH CLARK suggested that the relation--ship between nutrition and pregnancy was probablybiochemical; the word " nutrition " must be taken inits widest possible sense. He was not satisfied thatthere was any relation between maternal mortality

L and morbidity and the amount of food taken. Eventhe establishment of definite negatives would be a

- contribution of no little consequence.

97MEDICINES AND SURGICAL APPLIANCES (ADVERTISEMENT) BILL

Mr. VICTOR BONNEY advocated the election of asmall subcommittee for research ; the services of

people with both knowledge and time were essentialfor success.-Miss OLGA NETHERSOLE reported thatthe Royal College of Physicians of London at its nextmeeting would consider the appointment of a represen-tative on the new committee.-DAME LOUISE MCILROYsaid that the investigation would entail two or threeyears’ hard work, and the workers would probablyfind themselves up against some unknown quality inthe patient herself.-Sir COMYNS BERKELEY observedthat the subject was very complex.A list of members of the committee follows. Asterisks

denote that they are members in an advisory capacityonly.Sir_CoMNS BERKELEY, F.R.C.P., consulting obstetric

and gynaecological surgeon to the Middlesex Hospital,London.

Mr. VICTOR BONNEY, F.R.C.S., gynaecological surgeonto the Middlesex Hospital.

Dr. J. J. BucHAN, medical officer of health for Bradford.*Dr. W. L. BURGESS, medical officer of health for

Dundee.Prof. F. J. BROWNE, F.C.O.G., director of the obste-

trical unit, University College Hospital, London.*Prof. E. P. CATHCART, M.D., F.R.S., regius professor

of physiology in the University of Glasgow.Dr. R. VEITCH CLARK, medical officer of health for

Manchester.Miss M. L. CLARK, L.L.A.*Dr. G. P. CROWDEN, reader in industrial physiology

at the London School of Hygiene and Tropical Medicine.Prof. S. LYLE CUMMINS, M.D., David Davies professor

of tuberculosis, Welsh National School of Medicine.*Sir HENRY DALE, F.R.C.P., F.R.S., director of the

National Institute for Medical Research, Hampstead.*Prof. L. S. P. DAVIDSON, M.D., regius professor of

medicine, University of Aberdeen.*Prof. J. C. DRUMMOND, D.Sc., professor of biochemistry

at University College, London.*Dr. J. S. FAiRBAiRN, consulting obstetrical physician

and gynaecologist to St. Thomas’s Hospital, London;president of the College of Obstetricians and Gynmco-logists.

Dr. LETITIA FAIRFIELD, a senior medical officer of thePublic Health Department, London County Council.

Prof. AMY ’ FLEMING, F.C.O.G., director of theobstetrical and gynaecological unit, Royal Free Hospital,London.

Prof. W. M. FRAZER, M.D., medical officer of healthfor Liverpool.

Dr. JOHN Guv, medical officer of health for Edinburgh.Sir LEONARD HILL, M.B., F.R.S., late director of

applied physiology, National Institute of Medical Research.*Mr. EARDLEY HOLLAND, F.R.C.P., obstetric and

gynaecological surgeon to the London Hospital.Prof. J. JOHNSTONE JERVIS, M.D., medical officer of

health for Leeds.Dr. R. C. JEWESBURY, physician in charge of children’s

department, St. Thomas’s Hospital, London.*Colonel P. S. LELEAN, F.R.C.S., professor of public

health in the University of Edinburgh.Dr. HELEN MACKAY, physician to the Queen’s Hospital

for Children.*Sir ROBERT MCCARRISON, F.R.C.P., past director,

Nutritional Research Pasteur Institute, Coonor, India.Dr. A. S. M. MACGREGOR, medical officer of health for

Glasgow (corresponding member).Dame LouisE McILROY, F.C.O.G., late professor of

obstetrics and gynaecology. University of London.*Mrs. IAN MURRAY, Ph.D., of the University of Glasgow.Dr. ELWiN H. NASH, medical officer of health for Heston

and Isleworth.*Sir JOHN BoYD ORR, M.D., F.R.S., director of the

Rowett Research Institute, Aberdeen.Dr. THOMAS ORR, medical officer of health for Ealing.Dr. W. H. F. OxLEY, hon. medical officer, East End

Maternity Hospital, London.Dr. ERIC PRITCHARD, paediatrician to Queen Charlotte’s

Maternity Hospital, London.

Dr. H. J. RAE, principal medical officer of health forAberdeen.

*Sir JOHN ROBERTSON, M.D., late medical officer ofhealth for Birmingham.

Dr. G. W. THEOBALD, consulting obstetrician and

gynaecologist, St. Mary Abbots Hospital, Kensington.Sir PENDRILL VARRIER-JONES, F.R.C.P., director of

Papworth Village Settlement, Cambridge.Miss JEAN WISHART, matron, Queen Mary’s Maternity

Home, Hampstead.Prof. JAMES YOUNG, F.C.O.G., professor of obstetrics

and gynaecology at the British Postgraduate MedicalSchool, London.

MEDICINES AND SURGICAL

APPLIANCES (ADVERTISEMENT) BILLDEPUTATION TO THE MINISTER OF HEALTH

Sir Kingsley Wood, the Minister of Health, whowas accompanied by Sir Edward Campbell, receiveda deputation on July 4th from the ParliamentaryCommittee on Food and Health.The speakers were Lord Mamhead, Captain G. S.

Elliston, Sir John Pybus, and Sir Francis Fremantle.The associations represented were :-

Advertising Association; Association of MunicipalCorporations ; British Medical Association; CountyCouncils Association ; Institute of Incorporated Practi.tioners in Advertising; Newspaper Society ; PeriodicalTrade Press and Weekly Newspaper Proprietors’ Associa-tion, Limited; National Association of Insurance Com-mittees ; Pharmaceutical Society of Great Britain;National Pharmaceutical Union; Surgical InstrumentManufacturers’ Association Incorporated ; Society ofMedical Officers of Health; Parliamentary MedicalCommittee ; and Parliamentary Committee on Food andHealth.

Lord MAMHEAD, in introducing the deputation,recalled the fact that the Parliamentary Committeeon Food and Health had first been constituted at a

meeting held in 1911 and called by Dr. Addison,Lord Bledisloe, and others. It had always been anon-party and a lay body.

Captain ELLISTON said that the committee hadhad in preparation for some time the draft of a Billto control the advertisement of medicines and surgicalappliances. A Select Committee of the House of

Commons, the appointment of which arose out ofaction taken by the Parliamentary Committee,investigated the question in 1912-14 and reported infavour of legislation. Several endeavours had beenmade since then to introduce legislation, but it hadnot been possible to make progress with a Bill. Oneof the difficulties had been that, in the past, it hadbeen impossible to secure the agreement of the

many interests concerned. The present Bill hadbeen discussed with all the important interestsaffected, and a measure of agreement, never pre-viously attained, had now been reached. The prin-cipal objects of the Bill were :

(1) To prohibit the advertisement of medicines, surgicalappliances, or forms of treatment as effective for the cureor prevertion of certain specified ailments, such as cancerand consumption, and

(2) To prohibit the publication of invitations to membersof the public to obtain the diagnosis or treatment of theseailments by correspondence.The Bill also contained clauses safeguarding the

legitimate interests of those concerned, includingnewspapers and religious organisations.

Sir JOHN PYBUS, speaking as president of the

Advertising Association, said that the Bill, if it were