1
638 replied: The -Medical Research Council after extensive examination have recommended that all table and cooking salt should be iodised for the prevention of goitre and thyroid enlargement. - This recommendation has been endorsed by the Ministry of Health Standing Committee on Medical and Nutritional Problems, and it has the full approval of the Secretary of State for Scotland and the Minister of Health. The Food Standards Committee were asked to advise on what measures would be necessary to give effect to the medical recommendation. They have recently completed their inquiries and have recommended a standard of composition for iodised salt which can be enforced by chemical analysis. The com- mittee received evidence from representatives of the salt industry, who have concurred in the recommendation as a permanent measure, and from other expert witnesses, and have advised that within one year from the date of an order all pre-packed free-running salt should be treated with small traces of iodide and that within two years all other pre- packed salt should be similarly treated. I understand that this would- mean that the production of cut-lump salt would have to be discontinued. I am advised that if salt production as between pre-packed free-running salt and other salt used in the home remains substantially in the same proportion as in 1948 slightly more than half the population of Great Britain would benefit within the first year from the Medical Research Council’s recommendation and that the entire population would benefit by the end of two years. Steps will not be taken to give effect to the Committee’s recom- mendations until all concerned (the trade and technical interests, the medical profession and, indeed, the public) have had full opportunity to make any representations they wish. The Food Standards Committee will be open to receive representations until June 30, 1950. . Hospital Management Committees y Mr. DONALD KABEBBY asked the Minister of Health whether, in view- of the experience now gained as to the working of the hospital management committees and the filling of casual vacancies, he was prepared to review the rules governing the constitution of these committees, with a view to securing more adequate public representation.-Mr. ANEURiN BEVAN replied : The appointments are a matter for the regional hospital boards, who are required by statute to ensure that each committee includes members appointed after consul- tatiori with certain specified local public bodies. They are not, however, required by statute to undertake such consultations on the occurrence of every casual vacancy. , Motor-cars for Disabled Miners Mr. EMRYS HUGHES asked the Minister what steps he was taking to provide motor-cars to disabled miners similar to those provided for disabled soldiers.-Mr. ARTHUR BLENKINSOP replied : Motor propelled tricycles are provided for severely disabled civilians under the National Health Service, but I cannot undertake to provide motor-cars. , Foods for Diabetics Wing-Commander E. E. BULLus asked the Minister if he would arrange that special foods prepared for diabetic people should be supplied as medical necessities under the National Health Scheme.-Mr. BEVAN replied : I am afraid this is not possible. The Act of 1946 authorises the provision of all proper or sufficient drugs and medicines but does not cover the provision of foods. Health Centres Mr. SOMEJWILLE HASTINGS asked the Minister of Health what arrangements he had made for practitioners who are willing to undertake full-time service in health centres in any part of the country to secure an opportunity to practise their pro- tession in tans way, and wnai steps ne toon To ensure agreement by suitable practitioners of a district to undertake service in a health centre before he sanctioned the provision of such a centre by new construction or adaptation.-Mr. ANEURiN BEVAN replied : Before approving a health centre I obtain an assurance from the executive council, after consulting the local medical committee, either that enough local doctors want to practise there or that the need for more doctors in the area would justify advertising vacancies. Mr. HASTINGS : Does not the Minister think that if he agreed to the arrange- ment suggested in the first question, it would greatly improve the distribution of doctors, which is most unequal at present ? -Mr. BEVAN : A special committee of the -Central Health Services Council is exploring the whole question of the lilies on which health centres should be developed. In answer to a further question, Mr. BEVAN stated that one new building for a health centre was under construction, one other new building and one adaptation had been approved, and other schemes were under consideration. He had no informa. tion as to the numbers of doctors willing to transfer their practices to health centres. The present building situation would in any case make it impossible to provide health centres for all doctors who would like it. Number of Nurses Replying to a question, Mr. BEVAN said that the total nursing and midwifery staff employed whole-time or part- time in the National Health Service in England and Wales on Dec. 31, 1949, was 174,000. This was 12,000 more than on Dec. 31, 1948. Hospital Boards and Committees Mr. BOYD-CARPENTER asked the Minister whether it was with his approval that paid servants of regional hospital boards or group hospital management committees are appointed members of the particular boards or committees by whom they are employed.-Mr. BEVAN replied : As a general principle, I am not in favour of these officers serving as members of the bodies with which they are immediately connected. The requirements of the Acts make it inevitable, however, that a limited number of the senior medical and dental staffs should be so appointed, and I recognise that there may be other exceptional cases where it is desirable so to appoint officers. Unemployed Doctors Replying to a question, Mr. GEORGE ISAACS stated that there were at present 74 unemployed medical practitioners on the Appointments Register. This number included 36 foreign doctors, most of whom are Polish. Poliomyelitis and Inoculation Mr. S. P. VIANT asked the Minister of Health whether in view of the admitted risk of postvaccinal encephalitis he would consider making an investigation with the object of ascertain- ing if the numerous inoculation operations now being per- formed are playing any part’ in causing poliomyelitis.-Mr. BEVAN replied : I will consider the suggestion. Fat Content of Ice-cream Mr. SOMERVILLE HASTINGS asked the Minister of Food whether he would make regulations designating two or more qualities of ice-cream according to fat content, so that the public might have knowledge of the food value of the article purchased.-Mr. MK1JRIôE WEBB replied : I am afraid that shortage of ingredients still make it impossible to introduce a satisfactory single standard for ice-cream- without seriously reducing supplies to the public. The Food Standards Com- mittee has considered fixing two standards ; but after con- sulting the trade and the local-authority associations they felt that the lower standard, to which most of the manufacturers would have had to conform, would not have a good enough food value. In the circumstances, the committee recom- mended that the introduction of standards should be deferred until an improvement in the supply of rationed ingredients made it possible to prescribe a satisfactory minimum’standard. Public Health Smallpox A NURSE in a Glasgow hospital sickened on March 23, developed a rash on March 25, and has now been diag- nosed as having semiconfluent smallpox. By last Monday the diagnosis of smallpox had been confirmed in two other cases, both modified by previous vaccination. In addition, two adults and a baby were under observation. The source is probably a Goanese seaman who landed from R.M.S. Chitral at Tilbury on March 5 and travelled to Glasgow. He felt unwell on March 7 and developed a rash soon after admission to hospital on March 10. Chickenpox was diagnosed by competent physicians. This man was probably infected on the Chitral and there may be another missed case or cases amongst the passengers and crew who disembarked in London on March 5. Smallpox should be suspected in any passengers or contacts who report fever or rashes to their doctors.

Public Health

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638

replied: The -Medical Research Council after extensiveexamination have recommended that all table and cookingsalt should be iodised for the prevention of goitre and thyroidenlargement. - This recommendation has been endorsed bythe Ministry of Health Standing Committee on Medicaland Nutritional Problems, and it has the full approval ofthe Secretary of State for Scotland and the Minister of Health.The Food Standards Committee were asked to advise on

what measures would be necessary to give effect to the medicalrecommendation. They have recently completed their inquiriesand have recommended a standard of composition for iodisedsalt which can be enforced by chemical analysis. The com-mittee received evidence from representatives of the salt

industry, who have concurred in the recommendation as

a permanent measure, and from other expert witnesses, andhave advised that within one year from the date of an orderall pre-packed free-running salt should be treated with smalltraces of iodide and that within two years all other pre-packed salt should be similarly treated. I understand thatthis would- mean that the production of cut-lump salt wouldhave to be discontinued. I am advised that if salt productionas between pre-packed free-running salt and other salt usedin the home remains substantially in the same proportion asin 1948 slightly more than half the population of GreatBritain would benefit within the first year from the MedicalResearch Council’s recommendation and that the entirepopulation would benefit by the end of two years. Stepswill not be taken to give effect to the Committee’s recom-mendations until all concerned (the trade and technicalinterests, the medical profession and, indeed, the public)have had full opportunity to make any representations theywish. The Food Standards Committee will be open to receiverepresentations until June 30, 1950.

. Hospital Management Committees y

Mr. DONALD KABEBBY asked the Minister of Health whether,in view- of the experience now gained as to the working ofthe hospital management committees and the filling ofcasual vacancies, he was prepared to review the rules governingthe constitution of these committees, with a view to securingmore adequate public representation.-Mr. ANEURiN BEVANreplied : The appointments are a matter for the regionalhospital boards, who are required by statute to ensure thateach committee includes members appointed after consul-tatiori with certain specified local public bodies. They are not,however, required by statute to undertake such consultationson the occurrence of every casual vacancy.

, Motor-cars for Disabled MinersMr. EMRYS HUGHES asked the Minister what steps he was

taking to provide motor-cars to disabled miners similarto those provided for disabled soldiers.-Mr. ARTHURBLENKINSOP replied : Motor propelled tricycles are providedfor severely disabled civilians under the National HealthService, but I cannot undertake to provide motor-cars.

, Foods for Diabetics

Wing-Commander E. E. BULLus asked the Minister ifhe would arrange that special foods prepared for diabeticpeople should be supplied as medical necessities under theNational Health Scheme.-Mr. BEVAN replied : I am afraidthis is not possible. The Act of 1946 authorises the provisionof all proper or sufficient drugs and medicines but does notcover the provision of foods.

Health CentresMr. SOMEJWILLE HASTINGS asked the Minister of Health

what arrangements he had made for practitioners who arewilling to undertake full-time service in health centres in anypart of the country to secure an opportunity to practise their pro-tession in tans way, and wnai steps ne toon To ensure agreementby suitable practitioners of a district to undertake service ina health centre before he sanctioned the provision of such acentre by new construction or adaptation.-Mr. ANEURiNBEVAN replied : Before approving a health centre I obtain anassurance from the executive council, after consulting thelocal medical committee, either that enough local doctorswant to practise there or that the need for more doctors inthe area would justify advertising vacancies. Mr. HASTINGS :Does not the Minister think that if he agreed to the arrange-ment suggested in the first question, it would greatly improvethe distribution of doctors, which is most unequal at present ?-Mr. BEVAN : A special committee of the -Central HealthServices Council is exploring the whole question of the lilieson which health centres should be developed.

In answer to a further question, Mr. BEVAN stated thatone new building for a health centre was under construction,one other new building and one adaptation had been approved,and other schemes were under consideration. He had no informa.tion as to the numbers of doctors willing to transfer theirpractices to health centres. The present building situationwould in any case make it impossible to provide health centresfor all doctors who would like it.

Number of Nurses

Replying to a question, Mr. BEVAN said that the totalnursing and midwifery staff employed whole-time or part-time in the National Health Service in England and Waleson Dec. 31, 1949, was 174,000. This was 12,000 more thanon Dec. 31, 1948.

Hospital Boards and CommitteesMr. BOYD-CARPENTER asked the Minister whether it was

with his approval that paid servants of regional hospitalboards or group hospital management committees are

appointed members of the particular boards or committeesby whom they are employed.-Mr. BEVAN replied : As ageneral principle, I am not in favour of these officers servingas members of the bodies with which they are immediatelyconnected. The requirements of the Acts make it inevitable,however, that a limited number of the senior medical and dentalstaffs should be so appointed, and I recognise that there maybe other exceptional cases where it is desirable so to appointofficers.

_

Unemployed DoctorsReplying to a question, Mr. GEORGE ISAACS stated that

there were at present 74 unemployed medical practitionerson the Appointments Register. This number included 36

foreign doctors, most of whom are Polish. ’

Poliomyelitis and InoculationMr. S. P. VIANT asked the Minister of Health whether in

view of the admitted risk of postvaccinal encephalitis he wouldconsider making an investigation with the object of ascertain-ing if the numerous inoculation operations now being per-formed are playing any part’ in causing poliomyelitis.-Mr.BEVAN replied : I will consider the suggestion.

Fat Content of Ice-creamMr. SOMERVILLE HASTINGS asked the Minister of Food

whether he would make regulations designating two or morequalities of ice-cream according to fat content, so that thepublic might have knowledge of the food value of the articlepurchased.-Mr. MK1JRIôE WEBB replied : I am afraid thatshortage of ingredients still make it impossible to introducea satisfactory single standard for ice-cream- without seriouslyreducing supplies to the public. The Food Standards Com-mittee has considered fixing two standards ; but after con-sulting the trade and the local-authority associations they feltthat the lower standard, to which most of the manufacturerswould have had to conform, would not have a good enoughfood value. In the circumstances, the committee recom-mended that the introduction of standards should be deferreduntil an improvement in the supply of rationed ingredientsmade it possible to prescribe a satisfactory minimum’standard.

Public Health

Smallpox -

A NURSE in a Glasgow hospital sickened on March 23,developed a rash on March 25, and has now been diag-nosed as having semiconfluent smallpox. By last Mondaythe diagnosis of smallpox had been confirmed in twoother cases, both modified by previous vaccination. Inaddition, two adults and a baby were under observation.The source is probably a Goanese seaman who landed

from R.M.S. Chitral at Tilbury on March 5 and travelledto Glasgow. He felt unwell on March 7 and developeda rash soon after admission to hospital on March 10.Chickenpox was diagnosed by competent physicians.This man was probably infected on the Chitral and theremay be another missed case or cases amongst thepassengers and crew who disembarked in London onMarch 5.Smallpox should be suspected in any passengers or

contacts who report fever or rashes to their doctors.