Welsh Journals

TWENTY years ago we hailed the "Dawn of the Health Age." We were not mistaken, because great things have been done since, but, it must be confessed, the dawn has been some- what protracted. Interrupted by the thunder- storm of war, darkened by the fog of industrial de- pression, it is only now brightening into the full light of day. Apart from such indirect measures as housing and re-housing, sanitation, water supply, etc., the chief advance in the last two decades has been the improvement and extension of the direct health services through the National Insurance Act, through the development of the various "clinics," the increasing trend towards hospitalisation, the transfer of the health functions of the Poor Law to local authorities, and the growth of the King Edward VII Welsh National Memorial Associa- tion. Twenty years ago the administration of the In- surance Act was getting into its stride; the alar- ums and excursions associated with its passing were dying down, its potentialities and defects, but not its real limitations, were beginning to be understood. Admittedly a great administrative measure, re- ducing incredible chaos to order, it was meant to be a great public health measure. It was not real- ised that the restoration to health of the public was not synonymous with the preservation of the public health, that the urgency of the immediate need-the treatment of disease-would overshadow the ultimate aim the prevention of disease. The war and its economic consequences are largely, but not entirely, responsible for this crippling and deflecting of the original purpose of the Act. "1914" held up the establishment of a consult- ant service, the promise of greater things, whilst the post-war industrial depression has curtailed the provision of additional benefits and indefinitely postponed the extension of the panel system to dependants. In spite of its inherent limitations and stormy career, the Insurance Act can boast of its triumphs. It has raised the standard of medical practice; it has helped to allay-to the tune of sixteen million pounds in Wales alone-financial anxiety during illness and disablement; it has given a tremendous impetus to medical research but its effect in making the public and the pro- fession preventive-minded, in fostering a new orientation towards health problems by the com- munity, has been disappointing. The therapeutic tyranny of the bottle of medicine is still unchall- enged and the fatalistic acceptance of avoidable disease remains unimpaired. Health is purchas- HEALTH by Dr. D. A. Powell able-but not by the tablespoonful three times a day. An indication of the social upheaval that marks the period is the fact that in Wales since 1912, while the number of insured men has increased by about a third, the number of insured women has nearly doubled. That "this freedom" has to be paid for, the increasing incidence of sickness among women, and-always a sure index of econ- omic strain-their stationary death-rate from tuberculosis in spite of the general decline, bear mournful witness. The School Medical Service started in 1908 was the precursor of many similar examples of state intervention in medicine, e.g., the tuberculosis service which, as sanatorium benefit, was an in- tegral part of the Insurance Act; the Venereal Diseases Clinics established in 1916 the Maternity and Child Welfare Service of 1918, and, since the war, the amplification of these facilities in the form of open-air schools, clinics for rheumatism, orth- opaedics, mental conditions, etc. Their curative value is already obvious, but the immense pre- ventive and educational effects are only beginning to be felt. How encouraging these are is illus- trated by the facts that the expectation of life has gone up, the height and weight of school children have definitely improved, the death-rate from all causes shows an appreciable reduction. In more detail, the death rate from diphtheria, e.g., has fallen from 135 per million in 1911 to 67 per mil- lion in 1932; tuberculosis, from 1,468 per million in 1911 to 896 in 1932, while the infantile death- rate has been halved during that period and the death-rate from non-pulmonary tuberculosis has been halved since 1918. The problems of nutrition and their importance are now beginning to be appreciated at their proper value, and it is possible that the next great advance in public health will consist in teaching the young idea how to fend intelligently for itself. Homecraft is the master art of living and ought to be learnt by the young of both sexes and espec- ially girls. Most women, whatever their inter- mediate and temporary occupation may be, whether professional, commercial, industrial or domestic, end up with their life-work-home- making. A thorough and practical training in homecraft, not merely "cookery lessons," should therefore become an essential, in fact the most essential part of their education, and this could, with advantage, be made to coincide with adoles- cence, that critical period in their life history. The school-leaving certificate should be succeeded, even supplanted, if necessary, by the home-mak- ing certificate, testifying to a real proficiency in