Welsh Journals

the complicated curriculum expected of the wife and mother, and based upon the actual conditions that exist in typical working-class homes. The course, which should take at least a year, should include instruction in budgeting, marketing, simple dietetics, cooking, washing, cleaning, and the care of children, and should precede the training for their temporary money-making vocation. How to spend money is at least as important as how to earn money, and in the case of women, even in these days, much more important. If this training was made compulsory for all girls, with physical training, and a similar but suitably modified course for all boys, no class and no individual could steal a march on the other in the race for education or employment. The trag- edies of adolescence that now occur would be avoided and the benefits to the coming generation would be incalculable. The saving of money that is now wasted in treating disease would more than cover the cost of the scheme. The education of the public in the need for and appreciation of institutional treatment has been proceeding apace-the Memorial Association has been a powerful influence in this respect-and there is no doubt that the present trickle of hos- pital building will become a flood-with the return of prosperity-and a co-ordinated "grid" system of treatment institutions will be ultimately estab- lished. The man in the street, and particularly his wife, is gradually realising that the only place to be really ill or to have a baby and to be comfortably and cheaply and efficiently looked after, is in an in- stitution designed and equipped and staffed for the purpose. They are beginning to see that the pres- ent system of nursing a bed-patient at home in- volves unnecessary privation and strain upon the other members of the family, especially the mother, who, sooner or later, breaks down herself, per- haps after months and years of unconscious hero- ism. The value of adequate hospital facilities, not only to the patient in enabling him to get well, but also to the family in protecting them from break-down as a result of the strain of sick nurs- ing, will gradually dawn upon the public. If in those days the mother is the patient and ought to go to hospital, she will be able to do so with an easy mind, as a trained "home-help" would be provided to run the house and look after the child- ren. The Poor Law-like Charles II-is an uncon- scionable time dying, but its death-knell has been sounded in the Local Government Act of 1929, which requires that County Councils and County Borough Councils "shall have regard to the desirability of securing that as soon as circumstances permit all assistance which can lawfully be provided otherwise than by way of Poor Law relief shall be so provided." Thus freed from the dead hand of pauper- ism, the health services now have the op- portunity of stepping into their full inheritance; like the prisoners in the Bastille, however, some authorities seem, judging by their inaction, to be still incapable of realising their new-found liberty. The Memorial Association, rightly conceived on national lines, started as a voluntary organisation to combat tuberculosis in Wales, but has become the instrument by which Insurance Committees and, later, local authorities throughout the Princi- pality, exercise their statutory powers and duties in fighting against the ravages of that disease. Commencing in 1912 with a small sanatorium of eight beds, it has developed today into one of the most complete schemes in the world for dealing with tuberculosis. It has provided 5 sanatoria and 12 hospitals (totalling approximately 1,600 beds), 14 dispensaries and 85 visiting stations, 22 X-ray plants, 5 Light departments, together with a staff of 52 whole-time doctors and a galaxy of distinguished consultants, and some hundreds of nurses. It has also established a department of research, and an educational department for health propaganda. The whole organisation involves a personnel of nearly 900, and an annual expendi- ture of over £ 230,000. It works in closest liaison (through the University Chair of Tuberculosis) with the Welsh National School of Medicine, thus intimately linking undergraduate teaching with postgraduate practice and research. It is, there- fore, a comprehensive scheme co-ordinating in its activities treatment, prevention, research and edu- cation. Unique as yet as an administrative unit, it has a profound significance in that it is a portent of those probable future developments in the Public Health Service consequent upon man's rapidly increasing mobility, involving the recogni- tion that much larger administrative units will have to be constituted to deal with him as opposed to his surroundings. The developments in trans- port are already rendering anachronistic the old administrative areas; nowadays, John Citizen may sleep in one, work in another, and amuse himself in a third. His bonds and bounds used to be par- ochial, then county; today they are national; to- morrow they will be international. Personal as opposed to environmental health services will need organising on a correspondingly wider basis, in Wales, e.g., on a national basis; in England perhaps by a reversion to an adminstra- tive heptarchy or possibly a tetrarchy. Although environmental conditions are more