In his introductory remarks the Medical Officer briefly comments on the war in its relations to medical practice and public health. He reminds us that Japanese action, by depriving us of quinine, encouraged research for synthetic substitutes. Again, penicillin and D.D.T. were given attention that they, possibly, would not otherwise have had. Food standards, long urgently needed, have been established for many important foods. He further points out that “adequate finance and international scientific co‐operation” has aided atomic research. These remarks make an exceedingly appropriate introduction to what immediately follows. The Borough of Leigh has an area of 6,359 acres, that is ten square miles. The population is 45,317, or about 4,500 to the square mile. It lies in the centre of one of the greatest manufacturing districts in the world. This district includes Manchester, Liverpool, Bury, Wigan and other places whose names alone suggest intense industrial activity. Leigh, therefore, densely populated and taking an active part in this industrial activity, presents the special health problems that are always to be found in places where nature has been subordinated to the needs of industry. One of these problems, and by no means the least important one, is atmospheric pollution caused by the smoke of domestic fires and of factory fires. It is as old as any and it is still unsolved. It is but one of the many attempts that have been made in the past to better public or domestic hygiene. Weak or faulty administration or the lack of compulsory powers have enhanced difficulties, already considerable, when confronted with actively expressed popular prejudice, or worse still with the apathy of ignorance, or the opposition arising from vested interests. To enforce Acts of Parliament or regulations under such conditions was in some cases an almost impossible task. Thus the report states that the Manchester and Regional Smoke Abatement Committee is now functioning again—its work was suspended during the war. “It is a voluntary association of local authorities… and acts in an advisory capacity.” It seems that out of 91 local authorities—including two County Councils—sixty‐eight have joined or resumed their previous membership of the Regional Committee. Since only fifty‐three out of ninety‐one were pre‐war members the increase of membership from about 54 to 78 per cent. of the possible membership is taken to indicate that greater interest is being taken in the problem of smoke abatement. Just so. But why not the full possible membership? We can to a certain extent understand this if the powers of the Committee are merely advisory and they have to deal with some who have “urged that smoke means work, the inference being that the greater the degree of pollution the higher will be the level of employment.” Again, we arc told that the Manchester Corporation Bill proposes to create a smokeless zone in the centre of the city. The proposal to create such zones has been “criticised on the grounds that the area they comprise will still be subject to pollution from outside sources.” Of course they will! Who in the world doubts it? But we submit that a beginning should be made somewhere, somehow, and somewhen. A committee which can act only in an advisory capacity would have little influence on people who use perverted reasoning to justify conditions that the committee has been created to suppress. Some years ago, before the war brought everything to a standstill, the foul state of the Ribble, Mersey and associated streams engaged the attention of local authorities. It might, with as much reason, be urged that polluted streams were in like case. Hence fouled air and fouled streams are indications of and inseparable accidents of industrial success! The matter in some respects inclines slightly to the humorous side. Not so the following. The Medical Officer says “the high infant mortality and general death rates, together with the high incidence of respiratory diseases associated with atmospheric pollution of our industrial areas should be sufficient in themselves to dispel any attitude of complacency or apathy towards this problem.” We do not suggest Leigh is any better or any worse on the whole than any other industrial area in this respect. The old tag ex uno disce omnes seems to fit the case. The report calls attention to the following facts. That 70,000 tons of carbon black is discharged into London air every year, and its value is £40 a ton. That the Department of Scientific and Industrial Research in their report of 1945 on atmospheric pollution in Leicester point out that pollution from our industrial areas spreads all over England. That twice as much smoke is made from domestic fires than from industrial fires. That in burning coal in an ordinary grate only about one‐fifth of the coal is used to supply heat and that half a hundredweight per ton of coal used goes up the chimney as smoke. All this waste can be expressed with a fair approach to accuracy in terms of weight and monetary units. The Meteorological Office and later the Department of Scientific and Industrial Research have issued annual reports for the past twenty‐five years on this matter and Health Authorities and Public Analysts have done much the same thing. This scientific co‐operation has led to a great accumution of exact knowledge, and “all that is required for success is the application of this knowledge.” And this knowledge has not been adequately applied. Material waste and damage by smoke‐polluted air can be assessed in ordinary units. Waste of and damage to life cannot be so estimated. Mind and body suffer. Ill health, weakened physical powers, and resulting mental distress and impaired efficiency can, we suppose, only be duly appreciated by members of the medical profession whose duties bring them into personal touch with the patients. Vital statistics and bills of mortality but imperfectly reveal the truth. If atmospheric pollution had “impeded the war effort”—in the way in which that expression was usually taken to mean—adequate finance and scientific co‐operation would undoubtedly have been forthcoming, even perhaps to the extent of writing smoke abated for smoke abatement. Enemy action was sporadic and temporary. Smoke pollution has acted without haste but without rest for a hundred years and more. It is still acting as a persistent and contributory cause of ill‐health. At a time when enhanced national efficiency is declared to be an essential condition of national recovery and success this statement of responsible medical opinion should, like others of the same kind, receive practical and prompt consideration. However quickly the evil may be effectually dealt with, even if that were done to‐morrow, there still would be the time lag, and years must pass before the after effects have become eliminated. Nationalisation of all kinds is very much to the fore. “It would be wise,” says the Report, “to regard the problem as already calling for action on a national scale.” These it is suggested would include adequate supplies of standardised domestic and industrial equipment for burning smokeless fuels, and the revision of the powers of local authorities in whose hands the matter at present rests. While we are in full agreement with these suggested remedies the difficulties of applying them are obviously very great and the work of a generation if the authors of the fantastic objections already alluded to and possibly others of a like way of thinking have any real say in the matter.
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