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able service decided that they were henceforth Chest Physicians
and so by implication, if not by intention, they associated Pulmonary
Tuberculosis, by far the most serious of our social diseases, with
other chest ailments which while individually important have not
the same high priority in community medicine. Everyone in our
profession who had the opportunity wanted to jump on what they
thought to be the band-waggon. In this instance the hospital and
consultant services provided attractions that the other branches
could not emulate. All that remained apparently to the preventive
and promotive health services were the dull dry bones of routine
administrative procedure.
We in the Public Health Service have been counter-attacking
ever since but it seems to me that we have not even begun to argue
our case with anything approaching unanimity, nor indeed do many
seem to appreciate the change which must take place in regard to
the function of the Medical Officer of Health, his relationship with
his other medical colleagues and his ultimate position in the future
scheme of things. It has been said that the aim of the Medical
Officer of Health is to make himself unnecessary. This is nonsense.
One might as well say it is the aim of every doctor to make himself
unnecessary. Has Penicillin and Streptomycin and other startling
advances in the realm of curative medicine done away with the need
for the Physician? Surgery having conquered the abdomen is now
exploring the recesses of the heart, the lung and the brain. As one
problem is solved another becomes apparent and makes its challenge,
and so with preventive medicine.
The Infectious Diseases, with few exceptions, are no longer a
serious menace but require only constant vigilance. The main
known environmental problems are solved or at least the solution
is apparent and is only conditional on labour forces and economics.
Infant Welfare and the School Health Service, with the notable
exception of the Dental Service, have almost reached the peak of
their potentialities, and maternal care, although the organisation
may leave something to be desired, is satisfactory.
Having said that, have we exhausted the possibilities of preventive
medicine? I do not think so. However, it is certain that
the future study and the solution of newly recognised problems of
social medicine may perhaps necessitate a complete change of
organisation and of method in the present administration of the
Public Health Services. Disease and illness will always be with us,
this side of Shangri-la, and so long as Man is subject to the pressures
of environment and to the vagaries of hereelity, so long will the
Medical Officer of Health, or his equivalent, be required. But will
he survive in his present form? If we are to make any measurable