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12
progress, there will require to be gradual adjustments in his sphere
of activity and influence.
Prevention is surely not limited to the services controlled by
local Health and Sanitary Authorities. The preventive outlook
should permeate the hospital ward, the out-patient department and
the research laboratories, as well as the home. It has been stressed
many times since 1948 that the Medical Officer of Health must act
as a bridge between tho various medical services but no serious
attempt has been made to forge this link. Indeed, the contrary
is true and, as far as I know, no one has tried to define in exact
terms what part the Medical Officer of Health will actually play in
such an arrangement and one could wish that the hospitals and our
consultant friends would show a greater awareness of the need for,
and the importance of, prevention. But while it is as well to be
realistic about prevention and the limitation which ignorance
about underlying cause of disease imposes on any action, how can we
so arrange our resources that the possibilities of prevention at least
are explored exhaustively? Prevention may not ever provide the
complete answer in the case of many diseases but it should be
considered first and not last. This view is not only scientifically
sound but is also economically sound and necessary. A start could
be made to this end if the Medical Officer of Health were to act
and be officially recognised as tho director and co-ordinator of the
preventive functions of the multifarious activities of his local
hospitals, with specific and well-defined duties allotted to him.
Perhaps even an Annual Report to his superiors at Group or Board
level on the work performed during the year would be a progressive
and useful innovation. He is, or he should be, the expert trained
in human ecology but under the present set-up he is hopelessly
handicapped and is functioning to a fraction of his usefulness and
potentiality.
In some University towns the University Department of Public
Health and Social Medicine and the local infirmaries and hospitals
are linked for the purposes of social surveys and follow-up work.
How much greater would be the advantage if, in addition to their
environmental functions and personal health service obligations,
Health Departments of Local Authorities could have real linkage
and co-ordination with the hospitals, in order that research into
prevention and examination of the wider aspects of causation under
informed direction could be undertaken by Almoners, Social Workers,
Health Visitors and Sanitary Officers working as a team, into such
problems as peptic ulceration and so-called "stress" diseases, the
rheumatic diseases, the cardio-vascular degenerations, the psychiatric
disorders, the causes and results of ageing and many other