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in air cleanliness. When there is a combination of local dirty atmospheric conditions
together with the additional personal pollution and irritation of the respiratory
system caused by smoking, conditions are most favourable for the development of
bronchitis which may eventually become chronic, irreversible and distressing to the
patient himself and those around him. It should therefore be possible to reduce
and avert these two major causes of death and invalidism by the same kinds of
means which are, or should be, well within our reach as individuals and as members
of the community. The rate at which progress is made will depend very largely on
the rate which is demanded by the public. So far as atmospheric pollution is concerned,
the first steps by the Council have been taken under the Clean Air Act, 1956,
which should eventually lead to two substantial areas in the Borough becoming
Smoke Control Areas. However, Islington is a large Eorough and although it is
hoped that from this beginning there will be a constant succession of Smoke Control
Areas, nevertheless many years must elapse before this Borough (and adjacent
Boroughs) can become substantially smokeless.
Deaths due to accidents are another considerable group which it should be
possible to influence for the better by the concerted efforts of all concerned, and this,
of couse, includes almost everyone except perhaps those who are still too young and
for whom others must take responsibility. The fatal accidents include those due to
motor vehicles and also those occurring in the home and elsewhere. The number of
those injured by accidents, whether they suffer major disablements and disfigurements
or relatively trivial injuries, vastly outnumber the dead and comprise a
tremendous amount of avoidable suffering. The number of fatal accidents showed
little signs of diminishing although it may well be that the Road Safety Campaign
has at least made an impression, especially on safety for children, and that possibly
the casualty lists would be even greater without road safety propaganda.
The London County Council (General Powers) Act, 1957, gave Borough
Councils specific authority to carry out home safety publicity and it is hoped that
advantage will be taken of this to bring to the public a greater awareness of the
necessity for the avoidance of many needless accidents in the home by the exercise of
a little forethought. This applies not only to the citizens themselves in their own
homes, but also to those who have some responsibility for the construction, layout
and planning of dwellings, for the production of non-flammable clothing materials,
for the packaging of pills and medicines or other dangerous substances so that they
are clearly distinguished and stored where there is minimum risk, and many other
features of a similar nature. It is therefore obvious that there is a wide scope for
prevention in this field.
These are only a few of the possibilities where greater attention to environmental
measures, including health education itself, can be made to pay great
dividends in the prevention of sickness, suffering and premature death, and it is to
these fields that the public health service of the future will have to pay increasing
regard. The first century of public health began with an onslaught upon the
infections through environmental control—by the end of the century the major
dangers had been disposed of or brought under a high measure of control in this
country and others outside Asia and Africa. The second century of public health
may well begin by ushering in the early stages of a broad environmental attack upon
some of the major non-infectious groups of diseases and mishaps.
Turning now to the personnel side, reference must again be made to the
continuing establishment deficiency of Public Health Inspectors, averaging approvimately
33 per cent. An Inspector is essentially a field officer, and it cannot be