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personal services were still voluntary and until recently, supports this
contention in pointing out that the 'personal' services were "more or less
side lines and were taken on largely to back up the basic environmental
work which had produced such wonderful results."
It is instructive when considering the relative importance of environmental
and personal public health services to review some of the earlier
reports of Medical Officers of Health, that is to say, reports for the years
when, with the exception of the Poor Law Infirmaries, hospitals were
controlled by voluntary effort and the first indications of future tuberculosis
and maternity and child welfare services were emerging and
sponsored by voluntary effort before the work was taken over by
municipalities— reports of the years when the publicity surrounding the
'personal' services had not thrust the other services into the background.
From these reports it is possible for one to trace the gradual evolution
from the unhealthy and insanitary conditions forming the breeding
grounds of disease in which the people lived to the much more satisfactory
conditions which obtained at the outbreak of war in 1939 and showed
so great and steady an advance towards the environmental improvements
aimed at by the early pioneers in sanitation.
In earlier years, ignorance, disease and bad housing were rife and it
was not until public alarm arising from a succession of cholera and other
epidemics resulted in the passing of the Public Health Acts during the
latter half of the last century, and the consequent setting up of public
health or sanitary departments, that any serious effort to improve those
conditions was made. In those days the great scourges to which the
country was subjected were smallpox, cholera, typhoid and dysentery and
whilst it may be claimed that vaccination was responsible for the complete
eradication of smallpox, so far as this country was concerned, there is no
doubt that the control of contacts by the public health departments also
played a large part in combating this disease and it is certainly true to say
that the formerly recurrent outbreaks of the three latter diseases were to
a considerable extent eliminated by the progress made in the fields of
sanitation and improved water supplies.
Thus the Public Health Department in the form in which it exists
to-day was responsible for the first stage in the drive towards general
good health and whilst it is admitted that environmental public health is
limited in scope in that it cannot cure disease when contracted, prevention
is better than cure, and progress can be made only by a close alliance
between environmental and personal health services and the prevention
of environmental conditions giving rise to ill health. The Public Health
Department although no longer responsible for personal health services
continues to be intimately associated with the maintenance and welfare of
family life by safeguarding family environment and so enabling the
greatest advantages to be derived from the establishment of the National
Health Service.