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To discharge this responsibility the local authorities must know how many people
there are to be dealt with. At present it is unlikely that any service can be complete
while registration with the welfare department remains voluntary. It often happens that
the people in need of the service hear about it only when some specific need— such as
an adjustment in the house, or a recuperative holiday— sends them in search of help,
or when they are referred to welfare services by the voluntary agencies dealing with
their specific type of handicap.
Obviously, the first requirement of a comprehensive welfare service is a complete
register of people in need of its services. Such a register cannot be compiled unless the
welfare department is supplied with the name and address and medical history of every
handicapped school leaver, of every hospital patient discharged with a handicap, and of
every person handicapped through illness while under the care of a general practitioner.
But doctors in schools, hospitals or general practice should not be called upon to disclose
the medical histories of their patients to any organisation which does not employ
a medical officer qualified to interpret them in terms of the patient's needs. As yet, few
welfare departments have their own medical officers or are under the medical officer of
health. In the past year or so I have seen two or three serious consequences of this.
e.g. (1) Pseudohypertrophic dystrophy— A 16½ year-old boy was sent for training in a
job which required use of hands and in 1 year the disease had so progressed
that he had lost the use of his hands.
(2) Deaf— A girl who had left school suffering from deafness following tuberculous
meningitis but had normal speech was taken by a voluntary worker for tuition
in sign language. Some months later she had lost the faculty for lip reading
and her family hadn't learnt sign language so she was unable to communicate
with them except by writing, whereas she had previously been able to join in
family life by careful lip reading. She was withdrawn and showing behaviour
problems when she was seen by a medical officer.
Medical supervision of such help could have prevented both these well intentioned
failures.
Welfare services are only just beginning for the adult handicapped, and while they
remain entirely in lay administrative hands they cannot progress beyond providing for
social and occupational needs— and even these are frequently changing as the pattern of
the patient's disease progresses. It is essential that a service dealing specifically with
medical problems should have access to, and close liaison with medical services, whether
they be hospital, health department or general practice. Most of the problems met with
are those of chronic disability which has passed out of the field of active hopsital treatment
and into that of home and work, where the general practitioner without a much fuller
knowledge of local authority services cannot give as much help as he should. It therefore
seems appropriate that the medical officer of health, who is already responsible for
ascertainment and care of handicapped children, should also be responsible for handicapped
adults.
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