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Quae sint, quae fuerint, quae mox ventura trahantur.
The main provisions of the National Health Service reorganisation Act 1973
come into effect on the 1st April, 1974. It had thus seemed to me that it would
be appropriate and useful to embody in my Annual Report for 1973 a comprehensive
review of the development of, and progress made in, the Community Health
Services since the appointment locally of the first Medical Officer of Health in
1872 up to the time when this post is abolished at the end of March, 1974.
I realised, however, that difficulties would be met in embarking on such a
review. One difficulty arises from the amalgamation of Edmonton, Enfield and
Southgate to form the London Borough of Enfield in 1965, and the fact that
complete statistics and records for each of the constituent boroughs do not
appear to exist. Another is the fact that by the time local and national vital
statistics are available for 1973 and the first quarter of 1974, the post of
Medical Officer of Health will have been abolished. Largely for these reasons
the idea of a complete review and summary has been abandoned.
However, the unfortunate delay in the issue of my report for 1972 - despite
abridgement of text and omission of photographs - does provide an opportunity,
with 1974 upon us, to set out a few historical notes on local authority health
services. There is perhaps no better way of comparing with earlier times the
present-day extent of the duties of the Medical Officer of Health, or the
changing pattern of local authority health services, than to direct attention
to the Annual Report of the Medical Officer of Health of Enfield for 1888,
which is reproduced at the end of these notes. This is the oldest available
Annual Report of a Medical Officer of Health of the constituent authorities.
Of course, public health measures started a very long time ago, and although
in the Middle Ages medical care was undertaken mainly by the religious orders,
examples of public health measures could be found in sanitary regulations
issued in the City of London at that time; whilst overseas - in Venice - there
was provided the first Quarantine Station in 1448. During the Tudor Period,
medicine and surgery became more organised and the Parish became the
centre of local government with some sanitary duties; and then the eighteenth
century saw the growth of scientific medicine with Jenner's promotion of
smallpox vaccination in 1796, the provision of Poor Law Hospitals, and even
lectures on Public Health at Edinburgh University.
However, most people would agree that in this country the starting point of
modern public health was the nineteenth century, during the era of Dr. Southwood
Smith and Edwin Chadwick who exposed the insanitary conditions of the time.
Incidentally, it is interesting to note in connection with recent problems
related to the spread of cholera, that it was a cholera epidemic in this country
that led to temporary legislation which set up a Consultative Board of Health,
under the chairmanship of the President of the Royal College of Physicians, to
advise on means of protection; and also local Boards of Health with powers to
appoint inspectors to deal with gross sanitary defects.
The first great landmark in public health legislation was the Public Health
Act of 1848, which gave many permissive sanitary powers to local Boards of
Health and allowed the appointments of Medical Officers of Health. But it