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grouping of areas might with advantage be based on other considerations,
it is hoped that arrangements will be made by which the essence
of the scheme remains in being. It is to the advantage of the medical
officer of health as well as to the general medical- practitioner that he
keep in close contact with the practising pathologist who, desirably,
deals with the clinical matter from a number of areas, and who would
therefore be in a position to know from a study of what has been sent in
what is likely to be developing, not in one, but in a group of areas.
12. Because as far back as 1901 neither of the two urban districts
which became constituent authorities of the Harrow created in 1934
were of 20,000 population, in spite of the present population Harrow
was not a Local Education Authority ; nor did it seem likely that it
would become one except by the successful promotion of a special Act.
The revolutionary changes brought about by the 1944. Education Act
as regards local administration of its provisions has resulted in this
district being granted the same powers as many of the previous Part III
authorities. The school medical services then are to be locally administered.
The main benefit to follow from this is that the school medical
and the maternity and child welfare services will become merged, being
undertaken by the same staff. While there will be advantages in this
as regards the activities of the medical officer, the main benefit follows
in the case of the health visitor. The health visitor started as an official
whose chief activity was helping the mother in the upbringing of her
baby. From this she extended her interest to the child under five years
of age. She is now very far though from restricting her services to this
limited section of the family, and the concern of the good health visitor
is the entire family. It is for this reason that it is so very much better
if she is appointed school nurse as well.
In her efforts to bring down the infant mortality rate, the health
visitor had to battle against adverse hygienic conditions and to educate
the mother in the principles of domestic sanitation. For this reason
it was essential that much of her time should be spent in the homes
of the mothers. To-day in a district such as this which is fortunate in
being in general of a high hygienic level, once the health visitor sees the
mother and her home there is not the same necessity for her to continue
to see her there, and contact made at the clinic sessions, provided these
are not too busy to prevent satisfactory consultations, is adequate in
the majority of cases. To be of real advantage though, the interview
must take place in an atmosphere quieter and less hurried than that
obtaining in the usual infant welfare centre. It might well be then that
the most economical use of the health visitor's time will be by her
attending even more sessions than she does at present, with smaller
attendances at each, and each not necessarily attended by the medical
officer. This can be a successful arrangement though only in those
districts where the general standard of housing and house management
is high.
To-day much of the time of the health visitor is taken up by her
acting as adviser on such a variety of subjects to individual mothers.
Her particular function though is to be an educator, and she might