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4
In 1888, County Councils were created, doubtless for some good even
though unascertainable reason, but at least at that time their functions
did not embrace anything concerned directly with the physical health of
the community.
At the end of the century then, the sanitary conscience of the country
which had been awakening and developing more particularly from the
middle years, had resulted in the imposition of duties in regard to
sanitation on definite bodies, the county districts.
The turn of the century saw a complete reorientation in health
activities. Environmental hygiene had by this been established on a
firm basis. Now came the development of personal hygiene with the
growth of the personal services. Starting with the Midwives Acts in 1902,
the next step was the inauguration of the school medical services, followed
by the earlier stages of the child welfare schemes, arrangements for the
care and treatment of the tuberculous, treatment of those suffering from
venereal diseases, and provision for the mentally afflicted. The Maternity
and Child Welfare Act at the end of the last wafr extended broadly the
scope of the services provided for certain groups of the population. This
was followed by the Local Government Act of 1929 with the break up
of the Poor Law organization and the assumption by certain local
authorities of the responsibility for the provision of hospital accommodation.
The most recent step in this line of development is the Education
Act of 1944, which makes it the duty of the authority to provide free
medical services for the children attending schools.
At the same time that this change in the direction of the development
of the health services occurred, the allocation of duties and the emphasis
of responsibilities of authorities were altered. Hitherto the health duties
had been largely imposed on the local sanitary authorities, the county
council being left with little or none. They came into the picture though
in connection with the Midwives Acts, and also as education authorities
under the 1902 Act, to the exclusion of the smaller sanitary authorities.
The earlier maternity and child welfare services similarly went to them
and to the larger only of the county districts. From that time on,
practically all new health work has been imposed on the councils of
counties and county boroughs, with at the most provision for delegation
of certain functions to certain larger county districts. The culmination
of the progress was reached in the Education Act under which authorities
which had for years successfully provided a service were divested of
direct responsibility for them though most being granted alternative
obligations under powers of delegation.
So far as affects the health services provided in a community then,
it can be seen that these are by no means restricted to those provided by
the,Authority under the control of its Public Health Committee, but
that there is a very large collateral service provided by the County Council.
The health service embraces much more than this though. Quite apart
from the activities of the general medical practitioners, of the nursing
associations, of those responsible for managing nursing homes and voluntary
hospitals, there are services maintained entirely independently,
including amongst these the health provisions of those in the larger
factories. Apart again from these aspects, local sanitary authorities