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7
The development of the personal services seems to have been almost
haphazard as though it suddenly dawned on someone that a particular
section of the community or those suffering from special diseases should
receive special attention. The favoured sections are those of school
age, firstly those attending the then-called elementary schools, then
those of the secondary schools, enjoying first the benefits of medical
inspection and then the ever-widening treatment services, culminating
as a result of the 1944 Act in the almost full health services for those
attending maintained schools. The next sections were first the babies,
then the children up to five, the nursing mothers and the expectant
mothers. To help these groups authorities have very wide powers. Of
those sections of the community suffering from diseases or abnormal
states the first were those with tuberculosis, then the sufferers from
venereal disease, the mentally afflicted and mentally subnormal, and
then the blind. Later the Local Government Act, 1929, put the duty
on the councils of counties and county boroughs of providing a general
hospital service; and just before the war schemes were being made to
meet the needs of those suffering from cancer. The very success of
some of these endeavours lead to a dimunition in the need of the service,
and now they are all to be re-arranged. Some are to be integrated with
the national arrangements for the care of the sick and of those suffering
from the effects of accidents. Others are to remain at least for the time
being as independent services. Some persons are apprehensive for the
future, fearing that when these services are based on different foundations
there will be less likelihood of progress and improvement because of
lack of a driving force. In regard to many of these services possibly this
is now of less moment because of the advanced stage many of them
have reached. Certain of the personal services would seem to have
reached the stage of the environmental services. On the other hand
though there is still room for development. The cancer service has
barely begun; nothing very definite on a national scale has been done
for the sufferers from rheumatism; the care of the elderly certainly
looks like replacing as a prominent activity of authorities the attention
previously bestowed on the very young, while the developing new social
medicine has yet to be fitted into the scheme of things. Under the
new arrangements environmental hygiene will remain with the local
sanitary authorities, many of the personal services with the new local
health authorities and much of the treatment service with the new
hospital boards. Out of this development integration may evolve.
The fate of the smaller local authorities seems decided. The question
is whether movement on these lines might not result in local government
itself as it at present exists being put in the melting pot. The trend
definitely is towards larger units. Are we seeing the beginnings of
changes which are to result in the complete severing of the health services
from local government units? So far as Harrow is concerned, apart
from the temporary setback in the standard of housing, the general
environmental services are good. These are for the time being to remain
the responsibility of the local authority. Epidemiology, at one time
considered to be the chief responsibility of the medical officer of health,
is likely to pass out of his hands because of the development of the
laboratory service, coupled with the fact that the isolation hospitals pass