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73
private practice as a medical practitioner."Some districts combined in
the appointment of a Medical Officer of Health who was then engaged
full-time in the duties of a Medical Officer of Health. The more common
arrangement was and is for the Medical Officer of Health to be appointed
in such a way that he is engaged as medical officer of the one district, being
responsible for the supervision of the health services to different authorities—for
the impersonal or environmental services to the District Council
and for the supervision of the personal services to the County Council.
The Education Act of 1944 transferred the responsibility for providing
the education services previously maintained by many district councils
from those to the County Council ; included in this transfer, of course,
was the responsibility for the School Health Services. In the same way,
the National Health Service Act transferred to County Councils from even
more district councils, the responsibility they had had in providing
maternity and child welfare and midwifery services. By these changes,
County Councils have become responsible for providing these personal
services throughout their administrative areas, and the district councils,
shorn of the responsibility of providing these personal services, have
returned to their position of the last years of the last century when they
were responsible for the maintenance only of the impersonal or environmental
services. The Medical Officer of Health of the District Council as
such, then, has much less responsibility. In some areas, the local
authority has retained its Medical Officer of Health in a full-time capacity,
even though he is no longer responsible for the supervision of the personal
services previously provided by his authority. In most areas, though,
arrangements have been made by which the Medical Officer of Health
who had previously been responsible for the supervision of the personal
services, continued to be associated with them. This is the arrangement
in Middlesex. In general, there is more to be said for such an arrangement
than that by which the Medical Officer of Health is dissociated from the
personal services, because there are so many points of contact of these
services that it is helpful if there is one person whose duties overlap on
each side of the dividing line. Probably the Medical Officer of Health,
as such, is put in a better position to carry out the many and varied
duties of his appointment, if he is given the opportunity of being closely
associated with as many as possible of all the activities which comprise
the health services of the district. The Middlesex County Council and the
various District Councils agreed on such an arrangement and in regard
to most, agreed to an allocation of the time of the officer: 40 per cent. as
Medical Officer of Health of the district, and 60 per cent. on County
Council duties.
This arrangement was reached at a time when many changes were
about to be made and when no one could be expected to see exactly
what would develop. There was in the minds of a number, doubt about the
correctness of the allocation of the time; but at that time no information
was available which enabled anyone to demonstrate that the suggested
allocation was, in fact, wrong. Since that time, experience of the working
of the arrangement has been obtained—but even now it is not easy to
produce any returns which can show what the correct allocation should be.
One line of approach to get the answer is to consider what should be the