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population of a district which needs the whole time of a Medical Officer
of Health engaged solely on county district work—but it is not easy to
determine this, as so many factors have to be taken into account. A
scattered rural district with a small population might call for more time
than a district with a larger population living in a compact urban community.
The health problems in old established towns can be so very
different from those in even larger dormitory districts; then there are the
added difficulties if the work of the Medical Officer of Health is shared by
more than one sanitary district. If it is accepted that a town of, say,
80,000 to 100,000 can use the whole-time services of a Medical Officer of
Health solely engaged on the environmental services of the County
district, then it might well be that in a rural district and more so in a
combination of rural districts, there would be sufficient work even though
the population were as low as 50,000 or even less. On the other hand, in
new dormitory communities with their homogeneous character, the same
volume of work might not arise even though the population were 150,000
or even more. As Medical Officer of Health of a district administering no
personal services except for his duties in regard to the control of infectious
diseases, he is responsible for the work of the Sanitary Inspectors and his
special training as a medical man is not used to the full. If he is in charge
of a large district maintaining the personal services, then again he will
spend his time largely in administrative duties though in this case much
time will be spent on work for which the background his training gave him
is essential. It is unfortunate that promotion to offices of higher responsibility
takes the Medical Officer of Health from those duties for
which he elected to train and removes him in many cases entirely from
the field of clinical medicine. From this point of view, the position of
those in charge of small districts where they would spend the minimum
time on administration, and the maximum on contact with persons, was
the best, the Medical Officer of Health, with the help of one or more
medical assistants, himself being in charge of the isolation hospital and
the maternity hospital, and himself seeing mothers at the infant welfare
centres and ante-natal clinics, and children in the schools. Such a
Medical Officer of Health was in the best position to get to know his
district and to learn at first hand of any factors which might adversely
affect the health of those living in the district. But to-day, such sized
units no longer exist as separate entities, as their personal services have
passed into the hands of the County Councils.
The time of the Medical Officer of Health of the last quarter of the
last century was taken up with his concern about the adequacy and the
purity of the water supply, about the satisfactoriness of the drainage and
of sewage disposal. To-day's Medical Officer of Health has no direct
responsibility in maintaining these services, although he is only too aware
of the dangers following pollution of water or of the nuisances or risks
which would follow a breakdown in the sewerage system. Recent legislation,
too, has removed from those in the Public Health Department
responsibilities which they previously had in such matters as the conditions
under which milk was produced. What is there in the way of
additional work to balance these losses? First of all, perhaps there will
be the many complaints which have to be dealt with now, numbers greater