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76
the information ought to reach him officially and it ought to be understood
that he has a right to have it. It is because he can become aware
of so much about the conditions of his district by his association with
the Part III services that he is that much better a Medical Officer of
Health to the district council if he has direct association with the maternity
and child welfare, the midwifery and the school health services. It
might well be that his knowledge of such services and the local conditions
of his district could be of help to those administering the hospital services
of his district. Factory legislation had different beginnings from that of
the Public Health Service, so that the hygiene of industry has remained
distinct from the Public Health services of a district. There were hopes
that new legislation would lead to an integration of the factory health
services and the general health services. These, however, have not been
realised so that it is exceptional for a Medical Officer of Health of a district
to be put in a position that he can really know of the effect of the industries
in his district on the health of those living in the area. As matters are,
then, in many districts, at least those of the minor authorities, the Medical
Officer of Health is not placed in the position in which he can obtain that
accurate knowledge of influences, social, environmental and industrial,
in his area.
The National Health Service Act transferred the responsibility for
providing the maternity and child welfare service from minor to the
major authorities. As there are no county boroughs in Middlesex, the
County Council became responsible for providing these services throughout
the whole county, in just the same way as they had been made by the
Education Act, 1944, the Education Authority for the entire county.
County Councils were given power to arrange for certain of these transferred
services to be administered locally. The County Council divided
the County into ten areas, for each of which an Area Committee was
appointed locally to manage these services. In all but one of the areas,
namely No. 5, which is coterminous with the Urban District of Harrow,
the areas of two or more districts were included in each County area.
For each County area an Area Medical Officer was appointed, though
where an area comprised two County districts, each Medical Officer of
Health was appointed Joint Area Medical Officer. It was agreed that the
time of the Area Medical Officer should be allocated 40 per cent. to district
and 60 per cent. to County Council work. There was at the time this
agreement was reached, little enough information available to decide
whether the allocation was correct. Even to-day, probably few enough
of those concerned have any very definite information on the subject.
This will be for a number of reasons. One is that probably few have
analysed over a period, the way in which their time is spent. Then, too,
it would often enough be a difficult matter to decide whether any particular
problem being considered is being dealt with by the Medical Officer
of Health or the Area Medical Officer. Environmental or other factors of
a family which has a member suffering from tuberculosis may be considered
by either, just as may be the circumstances of the elderly or
chronic patient who might have to be dealt with by Section 47 of the
National Assistance Act; by the Welfare Officer of the County Council
or by the machinery of the Regional Hospital Board. The officer may