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6
hospitals. It is only because these proved to be utterly incapable of
meeting the demands that local education authorities were obliged,
haltingly at the start, to provide treatment services; a gradual
extension led to to-day's widely embracing school health services. In a
similar way, the shockingly high infant mortality rate, and the mortality
and the morbidity following childbirth led to beginnings which have
grown into to-day's maternity and child welfare service. Arrangements
for the detection and the treatment of those suffering from tuberculosis
were followed during the years of the first world war, because of the
sharp rise in the incidence, to similar provisions being made for those
suffering from venereal diseases. Up to this time, there had been no
organised provision for those suffering from these conditions. A similar
development led to a number of to-day's personal health services and
ultimately, in 1930, to local authorities becoming responsible for the first
time for seeing that there were adequate general hospital services in
their districts.
To the question of when does a health problem become a public
health problem? the answer has been given: When or if a given problem
of health and disease can no longer be resolved by the unassisted effort
of the citizen and the unco-ordinated resources of the community.
Judged by this standard, these were all public health problems.
But because the magnitude of a problem was such that it could be
dealt with only on a community basis, so necessitating a further public
health service to cope with it, must the answer always be the continuation
of the local authority activity? When medical inspection of school
children was introduced so many were found to be ailing, diseased, or
crippled, that they could not be attended to by the existing agencies.
The minor ailment clinics which were established were crowded with
those attending for treatment of sores, impetigo, and running ears. At
to-day's clinics few attend for such treatments: instead, the whole
character of the clinic has altered, and they have become essentially
consultation clinics. The reduction of the numbers needing treatment
has completely changed the position and what treatment is now required
can be made available by agencies other than the education authority.
But there is still the need for the routine medical inspection of the school
children or of something to take its place. The maternity and child
welfare service has grown on the basis of home visiting by the health
visitors and attendances at clinic sessions. The service was introduced
when the infant mortality rate was about 150; to-day this rate is in the
20s. Is this service now necessary? The giving of a correct answer is
complicated by to-day's shortages of health visitors. There is no doubt
about the desirability of the health visitors continuing to keep in touch
with the mothers. When home conditions were bad, this contact had
had to be in the home. Under to-day's conditions, at least in an area
such as this, this is the less necessary once the health visitor knows of
the homes. A health visitor though can keep in touch with more if the
mothers come to her at the clinics. Shortage of health visitors then may
be a reason for continuing the clinics which otherwise might not have
been found necessary. If they are to be closed though, some alternative