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THE WORK OF THE DEPARTMENT
CONTROL OF COMMUNICABLE DISEASE - NEW HORIZONS
Dr.Geoffrey Poole, Deputy Medical Officer of Health, writes:-
The trend in recent years for infectious diseases to play a diminishing role as causes
of illness and death continued throughout 1971. Even measles, the only notifiable disease to
show a significant increase, with 1,131 cases against (800) last year should, because of the
persistence of the biennial epidemic pattern despite vaccination, be compared with the 1,558
cases notified during 1969. Infectious Jaundice was somewhat increased at 80 cases (54) with
one death as was Tuberculosis at 86 (79) with six deaths. Two cases of Paratyphoid, one of
Typhoid and the discovery of a typhoid carrier in a house in multiple occupation involved
this section in some urgent visits and examination of specimens as did the surveillance and
screening of 149 Cholera contacts returned from the outbreak in Spain. Visits related to the
prevention and control of infectious disease totalled 1,839, including 633 routine visits to
newly arrived immigrant families and 621 specimens were examined. The most notable
epidemiological event during the year was the abandonment of routine vaccination of infants
against Smallpox which dated from the Vaccination Act of 1853 which made smallpox
vaccination obligatory for all infants. This forward step has been made possibleby the
extensive vaccination campaigns carried out in tropical and sub-tropical countries where
smallpox was prevalent. The World Health Organisation now reports only a few areas from
which Smallpox has not yet been eradicated so that, while vaccination is still necessary for
travellers to such areas, the risk of importing smallpox into the United Kingdom grows less
every year and no longer justifies the mass vaccination of infants.
It has been said that Medical Officers of Health exist to abolish the need for their own
existence and it is forecast that in the coming integration of all branches of the Health Service
in April 1974 Medical Officers of Health will indeed disappear - to be replaced by Community
Physicians. This is not quite the mixture as before under a new label, the whole emphasis of
the work has changed. Pure water supplies, the safe disposal of sewage, industrial wastes
and refuse are now the responsibility of other officers who need only occasionally to consult
the M.O.H. The Public Health Inspectorate has evolved into a corps of highly trained
technical officers over whose professional activities the M.O.H. exercises an advisory rather
than a supervisory role. The formation, in April, of the Social Services Department has
relieved the M.O.H. of much of his direct responsibility for the welfare of the aged, the
mentally and physically handicapped and the homeless. We have, in this country, moved a long
way from the cholera, typhoid and smallpox outbreaks which were largely responsible for the
appointment of Medical Officers of Health a century ago. Immunisation has replaced isolation
in fever hospitals for diseases like diphtheria, polio and smallpox. Modern drugs have brought
under close control diseases like meningitis, scarlet fever and tuberculosis. With a first class
Public Health Laboratory Service the new style community physician does not need to be a
bacteriologist, only a few will be needed as specialists in infectious diseases, chiefly those
imported from countries less advanced in public health.
What then remains for the Physician to the Community? The answer is a new and wider
concept of total community health. Last year I referred to the inversion which had taken place
between the mortality from Tuberculosis (Walthamstow and Leyton) and from Cancer of the
lung (Waltham Forest) over the last four decades.
Year Population Tuberculosis Lung Cancer
Deaths Deaths
1930 253,100 189 16
1950 229,300 68 85
1970 235,040 1 183
No more convincing illustration could be given of our hard-won but almost total success in
dealing with a disease spread by an infectious germ; or of our dismal failure to contain a
disease due to a cancer producing chemical in tobacco smoke spread by habit, example and
cigarette advertising. Following our report last year of the epidemic increase in smoker's
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