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long can do irreparable damage. What can be done to
encourage these young adults to discuss their
problems, and what advice to offer them, which will
be heeded, are the questions that still require
answering.
Screening Procedures and Medical Checks
The health of the people in the borough remains
good, but it is well known that there is still, in all
communities, the hidden base of a clinical iceberg of
minor and major mental or physical disease which
remains largely untapped and undetected by present
methods. It is, however, now becoming feasible that a
proportion of these hidden, incipient, latent or actual
diseases could be prevented from causing irreparable
damage by early detection before overt signs appear.
This early detection could only be instituted by means
of voluntary periodic medical checks of individuals
at risk or on a larger scale by the screening of populations
at risk. Such screening of selected groups has
already been carried out for many years in varying
degrees of depth, in the maternity and child health
clinics, the school health services and also in industry
and the armed forces. The following illustrate some
of these selective groups—
Ante-natal Clinics
Pregnant women for anaemia, rhesus incompatibility,
toxaemia and venereal disease
Infant and Child Development Clinics
Total development examination
Screening for
Hearing defect eg congenital deafness
Visual defects
Neurological and CNS defects
Phenylketonuria
Congenital dislocation of hip
Infants at risk
School Health Service
Audiometric sweep screening
Visual screening
Total medical examination
Pultibec assessment of handicapped etc
Dental screening
Student and Occupational Health Services
Mental Illness
Group work in Hounslow Project
(see later in report)
Screening of middle and later age groups must
await a suitable climate of opinion amongst the adults
in the population and, secondly the formation of
suitably trained medical teams who have the necessary
knowledge of the natural history of the disease
processes, accurate tests suitable for mass application,
and an ability to treat the diseases found and
favourably affect their prognosis.
With the spread of civilisation and universal
education, has come greater sophistication of its adult
members in regard to what they expect and require
of medicine and community medical care. In recent
decades, their expectation has been considerably
enhanced by the spectacular advances in the effectiveness
of medical diagnostic and therapeutic procedures
and in surgical techniques. Standards of health or
ill-health previously accepted by individuals and the
community have now become, or are becoming,
unacceptable. Resultant demands on doctor time and
skill will therefore continue to increase despite
individuals in society apparently becoming healthier.
This increased education and sophistication aided by
the ever increasing tempo of modern life leads to
demands that minor and major ills, often psychosomatic
in nature, are treated at an earlier and earlier
stage, or actually prevented altogether. The climate of
opinion in society is thus reaching a stage when the
demand and acceptance for such screening procedures
are matching with the recent interest shewn in medical
circles in such procedures.
In addition to the screening processes already
existing, the first new service of the type proposed for
the borough is for the early detection of cervical
cancer in its pre-malignant and treatable phase. It is
proposed that this service will commence in 1966, but
its extent will be determined by the number of smears
that can be dealt with by the hospital cytological
service. This service will supplement work already
carried out in this field by a number of family doctors
and the Family Planning Association. Screening for
diabetes has already been carried out in this country,
but very careful planning of resources is necessary
before this procedure can be adopted more widely.
With reference to screening in general, there is no
point in diagnosing on a mass basis if results are not
accurately recorded, and if preliminary ground work,
such as standardisation of forms, arrangements for
treatment and epidemiological studies has not been
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