The Medical Officer of Health in England and Wales, 1900-1974: watchdog or lapdog?

Abstract

The recent revival of interest in the potential of preventive medicine, reflected in its re-emergence as a medical specialism and in monitoring and campaigning activity at the local level, has been accompanied by growing interest in the history of public health. In particular, the work of the Medical Officers of Health (MOsH), the doctors appointed by many local authorities after 1850, has come under closer scrutiny. However, whereas historians have acknowledged that the MOsH played a key role in tackling environmental health and infectious disease in the second half of the nineteenth century, judgements have been less favourable for the period since 1900. It is alleged that the MOsH produced repetitive and complacent reports, delayed the introduction of immunization, and were seduced away from public health by hospital administration. Both they and their counterparts in the School Medical Service ignored wider threats to health such as malnutrition and unemployment, and campaigning on these issues was left to other individuals and pressure groups. Furthermore, it is argued that after the establishment of the National Health Service in 1948, MOsH failed to exploit the potential of health education, lagged behind thinking on social work, and were slow to develop services for 'community care'. According to this analysis, the demise of the MOH in the 1974 health service reorganization represented the logical culmination of trends in the previous 75 years. This paper examines the strengths and weaknesses of this interpretation, partly through a case-study based on the Midlands city of Leicester. It argues that, although some MOsH were complacent, all operated within the limitations of important local and national constraints, and that, given these restrictions on their room for manoeuvre, many were remarkably innovative and imaginative. The paper concludes that, until further research is undertaken, the charges levelled against these doctors remain largely unproven.

Introduction

“…48 John Welshman and Martin Gorsky have questioned this narrative, arguing that Medical Officers of Health (MOHs) continued to perform important public health functions. 49 It is generally acknowledged, however, that public health transitioned from concerns about infectious disease and epidemic control towards the management of chronic conditions. As hygiene improved, issues such as lung cancer and heart disease proved more pressing.…”

Diphtheria

“…9 Thus, it was embraced with varying levels of enthusiasm and administered with varying levels of competence, resulting in very uneven coverage. 10 The war provided an impetus to adopt immunisation as a mass public health measure. Mobile populations as a result of evacuation, bomb damage and general dislocation made traditional public health measures more difficult to maintain.…”

“…Local authorities had traditionally enjoyed a good degree of autonomy from central government, meaning that they could often be resistant if the Ministry attempted to interfere too much with regional matters. 31 However, the use of MOHs was administratively convenient -smallpox vaccination had been the responsibility of local authorities before 1948, and this was maintained and formalised by Section 26 of the National Health Service Acts. 32 There was an inherent tension, therefore, between national targets and local circumstances.…”

Local leadership in public health: the role of the medical officer of health in Britain, 1872-1974

“…26 Another failure was the slow adoption of diphtheria immunisation strategies, despite evidence of their success in North America. 27 Again, studies of individual locales have shown that some progressive MOsH did move forward in these areas, [28][29][30] and it should also be stressed that national leadership from the Ministry of Health and the Chief Medical Officer was lackinga reflection of official caution and conservatism. 31 On the credit side, the personal health services under the MOH's control saw some expansion in the 1920s and 1930s, despite a general atmosphere of resource constraint.…”