Welshman J
Wellcome Unit for the History of Medicine, Oxford.
J Public Health Med. 1997 Dec;19(4):443-50. doi: 10.1093/oxfordjournals.pubmed.a024675.
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.
近期对预防医学潜力的兴趣再度兴起，这体现在预防医学重新成为一门医学专科，以及地方层面的监测和宣传活动中。与此同时，人们对公共卫生史的兴趣也与日俱增。尤其是1850年后许多地方当局任命的卫生医疗官（MOsH）的工作，受到了更密切的审视。然而，尽管历史学家承认卫生医疗官在19世纪下半叶应对环境卫生和传染病方面发挥了关键作用，但对1900年以后这段时期的评价却不那么乐观。据称，卫生医疗官撰写的报告重复且自满，推迟了免疫接种的引入，还被医院管理工作吸引，从而偏离了公共卫生领域。他们以及学校医疗服务部门的同行都忽视了营养不良和失业等对健康更广泛的威胁，而围绕这些问题开展的宣传活动则留给了其他个人和压力团体。此外，有人认为1948年国家医疗服务体系建立后，卫生医疗官未能充分发挥健康教育的潜力，在社会工作理念方面滞后，并且在发展“社区护理”服务方面进展缓慢。根据这种分析，1974年卫生服务重组中卫生医疗官职位的废除，代表了此前75年趋势的合乎逻辑的 culmination（此处原文culmination有误，结合语境推测可能是“顶点、终结”之意）。本文通过对中部城市莱斯特的案例研究，部分地考察了这种解读的优缺点。文章认为，尽管一些卫生医疗官自满，但他们都在重要的地方和国家限制条件下开展工作，而且鉴于这些对其行动空间的限制，许多人仍具有显著的创新性和想象力。文章得出结论，在进行进一步研究之前，对这些医生的指控在很大程度上仍未得到证实。
