Public health

Helen Zealley

With an account of the work of Dr D Wilson MOH, by Dr IM Wilson

The period from 1945 to 2000 provided two distinct models of public health practice, changing in 1974.

From 1945 to 1974

Public Health continued as an East Lothian Council function under the direction of the Medical Officer of Health (MOH), initially Dr Campbell, then Dr Milne for a brief period in 1952 and finally Dr H Donald Wilson (1953-1974). In 1966, the team of staff included: two doctors; three dentists; a nursing superintendent with nine health visitors, 15 dual or triple duty district nurses/midwife and a school cleanliness visitor; a county sanitary inspector with three assistants and a milk officer; a social worker and mental health officer and two physiotherapists.

Their work involved protection of the public’s health from outbreaks of infection and environmental hazards such as poor housing; clinics for pregnant mothers and pre-school children, including immunisation; the school health service; home helps; home visiting; old people’s homes; and funding for an occupation centre for people with mental health problems. 1966 also saw planning for the introduction of the first cervical screening clinic for East Lothian in the Vert Memorial Maternity Hospital.

Interesting comments in the MOH 1966 Annual report included:

  • reference to an increase in the number of applications to run day nurseries / play centres throughout the county but ‘…no case for the provision of a whole-time day nursery by the local authority…’
  • replacement of the old roller towels in schools, initially to improve hygiene, but subsequently found to be both popular and cheaper
  • concern about sewage on the beach at Dunbar ‘It is for consideration whether the discharge of crude sewage into the sea at a short distance from inhabited areas or popular holiday spots can be tolerated much longer. This is, of course, a national problem… and it is no answer to say that no definite connection has so far been established between sewage polluted beaches and epidemics of disease…It is felt that a more vigorous national policy should be pursued…’
  • the possibility of supplying school milk (it was still provided free to all pupils at the time) in waxed containers rather than glass bottles
  • good co-operation with the hospital service through student nurse attachments to district nurses and health visitors.

The sanitary inspector’s separate report expressed concern about the failure of two families to clean up their homes and gardens, and suggested that action should be taken in terms of the Public Health (Scotland) Act 1897 – the legislation that continues to underpin protection from ‘nuisances’ as we enter the twenty-first century. In his 1970 report Dr Wilson referred to:

  • concern at an increase in the infant mortality rate ‘… we are currently living in a mobile society and many young mothers move into the area with no friends or relations to whom they can turn …’
  • the development of health centres in Tranent and North Berwick funded by the Scottish Home and Health Department
  • continuing difficulty attaching public health nursing staff to GP practices
  • concern on grounds of potential contamination of the water, shared by the sanitary inspector, that a Public Inquiry had found against their professional advice in favour of a farmer building a new farm steading close to the newly created Whiteadder Reservoir
  • the emergence of a ‘… hippy type of unwashed protestor and demonstrator …’ whom he acknowledged were anathema to most people ‘… yet many of these unfortunate people, however much revulsion we may feel towards them, are in fact desperately in need of help and many of them are psychopathic personalities who simply do not want to be helped although they sometimes in their infrequent moments of insight know that they are digging their own graves with the hypodermic needle. It must be realised, however, that there are limitations to the amount of help which one can give …’
  • a newly identified disease ‘Farmer’s Lung’ caused by an allergic reaction to certain fungi in mouldy hay
  • planned early discharge (at 48 hours) from maternity hospital for those who wish to continue their care at home, with added comment that this concept of planned early discharge could be extended to general hospitals because ‘… no person likes to stay in hospital for longer than is absolutely necessary nor do the hospitals wish to keep them for longer than this period in view of the current pressure on hospital beds …most people would prefer to convalesce in their familiar domestic surroundings …uneconomic not to discharge him [sic] at the earliest possible moment …but this needs an adequate force of home nurses with comparable pay and conditions to hospital nurses …’
  • ‘… problems relating to the welfare of unmarried mothers…’ (although the proportion was small – 6.8% of all births in 1970 compared with 36.8% in 2000, but higher than the all-time recorded low of 2.3% in 1960)

The sanitary inspector continued to express concern about housing and argued that the 1969 Housing Act’s ‘tolerable standards’ were too low and should have included reference to the state of repair. Dr Wilson shared this concern about the poor quality of housing available to those on low incomes and personally intervened with the council on behalf of those in greatest need, such as a new young mother discharged from the Vert Hospital on a Saturday afternoon.

From 1974 to 2000

In 1974 the focal point of the public health function changed. The sanitary inspectors remained with the council to form an Environmental Health Department; the dental staff joined a Lothian wide community dental service; the district nurses and health visitors were absorbed into the community nursing service for North Lothian District; medical staff providing clinics and the school health service transferred to the North Lothian community child health service; while responsibility for the control of communicable diseases and environmental health hazards, health education and planning liaison with hospitals and GPs transferred to the Chief Administrative Medical Officer (CAMO) of the Lothian Health Board. In practice, Dr Wilson became a member of the CAMO’s team of public health consultants (known between 1974 and 1989 as community medicine specialists), thus providing important continuity of the public health function in East Lothian although his deputy, Dr Margaret Anderson, who had contributed to the public health service in East Lothian since 1941, retired.

Between 1974 and 2000 numerous organisational changes occurred within the overall area of the Lothian Health Board. North Lothian District, which had originally covered East Lothian and north Edinburgh, was disbanded and eventually, after a period with separate sub-structures for each professional group, was replaced by the East Lothian Unit. This, in turn, expanded to cover East and Midlothian and became an independent NHS Trust before being joined by two Edinburgh based Trusts to form a single Lothian Community NHS Trust within which a separate ‘ Local Health Care Co-operative’ covered the GP, community and mental health services in East Lothian.

Public health activity throughout this succession of organisational changes continued to focus on protecting the health of the public through disease control; promoting changes to improve health; and contributing to the strategic planning and evaluation of health services to ensure, as far as possible, that they provided ‘the right care, in the right place, at the right time’.

Reflections on Public Health 1953-1985 (and part-time to 1988)

(from Dr Donald Wilson’s daughter, Dr Isobel M Wilson)

My father, Donald Wilson, took up the post of MOH of East Lothian in 1953 and retired in November 1985. When he was appointed at the age of 31, he was the youngest MOH in Scotland, and I think probably in the UK. After he officially retired, he was invited to return on a part-time basis and worked for a further three years.

One of my earliest and most vivid memories of Dad is watching him leave home very early one bitterly cold, dark winter morning when snow had just started falling. He put into the back of his car Wellington boots, a large shovel and long steel chains. He explained patiently that if the snow continued to fall throughout the morning, he would have difficulty reaching the deserted farmhouse in the Lammermuir Hills, where he had arranged to see ‘a wee [child] who was finding school very difficult’. This would be in the 1950s when, of course, children with learning difficulties just ‘disappeared’ from their original P1 class and mainstream schooling, and were educated in a room with children with varying ages, and very varied medical problems. How different from today!

I also remember being incredibly proud when he paid his annual visit as school medical officer to North Berwick Primary School where I was a pupil for several years. During the visit he always gave me a very cheerful wave from the staff room window while he was having his coffee break, and I was playing British Bulldogs or skipping in the playground.

Another very distinct lasting memory I have is of a phone ringing at home one Saturday afternoon just as we were all ready to go swimming. Dad then spent a very long time trying to arrange alternative local authority accommodation for a new mother, just discharged from the Vert (then the local maternity Hospital). The new family was going home to damp, unheated, totally unsuitable accommodation. However, Dad’s persistence that afternoon with innumerable telephone calls and council housing forms must have paid off because several months later, the mother appeared unexpectedly at our home to thank him personally for his efforts!

I suppose a remark made to my mother many years later – ‘He is a real people’s doctor, Dr Wilson’ – is as good a reminder as any of the role the MOH could play in the community. He was immensely dedicated to his work and was unfailingly enthusiastic. Nothing was ever too much trouble for him and he was very patient and unobtrusive. When I myself started at Edinburgh Medical School, he gave me his own original microscope in excellent working order.

Earlier this week (March, 2002), as a principal in general practice in Morningside, I was searching through a large set of case notes of a patient, born in the mid 1950s and currently living in supported accommodation. I suddenly saw my father’s instantly recognisable fountain-pen signature ‘H D Wilson’ at the foot of a letter dated January 1959. Intrigued, I read his letter to find that he had visited the patient at home and had found … ‘unsuited for … present school’ and ‘arrangements would be made’. Was this the same [child] that he had visited at home the day he set off mid-winter with boots, chains and shovel in the back of the car? I wonder