THE HEALTH VISITOR.*
Erna State medical service with woman in chief control. Of course this is not openly avowed in the very interesting and excellently written manual lying before us, but almost every other page seems to be seeking to demonstrate the advan- tages to the community which would result from a State medical service; and as it is assumed that women doctors, because they are women, are most suitable for the medical carp of women and children, an assumption possibly justifiable but not yet proved, it would appear to follow that ultimately women will have the predominant control of the medical services, for the doctor who is called in to attend the mother and children will certainly find that in the majority of cases the whole house- hold will pass into her charge. The advocates of a State medical service hope to find in the health visitor a strong sup- porter, a missionary with ample opportunity of spreading their views among large masses of the population. In this connexion it should be pointed out that in certain of the schemes for a State medical service the medical officers of health, who are already the administrative chiefs of the rate-paid health visitors, are to act in the same capacity for the medical service generally. It is true that Mrs. Eve and her collaborators pay lip-service to the rule of non-interference with the work of the general practi- tioner, it would not indeed be politic to do otherwise, but they hardly succeed in concealing their poor opinion of this personage —especially in connexion with maternity and child welfare. These ladies pin their faith to the specialist and then, failing such a one being obtainable, to the woman doctor. Their case for the children's specialist is rather spoilt by the following passage : " In large towns there is no difficulty usually in finding a specialist in children's diseases who is glad to have an • Manual for Health Visitors and Infant Welfare Workers. Edited by Ms• Raid Eve. London: Bale, Seas, and Daniel son. 1106. Gd. net.)
opportunity of studying the healthy ' child and the first beginnings of nutritional disorders." Exactly! Up to the present the specialist has had very limited opportunities of studying the healthy child and the first beginnings of nutritional disorders, whereas, whatever may be thought of his mental equipment, the general practitioner has had ample opportunities. When will these reforming enthusiasts understand that the improvement in the health of the community which they so conscientiously desire will never be brought about by centralizing such treatment and placing it in the hands of a few individuals hereinafter, as the lawyers say, styled specialists, but that such improvement depends on the general body of practitioners being given equal opportunities with their specialist colleagues of carrying out therapeutic measures, with which in theory at least they are well acquainted ? That important official, the health visitor, truly may find that some of the general practitioners have something to learn at the various health centres of the more recent ideas on treat- ment, but in the majority of instances this lack of knowledge will be more than compensated for by the vast stores of experi- ence possessed by so many of them—stores of experience unob- tainable in any medical school.
The foregoing is not written with any idea of disparaging the work of the health visitor, but to discourage the attempt to place her on too lofty a pedestal, from which she will inevitably be dragged down. In this manual it is suggested that tho health visitor should aim at being regarded in her district as " the authority on babies." She will be well advised to limit herself to the aim of being considered one of the authorities on babies, a very competent and important authority; nevertheless, only one of several. Up to the present the health visitor has, in spite of or possibly on account of the difficulties with which she has had to contend, done extremely useful work, and within certain limits her sphere of usefulness is great and such as to attract to the profession capable high-minded women ; but as Dr. Bostook Hill, M.O.H. for Warwickshire, maintains in his introduction, the right typo of woman will not be obtained unless adequate salaries are offered. Naturally, one never expects to meet the beet health visitor outlined by Dr. Hill. " The beet health visitor," he writes, " would combine the qualities of a doctor, a teacher, a student of domestic economy ; she should possess the arts of a ready public, speaker and a perfoot hostess, in short she should be a perfect paragon." The various contributors to the manual, of course, are fully aware of this, yet only on the assumption that the profession can attract to its ranks many hundreds of women approximating closely in character and attainments to this paragon can the very onerous duties and Important position assigned to the health visitor by these writers be made to fit in with the present or any other scheme of medical service without much embarrassing friction. The fault, if any, is not with the writers ; the manual they have produced is most informative, seta a high ideal before the health visitor, and should be most helpful to her in carrying out her highly important duties. The fault seems to us to lie in the failure to consult the general body of the medical profession, and to obtain its views on the subject of health visiting, which intimately affects for good or evil the medical profession's work. By "intimately affects" we do not refer to the financial aspects of this work, although these must be taken into consideration. We refer to the effects of this work on the well-being of the community. Anyone attending recent meetings of medical men will have been struck by the stress that is laid on this point, the well-being of the community. For this they are prepared to make great sacrifices, but they, very properly, are suspicious of schemes forced on them from above. The health visitor is now an integral part of our civic life, but only with the co-operation and guidance of the medical profession can she enter fully into her sphere of usefulness.
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