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CHAPTER III.

Co-ordination between Government Medical and Public Health
Departments.

     The activities of those responsible for medical relief and prevention
of disease are so closely inter-related that it is impossible to draw any
sharp line of distinction between them, and the necessity for co-ordinating
their activities is now fully recognised. No apology is therefore required
for a brief reference to this subject which has attracted the attention of
both administrations and of authorities concerned with medical education.
The Central Board of Health at its first meeting passed a special resolu-
tion which stressed the need for co-operation between Medical and Public
Health Departments, and recognising the important position which pre-
vention occupies in every phase of medical practice, both the Medical
Council of India and the General Medical Council of Great Britain recom-
mend that "throughout the whole period of study the attention of the
student should be directed to the importance of the preventive aspects
of medicine".

     2. In most countries all branches of medicine are administered by one
Health Ministry with separate higher directing staffs, and India is in
fact peculiar in the extent to which in some areas the activities of medical
and public health departments have been separated, or in a few cases even
divorced from each other. For this result the history of the development
of modern medicine in India is partly responsible, while the magnitude of
their tasks, the limited facilities available, and the need for expanding the
efforts of both require concentration to a large extent on their own affairs.
The inadequacy of existing arrangements has been outlined both in this
Review and in the annual reports of the Public Health Commissioner.

       *Sir John Megaw in 1933 wrote:—

       "There are historical reasons for the 'diarchy' which exists
       in the medical and public health departments. In
       the early days of the development of modern medicine
       in India disease prevention was scarcely attempted except
       in the case of vaccination against small-pox. The view
       which held the field at that time was that the people had
       not yet been educated up to the necessity for preventive
       medicine and that any attempt to enforce unpopular public
       health measures would do more harm than good. Medical
       effort was therefore concentrated on the establishment of
       hospitals and dispensaries for the treatment of the sick. When
       public health began to receive its due share of attention the
       physicians and surgeons were already strongly entrenched so
       that public health workers found it difficult to awaken any
       enthusiasm for preventive medicine amongst the administra-
       tive medical officers who were interested in their own speciali-
       ties. It was therefore necessary for the public health workers
       to put up a vigorous fight to secure autonomy and, generally
       speaking, the result has been an undesirable cleavage between
       medical relief and public health.

   * Some points connected with Medical Administration in India.