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Initial management of suspected meningococcal infection

regard local authority boundaries as marking their communities and would not consider their culture to be shaped by the "common media" of council affairs. Watkins's community is one of local institutions. While this is undeniably important in influencing health at a local level, these institutions should not be confused with the people who live within the boundary of the local authority: to do so reinforces bureaucratic patemalism, in which bureaucrats look after the population. One of the great advances in public health in recent years has been the growing recognition that people who live in districts and boroughs have a right to have their views heard by bureaucrats in the health service. This has been coupled with an ethos that encourages people to take more responsibility for their own health. In the light of this, Watkins's image of the doctor "responsible for . . . a community," which itself is eagerly listening for advice on action it can take to improve its health, is a retrograde one. Our challenge for the 1990s should rather be to devise ways of turning the rhetoric of involving and listening to local people into a reality, while avoiding the minefield of "community" ideology. Watkins's assertion that public health is multidisciplinary is brought into question by the emphasis in the article on public health doctors and nurses (the doctors' handmaidens?). This vision of the future is all the more remarkable given that the Faculty of Public Health Medicine is currently looking to open its door more widely to nonmedical members, who it seems to expect will be largely people with backgrounds in the social sciences, health economics, statistics, and management. Though I do not wish to be associated with the rampant managerialism that has become a feature of parts of our specialty in recent years, it does public health a disservice to harp back continually to the old days of medical officers of health. It is time for the specialty to look forward, to push aside the curtains of ideology, and to determine what our role really is in these turbulent and uncertain times.