In
a
previous
article
on
this
subject,
we
showed that the effect
the two last sessions of the British
passed during unify health administration in England and consolidate sanitary laws. The country has now been mapped out into a complete system of sanitary areas, each having its own sanitary authority, and the administration of all matters concerning public relief, medical and otherwise, and public health, has been vested in one central board, presided over by a minister of the crown, having as members all the principal functionaries cf the state, possessing a regular administrative staff, and empowered to control the action of all constituted
of two Acts
Parliament has been to
local authorities for health purposes. trative organization having been thus
A well-ordered adminis-
arranged, we havo now to look for developments, and these naturally take two directions, namely, the machinery for performing health work, and the rules in accordance with which such work shall be done.
The first
impulse has been to create a health executive?to provide skilled organs by which the local sanitary authorities shall be informed and advised, and an executive by which the regulations and laws already in existence shall be applied to the circumstances of To this end the 10th Section of the Act of 1872
communities.
sanitary authority shall select a medical inspector of nuisances. The duties of both these functionaries have been laid down by the Local Government Board. As regards the former, we quote the following
has
provided
that each
officer of health and
summary from "
recent
number of the Lancet
:?
1. The medical oflicer of health is to inform himself of all
injurious and
a
an
to the
distribution
influences
2. lie is to ascertain the causes, origin, of diseases within the district, and the extent to which
public
health
can be removed or mitigated. 3. Ho is to inspect the systematically and occasionally. 4. lie is to bo prepared to advise the sanitary authority on all matters affecting health; and, in cases requiring it, to certify, for the guidance of the magistrates and the sauitary authority, as to any matter in respect of which the certificate of a medical practitioner or officer of health is required as the basis or in aid of sanitaryaction. 5. lie is to advise the sanitary authority in framing bye-laws. 6. On receiving information as to the outbreak of contagious, epidemic, or infectious disease of a dangerous character, he is to visit the spot without delay, advise measures, and assist in the execution of the same. 7. On receiving information of a nuisanco from the inspector of nuisances, he is to take the earliest practicable steps to havo it removed. 8. When necessary, he is to inspcct and examine food of all kinds exposed for sale, and if ho finds it unwholesome, give directions for having it seized and dealt with by a justice. 9. lie is to perform all duties required of him by the bye-laws of the sanitary authority. 10. He is to inquiro into
these
causes
district both
processes of trade. 11. He is to attend at the olllce of the sanitary authority at stated times. 12. He is to report from time to time his proceedings, aud also with respect to the sickness and mortality of the district. 13. II? is to keep a book or books with uotes of his observa-
any offensive
tions, of applications made to him, and of any action taken on previous reporis. 14. He is also to prepare an annual report, in December, of the
;
,
year's sickness and mortality, and of his proceedings under the Sanitary Act. 15, 114 is to give immediate information to the Local Government'
March 1,
SEPOYS IN HOSPITAL.
1873.]
dangerous epidemic disease, and to transmit a quarterly return of sickness and deaths to the Board. 16. Ia matters not specifically provided for in this order, he is to execute the instructions of the Local Government Board and of the sanitary authority. 17. WhenBoard of any outbreak of
within the district, directions and regulations issued under that Act by the Local Government Board, so far as the same relate to his office." the Diseases Prevention Act of 1855 is in force
ever
he is to observe the
tation.
71
The measures we have described extend the scope and position of medicine most materially; and the affili-
elevate the ation in
practice
medicine is
gratulation
and administration of
preventive
and curative
matter of great importance and a subject of conto those who hold the unity of medical science. a
We shall endeavour in
our next issue to exhibit, by way of coninspector of nuisances, he is?(1) to be sub- trast, the position of matters in the country, indicate the laws ordinate to the sanitary authority or to the medical officer and administrative arrangements which have been enacted or of health for all purposes indicated by the laws or orders established for public health purposes, expose their defects, and in force; (2) to attend all meetings of the sanitary author- offer some suggestions for a more efficient and practical system. ity ; (3) to inspect systematically and periodically on occasion ; (4) to enquire into existing nuisances or breaches of sanitary law; (5) to report such to the sanitary authority ; (6) to report damage to water or other works, negligent waste or defilement of water; (7) to examine, and, if unfit foir consumption, seize articles and food exposed for sale, consulting the medical officer of health in case of doubt; (8) to obtain samples of adulterated food or drink, and take proceedings under the Act for their analysis ; (9) to report epidemics to the medical officer of health, and the existence of nuisances or other conditions
As
regards
the
disease ;
fostering
to carry out the instructions of the mea view to prevent the spread of
(10)
dical officer of health with
insalubrious conditions;
(11)
to
keep a proceedings; (12) record to the medical officer of health periodically, or when required; (13) to superintend the execution of works; and (14) to obey all lawful orders of the sanitary authority and Local epidemics
or
record of his
remove
inspections
to submit the
and
Government Board. "With the whole
sanitary inspection be
a
greater and
devoted to them. the
under
and control
doubt that health
no
obtain
by
country
questions
more
such
a
system of elaborate
these rules involve, there can and concerns will in future
detailed attention than has
The cardinal
authority
as
of law
that
learned in all the sciences bearing
over
been
has been
principal
medical
acknowledged practitioners?men
health;
versed in the know-
on
of disease and its causes; and skilled in its
prevention and the conditions on detecting agents ?which the origin, spread, and aggravation of disease depends, and for advising as to their modification and removal. Other subsidiary questions are still agitating the public mind :?Should the area of action of a medical officer of health be largo or small, a conjoint or single one ? Should the medical officer of health be allowed to practiso his profession ? Will his interests and obligations as a practitioner clash with his duties as a public health officer ? These and other allied questions will in time be solved by experience. The want of professional inspectors to guide and support local sanitary officers is also urged ; but this want, there is every reason to believe, will bo satisfied in time. There is also a well-founded desire, that specially qualified and trained men should be attached to the central health office for special investigations. The importance?nay necessity?of this cannot be too strongly urged j and we trust that the system of special investigation, so admirably conducted under the guidance of Mr. Simon, will be developed and extended' Medical and sanitary science can bo promoted by no other means so well as by special investigation by qualified observers. The necessarily general reports of inspectors and boards, which are mainly concerned with administrative considerations, can ledge
for
treatment?are the fittest
never
supply
possession of
a
this want.
We liavo now
placed
concise account of what has
England to promote the
cause
our
recently
of public health and
readers in
been done in
practical
sani*
a
previous
article
on
this
subject,
we
showed that the effect
the two last sessions of the British
passed during unify health administration in England and consolidate sanitary laws. The country has now been mapped out into a complete system of sanitary areas, each having its own sanitary authority, and the administration of all matters concerning public relief, medical and otherwise, and public health, has been vested in one central board, presided over by a minister of the crown, having as members all the principal functionaries cf the state, possessing a regular administrative staff, and empowered to control the action of all constituted
of two Acts
Parliament has been to
local authorities for health purposes. trative organization having been thus
A well-ordered adminis-
arranged, we havo now to look for developments, and these naturally take two directions, namely, the machinery for performing health work, and the rules in accordance with which such work shall be done.
The first
impulse has been to create a health executive?to provide skilled organs by which the local sanitary authorities shall be informed and advised, and an executive by which the regulations and laws already in existence shall be applied to the circumstances of To this end the 10th Section of the Act of 1872
communities.
sanitary authority shall select a medical inspector of nuisances. The duties of both these functionaries have been laid down by the Local Government Board. As regards the former, we quote the following
has
provided
that each
officer of health and
summary from "
recent
number of the Lancet
:?
1. The medical oflicer of health is to inform himself of all
injurious and
a
an
to the
distribution
influences
2. lie is to ascertain the causes, origin, of diseases within the district, and the extent to which
public
health
can be removed or mitigated. 3. Ho is to inspect the systematically and occasionally. 4. lie is to bo prepared to advise the sanitary authority on all matters affecting health; and, in cases requiring it, to certify, for the guidance of the magistrates and the sauitary authority, as to any matter in respect of which the certificate of a medical practitioner or officer of health is required as the basis or in aid of sanitaryaction. 5. lie is to advise the sanitary authority in framing bye-laws. 6. On receiving information as to the outbreak of contagious, epidemic, or infectious disease of a dangerous character, he is to visit the spot without delay, advise measures, and assist in the execution of the same. 7. On receiving information of a nuisanco from the inspector of nuisances, he is to take the earliest practicable steps to havo it removed. 8. When necessary, he is to inspcct and examine food of all kinds exposed for sale, and if ho finds it unwholesome, give directions for having it seized and dealt with by a justice. 9. lie is to perform all duties required of him by the bye-laws of the sanitary authority. 10. He is to inquiro into
these
causes
district both
processes of trade. 11. He is to attend at the olllce of the sanitary authority at stated times. 12. He is to report from time to time his proceedings, aud also with respect to the sickness and mortality of the district. 13. II? is to keep a book or books with uotes of his observa-
any offensive
tions, of applications made to him, and of any action taken on previous reporis. 14. He is also to prepare an annual report, in December, of the
;
,
year's sickness and mortality, and of his proceedings under the Sanitary Act. 15, 114 is to give immediate information to the Local Government'
March 1,
SEPOYS IN HOSPITAL.
1873.]
dangerous epidemic disease, and to transmit a quarterly return of sickness and deaths to the Board. 16. Ia matters not specifically provided for in this order, he is to execute the instructions of the Local Government Board and of the sanitary authority. 17. WhenBoard of any outbreak of
within the district, directions and regulations issued under that Act by the Local Government Board, so far as the same relate to his office." the Diseases Prevention Act of 1855 is in force
ever
he is to observe the
tation.
71
The measures we have described extend the scope and position of medicine most materially; and the affili-
elevate the ation in
practice
medicine is
gratulation
and administration of
preventive
and curative
matter of great importance and a subject of conto those who hold the unity of medical science. a
We shall endeavour in
our next issue to exhibit, by way of coninspector of nuisances, he is?(1) to be sub- trast, the position of matters in the country, indicate the laws ordinate to the sanitary authority or to the medical officer and administrative arrangements which have been enacted or of health for all purposes indicated by the laws or orders established for public health purposes, expose their defects, and in force; (2) to attend all meetings of the sanitary author- offer some suggestions for a more efficient and practical system. ity ; (3) to inspect systematically and periodically on occasion ; (4) to enquire into existing nuisances or breaches of sanitary law; (5) to report such to the sanitary authority ; (6) to report damage to water or other works, negligent waste or defilement of water; (7) to examine, and, if unfit foir consumption, seize articles and food exposed for sale, consulting the medical officer of health in case of doubt; (8) to obtain samples of adulterated food or drink, and take proceedings under the Act for their analysis ; (9) to report epidemics to the medical officer of health, and the existence of nuisances or other conditions
As
regards
the
disease ;
fostering
to carry out the instructions of the mea view to prevent the spread of
(10)
dical officer of health with
insalubrious conditions;
(11)
to
keep a proceedings; (12) record to the medical officer of health periodically, or when required; (13) to superintend the execution of works; and (14) to obey all lawful orders of the sanitary authority and Local epidemics
or
record of his
remove
inspections
to submit the
and
Government Board. "With the whole
sanitary inspection be
a
greater and
devoted to them. the
under
and control
doubt that health
no
obtain
by
country
questions
more
such
a
system of elaborate
these rules involve, there can and concerns will in future
detailed attention than has
The cardinal
authority
as
of law
that
learned in all the sciences bearing
over
been
has been
principal
medical
acknowledged practitioners?men
health;
versed in the know-
on
of disease and its causes; and skilled in its
prevention and the conditions on detecting agents ?which the origin, spread, and aggravation of disease depends, and for advising as to their modification and removal. Other subsidiary questions are still agitating the public mind :?Should the area of action of a medical officer of health be largo or small, a conjoint or single one ? Should the medical officer of health be allowed to practiso his profession ? Will his interests and obligations as a practitioner clash with his duties as a public health officer ? These and other allied questions will in time be solved by experience. The want of professional inspectors to guide and support local sanitary officers is also urged ; but this want, there is every reason to believe, will bo satisfied in time. There is also a well-founded desire, that specially qualified and trained men should be attached to the central health office for special investigations. The importance?nay necessity?of this cannot be too strongly urged j and we trust that the system of special investigation, so admirably conducted under the guidance of Mr. Simon, will be developed and extended' Medical and sanitary science can bo promoted by no other means so well as by special investigation by qualified observers. The necessarily general reports of inspectors and boards, which are mainly concerned with administrative considerations, can ledge
for
treatment?are the fittest
never
supply
possession of
a
this want.
We liavo now
placed
concise account of what has
England to promote the
cause
our
recently
of public health and
readers in
been done in
practical
sani*
