Proceedings of the North-Western branch of the society of medical officers of health

484

PROCEEDINGS OF THE NORTH-WESTERN BRANCH.

paper by Professor A. Corradi, of Pavia ; " O n the Notification of Infectious Diseases," papers by P. Boobbyer, M.B., Medical Officer of Health, Nottingham, and D. Biddle, M.R.C.S. ; " O n Temporary Shelters for Isolation Purposes," paper by J. Spottiswoode Cameron, M.D., Medical Officer of Health for Leeds ; "On Venereal Diseases and the Duty of the State in Regard to Them," papers by .L Birkbeck Nevins, M.D., and J. Holroyde, M.R.C.S.) Medical Officer of Health for Chatham. DIVISION II. DEMOGRAPHY,

List of Papers (the dates are liable to alteration) : - TURSDAY, August Ixth.--After a brief address by the President, will follow: L "Diseases and Mortality in Relation to Occupation," Win. Ogle, M.D., Superintendent of Statistics, General Register Office. 2. Insurance Societies of the Working Classes,)' Dr'. Von Mayr, of Munich. 3. "Thrift in Great Britain," Rowland Hamilton, F.S.S. 4. (' BenefitsOfferedto Workers by their Employers and by others," Fredk. Whymper, Factory Department, Home Office. 5- "Indian Factory Legislation," Holt. S. Hallett. 6. "Home Workin Russia," Dr. Madame Tkat. cheffi 7. Paper by Dr. Migerka, Chief Sanitary Inspector of Factories. Vienna, on Museums of Industrial Hygiene. 8. "The Economic Advantages of Industrial Hygiene," B. H. Thwaite, C.E. WEDNESDAY,August I '2th.--9. ' ' Temporary Migrationof Labour," E. G. Ravenstein, F.R.G.S. IO. "Migration within France,' M. Lavasseur. I I. "The suitabilityof Tropical Highlands for European Settlement," Surg.-Gen. Sir William Moore, K.C.I.E.; Dr. C. E. van der Burg; Robert ~,V. Felkin, M.D. ; Clements Markham, C.B. ; I2. "Report on an Inquiry into Leprosy in Egypt," Dr. Engel Bey. THURSDAY,August I3th.--I3. "Method of Conducting the Census in Switzerland in I888," M. le Dr. Milliet, of Berne. I4. "Results of recent French Census)" M. Bouffet, of Paris. !5. ,$ Demonstratmncf Electric Counting Machine used in the United States Census," M. Hollerith. xfi. " The influence of Clays and Limestones on Medical Geography, illustrated by the geographical distribution of Cancer among Females in England and Wales," Alfred Haviland, M.R.C.S. xY. "The influenceof Geology upon Health and the Distribution of Disease/' Win. Topley, Geological Survey Office, London. I8. On the Methods of Research into the causes of periodic Demographical Phenomena," Professor B61a F61des) of Budapest. FRIDAY,August x4th.~x 9. "Results of Anthropometry at Cambridge, Dr. John Venn, F.R.S. 2o. The Physical Condition of Children Sren in Schools, and the Local Dis. tribution of Conditionsof DefectiveDevelopment," Francis Warner, M.D., F.R.C.P. 2I. "The Physical Condition of Pauper Children Boarded-out Under Local Government • Orders, I87Oand I889,,) Mlss Fanny Fowke. 22. ,( Exami. nation into the Condition of the Teeth of School Children," J. S. Turner and N. B. Paterson, Delegates of the British Dental Association. 23. "Personal Identification by Scar Marks, &c.," by Col. Charles R. Greenleaf and Major Smart (United States Army), showing methods of record in United States Army, and comparingthem with M. Bertillon's method. 24. "Exhibition of Finger Prints and of Registers of them as a Means of Personal Identification," Francis Galton, F.R.S. Papers sent after authorised date and arrangement of programme. They will be read as opportunity may permit : - I. " A n Analysis of Factories, Hospitals, and Barracks in India, and its importance with reference to Mortality from Chest Diseases," Dr. K. N. Bahadhurji." z. "Table de mortalit6 !ear protession calcul6ed'apr6s la statistique de la ville de Paris ; comparaisonavec les tablesanaloguespubli6es

en Angleterre par M. Farret M. Ogle et en Sulsse," Dr. Jacques Bertillon. 3. "R6sultats statistiquesde l'anthropom~trie appliqu6e k l'identification des personnes," Dr. acques Berfillon and Dr. Alphonse Bertillon. 4. "The ~nfluenceof Parental Age on the Vitality of Childrens" Dr. Josef K6r6si.

P R O C E E D I N G S OF THE N O R T H - W E S T E R N B R A N C H OF THE S O C I E T Y OF M E D I C A L O F F I C E R S OF H E A L T H . A MEETING of this Branch was held at 44, John Dalton Street, Manchester, on Friday, July i Tth, at four p.m. The President of the Branch, Dr. Hope, occupied the chair. T h e minutes of the previous meeting were read and confirmed. John Robertson, M.D., B.Sc., assistant medical officer of health for St. Helens, a member of the Society of Medical Officers of Health, was duly elected member of the branch. Harvey Littlejohn, M.A., M.B., B.Sc., Medical Officer of Health for Sheffield, who is nominated for the membership of the Society of Medical Officers of Health, was nominated member of the branch. A letter was read from the H o n . Secretary of the Society of Medical Officers of Health asking the branch to name a representative to serve on the Council of the society. It was unanimously resolved that the President be nominated to serve on the Council. A letter was read from the Hon. Secretary of the Society of Medical Officers of Health thanking the branch for inviting the society to Manchester in August. Owing to the International Congress of Hygiene being fixed for the week beginning August xoth, the society did not think a satisfactory meeting could be arranged in August, and the society could not therefore accept the kind invitation of the branch. T h e hon. secretary stated that late in the autumn there would be a provincial meeting of the society at Leeds. A letter was read from Dr. James Niven, vicepresident of the branch, regretting his inability to be present owing to his absence in Aberdeen. Dr. Hirst then read the following paper : THE A P P O I N T M E N T ) POSITIONp AND TENURE OF OFFICE

OF M E D I C A L

OFFICERS

OF H E A L T H ,

By ALBERTHIRST, F.R.C.P.Edin., late Medical Officer of Health for Prestwich. Dr. HIRST said his subject, it would be generally admitted, was one of great importance. The system of appointing health officers for short terms and re-appointing them for a year or two could not be too strongly condemned. I f it was fair and reasonable to appoint medical officers of health in this way, town clerks, law clerks, borough surveyors, etc.) should be upon the same footing. The health of each district was of national importance) there-

P R O C E E D I N G S OF T H E N O R T H - W E S T E R N B R A N C H . - - D I S C U S S I O N . fore each health officer should be a national servant, and secure as regards tenure of office. Dr. Bond had wisely said, " I t cannot be for the public interest that medical officers of health, on whom are imposed important duties, calling in a singular degree for the exercise of courage and independence, Should be made to feel that their tenure of office is so insecure that they may be summarily deprived of their livelihood by the machinations of personal hostility." It had been alleged that practitioners serving as medical officers of health in small districts were handicapped heavily, as it was not reasonable to expect the co-operation of rival practitioners, and an officer's zeal for sanitation was apt to offend some of his patients. Dr. Hirst's experience was that he found no difficulty in getting on well with his neighbours in the profession. H e had no friction with them, and they assisted him cordially. His difficulties as a medical officer of health were with the local board only. The chairman of the Works Committee was the owner of a large number of cottages with old-fashioned deep ash-pits in the rear, into which slops, etc., poured ; and the Chairman of the Board was largely interested in cottage property, some being under his care. Suggestions that the Board were dilatory in sanitary matters aroused much righteous indignation, but defective sanitary arrangements were not corrected. Houses in the locality being scarce, the tenants dare not complain. Other members of the Board were owners of cottages also. Dr. Hirst learned that on many other Local Boards cottage property owners were largely represented. They appointed the medical officer of health annually, and were highly indignant if he presumed to question their conceptions of justice and expediency. A medical officer of health should be entirely independent of ,control from those interested in maintaining insanitary property in s/a/us qua. People do not adequately appreciate the influence for good to the community of a qualified medical officer of health supported in the performance of his duties and encouraged to persevere. When practicable it was doubtless well that the health officer should not be in general practice, but he was all the better qualified for having had some years' service in general practice H e should have all the required special knowledge and an aptitude for public health work. If he had this aptitude he was generally somewhat of an enthusiast. Such men are likely to obtain the confidence of general practitioners whose co-operation was almost a necessity. A well-organised staff of nuisance inspectors must also be provided, and under the direction of the health officer. At present Dr. Hirst ascertained that about twothirds of the medical officers of health receive salaries of not over .-~5o ~er annum. A man receiving such a salary could give but a small proportion of his working day to health studies or health work. What shall be said of the man paid

485

less than ~ o for supervising the sanitary work of a district? Yet more than one-fifth of medical officers receive less than ~ z o per annum for their services. I f a man neglects his work under such circumstances who will blame him ? I f he does his work, he is a philanthropist. Medical officers of health should take a prominent part in educating the public i n health topics by putting graphically and clearly before the public the fact of the great economy of due attention to sanitary matters. Sir Edwin Chadwick (born in Manchester, it was well to remember) and Dr. B. W. Richardson had set a good example in this direction, and medical officers by lecturing and writing papers could do much to inform the public, securing a better position for themselves, and intelligent support for these recommendations. Dr. Hirst concluded by eulogizing the good work done for many years past by the medical department of the Local Government Board, especially the investigations undertaken by the medical inspectors. He thought that all medical officers of health should be more directly under the control of the central authority, working more in unison than at present, and that they should be protected in the honest discharge of their duties. DISCUSSION. Dr. HOPE said it was doubtless an anomaly that medical officers of health should be appointed for one or two years, and be frequently obliged to seek re-appointment. Their appointment should be for so long as they are capable, and of good behaviour. I n a large town the medical officer of health was less likely to be interfered with than in a small one or a rural district. There were so many varying interests, Cottage property owners, even if members of the sanitary board and disposed to obstruct sanitary work, had little influence and power for harm in a large town. Dr. KENYON was of opinion the matter in debate was not one easy to settle. The method of appointing medical officers of health had been adapte:l tentatively, and as experience increased modifications in the pre,ent system would probably be made. As for the position ot the individual medical officer, it was to a great extent what he made it. Dr. SEtCt;ZANT said medical officers of health ward of great assistance to practitioners, and naturally looked to practitioners for information and support. This was an advantage in many cases in giving the medical officer of health secure tenure, but small appointments of ~ 5 o a-year or under were not permanent to facilitate the tormation of combined districts when desirable and practicable. Stillj men holding small appointments ought not to be at the mercy of local property owners representing the local sanitary authority, but should be duly protected by the Local Government Board or the County Council. Dr. McNICOLL thought that medical officers of health must learn to work harmoniously with their committees. Seeurity of tenure would do a man little good if he were at loggerheads with his board. In many towns, at all events, the medical officers were appointed once and for all. In many other districts the re-appointments from time to time were made as a matter of course, and without question. Daring his long experience at St. Helens, he had continually had to fight the manufacturers for polluting the air with noxious vapours, and tor pouring their acids and waste liquors lain the sewers. If the manufacturers had persistently o p p o s e d h i m , the common -~ense of the other representatives on the T o w n Council would have made such opposition ineffectual. With

486

PROCEEDINGS

OF

THE

BIRMINGHAM

patience and perseverance he generally got what he wanted, though for some suggested improvements he had to wait for years. T h , s the making of a main sewer he had persistently advocated for sixteen years, but it was made at last. Dr. VACHER said thatr owing to the insecurity of tenure, many able medical officers of health had suddenly been thrown out ofemployment, and great injustice had been done. Some additional security should be given, though it would be manifestly unwise to make permanent all the small appoint. merits referred to. He was of opinion that medical officers of health should be more directly und,:r the wing of the central authority. Dr. HIRST briefly replied, and a vote of thanks was passed to him for his interesting paper. O n t h e suggestion o f t h e p r e s i d e n t it was r e s o l v e d to h o l d t h e n e x t m e e t i n g o ~ t h e B r a n c h in O c t o b e r , aUowing A u g u s t a n d S e p t e m b e r for holidays.

PROCEEDINGS o r TrtE~ B I R M I N G H A M AND MIDLAND B R A N C H o r THE S O C I E T Y o r MEDICAL OFFICERS or HEALTH. A MEETING of t h e B i r m i n g h a m atad M i d l a n d B r a n c h was h e l d o n T h u r s d a y , July 2nd, a t t h e C o u n c i l H o u s e , B i r m i n g h a m , t h e P r e s i d e n t (Dr. A. S. U n d e r h i l l , T i p t o n ) in t h e chair. T h e r e were also p r e s e n t : Dr. H . Swete (Droitwich), D r . Beasley (Rowley), Dr. H . M a y ( A s t o n M a n o r ) , Dr. B o s t o c k H i l l (Sutton Coldfield), Dr. P e r k s ( B u r t o n ) , a n d D r . H . M a n l e y ( W e s t B r o m w i c h ) . Dr. H e r b e r t P a g e (hon. secretary) wrote e x p l a i n i n g t h a t h e was u n a b l e to a t t e n d , h a v i n g to b e in L o n d o n o n t h e d a y of t h e m e e t i n g , also stating t h a t h e s h o u l d b e u n a b l e to c o n t i n u e in t h e secretariat owing to t h e p r e s s u r e of his o t h e r e n g a g e m e n t s . Dr. J. B. W e l c h H a n d s w o r t h ) , v i c e - p r e s i d e n t of t h e b r a n c h , wrote apologising for his a b s e n c e , a n d d e c l i n i n g to h e p u t i n n o m i n a t i o n for t h e p r e s i d e n c y o f t h e b r a n c h , as h e h a d f o u n d it n e c e s s a r y to cut d o w n his e x t r a n e o u s work. T H E LAY PRESS AND BRANCH MEETINGS. Dr. R e i d , in a c c o r d a n c e with t h e n o t i c e h e h a d given, m o v e d t h e following resolution : "' T h a t t h e p r e s e n c e of reporters for lay p a p e r s at t h e o r d i n a r y m e e t i n g s of this Society is calculated to fetter discussion, a n d t h a t , if it b e t h o u g h t d e s i r a b l e to r e p o r t t h e p r o c e e d i n g s of s u c h m e e t i n g s in t h e daily papers, all s u c h reports s h o u l d b e c o m m u n i c a t e d b y t h e s h o r t h a n d n o t e - t a k e r of t h e Society, after revision by t h e secretary." Dr. REID ~aid that though, as a young member of the Branch, he felt it necessary to apologize for attempting to alter one of its established customs, he had acceded to the request of several members with whom he had discussed the subject, that he should bring this motion forward. He appreciates to the full the assistance that medical officers of health had received from the press, and he was quite certain that in vet F many cases that assistance had-gseatly contributed towards getting authorities to perfolm duties which, in the absence of the pressure of public opinion, thee might have neglected. But there were occasmns on whizh they, as medical offioersj should n~eet in private, and have an opportunity of expressing their opinions without the chance of what they said getting to the public ear. In that

AND

MIDLAND

BRANCH.

Branch they discussed many questions of great practical ira. po,tance, and. no doubt, it was an advantage that the public should know that such discussions went on, and for that reason he had so worded his resolution that, if it were adopted, it would not altogether prevent their meetings from being reported. But the arguments against the presence of reporters were many. When he first attended those meetings, and discovered that reporters were present, he felt, looking at the question broadly, that it was a mistake. But at the last meeting, in the course of a certain diseussion~ arguments were used which tended to show that the action which, as medical officers of health, they took in many cases could not be supported by law, and that the large amount of good that resulted from their action was, to a, certain extent, illegal. Those statements did not appear in the papers, but the possibility that such things might be published had the effect, to his mind, of greatly limiting dis. cussion in many cases. Since then he had ascertained that rather serious consequences had followed in one or two cases from their remarks being reported in the Birmingham papers. One argument that he had heard used against his proposal was that the society owed its existence and strength to the. fact that its meetings were reported in the daily press. (Dr. BOSTOCK HILL : Hear, hear.) Even if they admitted that that had been so in the past, they certainly ought now to be strong enough in themselves, and in the subjects they usually discussed, to maintain their existence. But he could not quite see that the argument applied to the case. He was quite willing to modify the resolution, or receive any amend. ment in deference to the opinion of the general body o members, or to postpone the discussion of the matter until they had a larger meeting of the Branch ; but, in order topromote discussion, he would move the resolution as it stood. Dr. SWETE seconded the motion, and said that he brought the question before the London Society, when Dr. Reid at once said that he was going to bring it before the branch. As country medical officers coming from different parts of the district, they really met to consult their brethren. On two occasions he had come there purposely to get the opinion of other medical officers of health as to whether he should take legal proceedings or not, and had some of the remarks h e made at the last meeting been reported in the daily papers he would not have been allowed to carry out the proceedings he had contemplated. He thought that the consultations for which they met would be very much hampered by the presence of reporters from the lay papers unless they made it a practice to go into committee. He did not object at all to the annual meeting being reported, tie referred to meetings which were practically consultations on delicate points connected with their work as medical officers of health. Dr. MAY said that they were much indebted to Dr. Reid for the way in which he had introduced this matter, and the fact that Dr. Reid's judgment was in favour of such a proposal was a strong argument for it. But he (Dr. May) felt very reluctant indeed to interfere with an arrangement which had gone on for the last seventeen years. He would not say the existence of the society, but a very great deal of the importance that the society possessed was due to the kindness and the support that it had always received from the press. (Hear. hear.) The society had, he believed, exercised a very great influence upon the vublie through the admirable reports that had been published in the papers of what had been clone at their meetings. He also thought that their remarks and their debates had been muck chastened and improved by the fact that they knew there was " a chiel amang us takin' notes." In the things he had said there he had never lost sight of the faot that there were reporters present ; and if he had wished to say anything it* private he simply mentioned his desire, and he had felt that that, altogether apart from the good sense and discre tion of the reporters, gave him security. He had been sorry to learn that in at least two instances matters had been reported that were not intended for publication, but he could not help thinking that these instances