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The need of a state department of public health
Sep~m~,~l ,A State Department oI Public Health
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THE NEED OF A STATE DEPARTMENT OF PUBLIC HEALTH.* BY JOHN HIGttET, M.D., Medical Officer of Health of ]Vorkington. MY first duty is to thank you, and that most sincerely, for the high honour you have done me in placing me for the ensuing year in the Presidential Chair, and to assure you that so far as my limited powers allow it will be my earnest endeavour during my term of office to do all,that I can to further the interests of this Border Branch of the British Medical Association. On an occasion such as this it is the invariable rule, I understand, to expect from your President something in the nature of an address. I cannot, if I would, escape from this custom, though in this case, in the words of the poet, I think I may truly ~ay that it hangs upon me as " a weight heavy as frost and deep almost as life." In the few remarks which I have to offer you I intend to return to a subject which has already attracted my attention, and which I very imperfectly dealt with in a paper which I wrote some years ago on the matter of " State Obligations in Relation to Public Health "; and I am the more inclined to do so because, being myself a medical officer of health, and having been for some time actively engaged in public health work, I feel that I can on this account speak from an experience which has extended over many years, and with a conviction which time has only served to deepen. The question, then, to which for a short time I wish to direct your attention is on the neceisity which I think exists for the establishment of a State Department of Public Health, with a special Minister attached. I venture to call this an important question, the most important, to my mind, on which public attention can and ought to be concentrated. And yet when one thinks about it and looks around at the callousness and indifference displayed, the undue importance attached to some other matters of the most trivial interest, one wonders how it is that this subject has hitherto ~-eceived so little attention at the hands of the Legislature. For after all, as Mr. Disraeli said in his memorable speech delivered in the Free Trade Hall, Manchester, 1872, " T h e first consideration of a ~Iinister ought to be the health of the people. Pure air, pure water, the inspection and condemnation of unhealthy habitations, the adul* Presidential Address read before the Border Counties Branch of the British Medical Association, July, 1900.
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teration of food, and many kindred matters, might be legitimately dealt with by the Legislature." I need not tell you, for it is a matter on which you are all informed, how public health affairs are at present regulated in this country; but it is not too much to say that the special department, the Local Government Board, is simply crowded out with work, that i~ is woefully undermanned in the matter of special Scientific assistance, and that it is utterly unfitted to deal efficiently with the grea~ sanitary problems which stand ready for solution. To throw even part of the work upon county councils, parish councils, and the like, only tends, in m y opinion, to make matters rather worse instead of better. It is the whole head that is sick. Decentralization in this way will not help us or supply us with a remedy. It is a mere sop thrown at the heads of the great British public by men who, like Gallio, c a r e for none of these things, intended no~ so much to fulfil any useful practical purpose, so far as sanitary matters are concerned, as to minister to that ~spirit of self-complacency and self-importance which for the time being at least are the special narcotics which lull the mind of the public into a state of false security. The necessary awakening can only be accomplished 'in one way--educate, educate, educate! Show the people the fools' paradise in which they are living--alast that it should be said many of them dying !--the need for further State interference in matters of public health, and then reform will speedily come. Let every constituency throughout the length and breadth Of the land impress upon its representatives that a few millions annually devoted to the preservation of human life, instead of to its destruction, would be sound policy from an economic point of view, and tha~ such a course !s indeed in strict keeping with that great period of social reform towards which.we hope the future of our race is tending. This is a matter in which we must work out our own salvation--we, the so.called intelligent and independent electors of this great country. And now it may be asked, What am I complaining about , and what do I want ? To the first query my answer, as I have tried to point out to you, is, The.maladministration of public health affah's. As to the second, I may as well be honest and admit tha~ I am afraid I want a good deal more than I am ever likely to see accomplished in my lifetime, and this for reasons that may become obvious later on. I am pleading, as I have before said, for the establishment of a great Sta~ Department of Public Health, with a special Minister attached, for a separate and distinct Government service which
September, 19001
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shall take upon itself the whole sanitary administration of the country, which shall concern itself alone ~vith this and other matters hereinafter to be mentioned. For I think no one will be bold enough to contend that the present system is a success, weighted down as it is with work which has enormously increased during the last few years--valuable and useful work, too, but which from want of arranging and systematizing is capable of producing little or no result, from which the country derives but scant benefit and the public health little or no improvement. I dare say none of y6u, except those specially interested, have ever taken the trouble to read the regulations issued by the Local Government Board for the guidance of medical officers of health, dated 1872. I will not read them to you in detail, for though art be long, yet life is short; but they impose duties of a most comprehensive character, and their proper fulfihnent demands special knowledge, which under the present conditions is in few cases obtainable. These appointments are, for the most part, held by men who are deeply engaged in other professional work; the remuneration in most cases is far from princely, varying on an average from s 10s. in rural districts to 214 10s. in urban, and the medical officer of health, being but human, is apt in too many instances to preach according ~ his stipend. Further, he has strong local influences to contend with, and a conscientious discharge of his duty is nearly certain sooner or later to bring him into collision with certain of his authority, with the result of resignation or dismissal. But if the conditions required and imposed upon a medical officer of health .by the Order of 1872 were exacting, and if properly carried out trespassed so much upon his time, in return for which, as we have already seen, he is not in some cases allowed even the wages of a common labourer, how much less is he able to cope with the added legislation which the last few years have placed upon the sanitary statute-book! What, it m a y be asked, are the two most pressing sanitary questions before the country at the present time ? Clearly, I think, the prevention of consumption and the better housing of the working classes. Both questions are intimately connected with each other, are problems of the very highest importance, and ought to bear heavily, provided they are handled in an active and energetic manner, on the time at the disposal of the medical officer of health. The housing question specially demands, and is likely soon to receive at t~he hands of the Legislature, increased attention. The Housing of thh Working Classes Act of 1890 is cumbrous to a degree, and the Bill which the present
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Government have introduced hardly touches this great question at all. It is useless to expect medical officers of health under existing circumstances to tackle this subject with afiy prospect of success. A burning of one's fingers is likely to be the nett result, an.d probably a curt intimation that it would be better to leave it severely alone. And this brings me to the question of the further obligations of the State in matters of public health. In this direction I regret to say that so far the tendency of successive Governments has been to relieve themselves as much as possible from further responsibility, and to devolve the powers ripen county councils, parish councils, and the like: By the Local Government Act of 1888 it was enacted that county councils might, if they deemed it expedient--note the language used --appoint medical officers of health for each of their counties. The matter was left entirely optional, and what has been the result.? At the present time some twelve counties have availed themselves of the powers granted by" the Act, while the rest have.either deemed it inexpedient to make any change in the present existing unsatisfactory conditions, or have contented themselves by having the returns tabulated for them, and there the matter ends. This very county in which we are adopts this practice, and even refuses an increase of salary to the gentleman it deputes to do the work. It cannot be maintained that there is not sufficient work to keep a county medical officer in healthy work, or that the present administration of sanitary affairs is so perfect that it needs no improving. The answer must be sought for in another direction, and is to be found in the feeble, supine manner in which matters of public health are regarded by many of these local authorities, and b y t h e so-called spirit of economy meted ou~ to this special department of the work. How, I ask, is all this to be altered ? 9 In the first place, as I have said, by educating public opinion, and this, I ~hink, is work in which thi3 association may well take part; by impressing upon our representatives in Parliament, and through them the Government of the day, our determination to have a State Board of Health, presided over by a i~[inister of Public Health, himself a member of the medical profession, whose selection should be due to his transcendent professional abilities, and not to his political leanings. I suppose for want of a better system we must continue to have government by party, but personally I am not in favour of this Minister being influenced by" the ris~ and fall of each successive Government, for this would necessitate such constant changes in the management of the department as would be detrimental to its best interests. The appointment, once made,
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should be azlt vitam aut c~dpam ; but a limitation as to age might be agreed upon, so that retirement could be induced at a given time. k Minister of Public Health and a State Board of Health--what is to be the function of this latter? Briefly, it must concern itself with all matters relating to the public h e a l t h of the community, with all that is known at the present day by the name of Hygiene, with this further addition, which appears to me desirable--that each c o u n t y medical officer of health should be superintendent registrar for the district under his control, and i n criminal cases have the conduct of post-mortem examinations. I shall not be surprised if this latter suggestion meets with some adverse criticism at your hands, but I have very little doubt in my own mind that the present system is unsatisfactory, and I can see no difficulty why special training for such work should not be included in qualifying for admission into this special service. Having supplied herself with a capable Minister, the State should attract and attach to her service in the meantime at least, say, twelve of the leading medical sanitarians of the day, the same to constitute the Board, these twelve to have respective districts assigned to them over which they are the heads, and for the administration of which they would be held to be responsible. Further, the Board must have the power of insisting upon every county in England supplying 9itself with the services of a thoroughly competent and well-trained official, whose qualification in the meantime at least should be that he has provided himself with a diploma in State Medicine. In the course of time, I should prefer to see the Board institute an examining body, where the standard shall be unif9rm, and where every practitioner who cares to devote himself to t h e work, and can satisfy the examiners as to his efficiency, shall be enrolled in the department, and shall be eligible for such appointments as may occur. In the case of county councils (and, as I have already shown, they are many) which have not up to the present time provided themselves with county medical officers of health, or in the event of any vacancy occurring in those already supplied, the Board should take upon itself the appointing of the same, having, as before stated, satisfied itself as to the capabilities of the individual with whom'their selection rests, and such appointment ought to be aut vitam mtt culpam, dismissal or retirement being subject to the authority of the State Board of Health. During the present session of Parliament an attempt was made by Dr. Farquharson to get through the House a Bill which was of special interest to medical officers of health and inspectors of
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nuisances, inasmuch as it aimed at fixity of tenure, but for ths present at least its further progress is blocked. I confess that at first I was much enamoured of the said Bill, and felt inclined to give it my heartysupport. But on further ~hinking Out t h e scheme, which I "now lay before you, for an entire re-arrangement of the public health service of this country,, it seemed to me desirable to approach this question of fixity of tenurg from a different direction than that contemplated in the Bill. I am, as you m/~y have gathered, quite as much in favour of fixity of tenure as Dr. Farquharson, both for medical officers of health and inspectors, but subject to certain conditions. I am quite aware that the said conditions would affect my own position, and that failure to fulfil them Would necessitate m y own retirement from the public health service. But I cannot help this : one's duty to the community, of which, after all, one is only a small part, must ever exceed one's duty to one's self, though it is.said that self-preservation is the first law of Nature. And what are these conditions Y Simply compliance with the requirements of the State Board as to admission into the service, and then fixity of tenure by all means on the lines I have already laid down. Let it be clearly understood by this Board, which in a short time would be able to regulate its examinations by supply and demand, as is done in the medical departments of the army and navy, that admission into its service would bring a salary of, say, not less than ~250 a year for a start, with the prospect of increase as promotion came, and I am certain the State would have no difficulty in attracting and attaching many of the best young practitioners, who a t the present time stand back disgusted with the competition, which becomes keener and keener every day, for even the most ill-paid sanitary appointments. Fancy the services of a gentleman to act as whole-time medical officer of health, medical officer to the infectious hospital, and surgeon to the police, being asked for at an inclusive salary of ~200 a year ! .What trades union would stand such a state of things? The State Board should also take upon itself to regulate the standard of efficiency for sanitary inspectors: These might well be increased in most districts, and extended powers given them as soon as it was determined they were capable of administering the same. I have thus shown you--somewhat hurriedly and imperfectly, I fear--how, in my opinion, the State might more intimately and with better results than are at present obtained connect itself with this subject of public health. And you ma3~ remember that I was candid enough at the outset to express the opinion that I wanted a good deal more than I was ever likely to see accomplished in my
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lifetime, at least. Tim why and wherefore now becomes apparent to you. It is not only a question of money, for when the public health of a nation i s concerned, this should and ought to be got over ; but it means a transference, so to speak, of the spending of much of that mone~, from local authorities (who are jealous of the patronage which this affords them) to a central Board, over which these same would have little or no control. "This seems to be a putting back of the hands of the political clock with a vengeance. I admit all this and something fimre, for I want this matter removed from all political and party strife. Government for the people, most certainly yes, but by the people in this case and at "the present time, most assuredly not yet. Where is the Ministry to be found that dare risk such an experiment ? I confess I do not know, though the benefits to be derived appear to me to be incalculable. You gain, in the first place, a distinct Department of Public Health, presided over by a Minister, himself a skilled member, and you bring the whole sanitary administration of the country into closer touch. The medical inspectors give advice and counsel to the county medical officers, these transmit it to their subordinates, and the whole machinery moves like clockwork. Reports which are now thrown into the waste-paper basket would become valuable, suggestions and improvements as to public health would be carried out, and the general well-being of the community would be benefited thereby. By the adoption of the system which I have feebly tried to sketch out for you, the State Board of Health could at a moment's notice inform itself as to the general sanitary surroundings and state of public health in any district, strengthen what was weak, and, without waiting for the panic induced by epidemic disease, continue to push forward the good work of sanitation. A medical officer of health who, as at present, is hampered and beset by local influences and considerations soon gets to know that he cannot get much of the' work in which he is interested can:led out, and if he is a wise man he bows to the inevitable, and ceases to kick against the pricks. This, it may be said, sounds very much like making unto one's self friends:of the mammon of unrighteousness, and yet, I regret to say, i~ is the inevitable out, 9 come of the system, or the want of system, he is forced to carry out. There are not a few martyrs, it would be found if. the matter were inquired into, whose excess of zeal in public health affairs has led to retirement or dismissal. It is this argument mainly which is at the bottom of the agitation for fixity of tenure which finds expression in Dr: Farquharson's Bill, but this same, u n l e s s the conditions are altered,' will not, in m y opinion, solve this question
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of public health. What is wanted is.a modern Hercules to sweep clean the whole stable. Query, is such a one likely to arise ? Most of us, I dare say, considering the present tone and temper of public.affairs, would be inclined to answer in the negative. And yet we need not despair. When the poet sighed and sang for " t h e coming of that glorious time," the question of free education was far removed from the region qf practical politics, and yet to-day it is an accomplished fact. The progress of social evolution in the future must, as Mr. Kidd says, be more and more i n the direction of bettering at the public expense the condition of the lower class of workers, and this can only be done by State interference and., State control. Thai other countrie's feel the same want and are alive to the importance of this question is evidenced by the account of the proceedings at the Health Conference in America, held in Atlantic City, New Jersey, on the 1st of this month. Dr. Wingate, the president, delivered an address on the subject of a National Commission of Public Health, and expressed the opinion that some organization separate and apar~ from any other service, devoting its entire time to a consideration of the public health, and presided over by a c6mpetent member of the medical profession, should be created by Congress. Meantime, education and agitation are the two main factors to which we must look for hope. To this end and towards the development of a great State service of public health this association may render great and useful help, and it is witl~ this purpose mainly in view that I have ventured to bring this matter before you. To most of you who are unconnected with public health work I must apologize for offeriug you what must be a dull and uninteresting paper, and to all I would tgnder my best thanks for the patient hearing you have given me.
THE SALE OF Po~so.~s.---The LondoT~ Gazette of August 1st contains an announcement that the Lords of the Privy Council have approved a resolution passed hy the Council of the Ph~rmaceutice,[ Society of Great Britain declaring that liquid preparations of carbolic acid and its homologues containing more than 3 per cent. of those substances (except any preparation prepared for use as sheep.wash, or for any other purpose in connection with agriculture or horticulture, and conrained in a closed vessel, distinctly labelled with the word "Poisonous," the name and address of the seller, and a notice of the agricultural or horticultural purpose for which the preparation has been prepared) ought to be deemed poisons within the meaning of the Pharmacy Act, 1868, and ought to be deemed poisons in the second part of Schedule A of the said Pharmacy Act, 1868.--Law Journal.
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THE NEED OF A STATE DEPARTMENT OF PUBLIC HEALTH.* BY JOHN HIGttET, M.D., Medical Officer of Health of ]Vorkington. MY first duty is to thank you, and that most sincerely, for the high honour you have done me in placing me for the ensuing year in the Presidential Chair, and to assure you that so far as my limited powers allow it will be my earnest endeavour during my term of office to do all,that I can to further the interests of this Border Branch of the British Medical Association. On an occasion such as this it is the invariable rule, I understand, to expect from your President something in the nature of an address. I cannot, if I would, escape from this custom, though in this case, in the words of the poet, I think I may truly ~ay that it hangs upon me as " a weight heavy as frost and deep almost as life." In the few remarks which I have to offer you I intend to return to a subject which has already attracted my attention, and which I very imperfectly dealt with in a paper which I wrote some years ago on the matter of " State Obligations in Relation to Public Health "; and I am the more inclined to do so because, being myself a medical officer of health, and having been for some time actively engaged in public health work, I feel that I can on this account speak from an experience which has extended over many years, and with a conviction which time has only served to deepen. The question, then, to which for a short time I wish to direct your attention is on the neceisity which I think exists for the establishment of a State Department of Public Health, with a special Minister attached. I venture to call this an important question, the most important, to my mind, on which public attention can and ought to be concentrated. And yet when one thinks about it and looks around at the callousness and indifference displayed, the undue importance attached to some other matters of the most trivial interest, one wonders how it is that this subject has hitherto ~-eceived so little attention at the hands of the Legislature. For after all, as Mr. Disraeli said in his memorable speech delivered in the Free Trade Hall, Manchester, 1872, " T h e first consideration of a ~Iinister ought to be the health of the people. Pure air, pure water, the inspection and condemnation of unhealthy habitations, the adul* Presidential Address read before the Border Counties Branch of the British Medical Association, July, 1900.
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teration of food, and many kindred matters, might be legitimately dealt with by the Legislature." I need not tell you, for it is a matter on which you are all informed, how public health affairs are at present regulated in this country; but it is not too much to say that the special department, the Local Government Board, is simply crowded out with work, that i~ is woefully undermanned in the matter of special Scientific assistance, and that it is utterly unfitted to deal efficiently with the grea~ sanitary problems which stand ready for solution. To throw even part of the work upon county councils, parish councils, and the like, only tends, in m y opinion, to make matters rather worse instead of better. It is the whole head that is sick. Decentralization in this way will not help us or supply us with a remedy. It is a mere sop thrown at the heads of the great British public by men who, like Gallio, c a r e for none of these things, intended no~ so much to fulfil any useful practical purpose, so far as sanitary matters are concerned, as to minister to that ~spirit of self-complacency and self-importance which for the time being at least are the special narcotics which lull the mind of the public into a state of false security. The necessary awakening can only be accomplished 'in one way--educate, educate, educate! Show the people the fools' paradise in which they are living--alast that it should be said many of them dying !--the need for further State interference in matters of public health, and then reform will speedily come. Let every constituency throughout the length and breadth Of the land impress upon its representatives that a few millions annually devoted to the preservation of human life, instead of to its destruction, would be sound policy from an economic point of view, and tha~ such a course !s indeed in strict keeping with that great period of social reform towards which.we hope the future of our race is tending. This is a matter in which we must work out our own salvation--we, the so.called intelligent and independent electors of this great country. And now it may be asked, What am I complaining about , and what do I want ? To the first query my answer, as I have tried to point out to you, is, The.maladministration of public health affah's. As to the second, I may as well be honest and admit tha~ I am afraid I want a good deal more than I am ever likely to see accomplished in my lifetime, and this for reasons that may become obvious later on. I am pleading, as I have before said, for the establishment of a great Sta~ Department of Public Health, with a special Minister attached, for a separate and distinct Government service which
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shall take upon itself the whole sanitary administration of the country, which shall concern itself alone ~vith this and other matters hereinafter to be mentioned. For I think no one will be bold enough to contend that the present system is a success, weighted down as it is with work which has enormously increased during the last few years--valuable and useful work, too, but which from want of arranging and systematizing is capable of producing little or no result, from which the country derives but scant benefit and the public health little or no improvement. I dare say none of y6u, except those specially interested, have ever taken the trouble to read the regulations issued by the Local Government Board for the guidance of medical officers of health, dated 1872. I will not read them to you in detail, for though art be long, yet life is short; but they impose duties of a most comprehensive character, and their proper fulfihnent demands special knowledge, which under the present conditions is in few cases obtainable. These appointments are, for the most part, held by men who are deeply engaged in other professional work; the remuneration in most cases is far from princely, varying on an average from s 10s. in rural districts to 214 10s. in urban, and the medical officer of health, being but human, is apt in too many instances to preach according ~ his stipend. Further, he has strong local influences to contend with, and a conscientious discharge of his duty is nearly certain sooner or later to bring him into collision with certain of his authority, with the result of resignation or dismissal. But if the conditions required and imposed upon a medical officer of health .by the Order of 1872 were exacting, and if properly carried out trespassed so much upon his time, in return for which, as we have already seen, he is not in some cases allowed even the wages of a common labourer, how much less is he able to cope with the added legislation which the last few years have placed upon the sanitary statute-book! What, it m a y be asked, are the two most pressing sanitary questions before the country at the present time ? Clearly, I think, the prevention of consumption and the better housing of the working classes. Both questions are intimately connected with each other, are problems of the very highest importance, and ought to bear heavily, provided they are handled in an active and energetic manner, on the time at the disposal of the medical officer of health. The housing question specially demands, and is likely soon to receive at t~he hands of the Legislature, increased attention. The Housing of thh Working Classes Act of 1890 is cumbrous to a degree, and the Bill which the present
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Government have introduced hardly touches this great question at all. It is useless to expect medical officers of health under existing circumstances to tackle this subject with afiy prospect of success. A burning of one's fingers is likely to be the nett result, an.d probably a curt intimation that it would be better to leave it severely alone. And this brings me to the question of the further obligations of the State in matters of public health. In this direction I regret to say that so far the tendency of successive Governments has been to relieve themselves as much as possible from further responsibility, and to devolve the powers ripen county councils, parish councils, and the like: By the Local Government Act of 1888 it was enacted that county councils might, if they deemed it expedient--note the language used --appoint medical officers of health for each of their counties. The matter was left entirely optional, and what has been the result.? At the present time some twelve counties have availed themselves of the powers granted by" the Act, while the rest have.either deemed it inexpedient to make any change in the present existing unsatisfactory conditions, or have contented themselves by having the returns tabulated for them, and there the matter ends. This very county in which we are adopts this practice, and even refuses an increase of salary to the gentleman it deputes to do the work. It cannot be maintained that there is not sufficient work to keep a county medical officer in healthy work, or that the present administration of sanitary affairs is so perfect that it needs no improving. The answer must be sought for in another direction, and is to be found in the feeble, supine manner in which matters of public health are regarded by many of these local authorities, and b y t h e so-called spirit of economy meted ou~ to this special department of the work. How, I ask, is all this to be altered ? 9 In the first place, as I have said, by educating public opinion, and this, I ~hink, is work in which thi3 association may well take part; by impressing upon our representatives in Parliament, and through them the Government of the day, our determination to have a State Board of Health, presided over by a i~[inister of Public Health, himself a member of the medical profession, whose selection should be due to his transcendent professional abilities, and not to his political leanings. I suppose for want of a better system we must continue to have government by party, but personally I am not in favour of this Minister being influenced by" the ris~ and fall of each successive Government, for this would necessitate such constant changes in the management of the department as would be detrimental to its best interests. The appointment, once made,
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should be azlt vitam aut c~dpam ; but a limitation as to age might be agreed upon, so that retirement could be induced at a given time. k Minister of Public Health and a State Board of Health--what is to be the function of this latter? Briefly, it must concern itself with all matters relating to the public h e a l t h of the community, with all that is known at the present day by the name of Hygiene, with this further addition, which appears to me desirable--that each c o u n t y medical officer of health should be superintendent registrar for the district under his control, and i n criminal cases have the conduct of post-mortem examinations. I shall not be surprised if this latter suggestion meets with some adverse criticism at your hands, but I have very little doubt in my own mind that the present system is unsatisfactory, and I can see no difficulty why special training for such work should not be included in qualifying for admission into this special service. Having supplied herself with a capable Minister, the State should attract and attach to her service in the meantime at least, say, twelve of the leading medical sanitarians of the day, the same to constitute the Board, these twelve to have respective districts assigned to them over which they are the heads, and for the administration of which they would be held to be responsible. Further, the Board must have the power of insisting upon every county in England supplying 9itself with the services of a thoroughly competent and well-trained official, whose qualification in the meantime at least should be that he has provided himself with a diploma in State Medicine. In the course of time, I should prefer to see the Board institute an examining body, where the standard shall be unif9rm, and where every practitioner who cares to devote himself to t h e work, and can satisfy the examiners as to his efficiency, shall be enrolled in the department, and shall be eligible for such appointments as may occur. In the case of county councils (and, as I have already shown, they are many) which have not up to the present time provided themselves with county medical officers of health, or in the event of any vacancy occurring in those already supplied, the Board should take upon itself the appointing of the same, having, as before stated, satisfied itself as to the capabilities of the individual with whom'their selection rests, and such appointment ought to be aut vitam mtt culpam, dismissal or retirement being subject to the authority of the State Board of Health. During the present session of Parliament an attempt was made by Dr. Farquharson to get through the House a Bill which was of special interest to medical officers of health and inspectors of
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nuisances, inasmuch as it aimed at fixity of tenure, but for ths present at least its further progress is blocked. I confess that at first I was much enamoured of the said Bill, and felt inclined to give it my heartysupport. But on further ~hinking Out t h e scheme, which I "now lay before you, for an entire re-arrangement of the public health service of this country,, it seemed to me desirable to approach this question of fixity of tenurg from a different direction than that contemplated in the Bill. I am, as you m/~y have gathered, quite as much in favour of fixity of tenure as Dr. Farquharson, both for medical officers of health and inspectors, but subject to certain conditions. I am quite aware that the said conditions would affect my own position, and that failure to fulfil them Would necessitate m y own retirement from the public health service. But I cannot help this : one's duty to the community, of which, after all, one is only a small part, must ever exceed one's duty to one's self, though it is.said that self-preservation is the first law of Nature. And what are these conditions Y Simply compliance with the requirements of the State Board as to admission into the service, and then fixity of tenure by all means on the lines I have already laid down. Let it be clearly understood by this Board, which in a short time would be able to regulate its examinations by supply and demand, as is done in the medical departments of the army and navy, that admission into its service would bring a salary of, say, not less than ~250 a year for a start, with the prospect of increase as promotion came, and I am certain the State would have no difficulty in attracting and attaching many of the best young practitioners, who a t the present time stand back disgusted with the competition, which becomes keener and keener every day, for even the most ill-paid sanitary appointments. Fancy the services of a gentleman to act as whole-time medical officer of health, medical officer to the infectious hospital, and surgeon to the police, being asked for at an inclusive salary of ~200 a year ! .What trades union would stand such a state of things? The State Board should also take upon itself to regulate the standard of efficiency for sanitary inspectors: These might well be increased in most districts, and extended powers given them as soon as it was determined they were capable of administering the same. I have thus shown you--somewhat hurriedly and imperfectly, I fear--how, in my opinion, the State might more intimately and with better results than are at present obtained connect itself with this subject of public health. And you ma3~ remember that I was candid enough at the outset to express the opinion that I wanted a good deal more than I was ever likely to see accomplished in my
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lifetime, at least. Tim why and wherefore now becomes apparent to you. It is not only a question of money, for when the public health of a nation i s concerned, this should and ought to be got over ; but it means a transference, so to speak, of the spending of much of that mone~, from local authorities (who are jealous of the patronage which this affords them) to a central Board, over which these same would have little or no control. "This seems to be a putting back of the hands of the political clock with a vengeance. I admit all this and something fimre, for I want this matter removed from all political and party strife. Government for the people, most certainly yes, but by the people in this case and at "the present time, most assuredly not yet. Where is the Ministry to be found that dare risk such an experiment ? I confess I do not know, though the benefits to be derived appear to me to be incalculable. You gain, in the first place, a distinct Department of Public Health, presided over by a Minister, himself a skilled member, and you bring the whole sanitary administration of the country into closer touch. The medical inspectors give advice and counsel to the county medical officers, these transmit it to their subordinates, and the whole machinery moves like clockwork. Reports which are now thrown into the waste-paper basket would become valuable, suggestions and improvements as to public health would be carried out, and the general well-being of the community would be benefited thereby. By the adoption of the system which I have feebly tried to sketch out for you, the State Board of Health could at a moment's notice inform itself as to the general sanitary surroundings and state of public health in any district, strengthen what was weak, and, without waiting for the panic induced by epidemic disease, continue to push forward the good work of sanitation. A medical officer of health who, as at present, is hampered and beset by local influences and considerations soon gets to know that he cannot get much of the' work in which he is interested can:led out, and if he is a wise man he bows to the inevitable, and ceases to kick against the pricks. This, it may be said, sounds very much like making unto one's self friends:of the mammon of unrighteousness, and yet, I regret to say, i~ is the inevitable out, 9 come of the system, or the want of system, he is forced to carry out. There are not a few martyrs, it would be found if. the matter were inquired into, whose excess of zeal in public health affairs has led to retirement or dismissal. It is this argument mainly which is at the bottom of the agitation for fixity of tenure which finds expression in Dr: Farquharson's Bill, but this same, u n l e s s the conditions are altered,' will not, in m y opinion, solve this question
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of public health. What is wanted is.a modern Hercules to sweep clean the whole stable. Query, is such a one likely to arise ? Most of us, I dare say, considering the present tone and temper of public.affairs, would be inclined to answer in the negative. And yet we need not despair. When the poet sighed and sang for " t h e coming of that glorious time," the question of free education was far removed from the region qf practical politics, and yet to-day it is an accomplished fact. The progress of social evolution in the future must, as Mr. Kidd says, be more and more i n the direction of bettering at the public expense the condition of the lower class of workers, and this can only be done by State interference and., State control. Thai other countrie's feel the same want and are alive to the importance of this question is evidenced by the account of the proceedings at the Health Conference in America, held in Atlantic City, New Jersey, on the 1st of this month. Dr. Wingate, the president, delivered an address on the subject of a National Commission of Public Health, and expressed the opinion that some organization separate and apar~ from any other service, devoting its entire time to a consideration of the public health, and presided over by a c6mpetent member of the medical profession, should be created by Congress. Meantime, education and agitation are the two main factors to which we must look for hope. To this end and towards the development of a great State service of public health this association may render great and useful help, and it is witl~ this purpose mainly in view that I have ventured to bring this matter before you. To most of you who are unconnected with public health work I must apologize for offeriug you what must be a dull and uninteresting paper, and to all I would tgnder my best thanks for the patient hearing you have given me.
THE SALE OF Po~so.~s.---The LondoT~ Gazette of August 1st contains an announcement that the Lords of the Privy Council have approved a resolution passed hy the Council of the Ph~rmaceutice,[ Society of Great Britain declaring that liquid preparations of carbolic acid and its homologues containing more than 3 per cent. of those substances (except any preparation prepared for use as sheep.wash, or for any other purpose in connection with agriculture or horticulture, and conrained in a closed vessel, distinctly labelled with the word "Poisonous," the name and address of the seller, and a notice of the agricultural or horticultural purpose for which the preparation has been prepared) ought to be deemed poisons within the meaning of the Pharmacy Act, 1868, and ought to be deemed poisons in the second part of Schedule A of the said Pharmacy Act, 1868.--Law Journal.