Sanitary Districts having several Medical Officers of Health.These districts have been almost wholly formed according to the advice first given by the Inspectors of the Local Govern

1 R. rural; U. urban.

ment Board, that the Poor-law Medical Officers should be made the Medical Officers of Health. The number of districts of this kind already formed exceeds seventy. We cannot give the list entire, and we must content ourselves with taking samples from it, picking them out promiscuously from the alphabetical arrangement.

Ashby-de-la-Zouch, rural, has appointed six Medical Officers of Health for a total acreage of 51,952 and population of 31,532, and these officers it pays "according to services." Auckland, rural, with an acreage of 59,303 and a population of 69,153, has three Medical Officers of Health, to each of whom a salary of 507. is given. Aylsham, rural, has seven Medical Officers of Health for an acreage of 68,123 and a population of 18,115, and to each Medical Officer a salary of 107. is given as a species of retaining fee, and 17. 1s. for every report of examination of premises. Barnstaple, with an acreage of 148,729 and a population of 37,406, has eleven Medical Officers of Health, who are paid 17. 1s. for each report they make, and are allowed 1s. per mile one way for travelling expenses. Bath, rural, has an acreage of 27,719 and a population of 18,690, with five Medical Officers of Health, having salaries varying from 20l. to 251. Belper, rural, appoints two Medical Officers of Health for an acreage of 65,764 and a population of 52,864, at a salary of 150l. each. Chippenham, rural, has seven Medical Officers of Health for an acreage of 58,100 and a population of 21,800, at salaries ranging from 91. to 237. Conway, rural, with an acreage of 30,778 and a population of 9,877, has two Medical Officers of Health, to each of whom a salary of 107. is given. Croydon, rural, is arranged in three districts, each with its respective Medical Officer of Health, as follows: (a), area 7,590, population 9,423, salary 601.; (b), area 6,269, population 3,110, salary 301.; (c), area 10,205, population 2,466, salary 301. Guildford, rural, with an acreage of 68,996 and a population of 24,461, has eight Medical Officers of Health, to each of whom it pays 10l. a year, and gives a fee of 10s. 6d. for every nuisance which he is called to inspect. Halstead, rural, has an acreage of 38,913 and a population of 18,453, with two Medical Officers of Health, each having a salary of 607. Haverfordwest gives "fees according to circumstances" to four Medical Officers of Health, the acreage of

the district being 169,700, and the population 34,500. Kingsbridge, rural, has appointed five Medical Officers of Health to a district of 73,455 acres and a population of 19,700, and it pays them 17. for every "case" they may be called to. Nuneaton, rural, is divided into two districts, each with its Medical Officer of Health one district has an area of 4,200 and a population of 514, with a salary of 77. 10s. attached; the other has an area of 1,500, with a population of 208, and a salary of 51. Pontefract, rural, is also divided into two districts, each with its separate Medical Officer of Health, and each Medical Officer of Health having a salary of 501.; but the one district has an area of 31,800 and a population of 10,000, the other district an area of 17,600 and a population of 9,400. Tavistock, rural, has appointed six Medical Officers of Health for an area of 159,317 acres and a population of 31,240, and to each of them it pays 25 per cent. on their salaries as Poor-law Medical Officers. Wantage, rural, for an acreage of 75,700 and a population of 17,360, has two Medical Officers of Health, to each of whom is given a salary of 251. Warrington, rural, with an area of 29,500 acres and a population of 22,300, has also two Medical Officers of Health, to each of whom is given a salary of 1007. Wickham, rural, with an acreage of 73,000 and a population of 72,000, has two Medical Officers of Health, each with a salary of 501.

There may be in the foregoing arrangements some harmony, hidden from crass unofficial judgment, between the appointments and the duties for which the appointments were presumed to be made. The appointment of the Poor-law Medical Officers as Medical Officers of Health was the scheme of the Royal Sanitary Commission, and although a crude one, it might in proper hands have been turned to good account. But here we have precisely the same kind of result as would have followed from putting a musical instrument for the first time into a child's hand, namely, a series of discords.

Sanitary Districts, uncombined, which have elected a single Medical Officer of Health.-Districts of this class far outnumber either of the other classes described. The list before us contains 340 of such districts. The appointment of Medical Officers of Health in the greater number of these districts has no doubt been made by the sanitary authorities independently of the Local

Government Board. Districts which had appointed Medical Officers of Health prior to the Public Health Act 1872 have been excluded from consideration. A great proportion of the districts included in this category are urban, and thus it would seem highly probable that the astonishing inconsistencies in the advice given to sanitary authorities by the Inspectors of the Local Government Board has had the effect of largely alienating urban districts from the Board. It is very difficult to deal with the districts contained in this category so as to convey any just impression of the characters of the appointments which have been made in them. We have analysed the appointments with reference first to area of districts, as perhaps most serviceable for use.

Twenty-two districts have areas of under 500 acres. In these districts the populations range from 1,300 to 19,000, the salaries of the Medical Officers of Health from 10l. to 50l.

Thirty districts have an area of 500 acres and under 1,000, the populations varying from 414 to 33,900, the salaries of the Medical Officers of Health from 107. to 100%.

Forty-three districts have an area of 1,000 acres and under 2,000, the populations varying from 296 to 42,000, the salaries of the Medical Officers of Health from 31. 3s. to 2007. The minimum salary is attached to the smallest population, but the salary attached to the largest (42,000) is only 50%.

Thirty-six districts have areas of 2,000 acres and under 3,000, with populations varying in number from 570 to 90,000. In these districts the salaries of the Medical Officers of Health range from 10l. to 500l. The Medical Officer of Health of the smallest population receives 107., of the largest 2001.

Twenty-five districts have an area of 3,000 acres and under 4,000, with populations varying from 2,600 to 127,700, the salaries of the Medical Officers of Health varying from 51. to 1507. The salary attached to the district of smallest population is 107, to the district of largest population 201. and fees for port sanitary work.

Twenty-three districts have an area of 4,000 acres and under 5,000. Their populations vary from 1,500 to 83,000, the salaries of the Medical Officers of Health from 40l. to 4007.

Forty-nine districts have an area of 5,000 acres and under

10,000, the populations varying from 3,400 to 355,000, the salaries of the Medical Officers of Health from 57. to 500l.

Twenty-eight districts have an area of 10,000 acres and under 20,000, the populations varying from 2,500 to 112,000, the salaries of the Medical Officers of Health from 30%. to 1607.

Thirty districts have an area of 20,000 acres and under 40,000, with populations varying from 2,400 to 239,900, the salaries of the Medical Officers of Health varying from 17. 1s. each inspection to 6007. yearly.

Of the remaining districts in our list (eighty-four), the areas vary from 40,000 acres to upwards of 100,000, the populations from 3,000 to 215,000, the salaries of the Medical Officers of Health from 207. to 5007.

If we examine these appointments on the basis of salary, their general incongruousness is shown in another aspect. The following illustrations may be given :

Mr. Stansfeld, in November 1872, defined his public health policy to be the development of local health self-government under the impartial guidance of his Board. Twelve months' application of his policy has been to bring about a state of local health self-anarchy, not because the policy was wrong, but because the means he adopted to give it effect were utterly bad.