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regularly to the Medical Officer or Officers of Health within the union. It is very important that this information should reach the Medical Officer of Health without delay, and the Board trust that arrangements will be made for the regular transmission of the copies referred to as early as practicable after each meeting.
"I am directed to add that the Board recommend that the Guardians should request the Poor-law Medical Officers to give to the Medical Officer of Health, or Inspector of Nuisances, acting within their respective districts, the earliest possible information of cases of dangerous infectious disease under their charge; as it is evident that unless such information is given as soon as the cases occur, the action of the Sanitary Authority, in regard to the prevention of contagion, must often fail in its effect.
Now this letter deserves study, first as an illustration of the mode in which the Local Government Board does its sanitary business; next, as an illustration of the fashion in which it deals with sanitary law; and finally as an illustration of its knowledge of sanitary matters. As to the business aspect of the letter, let it be noted that although duties were imposed upon certain Medical Officers of Health on the 11th November, 1872, by the Board itself, the Board took no steps to render these duties capable of being performed until the 23rd March, 1874. Indeed, as is known from other sources, the Board actually, in the course of last year, called for the tabular statements of sickness and mortality from Medical Officers of Health, knowing all the while that such returns, owing to its own action, could not be prepared. Seventeen months after the Board imposed certain duties, it issues the instructions which render the performance of such duties practicable, and which should have preceded or accompanied the imposition of the duties! As to sanitary law, let it be noted that since the passing of the Public Health Act 1872 some of the Sanitary Authorities created by it have, of their own motion and with the assent of their law clerks, procured for their Medical Officers of Health returns of deaths and causes of death from the registrars and paid for them, but the auditors have invariably disallowed the charge. Such disallowance has caused infinite dissatisfaction, because, judging from the practice of some of the
older Sanitary Authorities, it was held to be erroneous. mischievous effect of the disallowance need not be dwelt upon; but now it is discovered that the law of the Board was wrong, and the law of the snubbed Sanitary Authorities right. The Board blunders mischievously for months before it does what it ought to have done at first, when a doubt had arisen, namely, seek authoritative advice on the subject. As to knowledge of sanitary matters, let it be noted that the Board has at length come to the knowledge that the prevention of contagion, as an important part of the Medical Officer of Health's duties, is really a work which should be facilitated. In fact, from beginning to end of this letter, we can perceive that the Board has been determined to deal with sanitary work as an entirely new kind of labour, and with sanitary officers as entirely new inventions, concerning both of which previous experience could teach nothing.
How far the instructions issued will meet the difficulties they are intended to overcome is doubtful. They probably include all that the Local Government Board is at present empowered to do; and if this be the case, it is very needful when sanitary questions again come before the Legislature that the returns requisite for the efficient performance of a Medical Officer of Health's duties should be provided for. That legislation in this direction will be necessary must be obvious when it is considered that, except as to returns of deaths, the recent instructions do not apply to Urban Sanitary Authorities.
The foregoing circular is so far satisfactory as affording an earnest of better sanitary work from the new President of the Local Government Board.
Four other resolutions were passed by the Conference in the category under consideration. These resolutions were to the following effect:-With the view of bringing a district under sanitary supervision, it was held to be desirable that a detailed house-to-house survey should be made of the whole of it. It was held also desirable that a uniform set of forms for sanitary survey and other purposes should be issued for future use by the Local Government Board. It was further considered expedient that the Medical Officer of Health should be authorised generally to represent the Sanitary Authority under Section 48 of the
Sanitary Act 1866, in order to meet special emergencies; the Conference holding it to be objectionable that he should take the conduct of ordinary proceedings for the suppression of nuisances. Finally, the Conference was of opinion-wateranalysis being frequently essential for sanitary purposes, and the Local Government Board having expressed an opinion that Medical Officers of Health cannot be called upon to perform analyses without special remuneration-that the Board should determine what the remuneration should be.
The third category of resolutions referred to " Matters relating to the amendment or enlargement of Sanitary Law." The resolutions in this category will not command entire assent. The first proceeds to recite that there is urgent need for further legislation for the protection of the public health (a position which will ever be disputed); and amongst the matters for which such legislation, in the opinion of the Conference, should provide, is "the enlargement of the coercive powers generally of the Local Government Board over Sanitary Authorities, and especially in regard to the following matters, viz. : the compulsory combination of neighbouring Sanitary Authorities for objects which, in the opinion of the Board, can only be effectually carried out by such combination; and the compulsion of every Sanitary Authority to provide, either by itself or in combination with some other Authority or Authorities, a proper place for the reception of cases of infectious disease." While admitting that greater compulsory powers might be advisable with respect to the several objects here enumerated, it may be asked, after the late experience of the administrative capacity of the Local Government Board in sanitary matters, whether the Legislature would be justified in giving increased power to this Board?
Other matters which the Conference held to require amended or enlarged legislation are thus stated:-" The enlargement of the powers given for arresting the spread of infectious diseases, especially by the enforcement of a report to the Sanitary Authority of every case of such disease immediately on its occurrence; by the compulsory isolation of all cases in which, in the opinion of the Medical Officer of Health or any medical practitioner acting on his behalf, adequate provision cannot be made by the friends of the patient for this purpose; and by the
inl ticabl to then practitio ar indirect Assumin would give asked for, wo We believe it the very attem kind here conte Other matters legislative powe lution of rivers used or availabl ment of the pov supply of water compulsion of ev sufficient supply
powers of Sanitar house-accommoda able houses; and evils, the inclusio houses below a ce which Sanitary A gation and under case of sewers, wate ments;-and the er the duty of scaveng which are construct piers of which have Would it be poss regulate the action and repair of dwelli such a power being Authority in responsib Another resolution d ment of the Sanitary I
of establishing uniform
infliction of penalties on those who, by the neglect of such practicable precautions for arresting the disease as are recommended to them by the Medical Officer of Health or any medical practitioner acting on his behalf, are the means of either directly or indirectly spreading it."
Assuming (a somewhat wild assumption) that the Legislature would give to the Medical Officer of Health the powers here asked for, would it be possible to carry them out in practice? We believe it would not be so to any useful extent, and that the very attempt would show their futility. Precautions of the kind here contemplated are practicable only on paper.
Other matters for which the Conference held that increased legislative powers were wanted were: the protection from pollution of rivers and other natural sources of water which are used or available for use for drinking purposes; the enlargement of the powers of Sanitary Authorities in regard to the supply of water to limited portions of their districts, and the compulsion of every householder to provide for his tenants a sufficient supply of wholesome water; the enlargement of the powers of Sanitary Authorities to deal with insufficiency of proper house-accommodation in their districts, and with uninhabitable houses; and, with a view of providing a remedy for these evils, the inclusion of the erection and repair of dwellinghouses below a certain value in the category of improvements which Sanitary Authorities may carry out, after full investigation and under proper restrictions, as is now done in the case of sewers, waterworks, and other similar sanitary requirements; and the enforcement on every Sanitary Authority of the duty of scavenging all privies and other similar receptacles which are constructed and kept to its satisfaction, the occupiers of which have no convenience for so doing."
Would it be possible to devise "proper restrictions" to regulate the action of a Sanitary Authority in "the erection and repair of dwelling-houses," and which would admit of such a power being workable, without involving the Sanitary Authority in responsibilities it could not reasonably fulfil?
Another resolution of the Conference relating to the amendment of the Sanitary Laws was to the effect "That, with a view of establishing uniformity of action in sanitary matters and of
providing for the proper carrying out of statutory enactments, the Local Government Board should obtain parliamentary powers to enable it to draw up, for the use of Sanitary Authorities generally, a code of bye-laws, and that such code should contain provisions, with penalties for their enforcement, in respect of the following amongst other matters:-(a) The prevention of overcrowding; (b) the proper keeping of common lodginghouses; (c) the keeping of pigs and other animals, and the proper construction of the places in which they are slaughtered or kept; (d) the proper construction of new buildings intended for human occupation, the cleansing of privies and ash-pits, and the removal of accumulations of refuse of all kinds. That the Local Government Board should forward to every Sanitary Authority which is not previously provided with such bye-laws a copy of such code, with notice of its intention to enforce the same, subject to any additions, omissions, or amendments which the Authority may suggest, and which it shall be in the discretion of the Board to sanction."
We congratulate the Medical Officers of Health for Combined Districts on the success of their first Conference, and we trust that it is but the prelude to Conferences of the Medical Officers of Health for all kinds of districts.