to the medical officer of health at the offices of the board, and shall carry out without delay, in respect thereof, any measures for disinfection that he may direct.

"16. The owner or occupier of any registered house shall attend any meeting of the board, or sanitary committee thereof, to which he shall be summoned by letter or notice left at least three days clear beforehand at the house referred to, to answer any complaint made against him, or either of them, in respect to neglect of these regulations, and shall forthwith carry out such order as he may receive from the board, or sanitary committee, or medical officer of health, made with a view to bring his house into conformity therewith.

"17. A copy of these regulations shall be left for the owner of the premises affected, by the officer appointed by the board, as soon as his house is registered, and the infringement of any regulation shall render the offender liable to penalities not exceeding 40s. for any one offence, with an additional penalty not exceeding 20s. for every day during which a default in obeying such regulations may continue.

"The penalties shall be recovered in the same manner as directed by the 54th Section of the Sanitary Act 1866."

For further provisions concerning lodging-houses, see Appendix I.

3. Dwellings unfit for Habitation. With regard to dwellings which are so dilapidated as to be unfit for occupation in districts where the Artizans' and Labourers' Dwellings' Act is in force, it will be the duty of the health officer to report to the local sanitary authority on all such buildings, leaving it to the engineer or surveyor to point out what improvements may be necessary, or whether the whole of the premises, or parts of them, should be demolished. According to the Statute (see Appendix I.), such report may be of the briefest description, and unless encouraged by the sanitary authority to make suggestions, the health officer should merely certify that such and such buildings, in their present state

6

or condition, are dangerous to health, and unfit for human habitation. With regard to such buildings, Mr. Simon observes," By places unfit for human habitation,' I mean places in which, by common consent, even moderately healthy life is impossible to human dwellersplaces which therefore in themselves (independently of removable filth which may be about them) answer to the common conception of nuisances;' such, for instance, as those underground and other dwellings which are in such constructional partnership with public privies, or other depositories of filth, that their very sources of ventilation are essentially offensive and injurious; and dwellings which have such relations to local drainage that they are habitually soaked into by water or sewage, and so forth. But beyond these instances where the dwelling would, I think, even now be deemed by common consent unfit for human habitation,' instances varying in degree are innumerable, where, in small closed courts, surrounded by high buildings and approached by narrow and perhaps winding gangways, houses of the meanest sort stand, acre after acre of them, back to back, shut from all enjoyment of light and air, with but privies and dust-bins to look upon; and surely such can only be counted fit for human habitation' while the standard of that humanity is low. Again, by 'overcrowded' dwellings, I mean those where dwellers are in such proportion to dwelling-space that no obtainable quantity of ventilation will keep the air of the dwelling-space free from hurtfully large accumulations of animal effluvium-cases where the dwelling-space at its best stinks more or less with decomposing human excretions, and where at its worst this filthy atmosphere may (and very often does) have working and spreading

within it the taint of some contagious fever. And as a particular class of cases, in which both evils are combined in one monstrous form of nuisance, I ought expressly to mention certain of the so-called 'tenement-houses' of the poor; especially those large but ill-circumstanced houses, once perhaps wealthily inhabited, but now pauperised, and often without a span of courtyard either front or back; where in each house, perhaps, a dozen or more rooms are separately let to a dozen or more families—each family with but a room to itself, and perhaps lodgers; and where in each house the entire large number of occupants (which even in England may be little short of a hundred) will necessarily have the use of but a single staircase, and of a privy, which perhaps is placed in the cellar." (See Eighth Report of the Medical Officer of the Privy Council.)

In re

This was written in 1865, and since then the Sanitary Act of 1866, and the Artizans' and Labourers' Dwellings' Act of 1868, have been passed to remedy the evils so forcibly described by Mr. Simon. porting upon such dwellings, the medical officer of health must always take into account the general circumstances relating to the house-accommodation of his district, bearing in mind that sanitary improvements, even though they can be enforced by law, must be gradual where the evils to deal with are so gigantic, and that the house-accommodation, bad though it be, is better than no accommodation at all. (See Chapter VIII.)

With regard to cleanliness of premises, however, such as whitewashing, removal of filth, etc., he should have no hesitation in urging the sanitary authority to put in force the powers with which they are invested

by the Statutes, and see that they are carried out. (See Appendix I.)

4. Cellar-dwellings. (See Appendix I.)

5. Food. The duties of the health officer in respect to the inspection of food, and directions for its examination, are given in Appendix I. and Chapter II. Health officers, who are also public analysts under the Adulteration Act of 1872, must be specially qualified.

6. Infectious or Contagious Diseases.-This subject has been already so fully treated in the previous chapter, that little more need be said here. The statutory powers are given in Appendix I., together with the orders of the Local Government Board, relating more especially to smallpox epidemics and quarantine.

In the presence of any epidemic prevailing in or threatening his district, it will devolve on the health officer to recommend or not, as he thinks fit, the enforcement of the Prevention of Diseases Act, and it need hardly be said that this discretionary power should be exercised with all due discrimination, because the Sanitary Act of 1866 gives the sanitary authority full power to deal with all such diseases occurring within the district. Under the provisions of this Act, the health officer may recommend the erection of a contagious diseases hospital (see Chapter IX.), a mortuary or mortuaries, disinfecting premises, etc. With these aids for the prevention of epidemic disease, and the powers conferred by the Act with respect to the removal of the sick, disinfection, etc., it can only, in cases of the gravest emergency, and when the health of the district is seriously endangered, be incumbent on the health officer to recommend the enforcement of the Diseases Prevention Act.

As regards this subject, the following remarks from the articles in the Medical Times and Gazette, already referred to, are well worth quoting:-" On the promptitude, energy, tact, and skill, of the medical officer, it will in a great measure depend whether a disease spreads or not. At the same time we must warn him against becoming an alarmist. If a medical officer once cries 'Wolf!' and no wolf comes, his advice is liable to be thought of little account when he again raises the alarm of an impending epidemic. The prognosis of an epidemic must be given with great caution and reserve.

"As regards the detailed measures to be taken to check infectious and contagious diseases, our Own practice, which works well, is to instruct the sanitary inspector to visit and keep under surveillance every house in which enteric fever, typhus, relapsing fever, scarlet fever, diphtheria, smallpox, or diarrhoea has appeared, and to report to us on the sanitary or unsanitary condition of the premises. No difficulty is experienced in gaining access to even the best class of houses, if the sanitary inspector exercises tact and discretion. Let it be known that the object is to advise the inmates as to the best course to pursue, and that no officiousness or interference with the treatment of the patient is intended. In cases of difficulty, or where several cases of the disease have existed in a house or neighbourhood, it will be requisite that the medical officer should himself visit. Care should be taken to insure as far as possible the use of disinfectants. And where the sanitary authority sanctions the practice, it is a wise economy to furnish disinfectants gratuitously to those who are very poor, but this should not be done without the authority of the board under whom the