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SECTION XI.

THE DUTIES OF SANITARY OFFICERS.

CHAPTER XXXV.

THE DUTIES OF SANITARY OFFICERS.

DUTIES AND QUALIFICATIONS OF MEDICAL OFFICERS OF HEALTH.

(436) Qualifications of Medical Officers of Health.

THE qualifications of a Medical Officer of Health are expressly laid down by the Local Government Act, 1889, sect. 18. "Except where the Local Government Board, for reasons brought to their notice, may see fit in particular cases specially to allow, no person shall hereafter be appointed the Medical Officer of Health of any county or county district, or combination of county districts, or the deputy of any such officer, unless he be legally qualified for the practice of medicine, surgery and midwifery.

"No person shall after the 1st of January, 1892, be appointed the Medical Officer of Health of any county or of any such district or combination of districts as contained according to the last published census for the time being a population of 50,000 or more inhabitants, unless he is qualified as above mentioned, and also is either registered in the medical register as the holder of a diploma in sanitary science, public health or State medicine under section 21 of the Medical Act, 1886, or has been during three consecutive years preceding the year 1892, a Medical Officer of a district or combination of districts, with a population, according to the last published census of not less than 20,000, or has before the passing of this Act been for not less than three years a Medical Officer or Inspector of the Local Government Board."

The qualifications then with regard to future appointments are, adequate experience in a sufficiently populous place, or passing a particular examination.

(437) Duties of Medical Officers of Health.

There are at the present time several classes of Medical Officers of Health.

I. Medical Officers of Health for a county, as for example the county of London.

II. Medical Officers of Health for exclusively urban districts, as for example Metropolitan Health Officers, or those for Liverpool, Manchester, Bradford.

III. Medical Officers of Health for a port sanitary district.

IV. Medical Officers of Health for combined rural and urban districts.

V.

Poor-law Medical Officers, acting as Medical Officers of Health and others. This last class of appointments is profoundly unsatisfactory; individual officers here and there do good work, and this is cited as a defence of the system; but as a rule the appointments of this nature are only colourable, and the duties are insufficiently performed by medical men whose occupations do not admit of their paying the requisite attention to the subject.

I. Duties of County Medical Officers of Health.

This class of officers, created by the Local Government Act of 1889, has so recently been called into existence that there is but little experience as yet as to the nature of the duties. It is, however, obvious, that presuming the County Officer has official connexion with Officers of Health of the districts, he will receive regularly all the reports annual, monthly, or special that they have submitted to their respective authorities. He will tabulate and study the statistics relative to sickness and mortality. He will personally with the aid of the local Medical Officer of Health investigate any unusual incidence of disease. He will, where necessary, urge upon the local authority to undertake schemes of sewerage or water supply. His advice will be specially valuable in drawing out local regulations as to offensive trades, the framing of bye-laws and the like. The legislation which is now confidently expected in the formation of district councils will, without doubt, define the relation that the County Council will have to the district boards, and make this outline of the duties possible to be put into practical effect.

II. Duties of Urban Medical Officers of Health.

In urban districts there is a good deal of variety in the duties. Some urban districts, like those of the metropolis, are governed by special, local or general Acts. For example, the City of London has a code of laws differing in detail from the rest of the country; the other metropolitan districts are governed by the Metropolis Local Management Acts, by the Sanitary Act of 1866, by the Nuisance Removal Acts and several others. (The Public Health Acts as a whole are not in force in the metropolis.) Hence the duties laid down by the Local Government Board (see page 601), are not in force in the metropolis,1 but they are chiefly regulated by custom and by resolutions of the Vestry or District Board. Similarly local Acts obtained from time to time modify the details of the work in some urban districts. Nevertheless as a whole they are similar in all, and in the following sketch, the details of official duty are those which seem to the writer, from his personal experience and from a study of what is actually done in the model urban districts, as likely to ensure efficiency of local health administration.

(a) Attendance at the Health Office.-It is essential that the Health Officer attend with the greatest regularity at stated and published times at an office provided by the Local Authority in order that he can interview the inspector or inspectors, give them directions, and be accessible to any person who desires personally to lay a complaint or to consult the Health Officer.

(b) Supervising the Work of the Inspectors.-The Inspectors should be compelled to submit each morning a diary of the work of the preceding day; the diary being written with sufficient detail to show exactly how they have been employed, what visits they have made, and so forth. Their outside work should be checked by occasional visits of the Health Officer to premises previously visited by the Inspectors, and by comparing the state as reported by the Inspector with the state found. The Medical Officer of Health will particularly note any grave defects which may have been passed over by the Inspector, thereby proving incompetence or negligence. (c) Inspection of Premises.-The Health Officer should personally inspect premises in certain cases, viz., when the Inspector's report is disputed; when legal action for the enforcement of a sanitary order

1 Save in those instances in which half the salary is paid by the L. G. B.

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