Fine, STEVENS, J. Adulteration of Butter. STEWART, JOHN. Adulterated Whisky. Case TEBB, WILLIAM. Non-Vaccination of Child. TIPPLE, THOMAS. Sending Diseased Meat TUNESI, P. Selling Poisonous Sweets. Judg- ment. Fine, 64 TYNE PLATE GLASS COMPANY. Non-con- 418 147 VESTRY OF MARYLEBONE V. OWNER OF UN- VIALLS V. HALL. Application to restrain VINCENT, W. Adulteration of Milk. Fine, WAGNER, P. Adulteration of Bread. Fine, WALLER, FARMER AND CLARK. Discharging Mud into the Thames. Fine, 65 WALLIS, R. Milk Adulteration. Fine, 221 WEILAND, MAJOR. Impure Well in the City. | WOLLEY. SCOTT, MEESON V. SCOTT. Action 351 Brief Notes of Cases. Building on Dust Shoots, 41 Came into force Costs of Opposing an application for Provi. Disposal of Sewage, 339. Distress in an Infected House, 143 Dog Nuisance. Public Health Act has no 149 Bagshaw v. Buxton Local Board, 270 Baker v. Wisbeach Mayor. Rights as to Barnes v. Edleston. Interpretation of Statutes, Prest v. Royston Union. Audit, 307 Legal Pro- 1875, 204 v. Rippon. Election, 353 Water Company Powers. Richmond and Wood v. Harrogate Commissioners. Pollution Legal Notes, Queries, and Adulteration of Food Act. Analyst's Fees, 6 Improperly constructed of Medical Officers. A Medical Officer Pauper Inhabi- Increase in Number of Board of Guardians, Public Health Nuisances Removal Acts. Pri- Tea. Act came in force January 1, with No. 105, July 1, 1876. Special Reports. Furlong, 397. Boarding out of Pauper Children, the, 412 Chelsea, by Dr. Barclay, 368 Chesterfield, by Dr. Angus Mackintosh, Doncaster Sanitary Authority for 1875, by Dr. Fairbank, 285 Effects upon Human Life and Health, on the, Fox, Dr. Cornelius B., on the Impurities of Air Firle, by Dr. Sanger, 414 Health and Sewage of Towns, 333 Institution of Civil Engineers; Sewage Inter- Chimney Sweeps Act, 1876, 12 Drainage of the Thames Valley, 268 Enclosures Act, 133, 145 Hackney, by Dr. Tripe, Medical Officer of Harrogate Board of Health, 431 Hanley, by Dr. J. Swift Walker, 368 Health of Newcastle-on-Tyne in 1875, by H. E. Holsworthy Union, by T. L. Ash, L.R.C.P., Imprisonment for Breach of Vaccination Act, Knightsbridge Barracks, 202 Medical Men in Merchant Ships, 334 Medical Relief Grants, 268 Street Improvement Act, 351 Government of London, 132, 416 Infantile Deaths in Coventry, by Dr. Fenton, Martley Union, by G. E. Hyde, Medical Poisonous Drugs to Animals, (Sir J. Astley), 159 Public Health Act and Local Government Middlesex and Hertfordshire combined Radford District for 1875, 285 Rating, 77 Purification of the Clyde, 300 Rawlinson's Report on Sewage, 416 Sewage Discharged into the Thames (Sir C. and Rivers Pollution, 334 Skipton and Settle, Yorkshire, by Dr. West Street Accidents, 268 Grant, 145 Vivisection Bill, The, 369 Reviews. Crime in England and Wales, by W. Hoyle, 224 Deutsche Vierteljahrschrift für öffentliche Dictionary, a, of Hygiene and Public Health, Food, its Adulteration and the Methods for Manuals of Health; Personal Care of Health, Our Canal Population, by G. Smith, F.S.A., 288 Popular Summary, a, of Public Health and Proposed Sewerage at Urmston, by G. H. Tidman's Sea Salt, 339 Public Health in Germany, 205 Seeds of Disease, by Dr. A. Ransome, 289 Tongue's Patent Disinfecting Apparatus, 207 Woman in the Reign of Queen Victoria, by CORRESPONDENCE, 12, 31, 48, 66, 81, 82, 99, Sanitary Inventions. Earth to Earth Coffins, 372 Eucalyptus Globulus Soap, the, 290 115, 116, 135, 151, 169, 187, 207, 225, 241, NOTICES OF MEETINGS, 307, 323, 339, 335, SANITARY PATENTS, 15, 48, 66, 83, 117, 136, APPOINTMENTS OF MEDICAL HEALTH OF- FICERS, 14, 32, 48, 66, 82, 99, 117, 135, 153, L Original Papers. THE POWERS AND DUTIES OF MEDI- Medical Officer of Health, Hexham and Haltwhistle WHEN I promised our secretary to read a paper at this meeting, I fully intended to enter into the whole subject of the 'powers and duties of medical officers of health.' Circumstances, however, by which my time has been much occupied with private matters have prevented me from doing so, and unwilling to withdraw my promise altogether, I have endeavoured in a small measure to fulfil it, confining the following remarks at the present time to that branch of the subject which relates to the ' 'powers of medical officers of health with regard to infectious diseases,' hoping at some future time to continue the subject in a more careful manner than I have been able to do now. I must, therefore, crave your indulgence in the meantime for the very hasty and imperfect manner in which the following few remarks have been thrown together. These remarks, which I now offer for your consideration, refer more to certain difficulties which medical officers of health encounter in the performance of their various duties, and to the absolute want of power which, in many cases, prevents the adoption of such measures as they deem essential to sanitary progress, rather than to the very limited powers which they at present possess. The first point I shall refer to, is that of obtaining speedy information of the existence of infectious diseases. It is true that in many districts the neighbouring practitioners willingly afford that information to the medical officer of health, but this entirely depends on their courtesy and willingness to do so. In my own district, I am happy to say, that there is not one practitioner in it who has refused to give me information of the existence of infectious disease in his own practice. But this is not enough. No public official should be dependent on such means for acquiring a knowledge of what is absolutely necessary for the proper performance of his duties, and I can conceive no hardship in its being made compulsory on every medical practitioner to give immediate notice to the health officer of the occurrence of every case of infectious disease in his own practice. In large towns, during the prevalence of cholera, it has been customary to make this obligatory on medical attendants, and it is certainly much more necessary in the case of zymotic diseases which are of much more frequent occurrence. There need be no difficulty nor any great trouble required in doing this. Blank printed and stamped forms, similar to vaccination certificates, might be furnished by Government for this purpose, and all the trouble necessary would be for the practitioner to insert the date, name, residence, and disease of the patient. Not only should it be compulsory on the medical * Read before the meeting of the Northern Counties Association of Medical Officers of Health, at Keswick, October 6, 1875. Dr. Elliott, of Carlisle, president. man to supply this information, but it should be incumbent on all householders to report immediately to the medical officer of health the existence of infectious disease within his house. It is compulsory on keepers of common lodging-houses to do so, and there can be no reason why private individuals should not be compelled to do so also. Although this would be most useful, there can be no doubt that the certificate of the medical attendant would afford the most reliable information. Thus, whether there had been a medical attendant or not, information would be afforded to the medical officer of health. Of course, there would be the usual outcry about 'unpaid services' by medical men, but burdens upon them, I cannot conceive this to be one, averse as I am to the imposition of unnecessary so essential as it is for the effectual carrying out of sanitary action. By such means, the most complete statistics of the amount, geographical distribution and mortality of zymotic diseases would be obtained, and the 'registration of diseases and deaths' would become a source of the most useful information, which, as matters exist at present, cannot be said to be the case. Having acquired information of the existence of a case of infectious disease, our next difficulty arises from the want of power to insist on the adoption of means for preventing its spread, and according to the common sense and willingness, or ignorance and obstinacy of those with whom he has to deal, is the benefit or otherwise which will accrue from any action which the medical officer of health may take; and it is not difficult to estimate the disastrous effects which may follow from this absoof health. With the two exceptions of (1) its being lute want of power on the part of the medical officer illegal for a person not fully recovered from an infectious disease, to appear in public, and (2) its being illegal to let a house, or part of a house, in which a case of infectious disease has occurred, without previously disinfecting it, there is not a single provision in the Act whereby power is given to the medical officer of health to act independently of the sanitary authority, and to insist on means being taken to prevent the spread of disease. It is true that, by section 120, a local authority may, on the certificate of their medical officer of health, give notice to the owner or occupier of an infected house, to cleanse and disinfect it within a specified time; but no power is given to the medical officer time necessitated by this mode of proceeding renof health to do this, and consequently the loss of With regard to the prevention of the spread of disders the section in many cases practically useless. ease by isolating the patient-I refer specially, at an infected present, to prevention of visitors to person-there is no provision; although lately proceedings have been taken, under section 126, against a man who was in attendance on cases of small-pox, and afterwards went to his usual work. The case was as follows--and is gratifying as regards this single instance; but whether the statute can be, or, rather, will be, put into force on other occasions of a less gross character, remains to be seen. tract the case from the Lancet of October 2. 'A I ex linen-weaver, of Leeds, was charged at the policecourt of that town with what the magistrate, in pronouncing sentence, described as a "very imprudent act." It appeared, in evidence, that this weaver had a son who was unfortunately attacked with smallpox, and who died on September 9. It may here be parenthetically remarked, that this weaver has, or rather had, five children, not one of whom had been vaccinated, and all of whom have had smallpox; but this was not the " imprudent act" of which he has been found guilty. While the son above mentioned was suffering from small-pox, the weaver, like a dutiful father, sat up with the patient at night, but went to his work every day in the same clothes. He was engaged in a linen factory, where he had charge of a room in which sixty girls used to work. The result of the importation of the infection of small-pox into this room was that, at the time of hearing of the case, ten or twelve of the girls were stricken with the disease, and three had already died. The weaver was charged, under section 126 of the "Public Health Act, 1875," with having exposed, without previous disinfection, clothing which had been exposed to the infection of a dangerous disorder. He was convicted, and sentenced to pay a fine of 5., or, in default, to suffer two months' imprisonment. This was the offence which the Leeds magistrate described as a "very imprudent act." We confess that we should have been inclined to describe it in much stronger terms. Perhaps, however, under the circumstances, we ought to feel satisfied that the new "Public Health Act" contains a clause under which a magistrate, who regards so lightly such an offence as that of which the Leeds weaver was guilty, feels bound to convict.' Now, however gratifying such a conviction is, it seems to me very doubtful that many magistrates would take the same view of the statute as was taken here. The section is as follows. Any person who gives, lends, sells, transmits, or exposes, without previous disinfection, any bedding, clothing, rags, or other things, which have been exposed to infection, etc., shall be liable, etc." Such is the section of the Act, which quite evidently never was intended to apply to such a case as I have quoted. The case was a very gross one; but presuming any medical officer of health summoned a person, who had first visited an infected case and then mixed with others, in such places as a publichouse, railway carriage, or private dwelling, would any or how many magistrates convict under this section? Were we sure that it would be done always, an immense assistance to medical officers of health would be provided. In my own district lately, small-pox was rapidly and fatally spread in a large colliery village from a single imported case, and in almost every instance the disease was found to have spread from one house to another simply by the incautious visiting by friends of those affected. Had I possessed power to prevent this by any means, and to threaten prosecution should untoward results ensue, I feel confident that very few cases would have occurred. The great benefit which would accrue from a certainty that persons spreading disease in this manner would be convicted, is well exemplified in the following instance, which also occurred in my own district. A girl who had been in attendance on a case of small-pox in the same village I have referred to, on the death of the patient returned to her home at a distance of twelve miles, without having taken the slightest precaution against conveying infection, was seized with small-pox a few days afterwards, and thus became another centre for the spread of the disease. Another difficulty presents itself in the case of those who are willing to take advice, namely, the want of means to effect isolation. In the houses of the poor it is quite impossible to do this from want of space, and even if willing to be removed from the other members of the family, the question comes to be where are they to be removed to? In most 'rural districts it would be quite impossible to send them to a hospital, and failing the provision of a. fever-house' by the local authority, for the whole district, I have advocated that when infectious disease occurs in a village, or near one, a single unused cottage should be set aside for the reception of patients, who should at once be removed from their surroundings; and for this purpose the medical officer of health should be empowered to make the suitable arrangements. For instance, had the first case of small-pox I have mentioned been removed to such a cottage, and the house in which she was thoroughly disinfected, the probability is that the disease would have been stamped out, instead of forming, as it did, the nucleus of a considerable epidemic. A paper issued by the Medical Department of the Privy Council in 1871, 'for the assistance of health authorities who would provide requisite hospital accommodation within their districts,' contains the following: 'Each village ought to have the means of accommodating in stantly, or at a few hours' notice, say four cases of infectious disease, in at least two separate rooms; a decent four-room or six-room cottage at the disposal of the authority would answer the purpose; or permanent arrangements might be made beforehand with trustworthy cottage-holders without children, to receive and nurse in case of need, patients requiring such accommodation.' A very excellent suggestion of the Privy Council, but why should this not be imperative on, instead of merely permissive to, sanitary authorities? We know from experience, how little good is effected by merely permissive measures, and indeed throughout the Sanitary Act, an immense step would be made, and incalculable good effected, by, in almost every instance where it occurs, substituting the word 'shall' for 'may.' Dr. Bond, of the Gloucestershire Combined District, has made another proposal to his authority, which I cannot but consider a most extraordinary one-namely, to remove the healthy inmates to lodgings or other houses, distributing them if necessary (which would frequently be the case), and leav ing the infected person in his own house! I can conceive no more completely certain a method of rapidly increasing cases of infectious disease, than by this proposal, for not only might the other members of the family become media for conveying the disease to others, even if unaffected themselves, but the disease might be incubating in their own persons, and thus they might themselves become centres of disease. All these foregoing suggestions are based on the supposition that the medical officer of health has always ready access to cases of infectious disease; but this is by no means a necessity. Any ignorant person, and they are plentiful enough, persons of the anti-vaccinationist' type, may refuse admittance to the medical officers of health, may decline giving any information regarding the origin of the disease; and others, granting both admittance and information, may, at their will, refuse to use any of the means indicated by him for preventing the spread of disease. The remedy for all these difficulties, and that which must eventually obtain, is, that all cases of infectious disease, should, except in the matter of treatment, be under the control and direction of the medical officer of health, who should have full power to enter any house in which infectious disease is |