The Public Health Act, 1872, with special Reference to Plymouth, Devonport, and Stonehouse. By CHRISTOPHER BULTEEL, F.R.C.S., Surgeon to the Royal Albert Hospital, Devonport.

IT

has been seen very clearly that, for the proper development of our sanitary laws, two things were requisite: first, the enactment of new provisions under which the whole country should be placed, for sanitary purposes, under one central jurisdiction, sanitary presiding over local sanitary areas and authorities throughout the land; secondly, the consolidation of the existing sanitary laws into one harmonious whole. These subjects have been placed in the above order, not so much to mark their relative importance-for just now they are almost equally important; nor will one without the other satisfy the wishes of this Association-as to indicate the author's opinions as to their order of sequence, should it be impossible to accomplish both objects in one session of Parliament; and this is just what has taken place-the Public Health Act is passed, and Sir Charles Adderley's important Bill of consolidation is left for another year. The above order of sequence appears to be desirable, because, had Parliament commenced with consolidation, they would no sooner have completed it than a new Public Health Act would have followed, which itself would require the process of consolidation. It is quite true that, at the rate at which we are at present going in this fast age, no new enactment for the public health or any other object can be expected to have more than a limited finality; but still it appears desirable that some new Public Health Act such as that which has just passed should be enacted previous to the consolidation of the existing sanitary laws, and that such Act should no sooner be passed than consolidated, as it is to be hoped it will be in the next session of Parliament, opportunity being taken at that time, while consolidating, also to remedy existing defects, and amend faulty provisions. That there are still such deficiencies and faults in the Public Health Act, 1872, is an opinion on which the Council of this and the kindred British Medical Association have already pronounced their verdict; but that the above Act is so defective and faulty that it had better have been thrown out until a more perfect Act could be passed, is an opinion from which the writer of this paper strongly dissents. Nothing will tend more than the passing of this Act to test the soundness or otherwise of the views held by the Social Science Association; and the very breaking down of the machinery at different points, should it occur, will be the means of pointing out where the faults and deficiencies are, and of leading to their being remedied in the Act of Consolidation expected by the country in the next session of Parliament.

It is not the object of this paper to take a general review of the Public Health Act in all its bearings, but merely, in the first place, to refer to some of its more important provisions, pointing out where, in the author's opinion, the chief defects lie; and in the second place,

to give such opinions as shall be expressed a local application to the three towns of Plymouth, Devonport, and Stonehouse.

The provisons of the Act, passed under review, will be those relating to sanitary areas, sanitary authorities, and the appointment of medical officers of health.

I. As regards sanitary areas. It is scarcely necessary to remind this Association that under the Public Health Act the whole of England is divided into urban and rural sanitary districts, an urban district being a borough, or an improvement Act district, or any place under the Local Government Act, all other places being rural; that in urban districts the town council, the improvement commissioners, or the local board, are the ruling sanitary authority, while in rural districts the board of guardians undertakes that office, and that over the whole machinery the Local Government Board presides as the central authority,

Now, this arrangement involves three important defects, which ought to be remedied. First, and most important, is the want of a go-between, or intermediate authority between the local sanitary district and the central Local Government Board; for the present arrangement preserves the worst features both of centralization and of local government, as was so ably pointed out by G. W. Hastings, Esq., the illustrious President of the Council of this Association, in his admirable speech at Leeds, last year. The local government, especially in rural districts, is left in anything but desirable hands, unless the local authority is efficiently controlled by a superior authority nearer home than the Local Government Board; while the central power cannot but become most unpopular, because it will have to poke its fingers into every little parish pie, and cannot fail to raise the cry, and very properly too, against over-centralization. What is wanted, then, is evidently the creation of an intermediate area, and an intermediate authority between the individual sanitary district and the central board in London; and the obvious suggestion is that already made by this and the kindred Association, that each county should constitute such an area, and that a county board should be such an intermediate authority.

The second defect alluded to is the inconsistency as concerns rural districts, of placing some of them under one authority, and some under another, according to the accidental circumstances of their having, or not having adopted the Local Government Act; and thus the argument of uniformity, which was doubtless aimed at in making the boards of guardians the local sanitary authority in rural districts, entirely falls to the ground, while the obvious suggestion comes to the front-of which more by-and-bye-Why not secure uniformity by enforcing the Local Government Act throughout the country?

The third defect with regard to area appears to be that the ultimate local area of a parish or union is far too small. For rural districts at least the whole county should be mapped out into larger areas, consisting of unions of increased size, or, which amounts to much the same thing, divisions of counties of larger or smaller

extent. The Public Health Act, 1872, points in the direction of larger areas under sections 22 and 26. Section 22 empowers the Local Government Board to alter the area of a district, while section 26 provides for the same thing being done on the application of any sanitary district. But is not this clumsy legislation? Parliament should have made up its mind as to what is a desirable limit for the area of a sanitary district, and have carried it out promptly and fearlessly thus simplicity would have been obtained, and complications avoided.

II. As regards sanitary authorities.

(A) In urban districts the town council, the improvement commissioners, or the local board, are to be, as before, the sanitary authorities; and in all probability they are as good as any other body selected by the ratepayers is likely to be, but let it not be supposed that they are as fit for this work as they ought to be. Even town councils are not always characterized by as much common sense and other desirable qualities which might be mentioned, as ought to distinguish them if they are to be intrusted, not merely with the pockets, but with the health of the ratepayers; and here the opportunity may not unfairly be taken of suggesting to this Association, as a sphere of action not unworthy of social science, the desirability of bringing to bear on the general public, and especially on the upper classes, the importance of taking more interest than they do in the election of their local parliament. Can no means be adopted, such as the suggestion of a local standing committee, entirely free from political bias, who shall voluntarily devote themselves to the task of pointing out to the ratepayers the kind of men who should be elected, securing them as candidates, and giving them active support? There can be no question that within the last twenty years the materials of which town councils and boards of guardians consist have sadly deteriorated; and in many places matters have come to such a pass that it is with the greatest difficulty a gentleman or a first-class tradesman can be persuaded to offer himself as a candidate for municipal or board of guardian honours, because he feels that amidst the storms, and personalities, and jobberies of local bodies, his position would be both unpalatable and untenable; and it is to be feared that the ballot, desirable as it may appear in many ways, yet will have the tendency to make electors more apathetic than ever in recording their votes at municipal elections. Now all this must be altered if sanitary science is to stand a chance of being properly administered. The commonly-received idea, that if a gentleman or first-class tradesman is elected, it means increased expense to the borough or parish, is a delusion; for, on the contrary, no more extravagant body can be found than a board of small tradesmen, or men in that social position who cannot be expected to resist the temptation of playing into each other's hands, too often at the expense of the ratepayers. But to return from this digression.

(B) In rural districts the board of guardians is the sanitary authority under the Public Health Act. Is this a desirable arrangement?

It has simply been selected because it is ready to hand, because it has had already some experience of sanitary work under the Nuisances Removal Acts, and because in the parochial medical officer exists a man who is evidently pointed out by the Act as a desirable person for medical officer of health. There are many objections to the appointment of boards of guardians as sanitary authorities. First, the relief of the poor and sanitary work are two entirely distinct and separate objects, each of which, if properly administered, should afford ample employment for a separate body of men. Secondly, boards of guardians, especially in some rural districts, are not distinguished for breadth of mind or superior intellect; and the manner in which they bave exercised their sanitary powers under the Nuisances Removal Acts has not been such as to inspire confidence in their sanitary capacities. Thirdly, it is very questionable whether, with regard to expense, they would really be the most economical board; for, while often distinguished for cheese-paring economy in the relief of the poor, their other expenditure, especially as regards removals and proceedings at law, are too often recklessly extravagant. The above objections may at first sight appear to be met by the provisions of the 13th section of the Public Health Act, under which the board of guardians may appoint, first, a sub-committee of its own members to superintend sanitary work; or, secondly, in the case of a union (for the section cannot apply to the case of an individual parish), they may appoint, for any parish or contributory place of the rural district, a parochial committee, partly of themselves and partly of ratepayers outside their own body, and belonging to such sub-district. A very strange defect appears to be that no number of such outside members is laid down; so that, for ought the Act says to the contrary, a board of guardians of ten may elect a parochial committee of a hundred. Now this savours too much of a mischievous monopoly; for although the multiplica. tion of small boards, with too minute a division of duties, is a curse to the country, it would probably be a greater calamity to place in the hands of such bodies as boards of guardians, not only the relief of the poor, but the superintendence of all sanitary work; and does it not intensify this monopoly to a monstrous degree to give them the power of appointing a larger body than themselves to assist them in doing half their work? So that, in point of fact, while the ratepayers have only the power of appointing a small body of men as guardians, the guardians have the power of electing a much larger body, if they choose, as parochial committees. Such parochial committees, if appointed at all, should surely have been elected by the ratepayers, and thus this monopoly of power would have been avoided.

There are three other sections of the Act which must be referred to here, one of which clearly points out how necessary it will be, should the board of guardians remain the rural sanitary authority, to give them the means of increasing their present powers. Section 23 provides that on the application of the sanitary authority of any rural

district, or of ratepayers, to the extent of one-tenth of the rateable value of such district, the Local Government Board may invest such sanitary authority, [conditionally or unconditionally, with the powers of an urban district. Section 24 goes farther, and empowers the Local Government Board to declare any rural sanitary district to be an urban district by provisional order, which, when confirmed by Parliament, places such district under the Local Government Acts, and under the jurisdiction of a local board separate from the board of guardians. Section 25 enables any rural district itself to adopt the Local Government Acts in the ordinary way, on obtaining the consent of the Local Government Board.

These sections distinctly point out the extreme advisability of placing the whole country under one uniform system of sanitary authorities, although Parliament has unfortunately hesitated to carry out what it appears to have suggested as a desirable consummation. Such consummation, there can scarcely be a doubt, will ultimately be arrived at, and that at no distant date, and its effect will be to separate sanitary work entirely from the relief of the poor, placing them under distinct local authorities; to put the Local Government Acts in force throughout the country; and to administer both objects under one central body-the Local Government Board-at whose head should be, what has so long been a great desideratum, a minister of public health.

III. As regards medical officers of health.

Section 10 of the Public Health Act makes it incumbent, both on urban and rural districts, to appoint a medical officer of health, the moiety of whose salary will be paid by the Local Government Board, if he is elected under their regulations. These regulations have not yet been issued; but it is to be hoped that they will provide against the summary removal of an officer of health without the consent of the Local Government Board, and that they will make certain stipu lations with regard to the amount of his salary. The section goes on to suggest that a parochial medical officer may also be medical officer of health, an arrangement which will neither be conducive to the comfort and independence of such officer, nor to the best interests of the community. It further offers such officer the distinguished honour of being eligible as inspector of nuisances, or, as it is now less odoriferously, but more euphoniously styled, sanitary inspector. What can the medical profession want more when the honours of such a "triple crown" are placed within its grasp? Let the medical profession, however, well consider whether the acceptance of such an honour as the last named is not rather a degradation and an insult; and let them blush for shame to think that members of a liberal profession should be found willing, for the sake of a paltry increase of salary, to accept such a post as this. Still, they have themselves to thank for it; for the amount of work undertaken by parochial medical officers, both in large towns and rural districts, for a miserable pittance, not worthy to be called a salary, is a shame and disgrace alike to the guardians who offer it, to the medical