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In his opinion there were in existence two departments which were concern- ed with intimately connected subjects and which had no liaison.
The II.S.D maintained that there are many subjects included under the term “sanitation" and having a bearing on the health of the public which are simply mat- ters of order and cleanliness and which do not require the supervision of one legally qualified in medicine and hygiene. The Sanitary Board and Sanitary Department should shake off all semblance of being a general Health Board and Health Depart- ment and confine their efforts to cleanliness and order. Such a Board and Depart- ment would be much better under a Cadet Officer who understands the Chinese cus- toms and language than under a medical man.
During 1926-1927 there was much argument and a number of conferences but no final decision.
On 28.2.28 -The Secretary of State sanctioned the change of title from "Principal Civil Medical Officer" to that of "Director of Medical and Sanitary Ser- vices" and trusted that the new scheme would make it possible to give this Officer a greater measure of responsibility for the Public Health work of the Colony.
In September 1928 at the Meeting of Legislative Council the Officer Adminis- tering the Government said :-
"Much consideration has been given recently to a scheme which will bring the Medical more closely in touch with the Sanitary Depart- ment. No reduction of the duties or the responsibility of the Sanitary Department or the Sanitary Board is contemplated. the object being to co-ordinate these two departments more closely and to give the Sanitary Board the advantage of the experience of the Medical Department".
"The alterations in the titles in the Medical Department are the first step
in the direction indicated. "The Principal Civil Medical Office' becomes "Director of Medical and Sanitary Services" and will be responsible for the technical side of the work of the Medical Offi- cers of Health and for the advice that they will give to the Sanitary Bourd. It is hoped too that this arrangement will make it pos- sible to follow the principles on which the Colonial Office has re- cently laid so much stress, and to pay more attention to methods of prevention for which the best technical advice available is neces- sary, and under this scheme will be made available”.
The position became more obscure than ever. The only sanitary service the Colony possessed was the Sanitary Department which functioned under the only sanitary code the Colony possessed. Under this code the Medical Officers of Health were Officers of the Department and the Head of the Department was a cadet who was in no way under the D.M.S.S. and who was Chairman of the Sanitary Board with which the D.M.S.S. was in no way connected. The D.M.S.S. was thus made respon- sible for the conduct and advice of officers who were not under his control.
During 1928 Considerable correspondence passed between the parties concer- ned regarding the situation and it was finally decided to leave the question open pend- ing the arrival of the new D.M.S.S. who would enquire into the system and make re-
commendations.
The post of Director of Medical and Sanitary Services being vacant it was de- cided to appoint one who had specialised in sanitary science and who had had admi- nistrative experience in dealing with matters of public health importance. Hitherto the chief administrative post in the Medical Department had always been held by a clinician. In November the Secretary of State appointed the Chief Health Officer and Acting Principal Medical Officer Federated Malay States to be Director of Medical and Sanitary Services Hong Kong.
1929. During the year the Director of Medical and Sanitary Services was engaged in making investigations and in the formulation of a scheme for the reor- ganisation of the Sanitary Services and in June a comprehensive memorandum on the subject was submitted.
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In December the Legislative Council passed an amendment to the Public Health and Buildings Ordinance making the Director of Medical and Sanitary Services a member of the Sanitary Board in place of the Medical Officer of Health. The ob jects and reasons for the Bill were stated as follows :---,
"With a view to the reorganisation of the Medical and Sanitary Services of the Colony, it is considered desirable to associate the Director of Medical and Sanitary Services more closely with the working of the Sanitary Department, and in order that he may have the opportunity of acquiring first hand knowledge of the "working of that department it has been decided to place him on the Sanitary Board instead of the Medical Officer of Health. When the Direc- tor of Medical and Sanitary Services has replaced the Medical Officer of Health as a member of the Sanitary Board the Govern- ment will await such recommendations from him in the Public Health administration as his experience of the working of the Sanitary Department may prompt him to make”.
A Survey of the above shows that all or nearly all the controversy regard- ing sanitation in Hong Kong had some connection with the composition, the func- tions and the workings of the Sanitary Board and the Sanitary Department.
The original intention of Government was the creation of a Sanitary Board consisting of Officials and non-Officials to formulate policies for approval of Govern- ment and to carry into effect those sanctioned either through existing Government machinery or through the efforts of a corps of Government employees called the Sanitary Department It was generally agreed that the President should not only be the mouthpiece of the Board but should be in actual control of the Sanitary Depart-
ment.
The Public Health Ordinance of 1881 which was the basis for the present Pub- lic Health and Buildings Ordinance was formed on the lines of the English Public Health Act of 1875-Like that Act it dealt with
(1) Authorities for execution of Act.
(2) Sanitary provisions—sowers, drains, and sewage disposal, scaveng- ing and cleansing, nuisances, water supplies and water protection, prevention of epidemic disease, infectious disease and hospitals, mortuaries.
(3) Markets and slaughter houses
(4) Legal proceedings
But whereas under the 1875 Act the "authority" means the real governing body of the area concerned (Borough or town), in the Hong Kong Ordinance this is
• not the case, the Sanitary Board corresponding to a Sanitary Committee of an English City and the Sanitary Department to its Sanitary Department.
In many cases the Health Committee of an English town has as Chairman the Medical Officer of Health. In all cases the Health Department is under the direction of the same officer, who is responsible to the Council for the efficiency of the depart- ment and for the carrying out of the duties laid down for that department. same applies to most countries where there are up-to-date health systems.
The
It should be noted that as a rule the executive or mechanical side of scaveng- ing, street cleansing, conservancy, sewerage and dramage do not form part of the duties of the Health Department, this portion of the sanitary duties being placed under the Town Engineer.
It is very important that the very essential difference between an “authority” under the English Public Health Act of 1875 and the "Sanitary Board" under the Hong Kong Public Health and Buildings Act should be recognised, for it would seem that much of the misunderstanding which has occurred in Hong Kong on the question of control of Sanitary measures has been due to the fact that the Sanitary Board has
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