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The Central Authority in England is the Minister of Health the local authori- ties are in some cases Urban Boards, in some cases Rural Boards and in some cases County Councils. Whatever they be, the ultimate machinery is much the same is each case viz. -a Medical Officer of Health in charge of a Health Staff and responsible to the Council of which he is a servant, for the proper performance of duties prescribed by the various statutes. Under the Sanitary Officers Order 1926, the Sanitary Inspec- tors shall perform under the general direction of the M.O.HI. all the duties imposed on a Sanitary Inspector by statute and by orders, regulations, and bye-laws for the time being in force lawfully made by the Local Authority or by the Minister or his pre- decessors and observe and execute any directions or instructions of the Local Au- thority or the Minister applicable to his office.
The Health Officer and not a layman is therefore in charge of the health staff of his authority.
The Local Government Act of 1888 dealt mainly with Medical Officers of Health. It gave the County Council power to appoint an M.O.II., it stipulated that in districts of more than 50,000 the M.O.H should possess a special qualification in sanitary science, and it required district M.O.H.s to send copies of their reports to the County Council.
The Housing Acts and the Town Planning Acts placed definite and important obligations on the Medical Officer of Health. He is the person responsible for in- vestigating the conditions regarding housing and for placing before the authorities the need for improvement.
Quoting from the Minister of Health's foreword to Dr. Freemantles book "The Health of the Nation".
"The history of the growth of Public Health Organisation in this country re- veals, not only its strange and varied forms, but its steady incorporation of many aspects of human life formerly considered outside its scope. For, though it began with the relief of the poor and the registration of births and deaths, it now com- prises industrial welfare, the control of the food supply, the provision of housing ac- commodation, the care of the infectious person, anЛl the supervision of the mentally defective".
"The idea of our forefathers that the sanitation of the environment was suffi- rient has been proved by medical knowledge to be inadequate to meet modern needs. I am the last person to under-estimate the necessity of good sanitation and adequate housing which indeed must always remain the basis of public health reform-but it is significant to observe the growing disposition of Parliament to favour direct Medical Services which shall provide for the mother and the infant, the widow and the orphan, the industrial worker who is down and out, the cripple and the disabled. Not less significant is the straightforward attack which is being made upon special forms of disease such as tuberculosis, dental decay, venereal disease, rhumatism and cancer. It is no longer held to be sufficient to reduce total death rates.
We are beginning to concentrate upon actual morbid conditions which produce a premature death rate and this book sets forth the manifold means which are being applied to this end".
"We have left behind us the days of the parish pump, and we are moving for- ward to the implications of imperial and international health. From the time of the establishment of the Ministry of Health in 1919 to the present, the Ministry has found itself inevitably concerned in these larger issues".
"The greatest need of to-day is the further education of the people, so that they may be able to take full advantage of the opportunities offered them. There must of course be an alert and vigilant central authority, working hand in hand with Local Authorities of Governinent; there must be continual quest for new knowledge, and the accurate investigation of cause and effects; but above all there must be the cultivation of the "Public Health Conscience" in the minds of the people themselves. Without their co-operation, willingly accorded by reason of their understanding of the meaning of their actions, the machinery of the health services cannot fully per- form its functions".
"The education and equipment of the medical
man,
for service overseas as
well as at home, the investigation of the diseases associated with the tropics, on the mastery of which depends the prosperity of vast regions within the Empire, the ever widening responsibilities of international co-operation in isolating or controlling the spread of afflictions which know no frontiers- these are the subjects in which we fined ourselves interested to-day".
"The growth of the Public Health work of the Local Authorities has been such that a District of 20,000 population which would give but little work to a part- time officer twenty-five years ago, will now find full-time occupation for one man, if he arts as M.O. to the local Fever Hospital and carries out in his area the duties in connection with the recently established maternity and child welfare and school medi- cal services in addition to those of Medical Officer of Health".
"In the smaller towns of 30,000 population there is generally a whole-time Medical Officer of Health who finds it a heavy task to carry out all the Medical work which falls upon him. In addition to superintending the work of the clerks, sanitary inspectors, and health visitors, he frequently undertakes the clinical work at mater- nity and child welfare centres and the medical inspection of school children. When the population exceeds 30,000 it is almost impossible for one whole-time man efficiently to administer his department and undertake school medical work, maternity and child welfare work, and fever hospital work without an Assistant Medical Officer. When we arrive at a population of 60,000 it may be said that there is ample work in con- nection with administrative and office routine to give wholetime occupation to the Medical Officer of Health. In towns of 120,000 there is generally an Assistant who is the resident physician at the Fever Hospital, another who acts as tuberculosis officer, another who acts as school inspector, and perhaps one for general purposes. These assitants multiply in number as the population increases".
B. THE DEVELOPMENT OF PUBLIC HEALTH ORGANISATION UNDER THE COLONIAL OFFICE.
The first Secretary of State for the Colonies to realise the importance of Public Health Organisation in Colonial development was Mr. Joseph Chamberlain who stimulated by Manson and Cantley (once members of the Hong Kong Sanitary Board) circulated to the General Medical Council, the Medical Schools and the Gover- nors of the Colonies his views on the subject This was in 1898.
In 1899 Schools of Tropical Medicine were established in London and in Liverpool for the instruction of Medical men engaged or about to be engaged in the practice of medicine in the Tropics. The curriculum at each school included cour- ses in entomology, helminthology, and parasitology and instruction in sanitary and medical organisation to meet the needs of the tropics
In 1908 the Colonial Office established the Sleeping Sickness Bureau which in 1912 became the Tropical Diseases Bureau.
In the Tropics as elsewhere the bodies which had been instrumental in point- ing out the direction in which medical and sanitary progress should tend, and the organisation best suited for the purpose were the Medical Services of the areas con- cerned. But there was as yet no one medical service for the Colonies. Each Colony hat its own form of administration, its own officers, its own terms of service, and its own sources of revenue. Each was independent of the other, and there was prac- tically no exchange of personnel. Under these conditions it is not surprising that there was little attempt at uniformity of organisation or procedure. Each developed independently and as is natural there was great difference both as to what was at- tempted and to what was accomplished. Some were well up-to-date, some were just the reverse.
In 1909 the Secretary of State constituted for the African Colonies an ad- visory Medical Committee in London consisting of medical men of high standing in the world of tropical medicine. In 1922 the scope of this Committee was widened to cover all the Colonies and Protectorates becoming the Colonial Advisory and Medical Committee.
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