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It is true that all the existing powers of the Board (as indicated in Section 16 of the Ordinance) have an indirect hearing on the Pub- lic Health, but the somewhat wide powers given to the Board under sub-section 35 (4) of that section cannot in the opinion of the Government be interpreted (having regard to the context) as ex- eceding the powers indicated in the rest. The subsection, namely the powers to adopt routine measures generally, aimed at the pre- vention and mitigation of certain kinds of disease.
It must be clear from a consideration of the Public Health and Build- ings Ordinance that the main objects of the Ordinance are to main- tain a certain standard of cleanliness in the Colony, to safeguard the purity of the Colony's food supplies and to prevent overcrowd- ing etc. of tenement houses.
To give practical effect to such objects (the connection of which to the Public Health must be apparent) the Sanitary Board as at present constituted appears to Government to be and to have always been a most valuable instrument
But the Government cannot consent to entrust to such a body (whose value seems to Government to lie in its essentially lay and repre- sentative constitution) the more technical decisions upon which Government would naturally desire to have the advice of an ex- pert. Such matters as Quarantine, or the steps to be taken in a serious epidemic, or the making of any research that may seem necessary will continue to be submitted to Government by the Principal Civil Medical Officer.
The Government has no desire to restrict the Board's privilege of seeking for information, as the mouth-piece of the Public, on mat- ters which have any bearing whatever on the Public Health. and the existing practice whereby the Government (or the head of any Government Department) may explain to the Board through the medium of the President its poliev in such matters appears to be valuable. But the privilege should not be interpreted by the Board as involving any authority on its part over matters which are outside the Public Health and Buildings Ordinance or over such technical matters as in the opinion of the Government should not be subject to the control of a Board of Laymen such as the Sanitary Board is at present and should in the opinion of Govern- ment continue to be if it is to perform properly the highly im- portant duties with which it has been entrusted".
In acknowledging the receipt of the above information the P.C.M.O. informed Government that though the position was somewhat clearer "The Sanitary Board controls all machinery by which infectious disease can be dealt with and with the activities of which the P.C.M.O. has no connection.
The situation was an impossible one in that one Officer was made responsible for the health of the Colony while another totally independent of him still controlled by far the greater part of the Colony's machinery for dealing with public health mat- ters and was the authority under the only public health Ordinance the Colony pos-
sessed
In February 1926 there was a conference at Covernment House on the ques- tion of reorganisation of the Public Health machinery, both the P.C.M.O. and the H.S.D. being present. There is no written record of what took place but it appears to have been assumed that the Sanitary Department had sufficient duties, in town cleansing, conservancy, abatement of nuisances, promotion of cleanliness in build- ings, licencing of certain trades and premises and control of cemeteries, to warrant its continuance as a separate entity and that Public Health matters other than the above should be dealt with by a combined Public Health and Medical Department under the P.C.M.O
The P.C.M.O and H.S.I), were instructed to draw up proposals for future health administration.
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The P.C.M.O. submitted to the II.S.D. a draft scheme providing :-
A. that there be a combined Medical and Health Department under a Director of Medical and Health Services with an Assistant Director of Health Services and an Assistant Director of Medical Services.
B. that all matters concerning the public health and the notification of infectious disease be the concern of the Medical and Health De¬ partment and not of the Sanitary Board as hitherto.
( that the M.O.Hs be members of the Medical Health Department, 1. that the Public Health and Buildings Ordinance be repealed and re- placed by (1) a Public Health Ordinance; (2) a Sanitary Service Ordinance; (3) a Buildings Ordinance.
E. that the Sanitary Department be under the Assistant Director of Health and the latter President of the Sanitary Board. Also that there be a Secretary to the Sanitary Board and Sanitary Depart- ment who was well acquainted with Chinese customs.
The H.S.D. in reply stated :—
(1) It has been laid down that the D.M S.S, and not the Board is res-
ponsible to the Government for the health of the Colony.
(2) The Sanitary Board and Sanitary Department should shake off all semblance of being a technical Health Board and Health Depart- ment and stick to the important work entrusted to them under the Ordinance other than that under section 16 (34) to (37). The work being done at present by the Board and Department is not in any sense technical being concerned with subjects which are closely concerned with sanitation but which have little or nothing to do with a medical department or health department, This work would be more efficiently done by a lay board and a lay depart-
ment.
(3) There is no municipality in Hong Kong and no analogy to any other place. The duties which may be called municipal should be done by a representative body such as the present Board and not by a Government Department with a few representative advisers.
(4) With the present restricted sphere of action of the Board and De- partment the title M.O.H. is admittedly misleading and in no way indicative of his actual position. Moreover 9/10ths of the work which these officers do is not in any sense medical. But the Board would probably prefer to have directly under its control an officer or officers with medical as well as sanitary qualifications even though the bulk of the work required of them is not medical
(5) There is much health work needing to be done which at present is being done by nobody, particularly research work and prophylaxis. The minor questions of notification, removal and disinfection are already almost entirely in the hands of the M.O.H. and the Board would probably not object to losing its nominal control.
(6) It has been laid down that the D.M.S.S. and not the Board is re- sponsible to Government for the health of the Colony and even if para. 16, subsections 34-37 of the Ordinance were left to the Board the D.M.S.S. would naturally require a staff to deal with research. malaria work and vaccination. If notification, removal disinfection and enquiries in the medical history of cases (which the M O.H. through the inspectors has so far undertaken because no one else did so) and also work under the Food and Drugs Ordinance were taken over he would require a larger stuff.
The views held by the P.C.M.O and the ILS.D. were fundamentally different.
The P.C.M.O. regarded all sanitary subjects as health subjects and held that
all health subjects should be under one coordinating head and that head the Director of Medical and Sanitary Services.
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