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But in any large technical organisation there are many matters which are not technical but which have a very important bearing on the efficiency of the machine- For want of a better name such matters are generally grouped under the term “busi- ness. They include matters connected with the comfort and welfare of the indivi- dual workers--both as regards their homes and their workshops-the collecting of statistics and the filing of them in their proper order, the control of finance, and last but not least discipline and order. Such business matters are best left in the hands of non-technical men who have made "business" their speciality that is have had special training in book-keeping and accounts and general economy.
There are technical organisations which are business concerns primarily and where the technical machinery is really a means towards a business on financial end -There are technical organisations which are primarily technical and in which busi- ness is only a help towards the technical end-There are organisations where import- ance is equally divided. Where technology is the principal concern the head or direc- tor should be one qualified in the profession or trade concerned. When business is the predominate feature, the head should be a business man-but even here the tech- nical side of the business must be in the hands of technicians who are responsible to but who advise the director on their own particular subjects.
Where business and technology are equally important the best head is the best organiser and co-operator whether he be trained on the one side or the other is of secondary importance.
There can be no doubt that sanitation in its fullest sense is primarily tech- nical, the business element is of unquestionable importance but technichology comes easily first.
The care of the Public Health is not the concern of Medical men only-Con- nected with it are civil engineers (including architects or house engineers) water en- gineers, sewage engineers, town planners, chemists, physicists, physiologists.
It is therefore necessary for clarity that this large subject should be as far as possible divided into its branches and the functions of each branch clearly defined.
There is in Public Health no such thing as a science of organisation which distinct from medicine, engineering, physics, chemistry, etc., etc.
The head of a Medical Service should be a medical man-the head of an en- gineering service an engineer-but where there is a combination of the two for the good of a whole the head of that whole need be neither an engineer nor a doctor, but he must be a co-ordinator and not a dictator.
The Sanitary Authorities of England deal with town planning, town improve- ment, housing, water supply, scavenging, night soil disposal, sewerage and drainage. dairies, bath houses, common lodging houses, factories and workshops, infectious disease and disinfection, foods and drugs, tuberculosis and poor law infirmaries. Soon they will deal with all hospitals for public opinion is rapidly turning towards The Medical Officer of Health state control or municipal control of medical relief. is concerned with all above--the days are gone when the architect and engineer and the doctor each kept to his own water-tight department. The water-tight system so far as Public Health is concerned is long out of date. To-day is the period of co- operation.
The best means of producing perfection in co-operation is through a Board con- taining experts on the subjects concerned and headed by one who is an economist
It is being recognised all over the civilised world that whether it be proper or not to decentralise curative medicine, preventive medicine should not be decentralis- ed. The modern tendency is to link up the various health units, port, urban, rural, county and state into one national health service so that there may be uniformity and co-ordination to the end that there may be effective co-operation in controlling com- municable disease. Matters have even gone a step further and nations are now com- bining to prevent disease from entering or leaving their countries.
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In England under the Local Government Act, 1929, which had received the Royal Assent and become law a beginning has been made in bringing public health activities which were formerly under the direction of different authorities under one authority viz. the County Council or the County Borough Council. These Coun- cils now deal with medical relief, mental deficiencies, maternity and child welfare, school medical work, tuberculosis work, venereal disease work, midwives registra- tion and control, vaccination, isolation hospitals and the control of infectious disease. It is contemplated that in each county or county borough area there will be one chief administrative officer viz. The Medical Officer of Health who will be responsible to the various committees (public health, education, mental deficiency, maternity and child welfare, asylum, public assistance) for the work of the various medical officers and health officers engaged. The Poor Law Hospitals which were formerly un- der Boards of Guardians are now under the County Borough Councils or the County Councils and their Medical Officers are responsible to the Medical Officers of Health of the Borough or of the County.
This is the Beginning of a new era where there will be one public service for prevention and cure and that state service under one administrative medical head responsible to the Council. The English bill has become law and the corresponding Scottish bill has also become law
The argument advanced in Hong Kong for the propriety of placing a cadet at the head of the sanitary department is that in many cities which deal with sani- tation successfully, the head is a layman, and the Health Officer is subordinate to him and in making the cadet the Chairman of the Sanitary Board and the Head of the Sanitary Department of Hong Kong the Government is only following a precedent of proved value. The argument is not sound for the two cases are not comparable. In the cases quoted the administrative authority for the Government of the town is vested in the Municipality. In Hong Kong the situation is entirely different. There is no Municipality and the administrative authority of the Sanitary Board is very limited.
In Municipalities the Head of the Health Section is always a Health Officer and the head of the Engineering Section always an engineer. Their duties are both execu- tive and administrative. They are in control of their own departments and they are responsible to the Council (not the Chairman only) for the proper carrying out of the duties imposed in them by the decisions of the Conneil The powers of the Council in this respect are fixed by law.
The business secretary of a Municipality is the town clerk who receives the reports and recommendations of the Health Officer and the Engineer and who places them before the Council with all the facts technical and otherwise bearing on the subjects.
The President of a Municipality where there is full local Government is elected yearly from among the Councillors. Whether he be a professional man or a business man does not matter and there are many cases where a Medical man has made a most successful mayor.
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The President of a Limited Municipality, such as that of Singapore in the Straits Settlements, or the Chairman of a Limited Sanitary Board such Kuala Lumpur in the Federated Malay States, is appointed by Government and is always a Government Servant. He is the Business manager and co-ordinator for the sanitation of the whole city. But he is not a Departmental Head and he is not in direct charge of the Sanitary Department or of the Engineering Department.
The Sanitary Boards of Malaya have nothing to do with communicable dis- eases their Health Officers being responsible to the Government Medical Department in such matters. The Health Officers to the Sanitary Boards are members of the Government Medical Service and are advisers to the Board not servants of it. Each is a member of his particular board.
All laws dealing with Quarantine and Prevention of Disease are grouped to- gether under Quarantine and Prevention of Disease Ordinance which is administered by the Medical Department.
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