THE PUBLIC HEALTH.

Star (Christchurch), Issue 6730, 27 February 1900, Page 2

THE PUBLIC HEALTH.

+ ■ ;:■; URGENT NEED FOR REFORM. ADMINISTRATION OP THE ACTS. Afc the annual meeting of the Medical Association, Dr Scott read the following paper on the " Administration of the Health Acts" : — Auyane noting the characteristics of the politics of the present day will observe how great att influence the various trades unions and other like bodies have had on legislation. Indeed, thesfe Societies may be said to have constituted themselves, and beettjicceptett as, advisory Boards to the Government on matters in which they are specially interested. There tMist he some great, ftd* vantage in such a system, or surely these bodies would not yield so great an influence in the machinery of the State. This is an example which we have already followed to some extent, and undoubtedly we could confer a (service on the whole community if we constituted ourselves, and -were recognised by jihe authorities as, a Board to which sub-, jects relating to public health were" generallyto be referred for consideration, before being finally .dealt with by the Legislature The Public Health Act of 1876 undoubtedly < now requires revision, without further delay. It was in its day an admirable piece of legislation, being the embodiment of the jHajor part of the English Public Health Act of 1875, quite up 10, if not in advance of, the thought, and' the wants of the time. This Act remains substantially the same now as when it first came into force. We ate said to be a progressive people, but in this vital matter we have not only not advanced with the times, but- Jiave actually permitted^ the Public Health Act to become a dead letter, in so far as many of its important provisions- are concerned; Certain Boards are constituted for the administration of this Act. , A f central Board consisting of -not less than fftur nor more than seven members, ap. pointed by the Governor a nd holding office during his pleasure— df wnicih Board the Colonial SecFetarj- is ex-officio President. This Board is established for "superintending the. execution of" fot famtary Wo- ™&** of the Public Health -Act, and it shall, subject to the approval of the Governor, make such rule?, orders and regulations as it may deem, proper lor carrying out the sanitary provisions of this Act in every p&rtjcular." It is directed that every, medical officer of health appointed by erijlocal B6ard shall jjjef form duties and 'in such inahher as the central Board may from time to time direct. We medical officers of health have waited patiently for twenty-four years for thp central' Board to issue such directions, and my patience at ftriy rate is exhausted. There is, I may observe, no proviso that the local Board should inform the central Board of .the appointment of any medical officer of health, so that we may assume that the central. Board is unaware of any eucii officers ever having been appointed. This alone. could excuse the central Board's neglect of this provision. What a .contrast havs* we between the inactivity of our central Board in this and other particulars, and the energy displayed by the Local Government Board., in England, which, under exactly similar provisions, has issued exemplary regulations for tllfe guidance of medical officers of health; and which exercises a direct, efficient, and beneficent control over the actions of all local Boards. It is directed that the Governor may appoint such officers of the central Board as may be deemed necessary. It is not specified what officers shall be appointed, but the English Local Government Board has its surveyors, inspectors and medical officers, and I presume that -the like officers are here contemplated. Such officers are urgently required here to inspect the districts of the local Board, to advise the central Board as to the efficiency of any local Board in carrying out its duties, to examine into and report upon all schemes of water supply, drainage and other sanitary work proposed by any local Board, *n that the central Board may have such data as may be required to enable it to direct or "require any local Board to modify or alter any scheme under its consideration for the better protection of the health of the com, munily, and to direct any requisite sanitary requirements to be carried out, to advise the central Board as to the propriety of requiring a local Board to perform certain duties which are permissive or obligatory at the discretion of the cential Board ; such as it is provided that any local Board may, and when required by the central Board, shall provide a mortuary. Every local Board may, and when require&by the central Board shall, itself undertake or contract for the removal of house refuse, etc., the cleansing of closets, ashpits; cesspools, etc. Our central Board has hitherto attended to none of thes* things, and I am quite certain that many local Boards feel the want, of such control and advice as the central Board is authorised to give and exercise, for many oi these Boards remain quite in ignorance of the duties devolving on them and have no assistance fr6m, or correspondence with, the central Bourd. The central Board has neglected its during nearly the whole term 'of its existence, not only in the matters here referred to, as to which there are no absolute directions to be found in the Public Health Act, but also in those clearly set forth ; for it is positively la^d down that every local Board shall- annually, in the month of June in each year, make a report to the central Board in such form as such central Board shall direct, yet the central Board has not yet issued the said forms nor calted upon any local Board to fulfil its obligation in this matter, though jio local Board has sent in any such report. At Home the local Board is mulcted in one-half of the salary of its medical officers of health, in case the like provision is liot carried out by the local Board through its health offi cer. Our central Board should- be more ■in touch with our local Boards ; it should ba set free from -lindu'e inferfepenee l far the Government of the day. With this object the officers of this Board should not be subject to removal by the Government. Th,e orders and regulations of the central Board might be subject to confirmation by Parlia-. ment at its next session, so as to bring its actions more directly under the control of Parliament. Unfortunately — and I think it must have been unintentionally— a pro- T vision of the original Act requiring the central Board to lay a report on the table of the House of Representatives, was repealed in 1877. This provision should be reenacted. , The Pub-ic Health Act of Victoria provides a central Board of Health, consisting v of a chairman (permanent head of department), medical inspector and seven members elected for three years by groups of municipal Councils. These members are paid travelling expenses and one or two guineas fov each 'attendance. It is provided that they shall appoint a medical inspector, who shall be an expert in sanitary science, and shall receive ait annual salary of not less I than £1000 ; an engineering inspector, a secretary, and such^ other inspectors, health officers, clerks and officers as may be deemed necessary. -The Victorian Act is in these 1 respects superior to ours, as a permanent staff of paid officers is provided, thus ensuring that, work shall not be neglected, ■■'.for' we all know that '.colonials object to. pay. for sinecures'. It will be necessary* again to refer to tlie central Board after dealing with >the local Boards. . . - In this colony every local governing body is a local Board of Health, with all the powers, rights arid duties by this Act given or imposed. It is provided that every local Board may appoint a surveyor and inspector of nuifanees, and such officers and servants as may be necessary for the due carrying out of those provisions of this Act which come under their administration. The word may in this section appears to be permissive, yet I am of opinion it is obligatory, for we find that it shall be the duty of' every local Board to cause to be marie, from time to time, inspection nf it? district, with a vie*>v tp.asorrinin what nuipanres p.tist, ;md to enforce the. provisions of this Act, in order to abate the *3>.ne. This dutv can only be properly, performed by an inspector of-

nuisances. Section 46 of the same Act, on complaint of a certain nuisance try any person aggrieved thereby, requires ' the ' local Board, through its surveyor or inspector of nuissthces, to catry out an extensive examination of premises. Various other duties of a local Board, 66 set forth" in the Public Health Act, and in the Municipal Corporation Act, can only be carried out through the intervention of jin inspector of nuisances). Hence, euch officer 1* » necessary requirement of the local Board, Which may appoint him, and no local Board can fulfil it* obligations Withoiit. an inspector. EVery locfil Board may, if it iKihkß fit, appoint a medical officer, who shall be removable bv the said local Board, and shall perform such duties as tlie. Central Board directs. Note 1— • This may is clearly fjefmissive, a .'contrast to I the former may. (2) The. medical officer, ro long as he. hold* his appointment, mltst- pei J force obey the instructions of the central \Boardj ffnd it appears that he may, be 'th'rowti oiit ff office by the local Board 'if he carries out his dHty 'efficiently, a position which can only be imagined *as occurring' in an opera by Gilbert and Sullivan"* ' , In Victoria the appointment of medical i officer of health is incumbent on each local Board. A salary of not less than £10 £fcr annum is specified. The appointment is subject "to approval .of the Oehtral Board. The Governor-inrCouncii may .make an appointment on the recommendation of the Central Board, and fix the salary to be paid hi case any local Board has failed to make such appointment within two months ; such officer eo appointed cannct have his salary reduced. *r he ' r'emovpd . without the consent of the Govefiior-in-Council. At the , same time medical fifficei's appointed by* localßoards may be removed by the local Board apparently without reference to the Central Board. Very few of our loeal Boards have Appointed inspectors of nuisances, still less have they made regulations specifying the duties and conduct of these and other officers and servants appointed or employed by them; hence such inspectors suffer tinder the 'same disadvantage as I have shown the. medical officers to suffer under. According to the Victorian Act, inspectors are required to carry out oil , instructions of the officers of health. There is no provision in the English Act bearing I directly on this tnatter, but the Local Government Board has ordered that, subject to the instructions c£ the local Board, the medical officer of health shall direct or superintend the work ot the inspector of nuisances in the way and to the extent that the local Board shall approve. In accordance with btif law, any medical _ officer or inspector of nuisance irtay inspect any food exprsed for sale, and may seize and carry away any such food as appears to such medical officer or inspector to be disfeased or unsound. The regulations of the local Government Board provide, tinder the like clause in the English Act, that in case of doubt arising under this clause the inspec- | tor thall report the matter to the medical officer of health, with the view (of obt'ain- ! ing his advice thereon. With resold to other matters, it is provided at Home by the Local Government Beard that whenever it appears to the inspector that the intervention of the medical officer is necessary, in consequence of tha existence of any nuisance, etc., he Ehall forthwith inform such officer thereof; end that he shall when applied to by the medical officer of health produce to him his books, and render to him such information as he shall be able to furnish with respect to any matter to which the duties of inspector •of nuisances relate. Our Central Board has not yet deemed it proper to j make any rules, orders or regulations re-. ' lating to these subjects. Under the Victorian Act, the. Central Beard may make such regulations and by-laws as may be deemed- expedient and order local Boards to make Ruch, and in default for a period of two. months, the Governor-in-Council may make swell rules, orders, regulations and by-law* as may be deemed necessary. In regard to penalties on any local Board in default of carrying out its duties as required by our Publio Health Act, it is very likely that the central Board could, compel any local Board, by le.eal process in the Supreme Court, to fulfil its obligations, but, surely there should be some easy, inexpensive summary means of calling to book si negligent local Board. I can only find such penalties as these provided:—lf .a local Board, which has itself undertaken •or contracted for the removal of house refuse," etc., fail, without reasonable excuse, after notice in writing from th-8 occupier of any house requiring it to ' remove" any.' such refuse,, it •incuts' ii .penalty bf 5s per diem; awd again, when it is proved to 'the'' satisfaction of the central Board that a local Board has mads, default in doing its duty iri relation, to nuisances, the Central' Board may. authorise a police officer to institute any proceeding which the defaulting Board might institute, and sucV officer may recover any expenses in, curred by "him from the defaulting local Board. These are poor penalties in themselves, and it is uncertain whether they could be enforced except through the hu- ! premo Court. It appears to me that the J subsidy granted by the Government to the _ local Boards should be held over until the | Central Board is satisfied that the autu» ( and obligations of the local Board, regardintr • all sanitary matters, were faithfully performed. At present this principle is I carred out in so far as the Colonial bcere- j | tary holds this subsidy as security for pay- ; ments of amounts due by local Boards to the .Hospital and Charitable Aid Board. I The Municipal Corporations Act should be amended so as to compel a Corporation to have and keep in good order proper nnd suitable drainage works, and to provide a pure and efficient -water supply, these matters being left at prenent entirely to -the discretion of the . Corporations. Under the Act now in force it i? provided that the Council may cleanse any. drain-, etc. • Is this permissive or obligatory? As tb.? Council is not entitled to create a nuisance or .dfprive any person of ahy remedy he would • have agnJnst the Corporation, or any other ; person, in respect of any such- nuisance, 1 ' imagine it is übllgajiory, but the ' remedy is difficult of application. In the. Municipal Corporations Bill now under consideration in Parliament, the preface shows that with 'a view to emhodying as far as possible all the 'legislation affecting boroughs in our Bill, the present . measure include* various provisions- of the Public Health and other Acts affecting borough?, thirly-one Acts being expressed to be wholly or in -part repealed by thp Bill In' addition to the. npwer alvendy 'pospcfsed by Borough' Council.*, the Bill miitfvinllv ! enlarges thene' in relation to drainage and sanitation, and gives power lo provide workers 1 - dwellings; and' to orfevfinb -*-*«sr- >

orowdjng of land with houses and housep Sritk inhabitant*. The«e provision, are very good, but still nil which is permissive in the present. Act* appear to remain permiwive effll, and the new provisions of this Bill ar« permissive and are not made obligatory at> the of the Central Board. The 0ov» ernorf according to this Bill, may frame an* gpeetteunodel by-laws, wh.ich may be adopted by the Council j again there is no provision that $heße by-lawf? shall be enforced at the discretion of the Central Board. We have in this Bill, however, 6ne aaving clause of great value token from the Local Government Act of Victoria, .1890, Which declares that : If any Council, in the opinion of the Governor, wilfully refuses to act in the performaincft or exeroina of fche duties or powers respectively repoped and vested in, it. or in the like opinion substantially so refuses to act, the Governor may make Buch' provision W he fchinkfi fit for the due performance ancr exercise of «uoh dutijes and newer*. In pa*#cular the Governor shall have, and may excise, oil the pww«r» of such Council to make, Jevy «nd recover rates, and to expend tie saffte. , It seems to me i that the stoppage of subsidy, which I have already suggested, and this general power of superteding a defaulting local Board in the execution of it* duties, would have * salutary effect on the local Boards, but I consider that the authority should be exercised i by the Central Board, and not necessarily, | by the Government of the day, and, further. ! tkt the Central Board should in tS and I other matters be influenced bv the report i of the medical and other officers in its employment. We, as medical men, are surely entitled {JJST i<kr * tion hfto various local Boards We are required, under penalty | to .send in report* ofWtiou* disuses 00l | currmg m pur practices, If we fulfil ouf ! obligations, at any rate in the country di«---i !™? 8 ***,"*«*■ I ani acquainted, our rei J fiZ* Sheh '^ ° r dertro y«i. no records are filed, no action is taken in the matter of inspection, investigation or attemot a tprevention of thexdiseases, and no tabulated annual report is iurnished to the Central Board. We might just as well sa.ve ourselves the trouble of forwarding these row ports, and I fancy most of us do so. Time is wanting for me to show hew In. I specters of Nuisances or* appointed without/ any qualification fpr the work, that Ln specters of Factories 'have to satisfy themselves in some unknown manner as tft th« efficient disinfection of certain work-rooms or factories, that there as no general provision for training or examining. sani-J tary plumbers pricr to licensing them,' that the Public Morgues Act of 1886 is a dead letter, and thafc nearly all of the sanitary provisions with which we are acquainted nre in abeyance. Bt»t I think if we carefully consider these and other matters relating to the ad-' ministration of the Public Health Act, we ought to be able to make valuable suggestions regarding the amendment of this Act/ and I feel certain thai our efforts would b« duly appreciated by the Government.