“3298. Are they appointed?—They are appointed, I think, in all the parishes in Dublin except two; but they are inoperative: they are unpaid, and it is a very disgusting duty. They can be made to serve, but there is no control as to the amount of service they perform; so that the provision is quite inoperative, unless an alarm exists.
“3299. Do you not think the appointment of some such officers, properly appointed, properly paid, and having reasonable power, for the purpose of suggesting and enforcing such measures as shall be beneficial, would be highly valuable?—I am sure it would, and it would save an amazing quantity of expenditure to the country.”
It has only been under the strong pressure of professional duties by the physicians and paid medical and relieving officers responsible for visiting the abodes of the persons reduced to destitution by disease that the condition of those abodes in the metropolis have of late been known; and I believe that it is only under continued pressure and strong responsibilities and interests in prevention that investigation will be carried into such places, and the extensive physical causes of disease be effectually eradicated.
Whilst experience gives little promise even of inquiries from such a body as Boards of Health without responsibilities, still less of any important results from the mere representations of such bodies separated from executive authority, I would submit for consideration what appears to me a more advantageous application of medical science, viz., by uniting it with boards having executive authority.
Now, the claim to relief on the ground of destitution created by sickness, which carries the medical officer of the union to the interior of the abode of the sufferer, appears to be the means of carrying investigation precisely to the place where the evil is the most rife, and where the public intervention is most called for. In the metropolis the number of cases of fever alone on which the medical officers were required to visit the applicants for relief, at their own residences, amounted during one year to nearly 14,000. The number of medical officers attached to the new unions throughout the country, and engaged in visiting the claimants to relief on account of sickness, is at this time about 2300.
Were it practicable to attach as numerous a body of paid officers to any local Boards of Health that could be established, it would scarcely be practicable to insure as certain and well directed an examination of the residences of the labouring classes as I conceive may be ensured from the medical officers of the unions. In support of these anticipations of the efficiency of the agency. of the medical officers when directed to the formation of sanitary measures, I beg leave to refer to the experience of a partial trial of them under a clause of the recent Metropolitan Police Act, by which it is provided, that if the guardians of the poor of an union or parish, or the churchwardens and overseers of the poor of any parish within the Metropolitan Police district, together with the medical officer of any such parish or union, shall be of opinion, and shall certify under the hands of two or more of such guardians, churchwardens, and overseers, and of such medical officer, that any house, or part of any house, is in such a filthy unwholesome condition that the health of the inmates is thereby endangered, then the magistrates may, after due notice to the occupiers, cause the house to be cleansed at his expense.
The defects of the provision are, that it only authorizes cleansing and not providing for the means of cleansing and personal cleanliness, by directing supplies of water to be laid on; that it does not extend to the alterations of the external condition of the dwelling; that the immediate expense falls upon the occupier, who is usually in so abject a state of destitution as to serve as a barrier to any proceeding apparently tending to any penal infliction. With all these disadvantages, its working may be submitted to show the general eligibility of the medical officers of unions as officers for the execution of sanitary measures. The following account is given by the clerk to the Board of Guardians of Bethnal Green of the working of the provision in that part of the metropolis:—
Mr. William Brutton.—We have taken prompt measures to execute the clause of the Metropolitan Police Act, and the Commissioners’ recommendations upon it, in our parish, and the effect produced has already been beneficial. For example, the medical officer recently reported, through me, to the Board of Guardians, that fever had arisen in certain small tenements in a court called Nicholl’s Court, and that it was likely to spread amongst the poorer classes in the district. He reported that others of the houses than those in which fever existed (and the inmates) were in a filthy condition, and that, unless measures were taken for cleansing them properly, fever must necessarily ensue. The Board, on receiving this communication, desired me to proceed instantly, and take such measures as appeared to me to be necessary for the abatement and prevention of the evil. I immediately obtained a summons from the magistrates for the attendance of the owner of the houses. He came directly, and stated that he was not aware that the premises were in the condition in which our medical officer had found them; and he promised that measures should be taken for proper cleansing. Those measures were taken: the furniture of the houses was taken out and washed; the houses were lime-washed. Some of those who were ill died, but the progress of the fever was certainly arrested.
The Board followed up these proceedings by circulating the Commissioners’ instruction and form of notification in every part of the parish. But the proceeding had a very good effect in the immediate neighbourhood. The proceeding was observed by the neighbours, and there is every reason to believe that they have set to work to cleanse and prevent a similar visitation. We have also learned that the landlords of some of these smaller tenements have been rather more particular than before: they have said we must see to the cleansing of these places lest we should be had up for it before the magistrates.
The guardians, considering the form of notifications useful, have directed that they should be issued periodically before the times when disease usually appears. In the course of a fortnight or three weeks hence, when the equinoctial gales prevail, and when we have usually much sickness and claims to relief, we shall probably have another issue of the notifications.