With respect to the remedies, I find that the personal inconvenience to which the clause subjects the guardians of visiting the spot is a provision which will greatly obstruct its operations, and will at all events greatly delay proceedings from time to time. The guardians who, in our union, are men of business, consider that their time is fully occupied at the Board, and they object to any attendance out of the Board, and would give it reluctantly. If the cases are taken before the magistrate, it appears desirable that the medical officer should not be compelled to attend unless it were absolutely requisite, and that the relieving officer should be allowed to prove the facts as to the state of the dwellings recited in the medical officer’s certificate, which could rarely be disputed. If the point were disputed by the owner, then the medical officer or other witnesses might be forthcoming.
What is the number of houses in the union?—About 8000.
How many cases on the average do your medical officers visit in the year?—About 4000.
Those visits of course are sometimes to different rooms of the same tenement?—No doubt of that, and very frequently to the inmates of the same room.
Are the visits of the relieving officers to the dwellings of the labouring classes more extensive than the visits of the medical officers?—I should say more extensive.
Between the two, are any class of the poorer and otherwise neglected residences that would probably escape visitation?—I should say that they must visit every spot within the district.
Within such districts as that of Whitechapel, do you think the three present medical officers and the relieving officers would suffice to carry out sanitary measures actively and efficiently?—I think that for efficiency additional strength would be required; perhaps one officer, whose especial duty it should be to attend to the duties connected with sanitary measures, supposing them carried out by the agency of the existing establishments.
From the consideration of such practical evidence, it will be seen that the ordinary duties of the relieving officer in the first instance, and of the medical officer afterwards, ensure domiciliary inspection of large districts to an extent and with a degree of certainty that could scarcely be ensured or expected of any agents or members of a board of health unconnected with positive administrative duties. The inspection of these officers of the boards of guardians more than supplies the external inspection of inquests or of the leets; and it is submitted that in their position these boards may most beneficially exercise the functions of the leet in reclaiming the execution of the law, as against acts of omission and of commission, by which the poorest of the labouring classes are injured and the ratepayers burdened.
It may therefore be submitted as an eligible preliminary general arrangement, that it shall be required of the medical officer as an extra duty, for the due performance of which he should be fairly remunerated, that on visiting any person at that person’s dwelling, on an order for medical relief, he shall, after having given such needful immediate relief as the case may require, examine or cause to be examined any such physical and removable causes as may have produced disease or acted as a predisposing cause to it; that he shall make out a particular statement of them, wherein he will specify any things that may be and are urgently required to be immediately removed. This statement should be given to the relieving officer, who should thereupon take measures for the removal of the nuisance at the expense of the owner of the tenement, unless he, upon notice which shall be given to him, forthwith proceed to direct their removal. Except in the way of appeal by the owner against the proceedings of either officer, or where a higher expense than 5l., or a year’s rent of the tenement, were involved by the alterations directed by the medical officer, it appears to be recommended that no application to the Board of Guardians or the magistrates should be required in the first instance, as it frequently happens that the delay of a day in the adoption of measures may occasion the loss of life and the wide spread of contagious disease; and an application to the Board of Guardians or to the petty sessions would usually incur delay of a week or a fortnight. To repeat the words of Blackstone,—“The security of the lives and property may sometimes require so speedy a remedy, as not to allow time to call on the person on whose property the mischief has arisen to remedy it.” When any tenement is in a condition to endanger life from disease, as it comes within the principle of the law, so it should be included within its provisions, and should be placed in the same condition as a tenement condemned as being ruinous and endangering life from falling.
The instances above given of the working of the provisions of the Metropolitan Police Act for the cleansing of filthy tenements are, however, instances of zealous proceedings taken by competent officers in unions, where the attention of the guardians was specially called to the subject, and where there were no opposing interests. But several other instances might be presented, where the execution of the law is as much needed, but where it is already as dead as any of the older laws for the public protection, and the reason assigned is, that the local officers will not, for the sake of principle and without manifest compulsion, enter into conflicts by which their personal interests may be prejudiced. Medical officers, as private practitioners, are often dependent for their important private practice, and even for their office, on persons whom its strict performance might subject to expense or place in the position of defendants. Under such circumstances it is not unfrequent to hear the expression of a wash from these officers, that some person unconnected with the district may be sent to examine the afflicted place, and initiate the proper proceedings. The working of the provisions of the Factory Act for the limitation of the hours of labour of children has been much impeded by the difficulty of obtaining correct certificates of age and bodily strength from private medical practitioners. On this topic a large mass of evidence might be adduced, showing the unreasonableness of expecting private practitioners to compromise their own interests by conflicts for the public protection with persons on whom they are dependant.