County Councils other than County Borough Councils are not health authorities within the meaning of the Public Health Acts, but they have been given important duties under the Isolation Hospitals Act, under the Tuberculosis Regulations, the Maternity and Child Welfare Act, the Venereal Dieases Regulations, and also in regard to school medical inspection, and the tendency of present-day policy is gradually to shift much of the responsibility for these and similar personal health services from the smaller urban and rural authorities to the County Councils, and thus, by increasing the strength and efficiency of local administration, to diminish the need for detailed control and interference by the central departments.
Public Health Personnel.—The first local authority to ap point a salaried Medical Officer of Health in Great Britain was Liverpool in 1847. In 1848 the Corporation of the City of London appointed Dr. (afterwards Sir) John Simon to be its Medical Officer of Health. The larger cities followed and in 1872 the practice had become so general that the Public Health Act of that year made it obligatory on every urban sanitary authority to appoint a Medical Officer of Health. The Public Health Act of 1875 extended this obligation to all local authorities, both urban and rural.
At first no special qualification was prescribed, but in the Local Government Act of 1888 a clause was inserted requiring that after the 1st of January 1892 every Medical Officer of Health of a County or of a district containing a population of 50,000 or more inhabitants should be not only legally qualified in medicine, but also be the registered holder of a Diploma in Sanitary Science, Public Health or State Medicine. By an Order issued by the Ministry of Health in 1922, this requirement was extended to all Medical Officers of Health, so that to-day no candidate is eligible for such an appointment unless he holds a Diploma in Public Health, except by special dispensation of the Minister of Health. The Sanitary Officers Order of 1922 also laid it down that every Sanitary Inspector appointed by a local authority should possess a recognized qualification in Sanitary Science.
In the brief survey which follows reference is made to some of the more important matters dealt with by local public health authorities.
Vital Statistics.—Vital statistics furnish a measure of the influence of various conditions and occupations on the health of the population and a means by which the value and efficacy of the ameliorative and preventive action taken by local health authorities can be assessed. Every Medical Officer of Health is
required to furnish each week to the Registrar General a return of all cases of infectious disease notified in his district. These returns, together with those supplied by the local registrars of births and deaths, are the material on which the Registrar General bases his Weekly Report, and also his Quarterly and Annual Sta tistical Surveys. This information is supplemented by Annual and special reports of Medical Officers of Health and from the results of investigations by Medical Officers of the Ministry of Health and by other departments and voluntary bodies interested in the physical, industrial and social welfare of the people.
Environmental Hygiene.—Long before the discovery of bacteria and their relation to disease, sanitarians recognized the close association of dirt and pestilence and the importance of cleanliness in the prevention of infection. It is difficult to believe that elementary health services such as the provision of a public water supply, drainage, sewerage and sewage disposal, the regular removal of house refuse and the cleansing of streets, which are to-day accepted as indispensable to civilized life, were practically unknown through the greater part of England and Wales less than a century ago. These services are now regularly undertaken by all local sanitary authorities. Control is exercised over building to ensure freedom from dampness, adequate lighting, ventilation, drainage, closet accommodation in houses intended for human habitation. Many of the larger towns have long since reached out beyond these elementary objectives, undertaking other services which have, directly or indirectly, a beneficial effect on the welfare of the community—the provision of cheap transport which has helped to overcome the housing difficulty, the provision of gas and electricity which has lessened labour in the homes and con tributed to a cleaner and more wholesome atmosphere, the pro vision of parks and pleasure grounds where the people may recruit from their labour and the children play in safety.