208 , REPORT—1874., . 
districts. The authorities of these should include, besides elected, a certain number 
of ex officio members, or members recommended by the central authorities. 
IV. Complete executive organization. 
This should consist of— 
. The Central Authority. 
. The Medical Advisers of the Central Authority. 
. Inspecting Medical Officers of Health. 
The Superintendent Medical Officers of Health. 
Local Medical Officers of Health. 
. Engineering Staff. 
. Inspectors of Nuisances. 
Analysts. 
1. The Central Authority is in England and Ireland at present, and should con- 
tinue to be, the Local Government Board. In Scotland it is the Board of Super- 
vision for the relief of the Poor and of Public Health, which might be better called 
the Local Government Board of Scotland. In order to make these boards efficient 
as central authorities for supervision of matters connected with public health, I 
consider that certain duties now attached to other departments should be transferred 
to these boards—namely, the supervision of lunatics and the inspection of factories, 
and the registration of births, deaths, and marriages, and a new department for the 
registration of disease. The Central Health Authority is the only department 
which requires immediately to utilize the statistics collected by the Registrars- 
General ; and I would suggest that the Registrars-General departments should be 
amalgamated with the Local Government departments, and the Registrars-General 
become Local Government Commissioners. 
2. The Medical Adviser of the Central Authority.—I consider the position occupied 
by this officer in Ireland is his proper position, and that the medical adviser in 
such important matters should always occupy a seat on the Board. 
3. Inspecting Medical Officers of Health.—This title was proposed by my friend 
Mr. Furlong, and I consider it an extremely suitable one. It must be admitted 
that an efficient special department of experts exists in connexion with the English 
Local Government Board, namely, the medical department which is under the 
direction of Mr. Simon; but the inspectors (all eminent men) only exercise their 
functions under special circumstances, generally connected with outbreaks of disease. 
The duties, therefore, of this department do not so much tend to the prevention 
of disease (the object of sanitary legislation and organization) as to inquire into the 
cause of some disease which has already been allowed to produce fatal results. I 
would suggest that a staff of local government inspectors should be constantly 
employed, each with a special district assigned to him, these inspectors to be called 
Inspecting Medical Officers of Health. There would be considerable difficulty in 
selecting suitable districts; but I think this may be accomplished by taking as a 
basis the divisions adopted by the Registrars-General. 
4, The Superintendent Medical Officers of Health.—These are the officers provided 
for by the Irish Act of 1874, and are, I believe, intended to superintend only public 
health operations in populous places, such as large towns, say towns of 80,000 
inhabitants and upwards. Of such towns there are 180 in England, seven in 
Scotland, and four in Ireland, but with suburban districts added there must be 
several more in each country. I consider similar officers should be provided for 
towns in England, and they would correspond to the medical officers of health of 
urban sanitary districts. ; 
5. Local Medical Officers of Health.—These should be, as provided in the Irish 
Act, the poor-law medical officers, each for his own district ; but their employment 
is at present optional in England, and this has resulted in great confusion. The 
poor-law officers are manifestly the most suitable, as the very nature of their 
occupation brings them in contact with the first outbreaks of epidemics. 
6, The Engineering Staffi—Every sanitary authority must have a surveyor in 
arge towns permanently employed, but in small places and rural districts employed 
as consultants only when required, There should also be engineering inspectors cor- 
responding with the medical inspectors, but their districts might be much wider, 
CO WIS? OTR CO bo 
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