1867.] The Public Health. 67 



the Medical Officers of Health have been obstructed and opposed in 

 all their efforts to improve the sanitary state of their districts. 

 Their salaries have been reduced, their suggestions neglected, and in 

 too many instances they have found it wise to. say and do as little as 

 possible for the sanitary improvement of their parishioners. The 

 new Act gives powers to the Vestries to appoint Sanitary Inspectors, 

 and where these officers have been appointed they have been of 

 great and permanent utility. But in many parishes of London no 

 Sanitary Inspectors have been appointed at all, and there are whole 

 districts, including thousands of people, who have never been bene- 

 fited in the slightest possible manner by the passing of the Metro- 

 politan Management Act. At a meeting of the Association of 

 Medical Officers of Health on the 16th of August, at the time when 

 Cholera was at its height in the East End of London, Dr. Sarvis, 

 the Medical Officer of Health for the Bethnal Green district, stated 

 that the Orders in Council had found his Vestry " entirely unpre- 

 pared," and " so far from their being inclined to carry out his 

 suggestions as Health Officer, they, in fact, opposed him." " There 

 was scarcely any house-to-house inspection ; in fact, there were only 

 three Sanitary Inspectors appointed for a district numbering up- 

 wards of 115,000 inhabitants." He added, " the adjoining parishes 

 were quite as bad." Here, then, we have the most competent testi- 

 mony to the fact that the East End of London had not only neglected 

 taking advantage of the Metropolitan Management Act, but at the 

 very time that the population was being carried off by hundreds in 

 a day, they were opposing their Health Officers and refusing to 

 supply the only means by which the disease could be stayed. 



The advantage of an organization with a Medical Officer of 

 Health at its head has been clearly demonstrated in London during 

 the recent outbreak of Cholera. There was no reason to suppose, 

 from the general character of the disease in its progress from Asia 

 through Europe, that the present epidemic would be less fatal than 

 it had been in 1849 or in 1854, but the numbers who have perished 

 in London have been much less than in either of those two epidemics. 

 Before the epidemic had fairly broken out in the East End of London, 

 the Privy Council issued instructions to every Vestry, which com- 

 pelled those bodies to take immediate action, and although these 

 instructions were issued too late to be acted upon in the Eastern 

 districts before the terrible explosion at the latter end of July, they 

 were nevertheless very generally carried out in the Northern, 

 Southern, and Western districts of the Metropolis. The principal 

 measures adopted under their instructions were as follows : — 



1. A Sanitary Committee, appointed by the Vestry, was consti- 

 tuted in every parish, to whom full power was given to take such 

 measures as were found necessary for the prevention or arrest of the 

 disease. The meetings of the Committee were regulated according 



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