THE NEW SANITARY INSPECTORS.
WE are afraid that Mr. Stansfeld has made a mistake. By the Public Health Act of last Session every por- tion of England and Wales having. been provided with a local authority for the improvement of its sanitary condition, it became necessary to appoint Inspectors to see that these bodies discharge their duties, and it needs no very elaborate argu- ment to prove that on the manner in which these Inspec- tors perform their functions will largely depend the value of the Act. The wonderful power of obstruction possessed by Boards of Guardians ought to have impressed itself by this time on the most heedless of us. And, therefore, it is safe to predict that unless a very sharp spur indeed is applied to them, they will not show themselves very zealous in the removal of nuisances, or the abatement of causes of disease which may be profitable to any among them. This was foreseen as soon as it was decided to make the Union the unit of administration, and consequently an attempt was made, while the Bill was under discussion, to wring from Mr. Stansfeld a promise that he would appoint only experts. Mr. Stansfeld, however, declined to pledge .himself, though he left the impression that he was per- sonally favourable to the course recommended. If he was so, he has since seen reason to alter his views, for after full time for consideration he has now selected ten or twelve gentlemen, not one of whom is a medical man. Our readers will, doubtless, have read with interest the letter which an eminent authority in sanitary matters, Dr. Anstie, addressed to us last week with reference to these appointments. Dr. Anstie does not hesitate to say that their "effect, unless the policy be speedily reversed, will be to throw back sanitary work and sanitary science twenty years." And the language of our able contemporary the Lancet is even stronger still, while the Poor Law Medical Officers' Association is also out- spoken in its condemnation. We may be permitted to hope that these high authorities take an extreme view, yet we wish we could believe there was less ground than there seems to us to be for the unanimity with which they concur in blaming the course adopted by the Local Government Board.
We are not blind to the advantages of the policy which has been pursued. The carrying-out of the Public Health Act having been devolved upon the same bodies as were already entrusted with the relief of the poor, there is unquestion- able administrative convenience in 'utilising the old Poor- Law machinery to the utmost possible extent. England and Wales are divided into eleven Poor-Law districts, to each of which an inspector is allotted, and as the Boards of Guardians had been made the local sanitary authorities, it was a very natural suggestion, we admit, to add sanitary supervision to the duties of the Poor Law Inspectors. This is what has been done. But as the Inspectors already had their hands full, an Assistant has been appointed to aid each. Of course, medical experts could not have been expected to accept a mere assist- antship to the old Poor Law Inspectors. If they had been appointed, they must have been made the principals, and must have received a very much larger salary than non-professional apprentices are willing to accept. This consideration, doubt- less, played an important part in deciding the Local Govern- ment Board to content itself with the latter class. Lastly, we are inclined to suspect that the Board was literally afraid of the difficulties into which the zeal of the profession might lead it. An eminent medical man, who has devoted his life to the study of the causes and the prevention of disease, who appre- ciates in all its fullness the part played by sickness and death in adding to the burden of pauperism which is weigh- ing us down, and who sees in preparation the condi- tions precedent to the outbreak of an epidemic, might well be pardoned if he lost patience with the stolid ignorance that would scatter sorrow and suffering among friends and neighbours, and proceeded to compulsion before trying persuasion. But though the doctor who would do so would deserve honour, he would certainly not act most wisely for the cause he had at heart. We do not ourselves attach much importance to this fear, but we cannot help suspecting that it is entertained at the Local Government Board, as well as in the rural districts. If it really does exist in the rural dis- tricts, if the advice and the acts of medical inspectors would be looked upon with suspicion there, we cannot wonder that this fear should have considerable weight with the Local Government Board. It is unquestionably most important that the Guardians should be induced to co-operate heartily in the carrying-out of the Act, for if they were resolutely obstructive, it would be extremely difficult and excessively expensive to enforce it. Of that nobody can doubt who reads Mr. Tom Taylor's Report (included in the first Report of the Local Government Board) of the working of the Local Government and Sanitary Acts, during the last thirteen years. The conclusion is irresistible from Mr. Taylor's history of the proceedings under these Acts, that when the local authorities doggedly refuse to move, the Central Board is very nearly helpless. This indisputably is an unanswerable argument for prudence in selection of the Inspectors, but we cannot see that it is a reason against medical experts, who would also be men of the world.
The real objection in our opinion to non-medical Inspectors is furnished by the character of the ordinary Guardians. They have neither the intelligence nor the public spirit which would lead them to incur heavy expense for the sake of pre- venting disease. The ordinary farmer—and the small shop- keeper of the country town differs but little from him—is a man who loves to walk in the ways of his fathers. He looks with dislike or suspicion upon all innovation, and has a hearty contempt for all new-fangled notions. Such a man is not readily persuaded that the open sewer before his door is slowly poisoning him and his, that typhoid fever lurks in the well from which his father before him drank, and that the miser- able hovels in which his labourers are housed lower their strength and lessen the value of their labour. He knows that these things have existed as long as he can remember, he sees hale old men and women round him, and he cannot believe,
therefore, that they shorten life. Nor is he likely to be tolerant towards the person that would interfere with his business by preventing him from polluting streams or carrying on any kind of offensive trade. Yet we require the medical officer of his union to brave his displeasure by doing these things, by telling him that not only must he not continue profitable nuisances, but that he must lay out money to get rid of them. When we remember that the income of the average Poor Law medical officer pro- bably does not exceed, if it equals, £300 a year, that one-third of this he receives from the parish, and that his private practice lies among the class from which the Guardians are taken, we shall see how unreasonable it is to expect him thus to sacrifice all his prospects. He cannot afford to do it, and in truth, we have no right to demand the sacrifice of him. The utmost we should have a right to ask of him, it seems to us, would be that he should report on what needed improve- ment to a professional superior, and leave the latter to urge upon the Guardians to see it done. We say this on the sup- position that the ordinary parish surgeon is a competent authority in sanitary matters. But is it reasonable to expect that he should be ? The sort of man who settles down in a retired country place on a couple of hundred a year is hardly likely to have studied hygiene very profoundly ; and if he had, we fear an exhausting professional practice carried on under conditions that impose long and fatiguing daily journeys upon him is not favourable to the prosecution of such studies. It appears 'to us, therefore, that the parish
surgeon needs help and supervision only less than the Poor Law Guardians, and that a system which gives him neither, which places over him, not a professional adviser, but a lay official, can hardly be considered satisfactory.
It is true, and in justice to the Local Government Board the fact should be borne in mind, that attached to the Medi- cal branch of the Department there is a large and highly efficient Medical Staff. If any lay inspector wished for pro- fessional assistance, or if the Registrar-General's Report showed disease to be abnormally rife in any locality, one of these gentlemen, as a matter of course, would be sent down. But, on the other hand, we have never heard that this Staff is too large for the work it has already to perform. On the contrary, it is generally believed that Mr. Simon would gladly see it increased. If this be so, this supplementary inspection could be but rarely resorted to. Of course, however, if it was found after a little time that there was need for an increase, it would be easy to add indefinitely to its strength. Still, in any case, these professional inspections would be quite excep- tional. They would not take place unless there was some gross disregard of the law such as would become evident in the death- rate, or would excite the suspicion of the non-medical inspectors. If these latter and the parish surgeons were to prove utterly incompetent, and were generally to allow the statute to fall practically into abeyance, there might be nothing to excite attention for a long time, and no such special inspection would consequently seem called for. Now what we complain of is, that we can discover no guarantee that this may not occur. The lay inspectors will probably do as under the old system the inspectors of workhouse infirmaries used to do,—they will put a number of routine questions to the local medical officer, and the latter will answer them in the same routine manner. What that system produced in the Infirmaries we all know from the Lancet Commission, but it may be well to refresh the reader's memory by just two extracts. The first is from the description of the infirmary of St. Martin's-in-the- Fields, just seven years ago :—" The ground within the buildings," we are told, "is raised so much above the level of the surrounding streets that the ground-floor is converted into a basement on that aspect ; and this elevation of the ground is due to the circumstance that the site is, in fact, an ancient and well-stocked churchyard." To this we shall add the following from the paper on Clerken- well :—" The women's ward, in particular, offers an instance of thoughtless cruelty which nothing can excuse the Guardians for permitting. Twenty-one patients live entirely in this
ward There is no seclusion-ward for acute maniacs, and accordingly we saw a poor wretch who for five days had been confined to her bed by means of a strait-waistcoat, during the whole of which time she had been raving and talking nonsense, having only had two hours' sleep ; and there was the prospect of her remaining several days longer in the same condition. There were several epileptics in the ward, and one of them had a fit while we were present ; and there were imbeciles and demented watching all this with curious, half-frightened looks, which said very plainly how injurious the whole scene must be to them."
Such being our experience of non-professional inspection in the past, we confess we cannot regard the present experiment without apprehension.
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