The local authority shall appoint a medical officer or medical officers, and a sanitary inspector or inspectors, the latter of whom shall be also inspector or inspectors of common lodging-houses, and the local authority shall, subject to the approval of the Board, regulate the duties of such medical officers and sanitary inspectors and their relations to each other, whether appointed before or subsequent to the commencement of this Act; and the local authority may, and if required by the Board shall, appoint convenient places for their offices, and shall allow to every such medical officer and sanitary inspector and every other officer or clerk appointed by them on account of his employment a proper salary or remuneration; and the names and addresses and salaries of the said medical officers and sanitary inspectors shall be reported by the local authority to the Board immediately on such persons being appointed such salaries fixed; and the said medical officers and sanitary inspectors, and the local authority and their clerk, and the registrars of births, deaths, and marriages shall be bound to make such returns and special reports to the Board in such form and at such times as the Board shall require. The medical officer may, when required by the local authority, exercise any of the powers with which the sanitary inspector is invested by this Act.
No person shall, except with the express consent of the Board, be appointed as a medical officer of a burgh unless he possesses the qualifications set forth in Section seventy-seven of the Burgh Police (Scotland) Act 1892. No person shall be appointed as the medical officer in any district, other than a burgh, unless he possesses the qualifications set forth in Section fifty-four of the Local Government (Scotland) Act 1889.
No medical officer or sanitary inspector appointed by the local authority under this or any of the repealed Acts shall be removable from office, except by or with the sanction of the Board.
The registrar of births, deaths, and marriages in each registration district shall furnish to the local authority such periodical returns of births and deaths as may be required of him and approved by the Board, and for each death included in such return and for each return of births he shall be paid by the local authority the sum of twopence, and the local authority shall provide the forms on which such returns are to be made, and shall pay for their transmission by letter post.
The medical officer and sanitary inspector shall, if required by the local authority, respectively name a duly qualified substitute for whom they shall be responsible, and if the authority shall approve of the nomination, such substitute shall have the same powers and duties as the medical officer or sanitary inspector, as the case may be, during the temporary illness or authorised absence of either of them, and the local authority may from time to time with consent of the Board withdraw their approval of such substitute, and may require the medical officer or sanitary inspector, as the case may be, to name for their approval sonic other duly qualified substitute.
Nothing contained in this Act shall prejudice or affect the existing officers and servants of the local authorities under any Act in force at the passing of this Act, and such officers and servants shall without any further appointment be the officers and servants of the local authorities under this Act, with the same tenure (if any), powers, duties, and emoluments as heretofore.
§ SIR LEONARD LYELL (Orkney and Shetland)
moved, after the Words "The local authority shall" to insert the words "if required by the Board." He submitted that in the less populous districts in the north of Scotland, if there was to be a compulsory appointment of these officials, who were dismissible only by the Local Government Board, there would be great hardship inflicted, and he urged that there should be the dispensing power retained by the Board which he now asked for by his Amendment, and which was given in another part of the clause.
§ *THE LORD ADVOCATE
could not accept the Amendment. He did not think that the Local Government Board ought to be subjected to the pressure which might occasionally be put upon them to induce them to dispense with the appointment of these officials.
Amendment, by leave, withdrawn.
Amendment made: After "medical officers" insert "who shall be called medical officers or medical officers of health."—(Lord Advocate.)
moved, after the words last added, to insert the words, "whose duty it shall be to superintend and enforce the sanitary provisions of this Act." He explained that the object of the Amendment was to provide for a distinct definition of the position of the medical officer as the head of the sanitary department of the local authority. His 776 first reason for suggesting this Amendment was that in respect of this matter the Bill differed from the Bill of last year as it left the Committee of the House of Lords, and from the Bill as sent to the Standing Committee by the Government this year. Under the first part of this clause the local authority was given power to regulate the relations of the medical officer to the sanitary inspector, but in the last paragraph of the clause that power was encroached upon, and still further encroachments were made upon it in subsequent clauses. These clauses increased the statutory powers which the sanitary inspector already possessed, and to that extent limited the discretion of the local authority in this regard. In England, public health legislation had gone generally upon the lines of placing responsibility on the local authorities. It was true that the Local Government Board prescribed regulations under which the local authorities acted, but the idea was that local authorities should have liberty to regulate and co-ordinate the functions of their officers. But in Scotland the case had been different. Under the Public Health Acts powers were conferred upon the local authorities to make bye-laws to regulate the relations of medical officers and inspectors, but, on the other hand, special statutory powers were conferred upon sanitary officers, and the power of the local authority was thereby limited. The Board of Supervision and its successor, the Local Government Board, had lent their influence against enlarging the authority and discretion of local bodies. They had repeatedly pleaded that the statutory powers given to the sanitary inspectors rendered it undesirable that wider authority should be given to local bodies to regulate and co-ordinate the work and powers of the inspectors. Apparently by the beginning of the clause before the House, full power was now given to the local authority to regulate the relations of these officers, but when he looked at the end of the clause he found that that power was whittled and, as he had explained, it was encroached upon still further in other clauses. What lay behind this action On the part of the supporters of the Bill? Part II. of the Bill dealt with sanitary provisions, and Part III. with the mitigation and general prevention of diseases, 777 the usual discrimination being thereby set up between the work of the sanitary inspector and the work of the medical officer. The duty of attending to such matters as nuisances, offensive trades, slaughter houses, seavengering, unsound meat, foul ditches, sewers, etc., was to be regarded as the duty of the sanitary inspector, and when the disease had been engendered and developed, the medical officer was to step in and deal with it. Surely it was not right that about five-sixths of the causes of disease should be dealt with by the sanitary inspector. He knew of a case in a large town in Scotland where the sanitary inspector issued a notice requiring a certain owner to repair a block of houses, and sanitary conveniences had to be supplied throughout the block. Two years and a-half afterwards this block of buildings cone under the notice of the medical officer, who was obliged to bring the subject of their condition before the local authority, showing that these dwellings were unfit for habitation, and a closing order was issued, shutting them up. The circumstances were very hard upon the owner, and if there had been co-ordination between the sanitary and the medical authorities his interests would not have been sacrificed in the same way. He would give another instance of the evil results of the present system. In one county in Scotland the sanitary inspector refused for 12 months to lay before the medical officer information in his possession upon which alone the medical officer could take steps to prevent the spread of a disease. It was surely fair to say that sanitary inspectors in putting forward that argument, did so upon exceptional cases, and not on the general rule. The only other argument was that which would naturally come from any class of men who believed that their vested statutory rights were in peril. He did not himself doubt that the position of sanitary inspectors would be better in the future than it was at present, and that they would be better qualified to take their share in public health administration. He entirely disclaimed the idea of speaking against a deserving class of officers. For a few moments he turned to one or two points urged in Committee against his proposal. He was not present when the clause itself was under discussion, but in the 778 discussion on a later clause, he protested as he was protesting now against the relations with these officers, though he did not take a Division. In the first place, it was said that medical officers would want increased salaries, but there was no evidence of that, and no expectation, so far as he had ascertained, that the passing of this Amendment would lead to increased salaries for medical officers. Looking at the salaries of Scottish medical officers of health, they would be found in no way exceptional. The Lord Advocate the other day pointed out that his salary was subject to the inferiority of Scottish salaries as compared with those in England. Medical officers' salaries in Scotland were on a slightly lower scale than the English, but not so as to attract any particular attention, and there was every reason to believe that they were satisfied as much as any class of men were satisfied with their present salaries. Then there was the question of private practice, and it was put forward that we should rather lean on sanitary inspectors than on medical officers, because the latter often had private practice. That was perfectly true in the smaller burghs, but it was not true of the counties or the more important cities and towns that medical officers frequently engaged in private practice, but the tendency of public health administration in Scotland was to employ county medical officers in the small burghs. By a clause in the Bill, the main obstacle to the employment of county medical officers in burghs would be removed. There had been jealousy in burghs that they should be obliged to contribute to the salaries of county medical officers while paying their own, but the obligation would be removed, and he was certain that the extension of the authority of the county medical officers would be approved over the country generally, in order to render sanitary responsibility and administration more complete in the county. Looking at the question of private practice, and the position of sanitary inspectors, the latter were often occupied in duties no more akin to their duties than was the private practice of medical officers. Medical officers were qualified practitioners, and sanitary inspectors had not the required qualifications. Then there was the question of 779 the Highland counties, and it was said that it would sacrifice public health administration to put the whole of the sanitary responsibility on the medical officer as head of the department. What was the fact in the Highland counties? The Highland counties recognised the difficulty imposed by distance, and they had obtained the services of parish medical officers. In Argyllshire 27 medical officers were employed; in Aberdeenshire 41, in Inverness-shire 23, and Ross and Cromarty 16. And for what purpose? To advise the local sanitary inspectors as to carrying out the work that fell to them; so as hon. Members would see the medical officer of the department so to speak infusing into the work his knowledge, and dealing with any sanitary difficulty that arose. It was said that medical officers were frequently "faddists" and that they would be likely to involve local authorities in dangerous proceedings and owners in great expense, but he had shown by an instance which could he multiplied, that it was the action of sanitary inspectors and not of medical officers that involved householders in great expense. That was what might be expected. How could an unskilled man be expected to be conversant with the latest discoveries and to be guided by the spirit of public health administration rather than by adherence to some particular detail. A sanitary inspector would pin his faith to some particular kind of trap or sewers or drain which might have been superseded by later discoveries. It was not the case that acceptance of the proposal would involve the local authority in any greater responsibility than it had at present. With the clause amended as he suggested the local authority would always have the power to act independently of the medical officer; he would be the servant of the sanitary authority, bringing to that service the results of the latest discoveries, and the benefits of modern research, There was overwhelming evidence in favour of the course he suggested, from the experience of administration in England and Scotland. There was one exception to the public opinion to which he would allude. The full effect of the change made in Standing Committee was not appreciated until the later clauses were reached, and the 780 change was made under somewhat peculiar conditions, which would be familiar to the hon. Member for East Renfrew, and in opposition to the view of the County Councils Association. The Association were inclined to take the view he was expressing, but the hon. Member for East Renfrew, with that great authority which rightly attached to him, strongly represented that the Committee had made this change, and they should fall into line with the opinion of Scottish Members; but it would be found, on reference to the proceedings of the Association, that, though they deferred to the authority of the hon. Member, there were many protests against the change, and there were high authorities against it. The Scottish Chamber of Agriculture had unanimously passed a resolution disapproving of the proposal in the Bill the Glasgow Landlords Association had condemned it, so had the University Court of Glasgow and the General Medical Association. If any body of men had experience in this matter it was the Society of Medical Officers of Health. He asked hon. Gentlemen to consider what they were doing at the present time. If evidence were to count for anything, there was a very serious weight of evidence against the proposal of the Government. In England, both in urban sanitary authorities and rural sanitary authorities, the medical officer of health was at the head of the department.
On the return of Mr. SPEAKER, after the usual interval,
expressed his regret that he had been compelled to detain the House so long, but the question was a very important one.
§ *THE LORD ADVOCATE
wished to remind the hon. Member that the duty of a Member of Parliament sometimes was to resist pressure put upon him to put everything before the House. On this occasion he did not know how many Members had not been pressed again and again to bring up subjects on report, and to his knowledge they had done their best to minimise matters so as to bring the discussion within a certain compass. ["Hear, hear!"] It was nothing short of a Parliamentary outrage to have spoken on the Report stage over an hour upon a 781 subject which was never raised in Committee at all. How were they, consistently with Parliamentary form, to carry through a Bill of 191 clauses if everybody who had anything to say should speak an hour at least? [Cheers.] That was the reason. of course, that a Bill of this sort was sent to the Grand Committee, where the fullest and freest discussion was permitted. Yet upon that Grand Committee this Amendment was never moved—
§ *THE LORD ADVOCATE
The hon. and gallant Member said he was not there. Why not? Because he was packing his trunk in Canada. But if he was not present could nobody voice his views for him? This was no new point. There was, of course, always a contention between medical officers and sanitary inspectors in this matter, and that contention was fought out very keenly in the Select Committee of the House of Lords last year. After that discussion the words now in the Bill were arrived at. Therefore his hon. and gallant Friend's clients had plenty of time to think about them; and when they came to the Grand Committee this Session they had to represent them the hon. Member for the Universities (Sir W. Priestley) and the hon. Member for Bridgeton (Sir Charles Cameron), who were surely enough to represent that current of opinion. [''Hear hear!"] The first thing the Amendment would do would be to put the medical officer not above the sanitary inspector, but above the Local Authority.[Cheers.] He was not at all insensible to the claims of the great profession in whose interest the hon. and gallant Member had spoken. He did not wish for an instant to minimise the good the medical profession could do, or the debt we owed to them in the matter of public health. But he did not think the medical profession would do any good by doing what he was sure most of them did not do, but what some of them had done, apparently, by the quotations the hon. Member had read—by simply telling various stories about the sanitary inspector. It did not make a medical man white by calling a sanitary inspector black, but the point of the Amendment was, where they to have the 782 medical officer put as the statutory head of this department or were they to subordinate him to the Local Authority? He had no hesitation in saying that the view of the Committee upstairs was that the persons who were to be really responsible were to be the Local Authority, and that the medical officer was to be their servant and not their head. [Cheers.] The hon. and gallant Member ought to have known that the Lord Advocate was in communication with the heads of the medical profession, and though he could not do everything they wanted, he did put down certain clauses in the hope that they would minimise the grievance of the medical officers. He was sure the Amendment was against the sense of the Committee upstairs, and if they were to discuss the Bill in this way, they might as well drop it at once. [Cheers.]
§ DR. CLARK
said he was not on the Committee when the decision was come to, but if he had been present he would have voted against the provision now in the Bill. Although he was a medical man himself, he believed that a trade union of medical men was generally just as selfish as the ordinary industrial trade union looking after its own interest; but in this matter he was rather in favour of the view that the medical profession had taken. He had himself been a medical officer of health, and from his professional experience he thought the course suggested in the Amendment was better than the Bill, or even than the compromise in the Government Amendment, which would make it optional for the local authority to determine the position and duties of the sanitary inspector and the medical officer. The mistake the Government had made was that they had not adopted the provisions of the English Act in regard to the medical officer.
§ MR. MUNRO FERGUSON
said that the Lord Advocate had assumed that the manner in which this Bill was discussed by the Standing Committee was entirely satisfactory to the Scotch Members. The reference to the Standing Committee was strongly objected to because so many of the Scotch Members were unable to serve. As to the Lord Advocate's extremely offensive remark about the hon. Member for Forfarshire "packing his traps in 783 Canada," the hon. Member was not appointed on the Committee because there was not room enough for him.
§ *THE LORD ADVOCATE
said that he saw from a newspaper report of the proceedings in the Committee that the hon. Member for Forfarshire joined in the discussion.
§ MR. MUNRO FERGUSON
said that having had to do with the naming of the Committee, he could only say that his hon. Friend was not put on the Committee because there was not room for him.
§ *THE LORD ADVOCATE
said the whole point was whether the hon. Member was on the Committee on that particular day. He saw from a Report of the Proceedings in the Committee on the 8th May that the hon. Member took part in the discussion of Clause 15.
said that he was not on the Committee originally, but exchanged subsequently with another hon. Member.
§ MR. C. B. RENSHAW (Renfrewshire, W.)
did not agree that the authorities in Scotland looked with dislike on the proposals of the Bill. Recognising the difficulties, they had worked out an efficient system of public health. As to his relations with the County Councils Associations, the hon. Member for Forfarshire was quite inaccurate. He was not present on the day in question until the whole of the proceedings had terminated. He was glad that this Amendment was to be resisted by the Government.
§ MR. BRYCE
said that it was not the intention of his hon. Friend's Amendment to put the medical officer in a position of statutory superiority to the local authority itself. All that was desired was unity of administration, and that the medical officer should be at the head of administration under the local authority. But if the Lord Advocate would not accept this Amendment, perhaps he would not have the same objection to one standing in his name later in the Paper. This was not a question of quarrel between medical officers and the sanitary inspectors. Their relations were usually 784 harmonious. But the administration of the Act would be greatly simplified by one person being put at the head.
§ DR. FARQUHARSON
said that he entirely dissented from the Lord Advocate's opinion that it was waste of time to discuss this question. It was a question which had roused more feeling in the medical profession than any other. There was no want of appreciation for the work of the sanitary inspectors, but it was asked that the old conditions of things should continue, and the medical officers should be put at the head of the sanitary inspectors. In his opinion there was ample justification for bringing this matter before the House, and he was sorry that the Lord Advocate, in a moment of aberration, should have characterised his hon. Friend's proceedings in such harsh terms.
§ SIR W. PRIESTLEY
thought it would be best to leave the clause as it was, and leave the medical officer of health to take that position which his superior education and higher qualifications necessarily entitled him to.
Question put, "That those words be there inserted."
The House divided:—Ayes, 69; Noes, 127.—(Division List, No. 325.)
SIR. W. PRIESTLEY
moved, after "Local Government (Scotland) Act. 1889," to insertand this, notwithstanding anything contained in sections seventy-five, seventy-six, and seventy-seven of the Burgh Police (Scotland) Act 1892.He said the intention of the clause was to leave the regulation of the duties of the sanitary inspector to the local authority, but this would be interfered with if the sections named were not mentioned, because they governed the situation. He begged to move the Amendment.
said the earlier part of the clause gave power to the local authorities to regulate the relationships of these officers, and the Amendment was necessary if it was to be done.
Amendment agreed to.
§ SIR C. CAMERON
moved to omit following words:—No person shall be appointed as a medical officer of a burgh unless he possesses the qualifications set forth in section 77 of the Burgh Police (Scotland) Act, 1892.The step which it was proposed to take to lower the medical qualifications of the medical officers was a retrograde step. The reason which had been alleged for the words, was that in certain small towns there might not be a medical man possessing the medical qualification. But, would point out, what was wanted was not merely some sort of medical officer, but one who had made a special study of the subject. The matter had been decided there before three or four times, and he protested against this change being made,—not at the instance of the Committee as a whole, but by a very narrow majority of the Committee upstairs—in such a reactionary manner. He was perfectly certain the Local Government Board would never give permission to deviate from the common law of the country except on reasons shown.
§ *THE LORD ADVOCATE
said he would leave the matter to the decision of the House. As a matter of fact, he had himself voted for the present Amendment in Committee. Of course, he always felt bound so far as he could to support the Committee. But what had happened was this—the hon. Member for Dumfries Burghs moved to omit the qualification altogether; the hon. Member for Dumfriesshire then moved an Amendment which now stood in the Bill, that Amend-having been carried by a majority of 15 to 13. He had personally voted against it, but he was quite willing that there should he an open vote upon the matter.
§ DR. FARQUHARSON
hoped that the Lord Advocate would support them in the Division Lobby. This was one of the most retrograde and mischievous proposals ever made in connexion with public health.
§ MR. ROBINSON SOUTTAR (Dumfriesshire)
, believed that the clause was 786 inserted in order to meet certain cases of hardship of which the Mover of it was personally aware.
§ DR. CAMERON
moved, in the second paragraph, as a consequential Amendment, to leave out the word "in" ["in any district"] and to insert the words "of any burgh, or of."
Amendment agreed to.
§ DR. CLARK
moved the following proviso which stood on the paper in the name of Mr. Rentoul:No person shall, except with the express consent of the Board, for reasons brought to their notice, be appointed a sanitary inspector after the first day of January One thousand nine hundred who does not hold a certificate of such body, as the Local Government Board may from time to time approve, that he has by examination shown himself competent for such office, or shall have been, during three consecutive years preceding the year One thousand nine hundred, a sanitary inspector or inspector of nuisances of an urban sanitary district containing, according to the last-published census, a population of not less than twenty thousand inhabitants.He urged that it was desirable these persons should have some qualifications, and it was incumbent on the Government to do something.
§ *THE LORD ADVOCATE
commented on the unfortunate circumstance that an hon. Member moved an Amendment standing in the name of another hon. Member, and on his not being familiar with the reasons which prompted the Amendment being put down. He was quite willing to consult as to the point sought to be remedied, but he could not accept the Amendment. An "urban sanitary district," for example, did not exist in Scotland.
Amendment, by leave, withdrawn.
§ MR. BRYCE
, in the first paragraph, moved to leave out the words "duly qualified," and to insert the word "competent." He remarked that if duly qualified meant that a man should be competent he would be satisfied. But if the words meant that he should be a 787 diplomate of public health it might, in remote districts in Scotland, in the temporary absence of a medical officer, be difficult to find a substitute possessing that qualification.
§ *THE LORD ADVOCATE
said that a competent man was all that was expected.
Amendment, by leave, withdrawn.
Amendment made: In last paragraph, after "shall," insert "save in so far as expressly otherwise provided"; after "with," insert "save as aforesaid"; after "tenure," insert "of office."—(Lord Advocate.)
§ Clause 16,—