1899 The Lancet  
The front panel bears portraits of Lady Randolph Churchill (president), Mrs. Ronalds (honorary treasurer), and Mrs. Blow (honorary secretary of the American Ladies' Hospital Ship Committee), a picture of the hospital ship Maine, a scene representing the British Lion wounded by an arrow (which lies broken at his side) being administered to by Britannia and Columbia-Columbia pouring a healing balm upon the wound whilst Britannia bandages the paw. A frieze is formed by a representation of American
more » ... ntation of American Indian Wampum upon which are depicted Brother Jonathan and John Bull grasping hands. The other panels bear equally suitable designs descriptive of the bond of union between the English and American peoples. Prominently inscribed on the chest are Keble's line, " No distance breaks the tie of blood," and Ambassador Bayard's notable phrase, "Our kin across the sea." Surgeon-Lientenant-Colonel Hensman, A.M.S., will represent the War Office on the Maine, while Surgeon-Major Cabell will direct the services of Dr. A MATTER at present receiving considerable attention from medical officers of health and deserving even moie e attention from the general public is the question of fixity of tenure and superannuation for the above-named officials. Superannuation, not only for health officers, but for all officials engaged at a fixed salary in positions of trust, is desirable; fixity of tenure-by which is meant " undisturbed possession of office and emoluments, subject only to dismissal for approved reasons by the Local Government Board"-is for medical officers of health more than desirable, it is absolutely essential for the effectual fulfilment of their duties towards the best interests of the public. A casual observer is apt to consider this question of fixity of tenure as a matter affecting principally medical officers of health themselves. Such, however, is emphatically not the case; on the contrary, the greatest sufferers by the existing state of affairs, and those who have most to gain by reform, are the members of the general public; it is only incidentally that medical officers benefit by the reform. For nearly 30 years, ever since, in fact, appointments of medical officers of health have been made, the people have been robbed of the full benefit of the Public Health Acts by the sole circumstance that medical officers are liable to curtailment of salary or capricious dismissal by the members of their sanitary authority. A moment's consideration will convince anyone that this must continue to be the case until fixity of tenure is granted. Take, for example, the composition of the ordinary sanitary authority-whether of a city, county borough, urban or rural district council-in every case its members are drawn from those who have the largest vested interests in the district or town as the case may be, they are possibly the greatest owners of property, the largest house agents, or the chiefs of the principal industries of the place. Sanitary reform unfortunately entails a certain amount of expenditure and will directly or indirectly affect to some extent the pockets of these men, the result of which is obvious. It is not an uncommon thing for a medical officer whilst endeavouring to have some insanitary property put in a proper state of repair to find that a quantity of it is owned by a member of the sanitary authority-i.e., by one of his masters, by one of the men who have absolute power to discharge him neck and crop without giving rhyme or reason for their action. Or suppose the medical officer is taking active steps to provide an abattoir he is at once at variance with the vested interests of the meat trade on the council ; or suppose he agitates against the erection of insanitary dwellings he finds himself forthwith at loggerheads with the jerry-builder and his financiers, a class usually strongly represented on sanitary authorities. He points out defects in the water-supply and finds half his council suddenly cool to him, due, as soon dawns upon him, to the fact that half the members of the sanitary authority are shareholders in the local water company ; and so on. Examples might be multiplied ad nauseam. Such occasions constantly occur in the experience of every medical officer of health, and there are then two courses open : -, the medical officer may either allow the matter in hand to be referred to committee and quietly shelved or be may make a firm stand for what he considers to be his duty to the community. Adopting the first course the health of the community suffers and the medical officer is restored to favour and possibly gratified by hearing flattering allusions to his tact and good sense ; adopting the second the health of the community may still possibly be ignored, but one thing is very certain-the medical officer will, if the matter affects large interests, assuredly suffer. It reflects credit on medical officers of health as a class that so many prefer to suffer annoyance and risk loss of appointment rather than allow their sense of duty to be guided by expediency. That loss of appointment for mere performance of duty is no vague and remote risk is shown by the list of cases quoted by Dr. T. W. H. Garstang in his address delivered at the annual meeting of the Incorporated Society of Medical Officers of Health in October ; from these cases we select those of three medical officers who were dismissed for advocating a new water-supply; of seven who were dismissed for advocating various sanitary reforms; of two dismissed for urging the provision of an isolation hospital; and lastly, of one medical officer of health dismissed, after several years' service, for interfering with the concealment of a case of small-pox in the house of the chairman of his authority ! Now medical officers of health are drawn from the same ranks as are other professional men ; as a class they are not actuated by higher or by lower motives than others, and are not less prone or more prone than others to sacrifice themselves for conscience sake. What, then, must be the effect on the improvement of sanitation in the country from placing the chief of the sanitary administration in every district in such a situation that his duty puts him frequently face to face with two alternatives-one, performance of duty and loss of appointment, possibly starvation for himself and family, dismissed with the added stigma of having proved an incompetent officer ; the other, neglect of duty and the knowledge that thereby his path will be in pleasant places, he will be on good terms with his councillors, and will find applications for increase of salary very favourably received ? 2 Is it, then, a matter for surprise that the benefits anticipated from the passing of the Public Health Acts have not been realised ? Is it not, on the contrary, astonishing that any good at all should have been accomplished and that so many men have been found who have preferred to face loss of appointment rather than to allow their sense of duty to wait upon their personal enrichment ? ? These above-mentioned alternatives are not exaggerated. Every medical officer of health throughout the country has continually found that his popularity with the members of his sanitary authority has been increased or decreased according as his activity in sanitary reform has been slight or marked. A rural medical officer of health, a man of marked ability and a diplomate of public health, remarked recently, "Well, up to three years ago I took a great interest in public health, gave a lot of time to it and really worked hard to effect some much-needed sanitary reforms in my district-result, every year it was touch-andgo whether I were re-elected or not, consequently I decided to let the thing slide and now there is not a more popular official than myself ; in fact, at the end of the year I shall almost certainly obtain a considerable increase of salary." Here, then, is an example of considerable abilities, the result of a number of years of experience and practice, absolutely lost to the people for the sole reason that to exercise them would assuredly cost the medical officer his appointment. He would be a stern moralist who would attach much blame to this medical officer for the course he had the honesty to confess that he pursued, and there, are doubtless hundreds of medical officers throughout the kingdom who, though they may not give expression to their sentiments in the same words, are yet, consciously or unconsciously, coerced into adopting the same plan of campaign. That the medical officer of health is without security of tenure is, we hold, inimical to the well-being of the community : it retards sanitary progress, prevents the due administration of the Public Health Acts, and, lastly, places medical officers of health in unfair, ambiguous, and in what in many cases have proved untenable positions. Unless medical officers of health are independent of local authorities they are subject to unfair conditions to which no man should be
doi:10.1016/s0140-6736(01)01682-8 fatcat:wgmlo3t4evcofa2ex3gju2vbc4