View report page

2
A further advance was that made when Huddersfield, in 1876, followed by Bolton in 1877, and
then by other towns, obtained compulsory notification of certain forms of infectious disease. A
general Act, the Infectious Diseases Notification Act, was passed in 1889, empowering authorities
to put notification in force, and the duty of enforcing notification was made obligatory throughout
the country in 1899.
The Physical Deterioration Committee are now clearly of opinion that the time is ripe for taking
a further step. They point out that in the poor law records there has practically run to waste in
this country " an enormous mass of information which, had it been arranged and analysed on
suitable lines, would have been simply invaluable to the Committee at the present juncture." The
Committee therefore recommend that the tabulation and analysis of the Poor Law Returns should be
entrusted to the General Register Office.
It is obvious that such tabulation and analysis should be done by a central authority, but
inasmuch as to carry out the work for the entire country would be a large undertaking, and as it
might perhaps be thought well to make a beginning by dealing with the figures for a compact and
more or less homogeneous area such as the County of London, the Public Health Committee may
like to consider whether any help which they can afford could be immediately utilised for assisting
to initiate a very desirable new departure.
At the present time the returns of infectious disease in London are, with the sanction of the Public
Health Committee, tabulated in my department, and the tabulated statement is sent to the
Registrar-General and published by him in his weekly, quarterly and annual reports. It would no
doubt be practicable to adopt a similar system with regard to cases of illness at public institutions,
and to furnish a weekly statement showing total sickness, and cases of sickness of certain special
kinds, brought newly under treatment in infirmaries, hospitals and dispensaries. The value of a
return of this sort giving information as to cases, for example, of diarrhoea, measles, whooping cough,
phthisis, pneumonia, rheumatic fever, syphilis and cancer, would be very great, and if its importance
were once demonstrated for London, this would, no doubt, lead to its extension after no great
interval of time to the rest of the country.
(3) Advisory Council.
The Committee emphatically recommend the creation of an Advisory Council, the composition of
which should be modelled to some extent on Le Comite Consultatif d'Hygiene Publique de France ;
such a council, the Committee think, would be "of great assistance, especially to the Local Government
Board, and would supply the knowledge and stimulus which are necessary to give the public
health side of the Board's administration a prominence, which the multiplicity of its other functions
may have tended to obscure, and to attract to its work that measure of public interest and support
which has perhaps been lacking hitherto."
The present constitution of the French Consultative Committee referred to above is determined
by Article 25 of an enactment passed in 1902. It consists of 45 members ; 24 are chosen ex officio
on account of their occupying positions in which they may be held to be brought into touch with
public health questions ; the remainder are appointed by the ministry, six being selected from a list
of nominations made by six academies and corporations, and 15 being chosen as possessing medical,
public health, engineering, chemical or legal qualifications. The Committee appears to exercise
some of the functions which at the present time devolve upon the Local Government Board in this
country, and it may be questioned whether had there been in France a central authority, already
exercising all the powers of the Local Government Board, it would have been deemed necessary to
constitute a distinct advisory body.
The Physical Deterioration Committee (paragraph 64) introduce their recommendation as regards
an Advisory Council in connection with that concerning an anthropometric survey. They suggest
that a council representing the Departments of Stat6 within whose province questions touching the
physical well-being of the people fall, with the addition of members nominated by the medical
corporations and others, would apply the information derived from the labours of the Anthropometric
Survey Bureau" with the whole weight of Government authority and scientific prestige behind them."
It is, to begin with, open to question whether a council of 45 members, constituted after
the model of the French Council, would be a body well suited for the special purpose of
advising upon the information derived from the survey. But while advising on the survey is the
raison d'etre of the Advisory Council, its functions are intended by the Physical Deterioration
Committee to include that of acting as a " useful auxiliary" to the Central Government in
watching "the play of local administration throughout the country" and bringing "influence
to bear on backward districts." This is, of course, a most important function of the Local
Government Board at the present time. The Physical Deterioration Committee consider due
prominence has not been given to the exercise of this function in the past, and indeed that " the mass
of routine work in which the Local Government Board is immersed affords it little time for the
consideration of questions of public policy in the sphere of health, and may render it slow to assume
the responsibility of applying new principles of administration." It may be pointed out that the
function specially under discussion, far from being a new principle of administration, was the
principle upon which emphasis was laid at the outset, and it is enunciated with precision of detail in
the Public Health Act of 1848. As to whether the exact amount of prominence desirable has been
given to the exercise of this function there may be room for discussion, but if more prominence is
necessary it may be urged that it can be better given by a Government department, armed with
knowledge as to local circumstances and responsible to Parliament, than by a Council without the
necessary means of obtaining knowledge and without the authority and influence which direct
representation in Parliament implies.
The French Advisory Council is in large degree reminiscent of the General Board of Health,
constituted under the Act of 1848, the history of whose failure has been traced by Sir John Simon