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48
and, whatever be the policy laid down by the head of the Department,
without the subaltern co-operation of experienced and able
inspectors, the fruition of that policy must necessarily be disappointing.
The Public Health service is at present in a sadly inchoate
condition. Some lines of definition seem to be appearing, but, if in
the future, as seems to be likely, district medical officers of health
are to be so called whole-time officers, subsisting on a barely living
wage, and if public health departments are to be staffed by
inspectors who are merely clerks, I for one doubt if the quality of
the work done will be always so high as has been the case with the
medical officer in a less dependent position, and the inspector a man
used to responsibility and the exercise of discretion. It is not however
in machinery alone that change is occurring.
Old-fashioned commonsense sanitation, the sanitation of the
old officials and the civil engineers, responsible for the great
amelioration of the public health in the sixties, seventies, and even
the eighties, has been lately somewhat out of fashion. Bacteriology
has been thought to inaugurate a new era, and the gratuitous
distribution of tracts on hygienic subjects to bring about a sanitary
millennium, whilst many medical officers of health have seemed
to think that their duty lies in preaching the necessity for
socialistic experiments, rather than in attending to the drains
and milkshops of their districts.
There are, I think, signs that already a wholesome reaction is
in progress. Every day the latest discoveries of the laboratory
seem, as has been recently pointed out, a propos of typhoid carriers,
rather to justify confident insistence on the value of old methods,
empirical though they were, than to point out short-cuts to the
promised land of Hygeia.