The fertile fields of this new land of loving labour lies before them in all its fruitful freshness, let them have the courage to claim possession of it in the name of a high and holy cause —the health and happiness of the Irish people.

Mr. H. H. COLLINS, F.R.I.B.A. (London), said it might be supposed from the observations that had been made, that the medical officers of health in London had quite an easy task as compared with that of the medical officers of health of Ireland, but he had thought the address of the President last night would quite have dissipated that impression. The truth was that there existed amongst the masses of the population a lamentable apathy with regard to sanitary matters, although during the last twenty-five years there had been enough books written on Sanitary questions to fill that building, and despite the fact that such men as their President, Mr. Edwin Chadwick, Dr. Cameron, and others had been pressing this matter upon the people at large, it was extraordinary how very little real interest the question had aroused. Only those who had to administer the laws relating to sanitary matters could understand or appreciate the difficulties experienced in carrying them out. If a person noticed a disagreeable odour in his house he usually sent for a plumber, who probably, from ignorance or design in endeavouring to rectify defects, made them worse. One of the main objects of this Association was to prevent unqualified persons from assuming duties and undertaking to carry out the enactments contained in Acts of Parliament without the least fitness for their position; and it offered by the most highly qualified examiners to ascertain whether inspectors had acquired sufficient knowledge to enable them to perform their different duties; and to supply them (if efficient) with a certificate, which would not be merely a written testimonial, but would represent that they had an absolute knowledge of the subjects they professed as connected with principles of Public Sanitation.

Corporations in large towns were beginning to see that sanitary efforts were in a great measure nugatory, unless they could embrace within their control the outlying districts, and in London it had long been felt that there should be no distinction between urban and rural sanitary authorities. He had long since come to the conclusion that to educate the people into a knowledge that the neglect of such matters as Dr. Flinn had so ably brought before them, meant the taking of so much money out of their pockets, was the best way to lead to the enforcement of these laws.

Dr. ALFRED CARPENTER (Croydon) wished to confine the discussion to the question raised by Dr. Flinn's paper-viz., the difficulty of getting the Public Health Acts carried out in Ireland. It should be borne in mind that the great object of the Sanitary Institute in

holding these Congresses was the education of the people; and when he looked at that meeting and saw the number of persons who were anxious to learn and know something of sanitary laws, he was satisfied that sanitary progress was being made in Ireland. If they could get a spirit of enquiry diffused among the people as to the advantages that followed the adoption of sanitary arrangements much more good would be done than by a process of compulsion. The principles of sanitary law would be carried out much better in those districts where the people knew that these laws were for their advantage, and where they felt it was to their interest to attend to them, than in districts where they were compulsory; and wherever there was that favourable idea of the law, no difficulty would be experienced in obtaining proper sanitary inspectors. No doubt there were places in England, as well as in Ireland, where there were difficulties experienced in carrying out the sanitary laws, but he did not think there were any similar cases to that referred to by Dr. Flinn, in which typhus fever patients were treated in a small room, wherein many others slept during the night. It was only by "pegging away," as President Lincoln said, that sanitary reformers could get attention paid to them, and he trusted the visit of the association to Ireland would arouse a spirit of enquiry which would lead to the disappearance of those evils which had been brought under notice.

Dr. CHARLES A. CAMERON (Dublin) thought they were much indebted to Dr. Flinn for bringing this matter before them. He was disposed to agree with the views of the author. So far as he could ascertain, it was the universal opinion of the officers of health themselves that the Public Health Acts were not being carried out at all in the rural districts of Ireland. Those officers were not able to carry out Acts, and the reports that they sent in were not attended to. He should not like to be considered as unpatriotic, and he hoped he should not be taken as abusing his fellow-countrymen, but boards of guardians, as a rule, were not at all anxious to carry out the Sanitary Acts. This was especially true in regard to water-supply, as he hoped to have an opportunity of showing in the geological section. A most appalling state of things existed in regard to the water-supply of the greater part of Ireland, and this arose from a disinclination to spend money. He could fully confirm the observations of Dr. Flinn, that sanitary administration was not properly carried out in many of the small towns in Ireland. In England most towns of 3,000 or 4,000 people would have a supply of water at high pressure, but few towns in Ireland of even 7,000 or 8,000 inhabitants had this. In an Irish town of 3,000 inhabitants they would probably find a magnificent organisation of town commissioners, town clerk, medical officer of health, inspector of nuisances, and other officers; but perhaps the revenue of this great organisation did not exceed £50 or £60 a year, and the whole of it must be expended in payment of officers, leaving nothing for the carrying out of sanitary works. One gentleman whom he knew bore the high-sounding title of "Superin

tendent Medical Officer of Health," but had no one to superintend, and he had been promoted from the position of "Consulting Medical Officer of Health," which office also carried with it no duties. This gentleman had made no reports since his promotion, because his reports as consulting medical officer were not attended to. He (Dr. Cameron) thought they were greatly indebted to Dr. Flinn for bringing this subject before them.

Mr. R. O'BRIEN FURLONG (Dublin) expressed concurrence for the most part with the observations which had fallen from Dr. Flinn, but could not agree that the duties of English medical officers of health were so free from embarassment as Dr. Flinn's observations might lead them to suppose. In Ireland the results of the Public Health Acts had not been so satisfactory as might have been expected, but then it must be remembered down to the year 1874, when Sir Michael Hicks-Beach introduced the Public Health (Ireland) Act, there was practically no sanitary organisation in the country; there was an utter want of control, and the sanitary state of the country was about as bad as bad could be. The Act of 1874 utilised the existing poor law machinery, and dispensary medical officers were appointed ex-officio medical officers of health for their respective districts. That did not meet with general approval, but upon the whole it was the best arrangement that could have been then made. Boards of Guardians were not doing all that could be desired, but they were doing infinitely more than had been done under the old system. He was not prepared to approve such a step as the abolition of the ex-officio sanitary functions of the dispensary medical officers. They could hardly obtain the services of an independent medical officer for each union, as Dr. Flinn proposed, for less than £800 a year, and as there were 163 unions in Ireland, the expense would render such a proposal almost impracticable. The State should appoint and pay six or eight superintendent medical officers of health, each of whom should reside in a central position in his district, and should be responsible to the Local Government Board for the carrying out of the sanitary laws in his district. These officers would no doubt support the local officers, and enforce the carrying out of their recommendations by the local boards. The Local Government Board of Ireland might well give its attention to the amalgamation of districts. It was unfortunate that there was not a health department attached to the Local Government Board for Ireland. There was a staff of medical inspectors attached to the English Board, whose duties were distinct from those of the general inspectors, and he could not see why they should not have a similar arrangement in Ireland. It was not correct to say that nothing was being done in the rural districts. Large, and annually increasing sums were being lent to the local bodies for sanitary improvements, but it must be remembered that the ratepayers elected the guardians, and the latter, who made the rates, would not be again returned if the rates were too high. Such congresses as these brought such

questions prominently before the people, who could then see that they might be saving their pockets at the expense of their health.

Surgeon-General A. C. C. DE RENZY, C.B. (Bray), was of opinion that there was a great mass of the population in this country, as in India, who believed that it was utter nonsense to suppose you could add one single hour to human life or avert one hour's sickness. This was, no doubt, the reason why Boards of Guardians were unwilling to spend money on sewerage and water supply, or anything of the kind. Members of the Sanitary Institute believed, and rightly, that death and disease could be largely controlled, but the mass of the people did not hold that view, and that was why Boards of Guardians and other similar authorities refused to allow the rates to bear the necessary expenditure. It was desirable, he thought, to retain the dispensary medical officers in the position they now occupied, for he believed they were performing a very useful function in educating Boards of Guardians in sanitary matters. By and by these Officers would succeed in making Guardians understand that sickness was to a large extent preventible, and that by taking proper measures the duration of human life might be lengthened; and there would then be less difficulty in inducing the local authorities to grant the necessary funds.

Sir ROBERT RAWLINSON, C.B. (President of the Congress) wished to make some remarks on the difference between Ireland and England in this matter. The Irish Act had, he believed, been adopted mainly from the English Public Health Act, but in Ireland the engineering officer stood solus, and had no staff like he himself had in England, and he assumed that the medical officer in Ireland stood in the same position as the engineering officer. In Ireland, expense must be considered; that he fully admitted. England was a very much richer country than Ireland, both geographically and geologically. Ireland had not underneath her surface the stores of riches that were to be found in England. Economy in sanitary works ought therefore to be striven for. There ought not to be extravagance in England, but wealth and extravagance could not in all cases be kept separate, and some works devised and executed by English municipal bodies were extravagant. Applications for sanitary works of an engineering character made to the Local Government Board came before him, and he had looked at some of them with a heartache when he saw that the estimates represented a sum of money greater than the rateable value of the district. Sometimes there were reasons, especially in growing places, for incurring a heavy expenditure, but if a similar amount of expenditure were sanctioned in Ireland it might amount to confiscation. In Ireland there should be men especially adapted for Irish work. Dr. Cameron had told them that in many towns of Ireland there was scarcely such a thing as a good water-supply, and probably if some great engineers were applied to they would recommend a reservoir, mains, and a distributing apparatus, all of a most expensive character. The first question in

Ireland should, however, not be how an extravagant work of that description could be done, but how in the roughest and readiest manner to be efficient, water could be brought into a district, if not in the most perfect manner, yet in a far better manner, than at present; and this could frequently be done at a cheap rate. Gaspipes from two inches to one inch in diameter might be laid from mountain springs or lakes, and if there were a gravitating fall down to a town of 1,000 or 1,500 people, such pipes would bring in the twenty-four hours more water than would supply such a population if it were distributed properly, cheaply, and wisely. He had carried out works in England in such a manner that the poorest family could be supplied with as much pure water as could be required for the sum of ninepence per quarter.

Prof. F. DE CHAUMONT, M.D., F.R.S. (Southampton), agreed with Sir Robert Rawlinson, that Ireland would do well to take warning by the large expenditure incurred in England, in many cases unwisely; but in England they had been feeling their way, and Ireland could gain from their experience. One point which could not be dwelt upon too strongly was the necessity for medical officers of health being independent of the local bodies. If they had to deal with England only, he should say distinctly that the medical officers of health in any district ought to be prohibited from practising, and should receive an adequate salary accordingly; but there would be a difficulty in carrying out such a scheme in Ireland, on account of the smaller rateable value, though an extra charge upon the rates for such a purpose would not be money entirely lost, owing to the diminished expenditure in respect of poor houses and asylums, and, he hoped, of prisons.

The roseate view taken by Dr. Flinn of the working of the English Public Health Act was hardly borne out by experience, for in many cases where Boards of Guardians were the Sanitary authority, it was extremely difficult to get anything done.

Dr. EDGAR FLINN (Kingstown), in reply, justified by his own experience his assertion as to the working of the English Public Health Act, and maintained that the Sanitary laws would never be properly carried out in Ireland, until they had an independent medical officer of health, adequately remunerated, who could give all his time and attention to the duties of his office, without fear or favor. He thought that the discussion had shown that the time was opportune for ventilating this most important question, and he hoped that at no distant date a new and vigorous era would be initiated in the administration of the Public Health Act in Ireland; for truly (so far as his experience went) reform in this direction was urgently and imperatively needed throughout the entire country.