CHAPTER IX.

ROUTINE ATTENDANCE, AND REPORTS.

II. HE SHALL ATTEND AT THE OFFICE OF THE SANITARY AUTHORITY, OR AT SOME OTHER APPOINTED PLACE, AT SUCH STATED TIMES AS THEY MAY DIRECT.

It is desirable that the office should be a public one, paid for out of the public funds, and not the private house of the medical officer of health, so that every person in the district may feel at liberty to attend on business at the appointed hour. It should be conveniently situate, and if the district be a large one, more than one may be necessary.

It is also desirable that the medical officer of health should attend daily (Sundays excepted) at a fixed and convenient hour, with the utmost punctuality, and leave if there be no business to transact, or so soon as the business shall have been transacted. The importance of this will be the greater if he be not required to give his whole time to the duties of the office, but, if otherwise, a limit of time might be arranged for his attendance.

13. HE SHALL KEEP A BOOK OR BOOKS TO BE PROVIDED BY THE SANITARY AUTHORITY, IN WHICH HE SHALL MAKE AN ENTRY OF HIS VISITS, AND NOTES OF HIS OBSERVATIONS AND INSTRUCTIONS THEREON, AND ALSO THE DATE

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AND NATURE OF APPLICATION MADE TO HIM, THE DATE AND RESULT OF THE ACTION TAKEN THEREON, AND OF ANY ACTION TAKEN ON PREVIOUS REPORTS, AND SHALL PRODUCE SUCH BOOK OR BOOKS, WHENEVER REQUIRED, TO THE SANITARY AUTHORITY.

It is probable that book-keeping and report-writing will be an onerous part of the duties of the medical officer of health, but it is necessary, and may in part be done by a clerk. The forms will be provided, but as they may be defective, or capable of improvement, he should carefully consider them by the aid of experience in the discharge of his duties.

The notes to be taken should be terse, but so clear that they may give the information intended to be conveyed by them to any other person. Hence the records or the book which is carried about by the medical officer should be properly dated, and have the names and places, and the nature of the enquiry in full, whilst the observations may be condensed, and all should be legibly written in ink or in some very durable manner. It is also desirable that the views entertained by the medical officer at the time should be entered, as well as any directions which he may have given. Unless these conditions are observed, the notes will lose their value when the facts shall have been forgotten by the medical officer. This is the basis of all correct book-keeping and reports.

The notes should be copied into the proper diary or other books daily whilst the facts are fresh in the memory, and whilst any error may be corrected. Such entries should be quite clear, and convey the idea of the medical officer in as few words as possible to any one reading them. How

tar this transcription into the permanent record may be confided to any other person may be doubtful.

All orders given should be in writing, and all letters, reports, and other written documents, should be copied, and properly classified and preserved. Nothing should be left to memory, and every document should be so kept that it may be found without delay. Hence not only method will be required, but properly kept indices of all documents, classified according to their nature and locality.

Such documents will be public property, and the medical officer is required to produce them to the sanitary authority only; but it is probable that the clause must have a wider interpretation, and include the inspector of the Local Government Board and other official persons, if not persons in their private capacity who may be interested therein.

12. HE SHALL FROM TIME TO TIME REPORT IN WRITING TO THE SANITARY AUTHORITY HIS PROCEEDINGS AND THE MEASURES WHICH MAY REQUIRE TO BE ADOPTED FOR THE IMPROVEMENT OR PROTECTION OF THE PUBLIC HEALTH IN THE DISTRICT. HE SHALL IN LIKE MANNER REPORT WITH RESPECT TO THE SICKNESS AND MORTALITY WITHIN THE DISTRICT SO FAR AS HE HAS BEEN ENABLED TO ASCERTAIN THE SAME.

Whilst no specific period is mentioned, it is desirable that he should report his proceedings to every meeting of the sanitary authority; but such reports might ordinarily consist of his book of proceedings, or of a copy of such book in the same form. When any action is to be taken by the sanitary authority, he should, by a separate memorandum, call attention to his entries and recommendations thereon. As the time of the sanitary authority will be limited and fully

occupied, he need not do more than send a copy of his book, unless he desires action to be taken by them, or have special matter to bring to their knowledge; and in general he will do well not to needlessly occupy their time. At the same time occasions will arise when it is desirable that he should call their attention to matters of unusual magnitude, or involving important principles which must be treated in a separate document, and he should endeavour to restrict such to special periods; as, for example, to a quarterly report, which may be subsequently embodied in the annual report to be further referred to.

The subject-matter of such reports is exceedingly extensive, for the first part of the clause refers not only to the presence and causes of actual disease, but to the general improvement of health in the district. The degree of health will doubtless be due to natural and social causes, apart from constitutional peculiarities inherited from preceding generations; but it may not be an easy matter to name those which have a particular influence in lowering the standard, or to prove it to the satisfaction of others. Hitherto the basis has been the death-rate in different places, and a very imperfect view of the degree of health has been thus obtained, but it may be hoped that the measures now taken will speedily enable us to determine the amount of sickness which is not fatal, as well as that which is fatal, and bring us much nearer to a proper appreciation of the subject.

The medical officer in the report now under consideration will be able to point out conditions which in his opinion exert an injurious influence on health apart from actual sickness, as well as those that threaten, although they may not as yet have operated against, the public health. Such

will for the most part be large and general questions affecting a considerable part or the whole of the inhabitants in a locality, as drainage, water supply, industrial occupation, hospital accommodation, nurses, management of infants and young children, employment of women in agriculture and mill work, poverty, drunkenness, and indeed all those influences which affect the public health, and yet may not cause particular diseases. It supplies a defect which previous clauses had left, but is closely associated with Clause 1.

The second part of the clause takes up the subject of Clause 2, and the proper performance of it will be encompassed with the same difficulties; for whilst he may readily ascertain the mortality, he cannot, without the co-operation of all other medical practitioners, report fully on the amount of sickness. The form of such report should be the same as that of the annual report, to be referred to. It is probable that a form will be provided by the central authority to be used by all medical officers of health, so that it may be uniform and capable of ready tabulation for the whole kingdom. It is therefore desirable that this part of the report should be everywhere presented periodically, whether quarterly or semi-annually.

It may be again stated that the value of such reports of sickness will be not only in proportion to their correctness, but to their completeness, and will be very small if all the sick cases are not included.