Fabian Tract No. 148. 


WHAT AHEALTH 
COMMITTEE CAN DO 

PuBLISHED AND SoLD BY 

THE FABIAN SOCIETY. 

PRICE ONE PENNY. 

LONDON: 
THE FABIAN SociETY, 3 CLEMEKT's INN, STRAND, W .C. 
MARCH 1910. 



WHAT A HEALTH CoMMITTEE CAN no. 

"With all deductions the triumphs of sanitary reform, as well as of medical science, 
are perhaps the brightest page in the history of our century.''-W. E. H. LECKY. 

MEMBERSHIP of a Health Committee opens up opportumt1es for 
social work of the highest importance. The duty of a Health Committee 
is a very extensive one. It is to prevent all preventablesickness in their district, from whatever cause, and to see that no sickness 
goes neglected, whatever its nature. Public health administration 
in the past has done wonderful things in the way of preventingdisease and prolonging life. Typhus fever and relapsing fever, which 
were formerly scourges of the poor, have been swept out of the 
country ; the mortality from typhoid fever, scarlet fever and tuberculosis 
has been greatly diminished, and the general death-rate has 
fallen from 2r ·8 in 1848 to 14'7 in 1908. 

Amongst the many influences which have been at work to bringabout these results public health administration has certainly been 
the most important. But although much has already been accomplished, 
much remains to be done, and the object of this tract is to 
show in what directions further progress can and ought to be made.* 

A Who~e-time Officer of Health. 

The Medical Officer of Health is the chief of the Public Health 
Department, and much depends on what sort of man he is and how 
he is supported by the Health Committee. It is most importantthat he should devote the whole of his time to public health work. 
All areas of not less than so,ooo population should have a whole-
time Medical Officer of Health, and in many districts with less 
population, especially industrial towns with a large number of workshops, 
and scattered districts covering a wide area, a whole-time 
Medical Officer of Health is necessary. Pri,·ate practice greatlyinterferes with his public duties. If he is a capable, energetic and 
popular man-and a Medical Officer of Health should be all this-
he will gain a large private practice and can find little time for his 
public health duties. Moreover, you cannot reasonably expect a 
Medical Officer of Health to expose the insanitary cottages or slum 
dwellings owned by his own clients. Smaller districts should combine 
together to appoint a whole-time officer, which can be done under 
the Public Health Act, 1875 (Sec. 191). Towns over so,ooo need 
one or more Assistant Medical Officers. It is essential that every 

• This tract applies more particularly to England and \Vales, outside the Countyof London. In London the Public Health powers are divided between the L.C.C., the 
Metropolitan Borough Councils, and the Metropolitan Asylums Board. 

3 


Medical Officer of Health should be specially qualified for his work, 
and therefore no applicant should be considered who does not possessthe Diploma of Public Health (D.P.H.).

The Health Committee should see that only 

Whole-time Sanitary Inspectors 

are appointed. Unfortunately, in many districts the sanitary inspector(or inspector of nuisances, as he is called outside London) is also surveyor, 
and may even hold other posts. This always leads to the publichealth work being neglected. In the Urban District of Braintree 
with a population of 6,ooo the inspector of nuisances is also surveyorof highways, surveyor of buildings, engineer to the waterworks, 
engineer to the sewage works, surveyor to the cemetery, and 
superintendent of the scavenging. For three months this inspector 
was engaged in re-numbering the houses in the town, and had no 
time for his other duties.* 

A sanitary inspector should devote the whole of his time to his 
duties and he should hold a proper qualification. On no account 
ought any candidate to be appointed merely because he is a good 
fellow, or a honest man, or the victim of misfortunes, or the friend 
of one of the Councillors. The qualification recognized by the 
Local Government Board is the certificate of the Sanitary InspectorsExamination Board, without which no sanitary inspector can hold 
office in London. The certificate of the Royal Sanitary Institute 
is, however, a good qualification. At least one of the sanitaryinspectors of any district should hold a special certificate qualifying 
him in meat inspection. 

How many Sanitary Inspectors are wanted ? 

This depends upon the population, area, and social circumstances 
of the district. An industrial district covering a wide area will need 
more inspectors (among whom there should always be at least 
one woman) than a residential district of the same population with 
a smaller area. Furthermore, county boroughs administer the 
Food and Drugs Acts, which in the smaller boroughs and in urban 
and rural districts are under the charge of the County Council. As 
a general rule a district should appoint not less than one sanitaryinspector to every Io,ooo population, in addition to health visitors ; 
and if the women inspectors act also as health visitors more inspectors 
are required.

The most progressive towns already exceed this scale. For 
instance, Liverpool employs 43 male sanitary inspectors and 2 r female, 
besides a milk depot staff, inspectors of meat and animals, of fish and 
fruit, inspectors under the Food and Drugs Acts and the Factory and 
Workshops Acts, and others. The total sanitary administration staff 
consists of 162 persons (1 16 men and 46 women) besides the clerical 
staff. This is about 2 per ro,ooo population. 

* Dr. Reece's Report to the Local Government Board on the sanitary circumstances 
of Braintree. 

4 


Women Sanitary Inspectors 


are particularly needed in districts where female labor is employed. 
The women inspectors should ascertain whether proper and sufficient 
sanitary conveniences are provided for women in factories, workshops 
and work places, and they should supervise the general sanitation 
of workshops and work places where female labor is employedand of the homes of outworkers. Women inspectors may take partin house-to-house inspection and in the supervision of tenement 
houses, and they can do very useful work in making enquiries in 
cases of infectious disease, investigating cases of overcrowding and 
other insanitary conditions. In some districts the women sanitaryinspectors devote part of their time to health visiting; in others this 
work is carried out by special 

Health Visitors 

who give their whole time to the work. Health visiting is a most 
important department of the work of a Health Committee, and in 
every district there should be one or more properly salaried and 
qualified women for this work, as well as a staff of volunteer helpers.

The duties of health visitors are various, but perhaps most important 
is to visit mothers in their own homes and to give sympatheticcounsel on what is necessary for the successful rearing of babies. It 
is desirable that the health visitor should have had some experience 
in nursing, and even if she is not to be employed as a sanitaryinspector she should have had training in practical sanitation and 
should possess a certificate as a sanitary inspector.

An enquiry instituted by the National League of Physical Training 
shows that in at least ninety places there are one or more health 
visitors paid entirely from the rates, in twenty places there are from 
three to four women sanitary inspectors whose official duties include 
health visiting. In many districts bodies of voluntary health visitors 
have been organized, and if these are carefully supervised by the 
paid staff the results are often satisfactory. In thirty-five districts it 
is believed that infant mortality has been reduced through health 
visiting, and these include such towns as Glasgow, Hanley, Rudders-
field, Macclesfield and Middlesborough, where the conditions cannot 
be considered generally favorable to infant life. 

At Brighton the Town Council has started municipal home 

nursing. A trained nurse is employed who attends at home on such 

cases as puerperal fever or erysipelas, when removal to hospital is not 

considered desirable. Nurses to visit the sick poor in their homes 

are also provided by the Health Committee of the Worcestershire 

County Council, and this example might well be imitated elsewhere. 

The Barry Urban District Council also sends out its hospital nurses 

into the homes. 

Having briefly described the chief officers of a health department, 
we may now proceed to indicate some of the more important features 
of its work. 


5 


Now the bulk of a Health Committee's work may be summed upby saying that it strives to secure 

Systematic Cleanliness. 

"Cleanliness,'' said Sir B. W. Richardson, "covers the whole 
field of sanitary labor. It is the beginning and the end." This 
rather overstates the case ; but at all events we may agree with Sir 
John Simon, who said that "Uncleanness must be reckoned as the 
deadliest of our present removable causes of disease." We want 
cleanliness in many places, and in the first place we want 

Cleanliness in the Atmosphere. 

In most of our manufacturing districts the atmosphere is anything 
but clean. Professor Cohen, of the Leeds University, has calculated 
that within the four most thickly populated square miles of Leeds 
twenty tons of soot are discharged daily into the air. It is an offence 
against the Public Health Act, 1875, Sec. 91, to allow any chimney(not being the chimney of a private dwelling house) to send forth 
black smoke in such quantity as to be a nuisance ; and the same 
section provides that any fireplace or furnace used in any trade 
process must, as far as practicable, consume its own smoke. But in 
many districts this law is a dead letter, and the sanitary authority 
tacitly allows factories to pollute the air with poisonous smoke. It is 
said in excuse of this lazssez fa£re policy that the emission of smoke 
is unavoidable, and that any attempt to control it would only hamper 
home industries. This is nonsense. A smoky chimney is wasteful 
to the owner ; it is a danger to the community by shutting out the 
sunlight that is so essential to health, and it is an unnecessary evil. 
The emission of smoke can be prevented as in some districts it is 
prevented, and it is not necessary to instal elaborate and expensiveappliances. The chief preventive measure is good stoking. If a 
manufacturer chooses trustworthy stokers, pays them well, and makes 
it worth their while not to allow black smoke, he will keep his 
chimneys clean and at the same time confer a benefit on his neighbors. 
ln Glasgow, according to the chief sanitary inspector, 90 per cent. 
of the complaints made against manufacturers are caused by careless 
stoking. In Germany the training of stokers is subsidized by the 
Government as a branch of technical education.• The same thingis done by the Education Committee of the Leicester Town Council. 

It would often be a good thing to get the Health Committee to 
urge the Education Committee to start such classes for stokers. 
No Health Committee is doing its work properly if it fails to deal 
with the smoke nuisance. 

Cleanliness in the Street. 

Dirt in the street soon finds its way into the house. A good deal 
of the dust in a city dweller's house consists of dried horse dung 
blown in from the street. Street cleanliness is a matter partly of 

* "The Destruction of Daylight," by]. W. Graham. 

b 

paving and partly of scayenging, both under the control of the Highways 
Committee, but the Health Committee, being responsible for 
the health of the district, should take note of them and should offer 
to the Highways Committee any suggestions that seem called for jnthe interest of the public. It must be remembered that the side 
streets of our large towns serve as playgrounds for the children, and 
for their sake we should make them as healthy as possible. A town 
street should be paved with impervious material which does not, as 
macadam does, soak up filth. With a smooth impervious pavementthe street is washed clean by every shower and scavenging becomes 
much simpler and more effective ; for on a smooth impervious surface 
the hose and the squegee can be used with excellent effect, as is 
done in parts of London and in many continenial cities. The best 
form of pavement is asphalte, but tarred macadam is also very goodand is much less expensive to lay down. In Battersea, since 19041 
the carriage ways of fifty-two streets have been paved in this manner, 
and the great decrease in mortality that has taken place in the areas 
where this pavement has been laid down is attributed by the 
Medical Officer of Health in part to the improved paving.* Another 
important feature of civic cleanliness is a frequent 

Removal of Dust. 

In many districts garbage and house refuse is only taken away 
once a week. This is not often enough. The first principle of sanitation 
is that all refuse and waste matter should be removed as 
quickly as possible. Many towns have adopted a daily dust removal, 
and this system should be adopted in all urban areas. All fixed ash-
pits should be abolished and only moveable metal receptacles should 
be used. The frequent 

Removal of Manure 

from stables, mews and other premises should be insisted upon. 
Manure heaps are good breeding-grounds for flies, which are now 
known to be inimical to health. Flies convey the germs of disease 
from the filth in which they live to human food, especially milk, and 
in order to keep down the plague of flies accumulations of manure 
and other filth should be prevented. Under Section so of the Public 
Health Act, 1875, an urban sanitary authority can require the dailyremoval of manure or other refuse matter from mews, stables, or 
other premises, and this should be done particularly in the summer. 

Backyard Cleanliness. 

If the backyard is not clean the house will not be clean, for filth 
from the yard soon finds its way into the house. It will be broughtin as mud in wet weather and blown in as dust in dry weather. Yard 
cleanliness, like street cleanliness, is greatly promoted by imperviouspaving. The surface of a backyard tends to become polluted with 
all kinds of filth, the excrement of domestic animals. droppings from 
the dust-bin, scraps of putrefying food , etc., and there is reason 

• Annual Report of Dr. Lennane, Medical Officer of Health, Battersea, r9o8. 

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to think that the contamination of milk and other food with foul 
dust from a polluted backyard is one of the causes of summer 
diarrhcea. Backyards should be paved with a smooth, impervious 
surface properly sloped to a gully. Such a yard will be effectuallycleansed by every shower of rain. 

Having secured cleanliness outside we must see that there is 
cleanliness inside, and for this purpose the Health Committee must 
-institute a 

House-to-house Inspection. 

In every district there should always be going on a systematicinspection which should cover the whole of the district at least once 
in five years. Every year each of the inspectors engaged in this 
work should have a number of streets allotted to him, and he should 
go from house to house with a keen nose for insanitary conditions. 
This inspection should by no means be confined to the poorer quarters 
-of the district. Bad sanitation exists in good class houses. Overcrowding 
may occur in servants' bedrooms, and bad smells and rats 
from defective drains, although they may be unnoticed by the familyupstairs, may be a source of considerable discomfort and danger to 
the servants in their underground kitchens. 

The caretakers' quarters in a block of commodious and imposing 
ilats may be grossly insanitary. In Hampstead a systematic inspection 
of fiats revealed the fact that in many cases the caretaker was 
housed in illegally occupied underground rooms. • Some classes of 
house require more frequent inspection than once in five years. 
This applies particularly to 

Tenement Houses. 

Many of these need constant supervision by the sanitary inspector 
to keep them in a decent sanitary condition, especially those 
originally built for one family only and occupied by several owing to 
the "going down" of the neighborhood. Most of the London 
poor have to live in such houses, and it is only in a few exceptional 
cases that any structural alterations have been made to adapt the 
house for occupation by more than one family. The result is that 
the tenements lack many domestic conveniences and cannot be called 
homes. For instance, in many of these houses the only water supply 
for all the occupiers is a tap in the basement. When water is so 
hard to obtain it is idle to expect people to be clean. The London 
County Council have recently obtained power, under Section 78 of 
the General Powers Act, 1907, for the London sanitary authorities 
to require a proper and sufficient supply of water on each storey of 
a tenement house. This section should be rigorously enforced, and 
sanitary authorities outside London should ask Parliament for similar 
power.

Many tenement houses greatly benefit by being registered as 
houses let in lodgings, thus becoming subject to the bye-laws relating 
to such houses. These confer useful powers upon the sanitary 

* Annual Report of the Medical Officer of Health, Hampstead, 1908. 

8 

authority and impose certain duties upon the landlord, as for instance 

the duty of carrying out an annual cleansing of the house. The 

Health Committee should if necessary exert pressure to keep the 

local authority up to its dutyin making and enforcing these bye-laws.

Another type of house that needs special supervision is the 

Common Lodging House. 
The condition of these houses has greatly improved in recent 
years with the increasing efficiency of public health administration. 
The shifting population of a common lodging house has innumerable 
opportunities of spreading disease and vermin, and therefore requirescareful supervision. A high standard of cleanliness should be maintained 
in these places ; the beds should be kept free from vermin 
(an ordinary plumber's lamp will do wonders with an iron bedstead 
in the destruction of bugs) ; and spitting on the floor, which was 
formerly a common practice, should be sternly repressed. In the 
ordering of common lodging houses, as in many other things,
example is better than precept, and the sanitary authority will find 
that by providing a well managed municipal common lodging house 
they will achieve more than can be done by any amount of inspection 
to raise the standard of the other common lodging houses in the 
district. 
Cellar Dwellings. 
Cellar dwellings, that is, underground rooms occupied separately 
as dwellings, are subject to special sanitary requirements-for instance, 
the Housing, Town Planning, etc., Act prohibits the use of 
an underground room as a sleeping place-and it is the business of 
the Health Committee to see that these requirements are fulfilled. 
Special inspections should be made for the discovery of these dwellings, 
which should be entered in a separate register and dealt with 
as the law provides. 

The Protection of the Food Supply. 
This is a vitally important part of a Health Committee's work. 
All places where food is prepared and sold, such as slaughter houses, 
butchers' shops, bakehouses, milk shops, restaurant kitchens and 
sausage factories, should be brought under frequent and systematicsupervision. A vast amount of illness is due to unwholesome food. 
One at least of the sanitary inspectors should hold a special certificate 
of proficiency in meat inspection, and he should be on duty 
every Saturday night in the poorer parts of the district. Meat 
inspection is greatly helped by the establishment of a 

Municipal Slaughter House, 
which butchers should be encouraged to use. Private slaughterhouses are objectionable on several grounds. Adequate inspectionis extremely difficult, and the public has no proper security that the 
work is carried out either with humanity towards the animals or 
with the sanitary safeguards necessary for the consumers' health. 
But this is not all. "Besides the general public there is another 


9 


class which suffers from the system, namely, the unfortunate 
individuals who have to live in immediate proximity to the 
slaughter house. In nine cases out of ten we find these buildingspacked away at the end of some court or alley with dwellings 
crowded round within a few yards of them." This proximity is 
exceedingly bad both from a sanitary and a moral point of view for 
the dwellers in these courts, especially women and young children.* 
Brighton has had a public abattoir for I 5 years. This institution is 
made use of more and more every year, and yields an income of 
£400 to £sao a year in tolls.+ Cheltenham, Glasgow, South 
Shields, Liverpool, Manchester, Dundee, Lincoln, Edinburgh, Leeds, 
Birmingham, amongst other towns, also have public abattoirs. If 
all animals used for food were killed in municipal slaughter houses 
under proper inspection a good deal of disease would be prevented.
In this respect England is far behind Germany and other countries. 
More important than meat, however, is the question of the 

Milk Supply. 

Milk is a most valuable food, but it is easily contaminated, and 
when contaminated may be a deadly poison. Adulteration with 
water or chemicals may be dealt with under the Sale of Food and 
Drugs Acts, but filth and germs are much more serious, and the law 
at present is inadequate to deal with them. But even under the 
present law a good deal can be done to enforce decent sanitation in 
cowsheds, dairies and milk shops, and the Health Committee should 
see that these places are frequently inspected.

Towns are at a disadvantage in this matter, for nearly all the 
milk consumed in the towns is produced in the country. Rural 
sanitary authorities if they did their work properly could effect 
considerable improvements in our milk supply. Every member of a 
Health Committee should procure a copy of the regulations that 
apply to cowsheds, dairies aod milk shops, and should see that these 
regulations instead of remaining a dead letter, as is too often the 
case, are properly enforced. 

The Prevention of Adulteration. 

Every local authority charged with the administration of the 
Sale of Food and Drugs Acts should take a sufficient number of 
samples for analysis under the Acts. The number that ought to be 
taken will vary in different districts, but it should not as a rule fall 
below 10 samples per I,ooo population per year.

This work should be done by special inspectors, who should use 
their wits to frustrate the numerous dodges devised by dishonest 
traders to evade the Acts. The inspectors soon become well known, 
and it is useless for them to purchase samples personally. They 
must work through agents and must change the agents frequently. 

• See an excellent article on this subject by Christopher Cash, B.A., in the Medical 
Officer, May, rgog, p. 876, and the same writer's book" Our Slaughter House System," 
Bell, 1907. 
t See Report of the Medical Officer. 


10 

Another precaution is necessary. Fraudulent traders always keepthe genuine article and are careful to supply it to strangers who may 
possibly be inspectors' agents. The adulterated article is reserved 
for regular customers, and in dealing with this class of trader it is 
necessary for the agent to become a regular customer by making a 
number of purchases before the official sample is taken. This plan 
should also be adopted for the detection of the shopkeepers who 
make big profits by selling margarine as butter. 

The analyses made under the Food and Drugs Acts are chemical 
analyses, and although they afford valuable information of the kind 
of food that is consumed in the district it is necessary also in the 
case of certain articles of food and drink to make a periodical 

Bacteriological Analysis. 

The water supply, milk supply, and certain foods should be 
analysed for the presence of germs-either the germs of disease or 
germs that indicate pollution with sewage or other noxious matter. 
For instance, samples of milk should be examined for the presenceof tubercle hacilli. The Health Committee ought to know what 
proportion of milk consumed in their district contains the germs of 
tuberculosis. 

The sanitary authority should arrange with a bacteriologicallaboratory of repute for the examination of samples or else establish 
a municipal laboratory.

Bacteriological examination is most useful also in the 

Prevention of Infectious Disease. 
In the control of these diseases it is essential to arrive at an 
early diagnosis, so that the patient may be properly isolated and disinfection 
carried out. In certain diseases, for instance, diphtheriaand typhoid fever, the bacteriological examination of a specimentaken from the patient may result in an early diagnosis which otherwise 
would be delayed. The cost of such examinations, which are 
made chiefly in the interest of the public, should be borne by the 
public, and every sanitary authority should encourage the doctors in 
the district to send specimens for examination free of cost. 

Maintenance of the Public Health. 

But the duty of the Health Committee is not only to preYentthe occurrence of disease : it is also to see to all the disease that 
does occur, in order to ensure that the necessary steps may be taken 
to prevent its recurrence in the same or any other person. For this 
purpose the Health Committee has very large powers; indeed, under 
Section I 33 of the Public Health Acts, Health Committees may take 
almost any action that they think necessary in emergency to save 
life or prevent disease. Thus, they may do (as the Liverpool and 
Manchester Town Councils have done) pay the fees of doctors called 
in under the Midwives Act, 1902, in cases of emergency; they may(as many Health Committees have done) supply any medicines or 
drugs free of charge to patients or medical practitioners, and even 


II 

·(as some Health Committees have occasionally done) pay medical 
practitioners to administer them ; they may (as some Health Committees 
do) treat scarlet fever or puerperal fever, or, indeed, anyother disease, in the patient's own home, instead of removing the 
case to their hospital; they may (like the Worcestershire CountyCouncil) start a whole system of domiciliary nursing ; they may 
even, as part of the treatment, pay what is necessary for the maintenance 
of the sick patient in his own home; they may pay for the 
maintenance of "contacts," or those who are prevented from going 
to work because they have come in contact with infectious persons. 

Hospitals. 
The town or urban district council has power, under the Public 
Health Act, 1875, to establish and maintain public hospitals for all 
diseases whatsoever (including maternity). It is quite a mistake, 
though a common one, to suppose that this power is limited to 
isolation hospitals for infectious diseases. Very few Health Committees 
have yet used these powers, but the Barry Urban District 
Council and the Widnes Urban District Council have set up municipal 
hospitals for accidents and non-infectious cases. Why not get 
your council to do the same? The sanitary authority should at least 
provide hospital accommodation for the isolation of patients suffering 
from small pox, diphtheria, typhoid fever, and scarlet fever, and, 
wherever possible, for measles. In the latter disease, however, the 
hospital is wanted not so much to prevent the spread of infection, 
but to reduce the mortality from it. Children die of measles because 
they cannot in their own poor homes get the warmth, good food, and 
good nursing they need. Deaths are chiefly due to complicationsthat could be prevented if the patients were properly looked after, 
which in many· poor homes is impossible. Unhappily few districts 
provide as yet hospital accommodation for measles. The LiverpoolMunicipal Hospital now takes in cases of measles and whoopingcough, and the same is said to be the case in Edinburgh. But in 
London the Metropolitan Asylums Board (which is the isolation 
hospital authority) refuses to take cases of measles, and except for 
a whooping cough ward in the Evelina Hospital, the only accommodation 
available for the poor is that provided in the poor law infirmaries. 
Hospitals free from the stigma of pauperism for measles patients who 
cannot be properly cared for in their own homes are much needed 
just now, and a Health Committee can do very good work in persuading 
the local authority to provide them. 

The Prevention of Tuberculosis.* 
This is one of the most pressing public health problems of the 
present time. Tuberculosis is due to the successful invasion of the 
body by a germ, the tubercle bacillus. It is communicable from 
man to man, and by means of meat, and especially milk, from 
animals to man. In its onslaught the tubercle bacillus is greatly 

~~-= 

* On this subject the reader should consult " The Prevention of Tuberculosis,•· 
by Dr. Newsholme, Medical Officer of the Local Government Board. 

12 

helped if the person attacked lives among insanitary surroundings,
is underfed, overworked, or alcoholic. Anything that tends to remove 
these conditions is working for the prevention of tuberculosis, 
but we want also more direct preventive measures aimed at the destruction 
of the bacillus itself. The chief source of infection is the 
expectoration of a consumptive patient, which contains millions of 
bacilli. These remain in the dust on floors and elsewhere, and are 
blown about by the wind. An easy way of attacking tuberculosis is. 
to prevent indiscriminate spitting. The sanitary authority should 
distribute leaflets and printed notices on the dangers of spitting elsewhere 
than in a proper receptacle, and a byelaw against spitting in 
public places should be adopted. It is specially important that consumptive 
patients should be instructed as to the proper disposal of 
their expectoration. In order that such instruction may be given, 
proper spit-bottles provided, and disinfection carried out at publiccost, as well as for other reasons, consumption should be made notifiable. 
Among poor law patients it is already notifiable, and this. 
rule should be extended to all classes, either by a voluntary system, 
or by following the example of Sheffield and securing compulsorynotifications by means of a private Act. The early diagnosis of 
consumption is important, not only because it enables preventive 
measures to be taken at the beginning of the disease, but also. 
because the patient's chances of recovery depend chiefly upon 
the early adoption of proper treatment. The sanitary authorityshould offer free bacteriological examination of sputum and should 
establish a 

Tuberculosis Dispensary. 

These have been established in large numbers m France, and 
have been found of great value. In our country one has been at 
work in Edinburgh since 1887, and another has recently been 
established in Paddington. The work of these dispensaries is to 
detect early cases of consumption, to treat in their own homes 
patients who cannot go to a sanatorium and who are unable to 
pay for medical treatment, to help the patients to live healthylives as far as possible, and to instruct them so that they may not be 
a danger to others. The dispensary doctor supervises the home 
treatment and enquires as to the health of the other members of the 
family with a view to detecting cases of the disease while they are 
still in the early and curable stage. 

The dispensary supplies cod-liver oil and other medical necessaries,. 
and attached to it there is usually a body of pbilanthrophic workers, 
who obtain suitable employment for the patient, give financial 
assistance when required to the family, and afford help in various 
other ways. A tuberculosis dispensary should form part of the 
health department in every large urban area. Wherever possible,
the Health Committee should also have its own hospital for consumptive 
patients, as the Brighton Health Committee has, where 
the patient can go for a month or two, and be taught how to live. 

Another necessary institution is the 


13 

Phthisis Sanatorium. 


Sanatoria are needed for two classes. First there are the patientsin an advanced stage of the disease, for whom cure is hopeless. 
These patients are the most dangerous sources of infection, for they 
not only bring up a large quantity of sputum, but they are too weak 
to observe the strict cleanliness that a consumptive must maintain if 
he is not to be a source of grave danger to his family. The poor 
among these patients frequently die in Poor Law institutions, in 
many of which the consumptives are nursed in the general wards. 
Sanatoria where these unfortunate people may end their days free 
from the stigma of pauperism are much needed. 

Sanatoria are needed also for patients in the earlier stages of 
consumption. Dr. Newsholme thus sums up their advantages.* 

I. In early and suitable cases a cure may be expected. 
2. 
Short of a cure, in a large number of cases, arrest of disease 
occurs, the patient is able to resume his work at least to a 
modified extent, and his working life is much prolonged. 
3· While the patient is in the sanatorium his home is disinfected, 

his relatives are free from recurring infection, and have 

time to recover their full measure of resistance to infection. 

4· On his return home and to his work the patient is much less 

likely than before, even though he continues to have 

sputum containing tubercule bacilli, to be a source of 

infection to others. 

In some towns, for instance Brighton and Leicester, it has been 
found possible to devote one or more blocks of the isolation hospital 
to sanatorium treatment of consumption, and with great success. 

In Brighton this treatment is offered in all cases suitable for it, 
and in actual fact more than half the total cases at present under 
observation in Brighton have spent at least four weeks in the 
Borough Sanatorium, and have there been taught the precautionary 
measures needed to prevent infection and the personal regime 
suitable to their illness ; while at the same time their families have 
had · a temporary holiday from sick-nursing, the house has been 
disinfected, and the patient has returned with a knowledge of the 
way to avoid re-infecting it. 

The Cleansing of Verminous Persons. 

There is one communicable disease that calls for special mention, 
and that is ped£culos£s or lousiness. This is a horrible condition that 
ought not to be tolerated in a civilized community, and it specially 
affiicts two classes-school children and the inmates of common 
lodging houses. The Children Act, 1908, gives the local education 
authority power to enforce the cleansing of school children, and the 
London County Council's General Powers Act, 1907, contains a provision, 
which might with advantage appear in many local Acts, conferring 
a !\imilar power with regard to the inmates of common 

• Newsholme, " The Prevention of Tuberculosis," p. 382 (abbreviated). 

lodging houses. By the Cleansing of Persons Act, 1897, a sanitaryauthority has power to fit up and maintain a cleansing station, and 
in Marylebone, where the Act is energetically administered, about 
3o,ooo persons have been freed from vermin in the last ten years.
Do not despise this matter, or think it of no consequence. Every 
town ought to provide in some way for this help to the poor to keepthemselves clean. 

Infant Mortality. 

The prevention of infant mortality is a matter of supreme importance, 
and every member of a Health Committee should find out 
precisely what is being done in his district in this direction. Ask 
the Medical Officer for a special report as to how the infantile 
death rate compares with that of other places, and as to what is 
being done to reduce it. Infant mortality is due to many causes, 
and must be fought with many weapons. One of the most important 
causes is summer diarrha:a, which is a filth disease and 
can . be prevented by cleanliness. The measures for promotingcleanliness indicated in the earlier part of this tract are most 
important in this connection. Clean air, clean streets, clean 
yards, clean houses, all work together to protect infant life. But 
other measures are necessary. There should be a wide dissemination 
of information about the proper ways of feeding and generallylooking after babies. Cards containing instruction on these 
matters should be freely distributed, and a sufficient number of 
health visitors should be employed to visit mothers and give them 
practical instruction. The health visitors should begin their visits. 
early in the baby's life, and this cannot be done unless they have 
timely notice of the baby's arrival. The Notification of Births Act 
should, therefore, be adopted. Mothers should be encouraged to 
bring their babies periodically to be weighed, so that it may be seen 
whether their progress is satisfactory. In Battersea a room at the 
public baths is set aside one afternoon a week for baby weighing_
The mothers should be encouraged to nurse their babies ; but often 
this is impracticable, because the mother, from want of food, loses 
her milk. In many districts efforts are now being made to supplynursing mothers with the food required to enable them to continue 
to nurse. Such schemes should be supported by the Health Committee 
who, for instance, might arrange (as has been done in France) 
to supply nursing mothers with milk at reduced rates from the 

Municipal Milk Depot, 
which a progressive sanitary authority in earnest about infant 
mortality will establish. There are many babies who, for various 
reasons, cannot be naturally fed, and these too frequently are givencondensed milk, worthless patent foods, and unwholesome cow's 
milk. For these babies properly prepared milk may mean the 
difference between life and death.* 

• For further details see" Municipal Milk and Public Health, '' by F. Lawson 
Dodd, D.P.H. Fabian Tract No. 122. 

IS 
The Supervision of Midwives. 


The county and county borough councils administer the Midwives 
Act, 1902, which is one of the most important measures ever 
placed on the statute book. Every year thousands of women die in 
child-bed from causes that could have been prevented had the 
women been properly looked after. No less than so per cent. of the 
births in this country take place under the care of midwives, who 

_by the Midwives Act are brought for the first time under supervision.
The local authority should appoint skilled persons to supervise themidwives-
women doctors are specially useful for this purpose-andshould see that a high standard of cleanliness and efficiency is maintained. 
In difficult cases a midwife is obliged to call in a doctor, and 
one of the pefects of the Act is that no provision is made for the 
payment of ·the doctor in those cases, unfortunately very numerous, 
where the patient is unable to pay the fee. In some districts the fee 
is paid by the guardians, after much delay and repeated enquiriesby the relieving officer, and then only in cases i.n which the familyis adjudged to be destitute, but this is most inadvisable, for it makes 
the patient and her husband paupers, which they bitterly resent; it 
" worries" the poor woman, and it tends to prevent the smooth and 
effective working of the Act. The doctors summoned by midwives 
should be paid by the authority entrusted with the supervision of 
the midwives. This is done in Liverpool and Manchester, with 
highly satisfactory results ; and every Health Committee should 
order it to be done under Section 133 of the Public Health Act. 

USEFUL BOOKS on the subject which every Public Library should 
have, and which the Library Committee would probably procure on 
a Councillor's application :


Sanitary Law and Practice. ROBERTSON and PORTER. The Sanitary Publishing

Company. ros. 6d. 
Public Health Problems. J. F. SYKES. Walter Scott. 
The Health of the State. G. NEWMAN. Headley Brothers. Is. 
The Prevention of Tuberculosis. ARTHUR NEWSHOLME. Methuen. 7s. 6d. 
Infant Mortality. G. NEWMAN, Methuen. 7s. 6d. 
The Public Health Agitation, 1833-48. B. L. HUTCHINS. Fifield. 2s. 6d. 
English Sanitary Institutions. Sir ]OHN SIMON. Smith Elder and Co. 
The Destructiol) of Daylight. J. W. GRAHAM. Allen. Is. 6d. 
Infantile Mortality ~nd Infants' Milk Depots. G. F. McCLEARY. 1905. 
The Common Sense of the !'ytilk Question. JosEPH SPARGO. Macmillan. 
The Problem of the Milk Supply. F. LAWSON DoDD. Bailliere. Is. 6d. 
The Wor)t of the Health Visitor. G. F. McCLEARY. Albany RttJitw, April, 1907. 
Public Health Administration in Glasgow. J. B. RUSSELL and A. K. CHALMERS. 

Maclehose. rgos.
The Hygiene of Scnool Life. RALPH H. CROWLEY. Methuen. rgro.
Annuall{eports of the Public Health Committee of the _L.C.C., submitting reports of 

Chief Medical Officer and Medical Officer (Education). Kmg.
Annual Report of the Medical Officer of the Local Government Board. Wyman.
Annual Report of the Chief Medical Officer of the Board of Education. Wyma_n. 
Annual Reports of the Chief Inspector of Factories and Workshops. Wyman. 


Those wishing to keep informed on public health progress should refer to Public 
Health, the monthly official journal of the Society of Medical Officers of Health. 


N SOCIETY.-The Fabian Boole\y oonellia of Boolr.llah. A a\r.lemen\ 
of its Rules and \he following publloa\iona can be ob\ainell from ~ht 
Beore~ary, a~ \he Fabian Office, 3 Olement's Inn, London, W.O. 

THIS MISERY OF BOOTS. By H . G. WELLS. 3d., post free 4d. 
"THOSE WRETCHED RATES!" a Dialogue. By F. W. HAYES. Id, 

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FABIAN ESSAYS IN SOCIALISM. New Preface by BERNARD SHAW, 
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Tracts, ~ach 16 to 52 pp., price 1d., or 9d. ~er do•., unleu otherwiaeda,,d,

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I.-General Socialism in its various aspects.

TRAOTB.-147· Capital and Compensation. By EDw. R. PEl.SK. 146. Socialism 
and Superior Brains. A reply to Mr. Mallock. By B11:BNARD SHAW. 

142. Rent and Value. 139. Socialism and the Churches. By Rev. 
JoHN CLIFFORD, D.D. 138. Municipal Trading. 121. Public Service 
versus Private Expenditure. By Sir OLIVEB LODGlll. II3. Communism. 
By WM. MORRIS. 107. Socialism for Millionaires. By BERNl.RD SHJ.W. 133· 
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By Rev. S.D. HEADLAH, 79· A Word of Remembrance and Caution to 
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WEBB. 72. The Moral Aspects of Socialism. By SIDNliY B&Lt., 6g.
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and False. By S. WllBB, 45· The Impossibilities of Anarcbiem. ByBERNARD SHAW (price 2d.). 7· Capital and Land (7th edn. rni1ad 1g08).
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Is I. Why are the Many Poor? WELSH TRl.CTS-143· Sosialaeth 
yng N goleuni'r Beibl. G&n J. R. JoNES (Oaernarfon). 141. Translation 
of 139. 87. Translu.tion of 78. 38. Translation of 1. 
H.-Applications of Socialism to Particular Problema. 
TRAOTB.-145· The Case for School Nurseries. By Mrs. ToWNSHIIND. 144. 
Machinery: its Masters and its Servants. By H. SCHLOESSER & C GAMIII. 

140. Child Labor under Capitalism. By Mrs. HYLTON DALE. 136. The Village 
and the Landlord. By EDw. CARPENTER. 135. Paupers and Old AgePensions. By SIDNEY WEBB. 131. The Decline in the Birth-Rate. By S. 
WEBB. 130. Home Work and Sweating. ByMisaB.L. HuTOHIKB. 126. The 
Case for a Legal Minimum Wage. 126. The Abolition ofPoor Law Guardians. 
122. Municipal Milk and Public Health. By Dr. F . L&WBOK DoDD. 
125. Municipalization by Provinces. 119. Public Control of liii:lectrical 
Power and Transit. 123. The Revival of A&riculture. II8. The Secret of 
Rural Depopulation. 115. State Aid to Agriculture: an Example. us. 
Life in the Laundry. g8 State Railways for Ireland. I24. State Control 
of Trusts. 86. Municipal Drink Traffic. 85. Liquor Licenaiac zt.Home 
and Abroad. 84. Economic& of Direct Employment. 83. Sta'e Arbitration 
and the Living Wage. 48. Eight Houra by Law. •3· Caee fer an 
Eight Hours Bill. LliAli'LIIIT.-104. How Trade Union• beneit Workmen. 
111.-Local Government Powers : How to u&e them. 
Tru.cTB.-137· Parish Councils and Village Life. Iog. Cottaie Plana 
and Common Sense. By RAYMOND UKWIN. 76. Houaea for tbe People. 
gg. Local Government in Ireland. 82. Workmen'• Compoaa.:J.tien Act. 
New edition for the Ad of 1906. 6a. Pariab and Diatrict Cosooilo. 54• 
The Humanizing of tbe Poor Law. By J. F. OAJ[BIHOft. r.uLD'III.134
· Small Hotdings, Allotments and Common Pastures : and ltew to gettbem. 20. Questions for Poor Law Guardian1. FABIA}{ KU)UOIPALPROGRAM, FIBBT S•niiB (Nos. 32, 37). Municipalit:atioa of 'he Gas 
Supply. A Labor Policy for Public Autltoritiea. S•oo•D Iii•••&(Moa. 
go to 97)· Municipalization of Milk Supply. Municipal Pawaahops.
Municipal Slaughterhouses. Women as Councillors. Uunieipal Bakeries. 
Municipal Hospitals. Second Series in • red oonr for 1d. (gd, perdoz.) ; separate leaflets, 1/-per 100. 

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its Early H istory. By BERNARD SHAW. 
BnoK BoXlCs lent to Societies, Olubs. Trade Unions. for lOa. a