%. ^. ^>> SU\% IMAGE EVALUATION TEST TARGET (MT-3) // y. ^ ^ 4iJ w.. 40 fA 1.0 !ria IIM I.I 156 |17 M 2.2 IM 1.25 12.0 1.8 iA 11 1.6 V] <^ /i :^ ^5 >^ / Photographic Sciences brporation VJ 23 WEST MAIN STREET WEBSTER, N.Y. 14580 (716) 872-4503 m V :\ \ < «^\ '^\ % '1? ^ CIHM/ICMH Microfiche Series. CIHM/ICMH Collection de microfiches. Canadian Institute for Historical Microreproductions / Institut Canadian de microreproductions historiques Technical and Sibliographic Notes/Notes techniques et bibliographiques The Institute has attempted to obtain the best original copy available for filming. Features of this copy which may be bibliographically unique, which may alter any of the images in the reproduction, or which may significantly change the usual method of filming, are checked be'ov*', L'Institut a microfilm^ le meilleur exemplaire qu'il lui a 6t6 possible de se procurer. Les details de cet exemplaire qui sont peut-dtre uniques du point de vue bibliographique, qui peuvent modifier une image reproduite, ou qui peuvent exiger une modification dans la mdthode normale de filmage sont indiqu6s ci-dessous. Coloured covers/ L/l Couverture de couleur □ Coloured pages/ Pages de couleur □ Covers damaged/ Couverture endommagee D Pages damaged/ Pages endommag^es □ Covers restored and/or laminated/ Couverture restaur6e et/ou pellicul6e D Cover title missing/ Le titre de couverture manque I I Pages restored and/or laminated/ \^ Pages restaur^es et/ou pellicui^es Pages discoloured, stained or foxed/ Pages d6color6es, tachetdes ou piqu^es D D Coloured maps/ Cartes g^ographiques en couleur Coloured ink (i.e. other than blue or black)/ Encre de couleur (i.e. autre que bleue ou noire) I I PageF detached/ Pagb» detach^es Showthrough/ Transparence I ~V Showthrough/ D Coloured plates and/or illustrations/ Planches et/ou illustrations en couleur □ Quality of print varies/ Qualit^ in^gale de I'impression D Bound with other material/ Relie avec d'autres documents D Includes supplementary material/ Comprend du materiel supplementaire D n Tight binding may cause shadows or distortion along interior margin/ La reliure serree peut causer de I'ombre ou de la distortion le long de la marge int^rieure Blank leaves added during restoration may appear within the text. Whenever possible, these have been omitted from filming/ II se peut que certaines pages blanches ajoutdes lors d'une restauration apparai ssent dans le texte, mais, lorsque cela 6tait possible, ces pages n'ont pus 6te filmdes. D D Only edition available/ Seule Edition disponible Pages wholly or partially obscured by errata slips, tissues, etc., have been refilmed to ensure the best possible image/ Les pages totalement ou partiellement obscurcies par un feuillet d'errata, une pelure, etc., ont 6t(k film^es d nouveau de facon d obtenir la meilleure image possible. D Additional comments;/ Commentaires suppl6mentaires; This item is filmed at t^^ reduction ratio checked below/ Ce document est film^ au taux de reduction indiqud ci-dessous. 10X 14X 18X 22X 26X 30X i 1 / ¥ 12X 16X 20X 24X 28X 32X The copy filmed here has been reproduced thanks to the generosity of: Library of the Public Archives of Canada L'exemplaire fiim6 fut reproduit grAce d la g6n6ro8it6 de: La bibliothdque des Archives publiques du Canada The images appearing here are the best quality possible considering the condition and legibility of the original copy and in keeping with the filming contract specifications. Les images suivantes ont 6x6 reproduites avec le plus grand soin, compte tenu de la condition et de la nettet6 de l'exemplaire film6, et en conformity avec les conditions du contrat de filmage. Original copies in printed paper covers are filmed beginning with the front cover and ending on the last page with a printed or illustrated impres- sion, or the back cover when appropriate. All other original copies are filmed beginning on the first page with a printed or illustrated impres- sion, and ending on the last page with a printed or illustrated imp.ession. The last recorded frame on each microfiche shall contain the symbol — ► (meaning "CON- TINUED"), or the symbol V (meaning "END"), whichever appllas. Les exemplaires originaux dont la couverture en papier est imprimde sont fiimds en commenpant par le premier plat et en terminant soit par la dernidre page qui comporte une empreinte d'impression ou d'illustration, soit par le second plat, selon le cas. Tous les autres exemplaires originaux sont filmds en commenpant par la premidre page qui comporte une empreinte d'impression ou d'illustration et en terminant par la dernidre page qui comporte une telle empreinte. Un des symboles sulvants apparattr«i sur !i> dernidre image de cheque microfiche, suior, le cas: le symbole •^^ signifie "A SUIVRL , le symbole V signifie "FIN". Maps, plates, charts, etc., may be filmed at different reduction ratios. Those too large to be entirely included in one exposure are filmed beginning in the upper left hand corner, left to right and top to bottom, as many frames as required. The following diagrams illustrate the method: Les cartes, planches, tableaux, etc., peuvent dtre filmds 6 des taux de reduction diffdrents. Lorsque le document est trop grand pour dtre reproduit en un seul clich6, il est filmd d partir de Tangle supdrieur gauche, de gauche 6 droite, et de haut en bas, en prenant le nombre d'images ndcessaire. Les diagrammes suivants illustrent la mdthode. 1 2 3 1 2 3 4 5 6 ADDRESS ON THE EXPEDIENCY OF THE CHANGE FEOM MUNICIPAL TO COUNTY MEDICAL HEALTH OFFICERS FOR PROMOTING EFFICIENCY AND ECONOMY IN THE PUBLIC HEALTH SERVICE- BY P. H. BRYCE, M.A., M.D. Secretary ^ Provincial Board of Health of Ontario. Being a paper read before the Association of Executive Health Officers of Ontario, held at Belleville, August 14, 1895, ISSUED BY THE PROVINCIAL BOARD OF HEALTH. TORONTO : Warwick Bhos. & Rotter, Pbintkrs, 68 and 70 Front Street West 1895. H i '1 ADDEESS ON THE EXPEDIENCY OF THE CHANGE FEOM MUNICIPAL TO COUNTY MEDICAL HEALTH OFFICERS FOR PROMOTING- EFFICIENCY AND ECONOMY IN THE PUBLIC HEALTH SERVICE. BY P. H. BRYOE, M.A., M.D Secretari/, Provincial Boxrd of Health of Ontario. Being a paper read before the Association of Executive Heilth Officers of Ontario, held at Belleville, August 14, 1895, ISSUED BY THE PROVINCIAL BOARD OF HEALT.r TOnONTO : Warwick Bkos, & Ruttkh, Pkintkks, 68 amd 73 Front STewKT Wkst 1895. ?^ "THE EXPEDIENCY OF THE CHANGE FROM MUNICIPAL TO COUNTY MEDICAL HEALTH OFFICERS, FOR PROMOTING EFFICIENCY AND ECONOMY IN THE PUBLIC HEALTH SERVICE. By p. H. Brycb, M.A., M.D., Secretary Provincial Board op Health op Ontario. To th9 President and Member a of the Association of Executive Health Officers of Ontario : Gentlemen : I propose in my paper to urge some reasons for giv- ing our medical health officers a special training in chemistry and biology ; but before doing so 1 shall make some remarks concerning a phase of the probl *u upon which the practical results of any facilities made for the training of health officers must necessarily depend. This, as may naturally be supposed, is the position and present status of the Msdical Officer of Health in Ontario. Ife will be remembered that at the annual meeting of this Asso- ciation held in Trenton in 1891, Dr. J. Coventry, Medical Health Officer of Windsor, read a paper on "Auxiliaries to the Health Office," and, amongst the many apt remarks therein made, I quote the following : — " At the other end of the line legislators have been moat lavish with the executive powers conferred upon him (the M. H. 0.) ; but at this point they have deserted him and left him at the mercy of the municipal council to remunerate him for his services." And again, "the Medical Health Officer should become familiar with the methods of examining foods and othei articles of daily use, and his salary might be made contingent on his ability to pass an examination, a reasonable time being given him to enable him to fit himself for the work. *' All the foregoing anticipates an increase of the burdens of the most overburdened and unremunerated of public servants, and I 4 APPOINTMENT OP COUNTY HEALTH OFFICERS. will breathe easier if I am assured that there is not present in the audience a member of the Society for Prevention of Cruelty to Animals, otherwise I might be ordered under immediate arrest. " If you will bear with me for a few minutes longer I will tell you a tale of unrequited love. I have for a long time felt a great curiosity to know just what the Medical Health Officer received for his services, and how long a so-called Christian people would stand by and see him grow fat on ^he ea»t wind. "For the purpose of getting information on this subject, I recently addressed a circular to thirty-five cities and towns in the Dominion having a population of 5,000 and upwards. Replies from twenty- seven of these give Medical Health Officers' salaries ranging from zero to S3,000 :— 1 gives $3,000 1 " 2,400 3 " 1,000 1 " 800 1 " 400 1 " . . 300 1 " 250 4 " 200 1 " .. 120 4 «' 100 1 " 25 1 " I 7 " "The last of these, no doubt, are men who have discovered some pabulum other than bread and butter on which to sustain life in this cold, cold world. "The aggregate sum paid to Medical Health Officers is $11,496. The Inspectors fare a little letter. There are more of them. Six manage to maintain the dignity of their office on no salary. The whole sum paid Inspectors is $25,326. But it is the secretary who p. H. BRYCK, M.A., M.D. B is the Cr(u3us of the health office. This officer has actually absorbed $2,725 of the people's monty, and nineteen of them « cut no figure at all ' on pay day. " The population on which these figures are based gives a total of 809,061, representing an assessment of $418,100,072. This would ahow five cents per capita, and one-tenth of a mill on assessment to sustain our present municipal health organization. If the public ever blushed this statement should make its face scarlet." These statistics sufficiently illustrate the situation as it existed in 1891, and which has not, so far as I am aware, improved since in any notable degree in the matter of increased grants as salaries to Medical Health Officers, although a general improvement in the character of the work of Local Boards can, I think, on the whole be seen. Comparison of the health work of our municipalities with that of other branches of municipal work during the last ten years, may, I think, be made, and I believe it may be fairly asserted that progress in it is as great as in other directions ; but we have only to examine into the details of the work in any except our cities and perhaps larger towns in order to see how little exact health work is done. Let me summarize the work of a Medical Health Officer as it exists in England and elsewhere. (a) To inform himself resp3cting all influences affecting or threatening to injuriously affect the public health within the district. (b) Ascertain causes and distribution of diseases actually exist- ing within district. (c) He shall inspect periodically, and as emergency may require , his whole district. (d) He shall advise the Local Board on all matters and supply data for prosecution wherever nuisances exist. (e) Shall advise in the framing and execution of by-laws. (f) On being informed of infectious disease, he shall investigate And take such action as shall limit its spread. 6 A.PPOINTMENT OF COUNTY HEALTH OFFICERS. (g) lie shall superintend the Inspector of Nai'.ances. (A) He shall inspect meat, fish, vegetables, etc., personally it the occasion demands it. (i) He shall examine into all classes of offensive trades within the district, as factories, dairies, cow-sheds, milk-shops. (j) He shall report of all matters from time to time, ^'iving such returns of outbreaks and causes as is possible. (k) He shall report to the Central Board any dangerous out- break, and annually on all matters, including schools. In Fiance the district Councils of Hygiene are charged in additior to such as above, specifically : — (1) With powers for formulating plans for the suppression of epizootic diseases of animals. (2) The spread of vaccination. (3) The care of the indigent sick. (4) Local inspection of hospitals, asylums, prisons, etc. (5) Construction of public buildings, as schools, prisons, reser- voirs, sewers, cemeteries. (6) Obtain statistics of mortality, morbidity, topographical con- ditions, etc. This is certainly a very liberal bill of fare for a local health authority, and one cannot fail to think that if such matters demand public attention at all, they will demtnd not only all the time, but all the energies and intelligence of a Medical Officer of H: 'th with accomplishments of no mean order. If we group the woi k: we see that it includes : — 1. General inspection. "With regard to drainage, an officer must know accurately about soils and ground water ; with regard to mill-ponds, standing water, and organic deposits and refuse, he must be in a position to positively state what conditions are and have been proved, scientifically, positively injurious and give his reasons. 2. Suppression of contagious disease. He must have method and nerve enough to see that dangerous contagious diseases are- p. H. BRYCE, M.A., M.D. T reported to hira, whether of men or of animals, and must have so thoroughly the confidence of his medical confreres and the public as to his disii terestedness, scientific attainments b.^d practical abilities, as that all excuse from any standpoint for oversight on the part of practitioners or public will be removed. To dwell on this for a moment, we see that his work demands (a) medical experience ; (6) training and t-kill to diagnose in the laboratory by microscope, bacteriological cultures and chemical examinations, the special cause and source of diseases, principally the following :— Diphtheria, tvphoid, tuberculosis, actinomycoeis, trichina, cysticercus (measles in hogs), hog cholera, ptomaines in cases of poisoning from cheese, meat, milk, etc. It is needless to say that this work not only demands the highest skill, but it also demands laboratory facilities, (c) The isolation, and, where necessary, the removal of infectious diseasa to hospitals, the destruction of infected animals, and the disinfection of infected centres, whether houses, schools, workshops, stables, etc. This Dece»4sarily demands isolation hospitals and sufficient assistance by Inspectors to have work systematically carried out. 3. Inspection of foods, noxious trades, etc. This work, both difficult and constant, demands that slaughter-houses and their surroundings, cheese factories, cow byres, piggeries, knackeries, and other specially noxious trades be kept under the strictest supervision. The Medical Health Officer must know, and have Inspectors who know, diseased meat, and how diseased, must be able to accurately state wLat foods are injurious to milch cows, what stable surround- ings are good and what bad, and be able to diagnose diseased con- ditions in cows. He must be fully informed on the most recent appliances for testing milk as to quality, butter-fat, and its general fitness for children's food, and must know what to suggest for the re- duction to a minimum of the effects arising from noxious trades. 4. Inspection of schools and public buildings as to dampness, plumbing, heating, ventilation, overcrowding, lightin^r, etc. 8 APPOINTMENT OF COUNTY HEALTH OFFICERS. 5. The regular supervision of the public water supply of the district, and the control of drains, sewers, as regards the direct effects upon health, from sewer-gas in streets, etc., and the disposal of excreta. Enough then has been indicated to show that the work to be done is extended and of a most exacting character. At piesent we have this work distributed over the municipalities as giv^n in the following table : — ISJl -Table showing numbar Boards of Health and Health Officers to population in Ontario. t- 2 03 otal Sanitary Inspectors. otal organ municipali in Provinc otal nam be Boards rei ed organiz otal M. H. Officers. o c3 O ^■5 atesof pop tion to nun of M. H. cers. H H H H H tf 743 425 374 205 2,1(57,460 1 to every 5,795 Returns from Reports received in 1894. Cities Towns Villages . Townships Xl 03.2 S 2 n n n 2^3 bo O s- (- « ta o -!■ 58 87 271 5fi O W o 50 87 235 03 eS a C3 a a. _ a 384,303 189,190 81,431 663,494 M-l O . O +JI5J m H"^ to 03 O *^ 4J O O :^ 1 to every 38,700 1 " 3,780 1 " 1,000 1 '• 2,822 In England, by the Local Government Act of 1 888, the population necessary for a County Council (Health District) was 50,000 ; but as the area of England, compared with that of the organized municipali- ties in Ontario is 32,554,880 to 23,154,551 acres in Ontario, while the p. H. BRYCE, M.A., M.D. 9 population is 29,000,000 compared with 2,167,460, in Ontario, it is plain that the ex lent of area must in a large degree limit the extent of population for which a medical health officer's services would be available. That 20,000 of a population seems to be a practical work- ing limit in Ontario is seen in the folic wing comparison : — Members of House of Assembly for Ontario numbered in 1893 — 94 in population of 2,167,460. Inspectors of schools — Oities separate from counties. . 8 in 358,972 of population. Towns 7 in 35,694 " Counties (less cities and towns). GO in 1,772,794 " Included in their respective county inspectorates are, Brantford, Belleville, Stratford, St. Catharines and Windsor. Excluded from county inspectorates are, Chatham, Forest, CoHingwood, Oshawa, Peterboro', Waterloo, vVelland and Niagara Falls. I find that in 1894 there was expended upon our educational system $5,233,115.00, this includes $89,490.00 as salu-ies to county school inspectors. Assuming then that we have some 550 organized townships in Ontario, it would mean that there are now nominally in office some 400 medical health officers in the Province in 750 municipalities. We have seen to what extent the public moneys are expended in matters of education, and by comparison with the following we shall be able to estimate what is spent specifically in an average county on public health work. Under the heading. Local Board of Health, in the municipal returns made to the Department of Agriculture for the year 1893, from two of our oldest and most prosperous counties, we have the following : — The Expenditure under Local Boirds of Health in the county of Oxford varied : In 11 townships, from to !$97 ; total, ^481. In towns and villages, from $5.97 to $481. 10 APPOINTMENT OF COUNTY HEALTH OFFICERS. In the county of Grey it varied : In 16 townships, from in 4 townships to $75, with a total of $286. In towns and villages, from $6 to $344. Eoughly calculated, therefore, we may say, that, excepting the large cities, the total expenditure in the countiep of the Province would amount, on the above basis, to some $50,000 per year, to which we may add some $2,500,000, assuming there are 2,500 physicians in the Province, and that they receive $1,000 per year. Now, these figures mean either that almost no attention is given to public health in these districts or that the amounts of money thus expended have not been returned under the proper heading. As a matter of fact, both explanations are correct. With regard to the returns, I find in those for one of our largest villages, which I visited in 1894, on account of a serious outbreak of diphtheria, that the return under local board was but $24, while under poor relief were charged sums for diphtheria, nurses, etc., amounting to $121.95. This will doubtless explain how in many places the amounts returned for public health work are so small. When, however, I find $5 for the sanitary inspector and $5 for the medical health clficer, in examining details of expenditure in a village, it must be concluded that tl'^e public health of such munici- palities has been most satisfactory, or that Local Boards of Health in many instances exist only in name. When I find such amounts set down, however, for townships where correspondence shows public funerals to have taken place in cases of diphtheria, and where schools finally were closed on account of the disease, it would seem a fair inference that, from the public health standpoint, improvements are not only possible but seem to be greatly needed. From the figures and comparisons which have been made, it must be very apparent that, while the number of medical health officers in the Province is nominally very considerable, under existing con- ditions they are not in a position to effectively accomplish the work. p. H. BRYCE, M.A., M.D. 11 the extended and scientific character of which has been briefly indi- cated. It is probable, however, that were the remuneration received by them suflBcient to secure their active services, and the municipal grant enough to carry on their work, difficulties would arise, owing to the uncertain tenure of office under the present methods of appointment, which would seriously affect their independence of action. According to the usual interpretation of section 47 of the Health Act, the medical health officer is appointed annually at the time of the appointment of the Local Board of Health. While it is difficult to frame a clause which would make such an appoint- ment independent of the prejudices which too frequently affect the status of any official who has served under a council, succeeded by another hostile to it, especially politically, nevertheless it does seem possible that some court of reference should be appointed, such as a standing committee of this association, which might be called in instances where temporary feeling was liable to injuriously aff'ect the independent action of an efficient officer. This might be supple- mented by legislation, to the effect that some per capita basis of remuneration of medical health officers be established, preventing the possibility of a hostile council by reducing the salary of an officer to thereby force his resignation. A provision at present exists in the School Act whereby a county inspector cannot be dismissed by a county council without the assent of the Department of Education^ without the danger of a withdrawal of the governmental portion of his salary. We may now very properly discuss the desirability and possibility- of a change in the appointment of medical health officers, which has been provided for by the following amendment to the Public Health Act, contained in the Ontario Statutes of 1891 : — •* Whereas it may be desirable, in the interest of the public health, that there should be institutsd a system of health inspection more t orough than is at present practicable, owing to the expense 12 APPOINTMENT OF COUNTY HEALTH OFFICERS. attendant upon the appointment of an active and effiaient medical health officer for every municipality, an^ county council may appoint ono or more county or district medical health officers. '* Where a county council appoints a count/ health officer or offi- cers, the powers now possessed by medical health officers within the county or portion of a county, for which such county health officer is appointed, shall be deemed to be thereby transferred to and vested in such county health officer or officers, and all sanitary inspectors within the jurisdiction to be defined in the by law appointing a county health officer shall be subject to his direction and control." From this it will be seen that while the change is purely volun- tary on the part of the several municipalities in any county, its insertion in the Act is upon the assumption that public health work can in some, if not all, instances be made more efficient by transfer- ring to one medical health officer the public health work of a number of municipalities. Assuming that a number of the larger cities be excepted from the general operation of -the clause, as is the case now where a number of city and town inspectors of schools exist, Ave would say that, with the present political division of the Province, we have roughly the unit sup; d of 20,000 of a population as a possible health district. At present, even with the paltry sums paid to medical health cfficers in the municipalities, we have a total expenditure in some counties equal to what would be a minimum salary for a medical health officer who would devote all his time and energies to public health work. It is to be regretted that all purely scientific work is at present so inadequately i-emunerated ; but I think we may, from experience, find grounds for the belief that a sufficient number of young, active and trained applicants for such positions could be found willing to accept opportunities as county or district medical health officers, with the hope of their salary being gradually supplemented, if the primary condition of permanency in the position were supplied. Allow me to briefly summarize the advantages of such a change. p. H. BRYCE, M.A., M.D. 18 1. The position would be permanent during good conduct and efficiency. 2. The devotion of all his time to the duties of the position would serve largely to remove one of the greatest of existing- difficulties to effective action on the part of medical health officers, owing to their being in general practice, and therefore professional rivals to other practitioners, who are naturally sensitive to interference on his part. 3. By being engaged in investigations in a laboratory equipped for the purpose, he would be brought into friendly intimacy with local practitioners, whose time and opportunities are too limited to enable them to satisfactorily prosecute microscopic, chemical and bacteriological work. 4. By being within easy reach of all parts of his district he could, without delay or expense, have sent to him specimens of diseased tissue, membrane, sput'im, suspected water, milk, etc., and promptly determine the true nature of the disease, or its cause. 5. His laboratory would become a local depot of supply for vac- cine, anti-toxin, culture tubes, disinfectants, etc., and the means for their prompt and efficient use. 6. He would be within telephone call or an hour of two's ride of the several municipal sanitary inspectoib, who would be placed under his authority, and prompt action in any outbreak of disease would be possible. 7. He would systematically attend to and practice vaccination in all the schools of his district, and be in a position to attend the occasional cases of smallpox, which from time to time occur, to the oreat relief of the local practitioners, and the notable saving of expense, such as during the past year, amounted occasionally to .$20 per diem for attendance upon a single case. 8. He would gradually accumulate data for the preparation of a sanitary topographical map of the Province, in which the character of the soil, the drainage areas, the height above sea-level, the mill- ponds, and much other invaluable information, from the sanitary standpoint, would be supplied. 14 APPOINTMENT OF COUNTY HEALTH OFFICERS. 9. He would, through his inspectors, be able to obtain an accurate registration of mortality and morbidity statistics, and thus supply the only means by which we shall ever be able to ade(|uately inter- pret local conditions in their effect upon the public health. I am afraid to add further details, for fear that we shall nob be able to find anyone to apply for such onerous positions ; but surely enough have been supplied to illustrate what I believe the situation demands, and the many good reason? why this Association should lend all its influence to the attainment of the end in vio\.'. Where, it may be asked, shall we now find men fitted to do this work, or schools provided with means for their instruction and train- ing 1 On enquiry, I am led to the conclusion that none of our medical schools are supplying such training as would be required by such positions ; but, in justice to them, it must be stated that there have not hitherto been any such positions to look forward to which young men could profitably devote their time in preparing for. I learn that in two, at any rate, of the medical schools in Toronto, short courses of bacteriology are given ; and I have little doubt but that special chemical courses in water analysis, etc., would be insti- tuted if demanded. We have, in addition, in the provincial labora- tory, a centre of work which could readily be made available-' for giving practical direction to such courses of instruction. Remembering the starting point of our public health work, some thirteen years ago, and the achievements which, even under the im- perfect conditions which we all have been familiar with, have been attained, I do not believe you will think me too sanguine if I look upon this work as an accomplished fact within this the second decade of organized public health work. Most here are more familiar than myself with the crude character of the educational system of the Province prior to our present system of county inspection ar i organi- zation under a provincial department, and this, too, in a matter as old as the centuries. Have we not a right to expect not only that