Médical office

“ Medical Officer of Health: generally a busy man with a private practice covering a very large area, who earns a pittance for doing a most important public duty; a man appointed to his office and maintained in it by those whom he ought to criticise fearlessly and openly, when they are careless about the health of those dependent on them. ”

“ The specialists in surgery on the staff of the Bureau shall be recommended by the medical sanitary department, with the consent of the Board of Directors, preferably from among the surgeons connected with the hospital fund, and shall be confirmed by a general meeting of the office.
3. During the examination of a person at the Bureau of the Medical Commission, all persons who have applied for the examination may be present.
4. An application for the determination of the loss of working ability may be made by any person or institution. ”

“ The medical organization of the District Office has been developed primarily for the purpose of establishing claimants of the Veterans’ Bureau as patients entitled to treatment, and the furnishing of proper treatment, under regulations, orders and instructions issued by the Central Office. ”

“ The motive power is public opinion. Good work cannot for any prolonged period go beyond what the public demand, and the work of officials is one of constant education of their masters and of the public.
The Training and Tenure of Office of Health Officers
Every sanitary district is required to appoint a medical officer of health and since 1888 every medical officer of health for a district with a population exceeding 50,000 must have a special diploma in public health. The enforcement of this requirement has [Pg 64] done much to raise the standard of work of these officers. ”

“ Transfers of personnel on the District Office payroll in dispensaries and the follow-up nurses may be made within the District by the District Manager. If it is an interdistrict transfer, the same must be made by Central Office. All surplus personnel, either in hospitals, National Soldiers’ Homes, or in District Office, or in Sub-District Office, should be reported promptly to Central Office.
COMMUNICATIONS All communications from Central Office to personnel in a hospital will be routed through the Medical Officer in Charge of hospital. ”

“ The chief medical examiner may appoint and remove such deputies, assistant medical examiners, scientific experts, officers and employees as may be provided for pursuant to law. Such deputy medical examiners, and assistant medical examiners, as may be appointed, shall possess qualifications similar to those required in the appointment of the chief medical examiner. The office shall be kept open every day in the year, including Sundays and legal holidays, with a clerk in constant attendance at all times during the day and night. ”

“ It would be no imputation on the merits of a general medical practitioner that he was found unsuited to the performance of the duties devolving on an officer of public health. The working of the Parisian administrative arrangements shows the injury done to the public service by the difficulty of retrieving any mistaken appointment, and suggests the desirableness of an arrangement to facilitate changes of the officers of health even where there is the security of a previous special examination as to the qualifications for the office. ”

“ He opened his office in that town June 17, 1817, soon became well known as a careful physician, and by some good operations obtained control of nearly all the surgical cases occurring for years in that region. ”

“ As the population increases, more nurses should be added.
10. Office consultations between parents and physicians are among the most important activities of the Division and should be systematically encouraged. To this end arrangements should be made whereby definite hours for parent consultations are assigned to each school.
11. The Division of Medical Inspection has so organized its work that the attention of the staff is concentrated upon a different set of problems each year. This method is unquestionably effective in promoting growth and maintaining the interest of the staff. ”

“ Were this done, the ideal condition, in which each medical practitioner becomes a medical officer of health in the range of his own practice, would approach realization.— [Annual Report to the Local Government Board, 1917-18.]
Many medical practitioners already fulfill this ideal. It would oftener be realized were it not for the excessive work which many are obliged to undertake. In the early history of public health in England poor law medical officers, attending the impoverished in their dwellings and familiar with their home conditions, became part-time medical officers of health. ”

“ It is not a part of the functions of the Purveying Service to approve or disapprove requisitions for hospital supplies. This duty is performed by an officer who represents the Marine Hospital Division and who works in the office of the Medical Purveyor that the prompt handling of requisitions may not be delayed. It is greatly in your favor if you have in the eyes of the approving officer a reputation for practicing economy in the use of supplies. ”

“ Is it not obvious that there should be a staff of medical officers and orderlies, detached altogether from any association with the treatment of disease, who should devote themselves entirely to the problem of prevention? ”

“ If an assistant-surgeon, he must be prepared to practice his profession in the most comprehensive sense of the word: no distinction is made between medicine and surgery. Every medical officer must act in either capacity, as circumstances demand, (which is more reasonable after all than drawing a line between two branches which cannot be separated) ,and perform the duty of aurist, oculist, accoucheur, chemist, and medical jurist, as occasion presents itself. ”

“ We want independent Medical Officers of Health—appointed by the County Council, and removable only by them—men trained up for this as a profession; we want Sanitary Inspectors, with a proper qualification, appointed with the Medical Officer's approval; we want that each Medical Officer should be informed as to all approaches of dangerous disease, and bound in his turn to supply the information for other neighbouring districts ”

“ Again difficulties arose, since none of the medical officers wanted the job. In fact, medical officers in general never want to do anything except attend to patients. They are unsuited temperamentally for administrative work, and dislike it. ”

“ I resolved to watch the action [Pg 80] of the Department, and to do my best to make the permanent officials do their duty, so far as my observation could aid me. With that object in view, I arranged for an aggregate meeting of the profession, at the Freemason's Tavern, to discuss the composition of the so-called Board at Whitehall, and the grievances of the Poor Law medical officers. ”

“ It is expressly understood that all the work in Occupational Therapy should be upon prescription of the Medical Officer in Charge of the Hospital or his designated agent, and a proper cooperation between the Medical staff and the staff of the Reconstruction Section will insure most satisfactory results, and that this cooperation of the work will be very necessary in order to secure proper efficiency. ”

“ The practice of the Poor Law Board at this time was to assert on paper the supremacy of the medical officer in his own department, to give him no personal support when he did his duty, to visit on his head all the consequences of their own negligence or dilatoriness, and, right or wrong, to support the Guardians when they took offence at conscientiousness and zeal. ”

“ The Registrar, as the principal executive officer of the hospital, whose business it is to carry out the decisions of the Commanding Officer, is at present invariably a medical officer. The greater part of his work does not need medical knowledge, and the difficulty might be obviated by the adoption of one of two methods. Either the Registrar might be an educated business man or he might have such a one as his immediate understudy. ”

“ In November 1869 he was appointed to the second of the two public health inspectorships then created by the privy council, and, on the formation of the local government board in 1871, he was made assistant medical officer. ”

“ To go, therefore, to the station, make a cursory examination, and then write a certificate that the person is seriously ill and must be removed without delay, or in the case of a simply cut head send it at once away to the infirmary for the workhouse surgeon to get out of bed and dress it, is, in my judgment, an entirely unsatisfactory procedure, especially as the latter is paid no special fee, be his trouble ever so great. There was nothing in all my duty as a workhouse medical officer, which irritated me more than these police cases. ”

“ One of the provisions of the Bill was, as I have before stated, that every district Poor Law medical officer should be the health officer of his district, and that his reports of insanitary conditions should be sent to the Board of Guardians, many members of which Board would be found to be the principal offenders against sanitary requirements. ”

“ No person can be appointed as a medical officer, physician, or surgeon in the public service, or in any hospital or other charitable institution not supported wholly by voluntary contribution, unless he be registered (ib., s. 63) .
No certificate required from any physician or surgeon or medical practitioner is valid unless the signer be registered (ib., s. 64) . ”

“ Health Board of men especially accustomed to the dispatch of business, and in part of medical men of great skill and experience.
3. It should have a corps of skilled medical officers as inspectors, which should be the eyes, the ears, in a word, the senses of the board, in every part of the city, searching out disease, investigating the causes which give rise to it, the conditions under which it exists, the means of its propogation, and the most effectual mode of its suppression. ”

“ The duties of the Chief Nurses in the districts will be to superintend the activities of the nurses in their respective districts, to visit the local offices when directed by the District Medical Officer, to inspect the work of the nurses, to co-ordinate the work of the nurses in the districts, sub-districts, and local offices and to check up the nurses’ reports. ”

“ The governors of the hospital never had a medical officer more desirous of efficiently performing his duties; and he shewed the interest he took in the advancement of the pupils, by immediately instituting clinical lectures; thus adding to his own labours, at a period when his time was daily becoming more valuable to him. His patience in investigating a disease was only exceeded by his perspicacity in detecting it, and his anxiety to cure it. ”

“ The most able of the guardians would confess that if they are not entirely incompetent to supervise medical service, they are at the best but imperfectly qualified for such a task, and the medical officers would act with more satisfaction to themselves from the supervision of officers from whom they might derive aid and confidence. ”

“ Nothing in the above act shall prevent any person, not a British subject, who shall have obtained from any foreign university a degree or diploma of doctor in medicine, and who shall have passed the regular examinations entitling him to practise medicine in his own country, from being and acting as the resident physician or medical officer of any hospital established exclusively for the relief of foreigners in sickness ”

“ Dear Sir,—I am directed to forward you the annexed copy of a Resolution adopted by the Guardians at their meeting held on Friday last, when your resignation of the offices of Workhouse Medical Officer and Public Vaccinator of the Union was accepted. ”

“ On mentioning this to an ex-workhouse medical officer, he told me that on having occasion to represent the conduct of the resident midwife, who claimed and exercised the right to go out on every Sunday for several hours, leaving the wards wholly unattended on every such occasion except by pauper helps, the only action taken by the Board as a return for it, at the instance of the midwife's friend, was the adoption of a resolution that a return should be prepared and laid on the Board-room table, showing the occasions when the medical officer went out and the length of time he was out, &c., &c. ”

“ Only men who are, by thorough education and experience, especially fitted to fill their respective positions, have been chosen to serve as physicians and surgeons in this institution. After having spent a very large sum of money in erecting and furnishing this national resort for invalids with every requirement and facility for the successful treatment of all classes of chronic diseases, it is the determination of the Board of Directors that the Faculty of Physicians and Surgeons shall be superior in culture, experience and skill. ”

“ Between the years 1922 and 1932 we may expect to have established a National Board of Health, with a chief officer in the cabinet and an organization similar to that of the Army, in which every physician and every pharmacist will be an officer of the United States Government. Those physicians, under the new order, who remain in the office awaiting the call of the sick will be comparatively few in number. ”

“ Definition, Exception.—A person is regarded as practising medicine who professes publicly to be a physician and to prescribe for the sick, or who appends to his name “M.D.,” but students are not prohibited from prescribing under the supervision of a preceptor, and gratuitous services may be rendered in case of emergency, and the act does not apply to commissioned surgeons of the United States army or navy or marine hospital service (ib., s. 6,879) . ”