The Importance of Proper Training for

Sanitary Inspectors*
ERNEST W. J. HAGUE
Chief Health Inspector, City of Winnipeg, Man.
THE Sanitary Inspectors Association of Canada has done a great
deal to improve the status of the sanitary inspector-first, by
affording opportunities for the members to increase their knowledge
and usefulness, and second, by helping to remove that notion, once so
prevalent that any uneducated Tom, Dick or Harry was good enough
for a sanitary inspector.
However, in Canada we still have a long way to travel before the
inspector comes into his own.
We have to convince quite a number of the sanitary inspectors
themselves that in these days when public health work is progressing
by leaps and bounds, and when new discoveries in the conquest of
disease are being made almost every year, that a person taking up
public health work in any of its branches cannot be content with mere
routine work, but that he or she must be of a studious nature, pre-
pared to keep abreast of this rapid progress-to know about the new
discoveries, and to apply them in his daily work. We also need to
convince quite a number of inspectors of the advantage of belonging to
an association such as this, which exists for the benefit of sanitary
inspectors and other health workers.
Next, we want the support of the health officers. We want to show
them how much better work they will be able to accomplish when all
public health workers are properly educated and trained.
We also need to convince governmental and municipal authorities
who employ sanitary inspectors and other health workers that they can
get better value for their money by insisting on proper qualifications
for such workers.
Lastly, we seek to show the general public with whom we come in
contact so much, that the sanitary inspector is not a raw man pitch-
forked into a public position by means of some "pull," but a man
specially educated and trained for his particular work.
What is a sanitary inspector, and what are his duties? In the first
place we note a great diversity in these duties. H. P. Boulnois, late
*
Presidential Address to the Fourteenth Annual Convention of The Sanitary Inspectors Association of Canada,
held at Toronto, Ont., Sept. 14-16, 1927.
[1010)
 PROPER TRAINING FOR SANITARY INSPECTORS 1011

Engineering Inspector of the Local Government Board, England, once

had this to say on the matter:
In order to carry out the multifarious duties of his office, an inspector should
be partially educated in the following trades and professions: That of a plumber,
in order to detect bad work, and to be able to specify in his notices how the bad
work is to be rectified. That of a builder, in order to detect improper sanitary con-
struction, and state how it must be remedied. This is of greater importance where,
as in some towns, the sanitary inspector has to carry out the duties of a building
inspector, and watch the erection of new houses which are being erected under the
by-laws regulating new buildings. That of a butcher, in order to detect and intercept
bad meat. That of a veterinary surgeon, in order to observe animals that may be
suffering under the Contagious Diseases (Animals) Act, and also in connection
with his visits to slaughter-houses. That of a lawyer, in order that he may be well
cognizant with all the Acts and Regulations under which he carries out his duties,
and to enable him to form a judicial opinion upon all statements and facts. That
of an architect, in order that he may understand plans, and if necessary, make
sketches of anything that comes under his notice in connection with his duties. That
of a clergyman, in order that he may preach the good tidings of sanitation, and may
by his precept and example further the good work he is engaged upon, and also that
he may be able to patiently bear the abuse which he may sometimes receive for
what is called his "prying interference." Lastly, he must try and educate himself
in common sense, that most valuable commodity, without which book learning
availeth not much.
A few extracts from Taylor's Sanitary Inspector's Handbook may
not be out of place here:
To carry out his duties efficiently, the sanitary inspector must exercise great
forbearance, tact and good temper; sometimes technical objections will be raised
to his proceedings, vexatious delay and evasions will often occur in the fulfilment
of his notices, nuisances which the officer is anxious to suppress may elude his
authority; when he would force one person to refrain from tainting the atmosphere
with the result of an offensive trade, where he would oblige another to see that his
tenants were better housed than cattle, he will often be reminded of the rights of
property and of an Englishman's inviolable claim to do as he will with his own.
With private affairs he should interfere only when they become of public import, and
with private liberty only when it becomes a public encroachment.
Thus neither the personality nor the office should be magnified. To do this is
to court the contempt of ordinary men and women. Officialdom is the curse of any
administrative body. Therefore the man who goes about his duties in a way that
compels respect, and whose tactful demeanour impresses others that the thing he is
asking for cannot be denied, is the one who will win his way to the front. Owners
and occupiers are but human, and they like to feel that they are receiving the
attention of a friend, although an official.
And again speaking of qualifications:
Sanitary authorities do not and have not always sought to appoint the person
best fitted for the post of inspector. They have too frequently appointed the man
who could command the greatest influence with its members without the slightest
regard to his qualifications. The important duties which sanitary inspectors are
now called upon to discharge, and the large discretionary power that must be
vested in them, demands that only qualified persons should receive these appoint-
1012 AMERICAN JOURNAL OF PUBLIC HEALTH
ments, and experience has undoubtedly rendered it necessary to establish some
mode of testing the competency and qualifications of persons offering themselves
as candidates to fill such appointments. Some assurance should be given the public
that the persons entrusted with these responsible duties are properly qualified.
The modern practice in large cities is to divide a health department
into various bureaus or divisions, as for instance:
Communicable Diseases Scavenging
Sanitation and Housing Laboratory
Food Inspection Vital Statistics
Dairy Inspection Publicity, etc.
Child Welfare
The tendency in cities where the work is thus divided is for the
workers in each division to develop as specialists along certain lines.
In rural districts however, and in smaller places where the work is not
so highly specialized, the sanitary inspector is required to do work
along many of the lines indicated above. It is both desirable and neces-
sary for all inspectors, no matter what particular line is their specialty,
to have a knowledge of all branches of health work, for they may find
themselves in a position where such knowledge will be absolutely essen-
tial. The examining boards recognize this, and their syllabuses pro-
vide for the study of a great many subjects, and the questions set at
the examinations cover the whole field of health work. This is as it
should be. Workers in a narrow groove are apt to have narrow views,
whereas a modern health department is a highly complex organization
working along various lines, but with definite objects in view, viz:
the conquest of disease, the prevention of sickness, the improvement
of the happiness and efficiency of the human race, and the lengthening
of the span of human life. It makes for the efficiency of any health
department, therefore, when all the workers therein have a clear view
of the main objectives, and each knows something of the work being
done in other divisions than his own. This means that every officer
must find time to read and thus keep himself well informed as to the
rapid developments in theory and practice. A doctor who did not study
and read the literature pertaining to his profession, would soon become
a back number.
Consider a few of the subjects which are specified in our examina-
tion syllabus:
Water-its sources and methods of purification Industrial hygiene
Building construction Milk
Plumbing and drainage Foods
Housing, both good and bad Communicable diseases-their sources, modes
Sewage treatment and disposal of transmission, methods of prevention; dis-
Lighting infection
Ventilation Child welfare work
What constitutes a nuisance and how to Vital statistics
abate it Sanitary law
Offensive trades
 PROPER TRAINING FOR SANITARY INSPECTORS 1013
We must know something of all these subjects, and the more, the
better. We should have a good knowledge of sanitary law, and what
is more important, the scientific data on which our health laws are
based, in order to be able, should occasion require it, to demonstrate
to the public the reasonableness of any law with which we are asking
them to comply.
In England or Scotland it has not been possible since 1877 to obtain
an appointment as a sanitary inspector unless one is properly trained
and certificated.
For food inspectors, smoke inspectors, health visitors and school
nurses, maternity and child welfare nurses, additional certificates are
required. The leading examining bodies have been The Royal Sanitary
Institute, The Sanitary Inspectors' Association and The Incorporated
Sanitary Association of Scotland. Quite recently the Royal Sanitary
Institute and the Sanitary Inspectors' Association ceased to hold
examinations for sanitary inspectors' certificates, and with the
approval of the Ministry of Health a new examining body was set up
entitled "The Royal Sanitary Institute and Sanitary Inspectors' Exam-
inations Joint Board." The board consists of 30 members; 15 being
nominated by the Ministry of Health, 10 by the Royal Sanitary Insti-
tute, 3 by the Society of Medical Officers of Health, and 2 by the Sani-
tary Inspectors' Association. The offices are at the Institute and the
examinations will be conducted by the Institute. The certificate issued
by the new board is now the officially recognized qualification in Eng-
land and Wales for sanitary inspectors. In the Dominions the branches
of the Royal Sanitary Institute will continue to hold examinations and
to issue sanitary inspectors' certificates.
In Canada there are examining boards in Quebec (1901), Ontario
(1914), Manitoba (1913), Saskatchewan (1916), Alberta (1917),
British Columbia (1920). Some of these boards, however, do not pre-
sent much appearance of activity. Manitoba seems about the only
province where examinations have been held recently. This, however,
is no doubt largely due to the fact that during and since the war, all
municipalities have been exercising great economy, and appointments
of new inspectors have been few. However, we are over the bad times
now and must be prepared for expansion. If the examining board in
your province is not functioning, find out why. Only recently a candi-
date from Regina had to come to Winnipeg for examination.
The Royal Sanitary Institute is willing to co6perate with the gov-
ernments of the various provinces of Canada by erecting new exam-
ination boards with representatives appointed by these governments
on the boards, and that the name of the government shall appear on
1014 AMERICAN JOURNAL OF PUBLIC HEALTH
all certificates granted. I know that this offer has been made in Mani-
toba. It should be noted that the certificate of the Joint Examination
Board in England will be harder to get than the old one, mainly
because a much higher standard of preliminary education is required
of the candidates. Some secondary education is also insisted upon.
Candidates in addition to this must have attended a 6 months' course
and also have received practical training in a public health department
of lectures and demonstrations at an institute recognized by the board,
for at least 300 working hours during a period of 1 year. The Ministry
of Health is making arrangements with municipalities for the giving of
this training.
This is a very brief description of the new regulations, but it indi-
cates a movement toward a much higher standard for sanitary
inspectors in England and Wales. New Zealand and Australia are
moving in the same direction. What about Canada? Outside of the
Province of Saskatchewan and the City of Winnipeg, I know of no
place where the obtaining of a certificate is required as a precedent to
appointment. Surely now that Canada ranks as a nation, we should
not be satisfied with anything but the best. One of the main objects of
our association is to promote the knowledge of sanitary science. How
can we do this if we ourselves have not that knowledge?
One of the difficulties in this new country has been the lack of
courses of lectures for sanitary inspectors, and of opportunity for gain-
ing practical knowledge. The universities should provide the necessary
classes. Practical training might be obtained by students in acting
as voluntary part-time helpers in health departments. All, however,
might not be able to get to the university centers, but in the larger cities
private classes under a good tutor can accomplish much. This method
has been very successful in Winnipeg. But even isolated students
should not despair, for many students have prepared themselves for
examination by private study. A course of lectures or a class held for
students studying for examination, should be quite different from a
short course of lectures intended for inspectors holding offiicial posi-
tions. In the first instance the student has to begin with the elements
of the sciences, such as arithmetic, mensuration, geometry, physics,
chemistry, etc., before commencing to consider the application of these
to sanitation. The period of study must cover a fairly long interval.
The short courses on the other hand are intended for practical men
already knowing a good deal about the subjects dealt with, but anxious
to acquire the latest and best information. Examples of the latter may
be found in the lectures and demonstrations provided in England by
the Royal Sanitary Institute, or by the courses in dairy inspection now
 PROPER TRAINING FOR SANITARY INSPECTORS 1015
being given in England as arranged for by the Ministry of Health.
Our association stands for the enactment of legislation in all the
provinces which will require, in the case of future appointments to the
position of sanitary inspector, a qualifying certificate from some rec-
ognized national examining body.
We do not advocate this because we believe that a man who has
succeeded in obtaining a diploma knows all about public health work.
It takes years of practical experience to become really well qualified;
but we do claim that men and women who have taken the trouble to
obtain a certificate are likely to become valuable workers more quickly.
Some health officers say that they prefer to train their own men, and
no doubt a few health officers do good work along this line. Most of
them, however, are too busy to attempt it. If I were a health officer
and had to break in new men and train them to be useful, I should at
least like them to know something of the sciences underlying the work,
something of the triumphs of public health work in the past, and have
an idea of the best methods now pursued in this and other countries.
I am rather amazed at the indifference of many health officers as to
the qualifications of the men who are given them to work with. One
would think, in view of the fact that considerable importance is today
attached to the proper training of health officers, bacteriologists, public
health nurses, and other health workers, that both the Canadian and
American Public Health Associations would have adopted before now,
some scheme to help the sanitary inspector also.
It should be clearly understood that what has been said about certi-
ficates being compulsory does not apply to sanitary inspectors already
holding positions. By dint of study and hard practical experience many
of these are the equal of any certificated men. We need them all within
the fold of our association.
We want to raise the status of the whole profession, and the best,
and in fact the only way to do this, is by means of education. We claim
to be technical experts, and that we should receive remuneration on the.
scale of technical experts. This can only be accomplished by actually
becoming technical experts and then by convincing health officers and
employing authorities that we are entitled to better consideration as
such. Get the technical ability and the remuneration will follow natur-
ally. This education should be continuous. Systematic reading on
subjects pertaining to public health work is an absolute necessity.
There are available a large number of textbooks, reports and journals.
We should have a conception of what is being done all over the world in
public health work.
I said at the beginning that our first task was to convince the sani-
1016 AMERICAN JOURNAL OF PUBLIC HEALTH
tary inspector himself of the importance of education and proper train-
ing, and of a continuous process throughout life of absorbing knowl-
edge pertaining to his chosen profession and trust that what I have said
may convince some of this necessity.
The next most important work of our association is to convince
health officers of this necessity for trained men. Sanitary inspectors
have not the slightest desire to usurp in any way the functions or pre-
rogatives of health officers. On the contrary, our sole desire is to make
ourselves as efficient as possible that we may become what we should
be-the right hand of the health officer. In England the position of a
sanitary inspector is different. There he is a statutory officer and may
exercise certain powers, independently of the health officer. In Canada,
however, the health officer is in supreme control, and personally I think
ours is the better system, and tends to accomplish better work.
What could a health officer accomplish without his assistants? Imagine
a well qualified man-a D.P.H. if you like-being appointed as health
officer of a large city and given no assistants. He would naturally say:
"Where are my sanitary inspectors, my food and dairy inspectors, my
communicable disease inspectors and nurses, my bacteriologist? I
want these and I want good men and women, properly trained, if you
expect me to do anything of value for the community."
And so, we appeal to the health officers for a more active support.
We suggest that health officers might help along the following lines:
1. Demand that the public health workers appointed to assist them shall be
properly qualified.
2. Assist in procuring such legislation in each province of Canada as will pre-
vent the appointment in future of unqualified persons.
3. Assist in the training of the men and women composing their staffs, both by
their own personal instruction, and by helping to secure the provision of lecture
courses and demonstrations for sanitary inspectors.
4. In provinces where the Royal Sanitary Institute has at present no examining
board, to assist in having such a board appointed. If a Canadian certificate is
desired, arrange with the government of each province for a joint examination board
composed of representatives appointed by the government, the Royal Sanitary
'Institute, and the Sanitary Inspectors' Association. In each province the examina-
tions might be almost uniform, and the certificate issued to successful candidates
might bear the name of the government of that province. This certificate should,
however, be recognized officially throughout Canada as the certificate'required by
law for all future appointments after a given date. It might even be possible to
arrange with the Dominion Government and the Royal Sanitary Institute for the
establishment of an examination board for all Canada. Such a board would comprise
five or more members for each province.
5. Give this association and the branches thereof their personal sympathy and
support.
If we can induce health officers to do this, good results will follow.
 PROPER TRAINING FOR SANITARY INSPECTORS 1017
If our chiefs, the health officers of Canada, see that we are in earnest in
this matter, they can scarcely refuse to help in a matter which so closely
touches them and their work.
The above remarks apply equally to mayors, aldermen, and those
responsible for appointments to positions in health departments. This
association is not a trades union, and does not exist per se for the pur-
pose of raising salaries. But, if you are going to appoint men and
women to help to carry on this great work, why not make sure that they
know their job? If well qualified, they will be cheaper in the end.
The sanitary inspector and the public health nurse come into daily
contact with more citizens than any other health officials. In the course
of their daily work they are called upon to discuss health topics and
measures. They should be well qualified to do this convincingly, and
also be able to correct some of the inaccurate notions found among the
public and obtain their cooperation.
Just a word here, lest anything I have said should convey the
impression that there are no certificated inspectors in Canada-there
are many, and most of them belong to our association. Six candidates
obtained certificates in Manitoba in April, this year. If certificates
become obligatory there will be no lack of applicants.

Dental Service for School Children

dental treatment for children whose parents are unable to pay has recently
F REE
been started in Habana, Cuba, and nearby towns by the Department of Public
Health. Dental inspection of all public school children has been practiced for some
time. During December more than 5,000 children had their teeth examined; 3,200
of them needed treatment; 915 were treated free.
Conveyances have just been provided in order to permit better service in the
schools on the outskirts of the city.-Diarie de la Marina, Habana, Jan. 10, 1928.