Liverpool created a Port Sanitary Authority in 1874, with the City's Medical Officer of Health (MOH), Dr William Trench, reluctantly taking on the additional role of Port Medical Officer (PMO). He ignored the poor staffing level and lack of isolation hospital accommodation. Dr John Stopford Taylor, who replaced him as MOH in 1878 achieved some minor improvements, including a 26 bed isolation hospital built in 1880. The Local Government Board (LGB), which was the central government department responsible for local government activity, repeatedly criticised Liverpool in the 1880s for its failure to inspect shipping, provide adequate isolation facilities and improve the sanitary condition of the port. The weaknesses were exposed dramatically by the 1884 Smallpox epidemic, during which the city council could not cope with the number of cases, and had to beg for hospital accommodation in the Poor Law institutions. The LGB made an inspection of Liverpool PSA in 1893. In response, the PSA appointed an assistant PMO and two additional inspectors, and the activities of the PSA were separated from those of the city's health committee through the formation of a new Port and Sanitary Hospital Committee in November 1893. A PSA office was finally built, and the isolation hospital facilities also extended.
There was, however, ongoing dissatisfaction with the work of the PSA, particularly from the seamen themselves. Throughout the 1890s the Liverpool branch of the Amalgamated Sailors and Firemen's Union issued increasingly vociferous demands for a more thorough inspection of insanitary ships. They submitted a petition with over a thousand signatures claiming that no adequate system of inspection was currently operating. The MOH Dr Stopford Taylor suffered intense personal criticism and was accused of ordering the inspection of only a token number of the 22,000 ships which annually came into the port of Liverpool.
In 1894 Stopford Taylor was replaced by the ambitious Dr William Edward Hope, who served as MOH for 30 years until 1924. He brought a new enthusiasm and attitude to port sanitation and was determined to make a name for himself in international public health. He was the driving force behind the creation of the Liverpool School of Hygiene in 1889 and its national reputation for public health training. He was also instrumental in the opening of tropical diseases wards at the Royal Southern Hospital in Liverpool and the formation of the Liverpool School of Tropical Medicine -both these initiatives benefited the health of seamen.
Hope was fully cognisant of the risk to public health imposed by the huge volume of people and trade passing through Liverpool. He persuaded the city council to invest in extra staff and state-of-the-art equipment for ship fumigation.