PUBLIC HEALTH. State medicine as an organized department of administration is entirely of modern growth. By the common law of England the only remedy for any act or omission dangerous to health was an action for damages or an indictment for nuisance. (See NUISANCE.) At the same time the jurisdiction of the commissioners of sewers acted to a certain extent as a preventive means. Commissions of sewers were granted by the crown, at first in virtue of the general prerogative, afterwards under the provisions of numerous statutes, the earliest dating from 1427 (6 Hen. VI. c. 5). The powers of the com-missioners included the removal of obstructions in rivers, the making of fosses and drains, etc. Their jurisdiction, where still existing, is expressly preserved in the modern Public Health Acts. The indictment for nuisance still lies for many offences which are now punishable in a summary manner under the powers of recent legislation. But for a long time it was the only, not as now a concurrent, remedy. Its obvious defect is that proceedings can only be taken after the mischief has been done. Old examples of nuisances dangerous to health and punishable at common law are the keeping of swine in a town, the dividing of a house in a town so that by reason of overcrowding it would be more dangerous in time of sickness or plague, and the carrying on of offensive trades, such as the melting of tallow. The court leet seems to have had some jurisdiction in sanitary matters, confined to the prevention of nuisances and the determination of the quality of provi-sions within its local limits. At a comparatively early date statutes were passed dealing with matters for which the common law had provided too cumbrous a remedy The attention of parliament, though but to a slight extent, was directed to the health of London as early as the Statute of the City of London in 1285 (13 Edw. I. st. 5). The earliest legislative enactment affecting the public health generally appears to be 12 Kic. II. c. 13, 1388, forbid-ding the deposit of offensive matter in rivers and other waters, as well in the city of London as in other cities. Acts of a similar character were from time to time passed to meet particular offences, such as 4 and 5 Hen. VII. c. 3, by which no butcher was to slaughter cattle in London or other walled towns. The plague called forth the Act of 1 Jac. I. c. 31, which made it a capital offence for an infected person to go abroad after being commanded by the proper authority to keep his house. The Act for the rebuilding of London after the great fire, 19 Car. II. c. 3, contained various provisions as to the height of houses, breadth of streets, construction of sewers, and pro-hibition of noisome trades. In 1832 the fear of cholera led to 2 Will. IV. c. 10, empowering the privy council to take certain preventive measures against the spread of the disease. Numerous local Acts gave the authorities of the more important towns power over the public health. To this day London is governed by separate legislation. The Towns Improvement Act, 1847, contained provisions of a sanitary kind for incorporation in local Acts. But it was not until as recently as 1848 that a general Public Health Act, embracing the whole of England (except the metro-polis), was passed. The Public Health Act, 1848, created a general board of health as the supreme authority in sanitary matters. The Local Government Act, 1858, amended the Act of 1848, chiefly in the direction of greater local sanitary control. By an Act immediately preceding the Act of 1858 the general board of health was superseded partly by the home office, partly by the privy council. The Local Government Board, the present, central authority, was created in 1871 by 34 and 35 Vict, c. 70. The president of the Local Government Board is usually a member of the cabinet. Numerous other Acts dealing with public health were passed from 1849 to 1874. Finally in 1875 the existing law was digested into the Public Health Act, 1875 (38 and 39 Vict. c. 55).
The tendency of sanitary legislation has been to place local sani-tary regulations in the hands of the local authorities, subject to a. general superintendence by a Government department. The Act of 1875, which registers the results of this tendency, is a con-solidating not an amending Act, and did not materially alter the law. It is impossible in this place to do more than give a short notice of its comprehensive provisions. For the purposes of the Act England, except the metropolis, is divided into urban and rural sanitary districts, subject respectively to the jurisdiction of urban and rural sanitary authorities. The urban authority is either the corporation of a borough, improvement commissioners, or a local board, according to circumstances. A district becomes subject to a local board at the instance of either the Local Government Board or the owners and ratepayers of the district. The local board is elected by the owners and ratepayers. It must be elected before 15th April in every year. The members hold office for three years, one-third retiring every year. The Oxford local board is governed by regulations peculiar to itself, giving the university a large pro-portion of members. Rural districts are conterminous with poor-law unions, exclusive of any urban district. The guardians of the poor form the rural authority. There is a port sanitary authority in seaport towns. (See QUARANTINE. ) The jurisdiction of a local authority is both preventive and remedial. The matters falling under this jurisdiction include (1) sewers, with certain exceptions, among which come sewers under the authority of commissioners of sewers, (2) scavenging and cleansing streets, (3) water-supply, (4) cellar-dwellings and lodging-houses, (5) nuisances,2 (6) offensive trades, (7) unsound moat, (8) infectious diseases and hospitals, (9) prevention of epidemic diseases, (10) mortuaries and (by the Public Health Act, 1879) cemeteries, (11) highways, (12) streets, (13) buildings, (14) lighting, (15) public pleasure-grounds, (16) markets and slaughter-houses, (17) licensing of hackney carriages, horses, and boats. It is to be noticed that jurisdiction in some of these cases is confined to an urban authority. Contracts made by an urban authority, whereof the value or amount exceeds £50, must be in writing, and sealed with the common seal of the authority. Where the contract is of the value or amount of £100 or upwards tenders for its execution must be invited. A local authority has power, subject to the approval of the Local Government Board, to make bye-laws and impose penalties for their breach. The authority must appoint a medical officer and an inspector of nuisances ; if an urban authority, it must in addition appoint a surveyor, clerk, and treasurer. Officers may not contract with a local authority. An urban authority has power to levy a general district rate, a private improvement rate (an additional rate levied in return for some special advantage beyond that obtained by the inhabitants in general), and (in certain cases) a highway rate. The expenses of a rural authority are either general or special, the latter being chielly the expenses arising from sewerage and water-supply. General expenses are defrayed out of a common fund raised out of the poor rate. Special expenses are a charge upon the contributory places benefited. A local authority may, with the sanction of the Local Government Board, raise loans for the purposes of the Act. The loans are charged upon the general district rate. Legal proceed-ings under the Act are generally summary. Where proceedings are by action, one month's notice of action must be given where the cause of action is anything done, or intended to be done, or omitted to be done under the provisions of the Act. The action must be brought within six months after the accruing of the cause of action. The local authority and its officers are protected from personal liability for matters done in pursuance of the Act. An appeal from a court of summary jurisdiction lies to quarter sessions. In cases where the local authority decides a question as to liability to expenses, an appeal lies to the Local Government Board. The Local Government Board has power to alter areas and unite dis-tricts, to direct inquiries in relation to any matters concerning the public health in any place, to make provisional orders, and to enforce performance of duty by a defaulting local authority.
In addition to the Public Health Act, 1875, there are various Acts incorporated with that Act under the name of the " Sanitary Acts," dealing with similar subjects. These are the Bakehouse Begulation Act (1863), the Artisans and Labourers Dwellings Act (1868), the Baths and Washhouses Acts, the Labouring Classes Lodging-House Acts (1851, I860, 1867). Since 1875 numerous Acts amending and extending the Public Health Act have been passed, dealing with (among other matters) river-pollution, water-supply, hospitals for infectious diseases, nuisance arising from alkali-works, and lodging of fruit-pickers. There is besides a mass of legislation which in fact, if not in name, has for its object the sanitary welfare of the people. It is sufficient to mention the Vaccination Acts, the Factory Acts, the Artisans and Labourers Dwell-ings Acts subsequent to 1868, the Merchant Shipping Acts (insuring the carrying of medicines and antiscorbutics on board ships, the provision of sleeping space for seamen, and the inspection of seamen's lodging-houses), the Adulteration Acts, and the numerous Burial Acts. In many local Acts notification of infectious disease by the medical man in attendance to the local authority is made com-pulsory, but the legislature has not as yet adopted any general provision of the kind.
The scientific aspect of public health does not fall within the scope of the present article; it has been treated under the title HYGIENE. It is sufficient to say here that the effect of the attention which of late years has been given to the subject is seen in the reduction of the death-rate from 22'23 per thousand in the years 1841-51 to 2L27 for the years 1871-81.
London.The metropolis is governed by a series of statutes, some peculiar to itself, others general Acts, repealed as to the rest of England, but specially preserved as to the metropolis by the Public Health Act, 1875. The limits of the metropolis for the purposes of public health depend primarily upon the Metropolis Management Act, 1855 (18 and 19 Vict. c. 120, s. 250, schedules A and B). The local authorities are the metropolitan board of works, the vestries and district boards, and (in the city of London) the commissioners of sewers. Asylums and hospitals are administered by the metropolitan asylums board. The water-supply is regulated by the Metropolis Water Acts, 1852 and 1871, gas by the Metro-politan Gas Act, 1860.
Scotland.Sanitary legislation occurs as early as the reign of Alexander III. The Statuta Gilde, c. 19, forbade the deposit of dung or ashes in the street, market, or on the banks of the Tweed at Berwick under a penalty of eight shillings. At a later date the Act of 1540, c. 20, enacted that no flesh was to be slain in Edinburgh on the east side of the Leith Wynd ; that of 1621, e. 29, fixed the locality of fleshers and candlemakers. The existing law of public health is contained in the Public Health (Scotland) Act, 1867 (30 and 31 Vict. c. 101). The local authority is the town council,, the police commissioners or trustees, or the parochial board, accord-ing to circumstances. There is no distinction of urban and rural authority. The central authority is the board of supervision con-stituted by 8 and 9 Vict. c. 83. Proceedings by a local authority in cases of nuisance are by summary petition to a sheriff or a justice (in some cases only to a sheriff) upon requisition in writing under the hands of ten inhabitants. An appeal lies in cases of sufficient value from the sheriff-substitute to the sheriff and from the sheriff to the Court of Session. The list of nuisances in the Act differs, but not materially, from that in the English Act. The powers of local authorities in England and Scotland are very similar. There are no provisions as to contracts by local authorities corresponding to those in the English Act.
Ireland.Several Acts of the Irish parliament dealt with specific nuisances, e.g., 5 Geo. III. c. 15, forbidding the laying of filth in the streets of cities or county towns, and making regulations as to sweeping and scavenging. There were also numerous private Acts dealing with water-supply and the obstruction of watercourses. In 1S78 the existing legislation was consolidated by the Public Health (Ireland) Act, 1878 (41 and 42 Vict. c. 52), a close copy of the English Act of 1875. The list of statutory nuisances is the same in both Acts. The urban authority is the corporation, the commissioners, the municipal commissioners, or the town com-missioners, according to circumstances. Ireland has its own local government board.
United States.After the Civil War boards of health were established in the chief cities. Public health is under the control of the local authorities to a greater extent than in England. By the Act of Congress of 25th February 1799 officers of theUnited States are bound to observe the health laws of the States. A national board of health was created by the Act of 3d March 1879, c. 202. Its main duties are to give advice to local authorities and to carry on investigations in sanitary matters. It has certain jurisdiction in quarantine and in epidemics of a peculiarly dangerous nature. (J. W.)
For the history of sanitary legislation in England, see the Report of the Royal Sanitary Commission, 1869 ; M. D. Chalmers, Local Government, eh. vii. ; Stephen, Commentaries, vol. iii. bk. iv. pt. iii. ch. ix. ; G. A. R. Fitzgerald, The Public Health Act, 1875, Introd.
- The list of nuisances which may be dealt with summarily under the Act is as follows :" (1) any premises in such a state as to be a nuisance or injurious to health; (2) any pool, ditch, gutter, water-course, privy, urinal, cesspool, drain, or ashpit so foul or in such a state as to be a nuisance or injurious to health ; (3) any animal so kept as to be a nuisance, or injurious to health ; (4) any accumulation or deposit which is a nuisance or injurious to health ; (5) any house or part of a house so overcrowded as to be dangerous or injurious to the health of the inmates, whether or not members of the same family ;. (6) any factory, workshop, or bakeshop (not already under the opera-tion of any general Act for the regulation of factories or bakehouses) not kept in a cleanly state, or not ventilated in such a manner as to render harmless as far as practicable any gases, vapours, dust, or other impurities generated in the course of the work carried on therein, that are a nuisance or injurious to health, or so overcrowded while work is carried on as to be dangerous or injurious to the health of those employed therein ; (7) any fireplace or furnace which does not, as far as practicable, consume the smoke arising from the combustibles used' therein, and which is used for working engines by steam, or in any mill, factory, dyehouse, brewery, bakehouse, or gaswork, or in any manufacturing or trade process whatsoever ; (8) any chimney (not being the chimney of a private dwelling-house) sending forth black smoke in such quantity as to be a nuisance." In relation to these statutory nuisances it is provided that no penalty is to be inflicted in respect of any accumulation or deposit if it is necessary for business purposes and if effectual means have been taken for preventing injury therefrom to the public health, or in respect of a nuisance from unconsumed smoke if it be proved to the court that the smoke has been consumed as far as practicable and that the fire has been carefully attended to.
The above article was written by: James Williams, B.C.L.