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CHAPTER II.
THE DEVELOPMENT OF PUBLIC HEALTH ORGANISATION
A.--IN ENGLAND.
B. --UNDER THE COLONIAL OFFICE.
A. THE DEVELOPMENT OF PUBLIC HEALTH ORGANISATION
IN ENGLAND.
The History of what took place in England is clearly discribed in Sir George Newman's "Outline of the Practice of Preventive Medicine”.
Until the nineteenth century there was little done in England for the promotion of the Public Health. In the institutions established by Religious orders and in a few large Cities there was a certain amount of method and order in dealing with disease prevention and control, but outside these areas nothing was done.
There was prae- tically no medical learning and no knowledge of the causes of disease. The cause be- ing unknown the remedy was also unknown and nothing was attempted.
It was the cholera outbreaks in 1831, 1849, and 1854 and the alarm which they caused among all classes which roused the country to action and led to the first steps in administrative sanitary reform
In 1843 Edwin Chadwick a lawyer and philanthropist persuaded Sir Robert Peel to ask for the appointment of a Royal Commission to enquire into outbreaks of disease in large towns and the best means of improving the Public Health. The ('ommission found the existence of a serious national evil and recommended a legis- lative remedy.
The report of the Commission in 1845 contains the significant suggestion in its recommendation that each local governing body should have a medical Officer whose duty it should be to ascertain the true causes of disease and death more especially epidemics increasing the rates of mortality and the circumstances which originate and maintain such diseases and injuriously affect the Public Health. Up to this time the little preventive work that was being done was considered to be the con- cern of scavengers and those who engaged them and outside the scope of the me- dical man.
In 1848 the first Public Health Act was passed which created a Board of Health not responsible to Parliament with powers to create Local Boards. In 1847 Liverpool appointed the first Medical Officer of Health and the next year London fol- lowed suit by appointing Mr. Simon.
In 1848 Edwin Chadwick was appointed secretary to the newly established Poor Law Board. It is interesting to note that Disraeli described him at the time as "a monster in human form" and it is instructive to note that Disraeli afterwards was converted by Chadwick. It was Disraeli in 1872 who said "Sanitas sanitatum, omnia sanitas" and it was Disraeli's Government which passed the great Public Health consolidating Act of 1875,
In 1855 Dr. Simon became the first Central Medical Officer for Government which position he held for twenty-one years during which time he worked whole heartedly with Chadwick for the advancement of Public Health.
In 1869 because of the failure to reach the desired result through the estab- lished machinery a second Royal Commission was appointed This Commission found that the reason for failure lay in :-
1. The variety and confusion of the authorities concerned in the Pub-
lic Health.
2. The want of sufficient motive power in the central authority.
3 The non-coincidence of areas of various kinds of local sanitary
government.
4. The number and complications of enactments.
5. The needless separation of subjects
6. The leaving of some general acts to voluntary adoption and the
permissive character of other acts.
7. The incompleteness of the law.
The Commission recommended a Ministry of Health and they laid down the minimum for what is necessary for civilised life, niz. :-
1. The supply of wholesome and sufficient water for drinking and
washing.
2. The prevention of pollution of water.
3. The provision of sewerage and the utilisation of sewage
4. The regulation of streets, highways and new buildings.
5. The healthiness of dwellings
6. The removal of nuisances and refuse, and consumption of smoke.
7 The inspection of food.
8. The suppression of the causes of disease and regulations in the case
of epidemics.
9. Provision for the burial of the dead without injury to the living.
10. The regulation of markets etc. public lighting of towns.
11. The Registration of death and sickness.
on-
More than half a Contury ago that programme represented the most lightened thought of the time regarding the sphere and scope of preventive medicine. Even now it is almost a complete summary of the elements of a sanitary environ- But this prescription was not all the advice the Commissioners felt called upon to furnish.
ment.
First they showed how it could be worked out in practice, by laying down the general principles to be followed and by drafting a new stature.
The Public Health Act of 1875 which emerged from the labours of the Royal Sanitary Commission of 1869 and which was an act for consolidating and amending the Acts already in existence may be regarded as marking a great advance in the development of sanitary administration It was the real beginning of the recognition of the now universally accepted fact that Public Health is a science based on me- dical knowledge.
Before that time sanitation was interpreted as a negative policy, in a word the removal of nuisances, after that time sanitation received a new connotation, posi- tive, constructive. remedial. This is the reason why this act forms the great line of its division, the watershed in the programme of modern preventive medicine on environmental side.
It marks the beginning of the era of scientific investigation where the Medical Officer of Health gradually replaced the layman in the supervision of measures in- tended for the improvement of the Public Health and has assumed the position of Chief adviser to the Local Authority on all matters of public health importance.
The adviser to the Authority on all matters of mechanics is the Sanitary Engineer and his is the executive branch which deals with the mechanical side of wa- ter supplies, sewers and conservancy. town cleansing, scavenging and refuse disposal. The Medical Officer of Health reports on the health aspect of those matters and tests waters and sewage effluents otherwise he has no responsibility.
Public Health organisation in England is complex when compared to that of certain other countries. There is a multiplicity of authorities and a plethera of laws. The reason for this the Englishman's objection to change and his respect for any thing which has been sanctioned by time, custom, or use. The passing of the 1929 law has however shown that there is a tendency towards simplifications.
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