Medicine and Government in the United Kingdom
[Original Title: Relations of Medicine to the Body Politic]
The statutes of the United Kingdom which have direct relation to medicine are (1) those relating to the public health; (2) those relating to lunacy (and habitual drunkenness); (3) those relating to the status of the medical profession, to dentists, and to pharmaceutical chemists; (4) those relating to restrictions on the "practice" of anatomy and physiology. There are, besides, several statues in which medicine is concerned indirectly, -- such as the Poor Laws, the Prisons Acts. The Shipping Acts, the Registration of Births and Death Act, the Sale of Food and Drugs Act, the Sale of Poisons Act, the Factory and Workshops Act, the Artisan’s Dwellings (Metropolitan) Act, the Rivers Pollution Prevention Act, the Contagious Diseases (Animals) Act (1878), and the Public Health (Water) Act.
Public Health Law in the United Kingdom
in the United Kingdom
1. Most of the statutes relating to the public health in England and Wales were consolidated by an Act of 1875, the act relating to the metropolis being excepted; there are separate statutes of about the same period for Ireland and Scotland. The system of administration is by local sanitary authorities, in correspondence with the local government boards in London and Dublin and the board of supervision in Edinburgh. The board in London has a medical department, consisting of a chief medical officer, assistant medical officer, and inspectors, while the Dublin and Edinburgh boards are professionally advised on a somewhat different system. The sanitary authorities throughout the United Kingdom are divided into rural, urban, port, and metropolitan (sanitary and nuisance); they are formed out of pre-existing bodies, either the corporations of cities and towns, the improvement commissioners, or the local authorities. A medical officer of health is attached to most of the most of the several sanitary authorities, or to the combined sanitary authorities of a large district; his duties include making reports on the death-rate and the causes of mortality, the denunciation of nuisances and unwholesome dwellings, workshops, &c., inquiries into the local causes of favouring circumstances of epidemic outbreaks of diseases, measures to prevent the spread of contagion (by disinfection, isolation, and otherwise), and other more occasional duties arising under a variety of statutes. Each sanitary authority is required by law to appoint an inspector of nuisances, who practically carries out the instructions of the medical officer when there is one.
The Vaccination Acts (consolidated 1871) are an important part of the public health law of the kingdom; they are administered by the local government board, for the most part through the agency of the medical profession at large, but in some populous, parishes also by means of public vaccination stations. Prosecutions under the Acts are instituted by the parochial authorities. The practice formerly (and not unsuccessfully) resorted to of inoculating with the small-pox has been made a criminal office; but there is still much uncertainty as to the theory of vaccination, and, in particular, as to the relation of vaccinia to variola.
Other statutes which were not consolidated in the Public Health Act of 1875 are the Burials Act, the Contagious Diseases Act, and the Quarantine Act. The first of these is administered by a department of the home office, with a medical inspector. The second (1866 and 1869) relates, under a too general title, to the regulation of prostitution in certain garrison towns, the surgeons under the act being appointed by the board of admiralty or the secretary of state for war, and the administration otherwise carried out by the police.
The quarantine laws stand in the somewhat anomalous position of statutes which it is not though desirable to repeal, while yet are stripped bare of all their executive machinery. The Quarantine Act can be set in motion, as occasion arises, by an order of council; not only, however, is there no official medic al advice at the disposal of the privy council, upon which action under the act might be taken, but there is not even the framework remaining (except the ghost of a quarantine station on the Motherbank between Portsmount and the Isle of Wight) of the once considerable quarantine establishment, by which the provisions of the Act might be enforced. On the other hand, port sanitary authorities enjoy certain limited powers vessels powers under the Public Health Acts of isolating vessels arriving with contagious sickness on board. Aquarantine at British ports has not been put in force for many years, opinions being divided as to the abstract efficacy and suitableness of quarantine measures to prevent the importation and diffusion of plaque, cholera, or yellow fever (see QUARANTINE).
Numerous instances having occurred of the extensive diffusion of scarlet fever, typhoid fever, and diphtheria by means of milk, the privy council has issued an order, under the Contagious Diseases (Animals) Act of 1878, called the Dairies, Milkshops, and Cowsheds Order, with the object of enforcing extreme cleanliness in the premises and appurtenances of the milk, and particularly of guarding against the well-known liability of milk to take up effluvia existing or arising near it. The order of council having remained inoperative, it is proposed to deal with the matter by a new Act of Parliament, to be administered by the local government board. While cow’s milk has thus been recognized by the sanitary law as a carrier of certain of the human contagia, the milk of diseased cows, and more especially of tuberculous cows, continues to be sold with impunity, the alleged communication of tubercular disease from the cow to man being difficult to prove to the satisfaction of the legislature. The want of constant supervision of the slaughter-house is thought by many to be a serious defect in the sanitary law of the country; and there is no doubt that much flesh of diseased animals (especially the tuberculous) is sold merely as inferior meat.
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