A Chronology of State Medicine, Public Health, Welfare and Related ...

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INTRODUCTION
The chronology starts in 1066 following the radical changes in the structure of government at
that time; it ends in 1999 with the recreation of the Scottish parliament, the setting up of the
Welsh Assembly and the beginning of a comprehensive approach by central government to
matters affecting the health of the public. The first intervention by government in matters of
public health was concerned with the repair of sewers and the removal of nuisances (1225)*.
From then on governments increasingly legislated on public health and related matters.
Sometimes governments had to respond to new situations and discoveries, eg industrialisation
(1819) and radiation (1948); sometimes they tried new solutions to long-standing problems,
eg poverty (1601 and 1946) and support of children of wayward fathers (1576, 1733 and
1991); sometimes legislation codified what had become common practice in many places, eg
maternity and child welfare services (1918); sometimes it stopped abuses, eg selling poor
quality products (1266), child labour (1819) and adulteration of food (1860); sometimes
legislation set a pattern for future services, eg national insurance (1911) and the national
health service (1946).
Although medical practitioners had been involved in advising governments about the control
of epidemics from 1720, or perhaps earlier, the first appointment of a medical officer of
health concerned with sanitation as well as with epidemics was made in 1847 by Liverpool
City. At this time sanitary and public health measures were considered part of forensic
medicine and linked to police activities. In 1788 Samuel Farr published "Directions for
Preserving Public Health" as a chapter in his book "Elements of Medical Jurisprudence". In
Edinburgh (1832) and more widely in Scotland (1862) public health provisions were included
in police acts. In 1838 William Guy was appointed professor of medical jurisprudence at
King's College Hospital, London, and only later professor of hygiene as a separate subject. In
Scotland, in 1862, Sir Henry Littlejohn, lecturer in medical jurisprudence and police surgeon
in Edinburgh was appointed the first medical officer of health in Edinburgh. With the
appointment of medical officers of health in London (1848) and in provincial cities and the
large Scottish cities, and the introduction of specialist diplomas approved by the General
Medical Council (1871), "public health" became a distinctive medical specialty. At the same
time the roles of the inspector of nuisances (1848), later sanitary inspectors (1855),
developed, and in 1862 health visitors were introduced to be concerned with the care of
babies and infants.
The chronology reveals the persistence of some major problems. Schemes to alleviate
poverty have repeatedly tried to distinguish between the idle vagabond (1494 and 1531) and
the "deserving poor", or, in modern terms "to tackle fraud" (1998). Various measures have
been tried to force wayward fathers to support their children varying from the stocks (1576)
to the creation of a special agency (1991). Homelessness (1864) and housing "labourers or
* The dates given in brackets refer to the date of the relevant entry in the chronology.