- Communities of Health
Health and disease, and the methods used to analyze, promote, and control them, created communities of diverse geographic and demographic scope and size in Victorian Britain. These communities ranged from the individuals who lived within a particular local board of health district to those housed within a particular institution to those defined as in need of medical attention according to some conventional standard of health, illness, or ability. Membership in these communities had presumed medical benefits but often had costs as well, sometimes quite out of proportion to the benefits; people at risk for smallpox, women with syphilis, and individuals in lodgings were in one way or another restricted in the enjoyment of their bodily and civil liberties. They were not accorded all the rights associated with community membership; disease and the methods to prevent it marked out different people for different kinds of treatment. These methods, including inspection, notification, isolation, registration, and vaccination, operated throughout Victorian Britain and its empire and were inflected by a variety of general and local factors.
Mid-Victorian English and Welsh sanitary reform displayed these contradictory impulses, simultaneously including and excluding both problems and people. Under the 1848 Public Health Act, matters of potential concern to the health of the public were marginalized as a result of its focus on sanitary matters, and even the actions taken under its authority were applied partially and inconsistently. The property-based franchise for the act itself reproduced and reinforced the fact that inclusion within a jurisdiction did not imply membership in the political community. Yet sanitary reform was not always about exclusion and division, as the physical and financial boundaries created under the act showed. In the course of making these boundaries, local public health promoters developed a view of public health that constructed a new kind of community, integrating spatially, socially, and functionally distinct kinds of property into a common political and financial regime. [End Page 14]
The 1848 Public Health Act was one of several contemporary laws with boundary implications. As a result of boundary-making exercises associated with, for example, the 1832 Reform Act, the 1834 New Poor Law, and the 1835 Municipal Reform Act, spatial and hence political and financial relationships among the country’s rural, urban, and suburban populations changed in highly significant ways. Physical and financial boundaries created under the Public Health Act likewise redefined not only membership but also responsibility and, more importantly, liability. The establishment of the physical boundaries of the local health district could, depending on the circumstances, include property hitherto exempt from paying for urban improvement such as suburban houses, local industry, and building and agricultural land.
Once a physical boundary was set, the local board of health (lbh) still had to make difficult decisions about distributing the costs of sanitary improvement within that boundary. The Public Health Act left decisions about rating to lbh discretion, and local boards’ rating decisions consistently pushed the financial boundaries of health, rating property hitherto exempt from these charges. This was potentially legally controversial, and local boards could and did end up in front of the courts. The most important legal case of lbh financial boundary-making revolved around the ancient rating principle in Tudor sewer law that a property owner or occupier was not required to pay for any works from which their property did not derive a (direct) benefit. Practically speaking, the benefit principle was realized by having sewer districts subdivided into smaller areas so as to make assessments of benefit more meaningful; in the usual language of the time, separate subdistricts were to be identified, and, as near as possible, each subdistrict was to pay its own expenses. In the 1848 Public Health Act, by contrast, there was no explicit direction requiring the local boards of health to subdivide their districts. The 1848 Public Health Act thus permitted local boards to construct drainage and waterworks for a district encompassing several hitherto distinct neighbourhoods and to rate all of the property of the district equally for the work (some property was statutorily rated at a discount) instead of throwing the cost on the most densely populated and sometimes poorest part of a...