ZDROWIE PUBLICZNE I KWESTIE NADZORU SPOŁECZNEGO W ADMINISTRACJI PUBLICZNEJ NA TERYTORIUM UKRAINY NA PRZEŁOMIE XVIII I XIX WIEKU
Anatolii M. Hrynzovskyi1, Irina A. Holovanova2, Sergei T. Omelchuk, Olena V. Kuzminska1, Anastasia A. Hrynzovska2, Olena O. Karlova3, Vitalii Ye. Kondratiuk1
1 Bogomolets National Medical University, Kyiv, Ukraine
2 Higher State Educational Institution of Ukraine «Ukrainian Medical Stomatological Academy», Poltava, Ukraine
3 P.L. Shupyk National Medical Academy of Postgraduate Education, Kyiv, Ukraine
Introduction: The public health system modernization history is based upon the progress in state country administration and administration of healthcare within the sector-wide approach. The WHO European Bureau pays much attention to the National Health Service systems development while implementing their basic policies. The Ukrainian state health service management was founded basing on the regulatory field of the Russian Empire, using the European healthcare promotion experience.
Aim: of the article is the analysis of the regulatory field of police and amenity authorities of the Russian Empire and Ukraine within the medical and social service in the 18th-19th centuries.
Materials and methods: The structure of the article corresponds to the problem city and chronology principles, using the following methods and techniques of scientific learning: the systemic, historic, regulatory comparative, logical and structural-functional analysis of the studied medical-legal phenomena. The study sources are the scientific publications, collections of laws and executive orders of the Russian Empire and Ukraine in the 18th-19th centuries.
Review: As a result of the performed work it can be determined were the main directions of the police competence in late 18th- early 19th centuries.
Conclusion: Preserving health, treatment of the ill and injured, management of medical and social service of those in need, holding various preventive activities and supporting safe environment and regulating the safety of food were the main directions of the police competence in late 18th- early 19th centuries.
Wiad Lek 2018, 71, 1 cz. II, -251
The public health system modernization history is based upon the progress in state country administration and administration of healthcare within the sector-wide approach. The WHO European Bureau pays much attention to the National Health Service systems development while implementing their basic policies.
The Ukrainian state-health service management was founded basing on the regulatory field of the Russian Empire, using the European health care promotion experience.
The purpose of the article is the analysis of the regulatory field of police and amenity authorities of the Russian Empire and Ukraine within the medical and social service in the 18th-19th centuries.
MATERIALS AND METHODS
The structure of the article corresponds to the problem a city and chronology principles, using the following methods and techniques of scientific learning: the systemic, historic, regulatory comparative, logical and structural-functional analysis of the studied medical-legal phenomena.
The study sources are the scientific publications, collections of laws and executive orders of the Russian Empire and Ukraine in the 18th-19th centuries.
The modernization of the regional state regulation and medical regulation depended on the state development strategy, stipulated for the perception of state problems by the authorities. During the Russian Empire period of our history, many orders were issued by Catherine the 2nd, which referred to the processes providing for the healthcare management throughout the next decades.
The state and medical management were based on the decree “On establishment and management of the governorates of All-Russian Empire”, and the “Great Order” of Russian Empress Catherine the 2nd [1, 2].
According to the documents, the official structural units of the management system were police and amenity authorities.
The terms “police” and “police law” were used not only within the state order context but related to the state or local welfare and the welfare of external country management. Then the police law system ( state management system) was subdivided into the “welfare-providing” and “decency-providing” directions . The police law in the late 18th century directly defined that police was a component of state management, protecting the public law, general and personal safety of citizens .
In our country the establishment of legal authorities of police within the health service domain was related to the adopted on February the 28th 1768 Addendum to the “Great Order” of Russian Empress Catherine the 2nd, as by this document the “authority of amenity of police forces” was founded.
The Controlling Regulations defined by the Article 554 of Unit XXI state that health refers to the third domain of the police, so the police activities should be aimed at air safety, street and various water sources cleanliness, good quality of food and water provisions, prevention and treatment of diseases, including the infectious ones .
Except for the medical aspects, the duties of the police service included various social issues. The article 560 of Unit XXI stipulated for the active police participation in decreasing the share of homeless within the total population. The police were obliged to refer the homeless patients to the treatment institutions and provide for their financial coverage .
The “Statute of City Police Department”, approved on 08.04.1782, emphasized social equity . The document clearly states as follows: “The City Police Department cares about all people, without any exception: rich and poor, powerful and outcast ones” (paragraph. 44 of the «Statute»). Paragraph 119 of the “Statute” defines that the police officer must care and seek for those who are in need, making most efforts to provide them with dwelling, food, and work. If the mentioned seems impossible, the duties are delegated to the City Police Department. Paragraph 142 says about the following measures to be taken in cold season to prevent overcooling of people: «In large principal province towns, in each district there must be heating stoves, under shelter, but without high walls, in which one should keep the fire in winter to care about the strangers and night guards». Here, city sergeants received the authority to provide for decent city sanitation conditions According to paragraph 60 of the “Statute”, “The City Police Department is responsible for clean streets and city quarters during the Cross processions held in religious holidays”, paragraph 140; «The police Department arranges with the master builder for cleaning the streets and disposing of the wastes” and paragraph 139, “controls the master’s activities” .
Other functions of the City Police Department included infectious diseases control and monitoring unsafe products trading. Paragraph 232 of the “Statute” says about “prohibition to commit crimes against the general population, which includes:1) infection dissemination, 2)trading with spoilt food, with the obligatory punishment for these crimes. Part 1 of paragraph 274 disclosed the following: “If a person spreads infection, he should be arrested and sent to the court, where he would be treated appropriately to the Law”, part 2 says: “Should one sell the spoilt food, he will be arrested and treated according to the law” .
Another quite curious peculiarity of the “Statute” is that the patient’s hospital expenses were used as a dynamic regional equivalent when detecting certain punitive sanctions. Paragraph 265 states that “Whoever will swear and blaspheme, he will be fined with money equivalent to half-day hospital stay cost, to be kept under arrest until he pays” .
So, in late XVIIІ century, local authorities were represented with police departments or the “City Police Department”, which provided sanitation welfare and social care to the population. So, the Internal Affairs institutions could directly control all vital activity security domains, including quality of food products and water as infectious disease transmission factors .
All this predisposed to wide use of the new term “Medical Police”. The competence of medical police comprised preserving health, treating the sick and injured, management of medical assistance, conducting various preventive actions and supporting safe environment and providing safety of food .
This new concept was founded by I.P. Frank. He said: “Medical police is a science of prevention which must guard humans against the harmful consequences of crowded common inhabitance, provide their physical welfare and prolong life term as much as possible”. I.P. Frank is the author of the term “medical police”. He disclosed not only medical personnel’s functions referring to the disease treatment and prevention but explained on the state participation in preventive activities held with all population groups as well as effective control of their conduction. According to I.P. Frank’s concept, the term “medical police” also included responsibility taken by the state for the population health condition. Having considered all the above mentioned, it becomes clear that the term “medical police” is multiple-valued, partially covering sanitation and hygiene, requiring for their regulatory support.
The guide “Outlines of medical amenities or on the people’s health preservation resources depending on the government” (1795), written by I. Yu. Veltsin, states that the authorities must manage population health in order to strengthen the state power through the medical police participation .
«Preserving life and health is required for both human functioning and safety and welfare of the state. This is why the Government performs various activities for the safety and welfare of the country. This is why the Government conducts various activities for preserving the health of its citizens. All these activities represent the Medical Police subject. In my opinion, Medical Police is that component of the State Welfare and Amenity which teaches how, under the supervision and with assistance of the Government, it is possible to preserve the People’s health, using various diets and medical bases, and in case of its loss, to restore it», – says the M.F. Rozhdestvenskij’s thesis for acquiring the scientific degree of Doctor of Law, termed «Ideas on the governmental actions aimed at preserving life and health of people” (1830) . The issue of the state’s responsibility for the public health was covered by his other monographs. “It is within no any other State Welfare domain as the medical police, where the Basic Governance must be present”, he stated in his monograph «Bases of State welfare, applied with the Russian laws» .
Professor M.F. Rozhdestvenskij thought that all activities held by medical police could be divided into two groups. The first group was represented with activities aimed at eliminating the health and live affecting factors, the second – at restoring the lost health” .
Professor M.F. Rozhdestvenskij stated that medical police acted to eliminate or prevent the disease causes. He considered control of the quality of the artificially prepared beverages (wine, vinegar, beer, vodka, etc.) as the main direction of the medical police activity, as last could negatively affect the human health, partially through defect of production, partially through poisonous supplements. He provided for the chemical-analytical control of the production quality before it was released into the sale as well as responsibility for production and trading with the hazardous products. The scientist thought that the hazardous supplements could be detected by severe (without warning) studies of the beverages taken from the shops. If chemical analysis could detect any harmful supplements, both beverages and bottles had to be destroyed, and the person considered guilty had to stand the criminal responsibility .
Except for this, medical police performed some other functions. First of all, the medical police concentrated on various factors which predisposed to the health of next generations, even before the child was born. This included management of pregnant women (a pregnant woman received some benefits with refund); if a decision on penalty for committed crime was made, the woman was in advantageous position; there was severe punishment for illegal abortion; decreased workload of the mother of newborns; promotion of public upbringing; promotion of children’s physical development by physical exercises; protection of children from poor families from the hard and exhausting work, especially in manufactories.
The second point is that except for the food and beverages, medical police controlled the health of the cattle to be slaughtered as well as the fresh characteristics of meat, fish, vegetables, ready-made dishes and drinks offered to customers; stopped their faking and studied faking methods. This section of duties includes also supplying various territories with water of proper quality.
The third is that the medical police controlled crockery and cutlery quality (first of all – obligatory tinning). The crockery and cutlery made of hazardous compounds, toxic dyes, and poisonous substances were removed from sale.
The fourth point is that medical police functions also included: the explanation of the necessity of and drying swamp regions, performing air humidification in cities and towns, monitoring street cleaning, management of rainwater pipes, regulation of the position of the enterprises, factories and cemeteries to be located far from the city dwelling area.
The fifth point is that the police favored general medical activities aimed at prevention of widespread diseases; informed on newly infected people in the countries where the disease hasn’t outbroken yet, introduced marine and ground quarantines [10, 11, 12].
One of the key directions of the medical police activities was the social management: providing the population under quarantine with food and other required provisions. Usually, the government didn’t provide financial support of the patients, but in the epidemic, occurrences financing was urgently required to the ordinary support was insufficient, and no one could expect for reliable help from the privates. There the activities aimed at reducing the catastrophe extent had to be taken, though they weren’t directly referred as the treatment activities. During infection outbreaks, the city or town experienced lack of vital supplies. To avoid this, the authorities of the quarantined city created the trading commission. To prevent the quarantine-induced raise of prices, socially just charges were established. As trading activities with the quarantined region were abandoned, poor citizens remained without financial support, and the state provided them with the products. There, each adult man and woman could receive a military ration, each child – 50% of the ration, except this, each man, woman, and child received 5 kopecks daily, and each house, if necessary, from 7 to 14 feet of firewood a month .
So, the problem of material, medical and auxiliary supplies, required during the infectious outbreaks, was solved by the government. According to the Governmental requirements, pharmacies had to store all the necessary medicines, which the poor population was provided with by prescription.
Another medical-social solution was founding temporary infectious hospitals in the infected areas, which were functioning not only to treat the population but support the homeless, in order to limit the outbreaks.
The other functions performed by the medical police were the organization of medically safe environment: control of various institutions, control of punishments for breaking government and police orders; adopting medical limitations and regulations, and their control. This was reflected in the manuscripts of both medical specialists and lawyers of late 18th –early 19th centuries [10, 12].
In order to provide effective offered measures and some hygienic control conducted not only by medical specialists, and emphasize the importance of police medical activities aimed at preserving public health, the medical police course was introduced into the training of local and city police [4, 13].
The necessity of the organized activity of the state and civil establishments aimed at provision of the environmental safety and public health was noted by Wilgelm Prausnitz: “A private person can’t personally prevent the others from polluting the air she breathes in, prevent the others from polluting the water she consumes, can’t prevent the hazards arising before both the community and her own person, caused by crowding. All this refers to obligations of the state health service, the history of which originates in ancient times” .
In the mid-18th century the institution which supplied hygienic safety of the city, consisted of the legislative, judicial and administrative power branches. The hygienic legislation performance wasn’t a routine process, it required for special knowledge and experience. A sanitation specialist had to perform certain duties and be able to establish the unknown causes and detect the appropriate measures to be held, and control how they were held.
The question of the public health state intervention level was rather complicated, requiring for its management. Some would wish Central Bodies to control whole sanitation issues, records, quarantine cases, building regulations, etc., in the manner similar to that of the state supervisors of railways and telegraphs, which particularly referred to the working hours and salary.
The difference between the central supervision and central administration was significant, the first was aimed at supervising how the others performed their duties, the aim of the second one was to act through the others. The first case stipulated for some independence, while in the last one it was absent [15, 16, 17, 18, 19, 20].
Local sanitation power bodies could hold activities to prevent the diseases locally, being responsible for the unsatisfactory outcome of such activities. It was supposed that the good sanitation administration required for the universal pattern, which could be achieved by the continuous public health supervision by civil sanitation personnel in each region of the country. As for sketching the network of the sanitation institutions, one had to decide what the size of the region was, i.e., what the size of the unit supervised by a certain administration was. Each city would have its own sanitation authority as each city was characterized by a peculiar morbidity cause, the geographic and political city borders defined.
The predominating in the late 18th – early 19th centuries concept of the State Internal Affairs management, based on the “Statute of City Police Department”, which regulated the activities of the police city departments, was aimed at preserving public health within the broad context. The main tasks solved by the state management system, provided for possibilities of medical servicing of all in need, emphasizing medical and social support of the population, during both infectious outbreaks and routine social activities. The main characteristics of the state policy of studied period were similar to the bases of the European policy “Health 2020”.
Preserving health, treatment of the ill and injured, management of medical and social service of those in need, holding various preventive activities and supporting the safe environment and regulating safety of food were the main directions of the police competence in late 18th– early 19th centuries.
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Fig. 1. Tractates of Empress Catherine the 2nd// vol. 1. – 1849. – 666 pp.
Fig. 2. Tractates of Empress Catherine the 2nd // vol 1. – 1849. – 666 pp.
Fig. 3. С Tractates of Empress Catherine the 2nd // vol. 1. – 1849. – 666 pp.
Fig. 4. I.P. Frank 19 .03.1745 – 24 .04.1821
Fig. 5. I.Yu. Veltsin. Outlines of medical amenities or on the people’s health preservation resources depending on the government (1795)