Civil liberties and public good: detention of tuberculous patients and the Public Health Act 1984.

On 30 August 1998, the Mail on Sunday, under the headline "TB refugee 'must be held in hospital"', described the case of a Somalian man who had been "ordered by a court to remain in hospital for six months to prevent him spreading a highly infectious deadly disease". That disease was tuberculosis and a court order had been issued "after the man had twice staggered into Northwick Park Hospital in Harrow, North-West London, for treatment but left without trace. He failed to take prescribed treatment and his condition rapidly deteriorated, forcing him to return to hospital a third time."1 As was noted by the executive director of Brent and Harrow Health Authority, "there comes a time when you must clearly draw a balance between civil liberties and public good".2 That balance, as I shall show, has been redrawn in legislation and public policy over the past seventy-five years as concerns over the threat posed by those with tuberculosis has waxed and waned. Because no central records are kept, it is unclear how many individuals have been detained under legislation, but there are suggestions that more detention orders are being issued now than in earlier years, and that the duration of detention is, in some cases, considerably longer than previously.3 For example, the Ministry of Health noted, in 1958, that "the power [of detention] has not to our knowledge been invoked".4 Twenty-five years earlier, just a few years after the enactment of the 1925 Public Health Act, which first codified the authority to detain tuberculous individuals, Sir Arthur MacNalty, later to be Chief Medical officer, concluded that