ART. VI.-THE SCIENCE OF PUBLIC HEALTH.

1. Annual Report of the National Board of Health for 1879. Washington, D. C.

2. Reports and Papers of the American Public Health Association for 1877-1878. Vol. IV. Cambridge.

THE movement in behalf of the public health, which has taken on such broad proportions in modern times, had, like all important movements, a small beginning. The development of physiology and its allied sciences awakened the individual to a sense of personal responsibility for the ills he suffered, and led him to reflect on the means and methods within his control by which he could rid himself of them. It was discovered that health had its own laws, no less than disease; and the conclusion suddenly-and prematurely— dawned upon him, that if one lived in accordance with the laws of one's being, one need never be sick. This doctrine, so practically false and theoretically true, became a favorite maxim in the common parlance of the day, and was seized upon by a set of half-educated fanatics and preached to a gullible public, with endless changes in diet, bathing, fresh air exercise and sunlight, ad nauseam, apparently quite oblivious of the fact that the individual can no more escape the influences which beset him, or violate the laws of his environment, than he could avoid being poisoned in an atmosphere freighted with infection, or feeling cold in a temperature below zero.

The subjective position of the individual in the body politic becomes self-evident on a moment's reflection. His environment is not only in the control of the public, but is made by the public. It is for the public to say whether he shall have pure water or foul water to use, and

in what quantities; whether his food shall be pure or adulterated; whether his house and the highways shall be drained, and the air he breathes preserved in its native sweetness and simplicity, or otherwise; whether he shall be housed, by the cupidity of landlords, in overcrowded tenements, or have roomy, well-lighted and well-aired places to dwell in; whether he shall be protected from contagion without and infection within,-the poison-breeding fumes of manufacturing establishments, or the morbific causes engendered by contiguous cities; whether, indeed, he shall be protected from all noisome influences under the control of the public authorities. The greed of men has reached such proportions as to make it incumbent on the public to assume supervision of all the industries of civilized society. Short weight and defective measurements, spurious coin and counterfeit bank-notes, shoddy clothing and adulteration of food and medicines, are constantly met with on every hand; so that it has become a public necessity to have a board or commission appointed in every community with supervisory powers over every department of industry which affects the public weal or the individual welfare. This necessity has been appreciated in respect to many departments of trade, such as finance, for example, which affect the pecuniary interests of mankind; but the most important part of all, the sanitary condition of the public, has received the least attention, and it is just beginning to dawn upon our benighted sensibilities that the supervision of sanitary causes and influences, and the protecting the individual against the engendering and propagation of morbific causes, are as much a part of the function of government as is the protection of the political liberties of the citizen from either foreign or domestic enemies. The science of public health receives its sanction from this broad principle of government polity, and comprehends the application of sanitary science to the body politic.

It is interesting to observe that the movement in behalf of the public health was not, at the outset, inspired by any benevolent or philanthropic spirit toward the poor wretches who live in filth, feed on refuse, and imbibe death at every breath,

in the slums of the great cities, the overcrowded tenements, mines, workshops and counting-rooms of civilized countries. It seems to have been the outcome of self-interest, in a pecuniary sense. The life-insurance companies of England, half a century ago, were moved to investigate in their own interest the subject of mortality in towns-with the view of modifying their losses by lessening the death-rate among policy-holders-in the same way, and for the same reason, that fire insurance companies interest themselves in an efficient fire-department service. The result certainly justified the means, meagre and defective as they were, that were instituted to improve the public health and reduce the high death-rate, as may be seen in Chadwick's Report on the Health of Towns, published in London, in 1844. The decrease of the annual mortality which followed this inquiry was so remarkable as to excite surprise. Equally surprising was it that the subject had been neglected so long. But nothing was more natural. It has been the custom from time immemorial, to intrust matters relating to life and health to a Providence with a big P. It was a mistaken policy, of course, as the experience with plagues and pestilence has proved-providence with a small p having happily been found far more trustworthy in all such matters.

It may be still further observed that executives, as a general rule, have not been much in the habit of condescending to the sphere of matters which concern the physiques of mankind, looking rather away and abroad, over the frontiers, in the direction of "natural enemies," and bearing the sword at home to coerce and punish domestic transgressors. Politics have been regarded paramount to physical sanity; treason to disease. But science, with its many rays of light, is doing its inevitable work, however slowly, and men are becoming dissatisfied with the old fatalisms which left matters of health and sickness very much to the care of providence, after the manner of those Oriental traditions which have so largely influenced the social philosophy of our times. It is now thought that "our vile bodies" are worth treating with an enlightened respect; especially as they are found to be, after all, more intimately connected than people have hitherto supposed with

the more dignified elements or accidents of our being-the intellectual and the moral. Until very recently the knowledge and administration of the laws of health were in the keeping of a distinctive class of men, who, like their brethren of the religious order in the twilight ages, assumed an especial right to deal with the infirmities of our race. But, in the one case as well as in the other, the old reliances are losing ground, and men in general have resolved to understand and care for their own sanitary condition, and do what they can to remedy their own ailments of whatever sort. For this purpose, they are controlling their governments-which were never yet found in the van of human progress, though this would be the most reasonable and worthy place for them; and these last now find themselves bound to act in accordance with the rights and requirements of the people.

The obligations of government as regards national health have been already recognized in France, Germany, and England. In our great sister republic, a decree of the 9th of October, 1879, has ordained that a Consulting Commission of Public Hygiene, under the control of the Ministries of Agriculture and Commerce, shall have cognizance of all questions respecting quarantine; the prevention of epidemics; the propagation of vaccine; the preparation of mineral waters, especially for the benefit of the poor; the qualifications of medical practitioners; the organization of health societies and commissions; a pharmaceutical police, and the sanitary condition of workshops. Under this decree the Consulting Council of Public Hygiene is composed of twenty members; including the Director of Consulates and Commerce; the President of the Council of Military Hygiene; the President of the Council of Naval Hygiene; the Directors of Charities and Internal Trade; the Inspectors of Sanitary Service and Veterinary Schools, and the Inspector of Architecture belonging to the Ministry of Agriculture. With these are associated eight physicians. By another article of the decree the Council has the right to advise the directors of other governing departments. It meets once a week; its members are paid a certain sum for each session; and the secretary

has a fixed salary. The French precision, so proverbial in matters of organization, is very notable in the new sanitary arrangement.

Its main object is to

The Imperial Health Board of Germany was established at the close of 1875. Its purposes are to gather sanitary information and give counsel to the Government and to the health societies of the empire-as set forth in the Report of the Grand Chancellor, issued in 1876. elevate the care of the people's health to the dignity of a science; and that, certainly, is the noblest of all the imperial pretensions. The Board makes investigations concerning the causes, preventions and remedies of diseases, and collects and publishes the vital statistics of North-Germany.

Having merely glanced at the great work of a great people, we turn to the more familiar ground of England, where Parliament, immediately influenced by the British Medical Association, passed, in 1858, a registration law which greatly improved the material of the army, the navy and the Poor Law medical service. It also established boards independent of medical teachers, to grant diplomas. By its Acts of 1861, 1867 and 1871, it has made vaccination compulsory. But its chief steps in a sanitary direction were made in six Public Health Acts enacted between 1850 and 1875, establishing a system of public hygiene, under which Great Britain is now divided into about fifteen thousand sanitary districts, duly furnished with their proper officers. The British Medical Association is a grand ally of the government system, continually offering advice and proposing reforms; such, for instance, as the abolition of coroner's inquests, the building of asylums for habitual drunkards, and the forming of Conjoint Examining Boards to license pharmaceutists, midwives, dentists and nurses.

The central sanitary agency of England is named the Local Government Board, taking cognizance of hygiene and charity, supervising, advising and assisting local health boards in matters of drainage, sewerage, water supply, etc. It has little or nothing to do with quarantine-a notable peculiarity, due, of course, to the climate of England. The engineer of