REVIEWS 527 



Health and the State. By William A. Brknd, M.D. [Pp. 51. J (London: 

 Constable & Co., 1917. Price 10s. 6d. net.) 



Dr. Brend has produced an exceedingly interesting volume, relating, in the main, 

 to the beneficial influences which it is within the power of the State to exercise in 

 the protection of the health of the people. The volume opens with a short 

 reference to the history of public health administration, and traces the growth and 

 expansion of sanitary operations, many of which had their origin in individual 

 and philanthropic effort. The influence of disease in fixing or modifying geogra- 

 phical boundaries is considered : " The present distribution of peoples on the globe 

 has been largely determined by the prevalence of different diseases in different 

 parts. 1 ' The writer indicates the immensely beneficial results of the application of 

 scientific discoveries in the prevention of disease, by making the application of 

 preventive measures more accurate and more precise, especially in regard to the 

 insect vermin pest ; the manner and extent to which disease is carried by insects 

 is dealt with, and it is obvious that further action, based upon this knowledge, is 

 still called for, as Sir Ronald Ross remarks, " It is not the fault of science that we 

 do not fully utilise the gifts which she gives us." 



Dr. Brend gives its proper place to the importance of education in regard to 

 the advancement of public health, an education not limited to the popular teaching 

 of hygiene in schools, but so extended as to embrace all those responsible for 

 public health administration, whether officials, medical officers of health, councillors, 

 members of Parliament, cabinet ministers and those who advise them, and he lays 

 special emphasis upon the importance of an adequate Ministry of Health. Upon 

 this point it may be thought that the public are becoming fairly enlightened, but 

 those who are interested in maintaining the health of the community (and who is 

 not ?) must, from the publicity given to the question, begin to realise the difficulties 

 which beset the advancement of health conditions when each of half a dozen 

 Government Departments are taking a share in the administration ; it must be 

 clear that, if there is a division in administration at the centre, there cannot be 

 other than division and consequent overlapping at the periphery. Dr. Brend 

 devotes considerable attention to the problems of urban life, notably in connection 

 with housing ; in this connection it must not be overlooked that more recent 

 legislation has simplified the problem of dealing with insanitary areas, by making 

 procedure easier and less costly. The Housing and Town Planning Acts, for 

 example, have been the means of facilitating improvements in congested parts or 

 cities, and the provision of open spaces, whilst the conversion of long-disused 

 burying-grounds into public gardens has been a further step in the right direction. 

 Housing experiences in Liverpool have proved conclusively that the clearing away 

 of large insanitary areas, and rebuilding on sanitary principles on those sites, has 

 been of great benefit, the special feature in the case of Liverpool being that the 

 former occupants of the insanitary dwellings are, with rare exceptions, the only 

 tenants accepted in the new ones. Habits improve under the new environment, 

 and the improved habits and improved environment together have resulted in 

 greatly lowering the sickness and mortality amongst these people. 



In his references with regard to ''sleeping out," Dr. Brend, perhaps, has not 

 appreciated that the objections to promiscuous "sleeping out" were that the 

 persons who indulged in the practice were undesirable, and were out during the 

 night for other purposes than merely sleeping out. A wide range of subjects 

 affecting the public health is dealt with in the volume, and it certainly deserves 

 attentive perusal. 



