290 



NA rURE 



{Jan. 30, 1890 



thing it could require. Although the liberal endowment 

 of universities and schools is now fortunately much more 

 common, especially in America, than it used to be, yet 

 there are few instances of such liberality as the Nizam 

 has shown towards definite subjects of scientific research. 

 For the excellent example they have shown in this 

 matter, the Nizam and his enlightened Minister, Sir 

 Asman Jah, deserve the thanks of the scientific world, 

 while they also deserve that of the public in general for 

 their endeavour to save life and lessen suffering by 

 rendering the administration of anaesthetics so safe that 

 they may be employed without fear whenever they are 

 required. 



HYGIENE. 



Hygiene, or Public Health. By Louis C. Parkes, M.D. 

 (London: H. K. Lewis, 1889.) 



DR. LOUIS PARKES has conferred an important 

 service by the opportune publication of his manual 

 of hygiene. The public mind has been slow to perceive 

 the importance of the science of preventive medicine. 

 For nearly lialf a century Sir Edwin Chadwickand others 

 have preached the doctrine. It fell for a long time on 

 sterile ears. No doubt provisions have been made by 

 Parliament from time to time, when some special danger 

 or disease-cause was brought prominently into notice : 

 not, indeed, as a part of a system of sanitary protection, 

 but as if it were the only matter to be cared for. Thus, 

 vaccination was made compulsory to stop small-pox, but 

 for a long time many other diseases were ignored. These 

 scattered efforts in sanitary legislation were brought to a 

 focus in 1875, and systematic sanitation may be said to 

 have been instituted by the division of the country into 

 sanitary areas, and by the appofntment of medical officers 

 of health. These provisions were rather a theoretical 

 recognition of the importance of the subject than a prac- 

 tical creation of efficiency, for the medical officers in a 

 large number of instances have not received such re- 

 muneration as would enabl-e them to give their whole 

 time to their duties ; nor do they possess security of 

 tenure. They have been, for the most part, men in local 

 practice, who have been content to receive an honorarium 

 in some cases as low as £20 or ^10, and occasionally 

 even ^5 and ^3 a year. Such payments could not be 

 expected to induce men to do more than give a nominal 

 service to their official duties ; and it is, indeed, notorious 

 that in many instances the object of members of the 

 sanitary authority which has made the appointment, who 

 are themselves owners of house property, has been to 

 nominate men who would let matters rest, and would not 

 compel owners of cottages to spend money on sanitation. 



We are now, however, entering upon a new era in 

 sanitation. The creation of County Councils which took 

 place last year has introduced a new feature. Although 

 the powers vested in these bodies are permissive and 

 somewhat tentative, it has already become quite certain 

 that they will, sooner or later, bring the whole sanitary 

 service of the country under their general supervision 

 and control. 



The Local Government Act of 1888 lays down the 

 provision that the medical officer of health to be ap- 



pointed by a county must be qualified in sanitary know- 

 ledge — that is to say, in the knowledge of the prevention 

 of disease, as distinguished from curative knowledge. It 

 will, therefore, be necessary that the men appointed shall 

 have spent time and money in obtaining the required 

 qualifications for their duties : hence they will expect 

 adequate salaries to remunerate them for the trouble 

 and expense which they will have incurred in thus edu- 

 cating themselves. The call for education in preventive 

 medicine will react upon the medical schools and the 

 various degree-conferring bodies— such as the Univer- 

 sities — and will compel them to hold examinations in, 

 and to confer diplomas or certificates upon the possessors 

 of, sanitary knowledge. Moreover, the sanitary authori- 

 ties, in order to justify to themselves the higher salaries 

 which they will be compelled to pay, will be induced to 

 place enlarged areas under the medical officer, and, in 

 order that he may effectually perform his duties, he will 

 insist on being furnished with a better educated staff of 

 sanitary inspectors or inspectors of nuisances than have 

 been, as a rule, appointed under the old regime. 



It is thus evident that there will soon be a great call 

 for sanitary education, and Dr. Parkes's volume forms a 

 very useful commentary upon what are the general heads 

 comprised in a course of instruction in the methods 

 necessary for applying various branches of science to the 

 prevention of disease. A glance at the table of contents 

 shows the very large field embraced under the title of pre- 

 ventive medicine. It concerns not only the medical man, 

 but the engineer, the architect, the chemist, the physiologist, 

 the meteorologist, and the statistician. The questions to 

 be studied include climatic conditions ; the effect on 

 health of the state and movement of the atmosphere % 

 the health of soils ; the purity of water-supply, and the 

 prevention of injury to health from fouled water ; the 

 construction of buildings, their warming, lighting, and 

 ventilation ; questions of food and clothing ; the history 

 of communicable diseases ; and bacteriology, as well as 

 hygienic chemistry and statistics. 



A brief summary of the present position of our know- 

 ledge shows us that preventive medicine is still far re- 

 moved from being an exact science. We have, no doubt, 

 lately made much progress in removing from the medical 

 man the imputation that his proceedings were empirical. 

 Physiological studies in recent years have established the 

 relationship between certain diseases and the presence 

 of micro-organisms ; and although this relationship may 

 not be as universal as some persons wouldhold,yet we know 

 that there is a positive relationship in the case of certain 

 diseases. When the causes of diseases are known ; when 

 the action of the causes can be studied, and their mode of 

 entrance into the body ascertained ; when the methods 

 which can be applied to their destruction are discovered ^ 

 then the science of the prevention of disease ceases to be 

 empirical. 



Whilst, however, our progress in this knowledge has o^ 

 late years been extremely rapid as compared with former 

 experience ; yet when, as in this volume, we are brought 

 face to face with the various problems of the prevention 

 of disease, we are amazed to find what a vast field is still 

 unexplored in the knowledge of the causes of disease. Dr. 

 Parkes has given a very interesting summary of our 

 knowledge on this part of the question in his chapters on. 



