564 



NA TURE 



[April 12, 1894 



may then pass on to other international works which may present 

 more danger and greater difficulty. 



Prof. V. Babes on the Position of the State in Respect 

 to Modern Bacteriological Research. 



The health of the community is under the care of the Depart- 

 ment for Internal Administration of the State; and inasmuch 

 as health is essential to the happiness of the individual and the 

 development of human energy, it appears, for most important 

 economic reasons, to have a first claim on the Government. 

 Those learned in such matters are, however, of opinion that, 

 in spite of its immense importance, of all the different depart- 

 ments of internal administration that of hygiene has remained 

 the least developed in Europe. I will first attempt to throw 

 light on this sad circumstance, affecting as it does the most 

 valuable of human possessions — one that gives value to other 

 possessions — and then I v/ill search for means to obtain for 

 sanitation its proper position amongst State institutions. 



Historical Survey. 



The care of public health does not necessarily advance hand 

 in hand with education ; a lively and practical public spirit and 

 a great vitality in the people cause a place to be yielded to the 

 demands of State sanitation. The oldest civilised peoples 

 regarded it as a public duty to protect the health of the in- 

 dividuals. With a view to thi«, the laus of Sparta, of the 

 ancient Egyptians, and of the Israelites, had more hold than 

 modern legi.slation on the life of individuals. Still, their rules 

 were not founded on any sure basis, but rested entirely on old 

 traditions and experiences, which the spirit of the period clothed 

 in religious or political dress. 



In the laws of these old nations matters were regulated, 

 which, according to our modern feelings are now left to 'he care 

 of the individual, and sexual disease was more rigorously 

 opposed than it is at present. Leprosy, from which the first 

 civilised nations ran great danger, was opposed by more 

 rational laws than it is thought can be opposed to the just as 

 dangerous or more harmful disea'ses of to-day. The good 

 results of the working of the Mosaic laws can still be seen even 

 in our days when State sanitation can derive so much aid from 

 modern sanitary science. The Mosaic laws owing to thtir 

 religious form took deep root in the domestic life of the people, 

 and the vitali'y of the Jews of to-day bears witness to their 

 wisdom. The Jews thrive where the native population, in 

 spite of special legal protection, is decimated by infant 

 mortality and infectious diseases. The hardening oi the 

 constitution, the dress and baths of the people are neglected by 

 modern legislation for the reason, though expressed in various 

 ways, " that the State has only to look after the health of 

 individuals so far as the health of individuals aflfects the 

 community." 



When one contrasts this vaunted principle of individual 

 liberty with the limitation of this liberty which is effected in the 

 interest of religion, of the ruling classes, and even of traditions 

 and conventional ideas, one cannot repress the thought that thi-; 

 magnanimous permi>sion of the State allowing each individual 

 to make himself ill if he likes, to treat himself as he thinks best, 

 and spread his illness, is not merely dependent on the principle 

 of individual liberty. 



But also in anoiher direction did the civilised nations of 

 antiquity set us a good example — namely, in the repression 

 of general causes of disease. Aqueducts and canals were 

 made at great expense, marshes were drained ; during the 

 plague of Athens great fires were made and excreta burned, 

 dead bodies were cremated, and the principles of public 

 hygiene were also popularised by lectures. In spite of the 

 much greater State incomes and the technical facilities of 

 modern times, most modern States cannot nearly rival those of 

 ancient times in the proportion of their sanitary undertakings 

 to the number of their population. 



In respect of public health, Rome advanced still further than 

 Eastern civilisation. Aqueducts and canals were undertaken in 

 early times ; owing to the number of public baths in Rome, 

 probably each citizen could have a free bath daily, and similar 

 establishments existed in the smaller towns of the Roman 

 empire. The irruption of barbarian hordes on the Roman 

 empire disturbed the whole organisation of public health, and 

 Christianity to some extent helped in producing this disturbance, 

 especially by its ascetic disregard for corporal welfare, and by 



the absolute separation, which it enjoined, of religion from all 

 matters of bodily health. 



Epidemics raged and exercised a wholesome influence, in 

 part by reducing the population, and by directing attention 

 to the infeciious nature of diseases. People began to notice 

 that contagion was carried about by men and clothing, with 

 the result that quarantine and sanitary police were intro- 

 duced by some towns of Upper Italy. Venice was particularly 

 active in these matters of hygiene, but the unsettled political 

 stale of Italy long prevented the proper development of State 

 sanitation. After the unification of Italy this development 

 soon began to show it?elf, and the law of 1866, and particu- 

 larly that of 1888 ("Sulla tutela dell, Igiene e della Sani a 

 publica"), were framed, the latter of which might serve as a 

 model to other States of Europe, with the exception perhaps 

 of England. By this law the authorities on hygiene take that 

 position which, as competent authorities, is due to them. As 

 well as a competent upper board of health there are pr;;vincial 

 boards of health, all of which of their oivn initiative can move 

 proposals on hygienic questions, and must be consulted on 

 sanitary ordinances. These boards of health are not depen- 

 dent on the administrative officers, and all urgent measures 

 recommended by them must be immediately carried out by 

 the prefects. 



In England a practical public spirit early developed itself. 

 What was accomplished in hygiene began from below, and took 

 deep root in the customs of the people, before developing 

 into institutions of the State ; this insured its usefulness and re- 

 cognition. The practical independence of tht:- parishes, as well 

 as the Parliamentary system of that country, showed to advan- 

 tage in this matter ; there were water supply committees, and 

 the parishes left to the sanitary authorities the choice of their 

 own methods. As in other countries, infectious diseases first 

 gave occasion for thorough trial of sanitary arrangements. Com- 

 mittees were formed for statistical inquiry into mortality with 

 regard to soil, overcrowding, with regard to the pollution of air, 

 water, &c., and the activity of the-e committees led to important 

 conclusions regarding the artisan population, which had attained 

 so great an importance owing to the growth of the manufactur- 

 ing tow ns. 



The Public Health Act of 1848 was formed in accordance 

 with the then existing state of scientific knowledge on a 

 statistical basis, a testimony to the public spirit of the country. 

 Local bodies, under the guidance of a doctor, had executive 

 power, and could levy rates to cover the expense of water 

 supply, canalisation, &c. Unfortunately, as usually happens 

 in such cases, when a better hygienic condition was reached, 

 the means by which it had been obtained were neglected. The 

 Board of Health was abolished, but, on the other hand, the 

 Local Boards gained in power. In '871-72 a Board was 

 instituted for seeing to the poor, sanitary matters, and Local 

 Government, the whole country being divided up for this 

 purpose into sanitary districts. Each of these districts possesses 

 a medical officer of health, a sanitary inspector, and a public 

 analyst. These officers work in connection with each other, 

 and wiih the central officers, and possess the power of taking 

 measures to oppose epidemics. 



In Prussia the sanitary arrangements have a bureaucratic 

 aspect. There was a College of Medicine and a special Col- 

 lege of Hygiene, to which the doctors of towns and districts 

 were subservient. In 1862 officers were appointed to the dif- 

 ferent provinces, but their power was limited by the central 

 bureau. 



In Austria, since 1 870, there has been a chief sanitary officer 

 working with the junior ones, who, at all events, have the 

 power to take first steps. 



In Roumania, by the law of 1873, the sanita'-y administra- 

 tion is placed in active communication with the doctors of 

 towns and distiicts, and CDntrols them by yearly inspection. 

 The latter are, in the same way as the hospital doctors, recom- 

 mended by the special sanitary adviser to the cential adminis- 

 tration. 



In France, although the medical schools are distinguished, 

 public health is not sufficiently cared for, because the learned 

 scientific bodies have hardly any voice in its administration. 

 The prefect and the mayor do all the administrative work, and 

 an authority on hygiene is only consulted when the prefect 

 thinks fit. 



Of late years attempts have been made to include institutions 

 for the furtherance of scientific medicine within the Slate 



NO. 1276, VOL, 49] 



