April 12, 1894] 



NA TURE 



565 



organisations for hygiene. We shall see that just the most 

 rational hygienic measures are opposed and partly abolished 

 on the plea of their being inconvenient to commerce and inter- 

 course, and to the influential Government administrators. 

 International arrangements for protect'on against epidemics 

 have also lately several times been neglected for the sake of the 

 commerce and intercourse of the great nations, and partly at 

 the sacrifice of smaller nations with less complete sanitary 

 arrangements. 



The Position of Doctors toiuards the State. — The medical 

 profession in many countries is not permitted to exercise any 

 executive right to protect the country against epidemics. It 

 must be allowed that there is a tendency for the scientific 

 men employed in some State institutions of hygiene to separate 

 themselves from ihe statesmen who founded these institu- 

 tions. It must appear to us doc'ors unintelligible that, though 

 statesmen recognise the immense importance of public health, 

 they will not surrender the executive power of sanitary adminis- 

 tration into the hands of those who have made it their special 

 study. Doctors constitute a hard-worked class, possessing 

 neither the time nor the authority to make their claim felt, and 

 it is to be regretted that so few members of the upper classes of 

 society devo'e themselves to medicine, which offers them such a 

 field for useful work. 



Doc'ors are not much attracted towards State matters of 

 hygiene, because of the smallness of the pay allowed to those 

 who en'er the service of public hygiene. The State should pay 

 its sanitary advisers better, since it expects of them a special 

 professional education, and should, at the same time, forbid 

 them the practice of ordinary or legal medicine. Doctors would 

 then be able to devote themselves to finding out and remedying 

 the causes injurious to public health, just as they would those 

 injurious to the health of a family. Finally, every facility should 

 he given them of making themselves familiar with the science 

 of government, especially legislation, political economy, and 

 statistics. 



Governiiieut Sanitary Institutions. — The best way to im- 

 prove the quality of the doctors is for the State to afford them 

 the means of attaining the highe-t essential education. This 

 necessitates State institutions specially designed for the purpose. 

 An attempt of this kind was made in 1876 in Germany, but 

 want of understanding and money caused the institution to fall 

 short of the mark. The Imperial Board of Health at present 

 does not po.sess, as it was at first intended, the superintendence 

 either of medical and veterinary measures or of medical 

 instruction, neither are the laboratories sufficiently endowed to 

 meet the requirements of proper sanitary research. Neverthe- 

 less, with the exception of Roumania, no other country possesses 

 a similar institution, though they possess institutions, privately 

 erected, for the study of infectious diseases, which act more or 

 less in harmony with the State administration. 



A few word.«, therefore, may be said on this institution of 

 Roumania. As Roumania stands on the boundary between 

 East and West, it was peculiarly exposed to infectious 

 diseases, not to mention several imperfectly known diseases of 

 the country itself In 1887, epidemics amongst the cattle 

 and widespread hydro[ihobia rendered it advisable to establish 

 such an institution in Roumania ; moreover, no sort of institu- 

 tion for pathological anatomy, pathology, or bacteriology 

 existed there at ihat time. The institution is well endo^ved, 

 and adapted to meet the requirements of scientific investigation 

 and instruction, but unfortunately possesses no administrative 

 authority. 



[Prof Babes then gave a description of the work carried on in 

 the various departments of the Roumanian Institute, showing in 

 what way a State institution of this nature may, even in spite of 

 special difficulties, render service to hygiene and science. He 

 went on to say that] : — 



Such an institute should always be in connection with a hos- 

 pital for infectious diseases, and the institute itself should be 

 divided into five or six closely-connected parts : (i) For clinical 

 treatment and experimentation ; (2) for pathological ana- 

 tomy, bacteriology, and experimental pathology ; (3) for infec 

 tious diseases of animals ; (4) for chemistry ; (5) for statistics, 

 superintendence, and the library ; (6) for lecture rooms, museum, 

 and management. 



The building should consist of a main edifice and several 

 pavilions. The chief edifice must be for laboratories, and, if 

 outside the town, there must be a dwelling house close by for 

 the director, staff, and servants. Ttiere must be a completely 



NO. 1276, VOL. 49] 



isolated pavilion for inoculation of men, and about three o'hers 

 for examination of animals, and there must be several places 

 for breeding animals. 



The staff should consist of director, about four superin- 

 tendents of departments, eight assistants, officials in charge of 

 statistics, a librarian, a manager, and about eight or ten servants. 

 The total cost of the undertaking would reach about i,ooo,030 

 francs. 



The director and his staff" should give lectures, &c., with 

 special regard to hygienic administration in its widest sense — 

 for doctors in the public service, for candidates desirous of 

 obtaining medical offices, for architects, engineers, administra- 

 tive officials, and students. The institute for pathology and 

 bacteriology might be under the control of a " home office" or 

 a '■ health office,'' but must have the right of preparing hygienic 

 laws for the State authorities. 



Besides this great institution there should be well-endowed 

 professional schools for lower officers of health, and the ele- 

 ments of hygiene should be taught by capable teachers in all 

 schools. No public buildings, aqueducts, or canals should be 

 constructed by persons who have not received proper instruction 

 in hygiene. 



Institutions of this kind could systematically investigate the 

 mo>t important hygienic and medical questions. In times of 

 peace the fight should be for the people's health, and oidy a 

 scheme of this kind will enable hygiene to secure her place as 

 the most important part of statesmanship. 



The Attitude of Statesmen towards the Clai.ms of 

 Hygiene. 



The chief reasons advanced why statesmen refuse to give very 

 great power to the hygienic authorities, may be enumerated as 

 follows : That the necessary means are wanting to enable the 

 S'.ate to undertake the task demanded ; that the personal 

 liberty of the individual would be endangered ; that the scien- 

 tific basis is still not sufficiently sure ; that the demands of 

 science are very often hard to carry out ; and, lastly, that if 

 they were carried out, other equally necessary State duties might 

 have thereby to be neglected, or the consequences might be 

 injuiious t < the State (Lohning). 



[a] Libeity of tlu Individual. — Different countries and schools 

 an not agreed on its proper bounds. One opinion is that tie 

 State has not the right to exercise restraint on a man, provided 

 that he hurts himself only. Stein, on the other hand, considers 

 that the health of the individual affects the community just as 

 much as it does the individual himself; and, indeed, so many 

 diseases have turned out to be more or less of infectious nature, 

 that the ground is now removed on which the former opinion 

 was founded. Some hold up as their model English principles 

 of individual liberty, whereas it is exactly in England that the 

 sanitary authorities have most control over this individual 

 liberty. It is obviously not logical to argue that because it is 

 not right to compel a man to undergo an ordinary amputation, 

 therefore one should have no power over a man when he has an 

 infectious disease. Again, if the State is compelled to control 

 the liberty of a criminal, why should it not also control that of 

 persons affected with syphilis or tuberculosis, who may spread 

 their diseases and thus harm others? Another reason (less fre- 

 quently mentioned) against the right of restricting individual 

 liberty is that this power might be misused for the sake of party 

 politics, &c. This affords an additional argument in favour of 

 having a sanitary administration quite independent of party 

 politics. 



(/') The Disposal of Ptiblic Funds. — A more difficult question 

 is whether the State possesses money enough at her disposal 

 both for looking after public health and the health of individuals. 

 Emergency measures adopted during epidemics such as cholera, 

 can oft'.n not be carried out owing to want of previous orgijiisa- 

 tion in the hygie dc department. A bureaucratic paper regiment 

 is nowhere so unpractical as in battle against the powers of 

 nature. The administrations for war and religion in most large 

 nations are best endowed, whilst the condition of the other 

 administrations depends greatly on the energy and influence of 

 the Minister at the time, and since hygiene is usually included 

 in the department of the Minister for the Interior, who is no 

 professional man, but often influenced by party interests, the 

 prospect in this direction is not very hopeful. An independent 

 Ministry of Hygiene, with a professional man at its head, could 

 do much more. 



Under the present state of "armed peace" in Europe, the 



