566 



NA TURE 



[April 12, 1 8<-4 



maintenance of such large armies is very costly to the different 

 Governments. Part of the army might possibly be made use 

 of for sanitary purposes without impairing its power in case of 

 war. But besides the army, other departments (religioi and 

 law) are richly supplied in comparison with hygiene. On the 

 .'.'hole, it seems that hygiene is neglected because the State 

 funcis are employed for other and less necessary purposes. 



(fj The Importance of Hygienic in comparison with othet 

 Stale Expenses. — It must be allowed that quarantine is hurtful 

 to commerce, but modern quarantine methods are much less so 

 than the older ones. Quarantine is also a hindrance to inter- 

 course, but in this respect affects the ruling and wealthy classes 

 rather than the lower ones, to which latter, on the other hand, 

 epidemics are more baneful. If the money gained by neglect- 

 ing quarantine arrangements were spent for other .'^anitary 

 pui poses or for the lower classes, one could not object so 

 strongly ; but it is spent on the army, and therefore against the 

 direct interests of the lower classes. 



It is objected that quarantine is u"praclical. I cannot enter 

 on that question here, but perhaps the failure of quarantine \ 

 measures on the frontier depends not so much on the nature j 

 of the infectious disease as on insufficient knowledge or want 

 of exactness in carrying out the measures. At any rate no [ 

 international arrangement has the right to withdraw rational 

 ■quarantine from a State which has hitherto been protected by 

 it, an'] whose internal arrangements are not sufficiently organ- 

 ised to suppress an epidemic should one arise. The Hamburg ' 

 cholera epidemic was more injurious to th^ town than a rational 

 quarantine would have been. However important school 

 instruction may be to the Stale, schools should be closed imme- 

 diately on the outbreak of an epidemic. The danger in 

 institutions for small children is especially great on account of 

 their peculiar susceptibility to disease and mortality from it. 



Position of Modern Bacteriology with respect to 

 ITS Usefulness to the State. 

 One reason given for the Slate neglecting the care of health 

 is the belief that medical science and hygiene cannot on sure 

 ground fight against and keep off disease. This cannot be 

 altogether denied, and must be discussed as regards the various 

 diseases, but the belief arises in part from the means employed 

 by the State against the diseases being insufficient, and there- 

 fore failing to produce the required effect. 



(a) Precau'ions cibout Water and Soil. — Modern science has 

 demonstrated the important part pla)ed by drinking water in 

 the production of some diseases. Cholera bacilli have been 

 found in bad driiiking water, so also saprogenic bacilli, which, 

 according to my investigation, play an important part in infan- 

 tile diarrhoea, enteric fever, and d)sentery. The bacteria of 

 suppuration have likewise been found in drinking water ; and, 

 according to my latest investigations, it appears that the para- 

 sites of malaria pass through one stage of their development in 

 water. It is therefore clear that one urgent duty of the State 

 is to provide good drinking water. This may be obtained from 

 deep [wells or from springs diiect from the rocks, or (under 

 careful management) by filtration through sand. Our discovery 

 that by small quantities of alum, water may not only be clari- 

 fied, but also sterilised, may in lime be made of some practical 

 use. On the whole, one must doubt whether water obtained 

 by sand fill ration is sufficiently good to be used as drinking 

 water, and the various household filters must be rejected. 



The soil must be purified by drainage, but the canalis-ation of 

 towns is still an open question. The drains of a town can only 

 be carried into a river when the river is of large size. In last 

 year's cholera epidemic in Roumania, I found that the water 

 from the centre of the Danube was almost sterile at only a small 

 distance below the infected town-, although the cholera 

 bacillus could be repeatedly found in the water of the immediate 

 neighbourhood of the towns. Therefore, although drinking- 

 water from the Danube in the immediate neighbourhood of the 

 towns could undoubtedly be a cause of the spread of cholera, it 

 seems to me very unlikely that a town can be infected from 

 another town lying much higher up on the river. 



[Prof. Babes pointed out that the air can only be rendered in- 

 fective through dust, thou4h different gases in impure air can 

 produce other illnesses. He afterwards considered the means 

 to counteract such diseases as tuberculosis, syphilis, cholera, 

 typhus, yellow fever, the plague, and small-pox, urging that the 

 State should interfere to prevent the spread of all these and 

 Jinany others. Continuing, he said] : — 



NO. 1276, VOL. 49] 



From these few examples it becomes manifest that a Sta'e, 

 perfected in the way I have laid down, could by the means at 

 our disposal already do much more for the health of its citizens 

 than it does at present, and it is clear that the erection of proper 

 institutions would help to this end. It is clear also that we are 

 not justified in separating the public health from that of the 

 individual, but just on this account the State work will be in- 

 creased and a thorough reform of the sanitary a [ministration 

 appears necessary. 



If we were to contrast the d- mands made here with those 

 acknowledged by statesmen, we should see that the latter limit 

 the rights ol the State to ) much and do not take the universal 

 importance of hygiene into due consideration. Although they 

 profess to acknowledge the immense importance of hy^jiene, 

 they place other Slate interests in the front, which prevent the 

 carrying out of measures for the advantage of hxgiene ; they 

 only recognise certain conditions under which the Slate can talvc 

 care of the he.ilth of individuals, and iht-y always dread the 

 interference of the State with family life, though in the in'erest 

 of public health 



Against these objections science will he powerless until it cin 

 practically and clearly demonstra'e the results of molein re- 

 search ; but on our part it will fir?t be n<-cessary lo frt-e our- 

 selves of all non-scienlific interests, and leave lo others the 

 interests of commerce, industry, politics, the aimy, andtdelamily. 

 1 here should be doctors who are nit fe'iered by practice, but 

 specially trained tomakekno n to the ruling bodies — especially 

 the Parliament — the advances and pract ical ap[)licatior< of science, 

 so as to obtain that position for the orgamsition of h)giene 

 which belongs to it as being of the greatest importance f ^r the 

 happiness of the citizens. 



The fust re-ult of this should be the erection of a richly- 

 endowed institute of State hygiene, in which laboratory wi.rk 

 may be Unned to practical use, and which may seive as a hi^h 

 school for the stntesmen in question, direciors of hygiene and 

 hospitals, and all Government official-, whether of i he depart- 

 ments f )r instruction, medicine, nr the u-e!ul aiis, who occupy 

 themselves with matters of hygic'-e. 



An ii\ernational and social reform should be obtained, be- 

 cause individual health cannot be se| ar^ned fiom public health, 

 because the health of one class is neces-ary lo ihe health of 

 other classes, and the health of the lower classes is of the 

 highest economical value to the S'ate. The health, .hf)wevcr, 

 of the lower classes is affected by an unju-t want of the primary 

 necessities of life and health, as wtii as by the insufficient 

 care taken by the Stale for public and private heal h. A 

 settling of the social question becomes, tlKiefove, essen ial for 

 public health. 



Furthermore, there would have to be an international agree- 

 ment by which the sanitary interest- of the working classes 

 are placed above the interests of capital and com; etilion, 

 and by which a part of the expen.-ive State institu! ons — 

 namely, the armies — are lent or given up for hygienic purposes. 

 The position of the sanitary offi.ials shouhl be raised, and alt 

 the strength of the sanitary department should be used to fill up 

 lacunae in professional knowledge. The sanitary administration 

 should have equal power with the Ministry, but should I.e with- 

 out the political instability ol the latter, and, on urgent occa- 

 sions, should have the free right of direction. Its organs should 

 be more numerous, higher placed, well pail, and excluded from 

 all other jioliiical or medical work. 



Under such conuitions sanitary questions can be thoioughly 

 and 5cientifically Considered, and the proper extent can I'l- found 

 to which the Slate shall enter (m mailers of individual and 

 public health. 



Although the free mental devel ipmeni of the indiviHual is 

 necessary for progress, the proper conditions for bodily de- 

 velopment, which consist chiefly of the kee|)ing off of harmful 

 external influences, are more and more fcnimi to belong to the 

 sphere of State work. The State ihus perftc ed is justified 

 and boun 1 to interfere directly or indirectly in the Ireedora 

 of individual life, and moreover to a much greater extent 

 than before seemed justifiable, because modern research tells 

 that this is in favour of the sanitary developnien of the com- 

 munity. 



Although the sanitary administration of io-<lay, even in the 

 best developed countries, is but po riy lurni-hed svitli power, 

 and in most civilised countries is absolutely powerless, neverthe- 

 less, in some few countries rational measures could be carried 

 into effect which would clearly show how beneficial the general 

 I 



