July 5, 1877] 



NA TURE 



187 



write a prescription for a man without inquiring into his 

 disease, his antecedents, and modes of life, as for the 

 State physician to prescribe for national siclcness without 

 inquiry into the nature of the sickness, its antecedents, 

 and the cause or causes that led up to it. The great 

 work, therefore, and indeed the first sanitary work of 

 the future, standing before all other sanitary legisla- 

 tions except the formation of the central authority, is the 

 systematic enumeration, week by week, of the diseases of 

 the kingdom, through the length and breadth of the 

 kingdom. It is utterly hopeless to attempt any decisive 

 measure for lessening the mortality, which is certainly 

 more than double what it ought to be, until this State 

 labour is faithfully carried out. It is vain, comparatively 

 speaking, to know what totality disease hands over to 

 death, unless we know also what health under one or other 

 cause of disturbance yields over to disease. Physicians 

 and statists strain their eyes to try to get at the extent of 

 disease. Laborious geographers like Mr. Haviland spend 

 years in constructing maps from the tables of mortality, 

 in order to get a mere approximation of the distribution 

 of disease in England: and meanwliile disease itself, con- 

 stantly cheating the observers, is making its way without 

 being under any systematised recorded observation. 



For the omission of a registration of disease there is 

 no conceivable excuse. The thing has only to be done. 

 The organisation of the Registrar-General's department 

 has fully opened the way to the collection and the utilisa- 

 tion of the facts relating to birth and death. These 

 elements swing in the statist's balance readily, and are 

 weighed by our consummate stale weigher of life and 

 death. Dr. Farr, as accurately as the Chancellor of the 

 Exchequer balances the national ledger. With equal 

 readiness Dr. Farr, if the data were collected for him, 

 could tell from week to week the health as well as the 

 mortality of the kingdom. In a short time, under such 

 regular record, the whole nation would know the reigning 

 health, the reigning disease, of every centre of life. And 

 if, as might easily be done, the diseases of the lower ani- 

 mals and the diseases of the vegetable kingdom were 

 included in the returns, all the facts of disease would be 

 completely rendered. 



I think I have already referred to an effort I made 

 many years ago to carry out this design of registering the 

 diseases of the kingdom. I refer to that effort again for 

 a simple reason, — for the purpose of indicating that there 

 is really no greater difficulty in getting the facts than 

 there is in utilising them. I attempted no more than the 

 registration of the epidemic diseases, and I could afford 

 no more than the publication of a quarterly abstract of 

 the data that were forwarded. But in a short time fifty 

 medical observers were sending in returns from as many 

 stations, extending from St. Mary's, Scilly, to Lerwick, m 

 the Shetland Islands. These stations could easily have 

 been increased to any extent, and the amount of informa- 

 tion regularly communicated was indeed most valuable. 



Two facts connected with this attempt are perhaps 

 worthy of note, one as showing something determined, 

 and the other as showing something suggested. In 

 the returns sent from the district of Canterbury in the 

 spring quarter of the year 1857 was included the first 

 account of the invasion of this country, at least in any 

 known time, by the disease since then so prevailing and 

 fatal, diphtheria. This disease first appeared in the little 

 village of Ash, and was called the Ash fever. The out- 

 break was observed and recognised by Mr. Reid, of 

 Canterbury, and was reported to my register by Mr. 

 Haffenden, who collected for me the facts of prevailing 

 diseases from eight medical observers living near to him, 

 of whom Mr. Rtid was one. The first facts of a new 

 disease in this country were thus recorded on the spot, 

 which is something even as matter of history. How such 

 a fact, reported at once to a central government authority, 

 might be dealt with ; how promptly a central authority 



so advised might act in arresting a fatal epidemic at its 

 origin, and what national service might be rendered 

 thereby, you, quite as well as I, can judge ! 



The fact of a suggestive nature springing from the 

 working of the returns is not less interesting. The 

 labour led me to refer to the returns of sickness sent 

 every week by the medical officers of the Poor-Law 

 districts to their boards of guardians. I found that 

 these returns, over 3,000 in number, which, when they 

 have served their local purpose, are practically worth- 

 less, could by the slightest modification be utilised as 

 returns of the sickness of all the sick parochial popu- 

 lation under official medical care, and I submitted a plan 

 for such introduction to public approval and to the 

 Government, but without effect. Yet if the plan had been 

 adopted from those three thousand weekly returns, cast 

 away and still cast away, I calculate that 1 56,000 tables of 

 disease per year would have been submitted to scientific 

 analysis which, since the time when the suggestion was 

 first made, would have multiplied into 3,276,000 tables, 

 including in each table a record of at least ten times 

 as many particular examples of disease. To what im- 

 portant national uses such an array of facts systematically 

 arranged and examined could have been applied you, as 

 well as I, can judge ! And still neither of us can judge 

 effectively, because in dealing with data taken from 

 nature there is always something important to be elicited 

 which never was looked for, and often, too, that some- 

 thing unlocked for is better than that which was specially 

 looked for. 



Our Sanitary Institute will do well in continuing to 

 press this scheme for the registration of disease on the 

 Government, and it may greatly assist the work by lend- 

 ing its mind to the best means of collecting the facts on 

 which the weekly reports of disease will have to be based. 

 I might enlarge on this part of my subject, but I should 

 prefer to remain silent until the views of the medical 

 officers of health, now a large and influential class, have 

 been correctly ascertained. My present purpose is served 

 if I have sufficiently directed public attention to the prin- 

 ciples of the design. 



In the future of sanitary science the politician must 

 come forward more determinately than he has yet done, 

 in order to secure for those over whom he governs three 

 pure requisites — pure water, pure food, pure air. 



The Public Health Act of 1875 deals with the water 

 question, and makes provisions for the local authorities 

 to supply their respective districts, by means of a com- 

 pany, or by independent action. For my part I see no 

 hope of any effective change for the better by these pro- 

 positions. It is utterly hopeless to trust to companies in 

 a matter of such vital moment. It is equally hopeless to 

 trust to the undirected action of local authorities. If we 

 trusted to such agencies for the collection and delivery of 

 letters by post, does any one suppose that the results of our 

 present postage system would be attained ? Yet important 

 as intercommunication by letter is, it is less important 

 than the supply in due quantity and pure quality of that 

 vital fluid which makes up three parts out of four of every 

 human organism, and which is wanted as much by the 

 millions who never receive a letter, as by the millions who 

 do. In this political part of sanitation, the Government 

 must do one of two things. It must either produce a 

 process or processes for pure water supply, and insist on 

 every local authority carrying out the proper method ; or 

 it must, — and this would be far belter, — take the whole 

 mat'er into its own hands, so that under its supreme 

 direction every living centre should, without fail, receive 

 the first necessity of healthy life in the condition fitted 

 for the necessities of all who live. 



By recent legislation we have some security for ob- 

 taining fresh animal food, and foods freed of foreign 

 substances or adulterations. The penalties that may be 

 inflicted on those who sell decomposing, diseased, oradul- 



