PUBLIC HEALTH..
-THE authorities of King's College Hospital, an institution which, notwithstanding the hindrance of limited and precarious resources, may well bear comparison in usefulness with its richly-endowed rivals of the metropolis, recently founded a Chair of Hygiene, and appointed Dr. Guy, already well known as a sanitary reformer, to be its first occupant. In the volume before us, in which a subject -of perpetual and inexhaustible interest is handled with an evident mastery, the new professor fully vindicates the choice of his patrons. It contains his first course of lectures, eight in number, dealing, as it was natural and right that a first course should, with the historical aspect of his subject.
The first thought that occurs to one after reading such a collec- tion of facts as Dr. Guy has here brought together is a wondering inquiry,—with what temper of mind should we in this nineteenth century, used as we now are to a comparative immunity from such outbreaks, regard a visitation of epidemic sickness equally fatal in proportion to our number with those which our ancestors endured? Such catastrophes are not, indeed, wholly unknown to this genera- tion. Districts in Hindoostan have within the last twenty-five years been depopulated, in no figurative sense of that word, by * Public Health: a Popular Introduction to Sanitary Science. By William A. Guy, M.B. London: liewsbaw. 1870. typhus, and it is but a year or so since famine killed two-thirds of the people of Orissa. But here in England there has been nothing in the memory of man—we may say more, nothing in this century or the last—which can be compared with the destructive plagues which marked several of the earlier periods of our history. We take the Great Plague of 1665 as an instance, putting aside the Black Death of 1348 because, though probably it was more fatal than any epidemic before or since, we have no records on which we can rely for an accurate statement of numbers. But in 1665 there were regular bills of mortality, probably not giving what would now be considered a scientific classification of causes of death ; but probably, also, when we consider the strict supervision to which the _life of our ancestors was subjected, accurate in point of number. Now, the deaths in London during the year 1665 were 68,596 ; and these occurred in what was actually a period of little more than eight months, the earliest entry of deaths by plague being in the week ending April 25, when two cases were registered. What proportion these numbers bore to the total population we cannot say with certainty, but it could not have been less than a fifth part of the whole, and was probably more. " The plagues of London," says Sir William Petty, the famous physician and politician of the seventeenth century, "do com- monly kill one-fifth part of its inhabitants," and this was certainly more fatal than any that had preceded it. Imagine, then, a fifth part of the population of the London of to-day, the three millions which the census of next year will in all probability show to us, carried off in less than twelve months ! Imagine six hundred thousand deaths in a year, or, to take the figures of the moat fatal week of the plague year, September 12-19, when the deaths reached 7,125 ; imagine sixty thousand in a week ! The greatest mortality that this generation has seen was in the cholera year of 1854, when the maximum entry for one week was something under 4,500. What a panic that loss produced many of our readers will remember ; all of us know with what apprehension we regard au increase, absolutely insignificant when compared with the appall- ing figures of the plague year, in the fatality of scarlet fever or small-pox. It is not, therefore, unreasonable to ask, should we break down under the trial? NVould our sanitary arrangements be kept up? Would, we will not say our clergymen and doctors, but our scavengers and dustmen and the like, upon whose services we are far more dependent than our ancestors were, fly from their work ? Would the dead be buried with any kind of decency ? In a word, would society break up under the trial ? It is the absolute magnitude of the evil that would be so appalling. When the total numbers are very much increased, though the same proportion is preserved, not only is a very different effect produced on the imagination, but the actual difficulties and horrors of the case are increased. All who have busied themselves with the social and sanitary reform of London must have regarded with something like consternation its over- whelming magnitude, with which all their efforts seem to grapple in vain. Would not this magnitude make itself felt in a way which would task, all the resources of modern knowledge to meet ? We take one case, the removal of the dead. It is impossible to estimate the difficulty of conducting it when the bodies would have to be taken, not, as was the case in 1665, to churchyards close at hand, or special burying-places outside the City limits but still near, but through miles of streets to the suburban cemeteries. A mortality such as we have imagined occurring in one of the crowded districts of Central London—the densely-populated and squalid courts that surround Drury Lane, for instance—would in the single matter of the burial of the dead bring about difficulties of the most dreadful kind. We can only console ourselves with thinking that such a catastrophe is not likely to occur. The plague attacked a population which was subject throughout to much the same con- ditions of life, those conditions being of the most unfavourable kind. The London of to-day is not so much one city as a collec- tion of cities. The epidemics which attack one part are, if not unknown, far less fatal in another. Were the plague to visit us again, a contingency which Dr. Guy evidently thinks within the bounds of possibility, we may reasonably hope that its action, besides being modified everywhere by improved conditions of life, would be restricted within narrower limits.
How much depends on the absolute number of the population affected by a great sickness may be seen in the well-known instance of the plague of Eyam, a village in the wilds of the Derbyshire Peak, with which the name of Mompesson, its rector, whose wisdom and courage were beyond all praise, should always be connected. The plague was sent down to Eyam. in a box of clothes which was forwarded from London in September, the most fatal month of the plague year. It lasted for more than a year, reaching its culminating point in the following August, when there were seventy-seven deaths out of a population of two hundred, these two hundred being the number remaining out of 350 inhabitants which the village had contained before the outbreak. The total result was that 267 died, that is, about three-fourths of the whole, yet society in the village was never disorganized. The sick were attended to, the dead decently buried, and the register regularly kept. True, this was owing in a degree which it would be difficult to estimate to the exertions and influence of one man of heroic mould ; but then comes in the fact which proves our point, that one man can so influence a limited space and number, that the danger of great spaces and great numbers, a danger which we see illustrated in one way or other continually, is that the influ- ence of the individual, however great and noble he may be, is lost among them.
But civilization, though cities of overgrown size are among its dangerous results, and though it produces diseases of its own, the results not so much of luxury, the evil with which it is commonly credited, but of overwork and of a life too much crowded with cares, works unquestionablyon the whole favourably for the general health. The science which Dr. Guy professes is indeed its creation ; it is only in our own days that it is being organized, though for the last two or three centuries some of the more far-seeing of each genera- tion have been doing the work. And so this history, for such Dr: Guy's book, though somewhat loose in arrangement and very pro- perly colloquial in style, really is, is an encouraging one. It records a most distinctly marked progress. Whatever may be the case as to the great epidemics—and it is certain that, whereas they used to visit us once at least in twenty years, we have not had one of really formidable proportions for a century and a half — some diseases may be reckoned extinct. Such is the jail-fever, the abolition of which is a triumph of hygiene proper, as distinct from medicine, having been really accomplished by a layman, John Howard, whose claims to the sole honour of the work are ably vindicated by Dr. Guy in his seventh chapter, and being the result, not of the discovery of any remedy properly so called, but of the sanitary application of air and water. There are others which, though not extinct, have ceased to be formidable, and for the destruction of which there only needs a more complete application of the means which we hold in our hands ; small-pox, the mortality from which has fallen in less than a century under the gradual application of vaccination from 108 to 11 in a thousand ; and scurvy, which, though probably always liable to reappear in isolated cases of privation, may under ordinary conditions be effectually guarded against. May we not hope to add cholera and typhoid fever to the list of these preventi- ble diseases, on the 'strength of the great discovery which connects their spread with the use of impure drink-water?
We heartily commend to our readers Dr. Guy's volume, which, being as modest in size as it is full of matter, is within the reach of the most moderate means,—commend it all the more unreservedly and earnestly, because hygiene is a branch of the healing art which laymen may not only study, but may also practise,—we may go further, and say, which they are bound to practise, and consequently are under an obligation to study.
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