THE NATIONALISATION OF HEALTH.* Mn. HAVELOCK ELLIS tells us that
he uses the above some- what singular title simply "as a convenient term to indicate a rational and organised system of securing the conditions of health as against the private, individual, sporadic lack of system which, as we are now fortunately beginning to recog- nise, is no longer suited to the needs of our time," and speaks of the nationalisation of health as leading up to its "inter- nationalisation." He thus really means the nationalisation, or internationalisation (dread polysyllable !), of the means of maintaining or recovering health, since health itself can never be nationalised in the sense that government can be, or land, when all the members of the nation share in it.
It is no doubt characteristic of the present day that the question of the health of the nation at large, of its preserva- tion and improvement, has come more and more to the front.
But Mr. Ellis is hardly fair in restricting the" era of collective action, embodying itself in legislation," to this half-century- As far back as the reign of Richard IL, we find an Act for "the punishment of them which caude corruption near a city or great town to corrupt the air" (12 Rich. II., c. 13, A.D. 1388), the preamble of which notes that so much filth "be cast and put in ditches and other waters, and also within many other places that the air there is greatly corrupt and infect, and many maladies and other diseases do daily happen." Surely this is essentially sanitary legislation. A century later, we find an Act under the heading," Butchers shall kill no beasts within any walled town, or Cambridge" (4 Henry VII., 41 3, A.D. 1487). The preamble of this speaks of the "corruptions engendered by reason of the slaughter of beasts and scalding of swine,"—the "unclean, corrupt, and putrified waters ; " and goes on to the remarkable statement that "in few noble cities and towns, or none within Christendom the common slaughter-house of beasts should be kept within the walla of the same, lest it might engender sickness, unto the destruction of the people." Under Charles II., the "Act for Rebuilding the City of London (19 0h. II., c. 3, A.D. 1667) provides for the "cleansing and scouring of vaults, sinks, and common sewers ;" and a few years later, again, we find "an Act for the better paving and cleansing the streets and sewers in and about the City of London" (22 and 23 Oh. II., 0. 17, A.D. 1670). We must be just to our ancestors ; though they undoubtedly had not much science (and did not use long words ending in " ation "), the idea of health as a matter of public concernment was not foreign to their minds, The difference is, that what were sanitary instincts in them, have developed into sanitary methods with us.
* no Nationalisation of Health. 13y Havelock Ellis. London: T. Fisher Unwiu. 1802. After a somewhat bald introduction, Mr. Ellis goes on to speak of the treatment of disease, the present position of the hospital, the hospital of the future, the Poor-Law infirmaries, the Report of the Hospitals Committee (1892), typhoid fever,. blindness and short-sight, maternity and its perils, the dentist's place in health nationalisation, the registration of disease, the inspection of industries, workers in lead, the- " Laissez-faire " system, with a chapter of " Conclusion " in seventeen pages. It may be seen at once from the above summary of its contents that the arrangement of the work is neither exhaustive nor strictly logical, and, indeed, the author very frankly warns his readers in his preface that he "deals.
but with a few aspects of a very large matter." The subject of drainage, so important from a sanitary point of view, is.
nowhere specially treated of, nor that of ventilation, nor that of the pollution of the atmosphere by smoke and other pro- ducts of combustion, nor that of the disposal of the dead, nor of slaughter-houses, nor of the purity of articles of food or drink, &c.
Mr. Ellis is a strong advocate of the "Hospitals Board,'" recommended by the Hospitals Committee of 1892 to be appointed. He, moreover, looks forward to a period when a re- formed hospital, thoroughly in touch with the growing sanitary organisation of the country, shall be "a national institution of health," to which all may freely resort without the stigma of having recourse to charity, so that "in the end every medical man in the country would be attached to a hospital, and every person would be living within the district of a great institution of health." He seems to be unaware that, although not fol- lowing precisely the same lines as above indicated by him, the principle of State relief in disease for all classes is already at work in a Swiss canton (Brae-Ville). Nor has he done more than glance at one side of the ethical problem of disease. Let it be granted that in the body politic, as in the natural body, if one member suffer, all the members suffer with it, so that the health of each individual becomes a matter of social interest, all disease a foe to the community at large, and the right of the sick to relief prima facie coextensive with the duty of society to prevent as far as practicable, and, beyond that to- relieve sickness. Still, that duty is incumbent upon every member of the community, and what if the sick have neglected it in their own persons,—if their illness be the result of their own carelessness or misconduct ? Does their right to relief stand on the same footing as that of any purely innocent sufferer of the victims of their own ill-doing P It is easy to theorise on general lines, but when we come to facts, there is a whole realm of casuistry (in the true sense of the- word) in the apportionment of responsibility between the- State and the individual for disease incurred by himself, or- transferred or transmitted by him to others.
It is satisfactory to be told by Mr. Ellis that blindness in England is "slowly declining," though Great Britain still stands in this respect behind two other European countries, and three more come before Ireland. Short-sightedness,. however, appears to be increasing everywhere, Germany having a signal and sinister pre-eminence in this respect. A French doctor has noted the remarkable fact that wild beasts caught quite young or born in captivity become short-sighted, the conclusion being that the eye adapts itself to its habitual sphere of vision, and unless "educated," to use Mr. Ellis's term, to see objects at a distance, loses the capacity of so doing. Even in after-life the eye may be, to some extent, so. educated, though probably only when the myopia is not con siderable. It is thus within the experience of the present- writer that his sight greatly improved in days gone by, when he became a Volunteer, by practice at the butts, so that whilst. at first he could not see the target to shoot at without spectacles at the three-hundred-yards range, after a twelve- month or so he only needed to put on spectacles at four- hundred yards. But beyond that range he was never able to. dispense with them. Country excursions are, therefore, extremely valuable as means of strengthening the sight of town-bred children ; and the conductors of such excursions should take pains to direct the eyes of the children to distant objects,—to the farthest hill, church-tower, or other land- mark, noting, if possible, any incapacity to discern the selected object, and then selecting some nearer one for the weaker. sighted.
One of the most important steps towards the prevention of disease lies in its registration. Mr. Ellis points out that one of the best systems at present existing for the notification of disease is that which has been established at Zurich, where every case of sickness to which a medical man is summoned must be reported by him direct to the health-bureau on his first visit;" and a medical man's report is made compulsory in any case of infectious disease, mild or virulent. But he correctly observes that "a system for the registration of so- called ' infectious ' diseases only is not sufficient," since "the field of infectious disease is but a small portion of the great field of preventible disease." He does not, however, dwell on the closely connected subject of the registration of deaths, which is still far from being satisfactorily dealt with in this country.
Mr. Ellis in his preface ingenuously says that he "does not really see why he should write about the matters which form the subject of his book more than any other person." To most readers, however, his work will be suggestive, and his sesquipe- dalian words should not deter any from its perusal who feel the importance of the aims of which he is so earnest an advocate. Full of facts as it is, it would have deserved the addition of an index, which should not be overlooked on the issue of any farther edition.
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