Popular Science Monthly/Volume 23/September 1883/The Growth of Hygienic Science
|THE GROWTH OF HYGIENIC SCIENCE.|
By Professor DE CHAUMONT, M. D., F. R. S.
IT is a little difficult in a necessarily restricted lecture to convey any exact idea of the way in which modern hygiene became formulated into so much of a science as it can at present lay claim to; but I will attempt to make a brief sketch of its more salient points. In the eighteenth century there were several important questions inquired into, and to a large extent solved, of which the chief were—1. The influence of air as a factor in the spread of disease; 2. The true cause and prevention of scurvy; and, 3. The prophylaxis of small-pox. Taking the last first, we may say that the introduction of inoculation was a most important step, even although we must admit that it introduced a greater danger to the community at large than could be compensated for by the protection to individuals. But it was the first step on the road which led at the close of the century to vaccination, one of the most signal triumphs of preventive medicine, and in our own time to the magnificent results obtained by the renowned Pasteur, results which seem pregnant with so much hope for the future of our race.
The inquiry into the causes of scurvy was another step in advance, of the most signal importance. No one in the present day can form any idea of the ravages that terrible disease produced. All long voyages were imperiled by it, while the very existence of England depended upon her fleet, which had frequently to return to port absolutely crippled with scurvy, in some cases as many as ten thousand men being landed from the Channel fleet helpless. Although so far back as the seventeenth century the efficacy of fruits and fresh vegetables as preventives had been surmised if not actually noted, it is really to the renowned Captain Cook that the credit is mainly due of having established this important fact. That eminent navigator never lost an opportunity of taking on board fruits and fresh vegetables whenever he could, and the result was that he was able to bring home from a lengthened voyage crews in almost perfect health and condition, a thing never before known. It took many years, however, to impress this fact sufficiently upon the authorities, and it was not until 1796 that the medical officers of the navy (among whom was the renowned Sir Gilbert Blane) obtained the regulation ordering lime-juice to be supplied to our seamen. The effect was magical: scurvy lost its terrors, and it may be that the supremacy of England at sea during the Napoleonic wars was in part owing to the improved condition of her seamen during that gigantic struggle. We have still a monument of the extent of the disease in the immense naval hospital of Haslar, the largest in this country, which was built of such dimensions mainly to admit the extraordinary number of scurvy patients which were being continually landed from our fleets. We have not yet got entirely rid of this enemy, but I think we know now how to combat it, in spite of heretical opinions which find expression from time to time.
The recognition of foul air as a factor in disease was certainly begun in the last century, when the brilliant discoveries in pneumatic chemistry made by Lavoisier, Cavendish, Priestley, Black, and Rutherford threw such a flood of light upon a previously obscure subject, and opened the whole immense vista of the boundless science of modern chemistry. It was only then that the physiology of respiration could be even partially understood, and the changes recognized which take place in the respired air from the lungs of man. The great disaster of the "black hole" of Calcutta, and the terrible effects of the jail-fever, investigated by Howard and others, pointed to foul air as a main factor in the propagation of disease and death; and this was further corroborated by the observations made by military surgeons that outbreaks of typhus (or putrid fever) were most rapidly arrested when troops were encamped and scattered widely over the surface of the ground. It was reserved for the later researches of Neil Arnott and other hygienic observers of the present century to prove the still more important fact that foul air is the main cause of the still more general and fatal class of destructive lung-diseases, which in this and in other lands cut off so many of the brightest and the best.
Another important discovery of the last century was the determination of the cause of the well-known lead-colic by Sir George Baker. This opened up the large Held of metallic poisoning which has received so much elucidation and proved of such importance in reference to the water-supply of large communities.
In the present century we have to point to the establishment of the fact of the water-carriage of disease, with which the name of Snow is so honorably associated, the differentiation of continued fevers by Stewart and Jenner, and their connection with the poison of infected excreta by the labors of Budd and other eminent men. To those we must add the elaborate investigations into the modes of propagation of cholera, dysentery, and other tropical diseases, and the means by which scarlet fever, diphtheria, etc., are carried from place to place by various channels of communication. It would be unadvisable, even if it were possible, to enter into details on these points, but there is one branch of the subject on which we must dwell for a little. No inquiry can assume a scientific form unless it has a numerical basis to work upon, and therefore it behooves us to note the starting-point of such a basis in hygiene, if we can find it. This we do find in the collection of statistics, a beginning of which was made a long time ago in the bills of mortality kept in this country. We know how imperfect those were, and how even the population of this country was not correctly known until within the lifetime of men still living. But still beginnings were made, and the question taken up more and more enthusiastically by enlightened men, until at last the Government Statistical Department was formed, and that remarkable series of reports begun which will immortalize the name of William Farr. From that time the future of hygiene was assured; for there was sound ground to work on, and, if we add to that the valuable reports on the health of towns published by the commission of which the present Duke of Buccleuch was president, we shall have stated some of the most important foundations of modern sanitary science. Those reports disclosed a state of things little dreamed of, and the statistical returns compiled by Dr. Farr showed how much the life and health of the nation were dependent upon the conditions in which its individual members were placed. The establishment of the General Board of Health, under Mr. Chadwick, was one of the valuable outcomes of this remarkable movement. Although the original Board of Health was brought to an end in 1854, yet its work has been continued and expanded under Mr. Simon, his colleagues and successors, in spite of many difficulties and obstacles.
The part which the public services, such as the army and navy, played in the progress of hygiene was very important, as might indeed be expected; for under no other circumstances could bodies of men be so well observed, and the effects of surroundings and conditions upon health noted. Accordingly, we have a long roll of names connected with those services which must ever be remembered with honor: in the navy we have such men as Lind, Blane, Trotter, Burnett, etc.; and in the army, Pringle, one of the most philosophical physicians who ever lived; Brocklesby, Fergusson, McGrigor, and a host of others. The labors of the late Sir Alexander Tulloch, Deputy Inspector-General Marshall, and Assistant-Surgeon (now Surgeon General) Balfour, in collecting and arranging the army statistics, were of the highest value, and it is not too much to say that the publication of the first army medical statistical report marked an epoch in hygiene, especially in that part that deals with climatology. It exposed the fallacy of the common notions of acclimatization, of the advantages of a seasoning fever, and similar ideas. It showed also that it was possible for men of temperate habits and in hygienic conditions to live and thrive in the tropics, while the death and sickness that were unfortunately so common were due much more to the ignorance and folly of man than the influence of climate in any form. The truth of that is to be seen now when life in the West Indies is actually healthier, especially for young soldiers, than service at home, whereas sixty years ago a tour of service there was looked upon as almost a sentence of death. It is true we have still yellow fever to combat, but we know now much better how to deal with it when it does come, and how to obviate its invasion when it is threatened. The army medical statistics are continued now yearly, but it is a matter of regret that they have been allowed to be published in so abstract and undetailed a shape as to deprive them of much of their utility. It is to be hoped that this mistake may be remedied, and that the saving of a trifling sum, which is said to be the reason, may be recognized as a truly false economy. But perhaps the most remarkable contribution the army has made to sanitation has been by the evidence given to the Royal Commission of 1857, which met after the Crimean War to investigate the causes of the sickness and mortality of our troops. The results of that commission are well known, and from its publication may be dated the reforms which have been productive of much advantage both to our own and foreign armies, and to the civil population as well. The paramount influence of foul air in the production of lung-disease was proved to demonstration, and the art of ventilation was placed upon a secure foundation. The Barrack Hospital Committee, of which Dr. Sutherland and Captain Douglas Galton were the active members, laid down a series of regulations for the construction of barracks and hospitals, which have been followed with the utmost benefit both at home and abroad. Following this came the Indian Commission, which did for that vast dependency what the Home Commission had done for the rest of the empire. The mortality in India was found to be inordinate, and it was equally clearly traced to insanitary habits and surroundings. To recognize an evil and its cause is half-way to curing it, and after a lapse of a quarter of a century we can point, not certainly to perfection, but to such an improvement as might fairly at one time have been looked upon as chimerical. The death-rate of the army at home is only two fifths of what it was before the Crimean War; the death rate in India is only one third; and the death-rate in the West Indies one tenth.
In civil life it has recently been shown that the improvements of later times have resulted in a diminution of two per thousand in the general death-rate, and with the knowledge we now have of the causes of disease we may be sure that a general death-rate of not more than fifteen per thousand may be confidently looked for. We have not yet got rid of the fatal endemics in our midst, but they are in some direction's diminishing, and we have good hope for the future; while it seems probable that neither cholera nor any other introduced pestilence could establish a foothold in our land. The remarkable immunity of soldiers and prisoners in the last epidemic shows what can be done when people can be compelled to lead fairly hygienic lives.
I might extend this lecture by reference to the various theories of disease propagation, but time will not permit of it, even if it were otherwise desirable. I may, however, say that no one theory yet promulgated completely satisfies the requirements of the case, and that there may be some basis of truth even in the most conflicting views. So much has been done hitherto, and so much activity is being shown in investigation, that we can not fail ere long to find the key to many of the mysteries that now baffle and perplex us. It is quite clear that it is only by a knowledge of the causes of disease that hygiene can be advanced, and that it can never be in any way perfected without a complete system of etiology; and we are at present in this position, that practical hygiene has to some extent outstripped the knowledge of disease causes. We look, therefore, anxiously toward the pathological investigations of the time, and we deeply deplore the well-meaning but misguided zeal which is at present placing such grave obstacles in the way of the only means by which true science can advance—namely, direct experiment.
Although there are many names I might refer to as great writers in hygiene, abroad as well as at home, there is one which we can not omit in a lecture like this, more especially as it is the first delivered in this museum which has been founded to his memory. Edmund Alexander Parkes did more than any other one man in this or any age to make hygiene a positive fact, a practical science, based upon not only philosophical conceptions but actual experiment. Starting in life as an army medical officer, he was able to produce, during his short service in India and Burmah, works upon dysentery and cholera which will always be of the greatest value. Retiring into civil life, he became eminent as a physician and teacher, and in 1855 he undertook the organization of the hospital at Renkioi, in the Dardanelles, which was a perfect model of successful hygienic administration. Struggling with distressing and dangerous disease he continued to lead a life of intellectual activity not often accomplished by the most robust; and when, in 1860, the Army Medical School was established by Lord Herbert of Lea, Sir James Clark had no hesitation in advising that Dr. Parkes should be secured if possible as the Professor of Hygiene. How excellent the foresight of that eminent physician was, we all know, for Dr. Parkes was not only the first professor of the science in this country in point of time, but also the first in every sense of the word. The publication of his well-known "Manual of Practical Hygiene" gave us for the first time a work on the subject which was not merely a string of opinions and surmises, but at every point brought opinion to the test of figure and experiment, where it was possible, and thus laid the foundation for a real science in the future. Similarly with his teaching he pressed upon the Government to establish practical laboratories for his pupils, where they could do for themselves as much of the experimental work as time and opportunity allowed; and he impressed upon those who studied under him the necessity of testing everything by actual investigation and bringing all statements to the proof of figures before accepting them as true. There was never probably a man of calmer and more judicial mind, a man more rigidly critical of his own work, or more kindly disposed to allow every credit to the work of others. Having known him personally for many years, during thirteen of which I was his assistant and colleague, I can bear confident testimony to the exceeding beauty of his character, in which "sweetness and light" were never more truly displayed, and the scrupulous accuracy and care with which every investigation of his was carried out. The science of hygiene could have no purer and better founder and its votaries no brighter and more spotless example.—Lancet.
- From the inaugural lecture of the Parkes Museum, delivered June 1, 1883.