Imágenes de páginas
PDF
EPUB

64

Address

BY

DR. ACLAND, F.R.S., D.C.L.

ON

HEALTH.

THE

HE Public Health Acts of the last two Sessions appear to guarantee a remarkable change in the physical condition of the people of this country. In 1871, for the first time in the history of England, a chief central office of State was formed for the combined supervision of the health and of the destitution of a steadily increasing population. In the following Session of 1872, just brought to a close, a further and equally important step was taken-that of practically committing to the local self-government of the people the detailed charge and management of their own health; so, at least, I interpret the significance of the two Public Health Acts which have just been passed in these years of 1871 and 1872. If such be the condition of affairs as regards the public health, a new era is inaugurated; and there seems to be to-day a proper opportunity for calmly asking ourselves, what is the fundamental idea of health as it is entertained by those who have done their best to master that idea? and what are the circumstances of this country in respect of that idea? Experts, many of whom I see present, will understand that, to do this completely in an hour is just as possible as it would be to paint a complete picture in that space of time; yet a picture may quickly be blocked out with advantage, though detail be omitted; and such a rude sketch I endeavour to present to you.

I.—IDEA OF HEALTH.

First, then, Health itself has to be considered in its fundamental conception. That is a simple matter enough. There is for every living being a Personal Health; and it is either good or bad. Every living being, originally a particle derived from

a more or less similar being, is composed of few out of many ingredients which make up our planet, is arranged in a certain manner, and performs certain functions ill or well; if well, we say the individual is healthy, according to his age and inheritance; if ill, we call it unhealthy.

There is for every civilized country a Public Health, which is not either the health of the individual nor the health of the nation, but deals with the circumstances which affect individuals, taken as they are in relation to each other, as members of the body politic. For example-the question whether a man has been poisoned inadvertently or of malice prepense is a question of public health, sanitary police, and medical jurisprudence, without regard to the general health of the nation.

There is for every nation a National Health, which includes a much more complex idea. It includes not only the circumstances which affect the individual, but those which affect the nation as a body, such as race, religion, customs, laws.

There is for the human race a science of Comparative National Health, which has reference to that health which affects and is affected by the circumstances of the whole world, which seeks to compare one nation with another, to ask why one people is more, one less healthy; one more, one less long lived; which aims at presenting to the mind a correct conception of the circumstances and the fluctuations in the health of the whole of mankind.

The object of sanitary legislation in any civilized country is to influence the health of its people in each of these four aspects respectively, to influence the health of individuals, to regulate the circumstances of purely public health, to develop the physique of the nation, and to note for a purely scientific purpose the health of the human race throughout the globe. Doubtless these are ideas which some may think cannot be safely handed over for their practical expression to the tender mercies of common councillors and boards of guardians.

Nevertheless, before we allow this fear to be just, we must be sure that we have ourselves correct notions as to what is, and what is not, essential for the several kinds of health as I have endeavoured to pourtray them.

The essentials are, after all, very simple. In the first class, Air, Water, Food; which some would scientifically sum up in one term-Food. But for civilized communities there is a second class as essential-Clothing, Fire, and Habitations. To the happy savage-and to some extent, I own I believe in the happiness of one who, living in peace in some ideal island, diving off a pleasant shore, basking in a radiant sun, has

neither the charms nor the cares that literature would bring to his palm-tree-for him, if such there be, this class of provision is not essential.

Nor does the third class of complex essentials, though absolutely necessary for civilized life, touch him. Regulated Highways of safe and good communication; regulated Scavenging, or means of pure life; Laws of Police, or an assured Justice as between man and his fellow in all the transactions of life.

These nine essentials however of national health-Air, Water, Food, Fuel, Clothing, Habitations, Highways, Scavenging, Police, may be safely accounted futile in a modern civilized people, without that which is fundamental to all, a general though wise Education; an education leading to the development of the sense of good citizenship in an intellectual and religious being.

II. TYPICAL PROVISIONS FOR HEALTH.

All this being so, we ask ourselves, how are these conditions. to be obtained? What steps has modern civilization taken to obtain them? The answer is far too long for a brief hour, but your memories will supply the want of detail while I give one general illustration.

There happen to be a class of habitations where we can especially study the necessary conditions of health. If you go to a modern hospital you certainly ought to find nothing about it but that which is typical of the best health conditions. If you do, it implies in the managers deficient knowledge or faulty administration. What then is the idea of a modern hospital? When you mention a hospital to an expert in sanitary matters, he immediately recalls what is termed a "hospital unit." Now, I take leave to say that modern physicians and surgeons do not think they rightly treat the sick unless they put them in at least as healthy circumstances as they would wish them to be in when well. The idea that there is abstract advantage to masses of sick persons in collecting as many as possible into one place for the purpose of treatment has now passed away. A good hospital is a first-class illustration of the science of preventive medicine. The things most necessary for health as well as for the treatment of disease are to be seen there. Every essential is provided in the cheapest manner on the plan most approved by modern science and experience. Although there is a typical size of unit which on the whole is better than all other sizes, yet any number of persons may be accommodated, just as we can have a large

palace as healthily arranged as a small house, or a barrack as a guard-room. For this unit may be arranged under a great variety of circumstances in its relation to other units. A skilful architect will say, "Give me the plan of your site; tell me your latitude, and your maximum and minimum temperature; and with these I will arrange for a hundred, a thousand, or two thousand patients." I do not say that the plan of having 2000 sick in a hospital is the best, any more than we should say, that great towns offer the best conditions of human residence; yet civilization has to deal with masses, both of the sick and of the healthy, and it must apply to masses the principle of health which applies to individuals. Accordingly, the hospital units are grouped in various ways; are connected or unconnected; are placed parallel in line, are planted in echelon, arranged in three sides of a parallelogram like the Lariboisiére, on either side of a corridor, as at Blackburn, on one side, as at Malta, and as in the great hospital of St. Thomas', in London. The principle reached its maximum development in the great emergency of the American war, where, to pass by minor instances, the famous Chestnut Hill Hospital had 50 pavilions or units, each 175 feet in length, 2800 beds for patients, 500 for officers, a corridor 2400 feet long, a railroad connected with each pavilion, complete sewerage, water supply of 150,000 gallons daily, and a magnetic telegraph connecting every ward with the office of the surgeon in chief. All this improvised for a temporary emergency proves, I think, how principles clear and unmistakable for house and hospital arrangements are now accepted by those who are willing and able to keep up with the knowledge of the day.*

Now, if each important part of the largest hospital is carefully constructed and properly administered speaking generally, it ought to be as perfect as a whole as in the constituent parts; and is so, unless the collection of the sick into masses actually superadds, by cumulation, a new element of danger and disease. But, at all events, the principle of a perfect unit is equally applicable to the hospital of a village, of a town, a county, or an army, separate or united, according to circumstances and convenience.

It is the same with the abodes of the healthy. If you find in a hospital, great or small, a drain within the walls, a sink connected directly with a drain, an unventilated closet, you

* See "Treatise on Hygiene, with Special Reference to the Military," by William Hammond, M.D., Surgeon-General, United States Army; the excellent little volume on "Construction of Hospitals," by Captain Galton, F.R.S.; and Parkes' " Hygiene."

know the hospital is under incompetent management. If you find in a village, a town, or city, in any house similar faults of construction, you know you have to do with faulty organization, or with inadequate law, incompetent advisers, or careless people.

III. DISEASE AS IT AFFECTS NATIONS.

I wish now to present, though I fear in a similarly rude and slight manner, a fundamental conception of disease as it affects

nations.

There is a disease called Leprosy which was very prevalent in this country. I have not yet had an opportunity of ascertaining whether the information I have received is correct, that there is a case in Plymouth at this moment. But, at all events, leprosy may be practically considered as having died out from our nation. In that circumstance we note one important fact connected with disease, that it may first infect and then leave a country. What is Leprosy? A dreadful affliction that harassed the human race 3000 years ago, and that has persistently maintained its footing in many parts of the world until now. It called forth the most stringent sanitary regulations when Moses lived, if not indeed before his time, regulations that were conceived sometimes in a right, and at other times in a wrong interpretation of the nature of the malady. The disease is one which, if not uniformly fatal, is so frequently fatal that it may fairly be regarded as one of the gravest that can afflict man. It is one of the longest in its duration, and the most painful and horrible in its character; it destroys its victim piecemeal, and altogether produces effects so revolting that it would ill become me to describe it in a mixed assembly. Here, then, we have an affection enduring for several thousand years, capable of taking root and fixing itself in very different climates and dissimilar races; permanently in some, temporarily in others; still haunting, besides Norway, parts of India, Ceylon, Egypt, Arabia, Turkey, Greece, France, Spain, West Indies, and Norwegians in North America. Through the kindness of two eminent men, Dr. Danielson, of Bergen, and Dr. Hirrch, of Trondhjem, it was my good fortune to utilize a portion of a brief holiday in examining, on a large scale, this disease as it exists in Norway. What is it that a wise Government does for the health of a country the victim of such an affection? The Government of Norway sets to work the most skilled physicians it can find, and instructs and enables them to investigate the disease by every available means, whether by

« AnteriorContinuar »