A medical man who is restricted to the observation of only one establishment may be said to be excluded from an efficient knowledge even of that one. Medical men so restricted are generally found to possess an accurate knowledge of the morbid appearances, or of the effects amongst the people of the one establishment, but they are frequently found to be destitute of any knowledge of the pervading cause in which they are themselves enveloped, and have by familiarity lost the perception of it. Thus it was formerly in the navy that medical officers on board ship, amidst the causes of disease, the filth, and bad ventilation, and bad diet, were referring all the epidemic disease experienced exclusively to contagion from some one of the crew who was discovered to have been in a prison. We have seen that local reports present similar examples of similar conclusions from the observation of single establishments in towns, in which reports effects are attributed as essential to labour, of which effects that same labour is entirely divested in establishments in the county, or under other circumstances which the practitioners have had no means of observing and estimating. The various contradictory opinions on diet, and the older views on the innocuousness of miasma, are commonly referable to the circumstances under which the medical observers were placed; and examples abound in every district of the errors incidental to narrow ranges of observation in cases perplexed by idiosyncracies, and by numerous and varying antecedents. It should be understood by the public that the value of hospital and dispensary practice consists in the range of observation they give; and that the extent of observation or opportunities of medical knowledge are influenced or governed by administrative arrangements. In several of the medical schools of the metropolis, however, the opportunities of knowledge are dependent on the cases which may chance to arise there. Fortunate administrative arrangements have, in Paris, greatly advanced medical knowledge, by bringing large classes of cases under single observation. The most important discoveries made with respect to consumption, those made by M. Louis, were based on the results of the post-mortem examinations of nearly 1300 cases by that one practitioner. Nearly all the important conclusions deduced from this extensive range of observations were at variance with his own previous opinions and the opinions that had prevailed for centuries. The later and better knowledge of the real nature of fever cases has been obtained by a similar range of observation gained from the cases in fever hospitals. Applications have been several times made to the Commissioners by medical men engaged in particular researches to aid them in the removal of the impediments to extended inquiry, by collecting the information to be derived—from the sick-wards of the workhouses and the out-door medical relief lists.
The highest medical authorities would agree that, whatsoever administrative arrangements sustain narrow districts, and narrow practice, sustain at a great public expense, barriers against the extension of knowledge by which the public would benefit, and that any arrangements by which such districts or confined practice is newly created, will aggravate existing evils. An examination of the state of medical practice divided amongst poor practitioners in the thinly populated districts shows that, but for the examinations, imperfect though they be, as arrangements which sustain skill and respectability, a large part of the population would be in the hands of ignorant bone-setters.
On a full examination of the duties which are suggested for a district physician, or officer of public health, that which will appear to be most serious is not the extent of new duties suggested, but the extent of the neglect of duties existing. The wants, however, which it is a duty to represent and repeat, as the most immediate and pressing, for the relief of the labouring population, are those of drainage, cleansing, and the exercise of the business of an engineer, connected with commissions of sewers, to which the services of a board of health would be auxiliary. The business of a district physician connects him more immediately with the boards of guardians, which, as having the distribution of medical relief, and the services of medical officers, I would submit, maybe made, with additional aid, to do more than can be done by any local boards of health of the description given, separated from any executive authority or self-acting means of bringing information before them.
I have submitted the chief grounds on which it appears to me that whatever additional force may be needed for the protection of the public health it would everywhere be obtained more economically with unity, and efficiency, and promptitude, by a single securely-qualified and well-appointed responsible local officer than by any new establishment applied in the creation of new local boards. Including, as sanitary measures, those for drainage and cleansing, and supplies of water as well as medical appliances, I would cite the remarks on provisions for the protection of the public health, made by Dr. Wilson at the conclusion of a report on the sanitary condition of the labouring population of Kelso. After having noted some particular improvements which had taken place, as it were, by chance, and independently of any particular aids of science directed to their furtherance, he remarks that “it is impossible to avoid the conclusion that much more might still be accomplished, could we be induced, to profit by a gradually extending knowledge, so as to found upon it a more wisely directed practice. When man shall be brought to acknowledge (as truth must finally constrain him to acknowledge) that it is by his own hand, through his neglect of a few obvious rules, that the seeds of disease are most lavishly sown within his frame, and diffused over communities; when he shall have required of medical science to occupy itself rather with the prevention of maladies than with their cure; when governments shall be induced to consider the preservation of a nation’s health an object as important as the promotion of its commerce or the maintenance of its conquests, we may hope then to see the approach of those times when, after a life spent almost without sickness, we shall close the term of an unharassed existence by a peaceful euthanasia.”
VIII.—COMMON LODGING-HOUSES.
A town may be highly advanced in its own internal administration, its general drainage, and its arrangements for house and street-cleansing may be perfect, and they may be in complete action, and yet if the police of the common lodging-houses be neglected, it will be liable to the continued importation, if not the generation, of epidemic disease by the vagrant population who frequent them. I have reserved the evidence respecting them in order to submit it for separate considerations, because they may apparently be better considered independently of the administrative arrangements which affect the resident population of the labouring classes.
From almost every town from whence sanitary reports have been received that have been the results of careful examinations, the common lodging-houses are pointed out as foci of contagious disease within the district. These houses are stages for the various orders of tramps and mendicants who traverse the country from one end to the other, and spread physical pestilence, as well as moral depravation. The evidence everywhere received distinguishes them prominently as the subjects of immediate and decidedly strong legislative interference for the public protection.
The following extract from the Report of Mr. E. W. Baines, the medical officer of the Barnet union, is submitted as an example of the information received respecting them from the rural unions:
“The lodging-houses for trampers are a prolific source of disease, and productive of enormous expense to the parish in which they may be situate; from one I have within this week sent into the union workhouse six cases, namely, two of fever, three of itch and destitution, and one of inflammatory dropsy. These unhappy beings are boarded and bedded in an atmosphere of gin, brimstone, onions, and disease, until their last penny be spent, and their clothes pledged to the keeper of the house, when they are kicked out and left to the mercy of the relieving officer.”
The committee of physicians and surgeons, who have made a sanitary report on the condition of the labouring population in Birmingham, give the following account of the lodging-houses in that town:—