One of the most important problems of the present time is how to embody the sanitary knowledge which we possess in the life of the nation so that a higher standard of health may be gained by the present and succeeding generations.
The solution of this great problem must be attempted in many directions. It must be sought in the power of legislative action, in the wide-spreading influence of education, and in the strength of social combination.
The part which legislation should take in promoting national health demands serious consideration. Legislation is the human imitation, or visible representation, of the greatest facts in the universe—law, and it derives from this representative character its immense power in moulding the mind and habits of a people; for, as the Divine laws of the human organization limit its powers and direct its modes of action, so the human laws which rule a people determine their modes of thought and their relations to one another. Legislation, therefore, not only represents the life of the present generation, but is the most powerful educator of the rising generation. Every law contains this latent power hidden within it, and so often overlooked. In every subject of legislation, whether it be the most trifling village regulation or the gravest international question, there are principles hidden behind the facts which induced legislation, and it is the attitude that legislation assumes towards those hidden principles, which stamps its character as good or evil, which makes the human law obedient or disobedient to Divine law.
The health of a nation is a most important concern of a wise government. No other agency can act with such extensive and combined power. But much wise caution is needed in dealing with such a subject as national health. Human agencies are very imperfect, and much has to be learned as to the right way of dealing with most important subjects of health legislation. If the authorities introduce a supply of pure water into a village suffering from typhoid fever they do a righteous thing. They deal with causes. By careful investigation they have collected a body of facts which prove that impure water will produce typhoid fever. In this act of introducing a supply of good water there are many principles enfolded. Thus they destroy the cause of a great evil; they express approbation of that good thing—pure water; they educate the people into liking it; they show them, through experience, the blessings that flow from it. They thus render obedience to Divine law by their legislation. But it is very different if they attempt to regulate a village gin-shop. Gin, as a drink, is always bad, whether adulterated or not, and, in dealing with the greatest evil that afflicts our country—the curse of drink—legislation must adopt the same course that it did for typhoid fever: it must patiently and persistently accumulate the facts which will show what produces this dangerous disease of drinking.
Divine law rewards the good (i.e., the obedient), punishes the bad (i.e., the disobedient), swiftly, surely, inexorably, no matter at what cost or pain; and human law must never temporize with evil, neither directly nor indirectly sanction it, or it loses its character of law and becomes simply blind or blundering expediency. In dealing with evils legislation is bound to investigate the causes of evil and attack them. Herein lies the superiority of legislative over individual effort—that it is able to accumulate that body of varied facts through which causes can be clearly ascertained and the attention of the community directed to them. It is only on this sound basis that wise legislative measures can be framed; only in this way that great questions of national health can be judiciously dealt with.
Our English Government—in advance of every other nation—is learning to recognise this great function of legislation, and is gradually accumulating such a storehouse of facts as will render comprehensible measures of wise statesmanship possible. The mass of the people, however, must become sufficiently intelligent to support such measures. The difficulties which now stand in the way of health improvements from want of this intelligence, are inconceivable to those who have not considered the subject. No matter whether the health improvement suggested be great or small—whether it be the redemption of a lovely mountain river, whose sparkling waters have been turned into a black source of pollution, or a swamp that ought to be drained, or a poor cottage that needs the introduction of fresh air—there is always the same opposition and misconception. Thus a short-sighted view of expense will excite furious opposition from small ratepayers and ignorant farmers, even to the most necessary measures—measures which would rapidly diminish the poor-rates and increase the prosperity of a place. Incompetent men or poorly paid men are appointed to carry out Health Acts, or timid men, afraid to excite ill-will in the neighbourhood. The Acts thus become a dead-letter, or lawsuits are instituted against improvements, harassing and even destroying local health boards. Large proprietors enclose the commons, farm out their estates to agents, and thus neglect the duties which are inseparable from rights. The same ignorance which opposes such endless obstacles to the establishment of sanitary improvements often defeats the best laid plans when they are carried out, and proves, if proof were necessary, that a people must be educated to appreciate laws before the objects which those laws were intended to effect can be accomplished.
Much confusion also at present arises from patch-work legislation that has not been based on sound principles. This is shown by the present Acts regulating towns: ‘A recent edition of the laws affecting health and sanitary affairs gives the text of fifteen Acts relating to health, diseases prevention, nuisances, local government, sewage, and kindred subjects; twelve Acts consolidating provisions as to towns, lands, markets, police, loans, bakehouses, etc. The public health and local government supplemental Acts are twenty-nine in number, while the laws treated by the work are affected by not less than 296 public general statutes, which the author tabulates in the index as being referred to in the text. No lawyer can grasp these enactments save by great research, much less can a man who has his own business affairs to look after.’
The sanitary investigations carried on by the Privy Council and other government bodies, the labours of the Royal Commission appointed to inquire into the condition of the poor, etc., cannot be overestimated; but none feel more strongly than the very men who are carrying on these measures the necessity of effort in other directions—directions where the co-operation of every member of society is needed—viz., in education and in domestic and social life.
We now possess enough sanitary knowledge to reform the physical and moral condition of the human race if it were generally diffused and its rules systematically applied. Scientific investigations and the knowledge of hygienic laws are far in advance of the practices of daily life. The knowledge is within our reach, which, if employed, would save the lives of tens of thousands of human beings around us, keep this army of sick in vigorous health, and make our homes the precious centres of ennobling influence that they are intended to be. We fail, however, in the means of diffusing and putting into practice the substantial knowledge which scientific observation has laid before us. The first duty, therefore, which rests upon us all is an endeavour to secure the universal diffusion of sanitary knowledge. As every human being in the British Isles should know how to read and write, so every human being should be taught that health is a duty, and shown how to secure it. Sanitary teaching (varying, of course, in its style) should be introduced into every school and college in the kingdom—in the common school, in Oxford and Cambridge equally, into every series of lectures, whether at the Royal Institution or the South Kensington Museum, into every Working Man’s Institute, and into every medical and every theological seminary.
Above all other classes of men, it is certainly important that physicians and medical men generally should be thoroughly educated in sanitary knowledge. The authority which they possess, and their opportunities for instilling this knowledge when families are keenly alive to the dangers of illness, would give them greater success as health missionaries than any other class of society. But medical men are not taught that it is equally their duty to prevent disease as to cure it; and their attention is not, therefore, sharpened to observe and to deprecate the numerous habits in family life which tend to produce disease. There are but two chairs of hygiene established in connection with our medical schools, and attendance upon those lectures is not obligatory—i.e., is not essential to the attainment of a degree. Every practical instructor knows that the press of studies is so great that the student always neglects whatever is not absolutely necessary to his success. One of the most beneficial changes that could be introduced into medical education would be the establishment of hygiene as a first-class chair, of equal importance with anatomy, a searching examination in its teachings being indispensable to the attainment of any degree which gives authority to attend the sick. Almost equally important is the introduction of sanitary instruction into theological seminaries. The clergy generally seem to be sadly ignorant of the laws of health. The powerful and legitimate influence which they exercise would be more valuable if it were not so one-sided. If the clergy all over the land, who command a mighty army of parish visitors, could show those visitors the direct and positive connection between pure blood (made out of food, light, and air) and pure thought, what a revolution would be wrought in every country village! But the clergy themselves must be educated in such knowledge, for it is not simply intellectual assent, but a thorough realization of it that is necessary. The same knowledge is as necessary to our schoolmasters. No one is fit to direct the education of youth who does not perceive the difference between the young and the old, and suit education to the child’s nature and not to his own. The kind of studies, their variety, frequent movement, and change, the arrangement of schoolrooms, the unlimited supply of fresh air, the playground, etc., must all be based upon an acquaintance with sanitary knowledge, which would be a proper subject for examinations and certificates.