Besides being thus shown that, in all places in which epidemics appear, some sanitary defect may be found, we are shown that they come back and back to the same places, and that, if these defects are removed, the epidemics will not return. So we are led on to the great idea that they are preventible.
The facts advanced to prove these principles have not, of course, the wide range, the distinct statistical exactness, of those which the further progress of sanitary science has now enabled people to bring forward; but it is very interesting to see how all further advance has been but a development of the principles brought forward in this 'Treatise on Fever,' just as it was itself but a development of those brought forward five years before. Hardly any investigations had yet been made, but the results which research would bring to light are here foreshadowed. Even the direction which such research would take is indicated, for we are told, at the end of the chapter which treats of the "Causes of Fever," that—
"Further inquiries are necessary—such as, whether the vegetable and animal poisons we have been considering be the only true, exciting cause of fever;[[8]] by what means its general diffusion is effected; on what conditions its propagation depends; by what measures its extension may be checked and its power diminished or destroyed; what circumstances in the modes of life, in the habits of society, in the structure of houses, in the condition of the public streets and common sewers, in the state of the soil over large districts of the country as influenced by the mode of agriculture, drainage, and so on, favour or check the origin and propagation of this great curse of civilised, no less than of uncivilised, man."
Not a mere article or book contained the result of such inquiries. They occupied the greater part of his life, and that of many others. Their outcome is the present state of sanitary knowledge.
If some people think there was nothing new in the view of epidemics insisted on in this Treatise, they have only to see what was the common opinion at that time amongst medical men. A few shared the writer's opinions, but the majority of English physicians then certainly took quite the opposite view. When Asiatic cholera first broke out in 1831, it was of no avail that the physicians of Bengal had declared unanimously that "the attempt to prevent the introduction of cholera by a rigorous quarantine had always and utterly failed"; it was of no avail that the articles on "Quarantine Laws" had, six years before, urged the same truth; the London College of Physicians issued, notwithstanding, a notification that, wherever cholera appeared, the sick should be collected together in houses, which should be marked conspicuously Sick; and that, even after the sufferers had been removed, and the houses purified, Caution should be marked on them. That the dead from cholera should be buried in separate ground; that food to be delivered at a house where any one was sick should be placed outside, and only taken in when the person who brought it had gone away; and that no one who had communicated with a cholera patient should, during twenty days after, communicate with the healthy.
If cholera resisted all these precautions, and became fatal in the terrific way it had done in other countries, the authorities announced "that it might become necessary to draw a strong body of troops or police round the affected places."
This proclamation of the physicians of 1831 was published throughout the land in the form of an Order of the King in Council. It might have been more to the purpose to have cleansed the affected town.
"But," says Mr Howell,[[9]] "the strong good sense of the public averted many of the mischiefs which these scientific advisers would have produced had their counsels been carried into execution. The preventive measures, which were eventually adopted by them, consisted in prohibiting intercourse between one town and another by sea, and permitting it by land: thus communication between London and Edinburgh by stage-coach was perfectly free and uninterrupted, while communication between those capitals by sea was prohibited with such rigour that no interest, however powerful, could procure an exemption! Francis Jeffrey—at this time holding the high office of Lord Advocate of Scotland, and whose influence from his personal and official connections was very great—was unable to obtain permission for his faithful servant, in the last stage of dropsy, to go from London to Leith by water, lest he should carry with him to his native country by that mode of conveyance, not the dropsy which he had, but the cholera which he had not.
"'You will be sorry,' writes Jeffrey to Miss Cockburn, 'to hear that poor old Fergus is so ill that I fear he will die very soon. I have made great efforts to get him shipped off to Scotland, where he wishes much to go; but the quarantine regulations are so absurdly severe that, in spite of all my influence with the Privy Council, I have not been able to get a passage for him, and he is quite unable to travel by land.... He has decided water in the chest and swelling in all his limbs. The doctors say he may die any day, and that it is scarcely possible he can recover.'"[[10]]
Mr Howell adds that these examples are not adduced for the purpose of casting obloquy on the eminent physicians of that day, who vainly endeavoured to reduce to practice in the nineteenth century the standard, but obsolete, doctrines taught almost universally in the medical schools, but solely for the purpose of displaying the state of the science of Public Health in the year 1831-32, as far as the physicians of highest reputation and largest practice may be taken as its exponents.