PROGRESS OF SANITARY SCIENCE
By CHARLES McINTIRE, A.M., M.D.,
Lecturer on Sanitary Science, Lafayette College, Easton, Pa.
Since blessings brighten as they take their flight, it may be difficult to realize how much of our present happiness and comfort depend upon the constantly abiding benefactions brought about by the progress of Sanitary Science in the present cycle. The proper care of the body and the prevention of disease, rather than its cure, have occupied the minds of men from the dawn of history. Moses is the author of a well-digested code of hygiene, and erudite scholars can find hints of the proper conservation of health in the Egyptian papyri. Hippocrates wrote about the prevention as well as the cure of disease; indeed, all along the course of time the master minds of medicine attempted the solution of many of the problems of Sanitary Science as eagerly as they sought for the elixir vitæ or for the universal solvent. Notwithstanding all this, one can truthfully say that sanitation could not be fairly termed Sanitary Science until its rules of procedure began to be formulated with more or less exactness upon careful experiment and accurately recorded observation. Sanitary science, as such, could not begin to be until pathology (a knowledge of the morbid processes of disease) and etiology (a study of the causation of disease) had builded upon a scientific foundation. Before this all deductions were from experience, and had no other reason than the seeming helpfulness of the procedure; after this, as fast as the facts were demonstrated, deductions were made that determined a procedure which would of a certainty accomplish the purpose. In the olden times, during an epidemic of a contagious disease, tar barrels were burned in the streets,—and not without some benefit. At the present, the room, with its contents, can be disinfected with a certainty of destroying every atom of contagion.
This difference must be kept in mind when comparing the old with the new, and the true reason of the great advance be recognized as due to the spirit of scientific investigation, which began in the latter part of the last century with the employment of instruments of precision in research, and which has developed so wonderfully up to the present that the experimental psychologist measures the minute portion of time it takes to form a thought. At the same time, it must be kept in mind that the sciences which furnish sanitary science much of its material are progressing and, because progressing, changing; that the conditions desired to be removed are prevailing, and the necessity of overcoming them urgent. Not in every case has the sanitarian fully demonstrated and laid down scientifically accurate data on which to base his method of procedure. Hence it happens that even now sanitary empiricism must needs be mingled with sanitary science, and the mingling is sometimes as much of a motley as the dress of the court fool of the Middle Ages.
Since sanitary science had its origin during the present century, it will be helpful to assign a definite period for its birth. Not that any one would have the temerity to dogmatically assert that the science came into being at a fixed date, but rather to fix a period of time when the conditions working through the ages were so shaped that, perforce, the problems of sanitation would thereafter be treated more in a scientific and less in an empirical method than before. This time is associated with the beginning of the reign of Queen Victoria of England, since the first Act of Parliament for the registration of births, marriages, and deaths was passed in 1837, and the beginning made of accurately gathering information which is to the sanitarian what the pulse is to the physician. With his fingers on this tell-tale of the flow of the heart-blood of the nation, he is enabled to determine whether disease is above or below the normal, the character of the disease that abounds, and its whereabouts. Knowing where to find any disease in excess, he can study the conditions and surroundings, comparing them with other places, whether afflicted in like manner or, more favored, free from the disease. By means of these vital statistics he can compare year with year, and tell with a degree of exactness heretofore impossible whether any disease is increasing or decreasing; he can lay his returns by the side of the figures of the meteorologist and learn if the weather has any influence on the death-rate; he can follow the results of his efforts to improve the condition of the people and vindicate his expenditure of the public money by pointing to the reduced mortality rate. It may seem to be a gruesome task for every physician in the land to send to the proper official a notice of each death and of each patient suffering from a disease apt to be communicated to some one else; and almost ghoulish for the officer to sit at his desk, day after day, and catalogue and tabulate these returns. But it is only a modern version of the old riddle of Samson, out of the bitter came forth the sweet; for without this, much of the progress of sanitary science would be well-nigh impossible.
The act adopted in Great Britain has been modified and improved upon since then, and in the United States many of our cities and some of our States have been engaged in a similar effort. As yet we have no central bureau or collecting office for the nation; nor is this necessary, if each State would do its duty, or, at least, the general government in that event need only tabulate the returns of each of the States. The effort is now making, under the auspices of the American Public Health Association, to secure a uniform method of registration in all offices collecting vital statistics, by which the same name will be given to the same disease and the same facts recorded in each return made. This will cause a little confusion at first in those offices where statistics have been tabulated for a number of years, but the advantage will be so great as to fully repay any inconvenience at the first. If we desire to obtain the full benefits from the advance of sanitary science, we must see to it that in every State there is an efficient bureau of vital statistics, whether under the supervision of the State Board of Health or some other department of the State. The absence of such a bureau reflects upon the intelligence of the people or the integrity of the law-making power.
Are there tangible results to warrant so sweeping an assertion? is a fair question, since at the time of the preparation of the census of 1890 New Hampshire, Vermont, Massachusetts, Rhode Island, Connecticut, New York, New Jersey, and Delaware were the only States collecting vital statistics, and since then but Maine and Michigan have been added. Before quoting figures, it must be premised that even now the returns only approximate accuracy; they were much more inaccurate at the first, and before the general registration was undertaken most of the statements are merely estimates, after the fashion of the geographer who gives the number of inhabitants in China, where a census never has been taken. It may happen that the benefits are not as great as the figures seem to show, but after making all allowance there is great improvement.
LIVES SAVED BY PUBLIC-HEALTH WORK.