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Definition of Hygiene.

investigations relative to the public health was doled out in miserably small sums by the State. At present more enlarged and liberal ideas relative to sanitary matters prevail amongst the governing classes; and the Public Health Acts of 1872 and 1874 are a kind of recognition that the health of the British people is a matter worthy of the attention of our rulers.

The largest portion of the revenue of the country is devoted to the maintenance of our army and navy, designed to preserve to us our lives and liberty. This is a wise precaution; but are there not other enemies than our fellow-men, whose power we should always be prepared to resist? During the greatest wars waged by Great Britain, the deaths of her soldiers and sailors in actual combat were never a tithe of the number of her civil population slain by preventible diseases. In Dublin alone, small-pox, in a single year, has often killed more people than the British army lost at the battle of the Alma; and zymotic diseases annually carry off in London more lives than were lost by our army at the battle of Waterloo. I think I have said sufficient to convince even the most sceptical that the people of these islands require an army of sanitarians to protect them from the ravages of diseases which naturally have no abiding place amongst them. He who vanquishes those deadly enemies of man achieves a victory far more glorious than ever warrior won. Triumphs over those foes are not followed by the wail of the widow or the cry of the fatherless. The sole fruits of the conquest are long life, health, and happiness; and surely these are trophies worthy of a nation's ambition. I trust that at no remote period a fair proportion of the public funds will be devoted to the paramount object of promoting every measure tending to improve the health and increase the longevity of the community.

Hygiene is the science which relates to the physical condition of man, and to the means by which his health may be sustained, and his life prolonged to old age. were known to the ancients. Many of the laws of this science vantages resulting from the use of wholesome food, good water, Asclepiades was aware of the adand pure air, and insisted that dietetic means were the most important in promoting health. Herodicus, five centuries before the Christian era, employed gymnastic exercise in the treatment of disease, and as a means of preserving the health. Many of Hippocrates' medical aphorisms refer to the means by which the body may be invigorated, and life prolonged. Pythagoras wrote much on sanitary subjects, and often with great acumen. Greeks, the first code of State sanitary laws was that propounded Amongst the by Lycurgus, which, severe, and even cruel, as it undoubtedly was, powerfully contributed to produce a race of vigorous, healthy, well-formed men. The sanitary observances of the Athenians, less severe than those practised by their sterner Spartan neighbours, yet served to preserve the physical condition of their bodies, without retarding the development of their intellectual faculties.

Insanitary State of Medieval Towns.

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That the laws of public health observed by the classic Greeks were admirably adapted to promote the beauty of the human form, the exquisite marbles of Phidias and Praxiteles, of Scopas and Agasias, testify even at the present day.

The Romans contributed but little to the science of medicine; but they must at least have had a good practical acquaintance with military hygiene, for, even in modern times, the sanitary condition of armies in the field was inferior to that of the Roman legions during campaigns.

The Jews have long enjoyed the inestimable advantages of a code of sanitary laws derived from a divine source, and implicitly observed for a period of 3400 years by the great majority of that people. They have always suffered less than Christians during epidemics; and the comparative immunity of this "peculiar people" from contagious and infectious diseases is evidently due to their habits of personal cleanliness, so imperatively enjoined by their religion.

During the middle ages very little attention was given to the subject of public health. The houses of the middle and lower classes were small, and the rooms incommodious and dark, and ill ventilated. The towns and cities were mostly enclosed within high walls; there were no sewers; the streets were unpaved and unlighted; the water supplies were often impure; and the dead were interred within the town. No hospitals existed for the relief of the sick, and every house in which a patient suffering from an infectious malady lay became a focus from which the disease spread. These were, as a general rule, the conditions under which the denizens of European towns existed during that long and dreary period which so truly has been termed the dark ages. The disregard paid to the most obvious rules of health by the inhabitants of medieval cities produced a frightful mortality, which occasionally culminated to a point which threatened the extinction of populous communities. The average duration of human life did not exceed 20 years, and in some very unhealthy towns it was not more than 18 years. Dr. Farr states2 that the mortality of children has been diminished to one-half during the last half century. In London the proportion of deaths of children under 5 years were

From 1730 to 1749

1770,, 1789 ... 1851,, 1870 ..

...

...

At a late period, when great strides in civilization had taken place, London was, with respect to sanitary matters, very much in

De la Vitalité de la Race Juive en Europe; par M. Levy. Annalesd'Hygiene Publique, t. xxv., 2nd series, 1866. A paper full of most interesting information relative to the biostatic peculiarities of the Jews.

'MacCulloch's Statistical Account of the British Empire, vol. ii., page 543.

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Epidemics of the Middle Ages.

the same condition, or, perhaps, worse than in the darkest period of the middle ages. Between the years 1629 and 1635 five persons in every hundred died annually in London. From 1660 to 1679-a period in which the frightful "plague" ravaged the city -the annual death rate was 8 per cent. From 1728 to 1780 the average number of deaths per hundred living was five, showing the mean duration of human life to have been only 20 years. At the present time London is the healthiest of the large cities of the United Kingdom, its death rate being less than 23 per 1,000 living.

I have stated that during the middle ages-indeed, I might have said until the eighteenth century-disease occasionally threatened to extirpate whole communities. In the fourteenth century a dreadful epidemic swept over Europe, destroying millions of persons, and creating universal consternation. It was known by the terrific term, black death, and few affected by it recovered. It was a highly inflammatory malady, the more prominent symptoms being eruptions of painful boils, expectoration of blood, inflammation of the lungs, bleeding at the nose, and black or blue patches on portions of the body, more especially the tongue and fauces. Sometimes the patient fell into a profound sleep, from which there was no awakening in this world; at other times there was continued sleeplessness during the whole course of the disease. This malady appears to have been beyond the reach of medical skill. It spread to the lower animals, of which immerse numbers perished, more especially in the south of Europe. There is evidence to show that the black death originated in Asia-most probably in Chinaand gradually spreading westward, entered Europe, where, owing to the insanitary condition of the towns, the virus of the disease found a congenial, fructifying soil. It has been contended that the black death probably originated sporadically in Europe, owing to the filthy habits of the people; but I think it is most likely that the germ of the disease came in the first instance from the Eastthat fountain head of pestilential streams.

The history of nations is but little more than the biographies of monarchs. The annals of our country are ample on all subjects of a political character; but the inner life of the people, their habits and customs, their social condition and peculiarities, are topics which the historian touches lightly upon, or leaves unnoticed. The frightful pestilences which desolated the west of Europe in the fourteenth century are either not mentioned in the popular histories of France and England, or if alluded to, the space devoted to the description of those events, of such momentous interest to man, is less than that occupied in describing the personal appearance of a king or the details of a petty battle. Imagination fails to realise the extent of misery caused by the epidemics of the fourteenth century. In the great outbreak to which I have just alluded, it has been estimated that nearly 40,000,000 people perished in the east alone. In Germany, where the disease was least virulent,

Quarantine in the Olden Time.

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more than 1,200,000 fell victims to it. In Italy the mortality was frightful-Venice lost 100,000 of her citizens, Sienna, 70,000, and Florence, 50,000. In London the disease raged with great violence, 50,000 persons having been interred in one burial place. Throughout the whole country it is certain that more persons fell victims to the disease than were spared by it; for, according to one statement, but evidently an exaggerated one, not a tenth of the inhabitants were left alive. It has been stated that the black death carried off, at the most moderate computation, a fourth part of the inhabitants of Europe, or about 25,000,000 of souls.

I have alluded to the dreadful epidemics of the middle ages in order to show the great saving of life which has resulted from the improvement of the sanitary conditions of towns, and also from the more general habits of personal cleanliness which distinguish the modern Europeans from their medieval ancestors. I also wish to direct attention to those almost forgotten calamities, because they are calculated to teach us important lessons. Are we sure that we are safe from another visitation of the black death? There are epidemiologists who believe that the germs of this disease still linger amongst the deep valleys of the Himalayas, and that they may yet be wafted to Europe. If such an event should ever unfortunately take place, I fear that in some of our towns the virus of the disease would find a genial soil; but the general sanitary state of Europe renders unlikely the recurrence of the painful scenes of the fourteenth century. We know the means by which all such diseases may be successfully resisted, and it is to a great extent our own fault that even the Asiatic cholera is still allowed to force its way periodically into these countries. It was early discovered that these epidemic diseases were contagious, or, to use a popular expression, catching; and shortly after the first great outbreak of the black death, precautions were adopted in Italy for the purpose of isolating persons suffering from contagious disease. The earliest regulations for this purpose were issued on the 17th January, 1374, by the ruler of Reggio, the Viscount Bernabo, and they appear to have successfully accomplished his object. Bernabo's regulations, and those of his successor, were based on principles, the soundness of which is surprising, when we consider the darkness of the age in which they were framed. The patients were removed to the open field, and those in attendance upon them were not allowed to come in contact with healthy persons. Every consumable substance which had been in contact with the sick was committed to the flames. The houses of the affected were disinfected; and persons coming from places in which the disease existed were rigorously refused admission. Bernabo's regulations were, with various modifications, followed by the various States of Italy. In 1485 the first lazarettos, or quarantine houses, were established; and about 40 years later "bills of health" were issued to ship masters, stating whether or not the port from which they sailed was the seat of disease.

Since the sixteenth century the progress of sanitary legislation has been slow; but within the last few years increased attention has been given to the important subject of public health, and the prospects of great improvements being effected in it are brighter than they have ever been. The causes of epidemiological diseases are now being thoroughly investigated. Local authorities are improving the hygienic condition of towns. The people are gradually being supplied with pure water; and the legislature has taken active measures to prevent the pollution of our rivers and atmosphere. Every part of the United Kingdom is now provided with health officers.

CHAPTER II.

DUTIES OF SANITARY AUTHORITIES AND OFFICERS OF HEALTH.

SANITARY AUTHORITIES.

Under the provisions of the Public Health (Ireland) Act, 1874, this country is divided into sanitary districts of two kinds termed respectively urban and rural. The former comprise Dublin and the other incorporated towns, the towns and townships with local acts, and all towns of more than 6,000 inhabitants, having municipal governing bodies under the act of Geo. IV., relating to the lighting, cleansing, and washing of towns, under 3 & 4 Vict., cap. 108, and under 17 & 18 Vict., cap. 103. The rural districts comprise the poor law unions, except such parts of them as are included with urban districts. There are 38 urban, and 163 rural, districts. The present governing bodies of these districts-corporations and commissioners-are the sanitary authorities therein. They are entrusted with the execution of the Sanitary Acts, and have transferred to them all the sanitary powers formerly exercised by the "sewer" and "nuisance" authorities. During periods of epidemics the powers wielded by the municipal authorities relative to disinfection, burial of the dead, the conveyance of the sick, the providing of hospital accommodation, &c., are transferred temporarily to the Boards of Guardians of the urban districts. The sanitary authorities in the towns are for the first time brought under the supervision of the Local Government Board; whilst the same authority continues to exercise that control over the actions of the Boards of Guardians which it always did under the provisions of the Poor Law Acts.