Chapter XI.-Ventilation and Heating of Dwellings Chapter XII.-Pollution of Atmosphere by Manufactories 116 Chapter XV. Vaccination and Re-vaccination Chapter XVI.-Disinfectants-Deodorants-Antiseptics CORRECTIONS. Page 17. Title of page, for "Dublin," read "Duties." Line 15 from bottom, for "212," read "140." 100 First line, for "theain," read "the air." 104 For "Beall and Daucer," read "Beale and Dancer." 112 Title of page, insert before "ventilation," the word "bad." 128 Fourth line, read "Zeitschrift," for "Weitzschrift." 144 253 A MANUAL OF HYGIENE. CHAPTER I. INTRODUCTORY. The Public Health (Ireland) Act of 1874 has created a permanent army of sanitarians for Ireland. In virtue of this Statute every dispensary doctor has become a medical officer of health, and in every Poor Law Union and in every town of more than 6,000 inhabitants it renders compulsory the appointment of at least one inspector of nuisances. This Act constitutes the Local Government Board of Ireland the highest public health authority in the country, and entrusts to it important directive and controlling powers, in relation to the local sanitary authorities. As the Act increases the work of the Poor Law medical officers, so also it increases their salaries. It was the intention of the framers of the Act that the amount of the increase should be determined by the Local Government Board; but the clause to that effect was amended so as to allow the local authorities to settle this important point. It is to be hoped that they will deal liberally with their medical officers, and it is well that they should bear in mind that their decisions on this point are subject to the approval of the Local Government Board. As in England one half of the salaries of the medical officers of health is paid out of the imperial exchequer, there is little doubt but that a moiety of the Irish health officers' stipend will be paid out of the same fund, agreeably to section 10 of the Public Health Act, 1874. When, therefore, a Board of Guardians votes an increase of £30 a year to their medical officer, as remuneration for his work as health officer, it really only gives him £15 a year out of the union fund. The Public Health Act, Ireland, 1874, is chiefly intended to organize an administration for the purpose of carrying into effect the sanitary laws previously enacted. No doubt it will, in due time, be followed by other acts, framed for the purpose of dealing with sanitary evils which existing Statutes are unfitted to suppress. Perhaps, too, we may have before long the existing sanitary enactments codified, amended, and reconciled with each other; for at present many of them conflict. They are very numerous, too, if we include with the purely Sanitary Acts those relating to the protection of life and health, such as the Storage of Petroleum Act, the numerous Acts in reference to seamen, mines, and factories, and the Building Acts. The sanitary condition of the majority of Irish towns is far from satisfactory. Most of them are badly drained, and are deficient in good supplies of water. Their death rates are often above the normal standard. This unsatisfactory state of things is to some extent due to want of wealth. Rich towns are more likely to be properly sewered and abundantly supplied with pure water than 2 poor ones. Irish Sanitary Statutes. The Making due allowance for the comparative poverty of Ireland, her people have, on the whole, shown a strong predilection for the enactment and enforcement of sanitary measures. laws relating to vaccination have been cheerfully obeyed by all classes in this country. The Adulteration Act of 1860 was not put into force in any part of the United Kingdom, save Ireland. The first comprehensive Public Health Act passed by the British Parliament (that of 59 Geo. III., cap. 41) was applicable only to Ireland. In the Statutes of the Parliaments of Ireland we find numerous acts relating to public health. liament of Ireland), prohibited the making of bricks within two 2 Geo. III., cap. 6 (Parmiles of the public lamps of Dublin, under a penalty of ten shillings per 1,000 bricks made. 11 and 12 Geo. III., cap. 28, prohibited the erection of lime kilns within the city of Dublin, on the ground that they were a nuisance and injurious to health. There are now several lime kilns situated in the most central and densely inhabited parts of this city! Other noxious manufactures were dealt with by the Irish Parliament. Health Act for Dublin was passed, which enacted amongst other In 1717 a kind of Public useful measures that any driver of a cart or waggon who sat on the vehicle instead of walking at the horse's head was liable, on conviction, to be fined, imprisoned, or publicly whipped, at the discretion of the justices. If this Act (which probably has never been repealed) were now enforced in Dublin the mortality from street accidents would be sensibly lessened. food, drink, and medicine, several enactments are to be found in With respect to articles of the Statute Books of the Irish Parliaments. Early in the reign of George III. an Act was passed to guard against the sophistication of drugs. In 1719 an Act was passed to prevent the pollution of the River Dodder, which at that time was one of the chief supplies of water for the city of Dublin. with superior wines, and the adulteration of wines and other In 1665 the mixing of interior alcoholic liquors, were created statutable offences by the Act 18 Charles II., cap. 19. A long list of the articles, the addition of which to wines, &c., was illegal is given in this Act, and in substance resembles the adulteration clause of the Licensing Act of 1872. The penalties created by this Act were increased from £20 to £50 by a subsequent Act, passed in 1759. Political medicine, strictly speaking, concerns itself but little relative to the cure of disease: the problem which it seeks to solve is, how disease may be averted. gations of the pathologist and the physiologist establish more or The results of the investiless accurately the nature of a malady, and suggest the appropriate treatment. The cultivator of political medicine, applying the knowledge acquired by the labours of the physiologist and the pathologist to his own purpose, endeavours to remove the cause or causes which produced the disease. to the study of public hygiene require, therefore, a more extended Those who devote themselves knowledge of science than a mere physician or surgeon, who occu Specialists in Sanitary Science. 3 Sani pies himself solely with the curative treatment of disease. tary science is made up of many branches of knowledge, and the great questions relating to the public health can only be successfully answered by those who combine in themselves the knowledge -more or less profound-of the physician, the chemist, the physicist, the botanist, and the geologist. It is to be regretted that the Public Health Act of 1874 does not provide appointments for such a class of men: and let us hope to see ere long every county in Ireland made a separate health district, and placed under the sole direction of a medical sanitarian. There is much wanted a class of highly-educated medical men who would wholly devote themselves to sanitary science. Physicians who are so fortunate as to have numerous patients cannot, as a general rule, spare time for purely scientific pursuits not directly affecting their practice; and it requires no argument to prove that very few active practitioners could successfully study such subjects as, for example, the water supply and sewerage of towns, the heating and ventilation of dwellings, epizootics dangerous to man, and epiphytic outbreaks-all of which relate to the public health. There is a wide field for the labours of the professors of preventive medicine. A large proportion of the deaths which daily occur in these countries are due to diseases which hygienic means, vigorously employed, are capable of extirpating. Small-pox, some years ago, annually carried off several thousands of persons in Ireland alone; but, owing to the rigorous enforcement of that infallible preventive-vaccination-this loathsome disease has almost been "stamped out" in this island, though still permitted to ravage the sister countries. There is sufficient evidence to justify the belief that fever, cholera, whooping-cough, and, in a word, all infectious and contagious diseases, are produced by the introduction of an animal poison into the body-each variety of poison producing a different disease. These poisons are as much entities as are arsenic or strychnine; and as they possess in all probability an organized structure, they are capable of reproducing themselves under favourable conditions-that is, when located in the human body. On the other hand, it is nearly certain that these poisons cannot long exist in air, water, or earth. If these statements rest upon a foundation of truth, as I believe they do, then how important are not the problems of preventive medicine! The nature of the virus of each contagious disease has to be exhaustively investigated, and the conditions under which it is developed have to be discovered. These points ascertained, it would be easier to suggest efficacious measures for the prevention of the disease; and these measures might then come within the domain of State, or political medicine, and have to be enforced by sanitary enact ments. The effective administration of sanitary laws and the discovery of the facts upon which they are based involve a liberal pecuniary expenditure. Until very recently the money required to carry on |