A SINGLE OBSERVATION.

129

The "Scientific Committee" of the late Medical Council show, indeed, that, in this instance, and upon an area of 78,000 acres, the mortality from cholera, in the several sub-divisions, was not materially influenced by their respective densities of population.

But, as they candidly remark, the materies morbi of cholera was evidently diffused over every sub-district of London; and we may infer that the aggravating effect of the crowd told throughout the metropolis; and rather contributed to its total excess of mortality, than acted solely upon those smaller sub-divisions in which the crowd was closer. Besides, in some of these districts, there might be other modifying influences, temporary or permanent.

That the apparently slight effect of aggregation was on this occasion accidental and exceptional, becomes more probable from the circumstance that some of the most confessedly healthy parts of the metropolis-e. g., Hampstead-exhibited at the same time a disproportionate amount of mortality,-telling as much against a law of altitude as against a law of aggregation.

This circumstance affords an illustration of the insufficiency of limited and temporary observations. It shows the caution necessary in making use of them.

Among Hecker's admirable remarks on State inquiry, occur the following, which are quite pertinent to this matter:

"Such an insight into the nature and cause of popular diseases as is worthy the dignity of a science cannot be obtained by the observation of isolated epidemics, because nature never, in any one of them, displays herself in all her bearings, nor brings into action, at one time, more than a few of the laws of general disease. The experience of all ages is the source whence we must in this case draw, and medical investigation is the only road which leads to this source, unless, indeed, we would be unprepared to meet new epidemics, and would maintain the unfounded opinion that medical science, as it now exists, is the full result of all preceding efforts."*

§ 9. It is to be inferred, though it is not stated in so many words, that a decided majority of the respondents to the inquiries

* Epidemics of Middle Ages-Syd. Soc. p. 178.

K

circulated by the College of Physicians, either assert that the disease is communicable from person to person; or manifestly lean to that theory, without excluding other modes of its diffusion; or cite instances which can be explained on no other hypothesis but that of human communication, without expressing an opinion about them.*

This apparent decision of a probable majority of the profession in England, is corroborated by the recorded experience of the Dispensary Commissioners in Ireland, and by the majority, I believe, of the ablest foreign writers on the subject.

I am not now arguing a disputed question, as to the outbreak and extension of cholera in localities, or I might adduce additional facts which seem to admit of no other solution than the above. But it is to my purpose to notice that, while Dr. Baly is opposed to the exclusive theory of its spread by personal infection that is, by a material emanation from the bodies of the sick-he states that "a large body of evidence renders it certain that human intercourse has, at least, a share in the propagation of the disease, and that it, under some circumstances, is the most important, if not the sole means of effecting its diffusion." The probability of its being conveyed in this way by ships,† by importation, and along main lines of military march or commercial traffic|| on land, is almost converted into a certainty, by the facts which he brings to bear upon the discussion.

§ 10. The College reporter leaves, and wisely leaves, several important points undetermined, for future investigation. Had the official machinery for collecting facts been universal, and their registration compulsory and systematic, conclusions on one or more of these points might have been irresistible.

At all events, enough has been done thoroughly to explode and demolish the unphilosophical arguments and the dogmatical assertion of the first General Board of Health,-namely, that diseases, so specifically and essentially different, as the typhus of

* See Dr. Baly's Summary of 84 Medical Communications, pp. 3, 4.

+ Page 128.

+ Page 131.

|| Page 135.

BOARD OF SANITARY WORKS.

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Western Europe, the carbuncular or glandular plague of the East, the hæmagastric pestilence of the Tropics, and the cholera of the whole world,-each and all arise from the same cause or set of

causes.

It is marvellous that a Board, which, through its favourite organ of periodical criticism, presumed to accuse learned and painstaking medical writers of "ignorance of the most obvious rules of evidence"-" want of inclination or ability to analyse testimony," and "unreasoning credulity"+-should itself have ventured upon statements and conclusions so rash, so illogical, and (it must be added, when one considers the character and qualifications of the persons attacked) so dangerous to its own reputation.

§ 11. Doubtless, some advantages resulted from the independent and often differing views and conclusions of the three official reports on the second invasion of cholera. The plurality of reports afforded greater scope for originality of design and expression. Distinct lines of investigation were perhaps more boldly followed out.

But it was probably to avoid the repetition of a comparison so disadvantageous to the Board of Sanitary Works, that the acute and energetic baronet, who recently presided at that Board, determined upon comprehending within his own department the labours of the same statistical and medical authorities who had given the literary coup-de-grace to his predecessors.

His Medical Council accordingly contained the very authors of the two etiological reports last mentioned, And the result of his arrangement proves that the State is no loser by enlisting the co-operation of science, or by confiding sanitary inquiries to those whose special education and pursuits entitle them to be thus trusted.

It is, however, no less to the honour of medicine than to the discredit of the Government, that this medical council was unsa

Edinburgh Review, Oct. 1842, "Quarantine," &c.

+ What would the venerable author of Medical Logick have said to such impertinence ?

132

LABOURS OF THE MEDICAL COUNCIL.

laried; that the whole body of local evidence from medical practitioners was supplied and collected by voluntary effort; and that the labours of the three committees* were rewarded only by the gratitude and approbation of those who were capable of appreciating them.

It is also painful to add that the council seems to have been dismissed without an assurance on the part of Government that some comprehensive measure of public health should be forthcoming, which would recognise the medical profession as a main and independent constituent of the central and local organization requisite for sanitary inquiry and administration.

This is the more surprising, as the same council forcibly pointed out the necessity of an uninterrupted continuance of scientific inquiries during seasons of comparative immunity from epidemic disease, and the disadvantage under which they themselves laboured from not being called into existence until the pestilence had already passed its culminating point. Whether referring to former official reports, or by way of suggestion for future arrangements, they went on to remark, very truly,† "The way had not been sufficiently cleared by preliminary inquiries, and the prospective path of investigation had not been traced or enlightened by any scientific pioneers."

§ 12. The report of the Scientific' Committee at once declares, what I have already laboured to prove, that no correct idea of public disease in its relations to public health can be formed until the State establishes a registration of sickness.

"The list of the killed is complete; what was the number of the wounded?"‡

More than three hundred medical men afforded information as to the attacks attended by themselves; and the committee draw

*(1) The Committee for Scientific Inquiries, (on the history, statistics, ætiology and pathology of this cholera visitation); (2) the Treatment Committee; (3) the Committee for Foreign Correspondence.

The Administrative Reports were committed to Drs. Sutherland and Milroy. Rep. Scientific Committee, p.

Gen. Rep. Medical Council, p. 4.

9.

EPIDEMIOLOGICAL SOCIETY.

133

certain inferences from those returns as to the number attended by other practitioners. How different might be the result, how much more reliable the conclusion, how beneficial to the sufferers from disease, and how useful to the public, if the State possessed a competent machinery for discovering, inspecting, and recording disease in every district and institution of the land!

In a scientific aspect, perhaps the most interesting feature of this inquiry is Mr. Glaisher's Report on the relations possibly subsisting between the outbreaks of cholera and certain meteorological conditions.

These observations, confined to the metropolis, seem to throw some light upon Dr. Farr's law of greater mortality at lower altitudes. But on this point also no satisfactory conclusions can be drawn, until meteorological records and other physical researches are made compulsory everywhere.

§ 13. In this department of medical investigation, as in many others, voluntary association has attempted much, and indeed has performed more than can be permanently expected from it.

The foundation and progress of the Epidemiological Society are facts most suggestive to all who are interested, officially or as amateurs, in the improvement of the public health.

Its objects were high and noble :-"To institute a rigid examination into the causes and conditions which influence the origin, propagation, mitigation, prevention, and treatment of epidemic diseases; to collect and promulgate, with relation to these subjects, such facts as appear to be established on sound and sufficient evidence; and to point out those methods of investigation by which the misleading influence of false or deficient evidence may be best avoided."

The Society further proposed "to institute in this spirit of careful inquiry" original and comprehensive researches into the

* "Mr. Glaisher has clearly shown, that in the low-lying districts, wherein the epidemic assumed its highest malignity, the air was stagnant, and moisture, impregnated with impurities, was especially induced to hover."-General Report of the Medical Council.