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tion by some whose long study and experience in Military Hygiéne qualify them specially for the task of criticism and advice; and, secondly, because I would fain hope that the recent publication of an authentic Report-showing that thirty-five per cent. of our forces in the Crimea perished in about six months, owing chiefly (as it appears) to gross neglect of the most obvious precautions for the preservation of health and life, and to want of power in the Medical Department to enforce attention to its recommendations-may convince the most sceptical that the success of a campaign depends as much upon the completeness and efficiency of the medico-sanitary organization of the army as upon the strategic skill of its Generals or the heroism of its soldiers, and may thus impel the nation and the Government to make permanent provision against a recurrence of late errors and calamities.
The publication of these Essays has been deferred much longer than I intended; and I may perhaps state, as the main cause of the delay, that the greater part of the work has been written during the brief, uncertain, and weary intervals of an active professional life, and that, for months together, I have been unable, from various causes, even to look at the manuscript. I have also laboured under the disadvantage of being out of reach of any good library of reference; such literary accommodation being as yet supplied in very few of our provincial towns.
These circumstances are mentioned, not with the object of deprecating all fair criticism, but in the hope of encouraging others, more favourably situated, to pursue the subject more carefully and successfully.
The few who may be acquainted with my former writings, especially the Health and Sickness of Town Populations, may observe that I have often referred to them, and sometimes quoted from them without acknowledgment. If the authority of a great example be considered a sufficient justification for taking such a liberty with oneself, I may offer the following extract from the Editor's preface to Coleridge's Table Talk (2nd Ed., 1836):—
"Mr. Coleridge's prose works had so very limited a sale, that although published in a technical sense, they could scarcely be said to have ever become publici juris. Hence, in every one of his prose writings there are repetitions, either literal or substantial, of passages to be found in some other of his writings, and there are several particular positions and reasonings which he considered of vital importance, reiterated in the Friend, the Literary Life, the Lay Sermons, Aids to Reflection &c."
SINCE the Essay on Medical Education has passed through the press, another edition of the Bill for regulating the Medical Profession has appeared. The alterations it contains are not important. If any portion of the measure should perchance become law, the new clause (29) which empowers any one of the several colleges to procure the erasure of names from the National Register of legally qualified practitioners, will scarcely be allowed to pass. Another and more serious alteration is for the worse. According to the scheme of constituting the proposed Medical Council in the first version of this Bill, an undue, or at least disproportionate share of influence was to be conceded to the Scotch Colleges and practitioners (see p. 79). This preponderance is now to be made more remarkable, for out of the total number (twenty-four) not fewer than nine members of Council are awarded to Scotland, not more than nine to England, and only six to Ireland.
One is curious to know whence this amended scheme of representation proceeded.
CHELTENHAM, April 2nd, 1856.
2. Chemical Analysis. 3. Meteorological Observations, 13.
Subdiv. C. Jurisprudence. - § 1. Death-inquests, 13. 2. Personal
Disqualifications. 3. ... other Legal Questions, 14.
CHAP. THIRD-DIV. II. SANITARY REGULATIONS:
Subdiv. A. Preventive Measures. 1. Localities, 15. 2. Construction of
Towns and Buildings, 16. 3. Purification of the same,-viz., Nuisances,
-Water-supply,—Drainage and Sewerage,-Pavements,-Smoke, 18—20.
§ 4. Healthy progeny, physical education, 21. § 5. Sale of food, 22.
§ 6. Sale of medicines and poisons, 24. § 7. Trades and occupations,-
protection of operatives and of public, 24-26. § 8. Locomotion, 27.
§ 9. Recreations and places of public resort, 27-29. § 10. Public estab-
lishments, 29. § 11. Burial, 31.
Subdiv. B. Palliative Measures;—firstly, ordinary. § 1. Medical atten-
dance, 32. § 2. medicines and dispensaries, ib. § 3. Hospitals, &c., 33.
§ 4. Medical officers, 34. Secondly, during Epidemics.—§ 5. Preparatory
measures, 35. § 6. domiciliary visitations, &c., 36. § 7. Quarantine, 37.
§ 8. Vaccination, 38. § 9. Animal diseases, 39.
CHAP. FOURTH.-DIV. III. ADMINISTRATIVE MACHINERY:
Subdiv. A. Education of Agents.-§ 1. Medical education, 40. § 2. Licence
and Registration, 41, 42. § 3. District faculties, 42. § 4. Rights and
immunities, 43. § 5. Education and licence of other therapeutic agents, 44.
§ 6. Veterinarians, 45.
Subdiv. B. Official Authorities,-Councils and Boards.-§ 1. Metropolitan
Sanitary and Medical Council, 46,—its sections, 47. 2 2. Local Boards, 48.
Territorial Divisions. § 3. Sanitary districts, 49. § 4. Officers.-A. of
Central Council, B. of District Boards, c. of parishes, 50-53.
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§ 1. Introductory, 61. § 2. "Medical Reform," ib. § 3. Conflict of Col-
leges, ib.
§ 4. Protection to practitioners, 62. § 5. Heterodoxy, 63.
§ 6. Prohibition of ignorant pretenders, ib. § 7. Varieties of empiri-
cism, 64. 8. Protection to public, 65. § 9. State intervention in medical
education, 66. §§ 10 and 11. Professorships of Medical Jurisprudence and
Hygiéne, 67. § 12. Council of State Medicine, 69. §§ 13 and 14. Sub-
jects for medical studies and Regulations of Council, 70. § 15. Final ex-
aminations, 71. § 16. Limitation of numbers admitted to practise, ib.
§ 17. Examination for civil appointments, 73- $ 18. Age for licence to
practise, 74. §§ 19 and 20. State and Collegiate qualifications, 75.
§ 21. Obstetric art, 76. § 22. Pharmacy, ib. § 23. Chemists and Drug-
gists, 77. § 24. Last Medical Reform Bill, 78. $ 25. Its Council of
Medicine," 79. § 26. Plea for legislation, 80. § 27. District Faculties, 81.
§ 28. Practitioners' fees, ib. § 29. Penalties against Irregulars, 82.
§ 30. Medicine and Literature, 83.
CHARACTERISTICS OF ANCIENT AND MODERN
INQUIRY.
§ 1. Early records, 87. § 2. Hippocrates, 88. § 3. Lord Bacon, 89.
§ 4. Principles of Inquiry, 91. §§ 5 and 6. Statistical errors, 92.
§ 7. Health of Towns' Inquiry--sanitary reports-interment reports, 94.
§ 8. medical evidence 97. § 9. recent
official inquiries 98.
§ 10. Local inquiries, 99. § 11. indefinite results, ib.
CHAP. SECOND.-SUBJECTS ON WHICH PUBLIC SANITARY INQUIRY NEEDS EXTEN-
SION AND PERMANENCE IN ENGLAND.
§ 1. Neglect of duty by Government, 101. § 2. General register office, ib.
§§ 3 and 4. Certification of causes of deaths, 102. § 5. Statistics of Sick-
ness, 106. §§ 6 and 7. Medical relief returns-England and Ireland, ib.
from hospitals and dispensaries, ib. § 9.
from undefined classes, ib. § 11.
§ 10.
§ 12. from labourers in civil service, 109. §§ 13 and 14. Influence of
trades upon health and life, 110. § 15. "Industrial Pathology," III.
§ 16. Effects of "great-town" system, 112. "Flats" and cottages, 113.
§ 17. Inquiry as to food, 114. § 18. Agricultural statistics, 115.
§ 19. Climate and meteorology, 116. § 20. Voluntary meteorological
returns, 118. § 21. Local publication of sanitary reports, 119.
§ 22.... necessary to remove current fallacies, 120.
CHAP. THIRD.-INVESTIGATION OF EPIDEMICS.
§ 1. Our ignorance thereon, 122. §§ 2 and 3. Certain conditions of inquiry
and qualifications of inquirers-course taken by Board of Health, 123.
§ 4. Effects of pestilence upon research, 125. 85. Board-of-Health inquiry
in 1849, ib. § 6. Registrar-General and Dr. Farr-law of altitude, 126.
§ 7. College of Physicians and Dr. Baly, 127. § 8. law of aggregation, 128.
not affected by a late observation, 129. § 9. Personal communica-
bility of cholera, 130. § 10. Board of Health refuted, ib. § 11. Course
adopted in 1854, better, yet incomplete, 131. § 12. Want of registration
of sickness, 132. § 13. Objects of Epidemiological Society,
§ 14.
intended to supersede State action-mistakes and failures, 134.
§ 15. International Congress at Paris-its programme for inquiry, 135.
§ 16. Need for verification of facts, 136. § 17. Existence of three orders
of investigators, 137. § 18. Sir John Herschel's rules, ib.
MEDICAL CARE OF THE POOR. PART I.-HISTORICAL.
CHAP. FIRST.-FROM THE REFORMATION TO 1827.
§ 1. Medieval provision, 141. § 2. Separation of medicine from the ecclesias-
tical office, 142. § 3. Legislation under Henry VIII.—Diocesan medical
licences, 143. § 4. Establishment of College of Physicians, 144.
§ 5. Diminished number of practitioners, and their higher demands, 145.
§ 6. No public medical provision, 147. § 7. Statute of Elizabeth, 148.
§ 8. Plan of John Bellers, 149. § 9. Institution of Hospitals, T. Guy, 150.
§ 10. Statute of 1790, 151. § 11. Rise of parish medical contracts, 153.
§ 12. Growth of pauperism, 154. § 13. Efforts of Kerrison and Burrows, 155.
§ 14. Plans of Dunn, Yeatman, &c., 156. § 15. Warwickshire committee
of inquiry, 157.
CHAP. THIRD.-FROM 1838 TO 1842.
§ 1. Limited scope of government inquiries, 163. § 2. and of official
views, 164. § 3. Aggravation of former evils-i. tenders—ii. large
districts-iii. reduction of medical staff-iv. diminution of aid-v. medical
clubs, 165-169. § 4. Defence of Commissioners, 170. § 5. Reasons
for noticing controversy, 171. § 6. Parliamentary inquiry, 1838,
Mr. Wakley, 172. § 7. Counter inquiry by Commissioners, 173.
§ 8. Sir T. N. Talfourd, 175. § 9. ... his measure, 176. § 10. General
medical order of 1842-its provisions and their deficiencies, 177-180.
CHAP. FOURTH.-PROSPECTS OF SANITARY LEGISLATION UNDER THE POOR-LAW
BEFORE 1844.
§ 1. Causes of committal of sanitary functions to Poor-Law Boards, 181.
§ 2. Vaccination Acts-1840 and 1841-dilemma of authorities, 182.
§ 3. "General Sanitary Report"-1842-official recommendations of a
poor-law machinery, 185. § 4. Prospects not fully realized, 187.
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