Chapter I. Historical

It is a law of nature that those races of animals which fail to adapt themselves to their surroundings are doomed to perish. Man, however, has learned to adapt his surroundings to himself, whereby he is enabled to live in large measure independently of climate and adverse physical conditions. Sanitary Science is the body of facts and rules which teach the art of living under those external conditions which best promote health and length of days. No part of sanitary science is, in our climate at least, more important than that which is to be dealt with in this work - the part which treats of the proper construction of the houses in which we are compelled to spend the greater part of our time.

By Frederick W. Andrewes M.A., M.D(Oxon), Fr.C.P.(L0n.D), D.P H.(Cantab). Lecture On Pathology. Pathologist And Sanitary Officer, St. Bartholomlwl Hospital, London; Asistant Physician To The Royal Free Hospital, London; Late Mieiiard Medical Fellow Of Pembroke College, Oxford

As an exact science, sanitation is of quite modern growth, yet its beginning:-are of remote antiquity. While men lived a purely nomadic life, sanitary requirements may have been almost non-existent; as soon, however, as men came to live together in settled communities, regulations became necessary, and they have gradually acquired importance in direct proportion to the size of towns and the density of population. The earliest rudiments of sanitary law may be traced in the Pentateuch, and Layard has shown that there was a system of drainage in the palace at Nineveh. We know from the writings of the ancients, and from what remains to this day, that ancient Rome possessed a municipal public-health system, with public medical officers, and marvellous works for water-supply and drainage.

With the decay of ancient civilization, sanitation lapsed into a deplorable condition for many centuries. The havoc wrought by plague and pestilence ultimately terrorized men into some attempts at sanitary improvement even during the Middle Ages. In England the commencements of sanitary regulations are to be traced in the thirteenth century, and three centuries later we find definite attempts to restrict overcrowding in London, and to improve the system of sewers. The great fire of 1666 gave to London the opportunity for reconstruction on better principles, but a false economy and prevailing ignorance prevented more than partial use being made of it. The Rebuilding Acts of Charles II. did, however, secure wider streets, walls and party walls of brick or stone, and certain standards as to the height of stories and similar matters, while special surveyors were appointed to see that the new regulations were properly carried out.

An adequate system of sanitary science requires, as its basis, a knowledge of the nature and causation of disease, and of the conditions which foster its spread. So long as men were content to accept pestilences and death as visitations of God, to be endured with Christian fortitude and resignation, no great advance was possible. But with the growth of medical knowledge arose the idea of the preventihility of much of the disease from which mankind suffered; and the gradual spread of this idea may be traced throughout the eighteenth century, owing largely to the writings of Mead, Pringle, Lind, Howard, and other pioneers in sanitation. Yet it took a century for the idea to ripen and bear fruit, and when Queen Victoria ascended the throne, there was still to all intents and purposes no sanitary legislation. Doctors there were in plenty, and abundant experience to illustrate the truths that overcrowding, bad food, foul air, damp houses, and accumulations of filth, are fertile causes of disease and death, but the duty of effective action was not yet realized by the State, and as the State alone could take such action, practically nothing was done. Local and Central Boards of Health were indeed established in the reign of William IV., and upon them devolved certain duties of inspection and advice: in the last year of his reign, too, the Act for the Registration of Births, Marriages, and Deaths was passed. This act first made statistics of health possible, and it is such statistics that have driven home the facts of sanitary science into the public mind and conscience.

It is impossible to recount here the detailed growth of sanitary reform during the reign of Victoria, but it is possible to indicate some of the chief steps. We have gained accurate knowledge of the nature of many diseases and the modes in which they spread - a knowledge based on exact observation and statistical research. Public opinion has been awakened and educated, and is now fully alive to the importance of hygienic requirements. The State has realized its responsibilities, and we have a sound body of sanitary legislation, not perfect indeed, but comprehensive and workable; we have central and local bodies responsible for the due carrying out of the law, and in every district in the country we have a qualified medical officer of health charged with the sanitary welfare of his community. The State has, in short, taken medicine into its service, and avails itself of expert advice on sanitary matters.

In most preventible diseases there is an actual direct cause and various predisposing causes. Thus we have learned in the last decade or so that consumption depends upon a specific cause - the tubercle bacillus - but we knew, long before, that damp, overcrowding, and lack of ventilation were conditions predisposing to the disease, and it has now been proved that dinattention to these matters largely reduces the mortality from it Still more recently we have learned that cholera is due to a specific comma-bacillus, but we already knew that filth, squalor, and a foul water-supply were the main factors which promoted epidemics of the disease, and by obviating these defects we have removed its chief terrors. Speaking broadly, it is in the removal of the predisposing conditions of disease that the great sanitary advances of the last half-century have consisted. Nevertheless the hands of the reformer have been greatly strengthened by the exact knowledge which bacteriology has afforded as to the intimate nature of the actual causes of infectious disease.

Two names deserve honourable and special mention in connection with sanitary reform during the present reign - those of Sir Edwin Chadwick and Sir John Simon.1 Chadwick's name will be ever associated with the general inquiry (extending from 1839 to 1842) into the sanitary condition of the people - an inquiry which revealed the enormous part played by insanitary conditions in diminishing the health and wealth of the nation, and which resulted in valuable reforms being suggested in all directions. A Royal Commission was appointed, and the ultimate result was, among other Acts, the Public Health Act of 1848. A new executive department was created - the General Board of Health, which was the sanctioning authority for the various objects which local ratepayers and boards might desire under the Act, and which framed by-laws and instructional minutes, and was energetic in its attempts to popularize district cleanliness. The character of the Board was altered in 1854, and medical inspectors were appointed; and in the following year John Simon, who had been Medical Officer of Health to the city of London since 1848, was made permanent Central Medical Officer: his name became thenceforth identified with the cause of sanitary improvements.

A new Public Health Act was passed in 1858, but the Act of 1866 began the era in which local Sanitary Authorities were compelled to take action whether they would or no, and which gave powers to all districts for the provision of a proper water-supply, provided for the sanitary regulation of the tenement-houses of the poor, and endeavoured to put down overcrowding, and unwholesomeness of places of labour. In 1871 the Local Government Board was created, and became the central controlling sanitary authority. Medical Officers of Health were made compulsory for every district in 1872, and the qualifications for such a post were raised in 1888. The great consolidating Public Health Act (1875) marks a great step in advance as Amending the patchwork condition into which the law had got, and within a few years a number of other important sanitary acts were passed. The chief among them were the Sale of Food and Drugs Act (1875); the Rivers Pollution Prevention Act (1876); the Consolidating Factory and Workshop Act (1878); the Artisans' Dwellings Improvement Acta (1875-82); the Notification of Infectious Diseases Act (1889); the Housing of the Working Classes Acts (1885-90), dealing with unhealthy areas and dwellings, and with obstructive buildings; the Public.

1 The writer has to acknowledge the great assistance which he has derived from the writings of Sir John Simon in drawing up this historical sketch.

Health (London) Act (1891), which did for the metropolis what the 1875 Act had done for the rest of the country; and, most recently, the Factory and Workshop Act of 1895.