A Paper by the Author read at the Guildhall, June 7th, 1862, before the Public Health Department of the "National Association for the Promotion of Social Science."

The object of this paper is to bring under the notice of the Association what I believe to be a most important means of rendering persons less subject to attacks of disease, and of diminishing the fatality of diseases when they occur.

This means consists in a system of periodical medical examinations during the course of ordinary health; each examination being followed by such hygienic or other advice as may be found necessary at the time.

Whether the public, generally, will ever have the foresight to adopt such a system remains to be seen. My own opinion is that, to a great extent, they will, if its objects and importance are sufficiently made known.

But it is within our power to provide for the poorer classes a certain amount of the advantages of such a system. In this paper, therefore, I shall confine myself to the question of providing these advantages for the persons who frequent hospitals.

I recommend that the authorities of each hospital shall organise a department, to which every patient discharged from its wards shall be submitted before returning to the duties of life.

The business of this department would be as follows: -

1st. To examine the patient most carefully, for the purpose of detecting what damages the organism has sustained during the last or any previous illness, and what hereditary or other predispositions exist either to a recurrence of former diseases, or to the invasion of fresh ones.

2nd. To give the patient written instructions as to the best means of avoiding the evil effects of any damages the organism has received, or of removing those damages, and as to the best means of preventing the recurrence of diseases from which he has already suffered, or to which he is predisposed by his calling in life, or by hereditary or other causes.

3rd. To give the patient a card to admit him to a repetition of the examination after a stated interval.

The object of the department would be, in a word, to see that every patient, on leaving the hospital, was fully instructed in the best means of preserving his health under his own peculiar conditions of life.

Those who are acquainted with the arrangements and working of hospitals will not need to be told, that nothing of this sort is systematically done at present, and that it is not possible to do it without organising special departments for the purpose.

My statement, that this plan, if properly carried out, "will render persons less subject to attacks of disease," is based upon the well-known facts: - 1st. That nearly all diseases require that the individual to be attacked shall already suffer from some disorder of the health, which predisposes him to be affected by morbid influences to which he would not otherwise be susceptible. 2nd. That diseases which have a tendency to recur in the same individual are nearly always preceded by some premonitory symptoms; and that, in most cases, means may be adopted in these premonitory states by which the recurrence of the disease may be prevented.

My statement that this plan, if properly carried out, "will diminish the fatality of diseases when they occur" is based upon a fact, well known to medical men, although far too little borne in mind; a fact which I have attempted to demonstrate and to impress in a course of lectures, now before the medical public, viz., that in nearly every disease to which death is popularly attributed, the real cause of death is not that disease itself, but some previously existing defect in the health of the individual which makes an otherwise curable disease end in death. This statement is also based upon another fact, which I have attempted to demonstrate and impress in my Lectures, viz., that the normal functions of the organism include a power to conduct a natural process of cure in nearly all diseases, provided the organism is in a healthy condition and surrounded by healthy conditions of life.

The way in which a curable disease becomes fatal through a previous and preventable defect of health, is well illustrated by the deaths from whooping-cough. If a child is in normal health, and surrounded by normal conditions of life, whooping-cough is a disease having a natural termination in health, and leaves the child undamaged. If, on the other hand, the child is rickety, whooping-cough is a most fatal disease, and the child will probably die; or, should it recover, will have received such damage to its organism as may prove a cause of death at some future time. The fatality of the whooping-cough, then, is in this case due to rickets, which is a preventable disease. But after the whooping-cough has set in, it is too late to prevent the rickets, and hence, too late to prevent the death from whooping-cough. This is the important point to bear in mind.

The fertile cause of rickets in the child is debility in the mother, before its birth and during lactation. Whatever means, therefore, could find out this state of debility in the mothers, and provide for its removal, would prevent the rickets in the children, and as a necessary consequence, would prevent the deaths from whooping-cough to which I have referred.

I beg to submit to the Association, that just such a means of detection and prevention is provided in the system of periodical examination and sanitary instruction which I have recommended.

To obtain the full effect of this system, the examinations should, undoubtedly, be repeated at moderate intervals; but, supposing this to be impracticable amongst the poorer classes, a large amount of the advantages would be obtained by the examinations being made and the instruction given when patients are about to leave hospital.

It is well known, that one of the most fruitful and common causes of impaired or low health is imperfect convalescence after illness. Some years ago I examined and noted the state of health of patients about to leave St. Bartholomew's Hospital, and I found that a very large number were anaemiated when discharged, and yet there is no hospital in which the diet-scale, and the allowance of extra medical comforts during convalescence, is more liberal than at St. Bartholomew's.

The time at which a patient leaves hospital after illness, is then, a most advantageous one for the examination, not only because instructions are then required as to the complete restoration of strength; but because it is the time at which any fresh damages which the organism has received may be detected before they have been aggravated by mistakes in the habits of the patient; and, also, because the patient is then most deeply impressed with the evils of sickness, and the value of health.

The example I have given of deaths from whooping-cough, due, as their real cause, to debilitated health in the mother, and consequent rickets in the child, I have only chosen because it is so simple and familiar. It is but a specimen of what occurs in a multitude of other diseases; and it may tell the tale for the rest.

"A pebble, in the streamlet scant,

Has turned the course of many a river;

A dew-drop on the baby plant Has warped the giant oak for ever."