all, afterwards. An exact knowledge of the circumstances of the people, is the surest basis for correct and useful legislation. It would aid the physician. This would be done in various ways. The information obtained would be of immense consequence in giving him exact knowledge of the causes and prevalence of different diseases. This knowledge would greatly aid him in applying his remedies for prevention and cure. Instead of partial facts, obtained for a partial purpose, upon which to ground his theories, he would have a vast collection of impartial facts, truthfully gathered, for no other purpose than the promotion of truth. On such a basis he might construct a much better theory in medicine, and devise a more rational, philosophical system of remedies.

But there is another purpose which they would secure in this relation. One of the most trying circumstances in the life of a conscientious physician, is believed to be the capricious and unfounded judgment which the people often pass upon his skill and professional services. This opinion is frequently the result of accident or prejudice, combined with imperfect knowledge or entire ignorance, and would be changed if the people were better educated in sanitary science. This is an interesting consideration, and might be abundantly illustrated in the experience of every physician; but the mere suggestion is deemed sufficient for our purpose, to show that this is a useful measure to the medical profession.

It would benefit the people. We have already alluded to the murderous imposition which is practised upon a credulous people, by pretenders to medical skill, in curing disease, and by mercenary dealers in injurious nostrums and drugs. This matter may be again alluded to for a more general purpose. Though health is a matter in which every person is directly interested, yet there is scarcely any subject on which so much ignorance generally prevails. When well enough to do without medical advice, we are too apt to neglect to inform ourselves as to the means of avoiding the contingency of sickness. But when attacked with real or imaginary sanitary ills, no people are more liable to err, or can be more easily imposed upon. The body is subjected to experiments, by new advisers and

new remedies, come from whatever quarter they may; and faith is put in certificates, which perhaps have been forged. Many, very many, are thus drugged to death, either by the blind guides of their own uninformed minds, or the unfounded pretensions of others. The object of this measure is to diffuse, among all classes of people, more enlightened views of life, health and disease. In this way it is believed numerous lives might be saved, a great amount of sickness prevented, and a corresponding amount of suffering avoided. Is not this a useful purpose?

III. It should be approved because it is AN ECONOMICAL

MEASURE.

The expense of preventive sanitary measures is the most common argument brought against their adoption. Epidemics are considered by the ignorant as evils which it is useless to attempt to prevent; and among the better informed, a false idea of economy, which has sometimes led to the most fatal results, has been the ground of resistance to measures which were necessary to save life. It should, however, be known that public expenditures cannot be avoided during the prevalence of an epidemic disease. Money must be spent, either in saving life, or in the maintenance of pauperism, widowhood, and orphanage. In this case economy is on the side of humanity, and the most expensive of all things is-to do nothing.

for.

Debility, sickness, and premature deaths, are expensive matters. They are inseparably connected with pauperism; and whenever they occur they must, directly or indirectly, be paid The city or town must pay for the sick man's supportfor his food and clothing, for medical attendance on him during life, and for the support of his widow and children (if he leave any) after his death. A town in which life is precarious pays more taxes than its neighbors of a different sanitary character. An individual who is unable to perform a large amount of labor or no labor at all, is a less profitable member of society than one who can do whatever vigorous health allows.

"It is for the interest of the public at large, no less than for the happiness of the few immediately interested in each human being, that the life once breathed should, if possible, be pre

served, until it is released by the natural wearing away of its earthly tabernacle. We all know that, in the common sense of the term, a short-lived population is generally a surplus population,-not only because those who are reckless of preserving life, will be careless of all its obligations, and will

be poor and vicious, but because the tendency of early deaths is chiefly to shorten the existence of those who produce more than they consume, and to increase the number of those who must be dependent on the charity of others. 'A cholera widow' is a significant expression occasionally used by the Board of Health, to indicate one who has been thrown on the parish by the death of that husband who, if he had not been prematurely cut off, might have supported her for years, and left his children old enough to earn bread for themselves. Many communities are now thus paying, in alarmingly swollen poor-rates, for the short-sighted selfishness which made them grudge the cost of precautionary arrangements." 1

As an illustration, the proportion of deaths by cholera, in two parishes in England-Hampstead and Rotherhithe-have been stated. In the latter, 225 persons died of the disease in every 10,000 inhabitants, while in the former 8 only died. At Rotherhithe, out of 225 persons, 217 died of preventable causes. "There were in that place, 28 times the proportional number of deaths that there were at Hampstead, 28 times the cases of sickness, 28 times the number and cost of funerals, 28 times the doctors' bills, and 28 times the proportional number of widows and helpless children to be supported by somebody." "

As a further illustration we present the following extract from a speech delivered by Lord Ashley, at a meeting held Feb. 5th, 1850, to take into consideration the sanitary condition of the metropolis :—

"At least one third of the pauperism of the country arose from the defective sanitary condition of large multitudes of the people; and he had no hesitation in saying, upon the authority of experienced persons, that if the population of their great towns were placed under proper sanitary regulations, in less

1 Edinburgh Review, Vol. XCI, January, 1850, p. 212. 2 Do. for April, 1850, p. 389.

than ten years the poor rates would be reduced £2,000,000 annually. What had been the effect produced upon the parish of Lambeth by the ravages of the cholera, a large proportion of which might have been prevented by suitable sanitary meastures? He had the official return of the number of persons becoming chargeable to the parish in consequence of deaths from cholera between the 16th of June and the 16th of October, 1849. There were-orphans 310, widows 74; total 384 persons. There was a village in Wiltshire with a population. of 510; in this village four widows and 16 orphans, making a total of 20 persons, had become permanently chargeable. A still more remarkable instance occurred in another village, containing 54 inhabitants. Of these, 19 had been carried off by cholera, and their families had become chargeable upon the rates. Let it be observed, that if the attack of cholera in London had been in proportion to the attack in that village, 500,000 persons would have been carried off; but he quoted these instances of the ravages of the epidemic to show that what cholera did rapidly and by fits and starts, typhus and other fatal diseases were doing slowly day by day. If the cholera had sent 1,000 orphans and widows to the poor-house in a few weeks, typhus was permanently sending hundreds and thousands there, to become chargeable upon the rates payable by those parties who, if they had been wise and humane in time, might have obviated all fatal consequences and been the means of preserving the existence of many worthy and honorable citizens. Of all the agencies which predisposed the human body to disease, none were so fatal as over-crowding in small dwellings. There had been remarkable instances wherein localities ill drained, badly ventilated, and exposed to noxious influences, had continued without a visitation from the cholera, whilst a building where the inmates were well fed, well clothed, and had every appliance to keep them in health, with the single exception of over-crowding, presented a mortality greater in proportion than the awful mortality among the pauper children at Tooting. Under such circumstances it was impossible any particular class could insure immunity from disease. The deaths from cholera in London amounted to 16,696. Of these

72 per cent. occurred among the poorer classes, 16 per cent. among the middle, and 3 per cent. among the upper classes; but he reminded the middle and the upper classes that the expenses inflicted upon the community in the metropolis, during the late epidemic, amounted to no less than £1,060,096, including the cost of funerals, medical attendance, and the loss of reproductive labor. It might be asked, was this instructing the people? He did not say it was; but what they were doing in bringing such facts before the public was an indispensable preliminary to their moral and spiritual welfare."

The expenses and losses entailed by a neglect of sanitary measures may be classed under the following heads:-1. Expenses imposed upon the poor, by loss of work or of situations, for medical attendance and medicine, for nursing, for funerals, for the support of widows and orphans, and for other purposes. 2. Expenses imposed upon the tax-payers, for the support of those who are unable to support themselves, besides their own increased expenses arising from a bad sanitary condition. 3. Burdens imposed upon the charitable, for the support of hospitals, dispensaries, and for other more general or special charities. 4. A loss sustained by the state, in consequence of the diminished physical power and general liability to disease. Expenses imposed upon the community, by the crimes arising from the unfavorable physical circumstances by which the laboring poor are surrounded, and which lead with certainty to their moral degradation. Various estimates have been made of these expenses, some of which, as stated by Lord Morpeth, we have already noticed, (p. 44.)1

5.

1 We extract from the Report on the Condition of Large Towns, the following illustrative passage from the testimony of Dr. Taylor, an intelligent surgeon of London:-" Amongst others was the family of a policeman whom I attended. When he applied for relief, the observation which occurred was, 'You have, as a policeman, 20s. a week regular wages, and other advantages; you are never out of work, and cannot be considered a proper object of relief from the funds of a dispensary intended for the poorest class? His reply was, that he paid for his miserable one room, divided into two, 5s. a week; that he had 1s. Sd. weekly to pay for keeping up his clothes, which reduced the money he had for his family of four children and his wife to 13s. 4d.; that he had had all his children ill, and lost two; that he had during three years paid six doctors' bills, principally for medicine, at the rate of 2s. 6d. a bottle, amounting to between £30 and £40; that two of the children had died, the funerals of which, performed in the cheapest manner he could get it done, had cost him £7 : the wife and his four children were now ill. They were so depressed and debilitated, as to render them very great objects for the dispensary and the Samaritan Fund. All this misery was traceable to preventable causes. Take another case in the list before me. A porter, in regular employment, at wages producing £1 a week: he paid 3s. 6d. for a most miserable and unwholesome room, in which himself and six other people, four children and three adults, slept; the children were shoeless, extremely filthy, and badly clad; the wife ill in bed of a