REVIEWED IN THEIR COURSE OF DEVELOPMENT, AND IN SOME OF THEIR POLITICAL AND SOCIAL RELATIONS: BY SIR JOHN SIMON, K.C.B.; MEMBER OF THE GENERAL MEDICAL COUNCIL; CONSULTING SURGEON AND PAST SENIOR SURGEON TO ST. THOMAS'S HOSPITAL; PAST PRESIDENT (NOW HON, MEMBER) OF THE PATHOLOGICAL SOCIETY OF LONDON; FORMERLY THE MEDICAL OFFICER OF HER MAJESTY'S PRIVY COUNCIL. CASSELL & COMPANY, LIMITED: LONDON, PARIS, NEW YORK & MELBOURNE. 1890. F PREFACE. By way of preface to the following pages, I desire to offer a short explanation of the circumstances in which I found my motive to attempt the work, and of the spirit in which I have made my endeavour. Thirteen years ago, on my retirement from official connexion. with the public service, flattering wishes were expressed to me that I would re-publish in collective form the Reports, or the substance of the Reports, which, during some twenty-eight previous years, I had written in various official relations to the business of Sanitary Government. It was my intention, if possible, to give effect to those wishes; but causes not within my control delayed me year after year from making any real progress in the matter; and, with each postponement, it of course became more and more likely that the advancing disqualifications of age would finally close my hopes of accomplishing the task. In that dawdled state of the case, three years ago, I was very pleasantly surprised and honoured by an invitation from the Sanitary Institute of Great Britain that I would assent to their re-publishing the Reports. On my ready acquiescence in that proposal, the work was speedily put in hand, with the advantage that Dr. Edward Seaton, one of the foremost of our present healthofficers, undertook to be its Editor; and in the autumn of 1887, the two volumes of that re-publication were issued by the Sanitary Institute. During the years when I thought I might myself be the republisher of the Reports, I had always had in mind two accompanying hopes: first, that I might be able to prefix to the publication some kind of historical introduction rendering homage to those who, before my time, had attained the standpoint where my work began; and secondly, that, when I should have strung the reports into series with some sort of running commentary on the 064 occasions and conditions to which they had related, I might be able to append to them, as in outlook towards the future of the Sanitary Cause, some reflexions of more general scope on the principles and methods of Public Health Government. While the latter of those hopes represented no more than a personal aspiration, the former would, in the circumstances, have corresponded to a debt of honour. In the first words of the famous Oath which bears the name of Hippocrates-an oath which in great matters deserves to be for all time a law to the Medical Profession, the acolyte swears that he will ever hold himself under the obligations of filial duty towards the Master from whom he learns his Art; and I should have thought it disloyalty to the spirit of that oath, if, in setting forth my own very humble contributions to the cause of English Sanitary Reform, I had not striven to prolong the grateful memory of elder times: had, for instance, not told of Sir Edwin Chadwick's great campaign in the first ten years of her present Majesty's reign; or had been silent as to the men who, from more than a century before that period, had been pioneering forward, some of them in lines of scientific study, and others in lines of political principle, towards the day when state-craft and medical knowledge should sincerely take counsel together for the Health of the People. In 1887, such preparations as I had made towards the collateral intentions just described were not nearly advanced enough for immediate use; and, as I therefore could not hope to fulfil their purpose by way of graft on the object which the Sanitary Institute intended, I had to reserve it for fulfilment by postscript. So soon, however, as I attempted to proceed on this resolution, I found that the limits which I had thought convenient for my original plan would not be equally suited to a work meant for separate issue; and that the publication would be comparatively meaningless, unless I gave it wider and more systematic relation to the history of sanitary progress; not only beginning as far back in time as where stages of English progress can first be marked, but also extending my record and commentary to the proceedings of our latest years. It was of course evident to me that I could not attempt to make so wide a survey and criticism of sanitary progress, except with almost exclusive final regard to the mere practicalities of the case; but I ventured to hope that my survey of the ground, if only in that practical sense, might be contributive to purposes of public opinion-the more so, as hitherto there had not been any published general study of the matter; and I accordingly made up my mind to the endeavour which the following pages represent. Giving overleaf a List of the Chapters of the volume, and then a detailed Table of their Contents, I need not here dwell on what is mere matter of plan in the work. The reader will observe that, after some necessary but brief mention of times. and influences which in this context may be classed as preAnglian, I have endeavoured to show in sequence the chief steps of English progress, from early to present times, in Laws and Administrative Organisation regarding the Public Health; and that together with what is of mere narrative as to the steps (and particularly in proportion as the narrative comes into recent years) I have combined more or less of commentary on the steps, and sometimes more or less statement of my own opinions on them. To readers already familiar with the subject-matter, it will not occasion surprise that, though the volume opens with references to early historic, and even to pre-historic times, considerably more than half of it is occupied with the achievements and questions of the present Victorian reign. This period's unexampled productiveness in acts and thoughts which will be of permanent historical interest in our subject-matter has particularly called for that fulness of treatment; and it has also seemed to me an imperative reason for endeavouring to bring into just connection with it the too-often unappreciated importance of the great incubatory centennium which preceded. The Local Government legislation of 1871-2, and the action immediately consequent upon it, have been treated as belonging rather to present politics than to past history; for the shapings of the last nineteen years are hitherto but imperfectly solidified, and are still from day to day undergoing modification, or awaiting it. It has been chiefly with thoughts towards the future that I have dwelt on those comparatively recent passages of the past; discussing them in a spirit of free criticism, and |