TOPICS OF THE DAY.
MEDICAL ADMINISTRATION.
WHAT can we do 4" ask the Reformers installed in office, when called upon to proceed with reforms : " what is there to be done that is instant, practical, and practicable I" One class of im- provements there is at least—the construction of a truly efficient department of Public Health and Medical Police.
It is difficult to enumerate the evils which cry out for improve- ment in this direction, vast and glaring as they are, because they have been clamorous so long that the subject is stale. And yet it is matter of unceasing surprise that a community not lost in stupid ignorance or feeble helplessness can go on enduring such things unreformed.
Cholera is ravaging our towns: we were prepared for it by forewarnings ; yet we not only did not prepare for it practically, but when at last the Board of Health was empowered to act, the power was conceded under innumerable restraints, and the Ban_ rd was especially restrained from action in the Metropolis. In ho last report, just published, the Board shows that its powers are insufficient to insure obedience to its regulations ; that, in spite of the great success which has attended a real fulfilment in some places, in others niggardliness, perverseness, or total lack of accord, prevent due precautions; that people do not even know what the law is for the prevention of pestilential nuisances. The weekly report of the Registrar-General tells a similar tale. The Medical Times, a journal conducted with scientific skill and judgment, shows that while the profession is lost in sheer amazement and doubt, with- out any established rationale of the disease or its treatment, our public hospitals fail to afford that clue both to theory and practice which might be derived from systematic tentatives and persistent observation. That there should be no theory of a novel disease is no reproach to the profession, since theory is to be extracted from continued practice and observation ; but it is a reproach to the profession, and still more to that power which bears the name of government, if our treatment of the disease is so conducted as to prevent the progress towards a just rationale, the clue to future practice. Of course, active treatment of an active pesti- lence cannot wait for the development of a theory ; we must have a topical treatment, perhaps of various kinds, directed, on broad principles, to alleviate painful symptoms and to support nature in undergoing a severe trial ; but our topical and empirical treatment ought to be so scientifically and at all events so atten- tively conducted, as to keep open a path for the development of a theory. And at least those things which we know to be pestilen- tial should be prevented.
Burial-grounds within populous towns are known to be so. It is known that they evolve gases which are in themselves noxious ; known also, though the particular poison is not identified, that such gases emanating from the decomposition of death are frauoht with highly venomous and mortal qualities. Yet we suffer bu- rial-grounds to continue in our densest spots. It was with diffi- culty that the Bishop of London could feel authorized to interfere in closing one that lies pent up and almost hidden from eyesight, though not from smell, in Russell Court, a crowded section of Drury Lane ; Mr. Charles Knight complains that the churchyard of St. Bride's poisons his countinghouse and warehouse in Fleet Street ; the ground in Portugal Street is the open source of noxious miasmata, and a Magistrate declares that he can do no- thing to aid those who are injured by it ; the churchyard of St. Ethelburga is probably the source of the poison that carried off Aston Key ; and similar complaints arise in all quarters. The sewerage of London makes the whole town foul in the nostrils, as if London had rotted. We crowd to particular spots of the earth, and suffer it to become loaded and saturated by our exuvise, until it is changed like the rotten parts of a cheese loaded with the corpses and exuvim of the mites that still cling and crawl and crowd over the mortal mass, without sense to cleanse it or leave it. We are no better ; although " os homini sublime dedit," &c.
We cannot even count our dead correctly. It is certain that many are reckoned to have died of " cholera" where the term is not applicable ' • and on the other hand, it is not impossible that in many cases the true cause of death, when it is one of so alarm- ing a kind, is concealed. There is no one sufficient authority for distributing medical aid to those whose poverty requires help, or those whose ignorance does not recognize the danger. " House to house " visitation ought to be enforced, as it might well be. Every dead body ought to be visited by some one competent officer, in each district, to insure uniformity and accuracy of re- gistration. This regulation would be useful, not only as a check upon sweeping maladies, but upon crime ; and it would also be an effectual preventive to the most horrible of deaths—premature interment.
The last point would be secured by giving the post of local re- gistrar to some competent medical man. It might be a useful extension of his service, if he were to visit every birth as well as every death. Several concurrent duties might centre in the same officer : he might be the one, under the Health department, to denounce nuisances ; and under the same department, he might direct, though not dispense, the distribution of medical relief to paupers. Over him, it is implied, there should be an efficient Medical Department, with full powers to prohibit public prac- tices injurious to health, and to prosecute " nuisances. ' Some "interests" would stand in the way, vested interests in existing offices, clerical and lay interests in the continued heaping
of corruption upon corruption by burial; but those interests are matters of secondary consideration. Seeing the primary things to be done, let us do them; and then let us conscientiously make good the consequences. Here then is a class of reforms which are urgent, practical, and practicable; to achieve them would bring credit to the highest Ministry, and might redeem even the lowest,—no small considera- tion just now. They need not, we should think, altogether await the legislation of Parliament in a session several months distant, since they might be begun by the administrative branch of the Government, if that were moved by sufficient intelligence, earnest- ness, and boldness.