BY

LEMUEL S HATTUCK
AND OTHERS
WITH A FOREWORD BY
LARRY GORDON

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ii






INTRODUCTION

La r r y J . Gor don , M. S. , M. P. H.
Adju n ct Profes s or (a n d 1954 Delt a Omega En r ollee)
Depa r t men t of Polit ica l Scien ce
Un iver s it y of New Mexico

Th e Sh a t t u ck Repor t : Perhaps the mos t s ignif icant s ingle document in the his tory of public
health. --- I k now of no s ingle document in the his tory of that s cience quite s o remark able in its
clarity and completenes s and in its vis ion of the f uture.
C. -E.A. Win s low, 1948.

Th e 1850 Repor t of t h e Sa n it a r y Commis s ion of t h e St a t e of Ma s s a ch u s et t s is
common ly t er med t h e Sh a t t u ck Repor t . In 1849, Lemu el Sh a t t u ck, Na t h a n iel Ba n ks , J r . a n d
J eh iel Abbot t wer e a ppoin t ed by t h e Gover n or a s Commis s ion er s t o pr epa r e a plan f or a
S anitary Survey of the S tate, embracing a s tatement of s uch f acts and s ugges tions as they may
think proper to illus trate the s ubject.
Lemu el Sh a t t u ck wa s a t ea ch er wh o la t er beca me a books eller , pu blis h er , gen ea logis t
a n d legis la t or . His in t er es t gen ea logy ca u s ed h im t o become a s t a t is t icia n . Sh a t t u ck wou ld
n ot be con s ider ed a pu blic h ealt h pr ofes s ion al. He wa s a vis ion ar y wh o developed an d applied
a br oa d r a n gin g kn owledge of pu blic h ea lt h a n d pos it ively impa ct ed t h e pu blic policy pr oces s .
Th r ou gh h is effor t s , t h e Ma s s a ch u s et t s Sys t em for r egis t r a t ion of bir t h s , dea t h s , a n d ma r r ia ges
wa s es t a blis h ed in 1842. In 1845, h e con du ct ed a s an it a r y s u r vey of Bos t on . In 1849, as a
s t a t e legis la t or , h e s ecu r ed en a ct men t of a u t h or iza t ion for t h e Gover n or t o a ppoin t t h e t h r ee
Commis s ion er s t o pr epa r e t h e Sa n it a r y Su r vey.
Wh en t h e Sh a t t u ck Repor t wa s r e-pu blis h ed in 1948, pu blic h ea lt h gia n t C. -E.A.
Win s low wr ot e t h e For ewor d a n d s t a t ed t h a t t h e r epor t is on e of t h e mos t r ema r ka ble
docu men t s -- per h a ps t h e mos t s ign ifica n t s in gle docu men t -- in t h e h is t or y of pu blic h ea lt h .
Mor e t h a n h a lf a cen t u r y a ft er Pr ofes s or Win s lows a ppr a is a l, t h is is s t ill t r u e. I n u mber a mon g
u n t old t h ou s a n ds wh o h a ve fr equ en t ly qu ot ed por t ion s of t h e Sh a t t u ck Repor t in pu blic a n d
pr ofes s ion al pr es en t a t ion s .
Wh ile 2, 000 copies of t h e or igin a l r epor t wer e or igin a lly pr in t ed in 1850, it wa s r e-
pr in t ed by t h e Ha r va r d Un iver s it y Pr es s in 1948 in t ime for t h e Cit y of Bos t on t o pr es en t a copy
t o ea ch member of t h e Amer ica n Pu blic Hea lt h As s ocia t ion Gover n in g Cou n cil meet in g in
Bos t on t h a t yea r .
Sh a t t u ck u s ed t h e t er m s a n it a r y in t h e br oa des t s en s e a s mea n in g r ela t in g t o h ea lt h .
When applied to the inhabitants of a town or dis trict, in their s ocial capacity , it relates to public
health; when to individ uals , it relates to pers onal or private health.
Mor e t h a n 150 yea r s followin g t h e Sh a t t u ck Repor t a n d it s n u mer ou s s emin a l
r ecommen da t ion s , pu blic h ea lt h pr a ct it ion er s s t ill believe:

That the conditions of perf ect health, either public or pers onal, are s eldom or never attained,
though attainable;
That the average length of human lif e may be very much extended, and its phy s ical power
greatly augmented;
That in every y ear, within this Common wealth, thous ands of lives are s till los t which might
have been s aved;
That tens of thous ands of cas es of s ick nes s occur which might have been prevented;
That a vas t amount of unneces s arily impaired health and phy s ical d is ability exis ts among
thos e not actually conf ined by s ick nes s ;
iii
That thes e preventable evils require an enormous expenditure and los s of money , and impos e
upon the people unnumbered and immeas urable calamities , pecuniary , s ocial, phy s ical,
mental, and moral which might be avoided;
That means exis t within our reach f or their mitigation or removal;
And that meas ures f or prevention will af f ect inf initely more than remed ies f or the cure of
dis eas e.

Th e Sh a t t u ck Repor t cover ed a wide r a n ge of pu blic h ea lt h ma t t er s in det a il. Ma n y of it s
vis ion a r y a n d fa r r ea ch in g r ecommen da t ion s h a ve been implemen t ed widely. Bu t t o men t ion
ju s t a few of t h e ma n y t h a t a r e s t ill a pplica ble in Cen t u r y 21, n ot e t h e followin g:

We recommend that provis ion be made f or obtaining obs ervations of the atmos pheric
phenomena, on a s y s tematic and unif orm plan at diff erent s tations within the
Common wealth.
We recommend that meas ures be tak en to prevent, as f ar as practicable, the s mok e nuis ance.
We recommend that, in lay ing out ne w towns and villages , and in extend ing thos e already
laid out, ample provis ion be made f or a s upply , in purity and abund ance, of light, air, and
w ater; f or drainage and s ewerage, f or paving, and f or cleanlines s .

Th e r epor t a ls o con t a in ed fa r r ea ch in g r ecommen da t ion s r ela t ive t o h ou s in g, s ch ools ,
occu pat ion al h ealt h , an d adu lt er a t ed food an d dr u gs , an d r ecommen ded that pers ons be
s pecially educated in s anitary s cience.
In Cen t u r y 21, t h e Sh a t t u ck Repor t is s t ill a n a ma zin g docu men t a n d migh t a ppea r t o
h a ve been mor e t h a n a cen t u r y a h ea d of it s t ime. Ou r pr ogr es s in pu blic h ea lt h h a s n ot been
s o r a pid a s t o be ca u s e for con cer n . It wa s a n a s t ou n din g docu men t for 1850, a n d r ema in s
a s t ou n din g t oda y. Th e Repor t will con t in u e t o mot iva t e fu t u r e pu blic h ea lt h s t u den t s a n d
lea der s .
iv

COMMONWEALTH OF MASSACHUSETTS

In the year One Thousand Eight Hundred and Forty -Nine



RESOLVE
Relating to a Sanitary Survey of the State.

Res olved, Th a t His Excellen cy t h e Gover n or , by a n d wit h t h e a dvice a n d
con s en t of t h e Cou n cil, be a n d h e is h er eby a u t h or ized t o a ppoin t t h r ee
per s on s t o be Commis s ion er s , t o pr epa r e a n d r epor t , t o t h e n ext Gen er a l
Cou r t , a pla n for a Sa n it a r y Su r vey of t h e St a t e, embr a cin g a s t a t emen t of
s u ch fa ct s a n d s u gges t ion s a s t h ey ma y t h in k pr oper t o illu s t r a t e t h e
s u bject . Th e Commis ion er s s h a ll be pa id, for t h e t ime a ct u a lly s pen t in t h e
dis ch a r ge of t h eir du t y, a n d for t h eir - n eces s a r y t r a vel, t h e s a me
compen s a t ion t h a t is pa id t o t h e member s of t h e Gen er a l Cou r t ; a n d a ls o for
bla n ks a n d cir cu la r s u s ed, a n d for pos t a ge a n d ot h er n eces s a r y expen s es
pa id in s a id commis s ion ; a n d a s u m n ot exceedin g fift y dollar s , t o pu r ch a s e
books on t h e s u bject ; pr ovided, h owever , t h a t s a id books s h a ll be con s ider ed
t h e pr oper t y of t h e Common wea lt h , an d s h a ll be depos it ed in t h e St a t e
libr a r y wh en t h e commis s ion s h a ll be dis s olved :pr ovided, t h e wh ole expen s e
of s a id commis s ion s h a ll n ot exceed five h u n dr ed dolla r s ; a n d t h a t wa r r a n t s
be dr a wn a ccor din gly.




Hous e of Repres entatives , May 1, 1849
Pas s ed. Francis B. Crownins hield, Speak er
In Senate, May 2, 1849
Pas s ed. Jos eph Bell, Pres ident
May 2, 1849. Approved
Geo. N. Brigges

1


REPORT OF THE COMMISSIONERS


Th e Commis s ion er s , a ppoin t ed on t h e t h ir d da y of J u ly la s t t o pr epa r e
a n d r epor t , t o t h e next Gen er a l Cou r t , a pla n for a Sa n it a ry Su r vey of t h e
St a t e, embr a cin g a s t a t emen t of s u ch fa ct s a n d s u gges t ion s a s t h ey ma y
t h in k pr oper t o illu s t r a t e t h e s u bject , h a ve con s ider ed t h e ma t t er s r efer r ed
t o t h em, a s fa r a s t h e limit ed t ime a t t h eir comma n d, a n d ot h er
cir cu ms t a n ces , s in ce t h eir a ppoin t men t , wou ld per mit , a n d s u bmit t h eir
REPORT.
As t h e object of ou r commis s ion is compa r a t ively n ew, a n d ma y n ot be
clea r ly u n der s t ood by ever y per s on , we will s t a t e wh a t we u n der s t a n d t o be
it s in t en t ion . By a Sa n it a r y Su r vey of t h e St a t e is mea n t , a n exa min a t ion or
s u r vey of t h e differ en t pa r t s of t h e Common wea lt h , -it s cou n t ies , it s t own s ,
a n d it s loca lit ies , -t o a s cer t a in t h e ca u s es wh ich fa vor a bly or u n fa vor a bly
a ffect t h e h ea lt h of it s in h a bit a n t s . Th e wor d s anitary mea n s relating to
health.
1
Wh en we s pea k of t h e s a n it a r y con dit ion of a t own , we in clu de a
des cr ipt ion of t h os e cir cu ms t a n ces wh ich r ela t e t o, or h a ve a n effect u pon ,
t h e h ea lt h of it s in h a bit a n t s . Wh en a pplied t o t h e in h a bit a n t s of a t own or
dis t r ict , in t h eir s ocia l ca pa cit y, it rela t es t o pu blic h ea lt h ; wh en t o
in dividu a ls , it r ela t es t o per s on a l or pr iva t e h ea lt h .
Th e con dit ion of per fect pu blic h ea lt h r equ ir es s u ch la ws a n d
r egu la t ion s , a s will s ecu r e t o ma n a s s ocia t ed in s ociet y, t h e s a me s a n it a r y
en joymen t s t h a t h e wou ld h a ve a s a n is ola t ed in dividu a l; a n d a s will pr ot ect
h im fr om in ju r y fr om a n y in flu en ces con n ect ed wit h h is loca lit y, h is
dwellin g-h ou s e, h is occu pa t ion , or t h os e of h is a s s ocia t es or n eigh bor s , or
fr om a n y ot h er s ocia l ca u s es . It is u n der t h e con t r ol of pu blic a u t h or it y, a n d
pu blic a dmin is t r a t ion ; a n d life a n d h ea lt h ma y be s a ved or los t ,a n d t h ey a r e
a ct u a lly s a ved or los t , a s t h is a u t h or it y is wis ely or u n wis ely exer cis ed. Th e
con dit ion of per fect per s on a l h ea lt h r equ ir es t h e per fect for ma t ion of a ll t h e
or ga n s of t h e body, a n d t h e per fect per for ma n ce of ea ch of t h eir fu n ct ion s , in
h a r mon y wit h a ll t h e ot h er s . Su ch a con dit ion gives t o it s pos s es s or ,
s t r en gt h , en er gy, power , bu oya n cy of s pir it , h a ppin es s . Dis ea s e ma y be a
imper fect ion in s ome or ga n , or a der a n gemen t or impr oper a ct ion in s ome
fu n ct ion , or bot h : a n d it ma y exis t , a n d does a ct u a lly exis t , in a ll
commu n it ies , in a n in fin it e n u mber of degr ees , fr om t h e s ligh t es t devia t ion
fr om a s t a n da r d of per fect h ea lt h , t h r ou gh a ll t h e va r iet ies of s ickn es s , t o t h e
lowes t s t a n da r d of vit a lit y, ju s t a s t h e body is a bou t t o per for m it s la s t

1
This word is d erived f rom the Latin s anitas , meaning" s ound nes s of health." It is s ometimes
written, erroneous ly , as we think , s anatory , s anotary , and s anitary . The mos t correct authors ,
however, now write, s anitary . Hy giene (f rom a Greek word, derived f rom Hy geia, the goddes s of
health, meaning to be well,) is def ined "health, the pres ervation of health, that part of medicine
which regards the pres ervation of health." Hy giean and hy gienic have the s ame meaning as
s anitary . thes e words are s ometimes us ed as technical terms , es pecially by medical men; but we
dis lik e, and s ee no good reas on f or s ubs tituting them f or more s imple, proper and comprehens ive
Englis h words , health and s anitary , which are generally unders tood. We would dives t our
s ubject of all my s tery and prof es s ional technicalities ; and as it concerns every body , we would
ad apt it to univers al comprehens ion, and univers al application.
2
r es pir a t ion . Su ch a con dit ion gives t o it s pos s es s or , wea kn es s , la s s it u de,
in a bilit y, depr es s ion , pa in , mis er y, deat h . An d on e or t h e ot h er of t h es e
con dit ion s ma y be ch os en , a n d is a ct u a lly ch os en , t o a gr ea t er or les s ext en t ,
by a lmos t ever y h u ma n bein g.

WE BELIEVE that the cond itions of perfect health, either public or
pers onal, are s eldom or never attained, though attainable;- that the average
length of human life may be very much extended, and its phy s ical power
greatly augmented;-that in every y ear, within, this Common wealth, thous ands
of lives are los t which might have been s aved ;-that tens of thous ands of cas es
of s ick nes s occur, which might have been prevented ;-that a vas t amount of
unneces s arily impaired health, and phy s ical debility exis ts among thos e not
actually conf ined by s ick nes s ;-that thes e preventable evils req1tire an
enormous expend iture and los s of money , and impos e upon the people
unnumbered and immeas urable calamities , pecuniary , s ocial, phy s ical,
mental, and moral, which might be avoided ; -that means exis t, within our
reach, f or their mitigation or removal ; -and that meas ures f or prevention will
effect inf initely more, than remed ies f or the cure of dis eas e.

Some of t h e r ea s on s for t h is belief will be given in t h e pa ges of t h is
r epor t . If it s h a ll a ppea r t h a t it is well fou n ded, -if, in deed, t h er e a r e fa ct s t o
s u ppor t , a n d legit ima t e a r gu men t s t o s u s t a in it , -wh a t s u bject , it ma y be
a s ked, ca n come u p for con s ider a t ion , t h a t s h a ll t r a n s cen d it in impor t a n ce
? We look u pon t h in gs a s va lu a ble, t h a t a r e wor t h les s wit h ou t life, a n d t h a t
ca n n ot be en joyed wit h ou t h ea lt h . How mu ch mor e va lu a ble, t h en , t h e
mea n s t o pos s es s a nd t o en joy bot h life an d h ea lt h , wh ich a lon e give va lu e t o
ot h er object s ! Wh en compa r ed t oget h er , a ll ot h er ma t t er s t h is s ide t h e gr a ve
dwin dle in t o in s ign ifica n ce.
Bu t wh om does t h is gr ea t ma t t er of pu blic h ea lt h con cer n ? By wh om is
t h is s u bject t o be s u r veyed, a n a lyzed, a n d pr a ct ica lly a pplied? An d wh o a r e
t o be ben efit ed by t h is a pplica t ion ? Some will a n s wer , t h e ph ys icia n ,
cer t a in ly. Tr u e, bu t on ly in a degr ee; n ot ma in ly. It will a s s is t h im t o lea r n
t h e ca u s es of dis ea s e; bu t it will be in fin it ely mor e va lu a ble t o t h e wh ole
people, t o t ea ch t h em h ow t o pr even t dis ea s e, a n d t o live wit h ou t bein g s ick.
Th is is a bles s in g wh ich ca n n ot be mea s u r ed by mon ey va lu e. Th e people a r e
pr in cipa lly con cer n ed, a n d on t h em mu s t depen d, in pa r t , a t lea s t , t h e
in t r odu ct ion a n d pr ogr es s of s a n it a r y mea s u r es .
An emin en t ph ys ician h a s r ecen t ly s a id: Ou r edu ca t ion h a s ma de ou r
ca llin g exclu s ively a cu r a t ive, a n d n ot a con s er va t ive on e, a n d t h e bu s in es s of
ou r r es pon s ible lives h a s con fin ed u s t o it . Ou r t h ou gh t s ar e devot ed t o, ou r
in t er es t s a r e con cer n ed in , a n d ou r employmen t s a r e con n ect ed s olely wit h ,
s ickn es s , debilit y, or in ju r y ,-wit h dimin u t ion of life in s ome of it s for ms . Bu t
wit h h ea lt h , wit h fu lln es s of u n a lloyed, u n impa ir ed life, we, pr ofes s ion a lly,
h a ve n ot h in g t o do.
2
Th ou gh t h is ma y gen er a lly be t r u e, pr ofes s ion a lly, yet
t h e in t elligen t ph ys icia n ca n s ee a r r ows of dis ea s e, in vis ible t o a n yon e els e ;
wa t ch t h eir h a voc, a n d kn ow wh en ce t h ey come, a n d h ow t h ey ma y be
s t a yed; a n d t h er e ar e ma n y emin en t medica l men , wh o h a ve, a s in dividu a ls ,
n obly u s ed t h e mea n s wh ich t h eir s u per ior pos it ion a n d kn owledge h a ve

2
Dr. Edwa rd J a rvis ; Commu n ica t ion s , Ma s s . Medica l Societ y, Vol. VIII, p.1
3
pla ced wit h in t h eir con t r ol, in t h e pr even t ion of dis ea s e, a n d in t h e pr omot ion
of pu blic h ea lt h . And we wis h t o in cr eas e t h e n u mber of s u ch pr ofes s ion a l
men . We wou ld n ot , h owever , con fin e it t o t h em. We wou ld n ot ma ke it t h e
object of a n yon e pr ofes s ion exclu s ively.
3
We wou ld bes pea k t h e a t t en t ion of
in t elligen t men of a ll cla s s es a n d a ll pr ofes s ion s , wh a t ever t h eir pr eju dices or
opin ion s ma y h a ve been , t o a ca n did con s ider a t ion of t h e wh ole s u bject ; a n d if
fou n d wor t h y, wou ld s olicit t h eir cooper a t ion a n d a s s is t a n ce, in it s pr a ct ica l
a pplica t ion a n d it s on wa r d pr ogr es s .
Ign or a n t men , s a ys Dr . Simon , " ma y s n eer a t t h e pr et en s ion s of
s a n it a r y s cien ce; wea k a n d t imor ou s men ma y h es it a t e t o commit t h ems elves
t o it s pr in ciples , s o la r ge in t h eir a pplica t ion ; s elfis h men ma y s h r in k fr om t h e
la bor of ch a n ge, wh ich it s r ecogn it ion mu s t en t a il; a n d wicked men ma y t u r n
in differ en t ly fr om con s ider in g t h a t wh ich con cer n s t h e h ea lt h a n d h a ppin es s
of million s of t h eir fellow-cr ea t u r es ; bu t in t h e gr ea t object s wh ich it pr opos es
t o it s elf, in t h e immen s e a melior a t ion wh ich it pr offer s t o t h e ph ys ica l, s ocia l,
a n d, in dir ect ly, t o t h e mor a l con dit ion of a n immen s e ma jor it y of ou r fellow-
cr ea t u r es , it t r a n s cen ds t h e impor t a n ce of a ll ot h er s cien ces ; a n d, in it s
ben eficen t oper a t ion , s eems t o embody t h e s pir it , a n d t o fu lfil t h e in t en t ion s ,
of pr a ct ica l Ch r is t ia n it y."
4

In a s u bject of s u ch va s t impor t a n ce, on wh ich s o lit t le is gen er a lly
kn own , a n d s o mu ch ou gh t o be u n ivers a lly kn own , a n d wh ich is s o fu ll of
in t er es t in g a n d u s efu l illu s t r a t ion s , it is difficu lt t o con fin e ou r s elves wit h in
t h e limit s of a s in gle r epor t of r ea s on a ble len gt h . Th is gr ea t ma t t er ca n n ot ,
h owever , be pr es en t ed s o a s t o be u n der s t ood, wit h ou t s ome det a il. An d
t h ou gh we s h a ll r es t r a in a n y in clin a t ion t o go in t o min u t e illu s t r a t ion , yet , in
ou r ju dgmen t , it wou ld be u n wor t h y of Ma s s a ch u s et t s , u n der wh os e
a u t h or it y we a ct , a n d it cer t a in ly wou ld be u n s a t is fa ct or y t o ou r s elves , if we
fa iled t o ma ke t h e a t t empt , a t lea s t , t o pr es en t t h e s u bject s o t h a t t h e people
of t h e St a t e ma y kn ow wh a t we mea n ; s o t h a t t h ey ma y be a ble, if t h ey
ch oos e, t o ca r r y ou r r ecommen da t ion s in t o pr a ct ica l oper a t ion ; a n d s o t h a t ,
if t h u s a pplied, t h ey will a dd t o t h eir ph ys ica l power , a n d in cr ea s e t h eir
in t ellect u a l, s ocia l, a n d per s on a l h a ppin es s .
5

It s h ou ld be bor n e in min d, h owever , t h a t t h is r epor t is des ign ed t o
s u gges t a pla n for a s a n it a r y s u r vey of t h e St a t e, a n d n ot t o con t a in t h e
s u r vey it s elf. We wer e a u t h or ized, h owever , by t h e r es olve, t o embr a ce a
s t a t emen t of s u ch fa ct s a n d s u gges t ion s a s we migh t t h in k pr oper t o
illu s t r a t e t h e s u bject . An d a s t h is is , in s ome r es pect s , a r epor t in t r odu ct or y
t o ot h er u s efu l in for ma t ion , wh ich ma y h er ea ft er be diffu s ed, if ou r
r ecommen da t ion s s h ou ld be a dopt ed, it h a s s eemed t o u s t h a t it wou ld be
in s t r u ct ive a n d pr oper h er e, t o ma ke a gen er a l s u r vey of wh a t h a s been
s u gges t ed, a n d wh a t h a s a lr ea dy been don e on t h e s u bject , a br oa d a n d a t
h ome. Wit h ou t s u ch a view, we ca n n ot wis ely for m a pla n for ou r own

3
The medical department of the National Ins titute have s aid, in the Trans actions of the American Medical As s ociation,
Vol. I, p 306, that "they had reas ons to k now, that the med ical profes s ion in this country , as a general rule, has many
preconceived prejudices to res earch, which can alone mak e its deductions practically us ef ul." We s incerely hope, however,
that this prejud ice does not extens ively exis t.
4
Report on the S anitary Cond ition of the city of London," p.38, by Dr. John Simon, Off icer of Health,; pres ented Nov.6,
1849, To this valuable report we s hall have occas ion again to ref er.
5
The valuable Reports of the Commis s ions , heretof ore exis ting in Mas s achus etts , are of cons id erable length. That on
Ins ects contain. 460 pages ; that on Invertebrata, 374 pages ; that on Fis hes , Reptiles , and Bird s , 416 pages ; and that
on Trees and Shrubs , 547 pages ;bes ides illus trative plates in each. The f irs t of thes e reports has been ordered to be
reprinted this y ear. It would be reas onable to s uppos e that MAN was entitled to a cons ideration equal to either of thes e
s ubjects .
4
gu ida n ce. We h a ve a ccor din gly been a t n o in con s ider a ble la bor a n d expen s e,
t o obt a in t h e mos t recen t a u t h en t ic in for ma t ion con cer n in g t h e h is t or y a n d
pr es en t con dit ion of t h e s a n it a r y movemen t ; a n d we s h a ll pr oceed t o give
s ome of t h e r es u lt s of t h e in ves t iga t ion , befor e pr es en t in g ou r pla n for a
s a n it a r y s u r vey of t h is St a t e.

I. THE S ANITARY MOVEMENT ABROAD

Th e s a n it a r y movemen t goes ba ck t o gr ea t a n t iqu it y, a n d is t r a ced u p t o
t h e dir ect r evela t ion of t h e Su pr eme Lawgiver . In t h e da y t h a t t h ou ea t es t
t h er eof t h ou s h a lt s u r ely die, ma y be rega r ded a s t h e fir s t s a n it a r y a s well
a s mor a l pr ecept . An d fr om t h a t t ime, down t h r ou gh t h e pa t r ia r ch a l a ges ,
t h er e is eviden ce t h a t t h e pr es er va t ion of h ea lt h wa s in cu lca t ed a s on e of t h e
pr imit ive du t ies . Th e s a n it a r y la ws r evea led t o t h e J ews , con s t it u t ed a pa r t of
t h eir r eligion . Th e r egu la t ion s for clea n lin es s , pu r ifica t ion , pr ot ect ion fr om
con t a giou s dis ea s es , a n d for t h e gen er a l pr es er va t ion of h ealt h , a r e s a id t o
h a ve been well a da pt ed t o t h e cou n t r y in wh ich t h ey lived, a n d a r e s t ill
obs er ved by t h e Ar a bs in t h a t clima t e.
Th e a dva n t a ges of pu blic h ea lt h wer e kn own in ma n y of t h e cit ies of
Gr eece, a t t h e h eight of h er civiliza t ion . Th e Spa r t a n s pa id gr ea t a t t en t ion t o
t h e ph ys ica l edu ca t ion of you n g men a n d you n g women , a n d t r a in ed t h em t o
t emper a n ce, s obr iet y, a n d a t h let ic exer cis es . Pla t o a n d Ar is t ot le t h ou gh t t h a t
n o cit y cou ld exis t , wit h ou t h ea lt h officer s ; a n d Epa min on da s , Demos t h en es ,
a n d Plu t a r ch , s er ved in t h a t ca pa cit y. Hippocr a t es , t h e Fa t h er of Medicin e,
con s ider ed a kn owledge of t h e ca u s es of dis ea s e es s en t ia l t o t h e ph ys icia n .
Wh en a s ked, Wh o is t h e ph ys icia n t h a t is a n h on or t o h is pr ofes s ion ? h e
r eplied, He wh o h a s mer it ed t h e es t eem a n d con fiden ce of t h e pu blic, by
pr ofou n d kn owledge, lon g exper ien ce, con s u mma t e in t egr it y; wh o h a s been
led t h r ou gh t h e whole cir cle of t h e s cien ces ; wh o h a s a du e r ega r d t o t h e
s ea s on s of t h e yea r , a n d t h e dis ea s es wh ich t h ey a r e obs er ved t o ma r ks
ca r efu lly t h e loca lit ies of t own s , a n d of t h e s u r r ou n din g cou n t r y, wh et h er
t h ey a r e low or h igh , h ot or cold, wet or dr y; wh o, mor eover , n eglect s n ot t o
ma r k t h e diet a n d regimen of t h e in h a bit a n t s , a n d, in a word, a ll t h e ca u s es
t h a t ma y pr odu ce dis or der in t h e a n ima l econ omy.,
6
In con for mit y wit h t h e
a bove obs er va t ion s , h e s pen t a gr ea t pa r t of h is life in explor in g t h e is la n ds
of t h e Gr ecia n s ea s , a n d of t h e Ar ch ipela go, in r ela t ion t o t h e s u bject of t h e
h ea lt h of t h e in h abit a n t s . His life was s pen t in t r a cin g n a t u r e, a n d in
obs er vin g a n d r ecor din g fa ct s , a s in t er pr et ed by h er . Hen ce t h e immor t a lit y
s t a mped u pon h is n a me a n d wr it in gs .
Bu t t h e Roma n s wer e t h e mos t s a ga ciou s a n d ext en s ive legis la t or s in
s u ch ma t t er s . Th ey wer e in ma n y t h in gs ma s t er s of t h e pr a ct ica l; a n d h a ve
left ves t iges s t ill pr egn a n t wit h t h e wis dom of exper ien ce. Wit h t h em, n ot h in g
s eems t o h a ve been deemed common or u n clea n t h a t cou ld pr ot ect t h e
pu blic h ea lt h . We fin d Plin y wr it in g t o Tr a ja n a bou t a fet id s t r ea m pa s s in g
t h r ou gh Ama s t r is , a s if it wer e a n a ffa ir of s t a t e.
Th e cloa ca e of t h e Ta r qu in s a r e s t ill a mon g t h e a r ch it ect u r a l won der s of
t h e wor ld. Th e cen s or s , ediles , a n d cu r a t or s , wh o a t differen t per iods h a d
ch a r ge of t h e bu ildin gs , a n d of t h e a ppa r a t u s for t h e r emova l of impu r it ies ,

6
Bos ton Medical Journal, Vol. X V, p. 197. See als o "Traite de la Salubrite," p. 14.
5
wer e in ves t ed wit h gr ea t power s for t h e execu t ion of t h eir fu n ct ion s , a n d
der ived a cor r es pon din g dign it y fr om t h em. Th e a r r a n gemen t s for s u pplyin g
t h e h ou s es of Rome wit h wa t er wer e mos t min u t e. Th os e for ven t ila t ion a n d
dr a in a ge, s t ill t r a cea ble in t h e s ever a l r ema in s of Roma n a mph it h ea t r es ,
h a ve s t r u ck ou r mos t a dva n ced s a n it a r ia n s wit h s u r pr is e a t t h eir
r ema r ka ble a da pt a t ion t o t h eir pu r pos e; wh ile Mr . Ch adwick t ells t h e
commis s ion er s of s ewer s t h a t h e h a s la t ely r eceived fr om a fr ien d in Zu r ich a
s pecimen of exa ct ly s u ch a n ea r t h en wa r e pipe a s h e is n ow r ecommen din g
for t h e dis t r ibu t ion of s ewa ge. It h a d been la id down by t h e Roma n s , a n d
h a s wor ked u n t il r ecen t t imes u n der 500 feet of pr es s u r e ! In deed, it is ea s y
t o s ee fr om Vit r u viu s , a n d fr om por t ion s of t h e collect ion of Gr a eviu s , t h a t
t h e r u les a n d oper a t ion s for t h e pr ot ect ion of h ea lt h in Rome, wer e of a ver y
r a dica l a n d per empt or y ch a r a ct er , a n d a llowed n o min or in t er es t s t o
in t er fer e wit h t h em. It s eems t o h a ve been a r u le wit h t h em, t h a t fr om t h e
t ime wh en t h e fou nda t ion of a cit y was la id, t o t h a t of t h e s u mmit of it s
gr ea t n es s , n o s t r u ct u r a l oper a t ion , pu blic or pr iva t e, s h ou ld be per mit t ed t o
t a ke a s h a pe wh ich migh t r en der it a h a r bor eit h er for dis ea s e or cr ime; a n d
it is t o t h is vigila n t for et h ou gh t t h a t , in t h e a bs en ce of ot h er or ga n is in g
a gen cies dis cover ed on ly in ou r la t er t imes , we ma y a t t r ibu t e t h e s u cces s
wit h wh ich t h a t r ema r ka ble people pr es er ved s ocia l or der , t h r ou gh ou t s o
den s e a n d va s t a ma s s of h u ma n bein gs a s t h e in h a bit a n t s of t h e imper ial
cit y in t h e da ys of it s gr ea t n es s .
7

Th e ca u s e of pu blic h ea lt h r eceived a fa t a l ch eck, wh en Rome fell. Wh a t
wa s pr eviou s ly kn own , per is h ed on t h e in va s ion of t h e ba r ba r ia n s , a n d in
t h e gen er a l wr eck of civiliza t ion . Some diet et ic pr ecept s , der ived fr om t h e
Gr eeks a n d Roma n s , wer e r et a in ed, bu t t h ey wer e devoid of pr a ct ica l u t ilit y.
It does n ot a ppea r t h a t a n y s a n it a r y r egu la t ion s exis t ed, fr om t h e s even t h t o
t h e fou r t een t h cen t u r ies . In t h os e da r k a ges , t h e people lived wit h ou t r u le of
a n y kin d; a n d con s equ en t ly, fr igh t fu l epidemics oft en a ppea r ed, t o des ola t e
t h e la n d. Alt h ou gh s o a n cien t , few s u bject s h a ve s in ce ma de s o s low a n d s o
lit t le pr ogr es s , a s t h e s cien ce of pu blic h ea lt h .
In Fr a n ce, in 1350, Kin g J oh n II es t a blis h ed t h e fir s t Sa n it a r y Police;
8

a n d t h is h a s been con s ider ed t h e commen cemen t of s a n it a r y r efor m. Th e
or din a n ce pr ovided, t h a t h ogs s h ou ld n ot be kept in t h e cit ies ; t h a t s t r eet s
s h ou ld be clea n s ed, a n d t h e offa l r emoved; t h a t bu t ch er s s h ou ld n ot s ell
mea t mor e t h a n t wo da ys old in win t er , a n d on e a n d a h a lf in s u mmer ; a n d
t h a t fis h s h ou ld be s old t h e s a me da y t h ey wer e ca u gh t . Or din a n ces in 1486

7
Edin bu rgh Review, Vol. XCI, for J a n u a ry a nd April, 1850, pp. 214,405.
8
Bt h ere a re t h ree ter ms wh ich a re s omet imes u s ed, when s pea kin g of pu blic hea lt h ,= 1. In du s t r ia l Police; 2. Sa n it a r y
Police; a n d 3. Medica l Police, - wh ich it ma y be proper t o define. 1) Indu s t r ia l Police is mea n t , t h e la ws a n d regu la t ions
con cern in g t he occu pa t ion s of t h e people. Un der it a re in clu ded regu la t ion s for t he loca t ion , a n d for preven t in g t h e
loca t ion , of h ea lt h y or u n hea lth y Tr a des ; t h e h ou rs of labor , &c., a n d t he officer s a nd a gen ts by
wh ich t h ey a re con t r olled. 2) By Sa n it a r y Police is mea n t , la ws a n d regu la t ion s for t he preven t ion of dis ea s e, a nd
pr omot ion of h ea lt h . Un der it a r e in clu ded t h e la ws es t ablis hin g, a n d t h e regu la t ios of boa r ds of hea lt h ; r egu la t ion s for
clea n s in g a nd pu rifiyin g cit ies , villa ges , a nd priva te es t a blis hmen t s ; remova l of n u is a n ces , bu ryin g t h e dead, &c.; a n d
t h e officers or a gen t s by wh ich t h es e ma t ters a re ca rried forward. 3) By Medica l Police is mean t , la ws a n d regu la t ions
for t h e cu re of dis ea s e. Un der it a re in clu ded la ws pres cribing t h e qu a lifica t ions a n d du t ies of ph ys icia n s ,
a pot h oca r ies , midwives , &c.; t h e regu la t ions for t h eir own gover n men t a mon g t hems elves ; a nd t h e officer s a n d a gen cies
by wh ich t h ey a re con t rolled.
In du s t ria l, s a n it a ry, a n d medica l police, exis t in n ea rly a ll t he govern men t s on t he con t inen t of Eu rope, a n d
will be illu s t ra ted t o s ome exten t in t h is report . Th os e who wis h more pa rt icu la r in forma t ion on t h es e ma t ters , a re
r efer red t o t he lis t s of books a nd a rt icles in t h e appendix; a nd a ls o t o t he Germa n work, Fran k (J oh a n n Peter ) Sys tem
einer volls t aen digen mediciu n is chen Polizey. Complete Sys tem of t h e Medica l Police, 6 vols ., 8vo; - t o a n a rt icle on
Medica l Police, in t h e Wes t mins t er Review, Vol. XLV for 1846, p. 56; a n d t o t he works t here r eviewed. Als o
Tra n s a ct ion s Am. Med. As s ociat ion , Vol. II, p. 326.
6
a n d 1497, exclu ded pot t er ies fr om t h e cen t er of Pa r is . Soa p is t o h a ve been
u n kn own , u n t il t h e fift een t h cen t r y. In 1567, a n d a t la t er per iods , t a n -
ya r ds , dye-h ou s es , a n d like es t a blis h men t s , wer e r equ ir ed t o be loca t ed ou t
of t h e t own s , a n d n ea r t h e wa t er . Hen r y IV qu iet ed t h e people of Pa r is , wh o
wer e a la r med a t t h e u s e of En glis h coa l, by obt a in in g fr om t h e ph ys icia n s a
decla r a t ion t h a t n o h a r m cou ld come of it . L. Reyn con s u lt ed t h e ph ys icia ns
on t h e ma n u fa ct u re of br ea d. In s t r u ct ion s wer e given , bu t u n for t u n a t ely
t h ey wer e n ot ca r r ied ou t . Th e gr ea t es t n u mber of h ou s es , in cit ies , h a d n o
pr ivies , in t h e s ixt een t h cen t u r y. Th e a n cien t pa r t s of cit ies s h ow t h a t t h e
s t r eet s wer e n a r r ow a n d cr ooked, a n d t h e h ou s es low, da mp, a n d wit h ou t
ligh t or a ir . Pa vin g a n d ligh t in g t h e s t reet s a r e moder n in ven t ion s . Th e la s t
pa r t of t h e eigh t een t h cen t u r y wr ou gh t s ome impr ovemen t s , bu t pu blic
h ea lt h did n ot become a well-or der ed mea s u r e, u n t il t h e commen cemen t of
t h e n in et een t h cen t u r y.
Th e fir s t per ma n en t "Con s eil de Sa lu br it e," Cou n cil of Hea lt h , des ign ed
es pecia lly for t h e cit y of Pa r is , wa s es t a blis h ed by Du bois , t h e Pr efect of t h e
Police, on t h e 6t h J u ly, 1802, a n d wa s modified by n ew decr ees in 1810 a n d
1815. Th e s er vices of t h is cou n cil a r e r en der ed gr a t u it ou s ly, yet it h a s been
con s ider ed a gr ea t h on or t o belon g t o it .
9
It wa s a t fir s t compos ed of fou r
member s , - MM. Deyeu x, Pa r men t ier , Hu za r d, s en ior , a n d Ca det -Ga s s icou r t .
It h a s s in ce been in cr ea s ed t o t wen t y-fou r , bes ides t h e pr es iden t a n d
s ecr et a r y.
In 1803, M. Th ou r et ca lled t o t h e cou n cil; a ft er wa r ds , in 1807, Ler ou x
a n d Du pu yt r en ; in 1810, M. Pa r is et r epla ced M. Th ou r et , a n d it wa s a t t h e
s a me per iod t h a t t h e n omin a t ion of Dr . Pet it t ook pla ce. Fr om t h a t t ime, t h e
men of t h e gr ea t es t con s ider a t ion s ou gh t t o h a ve a pa r t in t h e la bor s of t h e
"Con s eil de Sa lu br it e." Th u s we s ee en t er s u cces s ively, M.d' Ar cet , in 1813;
M. Ma r c, in 1815; M. Ber a r d, in 1817; t h e en gin eer Gir a r d, a n d Hu za r d,
ju n ior , in 1819; Pellet ier a n d J u ge, in 1821; M. Ga u t ier de Cla u br y, a n d M.
Pa r en t -Du ch a t elet , in 1825 ; MM. Adelon , An dr a l, ju n ior , Ba r r u el, a n d
La ba r r a qu e, in 1828 ; Dr . Es qu ir ol in 1829 ; a ft er wa r ds MM. Pa yen a n d
Bou s s in ga u lt , member s - of t h e in s t it u t e; Dr . Fla n din ; M. Begin , member of
t h e cou n cil of h ea lt h for t h e a r my; a n d M. Br u za n d, a r ch it ect ; a n d ot h er
gr ea t men of t h e n at ion . MM. Deyeu x, Pa r men t ier , Hu za r d, s en ior , Ca det -
Ga s s icou r t , Th ou r et , Ler ou x, Du pu yt r en , Ma r c, Gir a r d, Pa r en t -Du ch a t elet ,
Ba r r u el, Es qu ir ol, Pellet ier , de La r r ey, de Bot iillon -La gr a 11ge, de D' Ar cet , d
'Olivier , (d ' An ger s , ) de Roh a u l t de Fleu r y, n o lon ger live t o dir ect t h e
la bor s of t h e cou n cil, a n d con t r ibu t e t h eir lon g exper ien ce a n d in defa t iga ble
a ct ivit y.
Th is cou n cil is mer ely con s u lt a t ive. It s advice, in a ll ma t t er s s u bmit t ed
t o it , is con s ider ed a n d a ct ed u pon by t h e a dmin is t r a t ion . It s la bor s a n d
decis ion s a r e, h owever , h eld in s o h igh es t ima t ion , t h a t t h ey a r e s eldom if
ever r ever s ed. Th eir r epor t s wer e pu blis h ed a n n u a lly, u n t il 1828, wh en t h ey
wer e dis con t in u ed. In 1840, a gen er a l r epor t of t h eir la bor s for t h e eleven
yea r s , 1828-1839, wa s pu blis h ed; a n d, in 1847, a n ot h er r epor t for t h e s ix
yea r s , 1840-1845.
Du r in g t h e fir s t per iod 4431 r epor t s , a n d du r in g t h e la s t per iod 3087
r epor t s , wer e ma de t o t h e a dmin is t r a t ion on t h e n u mer ou s qu es t ion s ,wh ich

9
See Tr a ite de la Sa lu brit e, pp. 23 a nd 25; a ls o, pp. 319-359, wh ere t he ordin a n ces appea r. An n a les d Hygiene
pu bliqu e, t ome I, I. 13.
7
it s u bmit t ed t o t h e cou n cil. Th is is a n a ver a ge of over eigh t r epor t s weekly,
du r in g t h e wh ole per iods . An d ma n y of t h es e r epor t s r equ ir ed mu ch
s cien t ific in ves t iga t ion , a n d gr ea t la bor t o pr epa r e t h em. Fr om t h es e fa ct s
s ome idea ma y be for med of t h e immen s e a mou n t of gr a t u it ou s s er vice
wh ich h a s been per for med by t h is cou n cil.
10

Th es e r epor t s r ela t e t o t h r ee gr ea t divis ion s , health, s alubrity , and
indus try . Un der health a r e cla s s ed, a mon g ot h er t h in gs , t h e r es ea r ch es on
t h e a du lt er a t ion of food, on t h e ves s els u s ed in it s pr epa r a t ion , on t h e
pr eca u t ion s t o be t a ken wit h r es pect t o t h e ves s els a n d u t en s ils of copper ,
r ega r d bein g h a d t o t h e u s es for wh ich t h ey a r e employed; t h e exper imen t s
on t h e a du lt er a t ion of s a lt s , on t h e a du lt er a t ion of br ea d a n d of flou r by
differ en t s u bs t a n ces , on t h e pois on ou s s u bs t a n ces employed t o color
bon bon s , liqu eu r s , &c. ; t h e exa min a t ion of t h e met h ods employed in
pr epa r in g por k; t h e exa min a t ion of t h e wa t er u s ed for dr in k ; t h e
a du lt er a t ion of t h e flou r s of lin s eed a n d mu s t a r d; t h e u s e of mea t of a n ima ls
wh ich h a d died of dis ea s e; t h e r es ea r ch es in t o t h e s a lu br it y of dwellin gs . Th e
head of s a lu br it y compr is es t h e a n a t omica l t h ea t r es , t h eir con s t r u ct ion , t h e
mea n s of r emedyin g t h e ca u s es of t h e Un h ea lt h in es s wh ich t h es e
es t a blis h men t s pr es en t ; t h e dis ch a r ge of s u lph u r ou s wa t er s fr om t h e pu blic
ba t h s , t h e u t ilit y of s t r eet fou n t a in s , t h e in s pect ion of bar r a cks , a n d t h e
s a n it a r y mea s u r es t o wh ich t h ey s h ou ld be s u bject ; t h e impr ovemen t s t o be
ma de in t h e fir es of t h e es t a blis h men t s ,wh ich employ coa ls ; t h e
a r r a n gemen t s t o be ma de for t h e depos it of filt h in t h e r u r a l dis t r ict s ; t h e
pu r ifica t ion of s ewer s ; t h e s u pply of wa t er for domes t ic a n d in du s t r ia l
pu r pos es ; t h e s t eps t o be t a ken in exh u ma t ion s ; t h e exa min a t ion of differ en t
con t r iva n ces t o empt y pr ivies , t h e a melior a t ion s t o be in t r odu ced in t o t h is
por t ion of s er vice; t h e wh oles omen es s of t h e ma r ket s , t h e in s pect ion of
pr is on s . Th e r epor t s wh ich r ela t e t o indus try pr in cipa lly t r ea t of t h e
con s t r u ct ion of s la u gh t er -h ou s es ; t h e con den s a t ion of t h e ga s a n d va por s
r es u lt in g fr om t h e refin in g of met a ls ; t h e fa br ica t ion , pr es erva t ion , a n d s a le
of fu lmin a t in g a n d lu cifer ma t ch es ; t h e pr eca u t ion s t o be t a ken in t h e
con s t r u ct ion of fu lmin a t in g powder -mills , a n d in t h e ma n ipu la t ion of t h e
s u bs t a n ces employed t h er e; t h e mea s u r es t o be t a ken for t h e con veya n ce of
t h e fu lmin a t e of mer cu r y; t h e r es ea r ch es in t o t h e employmen t of bit u men s ,
a n d t h e con dit ion s t o be pr es cr ibed t o t h e ma ker s ; t h e ma kin g of wa x
ca n dles ; t h e con dit ion s t o be impos ed on ca t gu t fa ct or ies ; t h e r es ea r ch es on
t h e fir es of wa s h -hou s es , a n d on t h e n eces s it y of decompos in g t h e s oa py
wa t er t o pr even t pu t r efa ct ion ; t h e s a n it a r y mea s u r es a pplica ble t o wh it e-lea d
ma n u fa ct or ies , a n d t h e r es ea r ch es on t h e dis ea s es of t h e wor kmen ; t h e
pr opos it ion s of cla s s ifica t ion for differ en t t r a des , s u ch a s t h e s ilk h a t
fa ct or ies , t h e for ges , t h e pla ces for ma kin g a n d keepin g et h er ; a n d t h e
bea t in g of ca r pet s .
Th u s h ea lt h , s a lu br it y, in du s t r y, offer t o t h e "Con s eil de Sa lu br it e" a
va s t field of r es ea r ch es a n d in ves t iga t ion s , a n d we ma y a ffir m t h a t t h er e is
n o qu es t ion r ela t in g t o t h es e t h r ee gr ea t depa r t men t s of t h e a dmin is t r a t ion ,
wh ich t h ey h a ve n ot pr ofou n dly medit a t ed, a n d in pa r t r es olved. If n ow we

10
Th es e report s appea r u nder t h e t it le, Report generau x des Tra va u x du Con s cil de Sa lu brit e, penda n t les An nes
1829 a 1839 illclu s ivemen t ." Abs t ra ct s of t hes e report s were pu blis hed in t he An n a les d' Hygiene pu bliqu e, t ome XXV,
po61, a n d XXXVI1I, p, 79. A t r a n s la t ion of t h e for mer is pu blis hed in t he Repor t on t h e Sa n it a r y Con dit ion of t h e
La borin g Popu la t ion of Grea t Brit a in , pp 409.
8
t u r n t o ot h er s u bject s , we s t ill fin d impor t a n t la bor s wh ich t ou ch in s ever a l
poin t s on t h e differ en t ma t t er s of wh ich we h a ve ju s s poken , bu t wh ich h a ve
n ot , like t h em, a s pecia l a n d clea r ly defin ed ch a r a ct er : s u ch a r e t h e r epor t s
on epidemics a n d s ma llpox; t h e mea s u r es t o be t a ken t o pr even t or comba t
t h em; t h e epiz ooties t h a t h a ve pr eva iled a t differ en t epoch s a mon g s ever a l
s pecies of a n ima ls , a n d pa r t icu la r ly a mon g milkin g cows ; t h e s a le of h or s es
wit h gla n der s , a n d t h e r egu la t ion s t o wh ich t h ey s h ou ld be s u bject , a s well
a s ot h er a n ima ls s eized wit h con t a giou s dis ea s es ; t h e mea s u r es t o be t a ken
a ga in s t r a bid dogs , a n d t h e pr eca u t ion s in ca s e of bit es fr om t h es e a n ima ls ;
t h e modelin g, exa min a t ion , a n d emba lmin g of cor ps es ; t h e a ids t o be
a ffor ded t o t h e dr own ed a n d s u ffoca t ed; t h e mea s u r es t o be t a ken t o
a s cer t a in t h e n u mber of t h es e a cciden t s , a s well a s of s u icides ; t h e
compila t ion of a n ew n omen cla t u r e of dis ea s es a n d ca u s es of dea t h ; t h e
mea s u r es t o be t a ken t o pr even t fir es in t h ea t r es , a n d va r iou s ot h er ma t t er s .
"Th e la w h a s divided ma n u fa ct u r es in t o t h r ee cla s s es , ea ch bein g
a n n oyin g a n d in s a lu br iou s in differ en t degr ees . Th os e of t h e fir s t cla s s a r e
n ot per mit t ed a t a ll n ea r dwellin gs , a n d ca n on ly be es t a blis h ed by a r oya l
or din a n ce, is s u ed by t h e Con s eil d'Et a t . In t h is ca t egor y a r e in clu ded
ma n u fa ct or ies of t h e n it r ic, s u lph u r ic, a n d h ydr och lor ic a cids , a n d of lee-
a s h es ; melt in g es t a blis h men t s u s in g a n a ked fir e; wor ks h ops for t h e
pr epa r a t ion of t a ffet a s a n d va r n is h ed t is s u es ; t h e pr emis es of kn a cker s ,
t r ipemen , a n d ca t gu t ma n u fa ct u r er s ; t h os e a ls o in wh ich a r e pr epa r ed
a n ima l bla ck, glu e, Pr u s s ia n blu e, blood ma n u r es , 'or s eille, ' (a kin d of dye,)
a n d s t a r ch ; a n d fa ct or ies of ph os ph or u s a n d lu cifer ma t ch es , or fu lmin a t in g
compou n ds . Th e r ea s on s for pla cin g t h es e in t h e fir s t cla s s is t h e da n ger of
fir e, t h eir a ct u a l in ju r iou s n es s t o h ea lt h , or t h e in t oler a bly fet id odor s wh ich
t h ey emit , a lt h ou gh n ot a ct u a lly n oxiou s . Th ey ca n on ly be es t a blis h ed a ft er
pr olon ged a n d n u mer ou s for ma lit ies . Th e dema n d for per mis s ion t o do s o is
fir s t a ddr es s ed t o t h e pr efect , a n d is t h en pos t ed, by or der of t h e commu n a l
ma yor s , in t h os e pla ces s it u a t ed wit h in a r a diu s of s ix kilomet er s (a bou t
13,000 feet ) r ou n d t h e pr opos ed loca lit y. It r ema in s pos t ed for on e mon t h ,
a n d du r in g t h is per iod t h e ma yor r eceives object ion s , a n d en t er s t h em in a
s pecia l r egis t er . Th e loca l a u t h or it ies t h en dr a w u p a r epor t de commodo et
incommodo, a n d t r a n s mit a ll t h e docu men t s t o t h e pr efect . Th e pr efect
t r a n s mit s t h e file of pa per s t o t h e Cou n cil of Hea lt h , wh ich a ppoin t s a
commis s ion of in qu ir y t o vis it t h e s pot an d h ea r t h e object ion s ; t h eir r eport
on t h e fa ct s is t h en dis cu s s ed by t h e cou n cil, a n d it a ft er wa r ds r et u r n s a ll
t h e docu men t s t o t h e pr efect , wit h it s opin ion a s t o t h e pr opr iet y of gr a n t in g
or n ot gr a n t in g t h e r equ ir ed per mis s ion . If t h er e be a n oppos it ion t o t h is
per mis s ion , a s is or din a r ily t h e ca s e, t h e ma t t er is r efer r ed t o t h e cou n cil of
t h e pr efect u r e. Th e opin ion of t h e la t t er is n ot a ju dgmen t , a ga in s t wh ich t h e
con demn ed ma n u fa ct u r e h a s n o a ppea l; it is commu n ica t ed t o t h e
pr opr iet or , wh o ma y eit h er des is t or per s is t in h is s pecu la t ion ; if t h e la t t er ,
a ll t h e docu men t s a r e r efer r ed t o t h e Min is t er of Commer ce, a n d a r oya l
or din a n ce is gr a n t ed or wit h h eld. If wit h h eld; a n d t h e ma n u fa ct u r er h a ve
a lr ea dy con s t r u ct ed h is pr emis es , h e is r equ ir ed t o pu ll t h em down , or n ot t o
u s e t h em for t h e pu r pos e in t en ded: t h is oft en occu r s .
"Th e s econ d cla s s of ma n u fa ct u r in g es t a blis h men t s compr is es t h os e, of
wh ich t h e r emova l fr om a n in h a bit ed loca lit y is n ot s t r ict ly n eces s a r y, bu t
wh ich ca n on ly be per mit t ed a ft er it h a s been clea r ly s h own t h a t n o pr oces s
9
will be a dopt ed in t h em wh ich will eit h er in con ven ien ce or in ju r e t h e
n eigh bor in g h older s of pr oper t y. Lime or pla s t er kiln s , h igh pr es s u r e s t ea m
en gin es , ga s -wor ks , t a n n er ies , fou n dr ies , h a t fa ct or ies , ma n u fa ct or ies of
s u lph a t e of ir on a n d zin c, of s u lph a t e of s oda in clos e ves s els , of
ph os ph or u s , of imit a t ion t r in ket s , bit u min ou s ma s t ic, ch a n dler ies , wh et h er
for t a llow or compos it ion ca n dles , a n d wor ks h ops for clea n s in g ver digr is
fr om copper , a r e a ll in t h is ca t egor y.
"Non e of t h es e a r e a ct u a lly in ju r iou s t o t h e h ea lt h , bu t ma n y a r e
dis a gr eea ble, a n d a n n oy eit h er wit h s moke, n ois e, s t en ch , or t h e da n ger of
fir e. Th e dema n d for per mis s ion t o es t a blis h a n yon e of t h em is a ddr es s ed t o
t h e pr efect or vice pr efect , wh o t r a n s mit s it t o t h e ma yor of t h e commu n e,
t h a t h e ma y ma ke a n in qu ir y de commodo et incommodo. Th e Cou n cil of
Hea lt h t h en gives it s opin ion , a s in t h e pr ecedin g cla s s , a n d t h e pr efect
is s u es h is decr ee. If per mis s ion is r efu s ed, t h e a pplica n t ca n a ppea l t o t h e
cou n cil of t h e pr efect u r e, a n d fr om t h en ce h e ca n go t o t h e Con s eil d'Et a t .
Th e s a me cou r s e is open t o t h e oppon en t s .
" Th e t h ir d cla s s compr is es lime-kiln s t h a t a r e ill oper a t ion on e mon t h
on ly in a yea r , pot t er ies , br ick a n d t ile wor ks , ma n u fa ct or ies of gela t in e a n d
is in gla s s , cr u cible fou n dr ies , dyeworks , &.c. Th e met h od of obt a in in g
per mis s ion is t h e s a me a s in t h e s econ d cla s s . Th ey a r e s a n ct ion ed n ea r
h a bit a t ion s , bu t a r e s u bject t o t h e in s pect ion of t h e pr efect wh o gr a n t s t h e
per mit ."
11

Cou n cils of Hea lt h , s imila r t o t h a t of Pa r is , wer e es t a blis h ed in Na n t es
in 1817; in Bor dea u x s oon a ft er ; in Lyon s in 1822 ; in Ma r s eilles in 1825; in
Lis le in 1828; in Rou en in 1831 ; an d ot h er la r ge cit ies followed t h eir
exa mple.
Th e impor t a n t r es u lt s der ived fr om t h e in ves t iga t ion of t h es e cou n cils
s t imu la t ed t h e la bors of pr iva t e in dividu a ls , a n d ver y ma n y impor t a n t wor ks
h a ve been pu blis h ed on t h e s u bject . In con s equ en ce of t h es e wor ks , a n d of
t h e exa mple of En gla n d a n d ot h er gover n men t s in t h e ca u s e of pu blic h ea lt h ,
t h e " Con s eil d'Et a t " pa s s ed a n or din a n ce, on t h e 18t h December , 1848, for
a gen er a l h ea lt h r egu la t ion t h r ou gh ou t t h e Fr en ch Repu blic.
Fr a n ce is divided in t o 86 depa r t men t s , a n d s u bdivided in t o 363
a r r on dis men t s , 2,834 ca n t on s , a n d 37,187 commu n es , bea r in g s ome
r es embla n ce t o ou r cou n t ies , t own s , a n d dis t r ict s . Ea ch depa r t men t is
gover n ed by a Pref ect, ea ch a r r on dis men t is s u per in t en ded by a s u b-pr efect ,
a n d ea ch commu n e by a ma yor or ot h er ma gis t r a t e.
Th e h ea lt h or din a n ce pr ovides t h a t t h er e s h a ll be in ea ch a r r on dis men t
a Cou n cil of Pu blic Hea lt h ; t h e member s t o con s is t of n ot les s t h a n s even ,
n or mor e t h a n fift een per s on s . An or der dr a wn u p by t h e Min is t er of
Agr icu lt u r e a n d of Commer ce r egu la t es t h e n u mber of t h e member s a n d t h e
compos it ion of ea ch cou n cil. Th e member s of ea ch cou n cil of h ea lt h of a n
a r r on dis men t a r e n omin a t ed for fou r yea r s by t h e pr efect , on e-h a lf
r emova ble ever y t wo yea r s . Commis s ion s of pu blic h ea lt h ma r be in s t it u t ed
in t h e ch ief t own s of a ca n t on , by a s pecia l or der of t h e pr efect , a ft er h a vin g
con s u lt ed t h e cou n cil of a n a r r on dis men t . Th er e mu s t be a cou n cil of pu blic
h ea lt h in ea ch depar t men t , a n d loca t ed in t h e ch ief t own s of a pr efect u r e ;
t h e n u mber of member s t o be t h e s a me a s a bove, a n d h oldin g t h eir office for

11
Brit is h a n d Foreign Medico-Ch iru gica l Review, Vol. I, for 1848, p. 364.
10
t h e s a me per iods . Th es e cou n cils of h ea lt h a r e pr e-s ided over by t h e pr efect
or s u b-pr efect , a n d t h e commis s ion er s of a ca n t on by t h e ma yor of t h e ch ief
t own . Ea ch cou n cil h a s a vice-pr es iden t a n d s ecr et a r y, wh o h old t h eir offices
for t wo yea r s . Th e boa r ds of h ea lt h a n d commis s ion s h old join t meet in gs a t
lea s t on ce ever y t h r ee mon t h s , a n d wh en ever t h ey a r e con voked by t h e
pr oper a u t h or it ies . Th e member s of commis s ion s of h ea lt h of a ca n t on ma y
be ca lled t o a t t en d meet in gs of t h e cou n cil of h ea lt h of a n a r r on dis men t ,
wh er e t h eir voice is mer ely a dvis or y. If a member of t h e boa r ds , or of t h e
commis s ion s of a ca n t on , a bs en t h ims elf fr om t h r ee con s ecu t ive meet in gs ,
wit h ou t a s s ign in g r ea s on s t h a t a r e a ppr oved by t h e pr efect , h e is con s ider ed
a s dis mis s ed.
Th e cou n cil of h ea lt h of a n a r r on dis men t a r e ch a r ged wit h t h e
exa min a t ion of a ll qu es t ion s r ela t ive t o t h e pu blic h ea lt h wh ich ma y be
s u bmit t ed t o t h em by t h e pr efect or s u b-pr efect , a n d t h ey h a ve s pecial
ch a r ge of t h e followin g s u bject s :-t h e s a n it a r y r egu la t ion s of loca lit ies a n d
h a bit a t ion s , t a kin g mea s u r es t o pr even t a n d t o con t r ol en demic, epidemic,
a n d con t a giou s dis ea s es ; epizoot ies a n d dis ea s es of a n ima ls ; t h e pr opa ga t ion
of t h e va ccin e dis ea s e; t h e or ga n iza t ion a n d dis t r ibu t ion of medica l a id t o t h e
s ick poor ; t o fu r n is h mea n s t o a llevia t e t h e s a n it a r y con dit ion of t h e la bor in g
a n d a gr icu lt u r a l popu la t ion ; t o pr ot ect t h e h ea lt h of wor kmen ; t o pr ovide for
t h e s a lu br it y of wor ks h ops , s ch ools , h os pit a ls , lu n a t ic a s ylu ms , a lms h ou s es ,
a n d ch a r it a ble es t ablis h men t s , ba r r a cks , a r s en a ls , pr is on s , a s ylu ms , et c.,
et c. ; t o decide qu es t ion s r ela t ive t o fou n dlin gs ; t h e qu a lit y of foods , dr in ks ,
con dimen t s , a n d medicin es kn own t o commer ce; t h e a melior a t ion or
impr ovemen t of es t a blis h men t s of min er a l wa t er s belon gin g t o t h e s t a t e, t o
t h e depa r t men t s , t o commu n es , or t o in dividu a ls , a n d t o pr ovide mea n s t o
r en der t h eir u s e a cces s ible t o t h e s ick poor ; t h e a ba t emen t by r equ is it ion of
da n ger ou s , u n h ea lt h y, or in con ven ien t es t a blis h men t s ; gr ea t wor ks of pu blic
u t ilit y, t h e con s t r u ct ion of edifices , s ch ools , pr is on s , ba r r a cks , h a r bor s ,
ca n a ls , r es er voir s , fou n t a in s , ma r ket s ; t h e es t a blis h men t of ma r ket pla ces ,
pon ds for s oa kin g h emp, s in ks , s ewer s , cemet er ies , bu t ch er s ' s t a lls , et c., et c.
All t h es e ma t t er s a r e t o come u n der t h e or ga n iza t ion of cou n cils of h ea lt h .
Th e cou n cil of h ea lt h of a n a r r on dis men t is t o combin e a n d a r r a n ge
docu men t s r ela t in g t o mor t a lit y a n d it s ca u s es , wit h t h e t opogr a ph y a n d
s t a t is t ics of t h e a r r on dis men t t ou ch in g t h e pu blic h ea lt h . Repor t s a r e t o be
ma de r egu la r ly t o t h e pr efect , wh o mu s t t r a n s mit a copy t o t h e Min is t er of
Agr icu lt u r e a n d of Commer ce. It is ma de t h e du t y of t h e r es pect ive cou n cils
of h ea lt h of ea ch depa r t men t t o give advice u pon a ll qu es t ion s of pu blic
h ea lt h t h a t ma y be s u bmit t ed t o t h em by t h e pr efect , u pon a ll qu es t ion s
common t o t h e gen er a l a r r on dis men t , or r ela t in g t o a n en t ir e depa r t men t . It
is t h eir du t y a ls o t o con den s e a n d a r r a n ge t h e r epor t s ma de t o t h em by t h e
cou n cil of h ea lt h of t h e differ en t a r r on dis men t s , a t t h e r equ es t of t h e pr efect .
Th is r epor t is immedia t ely t r a n s mit t ed by t h e pr efect , wit h t h e a ccompa n yin g
r epor t s a n d docu men t s , t o t h e Min is t er of Agr icu lt u r e a n d Commer ce.
12
Th e
cit y of Pa r is h a s s pecia l r egu la t ion s for t h e pr ot ect ion of t h e pu blic h ea lt h .
In t h e Ger ma n a n d Pr u s s ia n St a t es , s ys t ems of s a n it a r y a n d medica l
police exis t in gr ea t er per fect ion , a n d h a ve been a pplied mor e ext en s ively t o
s ociet y, t h a n in a n y ot h er pa r t s of t h e wor ld. Th ey a r e u n der t h e con t r ol of

12
Annuaire Medical et Pharmaceutique de la France, annie 1849, p. 60.
11
gover n men t , a n d es pecia lly t h e Home Secr et a r y or Min is t er of t h e In t er ior , by
mea n s of a cen t r a l medica l depa r t men t , t h e dir ect or of wh ich is a kin d of
u n der -s ecr et a r y of s t a t e. Th is depa r t men t con s is t s of t h r ee ph ys icia n s , t wo
a pot h eca r ies , a n d t wo vet er in a r y s u r geon s . A r egis t r a r a n d libr a r y a r e
a t t a ch ed t o it , t h e la t t er con t a in in g, a mon g ot h er docu men t s , copies of t h e
la ws r ela t in g t o s a n it a r y or medica l police by for eign gover n men t s . Bes ides
t h es e t h er e is a s cien t ific cou n cil of h ea lt h , compos ed of t h os e pr a ct it ion er s
wh o h a ve a t t a in ed t o pr ofes s ion a l emin en ce, wh os e du t y it is t o a dvis e t he
Execu t ive. Su bor din a t e t o t h es e a r e provin cia l boa r ds a n d cou n cils , t h e
dir ect or of wh ich , t er med medicin a l r a t h , s u per in t en ds t h e medica l police of
h is pr ovin ce, a n d is a s s is t ed by t h e medica l s u per in t en den t (lcr eis -ph ys ici) of
dis t r ict s , cor r es pon din g t o ou r cou n t ies .
It is t h e du t y of t h e medica l s u per in t en den t s t o r epor t t o t h e medica l
cou n cil, qu a r t er ly, met eor ologica l obs er va t ion s ; t h e s t a t e a n d pr os pect s of
t h e cr ops ; t h e epidemic con s t it u t ion of ea ch qu a r t er , a n d t h e pr eva ilin g
epidemic; s u gges t ion s for impr ovemen t s in t h e or din a n ces r ela t in g t o h is
du t ies ; pr ove a ct ion s for offen ces a ga in s t medica l la ws , or for qu a cker y; a n d
t h e vet er in a r y pr a ct ice of t h e qu a r t er . A yea r ly r et u r n of a ll medica l
pr a ct it ion er s , midwives , a pot h eca r ies , vet er in a r y s u r geon s , per s on s
va ccin a t ed, s t a t e of t h e a pot h eca r ies ' s h ops , &c., is ma de t o t h e s ecr et a r y of
s t a t e. Th e medica l s u per in t en den t mu s t pa s s a n exa min a t ion in s t a t e
medicin e, a n d be a ppr oved a s a ph ys ician , s u r geon , a n d vet er in a r y s u r geon .
He mu s t r es ide in t h e cen t r e of h is dis t r ict , a n d ca n n ot be a bs en t wit h ou t
lea ve of t h e pr ovin cia l boa r d. He h a s t o in s pect t h e pr ofes s ion wit h in h is
dis t r ict ; s ee t h a t s u rgeon s a n d midwives do n ot over s t ep t h eir pr oper lin e of
pr a ct ice; look a ft er qu a cks ; in s pect t h e s h ops of a pot h eca r ies ; s u per in t en d
t h e medica l t opogra ph y of h is dis t r ict ; t h e pa u per medica l r elief, pu blic
h os pit a ls , ba t h s , s ch ools , pr is on s , &c., in r ela t ion t o t h eir s a n it a r y con dit ion .
He mu s t a t t en d t o s u dden a cciden t s , a n d a s s is t s u r gica lly, or pr ocu r e
a s s is t a n ce, a n d ma ke pos t-mortem exa min a t ion s , a n d give eviden ce a t
in qu es t s . He h a s u n der h im a dis t r ict s u r geon , t o a ct a s h is a s s is t a n t or
depu t y. Th ey ea ch h a ve a n officia l s ea l. To ea ch pr ovin cia l execu t ive is
a t t a ch ed a cou n cil of h ea lt h , wh os e du t ies , like t h os e of t h e cen t r a l cou n cil,
a r e t o a dvis e t h e execu t ive, a n d t o a ct a s a boa r d of exa min er s for t h e
pr ovin ce.
13

In a ll t h e gover n men t s on t h e con t in en t of Eu r ope, la ws exis t by wh ich
ever y bir t h , ever y ma r r ia ge, a n d ever y dea t h , wh ich t a kes pla ce, is r ecor ded.
Th es e r ecor ds a r e compu ls or y a n d u n iver s a l. In ever y ca s e of dea t h , t oo, t h e
body is in s pect ed by a n a u t h or ized medica l officer , gen er a lly a ppoin t ed by
gover n men t , wh o cer t ifies t h e ca u s e of dea t h . Th e pr a ct ice va r ies in differ en t
pla ces . Th e followin g a r e t h e r egu la t ion s in Ha mbu r gh , commu n ica t ed t o u s
by Dr . Sch r oeder of t h a t cit y :-
1. A cer t ifica t e of a ph ys icia n on t h e a ct u a l a n d n a t u r a l dea t h of a n yon e
t h a t is t o be bu r ied, mu s t be deliver ed at a ll t h e ch u r ch es an d ch a pels
of t h e cit y, a t t he for eign r eligiou s ch a pels , a n d a t t h e J ewis h
s yn a gogu e, befor e t h ey will be a llowed t o give t h e per mis s ion for bu r ia l.
Th is cer t ifica t e con t a in s a for mu la , wh ich mu s t s pecify t h e n a me,

13
See article on Medical Police; Wes tmins ter Review, Vol. XLV, for 1846, p. 72.

12
r es iden ce, a ge, da y of dea t h , a n d dis ea s e of wh ich t h e per s on died, a n d
it s du r a t ion . Wit h ou t s u ch cer t ifica t e n o per mis s ion of bu r ia l is given in
a n y ca s e.
2. No ph ys icia n is per mit t ed t o give t h is cer t ifica t e, ot h er wis e t h a n on t h e
mos t con vin cin g s ign s of dea t h , a n d on fin din g n o t r a ce wh a t ever of a n
u n n a t u r a l ca u s e. In ca s e of dou bt of t h e a ct u a l dea t h , t h e ph ys icia n
mu s t immedia t ely apply a ll mea n s for r es t or in g life, a n d immedia t ely
in for m t h e police officer s , if t h e r ela t ives r efu s e t h e r equ ir ed a s s is t a n ce.
It is a ls o ma de his du t y t o give s peedy in for ma t ion , on h ea vy
r es pon s ibilit ies , wh en ever h e fin ds t r a ces of a n u n n a t u r a l dea t h .
3. An in qu es t is h eld gr a t u it ou s ly on a ll t h os e wh o h a ve died wit h ou t t h e
t r ea t men t of a ph ys icia n , or wh o, in cas es of s u dden dea t h , h a ve n ot
been fou n d a live by t h e ph ys icia n ca lled in , eit h er by t h e ma gis t r a t e,
s u r geon , or by on e of t h e member s of t h e cou n cil of h ea lt h , wh o a r e
a ppoin t ed t o t h is office for a s t a t ed t ime, a n d wh os e n a mes a r e du ly
pu blis h ed.
4. In t h e poor h ou s es a n d h os pit a ls t h is cer t ifica t e is given by t h e r es iden t
ph ys icia n s . Th e ph ys icia n of t h e poor of t h e pa u per dis t r ict gives it t o
t h os e wh o en joy t h e ou t -door pr ivilege of t h es e in s t it u t ion s .
5. In t h e pr in cipa l h os pit a l, a lis t is ma de u p weekly, by t h e r es iden t
ph ys icia n , of t h os e t h a t h a ve died wit h in t h e week, wit h t h eir n a mes ,
a ges , a n d la s t dis ea s es .
6. All t h es e cer t ifica t es a r e collect ed on Mon da ys , Wedn es da ys , a n d
Sa t u r da ys , by t h e mes s en ger of t h e cou n cil of h ea lt h , fr om t h e differ en t
pr es idin g officer s of t h e ch u r ch es , a n d t h e ot h er pr oper a u t h or it ies , a n d
a r e immedia t ely ca r r ied t o t h e cit y ph ys icia n . If h e s h ou ld t h in k it
n eces s a r y, on a ccou n t of a deficien cy in t h e cer t ifica t e, or fr om a n y
ot h er r ea s on , t o exa min e t h e cor ps e h ims elf, n obody ca n r efu s e h im t h is
exa min a t ion , wh ich is don e gr a t u it ou s ly, u n der h ea vy pen a lt ies .
7. Th e cit y ph ys icia n pr es en t s a n a bs t r a ct of t h es e cer t ifica t es ever y
mon t h , a n d in da n ger ou s ca s es immedia t ely, s pecifyin g t h e n u mber s ,
n a mes , s exes , a ges , a n d ca u s es of dea t h of t h os e t h a t died wit h in t h e
mon t h . At t h e en d of t h e yea r a n exa ct lis t of a ll t h e bu r ied is h a n ded in
t o t h e police officer by t h e pr oper a u t h or it ies , a n d by h im h a n ded t o t h e
cit y ph ys icia n , wh o fr om it pr epa r es a n d pu blis h es in t h e n ews pa per s a
gen er a l r epor t .
Ever y cit izen a n d in h a bit a n t is u r ged con s cien t iou s ly t o con for m t o
t h is r egu la t ion , s in ce, bes ide t h e a dva n t a ges in a s cien t ific view, it is t h e
on ly mea n s t o a void t h e in t er men t of livin g bodies , a n d pr even t s ecr et
mu r der s ; a n d t h e on ly wa y t o dis cover , s ea s on a bly, con t a giou s dis ea s es . "
Bes ides t h e mon t h ly r epor t s of t h e cit y ph ys icia n on t h e mort a lit y in
t h e cit y a n d t h e s u bu r bs , t h e pr es iden t for t h e t ime bein g of t h e ph ys icia n s
for t h e poor , exh ibit s ever y t h r ee mon t h s a n exa ct lis t of t h e n ewly-r eceived
s ick, dis t in gu is h in g t h eir dis ea s es , t a ken fr om t h e s ick lis t s of t h e
ph ys icia n s for t h e poor , t oget h er wit h t h e r epor t s of t h es e ph ys icia n s on
t h e s a me."
On e of t h e mos t in t er es t in g poin t s con n ect ed wit h t h e excellen t
s ys t em of r egis t r a t ion in Gen eva , is t h e mode of es t a blis h in g t h e a ccu r a cy
of t h e det a ils con cer n in g mor t a lit y, wh ich s er ve a s t h e ba s is of t h e r epor t s .
Th e dea t h s , wit h ou t a n y except ion s , a r e a ll cer t ified t o, n ot on ly by t h e
13
a t t en da n t ph ys icia n s , bu t t h os e s pecia lly a ppoin t ed t o t h is du t y by t h e
h ea lt h office. By t h es e, n ot es mor e or les s ext en ded a r e ma de ou t in r ega r d
t o t h e decea s ed, a n d t h e mor bid or a cciden t a l ca u s es wh ich led t o dea t h .
Th es e n ot es a r e exa min ed ever y fift een da ys by a medica l boa r d, dis cu s s ed,
a n d s omet imes ext en ded or modified. Even a ft er a ll t h is , t h e n ot e of
r egis t r a t ion is ca r r ied, by a per s on employed by t h e cou n cil of h ea lt h , t o
t h e a t t en din g ph ys icia n , wh o a dds t o it a ll t h e in for ma t ion of in t er es t t o be
r ecor ded.
14

" In Pa r is a n d Mu n ich , t h e ver ifica t ion mu s t in ever y in s t a n ce be
ma de by pu blic officer s , wh o a r e gen era lly medica l men in pr a ct ice, a n d
wh o r eceive a fee for ea ch ver ifica t ion . At Leipzig, t h e du t y is per for med by
t h e r egu la r medica l a t t en da n t of t h e fa mily, if t h er e be on e, bu t if t he
decea s e h a s t a ken pla ce wit h ou t a medica l ma n h a vin g been in
a t t en da n ce, t h e ver ifica t ion mu s t be made by t h e pu blic officer . At Ber lin
a n d Fr a n kfor t , t h e cer t ifica t e is filled u p by t h e fa mily a t t en da n t ."
Wh er e t h er e a r e r egu la r ly a ppoin t ed verifica t or s , t h e dis t r ict s of t h e
cit y a r e divided bet ween t h em; a n d a s s oon a s dea t h t a kes pla ce, t h e fa ct
mu s t be commu n ica t ed t o t h e dis t r ict ver ifica t or , wh o pr oceeds t o t h e
h ou s e, a n d s ign s t h e cer t ifica t e a ft er ma kin g t h e n eces s a r y exa min a t ion .
Th e in s t r u ct ion s u n der wh ich t h es e officer s a ct a r e of a ver y
s t r in gen t ch a r a ct er , a n d t h e pr ocedu r e is in t en ded t o obvia t e pr ema t u r e
in t er men t , a n d t o det ect cr ime.
" Th e Fr en ch a n d Ger ma n met h ods of ver ifica t ion a r e in t en ded t o be
preventive. A n u mber of in s t a n ces wer e men t ion ed t o u s , in wh ich cr imes ,
wh ich wou ld ot h er wis e h a ve es ca ped n ot ice, wer e det ect ed by t h e keen a n d
pr a ct is ed eye of t h e ver ifica t or , a n d t h e gen er a l opin ion cer t a in ly wa s t h a t
mu ch cr ime wa s pr even t ed. We h ea r d of n o ca s es of t h a t cold, ca lcu la t in g
des t r u ct ion of s u cces s ive member s of t h e s a me fa mily, wh ich h a s dis clos ed
it s elf in En gla n d. Su ch a s u cces s ion of mu r der s , or t h e pois on in g of
ch ildr en , or a llowin g t h em t o die fr om n eglect , in or der t o obt a in t h e bu r ia l-
mon ey fr om a clu b in wh ich t h ey wer e in s u r ed, or fr om ot h er ca u s es , t oo
fr equ en t ly pa s s u n not iced, bu t Un der t h e s ys t em of ver ifica t ion t h ey cou ld
h a r dly es ca pe bein g br ou gh t u n der ju dicia l in qu ir y, a n d cr ime migh t
pos s ibly be dimin is h ed by a kn owledge of t h e cer t a in t y of it s dis cover y."
15

In Gr ea t Br it a in , t h e s a n it a r y welfa r e a n d impr ovemen t of t h e people
s eems t o h a ve a t t r a ct ed ver y lit t le a t t en t ion u n t il wit h in t h e la s t t wen t y-five
yea r s . Boa r ds of h ealt h h a d exis t ed in ma n y cit ies , bu t t h ey wer e gen er a lly
void of mu ch vit a lit y. Th e r epor t fr om t h e s elect commit t ee of t h e Hou s e of
Common s , on t h e laws r ela t in g t o Fr ien dly Societ ies , ,va s pu blis h ed J u ly 5,
1925 ; a n d a s econ d r epor t on t h e s a me s u bject , J u n e 29, 1827. In t h e
Wes t min s t er Review for Apr il, 1828, t h er e a ppea r ed a n a ble a r t icle on t h e
ma t t er s s u gges t ed in t h es e r epor t s , t h e object of wh ich wa s "t o exh ibit t h e
pr es en t s t a t e of t h e in for ma t ion pos s es s ed r ela t ive .t o t h e ca s u a lt ies of
s ickn es s a n d mor t a lit y, a n d t h e con du ct of t h e gover n men t r es pect in g t h e
depa r t men t s of t h e pu blic expen dit u r e a ppr opr ia t ed a s mea n s t o dimin is h
t h e evil effect s of t h es e ca s u a lt ies ." Th es e wor ks h a ve been con s ider ed a s
t h e da wn in g t wiligh t of s a n it a r y impr ovemen t .

14
D'Es pine-" Annuaire de la Morlalile Genevois e," p. 4.
15
Chad wick 's Report on a General Scheme for Extramural Sepulture, p. 171.
14
Th e r eview wa s wr it t en by Edwin Ch a dwick, Es q., of t h e In n er
Temple, ba r r is t er -a t -la w, t h e in dividu a l t o wh om, per h a ps , mor e t h a n t o
a n y ot h er , t h e cau s e is in debt ed. A lea din g Lon don per iodica l, of
December , 1849, h a s des cr ibed h im as t h en " a s t u den t a t la w in t h e
Temple. He wa s n ot a ma n of va r ied or pr ofou n d a t t a in men t s , n or
dis t in gu is h ed by a n y ext r a or din a r y br illia n cy of in t ellect . Bu t h e wa s
r ema r ka ble for h is s a ga cit y in ext r a ct in g fr om ma s s es of det a il t h e ma s t er
fa ct s , a n d br in gin g t h es e t o bea r for t h e elu cida t ion of a ma s t er t h ou gh t .
He wou ld con fr on t , u n da u n t ed, a n y a mou n t of in t ellect u a l la bor ; explor in g
mou n t a in s of blu e books a n d s t a t is t ica l r et u r n s , t ill h e h a d fu lly
a s cer t a in ed a n d br ou gh t t o ligh t t h eir t r u e r ich es . For s ome yea r s h is
pecu lia r power h a d been wa s t ed on s ift in g eviden ce in pr iva t e ca s es for
a t t or n eys . Bu t in 1828, a s ligh t in ciden t t h r ew t h e idea of wh ich we h a ve
s poken a cr os s h is t r a ck. He s eized it , a n d it beca me t h e r u lin g t h ou gh t of
h is life." His n a me s h ou ld be h a n ded down t o pos t er it y a s on e of t h e
gr ea t es t a n d mos t u s efu l r efor mer s of h is a ge.
Dr . T. Sou t h wood Smit h , Pr ofes s or in t h e Lon don Fever Hos pit a l,-
a n ot h er in dividu a l wh o h a s been pr omin en t in a ll t h e s a n it a ry movemen t s ,
a n d t o wh om t h e wor ld is gr ea t ly in debt ed,-ca lled t h e pu blic a t t en t ion t o
t h e ca u s es of fever , in h is t r ea t is e on t h a t s u bject , in 1830; a n d
s u bs equ en t ly pu blis h ed a va lu a ble work on t h e Ph ilos oph y of Hea lt h . He
wa s a ppoin t ed, in 1832, by Lor d Melbou r n e, in con ju n ct ion wit h Mr . Took
a n d Mr . Ch a dwick, t o in ves t iga t e t h e qu es t ion of fa ct or y la bor , wh ich Lor d
As h leya n d Mr . Sa dler h a d a t t h a t t ime pr es s ed u pon pu blic a t t en t ion . Th is
r es u lt ed in t h e a ppoin t men t of Fa ct or y In s pect or s .
In 1832, a commis s ion of n in e per s on s wa s a ppoin t ed t o in qu ir e in t o
t h e pr a ct ica l oper a t ion of t h e la ws for t h e r elief of t h e poor in En gla n d a n d
Wa les . Mr . Ch a dwick wa s on e of t h is commis s ion . Th eir r epor t wa s t h e
ba s is of " An Act for t h e Amen dmen t a n d bet t er Admin is t r a t ion of t h e La ws
r ela t in g t o t h e Poor in En gla n d a n d Wa les ," wh ich wa s pa s s ed, Au gu s t 14,
1834. Th a t a ct pla ced t h e wh ole pa u per s ys t em u n der t h e ma n a gemen t .of
t h r ee commis s ion er s a n d a pr in cipa l s ecr et a r y. Rt . Hon . Th oma s
Fa u lkla n d Lewis , J oh n Geor ge Sh a w Le Fever , Es q., a n d Geor ge Nich ols ,
Es q., wer e immediat ely a ppoin t ed commis s ion er s , a n d Edwin Ch a dwick.
Es q., s ecr et a r y. He is t h e a u t h or of mos t of t h e a ble pa per s wh ich h a ve
a ppea r ed in t h e fift een a n n u a l r epor t s ma de s in ce t h a t t ime. Th es e
impor t a n t docu men t s exh ibit on e-fou r t h of a ll t h e pa u per is m a s t h e r es u lt
of pr even t a ble dis ea s e; if s o, t h en is pa u per is m in it s elf in a s imila r degr ee
pr even t a ble.
Ma r ch 28, 1833, a s elect commit t ee of t wen t y-s even per s on s , a mon g
wh om wer e. J oh n Wilks , Es q., Lor d Vis cou n t Mor pet h , Sir Geor ge Gr ey,
Lor d J oh n Ru s s ell, t h e s olicit or -gen er a l, Col. Da vis , a n d ot h er
dis t in gu is h ed men , wa s a ppoin t ed by Pa r lia men t , "t o con s ider a n d r epor t
on t h e gen er a l s t a t e of pa r och ia l r egis t er s , a n d t h e la ws r ela t in g t o t h em;
a n d on a gen er a l r egis t r a t ion of bir t h s , ba pt is ms , ma r r ia ges , dea t h s , a n d
bu r ia ls , in En gla n d a n d Wa les ." On t h e 15t h of Au gu s t s u cceedin g, a ft er a
t h or ou gh in ves t iga t ion , a fu ll r epor t of t h e r es u lt of t h eir la bor s wa s
s u bmit t ed. Th e con clu s ion s of t h e commit t ee wer e
1. Th a t t h e s u bject is u r gen t ly impor t a n t :
15
2. Th a t it in volves ma t t er s of gr ea t pu blic a n d n a t ion a l in t er es t ,
a s well a s in dividu a l s a t is fa ct ion , a n d r igh t s a n d cla ims t o
pr oper t y; a n d des er ves t h e a t t en t ion of t h e h u mbles t a r t is a n ,
a s well a s of t h e mos t ph ilos oph ica l a n d s t a t es ma n like
in qu ir er :
3. Th a t t h e exis t in g la w is imper fect a n d u n ju s t , a n d r equ ir es n ot
on ly pa r t ia l a men dmen t , bu t r ea l fu n da men t a l r efor m
4. Th a t gr ea t t r ou ble, va s t expen s e, u t t er u n cer t a in t y, ca pr iciou s
ch a n ges , a n d loca l a n d gen er a l evils exis t , wh ile n o mea n s a r e
s u pplied t o obt a in t h e in for ma t ion ot h er cou n t r ies pos s es s ,
a n d ju s t ly va lu e, as to the s tate of dis eas e, the operation of
moral and phy s ical caus es on the health of the people, t h e
pr ogr es s of t h e popu la t ion , a n d ot h er ma t t er s , on . wh ich
a ccu r a t e kn owledge ca n s ca r cely be t oo h igh ly a ppr ecia t ed or
t oo in t en s ely pu r s u ed. "
In con s equ en ce of t h e in for ma t ion con t a in ed in t h is r epor t , a n "Act for
t h e Regis t r a t ion of Bir t h s , Ma r r ia ges , a n d Dea t h s , in En gla n d a n d Wa les ," wa s
pa s s ed J u n e 6, 1836, a n d wen t in t o oper a t ion J u ly 1, 1837. Th is a ct wa s
br ou gh t in t o Pa r lia men t by Lor d J oh n Ru s s ell, t h e pr es en t Pr ime Min is t er of
Gr ea t Br it a in , a n d wa s a dvoca t ed by h im in a ver y a ble s peech , in wh ich h e
s a id," It wa s mos t des ir a ble t h a t a gen er a l s ys t em of civil r egis t r a t ion s h ou ld
n ow be ca r r ied in t o effect . It wa s a mos t impor t a n t s u bject : impor t a n t for t h e
s ecu r it y of pr oper t y; impor t a n t t o a s cer t a in t h e s t a t e a n d con dit ion of
in dividu a ls u n der va r iou s cir cu ms t a n ces ; impor t a n t t o en a ble t h e gover n men t
t o a cqu ir e a gen er a l kn owledge of t h e s t a t e of t h e popu la t ion of t h e cou n t r y,
t h a t t h er e s h ou ld be a gen er a l r egis t r a t ion of bir t h s , ma r r ia ges , a n d dea t h s ."
Sir Rober t Peel, Dr .Bowr in g, Lor d Mor pet h , a n d ot h er dis t in gu is h ed member s
of Pa r lia men t , wer e a ls o it s wa r m s u ppor t er s .
Un der t h e oper a t ion of t h is s ys t em, a cen t r a l office wa s es t a blis h ed in
Lon don , pr es ided over by a n officer s t yled t h e Regis t r a r -Gen er a l of Bir t h s ,
Dea t h s , a n d Ma r r ia ges . En gla n d is divided a t pr es en t in t o 11 divis ion s , 623
dis t r ict s , a n d 2189 s u b-dis t r ict s . In ea ch dis t r ict t h er e is a s u per in t en den t
r egis t r a r ; a n d in ea ch s u b-dis t r ict , a r egis t r a r . Lon don is divided in t o 5
divis ion s ,-ea s t , wes t , n or t h , s ou t h , a n d middle, 36 dis t r ict s , a n d 135 s u b-
dis t r ict s . Copies of t h e r ecor ds of a ll bir t h s , ma r r ia ges , a n d dea t h s , wh ich
t a ke pla ce du r in g t h e pr ecedin g week, a r e ma de by t h e r egis t r a r s of t h e s u b-
dis t r ict s , ever y Sa t u r da y even in g, a n d t r a n s mit t ed ever y Mon da y t o t h e
s u per in t en den t r egis t r a r s , a n d by t h em t r a n s mit t ed t o t h e Regis t r a r -Gen er a l.
An a bs t r a ct is ma de of t h es e r et u r n s on t h e s a me da y, an d pu blis h ed on
Tu es da y, a n d a ccompa n ied by r ema r ks on t h e s t a t e of t h e h ea lt h a n d wea t h er
du r in g t h e week. Not wit h s t a n din g t h e gr ea t n es s of t h e met ropolis , con t a in in g
over 2,000,000 in h a bit a n t s , n ea r ly equ a l t o t h r ee t imes t h e popu la t ion of
Ma s s a ch u s et t s , t h e r et u r n s a r e ma de wit h s o gr ea t r egu la r it y t h a t it s eldom
h a ppen s t h a t a s in gle on e is mis s in g. Th e dea t h s by ea ch dis ea s e a r e s h own ,
t h e pr eva ilin g epidemics r ecor ded a n d exh ibit ed, a n d ever yon e is t r a ced fr om
it s or igin t o it s t er min a t ion . A qu a r t er ly r epor t , compr is in g a n a bs t r a ct of t h e
r et u r n s fr om a ll t h e dis t r ict s of En gla n d, is pu blis h ed ; a n d fr om a ll t h es e
docu men t s a n a n n u a l r epor t is pr epa r ed. Nin e a n n u a l r epor t s h a ve been
pu blis h ed ; t h e fir s t t h r ee by T .H. Les t er , Es q., t h e fir s t Regis t r a r -Gen er a l.
Sin ce t h e dea t h of Mr . Les t er , Geor ge Gr a h a m, Es q.; h a s h eld t h e office, a n d
16
h e h a s ma de t h e la s t s ix r epor t s . Th es e r epor t s con t a in a va s t fu n d of
in for ma t ion , of t h e gr ea t es t va lu e, r ela t in g t o t h e life, t h e h ea lt h , a n d t h e
welfa r e of ma n .
Th is wa s t h e mos t impor t a n t s a n it a r y mea s u r e ever a dopt ed in
En gla n d; a n d it h a s been t h e fou n da t ion of n ea r ly a ll ot h ers . Wit h ou t it t h ey
wou ld h a ve been compa r a t ively of lit t le va lu e. A r ecen t wr it er s a ys
" Th e fir s t bill of h ea lt h wa s t h e a ct for t h e r egis t r a t ion of bir t h s ,
ma r r ia ges , a n d dea t h s . Befor e t h a t t ime, a per fect ch a os , r es pect in g
popu la t ion a n d mor t a lit y, r eign ed. Sin ce t h a t t ime, a ma s s of s t a t is t ics ,
r ela t in g t o life, h ea lt h , a n d dis ea s e, h a s been a ccu mu la t in g, wh ich will exer t ,
a n d is exer t in g, a n immen s ely ben eficia l in flu en ce u pon t h e ph ys ica l a n d
mor a l welfa r e of t h e popu la t ion of t h es e r ea lms , a n d in deed, u lt ima t ely, u pon
ever y people u pon t he fa ce of t h e globe. Th e dis cover ies in a s t r on omy h a ve n ot
a mor e pa lpa ble a pplica t ion t o n a viga t ion a n d commer ce, n or t h e
in ves t iga t ion s in ch emis t r y t o ma n u fa ct u r es , t h a n h a ve t h e s t a t is t ics of h ea lt h
a n d dis ea s e t o ph ys ica l a n d mor a l r egen er a t ion ."
16

"Th e Qu a r t er ly Repor t s of t h e Regis t r a r -Gen er a l a r e a mon g t h e mos t
in t er es t in g a n d in s t r u ct ive docu men t s of t h e da y. Th ey a r e t o u s wh a t , in a n
in fer ior degr ee, t h e Sa xon Ch r on icles wer e t o t h e 11t h a n d 12t h cen t u r ies .
Th ey en gr a ve, in br ief bu t expr es s ive ph r a s es , t h e n a t ion a l vicis s it u des ,
pr os per it ies , t r ia ls , a n d ca la mit ies . Wit h t h os e fa it h fu l a n d u n er r in g in dices ,
ma r r ia ges a n d dea t h s , t h e Regis t r a r -Gen er a l mea s u r es t h e r obu s t n es s of
n a t ion a l vigor , or pr obes t h e dept h of n a t ion a l s u ffer in g. Ba cked by t h os e
r a n ks of expr es s ive figu r es , wh ich per mit n o exa gger a t ion , a n d a r e s u s cept ible
of n o fa lla cy, h e pr es en t s t o u s a t r u e pict u r e of t h e pr es en t con dit ion of ou r
cou n t r y a n d n a t ion . No fa ls e r h et or ic or u n t r u e color in g is s u ffer ed t o ma r t h e
t r u t h of t h e h a r d a n d s imple ou t lin es . No polit ica l cr eed con cea ls t h e fa ct s , or
per ver t s t h eir mea n in g. No u n ju s t la w or der s t h e dis t or t ion of h a lf t h e t r u t h
by t h e con cea lmen t of t h e ot h er h a lf. Th es e r epor t s a r e, in deed, s omet h in g
mor e t h a n cu r r en t h is t or y; t h ey a r e t h e ju dgmen t s of t h e t ime u pon it s elf:
a n d, u n t in ct u r ed a s t h ey a r e by pa r t y s pir it , a n d u n s wa yed by per s on a l
con s ider a t ion s , t h os e ju dgmen t s a r e a s t r u e a n d fa it h fu l a s t h os e of fu t u r e
t imes ca n be. It is n o object ion t o t h e va lu e of t h es e r ecor ds , t o s a y t h a t t h ey
ch r on icle wit h gr ea t er min u t en es s a n d a ccu r a cy t h e n a t ion a l ills a n d
ch a s t is emen t s , t h a n t h e n a t ion a l h a ppin es s a n d s u cces s . Th e mos t dr ea r y
a n d pa in fu l s ide of h u ma n exis t en ce is cer t a in ly mos t la r gely pr es en t ed t o u s .
Th e s h a dow of imper fect ion a n d deca y t in ges a ll t h in gs wit h it s mela n ch oly
h u es . Ou r pa t h is ra t h er t h r ou gh t h e gloomy va lley, a n d u n der t h e s h a de of
cypr es s es , t h a n on t h e in vigor a t in g mou n t a in s ide, r es plen den t wit h t h e ligh t
of h ea ven . Bu t t h is s eems t o be t h e n eces s a r y r es u lt of a ll t r u e h is t or ies of t h e
s ocia l con dit ion of a people. Th a t wh ich is s t r on ges t a n d mos t per ma n en t
pr es s es a s ide t h a t wh ich is les s vigor ou s a n d en du r in g. Ha ppin es s a n d
comfor t es ca pe t h e ch r on icler ; t h e ga u n t fea t u r es of mis er y a n d dis t r es s a r e
ever befor e h im. Th e h a ppy h ou r s of a n a t ion 's , a s of a n in dividu a l's life, a r e
a s t h e s a n dy r ipples wh ich t h e a dva n cin g t ide wa s h es in t o s moot h n es s ; t h e
h ou r s of s or r ow a n d of t r ou ble a r e like t h os e r ipples fos s ilized in t o s t on e."
17

Th es e r epor t s a r e r ega r ded a s of t h e h igh es t a u t h or it y. "If t h er e is
a n yon e wh os e in for ma t ion ma y be s u ppos ed t o be a ccu r a t e, wh os e

16
London Lancet, Vol. II, f or 1848, p. 457.
17
Britis h and Foreign Medieo-Cbirurgieal Review, Vol. V, 1850, pp. 216, 222.
17
impa r t ia lit y ma y be r elied u pon , a n d wh os e ju dgmen t ma y be t r u s t ed, it is t h e
Regis t r a r -Gen er a l. He is bia s s ed by n o t h eor ies a n d is a bove t h e r ea ch of a ll
s u s piciou s lea n in g."
We h a ve compiled fr om t h e Appen dix t o t h e Nin t h An n u a l Repor t of t h e
Regis t r a r -Gen er a l, (pp. 17,36, a n d 70,) t h e t a ble on pa ges 34 a n d 35, t o s h ow
t h e r a t e of mor t a lit y a mon g fou r differen t popu la t ion s in En gla n d. Th e fir s t
pa r t embr a ces t h e wh ole of En gla n d; t h e s econ d, (Dis t r ict No.35,) on e of t h e
mos t h ea lt h y dis t r ict s ; t h e t h ir d, Liver pool, on e of t h e mos t u n h ea lt h y
dis t r ict s ; a n d t h e fou r t h , Lon don . It s h ows t h e popu la t ion , on t h e n igh t
bet ween t h e 7t h a nd 8t h of J u n e, 1841; t h e dea t h s for s even yea r s , 1838 t o
1844,-t h r ee yea r s befor e a n d t h r ee yea r s a ft er t h e en u mer a t ion a n d t h e
a ver a ge a n n u a l mor t a lit y per cen t . for t h a t per iod. It a ls o s h ows t h e in flu en ce
of loca lit y, a ge, a n d s ex, on mor t a lit y. Th is impor t a n t t a ble will be h er ea ft er
r efer r ed t o, a n d s h ou ld be ca r efu lly s t u died a n d u n der s t ood.

Popu la t ion , J u n e 6-7t h , 1841
1. En glan d 2. Par t of Su r r ey 3. Liver pool.



AGES Ma les Fema les Ma les Fema les Ma les Fema les
Un der 1, 210, 341 218, 851 444 496 3, 365 3, 348
1 t o 2, 215, 322 214, 250 436 465 3, 002 2, 935
2 t o 3, 218, 035 219, 006 492 506 2, 918 3, 022
3 t o 4, 203, 492 206, 368 436 457 2, 685 2, 729
4 t o 5, 201, 080 200, 263 454 424 2, 480 2, 458

Un der 5, 1, 048, 270 1, 058, 738 2, 262 2, 348 14, 450 14, 492
5 t o 10, 953, 235 952, 450 2, 113 2, 158 10, 983 11, 245
10 t o 15, 880, 907 852, 517 1, 974 1, 848 10, 554 10, 389
15 t o 20, 1, 507, 944 1, 633, 939 4, 073 3, 039 21, 389 25, 458
20 t o 30, 1, 178, 131 1, 275, 849 3, 431 2, 568 22, 894 23, 495
30 t o 40, 871, 845 902, 863 2, 144 1, 730 14, 777 14, 100
40 t o 50, 621, 142 653, 065 1, 435 1, 316 7, 504 7, 841
50 t o 60, 398, 937 433, 202 976 800 3, 738 4, 408
60 t o 70, 224, 863 259, 283 539 520 1, 553 2, 053
70 t o 80, 86, 736 103, 707 202 207 435 683
80 t o 90, 12, 635 17, 906 18 40 59 106
Over 90, 579 1, 091 0 3 3 19

All Ages , 7, 785, 224 8, 144, 610 19, 167 16, 577 108, 339 114, 289
Dea t h s in t h e 7 yea r s , 1838 - 44.

Un der 1, 301, 378 236, 261 426 323 7, 155 6, 004
1 t o 2, 100, 874 95, 764 97 82 3, 575 3, 455
2 t o 3, 53, 785 53, 449 55 59 1, 856 1, 743
3 t o 4, 35, 826 35, 802 46 49 1, 172 1, 038
4 t o 5, 26, 034 25, 634 29 35 767 720
653 548
Un der 5, 517, 897 446, 910 653 548 14, 525 12, 960
5 t o 10, 61, 659 59, 903 99 99 1, 333 1, 252
10 t o 15, 31, 028 32, 662 44 47 466 434
15 t o 20, 84, 833 95, 152 177 170 1, 476 1, 407
18
20 t o 30, 79, 703 89, 967 152 136 2, 030 2, 007
30 t o 40, 76, 093 78, 431 151 115 2, 234 1, 785
40 t o 50, 77, 047 70, 680 118 112 1, 767 1, 448
50 t o 60, 87, 539 84, 275 156 173 1, 387 1, 441
60 t o 70, 103, 873 106, 692 240 206 1, 155 1, 347
70 t o 80, 87, 218 95, 723 217 190 631 872
80 t o 90, 26, 167 34, 497 54 71 133 229
Over 90, 1, 727 3, 112 0 9 7 38

All Ages , 1, 234, 784 1, 198, 004 2, 061 1, 876 27, 144 25, 220

LAW OF MORTALITY - Ra t e of Mor t a lit y, &c.- Con t in u ed.
An n u a l Mor t a lit y per Cen t
1. En glan d 2. Par t of Su r vey 3. Liver pool AGES.
Ma les Fema les Ma les Fema les Ma les Femla es
Un der
1
20. 510 15. 440 13. 702 9. 296 30. 40
1
25. 609
1 t o 2 6. 706 6. 393 3. 177 2. 517 17. 02
7
16. 810
2 t o 3 3. 531 3. 490 1. 597 1. 665 9. 094 8. 237
3 t o 4 2. 520 2. 481 1. 507 10531 6. 241 5. 432
4 t o 5 1. 853 1. 831 . 921 1. 178 4. 422 4. 183

Un der
5
7. 072 6. 037 4. 123 3. 332 14. 372 12. 771
5 t o 10 . 926 . 900 . 669 . 655 1. 735 1. 590
10 t o
15
. 504 . 548 . 318 . 363 . 631 . 597
15 t o
20
. 805 . 883 . 621 . 799 . 987 . 789
20 t o
30
. 968 1. 009 . 633 . 756 1. 268 1. 220
30 t o
40,
1. 249 1. 242 1. 006 . 949 2. 162 1. 808
40 t o
50
1. 776 1. 548 1. 174 1. 215 3. 367 2. 637
50 t o
60
3. 141 2. 782 2. 283 3. 087 5. 305 4. 668
60 t o
70
6. 613 5. 885 6. 359 5. 655 10. 634 9. 370
70 t o
80
14. 394 13. 201 15. 342 13. 103 20. 740 18. 232
80 t o
90
29. 646 27. 553 42. 843 25. 338 32. 230 30. 851
Over
90,
42. 697 40. 795 42. 825 33. 361 28. 561
All
a ges -
2. 270 2. 104 1. 536 1. 616 3. 582 3. 151
Livin g
t o 1
dt h .
44. 1 47. 5 65. 1 61. 9 27. 9 31. 7
(2) Of t h e Ra t e of Mor t a lit y a mon g t h e Popu la t ion of Lon don .
Popu la t ion , 1841. Deat h s , 7 year s ,
1838-1844
An n u a l Mor t a lit y,
per Ct .
AGES
Ma les Fema les Ma les Fema les Ma les Fema les
19
Un der
1,
22, 987 24, 495 37, 617 30, 665 23. 420 17. 905
1 t o 2 22, 625 23, 245 16, 906 16, 033 10. 694 9. 865
2 t o 3 24, 927 25, 147 9, 285 9, 082 5. 331 5. 164
3 t o 4 21, 933 23, 221 5, 997 6, 067 3. 912 3. 737
4 t o 5 20, 977 21, 184 3, 982 3, 978 2. 717 2. 685
Un der
5,
113, 44
9
117, 29
2
73, 787 65, 825 9. 309 8. 027
5 t o 10 95, 653 98, 317 8, 269 7, 867 1. 237 1. 144
10 t o
15
88, 535 89, 271 2, 982 2, 906 . 482 . 466
15 t o
20
176, 82
5
217, 88
7
9, 371 9, 435 . 759 . 619
20 t o
30
167, 98
7
199, 97
3
12, 557 12, 825 1. 070 . 917
30 t o
40
121, 00
2
136, 25
3
15, 120 13, 122 1. 788 1. 377
40 t o
50
78, 369 88, 198 14, 927 12, 341 2. 726 2. 001
50 t o
60
43, 423 51, 299 14, 604 13, 649 4. 812 3. 805
60 t o
70
20, 995 27, 882 13, 478 15, 262 9. 185 7. 827
70 t o
80
5, 982 9, 573 7, 721 10, 823 18. 472 16. 170
80 t o
90
738 1, 478 1, 649 3, 134 31. 995 30. 326
Over
90
49 96 128 269 37. 304 39. 994
All ages 913, 00
7
1, 037, 5
19
174, 59
3
167, 45
8
2. 737 2. 308

By exa min in g t h e fir s t pa r t of t h is va lu a ble t a ble, a n d followin g down
t h e left h a n d colu mn , it a ppea r s t h a t in t h e wh ole of En gla n d, in 1841, t h er e
wer e 1,048,270 ma le per s on s u n der five yea r s of a ge, a mon g wh om 517,897
ma les died in t h e s even yea r s , 1838-1844, or a n a n n u a l a vera ge of 7.072 per
cen t . An d in t h e s econ d pa r t , followin g a lin e a cr os s t h e pa ge, it a ppea r s
t h a t , in Lon don , in 1841, t h er e wer e 136,253 fema les bet ween t h e a ges of
t h ir t y a n d for t y, a mon g wh om 13, 122 fema les died in t h e s even yea r s , 1838-
1844, or a n a n n u a l a ver a ge of 1.377 per cen t . An d if t h e pa r t r ela t in g t o t h e
a n n u a l mor t a lit y per cen t . be exa min ed a lon e, it a ppea r s t h a t in t h e mos t
h ea lt h y dis t r ict s in En gla n d, 4.123 per cen t . of t h e ma les die u n der five
yea r s of a ge; wh ile in t h e mos t u n h ea lt h y, 14.372 per cen t . die in t h e s a me
a ge. In like ma n n er, ot h er fa ct s ma y be a s cer t a in ed, by exa min in g ot h er
pa r t s of t h e t a ble.
In r es u min g ou r h is t or y of t h e s a n it a r y movemen t , it a ppea r s t h a t in
Oct ober , 1835, t h e Secr et a r y of Wa r in s t it u t ed a n in qu ir y " in t o t h e ext en t
a n d ca u s es of t h e s ickn es s a n d mor t a lit y a mon g t h e t r oops in t h e Wes t
In dies , wit h a view of fou n din g t h er eon s u ch mea s u r es a s migh t a ppea r
likely t o dimin is h t h e gr ea t los s of life a n n u a lly exper ien ced in t h es e
colon ies ." Th e in ves t iga t ion wa s con du ct ed u n der t h e s u per in t en den ce of
Ma jor Alexa n der M. Tu lloch , a n d in 1838 h is r epor t on t h e s u bject wa s
pu blis h ed; a n d it wa s followed by t h r ee ot h er volu mes , by t h e s a me a u t h or ,
u n der t h e followin g t it les : -
20
St a t is t ica l Repor t s on t h e Sickn es s , Mort a lit y a n d In va lidin g a mon g t h e
Tr oops : -
Vol. I. Th e Wes t In dies . Pu blis h ed in 1838.
Vol. II. Th e Un it ed Kin gdom; Th e Medit er r a n ea n ; a n d
Br it is h Amer ica . Pu blis h ed in 1839.
Vol.IlI. Wes t er n Afr ica ; St . Helen a ; Th e Ca pe of Good
Hope; a n d Th e Ma u r it iu s . Pu blis h ed in 1840.
Vol. IV . Ceylon ; Th e Ten a s s er im Pr ovin ces ; a n d Th e
Bu r mes e Empir e. Pu blis h ed in 1841.
Th es e r epor t s ext en d over 597 folio pa ges , a n d con t a in a va s t ma s s of
fa ct s r ela t in g t o medica l t opogr a ph y a n d dis ea s es , du r in g t h e per iod of 1818
t o 1836. Th ey ju s t ly a t t r a ct ed gr ea t a t t en t ion a t t h e t ime of t h eir fir s t
a ppea r a n ce, a n d a r e of r ea l per ma n en t va lu e.
In t h e mea n t ime, in 1836, t h e Lor ds Commis s ion er s of t h e Admir a lt y
is s u ed or der s for t he pr epa r a t ion of s imila r docu men t s r ela t in g t o t h e n a vy.
Dr . J oh n Wils on wa s a ppoin t ed t o s u per in t en d t h e wor k, a n d h is r epor t s
a ppea r in t wo volu mes : -
St a t is t ica l Repor t s on t h e Hea lt h of t h e Na vy, for t h e yea r s 1830, 1831,
1832, 1833, 1834, 1835, a n d 1836 :-
Vol. I. Sou t h Amer ica n , Wes t In dia n , a n d Nor t h Amer ica n ;
Medit er r a n ea n , a n d Pen in s u la r Comma n ds . Pu blis h ed in 1840.
Vol. II. Ca pe of Good Hope, a n d Wes t Coa s t of Afr ica , a n d Ea s t In dia
Comma n ds ; Home, a n d Va r iou s For ces . Pu blis h ed in 1841.
Ma r ch 12, 1840, a s elect commit t ee of fift een member s of t h e Hou s e of
Common s wa s a ppoin t ed "t o in qu ir e in t o t h e cir cu ms t a n ces a ffect in g t h e
h ea lt h of t h e in h a bit a n t s of la r ge t own s a n d popu lou s dis t r ict s , wit h a view t o
impr oved s a n it a r y regu la t ion s for t h eir ben efit . "Th e r epor t wa s pr es en t ed,
J u n e 17t h followin g, u n der t h e t it le of "Repor t fr om t h e s elect Commit t ee on
t h e Hea lt h of Town s , t oget h er wit h t h e min u t es of eviden ce t a ken befor e
t h em."
On t h e 2d of Oct ober , 1840, a commis s ion , con s is t in g of Th oma s Tooke,
Es q., T. Sou t h wood Smit h , M. D., Leon a r d Homer a n d Rober t J oh n Sa u n der s ,
Es qs ., wa s a ppoin t ed by t h e gover n men t , t o in qu ir e II in t o t h e employmen t of
t h e ch ildr en of t h e poor er cla s s es in min es a n d collier ies , a n d t h e va r iou s
br a n ch es of t r a de a n d ma n u fa ct u r e in wh ich n u mber s of ch ildr en wor k
t oget h er ; a n d t o collect in for ma t ion a s t o t h e a ges a t wh ich t h ey a r e employed,
t h e n u mber of h ou r s t h ey a r e en ga ged in wor k, t h e t ime a llowed ea ch da y for
mea ls , a n d a s t o t h e a ct u a l con dit ion a n d t r ea t men t of s u ch ch ildr en , a n d a s
t o t h e effect s of s u ch employmen t s , bot h wit h r ega r d t o t h eir mor a l a n d t h eir
bodily h ea lt h ." Two r epor t s wer e ma de by t h is commis s ion : on e in 1841, on
t h e ph ys ica l, a n d t h e ot h er in 1843, on t h e mor a l a s pect s of t h e in qu ir y,
compr is in g five la r ge folio volu mes . An a br idgemen t wa s pu blis h ed in 1843,
u n der t h e t it le of "Th e Ph ys ica l a n d Mor a l Con dit ion of Ch ildr en a n d You n g
Per s on s employed in Min es a n d Ma n u fa ct u r es ."
18

In 1838, t h e Poor -La w Commis s ion er s in s t it u t ed in qu ir ies in t o t he
effect s of differ en t met h ods of ma n a gin g pa u per ch ildr en ; a n d t h e r es u lt s of
t h eir in qu ir y a ppea r ed in 1841, in a "Repor t fr om t h e Poor -La w

18
See reviews of thes e reports in London Quarterly , Vol. LXX, f or 1842, p. 160; als o, in Wes tmins ter, Vol. XXXVIII, f or
1842, p. 86.

21
Commis s ion er s on t h e Tr a in in g of Pa u per Ch ildr en ." Th is wor k con t a in s
s ever a l va lu a ble pa per s r ela t in g t o h ea lt h , a s well a s edu ca t ion in gen er a l.
A "Repor t on t h e Pr eva len ce of cer t a in Ph ys ica l Ca u s es of Fever in t h e
Met r opolis , wh ich migh t be r emoved by pr oper Sa n it a r y Mea s u r es ; by Neil
Ar n ot t , M. D., a n d J a mes Ph illips Ka y, M. D.," da t ed 12t h Ma y, 1838 ; a n d
a n ot h er " Repor t on s ome of t h e Ph ys ica l Ca u s es of Sickn es s a n d Mor t a lit y t o
wh ich t h e Poor a r e pa r t icu la r ly expos ed, a n d wh ich a r e ca pa ble of r emova l by
Sa n it a r y Regu la t ion s ; exemplified in t h e pr es en t con dit ion of t h e Bet h n a l
Gr een a n d Wh it ech apel Dis t r ict s , a s a s cer t a in ed on a per s on a l in s pect ion by
Sou t h wood Smit h , M. D., Ph ys icia n of t h e Lon don Fever Hos pit a l," da t ed Ma y,
1838, wer e pu blis h ed in t h e Fou r t h An n u a l Repor t of t h e Poor -La w
Commis s ion er s , (8vo. ed., pp. 103, 129,) a n d a ls o in a s epa r a t e for m. An d a
"Repor t on t h e Pr eva len ce of Fever in Twen t y Met r opolit a n Un ion s Or
Pa r is h es , du r in g t h e yea r en din g t h e 20t h Ma r ch , 1838. by Sou t h wood Smit h ,
M. D.," wa s pu blis h ed in t h e Fift h An n u a l Repor t , (p. 160. )
In con s equ en ce of t h es e r epor t s , Lor d J oh n Ru s s ell, t h en Secr et a r y of
t h e Home Depa r t men t , on : mot ion of t h e Bis h op of Lon don , addr es s ed a let t er
t o t h e commis s ion er s , da t ed Au gu s t 21, 1839, dir ect in g t h em t o in qu ir e " a s
t o t h e ext en t t o wh ich t h e ca u s es of dis ea s e, s t a t ed in t h es e r epor t s t o pr eva il
a mon g t h e la bor in g cla s s es of t h e met r opolis , pr eva il a ls o a mon g t h e la bor in g
cla s s es in ot h er pa r t s of En gla n d, Scot la n d, a n d Wa les ." Th e commis s ion er s
bega n t h is in qu ir y t h r ou gh t h e a gen cy of t h eir s ecr et a r y, Edwin Ch a dwick,
Es q., in November , 1839; a n d t h a t dis t in gu is h ed s a n it a r y r efor mer diges t ed
t h e in for ma t ion obt a in ed; a n d pr es en t ed h is ver y a ble a n d mos t va lu a ble
r epor t , J u ly 9, 1842, wh ich wa s pu blis h ed u n der t h e t it le, "Repor t on t h e
Sa n it a r y Con dit ion of t h e La bor in g Popu la t ion of Gr ea t Br it a in , by Edwin
Ch a dwick, Es q."
In 1843, a ppea r ed "A Su pplemen t a r y Repor t on t h e Res u lt s of a Specia l
In qu ir y in t o t h e Pr a ct ice of In t er men t s in Town s , by Edwin Ch a dwick, Es q."
Ma r ch 8, 1842, a s elect commit t ee of fift een wer e a ppoin t ed, " t o
con s ider t h e expedien cy of fr a min g s ome legis la t ive en a ct men t t o r emedy t h e
evils a r is in g fr om t h e in t er men t of bodies wit h in t h e pr ecin ct s of la r ge t own s ,
or of pla ces den s ely popu la t ed." Th ey r epor t ed t h e 14t h of t h e s u cceedin g
J u n e, u n der t h e t it le of " Repor t fr om t h e Select Commit t ee on Impr ovemen t of
t h e Hea lt h of Town s . " - " Effect of In t er men t of Bodies in Town s ."
Th e fa ct s t h u s fa r developed bega n t o ma ke a pr ofou n d impr es s ion
u pon t h e pu blic min d ; a n d Sir Rober t Peel, for es eein g t h eir impor t a n ce, on
t h e 9t h Ma y, 1843, a ppoin t ed a n ot h er commis s ion , con s is t in g of t h ir t een
gen t lemen of emin en ce, t o in qu ir e " in t o t h e pr es en t s t a t e of la r ge t own s a n d
popu lou s dis t r ict s in En gla n d a n d Wa les , wit h r efer en ce t o t h e ca u s es of
dis ea s e a mon g t h e in h a bit a n t s ; a n d in t o t h e bes t mea n s of pr omot in g a n d
s ecu r in g t h e pu blic h ea lt h u n der t h e oper a t ion of t h e la ws a n d r egu la t ion s
n ow in for ce : a n d t he u s a ges a t pr es en t pr eva ilin g wit h r ega rd t o t h e dr a in a ge
of la n ds , t h e er ect ion , dr a in a ge, a n d ven t ila t ion of bu ildin gs ; a n d t h e s u pply
of wa t er in s u ch t own s a n d dis t r ict s , wh et h er for pu r pos es of h ea lt h , or for t h e
bet t er pr ot ect ion of pr oper t y fr om fir e; a n d h ow fa r t h e pu blic h ea lt h a n d t h e
con dit ion of t h e poor er cla s s es of t h e people of t h is r ea lm, a n d t h e s a lu br it y
a n d s a fet y of t h eir dwellin gs , ma y be pr omot ed by t h e a men dmen t of s u ch
la ws , r egu la t ion s , a n d u s a ges ."
22
Th is commis s ion ma de t h eir fir s t r epor t , J u n e 22, 1844, a n d t h eir
s econ d r epor t , Febr u a r y 3, 1845. Th es e wor ks con t a in 1363 folio pa ges ,
bes ides n u mer ou s ma ps , a n d ot h er pict or ia l illu s t r a t ion s ; embr a cin g a n
immen s e ma s s of fa ct s on t h e s u bject s t o wh ich t h ey r ela t e. Two edit ion s h a ve
been pu blis h ed: one in t wo volu mes , la r ge folio, a n d t h e ot h er s ligh t ly
a br idged, in fou r volu mes oct a vo, u n der t h e t it le of "Repor t s of t h e
Commis s ion er s for in qu ir in g in t o t h e s t a t e of La r ge Town s a n d Popu lou s
Dis t r ict s ." Th es e r epor t s h a ve been ju s t ly ch a r a ct er ized a s "cer t a in ly a mon g
t h e a bles t a n d mos t compr eh en s ive s t a t e pa per s t h a t ever is s u ed fr om a
gover n men t office."
Sept ember 24, 1847, a n ot h er commis s ion , con s is t in g of Lor d Rober t
Gr os ven or , Edwin Ch a dwick, Th os . Sou t h wood Smit h , Rich a r d Owen , a n d
Rich a r d La mber t J on es , wa s a ppoin t ed t o in qu ir e "wh et h er a n y a n d wh a t
s pecia l mea n s ma y be r equ is it e for t h e impr ovemen t of t h e h ea lt h of t h e
met r opolis , wit h r efer en ce mor e pa r t icu la r ly t o t h e bet t er h ou s e, s t r eet , a n d
la n d dr a in a ge; s t r eet clea n s in g a n d pa vin g; t h e collect ion a n d r emova l of s oil
a n d r efu s e, a n d t h e bet t er s u pply of wa t er for domes t ic u s e, for flu s h in g
s ewer s a n d dr a in s , an d clea n s in g s t r eet s ; a n d a ls o, t o t h e bes t mea n s of u s in g
exis t in g wor ks , a n d of er ect in g n ew wor ks r equ is it e, a n d of ma in t a in in g t h em
in good a ct ion ; a n d a ls o, t o t h e mos t equ it a ble pr ovis ion s for r egu la t in g t h e
ch a r ges , or a s s es s in g, collect in g, a n d pa yin g t h e mon eys r equ is it e for s u ch
pu r pos es , mor e es pecia lly in t h e dis t r ict s ch iefly in h a bit ed by t h e poor er
cla s s es of t h e popu la t ion ." Th ey ma de t h eir fir s t r epor t , November 19, 1847;
t h eir s econ d, Febr u a r y 19, 1848; a n d t h eir t h ir d, J u ly 13, 1848. Th e
commis s ion is s t ill open .
Th e followin g in t er es t in g s t a t emen t of fa ct s , con t a in in g a con den s ed
s u mma r y of t h e in for ma t ion t h en pos s es s ed, is t a ken fr om t h e s peech of Lor d
Mor pet h , ma de in t h e Hou s e of Common s , Ma r ch 30, 1847, on in t r odu cin g
h is "Bill for impr ovin g t h e Hea lt h of Town s in En gla n d." (pp. 6, 33. )
" By a s t a t emen t dr a wn u p by Dr . Gu y, Ph ys icia n t o Kin g's College
Hos pit a l, fr om t h e r epor t s of t h e Regis t r a r -Gen er a l, it a ppea r ed t h a t t h e
r ela t ive mor t a lit y in t h e t own a n d cou n t r y dis t r ict s wa s a s follows :-

Cou n t r y Dis t r ic t Town Dis t r ic t
Popu la t ion t o t h e s qu a r e mile 1 9 9 5 , 1 0 0
An n u a l de a t h s in 1 , 0 0 0 , 0 0 0 1 9 , 3 0 0 2 7 , 0 7 3
An n u a l e xc e s s in t own dis t r ic t s 7 , 7 7 3
Ra t e of mor t a lit y 1 in 5 2 1 in 3 7

He a ls o s u pplies fu r t h er pa r t icu la r s a s t o t h e r a t e of mor t a lit y in
differ en t pla ces :-

CONDITION OF ENGLAND

Is le of An gles ea 1 in 62 Leeds a n d Bir min gh a m, 1 in 37
Is le of Wigh t " 58 Sh effield, . " 33
En gla n d, " 45 Ma n ch es t er Un ion " 30
Lon don , " 39 Liver pool (Pa r is h ,) . " 29

23
Th u s t h e in h a bit a n t s of Lon don , compa r ed wit h En gla n d a t la r ge, los e
eigh t yea r s of t h eir lives ; of Liver pool, n in et een . Th e popu la t ion of t h e 1a r ge
t own s in En gla n d bein g 4,000,000, t h e a n n u a l los s is bet ween 31,000 a nd
32,000. Bu t a ll t own s a r e n ot n eces s a r ily equ a lly u n h ea lt h y, a s a ppea r s by
t h e followin g s t a t emen t :-Liver pool, dea t h s per 1,000, 35; Ma n ch es t er , 32;
Ba t h , Coven t r y, Der by, Du dley, Sh r ews bu r y, a n d Su n der la n d, 26; Ca r lis le
a n d Nor wich , 25; Ha lifa x a n d Kidder min s t er , 21. Now it ma y be t h ou gh t t h a t
low wa ges , a n d t h e con s equ en t compa r a t ively s ma ll comma n d over t h e
n eces s a r ies of life, ma y occa s ion t h e, gr ea t er r a t e of mor t a lit y in cer t a in
dis t r ict s ; bu t I fin d t h e followin g s t a t emen t , ma de by a colleagu e of my own ,
Lor d Ebr in gt on , in a lect u r e wh ich h e deliver ed a t Plymou t h : ' Th e mor t a lit y
of t h e s ou t h wes t ern dis t r ict , wh ich in clu des Cor n wa ll, Devon , Somer s et ,
Dor s et , a n d Wilt s , is on ly 1 in 52, n ot 2 per cen t ; wh ile t h a t of t h e
n or t h wes t er n , in clu din g Ch es h ir e a n d La n ca s h ir e, is 1 in 37. Now let it n ot
be s a id t h a t t h is is owin g t o ext r eme pover t y a n d wa n t of t h e n eces s a r ies of
life ; t h e con dit ion of t h e la bor er s of t h e wes t , t h e ba dn es s of t h eir dwellin gs ,
t h e lown es s of t h eir wa ges , t h e con s equ en t s ca n t in es s of t h eir food a n d
clot h in g, h a ve been t h e s u bject of pu blic a n ima dver s ion . Wit h t h e except ion
of t h e Cor n is h min er s , t h e con dit ion of t h e la bor er s t h r ou gh ou t t h e wes t er n
cou n t ies is des cr ibed a s n ea r ly t h e s ame: yet in Wilt s h ir e, t h e cou n t y of
lowes t wa ges , t h e dea t h s a r e 1 in 49 ; in La n ca s h ir e, 1 in 36. Th e a ver a ge
a ge a t dea t h , in 1841, wa s , in Wilt s h ir e, 35 yea r s ; in La n ca s h ir e, 22 ; a t
Liver pool, 17; t h a t of t h e la bor er s in Wilt s h ir e, 35; oper a t ives in Liver pool,
15. At Ma n ch es t er , in 1836, t h e a vera ge con s u mpt ion per h ea d of t h e
popu la t ion , wa s 105 lbs . of bu t ch er 's mea t ,-a bou t 2lbs . a week, -exclu s ive of
ba con , por k, fis h , an d pou lt r y; (wh a t a differ en t a ver a ge wou ld ou r cou n t y
pr odu ce !) t h e a ver a ge a ge a t dea t h wa s t wen t y. Th e pr opor t ion of pa u per s in
t h e fift een pr in cipa l a gr icu lt u r a l cou n t ies , is 1 in 8 ; in t h e t welve pr in cipa l
ma n u fa ct u r in g cou n t ies , 1 in 13; in La n ca s h ir e, 1 in 11 : a n d of t h e dea t h s
in 31500,000 of t own , a n d a bou t a n equ a l n u mber of a cou n t r y popu la t ion ,
t h er e wer e, r es pect ively, in 1838 a n d 1839 t oget h er ,-cou n t r y, 1 in 54.91, of
wh om a bove 70 yea r s of a ge, 20 per cen t . ; t own , 1 in 38.16, of wh om a bove
70, 9 per cen t . ; a ll En gla n d, 1 in 4.6.60, of wh om a bove 70, 14 per cen t .'
"Th e followin g wa s Dr . Gu y's s t a t emen t of dis ea s es wh ich occa s ion t h e
exces s ive mor t a lit y in la r ge t own s :-, Dea t h s in 1,000,000, fr om s ma ll-pox, in
t h e cou n t r y, 500; t own , 1,000. Fr om mea s les , Cou n t r y, 350; t own , 900.
Sca r let fever , cou n t r y, 500 ; t own , 1,000. Typh u s , cou n t r y, 1,000 ; t own ,
1,250. J Epidemic a n d con t a giou s dis or der s t oget h er , cou n t r y, 3,4.00 ;
t own , 6,000. (Wa s t e of life in t own s , u n der t h is h ea d, 2,600 a yea r . )
Dis ea s es of in fa n t s : t eet h in g, con vu ls ion s , wa t er in t h e h ea d,-cou n t r y, 1,300;
t own , 3,500. (Wa s t e of in fa n t life, u n der t h is h ea d, 2,200 a yea r .) Scr ofu lou s
dis ea s es a n d con s u mpt ion s , cou n t r y 1 3,800; t own , 4,600. Tot a l exces s of
dea t h s , 5,500 in t he 1,000,000, So t h at t h er e is a wa s t e of 22,000 lives in
t h e 4.,000,000 in h a bit in g la r ge t own s .'
Dr . Gu y a ls o s a id, ' Th e t ot a l n u mber of dea t h s in En gla n d a n d Wa les ,
du r in g t h e yea r 1841, wa s 343,847, or s ome wh a t les s t h a n 1,000 a da y.
Now t h is is a t t h e r a t e of on e dea t h in 4. 6 in h a bit a n t s . Bu t if, in s t ea d of on e
dea t h in 46 in h a bit a n t s , t h er e h a d been on e dea t h in 50 in h a bit a n t s , or 2
per cen t ., n o les s t ha n 25,407 lives wou ld h a ve been s a ved. Now a ll men wh o
h a ve pa id a n y a t t en t ion t o t h is s u bject , a gr ee in t h e opin ion t h a t , by pr oper
24
s a n it a r y mea s u r es , it is pos s ible t o in s u r e s u ch a s t a t e of h ea lt h a mon g t h e
commu n it y a t la r ge, t h a t t h e mor t a lit y s h a ll n ot exceed t h a t pr opor t ion . If
t h e s a n it a r y s t a t e of t h e en t ir e cou n t r y cou ld be r a is ed t o t h e con dit ion of t h e
mos t h ea lt h y cou n t ies , s o t h a t in s t ea d of on e dea t h in 46 in h a bit a n t s , t h er e
s h ou ld be on ly on e dea t h in 54, we s h ou ld h a ve a n a n n u a l s a vin g of n o les s
t h a n 49,349 lives , or a bou t on e-s even t h of t h e wh ole n u mber of dea t h s ! At
fir s t s igh t , it ma y appea r ext r a va ga n t t o r epr es en t s u ch a n impr ovemen t of
ou r s a n it a r y con dit ion a s pos s ible; bu t , wh en it is r ecollect ed t h a t , on t h e
on e h a n d, even ou r mos t a gr icu lt u r a l cou n t ies h a ve n ot yet a t t a in ed t o t h eir
bes t s a n it a r y s t a t e, a n d t h a t ou r la r ge t own s h a ve been h it h er t oa lmos t
en t ir ely n eglect ed, a n d a dmit of immen s e impr ovemen t ,-t h e a t t a in men t , for
t h e wh ole cou n t r y, of a s a n it a r y con dit ion r epr es en t ed by on e dea t h in 54
in h a bit a n t s , is a t lea s t wit h in t h e bou n ds of pos s ibilit y.'
" Dr . Sou t h wood Smit h s a id :- 'In s ome loca lit ies t h er e wa s n ot a s in gle
h ou s e in wh ich fever h a d n ot pr eva iled, a n d, in s ome ca s es , n ot a s in gle
r oom in a s in gle h ou s e, in wh ich t h er e h a d n ot been fever . Th e dis t r ict s in
wh ich fever pr eva ils , a r e a s fa milia r t o t h e ph ys icia n s of t h e fever h os pit a l, a s
t h eir own n a mes . In ever y dis t r ict in wh ich fever r et u r n s fr equ en t ly, a n d
pr eva ils ext en s ively, t h er e is u n ifor mly a ba d dr a in a ge, a ba d s ewer a ge, a
ba d s u pply of wa t er , a ba d s u pply of s ca ven ger s , a n d a con s equ en t
a ccu mu la t ion of filt h ; a n d I h a ve obs er ved t h is t o be s o u n ifor mly a n d
gen er a lly t h e ca s e, t h a t I h a ve been a ccu s t omed t o expr es s t h e fa ct in t h is
wa y :-If you t r a ce down t h e fever dis t r ict s on a ma p, a n d t h en compa r e t h a t
ma p wit h t h e ma p of t h e commis s ion er s of s ewer s , you will fin d t h a t t h e
commis s ion er s of s ewer s h a ve n ot been , t h er e fever is pr eva len t ; a n d, on t h e
con t r a r y, wh er ever t h ey h a ve been , t h er e fever is compa r a t ively a bs en t . Some
idea ma y be for med of t h e evils wh ich ou r n egligen ce in t h e ma t t er of'
s ewer a ge a n d dr a ina ge in flict s , wh en I t ell you t h a t t h e a n n u a l dea t h s fr om
t yph u s fever a mou n t t o 16,000, a n d t h e a t t a cks of t h is loa t h s ome dis ea s e t o
bet ween 150,000 a n d 200,000.'
" Fu r t h er s t ill, Dr . Lyon Pla yfa ir ca lcu la t es t h a t , for on e u n n eces s a r y
dea t h , t h er e a r e 28 ca s es of u n n eces s a r y s ickn es s ; con s equ en t ly, in ou r
la r ge t own s , a bove 700,000 ca s es of u n n eces s a r y s ickn es s . Th e s a me
ca lcu la t ion s in t h e met r opolis wou ld s a ve 10,000 dea t h s , a n d 250,000 ca s es
of u n n eces s a r y s ickn es s .
" Th en it ma y be a s ked wh et h er a ll pa r t s of ou r t own s a r e equ a lly
s u bject ed t o t h es e ca u s es of s ickn es s a n d dea t h ? So t h a t bein g t h e ca s e, I
fin d, fr om on e of t h e r epor t s of t h e Regis t r a r -Gen er a l, t h a t t h e met r opolis is
divided in t o t h r ee of t en dis t r ict s ea ch , u n der t h e t it le of t h e h ea lt h ies t , t h e
mediu m, a n d t h e mos t u n h ea lt h y dis t r ict s . Th e r es u lt is a s follows ;-10
h ea lt h ies t , wit h a n a llowa n ce of 202 s qu a r e ya r ds t o ea ch per s on , h a ve a
mor t a lit y of 1 in 49 ; 10 mediu m, wit h an a llowa n ce of 102 s qu a r e ya r ds t o
ea ch per s on , h a ve a mor t a lit y of 1 in 41; 10 u n h ea lt h ies t , wit h a n a llowa n ce
of 32 s qu a r e ya r ds t o ea ch per s on , h a ve a mor t a lit y of 1 in 36. Liver pool-
gen t r y, 1 in 35 ; wor kin g cla s s es , 1 in 15. Th e Rev. Mr . Cla y, of Pr es t on ,
ma kes fou r cla s s es of s t r eet s :-Well con dit ion ed, mor t a lit y a mon g ch ildr en
u n der on e yea r , 15 in 100 ; moder a t ely con dit ion ed, 21 in l00; ill
con dit ion ed, 38 in l00 ; wor s t con dit ion ed, 44 in 100, or t h r ee t imes a s mu ch
a s t h e fir s t . I will only r efer ba ck t o t h e ver y la s t h a lf-yea r 's r epor t , wh er e it
a ppea r s , fr om t a bles pr epa r ed by Mr . Ch a dwick, t h a t , in St . Geor ge's
25
Ha n over s qu a r e, t h e a ver a ge a ge a t wh ich t h e gen t r y die is 45; la bor er s , 27:
St . Giles 's a n d St . Geor ge's Blooms bu r y-gen t r y, 4.0; wor kin g cla s s es , 17.
"Th er e a r e it ems of expen s e wh ich ma y be r eckon ed t o be in cu r r ed
u n der t h e pr es en t s ys t em, or r a t h er wan t of s ys t em: - Dir ect a t t en da n ce on
t h e s ick; los s of wh a t t h ey wou ld h a ve ea r n ed; pr ema t u r e dea t h of pr odu ct ive
con t r ibu t or s t o t h e n a t ion a l wea lt h ; a n d expen s es of pr ema t u r e fu n er a ls . Dr .
Pla yfa ir es t ima t es t h is los s for Ma n ch es t er a t n ea r ly I,000,000 ;Mr.
Ha wkes ley ca lcu la t es t h e los s for Not t in gh a m a t 300,000 ; Mr . Cla y
es t ima t es t h e los s for Pr es t on a t 990, 000; Mr . Cou lt h a it t a kes t h e los s for
As h t on -u n der -Lyn e a t 235,000 ; a n d Dr . Pla yfa ir con s ider s t h e los s of
Lon don t o be a bove 2,500,000; a n d t h a t of En gla n d a n d Wa les lit t le s h or t of
11,000,000 ; a n d of t h e Un it ed Kin gdom, 20,000,000," or n ea r ly
$100,000,000 ! An d t h is a n a n n u a l los s !
On t h e 31s t of Au gu s t , 1848, t h e grea t mea s u r e wh ich h a d been
br ou gh t in t o Pa r lia men t by Lor d Mor pet h , (n ow Ea r l of Ca r lis le, ) beca me a
la w, u n der t h e t it le of "An Act for pr omot in g t h e Pu blic Healt h ." Un der t h is
a ct a Gen er a l Boa r d of Hea lt h h a s been or ga n ized, con s is t in g of t h e Ea r l of
.Ca r lis le, Lor d As h ley, Edwin Ch a dwick, Es q., a n d Th oma s Sou t h wood
Smit h , M. D. Hen r y Au s t in , Es q., is t h eir s ecr et a r y.
Wh ile t h es e va r iou s gover n men t a l mea s u r es wer e in pr ogr es s , t h e
people wer e n ot in a ct ive. Pu blic opin ion kept a h ea d of pu blic mea s u r es . In
November , 1844, a n impor t a n t meet in g wa s h eld a t Exet er Ha ll, compos ed of
s ome of t h e a bles t men in t h e kin gdom, wh ich for med t h e "Met r opolit a n
Hea lt h of Town s As s ocia t ion ."
19
Apr il 23, 1845, t h e Liver pool Hea lt h of
Town s As s ocia t ion wa s or ga n ized; a n d s oon a ft er , s imila r a s s ocia t ion s wer e
for med in t h e pr incipa l t own s in En gla n d. A mon t h ly per iodica l wor k,
en t it led "Th e Liver pool Hea lt h of Town s Advoca t e," wa s commen ced Sept . 1,
1845, a n d con t in u ed u n t il J u ly 1, 1847. In November , 1847, t h e "J ou r n a l of
Pu blic Hea lt h , a n d Mon t h ly Recor d of Sa n it a r y Impr ovemen t ," wa s
commen ced fn Lon don , a n d wa s con t in u ed u n t il December , 1849, u n der t h e
ma n a gemen t of t h e Met r opolit a n As s ocia t ion . Th e books , pa mph let s , a n d
docu men t s , officia l a n d pr iva t e, wh ich h a ve mor e r ecen t ly a ppea r ed on t h e
s u bject , a n d t h e differ en t s a n it a r y movemen t s t h a t h a ve been ma de for t h e
pu blic ben efit , a r e t oo n u mer ou s t o be s pecified. Th e wh ole cou n t r y s eems t o
be in t er es t ed; a n d t h e people, wit h s ome few except ion s , view t h e s a n it a r y
qu es t ion a s The Great Idea of the Age. Able a r t icles h a ve, fr om t ime t o t ime,
a ppea r ed in t h e lea din g per iodica l r eviews , mis cella n eou s a s well a s medica l
; a n d a mon g ot h er n ews pa per s , Th e Times , a n d Th e Mor n in g Ch r on icle, t h e
lea din g jou r n a ls of t h e wor ld, h a ve been it s power fu l a dvoca t es . Th e Times ,
du r in g n ea r ly t h e wh ole of la s t yea r , t eemed wit h a ble a r t icles . Th e Ch r on icle
commen ced, on t h e 18t h of Oct ober , 1849, t h r ee s er ies of mos t va lu a ble
pa per s on "La bor a n d t h e Poor ;" on e r ela t in g t o t h e met r opolit a n dis t r ict s ,
on e t o t h e ma n u fa ct u r in g dis t r ict s , a n d on e t o t h e r u r a l dis t r ict s .
Even t h e Qu een , in h er r ecen t s peech a t t h e open in g of Pa r lia men t ,
r ecommen ded t h e s u bject t o pu blic con s ider a t ion :-

19
As s ociations f or s cientif ic and benevolent purpos es , in England, are generally managed by "committees ." The f ollowing
gentlemen compos ed the committee of the London Health of Towns As s ociation. Others , equally eminent, in that city and
in other parts of the k ingdom, are earnes tly engaged in the caus e :-

26
"In t h e s u mmer a n d a u t u mn of t h e pa s t yea r , t h e Un it ed Kin gdom wa s
a ga in vis it ed by t h e r a va ges of t h e ch oler a ; bu t Almigh t y God, in h is mer cy,
wa s plea s ed t o a r r es t t h e pr ogr es s of mor t a lit y, a n d t o s t a y t h is fea r fu l
pes t ilen ce. Her Ma jes t y is per s u a ded t h a t we s h a ll bes t evin ce ou r gr a t it u de
by vigila n t pr eca u t ion s a ga in s t t h e mor e obviou s ca u s es of s ickn es s , a n d a n
en ligh t en ed con s ider a t ion for t h os e wh o a r e mos t expos ed t o it s a t t a cks ."
It wou ld be impos s ible h er e t o give even a n a n a lys is of t h es e docu men t s
a n d wor ks . Th e followin g a r e a mon g t h e ma n y con clu s ion s t o wh ich we a r e
led fr om t h e in for ma t ion t h ey con t a in ;-

1. It is proved t h a t t h ere die a n n u a lly, in each 100 of t h e popu lat ion , of t h e
wh ole of En gla n d, 2.27; of t h e mos t h ea lt h y dis t r ict , 1.53 ; a n d of t h e mos t
u n h ea lt h y dis t r ict , 3.58. An d t h a t t h e livin g t o on e dea t h a r e, in t h es e
dis t r ict s , r es pect ively, 4.4, 65, a n d 27.
2. It is proved t h a t t h e va r iou s for ms of epidemic, con t a giou s , a n d ot h er
dis ea s es , ca u s ed, or a ggr a va t ed, or pr opa ga t ed, by a t mos ph er ic impu r it ies ,
pr odu ced by decompos in g a n ima l or veget a ble s u bs t a n ces , by da mp a n d
filt h , a n d clos e a n d over cr owded dwellin gs , pr eva il a mon gs t t h e popu la t ion
in ever y pa r t of t h e kin gdom, wh et h er dwellin g in s epa r a t e h ou s es , in r u r a l
villa ges , in s ma ll t own s , or in t h e la r ge t own s , a s t h ey h a ve been fou n d t o
pr eva il in t h e lowes t dis t r ict of t h e met r opolis ."
3. It is proved t h a t dis ea s e a n d mor t a lit y fa ll mor e h ea vily u pon t h os e wh o
live in la r ge t own s a n d popu lou s pla ces , t h a n in t h e cou n t r y dis t r ict s , a n d
pa r t icu la r ly u pon t hos e wh o live in n a rr ow s t r eet s , con fin ed cou r t s , da mp
dwellin gs , clos e ch a mber s , cella r s , u n dr a in ed, u n ven t ila t ed, a n d u n clea n s ed;
a n d a ffect mos t s ever ely t h e in fa n t ile por t ion of t h e popu la t ion , a n d t h e
h ea ds of fa milies bet ween t wen t y a n d t h ir t y yea r s of a ge.
4. It is proved t h a t , in s u ch s it u a t ion s , t h e a ver a ge du r a t ion of life is five t o
t wen t y-five yea r s les s t h a n it migh t ot h er wis e be; a n d t h a t , du r in g t h is
cu r t a iled per iod of exis t en ce, t h e wor kin g power of t h os e wh o live, a n d t h eir
ca pa cit y for en joymen t , a r e gr ea t ly dimin is h ed by a con s t an t depr es s ion of
h ea lt h a n d s pir it s , a n d by t h e a ct ive a t t a cks of fever , ch oler a , s cr ofu la , a n d
con s u mpt ion .
5. It is proved t h a t s u ch dis ea s es , wh er ever t h eir a t t a cks a r e fr equ en t ,
a r e a lwa ys fou n d in con n ect ion wit h t h e ph ys ica l cir cu ms t a n ces a bove
s pecified; a n d t h a t wh er e t h es e cir cu ms t a n ces a r e r emoved by dr a in a ge,
pr oper clea n s in g, bet t er ven t ila t ion , a n d ot h er mea n s of dimin is h in g
a t mos ph er ic impu r it y, t h e fr equ en cy a n d in t en s it y of s u ch dis ea s es a r e
a ba t ed; a n d wh er e t h e r emova l of t h e n oxiou s a gen cies , a n d ot h er ca u s es of
dis ea s e, a ppea r s t o be complet e, s u ch dis ea s es a lmos t en t ir ely dis a ppea r ."
6. It is proved t h a t t h e a n n u a l mor t a lit y migh t be r edu ced, in t h e wh ole
kin gdom, fr om 2.27 per cen t ., or 1 in 44, t o les s t h a n t wo per cen t ., or 1 in
50; a n d in a ll la r ge t own s , a s low a s t h a t gen er a l a ver a ge.
7. It is proved t h a t t h is u n n eces s a r y exces s of mor t a lit y a bove 2 per cen t .,
occa s ion s a n a n n u a l los s of mor e t h a n 50,000 lives in t h e Un it ed Kin gdom,-"
gr ea t er t h a n t h e los s fr om dea t h or wou n ds in a n y wa r s in wh ich t h e cou n t r y
h a s been en ga ged in modem t imes ; "a n d t h a t t h e ca u s es of t h es e
u n n eces s a r y dea t h s occa s ion a t lea s t t wen t y ca s es of u n n eces s a r y s ickn es s ,
on t h e a ver a ge, t o ea ch dea t h , or on e million ca s es a n n u ally, wh ich migh t
h a ve been pr even t ed.
27
8. It is proved t h a t of t h e 43,000 ca s es of widowh ood, a n d 112,000 ca s es
of des t it u t e or ph a n a ge, r elieved fr om t h e poor r a t es of En gla n d a n d Wa les
a lon e, t h e gr ea t er propor t ion of dea t h s of t h e h ea ds of fa milies occu r r ed fr om
s pecified r emova ble ca u s es ; a n d t h a t t h e a ver a ge of t h eir a ges wa s u n der
for t yfive yea r s , or t h ir t een yea r s below t h e n a t u r a l r oba bilit y of life, a s s h own
by exper ien ce.
9. It is proved t h a t t h e pr even t a ble ca u s es of dis ea s e, a n d t h e u n n eces s a r y
mor t a lit y, impos e u pon t h e people immen s e pecu n ia r y bu r den s wh ich
migh t be a voided.
10. It is proved t h a t t h e you n ger popu la t ion , br ed u p u n der n oxiou s
ph ys ica l a gen cies , is in fer ior in ph ys ica l or ga n iza t ion a n d gen er a l h ea lt h t o a
popu la t ion pr es er ved fr om s u ch a gen cies ; a n d t h a t t h es e a dver s e
cir cu ms t a n ces t en d t o pr odu ce a n a du lt popu la t ion , s h or t -lived,
impr oviden t , r eckles s , in t emper a t e, immor a l, a n d wit h exces s ive des ir es for
s en s u a l gr a t ifica t ion s .

II. THE SANITARY MOVEMENT AT HOME

Sanitary Police. Some h is t or ica l n ot ice of t h e s a n it a r y legis la t ion of
Ma s s a ch u s et t s , s eems pr oper , pr elimin a r y t o a n y s t a t emen t s of it s pr es en t
con dit ion . We h a ve a ccor din gly pr es en t ed, in t h e a ppen dix, t h e t it les of a ll
t h e a ct s r ela t in g t o ma t t er s con n ect ed wit h t h e pu blic h ea lt h , fr om t h e
commen cemen t of t h e pr ovin cia l ch a r t er , in t h e yea r 1692, t o t h e pr es en t
t ime, a r r a n ged in ch r on ologica l or der ; a n d r efer r ed, in con n ect ion , t o t h e
pr in t ed wor ks wh er e t h ey ma y be fou n d. Th e s u bject s eems t o h a ve r eceived
lit t le a t t en t ion fr om t h e Gen er a l Cou r t , du r in g t h e old colon ia l ch a r t er .
20
Two
a ct s , wh ich h a ve s ome r ela t ion t o it , we s h a ll pr es en t ly n ot ice. La ws wer e
pa s s ed by t h e pr ovin cia l gover n men t , r ela t in g t o n u is a n ces , dr a in a ge, s ma ll-
pox, a n d s ome ot h er ma t t er s ; ma n y of wh ich wer e s pecia l a ct s , or pa r t ia l in
t h eir oper a t ion . Bu t t h ou gh imper fect , t h ey a t e h on or a ble t o t h e St a t e, a n d
exh ibit t h e ca r e wh ich t h e legis la t u r e h a s ever wis h ed t o exer cis e over t h e
people. To t h em we h a ve been in debt ed for ma n y excellen t s a n it a r y
mu n icipa l r egu la t ion s , wh ich h a ve con t in u ed u n t il t h e pr es en t t ime.
Nuis ances . In 1692 a n d 1708, a ct s wer e pa s s ed, pr ovidin g t h a t " in
Bos t on , Sa lem, Ch a r les t own , r es pect ively, a n d ot h er ma r ket t own s in t h e
pr ovin ce?" "s la u gh t er -h ou s es for killin g of mea t , s t ill-h ou s es , a n d h ou s es for
t h e t r yin g of t a llow, cu r r yin g a n d dr es s in g of lea t h er , eit h er wit h t ime, a lu m,
or oil, be a s s ign ed by t h e s elect men t o pla ces wh er e it ma y be lea s t

20
Towns , however, under the general authority which they pos s es s ed, s ometimes made regulations regarding s ick nes s .
The s electmen of Salem, in 1678, " ordered that William S tacy , who is s ick of the s mall-pox, doth not pres ume to come
abroad till three week s af ter this date; and that be very caref ul that when the time be expired he s hif t his clothes , and do
not frequent company till he wholly clear of the inf ection," And again-" The s electmen being informed that William Lord,
Jr., is vis ited with the s mall-pox, at his f athers hous e, do order that William Lord, s en., his wif e and children that live with
him, do k eep within their hous e, and that they do not offer to s ell any of their wares , viz . : bread, cak es ,gingerbread, and
the lik e; and that they s uffer none to come to their hous e, but what neces s ity requires , upon the penalty of 208, in money
for each offence. It is ordered that Thomas s tacey doth f orbear grinding at the mill, and that he be careful he doth not
inf ect others , on the penalty of 208. A hous e is ordered to be impres s ed for our s ick , having the s mall-pox."-Felt's Annals
of Salem, Vol. II, p. 423. The following act was pas s ed by the Mas s achus etts Colony , in 1660 :-" This court, cons idering
how f ar Satan doth prevail upon s everal pers on within this juris diction to mak e away thems elves , judgeth that God calls
them to bear tes timony agains t s uch wick ed and unnatural practices , that other may be deterred theref rom :"Do therefore
order, that from henceforth, if any pers on, inhabitant or s tranger, s hall at any time be f ound by any jury to lay violent
hand on thems elves , or be wilf ully guilty of their own death, every s uch pers on s hall be denied the privilege of being
buried in the common bury ing-place of Chris tians , but s hall be buried in s ome common highway , where the s electmen of
the town where s uch pers on did inhabit s hall appoint, and it cart-load of s tones laid upon the grave as a brand of Inf amy ,
and as a warning to others to beware of the lik ed amnable practices ." Ancient Charters and Laws , p. 187.
28
offen s ive," a n d pr oh ibit ed els ewh er e; a n d r ecor ds wer e t o be kept of s u ch
a s s ign men t . Th e pr ovis ion s of t h es e a ct s , wer e in cor por a t ed in t o t h a t of
J u n e 7, 1785, a n d t h en ext en ded t o New bu r ypor t , a n d ot h er t own s in t he
St a t e, in wh ich t he s elect men a n d t wo ju s t ices migh t ju dge it t o be
n eces s a r y; a n d in clu ded ea r t h en wa r e in t h e lis t of ma n u fa ct u r es t o be
r egu la t ed. A fin e of 5 wa s impos ed for a br ea ch of t h e law, wh ich , by t h e
a ddit ion a l a ct of Ma r ch 4., 1800, 'Wa s fixed a t $20. Th e Revis ed St a t u t es
modified t h is a ct , a n d ext en ded it s pr ovis ion s t o a n y t own in t h e St a t e, a t t h e
opt ion of t h e s elect men , a n d in clu ded " a n y t r a de or employmen t offen s ive t o
t h e in h a bit a n t s , or da n ger ou s t o t h e pu blic h ea lt h ."
Drainage and Sewerage. In 1702, a n a ct wa s pa s s ed pr ovidin g "for
a ppoin t in g commis s ion er s of s ewer s , for t h e dr a in in g a n d r emovin g of t h e
ba n ks a n d obs t r u ct ion s of t h e pa s s a ge of wa t er s in r iver s , br ooks , or pon ds
t h a t occa s ion t h e over flow a n d dr own in g of mea dows a n d low la n ds ; a n d a ls o
for t h e dr a in in g a n d flowin g of s wa mps a n d ot h er u n pr ofit a ble gr ou n ds , a n d
dr yin g of t h em." An ot h er a ct , " for r egu la t in g dr a in s a n d common s h or es ,"
[s ewer s ,] wa s pa s s ed in 1709, pla cin g t h em u n der t h e dir ect ion a n d con t r ol
of t h e s elect men of t h e t own . Th es e pr ovis ion s wer e in cor por a t ed in t o t h e t wo
la ws of t h e St a t e, pa s s ed Feb. 26, 1796, a n d Feb. 20, 1797, a n d r ema in ed
in for ce u n t il t h eir r epea l in 1836, wh en t h ey wer e r een a ct ed in t h e modified
for m of t h e Revis ed St a t u t es .
Sick nes s . Legis la t ion on t h is s u bject , pr in cipa lly wit h r efer en ce t o t h e
s ma ll-pox, h a s been fr equ en t in t h e h is t or y of t h e St a t e. As ea r ly a s 1701, "
a n a ct pr ovidin g in ca s e of s ickn es s ," wa s pa s s ed, "for t h e bet t er pr even t in g
t h e s pr ea din g of in fect ion ." By t h is a ct , wh en per s on s " wer e vis it ed wit h t h e
pla gu e, s ma ll-pox, pes t ilen t ia l or ma lign a n t fever , a n d ot h er con t a giou s
s ickn es s , t h e in fect ion wh er eof ma y be commu n ica t ed t o ot h er s ," t h e
s elect men wer e empower ed, "for t h e pr es er va t ion of t h e in h a bit a n t s ," t o
r emove s u ch in fect ed per s on s t o s epa r a t e h ou s es , a n d t o pr ovide " n u r s es ,
t en da n ce, a n d ot h er a s s is t a n ce a n d n eces s a r ies for t h em, a t t h e ch a r ge of
t h e pa r t ies t h ems elves , t h eir pa r en t s or ma s t er s , (if a ble,) or ot h er wis e a t t h e
ch a r ge of t h e t own or pla ce wh er et o t h ey belon g." An d t h e s h er iff of t h e
cou n t y, h is depu t y, or t h e con s t a ble of t h e t own , wer e r equ ir ed, u n der
dir ect ion of t h e s elect men , " t o impr es s a n d t a ke u p con ven ien t h ou s in g,
lodgin g, n u r s es , t enda n ce, a n d ot h er n eces s a r ies for t h e a ccommoda t ion a n d
r elief of t h e s ick." An d if a ves s el a r r ivin g in t h e pr ovin ce h a ppen ed " t o be
vis it ed wit h t h e pla gu e, s ma ll-pox, pes t ilen t ia l or ma lign a n t fever , du r in g t h e
voya ge, or t o come fr om a n y pla ce wh er e s u ch s ickn es s pr eva iled," t h ey wer e
a u t h or ized t o pr even t a ll per s on s belon gin g t o t h e s h ip comin g on s h or e, or
t h os e on s h or e h avin g a n y in t er cou rs e wit h t h em. Th is h a s been t he
fou n da t ion of a ll t h e s a n it a r y la ws pa s s ed s in ce t h a t t ime. It s pr ovis ion s
wer e r et a in ed a n d mu ch ext en ded in t h e gr ea t a ct of J u n e 22, 1797, wh ich
wa s t h e mos t impor t a n t s a n it a r y a ct pa s s ed in t h e Un it ed St a t es , pr ior t o t he
pa s s a ge of t h e Ma s s a ch u s et t s r egis t r a t ion la ws .
Th e s ma ll-pox h a s oft en pr eva iled ill t h e St a t e a n epidemic, a n d
legis la t ion t o gu a r d a ga in s t it s effect s h a s been fr equ en t . In 1730, a n a ct wa s
pa s s ed, "empower in g cou r t s t o a djou r n a n d r emove fr om t h e t owns
a ppoin t ed by la w for h oldin g cou r t s , t o ot h er t own s , in ca s es of s ickn es s by
t h e s ma llpox." An ot h er a ct wa s pa s s ed, in 1751, r es pect in g clot h in g a n d
ot h er goods s u ppos ed t o be in fect ed, con t a in in g a lmos t t h e s a me pr ovis ion s
29
a s wer e r een a ct ed in 1797, a n d in cor por a t ed in t o t h e Revis ed St a t u t es in
1836. Ot h er a ct s r es pect in g t h e s ma ll-pox wer e pa s s ed in 1742, 1757, 1776,
1777, 1792, a n d 1793. On t h e 6t h of Ma r ch , 1809, a n a ct wa s pa s s ed,
ma kin g it t h e du t y of t own s t o ch oos e a commit t ee t o s u per in t en d t h e
va ccin a t ion of t h e in h a bit a n t s . Th is excellen t la w wa s s o modified,
impr oper ly a s we t h in k, in t h e Revis ed St a t u t es , a s t o lea ve it t o t h e
dis cr et ion of t h e s elect men , t o a ct or n ot t o a ct u n der it s a u t h or it y, a s t h ey
migh t ch oos e.
Ins anity : In 1694, t own s wer e r equ ir ed t o pr ovide for t h e "r elief,
s u ppor t , a n d s a fet y" of per s on s "n a t u r a lly wa n t in g of u n der s t an din g, s o a s t o
be in ca pa ble t o pr ovide for h im or h er s elf, or by t h e pr oviden ce of God s h a ll
fa ll in t o dis t r a ct ion , a n d become n on compos men t is ." Act s " for s u ppr es s in g
r ogu es , va ga bon ds , common begga r s , a n d ot h er idle a n d dis or der ly a n d lewd
per s on s ," wer e pa s s ed in 1758 a n d 1798, by wh ich ju s t ices wer e empower ed
t o commit in s a n e per s on s t o t h e h ou s e of cor r ect ion . Th es e a ct s wer e
r epea led in 1834, t h ou gh s ome of t h eir ba d fea t u r es a r e s t ill r et a in ed. It
s eems t o u s t h a t , u n les s cr ime h a s a ct u a lly been commit t ed, in s a n e per s on s
s h ou ld n ot be t r ea t ed a s cr imin a ls , bu t s h ou ld be r es t r a in ed a n d pr ovided
for by s ome ot h er t r ibu n a l t h a n a cr imin a l cou r t .
Quarantine. We h a ve a lr ea dy a llu ded t o on e la w, pa r t ia lly qu a r a n t in e.
In 1700, t h e ma s t er of s h ips wer e r equ ir ed t o fu r n is h a lis t of a ll pa s s en ger s
t o t h e s elect men of t own s , a n d give s ecu r it y for t h e s u ppor t of a n y "impot en t ,
la me, or in fir m per s on " wh o migh t be dis ch a r ged. At a s u bs equ en t per iod,
n ot exa ct ly kn own , a h os pit a l wa s er ect ed on Spect a cle Is lan d, by t h e t own
of Bos t on ; a n d, in 1736, a n a r r a n gemen t wa s ma de bet ween Bos t on a n d t h e
Common wea lt h , for a per ma n en t qu a ra n t in e es t a blis h men t on Ra in s for d's
Is la n d. No h os pit a l, h owever , a ppea r s t o h a ve been er ect ed u n t il s ome t ime
a ft er wa r ds . In 1757, " An Act for r egu la t in g t h e Hos pit a l on Ra in s for d's
Is la n d, a n d fu r t h er pr ovidin g in ca s e of s ickn es s ," wa s pa s s ed. Th is a ct
commen ces , " Wh er ea s a good a n d con ven ien t h ou s e t h a t been pr ovided a t
t h e ch a r ge of t h e pr ovin ce, on t h e is la n d ca lled Ra in s for d's Is la n d, for t h e
r ecept ion of s u ch per s on s a s s h a ll be vis it ed wit h a n y con t a giou s s ickn es s ;"
a n d t h en follow t h e gen er a l pr ovis ion s of la w on t h e s u bject . An a ddit ion a l
a ct wa s pa s s ed in 1758 ; a n d in 1799 t h e wh ole qu a r a n t in e r egu la t ion s wer e
t r a n s fer r ed t o t h e Bos t on Boa r d of Hea lt h ; a n d t h er e it r es t ed, a s it a lwa ys
s h ou ld h a ve don e) u n t il t h e Revis ed St a t u t es wer e pa s s ed.
Special Legis lation. Th e fir s t Boa r d of Hea lt h in t h e St a t e was
es t a blis h ed in Bos t on , by a s pecia l a ct of t h e Legis la t u r e, pa s s ed Febr u a r y
13,1799. Th is fir s t a ct wa s , h owever , r epea led, a n d a n ot h er , mor e
compr eh en s ive a n d ext en ded, wa s pa s s ed in it s s t ea d, on t h e 20t h of J u n e in
t h e s a me yea r . Th is a ct con t a in s t wen t y-five s ect ion s , a n d h a s s in ce for med
t h e ba s is of ou r s pecia l legis la t ion . Bes ides it s own pr ovis ion s , it impos ed
u pon t h e boa r d a ll t h e power s a n d du t ies of t h e gen er a l a ct of J u n e 22,
1797. Addit ion a l a ct s wer e pa s s ed in 1803, 1804, 1806, 1809, a n d 1810. In
t h e la s t -n a med yea r , t h e Boa r d of Hea lt h wer e a u t h or ized t o ma ke r oles a n d
r egu la t ion s for bu r ia l gr ou n ds , a n d for t h e in t er men t of t h e dea d; a n d u n der
t h a t a ct , in t h a t yea r , wa s commen ced t h e excellen t pla n of r ecor din g t h e
n a me, a ge, a n d dis ea s e of ever y per s on bu r ied ; wh ich r ecor ds h a ve been
con t in u e u n t il t h e pr es en t t ime. J u n e 20, 1816, a r evis ed a ct for es t a blis h in g
t h e Boa r d of Hea lt h , dr a wn by Ben ja min Wh it ma n , Es q., wa s pa s s ed, a n d
30
r epea led s o mu ch on ly of t h e pr eviou s a ct s , a s wer e in con s is t en t wit h it s
pr ovis ion s . By t h e cit y ch a r t er , a ll t h e power s of t h e Boa r d of Hea lt h wer e
"t r a n s fer r ed t o a n d ves t ed in t h e cit y cou n cil."
Boa r ds of Hea lt h h a ve s in ce been es t a blis h ed in ot h er pla ces , a ccor din g
t o t h e followin g s t a t emen t :-



Town s
Wh e n
Es t a blis h e d His t or y Da t e
Bos ton Feb. 13, 1799 Trans f erred to City Council Feb.23, 1822
S alem June 21,1799
"
"
March
23,1836
Marblehead Feb. 22, 1802 S till exis ting in the town
Ply mouth Feb. 27. 1810
"
"
Charles town June 12,1818 Trans f erred to City Council Feb. 22,1847
Ly nn June 16, 1821
"
" April10,1850
Cambrid ge March 2,1828
"
"
March
17,1846

Th e a ct s of 1799 a n d 1816, es t a blis h in g t h e Boa r d of Hea lt h for Bos t on ,
pr ovide, "t h a t a ll t h e power s a n d du t ies wh ich a r e given t o or r equ ir ed of t h e
s elect men of t h e t own of Bos t on , by a la w of t h is Common wea lt h pa s s ed t h e
22d of J u n e, 1797, en t it led 'a n a ct t o pr even t t h e s pr ea d of con t a giou s
s ickn es s ,' a n d by t h e s ever a l a ct s in a ddit ion t h er et o, s h a ll be a n d t h ey
h er eby a r e t r a n s fer r ed t o a n d ma de t h e du t y of t h e Boa r d of Hea lt h of t h e
t own of Bos t on , a n y t h in g t o t h e con t r a r y n ot wit h s t a n din g." Th es e a ct s h a ve
been models , a ft er wh ich t h e ch a r t er s of ot h er boa r ds of h ea lt h , a n d t h e
mu n icipa l or din a n ces , r u les a n d r egu la t ion s t o ca r r y t h em in t o effect , h a ve
been for med. Th e la w of 1816 ,va s pr in cipa lly a modifica t ion of t h a t of 1799,
a n d r epea led on ly s u ch pa r t s of it a s wer e in con s is t en t wit h it s pr ovis ion s .
Th e for mer a ct s wer e occa s ion ed by t h e t h en r ecen t ou t br ea k of t wo' gr eat
epidemics in Bos t on ,-t h e s ma ll-pox, a n d yellow fever , wh ich will pr es en t ly be
n ot iced. Th e s pecia l a ct s cr ea t in g boa r ds of h ea lt h in Sa lem, Ma r bleh ea d,
Plymou t h , a n d Ch a r les t own , a ll r efer t o t h e a ct of 1797 a s pa r t of t h eir
ch a r t er s . Th os e of Lyn n a n d Ca mbr idge do n ot . Th e la w of 1797, h er e
r efer r ed t o wa s r epea led by t h e Revis ed St a t u t es ; bu t n eit h er t h e s pecia l
a ct s , n or a n y pa r t of t h em, cr ea t in g t h e loca l boa r ds of h ea lt h , wer e r epea led;
h en ce t h e gen er a l a ct of 1797 is in for ce in Bos t on , Sa lem, Ma r bleh ea d,
Plymou t h , a n d Ch a r les t own , bu t n owh er e els e!
Su ch wa s t h e h is t or y a n d con dit ion of s a n it a r y legis la t ion , pr ior t o t h e
codifica t ion of t h e la ws a s t h ey a ppea r in t h e Revis ed St a t u t es . Th e
commis s ion er s wh o per for med t h is wor k, s a y, in a n ot e t o t h eir r epor t of t h e
t wen t y-fir s t ch a pt er , r ela t in g t o pu blic h ea lt h , t h a t " s evera l pr ovis ion s of
t h is ch a pt er a r e a dopt ed wit h pr oper modifica t ion s fr om t h e s t a t u t e of 1816,
r ela t in g t o t h e cit y of Bos t on ; t h e gen er a l la ws bein g deficien t in va r iou s
det a ils , wh ich s eem t o be r equ is it e in ca s es wh er e it s h a ll be deemed
expedien t t o a ppoin t s u ch boa r ds . Th e pr ovis ion s of t h a t a ct , bein g t h e r es u lt
31
of lon g exper ien ce will pr oba bly be fou n d t o be a da pt ed t o t h e wa n t s of ot h er
popu lou s pla ces , in wh ich s u ch offices a r e r equ ir ed."
21

An d in lookin g a t t h e a ct it s elf, a s t h u s modified, it a ppea r s t h a t t wo
s ect ion s , 47 a n d 48t wer e t a ken fr om t h e a ct of 1785 ; t h a t n in e s ect ion s , 35
t o 43 in clu s ive, were t a ken fr om t h e a ct of 1792, r ela t in g t o t h e s ma ll-pox;
t h a t fift een s ect ion s , 5, 6 , 9, 10, 11, 16 t o 24 in clu s ive, a n d 33, wer e t a ken
fr om t h e a ct of 1797, t h a t on e s ect ion , 12, wa s t a ken fr om t h a t of 1801 ; t h a t
t wo s ect ion s , 45 a nd 46, wer e t a ken from t h a t of 1810 ;an d t h a t eigh t een
s ect ion s , I, 2, 3, 4, 7, 8, 14, 15, a n d 25 t o 32 in clu s ive, a n d 34, wer e t a ken
fr om t h a t of 1816.
An d t o wh a t t r ia ls of legis la t ion h a ve t h e Revis ed St a t u t es been
s u bject ed ? In 1837, s ect ion s 16 a n d 40 wer e r epea led, a n d t wo ot h er s
s u bs t it u t ed in t h eir pla ces . In 1838, s ect ion s 16, 17,38,40, 41,42,43, a n d
44, wer e r epea led, (bein g t h e s econ d r epea l of 16 a n d 40.) In 1840, t h e 43d
a n d 44t h s ect ion s , repea led in 1838, wer e r es t or ed a n d r een a ct ed. In 1848,
t h e t wo s ect ion s s u bs t it u t ed in 1837 for 16 a n d 40 of t h e Revis ed St a t u t es ,
wer e r epea led, s o fa r a s r ela t es t o t h e s ma ll-pox. An d, in 1849, s ect ion s 10,
", a n d 46 (a mon g t h e mos t impor t a n t in t h e wh ole a ct ) wer e r epea led, a n d
ot h er s , a pplica ble on ly t o cit ies , a n d n ot t o t own s , s u bs t it u t ed in t h eir
pla ces ! An d ma n y of t h e pr ovis ion s t h u s r epea led a r e in t h e act of 1797, a n d
a r e s t ill in for ce in Bos t on ; Sa lem, Ma r bleh ea d, Plymou t h , a n d Ch a r les t own ,
t h ou gh n ot in ot h er pla ces ! All t h is will a ppea r in t h e a ct s wh os e t it les we
h a ve r efer r ed t o in t h e a ppen dix.
Th e r es u lt of t h is exa min a t ion h a s led u s t o con clu de :-
1. Th a t t h e pr es en t h ea lt h la ws of t h e St a t e a r e imper fect in t h eir
pr ovis ion s , a n d a r e a r r a n ged on a n imper fect pla n ; a n d t h a t t h e wh ole
h a ve been r en der ed mor e defect ive by t h e r emova l of s ome of t h e
or igin a l pa r t s .
2. Th a t it is difficu lt , if n ot impos s ible, even a ft er wa din g t h r ou gh ma n y
wor ks n ot ea s ily a cces s ible, t o kn ow wh a t t h e la ws r ea lly a re, or wh a t
pa r t s a r e or a r e n ot in for ce.
3. Th a t t h ey a r e pa r t ia l in t h eir a pplica t ion a n d oper a t ion ; a n d, if
occa s ion s h ou ld r equ ir e, it is ext r emely dou bt fu l, n ow, wh et h er t own s ,
n ot cit ies , h a ve a n y a u t h or it y t o en for ce t h em.
4. Th a t , if t h ey cou ld be u n der s t ood a n d en for ced, t h ey a r e en t ir ely
in a dequ a t e t o t h e pr es en t con dit ion of s ociet y, a n d t h e pr es en t wa n t s of
t h e a ge.

It is h a r dly n eces s a ry t o r ema r k t h a t , u n der t h e oper a t ion of t h es e la ws ,
bu t few fa ct s h a ve been pr es er ved wh ich wou ld illu s t r a t e t h e s a n it a r y
h is t or y of t h e people. Recor ds of dea t h s h a ve been ma de in s ome of t h e
t own s ; a n d t h e imper fect a bs t r a ct s 0f t h es e r ecor ds wh ich h a ve been
pu blis h ed, r ela t in g t o Bos t on , s in ce 1810, u n der t h e t it le of " Bills of
Mor t a lit y," h a ve been n ot iced.
22

Th e mos t impor t a n t la ws for a s cer t a in in g t h e fa ct s r ega r din g t h e
s a n it a r y con dit ion of t h e St a t e, in Ma s s a ch u s et t s a s in En gla n d, a r e t h os e

21
Report of Commis s ioners , p. 124.

22
See American Journal or Medical Sciences, for April, 1840 ; Shattuck's Census and Statistics of Boston, pp. 126-177, and
Appendix, pp. 71-95 ; Curtis's Sanitary Report-Transactions of the American Medical Association. Vol. ", p 487. .
32
r ela t in g t o t h e r egis t r a t ion of bir t h s , ma r r ia ges , a n d dea t h s . Befor e t h es e
la ws wer e pa s s ed, gr ea t defect s exis t ed. Effor t s t o r emedy t h es e defect s h a d
oft en been ma de; a n d a n or der wa s in t r odu ced in t o t h e Bos t on cit y cou n cil,
Ma r ch 22, 1838, for t h e a ppoin t men t of a commit t ee t o con s ider t h e s u bject .
Bu t cir cu ms t a n ces exis t ed, a t t h a t t ime, wh ich pr even t ed a n y u s efu l a ct ion .
Aft er fr equ en t commu n ica t ion s wit h t h e la t e Hon . J oh n Picker in g, t h en
Pr es iden t of t h e Amer ica n Aca demy of Ar t s a n d Scien ces ; a n d wit h t h e la t e
Dr s . Ha le a n d Fis h er , a ct ive member s of t h e Ma s s a ch u s et t s Medica l Societ y;
t h e s u bject wa s br ou gh t befor e t h eir r es pect ive a s s ocia t ion s ; a n d h en ce
or igin a t ed t h e pet it ion s t o t h e Legis la t u r e for a modifica t ion of t h e la ws ,
wh os e s u bs equ en t h is t or y h a s a lr ea dy been n ot iced.
23
Some fa ct s obt a in ed
u n der t h es e la ws will pr es en t ly be given .
A n ot ice of t h e Med ical Organiz ation, t h e pr ofes s ion a l effor t s , a n d t h e
mea n s for t h e cu r e of dis ea s e, wh ich h a ve exis t ed in t h e St a t e, for m a pa r t of
t h e h is t or y of t h e s a n it a r y movemen t . Pr eviou s t o t h e for ma t ion of t h e
Ma s s a ch u s et t s Medica l Societ y, medicin e h a d been r ecogn ized r a t h er a s a n
a r t t h a n a s a s cience. Lit t le or n o pu blic in s t r u ct ion on t h e s u bject of
medicin e h a d been given . Th e pr ofes s ion wa s in deed r ecogn ized a s dis t in ct ,
a n d t h er e h a d been s ever a l ph ys icia n s of emin en ce.
24
Cler gymen , h owever ,
a t t h a t ea r ly per iod, fr equ en t ly pr es cr ibed for t h e dis ea s es of t h eir br et h r en ;
a n d a lt h ou gh t h ey wer e n ot en dowed wit h h igh a t t a in men t s in medica l
s cien ce, t h ey wer e n ever t h eles s qu a lified for gr ea t u s efu ln es s in t h eir
r es pect ive s t a t ion s . "Alt oget h er u n like t h e ign or a n t empir ics of t h e pr es en t
t imes , t h ey wer e a ct u a t ed by t h e pu r es t mot ives ; an d t h e h igh es t
con s ider a t ion of ben evolen ce. By t h eir a mia ble ma n n er s , zea lou s a t t en t ion ,
a n d piou s con ver s a t ion , t h ey en dea r ed t h ems elves t o t h eir people; mu t u a l
a t t a ch men t s wer e for med, a n d t h e fu lles t con fiden ce wa s r epos ed in t h eir
s kill."
25


For t h e fir s t h u n dr ed yea r s in t h e h is t ory of t h e colon ies , midwifer y wa s
a lmos t exclu s ively in t h e h a n ds of fema les . Th e ma le pr a ct it ion er wa s s eldom
ca lled in , except in difficu lt ca s es . Dr . J a mes Lloyd vis it ed Lon don in 1753,

23
See firs t , s econd, a n d fou rt h Regis t ra t ion Report s ; 8en a te Docu men t No.24, for 1848,a nd Hou s e Docu men t No.65,
for 1849.

24
LAWS IN THE OLD COLONIES. Th e followin g a ct s , rela t in g t o t h e pract ice of ph ys ic, a ppea r a mon g t he la ws of t he
old colon ies , a nd a re t h e oldes t a ct s on t h e s u bject in t h e Un ited St a tes . Th e firs t wa s pas s ed in Plymou t h , ill 1642. ;
a n d t he s econd ill Ma s s a chu s et t s , in 1649 :- 1." If a n y ch ildren or elder pers on s s ha ll be s ent or come from one town t o
a n ot her , t o be n u r s ed, s chooled, or ot her wis e edu ca ted ; or t o a ph ys icia n , or ch iru rgeon , 10 h e cu red of a n y dis ea s e or
wou nd, &c. : if t h ey come to s t a n d in need or r elief, t hey s h a ll be r elieved a nd ma in t a ined by t h e t own s h ips when ce
t h ey came, or were s en t fr om, a n d n o1 by t h a t t own s h ip where t hey a re So nu r s ed, edu ca ted, or a l cu r e ; a n d in cas e
t h ey come or be s en t fr om a n y t own or pla ce ou t of t h is colon y, t h en if t h e n u r s e, edu ca t or, ph ys icia n , or ch iru rgeon ,
t a ke n ot s u fficien t s ecu r it y of t h e per s on t o be nu r s ed, edu ca ted, or cu red, t o dis ch a r ge t he t own s h ip or a n d fr om a ll
cos t a nd ch a rge wh ich s h a ll or ma y come a nd befa ll t he s a id t own s h ip in wh ich be or t hey is s o t o be nu rs ed,
edu ca ted, or cu red: t h en t hey t h e s a id nu rs e, edu ca t or, ph ys icia n , or ch iru rgcon , a s neglects t h e s ame, s h a ll dis ch a rge
t h e s a id t own s h ip of t hem t hems elves ." Plymou t h Colon y Laws , p.72. 2."Fora s mu ch as t h e la w or God a llows n o ma n t o
impa ir t he life or limbs or a n y per s on , bu t in a ju dicia l wa y: . " It is t h erefore ordered, t h a t n o per s on or pers ons
wh a t s oever, employed a t a n y t ime a bou t t h e bodies or men , women , or ch ildren , for pres ervat ion of lit e or hea lt h , a s
ch iru rgeons , midwives , ph ys icia n s , or ot hers , pres u me t o exercis e or pUI fort h a n y a ct con t ra ry t o t h e kn own approved
ru les or a rt , in ea ch mys tery a n d occu pa t ion , n or exercis e a lly force, violen ce or cru elt y u pon or t owa rds t he body fl
a n y, wet her you n g or old, (n o, n ot in t h e mos t difficu lt a n d des pera te ca s es ) wit h ou t t he a dvice a n d con s en t of s u ch as
a re s kilfu l in t he s a me a rt , (if s u ch ma ybe h ad) or a t lea s t of s ome of t h e wis es t a n d gra ves t t h en pres en t , a n d con s en t
of t h e pa t ien t or pa t ien t s , if t h ey be men t is compotes , mu s h les s con t ra ry t o s u ch a dvice a nd con s en t , u pon s u ch
s evere pu n is h men t a s t he n a t u re of t he fa ct ma y des erve; wh ich la w, n evert heles s , is n ot in t ended t o dis cou ra ge a n y
fr om a ll la wfu l u s e of t h eir s kill, bu t r a t h er t o en cou ra ge a n d direct t h em in t h e r igh t u s e t herof, a n d in h ibit a n d
res t ra in t he pers u mpt ou s a rroga n cy of s u ch a s , t h rou gh prefiden ce of t h eir own s kill, or a n y ot h er s in is ter res pect s ,
da re boldly a t t empt t o exercis e a n y violence u pon or t owa rds t h e bodies of you n g or old, one or ot her, t o t h e preju dice
or h a za r d of t he life or limb of ma n , woma n , or ch ild."- An cien t Ch a rt er s a nd La ws , p. 76.
25
Th a t ch er's Medica l Biograph y, Vol I, p.14. In t h es e volu mes , t h e lives of ma n y ph ys icia n s a re n ot iced.
33
a n d wit n es s ed t h e pr a ct ice of s ome of t h e emin en t ph ys icia n s t h er e; a n d, on
h is r et u r n , h e commen ced t h e pr a ct ice h ims elf, a n d h a s . t h e cr edit of bein g
t h e fir s t ma le pr a ct it ion er in t h is br a n ch of t h e pr ofes s ion in
Ma s s a ch u s et t s .
26

Du r in g t h e r evolu t ion a r y wa r , t h e deficien cy in medica l kn owledge
beca me a ppa r en t , an d ph ila n t h r opic meu , in a n d ou t of t h e pr ofes s ion , wer e
des ir ou s t h a t t h e s t a n da r d of medica l edu ca t ion s h ou ld be r a is ed, medica l
in for ma t ion diffu s ed, a n d mea n s devis ed t o s ecu r e t o t h e commu n it y a
s u cces s ion of well edu ca t ed ph ys icia n s , compet en t t o it s wa n t s ; a n d t h es e
deliber a t ion s r es u lt ed in t h e for ma t ion of t h e Ma s s a ch u s et t s Medica l Societ y,
wh ich wa s in cor pora t ed Nov. 1, 1781. Th eir a ct of in cor por a t ion con t a in s
t h is pa s s a ge :-
" As h ea lt h is es s en t ia lly n eces s a r y t o t h e h a ppin es s of s ociet y ; a n d a s
it s pr es er va t ion or r ecover y is clos ely con n ect ed wit h t h e kn owledge of t h e
a n ima l econ omy, a n d of t h e pr oper t ies an d effect s of medicin es ; a n d a s t h e
ben efit of medica l ins t it u t ion s , for med on liber a l pr in ciples , a n d en cou r a ged
by t h e pa t r on a ge of t h e la w, is u n iver s a lly a ckn owledged."-" An d wh er ea s it
is clea r ly of impor t an ce t h a t a ju s t dis cr imin a t ion s h ou ld be ma de bet ween
s u ch a s a r e du ly edu ca t ed, a n d pr oper ly qu a lified for t h e du t ies of t h eir
pr ofes s ion , a n d t h os e wh o ma y ign or a n t ly a n d. wickedly a dmin is t er
medicin e, wh er eby t h e h ea lt h a n d lives of ma n y va lu a ble in dividu a ls ma y be
en da n ger ed, or per h a ps los t t o t h e commu n it y: be it en a ct ed,"&c.
Addit ion a l a ct s wer e pa s s ed in 1789, 1803,1818, 1819, 1830,1834,
1836, (Rev. St a t ., p. 214,) a n d 1850.
By-la ws for t h e r egu la t ion of t h e s ociet y h a ve been a dopt ed a t va r iou s
per iods , bu t t h ey h a ve n ever been en for ced ver y s t r in gen t ly. Ca s es of
expu ls ion for viola t ion s h a ve s omet imes , t h ou gh ver y r a r ely, occu r r ed. Th e
in flu en ce of t h e s ociet y h a s , h owever , been mos t s a lu t a r y, in r a is in g t he
s t a n da r d of medica l edu ca t ion , a n d in pr odu cin g a mor e res pect a ble, mor e
h igh ly edu ca t ed, a n d bet t er qu a lified cla s s of. ph ys icia n s .
27

Th e a ct s of 1818 a n d 1819 pr ovided a s follows :-" No per s on , en t er in g
t h e pr a ct ice of ph ys ic, or s u r ger y, s h a ll be en t it led t o t h e ben efit of la w for
t h e r ecover y of a n y debt or fee a ccr u in g for pr ofes s ion a l s ervices , u n les s h e
s h a ll, pr eviou s ly t o r en der in g t h os e s er vices , h a ve been licen s ed by t h e
officer s of t h e Ma s s a ch u s et t s Medica l Societ y, or h a ve been gr a du a t ed a
doct or of medicin e in Ha r va r d Un iver s it y." Th e lega l a dva n t a ges of t h es e a ct s
wer e, h owever , s eldom or n ever impr oved ; a n d t h ey wer e r epea led in 1836,
a t t h e s u gges t ion of t h e s ociet y. There is no s uch thing as a legal MEDICAL
POLICE exis ting in the S tate. No r es t r ict ion is la id u pon a n yon e in t h e
pr a ct ice of ph ys ic, or in dea lin g in dr u gs a n d medicin es . An yon e, ma le or
fema le, lea r n ed or ign or a n t , a n h on es t ma n or a kn a ve, ca n a s s u me t h e

26
Commu n ica t ions , Ma s s a chu s et t s Medica l Societ y, Vol. ", P.243
27
Th e followin g ext ra ct s a re from t h e by-la ws of t h e s ociet y:-
XII. An y pers on en ga ged in t he pra ct ice of medicine or s u rgery in t h is common wea lt h , wh o h a s n ot received s u ch a
medica l edu ca t ion as is requ ired; a n d a n y one who s h a ll be gu ilt y of pra ct ices forbidden t o fellows , s h a ll be deemed a n
ir r egu la r pra ct it ioner; a n d it s ha ll be u n la wfu l for a n y fellow t o a dvis e or con s u lt wit h a n y s u ch r egu la r pra ct it ioner, or
in a n y wa y t o a bet or a s s is t h im a s a pra ct it ioner of medicine medicine or s u r gery. For a n y br each of t h is la w, a fellow
of t h is s ociet y, or of t h e dis t rict s ociet y of wh ich be ma y be a member. He s h a ll a ls o be liable t o t h e cen s u re a nd
reprima id of t h e cou n s ellors , an d in a ggra va ted ca s es , t o expu ls ion .
XIII. An y pers on who s h a ll Pu blicly a dvert is e for s a le, or ot herwis e offer, a n y medicine, t he compos it ion of wh ich h e
keeps a s ecret medicine, s h a ll be con s idered a n irregu la r pra ct it ion er; a n d if a fellow of t h is s ociet y, s h a ll be lia ble to
expu ls ion , or t o s u ch ot her pena lt y a s t h e s ociet y, a t t h e s ociet y, a t t h eir a n n u a l meet in g, may t h in k proper t o in flict ."
34
n a me of a ph ys icia n , a n d "pr a ct ice" u pon a n yon e, t o cu r e or t o kill, a s eit h er
ma y h a ppen , wit h ou t a ccou n t a bilit y. "It 's a fr ee cou n t r y!"
28

Th a t t h e in flu en ce of t h e Ma s s a ch u s et t s Medica l Societ y u pon t h e h ea lt h of
t h e people ma y be mor e clea r ly s een , we h a ve compiled t h e followin g a ccou n t
of t h e movement of the med ical prof es s ion in the S tate, s in ce it s for ma t ion :-
Th e n u mber of Fellows belon gin g t o t h e s ociet y in 1789, 1808, 1826,
a n d 1840, h a s been a s cer t a in ed fr om it s pu blica t ion s ; in 1847, fr om a
commu n ica t ion fr om Dr . Z. B. Ada ms ,in t h e Tr a n s a ct ion s of t h e Amer ica n
Medica l As s ocia t ion , (Vo1.I, p. 366); t h e ph ys icia n s in 1850, fr om Ca pen 's
St a t e Recor d; a n d t h e dea t h s a n d a ges , pr eviou s t o 1840, fr om Dr . Eben ezer
Alden , of Ra n dolph .
29

Fr om t h e h is t or y of t h e s ociet y, it a ppea r s t h a t 1139 Fellows , (in clu din g
94 h on or a r y member s ,) join ed t h e s ociet y pr ior t o 1840, exclu s ive of t h os e
belon gin g t o Ma in e befor e it s s epa r a t ion ; of wh om 664 wer e t h en livin g in
t h e St a t e, 65 h a d r es ign ed, 105 h a d r emoved, a n d 276 h a d died.
Sin ce 1840, a s fa r a s ca n be a s cer t a in ed fr om t h e r ecor ds , 439 Fellows h a ve
been a dmit t ed, of wh om 165 wer e in Su ffolk cou n t y. Abou t 65 h a ve r es ign ed or
r emoved, a n d 125 h a ve died, lea vin g s t ill con n ect ed wit h t h e s ociet y, 254;
wh ich , a dded t o t h os e belon gin g t o it in 1840, ma ke 918, a s t h e pr es en t
n u mber of Fellows . Ca pen 's St a t e Recor d gives 1216, wh ich pr oba bly in clu des
ph ys icia n s fr om ot her s t a t es , wh o a r e n ot con n ect ed wit h t h e s ociet y, a n d s ome
wh o a r e n ot con s ider ed "r egu la r " ph ys icia n s . Th e n u mber of r egu la r ph ys icia n s
in t h e St a t e es t ima t ed a t 1100, a n d t h e ot h er s a t 400; bes ides den t is t s , a n d
t h os e wh o devot e t h ems elves exclu s ively t o on e pa r t icu la r bra n ch , a n d pa id for
medicin e, in clu din g t h e pa t en t n os t r u ms ) is mu ch mor e. Two millions of
dollars , a t lea s t , a r e expen ded a n n u a lly t h e St a t e, for t h e cu r e of dis ea s e.
Th e Med ical School con n ect ed wit h Ha r va r d Un iver s it y wa s fou n ded in
1783, t h ou gh t h e fir s t degr ee wa s n ot con fer r ed u n t il 1788. Degr ees wer e
con fer r ed u pon 25 per s on s , pr ior t o a r e ca lled " doct or s ." Th e a ver a ge
a n n u a l ch a r ges of ph ys icia n s in t h e St a t e h a ve been es t ima t ed, by in t elligent
member s of t h e pr ofes s ion , a t $800 ea ch , a n d t h e a ct u a l r eceipt s a t $600
ea ch . If t h is es t ima t e be cor r ect , a bou t $900,000 is pa id for medica l a dvice.
Th e a mou n t 1800 ; u pon 124, fr om 1800 t o 1820 ; u pon 393, fr om 1820 t o
1840; a n d u pon 259, fr om 1840 t o 1850.
Th e Berk s hire Med ical School, a t Pit t s field, wa s in cor por a t ed in 1823, a n d
pr oba bly mor e t h a n 700 h a ve s in ce gr a du a t ed.


28
Th e followin g a re t he lega l requ iremen t s of t h e medica l profes s ion in ot her s t a tes " Ma in t . Formerly, n one bu t
regu la rly licen s ed ph ys icIa n s cou ld collect t heir du es ; s evera l yea rs s in ce, h owever, t h e la w wa s repea led, a n d t he field
is n ow open t o a ll. "New Ha mps h ire. The s t a te la ws of New Hamps h ire do not requ ire a n y licen s e. Th ere a re n o la ws on
t h e s u bject of medicine." Ver mon t . Th e s t a te la ws requ ire n o licen s e. A la w was pas s ed in 1821, requ irin g t h e M. D. or
A. B. degree. bu t it wa s repea led in 1838."Rh ode Is la nd. " Th e legis la t u re h as done n ot h in g for t h e s u ppres s ion of
qu ackery.' There a re n o la ws on t h e s u bject . Con nect icu t . Th e legis la t u re, s evera l yea r s in ce, repea led t h e la w
requ irin g" a licen s e for t he legal collect ion of fees ,-t h u s virt u a lly licens in g a ll pra ct it ionors . Th e St a te Medica l Societ y
a dmit s t o members h ip on ly s u ch a s h a ve t he diploma of M. D., or t h e lega l licen s e.
" New York. No restrictions since 1844, when the law was repealed. All persons now have the right 10 practice, and recover
compensation for services.'

29
For a more pa r t icu la r h is t ory of t h e s ociet y, a n d medicine gen er a lly, s ee America n Qna rt er ly Regis ter, Vol. XII, p.
358, a n d VoI.XII1, p. 75. Als o, Th a t ch er's His tory of Medicine, prefixed t o h is America n Medica l. Biograph y.
35

Cou n t i e s Fe llows of Th e Soci et y
Z. B.
Ada ms
Ph ys ic ia
n s i n
De a
d i n
Age s
k n own
Avg
Age

178
9
180
8
182
6
184
0 1847 1850
184
2
Ba r n s t a ble 1 1 2 16 31 34 5 4
78. 2
5
Ber ks h ir e 3 8 27 36 70 69 20 10 53. 6
Br is t ol 2 4 13 35 72 78 7 4
66. 2
5
Du kes 0 0 0 2 3 5 1 0
Es s ex 9 30 44 86 124 130 42 35
62. 0
3
Fr a n klin 1 4 10 19 54 48 9 4
60. 2
5
Hampden 3 4 19 17 58 54 13 9
60. 7
7
Ha mps h ir e 1 7 12 25 57 59 14 10
66. 5
0
Middles ex 7 15 60 127 184 183 43 30
57. 7
3
Na t u cket 0 1 1 3 11 3 1 1
68. 0
0
Nor folk 4 11 31 50 82 77 13 12
63. 9
2
Plymou t h 3 10 22 34 56 52 19 15
61. 6
6
Su ffolk 13 25 60 136 280 261 53 42
53. 5
9
Wor ces t er 5 23 55 78 155 163 36 18
61. 3
9
Tot a l 5 2 1 4 3 3 5 6 6 6 4 1 2 3 7 1 2 1 6 2 7 6 1 9 4
6 0 . 2
3



Th e Boyls t on Medica l Sch ool, in cor por a t ed in 1847, a n d t h e Tremont
Medical School, for med in 1838, a n d in cor por a t ed in 1850, a r e loca t ed in
Bos t on . Th es e s ch ools a r e en t ir ely in depen den t of t h a t con n ect ed wit h
Ha r va r d Un iver s it y, a n d t h ey r eceive s t u den t s a t a n y t ime.
It is s a id, by t h os e wh o a r e fa milia r wit h t h e medica l s ch ools in Eu r ope
a n d t h is cou n t r y, t h a t few pla ces ca n be fou n d wh er e gr ea t er fa cilit ies exis t
for obt a in in g a t h or ou gh edu ca t ion t h a n in Bos t on ; wh et h er we con s ider t h e
h igh ch a r a ct er of t h e s cien t ific in s t ru ct ion given , t h e oppor t u n it ies of
wit n es s in g t h e pr a ct ica l a pplica t ion of t h os e pr in ciples , t h e ea s e wit h wh ich
s u bject s a r e obt a in ed, or t h e expen s es in cu r r ed.
Sch ools for in s t r u ct ion in ot h er modes of pr a ct ice h a ve a ls o been
for med in t h e St a t e.
Va r iou s medica l a s s ocia t ion s for impr ovemen t in medica l s cien ce a n d
medica l pr a ct ice ; a n d pu blic h os pit a ls , a n d ot h er pu blic in s t it u t ion s for t h e
cu r e of dis ea s e, a r e t o be fou n d in t h e St a t e, in a s good con dit ion a s in a n y
ot h er pa r t of t h e wor ld.
Th e Med ical Literature of t h e St a t e h a s h a d con s ider a ble in flu en ce u pon
t h e h ea lt h of t h e in h a bit a n t s . It wa s s t a t ed in 1810, a s a r ema r ka ble fa ct ,
36
t h a t " twenty -s even for eign medica l books h a d been r epu blis h ed in
Ma s s a ch u s et t s !"
30


Th e Med ical Repos itory , t h e fir s t per iodica l wor k devot ed t o medicin e in
t h e Un it ed St a t es , wa s commen ced in New Yor k in 1797. Th e New England
Journal of Medicine and Surgery wa s commen ced in Bos t on , in 1812, a n d
con t in u ed u n t il 1827. Th e Bos ton Med ical Intelligencer, edit ed by Dr . J . V. C.
Smit h , wa s commen ced in 1822, a n d wa s pu blis h ed weekly u n t il 1828. Th e
t wo la t t er wor ks wer e u n it ed; a n d, on t h e 19
t h
of Febr u a r y, 1828, t h e fir s t
n u mber of t h e Bos t on Medica l a n d Su r gica l J ou r n a l wa s is s u ed in t h eir
s t ea d, wh ich h a s s in ce been con t in u ed, u n der t h e edit or ia l ch a r ge of Dr .
Smit h . Th e Bos ton Med ical Magaz ine, commen ced in 1831, a n d t h e New
En gla n d Qu a r t er ly J ou r n a l of Medicin e a n d Su r ger y, commen ced in 1842,
wer e ea ch dis con t in u ed a ft er t h e fir s t volu me wa s pu blis h ed.
Th es e per iodica l pu blica t ion s , a n d s ever a l s epa r a t e wor ks a n d es s a ys ,
con t a in s ome fa ct s con cer n in g t h e pr eva len ce of epidemic a n d ot h er dis ea s es
in Ma s s a ch u s et t s , t h ou gh t h ey a r e ver y imper fect a n d dis con n ect ed.. Th ey,
h owever , s h ow t h e gr ea t va lu e of mor e complet e a n d t h or ou gh in ves t iga t ion
a n d kn owledge. Th e s a n it a r y h is t or y a n d con dit ion of t h e St a t e s h ou ld be
kn own ; for t h is kn owledge migh t s u gges t t h e r emedia l mea s u r es pr oper t o
be a dopt ed ; a n d we deem it pr oper , in t h is con n ect ion , t o r efer br iefly t o
s ome of t h e fa ct s wh ich we h a ve glea n ed on t h e s u bject .
In 1618, t wo yea r s befor e ou r for efa t h er s a r r ived a t Plymou t h , t h er e
a ppea r ed, a mon g t he In dia n s of t h e cou n t r y, on e of t h e mos t r ema r ka ble
epidemics of wh ich we h a ve a n a ccou n t . So wa s t h e pes t ilen ce, t h a t t h e
wa r r ior s "wer e r edu ced fr om n in e t h ou s a n d t o a few h u n dr eds ." Th e
Ma s s a ch u s et t s t r ibe s u ppos ed t o h a ve los t 2, 700 ou t of 3,000 per s on s . In
1621, ma n y pla ces wh ich h a d been popu lou s In dia n villa ges " a ll des er t ed--
a ll dea d." Th e bon es of t h os e wh o per is h ed wer e lyin g u n bu r ied. Hu t ch in s on
s a ys s ome h a ve s u ppos ed t h e dis ea s e t o h a ve been t h e s ma ll-pox ; bu t fr om
t h e we migh t in fer ot h er wis e. Gookin s a ys , "Wh a t t h e dis ea s e wa s wh ich s o
gen er a lly a n d mor t a lly s wept t h em a wa y, I ca n n ot lea r n . I h a ve dis cou r s ed
wit h s ome old In dia n s t h en you t h s , wh o s a y t h a t t h e bodies a llover wer e
yellow, ( des cr ibin g it by a yellow ga r men t t h ey s h owed me,) bot h befor e t h ey
died, a n d a ft er wa r ds ." It h a s in fer r ed fr om t h is t h a t it wa s t h e yellow fever ;
bu t wh et h er cor r ect ly or n ot s eems u n det er min ed.
31

1621. At t h e commen cemen t of t h e s et t lemen t of Plymou t h , ou r
ven er a ble a n ces t or s s u ffer ed s ever ely fr om s ickn es s . At t h e en d of t h r ee
mon t h s a ft er t h eir a r r iva l, fift y-five on ly s u r vived of t h e on e h u n dr ed a n d on e
wh o ca me in t h e Ma yflower . " Th e s ick wer e des t it u t e of a lmos t a ll t h e
comfor t s wh ich t h eir mis er a ble con dit ion r en der ed in dis pen s a ble. Th eir
s u ffer in gs wer e in cr ea s ed by t h e wa n t of well per s on s t o per for m t h e du t ies
a mon g t h e s ick; t h er e bein g, a t on e t ime, n ot mor e t h a n s ix or s even per s on s
in t oler a ble h ea lt h ."
32


1631. Th e s ma ll-pox, fir s t br ea kin g ou t a t Sa u gu s , s pr ea d fr om
Na r r a ga n s et t o Pis ca t a qu a , a n d wes t war d t o Con n ect icu t River , a n d s wept
off en t ir e villa ges of t h e In dia n s . Wh en In cr ea s e Ma t h er wr ot e, t h er e wer e

30
Communications , Mas s achus etts Medical Society , Vol. If , p. 265. See New York Journal of Medicine, f or March, 1850.
31
Mas s . His torical Collection, Vol. I, p.l43 ; Hutchins on's His t. Mas s ., Vol. I, p. 34
32
Thalcher's His t. Ply mouth, p. 32.
37
livin g s ome old r es iden t s , wh o on t h a t occa s ion h elped t o bu r y wh ole fa milies
of t h e n a t ives a t t h e s a me t ime.
1633. At t h e clos e of t h is yea r t h e s ma ll-pox a ga in br oke ou t , a n d ma de
gr ea t deva s t a t ion s a mon g t h e u n for t u n a t e n a t ive r a ces of Ma s s a ch u s et t s .
Ch icka t a bu t , t h e gr ea t s a ch em of t h e t r ibe, wa s a mon g t h e vict ims .
1634. Plymou t h wa s a ga in vis it ed wit h a mor t a l s ickn es s , of wh ich
t wen t y men , women a n d ch ildr en died; amon g wh om wa s t h at mos t excellen t
a n d piou s ma n , Dr . Sa mu el Fu ller , t h e fir s t ph ys icia n of New En gla n d. " It
mu s t h a ve been occa s ion ed by a fever of domes t ic or igin , a s t h e colon y h a d
a t t h a t t ime h o in t er cou r s e wit h for eign cou n t r ies , except En gla n d."
1639 wa s s ickly in t h e colon ies , a n d a gen er a l fa s t wa s obs er ved on
a ccou n t of t h e s ma ll-pox a n d fever s .
33

1645. Gr ea t s ickn es s pr eva iled a mon g t h e In dia n s a t Ma r t h a 's
Vin eya r d. Few es ca ped.
1647. A ma lign a n t fever pr eva iled, " occa s ion ed by t h e exces s ive h ea t of
s u mmer ;" a n d a n epidemic in flu en za pa s s ed t h r ou gh t h e wh ole cou n t r y, a n
u n iver s a lly a ffect ed t h e colon is t s a n d n a t ives ; bu t it wa s n ot ver y mor t a l: "
wh er e in a s pecia l pr oviden ce of God a ppea r ed, for n ot a fa mily n or bu t a few
per s on s es ca pin g it ; ou r h a y a n d cor n h a d t o be los t for wa n t of h elp; bu t
s u ch wa s t h e mer cy of God t o h is people, a s few died-n ot a bove for t y or fift y
in t h e Ma s s a ch u s et t s , a n d n ea r a s ma n y a t Con n ect icu t ."
34

1654. A gen er a l fa s t wa s a ppoin t ed, on a ccou n t of " t h e mor t a lit y wh ich
h a d been a mon g t h e people of Ma s s a ch u s et t s : Wh a t t h e dis ea s e wa s does
n ot a ppea r .
1655: An ot h er epidemic dis t emper , s imila r t o t h a t of' 1647, pa s s ed
t h r ou gh New En gla n d. It bega n in J u n e, a n d few per s on s es ca ped. Amon g
t h os e wh o died wa s Rev. Na t h a n iel Roger s , of Ips wich .
1658: Sickn es s a n d mor t a lit y t h r ou gh ou t New En gla n d.
1659: Cr ou p is firs t men t ion ed in t h e a n n a ls of t h e cou n t r y. Ot h er
ma lign a n t dis ea s es a ls o pr eva iled a bou t t h is t ime. Th ir t y ch ildr en died in
Rowley. A da y of t h a n ks givin g wa s a ppoin t ed in Con n ect icu t , for t h e "
a ba t emen t of t h e s ickn es s in t h e cou n t r y, a n d a s u pply of r a in in t ime of
dr ou gh t ."
1668: wa s a yea r of gr ea t s ickn es s , t h ou gh few fa ct s a r e pr es er ved
con cer n in g it s ext en t . In New Yor k a pu blic fa s t wa s h eld on a ccou n t of it .
1677: Sma ll-pox wa s ver y fa t a l in Ch a r les t own . Th e r ecor ds s t a t e t h a t
t h ir t y-on e died of t h e dis ea s e, on e of wh om wa s t h e Rev. Th oma s Sh epa r d.
1678: Sma ll-pox in Bos t on ; bu t we h a ve s een n o a ccou n t of it s
vict ims .
35
Seven or eigh t h u n dr ed a r e s a id t o h a ve died of it in t h e St a t e.
Abou t t h is t ime " t h e s ea s on s wer e u n fa vor a ble, a n d t h e fr u it s bla s t ed, wh ile
ma lign a n t dis ea s es pr eva iled a mon g t h e people. Th e s ickn es s a n d ba d
s ea s on s wer e a t t r ibu t ed by ou r piou s a n ces t or s t o t h e ir r eligion of t h e t imes ,
a n d t o t h eir dis u s e of fa s t in g; a n d a meet in g wa s h eld t o in ves t iga t e t h e
ca u s es of God's ju dgmen t s , a n d t o pr opos e a pla n of r efor ma t ion ."
36

1697-98: Th e in flu en za bega n in November , a n d pr eva iled u n t il
Febr u a r y, in Ma s s a ch u s et t s . Wh ole fa milies a n d wh ole t own s wer e s eized

33
Webs ter, Vol. l, p.l87.
34
Win t h r op s J ou rn a l, II, p. 310.
35
Felt : An n a ls of Sa lem, Vol. II, p.413.
36
Webs ter, Vol. I, p. 203.

38
n ea r ly a t t h e s a me t ime. In t h e s a me yea r , a " mor t a l dis ea s e pr eva iled s o
mu ch , in Fa ir field, Con n ect icu t , t h a t well per s on s wer e n ot fou n d t o t a ke
ca r e of t h e s ick a n d bu r y t h e dea d. Seven t y died in t h r ee mon t h s , ou t of a
popu la t ion of les s t h a n on e t h ou s a n d. At t h e s a me t ime, a dr ea dfu l mor t a lit y
occu r r ed in Dover , New Ha mps h ir e. Rev. Dr . Ma t h er s a id, in a s er mon
pr ea ch ed in Bos t on , in 1698 : " Th e s ma llpox h a s fou r t imes been a gr eat
pla gu e a mon g u s . Oft en h a d on e h u n dr ed bills , des ir in g pr a yer s for t h e s ick,
been r ea d in on e da y, in on e of ou r a s s emblies . In on e t welve mon t h a bou t
on e t h ou s a n d of ou r n eigh bor s h a ve been ca r r ied t o t h eir lon g h ome."
1702: Sma llpox in Bos t on : t wo h u n dr ed a n d t h ir t een , exclu s ive of
bla cks , died; a bou t . 4.4 per cen t . of t h e in h a bit a n t s . It bega n in J u n e, 1702,
bu t t h e fir s t dea t h wa s in Au gu s t of t h a t yea r . In Sept ember , it beca me very
mor t a l, a n d wa s a t t en ded wit h a fever r es emblin g t h e s ca r let fever . In
Oct ober ma n y died. Th e Gen er a l. Cou r t s a t a t Ca mbr idge, a n d t h ey pa s s ed
t h e fir s t la w for pr ot ect ion a ga in s t t h e s ma ll-pox a lr ea dy n ot iced. It bega n t o
s u bs ide in Febr u a r y, 1703.
37

1715: Plymou t h los t for t y of it s in h a bit an t s by a ma lign a n t dis ea s e, bu t
n o pa r t icu la r s a r e kn own .
38

1717-1718. Fr om November t o Febr u a r y, "a ver y ma lign a n t a n d mor t a l
dis t emper " pr eva iled in Con cor d. Twen t y s even per s on s , ch iefly h ea ds of
fa milies , died; ma n y ver y s u dden ly. Th e dis ea s e is n ot n a med in t h e r ecor d.
39

A fa s t wa s h eld in Da n ver s , Febr u a r y 13, on a ccou n t of a fa t a l dis ea s e t h a t
pr eva iled a t t h e villa ge, wh ich t h r ea t en ed a t on e t ime t o s weep a wa y t h e
en t ir e popu la t ion .
40

1721: Th e s ma ll-pox a ga in ma de it s a ppea r a n ce in Bos t on , wit h mor e
t h a n it s u s u a l r a va ges a n d h or r or s , a n d wa s t h e occa s ion of on e of t h e mos t
r ema r ka ble a n d impor t a n t even t s in t h e s a n it a r y h is t or y of t h e St a t e.
In ocu la t ion wit h t h e vir u s of s ma ll-pox, a s a s u bs t it u t e for t h e dis ea s e t a ken
in wa y ,-t o dis a r m it of it s ma lign it y, a n d t o r edu ce it t o compa r a t ive
mildn es s a n d s a fet y ,-wa s fir s t in t r odu ced t h is yea r . Rev. Dr . Cot t on Ma t h er ,
h a vin g r ea d, in t h e Tr a n s a ct ion s of t h e Roya l Societ y of Lon don , fa vor a ble
a ccou n t s of t h e oper a t ion , r ecommen ded a t r ia l of it t o t h e ph ys icia n s of
Bos t on ; bu t a ll of t h em u n a n imou s ly a n d decidedly oppos ed it , except in g
Dr . Za bdiel Boyls t on . Th a t en ligh t en ed a n d u pr igh t ma n beca me for cibly
impr es s ed wit h t h e impor t a n ce of t h e dis cover y ; a n d, t o s h ow h is con fiden ce
in it , ma de t h e fir s t exper imen t on h is own s on , t h ir t een yea r s of a ge, a n d
per s on s in h is fa mily, on e t wo, a n d t h e ot h er t h ir t y-s ix old; a n d a ll wit h
complet e s u cces s . Su bs equ en t ly, ot h er s wer e in ocu la t ed.
Th e con t r over s ies wh ich a ccompa n ied t h e in t r odu ct ion of t h is u s efu l
mea s u r e, wer e mos t dis r epu t a ble. Ma n y per s on s wer e s t r u ck wit h h or r or ;
s ome t h ou gh t it wa s s in n in g a ga in s t God, t h u s t o in t er fer e wit h t h e dis ea s e;
a n d ot h er s t h a t , if an y pa t ien t s died, Dr. Boyls t on ou gh t t o be t r ea t ed a s a
mu r der er . Pa mph let s a n d n ews pa per a r t icles fr equ en t ly a ppea r ed; a n d t h e
popu la ce, ch iefly led on by t h e in fla mma t or y con du ct of t h e ph ys icia n s , a t
t h e h ea d of wh om wa s Dr . Dou gla s s , beca me s o exceedin gly en r a ged, t h a t
Dr . Boyls t on wa s fr equ en t ly in s u lt ed in t h e s t r eet s , a n d for ced t o s ecr et e

37
Webs ter, I,p. 216.
38
Ibid, I, p. 224
39
Shattuck 's His tory of Concord, p. 223.
40
His tory of Danvers , p. 42.
39
h ims elf for mor e t h a n fou r - t een da ys , a n d a ft er wa r ds t o vis it h is pa t ien t s
on ly a t midn igh t . His fa mily wer e h a r dly s a fe in h is own h ou s e. Pa s s ion a n d
pr eju dice on t h e on e s ide, h owever , wer e met wit h decis ion a n d on t h e ot h er ;
a n d in ocu la t ion s oon t r iu mph ed over oppos it ion , a n d beca me gen er a l.
41


Du r in g t h is epidemic, 5,759 per s on s ,-mor e t h a n h a lf t h e in h a bit a n t s ,-
h a d t h e dis ea s e in t h e n a t u r a l wa y, of wh om 844 died Two h u n dr ed a n d
for t y-s even wer e in ocu la t ed by Dr .Boyls t on a n d t h ir t y-n in e by ot h er
ph ys icia n s , of wh om s ix on ly died. Th is wa s on e dea t h in s even of t h os e n ot
in ocu la t ed a n d on e in for t y-s even of t h os e in ocu la t ed, s h owin g decidedly t h e
a dva n t a ges of in ocu la t ion .
1735. On t h e 20t h of Ma y, in t h is yea r , s ca r la t in a , or pu t r id a ppea r ed
in Kin gs t on , New Ha mps h ir e, a n d beca me of t h e mos t dr ea dfu l epidemics
wh ich h a ve ever des ola t ed New En gla n d. Th e fir s t per s on s eized wa s a ch ild,
wh ich died in t h r ee da ys . In a week, t h r ee ot h er ch ildr en , in a fa mily fou r
miles dis t a n t , wer e t a ken , a n d died on t h e t h ir d da y a ft er war ds . Of t h e fir s t
for t y, n on e r ecover ed. In Au gu s t , it a ppea r ed in Exet er , a n d s oon a ft er
s pr ea d in t o ot h er pla ces . In fou r t een t own s in New Ha mps h ir e, 984,- ch iefly
per s on s u n der t wen t y yea r s of a ge,-died, bet ween J u n e, 1735, a n d J u ly,
1736. Of t h os e t a ken s ick, in s ome pla ces on e in t h r ee, in ot h er s on e in fou r ,
a n d in s ca r cely a n y les s t h a n on e in s ix, died.
In Bos t on , t h e fir s t ca s e occu r r ed on t h e 20t h of Au gu s t . Su bs equ en t ly
t h e dis ea s e s pr ea d t h r ou gh t h e t own . Dr . Dou gla s s s a ys , in t h e eigh t
pr eviou s yea r s of mediu m h ea lt h , a bou t 263 per s on s in Bos t on , on t h e
a ver a ge, died in s even a n d a h a lf mon t h s ,-Oct ober t o Ma y 18; bu t in t h is
yea r , 382, or 114 a bove t h e u s u a l n u mber , died. Abou t 4,000, or on e-qu a r t er
of t h e in h a bit a n t s , h a d t h e dis ea s e, of wh om on e in t h ir t y-five died.
In Newbu r y, it bega n in Sept ember , a n d, befor e Febr u a r y, 81 per s on s
died. Th oma s Smit h los t t wo ch ildr en ; J oh n Boyn t on fou r , -a ll bu r ied in on e
gr a ve,-t wo on Sa t u r da y, a n d t wo on Su n da y. Ben ja min Kn igh t h a d t h r ee
bu r ied in on e gr a ve. In Byfield, bet ween Oct ober , 1735, a n d Oct ober , 1736,
104 died i s u ppos ed t o h a ve been a bou t on e-s even t h of t h e popu la t ion .
Th ir t een fa milies bu r ied a ll t h eir ch ildr en . In on e fa mily eigh t died ; fou r of
t h em wer e bu r ied a t on e t ime, in t h e s a me gr a ve. In Rowley, 190 died; "
pr oba bly a bou t on e-eigh t h of t h e wh ole t own ." In 1736, in An dover , 35 died;
31 in 1737, a n d 123 in 1738; mos t ly ch ildr en a n d you n g people. " Ca pt .
J a mes St even a , h is wife, a n d t h r ee ch ildr en , died wit h in a mon t h . Nin e
fa milies los t t h r ee ch ildr en fr om ea ch in a few da ys . Fou r fa milies los t fou r
ch ildr en fr om ea ch in les s t h a n fou r t een da ys . J oh n Wils on los t eigh t

41
Th os e wh o ma y wis h t o in ves t iga t e t h is cu riou s s u bject a re referred t o a volu me of t h es e pamph let s , pres erved in t h e
libr a r y of t h e Ma s s a chu s et t s His t orica l Societ y; a n d t o Th a t cher's America n Medica l Biogr a ph y, Vol.I, pp.20, 185, 255,
wh ere will be fou nd n ot ices of Drs . Boyls t on a nd Dou gla s s .
Dou glas s h ad h is preju dices an d eccen t ricit ies . In h is "Su mma ry", Pu blis h in 1753. (II, p.351,) he wrote a s follows , of
t h e medica l profes s ion :-"In genera l, t h e ph ys ica l pra ct ice in ou r colon ies is s o pern iciou s ly ba d, t h a t except in g in
s u r gery, a n d s ome ver y acu te ca s es , it is bet ter t o let n a t u re, u n der a proper r egimen , t a ke her cou rs e, t h a n t o t r u s t t o
t h e h ones t y a n d s a ga cit y of t he pra ct it ioner: ou r America n pract it ioners a re s o ra s h a nd officiou s , t h e s a yin g in t he
Apocryph a (38 a nd 15) ma y wit h mu ch propriet y be a pplied t o t h em-'He t h a t s in net h before h is Maker, let h im fa ll in t o
t h e h a nds of t he ph ys icia n !" Frequ en t ly, t h ere is mre da n ger from t h e ph ys icia n s t h a n from t h e dis temper. ou r
pra ct it ioner dea l mu ch in qu a ckery a n d qu ackis h medicines , a s requ irin g n o labor of t h ou ght or compos it ion , a n d
h igh ly recommen ded in London qu a ck bills , (in wh ich a ll t h e readin g of ma n y of ou r pra t it ion ers con s is t s ,) in
a dver ten t ly en cou ra ged by pa ten t s for t h e benefit of cer t a in fees t o s ome offices , bu t t o t h e very gr ea t dama ge of t h e
s u bject ." "In mos t t r iflin g ca s es t h ey u s e a r ou t ine pra ct ice. Wh en I fir s t a r r ived in New En gla n d, I a s ked a mos t n oted
fa cet iou s pract t ioner wh a t wa s t h eir gener a l met hod of pra t ice; h e t old me t heir pract ice wa s ver y u n iform: bleedin g,
vomit in g, blis terin g, pu rgin g, a n odynes &c.; if t h e illn es s con tin u ed, t h ere wa s repetendi, a n d fin a lly mu dera ndi;
n a t u re wa s never t o be con s u lt ed, or a llowed t o h ave a n y con cern in t h e a ffa ir. wh a t s yden h am well obs er ves is t h e
ca s e wit h ou r pra ct it ioners : Eger n imia mecici diligen t ia ad plu res migra t ."
40
ch ildr en in s even da ys . In 1139, fou r t een ch ildr en died in fou r fa milies in a
few da ys . Eben ezer Lovejoy los t t h r ee ch ildr en in on e da y, a n d a n ot h er in five
da ys a ft er . J os h u a St even s los t t h r ee ch ildr en in fou r da ys . Th e dis ea s e
r a ged mos t fr om Au gu s t t o December ." In Ha ver h ill, 199 died, fr om
November , 1735, t o Oct ober , 1737. Wh a t is h er e exh ibit ed wa s t o be s een in
ver y ma n y ot h er t own s in t h e St a t e. It wa s in deed t h e " pla gu e a mon g
ch ildr en ."
42

1740-1744 wa s a s ickly per iod. Sca r la t in a pr eva iled in Ma s s a ch u s et t s .
In 1742 a des t r u ct ive fever pr eva iled in Hollis t on . Rev. Mr . St on e, t h e
min is t er , a n d fou r t een of h is con gr ega t ion , died. In 1753, fou r t een per is h ed
a ls o, by a fever , in t h a t t own .
Fr om 1745 t o 1749, s ever a l s ickly s ea s on s occu r r ed; bu t we h a ve s een
n o defin it e a ccou n t of t h em, wh ich wou ld exh ibit t h eir ext en t .
1752. Sma llpox ill Bos t on : 7,669 ca s es occu r r ed,-5,545 in t h e n a t u r a l
wa y, a n d 2, 124 by in ocu la t ion ,-in a popu la t ion of 15,684, of wh om 569
died.
1755. An a la r min g fever . a ppea r ed in Pepper ell, a n d s pr ea d t o s ome of
t h e n eigh bor in g t own s , du r in g t h is a n d t h e t h r ee s u bs equ en t yea r s . Fr om it s
or igin a n d gr ea t mor t a lit y, it a cqu ir ed t h e popu la r n a me of t h e Pepper ell
Fever . Ph ys icia n s ca lled it a " pu t r id ma lign a n t n er vou s fever ;" pr oba bly t h e
s a me a s a s ever e form of t h e t yph u s . On e h u n dr ed a n d eigh t y per s on s were
s ick, fr om Au gu s t 5 t o t h e la s t of Oct ober , 1756, of wh om eigh t een died.
Sept ember 16 wa s kept a s a da y of fa s t in g a n d pr a yer ; a n d December 13 a s
a da y of t h a n ks givin g, wh en t h e s ickn es s s eemed en t ir ely r emoved. Two
h u n dr ed a n d n in et een per s on s wer e s ick, fr om J u ly 1 t o Oct ober 15, 1757,
of wh om t wen t y-five died,-s even t een h ea ds of fa milies . Nin et y-s ix per s on s
wer e s ick, fr om Au gu s t 1 t o Oct ober 15, 1758, of wh om eleven died,-of wh ich
n u mber s even wer e of fa milies . Th e popu la t ion of t h e t own wa s t h en a bou t
s even h u n dr ed. J a n u a r y 3, 1760, wa s s et a pa r t , by Rev. Mr .Emer s on a n d
h is . people, a s a da y of t h a n ks givin g, " t o commemor a t e t h e goodn es s of God
t o t h em t h e pa s t yea r , es pecia lly in t h e r emova l of s ickn es s , a n d t h e r et u r n
of "s o ma n y s oldier s t h e a r my." Th e s er mon pr ea ch ed on t h e occa s ion wa s "
In t h e fou r yea r s ," s a ys Mr . Emer s on , " t h er e wer e 540 per s on s s ick; 103
died, of wh om 16 wer e s oldier s fr om h ome, or ju s t a ft er t h eir r et u r n ; n o les s
t h a n 48 h ea ds of fa milies ; 64 gr own per s on s . How gr ea t wa s ou r dis t r es s for
t wo yea r s , es pecia lly in t h e h eigh t of t h e s ickn es s , a n d we, n ot wit h s t a n din g,
obliged t o fin d ou r qu ot a for t h e wa r ! I kn ow n ot t h a t we wer e ea s ed mor e
t h a n a s in gle ma n , except in g t h e t ime of t h e gen er a l a la r m, wh en For t
Willia m Hen r y wa s bes ieged, in 1751, wh en ou r pr opor t ion wa s a bove t wen t y
men , a t wh ich t ime t h er e wer e n ot s o ma n y a ble t o bea r a r ms in t h e pla ce,
bes ides t h os e wh o wer e n eces s a r ily t a ken u p in a t t en din g on t h e s ick in t h eir
own fa milies , t h e field officer s wer e s o good a s n ot t o ca ll for a n y. On e of t h e
yea r s , t h er e wer e n ea r t wo h u n dr ed con fin ed a t t h e s a me t ime. You r pa s t or
a t t h e poin t of dea t h , a n d t h en con fin ed fr om t h e h ou s e of God for fou r
mon t h s . An d of t h is la r ge n u mber wh o h a ve been s ick, I kn ow n ot of t en
per s on s wh o h a ve been vis it ed by t h e s a me dis t emper t wice. Nor s h ou ld we

42
See Dou ga ls s His t ory of t he Epidemic. Th is t ra ct wa s repu blis hed in t he New En gla n d J ou rn a l of Medicine, Vol XIV,
for 1825, pp.1-13. s ee a ls o Coffin 's His tory of New bu ry, pp.204,205; Ga ge's His tory of Rowley, p. 432; Abbot 's His tory
of An dover, p.
182; New Ha mps h ire His t orica l Collect ion , Vol V,p.20; Webs ter's His t ory of Epidemics , Vol. I, p.233; Rev. Mes s rs . Fit ch
a n d Brown 's accou n t
41
for get t h e bou n t y we r eceived by or der of a u t h or it y, n a mely, fift y pou n ds , t o
be dis t r ibu t ed a mongs t t h e gr ea t es t s u ffer er s ." Th e ca u s e of t h is Pepper ell
fever wa s t h ou gh t t o be t h e mia s ma a r is in g fr om deca yed veget a ble ma t t er .
Th e s wa mp or mea dow of J oh n Sh a t t u ck, n ea r Hen r y J ewet t 's , h a d been
over gr own wit h bu s h es a n d va r iou s veget a bles ; a n d, in or der t o kill t h em;
a n d br in g t h e la u d in t o a s t a t e of cu lt iva t ion , a da m was bu ilt , a n d t he
s wa mp over flowed wit h wa t er . Wh en t h e wa t er h a d been dr a wn off, a n d t h e
veget a ble ma t t er expos ed t o a s u mmer 's s u n , t h e s t en ch wa s ver y offen s ive,
a n d ext en ded per cept ibly for s ever a l miles a r ou n d."
43

1763. " In Au gu s t , t h e In dia n s on Na n t u cket wer e a t t a cked by a biliou s
pla gu e; a n d, bet ween t h a t t ime a n d t h e Febr u a r y followin g, t h eir n u mber
wa s r edu ced fr om 358 t o 136. Of 258 wh o wer e a ffect ed, 36 on ly r ecover ed."
Th e In dia n s on Ma r t h a 's Vin eya r d s u ffer ed fr om t h e s a me fever . Not a fa mily
es ca ped. Of 52 a t t a cked, 39 died. It wa s con fin ed in bot h pla ces t o t h e
In dia n s , a n d n on e bu t t h os e of fu ll-blood died!
44

1764 t o 1780. Du r in g t h is per iod t h er e wer e ma n y yea r s of s ickn es s ,
bu t we h a ve few fa ct s pr es er ved t o s h ow it s ext en t . Th r oa t dis t emper a n d
s ma ll-pox pr eva iled in 1764. In Sa lem, 44 died of t h e dys en t er y, in 1769; 56
of fever , in 1771; 51 of dys en t er y, 29 of fever , a n d 17 of s ma ll-pox, in 1773.
Dys en t er y wa s ver y pr eva len t in 1775, in va r iou s pla ces . In Con cor d a bou t
for t y died. In t h e An dover Sou t h Pa r is h a bou t 200 wer e s ick, a n d 56 died.
Sma ll-pox occu r r ed in 1777 -8, in Bos t on , a n d ma n y of t h e cou n t r y t own s .
Rowley " es t a blis h ed a s moke h ou s e, in wh ich t h ey r equ ir ed a ll per s on s a n d
ba gga ge fr om Bos t on t o t a ke a s mokin g."
In 1780 a ma lign a n t t yph u s a ppea r ed in Bos t on , h a vin g been
In t r odu ced by t h e Allia n ce fr iga t e. Ma n y wer e s ick, a n d s ever a l died.
1792. Th is wa s t h e memor a ble s ma ll-pox yea r in Ma s s a ch u s et t s . On it s
a ppea r a n ce in Bos t on , t h e in h a bit a n t s wer e gr ea t ly a la r med." Th e wh ole
t own wa s in ocu la t ed in t h e cou r s e of t h r ee da ys , owin g t o t h e in fa t u a t ion of
t h e in h a bit a n t s wit h r es pect t o t h e da n ger of in fect ion , fou n ded on a
pr epos t er ou s n ot ion t h a t s o s oon a s a n y per s on h a d been in ocu la t ed t h e
wh ole n eigh bor h ood wa s en da n ger ed. Th os e wh os e cir cu ms t a n ces a dmit t ed
h a d gen er a lly s en t t h eir ch ildr en t o t h e n eigh bor in g h os pit a l for in ocu la t ion .
Th os e wh ich r ema in ed wer e, t h er efor e, gen er a lly in low cir cu ms t a n ces .
Wh ole fa milies wer e oft en cr owded t oget h er in s in gle r ooms , wh er e fir es wer e
con s t a n t ly kept u p for t h e pu r pos es of cookin g, a n d t h e pa t ien t s wer e
des t it u t e of mos t of t h e comfor t s of life, wit h ver y lit t le per s on a l a t t en da n ce,
fr om t h e dis pr opor t ion of n u r s es t o t h e n u mber s of t h e s ick.
" Th e con s equ en ces wh ich en s u ed con s t it u t ed a s cen e of con fu s ion a n d
wr et ch edn es s wh ich n o on e, wh o wa s a wit n es s of it , cou ld h a ve viewed wit h
ou t h or r or a n d commis er a t ion . It is t o be h oped, for t h e ca u s e of h u ma n it y,
t h a t t h e in h a bit a n t s of Bos t on will n ever a ga in exper ien ce t h is ca la mit y; a s
t h ey h a ve it n ow in t h eir power , by embr a cin g t h e mea n s wh ich h ea ven h a s
pu t in t o t h eir h a n ds in t h e va ccin e in ocu la t ion , t o s ecu r e t h ems elves for ever
fr om it s des ola t in g r a va ges ."
45

Two h u n dr ed a n d t h ir t y-t wo t ook t h e dis ea s e in t h e n a t u r a l wa y, of
wh om 33 died; a n d 8,114 by in ocu la t ion , of wh om 165 died. Th e popu la t ion

43
Butler's His tory of Groton, p. 350. See als o Holmes 's Priz e Dis s ertation, p. 113.
44
Webs ter, Vol. I, p. 252.
45
Communications , Mas s achus etts Medical Society , Vol. II, p; 482.
42
of t h e t own wa s t hen 19,484. Of t h es e, 10,655 h a d pr eviou s ly h a d t h e
dis ea s e, 262 r emoved ou t of t own , a n d 221 on ly, wh o r ema in ed, lia ble t o t h e
dis ea s e, es ca ped. Th e followin g t a ble exh ibit s t h e ca s es by s ma llpox a t t h e
differ en t t imes of it s a ppea r a n ce in Bos t on :-



Ra t i o pe r 1 0 0
of t h e
Popu la t i on Na t u r a l In oc u la t e d
Yea
r
Cas e
s
Death
s Sick Died
Cas e
s Deaths
Ratio
% Cas es Deaths
Ratio
%
172
1 6006 850 54. 6 7. 7 5759 844 14. 8 247 6 2. 4
173
0 4000 500 26. 6 3. 3 3600 488 13. 5 400 12 3. 0
175
2 7669 569 48. 9 3. 6 5545 539 9. 7 2124 30 1. 7
176
4 5646 170 36. 4 1. 1 669 124 18. 5 4977 46 0. 9
177
6 5292 57 44. 1 1. 0 304 29 9. 5 4988 18 0. 5
177
8 2243 61 16. 6 0. 4 122 42 34. 4 2121 29 0. 9
179
2 8346 198 46. 0 1. 0 232 33 14. 2 8114 165 1. 8


In Ch a r les t own , in Sept ember a n d Oct ober , 1,352 wer e in ocu la t ed, of
wh om n in e died. Twelve t ook t h e dis ea s e t h e n a t u r a l wa y, of wh om t h r ee
died. Eigh t h u n dr ed a n d s even t y-n in e wer e in h a bit a n t s ; t h e ot h er s belon ged
t o t h e n eigh bor in g t own s , a n d ca me in t o be in ocu la t ed.
46


In Con cor d, a h os pit a l wa s fit t ed u p, wh er e 130 per s on s wer e
in ocu la t ed. Some t ook t h e dis ea s e in t h e n a t u r a l wa y. Ten died,-t wo h a d t h e
dis ea s e by in ocu la t ion , a n d eigh t by con t a gion ,-a n d t h ey wer e a ll bu r ied in a
s epa r a t e bu r ia l gr ou n d.
47

In Fr a min gh a m, it a ppea r ed in t h is a n d t h e n ext yea r . Ba r r y, in h is
va lu a ble h is t or y of t h a t t own , s a ys : In Sept ember , 1792, a ccor din g t o t h e
r ecor ds , 'it h a vin g been pr opos ed by t h e ph ys icia n s of t h e t own t o r eceive
per mis s ion to inoculate the s mall-pox,' t h e t own vot ed' n ot t o h a ve t h e s ma ll-
pox in t own , by in ocu la t ion , n or a n y ot h er wa y, if it ca n be pr even t ed.' Ma y,
1793: ' Vot ed, t h a t t h e s elect men be a t o pr os ecu t e a n y per s on t h a t s h a ll
s pr ea d t h e s ma ll-pox, by in ocu la t ion , or a n y ot h er wa y .' At t h e s a me t ime,
t h e t own gr a n t ed 30 t o a s s is t t h e s ick, a n d a ppoin t ed a commit t ee of
dis t r ibu t ion . A h os pit a l wa s pr ovided a t t h e h ou s e of Mr . Geor ge Pr a t t . Th e
dis ea s e wa s in t r odu ced in t o t h e t own by on e Da vid Bu t ler , wh o ca me t o
Fr a min gh a m fr om Pet er bor ou gh , a n d fa llin g s ick wit h t h e dis ea s e, h is
n u r s es , t o t h e n u mber of s even t een , t ook t h e in fect ion , a n d five per s on s
bes ides Bu t ler died."
In Scit u a t e, a s ma ll-pox h os pit a l wa s open ed, bu t it did n ot r es t r a in t h e
dis ea s e. Twelve died, in differ en t pa r t s of t h e t own . "An a ct ion wa s
commen ced a ga in s t t h e ph ys icia n s , for a br ea ch of bon d for fa it h fu l

46
Medical Repos itory , Vol.II, p.10.
47
Shattuck 's His tory of Concord, p. 224.
43
dis ch a r ge of du t y, &c. bu t a ft er t h e pa n ic wh ich h a d s eized t h e people wa s a
lit t le ca lmed, t h e a ct ion wa s wit h dr a wn ."
48

1796: Th is wa s a ver y s ickly yea r . In Bos t on , a ver y ma lign a n t t yph u s
a ppea r ed on t h e 25t h of Au gu s t ; a n d bet ween t h a t t ime a n d December ma n y
wer e s ick, a n d t h ir t y died. It cr ea t ed gr ea t a la r m i s ome wer e bu r ied in t h e
n igh t . Dr . J oh n Wa r r en , wh o wr ot e a n a ccou n t of it , s a ys t h a t t h e ph ys icia n s
wer e u n a n imou s in t h e opin ion t h a t it or igin a t ed fr om loca l Ca u s es .
49
" A
ver y gr ea t por t ion of t h os e t a ken s ick wer e s it u a t ed n ea r ext en s ive fla t s ,
pa r t icu la r ly a bou t t h e ea s t er ly, s ou t h ea s t er ly, a n d wes t er ly s kir t s of t h e
t own . Th e pla ce ca lled Oliver 's Dock, wh er e t h e dis ea s e wa s mos t pr eva len t ,
wa s expos ed t o exha la t ion fr om fou l s u bs t a n ces lodged a bou t t h e wh a r ves
a n d docks of t h a t qu a r t er , wit h bu ildin gs s o' con s t r u ct ed a s t o a dmit of bu t
ver y imper fect ven t ila t ion , a n d wit h la r ge n u mber s of in h a bit a n t s cr owded
t oget h er in a s ma ll s pa ce." Th e followin g pr oph et ic la n gu a ge pr oves t h a t t h e
wr it er t h en well u nder s t ood t h e ca u s es of dis ea s e, wh ich h a ve been , in
r ecen t yea r s , br ou gh t s o fu lly befor e t h e pu blic: " Th a t it or igin a t ed fr om
n oxiou s s u bs t a n ces , exh a led in t o t h e a t mos ph er e fr om pu t r ifyin g a n ima l or
veget a ble ma t t er , or bot h , is ext r emely pr oba ble, fr om t h e pla ces in wh ich it
wa s mos t pr eva len t ; a n d t h a t a con fin ed s it u a t ion s , or filt h y s t a t e of t he
s t r eet s , a lleys , a n d by-pla ces of t h e t own , will, a s it becomes mor e popu lou s ,
r en t s h igh er , a n d con s equ en t ly t h e poor mor e clos ely cr owded t oget h er ,
fu r t h er expos e u s t o t h e da n ger of s u ch dis ea s es , is a s er iou s t r u t h , wh ich
ma y, per h a ps , in s ome fu t u r e da y, be t oo fa t a lly evin ced."
50

In t h is yea r , a ls o, a ver y ma lign a n t dys en t er y a n d bilou s fever a ppea r ed
in Sh effield. It wa s con fir medpr in cipa lly t o a s ect ion of t h e t own n ot over
on e a n d a h a lf miles in dia met er , - in t h e vicin it y of a pon d kn own a s
Hu bba r ds Pon d, - con t a in in g a bou t 100 fa milies , or 600 in h a bit a n t s . Of
t h es e, over 300 wer e s ick, a n d 44 died; 12 a du lt s , a n d 32 ch ildr en . Amon g
150 wh o lived n ea r t h e pon d, on t h e s ou t h ea s t er ly s ide, les s t h a n 10
es ca ped. Of t h os e on t h e wes t er ly s ide, a bou t 50 wer e a ffect ed.
Th e ca u s e of t h is r ema r ka ble s ickn es s , a n d ot h er s of s imila r ch a r a ct er ,
wh ich t h a t t own s u ffer ed in ot h er yea r s , wa s a t t r ibu t ed t o t h is pon d. A da m
wa s bu ilt a t t h e ou t let , a n d a t t imes of h igh wa t er , a la r ge t r a ct of la n d wa s
over flowed. In dr y s ea s on s t h e wa t er wa s dr a wn off, a n d la r ge qu a n t it ies of
decompos in g veget a ble ma t t er wer e expos ed t o t h e a ct ion of t h e s u n , wh ich
pr odu ced a pois on ou s exh a la t ion , or ma la r ia , wh ich a ffect ed n ea r ly a ll wh o
in h a led it . Th e a ccompa n yin g cu t will s h ow t h e s it u a t ion of t h e pon d.
51

1798. Th e yellow fev er a ppea r ed in Bos t on , J u n e 17, in a family livin g
on St odda r ds wh a r f. Of eigh t per s on s in t h e fa mily, five h a d t h e dis ea s e, of
wh om t wo died. It s pr ea d t o Lon g Wh a r f, a n d in J u ly t o For t Hill. On t h e
s ou t h ea s t s ou t h s ide of t h e h ill, s ca r cely a fa mily wh o r es ided below t h e
s u mmit es ca ped; on e fa mily los t five ou t of s ix. An d pr oba bly t h e gr ea t es t
pa r t of t h e in h a bit a n t s in t h a t pa r t of t h e t own wou ld h a ve fa llen vict ims t o
t h e dis ea s e, if t h ey h a d n ot r emoved in t o t h e cou n t r y. In Au gu s t , Sept ember ,

48
Deane's His tory of Scituate, p. 113.
49
Communications , Mas s achus etts Medical Society , Vol II, p. 445.
50
New York Medical Repos itory , Vol. I, p.139, 140.
51
Dr. William Buel, of Litchf ield, Conn., communicated to the New York Medical Repos itory (Vol. I, p. 453) an account of
the s ick nes s in 1796; and to the Mas s achus etts Med ical Society , in 1835, a more general des cription of the s anitary
condition of the Hous atonic Valley . Large parts of thes e papers were publis hed by Dr. O. W. Holmes , pres ent Dean of the
Medical Faculty of Harvard Univers ity , in his valuable Priz e Dis s eration on Intermittent Fever, pp. 60-81. We are indebted
to this work f or s everal valuable f acts , and als o f or the above illus tration.
44
a n d Oct ober , it s pr ea d t o t h e n or t h er n a n d wes t er n pa r t s of t h e t own . Th e
n u mber s ick wa s n ot a s cer t a in ed. Dr . Ra n d, wh o wr ot e a pa r t icu la r a ccou n t
of t h e epidemic, s ays , of 103 pa t ien t s h e los t 11. Wh et h er t h e gen er a l
pr opor t ion wa s t h e s a me, does n ot a ppea r . He con ject u r ed t h a t 8,000
in h a bit a n t s r emoved in t o t h e cou n t r y. Th e n u mber wh o died, bet ween J u n e
23 a n d Oct ober 22, wa s s t a t ed by Dr . Ra n d a t 145; by Dr . Br own a t 250,
a n d h e s a id, " I believe t h a t 300 is n ot a bove t h e r ea l a mou n t ." Th e dis ea s e
wa s s u ppos ed t o h a ve been of domes t ic or igin a n d wa s dis t r ibu t ed t o t h e
filt h y con dit ion of t h e s t r eet s a n d docks , a n d t o deca yed a n ima l a n d
veget a ble ma t t er . Th e N.Y.Med. Repos it or y con t a in s s ever a l a r t icles on t h e
s u bject .
52

In Newbu r y por t , t h e yellow fever a ppea r ed in J u n e, a n d bet ween t h a t
t ime a n d t h e 16t h of Oct ober , a bou t for t y per s on s died, pr in cipa lly on t h e
fou r t h , fift h , s ixt h , or s even t h da y of t h e a t t a ck. It excit ed gr ea t a la r m.
53

1800 Th e qu es t ion wh et h er over flowin g la n ds for mill pon ds or ot h er
pu r pos es , gen er a t ed a ma la r ia wh ich wa s pu r pos es , gen er a t ed a ma la r ia
wh ich wa s u n fa vor a ble t o h ea lt h , wa s mu ch dis cu s s ed a bou t t h is t ime,
es pecia lly by t h e people in t h e wes t er ly pa r t of Ma s s a ch u s et t s , a n d in
Con n ect icu t . As it is a qu es t ion a t a ll t imes of gr ea t impor t a n ce, it h a s
s eemed pr oper t o ga t h er u p s ome of t h e fa ct s wh ich wer e elicit ed a t t h at
t ime.
54
We h a ve a lr ea dy des cr ibed it s effect in Sh effield.

52
See Vol. II, pp.212,333,390,466.

53
Medica l Repos it ory, Vol. I, p.504; Coffin 's His t ory of Newbu ry, p. 270.
54
We in s ert t h e followin g " Brief Accou n t a n t of a Tria l a t la w, in wh ich t h e in flu en ce of
Wa t er , r a is ed by a Mill-Da m, on t h e hea lt h of t h e in h abit a n t s in t h e neigh borh ood, wa s cons idered. By Hon . Da vid
Da gget t ":-
" Before t h e s u per ior Cou rt , h eld a t Lit ch field, on t h e fou rt h Tu ers da y of J a nu a ry, 1800,
wa s t ried a n a ct ion of t res pa s , in s t it u t ed by J os eph Ru ggles , of New Milford, a ga in s t Elija h Boa rdma n , a n d ot hers ,
in h a bit a n t s of New Milford. " Th e cla im on t he pa r t of t h e pla in t iff wa s , t h a t t h e defen da n t s , in J a n u a ry, 1799,
des t royed a pa rt of h is mill-dam, erected a cros s t he Hou s a t on ic River, a n d nea rly oppos ite th e mos t compa ct pa rt of
t h e t own . Th e defenda n t s a cknowledged t h a t t h ey h a d in ju red t h e dam in ma n ner a s a lleged , a n d ju s t ified on t h e
grou nd t h a t t h e dam wa s a pu blic n u is a n ce, in t h a t it wa s t h e ca u s e of a dis t res s in g s icknes s wh ich h a d for s evera l
yea rs vis ited New Milford. It was a greed t h a t a dam h a d s tood a t or n ea r t he place of t he pres en t da m for a bou t s ixt y
yea rs pas t ; a n d t h a t t h e dam compla ined of h ad been , by t h e pla in t iff, in J u ly a n d Au gu s t , 1796, r a is ed a bou t t en
in ches . It wa s a ls o a greed t h a t a biliou s remit t in g fever, a n d t h e fever a nd a gu e, h a d ra ged wit h grea t viru len ce in t he
vicin it y of t h is da m, in t h e yea rs 1796-7-8 a n d 9. Th e grea t qu es t ion , t h erefore, in t h e ca s e wa s , wh et her t he ra is in g of
t h e da m in 1796 wa s t he s ine qu a non of t h e dis ea s e? A va riet y of t es t imon y was produ ced by t h e pa rt ies , ten din g t o
con vince t he cou rt a n d ju r y of t h e t r u t h of t h e a ffir ma t ive a nd n ega t ive of t h is qu es t ion s . It wa s proved t h a t , in ea ch of
t h e yea r above men t ioned, a n u n u s u a l s icknes s h a d preva iled; t h a t t h e wh ole n u mber a fflict ed wit h t h e biliou s fever
wa s a bou t 300; t h a t t h is fever common ly bega n in ju ly, a nd cea s ed in October; t h a t t h e fever a n d a gu e h ad a ls o been
preva len t in t h e per iod a fores aid , bu t wa s n ot con fined t o place or s eas on . It wa s a ls o approved t h a t t h ere were
u pwa r ds of Fiift y yea rs of low, Ma r s h y gr ou n d on t h e wes t s ide of t h e r iver , oppos ite t he t own ; t h a t t h ere wa s , in J u ly
a n d Au gu s t , mu ch s t a gna n t wa t er in a n d abou t t h os e ma rs hes ; a n d it wa s con tended ( t h rou gh t h e fa ct wa s dou bt fu l)
t h a t t h e wa t er s in a nd a bou t t h os e s u nken pla ces were ma ter ia lly a ffected by t he r a is in g of t h e da m. t o prove t h a t t h is
s t a t e of t h e wa ter , &c., migh t a n d proba bly wou ld produ ce th e fever , t h e opin ion of ph ys icia n s , a n d t he exis ten ce of
s imila r fa ct s in ot her pla ces , were res orted t o. "It wa s genera lly a greed by t he medica l gen tel men , t h a t t h e biliou s
r emit t in g fever , a n d fever a nd agu e, of ou r cou n t r y, a re produ ced by ma r s h efflu via ; t h a t t h is efflu via is cau s ed by
a n ima l a nd veget able pu t refa ction ; t h a t t h e a ct ion of t he s u n on veget ables or a n ima ls , u pon t h e recedin g of wa ters
fr om t h em, fr equ en t ly ca u s es th is pu t refa ct ion ; a n d t h a t t h e mon t h s of J u ly a nd Au gu s t a re s ea s on s pecu lia r ly
fa vor able for t h e produ ct ion of t h is efflu via , a n d it s opera t ion u pon t he h u ma n cons t it u t ion . It wa s a ls o a greed t h a t
wa t er, t h ou gh s t a gna n t , does n ot become da n gerou s t ill it is s o fet id a s t o offend t h e s en s es ; a n d t h a t been a dis ea s e of
New Milfors d; t h a t t h e t own s th rou gh wh ich t he h ou s a ton ic River ru n s , h a ve been frequ en t lyvis ited wit h biliou s fevers ,
a n d t he t oo, where n o mill-dams cou ld be res orted t o as t h e ca u s es . "t h e ph ys icia n s con cu red in opin ion , t h a t pers on s
a re s eldom a t t a cked wit h t h is fever more t h a n once du r in g t h e epidemic, bu t t h a t t h e fever an d a gu e frequ en t ly vis it s
t h e pa t ien t in t h e s pr in g or s u mmer followin g. t hey a ls o a greed, u n a n imu ou s ly, t h a t fr om 1793 or 4, fever s h ave been
more frequ en t a n d ma ligna n t t h a n in n a y precedin g yea rs , expect in g t h a t in t h e la s t s eas on t h ere appea red a n
a ba temen t in t h e n u mber of cas es a nd violen ce of t h e dis eas e. "It wa s proved t h a t t h e s a me dis ea s e wit h t h e one
u n der con s idera t ion h a d preva iled in ma n y pla ces , in t h is a n d t h e St a t es of New York a nd Ma s s ach u s et t s , wit h in t h e
la s t five yea rs , wh en no mill-dams or pon ds cou ld h a ve opera t ed, - on t he mos t eleva ted h ills , a n d in s it u a t ions
h eretofore deemed t he mos t hea lt h y; t h a t in Grea t Ba r r in gt on , a n d Wes t St ock bridge, t h e dis ea s e a ppea red remote
fr om t h e ponds , wh ile t h e people in t he vicin it y of t h em en joyed u s u a l hea lt h . A r es pect a ble ph ys icia n , fr om Sheffield,
ga ve a n a ccou n t of very dis t res s in g fever, wh ich h ad preva iled t h ere s in ce 1795. Th a t a mill-da m was erected in 1787,
45
" Th e Hou s a t on ic is a s t r ea m of t wo or t h r ee h u n dr ed ya r ds in widt h ,
r u n n in g n ea r t h e wes t er n bor der of t h e St a t es of Ma s s a ch u s et t s a n d
Con n ect icu t , a n d empt yin g in t o Lon g Is lan d Sou n d. Th is s t r ea m, for t h ir t y or
for t y miles a bove Ca n a a n Fa lls , mea n der s t h r ou gh a va lley of fr om on e t o five
or s ix miles in widt h , of a llu via l for ma t ion . It s cou r s e is s er pen t in e, a n d,
fr om t h e cir cu ms t a nce of t h e r egion bein g n ea r ly of a dea d level, it s cu r r en t
is or din a r ily ver y s ln ggis h . It is ver y lia ble t o be s o s wollen by h ea vy r a in s a s
t o over flow it s ba n ks , a n d ext en s ively in u n da t e t h e a dja cen t fla t s . Su ch a n
in u n da t ion a lmos t u n ifor mly s u cceeds t h e t h a win g of t h e s n ow in t h e s pr in g,
a n d n ot u n fr equ en t ly occu r s a t a ll t imes in t h e yea r . From t h e fr equ en t
occu r r en ce of n ew ch a n n els , occa s ion ed by t h e a br a s ion of it s a llu via l ba n ks
on on e s h or e, a n d depos it s on t h e ot h er , n ew ch a n n els a r e con s t a n t ly
for min g, lea vin g beds of t h e old on e is ola t ed r es er voir s of s t a gn a n t wa t er ,
ch a r ged wit h copiou s depos it s of deca yin g veget a ble s u bs t a n ces floa t ed in t o
t h em by s u cces s ive in u n da t ion s , bein g t h u s r en der ed s ou r ces of per ma n en t
delet er iou s exh a la t ion .
" Sit u a t ion s cir cu ms t a n ced like t h os e a bove des cr ibed h a ve been fr om
t ime immemor ia l r ecogn ized a s or igin a t in g ga s eou s ma t t er , h a vin g a n a gen cy
in t h e pr odu ct ion of in t er mit t en t fever a n d it s kin dr ed dis ea s es . An d
a lt h ou gh it is n ot cogn iza ble t o a n y of t h e s en s es , t h e exis t en ce of s u ch a n
a gen t ma y be con s ider ed a s in du bit a ble, a s , wh er e s u ch a s t a t e of t h in gs is
fou n d t o exis t , t h er e a s pecific cla s s of dis ea s es is developed ; a n d wh er e
t h a t , or s omet h in g an a logou s , does n ot exis t , n on e of t h a t cla s s of dis ea s es
a r e t o be fou n d. "
Mill-da ms on t h e Hou s a t on ic a n d it s t r ibu t a r y s t r ea ms , by for cin g t h e
wa t er , for miles a bove t h eir loca t ion , in t o low gr ou n ds , ma r s h es , a n d coves ,
a n d t h er eby pr odu cin g ma cer a t in g r es er voir s of veget a ble s u bs t a n ce,
pr odu ce foci of pes t ifer ou s exh a la t ion s , t o wh ich in t er mit t en t s , in a ll t h eir
gr a des a n d va r iet ies , h a ve been obviou s ly t r a cea ble."

55

" Th a t t h e s t a gn a n t wa t er in Sh effield," s a ys Dr . Bu el, " a n d t he
s ickn es s wh ich pr eva iled t h er e in 1796, a lr ea dy men t ion ed, a n d t h e ot h er
la t e s ickly yea r s , s t a n d in t h e r ela t ion of ca u s e a n d effect , is , I t h in k, a
pos it ion wh ich n o per s on , ca pa ble of r ea s on in g, ca n wit h h old h is a s s en t t o,
a ft er a dmit t in g a n d ca n didly con s ider in g t h e fa ct s wh ich I h a ve s t a t ed. I am
s en s ible t h a t n ew fa ct s wer e n ot wa n t in g t o con fir m a belief, a mon g
ph ys icia n s a n d ph ilos oph er s , t h a t ma rs h exh a la t ion s a r e a pois on wh ich
mos t in fa llibly pr odu ces wh a t a r e called biliou s fever s . Bu t , h owever
a s t on is h in g it ma y a ppea r , it is a fa ct , t h a t ma n y of t h e people wh o dwell in
t h e vicin it y of t h e s t a gn a n t wa t er s of t h is t own , a n d even t h os e wh o h a ve
been t h e gr ea t es t s u ffer er s in t h e s ever a l s ickly yea r s , dis believe t h e local

t o wh ich it wa s by ma n y a s cribed, yet h e decla red t h a t , fr om 17887 t o 1795, gr ea t h ea lt h preva iled, t h ou gh t he dam,
du r in g t h a t per iod, wa s a s h igh a s it h a s ben s in ce. He a ls o s a id t h a t , du r in g t h e da m, du r in g t h a t per iod, wa s a s h igh
a s it h a s been s ince. He a ls o s aid t h a t , du r in g t h e s pr in g of 1799, t he dam wa s lowered, a nd t h a t t h e dis ea s e, t he
s u mmer followin g, wa s mu ch more mild. "It wa s a dmit t ed t h a t t h e expos in g of vegeta bles or a n ima ls , or ot her
s u bs t a n ces capable of bein g redu ced t o s u dden pu t refa ct ion , t o t h e s u n , by dra win g ponds , or clea rin g u p low grou n ds ,
t ended t o produ ce dis ea s e; bu t cert a in ly, or even con nect ion , a s t o pa rt icu la r in s t a n ces in wh ich t h is con s equ en ces
h a d followed, s eemed s ca rcely a t t a in a ble. "It wa s obviou s t o a ll t h e hea rers of t h is t r a il, t h a t t h e more proof, t h e more
dou bt , a n d t h a t t h e qu es t ions grew perplexed by in ves t iga t ion. An d s o fu lly were t he cou rt an d ju ry impres s ed wit h t h is
idea , t h a t t h ey decided in fa vor of t h e owner of h te dam, a n d ga ve da ma ges a ccordin gly; s a yin g t h a t t h ey cou ld n ot fin d
it proved a n u is a n ce."-Memois of t h e Con nect icu t Academy of Art s a n d Sciences , Vol.I p.131. It is n ot s t r a n ge t h a t t h e
cou rt ca me t o t h is decis ion . Su fficien t obs er va t ion s h ad n t o t h en been ma de, wit h exa ct nes s , t o a ffor d t h e mea n s of
decidin g t he qu es t ion in telligent ly; a n d es pecia lly in oppos it ion t o t h e wis hes of in t eres ted part ies . It is pres u med t h a t
t h e opin ion s of ph ys icia ns wer e for med fr om genera l in for ma tion , n ot fr om exact fa ct s .
55
Homles 's Priz e Es s ay , p.46.
46
or igin of t h eir mis for t u n es , a n d s t r on gly oppos e a ll a t t empt s t o r emove or
les s en t h e for ce of t h eir ca u s e."
56

" Nea r t h e villa ge of Pit t s field, bet ween for t y a n d fift y yea r s a go, a mill-
da m wa s er ect ed, wh ich ca u s ed t h e wa t er t o s et ba ck, a n d cover over mor e
t h a n on e h u n dr ed a cr es of la n d, t h en clot h ed wit h it s n a t ive for es t t r ees of
s oft ma ple, a lder s , r ed a s h , a n d ot h er t imber a n d s h r u bs pecu lia r t o low
a llu via l la n ds u pon t h e s t r ea ms . Soon a ft er wa r ds a ll t h e t imber per is h ed;
t h en commen ced biliou s fever s , a n d t h e fever a n d a gu e, a s it wa s ca lled. It
wa s ver y s ickly; ma n y died, a ll wer e a la r med Th e own er of t h e mill wa s
pr os ecu t ed, a n d t h e da m des t r oyed. Th er e h a ve been n o in digen ou s ca s es of
in t er mit t en t wit h in my r es iden ce h er e, s a y for t y yea r s . Th e s ickn es s a bove
men t ion ed cea s ed s oon a ft er t h e des t r u ct ion of t h e mill-da m."
57

Dr . Ch a r les Seeger h a s s t a t ed t h a t , " in 1792, wh en a compa n y bu ilt t h e
Sou t h Ha dley Ca na l, bet ween eigh t a n d t en miles below t h e cen t r e of
Nor t h a mpt on , t o convey boa t s a n d r a ft s rou n d t h e fa lls in Con n ect icu t River ,
a da m wa s ma de a t t h e h ea d of t h e fa lls , eleven feet h igh , a cr os s t h e r iver ,
wh ich r a is ed t h e wa t er for t en miles above a bou t fou r feet h igh er t h a n it s
common level. In con s equ en ce of t h is , t h e s pr in g fr es h et s flowed ba ck mu ch
fa r t h er t h a n befor e, a n d left la r ge qu a n t it ies of s t a gn a n t wa t er wh en t h ey
wit h dr ew. A gr ea t ma n y of t h e in h a bit an t s of t h is t own , livin g a n d wor kin g
n ea r a n d a mids t t h es e low, ma r s h y pla ces , wer e for s ever a l yea r s a ft er wa r ds
a fflict ed wit h t h e fever a n d a gu e, a dis ea s e wh ich wa s u n kn own in t h is t own
for mor e t h a n s ixt y yea r s . Sever a l of t h e in h a bit a n t s in s t it u t ed s u it s a ga in s t
t h e pr opr iet or s of t h es e wor ks , u n der t h e n u is a n ce J a w, wh ich compelled t h e
la t t er , s ome yea r s a ft er , t o r emove t h e da m, a n d deepen t h e ca n a l s u fficien t ly
t o fill it wit h ou t t h e a id of t h e da m. Aft er r emovin g t h is ca u s e, it s effect of
cou r s e gr a du a lly cea s ed, a n d t h e t own r ecover ed it s ch a r a ct er of a h ea lt h y
pla ce. Th e fa ct s a s t o t h e or igin of t h e dis ea s e, a n d it s con t in u a t ion fr om
1799 t o 1803, wer e pr oved du r in g t h e r epea t ed t r ia ls .; a n d ma n y ca s es
comin g u n der my obs er va t ion , I wa s ca lled u pon t o in for m t h e cou r t a n d ju r y
of wh a t I kn ew of t he ca u s es a n d t r ea t men t of t h is dis ea s e."
58

1802. Th e yellow fever a ga in a ppea r ed in Bos t on , n ea r t h e lower en d of
Su mmer s h eet , in t h e vicin it y of Tiles t on 's wh a r f, a n d a bou t For t Hill. Abou t
.fift y died, eleven of wh om wer e in on e h ou s e. Th e or igin of t h e dis ea s e ,va s
n ot s a t is fa ct or ily a ccou n t ed for . Some s u ppos ed it wa s impor t ed; ot h er s , "
t h a t it a r os e fr om filt h , con s is t in g of pu t r id a n ima l a n d veget a ble ma t t er
collect ed n ea r t h e wh a r ves , or in a cellar in t h e n eigh bor h ood of t h e pla ce
wh er e it commen ced." Th e fla t t er opin ion wa s gen er a lly en t er t a in ed. No ca s e
wa s kn own of it s bein g commu n ica t ed fr om t h e s ick t o t h e a t t en da n t s .
59

1804-05: A t yph u s of " u n common ma lign it y" a ppea r ed in Bos t on :
fift een died of t h e dis ea s e.
1805-1810: Th e s pot t ed fever a n d ot h er epidemics pr eva iled du r in g t h is
per iod in s ome pa r t s of t h e St a t e, t h ou gh n o ver y pa r t icu la r a ccou n t h a s
been pu blis h ed con cer n in g t h em. In 1808, in Amh er s t , s ix ca s es wer e fa t a l.
In on e t own in Wor ces t er Cou n t y, on e h u n dr ed a n d t h ir t y wer e s ick, a n d t wo
died. Of n in et y-on e ca s es in Ba r r e, n in e wer e fa t a l. On t h e 19t h of Ma r ch ,

56
Holmes 's Priz e Es s ay , p. 72.
57
Ibid, p. 82.
58
Letter of Charles Seeger, M.D.: Holmes 's Priz e Es s ay , p.86
59
Communications , Mas s achus etts Medical Society , Vol. II, p. 469.
47
1810, a gen t lema n fr om Pet er s h a m wr ot e :-" Th e dis t r es s in t h is pa r t of t h e
cou n t y is beyon d a n yt h in g you ca n con cieve. Seven men a n d women , a n d
on e ch ild, wer e bu r ied in Ba r r e, t h is a ft er n oon : s ixt y a r e n ow s ick. Dr .
Holmes t old me t h a t t wen t y ph ys icia n s wou ld n ot be t oo man y for t h a t t own
a lon e." Th e s a me dis ea s e s pr ea d in va r iou s ot h er pa r t s of t h e St a t e.
60

1812-1814: Th is per iod wit n es s ed t h e in t r odu ct ion of a mos t fa t a l a n d
a la r min g epidemic. It fir s t a ppea r ed a mon g t h e s oldier s a t Gr een bu s h ,
oppos it e Alba n y, in Oct ober , 1812, a n d a bou t t h e s a me t ime in Sa cket t 's
Ha r bor a n d Bu r lingt on . It a ft er wa r ds s pr ea d t h r ou gh Ver mon t , New
Ha mps h ir e, a n d Ma s s a ch u s et t s . Dr . Ga llu p es t ima t ed t h a t 6,400 per s ons
died of t h e dis ea s e in Ver mon t a lon e, in five mon t h s , in a popu la t ion of
217,913. In Bos t on , 60 dea t h s a r e r ecor ded by t yph u s fever , in 1812 a n d
1813, a n d 81 of "pu lmon ic fever " in t h e s a me t ime,pr oba bly by t h e s a me
dis ea s e: 400 or 500 a r e s a id t o h a ve been s ick. It a t t a cked adu lt s pr in cipa lly,
a n d wa s gen er a lly fat a l t o old people. It pr eva iled ver y gen er a lly in Wor ces t er ,
a n d ma n y ot h er cou n t r y t own s , t h ou gh t h e r ecor ds a r e t oo imper fect t o
a ffor d ver y a ccu r a t e in for ma t ion .
61

1815-1816: Th is win t er , a t yph u s fever of ma lign it y, s imilar t o t h a t of
1812-1814, a lr ea dy n ot iced, a n d con fin in g it s a t t a cks prin cipa lly t o old
people, a ppea r ed in Sh a r om, in Nor folk Cou n t y. In t en da ys , eigh t een ou t of
t h e fir s t t wen t y-fou r ca s es t er min a t ed fa t a lly. Ma n y wer e a ft er wa r ds s ick,
a n d ma n y died. It s pr ea d in t o Ma n s field, Wr en t h a m, a n d ot h er pla ces in t h e
s ou t h er ly pa r t of t h e St a t e. In At t lebor ou gh , mor e t h a n on e h u n dr ed died of
t h is dis ea s e in t h r ee mon t h s . In Roch es t er , fift y died. " It is s t a t ed, a s a fa ct ,
t h a t t h is epidemic followed t h e cou r s e of r iver s , t r a cin g u p t h e Accu s h n et
a n d Ma t t a pois et , t o t h e gr ea t pon d in Freet own , a n d ext en din g bu t ver y lit t le
beyon d t h e meet in gh ou s e Roch es t er , wh ich h a s ever been on e of t h e mos t
h ea lt h y in New En gla n d, a n d wh er e it is dr y a n d s a n dy. Dr . s t a t es , t h a t
s ca r ce a per s on es ca ped t h is fever , wh o lived a mile of t h e gr ea t pon d in
Sh a r on , wh er e it pr eva iled s o fa t a lly. Six per s on s , of t h e family of As h ley,
died of t h is fever in on e h ou s e, s it u a t e n ea r t h e gr ea t pon d in Fr eet own . Th is
s in gu la r dis ea s e s eems , t h er efor e, t o ch oos e for it s loca t ion h u mid a n d
s wa mpy s it u a t ion s ."
62

1819. Th e yellow fever , a ga in a ppea r ed in Bos t on , a n d cr ea t ed gr ea t
a la r m. Th e fir s t vict im ,va s Pa t r ick Mu r ph y, a n Ir is h la bor er , wh o lived a t t h e
n or t h er ly en d of Pu r ch a s e, n ea r Br oa d s t r eet . He died t h e t h ir d da y a ft er t h e
a t t a ck, on t h e 30t h of J u n e. On t h e 3d of J u ly, a fema le died, in t h e fa mily of
J os ia h Br a dley, on For t Hill. On t h e 5t h , Mr s . Th a yer , (wh o kept a boa r din g-
h ou s e in Pu r ch a s e s t r eet , n ea r ly oppos it e t h e pr es en t s t on e ch u r ch ,) h er
da u gh t er a n d h er s on , wer e a ll a t t a cked in t h e mor n in g, a n d died befor e
t h r ee o'clock t h e s a me da y. Ot h er s died s oon a ft er . On t h e 1s t of Au gu s t , t h e
s h ip " Ten Br ot h er s " a r r ived, in a fou l con dit ion . Mr . Ea t on , (t h e cu s t om-
h ou s e officer ;) a n d t wo la bor er s , wh o boa r ded h er , died t h e n igh t a ft er . By
or der of t h e Boa r d of Hea lt h , t h e ves s el wa s t a ken in t o t h e h a r bor a n d
s cu t t led. Th e efflu via of t h e bilge-wa t er t h a t flowed fr om t h e ves s el wa s
exceedin gly offen s ive; a n d t wo per s on s wh o s cu t t led h er , an d s ome ot h er s

60
Communications , Mas s achus etts Medical Society , Vol.II, p.138; Gallup on Epidemics pp. 53,58.
61
The work s which afford s ome further inf ormation on this epidemic are: Gallup on Epidemics p. 69; Mann's Medical
Sk etches ; New England Medical Journal, Vol. II, p. 241. Vol.IV,p.98; Lincoln's His tory of Worces ter J. p. 311; New
Hamps hire Journal, Vol. I, p. 23, and Vol II, p. 199. See, als o, Sanitary His tory of Frank lin County , in append ix.
62
Mas s achus etts His torical Collection, Vol IV, p. 303, and New England Medical Journal,Vol.V,p.317.
48
wh o h a ppen ed t o be pa s s in g in a s a il-boa t , t ook t h e dis ea s e a n d died. Th e
a la r m n ow beca me ver y gr ea t , a n d ver y ma n y of t h e in t h e cit y.
Th e dis ea s e wa s con fin ed pr in cipa lly t o t h e s ou t h ea s t er n declivit y of
For t Hill, in t h e vicin it y of Pu r ch a s e, High , a n d Giffin s t r eet s , a n d Gibbs '
La n e. Ma n y per s on s wer e on boa r d t h e s h ip, a ft er h er a r r iva l, mos t of wh om
r ema in ed in h ea lt h . Abou t t welve, h owever , wer e s eized wit h t h e fever ,
a lmos t a ll of wh om died. Th ey a n d a few ot h er s wer e s ick a n d died in
differ en t pa r t s of t h e t own .
It is n ot cer t a in h ow ma n y wer e vict ims t o t h is epidemic. On t h e t own
r ecor ds , t h ir t y-fou r dea t h s by t h is "ma lign a n t fever " a r e r ecor ded, bu t t h is
does n ot in clu de t h e wh ole n u mber . Pa t r ick Mu r ph y, a ccor din g t o t h e r ecor d,
died in con s equ en ce of "dr in kin g cold wa t er ;" a n d Mr s . Th a yer a n d h er
fa mily, by " dis ea s e u n kn own ." Pr oba bly ot h er s died of t h e dis ea s e, t h ou gh
n ot s o en t er ed. Th is wa s don e, per h a ps , t o pr even t a la r m. Th e bills of
mor t a lit y, for t h a t yea r , s t a t e t h a t 108 died by "t yph u s ," a n d 46 by "pu lmon ic
fever ," bot h of wh ich ma y in clu de s ome ca s es of yellow fever . On e ph ys icia n
in for ms u s t h a t h e at t en ded s even t y-five ca s es of t h is dis ea s e in t h a t yea r . It
wa s a t fir s t exceedin gly ma lign a n t , a n d s oon t er min a t ed in dea t h ; bu t
gr a du a lly it beca me mor e a n d mor e mild a n d ma n a geable, a n d en t ir ely
cea s ed a bou t t h e 1s t of November .
Th e ca u s e of t h e dis ea s e wa s n ever s a t is fa ct or ily a s cer t a in ed. Some
a t t r ibu t ed it t o t h e " Ten Br ot h er s ;" bu t t h is cou ld n ot h a ve been t h e or igin a l
a n d pr in cipa l ca u s e, for it pr eva iled h er e a mon t h befor e t h e a r r iva l of t h at
ves s el. It u n dou bt edly a r os e fr om s ome loca l in flu en ce, wh ich migh t h a ve
been a ggr a va t ed by t h e fou l con dit ion of t h a t s h ip, a s it wou ld h a ve been by
a n y ot h er s imila r ca u s e, combin ed wit h t h e pecu lia r con dit ion of t h e
a t mos ph er e t h a t t h en exis t ed.
It is a r ema r ka ble fa ct , t h a t t h e dis ea s e wa s n ever kn own . To be
commu n ica t ed fr om on e s ick per s on , or fr om t h e clot h in g of s u ch per s on , t o
a n ot h er , n ot wit h s t a n din g expos u r e by n u r s es a n d ot h er s t o t h e dis ea s e in
t h e s ick a n d t h e dea d, except in a s in gle in s t a n ce; a n d con cer n in g t h a t t h er e
is s ome dou bt . Th e pois on exis t ed in t h e a t mos ph er e of t h e loca lit y, a n d
oper a t ed wh er e t h e per s on a l con dit ion wa s fa vor a ble t o it s r ecept ion .
63

1831-1832: In Bos t on , 70 died of As ia t ic ch oler a in 1832. Of s ca r la t in a ,
84 died in 1831, a n d 199 in 1832. Typh u s wa s a ls o ch a r ged wit h 45 dea t h s .
Th e ch oler a excit ed gr ea t a la r m, a n d ca u s ed s pecia l pr epa r a t ion s t o be ma de
in t h e cit y for it s a voida n ce.
64

On t h e 5t h of Au gu s t , 1832, a t t h e St a t e Pr is on in Ch a r les t own , 190
wer e t a ken wit h ch oler a ,-115 in t h e fir s t t wen t y fou r h ou r s , t h e r ema in der
s oon a ft er ,-a ll of wh om r ecover ed.
For t h e la s t for t y yea r s , n ot wit h s t a n din g t h e ma s s of medica l lit er a t u re
t h a t h a s been pu blis h ed, les s defin it e in for ma t ion h a s been obt a in ed
con cer n in g epidemics t h a n in t h e pr eviou s per iods , Th e a lmos t en t ir e.
n eglect of r ecor ds , pr ior t o t h e a dop t ion of t h e r egis t r a t ion s ys t em, r en der s it

63
New En gla n d Medica l J ou rn a l, Vol. VIII, p. 380, a n d Vol. IX, p. 98.
64
Th e s a n it a r y expens es of t h e cit y of Bos t on , for 1832, were :-

For In ter n a l Hea lt h Depa r t ment , $21,610 67
For Ext ern a l Hea lt h a n d Qu a ran t in e Es t a blis h men t , 5,222 95
For Specia l Mea s u res a ga in s t t h e Ch olera , a bou t . 23,600 00
Tot a l, $50,433 62
Bos t on Medica l J ou rn a l, Vol. 9,p. 209.
49
difficu lt t o give a n y t h in g a ppr oxima t in g t o a n a ccu r a t e view of t h e s u bject . If
a ca r efu l exa min a t ion wer e ma de in t o t h e h is t or y of ea ch t own , ma n y
impor t a n t fa ct s migh t be ga t h er ed. Bu t it is cu r iou s a n d la men t a ble t o
obs er ve, in lookin g over ou r pu blis h ed loca l h is t or ies , h ow lit t le a t t en t ion h as
been pa id t o t h is ma t t er . The His tory of the Health the People s h ou ld be
r ega r ded a s t h e mos t impor t a n t pa r t of h is t or y, yet it h a s gen er a lly been
con s ider ed u n wor t h y of n ot ice, or ) if n ot iced a t a ll, mer ely a mon g t h e
in ciden t a l ma t t er s of lit t le con s equ en ce. It is h oped t h a t h er ea ft er mor e
a t t en t ion will be pa id t o t h is s u bject by ou r loca l h is t or ia n s , a n d t h a t ou r
loca l s a n it a r y s u r veyor s will ma ke it a ma t t er of pa r t icu la r in ves t iga t ion . Th e
r a pid, imper fect r eview we h a ve t a ken of t h e s a n it a r y h is t or y of t h e St a t e,-
con t a in in g, a s it does , br ief n ot ices of s ome of t h e pr omin en t epidemics
mer ely ,-s u gges t s ma n y impor t a n t con s ider a t ion s , wh ich , if mor e fu lly
illu s t r a t ed, migh t con vey t h e mos t impor t a n t pr a ct ica l les s on s .
In s ome t own s , r ecor ds h a ve been ma de, a n d es pecia lly s in ce t h e
r egis t r a t ion la w wen t in t o oper a t ion . Fr om t h es e a n d ot h er s ou r ces of
in for ma t ion we fin d t h a t dys en t er y, t yph u s fever , s ca r la t in a , con s u mpt ion ,
a n d ot h er fa t a l dis ea s es , a r e common in n ea r ly a ll pa r t s of t h e St a t e. Th ey
a r e con s t a n t vis it or s . In s ome per iods a n d pla ces mor e s o t h an in ot h er s , bu t
in a ll s o common t h a t t h ey h a ve become fa milia r t o u s , a n d cea s e t o excit e
n ot ice or a la r m. An a mou n t of s ickn es s wh ich for mer ly wou ld h a ve t h r own
t h e wh ole commu n it y in t o a s t a t e of con s t er n a t ion ) ma y n ow occu r a s a n
or din a r y even t , a n d elicit n o s pecia l a t t en t ion .
To complet e t h is gen er a l view of t h e s a n it a r y con dit ion of t h e St a t e, a n d
a s fu r t h er illu s t r a t ion s , we h a ve compiled fr om t h e Regis t r a t ion Repor t s ,
fr om t h e "Bills of Mor t a lit y" of Bos t on , a n d fr om ot h er s ou r ces of
in for ma t ion , s ever a l t a bu la r s t a t emen t s , wh ich we s h a ll n ow pr es en t . A
gen er a l view of t h e inf luences on human lif e and longevity , exis t in g in t h e
St a t e, is pr es en t ed in t h e t a ble, (p. 82,) wh ich exh ibit s t h e r a t e of mor t a lit y
a mon g t h e in h a bit a n t s of Bos t on a t t h r ee differ en t per iods ; a n d a mon g t h os e
of a n in t er ior t own of t h e St a t e, of a n a ver a ge h ea lt h .
Th is impor t a n t t a ble h a s been compiled wit h gr ea t ca r e, an d will be fou n d
t o r epr es en t t h e la w of mor t a lit y in differ en t pla ces in Ma s s a ch u s et t s , mor e
a ccu r a t ely t h a n a n yon e h er et ofor e pu blis h ed. Th e colu mn s r ela t in g t o
Bos t on h a ve been ca r efu lly compiled by a compa r is on of t h e popu la t ion wit h
t h e dea t h s for n in e yea r s , fou r befor e a n d fou r a ft er t h at in wh ich t h e
en u mer a t ion wa s ma de. Th is a dmit s of a fa ir a ver a ge, a n d a n a ccu r a t e
r es u lt . Th e colu mn u n der " cou n t r y t own s " is compiled fr om a ca r efu l
exa min a t ion , a bs t r a ct , a n d combin a t ion of t h e r ecor ds of dea t h s in Con cor d
a n d Wor ces t er , Mas s a ch u s et t s , a n d in Ar n h er s t , N. H., for t h e t en yea r s ,
1826 t o 1835, in clu s ive, wit h t h e a bs t r a ct of t h e cen s u s of 1830. Th e r ecor ds
of t h os e t own s wer e a t t h a t t ime s u ppos ed t o be fu ll; a n d, t h ou gh n ot t h e
h ea lt h ies t , ma y be con s ider ed, a mon g t h e cou n t r y t own s , of a bou t a n
50

S tatement of the Rate Mortality among the inhabitants of Bos ton, for 1830,
1840 and 1845; and of and interior country town in Mas s achus etts , f or 1830
POPULATION OF BOSTON
1830 1840 1845
AGES
Bot h
Sexes
Bot h
Sexes
Ma les Fema les Bot h
Sexes
Popu la t ion
of Cou n t r y
Town s .
Bot h Sexes
Un der
5
8, 068 11, 52
2
7, 234 7, 214 14, 448 1, 249
5 t o 10 6, 106 8, 956 5, 690 5, 668 11, 358 1, 036
10 t o
15
5, 501 7, 221 4, 708 4, 928 9, 636 963
15 t o
20
6, 903 8, 841 5, 199 5, 750 10, 949 1, 013
20
t o30
16, 18
2
22, 96
0
15, 009 14, 586 29, 595 1, 791
30 t o
40
9, 070 112, 6
75
10, 455 9, 526 19, 981 1, 129
40 t o
50
5, 019 6, 707 4, 991 5, 038 10, 029 752
50 t o
60
2, 569 3, 561 2, 142 2, 618 4, 760 488
60 t o
70
1, 316 1, 640 1, 062 1, 406 2, 468 356
70 t o
80
504 673 3315 578 893 241
80 t o
90
140 212 73 146 221 86
Over
90,
14 32 12 16 28 9
All
Ages
61, 39
2
85, 00
0
56, 890 57, 476 114, 366 9, 113
De a t h s in Bos t on for 9 ye a r s
Dea t h s for
10 Year s .
Un der
5
4, 334 7, 660 6, 224 5, 481 11, 705 38. 2
5 t o 10 448 738 703 609 1, 912 6. 2
10 t o
15
274 397 292 341 633 3. 1
15 t o
20
309 483 330 408 738 5. 3
20 t o
30
1, 526 2, 036 1, 556 1, 747 3, 303 13. 2
30 t o
40
1, 484 1, 766 1, 540 1, 377 2, 917 11. 1
40 t o
50
1, 025 1, 276 1, 138 810 1, 948 11. 0
50 t o
60
678 903 679 594 1, 273 9. 4
60
t o70
544 723 516 541 1, 057 11. 0
70 t o
80
420 589 324 463 787 13. 8
80 t o
90
205 293 137 242 379 11. 6
Over
90
41 54 28 47 75 2. 1
51
All
Ages
11, 28
8
16, 85
8
13, 467 12, 660 26, 127 136. 0
An n u a l Mor t a lit y p e r c e n t
Un der
5,
5. 96 7. 32 9. 55 8. 44 9. 00 3. 05
5 t o 10 . 81 . 91 1. 37 1. 19 1. 28 . 59
10 t o
15
. 55 . 61 . 68 . 76 . 72 . 32
15 t o
20
. 49 . 60 . 70 . 78 . 74 . 52
20 t o
30
1. 04 . 98 1. 15 1. 33 1. 24 . 73
30 t o
40
2. 01 1. 54 1. 63 1. 60 1. 62 . 98
40 t o
50
2. 24 2. 11 2. 53 1. 78 2. 15 1. 46
50 t o
60
2. 93 2. 81 3. 52 2. 52 2. 97 1. 92
60 t o
70
4. 58 4. 89 5. 39 4. 27 4. 75 3. 08
70 t o
80
9. 24 9. 71 11. 42 8. 89 9. 78 5. 72
80 t o
90
16. 21 15. 33 20. 82 18. 10 19. 04 13. 48
Over
90
32. 14 18. 75 25. 83 32. 50 29. 64 23. 33
All
a ges
2. 04 2. 20 2. 63 2. 44 2. 53 1. 49
Livin g
t o 1
dt h
48 45 38 41 39 67

a ver a ge h ea lt h . In ma n y pla ces , a compa r is on of t h e wh ole n u mber of
dea t h s wit h t h e popu la t ion gives a mu ch mor e fa vor a ble r es u lt , a n d in ot h er s
n ot s o fa vor a ble. Th is t a ble des er ves t o be ca r efu lly s t u died. By it we ma y
lea r n t h e lia bilit y t o dea t h a t differ en t ages , in t h e pla ces s pecified. For a ll
a ges , t h e a ver a ge r a t e of mor t a lit y for t h e la s t n in e yea r s , in Bos t on , wa s
2.53 per cen t ., or 1 in 39 of t h e wh ole popu la t ion . In t h e cou n t r y t own s , in
1830, it wa s 1.49 per cen t ., or 1 in 67. In Bos t on , of t h os e u n der five yea r s of
a ge, 9 ou t of ever y 100 died ; wh ile in t h e cou n t r y, 3.05 on ly, or a bou t on e-
t h ir d a s ma n y, of t h e s a me a ge, died. At ot h er a ges , a ls o, a gr ea t differ en ce
ma y be s een bet ween , t h e r a t e of mor t a lit y in t h e cit y a n d cou n t r y", a n d
bet ween on e per iod a n d a n ot h er . A compa r is on of t h e t able wit h t h a t of
En gla n d (p. 34) will s h ow a ver y n ea r a gr eemen t of t h e h ea lt h of ou r cou n t r y
t own s wit h t h a t of t h e mos t h ea lt h y dis t r ict s in En gla n d, a n d of Bos t on wit h
Lon don .
Th e inf luence of the s eas ons u pon h ea lt h h a s u n iver s a lly been r ega r ded
a s impor t a n t . Some dis ea s es pr eva il wit h mor e fr equ en cy a n d ma lign it y a t
on e s ea s on t h a n a t a n ot h er . Per s on s a t t h e ext r eme a ges of life,-t h e you n g
a n d t h e old,- a n d t h os e of feeble h ea lt h , a r e, h owever , mos t lia ble t o be
a ffect ed by t h e ch a n ges of t h e s ea s on s . We h a ve compiled t h e followin g
s t a t emen t , t o s h ow t h e ext en t of t h is in flu en ce in t h is St a t e. It gives t he
n u mber of dea t h s in Bos t on , in ea ch mon t h , for t h e five yea r s , fr om 1840 t o
184.5 ; dis t in gu is h in g t h os e u n der 15, t h os e bet ween 15 a n d 60, a n d t h os e
52
over 60 yea r s of a ge ; a n d t h os e ou t of Bos t on , in t h e s even yea r s cover ed by
t h e Regis t r a t ion Repor t s , (1842-1848,) wit h ou t dis t in ct ion of a ge; a n d t h e
pr opor t ion per cen t . t h a t ea ch bea r s t o t h e wh ole ;-
By t h is s t a t emen t , it a ppea r s t h a t t h e s u mmer qu a r t er (J u ly, Au gu s t ,
a n d Sept ember ) is u n ifor mly t h e mos t fa t a l, bot h in cit y a n d cou n t r y;
a u t u mn s t a n ds n ext , win t er n ext , a n d s pr in g is lea s t s o. Au gu s t a n d
Sept ember a r e t h e mos t u n h ea lt h y mon t h s in t h e cit y, a n d Oct ober in t h e
cou n t r y. Th is a r is es fr om t h e gr ea t er pr eva len ce in t h e cit y of dis ea s es of t h e
diges t ive or ga n s , a n d in t h e cou n t r y of fever s . Th e effect s a r e, h owever ,
con fin ed pr in cipa lly t o per s on s u n der 15 yea r s of a ge. An d it is cu r iou s a n d
impor t a n t t o obs er ve t h a t , t o t h os e over 60, t h es e dis ea s es a r e les s fa t a l
t h a n t o t h os e of ot h er a ges . Th e win t er a n d s pr in g qu a r t er s a r e mos t fa t a l t o
dis ea s es of t h e or ga n s of r es pir a t ion , es pecia lly pn eu mon ia , or in fla mma t ion
of t h e lu n gs , a n d con s u mpt ion . Old people a n d t h os e of feeble h ea lt h , a ls o,
s u ffer mos t , a t t h is s ea s on . Th e impor t a n ce of t h e s u bject will r epa y a ca r efu l
in s pect ion of t h e t a ble, t o lea r n t h e effect of mor t a lit y in ea ch mon t h , a n d in
ea ch cla s s of a ges .
Th e inf luence of occupation on h ea lt h a n d lon gevit y is wor t h y of
con s ider a t ion . Th e Regis t r a t ion Repor t s , fr om wh ich we h ave compiled t h e
s u bjoin ed s t a t emen t , r ela t in g t o t h os e wh o died in t h e per iod t o wh ich t h ey
r efer ; t h e Amer ica n Qu a r t er ly Regis t er ,
65
a n d ot h er s ou r ces , fu r n is h s ome
in for ma t ion t o illu s t r a t e t h e s u bject .
Of t h e cler gymen wh o lived a n d died in Ma s s a ch u s et t s , pr ior t o 1825,
t h e a ges of 888 h a ve been a s cer t a in ed. Divided in t o per iods , a ccor din g t o t h e
t ime of t h eir decea s e, t h e followin g is t h e r es u lt :-

Agrega t e Ages Avera ge Age
90 wh o died pr ior t o 1700 h a d 5,560 yea r s 61.77 yea r s
123 " 1700 t o 1750 " 7,996 yea r s 65.00 yea r s
303 " 1750 t o 1800 " 18,957 yea r s 62.55 yea r s
372 " 1800 t o 1825 " 23,986 yea r s 64.47 yea r s
Tot a l s 8 8 8 5 6 , 4 9 9 6 3 . 6 2

Th e Qu a r t er ly Regis t er (Vo1. X, p. 39) gives t h e a ggr ega t e a ges of 840
cler gymen , wh o gr a du a t ed a t Ha r va r d Un iver s it y, a n d died pr ior t o 1835, a t
53,447 yea r s ;63.62 yea r s bein g t h e a ver a ge a ge: 41 in ea ch 100 a t t a in ed t h e
a ge of 70. Th is cor r es pon ds ver y n ea r ly wit h t h e pr ecedin g s t a t emen t ; 61/ 2
yea r s ma y be con s ider ed a s t h e a ver a ge a ge of t h e cler gymen , in t h is s t a t e
du r in g t h e la s t cen t u r y, a n d pr ior t o 1825. In t h e qu a r t er ly lis t s of dea t h s of
cler gymen , a s given in t h e fift een volu mes of t h e Regis t er , pr ior t o 1841, t h e
a ges of 147 in Ma s s a ch u s et t s a r e s t a t ed, a mou n t in g in t h e a ggr ega t e t o
8,642,-a ver a gin g 58.49; a n d of 167 in ot h er New En gla n d St a t es , a mou n t in g
in t h e a ggr ega t e t o 9,423,- Aver a gin g 56.42. Th e a ver a ge a ge of 114, wh o
died in t h e per iod cover ed by t h e r egis t r a t ion r epor t s , is given below, at
56.64 yea r s . Th is s h ows a n a ver a ge declin e in t h e lon gevit y of cler gymen , of
s even yea r s .

65
The s tatis tics of the churches and minis ters are contained in s everal volumes . the f if teenth volume, page 500, contains
a ref erence by which thos e of each county may be f ound . See, als o, vol X p.39, and vol XIII, p.75.
53


Nu mber of De at h s In Ea ch 1 0 Th e r e Die d
In Bos t on , 1 8 4 0 t o 1 8 4 5 In Bos t on , 1 8 4 0 t o 1 8 4 5
Un de
r 1 5 .
1 5
t o
6 0
Ove r
6 0
Tot a l
In
St a t e
.
7
ye ar s
All
a ge s
Mon t h s
In
St a t e
.
7
ye ar s
.
All
a ge s
Tot a l Un d
e r
1 5
1 5
t o
6 0
Ove r
6 0
438 292 96 826 4,752 J a n u a ry 7.52 7.93 4.21 2.80 .92
431 315 84 830 4,932 Febru a ry 7.80 7.96 4.14 3.02 .80
373 306 87 766 5,351 Ma rch 8.46 7.35 3.58 2.94 .83
421 322 100 843 5,041 April 7.97 8.09 4.04 3.09 .96
425 330 101 856 4,599 Ma y 7.28 8..21 4.08 3.16 .97
356 291 82 729 4,398 J u ne 6.96 6.99 3.41 2.79 .79
475 296 75 846 4,946 J u ly 7.82 8.12 4.56 2.85 .71
698 335 64 1,097 6,032 Au gu s t 9.54 10.53 6.70 3.22 .61
671 327 88 1,086 6,614 Septemb
er
10.46 10.42 6.44 3.14 .84
449 339 77 865 7,127 Oct ober 11.27 8.30 4.31 3.25 .74
377 351 80 808 4,667 Novembe
r
7.38 7.75 3.62 3.37 .76
429 337 104 870 4,765 Decembe
r
7.54 8.35 4.12 3.23 1.00
5,543 3,84
1
1,03
8
10,42
2
63,22
4
Tot a l 100.0
0
100.0
0
53.2
1
36.8
6
9.93
1,242 913 267 2,422 15,03
5
Win t er 23.78 23.24 11.9
3
8.76 2.55
1,202 943 283 2,428 14,03
8
Sprin g 22.21 23.29 11.5
3
9.04 2.72
1,844 958 227 3,029 17,59
2
Su mmer 27.82 29.07 17.7
0
9.21 2.16
1,255 1,02
7
261 2,543 16,55
9
Au tu mn 26.19 24.40 12.0
5
9.85 2.50
5,543 3,84
1
1,03
8
10,42
2
63,22
4
Tot a l 100.0
0
100.0
0
53.2
1
36.8
6
9.93

54


Phy s icians . It a ppea r s by t h e t a ble (p. 58) t h a t 194 member s of t h e
Ma s s a ch u s et t s Medica l Societ y, wh o lived a n d died in t h is St a t e pr ior t o
1840, a n d wh os e a ges a r e kn own , died a t t h e a ver a ge a ge of 60.23 yea r s ; of
wh om 42 in Bos t on lived 53.59 yea r s , a n d 134 in ot h er pa r t s of t h e St a t e
lived 64.04 yea r s . Of 900 ph ys icia n s wh o h a d t h en died in t h e St a t e, t h e
a ges of 490 wer e kn own , a n d t h ey a ver a ged 57.35 yea r s : 35 in ea ch 100
a t t a in ed t h e a ge of 70. For t h e s even yea r s pr ior t o Ma y, 1849, t h er e died 95
member s of t h e Ma s s a ch u s et t s Medica l Societ y, wh os e a ggr ega t e a ges
a mou n t ed t o 5,428, a ver a gin g 57.13 yea r s . Th e a bs t r a ct of t h e Regis t r a t ion
Repor t s , a s s t a t ed, (p. 87,) gives 55 yea r s a s t h e a ver a ge of 137 ph ys icia n s ,
n on e of wh om r es ided in Bos t on . Th is s h ows a declin e, fr om t h e lon gevit y of
t h e old ph ys icia n s , of over n in e yea r s .
Da vid Ben n et t died in Rowley, Feb. 4,1719, a ged 103 yea r s , 2 mon t h s ,
a n d 3 da ys . He n ever los t a t oot h , an d r et a in ed h is s en s es t o t h e la s t .
Hezekia h Mer ia m, of Wa r d, ,wh o died in 1803, lived wit h h is wife 78 yea r s ,
a n d s h e s u r vived h im. J oh n Cr ocker died in Rich mon d, Ma y 1, 1815. An d
Edwa r d Au gu s t u s Holyoke died a t Sa lem, Ma r ch 31, 1829, a ged 100 yea r s
a n d 7 mon t h s . All t h es e ph ys icia n s lived beyon d t h e a ge of 100 yea r s .
Lawy ers . Les s mea n s a r e a t h a n d t o illu s t r a t e t h e lon gevit y of t h e legal
pr ofes s ion , t h a n t h e t wo ot h er s a bove n ot iced. Th e a ges of 52 a r e given in
t h e Qu a r t er ly Regis t er , (Vol. XII,p. 47,) a mou n t in g t o 2,428 in t h e a ggr ega t e,-
a ver a gin g 46.68 yea r s . Fift y-t h r ee a r e given , (p. 87,) wh os e a ver a ge a ge wa s
55.47. It wou ld s eem t h a t t h ey lived r a t h er a les s n u mber of yea r s t h a n
t h os e belon gin g t o eit h er of t h e ot h er pr ofes s ion s ;t h ou gh t h e n u mber of
obs er va t ion s is t oo s ma ll t o fou n d t h er e on a cor r ect opin ion .
Th e Regis t r a t ion Repor t s con t a in a n a bs t r a ct of t h e n u mber a n d a ges of
a ll over 20 yea r s , wh os e occu pa t ion s a re s pecified in t h e r et u r n s . We s elect
a n d combin e t h e fa ct s in a ll t h e r epor t s , r ela t in g t o t h e followin g
occu pa t ion s , a s fu r t h er illu s t r a t ion s :-

OCCUPATIONS AND DOMESTIC CONDITION

Oc c u pa t i on s
Agg.
Age
Avg
Age Oc c u pa t i on s
Agg.
Age
Avg
Age
4737 Fa r mer s
313, 6
06
64. 8
9 46 Ba ker s 1, 961 46. 69
39 Ha t t er s 2, 293
58. 7
9 81
Ca bin et -
ma ker s 3, 629 44. 80
110 Cooper s 6, 313
57. 3
9 73 St on e-cu t t er s 3, 246 44. 46
114 Cler gymen 6, 457
56. 6
4 17
Pa per -
ma ker s 753 44. 29
55 La wyer s 2, 940
55. 4
7 902 Sh oe-ma ker s
39, 16
9 43. 41
137 Ph ys icia n s 7, 535
55. 0
0 1609 La bor er s
68, 85
8 42. 79
287 Bla cks mit h s
15, 63
9
54. 4
9 1061 Sea men
45, 07
0 42. 47
613 Ca r pen t er s
31, 36
6
51. 1
6 110 Pain t er s 4, 657 42. 36
55
323 Mer ch a n t s
16, 38
6
50. 7
3 138 Fis h er men 5, 745 41. 63
65
Ta n n er s a n d
Cu r r ies 3, 244
49. 9
0 115
Man u fa ct u r er
s 4, 656 40. 48
135 Ma s on s 6, 541
48. 4
5 110 Mech a n ics 4, 095 37. 20
213 Tr a der s 9, 967
46. 7
9 34 Pr in t er s 1, 255 36. 91


Dr . Ca s per i of Ber lin , Pr u s s ia , h a s ca lcu la t ed t h a t t h e a ge of 70 wa s
a t t a in ed by 42 cler gymen in 100, by 29 la wyer s , by 28 a r t is t s , by 27
pr ofes s or s , a n d by 24 ph ys icia n s . Dr . Ma da n , a n En glis h a u t h or , in
compa r in g t h e a ver a ge a ge of celebr a t ed men of differ en t cla s s es , fou n d t h a t
n a t u r a lis t s lived 75 yea r s ; ph ilos oph er s , s cu lpt or s , a n d pa in t er s , 70;
la wyer s , 69; ph ys icia n s , 68; a n d cler gymen , 67.
66
Th es e, pr oba bly, h owever ,
wer e s elect lives , a n d n ot t h e wh ole of t h e cla s s es .
Th e inf luence of domes tic cond ition on t h e s a n it a r y welfa r e of t h e people
is s u ppos ed t o be gr ea t ; a n d, t o es t ima t e t h is a ccu r a t ely, t h e a ge a t
ma r r ia ge, a n d t h e a ges a t dea t h of t h e ma r r ied a n d widowed, s h ou ld be
a s cer t a in ed a n d s t a t ed. Fr om t h e Regis t ra t ion Repor t s we a r e en a bled t o give
t h e followin g s t a t emen t s , s h owin g t h e a ge, in Ma s s a ch u s et t s , a t wh ich
12,949 men a n d 12,916 women wer e ma r r ied for t h e fir s t t ime, du r in g t h e
fou r yea r s , 1844 t o 1848 ; a n d a t wh ich 16,060 men a n d 15,969 women
wer e ma r r ied a t a ll t imes , (in clu din g fir s t , s econ d, a n d s u bs equ en t
ma r r ia ges , ) du r in g t h e s a me per iod. To r en der t h e s t a t emen t s t ill mor e
in t er es t in g, we h a ve in s er t ed s imila r fa ct s con cer n in g ma r r ia ges gen er a lly in
En gla n d, a n d fir s t ma r r ia ges in Belgiu m ;-


Fi r s t i n
Ma s s a c h u s e t t s
All i n
Ma s s a c h u s e t t s
All i n En gla n d Fi r s t i n
Be lgi u m
Age s
Males Female
s
Males Female
s
Males Female
s
Males Femal
es
Under
20
249 3, 688 257 3, 909 537 2, 711 757 2, 685
20 to
25
6, 493 6, 764 6, 790 7, 475 10, 38
3
10, 424 4, 530 6, 966
25 to
30
4, 654 1, 934 5, 283 2, 545 5, 103 3, 951 9, 420 8, 067
30 to
35
1, 052 373 1, 551 828 1, 900 1, 498 5, 497 3, 841
35 to
40
346 100 775 481 944 739 2, 488 1, 719
40 to
45
86 35 462 282 603 532 1, 000 653
45 to
50
39 11 320 201 371 273 340 225
50 to
55
26 6 220 117 271 161 137 76
55 to
60
2 3 146 67 147 69 56 27

66
Trait'e D' Hy giene Publique et privee; par Michel Levy : tom.II, p.737. Annales D' Hy giene, tom.XIV
56
Over
60
2 2 256 64 178 79 72 38
All
ages
12, 94
9
12, 916 16, 06
0
15, 969 20, 43
7
20, 437 24, 29
7
24, 297
Averag
e age
25. 71 22. 61 28. 27 24. 5 27. 3 25. 35 29. 47 27. 47


Fr om t h is s t a t emen t , it a ppea r s t h a t t h e a ver a ge a ge a t wh ich men
ma r r y, for t h e fir s t t ime, in Ma s s a ch u s et t s , is 25.71 yea r s ; a n d women ,
22.61 yea r s . In En gla n d, t h e fir s t ma r r ia ge of men is a t 25.45 yea r s , a n d of
women a t 24.3.0; a n d in Belgiu m of men a t 29.47, a n d of women a t 27.43.
Th is s h ows t h a t t h er e is a differ en ce in t h e a ges a t wh ich fema les ma r r y,
bet ween Ma s s a ch u s et t s a n d En gla n d, of n ea r ly t wo yea r s ; a n d bet ween
Ma s s a ch u s et t s a n d Belgiu m, of five yea r s . Th e a ver a ge a ge of a ll ma r r yin g in
Ma s s a ch u s et t s , ( eit h er fir s t or s u bs equ en t ma r r ia ges ,) is , of men , 28.27
yea r s , a n d of women , 24.50; a n d in En gla n d, of men , 27.30, a n d of women ,
25.35.
Th e la s t fou r Regis t r a t ion Repor t s give t h e n u mber , a ggr ega t e a ges , a n d
a ver a ge a ge, of a ll per s on s over 20 yea r s , wh o, a ccor din g t o t h e r et u r n s , died
u n ma r r ied, ma r r ied, a n d widowed; a n d s epa r a t ely of ma les a n d fema les .
Combin in g t h es e fa ct s , we obt a in t h e followin g r es u lt s :-


By compa r in g t h is r ema r ka ble s t a t emen t wit h t h e a ver a ge a ge a t fir s t
ma r r ia ge, (s ee pa ge 88,) a n d dedu ct in g t h a t a ge fr om t h e a ge a t wh ich
per s on s die in t h e ma r r ied con dit ion , we obt a in t h e a ver a ge len gt h of t h e
ma r r ied life; a n d fin d it t o be,-of men , 28.90 yea r s , a n d of women , 22.16 !
An d by dedu ct in g t h e a ver a ge a ge of t h os e wh o died in ma r r ia ge fr om t h e
a ver a ge a ge of t h os e wh o died in widowh ood, we obt a in t h e a ver a ge len gt h of
t h e per iod of widowh ood; a n d fin d it t o be,-of men , women , 28.90 yea r s !
67

Th e inf luence of dis eas e is t h e mos t impor t a n t t es t of t h e Sa n it a r y
con dit ion of t h e St a t e. We h a ve a ccordin gly pr epa r ed t h e a ccompa n yin g
t a ble, (pp. 90, 91, 92,) t o illu s t r a t e t h is pa r t of ou r s u bject . It con t a in s t he

67
Some interes ting inf ormation concerning the domes tic cond ition of the population of Bos ton may be f ound in the Cens us
Report f or 1845, pp. 57-63. The length of married lif e in the living ind ividuals is there s tated at 12.50 y ears .

Ma le s
Fe m a l
e s
Nu mber t h at died u n ma r r ied 1, 655 1, 984
Th eir a ggr ega t e a ges
59, 29
2 90482
Th eir aver age age 35. 82 45. 60
Nu mber t h a t died in t h e ma r r ied con dit ion 4, 920 5373
Th eir a ggr ega t e a ges
268, 7
25
240, 56
9
Th eir a ver a ge a ge 54. 61 44. 77
Nu mber t h a t died in t h e widowh ood 1, 051 2909
Th eir a ggr ega t e a ges
77, 72
0
21431
8
Th eir a ver a ge a ge 73. 94 73. 67
57
n u mber of dea t h s in Bos t on , by ea ch kn own ca u s e, for t h e 39 yea r s ,-1811-
1849, in clu s ive,
68
divided in t o fou r per iods ; a n d t h os e in t h e r ema in der of
t h e St a t e, for t h e s even yea r s ,- 1842-1848, Cover ed by t h e r egis t r a t ion
r epor t ; a n d t h e pr opor t ion per cen t . t h a t t h e n u mber by each kn own ca u s e
bea r s t o a ll t h e ca u s es , in t h e r es pect ive per iods . Th er e ma y be, a n d
u n dou bt edly a r e, s ome er r or s in t h e r et u r n s fr om wh ich t h is t a ble is
compiled, a n d a llowa n ces s h ou ld t h er efor e be ma de; bu t a dmit t in g ou r da t a
t o be gen er a lly cor r ect , it will a ffor d t h e mea n s of ju dgin g, a ppr oxima t ely, if
n ot wit h en t ir e a ccu r a cy, of t h e compa r a t ive pr eva len ce of t h e differ en t
dis ea s es .
69
Th e dis ea s es a r e cla s s ified a ccor din g t o t h e pla n r ecommen ded
by t h e Regis t r a r Gen er a l of En gla n d. Th e t a ble r ela t es t o 571,948 s pecified
ca u s es of dea t h in Bos t on , An d 57,484 ou t of Bos t on ; a n d t h ey a r e divided
in t o t welve ca u s es , t o ea ch of wh ich we pr opos e t o a llu de.

Fatal Dis eas e and Caus es of Death In Mas s achus etts

St a t e. Per
Ct .
Dea t h s in Bos t on in 39 yea r s
7
yea r s
.
1842
t o
In
s t a t
e. &
yea r
s
184
2
t o18
48
Per Cen t age in Bos t on
181
0
182
0
1830 1840 1848 183
0 t o
182
0 t o
181
0
t o t o
183
0
t o t o
1849
184
0
183
0
t o
182
0
183
0
1840
Ca u s es of
Dea t h .

184
0 t o
184
9
182
0
7, 52
2
9, 55
1
15, 07
7
25, 79
5
57, 48
4
Specified
Ca u s es ,
100 100 100 100 100
1, 19
2
2, 03
7
4, 155 8, 148 15, 83
9
1. Zymot ic
Dis eas es ,
Spor a dic
dis eas es of
27. 5
5
31. 5
9
27. 5
6
21. 3
2
15. 8
5
2, 20
4
1, 58
4
2, 121 3, 606 7, 467 2. Un cer t a i
n Sea t
12. 9
9
13. 9
8
14. 0
7
16. 5
8
29. 3
562 980 1, 717 2, 391 5, 200 3. Ner vou s
Or ga n s
9. 05 9. 27 11. 3
9
10. 2
6
7. 47

68
Errors are s ometimes made by beginners in s tatis tical inquiries , in divid ing ages and periods of time; and it may be
well to s tate what we unders tand to be correct method. When we s ay from " 20 to 30", we mean, f rom the end of the 20th
y ear, or f rom the begining of the 21s t, to the end of hte 30th, not the 29th. It is not 30 until that y ear is completed. "21-30"
has the s ame meaning; the das h ind icating that the y ears , at each end of it, -21 and 30, - are included; not f rom 21 to
30, or 21 to 30, which would exclude 21. When "to"is us ed between the numbers , it is unders tood to mean f rom one to
the other; and hence it has a d ifferent meaning from the das h. So the period 1811-1820 means , from the beginning of the
y ear 1811 to the end of 1820, and has teh s ame meaning as f rom 1810 to 1820. From 20 to 30, and other d ivis ions , are
s ometimes written in the f orm of a fraction, theus ,20/ 30; or thus ,-25-, giving th enumber intermediate between the two
periods . The middle of the Century is the end of the moment when the 50th y ear ends , and before the 51s t begins .
69
Though this method of comparing dis eas es with the d is eas es is interes ting, y et it has its imperfections . It is more
correct when means exis t to compare the number of deaths by each d is eas e with the number of the living inhabitants .
We are able at pres ent, however, to mak e s uch a comparis on in few places in Mas s achus etts , bes ide Bos ton.
58
2, 46
0
2, 80
2
3, 611 5, 778 17, 01
0
4. Res per at i
ve Or ga n s
29. 5
9
22. 4 23. 9
5
29. 3
3
32. 7
24 90 215 446 1, 105 5.
cir cu la t ive
or ga n s
1. 92 1. 73 1. 43 0. 94 0. 32
228 645 1, 236 3, 105 2, 814 6.
Diges t ive
Or ga n s
4. 9 12. 2
1
8. 2 6. 75 3. 03
9 30 22 77 261 7.
Ur a n a t ive
or ga n s
0. 45 0. 3 0. 14 0. 31 0. 12
64 132 214 408 654 8.
Gen er a t ive
or ga n s
1. 14 1. 58 1. 42 1. 38 1. 85
26 61 76 136 292 9.
Locomot ive
or ga n s
0. 51 0. 53 0. 5 0. 64 0. 35
3 17 30 61 92 10.
In t egu men
t ive Or ga n
0. 16 0. 23 0. 2 0. 18 0. 04
379 420 645 635 4414 11. Old age 7. 68 2. 46 4. 28 4. 4 5. 04
371 756 1035 939 2336 12. Violen t
Ca u s es
4. 06 3. 72 6. 86 7. 91 4. 93
752
2
955
4
1507
7
2579
5
5748
4
Tot a ls 100 100 100 100 100
103 60 164 724 299 0. 52 2. 81 1. 09 0. 63 1. 37
19 89 198 473 1042 1. 81 1. 83 1. 98 0. 93 0. 25
43 245 415 681 1387 2. 41 2. 64 2. 75 2. 57 0. 57
4 66 52 320 677 1. 18 1. 24 0. 34 0. 59 0. 06
111 363 390 955 2413 4. 2 3. 7 2. 59 3. 8 1. 48
1 12 74 202 5719 0. 99 0. 78 0. 49 0. 13 0. 01
110 133 124 167 - - 0. 65 0. 82 1. 39 1. 47
2 5 13 7 13 0. 02 0. 03 0. 09 0. 05 0. 03
13 6 - - 35 0. 06 - - 0. 06 0. 17
623 458 680 1664 5222 9. 09 6. 45 4. 51 4. 79 8. 28
728 184 326 344 513 0. 89 1. 33 2. 16 1. 93 1. 04
5 7 72 60 192 0. 33 0. 23 0. 48 0. 07 0. 06
28 332 341 387 417 0. 73 2. 28 2. 26 3. 48 0. 37
30 48 972 1500 2933 5. 1 5. 82 6. 45 0. 5 0. 4
6 8 214 345 106 0. 19 1. 34 1. 42 0. 08 0. 08
16 17 17 20 7 0. 01 0. 08 0. 11 0. 18 0. 21
- 4 3 99 12 0. 02 0. 38 0. 02 0. 04 -
119
2
203
7
4155 8148 15 27. 5
5
31. 5
9
27. 5
6
21. 3
2
15. 8
5
13 37 40 50 839 0. 12 0. 19 0. 27 0. 39 0. 17
61 36 211 518 70 0. 36 2. 01 1. 4 0. 38 0. 81
32 58 103 144 204 1. 23 0. 36 0. 68 0. 61 0. 42
44 82 132 266 706 0. 28 1. 03 0. 88 0. 86 0. 58
193 237 321 428 163 2. 47 1. 66 2. 12 2. 48 2. 57
12 8 4 1 1420 0. 03 0. 03 0. 03 0. 08 0. 01
6
23 10 21 77 16 0. 34 - 0. 14 0. 1 0. 31
158
7
883 983 1738 198 6. 41 6. 74 6. 52 9. 24 21. 1
- 26 35 5 3687 26. 2
6
0. 02 0. 23 0. 27 -
59
- - 2 - 152 0. 07 - 0. 01 - -
69 77 65 33 38 0. 62 0. 13 0. 43 0. 81 0. 92
14 35 72 111 359 0. 39 0. 43 0. 48 0. 47 0. 19
153 83 96 127 222 0. 23 0. 49 0. 64 0. 87 2. 03
3 12 36 108 130 0. 18 0. 42 0. 24 0. 12 0. 04
220
4
158
4
2121 3606 102 12. 9
9
13. 9
8
14. 0
7
16. 5
8
29. 3
109 107 188 188 7467 1. 02 0. 73 1. 25 1. 12 1. 45
22 73 98 130 586 0. 77 0. 5 0. 65 0. 76 0. 29
239 309 479 602 440 2. 16 2. 33 3. 18 3. 24 3. 18
- 38 72 64 1240 0. 13 0. 25 0. 48 0. 4 -
- 12 10 22 75 0. 13 0. 09 0. 07 0. 13 -
86 270 554 947 77 2. 12 3. 67 3. 67 2. 83 1. 14
14 22 20 17 1220 0. 23 0. 07 0. 13 0. 23 0. 19
80 113 132 205 131 1. 66 0. 79 0. 87 1. 18 1. 06
7 6 9 10 953 0. 07 0. 04 0. 06 0. 06 0. 09
5 30 `155 206 42 0. 76 0. 8 1. 03 0. 31 0. 07
562 980 1717 2391 5200 9. 05 9. 27 11. 3
9
10. 2
6
7. 47

1. Th e Zymot ic,
70
or epidemic, en demic, a n d con t a giou s dis ea s es , or
ca u s es of dea t h . Th e ext en t t o wh ich t h es e dis ea s es pr eva il is t h e gr ea t in dex
of pu blic h ea lt h . Wh en t h e pr opor t ion is compa r a t ively s mall, t h e con dit ion
of pu blic h ea lt h is fa vor a ble; wh en la r ge, it is u n fa vor a ble. If, a s a cla s s ,
t h es e dis ea s es a r e fou n d t o decr ea s e, it mu s t be in fer r ed t h a t t h e gen er a l
h ea lt h of t h e people is impr ovin g ; if ot h er wis e, t h a t it is gr owin g wor s e. Let
u s look a t t h e t a ble, a n d s ee h ow, s t a n d t h e fa ct s .
It a ppea r s , by a n in s pect ion of t h e r igh t -h a n d colu mn s , t h a t in Bos t on , in
t h e fir s t per iod, 15.85 per cen t . of t h e cau s es of dea t h wer e in t h is cla s s ; in
t h e s econ d per iod, 21.32 per cen t .; in t h e t h ir d per iod, 27. 56 per cen t .; a n d
in t h e fou r t h per iod, 31.59 per cen t ; s h owin g t h e r ema r ka ble fa ct , t h a t t h es e
ca u s es of dea t h h a ve dou bled in t h e cit y wit h in t h e la s t t h ir t y yea r s , a n d
t h a t t h e pu blic h ea lt h h a s been con s t a n t ly gr owin g wor s e. In t h e cou n t r y,
t h e pr opor t ion is 27. 55 per cen t .;-n ea r ly t h e s a me a s it wa s in Bos t on in t h e
per iod, 1830 t o 1840,-a mor e u n fa vor a ble con dit ion t h a n h as been gen er a lly
s u ppos ed t o exis t . By a n in s pect ion of t h efa ct s con cer n in g t h e differ en t
dis ea s es of t h is cla s s , it will a ppea r t h at n ea r ly a ll of t h em h a ve s omewh a t
in cr ea s ed ; bu t t h os e wh ich exh ibit t h e gr ea t es t differ en ce, a r e dys en t er y,
ch oler a in fa n t u m, a n d ot h er dis ea s es of t h e diges t ive or ga n s , a n d
s ca r la t in a ,-dis ea s es wh ich pr es s mos t h ea vily u pon in fa n cy a n d ch ildh ood.
Scarlatina, t h a t dr ea dfu l en emy of t h e you n g, h a s in cr ea s ed fr om 30, in t h e
per iod 1810 t o 1820, t o 972 a n d 1500, in t h e per iods 1830 t o 1840, a n d
1840 t o 1849 ;. or fr om for t y h u n dr edt h s of on e per cen t . t o 6.45 a n d 5.82
per cen t . ! Th is dis ea s e, a ls o, is t h e s econ d of t h e cla s s in fa t a lit y in t h e
cou n t r y ! Sma ll-pox, t oo, h a s in cr ea s ed, in t h e s a me t ime, fr om 6 t o 345, or
fr om .08 t o 1.34 per cen t . ! It is n ot cr edit a ble t o t h e a ge t h a t it h a s
per mit t ed t h a t dis ea s e t o s la y n ea r ly h a lf a s ma n y per s on s in t h e .fir s t fou r
mon t h s of t h e pr es en t yea r , 'a s it did in t h e gr ea t epidemic of 1792, befor e
t h e pr even t ive r emedy of va ccin a t ion wa s kn own Typh u s fever (u n der wh ich

70
This and s everal other med ical terms will be explained in the appendix.

60
is in clu ded t yph oid, n er vou s , a n d con t in u ed fever s ) does n ot s eem t o exh ibit
a compa r it ive in cr ea s e in Bos t on , t h ou gh a lwa ys a for mida ble dis ea s e; bu t in
t h e cou n t r y it is t h e lea din g dis ea s e of t h is cla s s . It is mos t fa t a l in
Sept ember a n d Oct ober . In s ome kn own loca lit ies , in s ome kin ds of s ea s on s ,
it is a lmos t s u r e t o ma ke it s a ppea r a n ce. Th a t 9.09 ou t of ever y 100 dea t h s ,
in t h e cou n t r y t own s , s h ou ld be pr odu ced by t h is fever , is a fa ct t h a t s h ou ld
a r r es t a t t en t ion t o a s cer t a in it s ca u s e a n d t h e mea n s of pr even t ion . Th e
in for ma t ion wh ich ma y be der ived fr om a mor e pa r t icu la r exa min a t ion of t h e
t a ble, will compen s a t e for devot in g mor e t ime t o it . Wh en t h e Regis t r a t ion
Repor t for 1849 is pu blis h ed, it will pr oba bly s h ow a la r ge in cr ea s e in mos t
of t h e' zymot ic dis ea s es .
2. In t h e Dis eas es of Uncertain Seat, t h e gr ea t es t n u mber a ppea r a ga in s t
in fa n t ile ; a n d t h er e is a n a ppea r a n ce of a pr opor t ion a l decr ea s e" in Bos t on ,
s in ce 1811-1820. Bu t t h is s h ou ld be a s cr ibed pa r t ly t o mor e a ccu r a t e
r ecor ds , wh ich h a ve t r a n s fer r ed ot h er defin it e ca u s es , s ome wh ich wer e
pr eviou s ly en t er ed u n der t h e in defin it e t er m, in fa n t ile. For t h e s a me r ea s on ,
t h e n u mber s h ou ld be s t ill fu r t h er r edu ced. Drops y a n d Cancer s eem t o be
t h e mos t pr omin en t dis ea s es . Abou t on e-eigh t h of a ll t h e dea t h s in Bos t on ,
a n d in t h e St a t e, for t h e la s t n in e yea r s , h a ve been a s s ign ed t o t h is cla s s .
3. Th e Dis eas es of the Nervous Organs h a ve pr eva iled in a bou t t h e s a me
pr opor t ion a t t h e differ en t per iods . Th e a n n u a l n u mber of dea t h s by
Hy drocephalus , wh ich pr in cipa lly a ffect s ch ildr en s u r r ou n ded by ba d
s a n it a r y in flu en ces , h a s n ea r ly dou bled in Bos t on wit h in t h e la s t t h ir t y
yea r s .
4. Th e Dis eas es of the Res piratory Organs fu r n is h on e of t h e la r ges t
cla s s es of ca u s es of dea t h ; a n d, in t h is cla s s , con s u mpt ion a n d pn eu mon ia
(in fla mma t ion of t h e lu n gs , or lu n g fever ) a r e pr eemin en t .
Cons umption, t h a t gr ea t des t r oyer of h u ma n h ea lt h a n d h u ma n life, t a kes
t h e fir s t r a n k a s a n a gen t of dea t h ; a n d a s s u ch we deem it pr oper t o a n a lyze
mor e pa r t icu la r ly t h e cir cu ms t a n ce u n der wh ich it oper a t es . An y fa ct s
r ega r din g a dis ea s e t h a t des t r oys one-s eventh t o one-f ourth of a ll t h a t die,
ca n n ot bu t be in t er es t in g. We h a ve compiled t h e followin g t a ble, t o illu s t r a t e
t h e in flu en ce of t h e s ea s on s u pon t h is dis ea s e. Th e Regis t r a t ion Rea dmit of
cla s s ifyin g t h e s exes for fou r yea r s on ly. Th e mon t h s a r e given for bot h
s exes , in a ll t h e r epor t s . We h a ve a dded Bos t on for 1849,-t h e on ly yea r in
wh ich t h e a bs t r a ct s pecify t h e mon t h s ,-a n d New Yor k for s ix yea r s :---

Ma s s a ch u s et t s except
Bos t on
New
Yor k
4 yea r s 1845-
1848.
6
yea r s .
1888-
1848.
Bot h
s exes
Mon t h s
7
yea r s .
1842-
1848.
Bot h
s exes
Male Fema le
Bos t o
n
1year -
1849

J a n u a r y 1, 113 273 446 68 888
Febr u ar y 1, 134 296 439 43 865
Mar ch 1248 317 484 57 923
Apr il 1242 306 484 75 916
May 1195 273 463 50 799
61
J u n e 1084 270 410 49 711
J u ly 1159 302 434 62 698
Au gu s t 1197 315 474 56 718
Sept ember 1270 315 498 45 754
Oct ober 1198 286 470 34 766
November 1060 277 417 50 690
December 1127 272 439 65 751

Tot a l 3502 3502 5458 654 9471

Win t er 3495 886 1369 168 2676
Spr in g 3521 849 1357 174 2427
Su mmer 3626 932 1406 163 2161
Au t u mn 3385 835 1326 149 2207


Th is s t a t emen t s h ows t h a t , in t h is St a t e, t h e s ea s on s do n ot exer cis e
mu ch in flu en ce u pon t h e dis ea s e, es pecia lly in it s t er min a t in g per iod. As in
ot h er dis ea s es , t h e la r ges t n u mber of dea t h s occu r in Sept ember ;t h ou gh in
Ma r ch a n d Apr il t hey a r e n ea r ly t h e s a me. In November , a n d t h e a u t u mn
qu a r t er , t h e s ma lles t n u mber occu r . Th is s eems t o be t h e gen er a l la w in New
Yor k a n d Lon don , a s well a s in Ma s s a ch u s et t s . It h a s been s u ppos ed,
h owever , t h a t in n o s ea s on a r e t h e s eeds of t h e dis ea s e mor e ext en s ively
pla n t ed t h a n in t h e a u t u mn a n d win t er . Spr in g h a s u s u a lly been con s ider ed
t h e mos t u n fa vor a ble, t h ou gh a ccu r a t e s t a t is t ica l in ves t iga t ion does n ot
pr ove it . Th e du r a t ion of t h e dis ea s e va r ies ver y mu ch in differ en t per s on s
a n d u n der differ en t cir cu ms t a n ces ; a n d dea t h ma y t a ke pla ce in a n y mon t h,
wit h ou t r efer en ce t o t h e t ime of it s commen cemen t . It wou ld be u s efu l t o
lea r n t h e in flu en ce of t h e s ea s on s u pon t h e ca u s es , r a t h er t h a n t h e
t er min a t ion , of t h is dis ea s e.
Age a n d s ex h a ve a gr ea t er in flu en ce, in modifyin g t h e oper a t ion s of t h is
dis ea s e, t h a n t h e s ea s on s , a s will a ppea r fr om t h e followin g s t a t emen t s ,
r ela t in g t o t h is St a t e, a n d t o t h e cit ies of New Yor k, Ph ila delph ia , a n d
Lon don :-

Ma s s a ch u s et t s

4 yr s 1845-
48
New Yor k
Cit y 6 year s
1838-1843
New Yor k
St a t e . 2 yea r
1847, 1848
Male
110
Ph ila delph
ia . 10
yea r s
1836-45
bot h s exes
Lon don 4
yea r s
Ages
7
yea r
s
1842
-
1848
Bot h
s exe
s
Mal
e
Fema l
e
Mal
e
Fema l
e
Mal
e
Fema l
e

Male Fema l
e
Un d
er 1
396 172 151 110 93 116 144 240 593 583
1 t o
2
255 97 79 123 119 87 82 194 491 525
2 t o
5
208 65 79 157 136 84 70 247 344 378
62
Un d
er 5
859 334 309 390 348 287 296 681 1428 1486
5 t o
10
192 62 82 107 101 56 74 142 350 439
10 t o
15
304 68 142 52 82 48 110 102 263 389
15 t o
20
1065 182 518 518 245 146 367 405 757 895
20 t o
30
3368 708 1409 959 1165 631 1010 2124 3199 1367
30 t o
40
2412 567 945 106
5
949 417 572 1815 3478 2999
40
t o 50
1649 431 610 812 498 339 372 1180 2819 2004
50 t o
60
1241 338 453 443 254 289 302 592 1644 1027
60 t o
70
1239 364 423 260 163 257 286 405 723 471
70 t o
80
1062 310 365 67 79 220 206 183 145 86
Over
80
320 79 128 37 27 86 71 37 18 11
Tot a l 1371
1
344
3
5384 435
0
3911 277
6
3720 7666 1482
4
1296
4
Un d
er 15
1355 464 533 549 531 391 480 925 2041 2314
15 t o
60
9735 222
6
3935 343
7
3111 182
2
2623 6116 1189
7
1009
2
Over
60
2621 753 916 364 269 563 617 625 886 568


Th is impor t a n t t a ble s h ows t h a t t h is dis ea s e t a kes it s s u bject s
pr in cipa lly a t t h e pr odu ct ive per iod of life,-15 t o 60,-t h e mos t pr eciou s a n d
mos t u s efu l s ea s on . In t h e a ges 20 t o 30,- " t h e bea u t y a n d h ope of life,"-fa r
mor e die t h a n a t ot h er a ges . In mor e a dva n ced life, h owever , it s elect s it s
vict ims in n ea r ly t h e s a me pr opor t ion fr om t h e s a me n u mber of livin g
in dividu a ls .
It s eems t o be pa r t ia l, t oo, in t h is St a t e, in it s s elect ion fr om t h e s exes .
It a ppea r s fr om t h e t a ble t h a t , a t , t h e a ges 20 t o 30, t h e n u mber of fema les
wh o die of con s u mpt ion is n ea r ly dou ble t h a t of t h e ma les ,-bein g 1409 of t h e
for mer t o 708 of t h e la t t er . At t h e a ges 30 t o 40, t h e n ext in t h e n u mber of it s
vict ims , it a ls o s elect s fr om t h e s exes in n ea r ly t h e s a me pr opor t ion . Th e
oper a t ion of t h e dis ea s e does n ot s eem t o be t h e s a me in t h e cou n t r y a s it is
in cit ies , a s will a ppea r fr om t h e followin g s t a t emen t :-

Places Bot h
s exes
Males Fema l
es
Pr opor t io
n of ea ch
Ma s s a ch u s
et t s
4
yea r s
8827 343 5384 As 39. 01
t o 60. 99
New Yor k
Cit y
7
yea r s
9606 4938 4668 51. 41
t o 48. 59
63
New Yor k
St a t e
2
yea r s
6715 2827 3888
42. 08 t o
57. 92
Ph ila delph i
a
10
yea r s
7666 3851 3815 50. 23
t o 49. 76
Lon don 4
yea r s
27788 14824 12964 53. 35
t o 46. 65
En gla n d 1
yea r s
52136 24048 28088 46. 13
t o 53. 87

Th es e r ema r ka ble fa ct s s h ow t h a t , wh ile t h e dis ea s e des t r oys mor e
ma les t h a n fema les in t h e cit ies of New Yor k a n d Lon don , it des t r oys n ea r ly
t h e s a me of bot h s exes in Ph ila delph ia In t h e cou n t r y t own s in
Ma s s a ch u s et t s , t h e pr opor t ion of t h e s exes is a s 39.01 ma les t o 60.99
fema les ; in New Yor k, it is a s 42.08 t o 57.92; a n d in En gla n d, except Lon don ,
it is a s 46.13 t o 53.87. A differ en ce a ppea r s in a ll t h e a ges over 20. It wou ld
s eem, fr om t h es e fa ct s , t h a t s ome ca u s es exis t in cou n t r y t own s t o ext en d t h e
dis ea s e a mon g fema les ; wh ile differ en t ca u s es exis t in cit ies , t o a ggr a va t e t h e
dis ea s e in t h e ot h er s ex.
Th e in flu en ce of occupation, place of birth, pers onal habits , and
hered itary tendency , is wor t h y of in ves t iga t ion , bu t it is h er e omit t ed.
71

We n ext des ir e t o a s cer t a in t h e in flu en ce of loca lit y on t h e dis ea s e; a n d
for t h is pu r pos e h a ve compiled t h e followin g s t a t e men t , s h owin g it s
pr eva len ce in ea ch cou n t y in t h e St a t e, in t h e per iod,1842-1848. We h a ve
a r r a n ged t h e cou n t ies in t o fou r divis ion s : t h e fou r wes t er n ; t h e t h r ee middle;
t h e s ix ea s t er n a n d s ou t h er n ) bor der in g on t h e ocea n , expos ed t o t h e ea s t er ly
win ds ; a n d t h e met ropolis . In ea ch we h a ve given t h e wh ole n u mber of dea t h s
by a ll ca u s es , a n d t h e n u mber by con s u mpt ion ) a n d t h e pr opor t ion t h e la t t er
bea r s t o t h e for mer :
72

Pla c e s Pe r i ods All
c a u s e
s
Con s u mpt i
on
In
1 0 0
1 i n
Ber ks h ir e 7
yea r
s
1842
-
1848
3055 559 18. 29 5. 43
Fr a n klin 2270 492 21. 67 4. 61
Ha mps h ir
e
3226 672 20. 83 4. 8
Hampden 3252 675 20. 75 4. 81
Tot a l 1 1 8 0
3
2 3 9 8 2 0 . 3 1 4 . 9 2
Wor ces t er 7
yea r
s
1842
-48
11269 2373 21. 05 4. 74
Middles ex 12564 2584 20. 56 4. 87

71
See s ome interes ting inf ormation on this s ubject, in Annales D'Hy giene Publique,tom.
Xl,p.5.
72
In this s tatement are included 5,935 deaths , -about one-tenth of the whole, - returned without a s pecif ied caus e. Some
of thes e were by cons umption. If they had been included, it would have given an increas ed proportion to this d is eas e. It is
probably really larger than here repres ented. The s till-born deaths are excluded from all tables in this work , as they
s hould alway s be in es timating relative mortality .

64
Nor folk 5049 1028 20. 36 4. 91
Tot a l 2 8 8 8
2
5 9 8 5 2 0 . 7 2 4 . 8 2
Es s ex 7
yea r
s
1842
-48
10721 2578 24. 04 4. 15
Plymou t h 3680 802 21. 79 4. 58
Ban s t a ble 2441 622 25. 48 3. 92
Br is t ol 4599 972 21. 13 4. 73
Du kes &
Nan t u cket
1489 359 24. 11 3. 87
Tot a l 2 2 9 3
0
5 3 3 3 2 3 . 2 5 4 . 2 9
St a t e,
exclu s ive
of Bos t on
7
yea r
s
1842
-
1848
63615 13716 21. 08 4. 63
Bos t on 10
yea r
s
1810
t o
1820
8470 1891 23. 22 4. 47
1820
t o
1830
11470 2054 17. 82 5. 58
1183
0 t o
1840
16414 2306 14. 01 7. 11
9
yea r
s
1840
t o
1849
26127 3795 14. 1 6. 88
Sa lem 5 1768
t o
1773
642 117 18. 22 5. 49
10 1799
t o
1808
1932 483 25 4
10 1818
t o
1828
2178 527 94. 19 4. 13
Lowell 13 1836
t o
1848
6168 929 15. 03 6. 63

It a ppea r s , fr om t h is s t a t emen t , t h a t t h e pr opor t ion of dea t h s in t he
fou r wes t er n cou n t ies , by con s u mpt ion , does n ot va r y mu ch fr om t h a t on t h e
s ea -coa s t ; a fa ct t h a t h a s been s u ppos ed n ot t o exis t . In Su ffolk a n d
Middles ex Cou n t ies , dis ea s es a ffect in g t h e diges t ive or ga n s pr eva il in gr ea t er
pr opor t ion s t h a n in ot h er pa r t s of t h e St a t e; a n d t h is fa ct will pr odu ce a n
a ppa r en t ly les s n u mber in t h e pr opor t ion by con s u mpt ion .
It t h u s a ppea r s t h at t h is dr ea dfu l dis ea s e is a con s t a n t vis it or in a ll
pa r t s of ou r Common wea lt h ,-on t h e mou n t a in s of Ber ks h ir e, a n d in t h e
va lley of t h e Con n ect icu t , a s well a s a lon g t h e s ea -coa s t . Th e occa s ion a l vis it
of t h e ch oler a , or s ome ot h er epidemic dis ea s e, cr ea t es a la r m, a n d
pr eca u t ion a r y mea s u r es a r e a dopt ed for pr even t ion . Bu t wh er e is t h e a la rm
a n pr eca u t ion a ga in s t a mor e in exor a ble dis ea s e, wh ich , in t h is St a t e, in
ever y da y in ever y yea r , depr ives mor e t h a n s even h u ma n bein gs of t h eir
lives ? Over t h is dis ea s e cu r a t ive s kill h a s lit t le or n o power . It gen er a lly goes
65
on , fr om it s commen cemen t t o it s t er min a t ion , u n con t r olled a n d
Un con t r olla ble by a n y r emedies a s yet dis cover ed. Ch oler a , t yph u s ,
s ca r la t in a , t h ou gh t er r ible in t h ems elves , wh en compa r ed wit h t h is dis ea s e,
a r e fa r les s s o in fa t a lit y. But it may be avoided, befor e it a t t a cks . It s on s et
a n d it s developed men t ma y be pr even t ed. An d if it is ever t o be a melior a t ed
or er a dica t ed, it ca n on ly be don e by pr even t ion , a n d n ot by cu r e. Ma y t h e
people be wis e in t ime t o lea r n t h e ca u s es a n d a pply t h e pr oper r emedies t o
a ver t t h is gr ea t es t of ca la mit ies ,-t h e in va s ion of con s u mpt ion !
Th e a ver a ge popu la t ion of Bos t on , in t h e per iods , t h e t a ble, wa s , in
1810-1820, 38,642; in 1820 t o 1830, 52, 345; in 1830 t o 1840, 73,196; a n d
in 1840 t o 1849, 111,429 Th e dea t h s by con s u mpt ion in t h os e per iods wer e
1,891 ; 2,054; 2,306, a n d 3,795 ; or , a n a n n u a l a ver a ge pr opor t ion of 1
dea t h in 204 livin g per s on s in t h e fir s t , 1 in 254 in t h e s econ d, 1 in 317 in
t h e t h ir d, a n d 1 in 264 in t h e fou r t h ; s h owin g a compa r a t ive declin e fr om
1810-1820 t o 1830-1840, bu t a n in cr ea s e s in ce t h a t per iod. In New Yor k, for
t h e s ix yea r s 1838-'43, t h er e wa s , on t h e a ver a ge, a n n u a lly, on e dea t h by
con s u mpt ion t o 194 in h a bit a n t s ; in Ph ila delph ia , in t h e t en yea r s , 1836-'45,
1 in 284; a n d in Lon don , in t h e fou r yea r s , 1838-'42, 1 in 205.
We s u bjoin s ome a ddit ion a l fa ct s r es pect in g t h is dis ea s e in pla ces
wit h ou t t h is Common wea lt h :-

Pla c e s Pe r i od
s
All c a u s e s Con s u mpt i
on
In
1 0 0
1 i n
Por t s mou t h , N. H
. ,
19
yea r s
1801-
11
2, 367 471 19. 81 5. 02
1829,
30
3
32,
329 72 21. 88 4. 58
Pr oviden ce 5 1841-
45,
3, 032 718 23. 68 4. 22
New Yor k cit y 10 1811-
20
25869 6061 22. 4 4. 27
10 1831-
40
42816 8010 18. 7 5. 34
10 1841-
45
68965 13415 19. 45 5. 14
5 1847,
48
43084 7437 17. 28 5. 79
Cou n t y 2 1811-
20
242378 6715 25 4
Ph ila delph ia 10 1821-
30
23582 3629 15. 38 6. 49
10 1831-
40
37914 5522 14. 56 6. 86
10 1841-
45
49678 7070 14. 23 7. 02
5 1821-
30
27238 3959 14. 53 6. 88
Ba lt imor e 10 1831-
40
18099 2810 15. 52 6. 44
10 1841-
15
23878 3778 15. 82 6. 32
66
5 1822-
30
12618 2450 19. 41 5. 15
Ch a r les t own ,
S.C.
9 1831-
40
7523 1139 15. 14 6. 6
10 1841-
45
6663 968 14. 63 6. 88
5 1838-
42
2974 475 15. 97 6. 26
ENGLAND 5 1840-
47
1734435 297390 16. 1 6. 2
Lon don 8 1840-
47
397871 57047 14. 33 6. 97
8
YEARS
Win t er
Qu a r t e
r s
106713 14581 13. 66 7. 31
8 year s
s pr in g
Qu a r t e
r s
89965 14978 16. 64 6
8 year s
s u mm
er
92538 13927 15. 05 6. 64
8 year s
au t u m
n
108655 13561 12. 48 8. 01
Par is , 4 1816-
19
85339 15375 18. 01 5. 55
Gen eva 2 1844-
45
2936 296 1008 9. 91
HAMBURGH 6 1833-
38
27257 5224 19. 16 5. 22
Ber lin 10 1830-
39
73216 12800 17. 48 5. 71
St u t t ga r d 10 1828-
37
4356 924 21. 21 4. 71

We migh t t h is s t a t emen t , a n d s h ow t h e pr eva len ce of t h is dis ea s e in t h e
milder clima t es of t h e Wes t In dies , a n d on t h e s u n n y s h ores of It a ly ; a n d
demon s t r a t e h ow fr u it les s , gen er a lly, a r e t h e a t t empt s t o a r r es t it s r a va ges .
It is s t a t ed t h a t , "of t h ir t y-five con s u mpt ive pa t ien t s wh o wen t t o Ma deir a in
1821,t wo-t h ir ds died a t s ea ; t h r ee died in t h e fir s t mon t h a ft er t h eir a r r iva l;
five or s ix s u r vived t h e win t er , a n d a bou t t h e s a me n u mber s u r vived t h e
followin g s pr in g ; t h r ee or fou r lived t o t h e s econ d win t er ; bu t , of t h e wh ole
n u mber , t h er e wer e bu t t h ir t een livin g in 1824. Th e gr a ve-ya r ds of Rome,
Na ples , Ma r s eilles , Pis a , Nice, a n d Malt a , bea r a mple t es t imon y t o t h e
fa t a lit y of t h is dis eas e a mon g t h os e wh o h a ve been in du ced t o s eek a for eign
clime in t h e va in h ope of r ecover y .
73

5. Th e Dis eas es of the Circulative Organs a r e pr in cipa lly con fin ed t o
t h os e a ffect in g t h e h ea r t . Th es e s eem t o h a ve in cr ea s ed, bot h in t h e St a t e
a n d in Bos t on . In t he la t t er , fr om .31 t o 1.73,-mor e t h a n 500 per cen t .
6. Th e Dis eas es of the Diges tive Organs embr a ce a ver y la r ge cla s s .
Some ma y be zymot ic or s por a dic, a s cir cu ms t a n ces occu r by wh ich t h ey a r e
developed. Th e zymot ic dis ea s es , a ffect in g t h es e or ga n s , a r e ch oler a , ch oler a
in fa n t u m, dia r r h ea , a n d dys en t er y; a n d t h e pr in cipa l dis ea s es of t h e

73
British and Foreign Medical Review, Vol. XXIV, p.l07.

67
s por a dic cla s s , a s t hey a ppea r in t h e t a bles , a r e en t er it is , or in fla mma t ion of
t h e bowels , t eet h in g, a n d t h e u n defin ed dis ea s e of t h es e or ga n s . Th e wh ole of
bot h cla s s es , in t h e t a ble, ma y be s t a t ed a s follows :-


St a t e Ci t y
Number Proportion Number Proportion
Zy motic
dis eas es
4431 7. 71 2472 9. 68
Sporadic
dis eas e
2814 4. 90 3150 12. 21
Tot a l 7 2 4 5 1 2 . 6 1 5 6 2 2 2 1 . 8 9

Th is s t a t emen t s h ows t h a t t h es e dis ea s es ca u s e 12.61 per cen t . or
a bou t on e-eigh t h , of t h e dea t h s in t h is St a t e, a n d 21.89, or a bou t on e-fift h ,
in Bos t on .
Th e in flu en ce of s ea s on s a n d a ges is gr ea t er in t h es e dis ea s es t h a n in
a n y ot h er cla s s , a s will a ppea r fr om t h e s t a t emen t on t h e n ext pa ge.
Th is t a ble illu s t r a t es , in a r ema r ka ble ma n n er , t h e modifyin g in flu en ces
of t h e s ea s on s a n d a ges u pon t h e dis eas es s pecified. Wh en it is kn own h ow
da n ger ou s t h e mon t h s of J u ly, Au gu s t , Sept ember , a n d Oct ober , a r e t o
ch ildr en , we s h ou ld be es pecia lly t a u gh t t o gu a r d a ga in s t a ll t h e ca u s es
wh ich , a t t h a t t ime, excit e t h es e dis ea s es .


Mon t h s Ch oler
a
Ch oler
a
in fa n t
u m
Dia r r h
ea
Dys en t e
r y
Tot a
l
Ages Ch oler
a
Ch oler
a
in fa n t
u m
Dia r r h
ea
Dys en t e
r y
J a n u ar y 7 4 4 19 34 Un de
r 1
22 469 254 341
Febr u ar
y
3 5 6 8 22 1 t o
2
20 246 122 377
Mar ch 7 6 17 13 43 2 t o
5
14 47 63 372
Apr il 6 7 17 12 42 5 t o
10
8 8 20 119
May 9 10 17 14 50 10 t o
20
11 - 11 86
J u n e 9 19 20 23 71 20 t o
30
14 - 21 97
J u ly 40 93 73 165 371 30 t o
40
17 - 14 69
Au gu s t 72 275 179 544 107
0
40 t o
50
15 - 8 73
Sept emb
er
25 184 170 660 103
9
50 t o
60
23 - 18 73
Oct ober 10 55 65 281 411 60 t o
70
32 - 14 57
Novemb
er
2 19 20 38 79 70 t o
80
20 - 26 75
Decemb
er
6 7 14 20 47 Over
80
17 - 16 42
Tot a l 1 9 6 6 8 4 6 0 2 1 7 9 7 3 2 7
9
Tot a
l
2 1 9 7 7 0 5 8 7 1 7 8 1
68

7. Th e Dis eas es of the Urinary Organs do n ot con s t it u t e a la r ge cla s s ,
a n d in n eit h er per iod a mou n t t o on e per cen t . Gr a vel a n d dia bet es a r e t h e
mos t n u mer ou s of t h e cla s s .
8. Th e Dis eas es of the Generative Organs a r e a ll impor t a n t t h ou gh n ot a
la r ge cla s s . Ca s es of pu er per a l fever a r e cla s s ed u n der t h e dis ea s es of ch ild-
bir t h ; a n d t h ey h a ve been in n ea r ly t h e s a me pr opor t ion in a ll per iods of ou r
h is t or y, in Bos t on a n d in t h e cou n t r y.
9. Th e Dis eas es of the Locomotive Organs . Rh eu ma t is m, or r h eu ma t ic
fever , h a s occa s ion ed t h e gr ea t es t n u mber of dea t h s . Spin a l dis ea s es a r e a ls o
in cr ea s in g.
10. Th e Dis eas es of the Integumentive Organs h a ve ca u s ed a bou t t h e
s a me u n ifor m pr opor t ion " Ulcer s a r e s t at ed t o h a ve pr odu ced mor e dea t h s
t h a n a ll ot h er dis ea s es of t h is cla s s .
11. Old Age h a s fewer dea t h s , in pr opor t ion t o t h e wh ole, t o r ecord
a mon g it s vict ims now, t h a n a t t h e for mer per iods of ou r h is t or y.In Bos t on,
in 1810 t o 1820, it des t r oyed 5.04 per cen t . ; in t h e la s t per iod, on ly 2.46 ; a
decr ea s e of mor e t h a n on e-h a lf.
12. Th e Deaths by Violence a r e n ea r ly a s gr ea t in t h e cou n t r y a s in
Bos t on , t h ou gh t h e pr opor t ion a l n u mber s va r y in bot h pla ces . Acciden t s a n d
dr own in g a r e t h e mos t n u mer ou s ca u s es . Bu r n s a n d s ca lds , in t emper a n ce
a n d s u icide, ca u s e n ea r ly t h e s a me pr opor t ion s .
Th e followin g a r e s ome of t h e ma n y impor t a n t con clu s ion s t o wh ich t h
fa ct t h u s fa r dis clos ed lea d u s :-
1. It is proved t h a t t h er e is a gr ea t differ en ce, in t h is St a t e, in t h e
lon gevit y of people livin g in differen t pla ces a n d u n der differ en t
cir cu ms t a n ces . Th is fa ct is pr es en t ed in a for cible ma n n er in t h e s u bjoin ed
illu s t r a t ion , t a ken from Cen s u s of Bos t on , (p. 158). Th e cu t is dr a wn in t en
divis ion s , ea ch wa y; t h os e fr om left t o r igh t r epr es en t in g t h e a ges of life;
t h os e fr om t op t o bot t om, t h e per cen t a ge of s u r vivor s :-
Ta ke on e h u n dr ed per s on s fr om ea ch of fou r differ en t cla s s es of people:
100 of t h os e wh o died a t Newt on , in 1810 t o 1830; 100 of t h os e wh o died in
Bos t on . In 1840 t o 1845; a n d 100 of t h e Ca t h olics of Bos t on . If ea ch of t h e
h u n dr ed per s on s in a ll t h es e cla s s es h a d lived 100 yea r s , ea ch cla s s wou ld
h a ve en joyed 10,000 yea r s of life. Bu t per s on s die a t a ll a ges , a n d in s ome
cla s s es ver y mu ch ea r lier t h a n in ot h er s . Accor din gly fou r lin es a r e dr a wn
dia gon a lly a cr os s t he cu t , fr om t h e t op on t h e left t o t h e bot t om on t h e r igh t ,
t o r epr es en t t h e a mou n t of, life t h a t ea ch cla s s en joyed. Th e wh it e a n d
s h a ded s pa ces below" t h es e lin es r epr es en t life, a n d t h e da r k a n d s h a ded
s pa ces a bove t h e lin es r epr es en t dea t h . Th e u pper lin e r epr es en t s t h e
s u r vivor s in En gla n d ; t h e n ext below, t h os e in Newt on ; t h e t h ir d, t h e gen er a l
popu la t ion of Bos t on ; a n d t h e fou r t h , t h e Ca t h olics . It will be per ceived t h a t
82 per cen t ., or 82 ou t of ever y 100, of t h e lives in En gla n d pa s s t h e lin e of
10 yea r s , or s u r vive t h a t a ge; wh ile on ly 34 per cen t ., or 34 ou t of ever y 100
Ca t h olics , pa s s t h e s a me lin e! Th a t 38.75 per cen t ., in Newt on , s u r vived 60
yea r s , wh ile on ly 9.95, in Bos t on , s u r vived t h e s a me a ge! Ot h er compa r is on s ,
equ a lly s t r ikin g, ma y be ma de.
2. It is proved t h a t ca u s es exis t in Ma s s a ch u s et t s , a s in En gla n d, t o
pr odu ce pr ema t u r e a n d pr even t a ble dea t h s , a n d h en ce u n n eces s a r y a n d
69
pr even t a ble s ickn es s ; a n d t h a t t h es e ca u s es a r e a ct ive in a ll t h e a gr icu lt u r a l
t own s , bu t pr es s mos t h ea vily u pon cit ies a n d popu lou s villa ges .
3. It is proved t h a t mea s u r es ,-legis la t ive, s ocia l a n d per s on a l,-do n ot a t
pr es en t exis t , or a r e n ot s o fu lly a pplied, a s t h ey migh t be, by t h e people, for
t h e pr even t ion , mit iga t ion , or r emova l, of t h e ca u s es of dis ea s e a n d dea t h .
4. It is proved t h a t t h e people of t h is St a t e a r e con s t a n t ly lia ble t o
t yph u s , ch oler a , dys en t er y, s ca r la t in a , s ma ll pox, a n d t h e ot h er gr ea t
epidemics ; a n d t o con s u mpt ion , a n d t h e ot h er fa t a l dis ea s es , wh ich des t r oy
s o ma n y of t h e h u ma n r a ce in ot h er pa r t s of t h e wor ld.
5. It is proved t h a t t h e a ct ive ca u s es of dis ea s e a n d dea t h a r e
in cr ea s in g a mon g u s , a n d t h a t t h e a ver a ge du r a t ion of life is lot a s gr ea t n ow
a s it wa s for t y or fift y yea r s a go.
We a r e fu lly a wa r e t h a t t h e gen er a l opin ion does n ot coin cide wit h t h is
fa ct , a n d t h a t a dir ect ly oppos it e on e h a s been expr es s ed. It h a s been
fr equ en t ly s a id, t h at , owin g t o t h e differ en t modes of livin g, t h e in cr ea s ed
medica l s kill, a n d ot h er ca u s es , dis ea s es h a ve been a melior a t ed, a n d t h e
a ver a ge len gt h of h u ma n life h a s been ext en ded; a n d pa r t icu la r ly wit h in t h e
la s t fift y yea r s . We h a ve lon g t h ou gh t differ en t ly, es pecia lly in r ega r d t o t h e
mor e r ecen t per iods of ou r h is t or y. Th os e wh o ma ke t h is as s er t ion s eem t o
r ely u pon imper fect or u n cer t a in da t a t o s u ppor t t h eir opin ion . St a t is t ica l
obs er va t ion s of t h e livin g a n d t h e dea d, ga t h er ed in a n cien t t imes , s h ou ld be
t a ken wit h gr ea t ca u t ion a s compa r a t ive t es t s . Ten yea r s s in ce, it wa s s a id
t h a t II t h e a ver a ge va lu e of life is n ot a s gr ea t a s it wa s t wen t y yea r s a go; t h a t
it wa s a t it s ma ximu m in 1810 t o 1820 ; a n d t h a t it h a s s in ce decr ea s ed."
74

Su bs equ en t in ves t iga t ion h a ve fu lly es t a blis h ed t h e cor r ect n es s of t h is
s t a t emen t . Ta kin g t h e mea n du r a t ion of life a s ou r gu ide, it a ppea r s t h a t t h e
a ver a ge a ge of a ll t h a t died in Bos t on , in 1810 t o 1820) wa s 27.85 yea r s ,
wh ile in 1840 t o 1845 it wa s 21.43 yea r s on ly, s h owin g a differ en ce of 6.42
yea r s . In New Yor k, in 1810 t o 1820, it wa s 26.15 yea r s , a n d in 1840 t o
1843 it wa s 19.69,-a differ en ce of 6.46 yea r s . In Ph ila delph ia in 1810 t o
1820, it wa s 26.25, a n d in 1840 t o 1844 it wa s 22.01-a differ en ce of 4.24
yea r s . If t h e mor e r ecen t a n d la s t yea r s wer e in clu ded, it wou ld s h ow a s t ill
fu r t h er declin e.
Ta kin g a compa r is on of t h e n u mber of t h e wh ole popu la t ion ou t of
wh om on e ma y die a n n u a lly, a s ou r gu ide, it a ppea r s fr om t h e t a ble, (p; 82,)
t h a t , in Bos t on , in 1830, t h e dea t h s were 1 in 48, a n d in 1845 t h ey wer e 1 in
39. Compa r e t h e a n n u a l mor t a lit y per cen t . of t h e differ en t a ges , (a n
u n dou bt ed t es t , ) a n d it a ppea r s t h a t , in t h os e u n der 5 yea r s of a ge, 5.96 per
cen t . died in 1830, 7.32 in 1840, a n d 9 in 1845 ; n ea r ly dou blin g in les s
t h a n 20 yea r s ; a nd, in a ll t h e yea r s u n der 40, t h er e a ls o a ppea r s a n
in cr ea s ed mor t a lit y.
We h a ve s h own (pp. 85, 86) t h a t n eit h er cler gymen n or ph ys icia n s live
a s lon g n ow a s t h ey did du r in g t h e la s t cen t u r y; a n d wit h in t h e la s t t h ir t y or
for t y yea r s , t h e for mer , on t h e a ver a ge, h a ve los t s even yea rs , a n d t h e la t t er
n in e yea r s of life. An d, it wou ld be difficu lt t o fin d a ph ys ica l power of'
en du r a n ce, a n d a n a ver a ge lon gevit y, a mon g men a n d women , in t h e
or din a r y occu pa t ion s of life, a s gr ea t a s exis t ed a t t h e t ime of a n d befor e t h e

74
American Journal of Medical S ciences , Vol. I, f or 1841, p. 382.

70
r evolu t ion . Th is , it s eems t o u s , migh t be fu lly pr oved, by exa min in g a n d
a n a lyzin g t h e pen s ion lis t of Ma s s a ch u s et t s , a n d ot h er a u t h en t ic s ou r ces of
in for ma t ion .
It is u n dou bt edly t r u e, t h a t in ma n y t h in gs s ociet y h a s impr oved; t h a t
medica l s kill in t h e cu r e of dis ea s e h a s gr ea t ly in cr ea s ed ; a n d t h a t s ome
dis ea s es a r e n ot a s fa t a l a s for mer ly, or a r e. n ow bet t er u n der s t ood a n d
con t r olled. Bu t wh ile a ll t h is ma y be t ru e, it is n o les s t r u e t h a t t h e a ct ive
ca u s es of dis ea s e h a ve in cr ea s ed fa s t er t h a n t h e a pplia n ces for t h eir
pr even t ion a n d cu r e; t h a t n ew dis ea s es , or old on es in a n ew a n d modified
for m, equ a lly fa t a l a n d u n con t r olla ble, h a ve a ppea r ed ; an d t h a t s ickn es s
a n d dea t h a dva n ce mor e r a pidly t h a n t h e impr ovemen t s devis ed t o a r r es t
t h em.
Th es e s t a t emen t s , con cer n in g t h e decr ea s in g vit a l en er gies of ma n , a r e
con fir med by r ecen t in ves t iga t ion s in En gla n d. Th os . Rowe Edmon ds , Es q.,
Act u a r y t o t h e Lega l a n d Gen er a l Life As s u r a n ce Societ y, in Lon don ,-a good
a u t h or it y in t h is ma t t er ,-h a s r ecen t ly pu blis h ed s ome in t er es t in g pa per s ,
fr om wh ich it a ppear s , "t h a t t h e mor t a lit y of t h e popu la t ion of En gla n d, a ft er
decr ea s in g for 35 yea r s t o t h e yea r 1815, h a s s in ce t h a t t ime, u p t o t h e en d
of 1848, been r egu la r ly in cr ea s in g ; t h a t n ea r ly t h e Wh ole of t h is in cr ea s e
a r is es fr om t h e in crea s e of t h e mor t a lit y of ch ildr en u n der 10 yea r s of a ge,
wh ich in cr ea s e h a s a mou n t ed 44 per cen t . in t wen t y yea r s ; t h a t t h e
mor t a lit y of ever y a ge a bove 20 yea r s h a s r ema in ed t h e s a me, wit h lit t le or
n o va r ia t ion , for t h e la s t 30 or 40 yea r s , a n d pr oba bly for a lon ger per iod ;
t h a t in t h e gr ea t es t pa r t of t h e popu la t ion of En gla n d, wit h t h e except ion of
t h e popu la t ion of la r ger t own s , t h e mor t a lit y of fema les exceeds t h a t of ma les
in t h e in t er va l of age compr eh en ded bet ween 8 a n d 45 yea r s ; a n d t h a t at
ot h er in t er va ls of a ge it is in exces s over t h a t of fema les in En gla n d a s in
ot h er cou n t r ies .
75
An d h e con fir ms t h e s t a t emen t by t h e followin g t a bu la r
En gla n d-1 8 ye a r s
1 8 1 3 -1 8 3 0
Ca r li s le - 9 ye a r s
1 7 7 9 -1 7 8 7

En gla n d- 7 ye a r s
1 8 3 8 -1 8 4 4

Age s
Males Females Males Female
s
Both s exes
Under 5 4. 9 4. 22 7. 07 6. 04 8. 23
5 to 10 0. 66 0. 61 0. 93 0. 9 1. 02
10 to 15 0. 46 0. 48 0. 5 0. 55 0. 54
15 to 20 0. 66 0. 7 0. 7 0. 79 0. 64
20 to 30 0. 93 0. 95 0. 94 0. 94 0. 75
30 to 40 1. 05 1. 14 1. 09 1. 13 1. 06
40 to 50 1. 37 1. 37 1. 45 1. 32 1. 43
50 to 60 2. 14 1. 98 2. 26 1. 98 1. 83
60 to 70 4. 15 3. 78 4. 28 3. 79 4. 12
70 to 80 9. 28 8. 88 9. 22 8. 42 8. 3
80 to 90 20. 82 19. 67 20. 11 18. 32 17. 56
Over 90, 33. 93 34. 09 36. 53 34. 58 28. 44
All ages 1. 99 1. 90 2. 27 2. 10 2. 50


75
London Lancet, Vol. I, f or 1850,pp.301,329. Mr. Edmonds had previous ly contributed s ome valuable papers on vital
s tatis tics to the lancet. Sec Dec. 5 and 12, 1835, pp, 364,408; Oct.28, 1837, p. 154; Vol.II, f or 1838-9,
pp.185,353,778,837. He als o publis hed, in 1832, a new theory in regard to Lif e Tables

71
compa r is on of t h e mor t a lit y in En gla n d in 1813-1830, wit h 1838-1844 ;
a n d in Ca r lis le in 1779-1787:- An except ion t o t h es e s t a t emen t s , in t h eir
gen er a l a pplica t ion , ma y be fou n d in Gen eva , wh ich h a s oft en been qu ot ed t o
s h ow t h e impr oving con dit ion of h u ma n life. Gr ea t impr ovemen t s h a ve
u n dou bt edly t a ken pla ce in t h a t cit y; a n d t h ey a r is e fr om t h e excellen t s ys t em
of r egis t r a t ion a n d t h e s u per ior s a n it a r y r egu la t ion s t h a t exis t t h er e, by wh ich
t h e people a r e ma de bet t er a cqu a in t ed wit h t h e la ws of h ea lt h a n d t h e mea n s
of pr even t in g dis ea s e. Bu t t h e impr ovemen t s a r e n ot s o grea t a s t h ey ma y at
fir s t s igh t a ppea r t o be. Th e pr oof r es t s u pon a compa r is on of t h e a ver a ge a ge
a t dea t h , wh ich , a s we s h a ll pr es en t ly s h ow, is a n u n cer t a in t es t . Mr . Ma llet ,
fr om wh om t h e s t a t emen t wa s or igin a lly der ived, gives s ome fa ct s , in t h e
s a me pa per wh ich pa r t ia lly a ccou n t for t h e gr ea t a ppa r en t , impr ovemen t . He
s a ys ma r r ia ge t h er e is n ow defer r ed t o a la t er per iod of life t h a n it wa s in t h e
18t h cen t u r y ; t h a t ea ch ma r r ia ge t h en , on t h e a ver a ge, pr odu ced five
ch ildr en , a n d n ow les s t h a n t h r ee; a n d t h a t , du r in g t h e 16t h cen t u r y, 25.92
in ea ch 100 dea t h s wer e t h os e of ch ildr en u n der on e yea r old; wh ile in t h e
per iod h e des cr ibes , 1814-1833, on ly 13. 85 died of t h a t a ge !" Th is s h ows t h a t
t h er e wer e les s ch ildr en to d ie, a n d con s equ en t ly t h e a ver a ge a ges of all that
died wou ld be gr ea t er . It s h ows , h owever a h igh er 's t a t e of civiliza t ion , a n d
t h a t a gr ea t er pr opor t ion of t h e ch ildr en bor n wer e pr es er ved t o t h e a ges of
ma t u r it y a n d u s efu ln es s .
76



III. PLAN FOR A SANITARY SURVEY OF THE STATE

We n ow pr oceed t o give a n ou t lin e of a pla n for t h e Sa n it a r y Su r vey of
t h e St a t e wh ich we pr opos e for a dopt ion . In dr a win g it u p we h a ve ca r efu lly
in qu ir ed in t o t h e circu ms t a n ces of ma n y cit ies a n d t own s in t h e St a t e, a n d
t h e s a n it a r y con dit ion of t h e in h a bit a n t s ; a n d h a ve, wit h n o in con s ider a ble
la bor , ma t u r ed a s er ies of mea s u r es , wh ich s eem t o u s bes t a da pt ed, u n der
a ll t h e cir cu ms t a n ces , a s t h e pla n wh ich wou ld be mos t likely t o be pr a ct ica l
a n d u s efu l. In t h e pr ogr es s of t h e in qu ir y, we h a ve exa min ed ma n y pr in t ed
wor ks on t h e s u bject , a n d h a ve a va iled ou r s elves of t h e in for ma t ion elicit ed
in cor r es pon den ce wit h gen t lemen in Eu r ope a n d in t h is Cou n t r y, wh os e
kn owledge, exper ien ce a n d ju dgmen t in t h es e ma t t er s a r e en t it led t o t h e
h igh es t r ega r d.
In a va lu a ble commu n ica t ion , pr es en t ed in t h e a ppen dix, r eceived fr om
t h e cou n cillor s of t h e Ma s s a ch u s et t s Medica l Societ y, a pr efer en ce is given t o
t h e pla n of a ppoin t in g a s in gle in dividu a l t o ma ke t h e s u r vey, a ft er t h e
ma n n er of t h e a gr icu lt u r a l, zoologica l, a n d ot h er s cien t ific s u r veys , wh ich
h a ve h er et ofor e been ma de by t h e St a t e. Object ion s a r e, h owever , u r ged wit h
con s ider a ble for ce a ga in s t t h is pla n . It is s a id t h a t t o in t r u s t s o gr ea t a n d
impor t a n t a wor k t o on e min d, h owever well qu a lified, wou ld be les s likely t o
r eceive pu blic con fiden ce a n d a ppr oba t ion , a n d h en ce wou ld be les s u s efu l,
t h a n if it wer e t h e join t pr odu ct ion of s ever a l min ds , or r eceived t h eir join t
a ppr ova l ; t h a t if ma de wit h t h e fa ct s a t pr es en t a cces s ible, a lt h ou gh it
wou ld a ffor d mu ch va lu a ble in for ma t ion , it migh t lea d t o er r on eou s

76
Annales d' Hy giene publique, tom. XVII, p. 114.

72
con clu s ion s ; a n d t h a t it wou ld be mer ely t r a n s ien t , a n d n ot of per ma n en t
u s efu ln es s .
Th e En glis h s a n it a r y s u r veys h a ve gen era lly been t h e r es u lt s of t h e join t
la bor s of s ever a l in dividu a ls ; a n d n ea r ly a ll of t h em, of a u t h or it y a n d
u s efu ln es s , h a ve been ba s ed pr in cipa lly u pon t h e fa ct s fu r n is h ed by t h e
efficien t s ys t em of r egis t r a t ion of bir t h s , ma r r ia ges , a n d dea t h s , in oper a t ion
t h er e. Th os e wh ich h a ve depa r t ed fr om t h es e fa ct s , or h a ve ma de a pa r t ia l
s elect ion fr om t h em, a r e mor e or les s mixed u p wit h er r or .
Hea lt h is a va r ia ble ma t t er , ca pa ble of impr ovemen t or det er ior a t ion . It
ma y be good in on e yea r , a n d n ot in a n ot h er , a n d n ot a like in t wo pla ces a t
t h e s a me t ime. No pla n ca n t h er efor e be ext en s ively u s efu l, or per ma n en t ly
va lu a ble, wh ich s h a ll be con fin ed t o a s in gle yea r or a s in gle s u r vey. It
s h ou ld ext en d over a s er ies of yea r s , a n d t h r ou gh a s er ies of s u cces s ive
obs er va t ion s a n d exa min a t ion s . In t h is wa y on ly ca n t h e la ws of h ea lt h a n d
life of a n y pla ce be a ccu r a t ely a s cer t a in ed, a n d a s a n it a r y s u r vey pr odu ce a ll
t h e good t h a t migh t be a t t a in ed by it . People a r e pr on e t o n eglect t h eir own
a n d t h e pu blic h ea lt h , a n d t h is fa ct is a r ea s on wh y t h e s u bject s h ou ld be
fr equ en t ly br ou gh t t o t h eir n ot ice.
Ou r pla n con s is t s of a s er ies of mea s u r es , wh ich ma y be r en der ed
per ma n en t if des ir ed; pr es en t ed in t h e for m of s epa r a t e r ecommen da t ion s .
Th ey a r e divided in t o t wo cla s s es , a n d a r e t o be r egu la t ed a n d con t r olled by
t h e a gen cies wh ich a r e pr opos ed t o be es t a blis h ed; on e by t h e legis la t ive
a u t h or it y of t h e St a t e, a n d t h e mu n icipa l a u t h or it ies of t own s a n d cit ies , a n d
t h e ot h er by s ocia l or ga n iza t ion a n d per s on a l a ct ion . Th ou gh in t ima t ely
con n ect ed, t h es e mea s u r es a r e in s ome r es pect s in depen den t of ea ch ot h er .
Th ey a r e n ot of equ a l impor t a n ce, a n d it is n ot expect ed - t h ey will a ll be
immedia t ely ma de u s e of; a pa r t on ly ma y be a dopt ed at on e t ime, a n d
a n ot h er pa r t a t a n ot h er t ime, a s cir cu ms t a n ces ma y r equ ir e. Th ey a r e h er e
pr es en t ed t oget h er , a s n eces s a r y t o - give fu lln es s a n d u n it y of des ign t o t he
wh ole pla n . It is n ot s u ppos ed, h owever , t h a t t h ey a r e a ll t h e u s efu l s a n it a r y
mea s u r es wh ich a complet e a n d per fect pla n wou ld r equ ir e. Th e pr ogr es s of
t h is in qu ir y, a n d t h e cir cu ms t a n ces wh ich it develops in differ en t yea r s ,-t h e
dis cover ies wh ich will be ma de by t h e u n it ed in t ellect u a l effor t s t h a t will be
br ou gh t t o bea r u pon t h is s u bject , will s u gges t ot h er s . Some of t h es e
mea s u r es a r e of gr ea t ma gn it u de, a n d wou ld ea ch fu r n is h ma t t er for a
volu me, if, fu lly expla in ed a n d illu s t r at ed. All we pr opos e t o do in t h is
con n ect ion is , t o n a me a n d defin e ea ch , a n d t o give a br ief expla n a t ion a n d
illu s t r a t ion of it s ch a r a ct er a n d des ign . Th es e mea s u r es , it mu s t be
r ecollect ed, h owever , a r e on ly a s er ies of pla n s by wh ich a s a n it a r y s u r vey
migh t be ca r r ied for wa r d. Th e a ccompa n yin g in for ma t ion is in s er t ed mer ely
t o illu s t r a t e t h es e pla n s .

I. STATE AND MUNICIPAL MEASURES RECOMMENDED.

Un der t h is cla s s of r ecommen da t ion s a r e t o be in clu ded s u ch mea s u r es
a s r equ ir e, for t h eir s a n ct ion , r egu la t ion a n d con t r ol, t h e legis la t ive a u t h or it y
of t h e St a t e, or t h e mu n icipa l a u t h or it y of cit ies a n d t own s . Th ey ma y be
ca lled t h e lega l mea s u r es ,-t h e Sa n it a r y Police of t h e St a t e, (p. 16. )

73
I. WE RECOMMEND that the laws of the S tate relating to Public Health be
thoroughly revis ed, and that a new and improved act be pas s ed in their s tead.
We s u ppos e t h a t it will be gen er a lly con ceded t h a t n o pla n for a s a n it a r y
s u r vey of t h e St a t e, h owever good or des ir a ble, ca n be ca r ied in t o oper a t ion ,
u n les s es t a blis h ed by la w. Th e legis la t ive n eces s a r y, t o give it efficien cy a n d
u s efu ln es . Th e effor t s , bot h of a s s ocia t ion s a n d in dividu a ls , h a ve fa iled in
t h es e ma t t er s . We h a ve s h own t h a t t h e pr es en t h ea lt h la ws of t h e s t a t e a r e
exceedin gly imper fect , even for t h e gen er a l object for wh ich t h ey wer e
des ign ed -t h a t it is difficu lt , a n d per h a ps impr a ct ica ble, t o a s cer t a in wh a t
pr ecis e power s t h ey con fer , a n d wh a t du t ies t h ey r equ ir e; a n d t h a t t h ey a r e
n ot a da pt ed, in a n y wa y, t o t h e pu r pos es of a s a n it a r y s u r vey. Th is mu s t be
a ppa r en t t o a n y on e wh o ma y exa min e t h em.
Th er e a r e t wo r emedies for t h es e defect s : on e t o a men d t h e exis t in g
la ws ; a n d t h e ot h er , t o combin e s u ch a men dmen t s a s it wou ld be des ir a ble
t o ma ke wit h s u ch pr ovis ion s of t h e exis t in g la ws a s it wou ld be des ir a ble t o
r et a in , a n d t o pr es en t t h e wh ole t oget h er , in t h is a men ded for m, a s a
complet e h ea lt h a ct r epea lin g s u ch a ct s a s a r e in con s is t en t wit h it s
pr ovis ion s . We pr efer t h e la t t er r emedy. It will be bet t er u n der s t ood, a n d
mor e ea s ily ca r r ied in t o pr a ct ice, by t h e people. Su ch legis la t ion h a s been
common , in t h is St a t e a n d els ewh er e, in r ela t ion t o t h is a n d ot h er ma t t er s .
En t er t a in in g t h es e views , we s u gges t t h a t a gen er a l h ea lt h la w s h ou ld
be pa s s ed, wh ich s h ot u d be compr eh en s ive in it s des ign a n d s imple in it s
pr ovis ion s ,-be a da pt ed t o t h e pr es en t cir cu m-s t a n ces of t h e St a t e, a n d be s o
fr a med t h a t it migh t be clea r ly u n der s t ood a n d ca r r ied in t o pr a ct ica l
oper a t ion ; a n d wh ich wh ile it wou ld a n s wer a ll t h e pu r pos es of a gen er a l
h ea lt h a ct a s h er et ofor e u n der s t ood, wou ld, a t t h e s a me t ime, a ccomplis h a ll
t h e pu r pos es of a s a n it a r y s u r vey.
We h a ve a ccor din gly dr a wn u p, a n d pr es en t in t h e a ppen dix, a dr a ft of
s u ch a n a ct a s , in ou r ju dgmen t , it wou ld be expedien t t o pa s s , t o s ecu r e t h e
a dva n t a ges des ign ed t o be a t t a in ed. It cr ea t es a per ma n en t a gen cy, for t h e
r egu la t ion a n d con t rol of a ll ma t t er s r elat in g t o t h e s a n it a r y con dit ion of t h e
St a t e a n d it s in h a bit a n t s . It r et a in s s u ch pr ovis ion s of t h e exis t in g la ws a s
a r e deemed wor t h y of bein g r et a in ed; an d in cor por a t ed s u ch ot h er s a s a r e
deemed n eces s a r y t o for m a complet e lega l s a n it a r y s ys t em. ," It con fer s n o
s u mma r y power s n ot n ow pos s es s ed by Boa r ds of Hea lt h , bu t it limit s mor e
clos ely, a n d defin es mor e clea r ly, t h e du t ies of t h os e by wh om t h es e power s
a r e t o be exer cis ed. Th e object s of a ll t h e s ect ion s of t h e r evis ed St a t u t es n ow
in for ce a r e pr ovided for . Th e fir s t fou r s ect ion s a r e con t a in ed in a mor e
ext en ded for m, a n d pr ovided for be ot h er a gen cies , in t h e fir s t 15 s ect ion s of
t h e n ew a ct ; 18 s ect ion s ,-5, 6, 7, 15, 17, 18, 35 t o 42 in clu s ive, 45,47, a n d
48,-in s ect ion 16t h i 8 s ect ion s ,-24 t o 34 in clu s ive,-in t h e 17t h ; 2 s ect ion s ,-
43 a n d 44,-in t h e 18t h ; 4 s ect ion s ,-24, 49,13 a n d 12,-a r e in s er t ed wit h bu t
lit t le modifica t ion ; 5 s ect ion s of t h e a ct of 1849, wh ich t a ke t h e pla ce of 10
a n d 11 of t h e Revis ed St a t u t es , a r e in s er t ed, s o modified a s t o a pply t o t own s
a s well a s cit ies . Wit h t h es e pr ovis ion s , va r iou s ot h er n ew a n d impor t a n t
on es a r e in cor por a t ed ; a n d t h e wh ole is s o a r r a n ged a s t o form a s imple bu t
s ys t ema t ic, efficien t , a n d pr a ct ica l pla n , a da pt ed t o t h e pr es en t con dit ion
a n d wa n t s of t h e St a t e. Th e wh ole a ct , lon g a s it s eems t o be, is n ot s o lon g
74
a s t h e a ct r ela t in g t o pu blic h ea lt h in t h e Revis ed St a t u t es . Th a t con t a in s 49
s ect ion s , a n d t h is 39 on ly.
77


II. WE RECOMMEND that a GENERAL BOARD OF HEALTH be es tablis hed,
which s hall be charged with the general execution of the laws of the S tate,
relating to the enumeration, the vital s tatis tics , and the public health of the
inhabitants .
Th e a ct es t a blis h in g t h e Boa r d of Edu ca t ion wa s on e of t h e mos t
impor t a n t a ct s r ela t in g t o common s ch ools , ever . pa s s ed in Ma s s a ch u s et t s .
Th a t cen t r a l a gen cy, u n der t h e gu ida n ce of it s la t e t a len t ed s ecr et a r y, h a s
given t o t h e ca u s e of pu blic edu ca t ion a n impor t a n ce, a n d t o t h e common
s ch ools a s t a n da r d of eleva t ion a n d u s efu ln es s , n ot befor e a t t a in ed. Th e
ca u s e of Pu blic Healt h n eeds a s imila r cen t r a l a gen cy, t o give t o t h e wh ole
s a n it a r y movemen t a u n ifor m, wis e, efficien t , econ omica l a n d u s efu l
dir ect ion . If differ en t loca l a u t h or it ies , or in a lwa ys pos s es s ed of t h e bes t
mea n s of in for ma t ion left t o or igin a t e pla n s for t h eir own gu ida n ce, a n d
a n yt h in g is don e, t h ey will be mor e likely t o ma ke u n in t en t ion a l mis t a kes ,
a n d cr ea t e u n n eces s a r y expen s e, t h a n if wis e a n d a ble min ds wer e devot ed
t o t h e s u bject , a n d s u gges t ed wh a t ou gh t t o be don e, a n d t h e bes t a n d mos t
econ omica l mode of doin g it . Su ch a n a gen cy wou ld h a ve a n exa ct kn owledge
of t h e con dit ion of ever y cit y a n d t own in t h e St a t e, a n d by t h es e mea n s of
in for ma t ion wou ld be a ble t o s u gges t t h e mea s u r es bes t a da pt ed t o t h e
differ en t cir cu ms t a n ces . Th ey wou ld pr even t a wa s t efu l expen dit u r e of
mon ey in imper fect or in efficien t mea s u r es . Th e a dva n t a ges wh ich wou ld
r es u lt t o t h e wh ole St a t e, a n d t o ever y pa r t of it ,-t o ea ch a n d a ll of t h e
in h a bit a n t s ,-fr om t h e es t a blis h men t of s u ch a cen t r a l Gen er a l Boa r d of
Hea lt h , compos ed of t h e bes t s cien t ific cou n s el a n d t h e bes t pr a ct ica l
exper ien ce wh ich t h e St a t e ca n a ffor d h a vin g con s t a n t a cces s t o t h e mos t
en ligh t en ed in t ellect s , a n d t o a kn owledge of t h e la bor s of t h e bes t pr a ct ica l
men in t h e wor ld, an d a s s is t ed by a t lea s t on e min d wh olly devot ed t o t h e
object in view , a r e t oo gr ea t t o be fu lly s een a t on ce, a n d ca n s ca r cely be
over -s t a t ed or over -es t ima t ed.
Th e du t ies of t h e Boa r d a r e poin t ed ou t in t h e fou r t h s ect ion of t h e a ct .
Th ey a r e t o h a ve t h e gen er a l dir ect ion of ea ch cen s u s ; t o s u per in t en d t h e
execu t ion of t h e s a n it a r y la ws of t h e St a t e; t o exa min e a n d decide u pon
s a n it a r y qu es t ion s , s u bmit t ed t o t h em by pu blic a u t h or it ies ; t o a dvis e t h e
St a t e a s t o t h e s a n it a r y a r r a n gemen t s of pu blic bu ildin gs a n d pu blic
in s t it u t ion s ; t o give in s t r u ct ion s t o loca l Boa r ds of Hea lt h , a s t o t h eir power s
a n d du t ies ; t o s u gges t loca l s a n it a r y r u les a n d r egu la t ion s ; t o r ecommen d
s u ch mea s u r es a s t h ey ma y deem expedien t , for t h e pr even t ion of dis ea s es
a n d t h e pr omot ion of t h e pu blic h ea lt h ; a n d t o r epor t t h eir pr oceedin gs
a n n u a lly t o t h e St a t e.

III. WE RECOMMEND that the Board, as f ar as practicable, be compos ed of
two phy s icians , one couns elor at law, one chemis t or natural philos opher , one

77
The "Act relating to Public Health in the City of New York ." Pas s ed by the legis lature, April 10, 1850, covers 48 octavo
pages and contains 89 s ections and 31 s ub-s ections ;the acts relating to the board of health in philadelphia cover 111
pages ; that relating to the publis health in england f ills a duodecimo volume of 330 pages ;that of Liverpool, contains 231
s ection, and s everal s ub-s ections ; that of Edinburgh, 260 s ections , or 101 clos ely printed octavo pages .

75
civil engineer , and two pers ons of other profes s ions or occupations ; all
properly qualif ied for the off ice by their talents , their education, their
experience, and their wis dom.
Th e con s t it u t ion a wl power s of t h e Boa r d a r e pr es cr ibed in t h e fir s t
s even s ect ion s of t h e a ct pr opos ed for it s es t a blis h men t a n d or ga n iza t ion . It
is in t en ded t h a t it s h a ll be compos ed of s even per s on s , bes ides t h e gover n or
a n d s ecr et a r y of t he Boa r d of Edu ca t ion for t h e t ime bein g. An d t h a t t he
dis a dva n t a ges of t oo fr equ en t ch a n ges ma y be a voided, t h a t s u cces s ive
Boa r ds ma y kn ow t h e pr oceedin gs of t h eir pr edeces s or s , a n d t h a t t h e
ou t goin gs a n d in comin gs of n ew member s ma y n ot des t r oy it s s ys t em a n d
vit a lit y, it is pr ovided t h a t t h e member s s h a ll be a ppoin t ed for s even yea r s ,
a n d go ou t of office a lt er n a t ely.
Th e member s s h ou ld n ot be s elect ed exclu s ively fr om on e pr ofes s ion ,
for t wo r ea s on s :- (1) Nu mer ou s qu es t ion s , r equ ir in g a kn owledge pos s es s ed
by differ en t pr ofes s ion s , will be pr es en t ed for dis cu s s ion a n d decis ion ; a n d it
is des ir a ble t h a t t h e Boa r d s h ou ld be able t o br in g compet en t kn owledge t o
t h e in ves t iga t ion of ever y s u bject . An d (2) To s h ow t o a ll t h a t t h e pr omot ion
of pu blic h ea lt h is a ma t t er wh ich does n ot belon g exclu s ively t o t h e medica l
pr ofes s ion , bu t con cer n s ever y pr ofes s ion a n d ever y per s on . Th e idea wh ich
t oo gen er a lly pr eva ils , t h a t ever y t h in g r ela t in g t o h ea lt h belon gs exclu s ively
t o on e pr ofes s ion , oper a t es a ga in s t s a n it a r y impr ovemen t . Th e s er vices of
medica l men a r e in dis pen s a ble; bu t t h e s er vices of ot h er pr ofes s ion s , a n d of
ever y per s on in t h eir r es pect ive s ph er es mu s t be pu t in r equ is it ion , befor e
r efor m ca n be complet e. Th e Boa r d s h ou ld t h er efor e con t a in -

1. Two ph ys icia n s , a t lea s t , of s cien t ific a t t a in men t s , a n d of ext en s ive
pr a ct ica l exper ien ce in t h eir pr ofes s ion , t h or ou gh ly u n der s t a n din g s a n it a r y
s cien ce, a n d deeply feelin g t h e impor t a n ce of wis e s a n it a r y mea s u r es .
2. On e cou n s ellor a t la w, wh o, bes ides t h e gen er a l kn owledge of la w a n d
medica l ju r is pr u den ce wh ich h e cou ld br in g t o t h e pu r pos es of t h e Boa r d,
migh t es pecia lly be a ble t o in ves t iga t e a n y lega l qu es t ion t h a t migh t a r is e.
3. On e ch emis t , or n a t u r a l ph ilos oph er . Ma n y qu es t ion s r ela t in g t o t h e
in flu en ce of t h e elemen t s on t h e pr odu ct ion or pr even t ion of dis ea s e, ma y
r equ ir e t h e s pecia l in ves t iga t ion of a n exper ien ced ch emica l ph ilos oph er , a n d
t h is impor t a n t br a n ch of s cien ce s h ou ld be a bly r epr es en t ed a t t h e Boa r d.
4. On e civil en gin eer , pos s es s in g compet en t kn owledge t o det er min e t h e bes t
met h ods of pla n n in g a n d con s t r u ct in g pu blic wor ks , a n d t h e bes t
a r ch it ect u r a l s a n it a r y a r r a n gemen t s of pu blic bu ildin gs , wor ks h ops , a n d
pr iva t e dwellin g-h ou s es , wou ld be a n exceedin gly va lu a ble member .
5. Two ot h er per s on s , of a ckn owledged in t elligen ce, good ju dgmen t , a n d of
pr a ct ica l exper ien ce in t h e common bu s in es s a ffa ir s of life, a n d ca pa ble of
in ves t iga t in g a n d fu lly u n der s t a n din g t h e pr in ciples of s a n it a r y s cien ce,
migh t compos e t h e r ema in der .
All s h ou ld ma ke t h ems elves t h or ou gh ma s t er s of t h e object s of t h eir
a ppoin t men t ; h a ve s a ga cit y a n d for es igh t t o per ceive bea r in g a n d effect of
ever y mea s u r e pr opos ed; be emin en t ly wis e in deliber a t ion , a n d ju diciou s in
decis ion . Th e object s of t h e Boa r d will be of t h e gr ea t es t impor t a n ce a n d
in t er es t ; a n d it s h ou ld, a n d u n dou bt edly will, comman d, n ot for it s
pecu n ia r y emolu men t s , bu t for it s h igh r es pect a bilit y, h on or , a n d
76
u s efu ln es s , t h e gr ea t es t t a len t in t h e Common wea lt h , a n d t h e s er vices of
t h os e wh o , in a n emin en t degr ee, pos s es s t h e pu blic con fiden ce.
78


IV. WE RECOMMEND that the Board be authoriz ed to appoint s ome s uitable
and competent pers on to be the Secretary of the Board, who s hould be
required to devote his whole time , and energies to the d is charge of the duties
of his off ice, and be paid a proper s alary for his s ervices .
Th e du t ies of t h e Secr et a r y a r e defin ed in t h e eigh t h s ect ion of t h e
pr opos ed a ct . Bes ides keepin g t h e r ecor ds a n d a ccou n t s of t h e Boa r d, h e is
t o s u per in t en d t h e t a kin g, a n d pr epa r e t h e a bs t r a ct s of ea ch St a t e cen s u s ; t o
per for m t h e du t ies r ela t in g t o t h e r egis t r a t ion of bir t h s , ma r r ia ges , a n d
dea t h s , n ow pr efor med by t h e Secr et a r y of St a t e; t o ma ke s pecia l s a n it a r y
s u r veys of pla ces , .wh en dir ect ed; t o r epor t a n n u a lly a n a bs t r a ct of t h e
in for ma t ion obt a in ed; t o per for m s u ch ot h er du t ies a s ma y be lega lly
impos ed u pon h im; a n d t o diffu s e "t h r ou gh ou t t h e Common wea lt h
in for ma t ion r ela t in g t o t h e s a n it a r y con dit ion of t h e St a t e a n d it s
in h a bit a n t s , t o t h e en d t h a t t h e la ws of h ea lt h a n d life ma y be bet t er
u n der s t ood, t h e ca u s e of dis ea s e a s cer t a in ed a n d r emoved, t h e len gt h of
h u ma n life ext en ded t h e vit a l for ce a n d pr odu ct ive power in cr ea s ed, a n d t h e
gr ea t es t a mou n t of ph ys ica l impr ovemen t a n d of h a ppin es s a t t a in ed a n d
en joyed."
He s h ou ld be a mply qu a lified, in a ll r es pect s , for t h e office ; kn ow wh a t
t o do, a n d h ow t o do it , a n d wh a t in for ma t ion t o obt a in , a n d h ow t o obt a in it .
He s h ou ld be t h or ou gh ly edu ca t ed in t h e s cien ce of pu blic h ea lt h , a n d t h e
ca u s es a n d pr even t ion of dis ea s e; a n d be ca pa ble of a r r a n gin g, a n a lyzin g;
a bs t r a ct in g, combin in g, a n d pu blis h in g t h e fa ct s t h a t ma y be collect ed, wit h

78
Dr. Duchatelet, an eminent member of the council of Health of Paris , in des cribing the qualif ications of off icers of Public
Health, s ay s :- It is generally thought in the world that the medical k nowledge acquired in the s chools is all that is
neces s ary to become a us eful member k nowledge acquired in the s chools is all that is neces s ary to become a us ef ul
member of the Council of Health. The greater part of medical men thems elves s hare this Opinion; and on the s trength of
s ome percepts which they have collected f rom book s on health and prof es s ions , they think thems elves s uff iciently
ins tructed to decide on the ins tant the graves t ques tions , which can only be res olved by s pecial s tud ies . A man may have
exhaus ted medical literature; he may be an excellent practitioner at the s ick -bed, a learned phy s icians , a clever and
eloquent prof es s or; but all thes e acquirements , tak en in thems elves , are nearly us eles s in a council lik e that of Paris . To
be really us ef ul in the Council, it is neces s ary to have an extended k nowledge of natural philos ophy ; to k now with
exactnes s them, and the much more important action of manufactories of every s pecies on men congregated in towns , on
animals and on plants . This k nowledge, s o important, of the action of manuf actories and trades , is not to be acquired by
ordinary s tud y , or in the s cience of the cabinet. It is not to be obtained without pos itive nations on the arts , and on the
greater part of the proces s es peculiar to each trade . It requires habit, and particularly the public health, a s pecial s tud y ;
and to join with them chemis ts , and other profes s ions .-Chad wick s Sanitary Report, p.423 The Edinburgh Review f or
Jan., 1850, (p.221) in an article on Sanitary ref orm, holds the following language in relation to the Board of Health in
England;- we believe that s ome not unnaturally jealous y has been felt by the med ical prof es s ion, as to the cons titution of
the Board; but we cannot regret the circums tances that its chief operative leader is not a phy s ician. It is very neces s ary
that s uch a department s hould have the bes t s cientif ic couns el and as s is tance that the country can afford, and the debt
which it owes to the recent s ervices of Dr, Southwood Smith, Dr. Sutherland, and other phy s icians , cannot well be
overrated; but, on the other hand, it s eems ind is pens able that an adminis trative body , coming in contact with
cons titutional rights and res pons ibilities , s hould have another k ind of leaders hip. To balance the herois m and
dis interes tednes s , f or which we mos t willing give them cred it, the medical bod y have s ome defects , es pecially in their
jealous ies and prejud ices . It is diff icult to them to countenance any thing incons is tent with what they have long s een and
practiced; and they would certainly not be s o ready as lay men to give way to the collective wis dom of their own brethren.
We f irmly believe, in s hort, that the f irs t phy s icians in the country will more f rank ly communicate to s uch a board as the
pres ent, their ind ividual convictions , than to any convocation of their prof es s ional brethren; and that the board will more
cand idly weigh and more cheerfully adopt their views . The value of unprofes s ional s uperintendence, - the s ame clas s of
pers ons who are to execute arrangements never being entirely the s ame as thos e who devis e them,- has been evinced in
the management of admiralty . It has been appos itely remark ed, that Nels on never would have obtained high command
from a board of old admirals . Nor is it unins tructive to remember that , though thy e have liberally res ponded to it, the idea
of s anitary ref orm, on the s cale which are now cons idering, did not originate within the med ical profes s ion. And, in truth,
the cons tant d irection of the f aculties to the cure of actual d is eas e, does not s eem lik ely to leave much obs ervation to
devote to the s tud y of its external caus es .

77
pr oper dedu ct ion s a n d con clu s ion s fr om t h em, in s u ch for m a s will be mos t
u s efu l t o s cien ce, a n d con t r ibu t e mos t t o t h e impr ovemen t of pr a ct ica l life.
To dis ch a r ge t h e du t ies of s u ch a n office in s u ch a ma n n er a s t h ey migh t
a n d ou gh t t o be dis ch a r ged, wou ld, in ou r ju dgmen t , be en ou gh t o s a t is fy
t h e des ir es of a n y ma n wh o wis h ed t o be h on or ed a n d u s efu l.

V. WE RECOMMEND that a LOCAL BOARD OF HEALTH be appointed in
every city and town, who s hall be charged with the particular execution of the
laws of the S tate, and the municipal ord inances and regulations , relating to
public health, within their res pective juris d ictions .
Th e con s t it u t ion , a n d t h e power s a n d du t ies of t h es e Boa r ds a r e defin ed
a n d pr es cr ibed in t h e pr opos ed a ct . Th ey a r e ea ch t o be compos ed of n ot les s
t h a n t h r ee n or mor e t h a n s even per s on s , bes ides t h e ma yor a n d cit y
r egis t r a r of cit ies , ( or t h e cit y cler k, wh er e t h er e is n o cit y r egis t r a r ,) a n d t h e
ch a ir ma n of t h e s elect men , a n d t h e t own cler k, of t own s ; a n d a r e t o be
a ppoin t ed for t h e s a me n u mber of yea r s a s t h er e a r e member s con s t it u t in g
t h e Boa r d; a n d t o go ou t of office a lt er n a t ely, like t h e Gen er a l Boa r d of
Hea lt h , a n d for t h e r ea s on s a lr ea dy given . An yon e, h owever , bein g du ly
qu a lified, ma y be r ea ppoin t ed. Th es e Boa r ds s h ou ld be filled by men of
s imila r ch a r a ct er t o t h e Gen er a l Boa r d, a n d wit h ou t r efer en ce t o a n y
pecu lia r polit ica l or r eligiou s opin ion s t h ey ma y en t er t a in . On e or mor e
ph ys icia n s , edu ca t ed in s a n it a r y s cien ce, s h ou ld be members of ea ch Boa r d.
Per s on s of s ou n d ju dgmen t a n d good edu ca t ion , of ot h er pr ofes s ion s or
occu pa t ion s , a n d qu a lified a n d fit t ed for t h es e pecu lia r du t ies , migh t s u pply
t h e r ema in der . All s h ou ld h a ve t h e pu blic r es pect a n d con fiden ce. It is
in t en ded t h a t t h ey s h a ll be a ppoin t ed by t h e ma yor a n d a lder men of cit ies ,
a n d t h e s elect men of t own s , beca u s e t h is mode wou ld be mor e likely t o
s ecu r e a bet t er Boa r d, t h a n a n omin a t ion a n d elect ion in gen er a l t own
meet in g.
Th e du t ies of t h es e Boa r ds a r e poin t ed ou t in t h e a ct , a n d pa r t icu la r ly
in t h e s ixt een t h s ect ion ; a n d a ls o in t h e s ever a l r ecommen da t ion s in t h is
r epor t . Th ey will be r equ ir ed, gen er a lly, t o ca r r y in t o execu t ion , wit h in t h eir
own t own , t h e s a n it a r y la ws of t h e St a t e, a n d t h e or der s of t h e Gen er a l
Hea lt h ; a n d, a s fa r a s pos s ible, t o pr even t dis ea s e, a n d r a is e s t a n da r d of
pu blic h ea lt h t o t h e h igh es t poin t .
We h a ve r efer r ed ( pp. 48-54) t o t h e s a n it a r y la ws a n d cu s t oms of t h is
St a t e; a n d we deem it pr oper a ga in t o r efer t o t h e s u bject , t h a t we ma y
compa r e t h em wit h t h e mea s u r es pr opos ed in t h is r ecommen da t ion . Th e
Revis ed St a t u t es (p. 208) pr ovide t h a t
"Ever y t own , r es pect in g wh ich n o pr ovis ion is ma de, by a n y s pecia l la w,
for ch oos in g a Boa r d of Hea lt h , ma y, a t t h eir a n n u a l meet in g, or a t a n y ot h er
meet in g lega lly wa r ned for t h e pu r pos e, ch oos e a Boa r d of Hea lt h , t o con s is t
of n ot les s t h a n t h r ee, n or mor e t h a n n in e per s on s ; or t h ey ma y ch oos e on e
per s on t o be a h ea lt h officer ; a n d, in ca s e t h ey s h a ll n ot ch oos e a n y Boa r d of
Hea lt h , or h ea lt h officer , t h e s elect men s h a ll be t h e Boa r d of Hea lt h ."
Ea ch of t h e ch a r t er s in cor por a t in g t h e n in e cit ies in t h is St a t e, con t a in
a pr ovis ion s imila r t o t h e followin g ;-
"All t h e power a n d a u t h or it y n ow by law ves t ed in t h e Boar d of Hea lt h
for t h e t own of -, or in t h e s elect men of s a id t own , s h a ll be t ra n s fer r ed t o a n d
ves t ed in t h e cit y cou n cil, t o be ca r r ied in t o execu t ion by t h e a ppoin t men t of
78
Hea lt h Commis s ion er s , or in s u ch ot h er ma n n er a s t h e cit y cou n cil s h a ll
deem expedien t ."
An d t h e a ct of Ma y 2, 1849, pr ovides t h a t
" 1.All t h e power s ves t ed in , a n d t h e du t ies pr es cr ibed t o Boa r ds of Hea lt h of
t own s , by t h e gen er a l la ws , s h a ll be ves t ed in , a n d pr es cr ibed t o, cit y
cou n cils of cit ies , in ca s e n o s pecia l pr ovis ion t o t h e con t r a r y is ma de in
s u ch la ws t h ems elves , or in t h e s pecia l la ws a pplica ble t o a n y pa r t icu la r cit y.
" 2. Th e power s a n d du t ies a bove n a med ma y be exer cis ed a n d ca r r ied in t o
effect by cit y cou n cils , in a n y ma n n er wh ich t h ey ma y pr es cr ibe, or t h r ou gh
t h e a gen cy of a n y per s on s t o wh om t h ey ma y delega t e t h e s a me,
n ot wit h s t a n din g a per s on a l exer cis e of t h e s a me, collect ively or in dividu a lly,
is pr es cr ibed in t h e in s t a n ce of t own s , a s a bove r efer r ed t o. An d cit y cou n cils
a r e h er eby a u t h or ized t o con s t it u t e eit h er br a n ch , or a n y commit t ee of t h eir
n u mber , wh et h er join t or s epa r a t e, t h e Boa r d of Hea lt h for a ll, or for
pa r t icu la r pu r pos es , wit h in t h eir own cit ies ."
In a ddit ion t o t h es e gen er a l pr ovis ion s of la w, s ome s pecia l Boa r ds of
Hea lt h , a s we h a ve a lr ea dy s h own , h a ve been in cor por a t ed. Un der t h eir
oper a t ion , it is left opt ion a l wit h ea ch cit y a n d t own t o ma ke or n ot t o ma ke
or din a n ces a n d r egu la t ion s on t h e s u bject of pu blic h ea lt h . Th e pr a ct ice of
differ en t cit ies a n d t own s , in exer cis in g t h eir power s , h a s been va r iou s .
In Bos t on , t h e ma yor a n d a lder men a r e con s t it u t ed Hea lt h
Commis s ion er s , a n d t h ey a ppoin t , an n u a lly, a Commit t ee on In t er n al
Hea lt h , on Ext er n a l Hea lt h , on St r eet s , on Dr a in s a n d Sewers , on Wa t er , a n d
on Bu r ia l Gr ou n ds ; ea ch con s is t in g of t h r ee member s , wh o exa min e in t o a ll
compla in t s a n d ma t t er s a ffect in g t h e pu blic h ea lt h in t h eir r es pect ive
depa r t men t s . Th e cit y cou n cil ch oos e, a n n u a lly, t h e followin g officer s :-
1. A Superintendent of Streets , t o h a ve t h e gen er a l ca r e of s weepin g a n d
clea n s in g t h e s t r eet s , la n es , a lleys , pu blic wa lks , s qu a r es , &c., of t h e cit y.
2. A Superintendent of Common Drains and Sewers , t o s u per in t en d t h e
loca t ion a n d con s t r u ct ion of t h es e impor t a n t a ids t o comfor t a n d h ea lt h .
3. A Water Board, t o s u per in t en d t h e dis t r ibu t ion of t h e in es t ima ble bles s in g
t o h ea lt h , wh ich is n ow fu r n is h ed in a ll des ir a ble qu a n t it ies by t h e Bos t on
Wa t er Wor ks .
4. A City Phy s ician, " t o exa min e in t o a ll n u is a n ces , s ou r ces of filt h , a n d
ca u s es of s ickn es s , wh ich ma y be on boa r d of a n y ves s el a t a n y wh a r f wit h in
t h e h a r bor of Bos t on , or in a n y a r t icle wh ich ma y h a ve been la n ded fr om a n y
ves s el on a n y wh a r f or ot h er pla ce, a n d, u n der dir ect ion of t h e ma yor a n d
a lder men , t o ca u s e t h e s a me t o be r emoved a n d des t r oyed;"-" t o va ccin a t e a ll
per s on s wh o ma y apply t o h is office for t h e pu r pos e, a n d t o give cer t ifica t es
of va ccin a t ion , wit hou t ch a r ge;"-" t o a t t en d u pon a ll ca s es of dis ea s e in t h e
ja il," a n d "wit h in t he cit y, wh en ever h e s h a ll be ca lled u pon by t h e Hea lt h
Commis s ion er s , or over s eer s of t h e poor ."
5. A Port Phy s ician, t o be t h e ph ys ician of t h e cit y es t a blis h men t s a t Deer
Is la n d, a n d t o s u perin t en d t h e t h e qu a ra n t in e of a ll ves s els a n d pa s s en ger s
wh ich a r r ive in t h e h a r bor of Bos t on .
6. Five Cons ulting Phy s icians , " in ca s e of a n a la r m of a n y con t a giou s ,
in fect iou s , or ot h er da n ger ou s dis ea s e, occu r r in g in t h e cit y or n eigh bor h ood,
t o give t h e ma yor , or eit h er br a n ch of t h e cit y cou n cil, a ll s u ch pr ofes s ion a l
a dvice a n d in for ma t ion a s t h ey ma y r equ es t , wit h a view t o t h e pr even t ion of
t h e s a id dis ea s e, a n d a t a ll con ven ien t t imes t o a id a n d a s s is t wit h t h eir
79
cou n s el a n d a dvice in a ll ma t t er s t h a t r ela t e t o t h e pr es er va t ion of t h e h ea lt h
of t h e in h a bit a n t s ."
7. A City Regis trar, t o r ecor d bir t h s , ma r r ia ges , a n d dea t h s , a n d t o
s u per in t en d t h e in t er men t of t h e dea d.
8. A City Mars hal, t o a ct a s h ea lt h officer ; " fr om t ime t o t ime t o pa s s t h r ou gh
t h e s t r eet s , a lleys , a n d cou r t s of t h e cit y t o obs er ve n u is a n ces , t o r eceive
compla in t s fr om t h e in h a bit a n t s ," &c.
Ea ch of t h es e depa r t men t s is in depen den t of t h e ot h er s . Th e
s u per in t en den t of s t r eet s collect s t h e s t r eet dir t a n d h ou s e dir t , depos it s it in
a n ou t er limit of t h e cit y, a n d s ells it a s wa n t ed. He a ls o collect s t h e h ou s e
offa l, a n d deliver s it a t a given pla ce wit h in t h e cit y, t o con t r a ct or s , wh o
r emove it wit h ou t t h e cit y, a n d wh o pa id $8,000 for it in 1849. Th e n igh t s oil
is r emoved u n der t h e dir ect ion of t h e cit y ma r s h a l; t h e h ou s eh older s pa yin g
$3.00 per loa d for it s r emova l in s u mmer , a n d $1.50 in win t er .
Th e a n n u a l n et expen s es of a ll t h e h ea lt h depa r t men t s h a ve been a s
follows , for t h e yea r s en din g Ma y 1: -


For 1 8 4 7 1 8 4 8 1 8 4 9 1 8 5 0
Se we r a ge a n d Dr a i n a ge
16, 705.
68
18, 532.
14
25, 872.
56
37, 268. 1
1
In t e r n a l He a lt h
53, 014.
44
67, 273.
04
68, 792.
16
88, 441. 7
1
Ext e r n a l He a lt h 805. 84
1, 339. 3
3
1, 121. 9
5 3, 531. 51
Tot a l
7 0 , 5 2 5
. 9 6
8 7 , 1 4 4
. 5 1
9 5 , 7 8 6
. 6 7
1 2 9 , 2 4 1
. 3 3

Th e ext r a expen s e of $28,245 87 for t h e Ch oler a Hos pit a l, a n d ot h er
pr eca u t ion a r y mea s u r es on a ccou n t of t h e ch oler a , in 1849, a r e in clu ded in
t h e a mou n t u n der 1850.
In Sa lem, Roxbu ry, Ch a r les t own , an d mos t of t h e cit ies , t h e
s u per in t en den ce of a ll ma t t er s r ela t in g t o t h e pu blic h ea lt h is pla ced u n der
t h e cit y ma r s h a ls , a s h ea lt h officer s , s u bject t o t h e con t r ol of t h e ma yor s a n d
a lder men . No Boa r ds of Hea lt h or h ea lt h commit t ees a r e a ppoin t ed, a n d n o
s epa r a t e a ccou n t s a r e kept of t h e expen s es in cu r r ed.
Th e t own s of Ma r bleh ea d a n d Plymou t h h a ve Boa r ds of Hea lt h u n der
t h eir s pecia l a ct s , t h ou gh oft en in a ct ive. Spr in gfield, Da n ver s , a n d s ome
ot h er t own s , h a ve h a d h ea lt h commit t ees for s ever a l yea rs . Da n ver s h a s
pu blis h ed s ome va lu a ble r epor t s of t h eir commit t ees . Bu t , a s fa r a s ou r
kn owledge ext en ds , few t own s h a ve ch os en Boa r ds of Hea lt h , or h ea lt h
commit t ees , n or h a ve t h e s elect men oft en a ct ed in t h a t ca pa cit y. Wit h t h e
except ion of a few cit ies a n d t own s , n ot h in g wh a t ever h a s been don e on t h e
s u bject . Mu ch good h a s r es u lt ed in Bos t on a n d s ome ot h er pla ces , fr om t h eir
h ea lt h r egu la t ion s , bu t n ot s o mu ch a s migh t a n d ou gh t t o h a ve been
effect ed. Th e wh ole pla n , wh er e a n y pla n exis t s , for t h e s a n it a r y police of t h e
St a t e, is es s en t ia lly defect ive. Th e s a n it a r y la ws a r e in efficien t a n d
in oper a t ive. Th ey allow s omet h in g, bu t require lit t le or n ot h in g t o be don e,
a n d con s equ en t ly lit t le or n ot h in g is don e. Hea lt h , if a t t en ded t o a t a ll, is
con s ider ed mer ely a s econ da r y, in ciden t a l ma t t er , a n d n ot , a s it s h ou ld be, a
lea din g, es s en t ia l ma t t er . In s ome t own s , wh en Boa r ds of Hea lt h or h ea lt h
80
commit t ees h a ve been ch os en , it h a s been don e in open t own meet in g, by
n omin a t ion s a t la r ge, like fen ce-viewer s , or ot h er u n impor t a n t t own officer s .
Su ch a pr a ct ice is n ot likely t o s ecu r e compet en t men . An d in pla ces wh er e
mor e con s ider a t ion is given , per s on s h oldin g office for on e yea r on ly a r e
oft en a ppoin t ed, wh o, t h ou gh wor t h y in ot h er r es pect s , ca n n ot , fr om t h eir
edu ca t ion a n d pos it ion , be s u ppos ed t o be qu a lified t o a ct in t elligen t ly on
t h es e gr ea t ma t t er s .
Even in Bos t on , wh er e s o mu ch h a s been don e, a n d well don e, fa r mor e
migh t be a ccomplis hed, a t t h e s a me expen s e, by t h e pla n wh ich we pr opos e,
t h a n by t h e exis t in g r egu la t ion s . Th is it wou ld be ea s y t o s h ow, if s pa ce wer e
a llowed for dis cu s s ion a n d illu s t r a t ion .
A per ma n en t Boa r d of Hea lt h , h a vin g t h e gen er a l s u per in t en den ce of a ll
s a n it a r y ma t t er s , con s t it u t ed a s it migh t a n d s h ou ld be, wou ld s u per s ede
t h e con s u lt in g ph ys icia n s , r elieve t h e over -bu r den ed a lder men of s ome of
t h eir on er ou s la bor s , a n d ma n a ge ever y depa r t men t wit h mor e u n ifor mit y,
wis dom econ omy, a n d efficien cy. Th e cit y r egis t r a r a n d ma yor wou ld be ex
officia l member s of t h e Boa r d. Th r ou gh t h e for mer t h ey wou ld h a ve a cces s t o
t h e r ecor ds of ever y dea t h wh ich t a kes pla ce a n d t h u s be ma de a cqu a in t ed,
a t a ll t imes , wit h t h e pr eva ilin g dis ea s es , a n d t h e pu blic h ea lt h ; a n d t h r ou gh
t h e la t t er a con s t a n t in t er cou r s e migh t be kept u p bet ween t h e Boa r d a nd
t h e cit y gover n men t . Th e a n n u a l r epor t s , wh ich s u ch a Boa r d wou ld be
r equ ir ed t o ma ke, migh t be ma de of far mor e in t er es t a n d u s efu ln es s t h a n
a n y n ow dis t r ibu t ed. Th ey wou ld be a n n u a l s a n it a r y s u r veys of t h e cit y,
a ffor din g s u gges t ion s of t h e h igh es t impor t a n ce t o t h e welfa r e a n d
impr ovemen t of t h e cit izen s .
An d wh a t migh t be don e on a la r ge s ca le in Bos t on , migh t be don e on a
s ma ller on e in a ll t h e t own s in t h e St a t e.

VI. WE RECOMMEND that each local Board of Health appoint a Secretary ;
and als o, if occas ion require, a Survey or and Health Off icer .
Th e 12t h s ect ion of t h e pr opos ed a ct pr ovides for t h e a ppoin t men t , a n d
t h e 13t h , 14t h a n d 15t h s ect ion s pr es cr ibe t h e du t ies , of t h e officer s of
Boa r ds of Hea lt h . Ever y Boa r d s h ou ldh a ve a s ecr et a r y, t o keep it s r ecor ds ,
books a n d pa per s , a n d per for m s u ch du t ies a s u s u a lly per t a in t o s u ch a n
office. A s u r veyor or en gin eer wou ld a ls o be u s efu l, es pecia lly in cit ies a n d
popu lou s villa ges , t o exa min e in t o a ll qu es t ion s wh ich ma y r equ ir e t h e
in ves t iga t ion of s u ch a n officer , a s pr es cr ibed by t h e a ct , or for t h e office of
en gin eer of t h e Gen er a l Boa r d, pa ge 113. In ma n y of t h e s ma ll cou n t r y t own s
t h is officer migh t be dis pen s ed wit h , t h ou gh in a ll h e wou ld be u s efu l. Ea ch
Boa r d s h ou ld h a ve a n Officer of Hea lt h , wh o s h ou ld, wh ere pr a ct ica ble, be
a n in t elligen t ph ys icia n , well edu ca t ed, a n d es pecia lly a cqu a in t ed wit h
s a n it a r y s cien ce, h a vin g n o pecu lia r t h eor y t o bu ild u p or s u ppor t , a s
r ega r ds differ en t modes of pr a ct ice for t h e cu r e of dis ea s e, bu t
con s cien t iou s ly des ir ou s of doin g a ll wit h in h is power t o pr even t dis ea s e, a n d
t o r a is e t h e s t a n da r d of h ea lt h wit h in h is ju r is dict ion , by ca r r yin g in t o
execu t ion a ll pr oper loca l r egu la t ion s , a n d t h os e of t h e gen er a l Boa r d of
Hea lt h . Some t own s ma y n ot be a ble t o s elect s u ch a n on e, a n d in s u ch
ca s es , per s on s of ot h er pr ofes s ion s or occu pa t ion s ma y be s u bs t it u t ed. All
officer s of loca l Boa r ds of Hea lt h s h ou ld pos s es s , in a s gr ea t degr ee a s
pos s ible, t h e qu a lifica t ion s a lr ea dy s t a t ed a s pr oper t o be pos s es s ed by t h e
81
member s a n d officer s of t h e gen er a l Boar d of Hea lt h . (Pa ge 113. ) Fr om a n
exa min a t ion of t h e s ect ion s of t h e pr opos ed a ct t o wh ich we h a ve r efer r ed,
a n d of t h e va r iou s recommen da t ion s a n d s u gges t ion s of t h is r epor t , officers
of loca l Boa r ds of Hea lt h will be a ble t o lea r n t h eir du t ies , wit h ou t a
r eca pit u la t ion in t h is pla ce.
Th e 3d a n d 4t h s ect ion s of t h e h ea lt h la ws in t h e Revis ed St a t u t es ,
a u t h or ize Boa r ds of Hea lt h t o II a ppoin t a ph ys icia n t o t h e boa r d," a n d t o II
es t a blis h t h e s a la r y or ot h er compen s a t ion of s u ch ph ys icia n , a n d s h a ll
r egu la t e a ll fees a nd ch a r ges of ever y per s on , a ppoin t ed by t h em in t h e
execu t ion of t h e h ea lt h la ws a n d of t h eir own r egu la t ion s . Th is is a power
gr ea t er t h a n is pr opos ed t o be con fer r ed by t h e n ew a ct .

VII. WE RECOMMEND that local Boards of Health endeavor to as certain, with
as much exactnes s as pos s ible, the circums tance of the cities and towns , and
of the inhabitants under their juris d ictions ; and that they is s ue s uch local
s anitary orders and mak e s uch regulations as are bes t ad apted to thes e
circums tances .
Th e s ixt een t h s ect ion of t h e pr opos ed act , a u t h or is es loca l Boa r ds of
Hea lt h t o is s u e or der s a n d ma ke r u les a n d r egu la t ion s for n in et een
pu r pos es . Th is a u t h or it y, h owever , is t o be exer cis ed on ly in cer t a in
con t in gen cies , of which t h ey a r e t o be ju dges . If, in t h eir opin ion , t h e pu blic
h ea lt h s u ffer s ; or if it wou ld be pr omot ed by ma kin g s u ch r egu la t ion s , in
r ega r d t o eit h er pa r t icu la r , t h ey a r e bou n d t o ma ke t h em; if ot h er wis e t h ey
ma y omit doin g it . No r egu la t ion s in con s is t en t wit h t h e con s t it u t ion a n d
la ws of t h e St a t e, h owever , ca n in a n y ca s e be ma de. An y r egu la t ion ma y be
modified or a n n u lled, a s cir cu ms t a n ces ma y r equ ir e. Dis cr et ion a n d wis dom,
in t h is a s in ot h er ma t t er s , will be r equ ir ed in ca r r yin g t h is pr ovis ion in t o
effect . Th e power s con fer r ed a r e n ot gr ea t er t h a n t h os e n ow pos s es s ed u n der
t h e Revis ed St a t u t es , n or in s ome r es pect a r e t h ey s o gr ea t a n d s u mma r y.
Th e pr opos ed a ct limit s , defin es , a n d r es t r a in s exis t in g power s , t h ou gh it
a llow t h em t o be ext en ded t o s ome ot h er ma t t er s n ot n ow s pecia lly pr ovided
for , wh ich s eem t o u s pr oper ly t o come u n der t h e cogn iza n ce of loca l Boa r ds
of Hea lt h .
In t h e a ppen dix, we h a ve given s ever a l r egu la t ion s for loca l Boa r ds of
Hea lt h , ext r a ct ed fr om ma n y exis t in g codes in ou r pos s es s ion ; a n d fr om
t h em ma y be for med a n d a r r a n ged, by modifica t ion , a lt er a t ion , a br idgemen t ,
a n d ext en s ion , a s ys t em a da pt ed t o differ en t loca lit ies .
VIII. WE RECOMMEND that local Boards of Health endeavor to carry into
effect all their orders and regulations in a conciliatory manner ; and that they
res ort to compuls ory proces s only when the public good requires it.
In ca r r yin g a n y pu blic mea s u r e in t o effect t h e fa vor a ble opin ion a n d
cooper a t ion of t h e people is des ir a ble. It ca n t h u s be a ccomplis h ed mor e
ea s ily a n d mor e t hor ou gh ly. Boa r ds of Hea lt h s h ou ld diffu s e in for ma t ion
con cer n in g t h eir r egu la t ion s , a n d t h e mea s u r es t h ey pr opos e for execu t ion ;
a n d pu blic opin ion s h ou ld be edu ca t ed a n d pr oper ly in flu en ced in t h eir
fa vor . It wou ld be u n wis e, in mos t ca s es , t o en for ce a n y r egu la t ion or
mea s u r e a ga in s t t h e gen er a l a n d deliber a t e wis h es of t h e in h a bit a n t s , a ft er
s u ch a r egu la t ion h a s been fu lly a n d fa ir ly la id befor e t h em a n d
compr eh en ded. It s omet imes h a ppen s , h owever , t h a t opin ion a r e given fr om
in t er es t ed mot ives , or fr om loca l or pa r t y pr eju dices , wh ich a r e n ot t h e
82
deliber a t e, u n bia s s ed s en t imen t s of t h e people gen er a lly. Su ch opin ion s
s h ou ld n ot be r eceived a s gu ides of pu blic a ct ion . Ca u t ion a n d ca r efu l
exa min a t ion s h ou ld be u s ed befor e execu t in g a n y mea s u r e n ot gen er a lly
s a n ct ion ed.
Un der t h e oper a t ion of s ect ion s 19 t o 24, of t h e 21s t ch a pt er of t h e
Revis ed St a t u t es , t h e s h er iff ca n , if h e ch oos es , wit h or wit h ou t t h e con s en t
of t h os e in t er es t ed, a ppr opr ia t e a n y per s on 's h ou s e a n d a n yon e's pr ovis ion s
a n d per s on a l s er vices , for t h e u s e of t h e s ick. Th is s u mma r y power h a s
exis t ed in t h is common wea lt h for n ea r ly t wo h u n dred yea r s ; bu t ,
n ot wit h s t a n din g it s a n t iqu it y, it is deemed pr oper t o modify it in s ome
degr ee, a s in t h e 21s t s ect ion of t h e pr opos ed a ct . Ca s es ma y occu r ,
h owever , wh er e, in a h ou s e or a loca lit y, a n u is a n ce or a dis ea s e ma y exis t ,
wh ich is dir ect ly in ju r iou s t o t h e h ea lt h of t h e n eigh bor h ood, a n d wh ich t h e
own er or occu pa n t , even a ft er per s u a s ion a n d r emon s t r a n ce, r efu s es t o
r emove or a ba t e. In s u ch ca s es it becomes t h e duty of t h e Boa r d of Hea lt h t o
in t er fer e. Pu blic s a fet y r equ ir es it -h u ma n life dema n ds it . An d for s u ch ca s es
t h e a u t h or it y of t h is s ect ion is ver y pr oper ly given .

IX. WE RECOMMEND that an appropriation be made annually by the S tate,
for the purchas e of book s for the us e of the general Board of Health; and by
each city and town for the purchas e of book s for the us e of each local Board of
Health.
We h a ve s a id t h a t a kn owledge of wh a t ou gh t t o be don e, a n d of t h e
bes t wa y of doin g it , is a n impor t a n t r equ is it e in t h e dis ch a r ge of a n y du t y;
a n d in n on e is it mor e impor t a n t t h a n in ma t t er s r ela t in g t o h ea lt h . Th e
pr in ciples on wh ich t h e s cien ce of pu blic h ea lt h is fou n ded, t h e differ en t
modes by wh ich t h os e pr in ciples h a ve been a pplied, a n d t h e pr a ct ica l
exper ien ce of t h os e by wh om t h ey h a ve been ca r r ied for wa rd, a r e fr om t ime
t o t ime pu blis h ed, a n d a r e a cces s ible t o t h e pu blic. An d a s a mea n s of
en ligh t en ed a ct ion an d ju diciou s econ omy, a n a ppr opr ia t ion s h ou ld be ma de
by t h e St a t e, a n d by ea ch cit y a n d t own , of s u ch a s u m a s cir cu ms t a n ces
ma y r en der expedien t , for t h e pu r ch a s e of t h e mos t u s efu l a n d impor t a n t of
t h es e pu blica t ion s for t h e u s e of t h e s ever a l Boa r ds of Hea lt h . Th ey wou ld
a id in t h e a dopt ion , a pplica t ion a n d a dmin is t r a t ion of differ en t mea s u r es , in
differ en t loca lit ies ; an d t h u s en a ble u s t o a void t h e u s eles s a n d expen s ive
mis t a kes ma de by ot h er s a n d t o wh ich we ma y be lia ble. Th e expedien cy of
t h is mea s u r e is t oo obviou s t o n eed dis cu s s ion . Th e Boa r d of Hea lt h of
Ph ila delph ia is t h e on ly on e in t h is cou n t r y, t o ou r kn owledge, wh ich h a s
commen ced t h e for ma t ion of a Sa n it a ry libr a r y. Th eir excellen t exa mple is
wor t h y of imit a t ion by ot h er s . Sect ion eleven of t h e a ct pr ovides for t h is
ma t t er . In t h e a ppendix we h a ve given a lis t of s ever a l wor ks t h a t h a ve come
u n der ou r own immedia t e exa min a t ion , a n d wh ich we h a ve fou n d t o be
va lu a ble for s u ch a n object .

X. WE RECOMMEND that each local Board of Health be required to mak e a
written report annually to the town, concerning its s anitary cond ition during
the next preced ing y ear; and to trans mit a written or printed copy of the s ame
to the General Board of Health.
Th e ca u s e of edu ca t ion is n ot of gr ea t er impor t a n ce t h a n t h e ca u s e of
pu blic h ea lt h ; a n d wh a t h a s been don e for t h e for mer ma y ver y pr oper ly be
83
don e for t h e la t t er . It is n ow t wen t y yea r s s in ce on e of t h is Commis s ion ,
bein g t h en a member of t h e s ch ool commit t ee of t h e t own of Con cor d,
pr epa r ed pu blis h ed a n ew code'. of s ch ool r egu la t ion s for t h a t t own . Amon g
ot h er ma t t er s it wa s pr ovided t h a t bou n d bla n k books for s ch ool r egis t er s for
ea ch s ch ool dis t r ict , pr epa r ed u n der s u ch for m a s h e pr es cr ibed, s h ou ld be
fu r n is h ed by t h e gen er a l s ch ool commit t ee t o t h e s ever a l t ea ch er s a t t h e
commen cemen t , a n d r et u r n ed a t t h e en d of t h e s u cces s ive s ch ool t er ms ; a n d
t h a t t h e commit t ee s h ou ld ma ke wr it t en r epor t s t o t h e t own a t t h e a n n u a l
meet in g, con cer n in g t h e s ch ools , u n der t h eir s u per in t en den ce, du r in g t h e
n ext pr ecedin g yea r . Th e fir s t wr it t en r epor t wa s pr epa r ed, pr es en t ed, a n d
pu blis h ed by h im in 1831. Th is r egu la t ion was original with him; a n d a s fa r
a s h is kn owledge ext en ds , this was the f irs t annual s chool report of that
des cription ever pres ented in a public town meeting in Mas s achus etts .
Su bs equ en t ly t h is r egu la t ion wa s in t r odu ced in t o Ca mbr idge, Nor t h bor ou gh
a n d ot h er pla ces ; a n d it oper a t ed s o well t h a t , a t h is s u gges t ion , wh ile a
member of t h e legis la t u r e, t h e la w of Apr il 13t h , 1838, r ela t in g t o t h is
s u bject , wa s ma t u r ed a n d pa s s ed. An d it ma y wit h per fect t ru t h be s a id t h a t
n o on e mea s u r e, a s ide fr om t h e es t a blis h men t of t h e Boa rd of Edu ca t ion ,
h a s don e s o mu ch good.
Wh a t h a s don e s o mu ch for edu ca t ion ma y do a s mu ch for pu blic
h ea lt h . Th e a n n u a l s ch ool r epor t s h a ve ma de edu ca t ion a s u bject of a bidin g
in t er es t a mon g t h e people, pr even t ed ign or a n ce a n d s a ved t h e in t ellect u a l
ch a r a ct er of t h e St a t e. Th e s a n it a r y r epor t s wou ld br in g ma t t er s of n o les s
impor t a n ce befor e t h e people of ever y t own ; ma ke pu blic a n d per s on a l h ea lt h
a s u bject of n o les s a bidin g in t er es t ; a n d t h u s t en d t o pr even t dis ea s e a n d
ph ys ica l s u ffer in g, an d s a ve life. Th ey wou ld be a n n u a l les s on s on s a n it a r y
s cien ce, loca lized an d r edu ced t o pr act ice in t h e kn own exper ien ce or
obs er va t ion of t h e cit izen s .
Th e ma t er ia ls for t h e compos it ion of t h es e r epor t s will of cou r s e va r y in
differ en t pla ces a n d in differ en t yea r s . Con cer n in g la r ge t own s a n d epidemic
s ea s on s , mor e ma y, wit h pr opr iet y, be s a id t h a n con cer n in g s ma ll t own s a n d
h ea lt h y s ea s on s . Bu t t o t h e Boa r ds of Hea lt h of ever y t own , in ever y yea r , a
s u fficien t n u mber of t opics will be s u gges t ed for a r epor t , wh ich migh t be s o
dr a wn a s t o be ma de in t er es t in g a n d va lu a ble. Th e bir t h s , ma r r ia ges a n d
dea t h s ;t h e differ en t dis ea s es a n d ca u s es of t h e dea t h s , a n d t h e ext er n a l
cir cu ms t a n ces u n der wh ich t h ey occu r r ed ; t h e a mou n t a n d kin d of s ickn es s
s u ffer ed a mon g differ en t occu pa t ion s , a n d in t h e pu blic s ch ools ; a
des cr ipt ion of loca lit ies wh er e dis ea s es h a ve been mos t pr eva len t ; fa ct s
wh ich develop t h e ca u s es of dis ea s e ; mea n s s u gges t ed for t h eir pr even t ion ;
a n d t h e va r iou s s u bject s men t ion ed in t h is r epor t , a n d es pecia lly in t h e
cir cu la r in t h e a ppen dix, r ela t in g t o a s a n it a r y s u r vey, or developed in t h e
pr a ct ica l dis ch a r ge of du t ies , will fu r n is h t o Boa r ds of Hea lt h a mple
ma t er ia ls a n d fa ct s for dis cu s s ion . We h a ve in s er t ed in t h e appen dix r epor t s
wh ich migh t h a ve been ma de in t wo t own s for t h e la s t yea r , t o illu s t r a t e ou r
idea s of wh a t s u ch r epor t s migh t con t a in .
A copy of t h e r epor t s fr om ever y t own in t h e St a t e is t o be t r a n s mit t ed
t o t h e Gen er a l Boa r d of Hea lt h t o fu r n is h ma t er ia ls for t h eir a n n u a l r epor t s .
In t h is wa y a s a n it a r y s u r vey of t h e St a t e wou ld be ma de a n d pu blis h ed
ever y yea r , impa r t in g in for ma t ion of t h e u t mos t impor t a n ce.

84
XI. WE RECOMMEND that the s anitary and other reports and s tatements of
the aff airs of cities and towns which may be printed s hould be in octavo f orm,
on paper and page of unif orm s iz e,( s imilar to the public documents of the
S tate, ) and des igned to be bound together, as THE ANNUAL REPORTS OF
THE TOWN; and that f ive copies be pres erved by the Board of Health, one
copy be furnis hed to the General Board of Health, one to the s tate Library , and
that others be given to Boards of Health els ewhere in exchange f or their
publications .
Th e s ys t em of exch a n ges of pu blic docu men t s a n d wor ks , wa s
in t r odu ced in t o t h is St a t e, by a member of t h is commis s ion , by a r es olu t ion
wh ich pa s s ed t h e Legis la t u r e, Apr il 23, 1838. Th is wa s s ome yea r s befor e
Mr . Va t t ema r e wa s kn own in t h is cou n t r y a s it s pr omot er . Th ou gh mu ch les s
h a s been a ccomplis h ed in ca r r yin g ou t t h e pr ovis ion s of t h a t r es olve, t h a n
migh t h a ve been don e, yet con s ider a ble ben efit h a s a lr ea dy r es u it ed fr om t h e
mea s u r e. A u n ifor m collect ion of a ll t h e pr in t ed docu men t s of a cit y or t own ,
bou n d a n d pr es er ved ; a n d in a ddit ion a collect ion of s imila r wor ks of ot h er
t own s a n d pu blic bodies , wou ld con s t it u t e a n exceedin gly va lu a ble fu n d of
t h e r ecor ded exper ien ce of t h e a ge; a n d cou ld n ot fa il of bein g of gr ea t u s e t o
a ll in t er es t ed. We h a ve a ccor din gly pr ovided for it in s ect ion eleven .
Th e cit y of Ba lt imor e r equ ir es r epor t s from a ll t h e depa r t men t s of t he
gover n men t a n d cit y in s t it u t ion s , t o be ma de a n n u a lly in J a n u a r y; a n d t h es e
r epor t s a r e pu blis h ed t oget h er , in a volu me, for min g a n exceedin gly va lu a ble
depos it or y of officia l pa per s , s h owin g t h e h is t or y a n d pr ogr es s of t h e cit y. A
s imila r pr a ct ice, embr a cin g a pa r t on ly of t h e cit y in s t it u t ion s , pr eva ils in
Sa lem, Lowell, Ca mbr idge-, a n d in s ome ot h er pla ces , in ou r own St a t e. It
s h ou ld be gen er a lly a dopt ed by a ll mu n icipa l cor por a t ion s , a n y of wh os e
docu men t s a r e pr in t ed.

XII. WE RECOMMEND, t hat the s ucces s ive enumerations of the inhabitants of
the S tate be s o made, abs tracted, and publis hed, that the mos t us ef ul and
des irable inf ormation concerning the population may be as certained.
Sever a l impor t a n t pu r pos es a r e a t t a in ed in a n a ccu r a t e en u mer a t ion or
cen s u s of t h e in h a bit a n t s . Th e con s t it u t ion of t h e Un it ed St a t es a n d of t h is
St a t e bot h r equ ir e s u ch en u mer a t ion s t o be ma de, a s t h e ba s is on wh ich t h e
n u mber of r epr es ent a t ives t o t h e n a t ion a l a n d s t a t e legis la t u r es s h a ll be
det er min ed. Th is is a polit ica l pu r pos e. Th e ch a r a ct er of ma n , a s a s ocia l
bein g, is modified by t h e cir cu ms t a n ces of h is exis t en ce, a n d va r ies a s t h es e
cir cu ms t a n ces va r y in t h eir developmen t in differ en t pla ces a n d a t differ en t
per iods ; a n d it is des ir a ble for a s ocia l a n d s cien t ific pu rpos e t h a t s u ch
ch a r a ct er is t ics ma y be a s cer t a in ed as will exh ibit t h es e va r iet ies or
differ en ces . An exact k nowledge, too, of the living inhabitants in a given
locality , is the f irs t, and an es s ential element, f or es timating their s anitary
condition. Th is is t h e t h ir d mos t impor t a n t pu r pos e.
It s h ou ld be t h e main des ign of ever y cen s u s , t a ken for a s cien t ific or
s a n it a r y pu r pos e, t oo a s cer t a in s ome pos it ive fa ct s , con cer n in g t h e t h en
exis t in g per s on s en u mer a t ed, wh ich ma y be compa r ed wit h ot h er s imila r
fa ct s , a s a common s t a n da r d, or t oget h er , t o s h ow t h e ch a r a ct er is t ics of
differ en t popu la t ion s . Two cen s u s es , on e con t a in in g a clas s of fa ct s a s t o
a ges or ot h er cir cu ms t a n ces , a n d a n ot h er , a differ en t cla s s , ca n n ot be s o
compa r ed t oget h er , a n d h en ce a r e n ea r ly u s eles s . Th e va lu e of t h e s ix
85
differ en t en u mer a t ion s of t h e in h a bit a n t s of t h e Un it ed St a t es , wou ld h a ve
been mu ch gr ea t er t h a n t h ey a r e, if a ll of t h em, bot h of t h e fr ee a n d s la ve
popu la t ion , h a d been ma de a n d a bs t r a ct ed u pon a well diges t ed a n d t h e
s a me u n ifor m pla n . As t h ey a r e, t h ey con t a in bu t , a few cla s s es of fa ct s
wh ich a dmit of compa r is on wit h ea ch ot h er . It is well t o con s ider , befor e
t a kin g a cen s u s , wha t fa ct s or ch a r a ct eris t ics a r e mos t des ira ble impor t a n t ;
a n d, wh en det er min ed u pon , t h e s a me fa ct s s h ou ld be obt a in ed in ever y
s u bs equ en t cen s u s .
To fu lfil a ll t h e polit ica l r equ ir emen t s of t h e con s t it u t ion of t h e Un it ed
St a t es , a n d of t h is St a t e, a n en u mer a t ion of t h e wh ole n u mber of t h e
in h a bit a n t s , mer ely, wit h ou t a n y pa r t icu la r s except a s t a t emen t of t h e fr ee
a n d s la ve popu la t ion s epa r a t ely, a n d "exclu din g In dia n s n ot t a xed," is a ll
t h a t is r equ ir ed. Bu t t h e s cien t ific a n d s a n it a r y in qu ir er s a r e n ot s a t is fied
wit h s u ch a n en u mer a t ion . Th ey des ir e t o kn ow s ome t h in g mor e t h a n t h e
mer e n u mber s of t h e people. Th ey kn ow t h a n t h e s ocia l ch a r a ct er a n d
eleva t ion , a n d t h e s a n it a r y welfa r e of t h e popu la t ion , depen d u pon va r iou s
ot h er ch a r a ct er is t ics , n ot pos s es s ed by all popu la t ion s a like, or in t h e s a me
degr ee; a n d t h a t t h es e ca n n ot be a s cer t a in ed by t h e n u mber a lon e. Wh at
t h en a r e t h e ch a r act er is t ics of a popu la t ion , wh ich it is des ir a ble a n d
impor t a n t s h ou ld be kn own , a n d wh ich a dmit of pos it ive a s cer t a in men t ? In
ou r ju dgmen t , t h e followin g cla s s es of fa ct s a r e des ir a ble in ever y cen s u s :
79

1. Color and Freedom. Th r ee cla s s es of per s on s exis t in t h is cou n t r y ,-t h e
wh it es , t h e color ed, a n d t h e In dia n s ; a n d of t h e color ed t h er e a r e t wo s u b-
cla s s es -t h e fr ee a n d t h e s la ve. Th e polit ica l r igh t s , pos s es s ed by ea ch of
t h es e cla s s es , differ in differ en t s t a t es ; a n d it h a s been s u ppos ed t h a t
t h ey a r e n ot a ll a ffect ed a like by t h e s a me s a n it a r y in flu en ces . Th e
n u mber s pos s es s in g ea ch of t h es e ch a r a ct er is t ics s h ou ld t h er efor e be
a s cer t a in ed bot h for polit ica l a n d s a n it a r y pu r pos es .
2. Sex is a n ot h er ch a ra ct er is t ic u n iver s a lly a ckn owledge a s impor t a n t , a n d
t h e n u mber s of ea ch s h ou ld be ca r efu lly obt a in ed.
3. Th e Ages of t h e popu la t ion a r e ch a r a ct er is t ics , in t er es t in g a n d impor t a n t
in ma n y r es pect s , a n d in dis pen s a bly n eces s a r y in a ll s a n it a r y in qu ir ies .
Wit h ou t t h em a cen s u s is compa r a t ively u s eles s . Th ey s h ou ld be
a s cer t a in ed by t h e en u mer a t or wit h a s mu ch exa ct n es s a s pos s ible; a n d
a ft er wa r ds s o a bs t r a ct ed t h a t u n ifor m compa r is on s ma y be ma de bet ween
t h e popu la t ion s of t h e s a me a ges livin g in differ en t pla ces , a t differ en t
per iods , a n d u n der differ en t cir cu ms t a n ces ; a n d wit h t h e dea d.
4. Th e Domes tic Cond ition, or t h e n u mber of u n ma r r ied, ma r r ied, a n d
widowed, is a n in t er es t in g ch a r a ct er is t ics , wh ich h a s been a s cer t a in ed in

79
The purpos e of this report will not admit of s o full an explanation and illus tration of thes e s everal clas s es of f acts , nor
of the plan obtaining them and of mak ing the abs tracts f or publication , as may be neces s ary to mak e them clearly
unders tood. Thos e who des ire further inf ormation on the s ubject, are ref ered to a report on the s tate cens us of
Mas s achus etts , (Hous e document No. 127 for 1849); to the Ins tructions is s ued f or tak ing the s eventh cens us of the united
States ; to the Report on the Cens us and Statis tics of Bos ton for 1845; to an article in the Journal of the Statis tical Society
of London, on the Bes t Mode of tak ing the cens us of the United Kingdom for 1841, Vol. III, p.72, f or April, 1840; to the
three volumes of Abs tracts of that Cens us , Publis hed under the titles of the Enumeration Abs tract, Occupation Abs tract,
and Age Abs tract; to the admirable but voluminous Report of the Commis s ioners for tak ing the Cens us of Ireland f or 1841;
to the s eries of Reports of the Regis trar General of Births , deaths and marriages in England, and es pecially to the
Appendices to the Ninth Annual Report, and to the " Recens ement General"- the General Cens us of Belgium for 1846,- a
work admirably executed, under the central S tatis tical Commis s ion, of which M.Quetelet is Pres ident. Thes e work s
contain the res ults of the more recent experience, and s hould be carefully s tud ied by all who may have the
s uperintendence of the cens us .

86
t h e cen s u s es ma de by n ea r ly a ll t h e gover n men t s of Eu r ope, a n d s h ou ld
be kn own for it s impor t a n t s ocia l a n d s a n it a r y in flu en ce.
5. Th e Occupations of t h e people h a ve a n in flu en ce u pon t h eir ch a r a ct er a n d
h ea lt h . Th e fa ct s s h ou ld be obt a in ed, a t lea s t , in r ela t ion t o a ll ma les over
fift een yea r s of a ge, a n d en ga ged in t h e pr in cipa l pr ofes s ion s a n d
occu pa t ion s .
6. Th e Place af Birth s h ou ld be kn own , s o fa r a s t o s pecify s epa r a t ely t h os e
bor n in t h e t own or cit y wh er e t h ey r es ide, (t o s h ow t h e s a n it a r y in flu en ce
of loca lit y) t h os e bor n in t h e differ en t St a t es of t h e Un it ed St a t es , a n d
t h os e bor n wit h ou t t h e Un it ed St a t es .
7. Education h a s a n in flu en ce u pon t h e s a n it a r y con dit ion of t h e people i
a n d s ome fa ct s r ega r din g it s h ou ld be kn own con cer n in g a ll per s on s over
20 yea r s of a ge. An a n s wer t o t h e qu es t ion , "Ca n you r ea d a n d wr it e ?"-
will a ffor d a s imple a n d defin it e fa ct , a n d ma y be obt a in ed con cer n in g
ever y per s on .
8. Hous e Accommod ation is qu it e impor t an t . Th e n u mber of per s on s t o a
fa mily, a n d t h e n u mber of fa milies a n d per s on s t o a h ou s e, a n d t h e
ext en t of t h eir a ccommoda t ion s , s h ou ld be kn own . Life a n d h ea lt h a r e
oft en a ffect ed by over -cr owded dwellin gs .
9. Means of Subs is tence and Comf ort a ls o h a ve a n in flu en ce u pon t h e
s a n it a r y con dit ion of a people. A s imple bu t defin it e, cer t a in a n d
impor t a n t fa ct , a s t o t h is ch a r a ct er is t ic, migh t be det er min ed by t h e
n u mber of "own er s of r ea l es t a t e," (n ot "t h e va lu e of r ea l es t a t e own ed,"
wh ich is in defin it e a n d u n cer t a in a s a pplied t o in dividu a l in qu ir y.) A
compa r is on of t h e pr opor t ion of t h is n u mber or cla s s of per s on s wit h t h e
wh ole popu la t ion of differ en t pla ces an d a t differ en t periods , wou ld
exh ibit in t er es t in g r es u lt s .
10. Health. Us efu l in for ma t ion con cer n in g fou r s pecia l dis ea s es ,-
blin dn es s , dea fn es s , in s a n it y a n d idiocy,-h a s been a s cer t a in ed in t h e la s t
t wo cen s u s es . Th e n u mber of per s on s t h u s a fflict ed, a s well a s t h e
n u mber of pa u per s a n d cr imin a ls , s h ou ld be kn own .
Two pla n s h a ve been devis ed for obt a in in g t h e fa ct s in a cen s u s .
1. By a bs t r a ct in qu ir y; a n d by t h e u s e of a bla n k t a bu la r for m of a s ch edu le,
con t a in in g h ea din gs , u n der wh ich a r e t o be en t er ed t h e differ en t cla s s es of
fa ct s , a n d in s u ch for m, a s t h ey a r e in t en ded t o a ppea r in t h e fin a l pr in t ed
a bs t r a ct . Th ey a r e elicit ed by t h e in qu ir y , -How ma n y a r e in t h is cla s s , a n d
in t h is , a n d s o on , n a min g ea ch cla s s . It is obviou s t h a t even by t h is pla n , if
accuracy is intended, t h e ch a r a ct er is t ics of ever y per s on a n d of ever y
elemen t a r y fa ct , s o fa r a s r ela t es t o a ll t h e pa r t icu la r s r equ ir ed by t h e
s ch edu le, mu s t fir s t be obt a in ed s epa r a t ely a n d a ft er wa r ds , t h ou gh , a t t h e
s a me t ime, t h ey mu s t be a n a lyzed, a bs t r a ct ed a n d combin ed, a n d en t er ed
u n der t h e r es pect ive h ea ds t o wh ich t h ey belon g. By t h is complica t ion of t h e
ma t t er er r or s a r e likely t o occu r , a n d ca n n ot ea s ily be a voided. Th is pla n
ma y a n s wer for gu es s es , or es t ima t es , bu t a ffor ds n o ch eck a ga in s t over -
es t ima t es or imper fect ion s , n or is it a n y t es t of a ccu r a cy; a n d bes ides , s u ch
a pla n a dmit s of n o ot h er combin a t ion or a bs t r a ct of t h e fa ct s t h a n t h e on e
poin t ed ou t in t h e s ch edu le.
2. By ind ividual or elementary inquiry ; a n d by t h e u s e of a bla n k s ch edu le,
in wh ich t h e n a me of ever y per s on en u mer a t ed is t o be en t er ed; a n d oppos it e
t h e n a me, u n der s epa r a t e des ign ed t o be a s cer t a in ed. Th es e ma y be mor e or
87
les s ext en ded a t plea s u r e. By t h is pla n , t h e s in gle object of obt a in in g t h e
elemen t a r y fa ct s of t h e cen s u s , in t h e mos t s imple, cor r ect a n d pos it ive
ma n n er , wit h ou t complica t in g t h e la bor a t t h e t ime wit h a n y combin a t ion or
a bs t r a ct , is a ll t h a t is a t t empt ed by t h e en u mer a t or . Th e a bs t r a ct s for
pu blica t ion a r e ma de in a differ en t for m by a n ot h er a gen cy. It is obviou s t h a t
by t h is pla n er r or s will be mu ch les s likely t o occu r , a n d ma y be mor e ea s ily
cor r ect ed a t t h e t ime if t h ey s h ou ld h appen , t h a n by t h e pla n of a bs t r a ct
in qu ir y. Ta kin g t h e n a me of ever y per s on will be a gu a r a n t ee t h a t n o mor e
will be r et u r n ed t h a n a ct u a lly exis t . An d t h e s a me fa ct s ma y be a ccu r a t ely
obt a in ed, mor e ea s ily, r a pidly, a n d econ omica lly. An d bes ides , t h e fa ct s
t h u s obt a in ed ma y be a bs t r a ct ed a n d combin ed in ver y ma n y differ en t wa ys ,
t o s h ow a mu ch gr ea t er va r iet y of in t er es t in g a n d impor t a n t r es u lt s .
Th e fir s t is t h e pla n h it h er t o a dopt ed in t h e cen s u s es of t h e Un it ed
St a t es . Th e s econ d, h owever , is n ow r ega r ded by a ll cor r ect s t a t is t s , wh o
h a ve ca r efu lly exa min ed t h e t wo pla n s , a s ver y mu ch t h e bes t , a n d a s t h e
on ly on e wh ich will en s u r e a ccu r a cy. It wa s fir s t in t r odu ced in t o t h is cou n t r y
in t h e cen s u s of Bos t on , in 1845; a n d, s in ce t h en , t h a t exa mple h a s been
commen ded a n d followed by ot h er cit ies . A modifica t ion of t h e pla n , des ign ed
for gen er a l a pplica t ion , wa s pr epa r ed, at t h e s pecia l r equ es t of t h e Cen s u s
Boa r d a t Wa s h in gt on , a n d h a s been a dopt ed, t h ou gh n ot wit h ou t s ome
devia t ion s , for t h e s even t h cen s u s of t h e Un it ed St a t es , t o be t a ken t h is
yea r .
80

Th e s ch edu le r ecommen ded, r ela t in g t o t h e fr ee in h a bit a n t s , con t a in ed
t h e followin g h ea din gs :

1. Dwellin g-h ou s e, n u mber ed in t h e or der vis it a t ion
2. Fa milies , n u mber ed in t h e or der of vis it a t ion
3. Na me of ever y per s on wh os e u s u a l pla ce of a dobe, on t h e fir s t da y of
J u ly 1850 wa s in t h is fa mily
4. Des cr ipt ion - Age
5. Des cr ipt ion - s ex
6. Des cr ipt ion Color (Wh it e, bla ck, or mu la t t o)
7. Domes t ic con dit ion _ Ma r r ied
8. Domes t ic con dit ion - widowed
9. Pr ofes s ion , occu pa t ion or t r a de of ea ch ma le per s on over fift een yea r s of
a ge
10. Own er s of r ea l es t a t e
11. Pla ce of Bor n in t h e t own , wh er e ea ch r es ides
12. Pla ce of Bir t h In wh a t ot h er s t a t es , t er r it or ies or cou n t r ies bor n .
13. a t t h e s ch ool du r in g la s t yea r
14. Per s on s over t wen t y yea r s of a ge wh o ca n n ot r ea d a n d wr it e
15. Wh et h er dea f a n d du mb, blin d in s a n e, idiot ic, a pa u per or a con vict

Th es e s ch edu les a r e des ign ed t o con t a in complet e Regis ters of the
Population. Th r ee s et s , or copies , a r e t o be ma de; on e of wh ich is t o be
depos it ed in t h e office of t h e cou r t of t h e cou n t y, a n d on e in t h e office of t h e
s ecr et a r y of t h e s t a t e, t o wh ich t h ey r elat e; a n d t h e ot h er is t o be for wa r ded

80
The des ign of the s chedule s hould be to obtain s ome pos itive, exis ting, k nown characteris tics of the population, at the
time of the enumeration. Whether " married within the y ear " is a his torical inquiry , and the " value of real es tate owned "
a collateral one, which des troy s the unity of the des ign.
88
t o t h e Secr et a r y of t h e In t er ior , a t Wa s h in gt on . Un der h is s u per in t en den ce,
or t h a t of s ome pers on wh om h e s h a ll a ppoin t , t h es e s ch edu les a r e t o be
a r r a n ged. Th ey a r e n ot t o be pu blis h ed, n or a r e t h ey t o be con s ider ed a s
models for pu blica t ion ; bu t t h ey a r e t o s er ve t h e s imple pu r pos e of
con t a in in g a compr eh en s ive ma s s of u s efu l elemen t a r y fa ct s con cer n in g t h e
people. Th es e fa ct s a r e t o be cla s s ified, a bs t r a ct ed, a n d pu blis h ed, in s u ch
for m, t o s u ch ext en t , a n d wit h s u ch dedu ct ion , a s s h a ll be be deemed u s efu l
a n d pr oper . An excellen t pla n for t h e a bs t r a ct s , a s t o t h e a ges , for gen er a l or
s a n it a r y pu r pos es , is fu r n is h ed in t h e exa mple, (p. 34,) t a ken fr om t h e
En glis h cen s u s . Th e a ges of t h e popu la t ion of ever y cou n t y in t h e Un it ed
St a t es , a n d of ever y t own in t h is St a t e, s h ou ld be a bs t r a ct ed in t h is wa y.
Ever y cen s u s s h ou ld be ma de u n der t h e s u per in t en den ce of in t elligen t ,
compet en t per s on s , fa milia r wit h s t a t is t ica l s cien ce, a n d es pecia lly wit h t h a t
pa r t of it wh ich r ela t es t o h u ma n life,-it s r epr odu ct ion , it s con t in u a n ce, a n d
it s ext in ct ion . Th e va lu e of t h e r es u lt s will gr ea t ly depen d u pon t h e degr ee of
in t elligen ce a pplied t o t h eir pr odu ct ion . Th e pla n we r ecommen d is n ot a n
except ion t o t h is gener a l r u le . Like ot h ers , it mu s t h a ve in t elligen ce t o ca r r y
it in t o s u cces s fu l execu t ion ; bu t , if s o execu t ed, it will s ecu r e a fa r mor e
complet e a n d per fect cen s u s t h a n a n y wh it h er t o t a ken . A compet en t cen t r a l
commis s ion , a t Wa s h in gt on , wit h power t o a ppoin t s u bor din a t e commis s ion s
in ea ch s t a t e, h a s h er et ofor e been r ecommen ded for t h e n a t ion a l cen s u s . For
ou r St a t e en u mer a t ion s , we h a ve pr opos ed t h a t t h ey s h a ll be ma de u n der
t h e dir ect ion of t h e Gen er a l Boa r d of Hea lt h . Th e pla n a bove r ecommen ded
migh t be fu lly ca r r ied ou t by t h em, a n d a s complet e a n d a s a ccu r a t e a St a t e
cen s u s a s ca n be des ir ed, migh t t h u s be obt a in ed. Th e s a me a gen cy t h a t
a bs t r a ct s a n d pu blis h es in for ma t ion con cer n in g t h e dea d, s h ou ld ma ke a n d
pu blis h in for ma t ion con cer n in g t h e livin g. Th e a bs t r a ct s s h ou ld be ma de on
a u n ifor m pla n , s o a s t o be ea s ily compa r ed t oget h er .
Ever y loca l Boa r d of Hea lt h s h ou ld h a ve, for t h eir own u s e a ma n u s cr ipt
Regis t er of t h e Popu la t ion of t h eir own cit y or t own , a s .pr opos ed, wit h a n
in dex for r efer en ce t o ea ch fa mily. It wou ld be of gr ea t s er vice in t h e va r iou s
s a n it a r y ma t t er s wh ich migh t come befor e t h em.
En u mer a t ion s of pa r t s of t h e popu la t ion , for a s pecia l pu r pos e, a r e
oft en ma de. Th e n u mber of ch ildr en bet ween cer t a in a ges is r equ ir ed t o be
kn own ever y yea r , a s a ba s is for t h e divis ion of t h e in come of s ch ool fu n ds ,
in differ en t s t a t es . In a let t er con t a in ed in t h e a ppen dix t o t h e fou r t h
Regis t r a t ion Repor t , t h e wr it er s a id :-" Th e educational age, a s fixed by t h e
la ws of Ma s s a ch u s et t s , is 4 t o 16. It s eems t o me, h owever , t h a t t h is s pecific
cla s s ifica t ion is in ju diciou s , a n d t h a t 5 t o 15 wou ld be bet t er . Th e la t t er
poin t s or a ges a r e u n iver s a lly a dopt ed by n a t ion s , a s impor t a n t in t h e
divis ion s of t h e popu la t ion , a n d in t h e s t a t is t ics of t h e dead ; a n d t h er e a r e
ma n y r ea s on s wh y t h e edu ca t ion a l a ge s h ou ld be wit h in t h es e poin t s . It
wou ld be les s la bor t o ma ke t h e en u mer a t ion ; a n d, fr om exa min a t ion s wh ich
h a ve been ma de, it a ppea r s t h a t t h e ch ildr en a t t en din g s ch ool mor e n ea r ly
cor r es pon d t o t h em. Compa r is on s cou ld be mor e r ea dily ma de wit h t h e
or din a r y divis ion s of t h e popu la t ion . I a gr ee in opin ion wit h a r ecen t emin en t
wr it er , in t h in kin g, in it s a pplica t ion t o s ch ools , t h a t 'h er ea ft er 15 will be t h e
a ge a t wh ich , in a n y cen s u s it will be con s ider ed t h a t , in t h e ma s s of t h e
commu n it y, occu pa t ion begin s , a n d edu ca t ion en ds .' " In 1849, t h is h in t wa s
89
ma t u r ed in t o a la w; a n d 5 t o 15 is now t h e lega l Edu ca t ion a l Age in
Ma s s a ch u s et t s .

XIII. WE RECOMMEND that the Cons titution of the S tate be s o altered, that
the S tate Cens us s hall be tak en in 1855, and at the end of every s ubs equent
period of ten y ears .
Th e con s t it u t ion of t h is St a t e, a s a men ded in 1839, [Ch a p. Sect . 2, Ar t .
I, a n d Sect . 3, Ar t . 2,] pr ovides t h a t " a cen s u s of t h e in h a bit a n t s of ea ch cit y
a n d t own , on t h e fir s t da y of Ma y, s h a ll be t a ken a n d r et u n ed in t o t h e office
of t h e Secr et a r y of t h e Common wea lt h , on or befor e t h e la s t da y of J u n e, of
t h e yea r on e t h ou s a n d eigh t h u n dr ed a n d for t y, a n d of ever y t en t h yea r
t h er ea ft er , wh ich cen s u s s h a ll det er min e t h e a ppor t ion men t of s en a t or s a n d
r epr es en t a t ives for t h e t er m of t en yea r s ."
81

Th e con s t it u t ion of t h e Un it ed St a t es or igin a lly pr ovided [Ar t .I, Sect .II,]
t h a t t h e a ct u a l en u mer a t ion [of t h e in h a bit a n t s ] s h a ll be ma de wit h in t h r ee
yea r s a ft er t h e fir s t meet in g of t h e Con gr es s , a n d wit h in ever y s u bs equ en t
per iod of t en yea r s , in s u ch ma n n er as t h ey s h a ll by la w dir ect ," for t h e
pu r pos e of det er min in g t h e n u mber of r epr es en t a t ives wh ich ea ch s t a t e s h a ll
be en t it led t o s en d t o Con gr es s . An d by t h e a ct of Ma r ch 1, 1790, t h e fir s t
en u mer a t ion of t h e in h a bit a n t s of t h e Un it ed St a t es wa s ma de t h a t yea r .
New a ct s h a ve been pa s s ed, or der in g n ew cen s u s es ever y t en yea r s , s in ce
t h a t t ime. Th e s even t h n a t ion a l cen s u s is t o be t a ken t h is yea r , ( 1850. )
By t h e oper a t ion of t h es e t wo con s t it u t ion s , t wo en u mer a t ion s of t h e
in h a bit a n t s of t h is St a t e wer e t a ken in 1840, a r e t o be t a ken t h is yea r , a n d
will con t in u e t o be t a ken a t t h e en d of ea ch s u cceedin g per iod of t en yea r s ,
s o lon g a s n eit h er of t h es e con s t it u t ion s r ema in u n a lt er ed. Two
en u mer a t ion s of t h e in h a bit a n t s of a pla ce, ma de in t h e s a me yea r by
differ en t a u t h or it ies , a r e n ot on ly in expedien t , bu t ma y be of pos it ive
in con ven ien ce. If t hey s h ou ld be es s en t ia lly differ en t , a s wa s t h e ca s e in
s ome pla ces a t t he la s t cen s u s , a dou bt migh t be t h r own over t h e
a u t h en t icit y of bot h , a n d n eit h er t a ken a s cor r ect . Bes ides , t wo, if equ a lly
cor r ect , wou ld a ffor d n o in for ma t ion t h a t on e migh t n ot give. If on e wer e
t a ken in t h e in t er ven in g per iod, bot h wou ld be of gr ea t va lu e. Bes ides
a ffor din g t h e mea n s of s h owin g t h e gr owt h of differ en t places , t h ey wou ld
en a ble u s t o ma ke mu ch mor e a ccu r a t e s a n it a r y compa r is on s a n d
dedu ct ion s . Th e wh ole ma t t er , t oo, bein g u n der t h e con t r ol of t h e St a t e, s u ch
a pla n migh t be a dopt ed a n d s u cces s fu lly ca r r ied ou t , a s wou ld s ecu r e t h e
bes t a n d mos t u s efu l r es u lt s , a s s u gges t ed in t h e la s t r ecommen da t ion . Th is
per iod migh t a ls o be u s ed for t h e a s cer t a in men t of ot h er s t a t is t ics , bes ide
s u ch a s r ela t e t o t h e popu la t ion .
Th e wor ds "in t h e yea r on e t h ou s a n d eigh t h u n dr ed a n d for t y" occu r
t h r ee t imes in Sect . 2, Ar t . 1, a n d t wice in Sect .3, Ar t . 2; a n d t h e pr opos ed
a men dmen t wou ld r equ ir e mer ely t h a t t h e wor ds f if ty -f ive be s u bs t it u t ed for
t h e wor d for t y in t h es e five in s t a n ces . It is wor t h y of con s ider a t ion , h owever ,
wh et h er t h e t ime for t a kin g t h e cen s u s s h ou ld n ot be t h e 1
s t
da y of J u ly,-t h e
middle of t h e yea r ,-in s t ea d of t h e 1s t da y of Ma y.


81
Rules and Orders of the House of Representatives, pp. 68, 100, 105.
90
We a r e oppos ed t o fr equ en t a lt er a t ion s of t h e con s t it u t ion of t h e St a t e;
bu t wh a t we n ow r ecommen d a ffect s n o pr in ciple. It s expedien cy a n d u t ilit y
a r e s o obviou s , t h a t it mu s t commen d it s elf t o gen er a l .a ppr oba t ion . Th e
con s t it u t ion of New Yor k pr ovides for a s t a t e cen s u s a t t h e s a me per iod h er e
pr opos ed.
To a void t h e expen s e a n d in con ven ien ce of t wo en u mera t ion s , a n
a r r a n gemen t h a s been pr opos ed t h a t t h e Un it ed St a t es s h ou ld u n it e wit h t he
St a t e, a n d t a ke on e cen s u s on ly. Bu t t h is h a s n ot been effect ed, beca u s e t h e
Un it ed St a t es cou ld n ot wit h pr opr iet y delega t e a n a u t h or it y t o on e s t a t e, t o
r et u r n a ba s is of r epr es en t a t ion , wh ich it did n ot t o a n ot h er .

XIV. WE RECOMMEND that the laws relating to the public regis tration of
births , marriages , and deaths , be perf ected and carried into effect in every city
and town of the S tate.
We h a ve a lr ea dy s a id t h a t a n a ccu r a t e kn owledge of t h e livin g
in h a bit a n t s of a pla ce for ms t h e fir s t elemen t for es t ima t in g it s s a n it a r y
con dit ion . An exa ct kn owledge of t h e bir t h s , ma r r ia ges , a n d dea t h s , for ms
t h e s econ d es s en t ia l elemen t . Wit h ou t bot h of t h es e elemen t s , we ca n n ot
det er min e, wit h a n y con s ider a ble degr ee of a ccu r a cy, wh et h er t h e pu blic
h ea lt h a t on e pla ce is bet t er t h a n a t a n ot h er , or wh et h er a t t h e s a me pla ce it
is bet t er a t on e t ime t h a n a t a n ot h er . By t h em we ca n det er min e bot h of
t h es e pr opos it ion s .
82

A n ew a ct r ela t in g t o r egis t r a t ion wa s pa s s ed on t h e 3d of 1849, a n d
in s t r u ct ion s h a ve been pr epa r ed for ca r r yin g it effect , a n d is s u ed by t h e
Secr et a r y of St a t e. Th e la w is becomin g mor e a n d mor e popu la r ; a n d if
s u per in t en den t by a n efficien t St a t e a gen cy, a n d fa it h fu lly ca r r ied in t o
oper a t ion by t h e loca l a u t h or it ies of a ll t h e t own s , it ma y s ecu r e t h e ma n y
impor t a n t ben efit s des ign ed by it s pa s s a ge. Th e h ea din g of t h e r egis t r y books
n ow in u s e a r e a s follows :-

82
The following extract f rom the Quarterly Return of the Regis trar- General in England, f or April, 1850, s hows s ome of
the purpos es to which this inf ormation may be applied;- While the returns of the exports , imports , and revenue,
furnis h good indications of the production, cons umption, and commerce of great clas s es in the country , the marriages ,
births , and deaths s upply a s urer tes t of the condition of the whole population. It is gratif y ing to f ind that the general
res ults of both clas s es of returns are f avorable. The marriages , which in 1847 were s o much depres s ed, and
increas ed almos t imperceptibly in 1848, ros e to 141,599 in the y ear 1849; and the autumn quarter were 43,632;
which is a higher number than has ever bef ore been celebrated , expecting in the autumn quarter of 1845. The deaths
have als o declined; they were 98,607. The country , which, af ter the f ailure of the potato crop in 1846, was covered
with funerals , - in the train of a multitude o d is eas e, and of two great epidemics , the f atal inf luenz a of 1847-8, and
the more dead ly cholera of 1849,- is now in health again. The deaths in the f irs t quarter of 1850 were les s by 21,065
and 21,414 than the deaths in the corres ponding quarters of 1847 and 1848. Fewer children have been lef t
f atherles s , f ewer parents have been bereaved of their children. Sick nes s and s uffering,- though perhaps not precis ely
in the s ame ratio as the mortality ,-have d iminis hed. The s k illful and active indus try of the k ingdom has been les s of
work men and the incapacity of mas ters ; the paris hes have had f ewer poor to relieve; the f riendly s ocieties f ewer s ick
members to s upport; ins urance s ocieties les s to pay on policies ; every thing dependent on the duration of human lif e
has been relieved of pres s ure; the minds of the people have not been irritated by hunger, fever, and d is content.


91


Ma r r ia ges
Solemn ized in ,
Cou n t y of
Back of
Book Regis t r a r
1 No 8 Names of Pa r en t s
2
Dat e of
Ma r r ia ge 9
Wh a t Ma r r ia ge
Wh ea t h er 1
s t
, 2d, 3d, &c.
3
Names &
Su r n a mes of
Gr oom & Br ide 10
Na me a n d officia l s t a t ion
of t h e per s on by wh om
ma r r ied
4
Res iden ce of
Ea ch a t t h e
Time of
Ma r r ia ge 11 Da t e of Regis t er
5 Age of Ea ch
6
Occu pat ion of
Gr oom
7
Place of Bir t h of
Ea ch

Th e r et u r n s t o t h e Secr et a r y of St a t e con t a in a ll t h e In for ma t ion in t h e
books of r ecor ds , except in g colu mn s 11 a n d 12 r ela t in g t o bir t h s ; 10 a n d 11,
r ela t in g t o ma r r ia ges ; a n d 12 a n d 13, r ela t in g t o dea t h s . Th es e r et u r n s a r e
pr in t ed on pa per of u n ifor m s ize,-18 in ch es s qu a r e,-a n d a r e des ign ed t o be
bou n d in t o a n n u a l volu mes . Th es e volu mes a r e t h u s ea s ily a cces s ible, a n d
a ffor d t h e mea n s of in ves t iga t in g t h e oper a t ion of a n y dis ea s es wh ich pr eva il
in t h e St a t e, a s well a s t h e per s on a l h is t or y of in dividu a ls .
A few impor t a n t impr ovemen t s s h ou ld be ma de in t h e a dmin is t r a t ion
a n d execu t ion of t h e la w; a n d t h e loca l Boa r ds of Hea lt h a r e a u t h or ized t o
ma ke a n y r egu la t ion s t h ey ma y deem expedien t for t h is pu r pos e. Effor t s
s h ou ld con s t a n t ly be ma de t o obt a in t h e r ecor ds of t h e even t s at or near the
time at which they tak e place. Wh en dela yed t o t h e en d of t h e yea r , or even
for a mu ch s h or t er per iod,-owin g t o t h e fr equ en t ch a n ges in t h e r es iden ces
of ou r people, a n d t o ot h er ca u s es ,-mis t a kes a n d omis s ion s a r e in evit a ble.
83


83
We are convinced, af ter repeated attempts , that it is impos s ible to obtain accurate accounts of pas t unrecorded
events , concerning either the living or the dead. Hitherto, every trial to obtain the number of births , marriages , and
deaths , a y ear or more af ter they happend, has been f ailure. This conviction has been expres s ed in relation to the
nation-al cens us this y ear. A
Dea t h s in
Back of
Book
Regis t r a r
No 8 Place of Bir t h
Dat e of Deat h 9
Names of
Par en t s
Name &
Su r n a me of t h e
Des eas ed 10
Dis ea s e, or
Ca u s e of Dea t h
Yea r s
Mon t h s
Days
A
G
E



11
Place of
In t er men t
Place of Bir t h 12
In for ma n t , or
Un der t a ker
Sex a n d
Con dit ion s 13
Wh en
Regis t er ed
Occu pat ion
Bir t h s
Regis t r a r (Ba ck of t h e
Book)
1 No 7 Res iden ce of Pa r en t s
2 Dat e of Bir t h 8 Occu pat ion of Fat h er
3 Na me, (if a n y) 9 Pla ce of Bir t h of Fa t h er
4
Sex a n d
Con dit ion
1
0 Place of Bir t h of Mot h er
5 Pla ce of Bir t h
1
1 In for man t
6
Name of
Par en t s
1
2 Wh en r egis t er ed
92
Th e fa ct s a s t o births migh t be obt a in ed, by t h e cler ks a n d r egis t r a r s by
t h eir own per s on a l a gen cy, or by ma kin g pr oper a r r a n gemen t s wit h
ph ys icia n s , or by dis t r ict officer s of t h e t own , or by r equ ir in g t h e pa r en t or
per s on in t er es t ed t o ma ke t h e r et u r n wit h in a fixed per iod, u n der pen a lt y.
As t o deaths , by t h e a ppoin t men t of compet en t u n dert a ker s : by
r equ ir in g t h em t o obt a in a n d r ecor d, in ea ch ca s e, a ll t h e in for ma t ion
des ir ed, before the burial. Th e cer t ifica t es of t h e ca u s es of dea t h s h ou ld
a lwa ys be obt a in ed, wh en pr a ct ica ble, t h e a t t en din g ph ys icia n ; a n d we h a ve
n o dou bt t h a t few in s t a n ces wou ld occu r in wh ich t h ey wou ld be r efu s ed:
u pon r equ es t . Th e En glis h ph ys icia n s , s a ys a r ecen t medica l wr it er of t h e
h igh es t a u t h or it y, "h a ve da ily a n d h ou r ly wr it t en ou t t h e ca u s es of dea t h ,
br in gin g t h e wh ole kn owledge of t h e pr ofes s ion t o bea r u pon t h is s in gle
poin t , a s u n pa id s er vices . In t h e a ggr ega t e, t h is la bor h a s been en or mou s ,
bu t it h a s been given , fr eely r en der ed, by t h e pr ofes s ion , t o t h e gover n men t ,
wit h ou t fee or r ewa r d. It ma y s eem a pla in , u n con s equ en t ia l ma t t er , t h is
gr a t u it ou s r et u r n of t h e ca u s es of dea t h , bu t it ma kes u p a bu lk of u n pa id
s er vice t o t h e s t a t e, s u ch a s ca n be pr es en t ed by n o ot h er body or pr ofes s ion
in t h e empir e."
84


As t o marriages , it is difficu lt t o per ceive a r ea s on for goin g ou t of t h e
St a t e t o be ma r r ied, or for n eglect in g t o h a ve t h e ma r r ia ge r ecor ded, u n les s
t h e pa r t ies a r e a s ha med of t h e con n ect ion for med, or mis a ppr eh en d t h e
impor t a n ce of t h e r ecor d t o t h ems elves per s on a lly, or t o t h e pu blic.
A n ew a ct r ela t in g t o t h e pu blica t ion of in t en t ion s of ma r r ia ge wa s
pa s s ed, Ma r ch 28, 1850, wh ich r emoves ma n y of t h e s a lu t a r y ch ecks
impos ed by pr eviou s la ws . Un der t h is a ct , t h e pa r t ies , by en t er in g t h eir
in t en t ion s in t h e office of t h e cler k h a ve per mis s ion t o ma r r y immedia t ely,

s trong des ire, however exis ted in the Cens us Board, that meas ures s hould be provided for obtaining the inf ormation; and
a s eparate s chedule in relation to deaths was prepared, at their reques t, f or the purpos e.
This duty is required by law,in s ome places , under heavy penalities . The act in relation to public health in the city of New
York , pas s ed this y ear, has the following provis ions :- SECT. 10. It s hall be the duty of each and every practicing
phy s ician in the city of New York , 1. Whenever required by the Board of Health, or the May or and Commis s ioners of
Health of s aid of s aid city , to report to the City Ins pector of s aid city , at s uch times , in s uch forms as s aid Board may
pres cribe, the number of pers ons attack ed with any pes tilential,contagious , or inf ectious d is eas e, attended by s uch
phy s ician f or the twenty -f our hours next preced ing, and the number of pers ons , attended by s uch phy s ician, who s hall
have d ied in s aid city during the twenty -f our hours next preceding s uch report, of any s uch pes tilential, contagious , or
inf ectious d is eas e. 2. To report in writing to the City Ins pector, the Board of Health, or to the May or and the
Commis s ioners of Health, every patient patient he s hall have laboring under any pes tilential,contagious , or inf ectious
dis eas e, and within twenty -f our hours af ter he s hall as certain or s us pect the nature of the dis eas e. 3. To report to the
City Ins pector, when required by the Board of Health, the death of any of his patients who s hall have d ied of dis eas e,
within twenty -f our hours thereaf ters uch death s hall have occurred, and to s tate in s uch report the s pecif ic name and ty pe
of s uch dis eas e. SECT. 27. Every practicing phy s ician who s hall ref us e or neglect to perf orm the duties enjoined on him
by the tenth s ection of this title, s hall be cons idered guilty of a mis demeanor, and s hall als o f orfeit f or each offence the
s um of two hundred and f if ty d ollars , to be s ued f or and recovered by the Board of Health.
2
The following are
provis ions of this act:- SECT. 1. All pers ons intending to be joined in marriage, s hall caus e notice of their intens ions to be
entered bef ore their marriage, in the off ice of the clerk or regis trar, or other off icer appointed for s uch purpos e, of the city
or town in which they may res pectively d well, (if within the S tate,) and if there be no s uch clerk in the place of their
res idence, the lik e entry s hall be made with the clerk of an ad joining town. SECT. 2. The clerk s hall deliver to the parties
a certif icate under his hand, s pecif y ing the time when notice of the intens ion of marriage was entered with him, which
certif icate s hall be delivered to the minis ter or magis trate in whos e pres ence the marriage is to be contracted, bef ore he
s hall proceed to s olemniz e the s ame. SECT. 3. Whenever parties living in this Commonwealth s hall go out of it f or the
purpos e of having a marriage s olemniz ed between them in another S tate, and a marriage s hall be s o s olemniz ed, and
they s hall return to d well here, they are hereby required to f ile a certif icate or declaration of their marriage, including the
f acts concerning marriages now required by law, with the clerk or regis trar of the town or city where either of them lived
at the time, within s even d ay s af ter their return, under a penalty of ten dollars , to be recovered in the manner and to the
us es s pecif ied in the third s ection of the "Act relating to the Regis tration of Births , Marriages , and Deaths ," pas s ed on the
2d day of May , 1849. Sect.4. The fee of the clerk or regis trar for mak ing the record of s uch marriage s hall Be f if ty cents ,
to be paid by the s aid parties S ect.5. So much of the s eventy -f ifth chapter of the Revis ed S tatutes as is incons is tent With
this act is hereby repealed: provided, nevertheles s , that nothing herein contained s hall be s o cons tructed as to mod if y or
alter the provis ions of the twenty -s econd s ection of the s aid s eventy -f if th chapter, which relates to marriages among the
people called Friends or Quak ers , but the s ame s hall remain in full force.

93
wit h ou t t h e fou r t een da ys ' pu blis h men t h er et ofor e r equ ir ed. Ver y pr oper ly,
h owever , it does not s u per s ede t h e n eces s it y of en t er in g t h e pa r t icu la r s
con cer n in g t h e pa r t ies , n ow r equ ir ed. by la w; a n d it impos es a pen a lt y-
u pon a n yon e wh o does n ot give s u ch in for ma t ion , wh et h er ma r r ied in t he
t own or St a t e, or n ot .
2
Dea t h a ffect s t h e h u ma n r a ce n ea r ly a ccor din g t o a u n ifor m la w,
modified in it s oper a t ion on ly by exch a n ge of cir cu ms t a n ces ; bu t it does n ot
a ffect differ en t a ges a like, even if a ll ot h er cir cu ms t a n ces a r e t h e s a me. At
s ome a ges per s on s a r e mu ch mor e lia ble t o dea t h t h a n a t ot h er s . Some,
h owever , s u ppos e t h a t , in a s ch ool compos ed of you t h , or in a ma n u fa ct or y
compos ed of oper a t ives of mor e a dva n ced life, or in a pr is on or in t h e a r my,
filled wit h per s on s in middle life, if t h e livin g t o on e dea t h , or t h e a ver a ge a ge
a t dea t h , a r e t h e s a me a s t h e wh ole popu la t ion of t h e t own or pla ce wh er e
loca t ed, t h en t h eir h ea lt h wou ld be t h e s a me; a n d if it differ ed, it wou ld
in dica t e a differ en t degr ee of h ea lt h . Bu t it is n ot go. Th es e a r e s elect lives ,
a n d t h ey a r e gover n ed by t h e la ws of t h eir a ge on ly, a n d n ot by t h os e
a pplica ble t o t h e wh ole popu la t ion of t h e t own , compos ed of per s on s of a ll
a ges . Th is ma t t er is s o lit t le u n der s t ood, a n d s o ma n y mis t a kes a r e ma de,
even by emin en t s t a t is t s , t h a t it s h ou ld be clea r ly illu s t r a t ed.
On r et u r n in g t o t h e t a ble a lr ea dy given on pa ge 35, t h e la w Of mor t a lit y
is given for t h e wh ole of En gla n d, a n d for Su r r ey, On e of t h e mos t h ea lt h y,
a n d for Liver pool, on e of t h e mos t Un h ea lt h y dis t r ict s of En gla n d. Now let u s
s u ppos e t h e exis t en ce of t h r ee commu n it ies , A, B, a n d a , ea ch con t a in in g
1,000 per s on s , bu t differ en t ly con s t it u t ed a s t o a ges . In A t h er e a r e 200
fa milies , con t a in in g 100 per s on s bet ween t h e a ges of 30 a n d 40 yea r s , 300
bet ween t h e a ges of 20 a n d 30 ; a n d each of t h es e fa milies con t a in , on t h e
a ver a ge, 3 ch ildr en u n der 5 yea r s of a ge. In B t h er e a r e s ever a l boa r din g-
s ch ools , in t h e fa milies con n ect ed wit h wh ich t h er e a r e 100 per s on s bet ween
20 a n d 30 yea r s , 300 s ch ola r s a n d ot h er per s on s bet ween 15 a n d 20, a nd
600 bet ween 10 a n d 15. An d in a , compos ed pr in cipa lly of elder ly per s on s ,
t h er e a r e 100 per s on s bet ween 40 a n d 50 yea r s , 300 bet ween 50 a n d 60,
400 bet ween 60 a n d 70, 150 bet ween 70 a n d 80, a n d 50 bet ween 80 a n d 90.
An d let u s s u ppos e t h a t ea ch of t h es e commu n it ies h a ve been s u bject ed t o
t h e s a me s a n it a r y la ws , a lt er n a t ely, a s t h e mos t h ea lt h y a n d t h e mos t
u n h ea lt h y dis t r ict s of En gla n d, a s given in t h e t a ble a lr ea dy r efer r ed t o, a n d
t h e r es u lt wou ld be a s in followin g t a ble :-

Su bject t h es e s ever a l popu la t ion s , a lt er n a t ively t o
t h e s a me r a t es of mor t a lit y in differ en t loca lit ies ,
t h e n u mber wh o wou ld die
Su ppos e t h e
n u mber a n d a ges of
t h e wh ole
popu la t ion in ea ch
of t h r ee differ en t
commu n it ies A, B
a n d C,- a r e a s
follows :-
In a h ea lt h y loca lit y
wou ld be
In a n u n h ea lt h y localit y
wou ld be
Ages
In A In
B
In
C
In A In B In C In A In B In C
Un d
er 5
600 - - 24.7
3
- - 86.2
3
- -
5 t o - - - - - - - - -
94
10
10 t o
15
- 600 - - 1.90 - - 3.78 -
15 t o
20
- 300 - - 1.86 - - 2.96 -
20 t o
30
300 100 - 1.90 .63 - 3.80 1.26 -
30 t o
40
100 - - 1.00 - - 2.16 - -
40 t o
50
- - 100 - - 1.17 - - 3.36
50 t o
60
- - 300 - - 6.85 - - 15.91
60 t o
70
- - 400 - - 25.4
3
- - 42.53
70 t o
80
- - 150 - - 23.0
1
- - 31.11
80 t o
90
- - 50 - - 21.4
2
- - 16.11
Tot a l 100
0
100
0
100
0
27.6
3
4.29 77.8
8
92.1
9
8.00 109.0
2
Dea t h s in 100 livin g, or
per cen t
Or t o t h e wh ole livin g, on e in
Th e a ver a ge a ge of ea ch wa s
2.76
36.1
9
5.22
.43
232.
55
16.4
1
7.78
12.8
4
73.5
5
9.92
10.8
4
4.17
.80
125.
00
16.2
8
10.9
0
9.17
68.7
3


It a ppea r s fr om t his t a ble t h a t in t h es e t h r ee commu n it ies u n der
h ea lt h y cir cu ms t a n ces , a like in a ll r es pect s expect in g 'a ge, t h e dea t h s wer e
27.63 per s on s , or 2.76 per cen t ., in A; 4.39 per s on s , or .43, or les s t h a n i of
1 per cen t ., in B; a nd 77.88 per s on s , or 7.78 per cen t ., in C;-t h a t t h er e wer e
livin g t o 1 dea t h , 36.19 per s on s in A ; 232.55 per s on s in B ; 12.84 per s on s
in C ;-a n d t h a t t h e a ver a ge a ges a t dea t h of t h os e wh o died wer e, 5.22 yea r s
in A, 16.41 yea r s in B, a n d 73.55 yea r s in C ! An d u n der u n h ea lt h y
cir cu ms t a n ces t h e fa ct s a s s t r ikin gly a ppea r .
It ma y per h a ps be s a id, t h a t commu n it ies s o con s t it u t ed h a ve n ever
exis t ed. Th ey h a ve n ot , exa ct ly in t h is r ea lt ion , bu t t h ey ma y a n d a ct u a lly do
exis t in s ome degr ee a ppr oxima t in g' t o it . If s o, n ot h in g n eed fu r t h er be given
t o illu s t r a t e t h e in cor r ect n es s a n d even a bs u r dit y of u s in g t h e a ver a ge a ge a t
dea t h , or t h e n u mber of a popu la t ion ou t of wh ich on e ma y die a n n u a lly,
a lon e, a s a ccu r a t e s t a n da r ds for s a n it a r y compa r is on s . An d it follows , a ls o,
t h a t it is n eces s a r y, n ot on ly t o kn ow t h e n u mber of t h e livin g a t ea ch a ge,
bu t h ow mu ch life is cr ea t ed a n d pr odu ced, or h ow ma n y per s on s a r e bor n ,
on wh ich t h e la ws of mor t a lit y oper a t e. By t h is kn owledge a lon e we migh t
es t ima t e t h e n u mber of dea t h s , a n d t h e a ver a ge a ge a t dea t h , wit h
con s ider a ble exa ct n es s .
95
Th e followin g pr in ciples ma y be con s ider ed a s s et t led ; t h ou gh we h a ve
n ot s pa ce in t h is con n ect ion t o illu s t r a t e t h em fu lly. Th ey s h ou ld gover n a ll
t h os e wh o ma ke s a n it a r y s u r veys of differ en t pla ces or popu la t ion s .
1. Th a t a u n ifor m la w of mor t a lit y exis t s , wh ich des t r oys mor e per s on s a t
on e a ge t h a n a t a n ot h er , in a ll ot h er cir cu ms t a n ces exa ct ly s imila r ; a n d t h a t
t h is la w is modified in it s oper a t ion in a h ea lt h y a n d in a n u n h ea lt h y loca lit y,
on ly by it s t h e on e t h a n in t h e ot h er .
2. Th a t t h e gen er a t ive power a n d a bilit y t o pr odu ce a h ea lt h y is ma in ly
a s cer t a in ed by t h e n u mber of ma r r ia ges , t h e a ge ma r r ia ge, an d t h e n u mber
of ma r r ied per s on s livin g in t h e pr ocr ea t ive a ges , combin ed wit h ot h er
per s on a l cir cu ms t a n ces ; a n d h en ce a r is es t h e s a n it a r y impor t a n ce of
a s cer t a in in g in a cen s u s , a s a ch a r a ct er is t ic of t h e popu la t ion , t h e n u mber of
t h e ma r r ied a t differen t a ges , a n d of r ecor din g ea ch ma r r ia ge a n d t h e a ge a t
ma r r ia ge.
3. Th a t wh en t h e n u mber of bir t h s is gr ea t , t h e n u mber of dea t h s is
pr opor t ion a lly gr ea t , a n d t h e a ver a ge a ge a t dea t h s pr opor t ion a lly low; a n d
t h a t a n exces s ive pr odu ct ion of life is on e of t h e ca u s es , n ot con s equ en ces , of
gr ea t mor t a lit y; a n d h en ce t h e n u mber of bir t h s is a n eces s a r y elemen t in
t h e s a n it a r y con dit ion of a popu la t ion .
4. Th a t t h e a ver a ge a ge a t dea t h , a s well a s t h e a ggr ega t e n u mber of a
opu la t ion ou t of t h e wh ole of wh ich on e dies is a fa lla ciou s t es t of it s s a n it a r y
con dit ion ; a n d ca n n ot be employed a lon e, for t h a t pu r pos es , wit h ou t lea din g
t o s er iou s er r or s . It ca n be a pplied, a s a n a ccu r a t e t es t , on ly wh en t h e a ges
of t h e livin g in h a bit a n t s compa r ed a r e a like.
5. Th a t s elect in g a cla s s of t h e popu la t ion , s u ch a s t h e pr ofes s ion a l men , t h e
t r a des men , t h e la bor er s , t h e r ich , or t h e poor , a n d givin g t h eir a ver a ge a ge,
or t h e a ver a ge n u mber of yea r s of life t h a t eit h er live les s t h a n t h e ot h er s , or
t h a t eit h er los e mor e t h a n t h e ot h er s , a s a t es t of t h e s a n it a r y con dit ion of
t h e cla s s , ma y mis lea d t h e in qu ir er , a n d ca n n ot be r elied u pon a s a n
a ccu r a t e t es t .
6. Th a t t h e in for ma t ion con cer n in g t h e r a t e of mor t a lit y s u ppos ed t o h a ve
pr eva iled in pa s t a ges , wh en t h e ca lcu la t ion s h a ve been ma de u pon t h e
er r on eou s ba s is men t ion ed in t h e la s t t wo con clu s ion s , ca n n ot be t a ken as
a n exa ct t es t for compa r is on wit h t h e pr es en t a ge, wit h ou t s ome a llowa n ce of
er r or . Few obs er va t ion s con cer n in g t h e livin g or t h e dea d wer e ma de wit h
a ccu r a cy in t h e olden t imes .
7. Th a t t h e on ly a ccu r a t e t es t s of mea s u r emen t for on e pla ce a r e t h os e
fou n ded on a join t compa r is on of t h e n u mber of per s on s livin g a t ea ch a ge,
wit h t h e n u mber of dea t h s a t t h e s a me a ge; or for differ en t pla ces , a
compa r is on of t h e s a me fa ct s r ega r din g t h e popu la t ion of t h e s a me a ges in
bot h pla ces ; or t h e s a me popu la t ion , in t wo pla ces , s u ppos in g it t o be
r emoved fr om t h e on e pla ce t o t h e ot h er .
8. Th a t in es t ima t in g t h e effect s of immigr a t ion a n d emigr a t ion on t h e
s a bit a r y con dit ion of a popu la t ion , t h e differ en ce bot h bet ween t h e a ges of
t h os e wh o come in a n d t h os e wh o go ou t , a n d t h e a ges of t h e per ma n en t
popu la t ion , mu s t a lwa ys be con s ider ed. Ot h er cir cu ms t a n ces bein g equ a l, a
differ en ce in t h is r es pect will pr odu ce a differ en t r a t e of t h e wh ole mor t a lit y.
9. Th e s a me join t compa r is on s h ou ld be ma de s eper a t ley of t h e a ges of t h e
livin g a n d t h e a ges at dea t h of a ll wh o die, by ea ch dis ea s e; in ea ch s ea s on of
t h e yea r ; of ea ch s ex ; of ea ch occu pa t ion ; a n d of t h os e ch a r a ct er ized by
96
ot h er cir cu ms t a n ces . Th e n u mber , a s in flu en ced by eit h er of t h es e
cir cu ms t a n ces , will be in cr ea s ed or dimin is h ed in pr opor t ion a s mor e or les s
a r e fou n d of on e a ge mor e t h a n of a n ot h er . For t h is pu r pos e a va r iet y of
t a bles migh t be con s t r u ct ed t o exh ibit t h e fa ct s in a con den s ed for m.
10. Th a t a n a ccu r a t e en u mer a t ion of t h e n u mber , a ges , &c., of livin g
per s on s , a n d a n a ccu r a t e pu blic r egis t r a t ion of ever y bir t h , ever y ma r r ia ge,
a n d ever y dea t h , wit h a ll t h e in for ma t ion des ir ed r ela t in g 10 ea ch , a r e
a bs olu t ely es s en t ia l a s t h e fou n da t ion of ever y es t ima t ion of t h e s a n it a r y
con dit ion of a popu la t ion ; a n d a s a n it a ry s u r vey, wh er e t h is is wa n t in g, ca n
be of lit t le va lu e.
11. Th a t for a ll pr a ct ica l pu r pos es , a s mea n s of compa r is on , t h e livin g a n d
t h e dea d ma y be divided a s t o t h e a ges , in t o decen n ia l per iods , or per iods of
t en yea r s ea ch , for t h os e over t wen t y; in t o qu in qu en n ia l per iods , or per iods
of five yea r s ea ch , for t h os e u n der t wen t y, a n d in t o ea ch year of life for t h os e
u n der five yea r s . Th is a dmir a ble divis ion h a s been a dopt ed in En gla n d, ( s ee
t a ble, p. 34. ) For s pecia l pu r pos es t h r ee divis ion s s h ou ld be ma de ;-of t h os e
u n der 15, of t h os e bet ween a n d 60, a n d of t h os e over 60,-a s t h e Depen den t ,
t h e a n d t h e Aged cla s s es . Th e divis ion , s omet imes ma de bet ween t h os e
u n der 20, a n d over 20, a s "boys a n d girls ," a n d " men a n d women ;" or a s
"ch ildr en a n d a du lt s ," is in defin it e, u n mea n in g, a n d u s eles s ; a s a r e a ls o t he
a ges 4, 8, 14, 16,21 a n d 45, wh ich h a ve been s omet imes u s ed a s dividin g
poin t s .
12. 'Th a t t o s ecu r e s u ch u n ifor mit y a t differ en t pla ces a n d a t differ en t t imes ,
in t h e a bs t r a ct s of t h e fa ct s con cer n in g t h e livin g in h a bit a n t s , a n d t h e dea d,
t h a t ea ch ma y be a ccu r a t ely compa r ed bot h s h ou ld be ma de u n der t h e
s u per in t en den ce, of on e a gen cy, a n d t h a t a gen cy s h ou ld be t h e Gen er a l
Boa r d of Hea lt h .
85


XV. WE RECOMMEND that provis ion be made f or obtaining Obs ervations of
the atmos pheric phenomena, on a s y s tematic And unif orm plan, at d ijf erent
s tations in the Commonwealth.
Th e a t mos ph er e or a ir wh ich s u r r ou n ds t h e ea r t h is es s en t ia l To a ll
livin g bein gs . Life a n d h ea lt h depen d u pon it ; a n d Neit h er cou ld exis t
wit h ou t it . It s ch a ra ct er is modified in Va r iou s wa ys ; bu t es pecia lly by
t emper a t u r e, weigh t , a n d compos it ion ; an d ea ch of t h es e modifica t ion s h a ve
a n impor t a n t s a n it a r y in flu en ce.
Th e temperature of t h e a t mos ph er e is mea s u r ed by t h e r is e a n d fa ll of
t h e mer cu r y in t h e thermometer; a n d it va r ies gr ea t ly in differ en t t imes a n d
s ea s on s , a n d in differ en t pla ces ln Ma s s a ch u s et t s , it s omet imes , r is es l00
degr ees a bove; a n d s omet imes s in ks t o 20 or mor e below zer o. Hea lt h is
oft en a ffect ed wh en ext r emes of h ea t or cold a r e lon g con t in u ed, or wh en t h e
ch a n ges fr om on e t o t h e ot h er a r e s u dden .
Th e weight of t h e a t mos ph er e is det er min ed by t h e r is e a n d fa ll of t h e
mer cu r y in t h e ba r omet er . Th is r is e a n d fa ll is a bou t 3 in ch es -gen er a lly fr om
28 t o 31. It is s eldom mor e t h a n 2 in ch es in t h e s a me loca lit y ; a n d
s omet imes n ot mor e t h a n 1. In Ma s s a ch u s et t s t h e r is e h a s been kn own t o be
a s h igh a s 31.11, a n d t h e fa ll a s low a s 28.47, s h owin g a differ en ce of 2.64

85
Thos e who may wis h further information on the s ubject of Regis tration of Births , marriages and deaths , may cons ult
the book s alread y ref erred to, in notes pp.30-36, 55,128.

97
in ch es . Th e weigh t of t h e a t mos ph er e a t t h e ea r t h 's s u r fa ce is 14.6Ibs . t o t h e
s qu a r e in ch . Allowin g t h e s u r fa ce of a ma ll's body of mediu m s ize t o be 15
s qu a r e feet , or 2160 s qu a r e in ch es , h e s u ffer s t h e en or mou s pr es s u r e of
31,536 lbs ., or mor e t h a n 15 t on s ! It is , h owever , gen er a lly u n per ceived,
beca u s e t h e pr es s u r e is equ a l, wit h in a n d wit h ou t . It is on ly by it s va r ia t ion s
t h a t we a r e a ffect ed. Bu t t h es e va r ia t ion s , wh en a n a lyzed, will a ppea r
immen s e. Each f all or ris e of one tenth of an inch ind icates a d ifference of
about 100 lbs . A fa ll of 1/ 10 of a n in ch s h ows t h e r emova l of a pr es s u r e of
a bou t 100 lbs . 2/ 10, 200lbs .;5/ 10, 500lbs .; 1 in ch , 1,000 lbs .; 3 in ch es ,
3,000 lbs ., &c. If t h es e va r ia t ion s wer e s u dden , in con ven ien t a n d fa t a l
con s equ en ces migh t follow. Wh en t h e pr es s u r e is r emoved we do n ot feel
ligh t a s we s h ou ld do by t h e r emova l of t h e s a me n u mber of pou n ds of ir on
or ot h er s u bs t a n ce; bu t we feel s lu ggis h , h ea vy a n d s pir it les s , owin g t h e
exces s ive expa n s ion of t h e flu ids of t h e ves s els , t h e n er ves a n d ot h er livin g
fibr es , pr odu ced by a n exces s ive expa n s ion a n d es ca pe of a por t ion of t h e a ir
in cor por a t ed wit h in t h em.
Th e atmos phere is compos ed of t wo pr in cipa l ga s es , a n d t h ey exis t in a ll
pla ces in n ea r ly t h e s a me pr opor t ion s -a bou t fou r -fift h s of n it r ogen a n d on e-
fift h of oxygen . Th e la t t er is t h e pr in cipal s u ppor t er of life. Ot h er ga s es ma y
a ls o be diffu s ed in gr ea t er or les s qu a n t it ies . Br a n d's En cyclopedia of Scien ce
s t a t es t h e a ver a ge or din a r y compos it ion per cen t . of t h e a t mos ph er e a s
follows :-


By
Mea s u r e
By
Weigh t
Nit r ogen , 77. 60 75. 55
Oxygen , 21. 00 23. 32
Aqu eou s Va por , 1. 32 1. 03
Car bon ic Acid, 0. 08 0. 10
100. 00 100. 00

Aqu eou s va por exis t s in gr ea t er a n d mor e va r ied pr opor t ion s t h a n
ca r bon ic a cid ga s , t h ou gh t h e qu a n t it y of t h a t ga s is ver y differ en t a t
differ en t t imes a n d pla ces . Su lph u r et t ed h ydr ogen , a mmon ia , a n d ot h er
ga s es , ma y a ls o be diffu s ed in qu a n t it ies s o gr ea t a s t o be det ect ed by t h e
s en s es , or by ch emica l a n a lys is , or s o min u t e a n d in odor ou s a s t o es ca pe
det ect ion , a n d in eit h er ca s e ma y be t h e ca u s e of dis ea s e. Some idea ma y be
for med of t h e a lmos t in fin it e divis ibilit y of ma t t er , diffu s ed in t h e
a t mos ph er e, fr om t h e fa ct t h a t t h e h ou n d in t h e ch a s e dis cer n s t h e t r a ck of
ma n a n d a n ima ls by t h e odor ifer ou s pa r t icles t h r own off fr om t h eir foot -
pr in t s ; a n d t h a t we det ect t h e odor of mu s k, n ot wit h s t a n din g t h e s in gle gr a in
fr om wh ich it pr oceeds wa s depos it ed t wen t y yea r s pr eviou s , a n d h a s s in ce
been con s t a n t ly diffu s in g it s pa r t icles in t h e s u r r ou n din g a t mos ph er e!
Th e a t mos ph er e is cor r u pt ed in va r iou s wa ys . Ma n h ims elf ca n n ot
br ea t h e t h e s a me a ir t wice wit h impu n it y. Ever y min u t e of ever y da y h e
a ppr opr ia t es t o t h e vit a liza t ion of h is blood of ca r bon ic acid ga s . Wh en
pr es en t in la r ge qu a n t it ies , fr om Wh a t ever ca u s e pr odu ced, ca r bon ic a cid
ga s is des t r u ct ive of Life. Ch a r coa l bu r n ed in a clos e r oom is a n illu s t r a t ion .
Some ot h er ga s es a re a ls o ver y des t r u ct ive. Th e exper imen t s of Th en a r d a n d
98
Du pu yt r en pr oved t h a t bir ds per is h wh en t h e va por s of s u lph u r et t ed
h ydr ogen a n d a mmon ia exis t in t h e a t mos ph er e t o t h e ext en t of a fift een t h
t h ou s a n dt h pa r t ; t h a t dogs a r e depr ived of life wh en t h e a ir con t a in s a
t h ou s a n dt h pa r t ; a n d t h a t ma n ca n n ot live wh en t h e a ir h e br ea t h es is
impr egn a t ed wit h a t h r ee-h u n dr et h pa r t ; a n d s u ffer s in cor r es pon din g
degr ee wh en a les s pr opor t ion of t h es e pois on ou s ga s es exis t s . Per s on s
fr equ en t ly fa ll dea d wh en en t er in g a well, va u lt , t omb, s ewer or ot h er pla ce,
filled wit h t h es e ga s es , or wit h s t a gn a t ed a ir in wh ich a r e diffu s ed
ema n a t ion s fr om decompos in g a n ima l, veget a ble or min er a l s u bs t a n ces .
Su ch a r e a few on ly of t h e fa ct s wh ich illu s t r a t e t h e impor t a n t a gen cy of
t h e a t mos ph er e in t h e a n ima l econ omy. Wh a t t h a t pecu lia r con dit ion is
wh ich pr odu ces a s pecific dis ea s e, or wh a t ch a n ges pr odu ce differ en t
dis ea s es , a r e a s yet u n kn own ; it h a s n ot been a s cer t a in ed, " beca u s e
met eor ologica l s cien ce, a s con n ect ed wit h t h e pr opa ga t ion a n d s pr ea d of
dis ea s e, is a s yet in it s in fa n cy. We h a ve, in deed, s ome kn owledge of t h e
in flu en ce of t wo of t h e obviou s con dit ion s , n a mely, t h os e of h ea t a n d
mois t u r e ; bu t of t h e a ct ion of t h e s u bt ler a gen t s , s u ch a s elect r icit y a n d
ma gn et is m, t h e pr es en t s t a t e of s cien ce a ffor ds u s lit t le in for ma t ion . St ill
t h er e a r e u n equ ivoca l in dica t ion s t h a t t h er e is a r ela t ion bet ween t h e
con dit ion s of t h e a t mos ph er e a n d t h e ou t br ea k a n d pr ogr es s of epidemic
dis ea s es , t h ou gh we a r e a s yet ign or a n t of t h e n a t u r e of t h a t r ela t ion ."
86

" Th e ea r t h , it is well kn own , " s a ys t h e Regis t r a r Gen er a l, " is
s u r r ou n ded by a n a t mos ph er e of or ga n ic ma t t er , a s well a s of oxygen ,

86
Report of the General Board of Health on Quarantine, p. 10. In Edinburgh, particular attention has been paid to the
inf luence of atmos pheric caus es on the production of dis eas e. Dr. James Stark , in his Report on the Mortality of Edinburgh
and Leith, f or the las t quarter of 1847, (pp. 4 and 5) s ay s , lhallhe " Inf luenz a s uddenly attack ed great mas s es of the
population twice during the cours e of November ;.f irs t on the 18th, and again on the 28th of the s ame month. In both
thes e cas es it Booearcd af ter a k een fros t, and an exces s ively damp thick f og, which came on rather s uddenly af ter
s uddenly af tera f ew d ay s of very mild weather. The d is eas e was theref ore clearly dependent on atmos pheric caus es .
Though inf luenz a was s o exceedingly general, it d id not of its elf materially increas e the mortality during November; but
this d is order and its atmos pheric caus es greatly increas ed the mortality of all other d is eas es . So much much has this
been the cas e, that f rom the 18
th
of November, when inf luenz a firs t appeared, the mortality d aily increas ed till it reached
61 deaths on the 3Oth day of the month. In f act, inf luenz a and its atmos pheric' caus es apparently attack ed the weak
point in every ind ividual. be that the lungs , bowels , or other organs , and has tened to a f atal termination eas e. which, in
ordinary s eas ons , might have s urvived f or month. or y ears ." Again, in hi. Report f or June, July and Augus t, 1848, the
s ame author s ay s :-" The inf luence of weather on dis eas e was , however, s till more s trik ingly manif es ted in regard to
bowel complaints and affections of the organs of diges tion, regis tered under the heads of diarrhea, dy s entery , cholera,
teething, inf lammation of the bowels , &c. During the heats of s ummer and autumn, thes e d is eas es in general become
exceedingly prevalent and f atal, and it has been the too Common belief that the us e of fruit and vegetables was the caus e
of thes e affections . The mortality of thes e dis eas es , however, d uring the above months , mos t s atis f actorily proves that
thes e d is eas es do not depend on, or are caus ed by the us e of fruit and vegetables as article of diet, but that atmos pheric
agencies , and es pecial, temperature, exert a mos t mark ed inf luence on their prevalence and fatality . During 1847, when
the mean temperature of thes e months was 59.09 degrees , the barometric pres s ure above the average, and the air very
dry , the deaths above 60 ros e to the proportion of 15 out of every 100 deaths at all ages . And during 1846, when the
mean temperature was s till higher, , viz ., 60.76 degrees , the barometric pres s ure above the average, and the f all of rain
exces s ive, the proportion of deaths among the aged ros e to 18 percent of the total deaths . The greates t abs olute number of
the deaths , however, among the aged occurred during the three months of 1847, when the mean temperature was high
and the atmos phere very dry . In former reports the banef ul effects of a low temperature on the aged have been f requently
pointed out. The f acts , theref ore, s tated in this and f ormer reports s eem to warrant the conclus ion that a mean
temperature s uch as we have had this y ear, with a moderately mois t cond ition of the atmos phere, and a low barometric
pres s ure, are the conditions of the atmos pheric phenomena which are mos t f avorable to the health of thos e advanced in
y ears . But, in f act, thes e are the conditions mos t f avorable to life at all ages , s eeing the above f acts s eem to prove that
though exces s ive heat, generally s peak ing, is mos t baneful to certain clas s es of dis eas e, even thos e, under the s ame
temperature, are rendred more or les s f atal accord ing as the atmos phere is more or les s dry humid. Thus extreme heat
with drought s eems to caus e a greater mortality among thos e laboring under dis eas es of the res piratory organs , and of
the brain, as well as in all pers ons above 60 y ears of age, than when an equally high temperature is accompanied with
cons iderable atmos pheric mois ture. On the other hand, bowel complaints and heart d is eas es s eem to be more under the
inf luence of temperature alone. Thes e f acts relative to the inf luence of atmos pheric agencies on dis eas e might be
rendered more tangible by arranging them in a tubular f orm. The following table, then, exhibits the inf luence of weather
on dis eas e,by s howing the vary ing number of deaths in the population of Edinburgh from certain clas s es of dis eas e
during the months of June, July , and Augus t of the y ears 1846, 1847, and 1848.

99
n it r ogen , ca r bon ic a cid, a n d wa t er y va por . Th is ma t t er va r ies a n d .is
con s t a n t ly u n der goin g t r a n s for ma t ion s fr om or ga n ic in t o in or ga n ic elemen t s :
it ca n n eit h er be s een , weigh ed, n or mea s u r ed. Th e ch emis t s ca n n ot yet t es t
it s qu a lit ies . Liebig, wit h a ll t h e a pplia n ces of t h e Gies s en la bor a t or y, ca n n ot
yet det ect a n y differ en ce bet ween t h e


DISEASES
1 8 4 6 : Hea t grea t ;
mois tu re exces s ive; h igh
ba romet ric pres s u re.
Mea n Tempera tu re,
60.76 degrees . Fa ll of
Ra in , 12.77 in . Mea n
Ba rom. 29.68 in .
1 8 4 7 : Hea t drou gh t
gr ea t ; h igh ba r omet r ic
pres s u re. Mea n
Tempera tu re, 59.09
degrees . Fa ll of Ra in ,
4.07 in . Mea n Ba rom.
29.70 in
1 8 4 8 : Hea t modera te;
mois tu re modera te;
low ba romet ric
pres s u re. Mea n
Tempera tu re, 55.79
degrees . Fa ll of Ra in ,
9.40 in . Mea n Ba rom.
29.36 in
Res pir a tory Orga n s
Bowel Compla in t s , & c.
..Or du rin g Au gu s t ,
Bra in Dis ea s e
Hea rt Dis ea s es
Aged a bove 60
Or percen t a ge of Aged
t o t ot a l
..mort a lit y

219
173
81
116
29
180

18

280
177
71
120
26
242

15
180
150
33
79
21
124

13
pu r e a ir of t h e Alps , a n d t h e a ir t h r ou gh wh ich t h e h ou n d ca n t ell a h a r e, a
fox, or a ma n h a s pa s s ed; or t h e a ir wh ich obs er va t ion s h ow will pr odu ce
s ma ll-pox, mea s les , s ca r la t in a , h oopin g cou gh , dys en t er y, ch oler a , in flu en za ,
t yph u s , pla gu e. Th es e ma t t er s ma y eit h er be in a s t a t e of va por , t h a t is
ela s t ic, or in ela s t ic or like wa t er , t h ey ma y exis t in bot h s t a t es . Th ey a r e
mos t pr oba bly in t h e s t a t e of s u s pen s ion ; h a n g, like t h e s moke in cit ies , over
t h e pla ces in wh ich t h ey a r e pr odu ced, bu t a r e s pr ea d a n d dr iven a bou t like
ves icllla r wa t er in clou ds . A s t r ea m of aqu eou s va pou r of t h e s a me ela s t icit y
fr om t h e At la n t ic, pa s s in g over En gla n d, is , in on e pla ce, per fect ly
t r a n s pa r en t ; in a n ot h er , mis t ; in a n ot h er , r a in : s o clou ds of epidemic ma t t er
ma y fleet over t h e cou n t r y, a n d in on e pla ce pa s s h a r mles s by, in a n ot h er
des t r oy t h ou s a n ds of lives . Th e ema n a t ion s fr om t h e livin g, t h e gr a ves , t h e
s la u gh t er -h ou s es , t h e h ea ps of filt h r ot t in g, t h e Th a mes , -in t o wh ich t h e
s ewer s s t ill empt y ,r a is e over Lon don a ca n opy wh ich is con s t a n t ly per va ded
by zymot ic ma t t er s ; in on e s ea s on t h is , in a n ot h er t h a t , pr epon der a t in g."
Alt h ou gh we a r e a s yet u n in for med on t h is s u bject , it is u n r ea s on a ble t o
s u ppos e t h a t we s h a ll a lwa ys r ema in s o. It open s a va s t field for
exa min a t ion , wh ich is a s yet a lmos t en t ir ely u n explor ed; bu t it pr omis es
r es u lt s of gr ea t va lu e a n d impor t a n ce t o s cien ce a n d t o h u ma n life. Th e
met eor ologica l obs er va t ion s , wh ich h a ve h it h er t o been ma de in t h is cou n ir y,
h a ve been pu blis h ed r a t h er a s con t r ibu t ion s t o gen er a l s cien ce, t h a n t o s h ow
t h eir s pecific r ela t ion t o h ea lt h . In En gla n d, a n d in s ome pla ces on t h e
con t in en t of Eu r ope, t h es e obs er va t ion s a r e ma de wit h mor e ca r e, a n d for a
mor e s pecific pu r pos e. For s ever a l yea r s pa s t Mr . Gla zier , dir ect or of t h e
Roya l Obs er va t or y a t Gr een wich , h a s pu blis h ed h is met eor ologica l
obs er va t ion s a n d r ema r ks on t h e wea t h er , in con n ect ion wit h t h e r et u r n s of
t h e Regis t r a r Gen er a l of bir t h s , ma r r ia ges a n d dea t h s . M. Qu et elet , dir ect or
of t h e a s t r on omica l obs er va t or y a t Bru s s els , a n d ot h er obs er ver s on t h e
con t in en t , h a ve pu blis h ed s imila r obs er va t ion s . Th ey a ffor d a n in va lu a ble
fu n d of in for ma t ion on t h e s u bject , a n d ca n n ot fa il t o lead t o impor t a n t
pr a ct ica l r es u lt s .
100
We h a ve s u ppos ed t h a t a s imila r plan of obs er va t ion s migh t wit h
a dva n t a ge be in t r odu ced in t o ou r own St a t e. Ou r des ir e h a s been t h a t t h es e
obs er va t ion s s h ou ld be ma de a t s ix or eigh t differ en t s t a t ion s in t h e
Common wea lt h , on a u n ifor m pla n , in s imila r loca lit ies , a t t h e s a me t ime of
da y, a n d by s et s of s imila r in s t r u men t s , ea ch compa r ed, cor r ect ed, a n d
ma de t o a gr ee wit h a common s t a n da r d ; a n d t h a t t h es e obs er va t ion s
s h ou ldbe a n a lyzed, a bs t r a ct ed, combin ed, a n d pu blis h ed by a compea n d
veget a bles a s a r t icles of diet , bu t t h a t a t mos ph er ic a gen cies , a n d in es pecia l,
t emper a t u r e, exer t a mos t ma r ked in flu en ce on t h eir pr eva la n ce a n d fa t a lit y.
Du r in g 1847, wh en t h e mea n t emper a t u r e of t h es e mon t h s wa s 59.09
degr ees , t h e ba r omet r ic pr es s u r e a bove t h e a ver a ge, a n d t h e a ir ver y dr y, t h e
dea t h s a bove 60 r os e t o t h e pr opor t ion of 15 ou t of ever y 100 dea t h s a t a ll
a ges . An d du r in g 1846, wh en t h e mean t emper a t u r e wa s s t ill h igh er , viz.,
60.76 degr ees , t h e ba r omet r ic pr es s u r e a bove t h e a ver a ge, a n d t h e fa ll of
r a in exces s ive, t h e pr opor t ion of dea t h s a mon g t h e a ged r os e t o 18 per cen t .
of t h e t ot a l dea t h s . Th e gr ea t es t a bs olu t e n u mber of dea t h s , h owever , a mon g
t h e a ged occu r ed du r in g t h e t h r ee mon t h s of 1847, wh en t h e mea n
t emper a t u r e wa s h igh a n d t h e a t mos ph er e ver y dr y. In for mer r epor t s t h e
ba n efu l effect s of a low t emper a t u r e on t h e a ged h a ve been fr equ en t ly t en t
a gen cy, a n d a ccompa n ied by s u ch gen er a l r ema r ks a n d dedu ct ion s a s t h ey
migh t s u gges t , in con n ect ion wit h t h e s a n it a r y r epor t s of t h e Gen er a l Boa r d
of Hea lt h . To a s cer t a in h ow fa r ou r pla n wa s pr a ct ica l, a n d migh t be
a ppr oved by compot en t ju dges , we a ddr es s ed a commu n ica t ion t o Wm.
Cr a n ch Bon d, Es q., of t h e Ca mbr idge Obs er va t or y. His commu n ica t ion
a ppea r s in t h e a ppen dix, t oget h er wit h a n ext r a ct fr om t h e r epor t of t h e
Roya l Obs er va t or y a t Gr een wich .
Aft er t h e a bove wa s "wr it t en , t h e legis la t u r e pa s s ed t h e followin g
"Res olve r ela t in g t o met eor ologica l obs er va t ion s ."
"Res olved, Th a t h is excellen cy t h e gover n or be a u t h or ized a n d r equ es t ed
t o fix u pon s u it a ble s t a t ion s , n ot exceedin g t welve in n u mber, in wh ich s h a ll
be in clu ded t h e t h r ee Nor ma l Sch ools a n d t h e t h r ee Colleges in t h is
Common wea lt h , wh er e s h a ll be depos it ed t h e in s t r u men t s n eces s a r y for
ma kin g s ys t ema t ic obs er va t ion s in met eor ology, a ccor din g t o t h e pla n
r ecommen ded by t h e Smit h s on ia n In s t it u t e, a t a n expen s e n ot exceedin g on e
h u n dr ed dolla r s for ea ch s t a t ion , t o be defr a yed fr om t h e s ch ool fu n d, a n d
t h a t h e be a u t h or ized t o dr a w h is wa r r a n t t h er efor e a ccor din gly."
If s u it a ble a gen t s a re a ppoin t ed u n der t h is r es olve, ou r r ecommen da t ion
ca n be fu lly ca r r ied ou t wit h ou t fu r t h er legis la t ion .

XVI. WE RECOMMEND that, as f ar as practicable, there be us ed in all
s anitary inves tigations and regulations , a unif orm nomenclature for the caus es
of death, and f or the caus es of dis eas e.
In ma kin g a s u r vey of differ en t pla ces , or differ en t a r t icles , it is pr oper
t h a t u n ifor m n a mes s h ou ld be given t o mea s u r es a n d weigh t s ; a n d t h a t
u n ifor m in s t r u men t s s h ou ld be u s ed. In a s a n it a r y s u r vey t h e ca u s es of
dea t h a n d t h e ca u s es of dis ea s e will be t h e pr in cipa l object s of in ves t iga t ion;
a n d it is expedien t , a n d even n eces s a r y, t h a t s u ch n a mes s h ou ld be given t o
ea ch a s h a ve a defin it e mea n in g a n d ca n be u n iver s a lly a pplied. Th ey a r e t h e
mea s u r es a n d weigh t s ,-t h e in s t r u men t s by wh ich t h e compu t a t ion s a r e t o be
ma de. Wit h ou t s u ch a u n ifor m s t a n da r d of compa r is on n o ju s t con clu s ion s
101
ca n be dr a wn . It wou ld be equ a lly pr oper t o u s e Fa h r en h eit 's t h er momet er in
on e pla ce a n d Rea u mu r 's in a n ot h er , t o es t ima t e t h e compa r a t ive
t emper a t u r e of t h e a t mos ph er e; or t wo differ en t kin ds of in s t r u men t s a s
mea s u r es of weigh t a n d len gt h , in ot h er ma t t er s , a s t o u s e on e n a me or
cla s s ifica t ion of ca u s es of dea t h , or ca u s es of dis ea s e, in on e pla ce, a n d a
differ en t n a me or cla s s ifica t ion for t h e s a me ca u s es in a n ot h er . Hen ce t h e
r ea s on for t h e a bove r ecommen da t ion in a pla n for a s a n it a r y s u r vey of t h e
St a t e will be a ppa r en t .
A r epor t con t a in in g a n omen cla t u r e a n d cla s s ifica t ion of t h e caus es of
death wa s dr a wn u p, a n d a dopt ed by t h e Na t ion a l Medica l Con ven t ion in
1847. Ext r a ct s fr om a r evis ed copy, a ppr oved by t h e Ma s s a ch u s et t s Medica l
Societ y, a r e in s er t ed in t h e a ppen dix. We h ope t h a t t h e dir ect ion s a n d
Su gges t ion s t h ey con t a in will be ca r efu lly obs er ved by a ll ph ys icia n s , a n d
ot h er s con cer n ed in ca r r yin g t h e s a n it a r y la ws of t h e St a t e in t o effect .
Th e caus es of dis eas e, in a ll s a n it a r y in qu ir ies , des er ve equ a l if n ot
gr ea t er a t t en t ion , t h a n dis ea s e it s elf, Th ey h a ve been differ en t ly cla s s ified
a n d n a med by differ en t a u t h or s . By s ome t h ey h a ve been divided in t o
external or extrins ic, a n d internal or intrins ic ;by ot h er s , in t o principal and
acces s ory " a n d in t o remote and proximate " a n d in ot h er wa ys . Copla n d
(Dict ion , VoI. I, pa ge 645,) divides t h em in t o fou r cla s s es ,- pred is pos ing,
exciting, s pecif ic, a n d determining or cons ecutive ca u s es ; a n d ma kes s ever a l
s u b-cla s s es u n der ea ch . Bigelow a n d Holmes (Ma r s h a ll Ha ll's Pr a ct ice of
Medicin e, Am. Ed. pp, 67-83) divide t h em in t o general a n d s pecif ic ca u s es ;
a n d s u bdivide t h e. for mer in t o pr edis pos in g a n d excit in g, an d t h e la t t er in t o
contagious a n d non-contagious . Willia ms (Pr in ciples of Medicin e, p. 23, Am.
Ed. ) divides t h em in t o predis pos ing a n d exciting ca u s es ; a n d ma kes a
s u bdivis ion of t h e s econ d in t o cognis able a n d non-cognis able a gen t s , Non e of
t h es e cla s s ifica t ion s , h owever well t h ey ma y be a da pt ed for pr ofes s ion a l u s e,
s eem well des ign ed for gen er a l s a n it a r y pu r pos es , Th ey a r e n ot s u fficien t ly
clea r t o be gen er a lly u n der s t ood a n d pr a ct ica lly u s efu l. Bigelow a n d Holmes
s a y, t h is cla s s ifica t ion "mu s t be con s ider ed con ven ien t r a t h er t h a n s t r ict ly
ph ilos oph ica l. " Even Willia ms h ims elf s a ys t h a t "t h es e divis ion s of ca u s es
a r e r a t h er con ven t ion a l a n d con ven ien t t h a n n a t u r a l a n d ph ilos oph ica l ;"
a n d ever yon e wh o ma y exa min e t h em will pr oba bly come t o t h e s a me
con clu s ion . It is ea s y t o per ceive t h a t on e ma y be a pr edis pos in g ca u s e in
on e ca s e a n d a n excit in g ca u s e in a n ot h er ; a n d vice ver s a , a ccor din g t o
cir cu ms t a n ces .
As in t h e n omen cla t u r e a n d cla s s ifica t ion of ca u s es of dea t h it h a s been
fou n d difficu lt t o ma ke on e wh ich s h a ll be u n iver s a lly a ppr oved, s o in
cla s s ifyin g t h e ca u s es of dis ea s e t h e s a me difficu lt y ma y occu r . Yet we deem
it pr oper t o r ecommen d t h a t a ll ca u s es of dis ea s e s h ou ld be divided in t o
t h r ee gen er a l cla s s es :-1. ATMOSPHERIC; 2. LOCAL; a n d 3. PERSONAL.
I. Un der ATMOSPHERIC CAUSES, we wou ld in clu de t h os e t o wh ich a ll
per s on s in a cou n t ry or dis t r ict , in cir cu ms t a n ce in a ll r es pect s a like, a r e
equ a lly expos ed. Sub-clas s es ; 1. clima t e; 2. Sea s on s ; 3. Win ds a n d wea t h er ;
4. Elect r icit y; 5. At mos ph er ic weigh t , t emper a t u r e, mois t u r e, a n d
compos it ion ; 6. Mala r ia ; 7. Un kn own con dit ion s of t h e a t mos ph er e. Wh a t
h a ve been ca lled epidemic ca u s es of dis ea s e come u n der t h es e cla s s es .
II. Un der LOCAL CAUSES we wou ld in clu de t h os e t o wh ich livin g in a
pa r t icu la r n eigh bor h ood or dwellin g h ou s e, in cir cu ms t a n ces in a ll r es pect s
102
a like, a r e equ a lly expos ed. .Su b-cla s s es ; 1. Eleva t ion or depr es s ion of
s it u a t ion ; 2. Deficien cy or impu r it y of wa t er ; 3. Defect ive s ewer a ge, dr a in a ge,
a n d s u r fa ce clea n s in g; 4. An ima l a n d veget a ble efflu via ; 5. Con fin ed a n d
cor r u pt ed a ir ; 6. Ir regu la r a n d imper fect s u pply of ligh t a n d h ea t ; 7. Filt h y
or da mp h a bit a t ion s ; 8. Exis t in g con t a giou s dis ea s es ; 9. Un kn own loca l
ca u s es . Wh a t h a ve been ca lled en demic ca u s es of dis ea s es come u n der t h es e
cla s s es . We wou ld, h owever , r es t r ict t h em t o a pa r t icu la r h ou s e, s t r eet , or
n eigh bor h ood. Wh en t h e in flu en ce s pr ea ds over a wh ole t own or dis t r ict , it
becomes a n a t mos ph er ic ca u s e.
III. Un der PERSONAL CAUSES we wou ld in clu de t h os e wh ich or igin a t e
wit h t h e per s on a lon e, in depen den t of a t mos ph er ic or loca l ca u s es . Su b-
cla s s es ; 1. Her edit a r y con s t it u t ion , or ga n iza t ion or vit a lit y.; 2. Acqu ir ed
con s t it u t ion , or ga n iza t ion or vit a lit y; 3. Deficien cy a n d exces s in qu a n t it y,
a n d impr oper kin d of food; 4. Impr oper qu a n t it y a n d kin d of clot h in g; 5.
Occu pa t ion s a n d h abit s ; 6. Exces s ive ph ys ica l exer t ion ; 7. Exces s ive men t a l
a ct ion ; 8. Alien a t ion of min d; 9. Expos u r e; 10. per s on a l con t a ct wit h a
dis ea s ed per s on , vir u s or pois on ; 11. Violen ce a n d a cciden t s ; 12. Un kn own
per s on a l ca u s es .
At mos ph er ic, a n d loca l, a n d per s on a l con t a gion ma y exis t a s ca u s es of
dis ea s e. Some dis ea s es ca n be commu n ica t ed on ly by a ct u a l con t a ct wit h
a n ot h er per s on , or wit h t h e pois on of t h e dis ea s e of t h e per s on ; a s it ch ,
s yph ilis , n ecu s ia , &c. Th is is pers onal contagion. Ot h er s ma y be
commu n ica t ed eit h er by con t a ct wit h t h e a ir of t h e loca lit y wh er e t h e
dis ea s ed per s on is or h a s been ; a s s ma ll-pox, mea s les , &c. ; or wit h t he
pois on ou s ema n a t ion s fr om decompos in g a n ima l or veget a ble ma t t er s , or
fr om ot h er s u bs t a n ces ; t h is is local contagion. Ot h er s ma y be commu n ica t ed
by con t a ct wit h t h e a t mos ph er e wh ile in a pecu lia r con dit ion ; a s in flu en za ,
dys en t er y, ch oler a , &c. ; t h is is atmos pheric contagion. All t h es e kin ds of
con t a gion ma y exis t , t o a gr ea t er or les s ext en t , a n d pr es s u pon u s wit h
gr ea t er or les s power .
At mos ph er ic con t a gion is gen er a lly h a r mles s u n les s a t t r a ct ed by loca l
ca u s es ; a n d if a t mos ph er ic a n d loca l con t a gion be combin ed, it ma y be
s u cces s fu lly r es is t ed by a per s on for t ified wit h s u fficien t per s on a l vit a lit y.
Th er e s eems t o be a ch emica l a ffin it y bet ween t h e epidemic con s t it u t ion of
t h e a t mos ph er e, an d filt h a n d u n fa vor a ble loca l cir cu ms t a n ces , wh ich
combin e r ea dily wit h t h e con dit ion s of t h e pa r t icu la r per s on s wh om it
a ffect s ; a n d t h e combin a t ion ga t h er s t oget h er t h e pois on of dis ea s e in s o
gr ea t in t en s it y t h a t few wh o a r e expos ed a r e a ble t o r es is t it . Un der s u ch
cir cu ms t a n ces t h os e wh o a r e h ea lt h y, a n d live t emper a t ely a n d r egu la r ly,
oft en es ca pe; wh ile t h e debilit a t ed, in t emper a t e, ir r egu la r liver s , gen er a lly
become vict ims ! An illu s t r a t ion of t h is fa ct ma y be dr a wn fr om t h e h is t or y of
t h a t t er r ible dis ea s e, t h e As ia t ic Ch oler a,-a dis ea s e wh ich der ives it s t er r ific
power ch iefly or en t ir ely fr om t h e a cces s or y or a ccompa n yin g cir cu ms t a n ces
wh ich a t t en d it . It bou n ds over h a bit a t ion a ft er h a bit a t ion wh er e clea n lin es s
a bides ; a n d gen er ally lea ves u n h a r med t h os e in ma t es wh o h a ve pr es er ved
a n d impr oved t h eir n a t u r a l con s t it u t ion s : wh ils t it a ligh t s n ea r s ome
con gen ia l a bode of filt h or impu r it y, a n d fin ds s u bject s pr epa r ed for ea s y
con qu es t by pr eviou s viola t ion s of t h e la ws of h ea lt h a n d life.
Dr . Mit ch ell, of Ph ila delph ia , s u gges t s t h e " cr ypt oga mou s or igin of
epidemic dis ea s es , a n d s ome En glis h per iodica ls h a ve s pecu la t ed on t h e
103
a lleged dis cover y of s por u les or or ga n ic cells , a s ca u s es of ch oler a . Bu t it
wou ld s eem difficu lt t o a s cer t a in t h e cau s e of t h es e ca u s es , even if t h ey a r e
ca u s es , (wh ich is yet t o be pr oved, ) wit h ou t lookin g t o s ome pecu lia r
a n t eceden t a t mos ph er ic con dit ion t o a ccou n t for t h eir pr odu ct ion .
If t h is wer e t h e proper pla ce it wou ld be ea s y t o s h ow t h a t t h is
cla s s ifica t ion is mor e n a t u r a l, s imple, compr eh en s ive, a n d ph ilos oph ica l,
a n d bet t er a da pt ed t o gen er a l pr a ct ica l pu r pos es , t h a n t h e cla s s ifica t ion s in
gen er a l u s e. Th e ext r a ct s we h a ve a lr ea dy given u n der ou r XVt h
r ecommen da t ion , pr ove t h a t a s imila r dis t in ct ion h a s been in dir ect ly
a ckn owleged by t h e bes t medica l wr it er s . Ma n y ot h er s imila r qu ot a t ion s
migh t be given . We a r e a wa r e t h a t it ma y s omet imes be difficu lt exa ct ly t o
dr a w t h e lin e wh ich s epa r a t es a t mos ph er ic fr om loca l ca u s es , t h ou gh n ot , a s
s eems t o u s , for gen er a l pu r pos es , in t h e r es t r ict ed s en s e in wh ich we u s e
t h e t er ms . It s eems t o u s t h a t a n y r et iologis t wou ld h a ve mor e difficu lt y in
dr a win g defin it e lin es t o s epa r a t e con t a giou s fr om in fect iou s , or pr edis pos in g
fr om excit in g, or cogn iza ble fr om n on -cogn iza ble ca u s es of dis ea s e.

XVII. WE RECOMMEND that, in lay ing out new towns and villages , and in
extending thos e alread y laid out, ample provis ion be made for a s upply , in
purity and abund ance, of light, air, and water ; f or drainage and s ewerage, f or
paving, and f or cleanlines s .
It is a r ema r ka ble fact , t h a t n ea r ly t h e wh ole in cr ea s e of t h e popu la t ion
of Ma s s a ch u s et t s , du r in g t h e la s t t wen t y yea r s , is t o be fou n d in cit ies a n d
villa ges , a n d n ot in t h e r u r a l dis t r ict s . Th e t en den cy of ou r people s eems t o
be t owa r ds s ocia l con cen t r a t ion . An d it is well t o in qu ir e wh a t will pr oba bly
be t h e con s equ en ces of t h es e cen t r a l t en den cies ; a n d "h ow, if evils a r e likely
t o a r is e fr om t h is ca u s e, t h ey ma y be a voided. It h a s been as cer t a in ed t h a t
t h e in h a bit a n t s of den s ely popu la t ed pla ces gen er a lly det er ior a t e in vit a lit y;
a n d t h a t , in t h e cou r s e of yea r s , fa milies fr equ en t ly become ext in ct , u n les s
r ecr u it ed by a u n ion wit h ot h er s fr om t h e cou n t r y, or wit h ot h er blood of
gr ea t er vit a l for ce. Th is is a s ign ifica n t fa ct , wh ich s h ou ld be gen er a lly
kn own . Cit ies a r e n ot n eces s a r ily h ea lt h y, bu t cir cu ms t a n ces a r e per mit t ed
t o exis t , wh ich ma ke t h em s o.
Ever y popu la t ion t h r ows off in s en s ibly a n a t mos ph er e of or ga n ic
ma t t er , exces s ively r a r e in cou n t r y a n d t own , bu t les s r a r e in den s e t h a n in
open dis t r ict s ; a n d t h is a t mos ph er e h a n gs over cit ies like a ligh t clou d,
s lowly s pr ea din g-dr iven fa llin g-dis per s ed by t h e win ds -wa s h ed down by
s h ower s . It is ma t t er wh ich has lived, is dea d, h a s left t h e body, a n d is
u n der goin g by oxida t ion decompos it ion in t o s impler t h a n or ga n ic elemen t s .
Th e exh a la t ion s fr om s ewer s , ch u r ch ya r ds , va u lt s , s la u gh t er -h ou s es ,
ces s pools , commin gle in t h is a t mos ph er e, a s pollu t ed wa t er s en t er t h e
Th a mes ; a n d n ot wit h s t a n din g t h e won der fu l pr ovis ion s of n a t u r e of or ga n ic
ma t t er in wa t er a n d a ir , a ccu mu la t e, a n d t h e den s it y of t h e pois on (for in t h e
t r a n s it ion of deca y it is a pois on ) is s u fficien t t o impr es s it s des t r u ct ive
a ct ion on t h e livin g- t o r eceive a n d impar t t h e pr oces s es of zymot ic pr in ciple
t o n ect by a s u bt le, s ickly, dea dly mediu m, t h e people a gglomer a t ed in
n a r r ow s t r eet s a n d cou r t s , down wh ich n o win d blows , a n d u pon wh ich t h e
s u n s eldom s h in es .
It is t o t h is ca u s e t h a t t h e h igh mor t a lit y of t own s is t o be a s cr ibed; t h e
people live in a n a t mos ph er e ch a r ged wit h decompos in g ma t t er , of veget a ble
104
a n d a n ima l or igin ; in t h e open cou n t r y it is dilu t ed, s ca t t ered by t h e win ds ,
oxidized in t h e s u n ; veget a t ion in cor por a t es it s elemen t s ; s o t h a t , t h ou gh it
wer e for med, pr oport ion a lly t o t h e popu la t ion , in gr ea t er qu a n t it ies t h a n in
t own s , it wou ld h a ve compa r a t ively les s effect . Th e mea n s of r emovin g
impu r it ies in t own s exis t pa r t ia lly, a n d h a ve pr odu ced a dmir a ble effect s ; bu t
t h e mos t ca s u a l obs er va t ion mu s t con vin ce a n yon e t h a t ou r s t r eet s wer e
bu ilt by per s on s ign or a n t . a s well of t h e n a t u r e of t h e a t mos ph er e, a s of t h e
mor t a lit y wh ich h a s been pr oved t o exis t , a n d is r efer a ble t o ca u s es wh ich ,
t h ou gh in vis ible, a r e s u fficien t ly eviden t .
" Th e occu pa t ion s of men in t own s a r e mos t ly ca r r ied on in -door s , oft en
in cr owded wor ks h ops , wh ile t h e a gr icu lt u r a l la bor er s pen ds t h e gr ea t er pa r t
of t h e da yt ime in t h e open a ir . Fr om t h e n a t u r e of t h e pa r t icles of a n ima l
ma t t er t h r own in t o t h e a t mos ph er e, it is impos s ible t o pla ce t h e a r t is a n in
cir cu ms t a n ces a s fa vor a ble a s t h e la bor er ; t h e s u n a n d win d des t r oy a n d
wa ft a wa y t h e br ea t h a s s oon a s it is formed; bu t in t h e works h ops of t own s
t h e men a r e s h u t fr om t h e s u n , a n d n o s t r ea ms of t h e s u r r ou n din g a ir ca r r y
off t h e s t ea min g br ea t h a n d per s pir a t ion , s o t h a t t h e mor t a lit y of
wor kin gmen in t h e met r opolis is mu ch gr ea t er t h a n t h e mor t a lit y of women
a t t h e cor r es pon din g a ges ."
87

Th e differ en t s a n it a r y in ves t iga t ion s in En gla n d h a ve r ela t ed pr in cipa lly
t o t h e s u bject s s u gges t ed in t h is r ecommen da t ion ; a n d fa ct s h a ve been
br ou gh t t o ligh t , in rela t ion t o t h e ma n n er in wh ich ma n y h u ma n bein gs live,
t h a t h a ve ma de a pr ofou n d impr es s ion u pon t h e pu blic min d.
Th er e a r e," s a ys Dr . Simon ," ma n y, ver y ma n y cou r t s a n d a lleys
h emmed in on a ll s ides by h igh er h ou s es , h a vin g n o pos s ibilit y of a n y
cu r r en t of a ir , a n d (wor s t of a ll) s omet imes s o con s t r u ct ed, ba ck t o ba ck, a s
t o for bid t h e a dva n t a ge of dou ble win dows or ba ck door s , a n d t h u s t o r en der
t h e h ou s e a s per fect ly a cul-de-s ac ou t of t h e cou r t , a s t h e cou r t is a cul-de-
s ac ou t of t h e n ext t h or ou gh fa r e.
" It is s u r ely s u perflu ou s t o obs er ve t h a t t h es e loca lit ies a r e u t t er ly
in compa t ible wit h hea lt h . Amon g t h e den s e popu la t ion it is r a r e t o s ee a n y
ot h er a ppea r a n ce t h a n t h a t of s qu a lid s ickn es s a n d mis er y; a n d t h e
ch ildr en , wh o a r e r epr odu ced wit h t h e fer t ilit y of a r a bbit wa r r en , per is h in
ea r ly in fa n cy. In t h e wor s t loca lit ies pr oba bly n ot mor e t h a n h a lf t h e ch ildr en
bor n s u r vive t h eir fift h yea r , a n d of t h e 3,799 dea t h s r egis t er ed la s t yea r in
t h e cit y of Lon don gen er a lly, 1,410 wer e a t or u n der s even yea r s of a ge.
Th e dis ea s es of t h es e loca lit ies a r e well ma r ked. Scr ofu la mor e or les s
complet ely bligh t s a ll t h a t a r e bor n , oft en ext in gu is h in g life pr ema t u r ely; in
ch ildh ood, by h ydr oceph a lu s ; in you t h , by pu lmon a r y a n d r en a l a ffect ion s ,
wh ich you r ea d of a s con s u mpt ion a n d dr ops y, oft en s ca r r in g a n d ma imin g
wh er e it does n ot kill, a n d r en der in g life mis er a ble by blin dn es s , decr epit u de
or defor mit y; oft en pr olon gin g it s elf a s a n h er edit a r y cu r s e in t h e
mis begot t en offs pr in g of t h os e wh o, u n der s u ch u n n a t u r a l con dit ion s , a t t a in
t o ma t u r it y a n d pr ocr ea t ion . Typh u s pr eva ils t h er e, t oo, n ot as a n occa s ion a l
vis it or , bu t a s a n h a bit u a l pes t ilen ce.
"It is impos s ible for me, by n u mber s , t o give you a n exa ct kn owledge of
t h e fa t a lit y of s u ch s pot s , beca u s e, in t h e gr ea t er pa r t of t h e cit y, h os pit a ls ,

87
Fif th Report of the Regis trar-General, pp. 418, 419, 420.

105
dis pen s a r ies , a n d pr iva t e pr a ct ice divide t h e t r ea t men t of t h e s ick wit h t h e
pa r och ia l' officer s a n d dimin is h t h e r et u r n s of s ickn es s wh ich t h os e officer s
wou ld ot h er wis e h a ve t o s h ow. Bu t t h is I ma y t ell you , a s an illu s t r a t ion of
wh a t I s t a t e, t h a t in t h e few h ou s es of Seven -s t eps Alley, t h er e occu r r ed la s t
yea r 163 pa r och ia l ca s es of Pr in ces Place a n d Pr in ces Squ a r e, 176 ca s es ;
t h a t beh in d in ea s t s ide of Bis h ops ga t e, in t h e s ma ll dis t a n ce fr om Widega t e
St r eet t o New St r eet , t h er e wer e 126 ca s es ; t h a t beh in d t h em wes t s ide, fr om
Pr imr os e St r eet t o Ha lf-moon St r eet , t h er e wer e 245 ca s es ; t h a t t h e pa r is h of
Cr ipplega t e h a d 354 ca s es over a n d a bove t h e n u mber (pr oba bly a ver y la r ge
on e ) t r ea t ed by pr iva t e pr a ct it ion er s , by h os pit a ls , a n d es pecia lly by
dis pen s a r ies . Simila r ly, t h ou gh wit h les s per fect in for ma t ion , I a m en a bled
t o t r a ce fever t o a t er r ible ext en t in ver y ma n y ot h er loca lit ies of t h e cit y,
even on t h e ver ge of it s bet t er r es iden ces , a n d clos e beh in d it s wea lt h ies t
t h or ou gh fa r es .
"It wa s in dis t r ict s s u ch a s t h es e t h a t , in 1665, t h e gr ea t Pla gu e of
Lon don fou n d t h e r ea dies t fa cilit ies for it s r ecept ion a n d it wa s by t h e
des t r u ct ion of s u ch dis t r ict s t h a t t h e Gr ea t Fir e of t h e followin g yea r
r en der ed t h e u t mos t con ceivea ble s er vice t o t h e s a n it a r y pr ogr es s of t h e
people, a n d complet ed t h eir ema n cipa t ion fr om t h e h or r or s of a n
u n pa r a lleled pes t ilen ce. Lon g in t er ven in g yea r s h a ve s u fficed t o r econ s t r u ct
t h es e mis er a ble h a bit a t ion s a lmos t a ft er t h eir fir s t t ype, a n d t o r e exemplify
a ll t h e evils wh ich belon g t o t h em ; s o complet ely, in deed, t h a t if t h e
in fect ion of t h a t s a me pla gu e s h ou ld ligh t a ga in a mon gs t u s , I s ca r cely kn ow
wh y it migh t n ot t r a ver s e t h e cit y a n d decima t e it s popu la t ion a s qu ickly a n d
a s vir u len t ly a s befor e. Mea n wh ile, h owever , t yph u s , wit h it s dis or der s , a n d
t h e occa s ion a l epidemics of in flu en za ,ch oler a , a n d ot h er dis ea s es , ma in t a in
t h eir a t t a ch men t t o t h e s oil, a n d r equ ir e n o fu r t h er r ein for cemen t fr om t h e
pes t ilen ce of ot h er clima t es ."
Th is pict u r e is r epr odu ced, s omet imes wit h mor e fr igh t fu l det a ils , in
ver y ma n y pla ces in Eu r ope, a n d in t h is cou n t r y-in Mas s achus etts ! Th e evils
wh ich it por t r a ys ma y n ot exis t t o s o grea t ext en t wit h u s , a s in t h e a n cien t
cit ies a n d popu lou s pla ces of t h e old wor ld; bu t even h er e t h eir ma gn it u de is
ver y mu ch gr ea t er t h a n is gen er a lly s u ppos ed. Pla ces ma y be fou n d in t h e
cit ies a n d t own s of t h is St a t e, a s we s h a ll s h ow fu r t h er on , t h a t a r e s ca r cely
t o be pa r a lleled in En gla n d. Th is fa ct will be developed t o t h e a s t on is h men t
of a n yon e wh o ma kes Th es e evils s eem a lmos t in s epa r a ble fr om a ll s o lon g
a s t h e people r ema in u n in s t r u ct ed a n d n ot ca r ed for . It is of t h e h igh es t
impor t a n ce, t h a t a ll pr oper s a n it a r y mea s u r es s h ou ld be a dopt ed t o pr even t
t h os e ca la mit ies wh ich h a ve been s u ffer ed els ewh er e, a n d wh ich will
in evit a bly in cr ea s e wit h u s , u n les s s ea s on a bly pr even t ed.
1. " Light," s a ys t h e Liver pool Hea lt h of Town s Advoca t e, (pp 125,) " is
n eces s a r y t o h ea lt h . Dr . Edwa r ds , of Pa r is , h a s s h own , t h a t if t a dpoles be
depr ived of ligh t , t h ey do n ot a dva n ce beyon d t h a t s t a t e of developmen t ,
h owever well t h ey ma y be fed, a lt h ou gh t h ey in cr ea s e in s ize; a n d h e t h en ce
con clu des , , t h a t t h e a ct ion of ligh t t en ds t o develop t h e differen t pa r t s of t h e
body in t h a t ju s t propor t ion wh ich ch a r a ct er izes t h e t ype of t h e s pecies :'
a n d t h a t , in wa r m clima t es , t h e expos u r e of t h e wh ole s u r fa ce of t h e body t o
ligh t will be ver y t o t h e r egu la r con for ma t ion of t h e body.' Ba r on Hu mboldt
s t r ikin gly cor r obor a t es t h is opin ion , for h e s a ys , a ft er a five yea r s ' r es iden ce
a mon gs t ma n y Amer ica n t r ibes , I h a ve n ot s een a s in gle in dividu a l wit h a
106
n a t u r a l defor mit y.' We may thus conclude that abund ance of light is es s ential
to the proper development of form in man: a n d it follows , a s a con s equ en ce,
t h a t if ch ildr en , a t t h e t ime of ea r ly gr owt h , be depr ived of t h is n eces s a r y
a gen t , t h eir developmen t will be ma t er ia lly modified, a r id t h e fou n da t ion for
a wea k con s t it u t ion will be la id, a n d con s equ en t in ca pa cit y for la bor , a n d
t en den cy t o dis ea s e s u per in du ced. Dr . Edwa r ds gives it a s h is opin ion t h a t
t h e wa n t of s u fficien t ligh t mu s t con s t it u t e on e of t h e ext er n a l ca u s es wh ich
pr odu ce t h es e devia t ion s of dr en a ffect ed wit h s cr ofu la ; wh ich con clu s ion is
s u ppor t ed by t h e obs er va t ion , t h a t t h is dis ea s e is mos t pr eva len t in poor
ch ildr en , livin g in con fin ed a n d da r k s t r eet s .
Th e opin ion s of Dr . Edwa r ds a r e fu lly bor n e ou t Wa r d, in h is eviden ce
befor e t h e Sa n it a r y Commis s ion s a ys t h a t h is exper ien ce mos t s t r on gly'
bea r s ou t men t s ; a n d t h a t , fr om n ot icin g h u n dr eds of t imes ficia l
con s equ en ces of t h e a lt er a t ion t h e evils res u lt in g fr om t h e wan t of ligh t , I am
s a t is fied t h a t it is a ma t t er of t h e h igh es t impor t a n ce.'
My a dvice t o you n g people wh o a r e a bou t t o ma r r y, a n d ca n a ffor d
on ly on e or t wo r ooms , t o ch oos e t h ey ca n fin d, a n d in wh ich t h ey ca n obt a in
t h e gr ea t es t qu a n t it y of s ola r ligh t ; t h e a mou n t of dis ea s e in ligh t compa r ed
wit h t h a t in da r k r ooms , bein g in fin it ely les s .'
" Ot h er medica l obs er ver s h a ve a r r ived a t s imila r con clu s ion s . Sir
J a mes Wylie r ela t es a r ema r ka ble in s t a n ce in poin t , in r ega rd t o a n ext en s ive
ba r r a ck in St . Pet er s bu r g, on e wh ich wa s expos ed t o t h e ligh t , a n d t h e ot h er
wa s compa r a t ively da r k. Th e r es u lt t o t h e s oldier s livin g in t h e bu ildin g wa s ,
t h a t u n ifor mly, for ma n y yea r s , t h er e wer e t h r ee ma n y t a ken ill on t h e da r k
s ide a s wer e a t t a cked on s ide of t h e ba rr a ck. We n eed h a r dly in s is t on t h e
impor t a n ce of t h es e fa ct s , a s s h owin g t h a t t h e wa n t of ligh t pr edis pos es t o
dis ea s e.
2. Air. We h a ve a lr ea dy s poken (pp. 143-148) of t h is impor t a n t elemen t ,
a n d s h a ll h er ea ft er r efer t o wor ks wh er e t h e s u bject is fu lly dis cu s s ed.
St r eet s s h ou ld be of s u fficien t widt h t o per mit a fr ee cir cu la t ion of a ir .
Ret r ict ion s s h ou ld be s o impos ed a s t o per mit few la n es , a lleys , a n d cou r t s ,
a n d n on e t h a t wou ld s o obs t r u ct t h e cir cu la t ion a s t o en da n ger t h e pu blic
h ea lt h . Ever y pla ce fr om wh ich ligh t is exclu ded, or in t o wh ich pu r e a ir , in
a n y des ir a ble qu a n t it ies , ca n n ot a t plea s u r e be in t r odu ced, s h ou ld be
pr on ou n ced u n fit for h a bit a t ion .
3. Wa t er ." Th e followin g a r e t h e ch ief con dit ion s in r es pect of wa t er
s u pply, wh ich per empt or ily r equ ir e t o be fu lfilled :-
" 1. Th a t ever y h ou s e s h ou ld be s epa r a t ely s u pplied wit h wa t er , a n d t h a t
wh er e t h e h ou s e is a lodgin g-h ou s e, or wh er e t h e s ever a l floor s a r e let a s
s epa r a t e t en emen t s , t h e s u pply of wa t er s h ou ld ext en d t o ea ch in h a bit ed
floor . "
2. Th a t ever y pr ivy s h ou ld h a ve a s u pply of wa t er a pplica ble a s oft en a s it
ma y be r equ ir ed, a n d s u fficien t in volu me t o effect , a t ea ch a pplica t ion , a
t h or ou gh flu s h in g a n d pu r ifica t ion of t h e dis ch a r ge pipe of t h e pr ivy. "
3. Th a t in ever y cou r t , a t t h e poin t r emot es t fr om t h e s ewer gr a t in g; t h er e
s h ou ld be a s t a n d-cock for t h e clea n s in g of t h e cou r t ; a n d
4. Th a t a t a ll t h es e poin t s t h er e s h ou ld a lwa ys a n d u n in t er r u pt edly be a
s u fficien cy of wa t er t o fu lfil a ll r ea s on a ble r equ ir emen t s of t h e popu la t ion ."
88


88
Dr. Simon's Report, p. 19.
107
"We mu s t h a ve s oft wa t er . All h a r d wa t er s a r e expen s ive, bot h for
domes t ic con s u mpt ion a n d ma n u fa ct u r in g pu r pos es . Th is h a r dn es s a r is es
fr om t h e pr es en ce of ea r t h y a n d s a lin e s u bs t a n ces , wh ich decompos e a n d
des t r oy a cer t a in qu a n t it y of s oa p in wa s h in g, a n d occa s ion a la r ger
con s u mpt ion of t h a t a r t icle t h a n n eces s a r y. It h a s been pr oved t h a t t h e
wa t er wh ich s u pplies Aber deen con t a in s on ly on e gr a in per ga llon of
h a r dn es s , wh ile t h a t of Ma n ch es t er con t a in s fou r t een gr a in s . Th e wa t er a t
pr es en t s u pplied t o Liver pool con t a in s r a t h er mor e ; bu t we ma y a s s u me t h e
h a r dn es s a t fou r t een gr a in s per ga llon . Now Dr . Pla yfa ir h a s s h own t h a t
wa t er wit h fou r t een gr a in s per ga llon des troy s and renders us eles s a
qu a n t it y of t h e s oa p u s ed for wa s h in g pu r pos es , equ a l in va lu e t o 16s . 8d. a
yea r , t o a fa mily of five in dividu a ls . If we a s s u me t h e pr es en t popu la t ion of
Liver pool a t 330,000, a n d s u ppos e t h er e wer e a s u pply of wa t er , of t h e s a me
qu a lit y n ow u s ed, a dequ a t e t o t h e wa n t s of t h a t popu la t ion , t h er e wou ld be
a n ext r a expen s e of n o les s t h a n 55,000 a yea r t o t h e t own , in a ddit ion t o
t h e wea r a n d t ea r of clot h es . Wa t er , h owever , cou ld n ot be obt a in ed qu it e
pu r e, bu t if it cou ld be h a d wit h a h a r dn es s of t wo degr ees a ga llon , which
we believe to be quite pos s ible, a s a vin g wou ld be effect ed t o t h e t own of
n ea r ly 50,000 a yea r ; a n d t h is wit h ou t t a kin g in t o a ccou n t t h e s a vin g
a ccr u in g in ma n u fa ct or ies , s t ea m boiler s , br ewer ies , &c. It is a low es t ima t e,
t h er efor e, t o s t a t e t h e hard water tax of Liver pool a t 50,000 a yea r , ever y
fa r t h in g of wh ich is a ct u a lly thrown away , without any return whatever. Now
t h is s u m r epr es en t s a ca pit a l of one million and a quarter s t er lin g, a t fou r per
cen t ."
89

Sever a l cit ies a n d villa ges in Ma s s a ch u s et t s h a ve con s t r u ct ed ot h er
wor ks bes ides wells t o s u pply t h em wit h wa t er . Bos t on , by a s t r u ct u r e t h a t
for a r t is t ic s kill a n d t h or ou gh wor kma n s h ip is pr oba bly u n s u r pa s s ed a n y
wh er e, h a s in t r odu ced, a t a n expen s e t o t h e cit y of a bou t $5,000,000, t h e
wa t er of La ke Coch it u a t e, n in et een miles a n d a h a lf dis t a n t ; a n d it a ffor ds t o
ever y in h a bit a n t a n a bu n da n t s u pply of wa t er of t h e bes t qu a lit y.
4. Drains and Sewers s h ou ld be ma de t o ca r r y off wa t er in t r odu ced in
a n y wa y in t o cit ies a n d villa ges . If t h e s u r plu s be per mit t ed t o r ema in , it
oft en becomes s t a gn a n t a n d pu t r id a n d is t h en a fr u it fu l s ou r ce of dis ea s e.
Wit h ou t a s ys t em of dr a in s , a la r ge s u pply of wa t er is r a t h er in ju r iou s t h a n
ot h er wis e ; yet wit h ou t a plen t ifu l s u pply t h er e ca n be n o dr a in a ge a t a ll."
Ever y cit y a n d villa ge s h ou ld be n o dr ain a ge eleva t ion s of t h e cr os s in gs of
ea ch s t r eet a bove a common level, a n d it s des cen t t o a n ou t er t er min a t ion ,
s h ou ld be la id down a n d ma r ked u pon a pu blic pla n ; s o t h a t a ll a bu t t er s ,
a n d ot h er s in t er es t ed, ma y be gu ided t o t h e pr oper con s t r u ct ion of bu ildin gs
wit h r efer en ce t o dra in s a n d s ewer s . Some gen er a l, defin it ive pla n s h ou ld be
fixed-u pon for ea ch cit y a n d villa ge, a n d wh en s o fixed it s h ou ld be
u n ifor mly ca r r ied ou t u n der on e a u t h or it y, a s cir cu ms t a n ces ma y r equ ir e.
Su r fa ce dr a in s will a n s wer for s ome loca lit ies , bu t u n der gr ou n d s ewer a r e
gen er a lly t o be pr efer r ed. Bos t on h a s a bou t 35 miles of s u ch s ewer s .
5. Paving is of gr ea t impor t a n ce a s a s a n it a r y mea s u r e. Th e followin g
a r e t h e con dit ion s r equ is it e for a good s ys t em:-


89
Liverpool Heallh of 'rowns Advocate, pg 131.
108
1. Pa vemen t s s h ou ld be ma de a s imper viou s t o flu ids a s pos s ible, ot h er wis e
t h e s u bs oil r ema in s mois t , a n d pr egn a t ed wit h ma t t er s delet er iou s t o t h e
pu r it y of t h e a t mos ph er e. All s t on e pavemen t s s h ou ld t h er efor e be clos ely
join ed ; a n d con s equ en t ly t h os e ma de of r ou n d bou lder s a r e in a dmis s ible for
s a n it a r y pu r pos es . Wood pa vemen t s a r e decidedly in ju r iou s t o h ea lt h . Th e
s t r eet pa vemen t s in s ome of t h e It a lia n cit ies a r e bet t er t h a n ou r s for
dr a in a ge. Th ey con s is t of polygon a l blocks of limes t on e, t h e join t s of wh ich
a r e a ccu r a t ely fit t ed t oget h er wit h cemen t , s o t h a t t h e r a in wa t er flows off a s
ea s ily a s fr om t h e r oof of a h ou s e, a n d t h er e a r e n eit h er r u t s n or h ollows .
Th e old Roma n pa vemen t s wer e s imila r ly con s t r u ct ed.
2. Gr ea t ca r e s h ou ld a l wa ys be t a ken t o pr even t t h e for ma t ion of pit s a n d
h ollows , wh ich a r e alwa ys in ju r iou s t o h ea lt h , by per mit t in g t h e r et en t ion of
s olid a n d flu id s u bs t a n ces in s t a t e of decompos it ion , a n d pr es en t in g gr ea t
obs t a cles t o clea n s in g.
3. All cou r t s a n d pa s s a ges s h ou ld be f lagged; t h e common is in a dequ a t e for
s a n it a r y pu r pos es in s u ch loca lit ies .
4. A complet e r eform s h ou ld be effect ed in t h e ma n n er of con s t r u ct in g s t r eet
gu t t er s . If a n yon e will t a ke t h e t r ou ble t o go t o t h e t own on a wet da y, h e
will be a s t on is h ed t o fin d h ow ma n y of t h es e con du it s h a ve t h e pr oper t y of
r et a in in g t h e wa t er , in s t ea d of fa cilit a t in g it s pa s s a ge in t o t h e s ewer . It
s h ou ld be n ever be for got t en t h a t a ba dly ma de gu t t er is lit er a lly wor s e t h a n
n on e; for it on ly dr aws t h e fou l wa t er from t h e s t r eet s n ear er t h e door s of
dwellin gs , wh ile t h e s pa ces bet ween t h e s t on es a llow of it s free pa s s a ge in t o
t h e s u b s oil, s o a s t o r en der t h e h ou s es mor e da mp t h a n t h ey wou ld
ot h er wis e be. Per fect s moot h n es s , a n d pr oper a da pt a t ion of t h e s t on es ,
a lon g wit h a pr oper continuous declivit y, a r e in dis pen s a ble r equ is it es a well
ma de gu t t er ."
90

5. Cleanlines s in t own s is of s u ch immen s e impor t a n ce t o h ea lt h -t h a t it
s h ou ld con s t it u t e a n in dis pen s a ble pa r t of s a n it a r y police. Th e on ly s a fe r u le
is , t o r emove ou t of t own , a n d ou t of a h ou s e r efu s e a s s oon a s it is
pr odu ced. Refu s e ma t t er , eit h er a n ima l or veget a ble, a r e con s t a n t ly
u n der goin g ch a n ge a n d givin g ou t va por s a n d ga s es wh ich , even in ext r emely
s ma ll qu a n t it ies , ar e in ju r iou s t o h ea lt h , t h ey a r e con s t a n t ly in h a led.
Con clu s ive pr oofs of t h is fa ct exis t . Wh er ever t h er e is a dir t y s t r eet , cou r t ,
or dwellin g-h ou s e, t h e elemen t s of pes t ilen ce a r e a t wor k in t h a t
n eigh bor h ood. Th e ca u s e of ma n y a n d ma n y a ca s e of t yph u s fever , ch oler a ,
mor bu s , or ot h er fa t a l dis ea s es , in ou r cit ies , villa ges , a n d in t h e r u r a l a n d
is ola t ed dwellin gs of t h e cou n t r y, ma y be t r a ced t o deca yed veget a ble ma t t er ,
or ot h er filt h , in or a r ou n d t h e h ou s e, or in t h e wa t er u s ed. Th e mos t
clea n lin es s is n eces s a r y in a ll pla ces , bu t es pecia lly in con fin ed loca lit ies , t o
pr es er ve t h e pu blic h ea lt h ; a n d n ot h in g be per mit t ed t o in t er fer e wit h it . It
mu s t n ever be for got t en t h a t we h a ve t o do wit h lif e. It is n ot a qu es t ion of
con ven ien ce, or per s on a l a n n oya n ce, bu t on e of h ea lt h . No per s on , t h er efor e,
s h ou ld be per mit t ed, on a n y plea of in t eres t , t o t a mper wit h t h is ma t t er ; a n d
ever y n u is a n ce t h a t occa s ion s filt h in s t r eet s or cou r t s , or t h a t a ccu mu la t es
it on a n y ot h er s u r fa ces , s h ou ld be a bat ed; if n ot ot h er wis e, by t h e a r m of
t h e la w. It is s omet imes n eces s a r y t o con s t r a in men t o do wh a t wou ld be
u s efu l, a n d t o a void wh a t wou ld be in ju r iou s t o per s on s h ou ld be per mit t ed

90
Liverpool Hea lt h of Town s Advoca te, p. 99.
109
t o con t a min a t e t h e a t mos ph er e of h is own h ou s e, or t h a t of h is n eigh bor s , by
a n y s u bs t a n ce da n ger ou s t o t h e pu blic h ea lt h . Su ch a per s on s h ou ld be
looked u pon a s wor s e t h a n a h igh wa y r obber . Th e la t t er r obs u s of pr oper t y,
t h e for mer of life.

XVIII. WE RECOMMEND that, in erecting churches , and other public
build ings , health s hould be regarded in their s ite, s tructure, heating
apparatus , and ventilation.
To pr ovide for a ll pu blic bu ildin gs , wh er e la r ge people con gr ega t e, a n
a bu n da n t a n d con s t a n t s u pply it s pu re, n a t u r a l s t a t e, an d of a pr oper
t emper a t u r e, impor t a n t , t h ou gh difficu lt ma t t er . It is s o, t oo, in pr iva t e
dwellin gs : It h a s r eceived mu ch t h eor et ica lt ica l a t t en t ion , a n d ver y ma n y
s ch emes h a ve been a t t a in t h e object . Wh ich of t h em is t o be pr efer r ed,
a n yon e a s yet kn own is u n object ion a ble a r e u n pr epa r ed t o decide. If t he
mea s u r es pr opos ed s h ou ld be a dopt ed, t h e Gen er a l Boa r d of Hea lt h wou ld
become a cqu in t ed wit h t h e differ en t met h ods of con s t r u ct in g a n d ven t ila t in g
pu blic a n d pr iva t e bu ildin gs , a n d wou ld be a ble t o r ecommen d t o t h e loca l
Boa r ds of Hea lt h , a n d t o t h e people gen er a lly, t h os e pla n s wh ich s eem bes t
a da pt ed t o t h e cir cu ms t a n ces of ea ch ca s e. Su ch in for ma t ion wou ld be gr ea t
impor t a n ce, wh et h er r ega r ded a s con t r ibu t in g t o t h e pecu n ia r y or s a n it a r y
welfa r e of t h e people.

91


91
The importance of free ventilation will appear f rom the s tatement of a f ew s imple f acts :- The object of res piration is t to
bring the oxy gen of the air in contact with the blood, by which the latter is deprived of its carbonic acid, and abs orbs a
new s upply of oxy gen. When the atmos pheric air tak en into the lungs , it cons is ts of about 79 percent of nitrogen, and 21
percent of oxy gen, and nearly 1 percent of carbonic acid; when it is expelled, it is f ound to have los t about 9 percent of its
oxy gen, the place of which is s upplied by an equal amount of carbonic acid. At the s ame time the blood has undergone
an important change from a dark purple hue, ind icative of carbon, which is unf itted f or the s upport of animal lif e, to a
highly oxy geniz ed f luid of a f lorid red color, carry ing health and vigor to every f ibre of the body . It is not not our purpos e
to inquire into the manner in which thes e changes are effected: it is s uff icient f or us that they are produced, and that they
are abs olutely es s ential to the exis tence of animal lif e. As the rapid ity with which the air is vitiated is not generally
appreciated, the f ollowing alculations may not be unimportant: An individual breathes , on an average, f rom 14 to 20
times in a minute, and inhales from 15 to 40 cubic inches of air at each ins piration. According to Southwood Smith, it
appears that, in one minute an individual requires 616 cubic inches , or about 18 pints of air; and that, during the s ame
s pace, 24 cubic inches of oxy gen have dis appeared, and been replaced by a lik e amount of carbonic acid; s o that, in one
hour, each adult pers on vitiates the air by the s ubtraction of 1440 cubic inches of oxy gen . In one hour the quantity of air
ins pired amounts to 2 hogs heads , 20 gallons , and 10 pints ; in one day , to 57 hogs head, 1 gallon, and 7 pints ; and,
during the s ame period of of time, 24 hogs head of blood, or 1 hogs head each hour, and 144 ounces each minute, are s ent
to the lungs , to undergo the change already pointed out. Suppos ing 1 pint of air to be inhaled at each ins piration, which
is very nearly the quanity , the amount decompos ed is about one-f ourth, or a quarter of a pint; s o that each ind ividual
actually vitiates or pois ons one-fourth of a pint of air every time he breathes . The rapid ity with which this deteriorating
proces s goes on is very clearly s hown by placing a mous e under a large, tight glas s jar, f ull of air. In a f ew moments it
becomes uneas y , pants f or breath, and in a s hort time d ies in convuls ions . There is another caus e of deterioration of the
air, not generally tak en into account, which is of cons iderable importance. An adult gives off, by ins ens ible pers piration,
from 12 to 30 grains of vapor per minute; and it is as certained that the air which has been s ome time in contact with the
s k in becomes chief ly carbonic acid gas . Tredgold s tates that it is des irable to change as much of the air of the room as
the mois ture given off would s aturate in the s ame time. Accordingly , in a room at 60
o
, on the s uppos ition, which is
probably very nearly correct, that the mois ture given off amounts to 18 grains , it will be neces s ary to change three cubic
feet of air per minute f or each indivdual in the room. If the temperature of the room be high, the exhalations of cours e will
be in proportion. Our rooms and public halls have als o to be lighted at night; and here is another s ource of deterioration
of the air. Each gas -burner is found to cons ume as much oxy gen as eight candles , and each candle renders about 300
cubic inches of air unf it f or breathing every minute; s o that two candles deteriorate the air as much as one ind ividual.
The total quantity of air, then , which will be vitiated by thes e caus es , f or each pers on, will be-

By Repiration 800 cubic inches per minute
By Exhalation 5,184 cubic inches per minute
By lights 432 cubic inches per minute
Total 6,416 cubic inches per minute

Or Nearly 4 cubic f eet, per minute. It is neces s ary , theref ore, in order to pres erve the purity of the air, that the above
quantity s hould be changed every minute. For example: I f a room contains 200 people, there s hould be 800 cubic f eet of
air changed every minute, or more than would f ill a room nine feet s quare and nine f eet high; 400 people will require 1600
cubic f eet of fres h air every minute. From the above es timates , any pers on may calculate the rapid ity of deterioration in a
110

XIX. WE RECOMMEND that, before erecting any d welling-hous e,
manuf actory , or other build ing, f or pers onal accommod ation, either as a
lodging-hous e or place of owner or build er be required to give notice to the
Health, of his intention and of the s anitary propos es to adopt.
Th e in for ma t ion wh ich s u ch a r egu la t ion migh t s ecu r e, wou ld s h ow t h e
gr owt h of a pla ce, a n d t h e in cr ea s e of h ou s e a ccommoda t ion s , bu t it wou ld
s ecu r e a mu ch mor e impor t a n t object . It wou ld pla ce wit h in t h e pos s es s ion
of t h e loca l of Boa r d of Hea lt h a kn owledge of t h e s a n it a r y a r r a n gemen t s of
ever y h ou s e. It is n ot in t en ded t h a t t h is r egu la t ion s h ou ld in t h e lea s t degr ee
wit h pr iva t e r igh t s , bu t con fer a s u bs t a n t ia l ben efit . Th e Boa r d of Hea lt h a r e
s u ppos ed t o pos s es s a mu ch bet t er kn owledge, gen er a lly, of t h e con s t r u ct in g
dewellin g-h ou s es , in r ega r d t o t h e pa r t icu la r s a n it a r y object s t h ey h a ve in
view, t h a n t h e gr ea t ma s s of t h e people; a n d few per s on s , it is s u ppos ed, will
be fou n d, wh o n ot feel gr a t efu l t o t h em for a n y s u gges t ion t o r ea l
impr ovemen t . It is des ign ed t o be s u gges t ive mer ely, n ot compu ls or y, u n les s
a pu blic in ju r y is in flict ed ; become t h e du t y of t h e Boa r d t o in t er fer e. A
r egu la t ion s imila r t o t h is exis t s in New Yor k, Ph ila delph ia , a n d ma n y pla ces ;
a n d is fou n d t o wor k s o well a s t o be wor t h y a dopt ion .

XX. WE RECOMMEND that local Board s of to prevent or mitigate the
s anitary evils aris ing crowd ed lodging-hous es and cellar-d wellings .
Su ch pla ces a r e u n iver s a lly a ckn owledged t o be in compa t ible wit h
h ea lt h . Th e h in t s a lr ea dy given , (p. 145,) h a ve s h own t h e des t r u ct ive
in flu en ce of cor r u pt ed a ir . Su ch a ir exis t s in t h es e pla ces , t o a gr ea t ext en t ,
a n d it s delet er iou s effect s s h ou ld by a ll pr oper mea n s be a voided. Th is
ma t t er h a s a t t r a ct ed mu ch t h ou gh n ot t h e u n des er ved a t t en t ion of differ en t
s a n it a r y in qu ir er s . Dr . J a mes St ewa r t , of New Yor k, in Ma r ch , t h is yea r ,
pr ocu r ed a cen s u s of t h e cella r popu la t ion of t h a t cit y, a n d fou n d t h a t
18,456 per s on s lived in 8,141 r ooms , in 3,741 s epa r a t e ba s emen t s . Th is is
a bou t 1 in 25, or 4 per cen t of t h e wh ole popu la t ion of t h e cit y.
92
Th e
pr opor t ion of s u ch is believed t o be n ea r ly a s gr ea t in Bos t on . In Lowell, a nd
ot h er pla ces in t h e St a t e, t h e s a me evil a ls o exis t s . We a r e plea s ed t h a t t h e
pr es en t legis la t u r e, on t h e 21s t of Ma r ch , t h e s u bject of s o mu ch
impor t a n ce, a s t o pas s t h e s u bs t a n ce a ct . It gives a ll r equ is it e lega l a u t h or it y
t o r egu la t e t h e ma t t er
Wh en ever t h e Boar d of Hea lt h of a n y cit y or t own s h a ll be s a t is fied,
u pon du e exa min a t ion , t h a t a n y cella r -r oom, t en emen t , or bu ildin g,
occu pied a s a dwellin g-pla ce wit h in s u ch cit y or t own , is u n fit for t h a t
pu r pos e, a n d a ca u s e of n u is a n ce or s ickn es s eit h er t o t h e occu pa n t s or t o
t h e pu blic, s u ch a Boa r d of Hea lt h ma y is s u e a n ot ice in wr it in g t o s u ch
per s on s , or a n y t h em, r equ ir in g t h em t o r emove fr om or qu it s u ch cella r -
r oom, t en emen t , or bu ildin g, wit h in s u ch t ime a s t h e s a id Boa r d of Hea lt h
ma y deem r ea s on a ble. An d if t h e per s on or per s on s s o n ot ified, or a n y of
t h em, s h a ll n eglect or r efu s e s o t o r emove a n d qu it wit h in t h e t ime
men t ion ed, it s h a ll be la wfu l for s u ch Boa r d of Hea lt h t o r emove t h em

clos e room, of given dimens ions , occupied by a given number of individuals . Dr. Charles A. Lee: Am. Ed. Copelands
Medical Dictionary , Vol. I, pp. 137,138.
92
A detailed acount of the res ults of this highly commendable effort of pr. Stewart, is being publis hed, whilc this s heet is
pas s ing through the pres s , in s everal interes tinK and valuable artieles . See the New York Tribune, June 5
th
, 13th, 19th
and July 9th.
111
for cibly, a n d t o clos e u p s u ch cella r -r oom, t en emen t , or bu ildin g, a n d t h e
s a me s h a ll n ot be aga in occu pied a s a dwellin g-pla ce wit h ou t t h e con s en t in
wr it in g of t h e Boa r d of Hea lt h , u n der a pen a lt y of n ot les s t h a n t en n or mor e
t h a n fift y dolla r s , t o be r ecover ed by in dict men t of t h e own er or own er s , if
t h ey s h a ll h a ve kn owin gly per mit t ed t h e s a me t o be s o occu pied."
93


XXI. WE RECOMMEND that open s paces be res erved, in cities and
villages , f or public walk s ; that wid e s treets be laid out; and that both be
ornamented with trees .
Su ch a n a r r a n gemen t wou ld h a ve a good effect u pon t h e bea u t y a n d
s ocia l en joymen t s of t h e pla ce; bu t it wou ld h a ve a gr ea t er effect u pon it s
gen er a l s a n it a r y con dit ion . Veget a t ion wou ld a bs or b mu ch of t h e ca r bon ic
a cid ga s wh ich is pr odu ced in s o gr ea t s u per a bu n da n ce in popu lou s pla ces ,
a n d t h u s r en der t he a ir mor e fit for res pir a t ion . Open s pa ces a ls o wou ld
a ffor d t o t h e a r t iza n a n d t h e poor er cla s s es t h e a dva n t a ges of fr es h a ir a n d
exer cis e, in t h eir occa s ion a l h ou r s of leis u r e.

XXII. WE RECOMMEND that s pecial s anitary s urvey s of particular cities ,
towns , and localities , be made, f rom time to time, under the d irection of the
General Board of health.
It is of gr ea t impor t an ce t h a t t h e exa ct s a n it a r y con dit ion of ever y t own
in t h e St a t e s h ou ld be a s cer t a in ed, t h a t a n y ca u s es u n fa vor a ble t o h ea lt h
ma y be r emoved or mit iga t ed. Pa r t ia l a t t empt s h a ve been repea t edly ma de,
by in dividu a ls a n d a s s ocia t ion s for a gen er a l or s pecia l pu r pos e, t o
a ccomplis h t h is object . Ver y limit ed s u cces s h a s , h owever , a t t en ded t h eir
effor t s . Exper ien ce, t h u s fa r , h a s led t o t h e con clu s ion t h a t n o pla n ca n be
s u cces s fu l a n d u s efu l, u n les s con du ct ed by compet en t men u n der t h e
s a n ct ion of lega l a u t h or it y.
In 1839 a n d 1841, Dr . J oh n D. Fis h er , la t e of Bos t on , is s u ed cir cu la r s
t o obt a in in for ma t ion r ela t in g t o t h e ca u s es a n d fa t a lit y of con s u mpt ion .
An s wer s t o t h is impor t a n t cir cu la r was is s u ed a n d ext en s ively cir cu la t ed;
bu t n ot t wo a n s wer s on ly wer e r eceived fr om t h ir t y-on e in dividu a ls on ly.
In 1835, a commit t ee wa s a ppoin t ed t o in ves t iga t e t h e h is t or y of
in t er mit t en t fever s in Ma s s a ch u s et t s a n d New En gla n d gen er a lly, a n d a
cir cu la r wa s is s u ed bu t t wo a n s wer s on ly wer e r eceived. An d in 1845, t h e
Ma s s a ch u s et t s Medica l Societ y s en t ot h er cir cu la r s t o t h e s ever a l t own s in
t h e St a t e, bu t r eceived a s in gle a n s wer on ly in r et u r n .
In 1830, t h e New Yor k Medica l Societ y is s u ed a cir cu la r t o t h e differ en t
cou n t y medica l s ociet ies , s olicit in g in for ma t ion con cer n in g t h e medica l

93
We are under great obligations to Dr. William H. Dunean, Medical Off icer of Health of Liverpool, f or the valuable
communications on the s ubject of this recommendation, whieh are ins erted in the append ix. The Edinburgh Review f or
January , 1850, (p. 217,) in allus ion to this matter, s ay s :-" It may s eem hard to deprive the wreteh of the bulk .head or
empty cellar, which he is content to mak e his id le home; but it is one of thos e hardhips with which acts of mercy of ten
mus t begin. When the frightful demoraliz ation of Liver- pool was recently expos ed, and it was s hown that between
thirty and f orty thous and inhabitants of that f ine cily lived in dens called cellars , the bold res olution was tak en of at
once amputating this morbid mas s , by rendering cellars illegal habitations . The operation commenced in 1842; and
af ter about 3000 people were ejected, a more s tringent method was adopted in 1847. The operation of removal-under
the jud icious management of Dr. the Medical Off icer of Health-was padual, but s y s tematic and s tead y ; and near Time
enough has not elaps ed to let the full effect of this bold meas ure be s een; but the off icer of health has alread y had to
report the s ignif icant f act, res pecting one of the dis tricts f ormerly mos t aff licted by poverty and dis eas e that, while the
las t epidemic preced ing the clearance carried off 500 inhabitants , the cholera, which brok e out during the time that
the f orced change of res idence was in progres s , s lew the comparatively s mall number of 94.

112
t opogr a ph y of t h a t s t a t e. Replies r ela t in g t o t h e followin g cou n t ies on ly h a ve
been r eceived a n d pu blis h ed :-Kin gs , in 1832; Sa r a t oga , 1833 a n d 1848 ;
Colu mbia , 1834 ; Ma dis on , 1834; On on da ga , 1835 a n d 1849 ; Ton r pkin &,
1836; Tioga , 1837; Bin gh a mpt on , 1843; a n d Ot s ego, in 1848.
94

Th e Amer ica n Medica l As s ocia t ion , in 1848-9, ma de t h e mos t
s u cces s fu l effor t of t h e kin d ever a t t empt ed in t h is cou n t r y. An s wer s t o t h eir
cir cu la r wer e r eceived, givin g s a n it a r y s ket ch es of Por t la n d, Me., by Dr . J . T.
Gilma n ; of Con cor d, N. H., by Dr . Ch a r les P. Ga ge; of Bos t on a n d Lowell, by
Dr .J .Cu r t is ; of New Yor k, by Dr . J oh n H. Gr is com; of .Ph ila delph ia , by Dr .
Is a a c Pa r is h ; of Ba lt imor e, by Dr . J a mes Wyn n e; of Ch a r les t on , S. a ., by Dr .
P. a . Ga illa r d; of New Or lea n s , by Dr . Edwa r d H. Ba r t on ; of Lou is ville, by Dr .
L. P. Ya n dell; a n d of Cin cin n a t i, by Dr . J . P. Ha r r is on . Th es e pa per s ,
in clu din g t h e r epor t of t h e commit t ee, wer e pu blis h ed in t h e Tr a n s a ct ion s of
t h e Amer ica n Medica l As s ocia t ion , (Vol. . II, pp. 431-649,) a n d a ls o in a
s epa r a t e volu me. Th ey a r e a h igh ly va lu a ble con t r ibu t ion on t h e s u bject .
Su ch s u r veys a r e exceedin gly va lu a ble a n d impor t a n t , a n d it is
des ir a ble t h a t t h ey s h ou ld be ma de, for gen er a l a n d n ot pa r t ia l pu r pos es ,
u n der t h e dir ect ion of t h e gen er a l a n d loca l Boa r ds of Hea lt h , of s ever a l
t own s ea ch yea r , u n t il t h e exa ct s a n it a r y con dit ion of ever y pa r t of t h e St a t e
s h a ll be, a s fa r a s pos s ible, defin it ely kn own . Th e a n n u a l r epor t s of t h e loca l
Boa r ds of Hea lt h migh t fu r n is h s u ch a ddit ion a l in for ma t ion a s wou ld exh ibit
t h e ch a n ges or impr ovemen t s wh ich occu r fr om yea r t o yea r .
Th e ma t t er s wh ich we r ecommen d for con s ider a t ion in s u ch s u r veys ,
t h e mode by wh ich t h ey a r e t o be con du ct ed, a n d t h e ma n n er of pr es en t in g
t h e r es u lt s t o t h e pu blic, ma y be a s cer t a in ed by a ca r efu l exa min a t ion of t h is
r epor t ; a n d, es pecia lly, t h es e r ecommen da t ion s ; t h e cir cu la r ; t h e s pecia l
r epor t s of t h e s a n it a r y s u r veys , wh ich ma y be fou n d in t h e a ppen dix; t h e
r epor t s t o wh ich we r efer in t h e lis t of books t h er e r ecommen ded; a n d t h e
cir cu ms t a n ces wh ich will s u gges t t h ems elves t o in t elligen t loca l Boa r ds of
Hea lt h .

XXIII. WE RECOMMEND that local Boards of Health, and other pers ons
interes ted, endeavor to as certain, by exact obs ervation, the effect of mill-
ponds , and other collections or s treams of water, and of their ris e and f all,
upon the health of neighboring inhabitants .
We h a ve s een (pp. 73-76) t h a t t h e qu es t ion in volved in t h is
r ecommen da t ion h a s h a d a n h is t or ica l in t er es t ; t h ou gh it s eems of la t e t o be
a lmos t en t ir ely for got t en . Th e s t r ea ms a t t h e wa t er fa lls , in a ll pa r t s of t h e
Common wea lt h , a r e obs t r u ct ed in t h eir cou r s es for ma n u fa ct u r in g pu r pos es
; a n d if ca s es of fever or ot h er dis ea s e occu r in t h e n eigh bor h ood, t h e people
h a ve gen er a lly a t t ribu t ed t h em t o s ome u n con t r olla ble a gen cy; wh ile
pos s ibly, per h a ps , t h ey ma y a r is e fr om ca u s es t h eir own h a n ds h a ve cr ea t ed,
a n d wh ich a r e ca pa ble of r emova l. It is t h en a qu es t ion of per ma n en t in t er es t
a n d impor t a n ce. If mill-pon ds , or s t a gn a n t wa t er s of a n y kin d, or pla ces
wh er e t h ey h a ve exis t ed, pr odu ce dis ea s e u n der cer t a in con dit ion s , it s h ou ld
be kn own , a n d cer t a in ot h er con dit ion s s h ou ld be pr ovided, u n der wh ich
t h ey ma y be per mit t ed a t a ll. Th eor y, va gu e s u gges t ion , per s u mpt ive
a s s er t ion , ca n n ot decide t h e qu es t ion . It ca n be fu lly don e on ly by a n

94
Trans action of the New York Medicla Society , Vol I,pp. 30,36,174,342,app.41; Vol.II, p.223; Vol III,pp.25,151;
Vol.V,p.294; Vol. VII,pp.61, 96,131.
113
ext en s ive s er ies of exa ct obs er va t ion s , t h r ou gh s ever a l yea r s , con cer n in g t h e
n a t u r e of t h e dis ea es , t h e ext er n a l cir cu ms t a n ces u n der wh ich t h ey occu r ,
a n d t h e con dit ion of t h e wa t er , a n d of t h e pla ces wh er e wa t er h a s been , in
t h e n eigh bor h ood, t r u t h fu lly ma de, u n in flu en ced by pa r t y or pecu n ia r y
in t er es t s , for n o ot h er pu r pos e t h a n t o obt a in t h e t r u t h . Th e pla n of
obs er va t ion s t a t ed in ou r XVIt h r ecommen da t ion migh t be a dopt ed. An d or
n ot s ome h u n dr eds of lives , s u ppos ed .t o be a n n u a lly los t in t h is St a t e for
wa n t of t h is in for ma t ion , wor t h ou r wh ile t o obt a in it ?

XXIV. WE RECOMMEND that the local Boards of Health provide f or
period ical hous e-to-hous e vis itation, f or the prevention of epidemic d is eas es ,
and f or other s anitary purpos es .
Th e a ppr oa ch of ma n y epidemic dis ea s es is oft en for es h a dowed by s ome
der a n gemen t in t h e gen er a l h ea lt h ; a n d, if pr oper ly a t t en ded t o a t t h a t t ime,
t h e fa t a l effect s may be pr even t ed. Th is is es pecia lly pr oper in r ega r d t o
ch oler a a n d dys en t er y. Th e pr emon it or y s ympt oms of ch oler a a r e s eldom
a bs en t ; a n d if t h es e a r e s ea s on a bly obs er ved a n d pr oper ly t r ea t ed, t h e
dis ea s e is con t r olla ble. Th er e a r e few dis ea s es over wh ich cu r a t ive mea s u r es
h a ve les s , a n d few over wh ich pr even t ive mea s u r es h a ve gr eat er power . Th is
well-kn own ch a r a ct er is t ic of t h e dis eas e led per s on s in ma n y pla ces in
En gla n d, du r in g la s t yea r , t o or ga n ize a s ys t em of h ou s e-t o-h ou s e vis it a t ion ,
by wh ich ever y fa mily, s ick or well, in a given dis t r ict , wa s vis it ed da ily by
s ome a u t h or ized pers on , wh et h er in vit ed or n ot ; a n d ever y in ma t e wh o h a d
t h e lea s t s ympt om of t h e dis ea s e r eceived a dvice a n d t r ea t men t . Th e object s
a imed a t wer e-
" 1. Th e dis cover y a n d immedia t e t r ea t men t of ever y ca s e of dia r r h ea , in
loca lit ies wh er e ch oler a pr eva iled, a n d wh er e t h e pa t ien t s h a d n ot a pplied a t
t h e dis pen s a r ies , in or der t o pr even t , a s fa r a s pos s ible, t h e developmen t of
t h e dis ea s e.
" 2. To pr even t per s on s wh o migh t n ot a pply for medica l a id, even in
ch oler a , fr om dyin g wit h ou t s u ch a id.
" 3. To br in g ca s es of ch oler a u n der t r ea t men t . a t t h e ea r lies t pos s ible
per iod of t h e dis ea s e.
" 4. To keep a con s t a n t medica l in s pect ion over a ffect ed dis t r ict s a n d
h ou s es , s o a s t o in s u r e t h eir bein g kept in a pr oper s a n it a r y con dit ion .
" 5. To exer cis e a mor a l a gen cy over t h e popu la t ion , by givin g s u ch
in s t r u ct ion s in r egar d t o clea n lin es s , ven t ila t ion , a n d per s on a l h a bit s , a s
migh t a ppea r n eedfu l, a n d by expla in in g a n d en for cin g t h e n eces s it y for
immedia t e a pplica t ion t o t h e dis pen s a r ies , or medica l officer s , by a ll pa r t ies
w h o migh t be t a ken ill du r in g t h e in t er va ls bet ween t h e da ily vis it s ."
Th is mea s u r e wa s a t t en ded wit h emin en t s u cces s , a n d wa s fou n d t o be
on e of t h e gr ea t es t econ omy a s weIl a s h u ma n it y. We s elect t h e followin g
s t a t emen t of it s effect s in on e dis t r ict , a s a n illu s t r a t ion of wh a t occu r r ed in
ma n y ot h er s :-
" In Sh effield, a n effect ive body of medica l officer s h a ve been a ppoin t ed
for t h e dis cover y of per s on s la bor in g u n der t h e pr emon it or y s ympt oms of
ch oler a , a n d for br in gin g s u ch per s on s u n der immedia t e medica l t r ea t men t .
Bes ides a n a dequ a t e s t a ff of h ou s e-t o-h ou s e vis it or s , n u mer ou s dis pen s a r ies
h a ve been open ed in con ven ien t pa r t s of t h e t own , for s u pplyin g a ll s u ch
per s on s gr a t u it ou s ly wit h pr oper medicin e. Ha n dbills h a ve been ext en s ively
114
dis t r ibu t ed, pa r t icu la r ly a mon g t h e mos t s u s cept ible pa r t of t h e popu la t ion ,
givin g t h em t h e n eces s a r y in for n 1a t ion r es pect in g t h es e dis pen s a r ies , a n d
wa r n in g t h em of t h e da n ger of n eglect in g a n y degr ee of bowel compla in t .
Ever y per s on , on ma kin g a pplica t ion t o a dis pen s a r y for a dos e of medicin e,
on r eceivin g t h e medicin e, is r equ ir ed t o give h is n a me a n d a ddr es s ; t h is is
for wa r ded a t on ce t o a medica l officer , wh o vis it s t h e pa t ien t wit h ou t dela y.
So t h or ou gh ly h a ve t h e people in Sh effield h a d t h eir a t t en t ion dir ect ed t o t h e
s ympt oms wh ich pr ecede ch oler a , a n d s o well do t h ey u n der s t a n d a n d
a ppr ecia t e t h e in for ma t ion wh ich h a s been given t h em, t h a t it is s t a t ed t h a t
t h e h ou s e-t o-h ou s e vis it or s s ca r cely ever meet wit h a ca s e of dia r r h ea wh ich
h a s n ot been a t t en ded by a medica l ma n in con s equ en ce of t h eir h a vin g
pr eviou s ly a pplied a t on e of t h e dis pen s a r ies for a gr a t u it ou s dos e of
medicin e. Du r in g t h e fir s t week t h a t t h is s ys t em of vis it a t ion h a s been in
pr a ct ice, t h e vis it or s dis cover ed 1582 ca s es of pr emon it or y dia r r h ea , a n d on
t h e s econ d week, 1387; in a l11 in on e for t n igh t , 2969. Ou t of t h is gr ea t
n u mber , on ly fou r dea t h s h a ve occu r r ed ; bu t in pa r t s of t h e t own n ot u n der
vis it a t ion , a mon g t h e wea lt h ier cla s s es , a t t en ded by t h eir own pr iva t e
medica l fr ien ds , t h er e h a ve occu r r ed s even dea t h s . In a r u r a l dis t r ict
con n ect ed wit h Sh effield,-n a mely, Alt er cliffe,-n ot du r in g t h is per iod u n der
vis it a t ion , wit h 279 ca s es of dia r r h ea , t h er e wer e 23 ca s es of ch oler a , a n d 11
dea t h s . No s t r on ger eviden ce ca n well be con ceived of t h e efficien cy of t h a t
pr even t ive mea s u r e wh ich is fou n ded on t h e fa ct , wh ich exper ien ce h a s t oo
fu lly pr oved, t h a t per s on s in gen er a l la bor in g u n der pr emon it or y s ympt oms
a r e n ot a wa r e of t h eir da n ger , a n d t h a t , if t h os e per s on s a r e t o be s a ved, t h ey
mu s t be s ou gh t ou t in t h eir dwellin gs , a n d pla ced a t on ce u n der pr oper
t r ea t men t ."
Th e s u cces s wh ich a t t en ded t h e mea s u r e in pa r t icu la r loca lit ies , led t h e
Bda r d of Hea lt h t o is s u e, on t h e Is t of Sept ember , 1849, a gen er a l or der for
it s in t r odu ct ion in t o Lon don , a n d t h e r es u lt for t h e fir s t 52 da ys , u p t o
Oct ober 22, wa s a s follows :-




Diar r h oea cas es dis cover ed 43127
Rice wa t er pu r gin g dis cover ed 976
Ch oler a dis cover ed 779
Pa s s ed in t o ch oler a a ft er t r ea t men t 52


Ha d it n ot been for t h es e vis it a t ion s , ver y ma n y mor e of t h es e ca s es
wou ld h a ve t er min a t ed in ch oler a a n d dea t h . wh a t fa ct s ca n mor e
for ciblyillu s t r a t e t h e u t ilit y of pr even t ive mea s u r es ? We ea r n es t ly commen d
t h e pla n t o ever y cit y a n d villa ge in wh ich ch oler a , dys en t er y, a n d ot h er
s imila r dis ea s es , ma y a ppea r a s epidemics . Th e expen s es wh ich wou ld
a t t en d it s execu t ion wou ld be fa r les s t h a n r es u lt fr om t h e effect s of t h e
115
dis ea s e, wh en s u ffer ed t o t a ke it s or din a r y cou r s e u n der or din a r y t r ea t men t .
Sma ll-pox, t oo, migh t in t h is ma n n er be ea s ily ext er min a t ed fr om a n y cit y.
95


XXV. WE RECOMMEND that meas ures be tak en to as certain the amount
of s ick nes s s uffered in d ifferent localities ; and among pers ons of different
clas s es , prof es s ions , and occupations .
Ever y per s on is lia ble t o s ickn es s . Th e ext en t of t h a t lia bilit y, h owever ,
va r ies in differ en t pla ces a n d cir cu ms t a n ces , a n d in t h e s a me pla ce a n d
cir cu ms t a n ces in differ en t a ges a n d s ea s on s . It h a s s ome, t h ou gh n ot a n
exa ct , r ela t ion t o mor t a lit y. Some dis ea s es u n der s ome cir cu ms t a n ces
pr odu ce mor e s ickn es s in pr opor t ion t o t h e mor t a lit y t h an ot h er s . It h a s
been s u ppos ed by Mr . Edmon ds , a n a u t h or en t it led t o cr edit (La n cet , Vol. II,
for 1839, p. 185,) t h a t t h e a ver a ge r ela t ion exis t in g bet ween t h e r a t e of
s ickn es s a n d t h e r a t e of mor t a lit y is t wo yea r s of s ickn es s t o ea ch dea t h . " If
a ilmen t s of a ligh t er kin d a r e in clu ded, t h e pr opor t ion of s ickn es s r is es t o 2
1/ 2 yea r s t o ea ch dea t h . As s u min g t wo yea r s t o be t h e pr opor t ion of
s ickn es s t o ea ch dea t h a t ever y a ge, it will follow t h a t t h e pr opor t ion of t h e
livin g con s t a n t ly s ick a t a n y a ge will a lwa ys be dou ble t h e pr opor t ion of t h e
popu la t ion of t h e s a me a ge dyin g in on e yea r . If t h e dea t h s a t a n y a ge will
r a t e of 2 per cen t ., or 1 in 50 per an n u m, t h e pr opor t ion of t h e livin g
con s t a n t ly s ick will be 4 per cen t ., or 1 in 25."
Th er e a r e s ever a l r ea s on s wh y t h is s u bject s h ou ld be fu lly a n d ca r efu lly
in ves t iga t ed, a n d t h a t exa ct fa ct s in r ela t ion t o differ en t popu la t ion s , exis t in g
u n der differ en t cir cu ms t a n ces , s h ou ld be kn own . We s h ou ld a llu de t o t wo
pr in cipa l on es on ly: -

Pa r t icu la r s of Hou s eh old Vis it a t ion in t h e pa r is h of -.Medica l Officer , Mr .
Vis it or , Mr . -.
St r eet
Nu mber
Floor
Sex
Age
Sympt oms r equ ir in g t r ea t men t

95
Dr. Simon, the able off icer of health f or the city of London, is s ued, on 21
s t
of September , 1849, the f ollowing excellent
ins tructions to the hous e to hous e vis itors under his s upervis ion, as to the manner in which they s hould perform their
duties -
It will be his duty to vis it every hous e in the d is trict as s igned to him by the ord inary med ical off icer of the locality , once
each d ay , at the leas t; and whenever s everal f amilies inhabit one and the s ame hous e, it will be his duty each vis it to
s ee one adult member at leas t of every s uch f amily .
Thes e vis its s hould be made as early as pos s ible in teh day , and the s everer the cas es of ind is pos ition s hould be
revis ited in the af ternoon, (or as early and as of ten as may be neces s ary ) in order to as certain the res ult of treatment
adopted.
The vis itor s hall be provided with med iciens s uitable to any emergency lik ely to f all with in his obs ervation; but in cas es
of no urgency ha s hall pres cribe ,and s hall ref er the patient to the depot of his d is trict, where medicien may be procured.
The vis itor s hall tak e notes of the particulars s pecif ied itn thetabular f orm with which he will be furnis he, and at the
clos e of each day s vis itation he chall communicate this return to the ordinary med ical off icer with whom he acts , and
s hall recieve that off icers directions for the next d ay s vis itation. The vis itor s hall ins ert in his return a notice of every
locality where cleans ing (either external or internal)s hall appear requis ite; and wherveer he s hall f iind the condition of a
houis e irremediably bad, or the inhabitants s o dens ely crowded as to endanger lif e, he s hall mak e this the s ub;ect of a
s pecial report. Es pecially he s hould impres s on the pers ons with whom he communicates , the extreme danger of
neglecting d iarrhoea, and the neces s ity of obtaining Medical advice as s peed ily as pos s ible. He s hould lik ewis e explain
to them the arrangements f or medical relief which prevail in the dis trict , and s hould s ee that they k now the res idence of
the ord inary med ical off icer;s o that, in cas e or any s udden s eiz ure in .the intervals or his own vis itation, there may be on
ignorance of the bes t cours e of procuring medical as s is tance. " All pers ons s uffering with the bowel complaint, however
s light, or with s ick nes s or other unus ual ailment, are es s entially reques ted to procure immediate as s is tance, either f rom
their ord inary med ical advis ers , or from the medicines ."
116
Pa s s ed in t o ch oler a s in ce la s t r epor t
Rema r ks on loca lit y
Dea t h s

Su mma r y of Hou s eh old Vis it a t ion in t h e Cit y.

Un ion
Dis t r ict
Or din a r y Medica l Officer
Vis it or s
Tot a l fa milies vis it ed s in ce la s t r epor t
New ca s es of per s on s r equ ir in g medica l
t r ea t men t
Tot a l ca s es n ow u n der vis it or s ' t r ea t men t
Ca s es t er min a t ed in ch oler a s in ce la s t r epor t


1. It would s ubs erve a pecuniary purpos e. Th e wea lt h of a cou n t r y
con s is t s in it s ca pa cit y for la bor . Th a t people wh o en joy t h e gr ea t es t vit a l
for ce,-t h e h igh es t degr ee of h ea lt h ,- a n d a pply it mos t s kilfu lly t o t h e
pr odu ct ion of wea lt h, a r e t h e mos t wea lt h y. It is t h eir ca pit a l, t h eir mea n s of
s u bs is t en ce. Per s on s wh o s u s t a in a low vit a lit y on ly, gen er a lly h a ve lit t le
s kill t o a pply wh a t t h ey pos s es s , con t r ibu t e lit t le or n ot h in g t o t h e gen er a l
welfa r e, a n d ma y, a n d oft en a ct u a lly do, become a pu blic bu r den . Th is is on e
view. An ot h er pr es en t s it s elf in t h e vas t n u mber of a s s ocia t ion s exis t in g,
u n der t h e n a mes of Fr ien dly Societ ies , Hea lt h In s u r a n ce Compa n ies , Odd
Fellows , a n d ot h er t it les , t h e object of wh ich is , dir ect ly or in dir ect ly, by t h e
pa ymen t of a cer t a in s u m, t o s ecu r e s u ppor t t o t h e member s du r in g t h e
con t in gen cy of s ickn es s . For t h e s t a bilit y of t h es e s ociet ies , a n d t h e s ecu r it y
of t h e member s t h ems elves , it is n eces s a r y t h a t t h e r a t e of s ickn es s u n der
differ en t cir cu ms t a n ces s h ou ld be defin it ely a s cer t a in ed. So lon g a s it is n ot
kn own , n o ju s t r a t es of pa ymen t ca n be es t a blis h ed. Some of t h e Hea lt h
In s u r a n ce Compa n ies in t h is St a t e h a ve clos ed t h eir bu s in es s , beca u s e t h ey
h a ve h a d t o pa you t mor e t h a n t h ey r eceived. Some lodges of Odd Fellows
h a ve a ls o been obliged t o cu r t a il t h eir pa ymen t s . All t h es e in s t it u t ion s a r e
n ow gr opin g in t h e da r k in r ega r d t o t h es e ma t t er s , a n d ma n y of t h em, it is
believed, ca n n ot exis t u n der t h e r a t es of pa ymen t pr opos ed t o be ma de. A
mis a ppr eh en s ion of t h e pr in ciples on wh ich t h ey s h ou ld h a ve been fou n ded
a n d ma n a ged, is a pr in cipa l ca u s e of t h eir fa ilu r e. Hea lt h in s u r a n ce migh t be
s o ma n a ged a s t o be a legit ima t e bu s in es s , of a u s efu l ch a r a ct er .
2. It would s ubs erve a s anitary purpos e, a n d s h ow t h e exa ct con dit ion of
t h e people. Some in t er es t in g fa ct s on t h is s u bject a r e a lr ea dy kn own . Th e
Ma n ch es t er St a t is t ica l Societ y h a ve given t h e a ver a ge n u mber of da ys of
s ickn es s a n n u a lly s u ffer ed by ea ch of t h e oper a t ives en ga ged in va r iou s
br a n ch es of in du s t r y, fr om wh ich it a ppea r s t h a t , in t h e St a ffor ds h ir e
pot t er ies , u n der t h e a ge of 60, it is 9.03 da ys ; in t h e s ilk mills , 7.08 da ys ; in
t h e woolen mills , 7.08 da ys ; in t h e fla x mills , 5.09 da ys ; in t h e cot t on mills a t
Gla s gow da ys ; a mon g t h e Ea s t In dia Compa n y s er va n t s , 5.04 .da ys a mon g
la bor er s in t h e dock-ya r ds , 5.38 da ys ; in t h e La n ca s h ir e cot t on mills , 5.35
da ys ; a n d for t h os e u n der 16, 3.14 da ys .
117
Fr om M'Cu lloch 's St a t is t ics we compile t h e followin g t a ble t o s h ow t h e
a ver a ge n u mber of da ys of s ickn es s per a n n u m a t differ en t a ges , s u ffer ed by
ea ch oper a t ive employed in t h e fa ct or ies in La n ca s h ir e a n d Gla s gow :-

Da ys of s ickn es s per a n n u m t o
ever y per s on employed
Da ys of s ickn es s per a n n u m t o
ever y per s on s ick
La n ca s h ir e Glas s gow La n ca s h ir e Glas s gow
AGES
Males Fema l
es
Males Fema l
es
Males Fema l
es
Males Fema l
es
Un der
10
2. 46 8. 03 1. 01 2. 63 13. 04 - 3. 61 14. 9
10-15 3. 81 4. 25 4. 8 6. 18 14. 58 11. 98 12. 35 13. 81
15-20 4. 42 5. 56 5. 52 6. 38 16. 43 12. 63 17. 14 15. 54
20 -25 4. 91 6. 85 9. 11 8. 16 18. 27 16. 42 20. 12 18. 96
25-30 6. 88 8. 62 7. 05 7. 38 22. 14 18. 51 16. 05 19. 81
30-35 3. 85 9. 29 7. 65 6. 05 12. 19 21. 77 16. 93 13. 05
35-40 4. 13 6. 16 8. 5 4. 16 13. 75 19. 19 22. 58 16
40-45 5. 09 14. 67 5. 12 11. 94 14. 25 14. 41 16. 41 20. 36
45-50 7. 18 20. 34 4. 84 11. 72 30. 31 26. 43 20. 57 40. 6
50-55 3. 47 15. 75 4. 9 16. 5 13. 1 21 16. 41 25. 85
55-60 12. 68 15. 75 3. 27 15 11. 5 21 8. 84 30. 2


Fr om t h is t a ble it a ppea r s t h a t , a t t h e a ges 15 t o 20 ever y ma le
oper a t ive in La n ca s h ir e s u s t a in s , on t h e a ver a ge, 4.42 da ys of s ickn es s
a n n u a lly, a n d ever y fema le, 5.56; in gla s s gow, t h e ma les 5.52 da ys , a n d
fema les , 6.38 da ys ; a n d t h a t t h e a ver a ge len gt h of s ick t ime t h a t ever y ma le
wh o is s ick will be, in La n ca s h ir e, 16.43 da ys , a n d ever y fema le, 12.63 da ys ;
a n d in Gla s gow, t he ma les , 17.14 da ys , a n d t h e fema les , 15.54 da ys . An
in s pect ion of t h e t a ble will s h ow a differ en ce in t h e a mou n t of s ickn es s in t h e
t wo pla ces , in ot h er a ges .
Th e mos t r elia ble wor ks wh ich exh ibit t h e pr oba ble s ickn es s wh ich a
la bor in g ma n will s u s t a in t h r ou gh life, a r e - 1. A Repor t of t h e High la n d
Societ y, by Ch a r les Oliph a n t Es q. Th is a ble wor k wa s pu blis h ed in 1824,
a n d wa s t h e fir s t pu blica t ion of t h e kin d. It wa s pr epa r ed fr om r et u r n s of 79
Fr ien dly Societ ies , in 16 cou n t r ies of Scot la n d, ma de fr om r ecor ds kept
bet ween 1750 a n d 1821, a n d r ela t ed t o 104,218 member s .-2. A Tr ea t is e on
Fr ien dly Societ ies , by' Ch a r les An s ell, Es q., Act u a r y t o t h e At la s As s u r a n ce
Compa n y; pu blis h ed in 1835, u n der t h e s u per in t en den ce of t h e Societ y for
t h e Diffu s ion of Us efu l Kn owledge. Th is wor k wa s dr a wn Fr ien dly Societ ies in
mos t of t h e cou n t ies a n d r ela t ed t o 24,323 member s , du r in g five yea r s , 1823
t o 1827 in clu s ive.-An d 3. Con t r ibu t ion s t o Vit a l St a t is t ics , by F. G. P.
Neis on , Es q., Act u a r y t o t h e Medica l In va lid a n d Gen er a l Life Office,
pu blis h ed in 1846. Th is wor k wa s pr epa r ed fr om t h e r et u r n s of t h e Fr ien dly
Sqciet ies in En gla n d 1836 t o 1840.
Fr om t h es e wor ks we h a ve compiled t h e followin g t a ble, t o t h e n u mber
of da ys of s ickn es s wh ich ea ch per s on , on a ver a ge, s u s t a in s a n n u a lly, at
ea ch a ge, fr om 20 t o 70 yea r s : -
118

Age Oliph a
n t
An s e
ll
Ne is o
n
Age Oliph a
n t
An s e
ll
Ne is o
n
21 4.025 5.46
0
5.917 46 7.224 9.87
7
10.98
1
22 4.032 5.49
5
5.960 47 7.756 10.3
25
11.56
9
23 4.046 5.53
7
6.009 48 8.302 10.8
08
12.22
2
24 4.067 5.58
6
6.062 49 8.904 11.3
33
12.94
0
25 4.095 5.04
2
6.120 50 9.527 11.9
07
13.72
2
26 4.130 5.70
5
6.183 51 10.057 12.5
37
14.56
8
27 4.172 5.77
5
6.240 52 10.787 13.2
30
15.51
2
28 4.221 5.85
2
6.291 53 11.431 13.9
93
16.55
5
29 4.227 5.93
6
6.336 54 12.082 14.8
40
17.69
5
30 4.347 6.02
7
6.374 55 12.747 15.7
92
18.93
2
31 4.417 6.13
2
6.407 56 13.426 16.8
70
20.26
9
32 4.487 6.25
1
6.475 57 14.126 18.1
02
21.95
9
33 4.564 6.38
4
6.577 58 14.854 19.5
16
24.00
5
34 4.641 6.53
1
6.713 59 15.610 21.1
47
26.40
5
35 4.725 6.69
2
6.885 60 16.422 23.0
44
29.15
9
36 4.816 6.86
7
7.091 61 17.500 25.2
77
32.26
9
37 4.914 7.06
3
7.331 62 19.152 27.9
37
36.33
2
38 5.026 7.28
0
7.608 63 21.700 31.1
36
41.35
1
39 5.159 7.51
8
7.919 64 25.900 35.0
07
47.32
3
40 5.306 7.77
7
8.265 65 30.800 39.7
04
54.25
0
41 5.488 8.05
7
8.647 66 37.800 45.4
02
62.13
2
42 5.698 8.36
5
9.057 67 46.200 52.2
97
70.47
5
43 5.964 8.70
1
9.495 68 55.300 60.6
13
79.27
9
119
44 6.314 9.06
5
9.962 69 65.100 70.6
02
88.54
5
45 6.734 9.45
7
10.45
7
70 74.907 82.5
51
98.27
3


It a ppea r s fr om t h is t a ble t h a t t h e a ver a ge n u mber of da ys ' s ickn es s per
a n n u m, wh ich ea ch per s on in t h es e s ociet ies s u ffer ed a t t h e a ge of 21, wa s ,
a ccor din g t o Oliph an t , 4.025 da ys a ccor din g t o An s ell, 5.460 da ys ; a n d
a ccor din g t o n els on 5.917 da ys . At t h e a ge of 60 it is , r es pect ively, 16.422,
22.044, a n d 29.159. Th er e is con s ider a ble dis cr epa n cy in t h es e r es u lt s ,
pr oba bly a r is in g fr om t h e differ en t . met h ods of obs er va t ion , or t h e differ ent
cir cu ms t a n ces of t h e per s on obs er ved, or fr om a n in cr ea s e of s ickn es s in t h e
la t t er over t h e for mer per iods , a s we h a ve befor e in t ima t ed, (pp. 103-106)
We a ls o compile fr om t h e dedu ct ion s in Mr . Neis on s Wor k, (p. 105,) t h e
followin g t a ble, t o pr es en t ot h er views of t h e r ela t ion s of s ickn es s :-

AGES Th e
n u mber of
at t a cks of
s ickn es s
a n n u a lly
in ea ch
100
member ,
will be,
Da ys of s ick-
Nes s wh ich
ea ch
member wh o
is s ick will
s u ffer
a n n u a lly
To ea ch 100
member s wh o a r e
s ick, t h e pr opor t ion
of deat h s per
a n n u m will be
To ea ch a n n u a l
dea t h t h e
pr opor t ion of
a n n u a l s ick
t ime, a mon g t h e
livin g will be,
10 t o 15 21. 9565 28. 8617 . 9901 416. 4290 wks or
8 yr s . 3 days
15 t o 20 22. 0743 25. 1209 2. 8571 125. 6032
= 2 151
20 t o 25 22. 0386 26. 9626 3. 0539 126. 1271
= 2 154
25 t o 30 21. 6997 29. 3447 3. 3271 125. 9977 =
2 83
30 t o 35 21. 0147 30. 5095 3. 7592 115. 9411 =
2 122
35 t o 40 21. 5471 34. 6241 4. 0686 121. 5732
= 2 190
40 t o 45 22. 9858 41. 5926 4. 5306 131. 1468
= 2 200

45 t o 50 24. 6042 47. 9892 5. 1657 132. 7133 =
2 226
50 t o 55 27. 6422 59. 5728 6. 2401 136. 3839
= 2 323

55 t o 60 30. 2424 76. 4827 7. 2732 150. 2235
= 2 142

60 t o 65 35. 5676 106. 3825 8. 6163 176. 3808
= 3 310

65 t o 70 46. 8493 169. 5519 9. 6004 252. 2988
= 4 62
70 t o 75 58. 3750 228. 3925 12. 1306 268. 9679
= 5 68
120
75 t o 80 73. 5916 253. 6579 11. 3636 318. 8876
= 6 343

80 t o 85 74. 4624 264. 3431 18. 4116 205. 1064
= 3 215

85 t o 90 79. 4872 287. 5803 17. 2043 238. 7943 =
4 151

By t h is t a ble it a ppea r s t h a t , on t h e a ver a ge, a t t h e a ge of 45 t o 50, in
ea ch 100 45 t o 50, in ea ch 100 member s , 24.6 (omit t in g ot h er fr a ct ion s )
a t t a cks of s ickn es s will t a ke pla ce, or t h a t n u mber of member s will be s ick
ever y yea r ; t h a t t h e len gt h of t h e s ickn es s of ea ch on e wh o is s ick will be
47.9 da ys ; t h a t in ever y 100 wh o a r e s ick, 5.1 will die; a n d t h a t t h e len gt h of
s ickn es s of ea ch be s u ffer ed by a ll will be 132.7 weeks , or 2 yea r s , 200 da ys .
It a ls o a ppea r s , fr om t h e a ge of 15 u pwa r ds , t h e a mou n t of s ickn es s will be
fou n d t o in cr ea s e in r egu la r a n d u n in t er r u pt ed s er ies . Wh ile 26.96 da ys of
s ickn es s a r e s u ffer ed in a yea r by ea ch per s on s ick, a t t h e per iod fr om 20 t o
25, 169.55 da ys a r e 65 t o 70. Th e r ela t ive ch a n ces , a ls o, of bein g s ick a t t h e
t wo per iods of life, 20 t o 25, a n d 65 t o 70, t h e r a t io of 22 t o 46 ; wh ile t h e
mor t a lit y a t t h e s a me per iod is in t h e r a t io of 3 t o 9 a mon g t h os e a ct u a lly
s ick. At per iod of 30 t o 35, for ever y 2 yea r s a n d 83 da ys s ickn es s t h er e is
on e dea t h ; a t 10 t o 15, 8 yea r s a n d 3 da ys ; a n d a t 65 t o 70, 4 yea r s a n d 310
da ys : or , in ot h er wor ds , a gr ea t er a mou n t of s ickn es s in pr opor t ion t o t h e
dea t h s is s u ffer ed in you t h a n d old a ge, or a t t h os e per iods of life in wh ich
t h e lea s t for ce exis t s , t h a n in t h e middle a ges , wh en a gr eat er of vit a lit y is
en joyed.
Th es e a r e s ome of t h e in t er es t in g r es u lt s of t h e in ves t iga t ion s ma de in
En gla n d a n d Scot la n d, r ela t in g t o s ickn es s . How fa r t h ey a r e a pplica ble t o
t h is cou n t r y we h a ve n ot t h e mea n s of kn owin g a ccu r a t ely. Some h a ve
s u ppos ed t h a t t h e pr opor t ion of s ickn es s t o h ea lt h is gr ea t er in
Ma s s a ch u s et t s t h a n in En gla n d, bu t ot h er s a r e of a differ en t opin ion . Th e
obs er va t ion s a r e t oo limit ed a n d imper fect t o fou n d t h er eon opin ion .
96



Age s In s u r e d Si c k Ave r a ge Wk s Si c k Ave r a ge
1 6 -3 0 533 122 4. 36 539 4. 4
3 0 -3 5 130 39 3. 3 161 4. 12
3 5 -4 0 59 19 3. 1 108 5. 68
4 0 -4 5 26 3 8. 66 25 8. 33

96
For s ome es timates on this s ubjects , s ee Shattuck s Cens us and Statis tics of Bos ton, pp 173-176.. Dr. Jarvis
(Communications , Mas s . Med ical Society , Vol. VIII, p.50) s ay s -: There are no data to determine the amount of s ick nes s in
New England. Some of the health Ins urance Companies here made up their rates of premiums accord ing to thos e of the
Englis h Benef it Societies , but thes e have been f ound on trial, too low. Probably there is more s ick nes s here than in
England, and s ome thes e companies have been pay ing out in benef its more than they received in premiums . The
Bos ton Journal of 30
th
July , 1847, -viz ., the Mas s achus etts Health Ins urance Company , -voted to d is continue f arther
bus ines s , and clos e up its aff airs . The Lowell and Wores ter ins titutions decided on this cours e about a y ear ago. During
the las t s ix months , Es s ex company has been wind ing up, and pay ing f rom 20 to 30 cents on a dollar. The S iloam Lodge
of odd Fellows , in Bos ton, f ound the s ame res ult and d iff iculty , and lately voted not pay f or the f irs t week of any cas e of
s ick nes s , but f or all af terwards , and charge the s ame premiums as bef ore. The average number of the members of the
Siloam lodge, for the y ears 1844, 45, 46, and 47, was 549. The average time of s ick nes s of all, in each y ear, f or which
benef it money was paid was 465 week s . Average s ick nes s , f or each member drawing benef it money was 5.9 day s in
each y ear. Dr. Ly man has furnis hed us with with the f ollowing abs tract of the records of Mas s achus etts Health
Ins urance Company , relating to thos e policies only which had expired:- According to this s tatement, 188 of 761, or 24.70
percent of the members ins ured were s ick ; and the length of s ick time was 31.7 day s to catch.
121
4 5 -5 0 13 5 2. 6 17 8. 04
1 6 -5 0 7 6 1 1 8 8 4 . 0 4 8 5 0 4 . 0 5



If t h e r u le of dou bling t h e a n n u a l mor t a lit y per cen t . be a pplied t o obt a in
t h e r a t e of s ickn es s , a ppea r t h a t .5.06 per cen t . of t h e popu la t ion , or 5,787 of
bot h s exes , h a ve on t h e a ver a ge been con s t a n t ly Bos t on , for t h e la s t n in e
yea r s . By t h e s a me -.- t own of a n a ver a ge h ea lt h y s t a n da r d, con t a in in g 2,000
a n t s , 60 will con s t a n t ly be s ick. Th is s eems a la r ge or a mou n t of s ickn es s ,
bu t it ma y n ever t h eles s be t r u e, wh er e t h os e in in fa n cy a n d old a ge a r e
in clu ded.
Th is s u bject is of va s t con s equ en ce. It wou ld in t er es t in g a n d u s efu l t o
kn ow t h e a mou n t of s ickn es s fa milies , a n d a mon g per s on s of t h e va r iou s
occu pa t ion s ,-t h e fa r mer s , t h e mech a n ics , t h e a n d ot h er s ,-a n d h ow fa r it ,
differ s in differ en t pla ces a n d u n der differ en t cir cu ms t a n ces . All t h e fa ct s
a n d u s ed in fa vor of a s a n it a r y s u r vey, ma y be a pplied t h e u t ilit y a n d
impor t a n ce of t h is br a n ch of t h e obt a in t h e fa ct s , s ome s imple pla n is
n eeded, wh ich ma y a n d wit h ou t mu ch la bor be ca r r ied in t o oper a t ion plan
we h a ve given in t h e a ppen dix.

XXVI. WE RECOMMEND that meas ures be tak en to the amount of
s ick nes s s uffered, among the s cholars the public s chools and other s eminaries
of learning Commonwealth.
It h a s r ecen t ly been r ecommen ded t h a t t h e ecology be t a u gh t in t h e
pu blic s ch ools ; s h ou ld be u n iver s a lly a ppr oved a n d ca r r ied s oon a s per s on s
ca n be fou n d ca pable of t ea ch in g it .
97

Sa n it a r y s cien ce is in t ima t ely
con n ect ed wit h s er ves equ a l a n d even gr ea t er commen da t ion a s a br a n ch of
edu ca t ion . Ever y ch ild s h ou ld be t a u gh t , ea r ly in life , t h a t t o pr es er ve h is
own life a n d h is own h ea lt h a n d t h e lives a n d h ea lt h of ot h er s , is on e of h is
mos t impor t a n t a n d a bidin g duties . By obeyin g cer t a in la ws , or Act s , h is life
a n d h ea lt h ma y be pr es er ved; by dis obedien ce, or per for min g cer t a in ot h er
a ct s , t h ey will bot h be des t r oyed. By kn owin g a n d a voidin g t h e ca u s es of
dis ea s e, dis ea s e it s elf will be be a voided, a n d h e ma y en joy h ea lt h a n d live;
by ign or a n ce of t h es e ca u s es a n d expos u r e t o t h em, h e ma y con t r a ct
dis ea s e, r u in h is h ea lt h , a n d die. Ever y t h in g con n ect ed wit h wea lt h ,
h a ppin es s a n d lon g life depen d u pon health; a n d even t h e gr ea t du t ies of
mor a ls a n d r eligion a r e per for med more a ccept a bly in a h ea lt h y t h a n in a
s ickly con dit ion .
Th is ma t t er h a s been t oo lit t le r ega r ded in t h e edu ca t ion of t h e you n g.
In t ellect u a l cu lt u r e a s deceived t oo mu ch a n d ph ys ica l t r a in in g t oo lit t le
a t t en t ion . Some mea s u r e is n eeded wh ich s h a ll impel ch ildr en t o ma ke a
s a n it a r y exa min a t ion of t h ems elves a n d t h eir a s s ocia t es , a n d t h u s elicit a

97
The following arc the provis ions of an act relating to public hy giene, pas s ed April 24, 1850 :
SECT. 1. Phy s iology and hy giene s hall hereaf ter be taught in all the public s chools of this Commonwealth, in
all cas es in which the s chool committee s hall deem it exped ient.
SECT.2. All s chool teachers s hall hereaf ter be examined in their k nowledge of the elementary principals of
phy s iology and hy giene, and their ability to give ins tructions in the s ame.
SECT. 3 This act s hall tak e effect on and af ter the f irs t d ay of October, one thous and eight hundred f if ty -one.

samc.
SECT.3. This act shall takc cffcct on and after the first day or eight hundrcd fifty.one."
122
pr a ct ica l a pplica t ion of t h e les s on s of s a n it a r y s cien ce in t h e ever y-da y
du t ies of life. Th e r ecommen da t ion n ow u n der con s ider a t ion is des ign ed t o
fu r n is h t h is mea s u re. It is t o be ca r r ied in t o oper a t ion in t h e u s e of a bla n k
s ch edu le, wh ich is t o be pr in t ed on a let t er s h eet , in t h e for m pr es cr ibed in
t h e a ppen dix, a n d fu r n is h ed t o t h e t ea ch er of ea ch s ch ool. He is t o a ppoin t a
s a n it a r y commit t ee of t h e s ch ola r s , a t t h e com of t h e s ch ool, a n d, on t h e fir s t
da y of ea ch mon t h , t o fill it ou t , u n der h is s u per in t en den ce, a ccor din g t o t h e
a ccompa n yin g dir ect ion s . Su ch a mea s u r e is s imple, wou ld t a ke bu t a few
min u t es ea ch da y, a n d ca n n ot oper a t e ot h er wis e t h a n u s efu lly u pon t h e
ch ildr en , in for min g h a bit s of exa ct obs er va t ion , a n d in makin g a per s on a l
a pplica t ion of t h e la ws of h ea lt h a n d life t o t h ems elves . Th is is edu ca t ion of
a n emin en t ly pr a ct ica l ch a r a ct er , a n d of t h e h igh es t impor t a n ce All t h e
r ea s on s in fa vor of ou r t wen t y-fift h r ecommen da t ion a pply a ls o t o t h is . By
a dopt in g it , ma n y a n d ma n y a life wou ld a n n u a lly be s a ved in t h is
Common wea lt h , a n d t h e gen er a l h ea lt h t h e r is in g gen er a t ion wou ld be
gr ea t ly impr oved.

XXVII. WE RECOMMEND that every city and town in, the s tate be
required to provide means f or the period ical vaccination of the inhabitants .
Th e s ma ll-pox is a t er r ific dis ea s e; bu t it is a lmos t en t ir ely s h or n of it s
t er r or s by t h e pr even t ive r emedy of va ccin a t ion . If a per s on is n ot va ccin a t ed,
t h er e is mor e t h a n t wo ch a n ces t o on e, t h a t , if expos ed, h e will t a ke t h e
dis ea s e; bu t , if pr oper ly va ccin a t ed, t h er e is s ca r cely on e ch a n ce in five
h u n der ed. Hen ce t h e impor t a n ce of t h is pr even t ive mea s u r e, a n d t h e gu ilt of
n eglect in g it .
Dr . Wa t er h ou s e, of Ca mbr idge, va ccin a t ed h is s on in J u ly, 1800 ; a n d
t h is wa s t h e fir s t per s on ever va ccin a t ed in : Amer ica . In 1810, a n a ct wa s
pa s s ed in t h is St a t e, pr ovidin g t h a t it s hall be t h e du t y of ever y t own t o
ch oos e per s on s t o s u per in t en d t h e in ocu la t ion of t h e in h a bit a n t s wit h t h e
cow-pox. Th is la w wa s r epea led in 1836 ; a n d t h e Revis ed St a t u t es pr ovides
t h a t ea ch t own may ma ke pr ovis ion for t h e in ocu la t ion of t h e in h a bit a n t s ."
Th is s u bs t it u t ion of t h e wor d ma y for s h a ll left it opt ion a l wit h t own s t o do or
n ot t o do it ; a n d it h a s pr oba bly ca u s ed t h e los s of ma n y lives . Un der t h e
oper a t ion of t h e old la w ma n y t own s wer e a ccu s t omed, on ce in five or mor e
yea r s , t o h a ve a gener a l va ccin a t ion of t h e in h a bit a n t s ; bu t t h is cu s t om, a s
fa r a s ou r kn owledge ext en ds , h a s been gen er a lly dis con t in u ed, a n d t h e
in h a bit a n t s h a ve t h u s been left lia ble t o t h e dis ea s e fr om ever y n ew
expos u r e. Bos t on h a s pr ovided t h a t n o ch ild s h a ll be a dmit t ed in t o t h e
pu blic s ch ool wit h ou t a cer t ifica t e fr om s ome ph ys icia n t h a t it h a s been
va ccin a t ed. It h a s als o pr ovided for t h e gr a t u it ou s va ccin a t ion of t h e poor
wh o ma y ch oos e t o go t o t h e office of t h e cit y ph ys icia n for t h a t pu r pos e.
Th es e excellen t r egu la t ion s s h ou ld be a dopt ed in ever y pla ce. An d loca l
Boa r ds of Hea lt h s h ou ld be r equ ir ed t o pr ovide for a gen er a l va ccin a t ion of
t h e in h a bit a n t a t lea s t a s oft en a s on ce in five yea r s .
Sin ce t h e r epea l, in 1837, of t h e s a lu t a r y la ws of t h e s t a t e r ela t in g t o
s ma ll-pox, n o mor e r es t r a in t h a s been la id u pon per s on s s ick wit h t h is t h a n
wit h a n y ot h er dis ea s e, a n d it h a s con s equ en t ly s eldom been a bs en t fr om
t h e la r ge cit ies . du r in g mor e t h a n 30 yea r s , pr ior t o 1837, t h e dis ea s e ca u s ed
t h e dea t h , in Bos t on , of 37 per s on s on ly; a n d mos t of t h es e wer e a t
Ra in s for d's Is la n d. It s eldom occu r r ed in t h e cit y pr oper . Du r in g t h e 12 yea r s
123
en din g December 31, 1849, s in ce t h e r epea l, it ca u s ed t h e dea t h of 533
per s on s ! a n d in t h e fir s t s ix mon t h s of 1850, one hundred and forty -s ix h a ve
died! Th es e wer e u n n eces s a r y dea t h s ,-t h ey migh t a n d ought to have been
prevented! a n d s o s h ou ld t h e t h ou s a n ds of ca s es of s ickn es s s a me dis ea s e
wh ich did n ot t er min a t e fa t a lly. Th e pla n of h ou s e-t o-h ou s e vis it a t ion ,
des cr ibed in ou r t wen t y-fou r t h r ecommen da t ion , migh t h a ve been a dopt ed.
Th e cit y migh t h a ve been divided in t o s ma ll dis t r ict s , t o ea ch of wh ich a
ph ys icia n migh t be a s s ign ed, wh o s h ou ld h a ve been a s s ign ed, wh o s h ou ld
h a ve been r equ ir ed t o vis it ever y fa mily, wh et h er in vit ed or n ot , a n d t o
va ccin a t e, or t o r eva ccin a t e, ever y per s on , if n eces s a r y or expedien t , By t h is
pla n t h e dis ea s e wou ld s oon h a ve been depr eived s u bject s t o feed u pon , a n d
mu s t h a ve been s t a r ved ou t . It migh t t h u s h a ve been expelled fr om t h e cit y
in les s on e mon t h ; a n d t h e lives of more t h a n on e h u n dr ed per s on s wh ich
n ow h a ve been los t , in les s t h a n s ix mon t h s migh t h a ve been s a ved . Th e
pu blic expen s e, t oo, of s u ch a mea s u r e wou ld h a ve been fa r les s t h a n t h a t of
t h e s ma ll-pox a n d t h e s ma ll-pox or ph a n s wh ich h a ve been t h r own t h e cit y
for s u ppor t , t o s a y n ot h in g of ot h er expen s es a n d t h e va r iou s ot h er ma r ked
effect s a n d ca la mit ies of t h e dis ea s e been a voided.
Un der exis t in g cir cu ms t a n ces , it becomes t h e s pecia l du t y of ever y
per s on t o pr ot ect h ims elf a ga in s t t h is dis ea s e. An y on e wh o per mit s h ims elf
t o be s ick wit h it , is a s ju s t ly ch a r gea ble wit h ign or a n ce, n egligen ce or gu ilt ,
a s h e wh o lea ves h is h ou s e open t o be en t er ed a n d pilla ged by r obber s ,
kn own t o be in n eigh bor h ood . An d u pon t h a t s t a t e, cit y, or t own , wh ich
does n ot in t er pos e it s lega l ext er min a t e t h e dis ea s e, s h ou ld r es t t h e
r es pon s ibilit y, a s mu s t r es t t h e con s equ en ce, of per mit t in g t h e des t r u ct ion of
t h e lives a n d t h e h ea lt h of it s cit izen s .

XXVIII. WE RECOMMEND that the caus es of cons umption, and the
circums tances under which it occurs , be mad e the s ubject of particular
obs ervation and inves tigation.
We h a ve given s ome fa ct s , (pp. 94-99,) t o illu s t r a t e t h e oper a t ion of
con s u mpt ion , a n d s t a t ed t h a t if t h a t dis ea s e is ever t o be er a dica t ed or
a melior a t ed, it ca n on ly be don e by pr even t ive mea n s a n d n ot by cu r e. Dr.
Fis h er , la t e of Bos t on , in t h e cir cu la r t o wh ich we h a ve a llu ded, (pa ge 166,)
s t a t es , t h a t "t h e dis ea s e, wh en on ce excit ed a n d s ea t ed in t h e s ys t em is
n eces s a r ily fa t a l. No r emedia l a gen t h a s ever yet been a n d pr oba bly n ever
will be, dis cover ed, wh ich will cu r e ma la dy wh en on ce developed in t h e
lu n gs . It becomes , t h er efor e, t h e du t y of t h os e wh o a r e a wa re of t h is fa ct a n d
of t h e mor t a lit y wh ich con s u mpt ion occa s ion s , t o a s cer t a in t h e ca u s e of t h e
dis ea s e, a n d t o in for m t h e pu blic h ow t h es e ca u s es ma y be a voided. If t h e
mor t a lit y pr odu ced by t h is dis ea s e t o be les s en ed, it is t o be effect ed by
pr even t ive mea n s .Th es e mea n s , wh en kn own a n d fu lly a ppr ecia t ed by t h e
will be a dopt ed, t o a gr ea t er or les s ext en t , a n d a va s t a mou n t of h u ma n
s u ffer in g. Th is is t h e opin ion of a n emin en t pr ofes s ion a l ma n , ma de t h is
dis ea s e t h e s u bject of pa r t icu la r in ves t iga n t ion , a n d h is views a r e en t it led t o
t h e h igh es t r ega r d.
Th e caus es of this d is eas e, a n d t h e mea n s of r emova l, a r e t h e gr ea t
object s of in ves t iga t ion ; a n d t h ey ca n ; a s cer t a in ed on ly by a n ext en s ive
s er ies of s ys t ema t ic, for m a n d exact obs er va t ion s of t h e ext er n a l
cir cu ms t a n ces , - a t mos ph er ic, loca l a n d per s on a l, -occu r r in g in ea ch ca s e.
124
An d we ca n n ot t oo s t r on gly impr es s u pon loca l Boa r ds of u pon t h e member s
of t h e medica l pr ofes s ion , a n d ot h er s in t er es t ed, t h e impor t a n ce of ma kin g a
en er get ic effor t t o obt a in s u ch obs er va t ion s ca s e wh ich occu r s in ever y pa r t
of t h e 3,000 ca s es , in t h is St a t e, a n n u a lly t er min a t e in dea t h ; t h ey wer e
pr oper ly obs er ved, for a s er ies of five, yea r s , it is impos s ible t o a n t icipa t e t h e
good r es u ]t s migh t follow. Pos s ibly, -a n d even probably , - dis cover ies migh t
be ma de wh ich wou ld r edu ce t h e a n n u a l ca s es , cer t a in ly by h u n dr eds , a n d
per h a ps by s h a ll h er ea ft er s u gges t a for m of a Regis t er of Ca s es t o t h is object
; a n d t h e gr ea t impor t a n ce of t h e t h e con fiden t h ope t h a t s ome dis cover y ca n
be will ma t er ia lly aba t e it s mela n ch oly r a va ges , s h ou ld a rou s e u s a ll t o
a ct ion .

XXIX. WE RECOMMEND that nuis ances end angering human lif e or
health, be prevented, des troy ed, or mitigated.
Nu is a n ces a r e divided, in la w, in t o t wo pr in cipa l cla s s es :-
I. Th os e wh ich a ffect t h e commu n it y, or t h e pu blic, den omin a t ed public
nuis ances ; a n d 2. Th os e wh ich a ffect t h e r igh t s or in ju r e t h e pr oper t y of
in dividu a ls , den omin a t ed private nuis ances . Some n u is a n ces h a ve a
dis a gr eea ble a n d s ome a pecu n ia r y ch a ra ct er on ly. Ot h er s , a vit a l or s a n it a ry
ch a r a ct er . Th e la s t cla s s , on ly, immedia t ely con cer n s t h is r ecommen da t ion .
A s t r eet , h igh wa y, or br idge, is common pr oper t y, a n d a n y obs t r u ct ion ,
pit -h ole, or defect , wh ich en da n ger s t h e lives of t r a veler s , is a n u is a n ce.
Hor s es , ca t t le, s win e, or ot h er a n ima ls goin g a t la r ge in s u ch s t r eet or
h igh wa y, ma y a ls o be a n u is a n ce. Locomot ive s t ea m ca r r ia ges , s t ea mboa t s ,
or ot h er veh icles or s t a t ion a r y s t ea m en gin es , ma y become s o by t h e ma n n er
in wh ich t h ey a r e ma n a ged. Th e ma n u fa ct u r e, s t or a ge, a n d u s e of
gu n powder a n d fir ewor ks ma y be a n u is a n ce, if wit h in t h e n eigh bor h ood of
livin g bein gs , s in ce t h ey en da n ger life. Ga s , ca mph in e, a n d ot h er bu r n in g
flu ids , a r e oft en des t r u ct ive of life. Th es e a n d a ll ot h er n u is a n ces of a
s a n it a r y ch a r a ct er , wh ich oft en occa s ion dir ect a cciden t a l in ju r y or dea t h ,
s h ou ld be s o r egu la t ed a s n ot t o become da n ger ou s t o h ea lt h a n d life. Th os e
wh o ca u s e t h em a re lia ble t o pr os ecu t ion a n d da ma ges .Th er e is a n ot h er
cla s s of n u is a n ces wh ich a r e equ a lly obn oxiou s . Ever y kin d of t r a de or
occu pa t ion ,- a n y filt h or ot h er s u bs t a n ces wh ich cor r u pt s t h e a t mos ph er e,-
ever y kin d of food or dr in k t h a t is u n wh oles ome, t h ou gh it s h ou ld n ot
pr odu ce immedia t e dea t h or dis ea s e, if it en da n ger s t h e h ea lt h or gr a du a lly
in ju r es it , -is a n u is a n ce; a n d ever y ma n wh o ca u s es a n u is a n ce t r a n s cen ds
h is r igh t , a n d r en der s h ims elf lia ble t o pr os ecu t ion . Boa r ds of Hea lt h s h ou ld
ma ke s u ch r egu la t ion t h a t n o per s on s h ou ld pr even t a n y ot h er per s on fr om
en joymen t of life a n d h ea lt h ; a n d n o a r t ificia l obs t r u ct ion s h ou ld be
per mit t ed, t h a t ma y des t r oy or in ju r e eit h er .

XXX. WE RECOMMEND that meas ures be tak en to prevent or mitigate
the s anitary evils aris ing f rom the us e of intoxicating drink s , and from haunts
of dis s ipation.
Th a t in t emper a n ce is a n en or mou s evil is u n iver s a lly a ckn owledged.
Th a t it is t h e ca u s e of a va s t a mou n t of dir ect s a n it a r y s u ffer in g,-of
u n n eces s a r y s ickn es s , a n d of u n n eces s a r y dea t h ,-t o t h os e wh o in du lge in it ;
a n d of a s t ill gr ea t er a mou n t of in dir ect s a n it a r y s u ffer in g a n d dea t h t o t h eir
a s s ocia t es , r ela t ives , a n d depen den t s , is equ a lly t r u e. Th e evil con s equ en ces
125
a r e s o gr ea t , a n d s o widely diffu s ed, t h a t t h ey h a ve lon g s in ce a r r es t ed pu blic
a t t en t ion . Good cit izen s , mor a l r efor mer s , r eligiou s t ea ch er s , a n d ot h er
cla s s es of ph ilia nt h r opis t h a ve deplor ed t h e evil, a n d devis ed va r iou s
mea s u r es of it s r emova l. It s t ill exis t s , h owever , a n d fills t h e cu p of s u ffer in g
a n d pr ovides a pr ema t u r e gr a ve for ma n y a per s on wh o migh t ot h er wis e
h a ve lived t o become a bles s in g in s t ea d of a cu r s e t o h u ma n it y. It is
u n n eces s a r y, h owever , h er e t o dis cu s s t h e s u bject . Th r ou gh t h ou s a n ds of
ch a n n els it is br ou gh t t o pu blic n ot ice. Th es e ch a n n els s h ou ld be widen ed
a n d deepen ed, a n d t h e n u mber s h ou ld be in cr ea s ed, u n t il a ll s h a ll feel t h eir
in flu en ce. Loca l Boar ds of by a ca r efu l obs er va t ion of t h e s a n it a r y evils of ,
in t empa n ce loca l a nd per s on a l cir cu ms t a n ces u n der wh ich t h ey occu r , a n d
by a dopt in g a n d en for cin g s u ch s a lu t a r y r egu la t ion s a s will r emove or
mit iga t e t h em, ma y con fer a n immea s u r a ble ben efit u pon t h e people.

XXXI. WE RECOMMEND that the laws f or tak ing inques ts upon the vie w
of dead bod ies , now impos ed upon corners , be revis ed.
In ou r ju dgmen t , ever y ma t t er r ela t in g t o life, t o h ea lt h , a n d t o dea t h ,
s h ou ld, t o s ome ext en t , come u n der t h e cogn iza n ce of Boa r ds of Hea lt h . Th e
ca u s e of t h e dea t h of ever y per s on wh o dies s h ou ld be fu lly kn own t o t h em;
in t h eir offices r ecor ds of in qu es t s u pon dea d bodies s h ou ld be pr es er ved.
Th es e Boa r ds , a n d es pecia lly t h e medica l h ea lt h officer , a r e pr es u mmed t o
be bet t er in for med t h a n ot h er s in r ela t ion t o qu es t ion s a s pr es en t t h ems elves
in in ves t iga t ion s of h en ce t h ey wou ld be a ble t o a ct mor e in t elligen t ly a nd
cor r ect ly. It s omet imes h a ppen s t h a t in qu es t s a r e h eld wh en t h er e is no
occa s ion for t h em, a n d u n n eces s a r y expen s e in cu r r ed. For t h e la s t n in e
yea r s , t h is St a t e h a s pa id, for cor on er s in qu es t s , $6,968.95; a n d, for t h e la s t
yea r s , t h e a ver a ge a n n u a l pa ymen t s h a ve been $1,030.33. Th is wou ld be
a voided, in pa r t , if Boa r ds of Hea lt h h a d s ome con t r ol over t h e s u bject , s o fa r
a s t o decide wh en in qu es t s a r e n eces s a r y or expedien t . We wou ld s u gges t ,
eit h t h a t s ome member s of t h e loca l Boa r ds of h ea lt h s h ou ld be a u t h or ized
a n d a ppoin t ed t o per for m t h e du t ies n ow impos ed u pon cor on er s , in r ela t ion
t o h oldin g in qu es t s , or t h a t t h e Boa r ds s h ou ld be con s u lt ed on t h e
expedien cy of h oldin g s u ch in qu es t s ; a n d t h a t , in a ll ca s es , a copy of t h e
ver dict of t h e ju r y s h ou ld be r et u r n ed t o t h e Boa r d.

XXXII. WE RECOMMEND that the authority now ves ted in jus tices of the
peace, relating to ins ane and id iotic pers ons , not arres ted or ind icted f or crime,
be trans f erred to the local Boards of Health.
By per s en t la ws of t h e St a t e, n o in s a n e or idiot ic per s on , ot h er t h a n
pa u per s , ca n be commit t ed t o a n y h os pit a l or pla ce of con fin emen t , except
on compla in t , in wr it in g, befor e t wo ju s t ices of t h e pea ce, or s ome police
cou r t . Pa u per s ma y be commit t ed by t h e over s eer s of t h e poor . By t h es e
pr oceedin gs , t h is u n for t u n a t e cla s s of per s on s a ppea r on t h e r ecor ds a s
cr imin a ls , wh ile t h ey a r e gu ilt y of n o cr ime, u n les s t h e pos s es s ion of an
u n s ou n d min d be con s ider ed on e. A s a n it a r y qu es t ion , mer ely is oft en t h e
on ly on e pr es en t ed in s u ch ca s es , a n d it h a s occu r r ed t o u s t h a t t h e loca l
Boa r ds of Hea lt h wou ld be t h e pr oper t r ibu n a ls befor e wh om t h ey s h ou ld be
br ou gh t , a n d by whom t h e s h ou ld be dis pos ed of. It ma y be s u ppos ed t h a t
s u ch Boa r ds will be bet t er a cqu a in t ed, gen er a lly, wit h t h e medica l
126
ju r is pr u den ces of ins a n it y, t h a n t h os e of cr imin a l cou r t s , in a ccor da n ce wit h
t h e s pir it of h u ma n it y wh ich h a s been ext en ded t o t h a t cla s s of per s on s .

XXXIII. WE RECOMMEND that the general management of cemeteries
and other places of burial, and of the interment of the dead, be regulated by
local Boards of Health.
Th e Revis ed St a t t u t es pr ovide t h a t t own s ma y gr a n t mon ey for bu r ia l-
gr ou n ds , a n d t h a t Boa r ds of Hea lt h s h a ll ma ke a ll r egu lat ion s wh ich t h e
ma y ju dge n eces s a r y for t h e in t er men t of t h e dea d, a n d r es pect in g bu r yin g-
gr ou n ds in t h eir t own s . Th is is a ll t h e lega l a u t h or it y t h a t is n eces s a r y for
t h e pu r pos es of t h is r ecommen da t ion . Boa r ds of Hea lt h a n d t h e s elect men of
t own s h a ve ever h a d t h e ma n a gemen t of t h es e ma t t er s in t h is St a t e. Th er e
a r e few if a n y s t a t es or cou n t r ies , wh er e mor e excellen t r egu la t ion s r ela t in g
t o t h e bu r ia l-gr ou n ds a n d t h e in t er men t of t h e dea d exis t , wh er e t h e bu r r ia l
is con du ct ed wit h mor e pr opr iet y, a n d wh er e gr ea t er r es pect is pa id t o t h e
decea s ed. Yet in s ome pa r t icu la r impr ovemen t migh t a n d ou gh t t o be ma de.
Th e h is t or y a n d con dit ion of bu r ia l-gr ou n ds , a n d t h e r egu la t ion s for t h e
dea d, a r e in t ima t ely con n ect ed wit h pu blic h ea lt h , -a n d s h ou ld for m a pa r t
of t h e s a n it a r y r egu la t ion s of ever y cit y a n d t own . We ca n , in t h is
con n ect ion , n ot ice on ly s ome gen er a l ma t t er s ,wh ich t h e s u bject s u gges t s .
Th er e a r e t wo pr in cipa l object s wh ich s h ou ld be kept in view in t h es e
r egu la t ion s ,-l. To pa y pr oper r es pect t o t h e dea d; a n d 2. To pr ot ect t h e
h ea lt h of t h e livin g. To a ccomplis h t h es e object s , t h er e a r e s ever a l ma t t er s
t o be con s ider ed.
1. Pla n s for obt a in in g a place of burial. Sever a l h a ve exis t ed in t h is
St a t e. On e pla n per mit s a fa mily t o s elect a pr iva t e pla ce of bu r ia l on it s own
es t a t e. Th is is a dopt ed in s ome pa r t s of t h is Common wea lt h , es pecia lly in
t h e wes t er n a n d s ou t h er n cou n t ies , bu t we ca n n ot bu t r ega r d it a s h igh ly
object ion a ble. In t h is cou n t r y, es t a t es do n ot gen er a t ion s of t h e s a me fa mily,
a s in Eu r ope. In t h e vicis s it u des a n d r evolu t ion s of Amer ica n life, t h e own er s
of pr oper t y, r ea l a s well a s per s on a l, oft en ch a n ge; a n d t h er e is n o s ecu r it y
t h a t t h e r ema in s of a per s on , if depos t ed on a n es t a t e h e own ed, will r ema in
u n dis t u r bed by ot h er own er s wh o s u cceed h im. Th e occu pa n t h a s n o
gu a r a n t ies fr om a pu blic or r es pon s ible body t h a t it s h a ll be s o. Th is s in gle
con s ider a t ion , in ou r ju dgmen t , s h ou ld in du ce ever yon e t o a n d even t o
r emove t h e r ema in s a lr ea dy s o s ecu r e a n d qu iet r es t in g-pla ce.
An ot h er pla n a llows pr opr iet or s , u n der t h e a ct of in cor por a t ion , t o t o
s ell lot s , or pla ces of bu r ia l, u n der s u ch r egu la t ion s a s t h ey ch oos e t o ma ke.
Th is is of r ecen t da t e, a n d or igin a t ed a t Mou n t Au bu r n . Th is model cemet er y
wa s con s ecr a t ed a s a bu r ia l-pla ce of t h e dea d, Sept . 21, 1831. Cemet er ies
wer e s u bs equ en t ly in cor por a t ed a t New Bedfor d, Apr il 12, 1837; a t
Wor ces t er , Feb 23, 1838; a t Hin gh a m, Feb 28, 1839; a t Br a in t r ee, Feb. 18,
1839; a t Sa lem, Feb. 19, 1839; a t Du dley, Ma r ch 23, 1840; a n d a t Lowell,
J a n . 23, 1841. A gen er a l la w, pa s s ed Ma r ch 17, 1841, a llows t en or mor e
per s on s in a n y t own t o or ga n ize t h ems elves in t o a cor por a t ion for t h es e
pu r pos es ; a n d, s in ce t h a t t ime, n u mer ou s compa n ies a n d cemet er ies h a ve
been es t a blis h ed in differ en t pa r t s of t h e St a t e. Some object t o t h es e
compa n ies , h owever , beca u s e t h ey ma ke t h e bu r ia l of t h e dea d t oo mu ch a
ma t t er of commer cia l s pecu la t ion .
127
An ot h er , a n d t h e mor e gen er a l pla n , ves t s t h e own er s h ip of a ll bu r ia l-
gr ou n ds in t h e t own , wh ich gr a n t s t o fa milies a n d t o in dividu a ls , s omet imes
gr a t u it ou s ly, a n d s omet imes for a con s ider a t ion , r igh t s for fa mily lot s , for
t ombs , a n d for s in glegr a ves . Th is pla n h a s been in exis t en ce fr om t h e fir s t
s et t lemen t of t h e St a t e; a n d we mu ch pr efer it t o t h e ot h er s . Ever y t own
s h ou ld h a ve t h e exclu s ive con t r ol in t h es e ma t t er s , for ma n y r ea s on s , wh ich
it is u n n eces s a r y n ow t o men t ion . Th e cit y of Roxbu r y h a s s et a n oble
exa mple, in t h e es t a blis h men t , in it s cor por a t e ca pa cit y, of t h e bea u t ifu l
For es t Hills Cemet er y.
Th e pla ce of bu r ia l s h ou ld be s elect ed in a s omewh a t s eclu ded, a n d n ot
in t h e mos t con s picu ou s pa r t of t h e t own , a n d s h ou ld be combin ed wit h
s u ch n a t u r a l s cen er y a s will t en d t o in s pir e t h os e feelin gs of s olemn it y a n d
decor u m wh ich pr oper ly belon g t o t h e cit y of t h e dea d. It s h ou ld n ot be
wh er e it wou ld ever be lia ble t o be en cr oa ch ed u pon for bu ildin gs , r oa ds , or
a n y ot h e pu r pos e; bu t wh er e t h e t en a n t s ma y r ema in for ever u n dis t u r bed in
t h eir qu iet r es t in g-pla ce. An d it s h ou ld be la r ge en ou gh t o meet t h e wa n t s of
t h e pr oba ble fu t u r e gr owt h of t h e t own wh ich it is des ign ed t o a ccommoda t e.
Pa r t s of s u ch a cemet er y migh t be a s s ign ed t o a pa r t icu la r r eligiou s
den omin a t ion , a n d, if des ir ed, s pecia lly con s ecr a t ed for it s u s e. It s h ou ld
never be within a populous city or village. Su ch a s it e is n ow gen er a lly
r ega r ded a s da n ger ou s t o t h e h ea lt h of t h e livin g; t h ou gh in t h is St a t e we
h a ve n ot a s yet exper ien ced, t o a ext en t , t h e evils wh ich h a ve exis t ed in
Lon don a n d ot h er cit ies in En gla n d, a s t h e followin g s t a t emen t s will s h ow:
98

Wh en t h e livin g body is expos ed t o pu t r id emin a t ion s in a h igh ly
con cen t r a t ed s t a t e, t h e effect s a r e immedia t e a n d dea dly; wh en mor e dilu t ed
t h ey s t ill t a in t t h e s ys t em, in du cin g a mor bid con dit ion , wh ich r en der s it
mor e pr on e t o dis ea s e in gen er a l, bu t es pecia lly t o a ll t h e for ms of epidemic
dis ea s e, a n d wh ich fu r t h er pr edis pos es it t o pa s s in t o a s t at e n ot a ct u a lly
t h a t of pu t r efa ct ion . Th e mos t r ecen t exa min a t ion of t h e gr a ve-ya r ds of t h e
met r opolis a ppea r s t o u s t o s h ow t h a t t h ey con t a in pu t r efyin g ma t t er en ou gh
t o commu n ica t e pu t r efyin g pr oces s t o t h os e wh o a r e expos ed t o it . It is
s t a t ed by Sir J a mes Ma cgr egor , t h a t on on e occa s ion in Spa in , s oon a ft er
20,000 men h a d been pu t in t o t h e gr ou n d wit h in t h e t wo or t h r ee mon t h s ,
t h e t r oops t h a t r ema in ed expos ed t o t h e ema n a t ion s of t h e s oil, a n d t h a t
dr a n k t h e wa t er fr om t h e wells s u n k in t h e n eigh bor h ood of t h e s pot , wer e
a t t a cked fever s a n d by dys en t er y; a n d t h a t t h e fever s pu t on t h e dys en t er ic
ch a r a ct er . In t h e met r opolis , on s pa ces of gr ou n d n ot exceedin g in a ll 218
a cr es , by t h e a bodes of t h e livin g, cr owded t oget h er in u pwa r ds of 50,000
dea d bodies a r e bu r ied ever y yea r . In Bet h n a l Gr een bu r ia l-gr ou n d a lon e,
con s is t in g of a n t wo a cr es a n d a h a lf, t h er e h a ve been in t er r ed, s in ce it s
open in g in t h e yea r 1746, u pwa r ds of 56,000 dea d bodies . In Bu n h ill Fields
bu r ia l-gr ou n d, Cit y Roa d, con s is t in g of a n a r ea of les s t h a n fou r a cr es , t h ere
h a ve been in t er r ed, fr om Apr il,1713 t o Au gu s t , 1832, a ccor din g t o t h e
r egis t r y , wh ich , h owever , in t h e ea r lier yea r s wa s ver y imper fect ly kept ,
107,416 dea d bodies . Bu t in St . Pa n cr a s ch u r ch -ya r d, on e-h a lf of wh ich h a s
been u s ed a s a bu r ia l-pla ce for a t leas t s ix cen t u r ies , t h er e h a ve been
depos it ed t h e r ema in s of mor e t h a n t wen t y gen er a t ion s ; a n d in t h is s pa ce of

98
Chadwick's Report on Extramural Sepulture, pp. 9, 5, 50 ; - Dr. simons Report, p.24;
Dr. Duncan's Communication in the Official Circular of the General Board of Health, No.
7, pp. 101, 1~, 103.
128
gr ou n d, wh ich does n ot even n ow exceed fou r a cr es , a n d a la r ge por t ion of
wh ich wa s con s ider ed exces s t wen t y yea r s a go, t h er e h a ve been in t er r ed
s in ce t h a t per iod u pwa r ds of 26,000 bodies . Es t ima t in g t h e du r a t ion of a
gen er a t ion a t 30 yea r s , t h er e mu s t h a ve been in t er r ed in t h e s ma ll s pa ce of
218 a cr es , in t h e la s t gen er a t ion , a million a n d a h a lf of dea d bodies ; a n d
wit h in t h e n ext 30 yea r s , mor e t h a n a n ot h er million a n d a h a lf of t h e dea d,-
t h a t is , a la r ge pr opor t ion of t h os e wh o n ow people t h e met ropolis ,-will h a ve
t o be cr owded in t o t h os e s a me ch u r ch -ya r ds , u n les s ot h er a n d bet t er
pr ovis ion for in t er men t be ma de.
Th e pla cin g of t h e dea d body in a gr a ve, a n d cover in g it wit h a few feet
of ea r t h , does n ot pr even t t h e ga s es gen er a t ed by decompos it ion , t oget h er
wit h t h e pu t r es cen t ma t t er s wh ich fr om per mea t in g t h e s u r r ou n din g s oil,
a n d es ca pin g in t o t he a ir a bove a n d t h e wa t er ben ea t h . Un der t h e pr es s u re
of on ly t h r ee-fou r t h s of a n in ch of wa t er , ga s , - common coa l-ga s , in s t a n ce,-
r a pidly ma kes it s wa y t o t h e t h r ou gh a s t r a t u m of s a n d or gr a vel s ever a l feet
in t h e s oil a ppea r in g t o oppos e s ca r cely a n y r es is t a n ce t o it s pa s s a ge. Th e
evolu t ion of t h e ga s es of decompos it ion pla ce wit h s o mu ch for ce, t h a t t h ey
oft en expa n d a n d occa s ion a lly bu r s t t h e lea den coffin in wh ich t h c body is
con fin ed a n d wh en , a s in a common gr a ve, t h ey pa s s gr a du a lly a n d wit h ou t
r es t r a in t in t o t h e s u r r ou n din g ea r t h , t h ey a r e on ly in pa r t abs or bed by t h e
s oil, a n d s ome of t h em a r e s ca r ely a bs or bed a t a ll, bu t a r e diffu s ed in ever y
dir ect ion , t h ou gh it . Su ch , in deed, is t h e t en den cy of t h es e ga s es t o r ea ch
t h e s u r fa ce t h a t it does n ot a ppea r t o be pos s ible t o pr even t t h e occu r a n ce.
If,' s a ys Mr . Leigh , a ch emis t a t Ma n ch es t er wh o a ppea rs t o h a ve pa id
pa r t icu la r a t t en t ion t o t h is s u bject , bodies wer e in t er r ed eigh t or t en feet
deep, in s a n dy or gr a vely s oil, I a m con vin ced lit t le wou ld be ga in ed by it ;
t h e ga s es wou ld fin d a r ea dy exit fr om a lmos t a n y pr a ct ica ble dept h ; wh ile it
is obviou s t h a t t h eir occa s ion a l es ca pe wou ld be s t ill mor e ea s y t h r ou gh t h e
fis s u r es wh ich a r e s o common in cla yey s oils . I h a ve examin ed,' s a ys Dr .
Lyon Pla yfa ir , va riou s bu r ia l-gr ou n ds , for t h e pu r pos e of a s cer t r a in in g
wh et h er t h e la yer of ea r t h a bove t h e bodies in s u fficien t t o a bs or b t h e pu t r id
ga s es evolved. Th e s ligh t es t in s pect ion s h ows t h a t t h ey a r e n ot t h or ou gh ly
a bs or bed by t h e s oil lyin g over t h e bodies . I kn ow s ever a l ch u r ch -ya r ds fr om
mos t foet id s mells ar e evolved ; a n d ga s es wit h s imila r odor a r e emit t ed fr om
t h e s ides of s ewer s pa s s in g in t h e ch u r ch -ya r ds , a lt h ou gh t h ey ma y be mor e
t h a n t h ir t y feet fr om t h em. If t h es e ga s es a r e t h u s evolved la t er a lly, equ a lly
emit t ed in a n u pwa r d dir ect ion .' Some of t h es e ga s es , a s h a s been s t a t ed, a r e
eit h er n ot a bs or bed a t a ll, or s pa r in gly ,-ca r bon ic a cid ga s , for exa mple ; yet
s o a bu n da n t is it s evolu t ion , t h a t , in old ch u r ch -ya r ds or n ea r gr a ve-pit s ,
t h e gr ou n d is a bs olu t ely s a t u r a t ed wit h it , s o t h a t , wh en a deep gr a ve is du g,
s u ch a n a mou n t of it is r a pidly collect ed, wor kmen ca n n ot des cen d wit h ou t
da n ger . Dr . Reid t h e r es u lt of h is own obs er va t ion , t h a t on s in kin g a pit in
t h e ea r t h , n ea r wh ich a n u mber of bodies wer e in t er r ed, t h e pit in a few
h ou r s beca me filled wit h s u ch a n a mou n t of ca r bon ic a cid ga s , a r is in g fr om
t h e decompos it ion of t h e n eigh bor in g bodies , t h a t t h e wor kmen cou ld n ot
r een t er it wit h ou t da n ger ; t h a t lives h ave been los t by t h e in ca u t iou s pit ,
on ly a few h ou r s a ft er it h a s been open ed; t h a t ca r bon ic a cid ga s is t h u s
for med, in t o wh ich a con s t a n t s t r ea m of t h e s a me ga s con t in u es per pet u a lly
t o filt er fr om t h e a dja cen t ea r t h ; a n d t h a t , in fa ct , t h e ea r t h a r ou n d loa ded
wit h ca r bon ic a cid ga s , a s ot h er pla ces a r e wit h wa t er . Dr . Pla yfa ir es t ima t es
129
t h a t t h e a mou n t of t h e ga s es evolved a n n u a lly fr om t h e decompos it ion of
1,117 cor ps es per a cr e, wh ich is ver y fa r s h or t of t h e n u mber a ct u a lly
in t er r ed in t h e met r opolit a n gr a veya r ds , is n ot les s t h a n 55,261 bu t as
52,000 in t er men t s t a ke pla ce a n n u a lly in t h e met r opolis , a ccor din g t o t h is
r a t io t h e a mou n t of ga s es emit t ed 2,572,580 cu bic feet , t h e wh ole of wh ich ,
beyon d wh a t is a bs or bed by t h e s oil, mu s t pa s s in t o t h e wa t er below or t h e
a t mos ph er e a bove."
" Wh a t ever por t ion of t h es e ga s es is n ot ea r t h ,-ea r t h a lr ea dy s u r ch a r ged
wit h t h e a ccu mu la t ion s of cen t u r ies ,-a n d wh a t ever pa r t does n ot mix wit h
a n d con t a min a t e t h e wa t er , mu s t be emit t ed in t o t h e a t mos ph er e, bea r in g
wit h t h em, a s we kn ow, pu t r es cen t ma t t er s per cept ible t o s en s e. Th a t t h es e
ema n a t ion s do a ct in ju r iou s ly on t h e h ea lt h of t h e people r es iden t in t h e
immedia t e n eigh bor h ood of t h e pla ces from wh ich t h ey is s u e, a ppea r s t o u s ,
by t h e eviden ce t h a t h a s been a ddu ced, t o be in du bit a bly es t a blis h ed. Fr om
t h e la w of t h e diffu s ion of ga s es , t h ey mu s t be r a pidly s pr ea d t h r ou gh t h e
wh ole of t h e a t mos ph er e t h a t s u r r ou n ds t h e met r opolis ; a n d t h ou gh t h ey
t h er eby become dilu t ed, a n d a r e t h u s r eu der ed pr opor t ion a lly in n ocu ou s , yet
t h a t t h ey do ma t er ia lly con t r ibu t e t o t h e con t a min a t ion of t h e a ir br ea t h ed
by t wo million s of t h e people, ca n n ot , we t h in k, a dmit of a n y r ea s on a ble
dou bt ."
Dr . Simon s a ys -" Int r a mu r a l bu r ia l is a n evil, n o dou bt , t h a t va r ies in
it s in t en s it y a ccor din g t o t h e n u mber s in t er r ed,- becomin g a ppr ecia ble in it s
effect s on h ea lt h on ly wh en s ever a l in t er men t s occu r a n n u a lly, or wh en
gr ou n d is dis t u r bed wh er ein mu ch a n ima l ma t t er h a d pr eviou s ly been left t o
deca y; bu t be t h e evil la r ge or lit t le in a n y pa r t icu la r ca s e, evil u n dou bt edly it
is in a ll, a n d a n u n mit iga t ed evil. "
Th e a t mos ph er e in wh ich epidemic dis ea s es mos t r ea dily diffu s e t h eir
pois on a n d mu lt iply t h eir vict ims , is on e in wh ich or gan ic ma t t er s a r e
u n der goin g decompos it ion . Wh en ce t h es e ma y be der ived s ign ifies lit t le.
Wh et h er t h e ma t t er pa s s in g in t o deca y be a n a ccu mlu a t ion of s oa kin g s t r a w
a n d ca bba ge lea ves in s ome mis er a ble cella r , or t h e ga r ba ge of a s la u gh t er -
h ou s e, or a n over flowin g ces s -pool, or dea d dogs floa t ed a t h igh ma t t er in t o
t h e mou t h of a s ewer , or s t in kin g fis h , or t h e r emn a n t s of h u ma n cor ps es
u n der goin g t h eir la s t ch emica l ch a n ges ea r t h , t h e pr eviou s h is t or y of t h e
decompos ed ma t er ia l is of n o momen t wh a t ever . Th e pa t h ologis t kn ows n o
differ en ce of oper a t ion bet ween on e deca yin g s u bs t a n ce a n d a n ot h er ; s o
s oon a s h e r ecogn izes or ga n ic ma t t er u n der goin g decompos it ion , s o s oon he
r ecogn izes t h e mos t fer t ile s oil for t h e in cr ea s e of epidemic dis ea s es ; a n d I
ma y s t a t e wit h cer t a in t y, t h a t t h er e a r e ma n y ch u r ch -ya r ds in t h e cit y of
Lon don wh er e ever y s pa de fu ll of s oil t u r n ed u p in bu r ia l s en s ibly a dds t o
t h e a mou n t of a n ima l decompos it ion , wh ich a dva n ces t oo oft en in evit a bly
a r ou n d u s . I h a ve t h er efor e n o h es it a t ion in cou n t in g in t r a mu r a l in t er men t s
a s on e of t h e in flu ences pr eva ilin g a ga in s t h ea lt h , in t h e cit y of Lon don ; a n d
I h a ve n o dou bt t h a t it con t r ibu t es con s ider a bly t o s well ou r lis t of fever a n d
t h e a llied dis or der s ."
Dr . Du n ca n s a ys :- Th er e a r e 39 ; bor ou gh of Liver pool. Th e in t er men t s
t a ke pla ce in gr a ves , va u lt s , or pit s . In 23 bu r ia l-gr ou n ds , gr a ves on ly a re
u s ed; in 7, gr a ves a n d va u lt s on ly; in 4, gr a ves a n d pit s ; gr a ves , va u lt s , a n d
pit s ; a n d in 1, pit s on ly.
130
Th e a ggr ega t e a n n u a l n u mber of in t er men t s wit h in g t h e bor ou gh is , in
or din a r y yea r s , fr om 10,000 t o 11,000. Of t h is n u mber , a s n ea r ly a s ca n be
es t ima t ed, a bou t t wo-t h ir ds t a ke pla ce in pit s , a n d on e-t h ir d in gr a ves ; t h e
in t er men t s in va u lt s pr oba bly n ot exceedin g 20 a n n u a lly.
Th e pit s va r y in dept h fr om 18 t o 30 feet , bein g fr om 7 t o 12 feet lon g,
a n d 3
1/ 2
t o 9 feet wide. Th e n u mber of bodies depos it ed in ea ch pit va r ies
fr om 30 t o 120. In St . J a mes s Cemet er y, a bou t s ix in ch es of ea r t h a re
pla ced a ft er ea ch da y's in t er men t s ; in t h e ot h er s , t h e coffin s a r e cover ed
wit h 2
1/ 2
feet of s oil, wh ich is r emoved pr eviou s t o t h e n ext in t er men t s ; bu t
wit h t h is except ion t h e pit s r ema in open , or on ly cover ed wit h a fr a me-work
of boa r ds , u n t il filled wit h coffin s , -a per iod va r yin g fr om t en da ys in t h e ca s e
of t h e s ma ller , t o t en weeks in t h e ca s e of t h e la r ger pit s . Alt h ou gh t h e evils
con n ect ed wit h t h e pr a ct ice of in t r a mu ra l in t er men t h a ve been les s s ever ely
felt in Liver pool t h a n in t h e met r opolis , wh er e ma n y of t h e gr a ve-ya r ds
s it u a t ed in den s ely peopled n eigh bor h oods h a ve been in u s e for cen t u r ies ,
t h er e ca n be n o dou bt t h a t , u n der an y cir cu ms t a n ces , t h e pr a ct ice of
bu r yin g wit h in t h e pr ecin ct s of t own s , u n les s gu a r ded by t h e s t r ict es t
r egu la t ion s , mu s t be pr odu ct ive of in ju r y t o t h e h ea lt h of t h e in h a bit a n t s .
It h a s been es t ima t ed t h a t a n a cr e of gr ou n d is ca pa ble of a ffor din g
decen t in t er men t t o n ot mor e t h a n 136 bodies yea r ly; bu t in t h e t h ir t y-s even
bu r ia l-gr ou n ds of Liver pool, t a kin g on e wit h a n ot h er , t h e n u mber of bu r ia ls
t o a n a cr e is fu lly dou ble of t h a t ju s t s t a t ed. Wer e t h e ca lcu la t ion con fin ed t o
t h e bu r ia l gr ou n ds in mos t fr equ en t u s e, t h e pr opor t ion wou ld be gr ea t ly
a u gmen t ed.
In s ome of t h es e pla ces it is a lmos t impos s ible t o dig a n ew gr a ve
wit h ou t dis t u r bin g bodies pr eviou s ly bu r ied; a n d in s ome, t h e s oil, wh en
open ed u p it , a ppea r s t o con s is t ch iefly of h u ma n r ema in s in a s t a t e of
decompos it ion . It can n ot be dou bt ed t h at gr a ve-ya r ds t h u s impr egn a t ed wit h
deca yin g a n ima l ma t t er mu s t con t a min a t e t h e a t mos ph er e in s u ch a wa y a s
t o in ju r e t h e h ea lt h , n ot s o mu ch by t h e pr odu ct ion of s u dden wh ich ma y be
dir ect ly t r a ced t o it s ca u s e, a s by a pr oces s of det er ior a t ion , lea din g t o t h e
developmen t of in a mor e s low bu t equ a lly cer t a in ma n n er . It wa s t he
obs er va t ion of t h e in ju r y t o h ea lt h a r is in g fr om t h e pr a ct ice of in t r a mu r a l
in t er men t , wh ich ca u s ed t h e legis la t u r e of Fr a n ce, a s well a s of t h e ot h er
wa r mer con t in en t a l cou n t r ies , u pwa r ds eigh t y yea r s a go, t o decla r e " illega l"
a ll in t er men t s in t own s , a n d s u bs equ en t ly t o depr ive even t h e pr ies t s of t he
pr ivilege wh ich t h ey h a d en joyed of in t er men t wit h in t h eir ch u r ch es .
Bu t t h e grand evil in t h e ca s e of Liver pool, a n d t h a t wh ich ca lls mos t
u r gen t ly for in t er fer en ce, is t h e pr a ct ice of bu r yin g la r ge n u mber s of bodies
in open pit s . It mu s t be u n n eces s a r y t o s a y a n yt h in g a s t o t h e in ju r iou s
n a t u r e of t h is pr a ct ice, if it be con s ider ed t h a t in t h e h ot wea t h er of s u mmer
mor e t h a n bodies a r e collect ed t oget h er in a n open pit , in a ll s t a ges of s ome
of t h em h a vin g la in t h er e for u pwa r ds of t wo mon t h s ! On ly t wo feet of s pa ce
a r e left bet ween t h e pit s , s a t u r a t ed wit h t h e decompos ed ma t t er of a djoin in g
pit , n ot u n fr equ en t ly per cola t es t h r ou gh t h e in t er ven in g r ock or s oil in t o
on e wh ich is n ewly ma de. In n o ca s e does t h e s oil cover in g t h e pit ; wh en
filled, exceed t h e lega l of 2
1/ 2
feet ."
2. Th er e a r e t wo modes of interment pr a ct iced in t h is St a t e ; on e in
gr a ves , a n d t h e ot h er in t ombs . We mu ch pr efer t h e for mer . Da n ger ou s ga s es
oft en es ca pe fr om t ombs , wh en in s ecu r ely clos ed , or wh en oft en open ed for
131
n ew depos it s . Bes ides t h es e evils , t h er e is n o s ecu r it y t h a t depos it s in t ombs
will ever r et u r n t o t h e ea r t h a s t h ey wer e," u n dis t u r bed. Th ey a r e t h er e
expos ed t o r emova l a n d des ecr a t ion , wh ich s omet imes t a ke pla ce. In Mou n t
Au bu r n , ver y pr operly, t ombs a r e n ot n ow a llowed. Gr a ves a lon e a r e u s ed. It
is des ir a ble, t oo, t h a t in n o gr a ve s h ou ld mor e t h a n on e body be pla ced.
Th e followin g s t a t emen t gives t h e bu r ia l a ccommoda t ion s in Bos t on ,
a n d t h e n u mber of in t er men t s in 1849. Depos it s ca n be ma de on ly in t ombs
in t h e cit y pr oper ; gr a ves h a ve n ot been a llowed for ma n y yea r s :-

Pla c e s of In t e r me n t

Tombs In t e me n t in
1 8 4 9
BOSTO
N
PROPE
R

Copp'S Hill a n d Hu ll
St r eet ,
Ch a pel Bu r ia l-Gr ou n d,
Un der Ch a pel Ch u r ch ,
Gr a n a r y Bu r ia l-Gr ou n d,
Un der Pa r k St r eet
Ch u r ch ,
Cen t r a l Bu r ia l- Gr ou n d,
Un der St ,. Pa u l's Ch u r ch ,
Un der Ch r is t Ch u r ch ,
Un der Tr in it y Ch u r ch ,
Sou t h Bu r ia l-Gr ou n d,
Tot a l in Cit y pr oper ,


222

79
21
203
38
149
64
34
55
248
395

62

92
24
160
23
39
21
663
Tot a l in Cit y Pr oper 1113 1479
SOUTH
BOSTO
N
Ha wes Pla ce Bu r yin g-
Gr ou n d,
Un ion Bu r ia l-Pla ce,
Un der s t . Ma t t h ew's
Ch u r ch ,
Roma n Ca t h olic Bu r ia l-
Gr ou n d,
Hou s e of In du s t r y,
Hou s e of Cor r ect ion ,
7

4
60

2

6
3

131

9
66

190

295
20

EAST
BOSTO
N
Ea s t Bos t on Bu r ia l-
Gr ou n d,
jews ' Bu r ia l-Gr ou n d,
Deer Is la n d,
8 324
12
214
Tot a l in t er r ed in t h e Cit y,

1203 2740

Th is in clu des 98 wh o died els ewh er e, a n d wer e br ou gh t in t o t h e cit y for
in t er men t . Th e followin g in t er men t s of per s on s wh o died in t h e cit y t ook
pla ce els ewh er e :-


Roma n Ca t h olic Bu r ia l-Gr ou n d a t 1562
132
Cambr idge
Roma n Ca t h olic Bu r ia l-Gr ou n d a t
Ch a r les t own 305
Roma n Ca t h olic Bu r ia l-Gr ou n d a t
Roxbu r y 80
Mou n t Au bu r n Cemet er y, a t
Cambr idge 212
For es t Hills Cemet er y, a t Roxbu r y 14
Va r iou s ot h er pla ces in Ma s s a ch u s et t s 364
Removed t o ot h er s t a t es 143
Tot a l r emoved fr om t h e cit y 2680
Tot a l in t er men t s in 1849 5420

INTERMENTS IN MASSACHUSETTS

Dea t h s in Bos t on du r in g t h e yea r 5079
St ill-bor n du r in g t h e s a me t ime 250
Br ou gh t in t o t h e cit y for in t er men t 91
5420

Th e cit y poor wer e in t er r ed in t h e t ombs in t h e Sou t h Bu r ia l-Gr ou n d
u n t il Au gu s t 27, 1849 ; s in ce t h en , a t Ea s t Bos t on .
Th e common ch a r ges for a bu r ia l in Bos t on a r e a s follows ,-va r yin g,
h owever , a ccor din g t o t h e a ge a n d ot h er cir cu ms t a n ces in ea ch ca s e :-Righ t s
in a pu blic t omb, $6 00; pin e coffin , $7 00; Cit y Regis t r a r 's a n d t h e
u n der t a ker 's fees , $6 00 ; t ot a l, $19 00. Th is is exclu s ive of ca r r ia ges for
mou r n er s , or a n y ext r a expen s es . Ma n y, of cou r s e, in cu r a mu ch h ea vier
expen dit u r e. A fa mily lot a t Mou n t Au bu r n , of 300 s qu a r e feet , cos t s $100,
bes ides la yin g ou t , gr a din g, a n d or n a men t s ; a n d t h e expen s e of a pr iva t e
bu r ia l t h er e is a bou t $15, bes ides ca r r ia ges . Th e expen s es in ot h er cit ies ,
a n d in cou n t r y t own s , va r y a ccor din g t o loca t ion a n d ot h er cir cu ms t a n ces .
3. Wa kes , wh ich a r e s omet ime's h eld over t h e bodies ' of t h e dea d, by
t h e for eign popu la t ion , s h ou ld be pr oh ibit ed a s impr oper , a n d da n ger ou s t o
t h e pu blic h ea lt h a n d t o good mor a ls . In cit ies a n d popu lou s villa ges , pu blic
r ecept ion -h ou s es s h ou ld be pr ovided, a n d pla ced u n der pr oper r egu la t ion s ,
t o wh ich dea d bodies migh t be r emoved, fr om fa milies livin g in a s in gle r oom,
or fr om a pu blic boa r din g or lodgin g h ou s e, or fr om ot h er pla ces , wh er e it
wou ld be in con ven ien t or da n ger ou s t o t h e pu blic h ea lt h t o per mit t h em t o
r ema in . We ext r a ct fr om Mr . Ch a dwick's r ecen t wor k (p. 102) t h e followin g
pa s s a ge, t o s h ow t h e effect of r et a in in g bodies in s u ch loca lit ies :-
"Of t h e con dit ion in wh ich t h e s u r vivin g member s of a fa mily a r e pla ced,
wh o h a ve on ly on e livin g a n d s leepin g r oom, wh en t h e ca la mit y of dea t h
occu r s , a n d of t he deplor a ble con s equ en ces t h a t oft en en s u e, s ome
con cept ion ma y be for med fr om t h e followin g s t a t emen t s :-
Th er e a r e s ome h ou s es in my dis t r ict ,' s a ys Mr . Leon a r d, t h e medica l
officer of t h e pa r is h of St . Ma r t in 's -in -t h e-fields , t h a t h a ve fr om 45 t o 69
per s on s , of a ll a ges , u n der on e r oof ; a n d in t h e even t of dea t h , t h e body
oft en occu pies t h e on ly bed, t ill t h ey r a is e mon ey t o pa y for a coffin , wh ich is
oft en s ever a l da ys . Th e body is r et a in ed in t h e r oom bes ide t h e livin g, fr om
five t o t welve da ys . In on e in s t a n ce t h e cor ps e been r et a in ed t welve da ys ; I
cou ld n ot r ema in in t h e r oom t wo min u t es , fr om t h e h or r ible s t en ch . Th e
133
coffin s t ood foot of t h e bed, wit h in eigh t in ch es of it ; t h is wa s r oom, n ot
a bove t en feet by t welve feet s qu a r e, a fir e bein g a lwa ys in it ; it wa s , a s in
mos t ca s es of a like kin d, t h e r oom for s leepin g, livin g, a n d cookin g in . In
a n ot h er in s t a n ce, a mot h er a n d h er in fan t wer e br ou gh t ill wit h fever , t o h er
fa t h er 's r oom, wh ich wa s t en feet s qu ar e, wit h a s ma ll of fou r pa n es ; t h e
in fa n t s oon died ; t a ken ill, a n d in a few da ys s h e a ls o died; t h e cor ps e of
gr a n dmot h er la y bes ide h er h u s ba n d in t h e s a me bed; in n ext pla ce t h e
h u s ba n d wa s s eized wit h fever , a t t en ded violen t delir iu m, a n d died ; a n d
s u bs equ en t ly t wo of h is ch ildr en , on e wit h in a week, a n d t h e ot h er wit h in
t en da ys , vict ims t o t h e dis ea s e; in s h or t , five ou t of t h e s ix in ma t es of t h is
r oom died. Fou n d in a n ot h er s imila r r oom a you n g per s on wh o h a d died of
fever ; t h e wer e ju s t t a ken ill of t h e s a me dis ea s e; t h e foot of t h e coffin wa s
wit h in t en in ch es of t h e fa t h er 's h ea d a s h e la y pillow, h ims elf in a fever ; in a
few da ys a n ot h er ch ild s eized wit h t h e s a me dis ea s e. Cit es t h es e ca s es a s
mer ely exa mples of t h e fa t a l con s equ en ces of t h e lon g r et en t ion body in
t h es e s ma ll a n d cr owded r ooms ; t h ey cou ld be mu lt iplied in defin it ely;
believes t h a t t h e r et en t ion of t h e cor ps e in t h e r oom wit h t h e livin g is fr a u gh t
wit h gr ea t er da n ger even t h a t pr odu ced by ema n a t ion s fr om cr owded gr a ve
ya r ds beca u s e wh en a body is r et a in ed in a s ma ll, h ea t ed a n d ill-ven t ila t ed
r oom, decompos it ion pr oceeds r a pidly; t h e n oxiou s ga s es evolved ca n n ot
es ca pe; t h ey a ccu mu la t e, a n d become con cen t r a t ed; a n d t h ey oft en pr ove
r a pidly a n d fa t a l t o t h e livin g in ma t es .
Ot h er wit n es s es s t a t e t h a t t h e dea t h of pa r en t s , lea vin g ch ildr en
or ph a n s a n d des t it u t e, is a fr equ en t occu r r en ce u n der t h os e cir cu ms t a n ces ;
a n d t h a t t h ey h a ve s omet imes s een fa milies s wept a wa y."
4. Loca l Boa r ds of Hea lt h s h ou ld a ppoin t in t elligen t a n d compet en t
h ea lt h officer s , u n der t a ker s , a n d ot h er s , wh o s h ou ld be r equ ir ed t o
a s cer t a in t h e s a n it a r y con dit ion of ever y fa mily in wh ich a dea t h h a s
occu r r ed; t o give advice a n d a s s is t a n ce wit h r efer en ce t o t h e fu n er a l a n d
ot h er ma t t er s , a s occa s ion r equ ir e; t o dir ect a n d s u per in t en d t h e r emova l of
t h e dea d fr om s in gle r ooms , occu pied a s dwellin g a n d a s s leepin g by on e or
mor e fa milies ; t o s ee t h a t t h is r emova l is effect ed in a r es pect fu l ma n n er ,
wit h a ll du e a t t en t ion t o t h e wis h es a n d feelin gs of t h e fr ien ds ; t o give t h e
n eces s a r y in s t r u ct ion s t o t h e s u r vivor s for t h eir own s a fet y; t o obvia t e, a s
ma y be pr a ct ica ble, t h e da n ger t o be a ppr eh en ded fr om pr es en ce of t h e
cor ps e, u n t il it ca n be r emoved ; t o exa min e in t o t h e exis t en ce of a n y loca l
ca u s es ca lcu la t ed t o pr omot e t h e ext en s ion of dis ea s e, mor e es pecia lly if t h e
dea t h h a s been by a n y for m of epidemic, en demic, or con t a giou s dis ea s e,
a n d wit h ou t dela y t o t a ke s u ch mea s u r es a s ma y be n eces s a r y or for t h e
r emova l of t h e evil ; t o ver ify t h e ca u s e a s well a s t h e fa ct of t h e dea t h , wh er e
t h er e h a s been n o medica l a t t en den t ; t o a s cer t a in t h e ca u s e of dea t h fr om
t h e medica l a t t en da n t , wh er e t h er e h a s been on e ; t o gr a n t , wh en r equ ir ed, a
cer t ifica t e of t h e fact of dea t h , wh en ever a ppr eh en s ion is en t er t a in ed of
pr ema t u r e in t er men t ; t o s ee t h a t du e ca r e is t a ken of t h e bodies in t he
h ou s es of r ecept ion ; t o ma ke a r r a n gemen t s wit h t h e fr ien ds of t h e decea s ed,
a n d wit h t h e officer s of t h e cemet er ies , a s t o t h e t ime a n d t h e mode of t h e
r emova l of t h e dea d, for of r egu la r it y, qu iet , a n d or der ; a n d t o s u per in t en d
in t o effect a n y ot h er r egu la t ion s of t h e Boa r d of Hea lt h .
5. Boa r ds of Hea lt h s h ou ld ma ke a n exact s u r vey a n d pla n ea ch bu r ia l-
gr ou n d in t h eir r es pect ive t own s , on wh ich s h ou ld be dr a wn a n d n u mber ed
134
s epa r a t ely, ea ch family or per s on a l lot , ea ch t omb, a n d ea ch gr a ve; a n d
t h es e n u mber s be en t er ed in a r ecor d-book, a n d a ga in s t ea ch t h e n a me of
t h e in dividu a l or in dividu a ls in t er r ed t h er ein . Th es e r ecor d s h ou ld, a s fa r a s
pr a ct ica ble, con t a in t h e n a mes a n d of t h e t en a n t s a lr ea dy t h er e, a s well a s
n ew on es . Un der t a ker s s h ou ld r et u r n t h e n u mber of t h e lot , t omb, or gr a ve,
t o be en t er ed u n der pla ce of in t er men t , in t h e r ecor ds of dea t h s . All t h es e
r ecor ds s h ou ld be ca r efu lly pr es er ved, s o t h a t a n y per s on ma y be a ble t o
iden t ify t h e exa ct s pot wh er e a fr ien d or con n ect ion wa s depos it ed. Th e
pr ecis e qu a n t it y of la n d, in a cr es or pa r t s of a cr es , in ea ch gr ou n d, s h ou ld be
en t er ed on t h e pla n .

XXXIV. WE RECOMMEND that meas ures be tak en to pres erve the lives and
the health of pas s engers at s ea, and of s eamen engaged in the merchant
s ervice.
Ves s els a t s ea a r e t h e floa t in g h a bit a t ion s of livin g bein gs ; a n d in t h es e,
a s in dwellin gs on t h e la n d, t h e a ir ma y be cor r u pt ed by over -cr owdin g, filt h ,
a n d ot h er ca u s es , a n d t h u s become a fr u it fu l s ou r ce of dis ea s e. " Of a ll
kn own pois on s ," s a ys Dr . Combe, " t h a t pr odu ced by t h e con cen t r a t ed
efflu via fr om a cr owd of h u ma n bein gs , con fin ed wit h in a s ma ll s pa ce, a nd
n eglect fu l of clea n lin es s , is on e of t h e wor s t ; a n d in s h ips wh er e ven t ila t ion
is n ot en for ced,--es pecia lly if t h e pa s s en ger s a r e dir t y in t h eir h a bit s , a n d
mu ch kept below by ba d wea t h er , it fr equ en t ly oper a t es wit h a n in t en s it y
wh ich n o con s t it u t ion ca n lon g r es is t ." " Th e occu r r en ce of a s in gle ca s e of
fever on boa r d a mer ch a n t -ves s el, a n d mu ch mor e t h e s pr ea din g of dis ea s e
a mon g a s h ip's cr ew or it s pa s s en ger s , is , prima f acie, eviden ce of n eglect ,-
n eglect of r emova ble ca u s es of dis ea s e ; ca u s es wh ich migh t be cer t a in ly
obvia t ed by s imple a n d in expen s ive mea n s , a n d for t h e pr even t ion of wh ich ,
t h er efor e, t h e well-bein g of la r ge cla s s es r equ ir es t h a t s ecu r it ies s h ou ld be
pr ovided. Th a t s u ch s ecu r it ies s h ou ld be pr ovided for t h e cr ews a n d
pa s s en ger s of s h ips , t h eir pecu lia r s it u a t ion wh en over t a ken by s ickn es s
a ppea r s t o r en der pecu lia r ly n eces s a r y. Th ey a r e r es t r ict ed t o a n a r r ow
s pa ce; t h ey ca n n ot s h ift t h eir loca lit y; t h ey ca n n ot a lt er , in a n y wa y, t h e
s a n it a r y con dit ion of t h e ves s el; a n d t h ey a r e ou t of t h e dir ect r ea ch of civil
a u . t h or it y ,-a ll wh ich pecu lia r it ies s eem t o be s pecia l r eas on s , ca llin g for
gen er a l s a n it a r y r egu la t ion s ."
" A fou l s h ip is n ot on ly a cen t r e of dis ea s e t o t h os e on boa r d, bu t a
s ou r ce of dis ea s e t o h er n eigh bor h ood. Fr om a va r iet y of eviden ce it a ppea r s
in dis pu t a ble t h a t , wh ile t h e fou l s t a t e of a s h ip's h old is t h e fr equ en t ca u s e
of ma lign a n t fever t o h er cr ew, t h e a ir is s u in g fr om s u ch a h old, a n d t h e
ca r go t a ken fr om it , a r e ca pa ble of pr odu cin g dis ea s e in t h e n eigh bor h ood of
t h e wh a r f wh er e t h e u n loa din g t a kes pla ce, a n d of a ffect in g per s on s wh o
come on boa r d fr om t h e s h or e. obs er va t ion s of t h is kin d h a ve led t o t h e
a ppr eh en s ion a n d belief t h a t epidemic dis ea s es ma y be in t r odu ced fr om on e
cou n t r y in t o a n ot h er in t h is ma n n er ; a n d, wer e t h is pos s ible, t h e a ct u a l
con dit ion of s h ips in gen er a l wou ld a ffor d t h e mos t per fect n idu s for t h e
in cu ba t ion a n d developmen t of pes t ilen t ia l vir u s t h a t h u ma n in gen u it y cou ld
devis e. Th a t a fou l s h ip s h ou ld pr odu ce dis ea s e in t h os e wh o go on boa r d of
135
h er , or n ea r h er , is n o mor e s u r pr is in g t h a n t h a t a fou l ch amber s h ou ld do
s o."
99

Wit h ou t a t t empt in g in t h is pla ce t o r ecommen d a s pecific s ys t em of
s a n it a r y r egu la t ion s for s h ips , we u r ge, in gen er a l t er ms , u pon mer ch a n t s ,
s ea -fa r in g men , a n d ot h er s in t er es t ed, t h e gr ea t impor t a n ce of t h e s u bject .
Dr yn es s , ven t ila t ion , a n d clea n lin es s , s h ou ld be en for ced in every
depa r t men t of t h e s h ip; fou l a n d pu t r id ca r goes s h ou ld be avoided; a n d ever y
mea n s u s ed, by pr oper diet a n d r egimen , t o pr es er ve t h e h ea lt h of t h e
s ea men a n d pa s s en ger s . Sa n it a r y impr ovemen t wa s ea r ly in t r odu ced on
boa r d s h ips , a s we s h a ll pr es en t ly s h ow; a n d a gr ea t n u mber of h u ma n lives
h a ve con s equ en t ly been s a ved. In n o depa r t men t of s ocia l econ omy ca n
pr even t ive mea s u r es h a ve a gr ea t er in flu en ce. Boa r ds of Hea lt h migh t do a
good s er vice t o h u ma n it y, by is s u in g a s imple a n d ju diciou s code of s a n it a r y
r egu la t ion s for s h ips .
100


XXXV. WE RECOMMEND that the authority to mak e regulations f or the
quarantine of ves s els be intrus ted to the local Boards of Health.
Th e s even t een t h s ect ion of t h e pr opos ed a ct con t a in s a ll n eces s a r y
a u t h or it y for ma kin g qu a r a n t in e r egu la t ion s . Boa r ds of Hea lt h in s ea -por t
t own s will be a ble t o obt a in a ll in for ma t ion r ega r din g t h eir du t ies , by
colls u lt in g t h e pr eferr ed t o in t h e a ppen dix, a n d ma kin g s u ch r egu la t ion s a s
a r e a da pt ed t o t h eir own pecu lia r cir cu ms t a n ces . Th e ext r emely va lu a ble
Repor t of t h e Gen er a l Boa r d of Hea lt h of En gla n d on Qu a r a n t in e, pu blis h ed

99
Report of the General Board of Health on Quartine, p. 108, 110.
100
The Introduction to the Statistical Reports on the Health of the Navy, already referred to, (p.37,) and the Reports to the General Board of
Health of England on Quarantine, contain many very valuable suggestions on this subject, to which we refer those interested. We extract
from the latter work (pp. 115-118) an account of one regulation, which has had great influence:- It is stated that when the system of
transporation was first adopted, in some of the earlier voyages full one-half of those who embarked, later, on the passage to New South
Wales, as in the Hillsborough, out of 306 who embarked, 100 were lost and in another ship, the Atlas, out of 175 embarked , 61 were lost.
Yet there were no omissions palpable to common observation, or which could be distinctly proved as matter of crimination, to which
responsibility might be attached. The shippers were no doubt honorable men, chargeable with no conscious designs against the lives of the
human beings committed to their care, and with no unusual omissions; but their thoughts were directed by their interests exclusively to
profits: they got as much freight as they could, and they saw no reason why convicts or emigrants should not put up with temporary
inconveniences to make room for cargo. By a simple change, (based on the principle of self interest, the most uniform, general, and, when
properly directed, really beneficent of all priniciples of action ,) by the short alteration of the terms of the contract, so as to apply the motive
where alone there was the effectual means of prevention, by engaging to pay only for those landed alive, instead of paying for all those
embarked,-these extreme horrors were arrested, the generation of extensively mortal epidemics was in a short time prevented, and clean bills
of health might have been given to all th eships which before would have been entitled to none. From the Report of the Select Committee on
Transportation, in the year 1812, it appears that in one subsequent period,-namely, from 1795 to 1801 , - out of 3,833 convicts embarked,
385 died, being nearly one in ten. But since 1801, after the principle of responsibility began to be applied , out of 2398 embarked, only to
one and a half percent ., or even lower than the average mortality of such a class living shore. The shippers themselves, without any
legislative provisions s, or any official supervision or regulations thereto, appointed medical off icers , or s urgeons , and put the whole
of the convicts under their charge; the s hippers attes ted their own s ens e of the propriety , s ound policy , and eff iciency
of the principle, by voluntarily adopting it, and apply ing it to each s hip-s urgeon in charge, whos e remuneration was
made dependent on the number of pas s engers landed alive. The alteration, s timulated by the s elf -interes t of the
s hip-s urgeons or off icers engaged in that s ervice, led to highly important practical res ults as to the means of s ecuring
health and preventing d is eas e. In the cours e of the s anitary inquiries which have s erved as the bas is of legis lation, a
s urgeon who had the charge of trans port s hips des cribed the toils of his s ervice during long voy ages , his
s leeples s nes s on s tormy nights , his getting out of his hammock to s ee that the wearied s ailors , whom he would not
trus t to thems elves , took off their wet clothes and put on a proper change before they turned in; and he narrates how
he was complimented on his s entiments of active benevolence, when he frank ly owned that he was really only
entiltled to prais e f or vigilance to his own interes ts . Some benevolent and intelligent s hip-owner had tak en care that
the s ailors as well as the pas s engers s hould be included in his contract f or remuneration. He ack nowleged it was
that which k ept his thoughts intent on the means of pres erving their health, as well as s aving his own trouble in
merely treating illnes s when it occurred, which alone, in cons equence of a vicious s hort-s ighted nes s , is ord inarily
cons idered the s urgeons s ole duty , and not that of a giving general advice or d irections f or the pres ervation of health.
In cas es of contracts on thes e terms for the trans port of where the off icers in command had f orgotten to provide
s urgeons for their care, the pecuniarily res pons ible s hippers had not f ailed to provide them. There is s trong reas on
to believe, from recent experience, that the general adoption of this principle in its full extent would do more to meet
the f ormid able d iff iculties of thes e emigration s hips , than the bes t devis ed s y s tem of ins pection in the abs ence of this
priniciple.

136
la s t yea r , is pa r t icu la r ly commen ded. Pu blic opin ion on t h is s u bject s eems t o
h a ve u n der gon e a ch a n ge wit h in a few yea r s pa s t .

XXXVI. WE RECOMMEND that meas ures be adopted venting or
mitigating the s anitary evils aris ing emigration.
Th is r ecommen da t ion in volves on e of t h e mos t momen t ou s , pr ofou n d,
a n d difficu lt s ocia l pr oblems ever pres en t ed t o u s for s olu t ion . Wh en
ca r efu lly exa min ed wit h it s a t t en da n t cir cu ms t a n ce t h e view pr es en t ed is
s t a r t lin g a n d s icken in g. Ever y ma n in wh os e vein s cou r s es a n y pu r it a n
blood, a s h e looks t h e even t s of t h e pa s t , or for wa r d t o t h e h opes of fu t u r e, is
a ppa lled a n d a s t ou n ded. Pu blic a t t en t ion h a s been fr equ en t ly ca lled t o t h is
mos t impor t a n t ma t t er . We des ir e a ga in t o pr es en t t h e s u bject , wit h a s pecia l
view t o it s s a n it a r y r ela t ion s . An d we ea r n es t ly h ope t h at t h e few fa ct s
wh ich we s h a ll n ow give, even if t h ey come in t h e s h a pe of figu r es a n d
s t a t is t ics , will a r r es t n ot ice a n d ca refu l con s ider a t ion . In ma kin g a n
a pplica t ion of t h es e fa ct s a n d s t a t emen t s , it s h ou ld be be r ecollect ed t h a t
t h ey a r e ma de con cer n in g cla s s es . Th er e a r e in dividu a ls wh o a r e h igh ly
wor t h y, a n d a r e n ot obn oxiou s t o t h e gen er a l ch a r a ct er of t h e wh ole cla s s .
Th e Repor t on t h e Cen s u s a n d St a t is t ics of Bos t on , for 1845, fir s t ga ve
t h e bir t h -pla ce of t h e in h a bit a n t s , a n d s t a t ed t h a t t h e for eign er s a n d t h eir
ch ildr en wer e t h en 37,289, or 32.61 per cen t . of t h e wh ole popu la t ion ; a n d
t h a t t h er e a r r ived in Bos t on , du r in g t h e n in e yea r s pr eviou s , 50,000 a lien
pa s s en ger s ,- 33,436 by wa t er , a n d t h e r ema in der by la n d, in cr ea s in g
a n n u a lly fr om 1,262, in 1838, t o 8,550, in 1845.
Fr om t h e fa ct s we h a ve s in ce collect ed, it a ppea r s t h a t 15,504 a r r ived
by wa t er , in 1846; 24,245, in 1847 ; 25,042, in 1848 ; a n d 34,873, in 1849,
ma kin g 99,658 ; a n d t h a t ot h er s a r r ived by la n d s u fficien t t o ma ke t h e wh ole
n u mber equ a l t o 125,000 wit h in t h e la s t fou r yea r s .
101


We es t ima t e t h e in cr ea s e of t h e popu la t ion of Bos t on , t h is per iod, a t
a bou t 23,000 ; a n d t h a t t h e wh ole of cr ea s e wa s of for eign er s . Th e Amer ica n
r es iden t s a r e t o be n o mor e n u mer ou s n ow t h a n in 1845.
102

101
I h a ve boa rded," in 1849, s a ys Mr. Mon r oe, Su per in tenden t of Alien Pa s s en ger s , " t en h u ndr ed a n d s even teen
ves s els , in wh ich were brou gh t t h e followin g nu mbers :
Nu mber of t h os e who h ad been in t h e St a t e before - 3,912
Number for which bonds have been tak en, -2,598
Number for which head money has been received, ---11,548
Number for which no s ecurity or tax has been received, as per d ecis ion of Supreme Court - 16,815
Total ---34 873
" Th e for egoin g pa s s en ger s were fr om t he followin g por t s , in s u ch ves s els a s is here u n to a nn exed, viz. :
In 32 Englis h ves s els f rom Livepool, 4,007
In 41 Englis h ves s els f rom Ireland, -4,341
In 665 Englis h ves s els from the Provinces - 5,191
_______________________13,569
In 68 American ves s els f rom Liverpool, -13,350
In 9 American ves s els from Ireland, -1,510
In 69 American ves s els f rom the Provinces , 4,662
In 133 American ves s els f rom all other ports , 1,782

The principle part of thos e arrived are Iris h laborers , s ay three fourths , and the balance f rom all nations , of all
profes s ions and occupations . The condition of the pas s engers , s o f ar as relates to their health, (notwiths tand ing the
cholera has been among them to s ome extent,) has been better than the the two preced ing, y ears , but their poverty is full
up to the us ual s tand ard. Not only have large f amilies of children been s ent f or by their parents , who have managed to
get money s uff icient to pay their pas s age to this country , but many orphan children and paupers , of the mos t unfortunate
k ind, as s is ted (by their landlord) to this country , and will very s oon become inmates of our public ins titutions ,-in f act,
many are alread y there.
102
While this s heet is pas s ing through the pres s , the S tate cens us of the City has been publis hed; and it appears that the
population is now 138,788,-of whom 63,320, or 45.62 percent., are f oreigners . This proves the correctnes s of the above
es timate, and s hows a decreas e of 1,879 Americans , and an all increas e of 26,031, or 13 percent., of foreigners .
137
Of 1,133 in t en t ion s of ma r r ia ge en t er ed by t h e Cit y Regis t r a r , in Bos t on ,
fr om J u ly 12t h , when t h e r ecor d commen ced t o December 31, 1849, t he
for eign er s wer e 621, or 55 per cen t .; a n d t h e Amer ica n s on ly 45 per cen t . !
Th e a ct u a l ma r r ia ges s h ow a s t ill gr ea t er pr opor t ion of for eign er s .
Of 5,031 ch ildr en bor n in Bos t on , in 1849, a n d wer e r et u r n ed t o t h e
Regis t r a r 's office, 3,149, or 62 per cen t ., wer e t h e of for eign er s , a n d 38 per
cen t . on ly, of Amer ica n s .
Bos t on h a s pa id on t h e a ver a ge, for t h e la s t fou r yea r s , a bou t
$1,100,000 t a xes ; of t h is s u m, $350,000 per a n n u m is for t h e ben efit of t h e
pu blic s ch ools ; a n d half of that s um, or $175,000, for t h e edu ca t ion of
ch ildr en of for eign pa r en t s , mos t of wh om con t r ibu t e lit t le or n ot h in g t o t h e
pu blic expen s es , in t a xa t ion or ot h er wis e. An d in ma n y ca s es t h e a dmis s ion
of gr ea t n u mber s of t h es e ch ildr en exclu des ch ildr en of Amer ica n pa r en t s .
Th e Cit y Ma r s h a l of Bos t on es t ima t ed, in J a n u a r y 1849, t h a t t h er e wer e
1,500 t r u a n t a n d vaga bon d ch ildr en in t h e cit y, bet ween t h e a ges of 6 a nd
16 yea r s , wh o, fr om n eglect a n d ba d h a bit s , wer e u n fit t o en t er t h e pu blic
s ch ools ; a n d of 1,066 wh om h e a ct u a lly en u mer a t ed, 963, or 90.3 per cen t
per cen t wer e for eign er s , a n d 103, or 9.7 per cen t ., on ly, wer e Amer ica n s !
Th e Bos t on Societ y for t h e Pr even t ion of Pa u per is m, in t h eir office for
pr ovidin g employmen t for fema les , h a ve r eceived, du r in g t h e la s t five. yea r s ,
a pplica t ion s for 15, 697 fema les , of wh om 14,044, or 90 per cen t ., wer e
for eign er s a n d 10 per cen t . on ly wer e Amer ica n s . An d a t t h e ma le
employmen t office, of 8,602 a pplican t s , 5,034, or 58 per cen t ., were
for eign er s .
Th e wh ole n u mber of per s on s r elieved a s pa u per s in t h e cou n t y of
Su ffolk, for t h e yea r 1849, wa s 7, 728,-of wh om , 4,549 or 58 per cen t wer e
for eign er s ; a n d t h eir pr opor t ion of wh ole expen s e of $103,716, wa s over
$60,000. Th e n u mbe of pa u per s in t h e wh ole St a t e wa s 24,892,-of wh om
10,253, or 41 per cen t ., wer e for eign er s , a n d t h eir pr opor t ion of wh ole
expen s e of $441,675, wa s $182,311.
Th e n u mber of for eign pa u per s wa s 7,413, in 1848, a n d on ly 2,765 in
1838 ; s h owin g a n in cr ea s e in 10 yea r s of 268 per cen t . In t h e la s t 11 yea r s ,
42,928 for eign er s h a ve been a s s is t ed, a t a n expen s e, bes ide all mon ey wh ich
h a s been r eceive t h em, of $737,564.
Th e cit y of Bos t on is t h is yea r bu ildin g a la r ge h ou s e a t Deer Is la n d, for
pa u per s , a t a n expen s e of $150,000; a n d a n ext en s ive ja il, a t a n expen s e of 5
or $600,000 ; bot h of wh ich t h e n a t ive popu la t ion ! Th e exis t in g pu blic wou ld
h a ve been s u fficient bu t for t h e gr ea t in cr ea s e of for eign er s . Of 1,170
dr a ms h ops in Bos t on , in J u n e, 1849, over 800, or 70 per cen t . wer e kept by
for eign er s .
Mor e t h a n three f ourths of a ll t h e a r r es t s by t h e n igh t wa t ch a n d police
in Bos t on , a n d n ea r ly t h r ee fou r t h s of a ll t h e commit men t s t o t h e cou n t y
ja il, a n d of t h e ca s es befor e t h e police a n d mu n icipa l cou r t s , wer e t h os e of
for eign er s .
Th er e h a ve been commit t ed t o t h e h ou s e of cor r ect ion in Bos t on , du r in g
t h e la s t five yea r s , 3,737 per s on s , -of wh om or 63 per cen t ., wer e for eign er s ,
a n d 37 per cen t . Amer ica n s ; a n d, in t h e la s t yea r , t h e pr opor t ion of
for eign er s wa s ver y mu ch la r ger . An d in t h e wh ole St a t e, du r in g la s t yea r ,
3,035,-of wh ich 1, 770, or 58 per cen t ., wer e of for eign er s . Th e in cr ea s e of
cr ime h a s been ver y gr ea t du r in g t h e la s t eigh t yea r s , bu t it h a s been a lmos t
138
en t ir ely t h e for eign popu la t ion . Not wit h s t a n din g t h e in cr ea s e of t h e n a t ive
in h a bit a n t s , t h e n u mber of commit men t s a mon g them h a s n ot in cr ea s ed.
Abou t on e t h ir d of a ll t h e in ma t es of t h e St a t e pr is on , for t h e la s t t wen t y
yea r s , h a ve been for eign er s . An d t h e St a t e h a s a ppr opr ia t ed $100,000, t h is
yea r , for t h e er ect ion of a n a ddit ion a l bu ildin g for t h e r ecept ion of pr is on er s ,
wh ich wou ld h a ve been u n n eces s a r y wer e it n ot for t h e gr ea t in cr ea s e of
for eign cr imin a ls .
In t h e Bos t on Lu na t ic Hos pit a l, 327 in ma t es fr om t h e t ime it wa s
open ed, in 1839, t o 1845, of wh om 160, or 48.93 per cen t ., wer e for eign er s .
For t h e n in e yea r s , 1837-1845, in clu s ive, t h e Bos t on Dis pen s a r y h a d u n der
it s ca r e 21,908 ca s es ; of t h es e, 15,522, 70.56 per cen t ., wer e t h os e of
for eign er s a n d ch ildr en of 1,876 on ly of Bos t on ia n s . An d du r in g t h e year
Sept ember 30, 1849, it h a d 3,950 ca s es ,-of wh ich 3,487, or 88 per cen t ., were
t h os e of for eign er s , a n d 463, or 12 per cen t ., on ly wer e t h os e of Amer ica n s .
At t h e Bos t on a lms hou s e es t a blis h men t , on Deer Is la n d, 4,816 per s on s
wer e a dmit t ed, fr om t h e t ime it wa s open ed, in 1847, t o J a n u a r y 1, 1850, of
wh om 4,661, or 97 per cen t ., wer e for eign er s ; a n d 155, or 3 per cen t . on ly,
wer e Amer ica n s . Th e n u mber wh o wer e s ick wh en a dmit t ed wer e 4,069,
wh om 759 h a ve died; 402 r ema in ed J a n u a r y 1, 1850, of wh om 369 wer e
for eign er s , a n d 33 Amer ica n s .
In 1849 t h er e died of ch oler a , in Bos t on , 707 wh om 572, or 81 per
cen t ., wer e for eign er s ; a n d 135, or 19 per cen t . wer e Amer ica n s ; 42 on ly
wer e Bos t on ia n s .
5,079 per s on s died in Bos t on in 1849, of wh om 2,982, or 59 per cen t .,
wer e for eign er s .
Simila r fa ct s migh t be mu lt iplied; bu t if t h es e comma n d a t t en t ion , it
wou ld be a wor k of s u per er oga t ion t o go fa r t h er .
As lon g a go a s 1834, t h e commis s ion er s for r evis in g t h e poor la ws of
En gla n d, a mon g ot h er mea s u r es , r ecommen d t h a t t h e ves t r ies of ea ch
pa r is h be empower ed t o or der ou t t h e pa ymen t , ou t of t h e r a t es r a is ed for
t h e r elief of t h e poor , of t h e expen s es of t h e emigr a t ion of a n y per s on s h a vin g
wit h in t h eir pa r is h ."
103
Th is r ecommen da t ion wa s embodied in t h e 62d
s ect ion of t h e Poor La w a men dmen t a ct ,
104

a n d t h er e is n o dou bt , t h a t , in
ver y ma n y in s t a n ces , it h a s been ca r r ied in t o pr a ct ica l oper a t ion . Some poor -
h ou s es h a ve been empt ied, a n d t h eir in ma t es h a ve been t r a n s por t ed t o
Amer ica , -t o Ma s s a ch u s et t s ! Th e s t r ea m of emigr a t ion h a s con t in u ed t o a n d
s eems t o ga in a n ew a cces s ion of s t r en gt h in pa s s in g year . Ma s s a ch u s et t s
s eems t o h a ve r es olved it s elf in t o a va s t ch a r it a ble a s s ocia t ion . In t o h er
in s t it u t ion s a r e a dmit t ed t h e emigr a n t pr egn a n t woma n a t h er lyin g-in ; t h e
ch ild t o be n u r s ed an d edu ca t ed ; t h e pa u per t o be s u ppor t ed; t h e cr imin al
t o be pu n is h ed a n d r efor med; t h e in s a n e t o be r es t r a in ed a n d ca r ed for ; t h e
s ick t o be n u r s ed a n d cu r ed; t h e dead t o be bu r ied; t h e widow t o be
comfor t ed ; t h e or ph a n t o be pr ovided wit h a s u bs t it u t e for pa r en t a l ca r e;
a n d h er e t en t h ou s a n d offices of s ocia l a n d per s on a l kin dn es s r ecogn ized by
t h e pu blic la ws of t h e St a t e, t h ou s a n ds u pon t h ou s a n ds of dolla r s , a r e
bes t owed. Th e door s of t h es e gr ea t in s t it u t ion s h a ve been t h r own wide ; t h e
ma n a ger s of t h e pa u per -h ou s es of t h e old wor ld, a n d mer cen a r y s h ip-own er s

103
Report of Commis s ioners on Poor Laws , 1834, p. 357.
104
Firs t Report of Poor Law Commis s ioners , p. 90.
139
wh o ply t h eir cr a ft a cr os s t h e a n d pou r t h eir fr eigh t fr eely in , ea ch s mile a t
t h e bu t la x s ys t em of gen er os it y wh ich gover n s u s , a n d r ejoice a t a n
oppor t u n it y t o get r id of a bu r den , or a n d a yet gr ea t er ca la mit y a t t en ds t h is
Ou r own n a t ive in h a bit a n t s , wh o min gle bou n t y, oft en become t h ems elves
wit h dis ea s es , a n d s icken a n d die; a n d t h e t h e livin g is depr ecia t ed: a n d t h e
s ocia l a n d mor a l ch a r a ct er we on ce en joyed is lia ble be for ever los t .
Pa u per is m, cr ime, dis ea s e a n d dea t h , s t a r e u s in t h e fa ce.
We will n ot a t t empt t o s u gges t a r emedy for t h is mos t r egn a n t a n oma ly.
It r equ ir es t o be mor e ca r efu lly s t u died, a n d t h or ou gh ly s u r veyed t h a n t h e
pr es en t occa s ion a llows . Th a t St a t e s h ou ld pa s s s u it a ble la ws on t h e
s u b;ect , a n d t h e a n d loca l Boa r ds of Hea lt h s h ou ld ca r efu lly obs er ve evils in
a ll t h eir s a n it a r y bea r in gs a n d r ela t ion s . We h owever , s u gges t ,-
1. Th a t emigr a t ion , es pecia lly of pa u per s , in va lids , a n d cr imin a ls , s h ou ld, by
a ll pr oper mea n s , be dis cou r a ged ; t h a t mis r epr es en t a t ion a n d fa ls eh ood, t o
in du ce emba r k in pa s s en ger -s h ips , s h ou ld be dis cou n t en a n ced a n d
cou n t er a ct ed.
2. Th a t s h ip-own er s a n d ot h er s s h ou ld be h eld t o s t r ict a ccou n t a bilit y for a ll
expen s es of pa u per emigr a n t s : exis t in g bon ds for t h eir s u ppor t s h ou ld be
s t r ict ly en for ced.
3. Th a t a s ys t em be devis ed by wh ich a ll t h os e wh o in t r odu ce t h em, by wa t er
or by la n d, s h ou ld r equ ir ed t o pa y a s u fficien t s u m t o cr ea t e a gen er a l
s in kin g fu n d for t h e s u ppor t of a ll wh o ma y r equ ir e a id in t h e St a t e, a t
wit h in five yea r s a ft er t h eir a r r iva l.
4. Th a t s u ch a des cr ipt ion of ea ch emigr a n t be r egis t r a t ed a s will a ffor d t h e
mea n s of iden t ifica t ion of a n yon e, a t a n d in a n y pla ce, wit h in five or mor e
yea r s a ft er a r r iva l.
5. Th a t en cou r a gemen t be given t o emigr a t e fr om t h is St a t e, wh er e t h er e is
lit t le dema n d for la bor , t o pla ces ; a n d t h a t a s s ocia t ion s be for med a mon g for
s et t lin g on t h e pu blic la n ds of t h e Un it ed St a t es .
6. Th a t effor t s be ma de, by a ll pr oper mea n s , s a n it a r y a n d s ocia l con dit ion of
for eign er s , a n d t o a mon g t h em h a bit s of clea n lin es s a n d bet t er modes of
livin g.
7. Th a t ou r s ys t em of s ocia l a n d per s on a l s h ou ld be r evis ed a n d r emodeled,
a n d t h a t a gen er a l devis ed wh ich s h a ll br in g a ll t h e ch a r it ies of t h e a n d
s t a t e, u n der on e con t r ol, a n d t h u s pr even t givin g a n d impos it ion .
8. Th a t a n es t a blis h men t for pa u per s , in clu din g a wor ks h ops , be for med in
ea ch cou n t y in t h e St a t e pa u per s migh t be s en t , a n d wh er e t h ey qu ir ed t o
la bor , a s fa r a s pr a ct ica ble, for t h eir s u ppor t .

II. SOCIAL AND PERSONAL MEASURES RECOMMENDED

Mos t of t h es e r ecommen da t ion s ma y be ca r r ied in t o effect wit h ou t a n y
s pecia l legis la t ive a u t h or it y, St a t e or mu n icipa l.

XXXVII. WE RECOMMEND that a s anitary as s ociation be formed in every
city and town in the S tate, f or the purpos e of collecting and d iffus ing
inf ormation relating to public and health.
Th e s u bject of s a n it a r y impr ovemen t is compa r a t ively n ew. Few min ds ,
in t h is cou n t r y a t lea s t , h a ve a s yet been led t o exa min e it , t o s ee it s bea r in g
u pon t h e welfa r e a n d pr ogr es s of h u ma n it y. Th os e, h owever , wh o h a ve
140
looked a t it wit h a n y con s ider a ble degr ee of ca r e, h a ve been con vin ced of it s
impor t a n ce; a n d it on ly r equ ir es t o be gen er a lly u n der s t ood t o be u n iver s a lly
r ega r ded a s the gr ea t s u bject of t h e a ge. Pu blic opin ion n eeds t o be
edu ca t ed, a n d in n o wa y ca n it be mor e effect u a lly don e t h a n by a s s ocia t ed
effor t . If a Met r opolit a n Sa n it a r y As s ocia t ion exis t ed in Bos t on , a s a cen t r a l
a gen cy, a n d a Br a n ch Sa n it a r y As s ocia t ion in ever y cit y a n d t own in t h e
St a t e, t h ey migh t do mu ch t o effect t h is object , by collect in g a n d diffu s ing
u s efu l in for ma t ion ; a n d, by t h eir cooper a t ion wit h t h e pu blic a u t h or it ies ,
r en der t h e dis ch a r ge of t h eir du t ies compa r a t ively mor e ea s y. In es t ima ble
ben efit s migh t t h u s be s ecu r ed t o t h e ca u s e a n d t o t h e people. To a id t h os e
wh o ma y wis h t o for m s u ch a s s ocia t ion s , we s u gges t t h e s u bjoin ed for m of a
con s t it u t ion :
105


XXXVIII. WE RECOMMEND that tenements f or the better accommod ation of
the poor, be erected in cities and villages .
Th e con dit ion of dwellin g-h ou s es h a s a mos t impor t a n t r ela t ion t o t h e
h ea lt h of t h e in ma t es ; a n d n o dou bt t h a t t h e dis ea s es of t h e la bor in g cla s s e,
poor , a r e oft en pr odu ced a n d a cceler a t ed t o fa t a l defect s in t h es e r es pect s ,
wh ich a r e r emova ble.
In 1846, a meet in g of t h e cit izen s of Bos t on wa s a va lu a ble Repor t of
t h e commit t ee on t h e pr ovidin g Bet t er Ten emen t s for t h e Poor ; wa s a dopt ed
a n d pu blis h ed. Aft er s t a t in g ma n y in t er es t in g pa r t icu la r s r ela t in g t o t h e
s u bject , t h e commit t ee ca me t o t h e con clu s ion :
1s t . Th a t pr oper t y in ves t ed in well-con s t r u ct ed a n d well-s it u a t ed h ou s es , t o
be lea s ed t o t h e poor er cla s s es of by a pa r t men t s a n d by t h e week, is a s s a fe
a s es t a t e except in g t h e bes t , a n d fa r mor e s o t h a n t h e a ver a ge.
"2d. Th a t it yields a s mu ch a s a s a n y r ea l es t a t e wh ich equ a lly is s a fe.
3d. Th a t , by pu t t in g a por t ion of h is fu n ds in t o s u ch bu ildin gs , t h e
ca pit a lis t ma y con fer a n immen s e ben efit s on h is fellow-cit izen s , wh ich mu s t
s oon r ea ct u pon ch ildr en .
4t h . Th a t h e wou ld t h er eby in cu r n o r is k of colla t er a l in ju r y, s u ch a s , in
ma n y for ms of ch a r it y, goes s o fa r t o offs et t h e mos t obviou s ben efit s ."
An d t h ey r ecommen d t o a ccomplis h s u ch a n object :

105
I. This as s ociation s hall be called the-(here ins ert the name of the place) S anitary As s ociation
II. The object of the as s ociation s hall be-1. To ins titute and promote local and pers onal s anitary inquiries and
improvements . 2. To correct mis conception and mis repres entations of the nature and des ign of s anitary meas ures . 3. To
promote the pas s age of us eful laws , ord inances and regulations , relating to public health. 4. To aid the public authorities ,
by coorperation and as s is tance, in carry ing them into effect. And 5. To collect and d iffus e, by pers onal intercours e, public
lectures , printed work s , or otherwis e, inf ormation, es pecially as to the s anitary condition of this town and its inhabitants ,
and generally as to the s anitary cond ition of this S tate and other places , and their inhabitants ; to the end that among all
pers ons the laws of health and lif e may be better unders tood, the caus es of dis eas e k nown and avoided, the term of lif e
extendd, the vital f orce and productive power increas ed, and the greates t pos s ible amount of phy s ical and s anitary
happines s enjoy ed.
III. Any s ubs criber pay ing annually s hall be a member f or one y ear; and any s ubs ciber pay ing at any one time s hall
be a member f or lif e.
IV. The off icers of the as s ociation s hall be, a pres ident, vice pres ident, s ecretary , treas urer, and aud itor, who s hall be
chos en at the s tated meeting in January , or at any other time when a vacancy s hall have occurred; and who together
s hall cons titute the Board of Directors .
V. Committees may be appointed to inves tigate and report upon local or general s ubjects embraced in the objects of the
as s ociation.
VI. The as s ociation s hall meet s tatedly on the s econd Thurs day of each month, and at s uch other times as the Board of
Directors s hall appoint. At the meeting in January a report s hall be made of the proceedings during the next preced ing
y ear.
VII. By -laws f or the more particular government of the as s ociation may be made by the Board of Directors .
VIII. No alteration of this cons titution s hall be made, except at a s tated meeting, on recommendation of the Board of
Directors , and by vote of two thirds of the members pres ent.
141
1s t . To for m a compa n y t o h ir e bu ildin gs a n d let r ooms t o poor t en a n t s
u n der dir ect ion of a pa id a gen t ; a n d
"2d. To t a ke s u ch . s t eps a s ma y s eem t o t h em bes t , by t h e es t a blis h men t of
ch a r t er ed or pr iva t e compa n ies , t o pr ocu r e t h e con s t r u ct ion of la r ge, well
fit t ed bu ildin gs , es pecia lly des ign ed for t h e u s e of s u ch t en a n t s .
Wis h in g t o lea r n wh a t h a d been don e, a n d h ow fa r t h e exper imen t h a d
s u cceeded, we a ddr es s ed in qu ir ies t o St eph en H. Per kin s , Es q., of Br ooklin e,
t h e a u t h or of t h e Repor t a bove r efer r ed t o, a n d obt a in ed fr om h im t h e
commu n ica t ion wh ich a ppea r s in t h e a ppen dix. We h a ve a ls o given ,
immedia t ely followin g t h a t commu n ica t ion , ext r a ct s fr om t h e a ble Repor t of
Dr . Simon , On t h e s a n it a r y con dit ion of t h e Lon don ," pr es en t ed November
6, 1849. Th es e docu men t s , a ffor d mu ch in t er es t in g in for ma t ion on t h e
pr es en t s t a t e of t h is qu es t ion , ,a n d we pa r t icu la r ly commen d t h em t o pu blic
a n d gen er a l a t t en t ion . We r ecommen d t h e s u bject a s wor t h y t h e pa t r on a ge of
t h e wea lt h y a n d ph ila n t h r opic, a s a mea n s of r a is in g t h e pu blic s a n it a r y
con dit ion of cit ies . Th os e wh o ca s t t h eir br ea d on t h e wa t er s " in t h is wa y
give t o r eceive a ga in .

XXXIX. WE RECOMMEND that public bathing-hous es and was h-hous es be
es tablis hed in all cities and villages .
Wit h in t h e la s t few yea r s , a n ew movemen t for t h e gen er a l a n d s a n it a r y
ben efit of t h e poor h a s been ma de, in t h e es t a blis h men t of pu blic ba t h in g-
h ou s es a n d wa s h -h ou s es . Liver pool h a s t h e h on or of or igin a t in g t h e idea ,
a n d of er ect in g t h e fir s t in s t it u t ion , wh ich wa s open ed t h e 28t h of Ma y,
1842. A s econ d was er ect ed t h er e. in 1847. Th e s t a t is t ics of t h es e t wo
es t a blis h men t s s h ow t h a t t h e pu blic pa t r on a ge h a s been a n n u a lly
in cr ea s in g fr om t h eir commen cemen t , a n d t h a t , du r in g t h e yea r Au gu s t 31,
1849, t h e n u mber of ba t h s t a ken wa s 104,691; t h e n u mber of dozen clot h es
wa s h ed, 120,875; t h e 1,230 4s . 11d., a n d t h e expen s es 1,392 178. Dr .
Du n ca n , t h e Medica l Officer of Hea lt h of Liver pool, t o wh os e kin d a t t en t ion
we a r e mu ch in debt ed, wr ot e u s on t h e 4
t h
December la s t ;-You will obs er ve
t h a t t h e in come bu t n ot qu it e, equ a ls t h e expen dit u r e; bu t s o well s a t is fied
a r e t h e t own cou n cil of t h e ben efit s con fer r ed on t h e wor kin g cla s s es by
t h es e es t a blis h men t s , t h a t t h ey h a ve r ecen t ly decided t o er ect s ix a ddit ion a l
ba t h s a n d wa s h -h ou s es in differ en t dis t r ict s of t h e bor ou gh , a t a cos t of
25,000. Th e la n d for fou r of t h es e bu ildin gs is pu r ch a s ed, a n d on e of t h em
is n ow in cou r s e of er ect ion . Th is will con t a in t wo plu n ge ba t h s , on e 42 by
27 feet , a n d t h e ot h er 39 by 27 feet ; 49 dr es s in g boxes , 87 wa s h in g h a lls , 8
in fect ed wa s h in g h a lls , 10 fir s t cla s s ba t h s , a n d 33 s econ d a n d t h ir d cla s s ."
Th e exa mple of Liver pool h a s been followed in ma n y ot h er pla ces in
Gr ea t Br it a in . Dr . J oh n Rober t s on , of Ma n ch es t er , fu r n is h ed u s wit h t h e
followin g fa ct s con cer n in g a por t ion on ly of t h es e in s t it u t ion s in t h a t cit y. In
t h r ee yea r s , en din g Sept ember , 1849, t h er e h a d been given 79,408 ba t h s , of
wh ich 30,242,-27,626 for men , 2,616 for women , wer e of t h e fir s t cla s s ; a nd
49,166,-43,377 for men , a n d 578 for women ,-wer e of t h e s econ d cla s s . Th er e
h a d been 16,907 wa s h er s a n d 594,294 dozen a r t icles wa s h ed. Th e r eceipt s
1,227, a n d t h e expen s es 1,194, lea vin g a ba la n ce in fa vor , for t h e t h r ee
yea r s , of 33.
Dr . Simon , of Lon don , s a ys , in h is r eport , a lr ea dy r efer r ed t o, t h a t "t he
commit t ee for pr omot in g t h e es t a blis h men t of ba t h s a n d wa s h -h ou s es ,
142
h a vin g Sir H. Du kin field for it s ch a ir ma n a n d in clu din g in it s n u mber , wit h
ot h er in flu en t ia l per s on s , s ever a l member s of t h is cor por a t ion , fou n ded, a t
gr ea t pa in s a n d expen s e, a model in s t it u t ion a t Gou ls t on Squ a r e,
Wh it ech a pel. In s pit e of ma n y cir cu ms t a n ces con s pir in g t o r en der t h is fir s t
a n d exper imen t a l es t a blis h men t pa r t icu la r ly expen s ive, it h a s mor e t h a n
s u ppor t ed it s elf by t h e s ma ll pa ymen t s of t h e poor ; a n d it s a rr a n gemen t s a r e
s u fficien t ly ext en s ive for it t o h a ve given on on e da y a s ma n y a s 932 ba t h s .
Th is fa ct h a vin g occu r r ed in t h e fir s t yea r of it s es t a blis h men t , s h ows t h e
poor mu s t h a ve a ppr ecia t ed t h e a ddit ion a l comfor t wit h in t h eir r ea ch ; a n d I
ma y a dd, t h a t , fr om t h e fir s t open in g of t h e bu ildin g, t h e a n n u a l r eceipt s
h a ve been pr ogr es s ively on t h e in cr ea s e. Somewh a t ea r lier , a n d u n der t h e
in flu en ce of t h e s a me pa r en t commit t ee, t h ou gh s pecia lly dir ect ed by a
br a n ch commit t ee, a s imila r es t a blis h men t wa s fou n ded in Geor ge St .
Eu s t on Squ a r e. Du r in g t h e yea r 1848, t h e n u mber of pa ymen t s ma de h er e
for ba t h in g wa s 111,788; t h e pa ymen t s for wa s h in g in t h e la u n dr ies ,
246,760. Th is es t a blis h men t h a s n ot on ly pr oved s elf-s u ppor t in g, bu t h a s
en a bled t o a ccu mu la t e a la r ge s u r plu s , wh ich is n ow bein g a pplied t o en la r ge
a n d impr ove t h e bu ildin g. At Gla s s h ou s e Ya r d, n ea r t h e en t r a n ce t o t h e
Lon don Docks , t h er e h a s been fou n ded, on t h e s a me model, a s ma ll
es t a blis h men t of fr ee ba t h s a n d wa s h -h ou s es for t h e des t it u t e poor . It wa s
open ed in Ma y, 1845. In it s fir s t yea r , t h e ba t h s given a mou n t ed t o 27,662;
t h e u s in gs of t h e la u n dr y, t o 35,840 ; a n d it s t ot a l wor kin g expen s es wer e
cover ed by 378.
" No la n gu a ge, h owever eloqu en t , n o commen t , h owever in s t r u ct ive,
cou ld equ a l t h e s ign ifica n ce of t h e figu r es wh ich I h a ve cit ed, a s illu s t r a t in g
t h e gr ea t u t ilit y of t h es e in s t it u t ion ; a n d, a s r ega r ds t h eir pecu n ia r y
s u cces s , it is impos s ible t o fu r n is h you wit h bet t er t es t imon y t h a n is
compr is ed in t h e fa ct , t h a t t h e gu a r dia n s of t h e poor in a grea t met r opolit a n
pa r is h ou t of t h e poor -r a t es , fou n ded a n in s t it u t ion of t h is n a t u r e. Th ey h a ve
become wit n es s es t o t h e fin a n cia l econ omy of t h a t s a n it a r y a n d s ocia l boon .
In t h eir es t a blis hmen t , wh ich is n ot on ly s elf-s u ppor t in g bu t a mply
r emu n er a t ive, t h e poor a r e en a bled t o h a ve ba t h s a t a n expen s e of a pen n y
for a cold a n d t wo pen ce for a wa r m ba t h ; a n d t h e women a r e en a bled t o do
t h eir wa s h in g, ir on in g, a n d dr yin g, wit h a n u n limit ed wa t er s u pply, a n d wit h
ot h er a r r a n gemen t s of t h e mos t a dmir a ble complet en es s , a t a n expen s e of
on ly t wo pen ce for t h e fir s t t wo h ou r s du r in g wh ich t h ey occu py t h e s epa r a t e
ch a mber s a llot t ed t o t h em. A ver y con s ider a ble pr opor t ion of t h e expen s e is
cover ed by t h e r eceipt s for ba t h s given a t t h e h igh er pr ice of s ix pen ce, a n d
wit h s ome a ddit ion a l lu xu r ies , t o per s on s of a h igh er gr a de in s ociet y t h a n
t h os e wh o u s e t h e or din a r y ba t h s ; t h e for mer , t h ou gh u s ed by a differ en t
cla s s of per s on s , bein g s ou gh t wit h a lmos t a s mu ch a vidit y a s la t t er .
"In t h e s a n it a r y poin t of view, I pr oba bly n eed n ot in s is t on t h e
a dva n t a ges wh ich t h es e es t a blis h men t s h a ve con fer r ed. You will h a r dly
dou bt h ow good a n d wh oles ome a t h in g it h a s been for s o ma n y t h ou s a n ds
t o h a ve h a d t h e mea n s t h eir bodies a n d t h eir clot h in g, wh o, in t h e a bs en ce
s u ch fa cilit ies , mu s t oft en h a ve ca r r ied a bou t t h eir per s on s a lon g a n d
offen s ive a ccu mu la t ion of dir t a n d s wea t ."
A movemen t wa s ma de by t h e cit y of New Yor k t o es t a blis h t h es e
in s t it u t ion s , a n d a va lu a ble r epor t on t h e s u bject , s u bmit t ed t o t h e Boa r d of
Alder mep, Ma y 29, 1849, h a s been pu blis h ed. An a ct of in cor por a t ion wa s
143
obt a in ed fr om t h e legis la t u r e; bu t h ow fa r t h eir pr opos ed mea s u r es h a ve
been a r e n ot in for med.
In Bos t on t h er e a r e t welve or mor e ba t h in g es t a blis h men t s , own by
in dividu a ls , wh o ch a r ge t wen t y-five cen t s for a dmis s ion . At t h e Eolia n Ba t h s
in Wa s h in gt on St r eet , fit t ed u p in excellen t s t yle, t h os e on Cr a gie's Br idge,
a n d t h os e on Wa r r en Br idge, t welve a n d a h a lf cen t s is ch a r ged. Th es e
es t a blis h men t s a r e mu ch fr equ en t ed, an d, on a s in gle Sa t u r da y n igh t , 200
ba t h er s a r e kn own t o h a ve been a dmit t ed t o on e of t h em. Th e s a n it a r y
a dva n t a ges wh ich wou ld r es u lt t o a ll, a n d es pecia lly t o t h e poor er cla s s es , by
a mor e ext en ded pr act ice of ba t h in g, h a ve oft en been s u bject s of dis cu s s ion .
On t h e 7
t h
of J a n u a r y, 1850, Dr . Sa mu el Ca bot , J r ., r ea d befor e t h e Societ y
in Aid of Socia l Improvemen t ," a r epor t on t h e s u bject , wh ich wa s pu blis h ed.
Th e Bos t on Ba t h in g a n d Wa s h -h ou s e Compa n y wa s in cor por a t ed, Ma r ch 11,
1850, for t h e es t a blis h in g ba t h a n d wa s h -h ou s es in differ en t pa r t s of t he
cit y; a n d t h is or ga n iza t ion , it is believed, if pr oper ly con du ct ed, will s er ve a ll
t h e pu r pos es des ign ed by s u ch es t a blis h men t s .

XL. WE RECOMMEND that, whenever practicable, and s ewage of cities and
towns be collected, and applied to the purpos es of agriculture.
Th e r efu s e a n d s ewa ge of cit ies a n d villa ges a r e of gr ea t va lu e a s
ma n u r e; a n d pla n s h a ve been devis ed abr oa d t o collect a n d a pply t h em for
a gr icu lt u r a l pu r pos es . Compa n ies h a ve been for med, es t ima t es ma de, a n d
exper imen t s t r ied, t o t es t t h eir va lu e a n d t o devis e t h e bes t mea n s by wh ich
t h ey migh t be t o t h eir gr ea t va lu e a ll a gr ee ; bu t t h e differ en t pla n s of
collect in g a n d dis t r ibu t in g t h em, s eem n ot a s yet s o fu lly t es t ed a s t o
wa r r a n t a r ecommen da t ion of a n y pa r t icu la r on e in pr efer en ce t o ot h er s . We
in s er t s ome ext r a ct s fr om differ en t wor ks , a n d r ecommen d t h e s u bject t o t h e
ca r efu l exa min a t ion of t h os e in t er es t ed. Pu blic u r in a ls a n d pu blic pr ivies
s h ou ld in ever y popu lou s cit y a n d villa ge, a n d pla ced u n der pu blic a u t h or it y,
for t h e pu r pos e of con ven ien ce, econ omy, a n d h ea lt h .
Th e va lu e of ma n u r es a s pr omot er s of veget a t ion is kn own t o r es u lt
fr om t h eir pos s es s ion of t h e es s en t ia l elemen t , n it r ogen , in t h e for m of
a mmon ia , wit h t h e s u bor din a t e pr oper t ies of a lka lies , ph os ph a t es , a n d
s u lph a t es . Now t h e exper imen t s of Bou s s in ga u lt a n d Liebig h a ve fu r n is h ed
u s wit h t h e mea n s of es t ima t in g t h e qu a n t it y of n it r ogen con t a in ed in t h e
excr emen t s of a ma n , du r in g on e yea r , a t 16.41 lbs ., u pon pr oba ble da t a ,
a n d a ls o t h a t t h is qu a n t it y is s u fficien t for t h e 800 lbs . of wh ea t , r ye, or oa t s ,
or of 900 lbs . of ba r ley. Th is is mu ch mor e, s a ys Liebig, t h a n it is
n eces s a r y t o a dd t o a n of la n d, in or der t o obt a in , wit h t h e a s s is t a n ce of t h e
n it r ogen a bs or bed fr om t h e a t mos ph er e, t h e r ich es t cr ops ever y yea r . By
a dopt in g a s ys t em of r ot a t ion of cr ops , ever y t own fa r m migh t t h u s s u pply
it s elf wit h t h e ma n u r e, wh ich , be con t a in in g t h e mos t n it r ogen , con t a in s a ls o
t h e mos t ph os ph a t es . By u s in g, a t t h e s a me t ime, bon es a n d t h e lixivia t ed
a s h es of wood, a n ima l excr emen t s migh t be complet ely dis pen s ed wit h on
ma n y kin ds of s oil. Wh en h u ma n excr emen t s a r e t r ea t ed in a pr oper
ma n n er , s o a s t o r emove t h is mois t u r e wit h ou t per mit t in g t h e es ca pe of
a mmon ia , t h ey may pu t in t o s u ch a for m a s will a llow t h em t o be
t r a n s por t ed even t o gr ea t dis t a n ces .' Ma kin g r ea s on a ble a llowa n ce for t h e
r edu ced qu a n t it y pr odu ced by ch ildr en , we s h a ll be s a fe in a s s u min g t h e
n it r ogen t h u s r es u lt in g fr om a n y a mou n t of popu la t ion t o be equ a l t o t h e
144
s u pply r equ ir ed for a ffor din g 2 lbs . of br ea d per diem for ever y on e of it s
member s ! Or a s s u min g a n a ver a ge of 600 Ibs . of wh ea t t o be ma n u r ed by
ea ch in dividu a l popu la t ion of Lon don , a n d t a kin g t h is a t t wo million s for a
r ou gh ca lcu la t ion , t h e ma n u r e t h u s pr odu ced is s u fficien t t o s u pply t h e
gr owt h of wh ea t of a t ot a l weigh t of 1200 million or 535,714 t on s . Th e t ot a l
ma n u r in g ma t t er s , s olid a n d liqu id, pr odu ced in a t own , a llowin g for t h os e
wh ich pr odu ced in ma n u fa ct or ies a n d s ewa ge wa t er , a r e pr oba bly equ a l in
weigh t t o on e t on a n n u a lly for ea ch member of t h e popu la t ion , or t wo
million s of t on s pr odu ced in t h e met r opolis . Th a t t h is va s t qu a n t it y of
ma n u r e s h ou ld be ma de a va ila ble for a gr icu lt u r a l pr odu ct ion , is a pr in ciple
wh ich ca n n ot be den ied a n d wh ich is pr oper ly limit a ble on ly by t h e
con s ider a t ion of expen s e a s weigh ed a ga in s t t h e va lu e of t h e r es u lt s . Th e
expen s e will be ma de u p ma in ly of t h r ee it ems , viz. : of t h e collection, of t h e
rais ing, a n d of t h e d is tribution of t h e r efu s e ma t t er s ."
A ver y r edu ced es t ima t e of t h e va lu e, for ma n u r e, of t h e h u ma n bein gs ,
(r edu ced a vowedly for t h e s a ke of pu blic belief,) r epr es en t s it a t 5s . for ea ch
per s on , a n n u a lly. Th e va lu e of t h e pr odu ce of t h e popu la t ion of Lon don
wou ld t h u s be 500,000 per a n mu n . Admit t in g on e-h a lf of t h is t o be n ow
ma de a va ila ble, we s h a ll h a ve t h e ot h er h a lf, a mou n t in g t o 250,000, ga in ed
by t h e pr opos ed mode of collect ion ; a n d a ddin g t h is t o t h e 134,000
es t ima t ed s a vin gs , we h a ve a t ot a l of 384,000 a n n u a lly a va ila ble for t h e
expen s es of con s t r u ct ion a n d r epa ir of a ppa r a t u s , a n d cu r r en t cos t of
collect in g, r a is in g a n d t r ea t in g t h e s ewa ge of t h e met r opolis . Th is s u m will
en dow t h ir t y-eigh t s t a t ion s wit h a n a n n u a l in come ea ch exceedin g 10,000,
for t h e in t er es t of ca pit a l in fir s t con s t r u ct ion a n d cu r r en t expen s es of
wor kin g a n d t r ea t in g. An d t h is n u mber of s t a t ion s a ppea r s fu lly a dequ a t e t o
econ omy of power wh ich ca n be a t t a in ed by pr ovidin g for s ever a l levels in
ea ch dis t r ict of t h e met r opolis
106
.

Mr . Ch a r les F. Eller ma n , in h is t r ea t is e on Sa n it a r y Refor m a n d
Agr icu lt u r a l Impr ovemen t ," u r ges t wo poin t s on t h is s u bject :-
1. An y pla n is u n h ea lt h y, u n clea n ly, a n d en or mou s ly wa s t efu l, wh ich
con s ign s t h e excr et a of t h e popu la t ion t o r iver s or wa t er -cou r s es .
2. An y pla n wh er eby t h e r efu s e of t own s is employed t o fer t ilize t h e cou n t r y,
is s er iou s ly defect ive, u n les s du e pr ovis ion is ma de t h a t t h e n u is a n ce a n d
in ju r y t o pu blic hea lt h s h a ll n ot a r is e; t h a t s u bs t a n ces per n iciou s t o
veget a t ion s h a ll n ot be mixed wit h t h os e wh ich a r e ben eficia l t o veget a t ion ;
t h a t t h e s ma lles t pos s ible qu a n t it y of t h e la t t er s h a ll be s u ffer ed t o es ca pe;
a n d t h a t it s h a ll be s a ved in s u ch a for m a s ma y a dmit of it s bein g r en der ed
a va ila ble in a n y pla ce, a n d in s u ch a s t a t e of dilu t ion or con cen t r a t ion a s
va r yin g s oils , s ea s on s , or ot h er cir cu ms t a n ces , ma y r equ ir e.
Of t h e immen s e econ omic va lu e of t h e pr es er va t ion of h u ma n excr et a ,
wh en we a r e s en din g wh ole fleet s in s ea r ch of t h os e of bir ds , (gu a n o,) wh ich
con s is t of pr ecis ely t h e s a me ma t er ia l in a les s a dva n t a geou s for m, n o
t h ou gh t fu l ma n ca n en t er t a in a r ea s on a ble dou bt . Mr . Smit h , a well-kn own
a gr icu lt u r is t s , r a t es t h e a ver a ge a n n u a l va lu e of t h e excr et a of ea ch
in dividu a l a t 1; s o t h a t , t a kin g t h e wh ole popu la t ion of Gr ea t Br it a in a t
t wen t y-eigh t million s , we a r e pos it ively throwing away , ever y yea r , t h a t
wh ich is equ iva len t t o twenty -eight millions s terling! Th e a ct u a l s a lea ble

106
Demps ey 's Drainage and Sewage of Towns and Build ings , pp. 4, 5, and 20.
145
va lu e in Belgiu m of t h e is 37 s h illin gs for ea ch in dividu a l. Th er e ma y be
ext r a va ga n ce in t h is es t ima t e bu t , a ccor din g t o Dr . Pla yfa ir , a pou n d of u r in e
is ca pa ble of in cr ea s in g t h e pr odu ct ion of gr a in by a n equ a l weigh t ; s o t h a t ,
even a llowin g for s ome exa gger a t ed h u ma n u r in e a t pr es en t wa s t ed in t h is
cou n t r y wou ld t o pr odu ce mor e t h an a ll t h e gr a in r equ ir ed for t h e
con s u mpt ion of t h e en t ir e popu la t ion ."
It is a la w of n a t u r e t h a t t h e veget a ble a n d a n ima l kin g- s h ou ld be, a s
it wer e, s u pplemen t a r y t h e on e t o t h e ot h er . An ima ls , by br ea t h in g a ir , loa d
it wit h ca r bon ic a cid, a n d r en der it n oxiou s t o t h ems elves ; wh ile veget a bles
a bs or b t h e a cid ga s , it s s t ea d, a n d t h u s s u pply t h e a n ima l wit h kin gdom
wit h vit a l a ir . Th en a ga in , wh a t ever elemen t s a n a n ima ls t akes fr om t h e s oil
a s food, it r et u r n s a ga in t o t h e ea r t h in a differ en t for m, n oxiou s t o it s elf, bu t
n ever t h eles s fu r n is h in g veget a ble kin gdom a bu n da n t a n d wh oles ome
n ou r is h men t . It is t h u s t h a t t h e or ga n ic elemen t s complet e t h eir cir cu it in
livin g bein gs . Not h in g is los t , it is on ly r epr odu ced in a n ot h er for m. Th es e
pr in ciples lie a t t h e r oot of t h e wh ole s cien ce of a gr icu lt u r e, wh ile t h ey
con s t it u t e t h e ba s is of a ll econ omic s a n it a r y a r r a n gemen t s .
Th e pr in ciple h a s been lon g a dmit t ed, a n d t o a cer t a in ext en t a ct ed
u pon , t h a t t h e r efu s e of a t own , wh en a pplied t o a gr icu lt u r a l pu r pos es , h a s
s ome mon ey va lu e; bu t t h er e s eems , wit h few except ion s , t o h a ve been n o
a ppr oxima t ion even t o a n a dequ a t e es t ima t e of t h a t va lu e. It is s t a t ed in Dr .
Pla yfa ir r epor t , ma de in 1844, t h a t t h e a mou n t obt a in ed by t h e s a le of t h e
t own ma n u r e of Ma n ch es t er wa s 800 per a n n u m ; a n d in Liver pool it
pr odu ced 1, 150 ; wh ile a t Roch da le it wa s wor t h 18 10s . In s ome of t h e
Scot ch t own s t h es e t h in gs a r e ma n a ged bet t er . Th e cos t of clea n s in g
Edin bu r gh is 12.1000 pou n ds a yea r , a n d t h e ma n u r e, wh ich is pu blic
pr oper t y - as it ought to be in all towns ,-s ells for 10,000 per a n n u m. At
Per t h a n d Aber deen t h e ma n u r e pa ys t h e wh ole cos t of clea n s in g, a n d
r et u r n s , in a ddit ion , a n a n n u a l of 430 t o t h e for mer t own , a n d 600 t o t h e
la t t er . Th e wh ole of t h e r ich a n d bea u t ifu l cou n t r y ext en din g Gr a velin es t o
Os t en d, or igin a lly con s is t ed of a ba r r en , s a n dy wa s t e, wh ich h a s , in t h e
cou r s e of a ges , been con ver t ed in t o ga r den by t h e con t in u ed a pplica t ion of
ma n u r e br ou gh t fr om a dis t a n ce.
"Th e in s t a n ces given a bove s h ow, in a ll pr oba bilit y, mos t t h a t h a s been
ma de of s olid t own ma n u r e. It is expen s ive t o collect a n d r emove, a s well a s
t o dis t r ibu t e la n d, a n d a good dea l of t h e weigh t a n d bu lk of it is
u n pr odu ct ive ; wh ile in a ll t own s wh er e ces s pools exis t , t h e bes t pa r t of t h e
ma n u r e s in ks in t o t h e s u bs oil or eva por a t es in t o a t mos ph er e, s o a s n ot on ly
t o be a los s t o t h e pu blic, bu t a s er iou s ca u s e of dis ea s e. Common s en s e,
t h er efor e, a s well as econ omy, wou ld poin t ou t t h e n eces s it y of h a vin g a
per fect of s ewer s for ever y h ou s e, cou r t , a n d s t r eet , s o a s t o con vey a wa y a ll
t h e ma n u r e in a liqu id for m, dilu t ed wit h wa t er . It s h ou ld n ever be mixed
wit h coa l-a s h a n d cin der s , wh ich ou gh t t o be r emoved s epa r a t ely. Now t h is
liqu id ma n u r e, SEWER WATER, wh ich is a t pr es en t pou r ed in t o ou r dock-
ba s in s , a s a n u is a n ce t o be got r id of, migh t be ma de a s ou r ce of gr ea t
wea lt h t o t h e t own . If by a n y mea n s it cou ld be br ou gh t , in con t a ct wit h t h e
ba r r en s oils in t h e n eigh bor h ood, it wou ld cover t h em wit h t h e mos t
lu xu r ia n t veget a t ion . For t u n a t ely t h is is n ot a ma t t er of mer e s pecu la t ion . It
h a s been in oper a t ion for ma n y yea r s , a n d we a r e mu ch mis t a ken if t h e
pr a ct ice does come u n iver s a l, s o fa r , a t lea s t , a s cir cu ms t a n ces will per mit .
146
Th e s ewer wa t er of s ever a l of t h e t own s in Devon s h ir e is employed for t h e
pu r pos es of ir r iga t ion , pa r t icu la r ly a t wh er e it h a s been s o applied for a bove
for t y yea r s . Th e mea dows a r e deep dr a in ed, t o pr even t a n y s t a gn a t ion , a n d
t h e s ewer wa t er is t h u s a llowed t o pa s s off a s s oon a s it h a s n u t r it iou s
pr in ciples t o t h e gra s s . La n d wh ich is n ot u n der t h is irr iga t ion yields a
coa r s e h er ba ge, wit h r u s h es ; bu t a ft er t h e a pplica t ion of t h e liqu id ma n u r e it
gr ows t h e fin er a n d n u t r it iou s gr a s s es in a bu n da n ce, a n d t h er e is a cr op for
ewes a n d la mbs fu lly a mon t h ea r lier t h a n in ot h er s it u a t ion s n ot s imila r ly
cir cu ms t a n ced. Th e va lu e of unimproved fr om 30s . t o 40s . a n a cr e, bu t af ter
irrigation it is wor t h fr om 8 t o 12 per a cr e. We h a ve h er e, a t a ll even t s , a
ver y s t r on g pr oof of t h e va lu e of t h e ma n u r e.
Th e wh ole of t h e s ewer wa t er of Mila n , a cit y con t a in in g 150,000
in h a bit a n t s , is dis t r ibu t ed by ch a n n els over a la r ge ext en t of mea dow la n d,
wh ich it fer t ilizes t o a pr odigiou s degr ee. Du r in g t h e s u mmer mon t h s t h e
ir r iga t ion t a kes pla ce for a few h ou r s on ce a week, a n d du r in g t h e win t er it is
n ea r ly per ma n en t . Th e mea dows a r e mown in November , J a n u a r y, Ma r ch ,
feedin g; a n d in J u n e, J u ly, a n d Au gu s t , t h r ee cr ops of h a y for win t er ; wh ile
in Sept ember t h ey fu r n is h a bu n da n t pas t u r e for ca t t le t ill t h e begin n in g of
t h e win t er ir r iga t ion . Th es e la n ds , a ft er pa yin g la n d-t a x a n d a ll ot h er
expen s es , yield a n et a n n u a l r en t of eigh t gu in ea s a n a cr e.
Th e mos t r ema r ka ble exa mple, h owever , of t h e va lu e of of ir r iga t ion is
a ffor ded by cer t a in mea dows in t h e mea dows in t h e n eigh bor h ood of
Edin bu r gh . A por t ion of t h e s ewer wa t er of t h e Old Town is r eceived in t o
pon ds , a n d a llowed t o depos it a con s ider a ble qu a n t it y of s olid ma t t er . Fr om
t h es e pon ds it is a llowed t o flow equ a lly over plot s of la n d, s o a s t o cover
t h em, a n d a ft er pas s in g t h r ou gh t h e s oil it is ca r r ied off by t h or ou gh
dr a in a ge. Th r ee kin ds of s oil h a ve been t r ea t ed in t h is wa y: 1
s t
, a s t r on g loa m
on a cla y s u bs oil; 2
nd
, a ligh t er s oil n ea rer t h e s ea ; a n d 3
rd
, a pure s ea s and,
without any appreciable mixture of earthy matter; goin g down t o h igh -wa t er
ma r k. Abou t 300 a cr es h a ve been ir r iga t ed a t va r iou s t imes , s ome for
u pwa r ds of 30 yea r s . Th e pr odu ct iven es s of t h es e mea dows is ext r a or din a r y.
In t h e yea r 1835, s ome of t h e r ich es t la n d wa s let for 38 a n a cr e; a n d in
1826, wh ich wa s a s ca r ce yea r , a s mu ch a s 57 per a cr e wa s obt a in ed for
t h e s a me mea dows . Mr . Smit h , of Dea n s t on , wh o is t h e h igh es t a u t h or it y on
s u ch s u bject s , con clu des h is r epor t of t h is mos t s a t is fa ct ory exper imen t a s
follows ;-
Th e pr a ct ica l r es u lt of t h is a pplica t ion of s ewer wa t er is , t h a t la n d,
wh ich let for mer ly a t fr om 40s . t o 6 per Scot ch a cr e, is n ow let a n n u a lly a t
fr om 30 t o 40; a nd t h a t poor , s a n dy la n d on t h e s ea -s h ore, wh ich migh t
be wor t h 2s . 6d. per a cr e, let s a t a n a n n u a l r en t of fr om 15 t o 20. * * Th e
a ver a ge va lu e of t h e la n d, ir r es pect ive of t h e s ewer wa t er a pplica t ion , ma y be
t a ken a t 3 per imper ia l a cr e, a n d t h e a ver a ge r en t of t h e ir r iga t ed la n d a t
30, ma kin g a differ en ce 27; bu t 2 ma y be dedu ct ed a s t h e cos t of
ma n a gemen t , lea vin g 25 per a cr e of clea r a n n u a l in come du e t o t h e s ewer
wa t er .
107


107
Liverpool Health of Towns Advocate, pp. 60-62.
147

XLI. WE RECOMMEND that meas ures be tak en to prevent as f ar as
practicable, the s mok e nuis ance.
Th e s moke of fu r n a ces , ma n u fa ct or ies , a n d ot h er es t a blis h men t s , is
oft en a gr ea t n u is a n ce t o a n eigh bor h ood, a n d is s u ppos ed t o be delet er iou s
t o h ea lt h . It cor r u pt s t h e a ir , a n d oft en r en der s it u n fit for r es pir a t ion ; a n d
a ll pr oper a n d pr a ct ica ble mea s u r es s h ou ld be a dopt ed t o pr even t t h e evils
wh ich r es u lt fr om it . Exper imen t s h a ve been ma de in t h e ma n u fa ct u r in g
t own s in En gla n d, t o con s t r u ct fu r n a ces a n d fir epla ces s o a s t o burn up the
s mok e, a s fa s t a s pr odu ced, a n d t h u s pr even t it s es ca pin g, t o become a n
in con ven ien ce, in ju r y t o t h e in h a bit a n t s . Th es e exper imen t s h a ve s h own
t h a t t h e a r r a n gemen t is a n econ omica l a n d pr a t ica l a s well a s a s a n it a r y
impr ovemen t . Les s fu el is r equ ir ed wh en t h e s moke is bu r n ed t h a n wh en it
is per mit t ed t o es ca pe u n bu r n ed. We des ir e t o ca ll t h e a t t en t ion t o a ll
in t er es t ed t o t h e s u bject , a s wor t h of ca r efu l in ves t iga t ion . Sever a l
impor t a n t fa ct s a n d illu s t r a t ios r ela t in g t o t h is s u bject may be fou n d in
r ecen t En glis h s a n it a r y pu blica t ion s
108


XLII. WE RECOMMEND that the s anitary effects of patent med icines and
other nos trums , and s ecret remed ies , be obs erved; that phy s icians in their
pres criptions and names of med icines , and apothecaries in their compounds ,
us e great caution and care; and that med ical compounds ad vertis ed f or s ale
be avoided, unles s the material of which they are compos ed be k nown, or
unles s manuf actured and s old by a pers on of k nown hones ty and integrity .
Th e s a n it a r y effect s of pa t en t medicin es a n d ot h er n os t r u ms , a dver t is ed
for s a le, is on e of t h e gr ea t es t evils of t h e pr es en t da y. If t h e people wer e
a wa r e of t h e immens e a mou n t of s u ch s a les , a n d of t h e impa ir ed h ea lt h , t h e
r u in ed con s t it u t ion s , a n d t h e pr ema t u r e dea t h s , wh ich t h ey occa s ion , t h ey
wou ld be a s t ou n ded. An in s a t ia ble des ir e t o ma ke mon ey, fr equ en t ly wit h ou t
r ega r d t o t h e ju s t ice or mor a lit y of t h e mea n s , on t h e pa r t of t h e
ma n u fa ct u r er s a n d ven der s , a n d a n in clin a t ion t o do s omet h in g for t h e r elief
of r ea l or ima gin a r y s u ffer in g, a n d a n u n en ligh t en ed belief, on t h e pa r t of
pu r ch a s er s , t h a t wh a t is a dver t is ed a s t r u e mu s t be t r u e, a r e t h e pr omin en t
ca u s es of t h is mon s t r ou s evil. Th is ma t t er h a s a t t r a ct ed mu ch pu blic
a t t en t ion , bu t n ot s o mu ch a s it s impor t a n ce dema n ds ; a n d n o pla n for a
s a n it a r y s u r vey of t he St a t e wou ld be perfect in wh ich it wa s omit t ed. Th er e
is mu ch good s en s e in t h e Tr a n s a ct ion s of t h e Medica l Societ y of t h e St a t e of
New Yor k. On t h e 7
t h
of Febr u a r y, 1849, a r epor t from which we make the
following extracts :- So far as the pecuniary interests of our profession is concerned, the
vending of secret nostrums is advantageous, since it unquestionably greatly increases the
amount of disease whenever such nostrums are used. We, therefore, invite no legislation in
this matter for the protection of ourselves, yet, as a humane profession, we do not feel at
liberty to withhold our advice, as all experience has shown that the most effectual mode of

108
The s mok e nuis ance is , perhaps , one of the mos t gratuitous injuries inf licted on the public, f or, in the f irs t place, it is
altogether unneces s ary , and, s econdly , it cos ts the perpetrators of it good round s um every y ear to k eep it going. The los s
to the public, f rom exces s of was hing, &c., which a s mok y atmos phere renders neces s ary , is more than at f irs t might
appear. Dr. Ly on Play f air has s hown, that in this one item Manches ter has been expending 60,000 a y ear, and that, if
the expens e of additional painting and whitewas hing be added, the actual money los s would be double the amount of the
poor rates every y ear. The Rev. Mr. Clay s tates , that in Pres ton only two furnaces cons ume their s mok e,and even that
imperf ectly ; but were all the f actories in town to do as much, the public would s ave 10,450 a y ear in extra was hing.-
Liverpool Health of Towns Adv.
148
cor r ect in g impos it ion is t o dives t it of mys t er y, a n d t h u s en a ble a n in t elligen t
commu n it y t o ju dge of it s t r u t h or fa ls it y; a n d beca u s e we t h in k, in a
h u ma n e s cien ce, des ign ed for t h e r elief of ph ys ica l s u ffer in g, it is a gr eat
wr on g t h e wor ld of a n y kn owledge wh ich on e ma y pos s es s of t h e mea n s of
s a vin g life or a llevia t in g s u ffer in g. Th er efor e we r ecommen d, t h a t a ll a r t icles
des ign ed for medica l u s e, pu t u p for s a le a s mer ch a n dis e, s h a ll be by la w
r equ ir ed t o be a ccompa n ied wit h t h e n a mes of t h e con s t it u en t s , wr it t en or
pr in t ed in pla in a n d legible En glis h .
On t h e s a me da y a n ot h er r es olu t ion wa s pa s s ed :
Res olved, t h a t a pr ize of twenty dollars be offer ed by t h is s ociet y for a
t r a ct , of n ot les s t ha n fou r n or mor e t h a n s ixt een pa ges , wh ich s h a ll mos t
clea r ly expos e t h e per n iciou s in flu en ce of t h e n os t r u ms a n d s ecr et r emedies ,
u pon t h e h ea lt h a n d mor a ls of t h e commu n it y.
109

Th e t ime will come wh en t h a t s ys t em of legis la t ion wh ich a llows
u n pr in cipled men , for t h eir pr iva t e ben efit , t o s en d for t h pa t en t medicin es
u n der t h e gr ea t s ea l of t h e n a t ion , will be s een t o be n o ot h er t h a n a licen s ed
impos it ion on t h e pu blic. Hea lt h a n d life a r e t oo va lu a ble t o be t h u s
s a cr ificed. An y ma n wh o r ea lly believes t h a t h e h a s dis cover ed t h e mea n s of
mit iga t in g h u ma n s u ffer in g, is bou n d, by ever y pr in ciple of mor a lit y a n d
ben evolen ce, t o pu n is h it t o t h e wor ld. Th e power t o do good implies a n d
in volves a n obliga t ion t o do it , a n d t h e fact of a n a t t empt t o con cel fr om men
t h a t wh ich is r epr es en t ed t o be of pa r a mou n t impor t a n ce for t h em t o kn ow,
is pr es u mpt ive eviden ce of wa n t of in t egit y. Th e t r iu mph of ign or a n ce over
s cien ce is t h e pr ecu r s or of t h e down fa ll of ou r r epu blic.
110


XLIII. WE RECOMMEND that local Boards of other's interes ted, endeavor to
prevent the s ale wholes ome, s purious , and adulterated articles , the public
health, des igned f or food, drink , or med icine.
Th e evil s u gges t ed in t h is r ecommen da t ion is n ea r ly a llied t o t h a t
pr ecedin g, It is on e of immen s e ma gn it u de por t a n ce, a n d exis t s t o a n ext en t
gr ea t er t h a n h a s a lly s u ppos ed, Pr odigiou s qu a n t it ies of s pu r iou s a r t icles , of
food, dr in k, a n d medicin e, wh ich a r e h igh ly da ily pa lmed u pon t h e pu blic by
mer cen a r y a n d ma n u fa ct u r er s a n d dea ler s . An d it is gen er a lly con ceded t h a t
a gr ea t a mou n t of dis ea s e a n d n u mer ou s pr ema t u r e dea t h s a r e t h er eby
pr odu ced.
Food is a du lt er a t ed in va r iou s wa ys , A r ecen t wr it er eu n er ma t es t h e
followin g pu r pos es of t h es e a du lt er a t ion s :
(1) To ma ke t h e s u bs t a n ce mor e s a lea ble by impr ovin g it s appea r a n ce,
by t h e a ddit ion of s ome body in n ocu ou s or ot h er wis e,
(2) To depr ecia t e it s qu a lit y, by a ddin g t o it s ome s u bs t a n ce wh ich will
dimin is h it s r ea l, wit h ou t a lt er in g it s a ppa r en t s t ren gt h or gen er a l
a ppea r a n ce. Th is is gen er a lly a ver y dea dly fr a u d.
(3) To depr ecia t e it s qu a lit y by t h e a ddit ion of s ome s imple s u bs t a n ce,
a s wa t er , or , if it be a s olid body, a s pla s t er of pa r is , s a n d, & c.
Br ea d is oft en a du lt er a t ed wit h a lu m, car bon a t e of a mmon ia , ca r bon a t e
of ma gn es ia , s u lph a t e of copper a n d zin c, &c., t o impr ove it s a ppea r a n ce,
wh en ma de of flou r of in fer ior qu a lit y. Bu t t er a n d ch ees e ar e oft en pois on ed

109
Appendix to Trans actions New York Medical Society , Vol. VII, pp. 96,98.
110
Dr. Alden. American Quarterly Regis ter, Vol. XII, p. 263.

149
wit h color in g ma t t er . Milk is wa t er ed, s u ga r s a n ded, a n d va r iou s ot h er
in t en t ion a l fr a u ds a r e pr a ct iced. Un in t en t ion a l a du lt er a t ion s ma y a ls o
s omet imes t a ke pla ce by mea n s of keepin g or cookin g differ en t kin ds of food.
Drink is a ls o ver y ext en s ively a du lt er a t ed. It is s a id t h a t ver y lit t le of
wh a t is s old a s ch a mpa gn e win e is ma de fr om t h e ju ice of t h e gr a pe, bu t is a
delet er iou s compou n d of ot h er s u bs t a n ces . Few of ot h er kin ds of s pir it u ou s
liqu or s go t o t h e con s u mer in a pu r e s t a t e. It is t h e opin ion of emin en t
t emper a n ce r efor mer s t h a t on e of t h e pr in cipa l ca u s es of t h e s a d s a n it a r y
effect s of in t emper an ce a r is es fr om t h e pois on ou s s u bs t a n ces compou n ded
wit h t h e pu r e s pir it a n d t a ken in t h e in t oxica t in g cu p. Ot h er kin ds of mor e
or din a r y dr in k, n ot in t oxica t in g, a n d even wa t er it s elf, ma y be a du lt er a t ed
a n d r en der ed u n fit for u s e.
Drugs and med icines h a ve been a du lt er a t ed by t h e for eign pr odu cer ,
ma n u fa ct u r er a n d dea ler , expr es s ly for t h e Amer ica n mar ket , a n d va s t
qu a n t it ies of s u ch a r t icles h a ve been impor t ed a n d s old in t h is cou n t r y.
Some of ou r own pr odu cer s , ma n u fa ct u r er s a n d dea ler s , a ls o, h a ve been
gu ilt y of a s imila r fr a u d. By ca r efu l s t u dy t h e pr oper t ies a n d mode of
oper a t ion of t h e va r iou s a r t icles u s ed a s medicin e h a ve been a s cer t a in ed,
a n d t h e in t elligen t , con s cien t iou s , cu r a t ive ph ys icia n , ca n es t ima t e t h eir
effect wit h s ome degr ee of a ccu r a cy. It is n eces s a r y, h owever , t o en a ble h im
t o do .t h is s u cces s fu lly, t h a t t h ey s h ou ld be of kn own pu r it y a n d s t r en gt h . If
s pu r iou s , of in fer ior qu a lit y, or a du lt er a t ed wit h ot h er s u bs t a n ces , n ot
con t a in ed in t h e gen u in e a r t icle, dis a ppoin t men t follows , a n d t h e pa t ien t
s u ffer s a n d per h a ps dies . Th is r es u lt ma y h a ppen u n der t h e a dvice of t h e
bes t cu r a t ive medica l s kill, a n d life ma y be, a n d h a s a ct u a lly been los t ,
fr om s ome defect exis t in g a lon e in t h e medica l r emedies u s ed. A mer e
s t a t emen t of t h is fa ct will r en der obviou s t h e impor t a n ce of t h is
r ecommen da t ion .
In s ome of t h e govern men t s of Eu r ope n o on e is a llowed t o dea l in dr u gs
a n d medicin es u n les s pr oper ly edu ca t ed a n d licen s ed for t h e pu r pos e ; a n d a
con s t a n t gover n men t a l s u per vis ion is exer cis ed over a ll a pot h eca r ies , t o
keep t h em wit h in t h e lin e of t h eir s pecific du t ies , a n d t o pr even t t h em fr om
s ellin g a r t icles wh ich ma y be in ju r iou s t o h ea lt h . Th e s ys t em of fr ee t r a de,
a n d t h e en t ir e a bs en ce of a ll s u ch s u per vis ion in t h is cou n t r y, h a s led ma n y
in compet en t a n d fr a u du len t ma n u fa ct u r er s a n d dea ler s t o en t er la r gely in t o
t h is kin d of bu s in es s , a n d a s ys t em of impos it ion a n d pos it ive evil h a s been
ca r r ied on , wh ich , if fu lly kn own , wou ld fill t h e people wit h a s t on is h men t .
Th e s u bject wa s br ou gh t t o t h e a t t en t ion of Con gr es s , a n d, on t h e 26t h
of J u n e, 1848, an a ct t o pr even t t h e impor t a t ion of a du lt er a t ed a n d
s pu r iou s dr u gs a n d medicin es ," wa s pa s s ed. Un der t h is a ct s pecia l
exa min er s a r e a ppoin t ed t o r es ide in va r iou s por t s of en t r y, t o ca r r y t h e la w
in t o execu t ion . Dr . W. J . Ba iley, t h e exa min er a t New Yor k, h a s r epor t ed t h a t
du r in g t en mon t h s en din g Apr il, 1849, a bou t 90,000 pou n ds of va r iou s
kin ds of dr u gs h a ve been r eject ed a n d r efu s ed a dmit t a n ce a t t h e cu s t om-
h ou s e in t h a t cit y a lon e! Amon g t h es e wer e 16,989 pou n ds of r h u ba r b; 3,253
pou n ds of opiu m; 34,570 pou n ds of s pu r iou s yellow ba r k; 12,483 pou n ds of
ja la p; 5,058 ou n ces of iodin e, a n d la r ge qu a n t it ies of va r iou s ot h er a r t icles . It
h a s been s a id t h a t mor e t h a n h a lf of ma n y of t h e mos t impor t a n t ch emica l
a n d medicin a l pr epa r a t ion s , t oget h er wit h la r ge qu a n t it ies of cr u de dr u gs ,
150
come t o u s s o mu ch a du lt er a t ed, or ot h er wis e det er ior a t ed, a s t o r en der
t h em n ot on ly wor t h les s a s a medicin e, bu t oft en da n ger ou s .
We ext r a ct fr om a r epor t on t h is s u bject , by Hon . T. O. Edwa r ds , M. D.,
t h e followin g pa s s a ge :- Th a t a du lt er a t ion s of medicin es , t o a ver y
con s ider a ble ext en t , will be ca r r ied on in t h is cou n t r y, n on e ca n den y. Ba d
Con gr es s t h e power t o pr even t it , by a gen er a l la w, it migh t be a voided. Th e
gen er a l gover n men t h a s don e a ll in it s power , a n d it is in cu mben t on t h e
s ever a l s t a t es , by s pecia l s t a t u t e, t o r en der pen a l t h e con du ct t h a t en da n ger s
t h e lives a n d h ea lt h of t h e cit izen s . No on e ca n believe t h a t a du lt er a t ion s
h er e wou ld be ca r r ied t o t h e ext en t pr a ct is ed by for eign er s . It is s ca r cely
pr es u ma ble t h a t a ll t h e dr u ggis t s will be en ga ged in a t r affic s o n efa r iou s .
Th e r iva lr y of bu s in es s , t h e pr ide of t h e pr ofes s ion , a n d t h e h igh er a n d
n obler mot ives of h u ma n it y, will be equ a l t o t h e in gen u it y a n d in ven t ion of
t h e dis h on es t , a n d will effect it s expos u r e. If t h is la w be fa it h fu lly complied
wit h , t h e h ou s e t h a t s ells a n a du lt er a t ed a n d s pu r iou s medicin e mu s t n eeds
h a ve ma de it , t h e wa t ch fu ln es s of t h e pr ofes s ion , t oget h er wit h t h e
n u mer ou s medica l jou r n a ls , jea lou s of t h e in t er es t s a n d in for med of t h e
r igh t s of t h e medica l pr ofes s ion , will pr ocla im t h e fr a u d. La w a n d pu blic
opin ion will poin t t o t h e r emedy. Th e la w r equ ir in g a ll medicin a l a gen t s
impor t ed t o be pu r e, a n d of a n a ckn owledged s t a n da r d, will give a n impet u s
t o t h e employmen t of t a len t s a n d ca pit a l in ou r own cou n t r y. Ha vin g t h e
a dva n t a ge of t h e pr ot ect ion a ffor ded by t h e du t y, a n d a fu r t h er gu a r d a ga in s t
fr a u ds by t h is la w, Amer ica n en t er pr is e will s oon r iva l older a n d mor e
exper ien ced ch emis t s in t h e ma n u fa ct u r e of n eces s a r y "a r t icles ."
Th e Revis ed St a t u t es of Ma s s a ch u s et t s con t a in t h e followin g pr ovis ion s
of la w on t h e s u bject :-
" SECT. 1. If a n y per s on s h a ll kn owin gly s ell a n y kin d of dis ea s ed, cor r u pt ed,
or u n wh oles ome pr ovis ion s , wh et h er for mea t or dr in k, wit h ou t ma kin g t h e
s a me fu lly kn own t o t h e bu yer , h e s h a ll be pu n is h ed by impr is on men t in t h e
cou n t y ;a il n ot mor e t h a n s ix mon t h s , or by fin e n ot exceedin g t wo h u n dr ed
dolla r s .
" SECT. 2. If a n y per s on s h a ll fr a u du len t ly a du lt er a t e, for t h e pu r pos e of
s a le, a n y s u bs t a n ce in t en ded for food, or a n y win e, s pir it s , ma lt liqu or , or
ot h er liqu or , in t en ded for dr in kin g, wit h a n y s u bs t a n ce in ju r iou s t o h ea lt h ,
h e s h a ll be pu n is h ed by impr is on men t in t h e cou n t y ;a il n ot mor e t h a n on e
yea r , or by fin e n ot exceedin g t h r ee h u n dr ed dolla r s , a n d t h e a r t icles s o
a du lt er a t ed s h a ll be for feit ed a n d des t r oyed.
" SECT. 3. If a n y per s on s h a ll fr a u du len t ly a du lt er a t e, for t h e pu r pos e of
s a le, a n y dr u g or medicin e, in s u ch a ma n n er a s t o r en der t h e s a me
in ju r iou s t o h ea lt h , h e s h a ll be pu n is h ed by impr is on men t in t h e cou n t y ;a il
n ot mor e t h a n on e yea r , or by fin e n ot exceedin g fou r h u n dr ed dolla r s , a n d
s u ch a du lt er a t ed dr u gs a n d medicin es s h a ll be for feit ed a n d des t r oyed."
Th is a ct gives s u fficien t lega l a u t h or it y t o pr even t t h e evil. If it be
ca r efu lly obs er ved, a n d on ly t h os e dea ler s wh o a r e pr oper ly qu a lified for
t h eir bu s in es s , a n d a r e of kn own h on es t y a n d in t egr it y, r eceive pu blic
pa t r on a ge, a n d t h os e of a n oppos it e ch a r a ct er a r e dis cou n t en a n ced, a n d
in s t a n ces of fla gr a n t a bu s e pr os ecu t ed a n d pu n is h ed, it ma y be r ea s on a bly
s u ppos ed t h a t t h e evil will gr ea t ly dimin is h .

151
XLIV. WE RECOMMEND that ins titutions be formed to educate and qualif y
females to be nurs es of the s ick .
It is h a r dly n eces s a r y t o commen d t h e impor t a n ce of good n u r s in g in
t h e cu r e of dis ea s e. Let a ph ys icia n be ever s o s kilfu l, a n d pr es cr ibe h is
r emedies wit h ever s o mu ch ca r e a n d s a ga cit y, if t h e n u r s e does n ot follow
h is dir ect ion s , or if s h e n eglect s h er du t y, or per for ms it u n s killfu lly, or
imper fect ly, or wit h a n impr oper dis pos it ion , t h e r emedies will be
u n s u cces s fu l, a n d t h e pa t ien t will s u ffer ; a n d per h a ps life is los t a s t h e
con s equ en ce. On t h e ot h er h a n d, let a ph ys icia n of moder a t e ca pa cit y
pr es cr ibe wit h or dina r y s kill, if h is or der s a r e ca r r ied in t o execu t ion by a
n u r s e, wh o u n der s t a n ds , loves , a n d con s cien t iou s ly dis ch a r ges h er du t y, t h e
pa t ien t is r elieved, a n d life is pr es er ved a s t h e con s equ en ce. It is t h u s t h a t
ba d n u r s in g oft en defea t s t h e in t en t ion s of t h e bea s t medica l a dvice, a n d
good n u r s in g, oft en s u pplies t h e defect s of ba d a dvice. Nu r s in g oft en does
mor e t o cu r e dis ea s e t h a n t h a t t h e ph ys icia n s h ims elf; a n d, in t h e pr even t ion
of dis ea s e a n d in t h e pr omot ion of h ea lt h , it is of equ a l a n d even of gr ea t er
impor t a n ce. Ma n y a n d ma n y a life, wh ich migh t h a ve been s a ved, h a s been
los t in t h e h a n ds of qu a ck n u r s es , a s well a s in t h os e of qu a ck doct or s .
In con s equ en ce of t h e gr ea t ign or a n ce wh ich gen er a lly pr eva ils in r ega r d
t o t h e la ws of h ea lt h , a n d t h e ca u s es a n d cu r e of dis ea s e, t h er e a r e few
fema les or ot h er s wh o a r e r ea lly ca pa ble of a ct in g a s in t elligen t n u r s es .
Ma n y, it is t r u e, a n n ou n ce t h ems elves a s pr ofes s ion a l n u r s es , a n d ma n y in
mor e pr iva t e life s u ppos e t h ems elves ca pa ble; bu t h ow few r ea lly u n der s t a n d
t h e du t ies of a n u r s e, or t h e domes t ic ma n a gemen t of t h e s ickr oom, a n d h ow
ma n y lives a r e s a cr ificed in t h e h a n ds of t h e ign or a n t ! We h a ve lon g des ir ed
t h a t s ome r emedy s h ou ld be devis ed fr om t h is imper fect ion of ou r s ocia l life.
In 1836, t h er e wa s fou n ded a t Ka is er s wer t h , a cit y on t h e Rh in e, in
Pr u s s ia , a n In s t it u t ion of Pr ot es t a n t Dea con es s es a n d Nu r s in g Sis t er s ." It s
or igin a l object wa s t h e ca r e of t h e s ick a n d poor in t h e n eigh bor h ood of it s
loca t ion . A h os pit a l wa s er ect ed, in t o wh ich t h e s ick wer e a dmit t ed, a n d a ls o
s u ch fema les of pr oper a ge a s wis h ed t o devot e t h ems elves t o t h e n u r s in g
a n d ca r e of t h e s ick. Her e t h es e fema les r ema in ed for a s u fficien t per iod of
t ime t o r eceive a t h or ou gh edu ca t ion in t h e kn owledge a n d pr a ct ice of t h e
n u r s in g a n d ca r e of t h e s ick ;a n d t h ey wer e a ft er wa r ds s en t for t h on t h eir
mis s ion of mer cy, t o diffu s e t h e bles s in gs of t h eir s u per ior edu ca t ion
wh er ever t h eir s er vices migh t be wa n t ed. Some h a ve been employed in t h e
ca r e of t h e s ick in t h eir own h omes , ot h er s a t t h e expen s e of pr iva t e
ch a r it a ble in s t it u t ion s , a n d ot h er s in pu blic h os pit a ls . It s or igin a l object h as
been ext en ded, a n d it h a s become a n immen s e cen t r a l in s t it u t ion , h a vin g
t h e h igh es t object of ben evolen ce, a n d pr omis in g t h e gr eat es t ben efit s t o
h u ma n it y.
To t h e Rev. Th oma s Fliedn er , pa s t or of a Pr ot es t a n t ch u r ch in
Ka is er s wer t h , belon gs t h e h on or of fou n din g t h is n oble in s t it u t ion . He pa id a
vis it t o t h e Un it ed St a t es in 1849, a n d on e of t h is commis s ion h a d t h e
plea s u r e of ma kin g h is a cqu a in t a n ce. Fr om a n ot ice of t h e in s t it u t ion , wh ich
h e fu r n is h ed, we ma ke t h e followin g ext r a ct s :-
Th e s u cces s wh ich t h e es t a blis h men t a t Ka is er s wer t h h a s met wit h h a s
been ver y gr ea t . For , a ccor din g t o t h e t welft h pr in t ed r epor t for 1849, a bove
115 dea con es s es a r e n ow a t wor k in differ en t pa r t s of Ger ma n y a n d
En gla n d. Sixt y-s ix a r e occu pied in t wen t y-five h os pit a ls a n d or ph a n -h ou s es
152
a t Ber lin , Dr es den , Fr a n kfor t , Wor ms , Cologn e, Elber feld, Lon don , et c.
Somet imes , in a la r ge con gr ega t ion , wh ich h a s n o h os pit a l, s ever a l of t h es e
n u r s es go a bou t a s mot h er s of t h e poor a n d s ick, s u ppor t in g a n d n u r s in g
t h em in t h eir dwellin gs , a n d r epor t in g t h eir wa n t s t o t h eir pa s t or s a n d t h e
over s eer s .
Th e h os pit a l a t Ka is er s wer t h h a s r eceived in t h es e t h ir t een yea r s a bou t
3,500 pa t ien t s , of bot h s exes , a n d of a ll r eligiou s per s u a s ion s , a fflict ed wit h
diver s dis ea s es ; ma n y of t h em wer e a dmit t ed gr a t u it ou s ly.
Some dea con es s es h a ve a ls o been edu ca t ed a t Ka is er s wer t h for
h os pit a ls in Swit zer la n d, Fr a n ce, a n d Holla n d ; a n d t h e ca lls fr om ma n y
pa r t s of t h e con t in en t , for dea con es s es fr om Ka is er s wer t h , a r e s o n u mer ou s ,
t h a t t h is es t a blis h men t ca n n ot s a t is fy t h em a ll. It r es u lt s fr om t h e
t es t imon ies of t h e admin is t r a t ion a n d t h e medica l officer s of t h os e pu blic
in s t it u t ion s , a n d it is a fa ct of gen er a l n ot or iet y, t h a t t h es e dea con es s es h a ve
been in t r u s t ed wit h t h e ca r e of a h os pit a l, a vis ible ch a n ge for t h e bet t er
t a kes pla ce in a ll depa r t men t s , a n d t h e s a t is fa ct ion , t h e gr at it u de, a n d t h e
bles s in gs of t h e pa t ien t s follow t h es e s elf-devot ed n u r s es ever ywh er e.
On t h e fift h of J u ly, 1849, t h e Rev. Mr . Fliedn er br ou gh t over , fr om t h e
pa r en t in s t it u t ion , fou r of t h es e dea con es s es , t o t h e Un it ed St a t es , t o t a ke
ch a r ge of a n in fir ma r y es t a blis h ed in Pit t s bu r gh , Pa ., by t h e Rev. Wm.
Pa s s a va n t . It is pr opos ed in t h is in s t it u t ion , likewis e, t o qu a lify ot h er
Ch r is t ia n fema les a s dea con es s es , t o n u r s e t h e s ick a n d poor in ot h er
Amer ica n h os pit a ls , con gr ega t ion s , a n d fa milies . In t h is way, we t r u s t , t h e
n ew in fir ma r y a t Pit t s bu r gh will become, u n der Gods bles s in g, a cen t r e of
ligh t , love, a n d mer cy.
To t h e Ch r is t ia n r ea der it will be in t er es t in g t h e pr ovis ion for t h e ca re
of t h e s ick a n d poor is bles s in g wh ich t h e pa r en t es t a blis h men t diffu s es
la n ds . It con t a in s a ls o t h r ee br a n ch in s t it u t ion s , for ot h er pu r pos es : -Firs t,
a s emin a r y, t o t r a in you n g da y, a n d in du s t r ia l s ch ools , wh ich h a s :t h a n 370
s u ch t ea ch er s for differ en t pa r t s of in s t r u men t a lit y of wh om ma n y
t h ou s a n ds of h a ve been r es cu ed fr om ign or a n ce a n d mis er y, a n d h ea ven ly
Fr ien d. Secondly , a n or ph a n a s ylu m, t h e mot h er -h ou s e, wh er e t wen t y-five t o
t h ir t y or ph a n s of cler gymen , mis s ion a r ies , s ch oolma s t er s , &c., a r e edu ca t ed
by t h e s is t er s , in a Ch r is t ia n ma n n er , a s n u r s es , s ch ool-mis t r es s es , &c.
An d third, a br a n ch in s t it u t ion , des ign ed t o edu ca t e deacon es s es for t h e
n u r s in g a n d mor a l impr ovemen t of fema le pr is on er s . Th is br a n ch is t h er efor e
con n ect ed wit h a n a s ylu m for r elea s ed fema le pr is on er s , wh ich Pa s t or
Fliedn er fou n ded s ixt een yea r s wh ich h a s r eceived s in ce t h en mor e t h a n on e
h u n dr ed eigh t y poor , deeply-fa llen in dividu a ls , ma n y of wh om h a ve by
Ch r is t ia n in s t r u ct ion , t o become good s er va n t s , r es pect a ble member s of
s ociet y .
Th e emin en t s u cces s wh ich a t t en ded t h es e es t a blis h men t s t o t h e
for ma t ion of s imila r on es in ot h er pla ces on t h e con t in en t of Eu r ope, a n d in
En gla n d. Fr om a n in t er es t in g n ot ice wh ich a ppea r s in t h e Edin bu r gh
Review , we ext r a ct t h e followin g s t a t emen t , t o illu s t r a t e t h eir good r es u lt s :-
" An epidemic n er vou s fever wa s r a gin g in t h e t wo commu n es of t h e
cir cle of Du is bu r g, Ga r t r op, a n d Ga h len . It s fir s t a n d mos t vir u len t ou t br ea k
t ook pla ce a t Ga r t r op, a s ma ll, poor , s eclu ded villa ge, of s car cely 130 s ou ls ,
wit h ou t a doct or , wit h ou t a n a pot h eca r y in t h e n eigh bor h ood, wh ile t h e
cler gyma n wa s u pon t h e poin t of lea vin g for a n ot h er pa r is h , a n d h is
153
s u cces s or h a d n ot yet been a ppoin t ed. Fou r dea con es s es , in clu din g t h e
s u per ior Pa s t or Fliedn er 's wife, a n d a ma id, h a s t en ed t o t h is s cen eof
wr et ch edn es s , a n d fou n d fr om t wen t y t o t wen t y-five fever pa t ien t s in t h e
mos t a la r min g con dit ion ; a mot h er a n d ch ildr en in on e h ovel, fou r ot h er
pa t ien t s in a n ot h er , a n d s o on ; a ll lyin g on fou l s t r a w, or on bedclot h es t h a t
h a d n ot wa s h ed for weeks , a lmos t wit h ou t food, u t t er ly wit h ou t h elp. Ma n y
h a d died a lr ea dy ; t h e h ea lt h y h a d fled ; t h e pa r is h doct or lived fou r Ger ma n
lea gu es off, a n d cou ld n ot come ever yday. Th e fir s t ca r e of t h e s is t er s , wh o
cou ld h a ve fou n d no lodgin g bu t for t h e va ca n cy of t h e par s on a ge, wa s t o
in t r odu ce clea n lin es s a n d ven t ila t ion in t o t h e n a r r ow ca bin s of t h e pea s a n t s ;
t h ey wa s h ed a n d cooked for t h e s ick, t h ey wa t ch ed ever y n igh t by t u r n s a t
t h eir beds ide, a n d t en ded t h em wit h s u ch s u cces s , t h a t on ly fou r per s ons
died a ft er t h eir a r r iva l, a n d t h e r es t wer e left con va les cen t a ft er fou r weeks '
s t a y. Th e s a me epidemic h a vin g br oken ou t in t h e n eigh bor in g commu n e f
Ga h len , in t wo fa milies , of' wh om eigh t member s la y ill at on ce, a s in gle
dea con es s h a d t h e h a ppin es s , in t h r ee weeks , of lea vin g ever y pa t ien t
r es t or ed t o h ea lt h , a n d of h a vin g pr even t ed t h e fu r t h er s pr ea d of t h e dis ea s e.
Wh a t wou ld n ot Dr . Sou t h wood Smit h or Mr . Ch a dwick give for a few dozen
of s u ch h a r d-wor kin g, zea lou s , in t elligen t
min is t er s , in s a n it a r y r efor m ?
111

We commen d t h is ma t t er ea r n es t ly t o pu blic a t t en t ion . In wh a t wa y it
cou ld be bes t ca r r ied in t o effect , we will n ot a t t empt t o s pecify. We wou ld,
h owever , s u gges t t ha t a r r a n gemen t s be ma de in t h e Ma s s a ch u s et t s Gen er a l
Hos pit a l, a n d in ot h er s imila r in s t it u t ion s , t o a dmit fema les of a pr oper
ch a r a ct er t o be edu ca t ed for t h es e s pecia l object s .
Pr elimin a r y pr oceedin gs h a ve t a ken pla ce for er ect in g a n ew h os pit a l in
Bos t on , for t h e a ccommoda t ion of t h e la bor in g cla s s es a n d t h e poor . If s u ch
a n in s t it u t ion s h ou ld be es t a blis h ed, t h is s h ou ld be on e of it s pu r pos es . It
migh t be ma de a kin d of n or ma l s ch ool, of t h e h igh es t ch a r a ct er a n d
u s efu ln es s , a t wh ich fema les a n d ma les migh t be edu ca t ed a n d pr epa r ed t o
be in t elligen t n u r s es in a n d ou t of t h e cit y; a n d t h u s con fer t h e dou ble
ben efit of r elievin g it s own pa t ien t s a n d con t r ibu t in g t o t h e r elief of ot h er s .
Th er e a r e ma n y fema les a mon g u s wh o wis h for employmen t a n d s u ppor t ;
a n d we kn ow of n o wa y bet t er t h a n t h is in wh ich t h ey migh t obt a in t h eir
des ir es , a n d a t t h e s a me t ime ma ke t h ems elves h on or ed a n d u s efu l t o
ot h er s .
112


XLV. WE RECOMMEND that pers ons be es pecially educated in s anitary
s cience, as preventive advis ers as well as curative advis ers .
Th e gr ea t object of s a n it a r y s cien ce is t o t ea ch people t h e ca u s es of
dis ea s e,-h ow t o r emove or a void t h es e ca u s es , -t o pr even t dis ea s e, -h ow t o
live wit h ou t bein g s ick,- h ow t o in cr ea s e t h e vit a l for ce, -h ow t o a void
pr ema t u r e deca y. An d on e of t h e mos t u s efu l r efor ms wh ich cou ld be
in t r odu ced in t o t h e pr es en t con s t it u t ion of s ociet y wou ld be, t h a t t h e a dvice
of t h e ph ys icia n s h ou ld be s ou gh t for a n d pa id for wh ile in h ea lt h t o keep t h e
pa t ien t well; a n d n ot , a s n ow, wh ile in s ickn es s , t o cu r e dis ea s e, wh ich migh t
in mos t ca s es h a ve been or pr even t ed. An d t h is pr a ct ice, we u n der s t a n d,

111
Ediburgh Review, Vol LXXXVII, f or 1848, p. 442.
112
For further inf ormation, s ee article Deacones s es of Protes tant Sis terhoods , Edinburgh Review, Vol. LXXXVII, f or
1848, pp. 430-451, and the work s their reviewed.
154
exis t s t o s ome ext en t in s ome civilized cou n t r ies . Th r ee exis t in g r ea s on s ,
h owever , n ow occu r t o u s ; wh ich we fea r will pr even t or obs t r u ct , a t lea s t for
a con s ider a ble per iod, t h e in t r odu ct ion in t o ou r cou n t r y of t h is u s efu l
r efor m. On e r ea s on is , t h a t per s on s wh o a r e well gen er a lly t h in k t h a t t h ey
h a ve n o n eed of a ph ys icia n ; - a n ot h er , t h a t if a dvice is s ou gh t for or given a t
s u ch t imes , it is n ot gen er a lly con s ider ed wor t h pa yin g for ; -a n d a t h ir d,
t h a t t h er e a r e few per s on s edu ca t ed in s a n it a r y s cien ce, a n d ca pa ble of
givin g good s a n it a r y a dvice. Th es e a r e fa t a l er r or s , a n d s h ou ld be cor r ect ed,
for t h ey h a ve cos t t h ou s a n ds of lives . Sa n it a r y pr ofes s or s h ips s h ou ld be
es t a blis h ed in a ll ou r colleges a n d medica l s ch ools , a n d filled by compet en t
t ea ch er s . Th e s cien ce of pr es er vin g h ea lt h a n d pr even t in g dis ea s e s h ou ld be
t a u gh t a s on e of t h e mos t impor t a n t s cien ces . It wou ld be u s efu l t o a ll, a n d
t o t h e s t u den t in cu r a t ive medicin e a s well a s t o ot h er s . To t h e you n g ma n
wh o is edu ca t in g h ims elf for t h e gr ea t pu r pos es of life, wh a t ever pr ofes s ion
h e ma y s elect , it ca nn ot be in fer ior , in in t er es t a n d impor t a n ce, t o a n y ot h er
br a n ch of edu ca t ion. An illu s t r a t ion of ou r idea s on t h is ma t t er is con t a in ed
in t h e followin g ext ra ct fr om t h e Weekly Su mma r y of t h e Pu blic Hea lt h in
Lon don , is s u ed by t h e Regis t r a r -Gen er a l, Sept . 19, 1849 ;-
"No cit y, per h a ps , ever pos s es s ed s u ch a n efficien t body of medica l men
a s a r e n ow pr a ct is in g in Lon don . Du r in g t h is epidemic t h ey h a ve per for med
s er vices wh ich in a n y ot h er field mu s t h a ve won t h e h igh es t h on or s ;
comba t in g t h e dis eas e n igh t a n d da y in t h e mos t pes t ilen t ia l qu a r t er s , a n d
t h a t on mu ch mor e s et t led pr in ciples t h a n t h e pu blic migh t be led t o s u s pect
fr om cer t a in dis cu s s ion s a t t h e medica l s ociet ies . An d t h eir office h a s been
dis ch a r ged wit h s o mu ch kin dn es s a s t o des er ve t h e gr a t it u de of t h e poor ,
in s t ea d of dr a win g down on t h eir h ea ds t h e ch a r ges wit h wh ich t h e
ph ys icia n s of ot h er cou n t r ies h a ve oft en been a s s a iled by t h e popu la ce.
Nea r ly a ll t h e s ick ha ve been s een by t h es e pr a ct it ion er s , yet 14,500 per s on s
h a ve a lr ea dy died of ch oler a in Lon don . How is t h is ? Th e medica l for ce will
be fou n d t o h a ve been employed a t a n immen s e dis a dva n t a ge. It is ca lled
in t o a ct ion a t t h e wr on g en d of t h e ma la dy. In qu ir ies pr ove, t h a t wh ile
medica l a dvice I is gen er a lly s ou gh t in t h e ch a r a ct er is t ic s t a ge, it is s eldom
obt a in ed in t h e pr emon it or y s t a ge, wh en t h e power of medicin e is decis ive;
a n d t o t h a t ea r lier an d s t ill mor e impor t a n t per iod pr ecedin g t h e pr emon it or y
s t a ge, wh ich is pr even t ed a s ea s ily a s cu r ed, medica l pr a ct ice h a s h a d lit t le
or n ot h in g t o s a y. Ch oler a h er e, a ls o, on ly s h ows in h igh r elief wh a t exis t s in
or din a r y cir cu ms t a n ces . Medica l men ra r ely if ever t r ea t t h e begin n in gs of
dis ea s es , a n d a r e s ca r cely ever con s u lt ed pr ofes s ion a lly on t h e pr es er va t ion
of t h e h ea lt h of cit ies or fa milies . Th e a r t of pr es er vin g h ea lt h is t a u gh t in n o
r egu la r cou r s e of lect u r es a t a n y of t h e gr ea t s ch ools of medicin e in t h e
Un it ed Kin gdom. Yet t h e cla s s ica l s a n it a r y wor ks of Pr in gle, Lin d, Bla n e,
J a cks on , J oh n s on , a n d Ma r t in , h a ve been fr a med fr om obs er va t ion in t h e
Br it is h n a vy a n d ar my. In t h e s cien ce of h ea lt h t h er e a r e mor e exa ct ,
demon s t r a ble t r u t h s t h a n in t h e s cien ce of dis ea s e; a n d t h e a dva n t a ge of
pr even t ion over cu r e r equ ir es n o pr oof. In t h e Cyr opr edia of Xen oph on ,
ph ys icia n s wh o on ly t r ea t t h e s ick a re compa r ed t o member s of t or n
clot h es , wh ile t h e pr es er va t ion of h ea lt h is decla r ed a n oble a r t , wor t h y of
Cyr u s h ims elf. Veget iu s s pea ks in s imila r , J a cks on in s t r on ger t er ms , bu t
per h a ps u n ju s t ly: for if it godlike t o s a ve ma n y fr om s u ffer in g, a n d t o ca r r y
155
t h em in h ea lt h y life u p t o t h e n a t u r a l t er m of exis t en ce, it is a wor t h y
occu pa t ion t o r es cu e a few fr om t h e a r ms of dea t h or in cu r a ble in fir mit y.
Bu t t h e pr es er va t ion a n d r es t or a t ion of h ea lt h a r e pa r t s of on e s cien ce;
a n d if, a s h a s been don e by Lon don a n d Liver pool, h ea lt h officer s be
a ppoin t ed in a ll t h e dis t r ict s of t h e kin gdom, t h e a r t of pr es er vin g h ea lt h will
be s t u died by a h igh or der of men , well pa id by t h e pu blic; a n d u lt ima t ely,
wit h a n in cr ea s e of t h eir r emu n er a t ion ,-t h e dimin u t ion of s ickn es s , t h e
dis a ppea r a n ce of epidemics , immen s e a dva n t a ge t o t h e pu blic,-t h e wh ole
medica l pr ofes s ion ma y devot e t h ems elves t o t h e pr es er va t ion a n d
developmen t of t h e vigor of t h e h u ma n fa cu lt ies , in s t ea d of bein g t ied down
t o t h e t r ea t men t of t h e s ick a n d dyin g. An d t h is ,' Lor d Ba con s a ys , a ft er h is
gr ea t s u r vey of lea r n in g, we h ope migh t r edou n d t o a gen er a l good, if
ph ys icia n s wou ld bu t exer t t h ems elves , a n d r a is e t h eir min ds a bove t h e
s or did con s ider a t ion s of cu r e; n ot der ivin g t h eir h on or fr om t h e n eces s it ies of
ma n kin d, bu t becomin g min is t er s of
t h e divin e power a n d goodn es s , bot h in pr olon gin g a n d r es t or in g t h e life of
ma n ; es pecia lly a s t h is ma y be effect ed by s a fe, commodiou s , a n d n ot
illiber a l mea n s , t h ou gh h it h er t o u n a t t empt ed. An d cer t a in ly it wou ld be a n
ea r n es t of divin e fa vor if, wh ils t we a r e jou r n eyin g t o t h e la n d of pr omis e, ou r
ga r men t s , t h os e fr ail bodies of ou r s , wer e n ot gr ea t ly t o wea r ou t in t h e
wilder n es s of t h is wor ld.' "
In con n ect ion wit h t h es e s en t imen t s , in wh ich we fu lly con cu r , t h er e is
a n ot h er ma t t er des er vin g in ves t iga t ion , wh ich h a s a s gr ea t if n ot gr ea t er
in flu en ce on t h e s a n it a r y con dit ion of t h e people. We a llu de t o t h e n u mer ou s
in compet en t , u n edu ca t ed medica l a dvis er s , wh o a r e employed a s cu r a t ive
ph ys icia n s . We boas t of livin g in a n en ligh t en ed er a of t h e wor ld, a n d
per h a ps , wh en compa r ed wit h ma n y ot h er s , ou r boa s t in g ma y be well
fou n ded. Th is a ge is in deed r ema r ka ble in ma n y r es pect s , a n d u n like a n y
t h a t h a ve pr eceded it . Th e elemen t s of pr ogr es s t h a t exis t in it s ver y
con s t it u t ion , h old ou t , for t h e fu t u r e des t in ies of s ociet y a n d for t h e,
eleva t ion of ma n , h igh er h opes t h a n h a ve ever befor e been en t er t a in ed.
Not wit h s t a n din g t h is gen er a l ch a r a ct er is t ic, t h er e wa s n ever a per iod wh en
ign or a n t pr et en s ion wa s mor e bold, or s eemed t o h a ve gr ea t er pa t r on a ge. We
h a ve, bes ides ph ys icia n s edu ca t ed a ccor din g t o t h e r oles of s ome s t a t e
medica l or ga n iza t ion , or s ome medica l s ch ool, t h e h omeopa t h ic, t he
h ydr opa t h ic, t h e a na lyt ica l, t h e Th oms on ia n , t h e bot a n ica l, t h e eclect ic a n d
elect r ica l, t h e mes mer ic, t h e pa t h et is t ic, t h e elect r o-biologic, t h e ch r on o-
t h er ma l, t h e In dia n , a n d ver y ma n y ot h er den omin a t ion s of ph ys icia n s , ea ch
pu t t in g for t h t h eir own s ys t em a s t h e on ly s u r e on e for t h e cu r e of a ll
dis ea s es . Lookin g s u per ficia lly a t a ll t h es e cla s s es , it wou ld s eem t h a t a t n o
per iod h a s medica l pr a ct ice been mor e u n s et t led. Th er e a r e men of in t egr it y
a n d s kill in t h es e differ en t den omin a t ion s ; bu t t h er e u n dou bt edly exis t s in
mos t , if n ot a ll of t h em, a va s t a mou n t of pr a ct ice wh ich is in ju r iou s , or does
violen ce t o h ea lt h a n d life.
An immen s e ext en t of s u ffer in g, of a br idgmen t of h u ma n life, is
r egu la r ly bou gh t a n d pa id for , a mon g u s . A ma r ket of impos it ion is open ed t o
s u pply t h e dema n ds of ign or a n ce ; a n d t h is mu s t con t in u e t o be s o, u n t il t h e
people a r e mor e en ligh t en ed. Did t h e pr et en der s t o medica l s cien ce, wh o
in fes t t h e cou n t r y in s u ch for mida ble n u mber s , con fin e t h ems elves t o t h e
ba r ba r ia n s ' pr a ct ice of ch a r ms a n d in ca n t a t ion s , t h e mis ch ief wr ou gh t by
156
t h eir a r t wou ld be fa r les s deplor a ble; bu t a ccu s t omed a s t h ey a r e t o mor e
pot en t pr es cr ipt ion s , t h ey commit wider h a voc of h u ma n h ea lt h a n d life,
t h a n t h e medicin e-men of t h e s a va ges t h ems elves ."
113

It is n ot ou r in t en t ion h er e t o dis cu s s t h e ca u s es wh ich pr odu ce t h is
ch a r a ct er is t ic of s ociet y, bu t t o ca ll pu blic a t t en t ion t o it , t h a t it ma y be
exa min ed, a n d it s effect s ma de kn own amon g a ll cla s s es of t h e people. If t he
fa t a l con s equ en ces wh ich r es u lt fr om t h e pr a ct ice of t h os e wh o dea l in t he
h u ma n con s t it u t ion a n d it s dis ea s es , a n d in t h e con fiden ce of it s pos s es s or s ,
a s a t r a de mer ely, wer e t r u ly exh ibit ed, t h e dis clos u r e wou ld be s t a r t lin g.
Men t o wh om h u ma n life a n d h u ma n h ea lt h a r e in t r u s t ed, s h ou ld kn ow
s omet h in g of t h e n at u r a l con s t it u t ion of t h e body, t h e opera t ion of dis ea s e
u pon it , a n d t h e n a t u r e a n d effect of r emedies ; a n d t h ey s h ou ld pos s es s
common s en s e a n d exper ien ce s u fficien t t o a pply t h is kn owledge s killfu lly t o
t h e a lmos t in fin it eva r iet y of for ms a n d cir cu ms t a n ces u n der wh ich dis ea s e
a ppea r s . Neit h er a bla cks mit h fr om h is a n vil, a n h os t ler fr om h is s t a ble. A
ba r ber fr om h is s h op, or a woma n fr om h er wa s h -t u b, ca n be s u ppos ed,
wit h ou t pr eviou s edu ca t ion or exper ien ce, even a cqu ir ed fr om t h e In dia n s ,"
t o pos s es s t h is kn owledge, or t o be qu a lified t o a ct a s a cu r a t ive ph ys icia n .

XLVI. WE RECOMMEND that phy s icians k eep records of cas es profes s ionally
attended.
Th e s cien ce of medicin e, like mos t ot h er s cien ces , is fou n ded u pon
fa ct s . Ma n y of t h es e fa ct s a r e s t a t ed in t h e in t h e r ecor ded obs er va t ion a n d
exper ien ce of t h e profes s ion , h a n ded down t o u s in t h e a ccu mu la t ed medica l
lit er a t u r e of t h e a ge. In a n a t omy a n d ph ys iology, ( a n d in s u r ger y, t oo, t o
s ome ext en t ,) br a n ch es of t h is s cien ce, t r u t h a n d demon s t r a t ion ma y be
fou n d; bu t in t h e pr a ct ice of medicin e mor e u n cer t a in t y exis t s . Th e gr ea t
va r iet y of dis ea s es , a n d t h e in fin it e a n d ever va r yin g for ms in wh ich t h ey
a ppea r in livin g in dividu a ls , r en der it ver y difficu lt t o a s cer t a in , a lwa ys , wh a t
t h eir exa ct n a t u r es a r e, or wh a t a ppr opr ia t e r emedies s h ou ld be a pplied for
t h eir r emova l. An d in lookin g over t h e h is t or y of medica l pr a ct ice, a s
exh ibit ed in t h e books , it is cu r iou s t o obs er ve h ow ma n y s u cces s ive t h eor ies
h a ve been s et u p by on e ma n or s et of men , a n d h a ve been over t u r n ed a n d
demolis h ed by a n ot h er , or a ba n don ed by t h e a u t h or s t h ems elves . Th e ca u s e
of t h is gr ea t va r iet y a n d ch a n ge of opin ion is t o be fou n d, eit h er in a n h on es t
des ir e for t h e t r u t h , a n d a belief t h a t it h a s been dis cover ed, or in a des ir e t o
in t r odu ce s ome n ew t h eor y, t h a t ma y a t t r a ct n ot or iet y a n d pr omis e wea lt h t o
it s a dvoca t es . Th is h a s given r is e t o t h e n u mer ou s medica l s ys t ems a n d
den omin a t ion s wh ich h a ve exis t ed a n d con t in u e t o exis t . Th e gr ea t er r or h a s
been in for min g t heor ies u pon obs er va t ion s or s t a t emen t s , wit h ou t du ly
in qu ir in g wh et h er t h ey h a ve been s u fficien t ly n u mer ou s , a n d h a ve been
ca r efu lly a n d t r u t h fu lly ma de, u pon a u n ifor m a n d compr eh en s ive pla n , or
wh et h er t h ey a r e ot h er wis e imper fect . An y t h eor y, h owever pla u s ible, r es t in g
u pon a ba s is in wh ich imper fect ion exis t s , is lia ble t o be over t h r own .
On e gr ea t des ider a t u m s eems t o be a regis ter of cas es , for pr iva t e
pr ofes s ion a l pr a ct ice, con s t r u ct ed on a pla n s o s imple in it s requ ir emen t s , s o
con ven ien t in it s for m, a t s o low a cos t , a n d s o compr eh en s ive in it s des ign ,
t h a t it s h a ll commen d it s elf t o u n iver s a l fa vor , a n d be u n iver s a lly u s ed. If

113
Mann's Sixth Report or the Board or Education, p. 74.
157
s u ch a des ir a ble en d cou ld be a t t a in ed, mea n s wou ld be pr ovided, wh ich
h a ve n ot h it h er t o exis t ed, t o illu s t r a t e t h e ca u s es , n a t u r e, effect s , a n d
t r ea t men t of dis ea s e. Th e a bs t r a ct s of a la r ge n u mber of a u t h en t ic r egis t er s ,
if pr oper ly pr es en t ed t o t h e pu blic, wou ld, it is believed, over t h r ow a n d
des t r oy mu ch of t h e medica l t h eor y a n d pr a ct ice of t h e a ge, a n d in t r odu ce a
mor e n a t u r a l, r a t ion a l, a n d s u cces s fu l s ys t em.
Th e pr iva t e r egis t er of t h e medica l pr a ct it ion er ," s a ys Mr . Fa r r , wou ld,
a t t h e en d of a few yea r s , be of in ca lcu la ble ben efit t o h im; h e migh t r efer
ba ck t o it for impor t a n t in for ma t ion , t r a n s mit it t o h is s on s or s u cces s or s in
pr a ct ice, a n a lyze t h e r es u lt s of h is exper ien ce, a n d, in con ju n ct ion wit h h is
br et h r en a llover t h e cou n t r y, wou ld u lt ima t ely a ccu mu la t e a la r ge ma s s of
ma t er ia ls , wh ich cou ld n ot fa il t o a dva n ce medica l s cien ce. Too mu ch n eed
n ot be a t t empt ed a t fir s t ; a ll ca s es s h ou ld be n ot iced; bu t t h os e fa ct s s h ou ld
be ch iefly r ecor ded wh ich a r e of a n u n qu es t ion a ble n a t u r e, a n d t h a t a dmit of
pr ecis e s t a t emen t a n d compa r is on , in r es pect t o n u mber , t ime, weigh t , a n d
mea s u r e."
How s h a ll t h is r egis t er be con s t r u ct ed? We h a ve exa min ed a la r ge
n u mber of differ en t pla n s , bu t n on e of t h em exa ct ly meet ou r views . Aft er
con s u lt in g wit h s ever a l differ en t ph ys icia n s , wh os e opin ion s a n d a ppr ova l
a r e en t it led t o a ll r es pect , we pr opos e on e for a dopt ion , a dou ble pa ge of
wh ich is pr es en t ed a n d expla in ed in t h e a ppen dix. It ma y a t a low pr ice ; a n d
it s for m is s u ch t h a t it ma y be con ven ien t ly ca r r ied a bou t by t he
pr a ct it ion er , t h u s a llowin g h im t o h a ve a t h a n d t h e mea n s of en t er in g h is
obs er va t ion s in the place a n d at the time t h ey a r e ma de.
Su ch a r egis t er wou ld en a ble t h e ph ys icia n t o give t h e cer t ifica t e of t h e
ca u s e of dea t h , r equ ir ed u n der t h e r egis t r y la ws , a n d a ls o t o give t h e a mou n t
of s ickn es s s u ffer ed in a n y fa mily h e vis it s , a s pr opos ed t o be obt a in ed in ou r
XXVt h r ecommen da t ion .

XLVII. WE RECOMMEND that clergy men of all religious d enominations mak e
public health the s ubject of one or more d is cours es annually , bef ore their
congregations .
Th e Amer ica n Qu a r t er ly Regis t er , VoI. XII, for Febr u a r y 1840, con t a in s
a pla n for a n Eccles ia s t ica l Regis t er , in wh ich s ever a l for ms for keepin g
r ecor ds a r e s u gges t ed; a n d a mon g ot h er s , on e for t h e r ecor d of dea t h s wh ich
t a ke pla ce a mon g t h e member s of t h e ch u r ch a n d con gr ega t ion . Th e
in t r odu ct ion in t o Ma s s a ch u s et t s of a s ys t em of pu blic r egis t r a t ion r en der s
s ome of t h e pa r t icu la r s t h er e pr opos ed t o be r ecor ded, u n n eces s a r y; yet it
wou ld be u s efu l t o an y cler gyma n t o kn ow s ome fa ct s con cer n in g t h e h is t or y
of ever y per s on in h is con gr ega t ion , a n d es pecia lly t h os e wh o become or
cea s e t o be member s of h is ch u r ch ; a n d h e s h ou ld keep r ecor ds for h is
pu r pos e. Th e n a me, s ex, da t e of a n d a ge a t a dmis s ion , da t e of dis mis s ion , of
r emova l, or of dea t h ; ca u s e of a n d a ge a t dea t h ,-a r e impor t a n t t o be
r ecor ded. It wou ld en a ble h im t o give a h is t or y of h u ma n life, loca lized s o a s
t o in clu de a cqu a in t a n ces a n d fellow-wor s h ipper s . Th e in flu en ce of s ickn es s
a n d dea t h u pon t h e con gr ega t ion ; t h e n u mber wh o h a ve died du r in g t h e
yea r ; t h e in cr ea s e an d decr ea s e of epidemic a n d ot h er fa t al dis ea s es ; t h e
s t a t e of t h e pu blic hea lt h of t h e t own , of t h e St a t e, a n d of t h e wor ld; t h e la ws
by wh ich ph ys ica l life a n d h ea lt h a r e impr oved; t h e won der fu l pla n of
h u ma n or ga n iza t ion ; t h e in comin gs a n d ou t goin gs of h u ma n exis t en ce;
158
ma n 's mor t a lit y, a n d it s con n ect ion wit h immor t a lit y; t h e n a t u r e, des ign ,
a n d impor t a n ce of s a n it a r y mea s u r es , a n d t h eir in t ima t e r ela t ion t o mor a l
a n d s pir it u a l life ; an d t h e va r iou s colla t er a l s u bject s con n ect ed wit h t h es e
ma t t er s , a r e t h emes of a bs or bin g in t er es t , a n d ca n n ot fa il of s u gges t in g t h e
mos t u s efu l a n d impor t a n t les s on s ,-ph ys ica l, s ocia l, mor a l, a n d r eligiou s ; -
a n d a s s u ch , t h ey ver y a ppr opr ia t ely come wit h in t h e s ph er e of a
cler gyma n 's du t y.

XLVIII. WE RECOMMEND that each f amily k eep s uch records as will s how
the phy s ical and s anitary cond ition of its members .
Bet ween t h e s a n it a r y con dit ion of fa milies a n d of t h e St a t e a n in t ima t e
r ela t ion exis t s . Wh a t a ffect s t h e for mer mu s t of cou r s e a ffect t h e la t t er . An d
r efor m, if begu n a t a ll, mu s t fir s t commen ce in t h es e pr ima r y commu n it ies .
It is h er e t h a t t h os e gr ea t pr in ciples of s a n it a r y impr ovemen t , wh ich pr omis e
s u ch fa vor a ble r es u lt s , mu s t fir s t be a dopt ed a n d developed. A s ys t em of
s imple bu t exa ct obs er va t ion s , con cer n in g t h e ph ys ica l con dit ion a n d
pr ogr es s of t h e differ en t member s of t h e fa mily, wou ld gr ea t ly a id a n
con cer n ed in t h e a dopt ion of s u ch a pla n of ma n a gemen t a s wou ld pr omot e
t h eir h igh es t welfa r e a n d impr ovemen t .
In 1841, a Sys t em of Fa mily Regis t r a t ion " wa s pu blis h ed, wh ich
con t a in ed, a mon g ot h er ma t t er s , bla n ks , for en t er in g, in a s imple a n d
con cis e ma n n er , s ome of t h e per s on a l a n d ph ys ica l fa ct s con cer n in g t h e
member s of t h e fa mily. Amon g t h e bla n ks wa s on e des ign ed t o exh ibit s ome
of t h e ma in fa ct s con cer n in g ea ch ch ild; a n ot h er , t h e s ickn es s s u ffer ed;
a n ot h er , t h e pr ogr es s ive developmen t in weigh t a n d h eigh t ; a n d a n ot h er , t h e
a ver a ge ph ys ica l a n d s ocia l con dit ion , t h e in cr ea s e, a n d t h e lon gevit y of t h e
member s of t h e fa milies bea r in g on es own n a me, fr om wh om des cen ded,
a n d wit h wh om conn ect ed. Six cla s s es of fa ct s wer e s u gges t ed, wh ich might
come u n der n ot ice in t h e r ecor ds , t o be obs er ved or omit t ed, a s
cir cu ms t a n ces or con ven ien ce migh t dict a t e. 1.Fa ct s ; 2. In t ellect u a l Fa ct s ;
3. Mor a l a n d Religiou s Fa ct s ; 4. Pr ofes s ion a l Fa ct s ; 5. Mis cella n eou s Fa ct s ;
a n d 6. Gen er a l Res u lt s ." Th e des ign of t h es e s u gges t ion s wa s , t o obt a in t h e
ph ys ica l a n d s a n it a r y fa ct s r ela t in g t o gen ea logy .
114

114
We s elect the f ollowing inquires relating to the f irs t clas s of f acts :-
I. Phy s ical f acts .-1. The height and weight of children at birth, and at the end of each three months , during the f irs t y ear
of lif e; als o, the height, weight, and s trength of s everal members of the f amily m to be tak en and recorded on each birth-
day or new-y ears d ay . 2. At what age and date began to walk alone and to talk ; at what age attained the greates t
height, weight, and s trength; and at what age began to decline. 3. Caus es which promote or retard the growth of the
body . 4.The color of the hair, the ey es , the complexion of the s k in, the tone of the voice, or any other perculiar f ormation or
expres s ion, and whether they have been unif orm through lif e. 5. The prenological characteris tics and developments of the
different ind ividuals , and of the s ame ind ividuals at d ifferent ages . 6. In what res pects the children, either in pers on or
temperament, res emble the f ather, mother, or any other more d is tant ances tor or relative; and the peculiar temperament
or propens ity of individuals . 7. Effect of marriages between blood relations , and of other marriage connections ; and of
peculiar propens ities of f athers or mothers of offs pring. 8.Effect of peculiar d iet, f ood, clothing, exercis e, expos ure,
amus ements , and occupation of s edentary , active, and other habits of lif e; of climate, s eas ons , place of res idence, and
other external circums tances of inf luences on phy s ical developments , health, d is eas e, and lif e. 9.Accidents which affect
the bod y , the mind, and general health what they are, and the date and place of their occurrence. 10.When vaccinated,
or had meas les , hopping cough, or other epidemic d is eas es ; the name, characteris tics , and various forms of all d is eas es ,
the d ate of their commencement and termination, and their effect on the cons titution; the length of time d is abled by
s ick nes s , name of f ailure. 12.The caus e, place, and particulars of death. As a further illus tration of this s ubject, we have
compiled f rom M. Quetelets valuable work , Sur LHomme, the f ollowing table, repres enting the weight and height of
males and f emales , in Belgium, at d ifferent periods of lif e:-- The report on The Phy s ical and Moral Condition of the
Children and Young Pers ons employ ed in Mines and Mauf actories , contras ts the height and s iz e of children employ ed. in
mines and on f arms . From this report, it appears that 10 collier boy s , between 12 and 14 y ears of age, meas ured, in the
aggregate, 44 feet 6 inches in height, and 274 inches round the breas t; while 10 f arm boy s meas ured 47 feet in height
and 272 inches round the breas t. And 10 collier girls, between the ages of 14 and 17, meas ured in the aggregate 46
feet 4 inches in height, and 293 inches round the breas t; while 10 f arm girls meas ured 50 feet 5 inches in height,

159

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Th e followin g fa ct s a r e s elect ed, a s illu s t r a t ion s , fr om t h e en t r ies
con cer n in g five fa milies in Ma s s a ch u s et t s ,-A, B, C, D, a n d E, -in t h e t a ble
en t it led Th e Ph ys ica l a n d Socia l Con dit ion , t h e In cr ea s e a n d Lon gevit y :"-

1
The following are the head ings of s ome of thes e blank f orms . One of them covers two oppos ite pages , f or mak in, on the
lef t, a record concerning the f ather, and, on the right, concerning the mother; and, under them, the f ollowing particulars
concerning the children:-and 297 inches round the breas t. Other s imilar f acts might be extracted from that report. They
s how that employ ment and external circums tances have an important inf luence upon human growth and development.
Such f acts , when derived from and extens ive s eries of obs ervations are extremely interes ting.
Records have been k ept by s ome of the phy s icians , as they s hould be by all in Mas s achus etts , of the height and weight of
children at birth. From an exceedingly valuable paper On S tatis tics of Mid wif ery , by Dr, John G, Metcalf , of Mendon,
publis hed in the American Journal of Medical Sciences , Vol. XIV, for 1847, p. 295, we learn that of 836 children born in
Mendon and vicinity the average weight of 429 males was 8 lbs . 10 oz . each, and of 407 females was 8 lbs . each; and of
407 females was 8 lbs . each and the average height of 242 was 19 inches . This s hows a larger inf ant development
than in Belgium, as ind icated in the table.
160

Su bject s of In qu iry A. B. C. D. E. Tot a l
Ch ildren in t he fa milies 60 34 19 32 25 170
Ma le ch ildren 31 19 11 16 13 90
Fema le ch ildren 29 15 8 16 12 80
Ma les wh o were ma rried 29 13 11 16 10 79
Th eir a vera ge a ge a t ma rria ge 24 25 25 28 27 25.5
Fema les wh o were ma rried 25 11 6 13 9 64
Th eir a vera ge a ge a t ma rria ge 24 27 24 24.5 23 24.5
Avera ge birt h s t o ea ch ma rria ge 7 7 5 7 9 7
Ma les wh os e a ges a t dea t h were kn own 23 15 9 10 6 63
Th eir a ge a t dea t h 65.5 58.5 76 66 68 65
Fema les wh os e a ges a t dea t h were kn own 6 11 6 7 2 32
Th eir a ge a t dea t h 65 57 46 55 58 55



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Bir t h 1.64 7.06 1.61 6.42 14 4.90 85.48 4.77 80.94
1yr 2.29 20.84 2.26 19.39 15 5.07 96.40 4.92 89.04
2 2.60 25.01 2.56 23.53 16 5.23 109.55 5.04 96.09
3 2.83 27.50 2.79 26.00 17 5.36 116.56 5.10 104.34
4 3.04 31.38 3.00 28.67 18 5.41 127.59 5.13 112.55
5 3.24 34.78 3.20 31.67 20 5.49 132.46 5.16 115.30
6 3.44 38.80 3.38 35.29 25 5.51 138.79 5.17 117.51
7 3.63 42.98 3.56 38.68 30 5.52 140.38 5.18 119.82
8 3.81 45.78 3.74 42.68 40 5.52 140.42 5.18 121.81
9 4.00 49.95 3.92 47.10 50 5.49 139.96 5.04 123.86
10 4.18 54.08 4.09 51.87 60 5.38 136.07 4.97 119.76
11 4.36 59.77 4.26 56.57 70 5.32 131.27 4.97 113.60
12 4.54 65.77 4.44 65.77 80 5.29 127.54 4.94 108.88
13 4.72 75.80 4.60 72.65 90 5.29 127.56 4.93 108.81


Th is t a ble s h ows , in t h e la s t colu mn , t h a t in t h e t ot a l of t h e five fa milies
n a med, con t a in in g 170 per s on s , 90 wer e ma les ,a n d 80 wer e fema les ; t h a t 79
ma les wer e ma r r ied a t t h e a ver a ge a ge of 25 yea r s , a n d 64 fema les a t t he
a ver a ge a ge of 24 yea r s ; t h a t ea ch ma r r ia ge pr odu ced 7 ch ildr en ; a n d t h a t
t h e a ver a ge a ge a t dea t h , of t h e ma les , wa s 65 yea r s , a n d of fema les , 55
yea r s .
An ot h er s t a t emen t , compiled fr om a la r ger n u mber of fa milies a n d
in s er t ed in t h e s ame bla n k for m, exh ibit s t h e followin g fa ct s :-In 306
fa milies , con t a in in g 2,267 ch ildr en , -1,197 ma les , a n d 1,070 fema les ,-1,680,
or 74 per cen t ., were ma r r ied, a n d 587, or 26 per cen t ., wer e n ot ma r r ied.
Ea ch ma r r ia ge pr odu ced 7,3 ch ildr en .
161
If s imila r obs er va t ion s , mor e or les s ext en ded, a bs t r a ct ed, con cer n in g a
la r ge n u mber of families , t h e r es u lt s migh t s h ow, in a s t r ikin g ma n n er t he
.ph ilos oph ica l a n d s t a t is t ica l u s es of gen ea logy, a n d cou ld n ot fa il t o oper a t e
fa vor a bly u pon t h e s a n it a r y welfa r e of a ll con cer n ed.



XLIX. WE RECOMMEND that parents , and others to whom the care of thos e
in inf ancy and childhood are intrus ted, endeavor to unders tand and d is charge
their duties s o that a good found ation may be laid f or vigorous manhood and
old age.
Th e ma n a gemen t of in fa n cy a n d ch ildh ood h a s a n immen s e in flu en ce
u pon t h e h ea lt h , vigor , a n d con t in u a n ce of life; a n d t h e con cu r r en t
t es t imon y of a ll in t elligen t men , wh o h a ve exa min ed t h e s u bject , is , t h a t a
gr ea t pr opor t ion of debilit y, dis ea s e, pr ema t u r e dea t h s , a n d s a n it a ry
s u ffer in g, wh ich a re con s t a n t ly occu r rin g a r ou n d u s , is a t t r ibu t a ble t o
ign or a n ce of t h e phys ica l la ws , a n d in a t t en t ion t o t h e ph ys ica l la ws , a n d
ea r ly yea r s ,-t h e for ma t ive per iods of life. Debilit y, s cr ofu la , con s u mpt ion a n d
pr ema t u r e deca y, a s well a s va r iou s epidemic dis ea s e, a r e br ou gh t on a n d
a cceler a t ed t o t h eir fa t a l t er min a t ion , by n eglect of a pr oper s ys t em of
ma n a gemen t fr om t h e ver y commen cemen t of in fa n t exis t en ce. If t h e h is t or y
of t h e gr owt h a n d developmen t of t h e h u ma n body, of it s pa r en t a l
ma n a gemen t , a n d of t h e da n ger s t o wh ich it h a s been expos ed a t it s ea r ly
per iods , cou ld be t r u t h fu lly ma de a n d s pr ea d befor e u s , wh a t a les s on wou ld
it give of t h e imper fect ion of h u ma n kn owledge, a n d of t h e dis obedien ce of
t h os e wis e la ws wh ich t h e Cr ea t or h a s given for ou r gu ida n ce! Fr om on e-
t h ir d t o on e-h a lf of a ll t h e dea t h s in popu lou s cit ies . a n d villa ges , a n d a bou t
on e qu a r t er in a ll pla ces , a r e t h os e of ch ildr en u n der five yea r s of a ge. If t h e
la ws of h ea lt h a n d life h a d been kn own a n d obeyed, t h is gr ea t s a n it a r y evil
migh t h a ve been ma t er ia lly les s en ed, a n d t h ou s a n ds of lives migh t h a ve
been pr es er ved, wh ich h a ve been los t .
Th is is a gr ea t , a n a ll-impor t a n t ma t t er , a n d des er ves t o be t h or ou gh ly
exa min ed a n d ca r efu lly s t u died in a ll it s bea r in gs , by fa t h er s a n d mot h er s ,
a n d t h os e wh o expect t o be fa t h er s a n d mot h er s , a s well a s by n u r s es ,
gover n es s es , t ea ch er s , a n d a ll ot h er s in t er es t ed in t h e ca r e of t h e you n g. Th e
s u bject is t oo gr ea t , h owever , for dis cu s s ion in t h is con n ect ion . Ou r pu r pos e
is mer ely t o ca ll pu blic a t t en t ion t o it , a s on e of t h e s a n it a r y mea s u r es in
wh ich t h er e is gr eat r oom for r efor m, a n d in wh ich r ea l refor m wou ld be
immen s ely ben eficia l. Th er e a r e ma n y va lu a ble wor ks a lr ea dy pu blis h ed,
wh ich a ffor d u s efu l in s t r u ct ion on t h e s u b;ect . Th es e wor ks , t h e les s on s of
exper ien ce wh ich t h e mor e a ged a n d t h e wis e migh t impa r t , a n d ea ch on e's
own ca r efu l exa mina t ion a n d r eflect ion , migh t s u gges t s ys t ems a da pt ed t o
differ en t cir cu ms t a n ces ; t h e vit a l for ce of in comin g gen er a t ion s migh t t h u s
be gr ea t ly in cr ea s ed, a n d t h e life of ma n y a n d ma n y a u s efu l cit izen
pr olon ged.
115

L. WE RECOMMEND that ind ividuals mak e f requent s anitary examinations of
thems elves , and endeavor to promote pers onal health, and prevent pers onal
d is eas e.

115
The Phy s iological and Moral Management of Inf ancy ," by Dr. Andrew Combe, is one of the bes t popular work s on the
s ub;ect with which we are acquainted.
162
If t h er e is a fa u lt in t h e pr in t ed dis cu s s ion s of s a n it a r y r efor mer s , it is
in a t t a ch in g t oo mu ch impor t a n ce t o pu blic a n d t oo lit t le t o per s on a l
mea s u r es , for t h e pr omot ion of h ea lt h . Th e ca u s es of dis ea s e ma y be
diffu s ed in t h e a t mos ph er e, or ma y exis t in a loca lit y, or ma y be con n ect ed
wit h t h e in dividu a l h ims elf. If t h e per s on be well for t ified a n d well gu a r ded,
lit t le n eed be fea r ed fr om a n u n s ea s on a ble in va s ion of t h e en emy fr om
wit h ou t ; bu t if ot h er wis e, it s on s et will be ea s y a n d it s vict or y cer t a in . Th is is
a ma t t er in wh ich u n cer t a in t y s h ou ld, a s fa r a s pos s ible, be exclu ded. We
s h ou ld n ot gu es s a t t h e va lu e of life, or t h e mode of pr es er vin g it . Ever y
per s on s h ou ld k now, by h is own obs er va t ion a n d exper ien ce; h is own
ca pa bilit ies a n d h is own lia bilit ies ; a n d ma ke ma t t er of pr es er vin g h is h ea lt h
a n d con t in u in g t h e s a me ca r e a n d pr u den t for et h ou gh t , a n d a pply t o it t h e
s a me in t elligen ce a n d s a ga cit y, t h a t h e u s es in a n y or a ll of h is or din a r y
a ffa ir s .
Ever y per s on s h ou ld ma ke fr equ en t s a n it a r y in ves t iga t ion s r ela t in g t o
h ims elf. Th e h is t or y a n d con dit ion of h is con s t it u t ion s h ou ld be s t u died. Th e
h er edit a r y or ga n iza t on a n d t en den cy, a n d t h e ch a r a ct er of t h e blood t h a t
cou r s es in h is vein s , s h ou ld be a s cer t a in ed. Th e a lt er a t ion s of t h e or igin a l
con s t it u t ion , pr odu ced by dis ea s e, h a bit s of life, or a n y ot h er mea n s , a n d t h e
ca u s es of t h es e a lt er a t ion s , a n d t h e r emedies t h a t h a ve been u s ed t o
cou n t er a ct a n d pr even t t h eir effect s , be ca r efu lly s t u died a n d n ot ed. Th e
in flu en ce of va r iou s h a bit s a n d a ct ion s u pon t h e or ga n s a n d fu n ct ion s of ou r
bodies , wh et h er r ela t in g t o t h eir pr ot ect ion , n ou r is h men t , or pr es er va t ion ,
s h ou ld be ca r efu lly obs er ved; a n d s u ch a s a r e fou n d t o be fa vor a ble s h ou ld
be r epea t ed, a n d s u ch a s a r e kn own t o be u n fa vora ble s h ou ld be
dis con t in u ed. Ever yt h in g wh ich ma y excit e or develop a n u n h ea lt h y
t en den cy, h er edit a r y or a qu ir ed, s h ou ld, a s fa r a s pos s ible, be a voided; a n d
ever yt h in g of a n oppos it e t en den cy s h ou ld be don e t o ch eck s u ch
developmen t .
Ou r per s on s s h ou ld be protected, a n d kept in u n ifor m t emper a t u r e, by
clot h in g of t h e r igh t kin d, pr oper ly ma de, a n d wor n a t s u ch t imes , in s u ch a
ma n n er , a n d in s u ch qu a n t it ies , a s a r e bes t a da pt ed t o pr omot e h ea lt h .
Dis ea s e s h ou ld n ot be a llowed t o in va de t h e s ys t em by mea n s of t oo lit t le or
t oo mu ch clot h in g, or t h r ou gh a n y ot h er defect or imper fect ion ; bu t ea ch
per s on s h ou ld wea r ju s t s u ch clot h in g, a t a ll t imes , a s will in volve t h e lea s t
r is k, a n d pr odu ce t h e gr ea t es t vigor a n d ph ys ica l en joymen t .
Ou r per s on s s h ou ld be nouris hed by food of t h e r igh t kin d, a n d in s u ch
qu a n t it ies , a s will pr omot e t h e gr ea t es t vigor . We s h ou ld " ea t t h a t we ma y
live, n ot live t h a t we ma y ea t ;" t a ke food t o n ou r is h u s , n ot t o s a t ia t e a
depr a ved a ppet it e; a n d a da pt ou r food a n d ou r r egimen , a t a ll t imes , t o t h e
pr es en t ph ys ica l a n d s a n it a r y con dit ion of t h e body. Wh en debilit a t ed a n d
fa t igu ed, we ca n n ot t a ke wit h impu n it y t h e s a me kin d or qu a n t it y of food a s
wh en in a differ en t con dit ion .
Ou r per s on s s h ou ld be pres erved a n d s trengthened by wis e a n d u n ifor m
ca r e a n d t r a in in g. We s h ou ld clea n s e ou r per s on s by da ily a blu t ion s ,
pr oper ly a pplied, a t s u it a ble t imes , a n d of t h e r igh t kin d an d t emper a t u r e;
s trengthen ou r per s on s , ph ys ica lly a n d in t ellect u a lly, by r egu la r a n d
pr ogr es s ive, n ot t r an s ien t a n d exces s ive, exer cis e a n d la bor , a t s u ch t imes ,
t o s u ch a n d in s u ch pla ces , a s will be mos t in vigor a t in g; a n d s h ou ld refres h
163
ou r per s on s by r es t a n d s leep, a t pr oper t imes , in r igh t pla ces , by s u it a ble
mea n s , a n d in s u fficien t qu a n t it ies .
Wh a t is r igh t a n d s u it a ble a n d pr oper , in ea ch of t h es e ca s es , mu s t be
det er min ed by ea ch on e's own in t elligen ce, obs er va t ion , exper ien ce, feelin gs ,
a n d con dit ion , a s cer t a in ed by h ims elf. If ca r efu l pers on a l s a n it a r y
exa min a t ion s wer e fr equ en t ly ma de in t h is wa y, a n d per s on a l h ea lt h wa s
gu a r ded a n d impr oved by t h es e mea n s , we s h ou ld h ea r les s of t h e r a va ges of
ch oler a ; t yph u s , a n d ot h er epidemics , a n d of is ola t ed s por a dic dis ea s es .

IV. REASONS FOR APPROVING THE PLAN RECOMMENDED

We h a ve pr es en t ed, in t h e pr ecedin g pa ges , s ome of t h e pr in cipa l
mea s u r es t h a t h a ve occu r r ed t o u s a s wor t h y of bein g embr a ced in a pla n for
a s a n it a r y s u r vey of t h e St a t e, wh ich we r ecommen d for a dopt ion . We migh t
h a ve in clu ded ot h er colla t er a l s u bject s , a n d migh t h a ve given a mor e fu ll
expla n a t ion a n d illu s t r a t ion of t h os e a lr ea dy pr es en t ed, bu t t h e occa s ion did
n ot s eem t o r equ ir e it or ma ke it n eces s a r y . Ou r des ign will h a ve been
a ccomplis h ed if ou r r ecommen da t ion s h a ve been expla in ed s u fficien t ly t o be
gen er a lly u n der s t ood a n d ca pa ble of bein g r edu ced t o pr a ct ica l oper a t ion . We
cla im for t h e wh ole pla n , a n d for ea ch pa r t of it in con n ect ion wit h t h e ot h er
pa r t s , a ca r efu l con s ider a t ion befor e ju dgmen t is pa s s ed u pon it , a n d wh en
s o con s ider ed we ha ve gr ea t con fiden ce t h a t s h a ll h a ve t h e a ppr ova l of a ll
ca n did min ds . We h a ve a lr ea dy given , in t h e illu s t r a t ion s of t h e s ever al
r ecommen da t ion s , ma n y r ea s on s for t h eir a ppr ova l; a n d t h ey a r e s u fficien t ,
it is s u ppos ed, t o in clin e mos t in t elligen t min ds in t h eir fa vor ; we migh t
s a fely lea ve t h e s u bject h er e wit h ou t fu r t h er dis cu s s ion . Th er e a r e, h owever ,
s ome gen er a l con s ider a t ion s in fa vor of t h e pla n wh ich we deem it pr oper t o
pr es en t .
I. It s hould be approved becaus e it is a practical meas ure. Th e gr ea t outline
of the plan is t h e Es t a blis h men t of a Cen t r a l Gen er a l Boa r d of Hea lt h for t h e
wh ole St a t e, a n d a Loca l Boa r d of Hea lt h for ea ch cit y a n d t own in t h e St a t e;
ea ch t o be compos ed of compet en t men , wh o a r e t o h a ve gen er a l
s u per in t en den ce of a ll ma t t er s r ela t in g t o t h e pu blic h ea lt h wit h in t h eir
r es pect ive ju r is dict ion s . Th es e Boa r ds , h a vin g t h e a s s is t a n ce a nd
cooper a t ion of t h e people in a ll pa r t s of t h e Common wea lt h , wou ld be a ble t o
br in g t o bea r , by pr a ct ica l, s ys t ema t ic, u n ifor m, a n d efficien t pla n , a va s t
n u mber of min ds a n d a gr ea t a mou n t of in t elligen ce u pon t h e s u bject of
h ea lt h , a n d u pon t h e ca u s es a n d pr even t ion of dis ea s e; a n d it is impos s ible
t o for et ell t h e immen s e a dva n t a ges wh ich migh t r es u lt fr om t h e fa ct s t h ey
migh t collect , a n d fr om t h e t h ey migh t ma ke, r ela t in g t o t h e n u mber of of
lives s a ved, t h e pr olon ga t ion of t h e per iods of h u ma n exis t en ce, a n d t h e
dimin u t ion of h u ma n s u ffer in g.
In t h e pr epa r a t ion of t h e pla n , we h a ve des ir ed, on t h e on e h a n d, t o
a void t oo mu ch , a nd on t h e ot h er t oo lit t le complica t ion a n d det a il. Th e
pr opos ed a ct , wh ich is t h e ma in lega l fou n da t ion of t h e pla n , is des ign ed t o
occu py t h e middle gr ou n d bet ween t h es e t wo ext r emes . It con t a in s n o
pr ovis ion s wh ich s eem t o u s u n es s en t ia l, a n d it is des ign ed t o con t a in a ll
s u ch a s a r e n eces s a r y. So impor t a n t a ma t t er ca n n ot be pr ovided for by a
few gen er a l s ect ion s . It mu s t be ma de clea r a n d s imple; a n d con s ider a ble
det a il is r equ ir ed for t h is pu r pos e, ot h er wis e it ca n n ot be u n der s t ood, a n d
164
ea s ily in t r odu ced in t o a ll t h e t own s in t h e St a t e. It is believed t h a t if t h e a ct
wer e pa s s ed a n d pu t in t o oper a t ion by s u ch Boa r ds of Hea lt h a s migh t a n d
ou gh t t o be a ppoin t ed u n der it s pr ovis ion s , n ot h in g wou ld be r equ ir ed bu t
or din a r y in t elligen ce a n d a t t en t ion t o ma ke it s u cces s ft t l, a n d t h is ever y
mea s u r e mu s t h a ve or it will be u s eles s . If t h is a ct s h ou ld become a la w,
s ever a l of t h e r ecommen da t ion s mu s t be ca r r ied in t o effect ; ot h er s ma y or
ma y n ot be, a s cir cu ms t a n ces ma y r en der it n eces s a r y or expedien t . Th e
XIIt h , XIIIt h , XVlIt h , XXXIs t , XXXIIn d, a n d XXXVIt h , wou ld r equ ir e
a ddit ion a l legis la t ion t o ca r r y t h em in t o oper a t ion . Th e r ecommen da t ion s
r ela t in g t o s ocia l a n d per s on a l ma t t er s a r e des ign ed for t h e gen er a l good,
a n d come in a id of t h e ot h er s wit h ou t s pecia l legis la t ion . Th ey ma y or ma y
n ot be a dopt ed, a ccor din g t o in clin a t ion of t h os e in t er es t ed.
An d wh a t is t h e des ign , wh a t a r e t h e pu r pos es of t h is mea s u r e? Wh a t
will it pr oba bly a ccomplis h , if ca r r ied in t o execu t ion ?
It would s ave lif e. It h a s been well s a id :- " In En gla n d a lon e, t h e
a ver a ge a n n u a l n u mber of dea t h s fr om dis ea s e is , in r ou n d n u mber s ,
300,000, wh ile t h a t of dea t h s fr om t h e mer e deca y a n d exh a u s t ion of t h e
h u ma n fr a me by t h e pr ogr es s of t ime, is on ly 35,000. In t h e differ en ce
bet ween t h es e t wo n u mber s we s ee t h e va s t a n d vit a l field in wh ich t h e
s a n it a r y r efor mer pr opos es t o wor k. Th a t dis ea s e s h a ll ever be en t ir ely
ext er min a t ed, is of cou r s e beyon d t h e belief or h ope of t h e mos t s a n gu in e.
Bu t ever y dis ea s e h a s s omewh er e it s s pecific a n d efficien t ca u s e,-a n d t h a t
t h es e ca u s es ca n be r emoved or mu ch wea ken ed in t h eir a ct ion , in ver y
ma n y in s t a n ces , is n ot on ly wit h in t h e bou n ds of h ope, bu t h a s been
s a t is fa ct or ily pr oved. Wh en s a n it a r y legis la t ion gives u s it s s u cces s fu l
r es u lt s , t h ey will be r epr es en t ed by t h e r edu ct ion of t h e n u mber of t h os e wh o
die of dis ea s e in t h eir ea r ly da ys , or in t h e pr ime of life-a n d in t h e in cr ea s ed
n u mber of t h os e wh o h a ve complet ed t h eir a llot t ed cou r s e in h ea lt h , a n d
been pea cefu lly ga t h er ed t o t h eir fa t h er s . Accor din gly, s a n it a r y
impr ovemen t s h a ve n ot dir ect ly in view t h e ext en s ion of t h e n a t u r a l per iod of
h u ma n life, bu t on ly t h e r emova l of in flu en ces wh ich a r t ificia lly cu r t a il it .
116


Simila r illu s t r a t ion s ma y be der ived fr om obs er va t ion s a mon g u s . In
Ma s s a ch u s et t s , du r in g t h e s even yea r s cover ed by Regis t r a t ion Repor t s ,
64,510 dea t h s , in a ll t h e cou n t ies except Su ffolk, wer e r ecor ded a n d
r et u r n ed t o t h e office of t h e Secr et a r y of St a t e; a n d of t h es e, 4,414, or 6.84
per cen t . on ly, r ecor ded a s h a vin g died of old a ge, a n d 93.16 per cen t fr om
dis ea s es a n d ot h er ca u s es .
In Bos t on , du r in g t h ir t y-n in e yea r s , 1811 t o 1849 in clu s ive, 62,431
dea t h s t ook pla ce, of wh ich 2,079, or 3.33 per cen t on ly, wer e fr om old a ge,
a n d 96.67 per cen t fr om dis ea s es a n d ot h er ca u s es ; a n d for t h e yea r 1849 it
a ppea r s s t ill mor e u n fa vor a ble, bein g 5,079 fr om a ll ca u s es , a n d 95, or 1.87
per cen t on ly fr om old a ge, a n d 98.13 per cen t . fr om ot h er ca u s es . It n ot a
pr a ct ica l mea s u r e t o pr even t s ome of t h is gr ea t a mou n t of dis ea s e, a n d
a s s is t s ome of t h es e lives t h a t t h ey ma y old, a n d die on ly beca u s e t h ey a r e
old ?
We h a ve con s t r u ct ed a n d given a ver y impor t a n t s h owin g t h e la w of
mor t a lit y for Bos t on , a t t h r ee per iods , a n d a ls o for a dis t r ict of t h e a ver a ge
h ea lt h of t h e cou n t r y t own s in t h e St a t e. By t h is t a ble it a ppea r s t h a t

116
Edinburgh Review, Vol. XCI, f or Jan. 1850, p. 210
165
per cen t ., or 1 in 67 of t h e popu la t ion , is a bou t t h e r a t e of mor t a lit y for t h e
in t er ior h ea lt h y t own s in New En gla n d. In s ome t own s it r is es a bove a n d in
ot h er s fa lls below t ha t r a t e; bu t t h a t may be a s s u med a s a h ea lt h y s t a n da r d.
Th is is n ea r ly t h e r a t e of t h e h ea lt h y dis t r ict s in En gla n d. It a ls o a ppea r s
t h a t in Bos t on , du r in g t h e la s t n in e yea r s , t h e por t ion of dea t h 's wer e, on t h e
a ver a ge, 2.53 per cen t ., or 1 in 39. An d by t h e r epor t of t h e Cit y Regis t r a r
t h ey wer e, in a t t h e r a t e of 3.84 per cen t ., or 1 in 26 of t h e of 132,000. If
Bos t on h a d s u ffer ed a n a n n u a l los s by dea t h of 1 per cen t ., equ a l t o t h e
a ver a ge h ea lt h y cou n t r y t own s , in s t ea d of 2.53 per cen t ., t h er e wou ld h a ve
been on t h e a ver a ge for t h e la s t n in e yea r s , 1,715 dea t h s an n u a lly, in s t ea d
of 2,903; s h owin g a n exces s of 1,188 u n n eces s a r y. An d by a pplyin g t h e
s a me r u le t o t h e yea r 1849, it will give 1, 980 dea t h s on ly, wh ich s h ou ld h a ve
t a ken pla ce, in s t ea d of 5,079, s h owin g a n exces s , for t h a t yea r a lon e, of
3,099 u n n eces s a r y dea t h s ! a n d t h is is on t h e s u ppos it ion t h a t t h e r a t e ma y
r ema in a t 1 per cen t ., wh en it is believed t o be pos s ible t o r a is e t h e pu blic
h ea lt h t o a s t a t e even bet t er t h a n t h a t . Wh a t Bos t on s u ffers , in s o gr ea t a
degr ee, is s u ffer ed, t o a gr ea t er or les s ext en t , in a ll pla ces , cit y a n d cou n t r y.
Ver y ma n y cou n t r y t own s s u ffer gr ea t u n n eces s a r y mor t a lit y; a n d is it n ot a
pr a ct ica l mea s u r e t o pr even t a s mu ch of t h is exces s of dea t h s a s pos s ible?
It would prevent s ick nes s . We h a ve s t a t ed t h a t t h e es t ima t ed r a t e wh ich
s ickn es s is s u ppos ed t o bea r t o t h e popu la t ion is dou ble t h e r a t e per cen t . of
t h e a n n u a l dea t h s . Th is r u le, if a pplied t o ou r popu la t ion , wou ld in dica t e, in
t h e opin ion of s ome, t oo mu ch , a n d of ot h er s t oo lit t le s ickn es s . Bu t
a s s u min g it t o be n ea r ly t h e a ver a ge, u n t il we get mor e per fect r et u r n s , let u s
ma ke t h e a pplica t ion . Th e a ver a ge n u mber s ick du r in g t h e wh ole yea r , in a
h ea lt h y cou n t r y t own , is (1 X 2) 3 per cen t . of t h e popu la t ion ; a n d in
Bos t on for t h e la s t 9 yea r s (2.53X2) 5. 06 per cen t ., a n d for t h e yea r 1849
(3.84X2) 7.68 per cen t . Accor din g t o t h is r u le, if Bos t on h a d s u ffer ed n o
mor e t h a n a h ea lt h y cou n t r y t own , s h e wou ld h a ve h a d bu t 3,960 per s on s
con s t a n t ly s ick, or s u ffer ed t h a t n u mber of yea r s ' s ickn es s in t h e a ggr ega t e,
in s t ea d of 9,837 ; s h owin g a n exces s of u n n eces s a r y s ickn es s , for t h a t yea r
on ly, of 5,871 yea r s !
Applyin g t h e s a me r u le t o t h e cou n t r y t own s , it will s h ow a n immen s e
t h ou gh n ot s o gr ea t a pr opor t ion of u n n eces s a r y s ickn es s . Es t ima t in g t h e
popu la t ion of t h e St a t e a t 800,000, a n d a s s u min g it t o en ;oy a h ea lt h y
s t a n da r d, t h er e wou ld be 12,000 dea t h s a n n u a lly, a n d 24,000 per s on s
con s t a n t ly s ick. Bu t t h e dea t h s r et u r n ed in t h e cou n t ies ot h er t h a n Su ffolk,
wer e 11,346 for t he yea r en din g Ma y 1, 1848, a n d ver y ma n y wer e n ot
r et u r n ed a t a ll. An a bs t r a ct of t h e r et u r n s of dea t h s for 1849, h a s n ot yet
been ma de, bu t wh en it is ma de we h a ve n o dou bt t h a t it will s h ow a n
a n n u a l mor t a lit y a s h igh a s 21 per cen t . , or a n exces s in t h e wh ole St a t e of
6,000 u n n eces s a r y dea t h s , a n d of 12,000 yea r s of u n n eces s a r y s ickn es s !
It would increas e the vital f orce. We h a ve pr es en t ed t h e los s of life a n d
t h e a mou n t of s icknes s a s t wo of t h e grea t wh ich t h e people s u ffer . An ot h er
is fou n d in t h e -of impa ir ed h ea lt h a n d ph ys ica l debilit y wh ich exis t t h os e
n ot a ct u a lly dis a bled by s ickn es s . Ma n y, ver y ma n y, move feebly a bou t ,
dis ch a r gin g imper fect ly t h e gr ea t life, an d h a ve n ot t h e ca pa cit y t o per for m
t h e la bor wh ich per fect h ea lt h a llows .
"Th e a ggr ega t ion of a ll t h e ph ys ica l power s , t h e or igin a l or ga n iza t ion ,
t h e u n it ed en er gies of t h e n u t r it ive, r es pir a t or y, cu t a n eou s , locomot ive, a n d
166
n er vou s a ct ion s , a n d t h e pr edomin a n ce of t h e vit a l over t h e ch emica l
a ffin it ies , cooper a t e in t h e pr odu ct ion of vital f orce; a n d t h es e t oget h er ma ke
u p wh a t common ly ca lled t h e cons titution of ma n ,-t h a t is , h is power for la bor
or en du r a n ce, -h is power of a ccomplis h in g h is pu r pos es : or r es is t in g t h e
ca u s es of in ju r y.
" Th is con s t it u t ion , or t h is qu a n t u m of vit a l for ce, ma y con s ider ed a s
t h e capital of lif e, wit h wh ich ma n oper a t es , does a ll h is wor k, en joys a ll h is
plea s u r es , a n d s u s t a in s in h is pr es en t bein g.
" Some few per s on s h a ve on ly vit a l for ce s u fficien t t o s u s t a in life. Th ey
ca n diges t t h eir food, a n d per for m fu n ct ion s n eces s a r y for t h e r eplen is h men t
of t h e exh a u s t ed power s , a n d n o mor e. Th ey ca n on ly keep t h eir vit a l ch in es
in oper a t ion . Bu t mos t per s on s h a ve mor e t h a n t h is . Aft er s u pplyin g t h eir
n a t u r a l wa n t s , a n d r a is in g t h e power of t h e ma ch in e t o it s h igh es t h ea lt h y
poin t , t h en dedu ct in g vit a l for ce n eces s a r y for t h es e from t h e wh ole
con s t it u t ion a l for ce, t h er e is in t h em a s u r plu s of en er gy left t o be dis pos ed
of ot h er wis e; a n d t h is ma y be expen ded, a t t h eir own a ct ion s of t h e mu s cles
or of t h e br a in , for pr ofit or for plea s u r e.
"If t h e con s t it u t iona l power is con s ider ed a s t h e ca pit a l of life, t h is
s u r plu s en er gy ma y be con s ider ed a s t h e income of lif e. Th is ma y be
expen ded da ily, a n d yet lea ve u n impa ir ed. Bu t t h is expen dit u r e mu s t be
limit ed, in ea ch da y, t o t h e qu a n t it y of vit a l for ce t h a t is gen er a t ed by da y's
n u t r it ion , a n d ea ch n igh t 's s leep.
"Th is con s t it u t ion , or qu a n t it y of vit a l for ce, mu s t differ in differ en t
per s on s , a n d in s ome it differ s ver y widely. Th er e a r e differ en ces in t h e
pr imor dia l elemen t s , in t h e or igin a l or ga n iza t ion , in t h e dis t r ibu t ion of
s t r en gt h t h r ou gh t he s ever a l or ga n s , in t h e t en a cit y of t h e vit a l pr in ciple,
a n d in t h e ea r ly developmen t of t h e power s .
Th er e a r e a ls o differ en ces in t h e s u bs equ en t ma n a gemen t of t h e
s ys t em, a n d in t h e a ppr opr ia t ion of t h e s u r plu s en er gies . Th e a n ima l
or ga n iza t ion is fir s t det er min ed by t h e Cr ea t or ; t h e con s t it u t ion is n ext
developed by t h os e wh o h a ve t h e ca r e of ch ildh ood a n d you t h , a n d t h en it is
en t r u s t ed t o t h e h an ds of ma n h ims elf, for pr es er va t ion an d for u s e. Th e
Cr ea t or does n ot r et a in a bs olu t e con t r ol over t h e or ga n s , n or h a s He
en dowed t h em wit h a cer t a in a n d ir r es is t ible for ce, by wh ich t h ey s h a ll
s u pply t h eir own wan t s , per for m t h eir fu n ct ion s , a n d r egu la t e t h eir a ct ion s
in t h e ma n n er wh ich is bes t for t h e wh ole. All of t h es e a dmit of va r iou s
degr ees ; a n d, in t h is br oa d la t it u de, ea ch on e mu s t s eek ou t for h ims elf t h a t
degr ee wh ich is bes t , a n d det er min e wh a t degr ee s h a ll be a llowed."
117

Her e t h en is t h e immen s e field t o wh ich ou r mea s u r e a pplies . It s
pu r pos e is t o r edu ce t h is gr ea t n u mber of dea t h s , t o preven t t h is va s t
a mou n t of s ickn es s , a n d t o r a is e t h e gen er a l s t a n da r d of h ea lt h a s h igh a n d
even h igh er t h a n t h a t of t h e mos t h ea lt h y dis t r ict s ; a n d t h is it pr opos es t o
a ccomplis h by givin g t o t h e legis la t u r e a n exa ct kn owledge of t h e con dit ion
of t h e people; by t h e pa s s a ge of u s efu l la ws for t h e pr omot ion of t h eir
welfa r e; by givin g t o t h e ph ys icia n a bet t er kn owledge of t h e ca u s es a n d
pr eva len ce of dis eas es , t h a t h e ma y bet t er a da pt h is r emedies t o t h eir
pr even t ion a n d cu r e; a n d by diffu s in g a mon g a ll cla s s es of t h e people la ct s

117
Dr. Jarvis 's Addres s , Communications Mas s . Med. Soc., p. 4.
167
con cer n in g life a n d h ea lt h , a n d t h e gen er a l pr in ciples of s an it a r y s cien ce,
a n d by lea din g t h em t o ma ke pr ogr es s in s a n it a r y impr ovemen t .
We do n ot s u ppos e, if ou r mea s u r e s h ou ld be a dopt ed, t h a t t h es e gr ea t
impr ovemen t s will immedia t ely t a ke pla ce, n eit h er do we s u ppos e t h a t t h e
t ime will ever come, let ou r s a n it a r y r egu la t ion s be ever s o well ma t u r ed,
wh en n o h u ma n bein g will die of a n y ot h er ca u s e t h a n old a ge,-t h e wea r in g
ou t of t h e h u ma n ma ch in e. Bu t wh a t we a n t icipa t e is , a gr a du a l s a n it a r y
impr ovemen t , a gr a du a l r emova l a n d a voida n ce of t h e ca u s es of dis ea s e, a
gr a du a l dimin u a t ion of h u ma n s u ffer in g a n d a gr a du a l r edu ct ion of t h e
n u mber of pr ema t u r e a n d u n n eces s a r y dea t h s . An d t h er e ca n be n o
object ion t o a imin g a t a bs t r a ct per fect ion , a n d t o con t in u in g ou r effor t s a t
r efor ma t ion u n t il it is a t t a in ed.
Th a t ou r mea s u r e will accomplis h what it propos es , if pu t in oper a t ion ,
t h er e is a bu n da n t eviden ce in h is t or y of s a n it a r y exper ien ce. Th e r ecor ded
fa ct s con cer n in g t h e ca u s es of dis ea s e, a n d con cer n in g dis ea s e it s elf, in a ll
a ges a n d in a ll cou n t r ies , pr ove it .
Sa n it a r y impr ovemen t s in En gla n d fir s t bega n in t h e n a vy. It is
obs er ved in a Sa n it a r y Repor t , t h a t s o dr ea dfu l wa s on ce t h e con dit ion of
t h e Roya l Na vy, t h a t in t h e yea r 1726, wh en Admir a l Hos ier s a iled wit h
s even s h ips of t h e lin e, t o t h e Wes t In dies , h e bu r ied h is s h ips compa n ies
t wice, a n d died h ims elf of a br oken h ea r t . Amon gs t t h e pict u r es t h en
pr es en t ed, a s in An s on s Voya ges , 1740-44, wer e t h os e of dea t h s t o t h e
a mou n t of eigh t or t en a da y in a moder a t e s h ips compa n y; bodies s own u p
in h a mmocks a n d wa s h in g a bou t t h e decks , for wa n t of s t r en gt h a n d s pir it
on t h e pa r t of t h e mis er a ble s u r vivor s t o ca s t t h em over boa r d. Dr . J oh n s on ,
in t h e yea r 1778, t h u s des cr ibes a s ea life:-As t o t h e s a ilor , wh en you look
down fr om t h e qu a r t er -deck t o t h e s pa ce below, you s ee t h e u t mos t ext en t of
h u ma n mis er y; s u ch cr owdin g, s u ch filt h , s u ch s t en ch ! A s h ip is a pr is on ,
wit h a ch a n ce of bein g dr own ed-it is wor s e, wor s e in ever y r es pect -wor s e a ir ,
wor s e food, wor s e compa n y.
In 1779 t h e pr opor t ion of dea t h s in t h e Roya l Na vy wa s 1 in 8 of t h e
employed; in 1811 t h e pr opor t ion wa s 1 in 32 of t h e employed; a n d fr om
1830 t o 1836, t h e a ver a ge n u mber of dea t h s a n n u a lly wa s 1 in 72 of t h e
employed. An in t his ca lcu la t ion t h e dea t h s fr om a ll s ou res a r e in clu ded,
fr om wou n ds , dr own in g, a n d a ll ot h er ext er n a l ca u s es , a s well a s fr om
dis ea s e. Fr om t h e la t t er s ou r ce t h e dea t h s wer e in pr opor t ion of 1 in 85 of
t h e n u mber employed a n n u a lly. Th es e figu r es a r e eloqu en t beyon d a n y
wor ds t h a t ca n be employed. Th ey excit e a s t h ey a r e fit t ed t o excit e,
es pecia lly a t fir s t s igh t , ou r won der . Th ey ou gh t , h owever , t o occa s ion mor e
of gr a t it u de t h a n a s t on is h men t , beca u s e t h e ca u s es of t h e differ en ce a r e n ot
difficu lt t o det er min e, a n d beca u s e a lmos t a ll t h a t a ppea r s in fa vor of r ecen t
t imes is du e t o t h e s u per ior in t elligen ce a n d h u ma n it y in fu s ed in t o t h e
a dmin is t r a t ion of t h e n a vy."
Equ a lly good effect s h a ve followed t h e s a n it a r y r efor ms in t h e Br it is h
a r my. Th e mor t a lit y a mon g t h e Br it is h t r oops a t Hon g Kon g, in 1842, wa s a t
t h e r a t e of 19 per cen t ., or 190 in 1000 ; in 1843, it wa s 22 per cen t ., or 220
in 1000 ; a n d in 1844, it wa s 13 per cen t ., or 135 in 1000. Bu t du r in g
t h es e yea r s , t h e ga r r is on wa s ver y ba dly a ccommoda t ed; in 1845 t h eir
a ccommoda t ion wa s gr ea t ly impr oved, an d t h e mor t a lit y dimin is h ed t o 8
per cen t ., or 85 in 1000; a n d s in ce t h a t t ime, t h e t r oops h a vin g been lodged
168
in wh a t ma y be t er med fr om t h eir excellen ce, "model ba r r a cks , t h eir
mor t a lit y a t on ce dr opped down t o 2 per cen t ., or 25 in 1000; a r a t e n ot
mu ch exceedin g t h at of s t a t ion s es t eemed h ea lt h y. Sin ce t h e a dopt ion of t he
mea s u r e pr opos ed by Dr . R. J a cks on , of r emovin g t h e t r oops s t a t ion ed in t h e
Wes t In dies t o ca n t on men t s on t h e mou n t a in r a n ges , t h e dimin u t ion in t h e
r a t e of s ickn es s a n d mor t a lit y h a s been s u ch a s t o ju s t ify t h e a s s er t ion , t h a t
if t h is mea s u r e h a d been ca r r ied in t o effect a t t h e t ime it wa s fir s t u r ged by
h im, t h e lives of fr om 8,000 t o 12,000 men wou ld h a ve been s a ved,-a
s u fficien t les s on , on e wou ld t h in k, t o ou r a u t h or it ies , n ot t o dela y t h e
in t r odu ct ion of impr ovemen t s wh ich exper ien ced medica l officer s con cu r in
u r gen t ly r ecommen din g.
Th e s u bjoin ed fa ct s r ela t e t o t h e compa r a t ive mor t a lit y of cit ies a n d
ot h er pla ces , u n der differ en t s a n it a r y a r r a n gemen t s :-
"Th e followin g t a ble dis pla ys t h e r ela t ive mor t a lit y in t h e differ en t pa r t s
of t h e Bolt on Un ion , ca lcu la t ed fr om a n a ver a ge of five yea rs ; s h owin g a ls o
t h e a n n u a l exces s of dea t h s a bove t h e s t a n da r d r a t e of 2 per cen t ., or 1 in
50, t o wh ich , a s we h a ve for mer ly s h own , it is n ext t o cer t a in t h a t t h e
mor t a lit y even of la r ge t own s n ligh t be r edu ced by pr oper s a n it a r y
r egu la t ion s .


Town s h i p s Pop . In 1 8 4 5 Dea t h s per a n Mor t a i t y % Or on e i n Ex ces s
over 2 %

Gr eat Bolt on 35, 914 1, 313 3. 65 27. 39 595

Lit t le Bolt on 17, 251 485 2. 81 35. 38 140

Ou t Town s h ips 51, 043 1, 119 2. 19 45. 66 86

"Th u s t h e mor t a lit y of Gr ea t Bolt on is gr ea t er t h a n t h a t Sh effield, wh ich
h it h er t o en joyed a ba d emin en ce in s pect ; a n d ou t of a popu la t ion of a bou t
36,000, n ea r ly s ix hundred, or 1 in 60, die u n n eces s a r ily ever y yea r . Wh a t
s h ou ld we t h in k of a n a n n u a l s a cr ifice of on e ou t s ixt y of ou r popu la t ion , t o
s a t is fy t h e cr a vin gs of mon s t er like t h e Min ot a u r of old ? Sh ou ld we n ot for t h
ever y effor t , a n d be r ea dy t o s a cr ifice a ll ou r wor ldly pos es s ion s , t o a ver t it ?
An d yet t h is s a cr ifice is in effect u p ever y yea r in Gr ea t Bolt on t o t h e Ogr e
filt h . Th e fa ct is t oo pla in t o be ga in s a id."
118

We ext r a ct fr om a n a r t icle on Ch oler a a n d Sa n it a r y Refor m, in t h e
wor k fr om wh ich t h e la s t pa r a gr a ph is t a ken , Vol. IV, for J a n .1, 1850 t h e
followin g pa s s a ge:- Let u s en dea vor t o r ea lize t h is a s t on is h in g fa ct . A
dis ea s e h a s la t ely cr os s ed over t h es e cou n t r ies , wh ich , in ou r met r opolis
a lon e, h a s s wept a wa y 15,000 s ou ls . We h a ve los t in a ll Brit a in mor e lives
t h a n we h a ve los t in ba t t le s in ce t h e da ys of Ma r lbor ou gh . An d, lookin g a t
t h e ma t t er in a mer e wor dly s en s e, wh o ca n kn ow in ca lcu la ble va lu e of ma n y
of t h es e lives ? Ever y ma n in s t in ct ively pict u r es t o h ims elf h ow mu ch
mis er y a n d la s t in g gr ief a n d s or r ow t h is gr ea t mor t a lit y s ymbolizes . It
r equ ir es n o s t r et ch of ima gin a t ion t o r ea lize a gr ea t n a t ion a l ca la mit y, of
wh ich t h e a ct u a l dea t h s a r e bu t t h e s ma ller it ems . Beh in d ea ch dea t h we

118
Britis h and Foregn Medico-Chirurgical Review, Vol. II, f or October, 1848, pp. 509, 510.
169
ca n t r a ce ea s ily t h e a n gu is h of t h e livin g; t h e dis t r es s of t h os e left fa t h er les s ,
h u s ba n dles s , ch ildles s ; t h e h opes bligh t ed; t h e t ies br oken ; t h e
compa n ion s h ip a n d s ympa t h y for ever des t r oyed. A t h ou s a n d men t a l pa n gs ,
a n d a mon g t h e poor , a t h ou s a n d bodily h a r ds h ips , a r e t h e lega cies a n d s a d
memor ia ls of ever y dea t h . Ca llou s a n d cold-h ea r t ed in deed mu s t h e be, wh o
ca n t u r n a s ide fr om s u ch a r ecor d, wit h ou t s eekin g pr obe t h is n a t ion a l
wou n d, a n d t o dema n d wh et h er t h er e is n o h ea lin g for ce wh er eby it s
bleedin g s u r fa ce ma y be s t a u ch ed. In t h e mids t of t h e gen er a l dis t r es s , a s et
of men come for wa r d t o s a y, t h a t t h ey h a ve fou n d a pla n for pr even t in g t h e
r ecu r r en ce of t h is fr igh t fu l s la u gh t er . Th es e ma n a r e n o en t h u s ia s t s , bu t a r e
t h e per s on s wh o, of a ll ot h er s , by edu ca t ion a n d exper ien ce, a r e bes t a ble t o
kn ow t h e t r u t h of t h eir a s s er t ion s . Th e wh ole medica l pr ofes s ion a n n ou n ce,
t h a t t h ey ca n pr even t , if mea n s a r e given t h em, t h e r ecu r r en ce of t h is
mor t a lit y a n d s u ffer in g. Ar e t h es e men wor t h y of cr edit or a r e t h ey n ot ? If
t h ey a r e, t h en wh er e is t h e gover n men t , wh er e is t h e n a t ion , t h a t can
dis r ega r d t h is a s s er t ion ,-t h a t ca n blin dly s h u t it s ea r s t o t h os e gr oa n s of
a n gu is h , t h e ech o of wh ich h a s n ot yet died fr om ou r a ffr igh t ed a ir ,-a n d,
ca r eles s of t h e fu t u r e, ca n s ee wit h in differ en ce t h e in evit a ble r ecu r r en ce of
t h a t fea r fu l dr a ma wh ich , in a few s h or t yea r s , mu s t be a ga in r epea t ed?
Au t h en t ic fa ct s a n d well fou n ded opin ion s like t h es e, a bou n d in t h e
va r iou s En glis h works on s a n it a r y improvemen t . Simila r opin ion s , fou n ded
u pon well es t a blis h ed fa ct s , a ls o exis t in ou r own commu n it y. Th er e ca n be
n o dou bt , in a n y u n pr eju diced min d, of t h e pr a ct ica bilit y of t h e mea s u r e.
In 1842, t h e Hon . Hor a ce Ivla n n , a s Secr et a r y of t h e Boa r d of
Edu ca t ion , pr opos ed t o s ever a l ph ys icia n s , t h e followin g qu es t ion :-"How
gr ea t a pr opor t ion of dis ea s e, of s u ffer in g, of dimin u t ion of ph ys ica l ca pa cit y,
of u s efu ln es s , a n d of a br idgmen t of life, comes fr om s h eer ign or a n ce, a n d
wh ich , t h er efor e, we migh t h ope t o s ee a ver t ed, if t h e commu n it y h a d t h a t
degr ee of kn owledge wh ich is ea s ily a t t a in a ble by a ll? To t h is qu es t ion Dr .
J a mes J a cks on , of Bos t on , r eplies , -" I feel a s s u r ed t h a t t h e a n s wer s h ou ld
be-more than one half . Wh en it is br ou gh t t o min d t h a t t h e ign or a n ce of
pa r en t s is in clu ded in t h e t er ms of t h e in qu ir y, t h e ;u s t ice of t h e a n s wer will
pr oba bly be a dmit t ed by a ll wh o a r e con ver s a n t wit h t h e s u bject ."
Dr . S. B. Woodwa r d, la t e s u per in t en den t of t h e St a t e Lu n a t ic Hos pit a l,
s a ys , " I h a ve n o dou bt t h a t half of t h e evils of life, a n d half t h e dea t h s t h at
occu r a mon g ma n kin d, a r is e fr om ign ora n ce of t h e la ws of h ea lt h a n d life;
a n d t h a t a t h or ou gh kn owledge of t h es e la ws wou ld dimin is h t h e s u ffer in gs
in ciden t t o ou r pr es en t s t a t e of bein g in ver y n ea r ly t h e s a me pr opor t ion ."
Dr . Edwa r d J a r vis r eplies , -"Fr om a n obs er va t ion of, t h ir t een yea r s , I
h a ve been led t o believe t h a t three f ourths , per h a ps mor e, of t h e a ilmen t s of
men come fr om a wa n t of s u fficien t kn owledge of t h eir fr a me, or a dis r ega r d
for it ."
Dr . Ma r s h a ll S. Per r y, fr om a s pecia l r ecor d, es t ima t ed more than half
of a given n u mber of ca s es of s ickn es s , h a ve been a voided, by kn owledge,
a t t en t ion a n d ca r e.
119


Th e opin ion s of a la r ge n u mber of pr ofes s ion a l men wh om we h a ve h a d
per s on a l in t er cou r s e, fu lly coin cide t h os e h er e r ecor ded; a n d we a r e led t o
t h e s t a r t lin g con clu s ion t h a t half of all the d is eas es and half of the deaths

119
Mann's Sixth Annual Report, pp. 84, 85, 88, 89, 97.
170
t h a t pla ce migh t h a ve been a voided! It is u n n eces s a r y t o br in g fu r t h er pr oof
of a t r u t h s o well es t a blis h ed. Th er e is s ca r es ly a n y per s on wh o, in a
r et r os pect of h is own life, n u mber in s t an ces of s a n it a r y s u ffer in g in h ims elf,
wh ich h e h a ve a voided h a d h e u n der s t ood a n d obs er ved t h e la ws of a n d lir e.
Ou r mea s u r e t h en is n ot a vis ion a r y, bu t a s imple, ever yda y pr a ct ica l r ea lit y,
compr eh en s ible, a n d a pplica ble t o a ll per s on s , in ever y pla ce, a n d a t a ll
t imes .
II. It s hould be approved becaus e it is a us eful meas ure.
If t h e impor t a n t pr a ct ica l r es u lt s wh ich h a ve wou ld follow t h e a dopt ion
of ou r pla n , it is n eces s a r y t h a t a n yt h in g fu r t h er be s a id t o s h ow t h a t it is a
u s efu l To s a ve life, t o pr even t s ickn es s , a n d t o in vigor a t e t h e h u ma n fr a me,
a r e it s object s ; a n d n on e ca n be of gr ea t er u t ilit y.
It would give the S tate a k nowledge of its inhabitants . Ha s t y legis la t ion ,
ba s ed u pon imper fect kn owledge, is on e of t h e evils of t h is r epu blic. It
pr eva ils , t o a gr ea t er or les s ext en t , in a ll t h e legis la t u r es , n a t ion a l, s t a t e a n d
mu n icipa l. It is t h e pr a ct ice of s ome gover n men t s , wh en mea s u r es deemed
wor t h y of legis la t ion a r e pr opos ed, t o a ppoin t a commis s ion or commit t ee t o
ma ke a t h or ou gh in ves t iga t ion of t h e wh ole s u bject , a n d t o r epor t t h e fa ct s
a n d t h e eviden ce. A bill is t h en ca r efu lly dr a wn , ba s ed u pon t h e fa ct s t h u s
dis clos ed, a n d a da pt ed t o t h e exigen cies of t h e ca s e. Th is is en ligh t en ed,
effect ive, u s efu l a n d econ omica l legis la t ion . En gla n d is mu ch in debt ed for
h er gr ea t n es s a n d power t o t h is pr a ct ice; a n d h er exa mple, in t h is r es pect , is
wor t h y of imit a t ion . Th e ver y r ever s e of t h is , h owever , t oo oft en h a ppen s in
t h e Un it ed St a t es . We t oo oft en legis la t e fir s t , a n d obt a in t h e fa ct s , if we
obt a in t h em a t a ll, a ft er wa r ds . An exa ct kn owledge of t h e cir cu ms t a n ces of
t h e people, is t h e s u r es t ba s is for cor r ect a n d u s efu l legis la t ion .
It would aid the phy s ician. Th is wou ld be don e in va r iou s wa ys . Th e
in for ma t ion obt a in ed wou ld be of immen s e con s equ en ce in givin g h im exa ct
kn owledge of t h e ca u s es a n d pr eva len ce of differ en t dis ea s es . Th is kn owledge
wou ld gr ea t ly a id him in a pplyin g h is r emedies for pr even t ion a n d cu r e.
In s t ea d of pa r t ia l fa ct s , obt a in ed for a pa r t ia l pu r pos e, u pon wh ich t o gr ou n d
h is t h eor ies , h e wou ld h a ve a va s t collect ion of impa r t ia l fa ct s , t r u t h fu lly
ga t h er ed, for n o ot h er pu r pos e t h a n t h e pr omot ion of t r u t h . On s u ch a ba s is
h e migh t con s t r u ct a mu ch bet t er t h eor y in medicin e, a n d devis e a mor e
r a t ion a l, ph ilos oph ica l s ys t em of r emedies .
Bu t t h er e is a n ot h er pu r pos e wh ich t h ey wou ld s ecu r e in t h is r ela t ion .
On e of t h e mos t t r yin g cir cu ms t a n ces in t h e life of a con s cien t iou s ph ys icia n ,
is believed t o be t h e ca pr iciou s a n d u n fou n ded ju dgmen t wh ich t h e people
oft en pa s s u pon h is s kill a n d pr ofes s ion a l s er vices . Th is opin ion is fr equ en t ly
t h e r es u lt of a cciden t or pr eju dice, combin ed wit h imper fect kn owledge or
en t ir e ign or a n ce, a n d wou ld be ch a n ged if t h e people wer e bet t er edu ca t ed in
s a n it a r y s cien ce. Th is is a n in t er es t in g con s ider a t ion , a n d migh t be
a bu n da n t ly illu s t r at ed in t h e exper ien ce of ever y ph ys icia n ; bu t t h e mer e
s u gges t ion is deemed s u fficien t for ou r pu r pos e, t o s h ow t h a t t h is is a u s efu l
mea s u r e t o t h e medica l pr ofes s ion .
It would benef it the people. We h a ve a lr ea dy a llu ded t o t h e mu r der ou s
impos it ion wh ich is pr a ct is ed u pon a cr edu lou s people, by pr et en der s t o
medica l s kill, in cu r in g dis ea s e, a n d by mer cen a r y dealer s in in ;u r iou s
n os t r u ms a n d dr u gs . Th is ma t t er ma y be a ga in a llu ded t o for a mor e gen er a l
pu r pos e. Th ou gh h ea lt h is a ma t t er in wh ich ever y pers on is dir ect ly
171
in t er es t ed, yet t h er e is s ca r cely a n y s u bject on wh ich s o mu ch ign or a n ce
gen er a lly pr eva ils . Wh en well en ou gh t o do wit h ou t medica l a dvice, we a r e
t oo a pt t o n eglect t o in for m ou r s elves a s t o t h e mea n s of a voidin g t h e
con t in gen cy of s ickn es s . Bu t wh en a t t a cked wit h r ea l or ima gin a r y s a n it a r y
ills , n o people a r e mor e lia ble t o er r , or ca n be mor e ea s ily impos ed u pon .
Th e body is s u bject ed t o exper imen t s , by n ew a dvis er s a n d n ew r emedies ,
come fr om wh a t ever qu a r t er t h ey ma y; an d fa it h is pu t in cer t ifica t es , wh ich
per h a ps h a ve been for ged. Ma n y, ver y ma n y, a r e t h u s dr u gged t o dea t h ,
eit h er by t h e blin d gu ides of t h eir own u n in for med min ds , or t h e u n fou n ded
pr et en s ion s of ot h er s . Th e object of t h is mea s lu e is t o diffu s e, a mon g a ll
cla s s es of people, mor e en ligh t en ed views of life, h ea lt h a n d dis ea s e. In t h is
wa y it is believed n u mer ou s lives migh t be s a ved, a gr ea t a mou n t of s ickn es s
pr even t ed, a n d a cor r es pon din g a mou n t of s u ffer in g a voided. .Is n ot t h is a
u s efu l pu r pos e?
III. It s hould be approved becaus e it is an economical meas ure.
Th e expen s e of pr even t ive s a n it a r y mea s u r es is t h e mos t common
a r gu men t br ou gh t a ga in s t t h eir a dopt ion . Epidemics a r e con s ider ed by t h e
ign or a n t a s evils which it is u s eles s t o a t t empt t o pr even t ; a n d a mon g t h e
bet t er in for med, a fa ls e idea of econ omy, wh ich h a s s omet imes led t o t he
mos t fa t a l r es u lt s , h a s been t h e gr ou n d of r es is t a n ce t o mea s u r es wh ich
wer e n eces s a r y t o s a ve life. It s h ou ld, h owever , be kn own t h a t pu blic
expen dit u r es ca n n ot be a voided du r in g t h e pr eva len ce of a n epidemic
dis ea s e. Mon ey mu s t be s pen t , eit h er in s a vin g life, or in t h e ma in t en a n ce of
pa u per is m, widowh ood, a n d or ph a n a ge. In t h is ca s e econ omy is on t h e s ide
of h u ma n it y, a n d t h e mos t expen s ive of a ll t h in gs is -t o do n ot h in g.
Debilit y, s ickn es s , a n d pr ema t u r e dea t h s , a r e expen s ive ma t t er s . Th ey
a r e in s epa r a bly con n ect ed wit h pa u per is m; a n d . wh en ever t h ey occu r t h ey
mu s t , dir ect ly or in dir ect ly, be pa id for . Th e cit y or t own mu s t pa y for t h e
s ick ma n 's s u ppor t for h is food a n d clot h in g, for medica l a t t en da n ce on h im
du r in g life, a n d for t h e s u ppor t of h is widow a n d ch ildr en (if h e lea ve a n y)
"a ft er h is dea t h . A t own in wh ich life is pr eca r iou s pa ys mor e t a xes t h a n it s
n eigh bor s of a differen t s a n it a r y ch a r a ct er . An in dividu a l wh o is u n a ble t o
per for m a la r ge a mou n t of la bor or n o la bor a t a ll, is a les s pr ofit a ble
member if s ociet y t h a n on e wh o ca n do wh a t ever vigor ou s h ea lt h a llows .
It is for t h e in t eres t of t h e pu blic at la r ge, n o les s t h a n for t h e
h a ppin es s of t h e few immedia t ely in t er es t ed in ea ch h u ma n bein g, t h a t t h e
life on ce br ea t h ed s h ou ld, if pos s ible, be pr es er ved, u n t il it is r elea s ed by t h e
n a t u r a l wea r in g a wa y of it s ea r t h ly t a ber n a cle. We a ll kn ow t h a t , in t h e
common s en s e of t h e t er m, a s h or t -lived popu la t ion is gen er a lly a s u r plu s
popu la t ion ,-n ot on ly beca u s e t h os e wh o a r e r eckles s of pr es er vin g life, will be
ca r eles s of a ll it s obliga t ion s , a n d will be poor a n d viciou s , bu t beca u s e t h e
t en den cy of ea r ly dea t h s is ch iefly t o s h or t en t h e exis t en ce of t h os e wh o
pr odu ce mor e t h a n t h ey con s u me, a n d t o in cr ea s e t h e n u mber of t h os e wh o
mu s t be depen den t on t h e ch a r it y of ot h er s . 'A ch oler a widow' is a s ign ifica n t
expr es s ion occa s ion a lly u s ed by t h e Boa r d of Hea lt h , t o in dica t e on e wh o h a s
been t h r own on t h e pa r is h by t h e dea t h of t h a t h u s ba n d wh o, if h e h a d n ot
been pr ema t u r ely cu t off, migh t h a ve s u ppor t ed h er for yea r s , a n d left h is
ch ildr en old en ou gh t o ea r n br ea d for t h ems elves . Ma n y commu n it ies a r e
n ow t h u s pa yin g, in a la r min gly s wollen poor -r a t es , for t h e s h or t -s igh t ed
172
s elfis h n es s wh ich ma de t h em gr u dge t h e cos t of pr eca u t ion a r y
a r r a n gemen t s ."
120

As a n illu s t r a t ion , t h e pr opor t ion of deat h s by ch oler a , in t wo pa r is h es
in En gla n d-Ha mps t ea d a n d Rot h er h it h e-h a ve been s t a t ed. In t h e la t t er , 225
per s on s died of t h e dis ea s e in ever y 10, 000 in h a bit a n t s , wh ile in t h e for mer
8 on ly died. At Rot h er h it h e, ou t of 225 per s on s , 217 died of pr even t a ble
ca u s es . " Th er e wer e in t h a t pla ce, 28 t imes t h e pr opor t ion a l n u mber of
dea t h s t h a t t h er e wer e a t Ha mps t ea d, 28 t imes t h e ca s es of s ickn es s , 28
t imes t h e n u mber a n d cos t of fu n er a t s , 28 t imes t h e doct or s ' bills , a n d 28
t iu les t h e pr opor t ion a l n u mber of widows a n d h elples s ch ildr en t o be
s u ppor t ed by s omebody."
121

As a fu r t h er illu s t r at ion we pr es en t t h e followin g ext r a ct fr om a s peech
deliver ed by Lor d As h ley, a t a meet in g h eld Feb. 5t h , 1850, t o t a ke in t o
con s ider a t ion t h e s a n it a r y con dit ion of t h e met r opolis :
"At lea s t on e t h ir d of t h e pa u per is m of t h e cou n t r y a r os e fr om t h e
defect ive s a n it a r y con dit ion of la r ge mu lt it u des of t h e people; a n d h e h a d no
h es it a t ion in s a yin g, u pon t h e a u t h or it y of exper ien ced per s on s , t h a t if t he
popu la t ion of t h eir gr ea t t own s wer e pla ced u n der pr oper s a n it a r y
r egu la t ion s , in les s t h a n t en yea r s t h e poor r a t es wou ld be r edu ced
2,000,000 a n u a lly. Wh a t h a d been t h e effect pr odu ced u pon t h e pa r is h of
La mbet h by t h e r a va ges of t h e ch oler a , a la r ge wh ich migh t h a ve been
pr even t ed by s u it a ble s a n it a r y .He h a d t h e officia l r et u r n of t h e n u mber of
becomin g ch a r gea ble t o t h e pa r is h in con s equ en ce of fr om ch oler a bet ween
t h e 16t h of J u n e a n d t h e 16
t h
of Oct ober , 1849. Th er e wer e-or ph a n s 310,
widows 74 ; t ot a l 384 per s on s . Th er e wa s a villa ge in Wilt s h ir e wit h a
popu la t ion of 510; in t h is villa ge fou r widows a n d 16 or ph a n s , ma kin g a t ot a l
of 20 per s on s , h a d become per ma n en t ly ch a r gea ble. A s t ill mor e r ema r ka ble
in s t a n ce occu r r ed in a n ot h er villa ge con t a in in g 54 in h a bit a n t s . Of t h es e, 19
h a d been ca r r ied off by ch oler a , a n d t h eir fa milies h a d become ch a r gea ble
u pon t h e r a t es . Let it be obs er ved, t h a t if t h e a t t a ck of ch oler a in Lon don h a d
been in pr opor t ion t o t h e a t t a ck in t h a t villa ge, 500,000 per s on s wou ld h a ve
been ca r r ied off ; bu t h e qu ot ed t h es e in s t a n ces of t h e r a va ges of t h e
epidemic t o s h ow t h a t wh a t ch oler a did r a pidly a n d by fit s a n d s t a r t s ,
t yph u s a n d ot h er fat a l dis ea s es wer e doin g s lowly da y by day. If t h e ch olera
h a d s en t 1,000 or ph a n s a n d widows t o t h e poor -h ou s e in a few weeks ,
t yph u s wa s per ma n en t ly s en din g h u n dr eds a n d t h ou s a n ds t h er e, t o become
ch a r gea ble u pon t h e r a t es pa ya ble by t h os e pa r t ies wh o, if t h ey h a d been
wis e a n d h u ma n e in t ime, migh t h a ve obvia t ed a ll fa t a l con s equ en ces a n d
been t h e mea n s of pr es er vin g t h e exis t en ce of ma n y wor t h y cit izen s . Of a ll
t h e a gen cies wh ich pr edis pos ed t h e h u ma n body t o dis ea s e, n on e wer e s o
fa t a l a s over -cr owdin g in s ma ll dwellin gs . Th er e h a d been r ema r ka ble
in s t a n ces wh er ein loca lit ies , ill dr a in ed, ba dly ven t ila t ed, a n d expos ed t o
n oxiou s in flu en ces h a d con t in u ed wit h ou t a vis it a t ion fr om ch oler a , wh ils t a
bu ildin g wh er e t h e in ma t es wer e well fed, well clot h ed, a n d h a d ever y
a pplia n ce t o keep t h em in h ea lt h , wit h t h e s in gle except ion of over -cr owdin g,
pr es en t ed a mor t a lit y gr ea t er in pr opor t ion t h a n t h e a wfu l mor t a lit y a mon g
t h e pa u per ch ildr en a t Toot in g. Un der s u ch cir cu ms t a n ces it wa s impos s ible

120
Edinburgh Review, Vol. XCI, January , 1800, p. 212.
121
Do. for April, 1850, p. 389.
173
a n y pa r t icu la r cla s s cou ld in s u r e immu n it y fr om dis ea s e. Th e dea t h s fr om
ch oler a in Lon don a mou n t ed t o 16,696. Of t h es e 72 per cen t . occu r r ed
a mon g t h e poor er cla s s es , 16 per cen t . a mon g t h e middle, a n d 3 per cen t .
a mon g t h e u pper cla s s es ; bu t be r emin ded t h e middle a n d t h e u pper cla s s es
t h a t t h e expen s es in flict ed u pon t h e commu n it y in t h e met r opolis , du r in g
t h e la t e epidemic, a mot mt ed t o n o les s t h a n 1,060,096, in clu din g t h e cos t
of fu n er a ls , medica l a t t en da n ce, a n d t h e los s of r epr odu ct ive la bor . It might
be a s ked, wa s t h is in s t r u ct in g t h e people? He did n ot s a y it wa s ; bu t wh a t
t h ey wer e doin g in br in gin g s u ch fa ct s befor e t h e pu blic wa s a n
in dis pen s a ble pr elimin a r y t o t h eir mor a l a n d s pir it u a l welfa r e.
Th e expen s es a n d los s es en t a iled by a n eglect of s a n it a ry mea s u r es
ma y be cla s s ed u n der t h e followin g h ea ds : -1. Expen s es impos ed u pon t h e
poor , by los s of wor k or of s it u a t ion s , for medica l a t t en da n ce a n d medicin e,
for n u r s in g, for fu n er a ls , for t h e s u ppor t of widows a n d or ph a n s , a n d for
ot h er pu r pos es . 2. Expen s es impos ed u pon t h e t a x-pa yer s , for t h e s u ppor t of
t h os e wh o a r e u n a ble t o s u ppor t t h ems elves , bes ides t h eir own in cr ea s ed
expen s es a r is in g fr om a ba d s a n it a r y con dit ion . 3. Bu r den s impos ed u pon
t h e ch a r it a ble, for t h e s u ppor t of h os pit a ls , dis pen s a r ies , a n d for ot h er mor e
gen er a l or s pecia l cha r it ies . 4. A los s s u s t a in ed by t h e s t a t e, in con s equ en ce
of t h e dimin is h ed ph ys ica l power a n d gen er a l lia bilit y t o dis ea s e. 5.
Expen s es impos ed u pon t h e commu n it y, by t h e cr imes a r is in g fr om t h e
u n fa vor a ble ph ys ica l cir cu ms t a n ces by wh ich t h e la bor in g poor a r e
s u r r ou n ded, a n d wh ich lea d wit h cer t a in t y t o t h eir mor a l degr a da t ion .
Va r iou s es t ima t es h a ve been ma de of t h es e expen s es , s ome of wh ich , a s
s t a t ed by Lor d Mor pet h , we h a ve a lr ea dy n ot iced, (p. 44.)
122



122
We extract from the Report on the Condition of Large Towns , the f ollowing illus trative pas s age from the tes timony or
Dr. Tay lor, an intelligent s urgeon of London:-"Amongs t others was tbe f amily of a policeman whom I attended. When be
applied f or relief , the obs ervation which occurred was , You have, as a policeman, 20s . a week regular wages , and other
advantages ; y ou are never out of work , and cannot be cons idered a proper object of relief from the funds of a dis pens ary
intended for the poores t clas s ? His reply was . that he paid f or his mis erable one room, divided into two, 5s . a week ; that
be had Is . 8d. week ly to pay f or k eeping up his clothes , which reduced the money he had f or his f amily of four children
and his wif e to 13s . 4d.; that he had had all his children ill, and los t two ; that he had during three y ears paid s ix doctors '
bills , principally f or medicine, at the rale of 2s .6d a bottle, amounting to between :30 and 40; that two of the children
had d ied, the funerals of which , performed in the cheapes t manner he could get it done, had cos t him 7 : the wif e and
his f our children were now ill. They were s o depres s ed and debilitated, as torender them very great objects f or the
dis pens ary and the Samaritan Fund. All his mis ery was traceable to preventable caus es . Tak e another cas e in the lis t
bef ore me. A porter, in regular employ ment, at wages producing 1 a week : he paid 3s . 6d. for a mos t mis erable and
unwholes ome room, in which hims elf and s ix other people, f our children and three adults , s lept; the children were
s hoeles s , extremely f ilthy , and bad ly clad; the wif e ill in bed of a d is eas ed k nee, f or while I attended her; two children
had been s til-born, and he had los t three others ; tbe s ick nes s of one of thes e children, which had d ied at f ourteen of
cons umption, had cos t him in doctors ' bills 16 guineas ; the s ick nes s of the one which d ied eleven months old, of water on
the bruin, had cos t him 6; the third had d ied f ourteen day s old. The expens es in the three cas es had s o impoveris hed
him, that he was compelled to apply to the paris h f or aid f or their burial. I will s ubmit a third cas e-that of a cook , in
receipt of 25s . per week regular wages . He was .living with his wif e and three children in a s mall, clos e, ill-conditioned
room, for which he paid 5s . per week rent. He complained that the water was alway s 'thick ,' and very d is agreeable to the
tas te, and the s mells from the s ewers and the drains in the hous e were very bad: he had f ive children, of whom two had
died; that he had paid doctors ' bills f or his wif e's conf inements 5 each; and for one child which died of s carlet f ever, at
four y ears of age, the doctor's bill was 4 18s .; the one which died of debility at the age of ten week s , cos t hIm 1, 10s .;
the funeral of the eldes t child cos t him 3; and the one at the age of ten week s , 1, 10s . He s howed that the expens es of
conf inements , the doctors ' bills , and the unndertak ers ' bills , and. the illnes s of his ,wif e, aris ing from f ive mis carriages ,
had s o impoveris hed him, that having now two children ill with s crofula, he was obliged, though reluctantly , to apply to
the d is pens ary f or relief . The las t cas e I will s ubmit to the commis s ioners is that of a s hoemak er, a. good work man, who
earns 20s . a week : be pay s 5s . a week f or one s mall, mis erable room, in a narrow court; he has had s even children, of
whorn he has los t f ive, f or which he has paid in doctors ' bills between 2 and 3 each; his wif es age was thirty two, his
own age thirty -s even, and at this age of thirty -s evern he continually s uffered from nervous depres s ion; and having one of
his two othere children with a lingering dis eas e-a s crof ulous affection of the hip-he was compelled to come to the
dis pens ary ; he complained that the water of his hous e was never clear and never s weet. A man in receipt of 30s .per
week s wages , cons idering his amount of rent which was 5s .6d. for one room, for hims elf , wife, and three children;
having had f our deaths af ter lingering cons umptions , and a wif e and children never well, I f elt that he also was a proper
object of the charity. At the time I visited these 100 families, no less than 212 of the members were suffering under
dis eas e manif es t in various s tages . They had alread y had no les s than 251 deaths and funerals , and a corres ponding
174
At t empt s h a ve been ma de t o s h ow t h e pecu n ia r y wh ich wou ld r es u lt t o
Ma s s a ch u s et t s by t h e a dopt ion efficien t s a n it a r y s ys t em. Th e s u bjoin ed is
given a s ma t e, wh ich we believe wou ld fa ll fa r below t h e r ea lit y. n u mber of
u n n eces s a r y dea t h s t h e pa s t yea r , h a s (p. 245) a t 6,000, a n d of ca s es of
u n n eces s a r y 12,000. Th is is a dir ect pecu n ia r y los s t o t h e St a t e. of t h es e
6,000 per s on s h a d been s a ved, a n d h a d lived wh ich ma y be t a ken a s t h e
a ver a ge len gt h of t h e of life; or if t h e wh ole 18,000 per s on s wh o died in cou ld
h a ve lived, on t h e a ver a ge, s ix yea r s lon ger did, ( a n d wh o will s a y t h a t t h ey
migh t n ot mor e t h an t h a t per iod?) t h en we h a ve 108,000 yea r s of los t la bor
on cou n t , wh ich ma y fa ir ly be es t ima t ed a t $50 ea ch per Th e cos t of 12,000
yea r s of u n n eces s a r y s ickn es s ma y be es t ima t ed a t $50 ea ch , a n d t h e los t
la bor of t h e s ick a t $100 ea ch . Th en t h er e a r e t h e pu blic pa u per s , widows
a n d or ph a n s , ma de s o by t h e pr ema t u r e dea t h s of r ela t ives , wh ich ca n n ot be
es t ima t ed a t les s t h a n 6,000, a t $1 per week. Accor din g t o t h is ca lcu la t ion
we h a ve
Los s of 108,000 yea r s of la bor , a t $50 per a n n u m,
$5,400,000

Cos t of 12,000 yea r s of s ickn es s , a t $50 " "
600,000

Los t la bor of t h e s ick, a t $100 " "
1,200,000

Cos t of s u ppor t in g 6,000 widows a n d or ph a n s , a t $52 per a n n u m
312,000

Tot a l a n n u a l los s
$7,512,000

Th er e a r e ot h er expen s es a n d los s es wh ich migh t be a voided. Th e
Gen er a l Boa r d of Hea lt h , by t h eir s u per ior s ou r ces of in for ma t ion , wou ld be
a ble t o s u gges t t o t h e loca l Boa r ds of Hea lt h , a n d t o ot h er s in t er es t ed, t h e
bes t a r r a n gemen t s a n d r egu la t ion s for differ en t object s of s a n it a r y
impr ovemen t ; a n d ma n y expen s es n ow in cu r r ed for wa n t of s u ch in for ma t ion
wou ld be a voided. Ma n y wor ks , pu blic an d pr iva t e, h a ve been con s t r u ct ed at
gr ea t expen s e, wh ich a r e n ea r ly wor t h les s in a s a n it a r y view, a n d migh t h a ve
been dis pen s ed wit h if a bet t er pla n h a d been kn own . It h a s been well s a id
"t h a t it cos t s mor e mon ey t o cr ea t e dis ea s e t h a n t o pr even t it ; a n d t h a t t h er e
is n ot a s in gle s t u ct u r a l a r r a n gemen t ch a r gea ble wit h t h e pr odu ct ion of
dis ea s e t h a t is n ot in it s elf a n ext r a va ga n ce."

amount of s ick nes s . It was only in a late s tage of my inves tigations that I began to s ee the very s erious amount of
mis carriages they have had, and which in many ins tances exceed the deaths . Three hundred and f if ty of the members of
thes e 100 f amilies were dependent children, whos average age was little more that ten y ears . Henry Aus tin, Es q., in his
Report on the Sanitary Cond ition of Worces ter, (p. 40.) s ay s the attack s of fever appear to commit the greates t ravages
among thos e in the vigor of lif e; and to one f atal cas e there is at leas t 10 attack s . An ins urance charge for the mitigation
of the effects of s ick nes s and premature mortality f or an average f amily , is more than three times the annual cos t of the
outlay f or the whole of the intended work s at Worces ter," s uff icient to place the city in a good s anitary cond ition
175
An d wh a t would be the expens e of the meas ure? If t h e a ct we pr opos e
s h ou ld become a la w, t h e expen s es of t h e Gen er a l Boa r d of Hea lt h mu s t be
pr ovided for by t h e St a t e; a n d t h ey wou ld be n ea r ly a s follows , a n n u a lly ;-

For t h e s a la r y of t h e. Secr et a r y of t h e Boa r d, s a y -
$2,000

For con t in gen t expen s es , in clu din g t h e expen s es of t h e Boa r d,
1,000
pr in t in g, s t a t ion er y, &c. -

Tot a l $3,000

Th e s er vices of t h e cler ks in ma kin g a bs t r a ct s of a cen s u s of t h e
in h a bit a n t s a n d of t h e r et u r n s u n der t h e r egis t r a t ion s ys t em, a n d for ot h er
s er vices , wou ld cos t n o mor e, if pr epa r ed u n der t h e dir ect ion of t h e Boa r d,
t h a n t h ey n ow cos t in t h e office of t h e Secr et a r y of St a t e. Th is t h en wou ld be
t h e expen s e t o t h e St a t e ; a n d in t h e cit ies a n d t own s wh ich n ow h a ve a
Boa r d of Hea lt h , a n d do a n yt h in g for t h e s a n it a r y fa r e of t h e in h a bit a n t s , n o
mor e expen s e wou ld be t h e s a me s er vice t h a n is n ow pa id.
This would be a wis e expend iture of money . Accor din g t h e es t ima t e
a bove pr es en t ed, t h e St a t e s u ffer s , fr om it s imper fect s a n it a r y con dit ion , a n
u n n eces s a r y a n n u a l los s of t h a n 7 million s of dolla r s ! a n d t h is a r is es ,
pa r t ly a t lea s t , fr om t h e n on -a dopt ion of a mea s u r e wh ich will cos t bu t
$3,000. If s a ved, it wou ld a dd t h a t a mou n t t o t h e wea lt h of t h e St a t e,
bes ides t h e in defin it e a mou n t of in cr ea s ed wh ich wou ld a ccompa n y it .
Sh ou ld a n yon e con s ider t h is a n ext r a va ga n t es t ima t e, let h im r edu ce it t o 3
million s , mor e on e ha lf, a n d t h en t h e r ela t ion of expen dit u r es t o t h e s a vin gs ,
or t o t h e in come, will be a s one dollar to one thous and dollars ! An d even if
n in e t en t h s of t h is la t t er s u m be dedu ct ed, it be like pa yin g ou t one dolla r ,
a n d r eceivin g ba ck a ga in ten a s t h e r et u r n pr ofit ! Wh a t mor e wis e
expen dit u r e of mon ey ca n be des ir ed?
Look a t t h e a ble r epor t of t h e St a t e Au dit or for 185, a n d compa r e it wit h
a n y expen dit u r e of t h e St a t e, or compa re it wit h a n y mea s u r e t h a t h a s been
in t r odu ced for con s ider a t ion , a n d few, if a n y, ca n be fou n d of gr ea t er
expedien cy, pr opr iet y a n d u s efu ln es s , or t h a t will con t r ibu t e mor e t o t he
pr os per it y a n d welfa r e of t h e people of t h e Common wea lt h . Ma s s a ch u s et t s
h a s r equ ir ed a n n u a l r et u r n s of in for ma t ion t o be ma de a n d pu blis h ed,
con cer n in g pa u per is m a n d cr ime, ba n ks in s u r a n ce compa n ies , a gr icu lt u r e
a n d ot h er ma t t er s . Sh e h a s in dir ect ly offer ed pr emiu ms for t h e bes t fa r ms ,
a n d t h e bes t pr odu ct ion s ; t h e bes t implemen t s for ma n u fa ct u r es , a n d t h e
bes t a r t icles pr odu ced ; a n d h a s pa id t o a gr icu lt u r a l s ociet ies , for t h es e
object s , s in ce 1830, t h e s u m of $123,319 18. Sh e h a s in s t it u t ed s cien t ific
s u r veys -a s t r on omica l, t r igon omet r ica l, geologica l, bot a n ica l, a n d zoologica l-
h a s a s cer t a in ed t h e or n it h ology, t h e ich t h yology, a n d t h e en t omology of
St a t e; a n d h a s expen ded, for t h es e s u r veys , s in ce 1830, s u m of $103,414 84.
Sh e con t r ibu t es , a nn u a lly, t o common s ch ools , over $750,000. In a ll t h es e,
a n d in ma n y ot h er a ct s , s h e h a s don e well. We wou ld n ot oppos e t h es e
object s of St a t e in qu ir y a n d St a t e expen dit u r e ; n or decr y t h e va lu e of fa ct s
t h u s obt a in ed. All u s efu l in for ma t ion s h ou ld be s pr ea d befor e t h e people.
176
Bu t wh ile we a ppr ove of t h es e ma t t er s , we a r e a ls o of t h e opin ion t h a t t h er e
a r e ot h er object s of equ a l a n d even of gr ea t er impor t a n ce for in ves t iga t ion .
" It ma y be u s efu l t o kn ow t h e ext en t , t h e expen s e, a n d t h e
cir cu ms t a n ces of pover t y a n d cr ime7 in t h e St a t e ; bu t is it n ot mor e u s efu l
t o kn ow t h e ca u s es of t h is pover t y a n d cr ime, a n d h ow mu ch of it a r is es
fr om dis ea s es a n d dea t h s , wh ich migh t be pr even t ed? Fa ct s a n d figu r es ma y
be u s efu l t o s h ow u s t h e s a n it a r y con dit ion of ba n ks a n d in s u r a n ce
compa n ies ; bu t a r e n ot fa ct s a n d figu r es mor e u s efu l wh ich s h ow u s t h e
s a n it a r y con dit ion of ma n , wh o dir ect s a n d con t r ols t h em a ll, wh o
pa r t icipa t es in a ll t h eir ben efit s , a n d wh os e a gen cy cea s es on t h e in va s ion of
dis ea s e a n d dea t h ? Th e mon ey of t h e St a t e ma ybe u s efu lly expen ded in
pr emiu ms for t h e bes t fa r ms , t h e bes t cr ops , t h e bes t h or s es , ca t t le, s h eep:
s win e, t h e bes t a pplica t ion of la bor , a n d t h e bes t pr odu ct ion s of mech a n ica l
s kill ; bu t migh t n ot s omet h in g a s pr oper ly be expen ded in t ea ch in g u s h ow
a n d wh er e t h e bes t s pecimen s of h u ma n life ma y be pr odu ced? wh a t a r e t h e
ca u s es wh ich mos t fa vor a bly a ffect it s commen cemen t , it s ch ildh ood, it s
ma t u r it y, it s decr epit u de, a n d it s ext in ct ion ? in t ea ch in g t h e people in wh a t
pla ces , a t wh a t s ea s on s , a n d u n der wh a t cir cu ms t a n ces it is mos t
in vigor a t ed a n d lon ges t pr es er ved? a n d h ow we ca n bes t a void t h os e ca u s es
a n d dis ea s es , wh ich a r e mos t likely t o occu r t o debilit a t e a n d des t r oy it ? it
ma y be u s efu l t o layou t la r ge s u ms of mon ey t o obt a in a kn owledge of t h e
t opogr a ph y, t h e min er a logy, t h e bot a n y, a n d t h e zoology ,-t o h a ve des cr ibed
t o u s t h e ch a r a ct er a n d h a bit s of a ll t h e wild a n ima ls exis t in g in t h e St a t e;
bu t is it n ot mor e impor t a n t t o h a ve des cr ibed t o u s t h e differ en t s pecimen s
of h u ma n life, a s t h ey a r e modified, for med, a n d exis t , u n der t h e va r iou s
cir cu ms t a n ces wh ich s u r r ou n d t h em in differ en t loca lit ies , a n d h ow t h os e
cir cu ms t a n ces a ffect t h em for good or evil? Ar e bea s t s , bir ds , fis h , in s ect s , of
mor e impor t a n ce t h a n ma n , wh o wa s or da in ed t o h a ve domin ion over a ll
t h es e cr ea t u r es ?' Th e con t r ibu t ion s of t h e St a t e for pu blic s ch ools ma y
pr oper ly be s welled t o a s u m exceedin g $750,000 per an n u m,a n d t h u s
s ecu r e t h e gen er a l edu ca t ion of t h e min d; bu t is it n ot mor e impor t a n t t o
expen d a t it h e of t h is s u m in edu ca t in g t h e body, a n d in prepa r in g h ea lt h y
a n d vigor ou s a bodes for t h e min d, t h a t we ma y, a s a people, become
ph ys ica lly, a s well as in t ellect u a lly gr ea t ? Compa r e it wit h an y mea s u r e t h a t
h a s en ga ged t h e a t t en t ion of people of t h is Common wea lt h , or t h e
Legis la t u r e, a n d few if a n y ca n be fou n d, wh ich h a ve r is en s o h igh , or h a ve
equ a lled it in u t ilit y a n d impor t a n ce. "
All neces s ary expens es for this object may be eas ily provided for. If t h e
differ en t it ems of St a t e expen dit u r e, a s given by t h e St a t e Au dit or , wer e
exa min ed, s ever a l ma y be fou n d t h a t s eem t o u s u n n eces s a r y,or migh t be
r edu ced s o a s t o meet a ll t h e cos t of t h is mos t impor t a n t mea s u r e. It wou ld
be ea s y t o s pecify s u ch it ems . Th e Legis la t u r e cos t a bou t $1,000 per da y
wh ile in s es s ion . By s h or t en in g t h e s es s ion t h r ee da ys on ly, en ou gh migh t be
s a ved t o pa y t h e a n n u a l expen s es . As mu ch is pa id t o t h e Ba n k
Commis s ion er s a s wou ld be r equ ir ed for t h e Boa r d of Hea lt h ; a n d it is
s u ppos ed t h a t a ll t h e a dva n t a ges wh ich r es u lt fr om t h a t commis s ion migh t
be obt a in ed in s ome ot h er wa y wit h ou t a n y expen s e. Ot h er it ems migh t be
s pecified wit h equ a l pr opr iet y, a n d ma n y ma y be fou n d of dou bt fu l
expedien cy a s compa r ed wit h t h is . An y ca n did min d ca n ma ke h is own
s elect ion . Bu t s u ppos e we let t h em a ll s t a n d a s t h ey n ow do, t h e a dopt ion of
177
ou r mea s u r e wou ld be r edu ce t h e cos t of s u ppor t in g s t a t e pa u per s , n ow
in cu r r ed on a ccou n t of u n n eces s a r y s ickn es s a n d deat h s , mor e t h a n
s u fficien t t o pa y a ll expen s es s ever a l t imes over . An d if a dir ect t a x wer e la id
u pon t h e people for it s s u ppor t , t h ou gh u n n eces s a r y it wou ld be, on t h e
a ver a ge, les s t h a n t h r ee mills t o ea ch per s on ! Wh o wou ld n ot con s ider t h is a
ver y in s ign ifica n t expen dit u r e for s o n oble a pu r pos e ?
IV. It s hould be approved becaus e it is eminently a philanthropic and
charitable meas ure.
We h a ve r ecen t ly wit n es s ed t h r ee of t h e gr ea t es t n a t ion s of t h e ea r t h
len din g t h eir a id t o dis cover a n d s a ve a s in gle a dven t u r ou s n a viga t or , wh o
s a iled for t h e n or t h er n r egion s of t h is con t in en t t o ma ke dis cover ies , wh ich ,
if ma de, wou ld pr oba bly h a ve con fer r ed n o s u bs t a n t ia l ben efit on ma n kin d.
An d on e of t h e s ons of Ma s s a ch u s et t s , wit h ch a r a ct er is t ic liber a lit y, h a s
offer ed, a t h is own expen s e, t o equ ip a fleet t o con t in u e t h e s ea r ch , if t h e
gover n men t will pr ovide officer s a n d men . In a bea u t ifu l a llu s ion t o t h is
ma t t er , Hon . Hor a ce Ma n n s a id: Th u s t h e t h r ee mos t powerfu l gover n men t s
in Ch r is t en dom expr es s t h eir r egr et a n d pr offer t h eir a s s is t a n ce for t h e
r ecover y of a s in gle ma n ,-Sir J oh n Fr a n klin . An d yet you ca n n ot pa s s
t h r ou gh on e of t h e gr ea t s t r eet s of t h is or a n y ot h er of t h e cit ies of t h is
cou n t r y, you ca n n ot go t h r ou gh t h e mos t s eclu ded t own or villa ge in a ll t h is
br oa d la n d, wit h ou t meet in g s ome ju ven ile Sir J oh n Fr a n klin , s ome gr ea t
ma n in embr yo, mor e va lu a ble, a n d of mor e con s equ en ce t o fu t u r it y, t h a n
t h e on e wh o, we fea r , n ow lies bu r ied ben ea t h t h e icebergs of t h e Ar ct ic
Ocea n . All t h es e Sir J oh n Fr a n klin s , a ye, a n d Dr . Fr a n klin s t oo, a n d ot h er
n a mes of pot en t ia l a n d pr os pect ive gr ea t n es s , wh o h a ve wit h in t h em t h e
la t en t power s wh ich , in t h eir fu ll developmen t , migh t bles s a n d r egen er a t e
t h e wor ld, a r e s ca t t er ed a ll over t h is cou n t r y; bu t n on e of t h e t h r ee gr ea t
n a t ion s of Ch r is t en dom offer s it s s ympa t h y or s u ccor , or ext en ds a n a r m for
t h eir deliver a n ce from a fa t e wh ich is a s mu ch wor s e t h a n t o be bu r ied
ben ea t h t h e s n ows of t h e Ar ct ic, a s mor a l per dit ion is mor e t er r ible t h a n
ph ys ica l."
Yes ; a n d we s a y if t h e mon ey t h a t h a s been t h u s expen ded,-if t h e lives
t h a t h a ve been los t in t r yin g t o s a ve on e life,- h a d been a pplied t o t h e
dis cover y of t h e ph ys ica l cir cu ms t a n ces of t h e gr ea t ma s s of t h e people, in
t h e a pplica t ion of u s efu l r emedies for t h eir impr ovemen t , in s a vin g t h eir lives
a n d in eleva t in g t h eir s ocia l a n d s a n it a r y con dit ion , t h en , in s t ea d of on e life
s a ved, t h e n u mber wou ld h a ve been t h ou s a n ds .
Th er e is a n ot h er cla s s of ph ila n t h r opis t s wh o a r e oppos ed t o ca pit a l
pu n is h men t u n der a n y cir cu ms t a n ces . Th ey look wit h h or r or u pon t h e
t a kin g of t h e life of a h u ma n bein g, wh ich h a s been for feit ed t o la w a n d
;u s t ice, even for t h e cr ime of wilfu l mu rder , t h ou gh it s eems n eces s a r y for
t h e s a fet y a n d pr ot ect ion of ot h er lives . A gr ea t a mou n t of la bor a n d mon ey
is s pen t in t h e pr opa ga t ion of t h es e s en t imen t s . Bu t of s u ch per s on s
a ppa r en t ly t u r n a s ide t o n ot ice t h e of lives t h a t a r e u n n eces s a r ily s a cr ificed,-
t h e s ocia l mu r der s a n d s u icides t h a t a r e da ily occu r r in g a r ou n d u s , on
a ccou n t of exis t in g evils wh ich migh t be r emoved! If t h e s a me zea l, la bor a n d
mon ey wer e expen ded in diffu s in g cor r ect s a n it a r y in for ma t ion a mon g t h e
people, in r emoving t h e ca u s es of dis ea s e wh ich pr ey u pon t h em, in
pr opa ga t in g s ou n d s en t imen t s r ela t in g t o life a n d h ea lt h , a n d in eleva t in g
t h e ph ys ica l, s ocia l a n d mor a l con dit ion of ma n , h ow ma n y mor e lives migh t
178
be s a ved! In t h e on e ca s e, if ca pit a l pu n is h men t s h ou ld be a bolis h ed, a n
occa s ion a l wicked life migh t be s a ved fr om t h e ga llows , t h ou gh t h e r emova l
of t h e t er r or of in s t r u ma n t migh t lea d t o t h e los s of ma n y mor e good lives by
t h e h a n d of t h e mu r der er . In t h e ot h er ca s e, t h e ph ila n t h r opis t migh t cou n t
u p t h e lives of t h ou s a n ds s a ved, a n d wit n es s s ocia l eleva t ion , a n n dr ea s e of
s ou n d mor a ls a mon g a ll cla s s es , a n d a dimin u t ion of t h e n u mber of
mu r der er s a n d ot h er cr imin a l offen der s .
Sever a l n oble pu blic in s t it u t ion s , for t h e r emova l, cu r e or relief of t h e
imper fect ion s of h u ma n or ga n iza t ion , n a t u r a l or a cqu ir ed, h a ve been
es t a blis h ed a n d pa t r on ized by t h e s t a t e. Th e St a t e Lu n a t ic Hos pit a l h a s
r eceived fr om t h e St a t e, du r in g t h e n in et een yea r s of it s exis t en ce, $217,140
91, a n d in 1849 a lon e, $11,606 34. Th e As ylu m for t h e Deaf a n d Du mb a t
Ha r t for d, s in ce 1830, h a s r eceived $87,847 25, a n d in 1849 a lon e, $8,155
08. Th e As ylu m for t h e Blin d h a s r eceived $150,773 91, a n d du r in g la s t
yea r , $11,500, in clu din g $2,500 for t h e Sch ool for Idiot s . Th e Eye a n d Ea r
In fir ma r y, du r in g t he t h ir t een yea r s of it s exis t en ce, h a s r eceived $44,000;
a n d for t h e la s t t h r ee yea r s , $7 ,000 per a n n u m. Th e St a t e Refor m Sch ool,
du r in g t h e t h r ee yea r s of it s exis t en ce, h a s r eceived $115,648 94. An d t h e
pr iva t e con t r ibu t ion s a n d a n n u a l pa ymen t s t o t h es e in s t it u t ion s h a ve
pr oba bly been a s gr ea t or gr ea t er t h a n t h os e der ived fr om t h e pu blic
t r ea s u r y. We wou ld n ot lis p a wor d a ga in s t t h es e gr ea t ch a r it ies , n o wis h
t h ey h a d been s ma ller . Th ey a r e h on or a ble t o t h e St a t e, a n d u s efu l t o t h eir
ben eficia r ies . It may, h owever , be s t a t ed t h a t t h e n u mber of r ecipien t s of
t h es e ch a r it ies is compa r a t ively few a n d limit ed. Th ey compr eh en d a ver y
s ma ll pa r t on ly of t h e gr ea t ma s s es of t h e people. An d t h er e is n o dou bt t h a t
t h e s a me a mou n t of mon ey, a n d even t h e per cen t a ge of it , wh ich ou r
mea s u r e migh t r equ ir e, if a pplied t o t h e ca r efu l a s cer t a in men t of t h e ca u s es
of in s a n it y ,-t h e ca u s es of dea fn es s a n d du mbn es s ,-t h e ca u s es of blin dn es s ,-
t h e ca u s es of ju ven ile depr a vit y, a n d t o a vigor ou s pr os ecu t ion of t h e mea n s
for t h e mit iga t ion an d r emova l of t h es e ca u s es , a s gr ea t an d even gr ea t er
good migh t be effect ed,-a mu ch gr ea t er n u mber of ben eficia r ies migh t be
a s s is t ed. Th e dis ea s es wh ich t h es e in s t it u t ion s a r e es t a blis h ed t o r elieve,
wou ld. be dimin is h ed) a n d h u ma n it y wou ld be mor e la r gely bles s ed.
A Hu ma n e Societ y h a s exis t ed in Ma s s a ch u s et t s s in ce 1786," for t h e
pu r pos e," s a ys a n ea r ly h is t or ia n , "of r es t or in g s u s pen ded a n ima t ion ,
pr es er vin g h u ma n life, a n d a llevia t in g it s mis er ies ." "Dis cr eet a n d con cis e
dir ect ion s for t h e recover y of per s on s a ppa r en t ly dea d, fr om dr own in g,
s t r a n glin g, s u ffoca ca t ion , elect r icit y, or t h e u s e of pois on s ; ;u diciou s r ewa r ds
t o s u ch a s h a ve ;eopa r ded t h eir lives for t h e pr es er va t ion of ot h er s , a n d
fu r n is h in g con ven ien t s h elt er s , on ou r s ea coa s t , for s h ip-wr ecked ma r in er s ,
h a ve ext en s ively diffu s ed t h e ben efit s of t h is ben evolen t in s t it u t ion ." Up t o
1830, over $20,000 h a d been expen ded in pr omot in g it s object s . Meda ls a n d
gr a t u it ies h a ve been a wa r ded t o mer it or iou s s er vices in s a vin g life. Simila r
r ewa r ds h a ve been gen er ou s ly gr a n t ed by t h e gover n men t of Gr ea t Br it a in
for t h e a id a ffor ded by Amer ica n s ea men t o for eign s ea men in dis t r es s . A
ver y la r ge n u mber of ot h er volu n t a r y a s s ocia t ion s exis t in t h is St a t e; a n d t h e
h a n d of pr iva t e ch a r it y is widely open ed for t h e cu r e of dis ea s es , for r elief in
s ickn es s , for t h e s u ppor t of widows a n d or ph a n s , a n d for va r iou s ot h er
s imila r object s of ben evolen ce a n d ch a r it y. Too mu ch ca n n ot be s a id in
pr a is e of t h es e n oble in s t it u t ion s , fr om wh ich flow s o ma n y s t r ea ms of " oil
179
a n d win e," t o comfor t a n d bles s h u ma n it y; bu t it ma y be well t o in qu ir e
wh et h er t h er e is h ot a n ot h er a n d s t ill mor e n oble object of ph ila n t h r opy.
Th e evils wh ich it is t h e object of t h es e in s t it u t ion s t o r elieve ma y be
ca lled t h e d is eas es of s ociet y. By t h em a ll ou r cit ies a n d t own s s u ffer . Th e
r emedies lie deeper a n d fa r t h er ba ck. All a lon g we h a ve en dea vor ed t o pr ove
t h a t pr even t ion is bet t er t h a n cu r e;" a n d t h e dis t in ct ion we h a ve ma de
bet ween t h e cu r a t ive a n d t h e pr even t ive ph ys icia n , migh t wit h gr ea t
pr opr iet y be a pplied t o t h es e in s t it u t ion s a s t h e cu r a t ive mea s u r es , a n d t o
ot h er s wh ich migh t be a dopt ed a s t h e pr even t ive mea s u r es . Thes e are the
removal of the caus es which produce the mis ery which thes e s treams of
benevolence are applied to alleviate. On t h is deep a n d br oa d fou n da t ion lie
t h e mea s u r es we r ecommen d ; a n d t h ey s h ou ld be a ppr oved a s t h e fir s t , t he
gr ea t es t , a n d mos t impor t a n t object s of ph ila n t h r opy a n d ch a r it y. If we
wou ld r elieve s ickn es s we mu s t r emove t h e ca u s es of s ickn es s , a n d pr even t
it ; if we wou ld r elieve in s a n it y, a n d dea fn es s , a n d blin dn es s , we mu s t
r emove t h e ca u s es of in s a n it y, a n d dea fn es s a n d blin dn es s ; if we wou ld
pr even t pr ema t u r e dea t h s , a n d pr ema t u r e old a ge, we mu s t r emove t h eir
ca u s es ; if we wou ld pr ovide a ga in s t widowh ood a n d or ph a n a ge, we mu s t
r emove t h e ca u s es of widowh ood a n d or ph a n a ge ; a n d s o of ever y ot h er evil
wh ich it is t h e object of t h es e ch a r it ies t o a llevia t e.
123

V. It s hould be approved becaus e it is a moral meas ure. Th er e is a mos t
fa t a l a n d cer t a in con n ect ion ," s a ys t h e Edin bu r gh Review, (Vol. XCI, for
Apr il, 1850, pp. 384, bet ween ph ys ica l u n clea n lin es s a n d mor a l pollu t ion .
Th e con dit ion of a popu la t ion becomes in va r ia bly a s s imila t ed t o t h a t of t h eir
h a bit a t ion s . Th er e ca n be n o s igh t mor e pa in fu l t h a n t h a t of a h ea lt h y, r os y,
a ct ive cou n t r ywoma n br ou gh t t o on e of t h es e dwellin gs . For a t ime t h er e is a
des per a t e exer t ion t o keep t h e pla ce clea n ; s ever a l t imes in t h e for en oon is
t h e pa vemen t in t h e fr on t of t h e h ou s e wa s h ed, bu t a s oft en does t h e oozin g
filt h cr eep a lon g t h e s t on es , a n d s h e feels , a t len gt h , t h a t h er la bor is in va in .
Th e n oxiou s exh a la t ion s in fu s e t h eir pois on in t o h er s ys t em, a n d h er
en er gies dr oop. Th en s h e becomes s ick. Clea n lin es s becomin g impos s ible,
s h e get s a ccu s t omed t o it s a bs en ce, a n d gr a du a lly s in ks in t o t h e wa ys of h er
n eigh bor s . Th e a r t of con cea lin g dir t is s u bs t it u t ed for t h e h a bit of
clea n lin es s ; s h e becomes . a dir t y, debilit a t ed s la t t er n , followed by s ickly,
s cr ofu lou s , fever is h ch ildr en ; a n d s h e fa lls t h r ou gh s u cces s ive s t a ges of
degr a da t ion , t ill, phys ica l wr et ch edn es s h a vin g don e it s wor s t , s h e r ea ch es
t h e lowes t of a ll, t ha t in wh ich s h e h a s cea s ed t o compla in . Th e fa t e of t h e

123
Af ter the above was written, ans while this s heet was pas s ing through the pres s , the able notice of Ed win Chad wick ,
Es q., the dis tinquis hed s anitary reformer, in the North Britis h Review, f or May , 1850, arres ted our attention. We extract
from page 26, (Am. Ed.) the f ollowing pas s age, coincid ing with the views we have s cpres s ed:-Ther principle, though
apparently s o s imple that no one could mis s it, is in reaity a d is covery . It may be s tated thus :-In every cas e of s ocial
wrong that it is des ired to remedy , get at the antecedents , and apply the legis lative or adminis trative interf erence at that
point or at thos e points , in the chain of antecedents , where s uch interf erence may be either mos t eas y or mos t rad ical and
effective. Thes e phas es , Get at the antecendnts , Mount to the s ources , appear to be s tereoty ped maxims in the mind of
Chad wick -s ecrets in his mode of dealing with all ques tions of s ocial d is eas e whatever. Whether it is into the means of
preventing crime that he inquires , or into the means of preventing pauperis m, or las tly , as he has more than once
propos ed, into the means of preventing ins anity , his method is s till the s ame; namely , by a rigorous examination of
numerous ind ividual cas es , to as certain the mos t common antecedents of the evil under notice, and out of thes e
antecedents to s elect that one or thos e f ew, on which rap of legis lative enactment or an adminis trative precaution may
mos t eas ily and s urely come down. Even in cas es of what s eems inevitable and hopeles s evil, at which s ociety mus t jus t
gaz e with pity and s hak e its head, he has commonly f ound that a little inquiry will reveal at leas t one antecedent that
may be des troy ed, one s ource that may be drided up. Thus as regards lunacy , it is his f irm belief , announced more that
once in his more recent communications with the public, that were all the cas es of lunacy in the country to be undertak en
by the s tate in s uch a manner that the antecedents in each cas e s hould be rigorous ly traced out, caus es of that f earful
malad y would be expis cated perfectly within the range of general regulation and s tatute
180
ch ildr en is , if pos s ible, mor e h ea r t -br ea kin g. All idea of s obr iet y, a ll n ot ion of
s elf-r es pect , a ll s en s e of modes t y, a ll in s t in ct of decen cy, is n ipped in t h e
bu d ; t h ey con gr egat e in ma s s es , a n d mix wit h t h e wor s t va gr a n t s . At la s t
s ome dr ea dfu l fever for ces on t h e n ot ice of t h e pu blic t h e exis t en ce of t h eir
s qu a lid den s of mis er y ; s u ch a s t h os e in t h e Sa ffr on .Hill dis t r ict ,-wh er e
t wen t y-five people wer e fou n d livin g in a r oom s ixt een feet s qu a r e,-wh er e a
ma n a n d h is wife a n d fou r ch ildr en , occu pyin g on e r oom, t ook in s even
lodger s ,-a n d wh er e on e h ou s e con t a in ed a h u n dr ed a n d t wen t y-s ix people,
a n d on ly s ix or s even beds . Th es e people s a ve n ot h in g, bu t in va r ia bly s pen d
a ll t h ey ea r n in dr ink ; a n d wit h t h a t pr ecociou s depr a vit y t oo s u r ely evin ced
by h u ma n bein gs wh en h er ded t oget h er like bea s t s , t h e you n g of bot h s exes
live t oget h er fr om t h e a ges of t welve a n d t h ir t een yea r s ."
"Th e in dir ect effect s of s ickn es s a r e fa r mor e h u r t fu l, t h ou gh les s
obs er va ble, t h a n t h e dir ect effect s of mor t a l dis ea s e. Th os e wh o mer ely s u ffer
fr om fever a r e a bou t t welve t imes a s ma n y a s t h os e wh o per is h . Th e pois on
a r is in g fr om a n ima l or veget a ble decompos it ion a ct s a s a s eda t ive; it lower s
t h e t on e, u n s t r in gs t h e n er ves , a n d br in gs on ph ys ica l la n gu or a n d men t a l
a pa t h y. Per s on s a ffect ed by it become u n fit for , a n d h a ve a h a t r ed of, la bor .
Th er e is n o expedien t t h ey will n ot s eek in or der t o es ca pe fr om t oil. Un der
t h is depr es s ion , a n d a s a r elief fr om a pecu lia r in wa r d s ink ing feelin g, t h ey
h a ve a cr a vin g for t h e s t imu lu s of a r den t s pir it s t o a n ext en t in con ceiva ble
by per s on s in h a ppier cir cu ms t a n ces ; it a mou n t s t o a pa s s ion , a n d t h es e
debilit a t ed bein gs a r e s omet imes a lmos t u n a ble t o con t r ol it . Th e s a me
pois on , by der a n gin g a n d wea ken in g t h e diges t ive or ga n s , pr odu ces
compla in t s of a s cr ofu lou s a n d con s u mpt ive ch a r a ct er , gen er a lly
a ccompa n ied by a fever is h a n d n er vou s ir r it a bilit y, con s t a n t ly u r gin g t h em
t o t h e u n r es t r a in ed gr a t ifica t ion of t h eir a ppet it es ; a n d s o t h e pr oces s of
degr a da t ion goes for wa r d. Th e effor t t o s t r u ggle a ga in s t t h e s u r r ou n din g
ma s s of filt h a n d wr et ch edn es s , is given u p in s h eer h opeles s n es s , a n d t h e
ma n 's bes t en er gies a r e s a pped by t h e ir r es is t ible pois on , even wh ile h e is
en dea vor in g t o r es is t it s in flu en ce. Th e la bor er comes h ome t ir ed, a n d is gla d
t o es ca pe fr om t h e dir t a n d dis comfor t ,-t h e pois on ou s a t mos ph er e of h is
h ome,-t o a pot h ou s e. In t h e mor n in g t h er e is n o r efr es h in g mea l for h is
s u ppor t ,-a ga in h e is dr iven t o t h e beer s h op; over power ed by t h e in t er n a l
cr a vin g a n d ext er n a l t empt a t ion s , h e becomes a dr u n ka r d, a n d, in t ime,
u n equ a l t o h a r d work. Soon t h e comfor t s of life a r e gon e; t h en it s decen cies
a r e n eglect ed; t h e mor a l feelin gs , on e a ft er t h e ot h er , a r e br oken down befor e
t h e mos t s or did a ppet it es , a like u n gover n a ble a n d in s a t ia ble: h e is cr u s h ed
by dr u n ken n es s , profliga cy, a n d pover t y, a n d s in ks fr om on e s t a ge of vice
a n d mis er y t o a n ot h er , t ill t h e in t ellect u a l fa cu lt ies become dimmed, a ll
mor a l a n d r eligiou s feelin g expir es , t h e domes t ic a ffect ion s a r e des t r oyed, a ll
r ega r d for la w or pr oper t y i~ los t , a n d h ope is qu en ch ed in des per a t e
"wr et ch edn es s : s o t h a t a t la s t , owin g t o t h es e wit h er in g ca u s es , fa milies
h a ve been fou n d, even in Lon don , h u ddlin g t oget h er like a n ima ls , t h e ver y
in s t in ct s of h u ma n it y oblit er a t ed, a n d, like t h e br u t es , r elievin g ever y wa n t ,
a n d gr a t ifyin g ever y pa s s ion in t h e fllll view of t h e commu n it y. Th es e a r e t h e
r ea s on s wh y t h e dis t r ict s of filt h a r e n ot on ly t h e dis t r ict s of fever , s cr ofu la ,
con s u mpt ion , a n d ch oler a , bu t a ls o of cr ime. Ha bit s a r e ea r ly for med of
idlen es s a n d dis h ones t y ,-of br u t a lit y, in expr es s ible pr ofliga cy, a n d s en s u a l
in du lgen ce; a n d h er e a r e edu ca t ed t h e ir r ecla ima ble ma lefa ct or s .
181
"Th es e a r e n o fa n cied s ket ch es , bu t a wfu l r ea lit ies . Su ch pict u r es of t h e
s a d mor a l effect s of livin g in ba dly loca t ed, over -cr owded, a n d filt h y
h a bit a t ion s , a r e t o be s een in mos t of t h e popu lou s cit ies , a n d, t o s ome
ext en t , in t h e cou n t r y. We h a ve h a d fr equ en t occa s ion t o en t er t h es e a bodes
of wr et ch edn es s . Th e offen s ive r efu s e wh ich even a n ima ls will bu r y ou t of
s igh t , is br ou gh t in t o per pet u a l con t a ct wit h h u ma n bein gs . It s t a gn a t es in
t h e cou r t s a n d a lleys , flows in t o t h e cella r s , a n d is s u cked u p in t o t h e wa lls .
Men , women a n d ch ildr en ea t , dr in k a n d s leep, s u r r ou n ded by it s dis gu s t in g
efflu via . Th e pig in it s s t y is n ot mor e fa milia r wit h it s own odor , t h a n is t h e
wr et ch ed immor t a l in t h e dwellin g wh ich ign or a n t ca r eles s n es s h a s bu ilt for
h u n , a n d mu n icipa l a n d legis la t ive in differ en ce h a s s u ffer ed h im t o in h a bit ."
In s ome of t h es e h ou s es , on e, t wo, or mor e fa milies a r e fou n d in on e
a n d t h e s a me room,-cookin g, ea t in g, dr in kin g, wa s h in g, dr es s in g,
u n dr es s in g, s leepin g, a n d doin g ma n y ot h er a ct s n a ma ble a n d n a meles s .
Fa t h er s a n d mot h er s , men a n d women , boys a n d gir ls , ma y be s een livin g
a n d s leepin g in pr omis cu ou s con fu s ion . In s ome in s t a n ces , t oo, per s on s ma y
be fou n d in t h e immedia t e pr es en ce, or in t h e s a me bed, wit h a dea d body,
s t r u ck down wit h t yph u s , ch oler a , or s ome ot h er zymot ic dis ea s e; or by t h e
s low wa s t in g of cons u mpt ion ; a n d in ot h er s , a ch ild is bor n , or a n a du lt
dies ,-on e immor t a l s pir it ma kes it s en t r an ce in t o, a n d a n ot h er ma kes it s exit
fr om, t h is wor ld, a t n ea r ly t h e s a me t ime, in t h e s a me wr et ch ed a bode, a n d
s u r r ou n ded by s imila r a ppa llin g cir cu ms t a n ces . Ca n mor a l pr in ciple be
in cu lca t ed in s u ch a n a t mos ph er e, a n d s u r r ou n ded by s u ch in flu en ces ?
Mu s t n ot degr a da t ion , vice, cr ime, be t h eir n a t u r a l, in evit able t en den cy? If
t h ey a r e n ot , in in dividu a l in s t a n ces , t h ey mu s t be t a ken a s r a r e except ion s .
You ca n n ot degr a de t h e ph ys ica l ma n by a life-lon g fa miliar it y wit h s cen es
of filt h a n d in decen cy, wit h ou t deba s in g h is wh ole mor a l n a t u r e."
124

Th e object of t h e mea s u r es we r ecommen d is t o r emove filt h a n d
pr even t dis ea s e, t o in t r odu ce t h os e a ccommoda t ion s wh ich a llow, a n d r efor m
t h os e h a bit s wh ich pr even t , t h e , t h e ph ys ica l ma n , t h e s ocia l n a t u r e a n d
mor a l con dit ion of fellow-bein gs . Th ey a r e t h e bes t h a n dma ids we' ca n ,
pr os per it y, t o mor a lit y, a n d t o r eligion .
Dr . Simon , wh om we h a ve oft en qu ot ed, gives u s pict u r e. II Amon g t h e
in flu en ces pr e;u dicia l t o r eckon ed t h e s ocia l con dit ion of t h e lower cla s s es ;
a n d I r efer t o t h is t h e mor e es pecia lly, beca u s e, oft en in s a n it a r y s u b;ect s ,
t h e filt h y, or s loven ly, or impr oviden t , des t r u ct ive, or in t emper a t e, or
dis h on es t h a bit s of t h es e a r e cit ed a s a n expla n a t ion of t h e in efficien cy of
s ign ed for t h eir a dva n t a ge. It h a s been u r ged t h a t t o impr oved domes t ic
a r r a n gemen t s wit h in t h e r ea ch of s u ch per s on s is a wa s t e a n d a folly; t h a t if
you give t h em a coa l s cu t t le, a wa s h in g-ba s in , a n d a wa t er -clos et , ea ch of
t h es e s ever a l u t en s ils will be a pplied t o t h e pu r pos e of a n ot h er , or pu r pos es
of a ll; a n d t h a t mean wh ile t h e object of s olicit u de will r ema in in t h e s a me
u n r edeemed lown es s a n d mis er y a s befor e. Now it is u n qu es t ion a ble, a n d I
a dmit it , t h a t in hou s es combin in g a ll t h e s a n it a r y evils wh ich I h a ve
en u mer a t ed, t h er e do dwell wh ole h or des of per s on s wh o s o lit t le in s elf-
defen ce a ga in s t t h a t wh ich s u r r ou n ds t h a t t h ey ma y be con s ider ed a 1mos t
in differ en t t o it s exis t en ce or a lmos t a cclima t ed t o en du r e it s con t in u a n ce. It
is t oo t r u e t h a t a mon g t h es e cla s s es t h er e a r e s wa r ms of men a n d women

124
. Mr. Chad wick , in his report, s ay s of s uch s cenes in England, " Ihe corps e is never abs ent f rom the s ight of the
s urvivors ; eating, drink ing or s leeping, it is there. ' (See S anitary Movement, p. 13.
182
wh o h a ve yet t o lea rn t h a t h u ma n bein gs s h ou ld dwell differen t ly fr om ca t t le;
s wa r ms t o wh om per s on a l clea n lin es s is u t t er ly u n kn own ; s wa r ms by wh om
delica cy a n d decen cy, in t h eir s ocia l r ela t ion s , a r e qu it e u n con ceived. Men
a n d women , boys a n d gir ls , in s cor es of ea ch , u s in g join t ly on e common
pr ivy; gr own per s ons of bot h s exes s leepin g in common wit h t h eir ma r r ied
pa r en t s ; a woma n s u ffer in g t r a va il'in t h e mids t of t h e ma les a n d fema les of
t h r ee s ever a l fellow-lodger s in a s in gle r oom; a n a du lt s on s h a r in g h is
mot h er 's bed du r in g h er con fin emen t ; s u ch a r e in s t a n ces r ecen t ly wit h in my
kn owledge of t h e degr ee a n d of t h e ma n n er in wh ich people ma y r ela ps e in t o
t h e h a bit s of s a va ge life, wh en t h eir domes t ic con dit ion is n eglect ed, a n d
wh en t h ey a r e s u ffer ed t o h a bit u a t e t h ems elves t o t h e u t t er mos t dept h s of
ph ys ica l obs cen it y a n d degr a da t ion . Con t empla t in g s u ch ca s es , I feel t he
deepes t con vict ion t h a t n o s a n it a r y s ys t em ca n be a dequ a t e t o t h e
r equ ir emen t s of t h e t ime, or ca n cu r e t h os e r a dica l evils wh ich in fect t h e
u n der -fr a mewor k of s ociet y) u n les s t h e impor t a n ce be dis t in ct ly r ecogn ized,
a n d t h e du t y ma n fu lly u n der t a ken , of impr ovin g t h e s ocia l con dit ion pf t he
poor . Th os e wh o s u ffer u n der t h e ca la mit ou s s a n it a r y con dit ion s wh ich I
h a ve dis clos ed, h a ve been led, per h a ps , t o con s ider t h em a s in s epa r a ble
fr om pover t y, a n d a ft er t h eir lon g h a bit u a t ion t o s u ch in flu en ces , wh o ca n
won der if per s on a l a n d mor a l degr a da t ion con fir m t h em mor e a n d mor e t o
t h e ph ys ica l deba s emen t of t h eir a bode ? In t h e mids t of in evit a ble domes t ic
filt h , wh o ca n won der t h a t per s on a l clea n lin es s s h ou ld be n eglect ed ? In a n
a t mos ph er e wh ich for bids t h e br ea t h t o be dr a wn fr eely, wh ich ma in t a in s
h a bit u a l ill h ea lt h , wh ich depr es s es a ll t h e n a t u r a l s pr in g a n d bu oya n cy of
life, w h o ca n won der t h a t fr equ en t r ecou r s e s h ou ld be h a d t o s t imu la n t s ,
wh ich , h owever per n iciou s in t h ems elves , s t ill for a momen t dis pel t h e
in ces s a n t la n gu or of t h e pla ce, give t empor a r y vigor t o t h e br a in , a n d ch eer
t h e fla ggin g pu ls es of a pois on ed cir cu la t ion ? Wh o ca n won der t h a t h a bit s of
impr oviden ce a n d reckles s n es s s h ou ld a r is e in a popu la t ion , wh o n ot on ly
h a s mu ch ign or a n ce a n d pr e;u dice a mon gs t it , bu t wh ich likewis e is
u n a ccu s t omed t o con s ider a t ion a n d kin dn es s ? Wh o ca n won der t h a t t h e
la ws of s ociet y s h ou ld a t t imes be for got t en by t h os e wh om t h e eye of s ociet y
h a bit u a lly over looks , a n d wh om t h e h ea r t of s ociet y oft en a ppea r s t o
dis ca r d? I believe t h a t n ow t h er e is a ver y gr owin g feelin g a br oa d t h a t t h e
poor a n d degr a ded of a Ch r is t ia n cou n t r y ca n n o lon ger , in t h eir own
ign or a n ce a n d h elples s n es s , be s u ffer ed t o en cou n t er a ll t h e ch a n ces wh ich
a ccompa n y des t it u t ion , a n d wh ich is a llied, oft en in dis s olu bly, t o
r eckles s n es s , pr ofliga cy, a n d per dit ion . Th e t a s k of in t er fer in g in beh a lf of
t h es e cla s s es , h owever in s en s ible t h ey ma y be of t h eir own da n ger a n d
fr equ en t degr a da t ion , begin s a t len gt h t o be r ecogn ized a s a n obliga t ion of
s ociet y."
It is r igh t t h a t t h es e t h in gs s h ou ld be kn own ,-it is well t h a t t h ey s h ou ld
be con s ider ed. We h a ve on e pes t ilen ce a ft er a n ot h er t o wa r n u s t h a t t h e
des t r oyin g a n gel is a t h a n d. In t h e mea n t ime, t h ou s a n ds of cit izen s a r e
h u r r ied t h r ou gh a mis er a ble exis t en ce t o a n u n t imely en d. Wh ile we wr it e,
t h ey a r e dr oppin g int o t h eir gr a ves . We fill ou r ;a ils wit h felon s , a n d we h a ve
cit y mis s ion s , a n d pu t ou r t r u s t in edu ca t ion ; bu t t h e in flu en ces of filt h a nd
dis ea s e a r e s t r on ger t h a n t h e police-ma n , t h e mis s ion a r y, a n d t h e
s ch oolma s t er . To t h e a bodes wh ich we h a ve des cr ibed," t h e Sa bba t h n ever
comes . In va in it s mor n in g eye peeps kin dly in a t t h e gloomy win dows , for it
183
meet et h n o r ecogn it ion t h er e! In va in it s mer idia n bea ms , s t r u gglin g t h r ollgh
t h e mu r kin es s a n d filt h , a bove, a r ou n d, a n d ben ea t h , s eek t o s h in e in t o t h e
door wa ys of t h os e den -Iike h omes ,- for t h ey a r e qu ickly qu en ch ed by t h e
deep da r kn es s t h a t a bidet h t h er e! Th er e t h e Sa bba t h 's decen cies a r e n ever
cu lt iva t ed,- t h e Sa bba t h 's pea ce n ever en joyed,-t h e Sa bba t h 's fes t iva l is
n ever kept ,-t h e Sa bba t h 's bles s in g is n ever kn own !"
VI. It s hould be approved becaus e the progres s of the age demands it.
Th e h a lf cen t u r y ju s t n ow dr a win g t o a clos e, is a won der fu l per iod in
t h e wor ld's h is t or y. In qu ir y a n d dis cover y h a ve been a br oa d in t h e ea r t h .
New fa ct s a n d n ew t r u t h s been a s cer t a in ed -n ew s cien ces h a ve been
developed, a n d bou n da r ies of old on es h a ve been gr ea t ly en la r ged. Th es e
dis cover ies h a ve pr odu ced r evolu t ion a ft er r evolu t ion , - h a ve mu lt iplied t h e
mea n s of con ven ien ce, comfor t , lu xu r y , -u n t il ou r s ocia l a n d pr a ct ica l life is
a t h in g fr om t h e s ocia l a n d pr a ct ica l life t h a t exis t ed a go. An d wer e it n ot
t h a t we h a ve gr own u p wit h t h ey wou ld a ppea r a lmos t beyon d t h e limit s
s ibilit y.
How a r e t h es e won der s pr odu ced ? Ma in ly by givin g t o t h e h u ma n min d
a kn owledge of n ew fa ct s , a n d kn owledge t o t h e dis cover y of t h e la ws of
combin a t ion a n d pra ct ica l a pplica t ion . Th e s t ea m en gin e, bes ides givin g u s a
n ew a n d mech a n ica l power , h a s r evolu t ion ized h a bit s of locomot ion , by s ea
a n d by la n d. A jou rn ey fr om Bos t on t o New Yor k, wh ich for mer ly r equ ir ed
da ys for it s per for ma n ce, is n ow a ccomplis h ed wit h in a few h ou r s . A voya ge
t o En gla n d, on ce a lwa ys of u n cer t a in du r a t ion , a n d fr equ en t ly r equ ir in g
mon t h s for it s per for ma n ce, is n ow ma de in t en da ys . On e mon t h on ly,
in s t ea d of s ix, is con s u med in a voya ge t o t h e Pa cific coa s t . Even t s wh ich
h a ve t a ken pla ce in t h e Ea s t In dies h a ve been kn own h er e wit h in a mon t h
a ft er wa r ds ! Th es e gr ea t fa cilit ies of in t er cou r s e in cr ea s e, immen s ely, t h e
n u mber of t r a veller s , a n d br in g t h e in h a bit a n t s of t h e wh ole civilized wor ld
in con t a ct , a n d ma ke t h em a cqu a in t ed wit h ea ch ot h er . Wh a t is kn own by
on e per s on , in on e pla ce ma y be kn own by a ll in ever y pla ce. "Ma n y r u n t o
a n d fr o, a n d kn owledge is increas ed." Th es e a r e t h e dis cover ies ,-t h e
ch a r a ct er is t ics of t h e a ge,-a n d t h ey h a ve a n in ca lcu la ble in flu en ce on h u ma n
developmen t a n d pr ogr es s .
A pr oces s by wh ich t h e la ws of elect r icit y a n d ma gn et is m ma y be
a pplied t o t h e pu r pos es of in t er commu n ica t ion bet ween differ en t min ds in
differ en t pla ces , is a r ecen t dis cover y, a ls o excit in g t h e a dn lir a t ion a n d
a s t on is h men t of ma n kin d. Wh o wou ld h a ve ima gin ed, a few yea r s s in ce, t h a t
a commer cia l or der cou ld be s en t fr om Bos t on t o New Yor k, t h a t or der
execu t ed, a n d t h e a n s wer r eceived in Bos t on , a n d t h e wh ole occu pyin g bu t
t en min u t es ! An d yet t h is won der h a s been a ccomplis h ed. Th ou gh t , t h e
momen t it is u t t er ed, ma y be t r a n s mit t ed wit h t h e s peed of ligh t n in g t o
dis t a n t r egion s , a n d lea ve it s foot -pr in t s , a t plea s u r e, a t a n y pla ce a lon g it s
cou r s e. An d copies of t h es e foot -pr in t s ca n be mu lt iplied by t h e power of
s t ea m a t t h e r a t e of t en or mor e t h ou s a n ds per h ou r , a n d by t h e s a me power
s ca t t er ed in a ll dir ect ion s . It is t h u s t ba t n ea r ly ever y impor t a n t even t is n ow
kn own t h r ou gh ou t t h is va s t cou n t r y a lmos t a s s oon a s it occu r s .
Th e dis cover ies , t oo, in geology, in ch emis t r y, a n d in ot h er n a t u r a l a n d
ph ys ica l s cien ces , a r e n o les s won der fu l. In a lmos t every depa r t men t of
kn owledge, a n d in a lmos t a ll t h e fea t u r es of pr a ct ica l a n d mech a n ica l life,
t h er e pr eva ils a n a s t on is h in g a ct ivit y. New dis cover ies a r e con s t a n t ly ma de,
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a n d ea ch gives n ew impet u s t o fu r t h er developmen t s . Ma n a ccomplis h es
mor e in a few mon t h s n ow t h a n for mer ly in ma n y yea r s . He s eems t o live
fa s t er a n d lon ger in t h e s a me t ime. All is en er gy a n d pr ogr es s . If t h es e
dis t in gu is h in g ch a r a ct er is t ics of t h e a ge a r e wis ely dir ect ed, by wis e men ,-if
t h e pr ogr es s s h a ll good a n d n ot t owa r ds evil,-it is impos s ible t o t ell wh a t
fu t u r e glor ies a r e yet r es er ved for t h e t r iu mph of t h e h u ma n We a r e a mon g
t h os e wh o believe t h a t t h e a ge of yet in it s in fa n cy; a n d t h a t , gr ea t a s a r e t h e
h u ma n in t ellect , ot h er s s t ill mor e won der fu l a r e yet s t or e for u s .
Do n ot t h es e ch a r a ct er is t ics of t h e a ge dema n d t h a t t h in g s h ou ld be
don e for Sa n it a r y Refor m? Sh a ll pr es er vin g ou r lives , a n d of in vigor a t in g ou r
h ea lt h , be t h e on ly a r t t h a t s h a ll r ema in in t h e s a me s t a t ion a r y pos it ion
wh ich it h a s lon g exis t ed; or t h a t s h a ll be per mit t ed s omet imes t o ma ke a
r et r ogr a de movemen t ? Sh a ll ign or a n ce, pr es u mpt ion a n d a pa t h y br ood over
t h is mos t vit a lly ma t t er , wh ile in t elligen ce, a t t en t ive a pplica t ion , a n d a ct ivit y
pr es s for wa r d ot h er object s in t h eir r apid ca r eer of a dva n cemen t t owa r ds
per fect ion ? We h a ve des cr ibed t h e field of in qu ir y,-we h a ve s h own t h a t t h er e
is en cou r a gemen t t o la bor ; a n d we believe t h a t in n o s cien ce or a r t ,-in n o
depa r t men t of kn owledge or dis cover y, ca n mor e impor t a n t or mor e u s efu l
a ch ievemen t s be ma de. Va ccin a t ion , et h er iza t ion , ot h er pr even t ive a gen cies ,
a r e gr ea t dis cover ies , bu t n ot gr ea t er t h an ot h er a n d s imila r on es wh ich a r e
des t in ed h er ea ft er t o be kn own .
Obs er va t ion a n d dis cover y in t h e cu r e an d expu ls ion of dis ea s e a ft er it s
in va s ion we wou ld n ot exclu de, bu t wou ld a dvoca t e a n d elicit in ever y
a va ila ble a n d u s efu l for m; a n d we believe t h er e is mu ch in t h is depa r t men t
of kn owledge yet t o n ot wit h s t a n din g t h e gr ea t pr ogr es s wh ich medica l ma de
wit h in t h e pa s t few yea r s . On e of ou r mos t a n d emin en t ph ys icia n s wa s
la t ely a s ked-"Do you t h a t t h e medica l edge wh ich s h a ll a dmit t h e belief t h at
fu r t h er u s efu l dis cover ies ca n n ot be ma de in t h e modes of t r ea t in g dis ea s e?
Cer t a in ly n ot ," s a id h e ; we are as y et only on the borders ignorance! Th is
ma y be t r u e in ma n y r es pect s . Not wit h s t a n din g t h e br illia n t dis cover ies t h a t
h a ve been ma de in ph ys iology a n d in t h e va r iou s depa r t men t s of medica l
s cien ce a n d medica l pr a ct ice,-n ot wit h s t a n din g t h e mor e t h orou gh edu ca t ion
a n d t h e mor e emin en t medica l s kill t h a t ch a r a ct er izes ma n y ph ys icia n s of
t h e pr es en t da y ,-t h er e a r e few of t h em wh o h a ve n ot s omet imes dis cover ed
t h e imper fect ion of h u ma n a t t a in men t s , a n d t h e u n cer t a in t y t h a t ma y yet
a t t en d a pr a ct ice gu ided by t h e h igh es t medica l s kill. Th e mea s u r e we
r ecommen d is des ign ed t o pile u p fa ct u pon fa ct , in r ela t ion t o life, dis ea s e,
a n d mor t a lit y, u n t il t h eir n a t u r e a n d la ws a r e a s cer t a in ed a n d demon s t r a t ed
; a n d t h u s a id, in va r iou s wa ys : in in cr ea s in g kn owledge, in lea din g t o
impor t a n t dis cover ies , a n d in r emovin g t h os e u n cer t a in t ies wh ich a t t en d t h e
pr a ct ice a n d s u cces s of t h e pr ofes s ion . An d in t h is wa y we s h a ll a t t empt t o
meet t h e dema n ds of t h e a ge.
Bu t t h e Sa n it a r y Refor m we a dvoca t e lies ch iefly in a n ot h er field of
obs er va t ion a n d dis cover y, wh ich h a s a s yet been ver y imper fect ly explor ed.
Th is ma y be ca lled t h e Province of Prevention -pr even t ion of dis ea s e -
pr even t ion of s u fferin g-pr even t ion of s an it a r y evils of ever y kin d; a n d t h e
effor t s of t h os e wh o en t er t h is h opefu l pr ovin ce s h ou ld be dir ect ed t o t h e
dis cover y a n d t h e mea n s of r emova l of t h e ca u s es of t h es e evils . Ever y effect
mu s t h a ve a ca u s e-ever y dis ea s e h a s it s ca u s e. An d t h e effor t s h ou ld be t o
a s cer t a in t h e exa ct r ela t ion wh ich on e bea r s t o t h e ot h er -wh a t kn own , exa ct
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a n d pos it ive ca u s es , will pr odu ce a kn own , exa ct a n d pos it ive dis ea s e, or a
s a n it a r y evil of a n y s pecific kin d, a n d n on e ot h er . An d is n ot t h is a s fa r
wit h in t h e limit s of pos s ibilit y a n d cer t a in t y a s is t h e t r ea t men t a n d
er a dica t ion of dis ea s e? Ca n n ot t h e exa ct n a t u r e of a n a t mos ph er ic, loca l or
per s on a l ca u s e of dis ea s e, a n d t h e exa ct per s on a l con dit ion wit h wh ich it
mos t ea s ily a s s imila t es , a n d wh ich it mos t ea s ily a ffect s , be defin it eIy a nd
a ccu r a t ely a s cer t a in ed? If s u ch a des ir able dis cover y cou ld be ma de, wh a t
ma n ifold bles s in gs on h u ma n it y wou ld it con fer ! We ku ow t h a t a h u ma n
body, u n a lt er ed fr om it s or igin a l or ga n iza t ion or fu n ct ion s , comin g in con t a ct
wit h t h e vir u s of s ma ll-pox, eit h er in h a led wh ile floa t in g in t h e a t mos ph er e,
or imbibed by ou t wa r d con t a ct or in ocu la t ion , will pr odu ce a s pecific effect ,-a
s pecific dis ea s e. Her e is ca u s e a n d effect of a kn own a n d exa ct r ela t ion t o
ea ch ot h er . We kn ow, t oo, t h a t va ccin a t ion , pr oper ly per formed, will a lt er t h e
or igin a l or ga n iza t ion or fu n ct ion s , s o t h a t t h e s a me vir u s will n ot in eit h er
wa y t a ke effect . Here is a n ot h er exa ct ca u s e a n d effect wh os e r ela t ion s a re
equ a lly kn own . Th is is a dis cover y wh ich h a s , "wit h in t h e la s t fift y yea r s ,
s a ved t h ou s a n ds a u d t h ou s a n ds of lives , a n d migh t h a ve s a ved t h ou s a n ds
mor e, h a d it been u n iver s a lly a pplied. Now it is bu t fu lfillin g t h e dema n ds of
t h e a ge t o pr es s in qu ir ies vigor ou s ly, a n d t o en dea vor t o dis cover t h e ca u s es
of ever y dis ea s e wh ich ma y a t t a ck t h e h u ma n body. If t h e s a me exa ct a n d
defin it e in for ma t ion cou ld be obt a in ed, a s t o t h e ca u s es of ch oler a ,
dys en t er y, s ca r la t in a , t yph u s , con s u mpt ion , a n d t h e ot h er gr a ve dis ea s es , t o
wh ich we a r e s u bject , a n d a s t o t h e pa r t icu la r con dit ion of t h e in dividu a l
wh ich t h ey mos t ea s ily a ffect , h ow mu ch migh t be don e for t h e a voida n ce of
t h os e dis ea s es by t h e r emova l of t h eir ca u s es ! How ma n y lives migh t be
s a ved, h ow mu ch s u ffer in g migh t be pr even t ed! Does n ot t h e s pir it of t h e a ge
t h en dema n d t h e a ppr ova l of a mea s u r e wh ich pr omis es t o do t h is gr ea t ,-
mos t impor t a n t wor k?
125

VII. It s hould be approved becaus e it involves an important duty .
If a mea s u r e is pr a ct ica l, u s efu l, econ omica l, ph ila n t h r opic, mor a l, a n d
dema n ded by t h e s pir it of t h e a ge, it n eeds n o a r gu men t t o s h ow t h a t it is
ou r du t y t o a ppr ove it . An d if s u ch is ou r obliga t ion , n ot h in g fu r t h er n eed be
s a id. For , in ou r ju dgmen t , wh oever viola t es a k nown duty is gu ilt y of cr ime,
a n d ju s t ly ma kes h ims elf lia ble t o it s pen a lt ies . If a n in dividu a l s wa llows
pois on , a n d dea t h immedia t ely follows ; or if, by impr oper ea t in g, dr in kin g, or
cou r s e of life, h e gr a du a lly debilit a t es h is con s t it u t ion , a n d dea t h is t h e
u lt ima t e con s equ en ce, h e viola t es a kn own la w, n eglect s h is du t y, a n d ju s t ly
s u ffer s t h e ph ys ica l pen a lt ies of h is gu ilt . If we, a s s ocia l bein gs , ma ke n o
effor t t o eleva t e t h e s a n it a r y con dit ion of t h os e a r ou n d u s by r emovin g t h e
ca u s es of dis ea s e, we viola t e a kn own du t y, a n d ma ke ou r s elves ;u s t ly
gu ilt ya n d lia ble t o pu n is h men t ; a n d we s h a ll in evit a bly be pu n is h ed, eit h er
by s u ffer in g s ickn es s , or by dea t h , or in s ome ot h er wa y. If a mu n icipa l or
s t a t e a u t h or it y n eglect s t o ma ke a n d execu t e t h os e s a n it a r y la ws a n d
r egu la t ion s on wh ich t h e h ea lt h a n d life of t h e people depen d, t h ey viola t e a
kn own du t y, a n d a r e ;u s t ly ch a r gea ble wit h gu ilt a n d it s con s equ en ces ; a n d

125
Of all the great undertak ings by which the era is s ignaliz ed, there is perhaps none wnich s o clearly s tamps a
character of real and es s ential progres s as the Sanitary Movement; f or the res ult of this , med iate and immed iate, is a
pos itive, a cumulative good; a s ocial, moral, and intellectual amelioration of a mos t benef icial nature,--one which we
believeis des tined to effect great res ults in the material advancement of a people. Its ultimate effect whether s o intended
or not, lies bey ond the pecuniary advantage-the dollars and cents ; it recogniz es the exis tence of claims and s y mpathies -
intimate relations between all phas es and grades of s ociety ."-Chambers ' Papers f or tile People, No. 9,p. I.
186
t h ey will cer t a in ly be pu n is h ed, eit h er by mea n s of les s ca pa cit y for la bor , of
in cr ea s ed expen dit u r es , of dimin is h ed wea lt h , of mor e a bject pover t y a n d
a t r ociou s cr ime, or of mor e ext en ded s ickn es s a n d a gr ea t er n u mber of
dea t h s ; or in s ome ot h er for m. Th es e a r e t h e ph ys ica l a n d s ocia l
con s equ en ces of a n eglect of s a n it a r y du t y. Bu t t h er e a r e ot h er s ; a n d we
wou ld men t ion t h em wit h a ll t h a t r ega r d wh ich is t h eir du e.
It h a s a lr ea dy been s a id t h a t t h e fir s t s a n it a r y la ws wer e t h e dir ect
r evela t ion of t h e Divin e La wgiver ; a n d t h a t t h ey h a ve been fu r t h er developed
in t h e s u cces s ive a ges of t h e wor ld. Th es e la ws a r e n ow, t o s ome ext en t , well
u n der s t ood. An d ma y we n ot con clu de t h a t we s h a ll be br ou gh t t o a n
a ccou n t for t h e man n er in wh ich we h a ve obs er ved a n d obeyed t h em? Ma y
we n ot r ea s on a bly believe t h a t we s h a ll h er ea ft er s ee t h e wis dom of t h a t
pr oviden ce wh ich pr odu ces t h e ea r lier a n d la t er dea t h s , t h e ph ys ica l
s u ffer in gs , a n d t h e in n u mer a ble s a n it a r y evils wh ich s u r r ou n d a n d a fflict u s
in t h is wor ld,-t h a t t h ey wer e t h e ju s t a n d in evit a ble r es u lt of viola t ion s of
t h os e s a n it a r y la ws wh ich wer e given u s for ou r gu ida n ce a n d h a ppin es s ,-
a n d t h a t t h es e evils migh t h a ve been a voided if t h es e la ws h a d been
u n der s t ood a n d obeyed? Ma y it n ot t h en a ppea r t h a t ma n y a la w-ma ker ,
ma n y a pu blic a dmin is t r a t or , a n d ma n y a pr iva t e in dividu a l, h a s beell gu ilt y
of r obbin g ot h er s , a n d of r obbin g h ims elf, of h ea lt h a n d of life,-a ll t h a t is
dea r on ea r t h ;-gu ilt y of mu r der s a n d of s u icides ;-a n d n on e t h e les s fea r fu lly
r ea l a n d pu n is h a ble beca u s e t h ey wer e u n in t en ded? Th e pos s ibilit y of s u ch a
r es u lt ma y well a r r es t u n iver s a l a t t en t ion . " In r ega r d t o t h e wh ole r a n ge of
t h e la ws of h ea lt h a n d life, Pr oviden ce s eems t o t r ea t mer e ign or a n ce a s a n
offen s e, a n d t o pu n is h it a ccor din gly. Th er e is a gr ea t s ocia l per s on a l
r es pon s ibilit y r es t in g u pon ever yon e in t h is ma t t er ; a n d it is well t h a t it
s h ou ld be felt in a ll it s for ce a n d t h a t a ll t h e du t ies wh ich it r equ ir es s h ou ld
a t a ll a n d in a ll pla ces , be wis ely dis ch a r ged.
VIII. It s hould not be d is approved becaus e objections may be brought
agains t it.
In t h e pr eviou s pages we h a ve a n t icipa t ed a n s wer s t o s ome of t h e
object ion s t h a t ma y be br ou gh t a ga in s t t h is mea s u r e. Th er e a r e s ome ot h er s ,
h owever , wh ich r equ ir e t o be n ot iced.
1. It may be s aid,-"You r pla n is t oo complica t ed ; r equ ir e t oo mu ch ; it
will n ot a n d ca u n ot be ca r r ied in t o oper a t ion ."
Befor e ch a r a ct er izin g a n y mea s u r e, a ca n did min d lea s t exa min e, a n d
en dea vor t o u n der s t a n d it . Th er e a r e s ome per s on s , h owever , wh o, even
wit h ou t pr eviou s s t u dy or kn owledge, a n d by a mor e ca s u a l gla n ce, deem t o
give a n in t elligen t opin ion wh et h er a mea s u r e demer it . Somet imes a pla n
ma y a ppea r exa mina t ion , bu t s imple a ft er wa r ds . It h a s been t h e fa t e of n ew
mea s u r es , gen er a lly, t o be t h u s h a s t ily ju dged. It wa s s o in t h e fir s t s t a ges of
t h e s a n it a r y movemen t in En gla n d; a n d it is n ot s u ppos ed t h a t ou r
r ecommen da t ion s will be except ion s t o t h e gen er a l r u le. Va r iou s r ea s on s a n d
mot ives oper a t e u pon t h e min ds of men t o lea d t h em t o differ en t
con clu s ion s . Igon r an ce, pr eju dice, in t er es t , or s ome ot h er ca u s e, ma y do it .
We well r ecollect t h e r ema r k of a n in t elligen t a n d dis t in gu is h ed member of
t h e Legis la t u r e, n ow decea s ed, wh en t h e a pplica t on for a n a ct of
in cor por a t ion for bu ildin g a r a ilr oa d bet ween Bos t on a n d Wor ces t er wa s
u n der con s ider a t ion , a n d h is in flu en ce wa s s olicit ed in it s fa vor : - I h a ve n o
object ion , s a id h e, t o t h e pa s s a ge of t h e a ct , for t h e r oa d will n ever be
187
bu ild,- it is impr a ct ica ble. An d if it cou ld be bu ilt , it wou ld be per fect folly t o
do it ,-it cou ld n ot be s u ppor t ed. He did n ot live t wen t ly yea r s a ft er wa r ds t o
s ee $5,000,000 expen ded on t h e r oa d, a n d 57 t r a in s pa s s over it da ily; a
s in le pa s s en ger t r a in s omet imes ca r r yin g 2,700 per s on s , a n d a fr eigh t t r a in
ca r r yin g 400 t on s of mer ch a n dis e! Th e pla n for t a kin g t h e cen s u s of Bos t on ,
in 1845, wa s oppos ed by s ome, a t it s fir s t in t r odu ct ion , beca u s e it wa s
a lleged t o be impr a ct ica ble a n d u s eles s . Th e r es u lt , h owever , pr oved it
ot h er wis e in bot h r es pect s ; a n d t h e s a me pla n , s u bs t a n t ia lly, h a s s in ce been
a ppr oved a n d followed in ot h er cit ies , a n d h a s t h is yea r been a dopt ed for
t a kin g t h e s evea t h cen s u s of t h e Un it ed St a t es . It wa s s a id t h a t t h e la ws for
t h e r egis t r a t ion of bir t h s , ma r r ia ges a n d dea t h s cou ld n ot be ca r r ied in t o
oper a t ion ; a n d n o s pecia l a t t empt wa s ma de t o do it in Bos t on u n t il 1849,
wh en , by a s imple or din a n ce, it wa s s u cces s fu lly don e. Simila r illu s t r a t ion s
migh t be fu r n is h ed in t h e h is t or y of t h e in cipien t s t a ges of n ea r ly a ll n ew
mea s u r es a n d en t er pr is es ; bu t a ft er t h ey h a ve been pu t in t o oper a t ion , t h ey
h a ve been fou n d s o pr a ct ica l a n d s o u s efu l t h a t it h a s been t h ou gh t s t r a n ge
t h a t t h ey wer e oppos ed, a n d t h a t t h e s a me t h in g h a d n ot been t h ou gh t of
befor e! An d in t h is ligh t , we h a ve n o dou bt , t h is mea s u r e will s oon be viewed.
2. It may be s aid,-" Th e mea s u r e is n ot a pplica ble t o t h is St a t e; it ma y
be well en ou gh in s ome ot h er pla ces a n d cou n t r ies , bu t we do n ot s u ffer evils
wh ich r equ ir e s u ch r emedies for t h eir r emova l ; n o people a r e mor e h ea lt h y
t h a n we; we a r e well en ou gh a s we a r e. "We mos t ch eer flu ly a n d mos t
gr a t efu lly a dmit t h a t in s ome of ou r t own s , a n d a mon g s ome cla s s es of ou r
people, s a n it a r y evils do n ot exis t t o s o gr ea t a n ext en t a s in s ome ot h er
pla ces . Bu t wh ile we a dmit t h is , we a ffir m, fr om t h e mos t a u t h en t ic
eviden ce, t h a t in ma n y pla ces a n d a mon g ma n y cla s s es of ou r popu la t ion ,-in
ma n y fa milies a n d a mon g ma n y per s on s ,-t h er e is s ca r cely t o be fou n d,
a n ywh er e, mor e ign or a n ce of t h e la ws of h ea lt h , mor e dis r ega r d t o pr oper
s a n it a r y r egu la t ion s , a n d mor e s u ffer in g for t h eir n eglect . Ou r t own s , ou r
cit ies , a n d ou r dwellin g-h ou s es , it is t r u e, a r e n ot s o old, n or do ma n y of
t h em h a ve s o for biddin g a n ext er ior , a s ma n y in Eu r ope ; bu t it does n ot
t a ke a ges t o con ver t a n ew h ou s e,-a pa la ce,-in t o a den of filt h a n d dis ea s e.
Con dit ion s ma y exis t , a n d do a ct u a lly exis t , on open fields , on h ill s ides , in
t h e in t er ior of t h e cou n t r y , a s well a s in cit ies , fa vor a ble t o t h e pr odu ct ion of
dis ea s e. A wh it ed s epu lch r e ma y be fu ll of dea d men 's bon es ( or ca u s es t h a t
will pr odu ce t h em) a n d a ll u n clea n n es s . Th os e wh o s a y t h a t , in t h is St a t e,
t h e mea s u r e is in a pplica ble, h a ve yet lea r n t h e con dit ion of t h e people a n d
fu r n is h t h ems elves a r gu men t for it s n eces s it y.
How s t a n d t h e fa ct s ? Th e a ver a ge n u mber of per s on s t o a dwellin g-
h ou s e in Lon don , in 1841, wa s 7.5; in Liver pool, 6.9; in Ma n ch es t er , 5.7; in
Edin bu r gh , 6; a n d in t h e wh ole of En glan d, 5.4. An d it h a s been s a id t h a t , in
s ome of t h e dis t r ict s in t h e cit y of Lon don , s ixt y per s on s a r e t o be fou n d in
on e h ou s e. Th e n u mber of per s on s a dwellin g-h ou s e in Bos t on , in 1845, wa s
10.75; a n d, s ect ion of t h e cit y con t a in in g 3,131 in h a bit a n t s , t h e n u mber t o
ea ch h ou s e wa s 37 ; a n d t h e s pa ce for ea ch in h a bit a n t , in t h e wh ole dis t r ict ,
in clu din g s t r eet s , was equ a l on ly t o s even ya r ds ! Th is is equ a l t o s ome of t h e
wor s t dis t r ict s in Liver pool. On e of t h is commis s ion pr edict ed, yea r s a go,
t h a t if t h e ch oler a or a n y ot h er epidemic s h ou ld a ppea r in Bos t on , fir s t t a ke
u p it s a bode in s u ch pla ces . We r efer t o fr om t h e va lu a ble r epor t of t h e Cit y
Ph ys icia n , in t h e for eviden ce of t h e fu lfilmen t of t h is pr edict ion . An d it mu s t
188
be r ecollect ed t h a t , in t h es e pla ces , t yph u s , s ca r la t in a , dys en t er y, a n d ot h er
epidemic dis ea s es , a r e doin g da ily wh a t ch oler a does on ly occa s ion a lly. In
t h es e a bodes in fa n cy is ma de s t in t ed, u gly, a n d fu ll of pa in s ,-ma t u r it y ma de
old,-a n d old a ge imbecile; a n d pa u per is m ma de h opeles s ever y da y.
Mu ch h a s been s a id of t h e s a n it a r y evils of Lon don ,
126
wh er e 32 per
cen t . Of t h e dea t h s a r e t h os e of per s on s u n der 5 yea r s of a ge, wh er e t h e
a ver a ge a ge of a ll, a t dea t h , is 26 yea r s , a n d wh er e t h e a n n u a l r a t e of
mor t a lit y for t h e wh ole popu la t ion is 1 in 40. In Bos t on , fr om 1840 t o 1845,
46.62 per cen t . of a ll t h e dea t h s wer e t h os e of per s on s u n der 5 yea r s of a ge,
a n d in s ome cla s s es of t h e popu la t ion mor e t h a n 62 per cen t . wer e u n der
t h a t a ge; t h e a ver a ge a ge of a ll t h a t died in t h e s a me per iod wa s 21.43 yea r s ,
a n d of t h e ca t h olic bu r ia ls , 13.43 yea r s on ly. An d t h e r a t e of mor t a lit y for t h e
wh ole popu la t ion , for t h e la s t 9 yea r s , wa s 1 in 39, a n d for t h e la s t yea r , 1 in
26. An d yet Bos t on is a "h ea lt h pla ce!" Lon don , wit h it s imper fect s u pply of
wa t er
127
1
-it s n a r r ow, cr owded s t r eet s ,-it s fou l ces s pools ,-it s h opeles s
pa u per is m;-it s cr owded gr a ve-ya r ds ,- a n d it s ot h er mon s t r ou s s a n it a r y evils ,
is a s h ea lt h y a cit y a s Bos t on , a n d in s ome r es pect s more s o. If s a llit a r y
r efor m is n eeded in on e, it is n eeded in t h e ot h er a ls o. An d ma n y of t h e
cou n t r y t own s s u ffer a mor t a lit y n ea r ly a s a ppa llin g,-a n d yet " t h is mea s u r e
is n ot a pplica ble t o u s ! "
Th er e is a n ot h er con s ider a t ion s h ewin g t h e a pplica bilit y of t h is
mea s u r e. Un der n o gover n men t is h u ma n life mor e va lu a ble t h a n wit h u s ;
a n d u n der n on e is it mor e impor t a n t t h a t it s h ou ld be pr es er ved a n d
in vigor a t ed. If it is for t h e well bein g of s ociet y in Eu r ope t h a t h u ma n life
s h ou ld be pr es er ved,-if it is con s ider ed a h igh s ocia l a n d mor a l du t y t o
eleva t e it fr om a low t o a h igh s t a n da r d of h ea lt h , wh er e t h e poor h ou s es a r e
cr owded wit h in ma t es ,-wh er e la bor is ch ea p, a n d wh er e it s pr odu ct s a dd s o
lit t le t o gen er a l or t o in dividu a l wea lt h , h ow mu ch mor e is it for t h e well
bein g of s ociet y in t h is cou n t r y t o pr es er ve h u ma n life, wh er e la bor is in s o
gr ea t dema n d, a n d wh er e ea ch la bor er , s o lon g a s h e con t in u es in h ea lt h ,
n ot on ly con t r ibu t es t o t h e gen er a l wea lt h , bu t pr ovides for h is own
in dividu a l in depen den ce! If s a n it a r y r efor m is a du t y t h er e, wh er e t h e life of
ma n is , in a pecu n ia r y view, of s o lit t le va lu e,h ow mu ch mor e is it du t y h er e
wh er e it is of s o gr eat ! An d in a s ocia l a n d mor a l view t h e con t r a s t ma kes t h e
obliga t ion s t ill t n or e bin din g.

126
The opponents of the s anitary movement in England, in its incipient s tages , repres ented London as the mos t healthy
city in the world; and y et its condition has jus tif ied the f ollowing s tatement: - About two millions of inhabitants are
contained in the metropolis , or about the Kingdom. Of this number, accord ing to the Regis trar-Generals s tatement f or
1844, 50,423 die annually , or 1 in 39. But if the rate of mortality were 1 in 50, in place of 1 in 39, as it is in s everal large
towns of England, and in the healthier parts of the metropolis its elf , there would be an annual s avings of 10,278 lives . In
the metropolis , there are about 266 deaths every week , nearly 38 deaths a d ay , or cons iderably more than one every
hour, over and above what ought to happen in the common cours e of nature. Now, it has been calculated that, f or every
death which ts ak es place, there are 28 cas es of s ick nes s which do not end f atally . We have, therefore, 387,296 cas es of
s ick nes s occurring in the metropolis every y ear, which are unneces s ary and preventable. 13,832 lives could be s aved, -
more thana third of a million of cas es of s ick nes s could be prevented. One-f if th of the total was te of health and lif e which
tak es place in the United Kingdom occurs in the metropolis . Of the 49,089 pers ons who d ied in London in the y ear 1846,
22,275 died bef ore they reached the 15th y ear of their age, and only 2,241 of old age, which the illus trious Boerhaave
s tated to be the only d is eas e natural to man.-Journal of Public Health, vol.ii.p.225.
127
The following des cription of the water us ed by the citiz ens of London, is from the Edinburgh Review, (April, 1850,
p.381): The refus e and dirt from two millions of ind ividuals , and off al of s laughter-hous es , - the outpourings from gas -
work s , d y e-work s , breweries , d is tilleries , glue-work s , bone-work s , tanneries , chemical and other work s , - and a thous and
wards and forwards by the tide, and, having been thoroughly s tirred up and f inely comminuted by the unceas ing s plas h
of 298 s teamboats , is then pumped for the us e of the wealthies t city in the world! And y et a city which depens upon
s uch water f or its domes tic us e is as healthy as Bos ton!
189
An ot h er view of t h e s u bject ma y be pr es en t ed in t h is con n ect ion .
Wh a t ever ma y h a ve been t h e s a n it a r y t h e people of Eu r ope, s ome of t h e h a ve
emigr a t ed t o t h is cou n t r y, br in gin g wit h t h em a n d imit a t in g t h e cu s t oms in
wh ich t h ey wer e edu ca t ed in t h e la n d of t h eir n a t ivit y. By t h es e mea n s ma n y
of t h e evils wh ich h a ve t h er e ca lled s o lou dly for r efor m h a ve in t r odu ced
a mon g u s . Su ch evils ca n n ot be t h is St a t e. It is in va in for u s t o s u ppos e
t h a t t h ey ca n be fined t o t h e per s on s a lon e wh om t h ey immedia t ely a ffect .
We ca n n ot wa ll u p t h e pes t ilen ce, or s h ield ou r s elves fr om it s in flu en ce. It
will diffu s e it s elf t hr ou gh t h e wh ole u n t il a ll cla s s es , t o a gr ea t er or les s
ext en t , feel it s power , - u n t il a ll per s on s a n d a ll in t er es t s , in a ll pa r t s of t h e
St a t e, a r e a ffect ed. We h a ve s h own t h a t t h e pu blic h ea lt h is det er ior a t in g, -
t h a t h u ma n life, on t h e a ver a ge, h a s been gr a du a lly gr owin g s h or t er ; a n d it
ma y per h a ps be pa r t ly owin g t o t h is ca u s e. An d if we wou ld a r r es t t h e
down wa r d t en den cy, we mu s t a dopt , a n d ca r r y for wa r d a n efficien t pla n of
s a n it a r y r efor m. All t h e a r gu men t s in it s fa vor a pply wit h t en fold mor e for ce
h er e t h a n in for eign cou n t r ies . Ca n a n yon e s a y wit h t r u t h , in t h is view of t h e
s u bject , t h a t t h e mea s u r e is n ot a pplica ble t o u s ? We n eed s u ch a mea s u r e
t o eleva t e t h e s a n it a r y a n d s ocia l con dit ion ever y pa r t of t h e popu la t ion .
We h a ve s a id t h a t gr ea t ign or a n ce of t h e la ws of a r eckles s dis r ega r d for
t h eir r equ ir emen t s , pr eva il la r ge por t ion of ou r n a t ive popu la t ion . An d t h is is
emph a t ica lly t r u e; a lt h ou gh a s a people we ma y be gen era lly edu ca t ed, -
pos s es s gr ea t a pplica t ion a n d in du s t r y ,-gr ea t en er gy per s ever a n ce, yet a t
t h e s a me t ime we a r e s omet imes led r eckles s ly on by des ir es for wea lt h , for
for s elf-gr a t ifica t ion , in t ot a l ign or a n ce of cor r ect s a n it a r y la ws , or in t ot a l
dis r ega r d of t h e of pr es er vin g ou r own lives a n d t h e lives of ot h er s . Th es e
da n ger ou s s a n it a r y h a bit s s h ou ld be dis ca r ded, a n d mor e s a fe a n d cor r ect
on es s u bs t it u t ed in t h eir pla ces . An d in n o cla s s of ou r people, a mon g few or
n o in dividu a ls , does t h er e exis t a s t a t e of h ea lt h s o h igh t h a t n o h igh er can
be a t t a in ed. By a clea r er kn owledge of t h e ph ys ica l la ws , a n d a clos er
a pplica t ion of t h os e la ws t o h a bit s , regimen a n d t r a in in g, t o loca l a nd
a t mos ph er ic in flu en ces , a mu ch h igh er vigor , a gr ea t er power of en du r a n ce,
a n d a mor e fu ll en joymen t of life ma y be a t t a in ed by ever y cla s s of t he
people. An d will n ot t h is mea s u r e gr ea t ly a id in t h e a ccomplis h men t of t h is
mos t des ir a ble r efor m? Is it n ot a pplica ble t o u s , -to any people?
3. It may be s aid, -" I don 't t h in k mu ch of you r s t a t is t ics ; you ca n pr ove
a n yt h in g by figu r es . "
Th is is a n oft -r epea t ed r ema r k, bu t in ou r ju dgmen t ma y be ea s ily
a n s wer ed. S tatis tics ma y be defin ed t h e s cience or art of apply ing f acts to the
elucid ation and de1nons tration of truth. It is t h e ba s is of s ocia l a n d polit ical
econ omy, a n d t h e on ly s u r e gr ou n d on wh ich t h e t r u t h or fa ls eh ood of
t h eor ies ca n be br ou gh t t o t h e t es t . Mer e colu mn s of figu r es ma yor ma y n ot
be s t a t is t ics . Th ey for m, in a n y ca s e, a s ma ll pa r t on ly of t h e illu s t r a t ion .
Combin a t ion a n d dedu ct ion a r e r equ ir ed t o give t h em fu ll effect . We belon g
t o t h a t cla s s of s t a t is t s ,wh o h a ve n o pa r t icu la r fon dn es s for figu r es , t h ou gh
we h a ve a gr ea t fon dn es s for fa ct s . We u s e figu r es a s t h e r epr es en t a t ives of
fa ct s , n ot fict ion ,-of t r u t h , n ot fa ls eh ood,-a n d fin d t h em ver y con ven ien t for
t h a t pu r pos e. We fin d it ver y difficu lt t o pr ove or dis pr ove ma n y pr opos it ion s
wit h ou t t h em. We a r e a wa r e t h a t s ome per s on s h a ve a gr ea t a n t ipa t h y t o
fa ct s a n d s t a t is t ics ; bu t in t h is " ma t t er-of-fa ct -a ge," t h ey a re r equ ir ed ; a n d
t h ey a r e fa r mor e u s efu l a n d impor t an t t h a n t h e fict ion a n d t h eor y, t h e
190
a s s u mpt ion a n d a s s er t ion , t h a t h a ve occu pied s o mu ch of pu blic a t t en t ion .
We wou ld follow, in es t ima t in g h u ma n life a n d h u ma n h ealt h , in a ll t h eir
va r iou s depa r t men t s , bea r in gs a n d r ela t ion s , t h e s a me cou r s e t h a t ju diciou s
men pu r s u e in ot h er ma t t er s .
Th e s t a t e a n d con dit ion , t h e s t a t is t ics of a cou n t r y, ca n be kn own on ly
by ga t h er in g t oget h er t h e fa ct s a s t o it s movemen t s a n d pr ogr es s ; a n d t h e
s t a t es ma n looks a t t h e figu r es wh ich r epr es en t t h es e fa ct s , a n d combin es
a n d dedu ces t h e t r u t h s t h ey con t a in , for h is gu ida n ce.
It is a fa ct t h a t a t an elect ion Mr . A. r eceived a cer t a in n u mber of vot es ,
a n d Mr . B. a cer t a in ot h er n u mber , in ea ch s ever a l t own s . Th es e fa ct s , or
s t a t is t ics , bein g ga t h er ed t oget h er a n d r epr es en t ed by colu mn s of figu r es ,
pr ove A. r eceived mor e vot es t h a n Mr . B., a n d is t h er efor e Su ppos e you
a t t empt t o pr ove by t h es e figu r es t h a t elect ed, wh a t pr oces s wou ld you
a dopt ?
It is n ot oft en t h a t t h e ju diciou s mer ch a n t or ot h er ma n gu es s es ,
es t ima t es , or t h eor is es on t h is or t h a t kin d of bu s in es s ,-on t h is or t h at
ma n 's a ccou n t ,-on h is own pr ofit a n d los s ,-or on h is own pecu n ia r y s a n it a r y
con dit ion ; bu t h e goes t o t h e s t a t is t ics of h is bu s in es s ,-t h e r ecor ds of h is
pr ogr es s -h is books ; a n d h e va lu es a n d is gu ided by t h e defin it e fa ct s t h u s
dis clos ed. So we pr efer a defin it e fa ct , even if it a ppea r a s a s t a t is t ica l t r u t h ,
a n d r epr es en t ed by figu r es , t o u n cer t ain t h eor y or va gu e s pecu la t ion a n d
a s s u mpt ion .
It wou ld be ea s y t o illu s t r a t e, a lmos t in defin it ely, t h es e gen er a l r ema r ks ,
a n d t o s h ow t h e a dva n t a ge a n d a bs olu t e n eces s it y of t h is mode of pr es en t in g
t r u t h , bu t we deem it n eces s a r y.
4. It may be s aid- " Th is mea s u r e will in t er fer e pr iva t e ma t t er s . If a ch ild
is bor n , if a ma r r ia ge t a kes pla ce, or if a per s on dies , in my h ou s e, it is my
own a ffa ir ; wh a t bu is in es s is it t o t h e pu blic ? If t h e per s on die a t on e a ge or
a n ot h er ,-if h e die of on e dis ea s e or of a n ot h er , con t a giou s or n ot con t a giou s ,
it 's my bu s in es s , n ot a n ot h er s , - t h es e a r e pr iva t e ma t t er s ."
Men wh o object a n d r ea s on in t h is ma n n er h a ve ver y con cept ion s of t h e
obliga t ion s t h ey owe t o t h ems elves or t o ot h er s . No fa mily ,-n o per s on livet h
t o h ims elf a lon e. Ever y per s on h a s a dir ect or in dir ect in t er es t in per s on . We
a r e s ocia l bein gs -bou n d t oget h er by in dis s olu a ble t ies . Ever y bir t h , ever y
ma r r ia ge, a n d ever y dea t h wh ich , t a kes pla ce, h a s a n in flu en ce s omewh er e;
it ma y n ot be u pon you or me n ow ; bu t it h a s u pon s ome ot h er s , a n d ma y
h er ea ft er h a ve u pon u s . In t h e r evolu t ion s of h u ma n life it is impos s ible t o
for et ell wh ich s h a ll pr os per , t h is or t h a t ,-wh et h er I s h a ll be a pa u per or h a ve
t o con t r ibu t e t o s u ppor t my n eigh bor . a s a pa u per ,-wh et h er I s h a ll in h er it
h is pr oper t y or h e inh er it min e; a n d every per s on s h ou ld be willin g, a n d even
des ir ou s , t o pla ce wit h in t h e r ea ch of ever y ot h er per s on , t h e fa ct t h a t h e h a s
exis t ed, a n d t h e mea n s of iden t ifica t ion . Th is is t h e common r igh t wh ich t h e
pu blic s h ou ld cla im of ever yon e, a n d t h e common pr ivilege wh ich ever yon e
s h ou ld h a ve in a ll ot h er s .
A well-or ga n ized s ys t em of civil r egis t r a t ion ," s a ys t h e Edin bu r gh
Review, (Vol. XOIl, for J u ly, 1850, p. 43,) is on e of t h e fir s t wa n t s of a n
en ligh t en ed people. No ma n in s u ch a people is a bove or ben ea t h t h e
obliga t ion of a u t h en t ica t in g h is exis t en ce, h is cla ims on t h e pr ot ect ion of h is
cou n t r y, a n d h is fu lfilmen t of t h e du t ies of a cit izen ,-or of con t r ibu t in g h is
in dividu a l qu ot a of in for ma t ion , in wh a t per s on a lly con cer n s h ims elf or h is
191
fa mily, in r eply t o a n y s ys t em of qu er ies wh ich t h e gover n men t in it s wis dom
ma y s ee fit t o in s t it u t e r es pect in g t h em. Su ch in for ma t ion ma y be r ega r ded
a s a pollt a x, wh ich , in t h is for m, a gover n men t is fa ir ly en t it led t o impos e,
wh ich is a t on ce t h e ju s t es t a n d lea s t on er ou s of t a xes ; or r a t h er it ma y be
looked on a s a mode of s elf-r epr es en t a t ion , by wh ich ea ch in dividu a l t a kes a
pa r t in dir ect in g t h e views of t h e legis la t u r e in object s of u n iver s a l con cer n .
Not h in g, t h er efor e, ca n be mor e u n r ea s on a ble t h a n t o excla im a ga ips t it , or
t o en dea vor t o t h wa r t t h e views of gover n men t in es t a blis h in g s u ch a
s ys t em,-n or a n yt h in g mor e ju s t t h a n t o gu a r a n t ee it s fidelit y by pen a lt ies
impos ed on fa ls e r et u r n s or wilfu l omis s ion s ."
Er r on eou s idea s on t h is s u bject h a ve, t o s ome ext en t , exis t ed in t h e
min ds of ma n y per s on s . It h a s been t h ou gh t t h a t it wa s in delica t e a n d
imper t in en t t o be t hu s in qu is it ive ; bu t h a ppily t h es e views a r e fa s t pa s s in g
a wa y. It is becomin g mor e a n d mor e a ppa r en t t h a t s u ch in for ma t ion is
u s efu l t o t h e pu blic, t o pr ot ect pu blic r igh t s a n d pu blic h ealt h , a n d ma y be
ver y impor t a n t t o t h e in dividu a l, t o prot ect per s on a l r igh t s a n d per s on a l
h ea lt h . An d a lit t le ca n did t h ou gh t mu s t con vin ce ever y u n pr eju diced min d,
t h a t immen s e ben efit wou ld r es u lt t o t h e wh ole commu n it y a n d t o ea ch
member of it , by t h e a dopt ion of t h is mea s u r e, a n d by t h e in for ma t ion wh ich
it wou ld elicit . A kn owledge of t h es e ma t t er s , a lleged t o be pr iva t e, ma y be a n
in ca lcu la ble pu blic ben efit . Wit h ou t it , a n y a t t empt t o es t ima t e t h e s a n it a r y
con dit ion of a pla ce or a people, a n d t h e pr eva len ce of differ en t dis ea s es , will
be n ea r ly wor t h les s r es u lt s will be u n cer t a in , a n d n ot r elia ble a s a cor r ect
ba s is on wh ich t o fou n d r emedies for impr ovemen t a n d pr ogr es s .
5. It may be s aid, -" Th is mea s u r e will in t er fer e wit h pr iva t e r igh t s . If I
own a n es t a t e h a v'n 't I a r igh t t o do a s I plea s e ? t o bu ild u pon it a n y kin d of
h ou s e, or t o occu py it in a n y wa y, wit h ou t t h e pu blic in t er fer en ce ? Ha v'n 't t o
cr ea t e or con t in u e a n u is a n ce-t o a llow dis ea s e of a n y on my own pr emis es ,
wit h ou t a ccou n t a bilit y t o ot h er s ?
Differ en t men r ea s on differ en t ly, in ju s t ifica t ion of s elves , on t h is
ma t t er . On e ma n own s r ea l es t a t e in a n h ea lt h y loca lit y; a n d if it s con dit ion
wer e kn own , it migh t a ffect it s va lu e. An ot h er h a s a dwellin g h ou s e u n fit
r es iden ce of h u ma n bein gs ; a n d h e will oppos e a n y impr ove it beca u s e it will
cos t mon ey, a n d h e ca n in it s pr es en t con dit ion . An ot h er does bu s in es s in a
pla ce wh er e, a n d a t a t ime wh en , a n epidemic pr eva ils ; a n d occu pa t ion ma y
t en d t o in cr ea s e it ; a n d, if t h es e fa ct s wer e kn own , it migh t a ffect h is pr ofit s .
Th es e a n d s imila r ma y lea d differ en t min ds t o oppos e t h is mea s u r e. How
ext en s ively s u ch opin ion s pr eva il we will n ot a t t empt t o s t a t e. Some t welve
yea r s s in ce on e of t h is commis s ion in t r odu ced , in t o t h e cit y cou n cil of
Bos t on , a n or der of in qu ir y r ela t in g t o a cer t a in loca lit y s u ppos ed t o be
u n h ea lt h y; bu t it wa s s t r on gly oppos ed, beca u s e, a s wa s s t a t ed, it wou ld t h e
r ea l es t a t e in t h e n eigh bor h ood! Th er e ma y be in dividu a ls wh o pla ce dolla r s
a n d cen t s , even in s ma ll a mou n t s , by t h e s ide of h u ma n h ea lt h a n d h u ma n
life, in t h eir es t ima t e of va lu e, a n d s t r ike a ba la n ce in fa vor of t h e for mer ;
Bu t it is t o be h oped t h a t t h e n u mber of s u ch per s on s is n ot la r ge.
We s u bjoin ext r a ct s fr om t h r ee differ en t a u t h or it ies , wh ich con t a in
cor r ect views on t h is s u bject :-
" Ever y ma n wh o ch oos es t o h old pr oper t y in a t own mu s t lea r n t h a t
t h er e a r e cer t a in du t ies con n ect ed wit h t h a t pr oper t y by t h e ver y n a t u r e of it ,
wh ich mu s t be fu lfilled. He ca n n ot u s e it a s h e wou ld. He mu s t , on t h e
192
con t r a r y, s u bmit t o t h os e wis e legis la t ive mea s u r es wh ich in a ll a ges h a ve
been fou n d n eces s a r y t o pr ot ect t h e common wea l. Th e a t t empt t o obt a in
exor bit a n t pr ofit , eit h er fr om t h e s a le of la n d or t h e r en t of h ou s es , mu s t be
cu r bed by a pr oper pu blic s pir it , a n d by t h e legis la t u r e decla r in g wh a t kin d
of s t r eet s a n d h ou s es it will a llow t o be bu ilt , a n d h ow man y u pon a given
s pa ce. We mu s t r ever t t o t h e a n cien t laws , a n d per mit n ot h in g t o be don e,
come wh a t ma y, wh ich s h a ll in ju r e t h e h ea lt h or comfor t of t h e in h a bit a n t s .
Bu t t h os e wh o pos s es s pr oper t y mu s t n ot ima gin e t h a t in doin g t h is we s h a ll
in t er fer e wit h t h eir r ea l in t er es t s ; for in t h e mor a l a r r a n gemen t s of t h e
u n iver s e t h er e a r e cer t a in ch ecks wh ich in fa llibly pr even t ou r doin g a s we
wou ld in t h es e ma t t er s . We ma y bu ild dou ble t h e n u mber of h ou s es , a n d
qu a dr u ple t h e popu la t ion on a n t given s pa ce, bu t s ickn es s a n d dea t h , a n d
mor a l a s well a s ph ys ica l degr a da t ion , will s t ep in a n d pr even t ou r r ea pin g
t h e fr u it s we a n t icipa t e."
128

" On e of t h e pr ima r y pr eju dices ,-on e of t h os e lea s t s poken of bu t mos t
felt ,-wh ich s a n it a r y r efor m h a s t o en cou n t er , is a va gu e a ppr eh en s ion of
u n du e in t er fer en ce. All r egu la t ion s for s ecu r in g clea n lin es s a n d r emoving
filt h , a r e a pt t o be con s ider ed a s in va s ion s of t h e pr iva cy of t h e domes t ic
h ea r t h a n d t h e per s on , a n d a mou n t in g t o a n imper t in en t in t er meddlin g, in
ma t t er s con cer n in g wh ich it is in s u lt in g even t o be in qu is it ive. Bu t in r ea lit y
t h e object of s a n it a r y r efor m is t o fr ee t h e cit izen fr om t h e vile fet t er s wit h
wh ich t h e a ct s of ot h er s h a ve a ct u a lly bou n d h im, a n d t o lea ve h im fr ee t o
pu r s u e t h e n a t u r a l t en den cy t owa r ds civiliza t ion a n d r efin emen t , r a t h er t h a n
t o a s s u me a n y a r bit r a r y con t r ol over h is a ct ion s . We believe it t o be qu it e
t r u e t h a t it a lwa ys in ;u r es t h e in dividu a l t o do for h im W h at h e ou gh t , a n d
is a ble, t 9 do for h ims elf. Bu t t h e oper a t ive wor kma n mu s t live in t h e cit y, or
s t a r ve ; a n d if s elfis h wea lt h h a s ma de t h e cit y s u ch t h a t h e ca n n ot fin d a
cell in it wh ich is n ot a livin g t omb, s a t u r a t ed wit h cor r u pt ion ,-t h en h e is n ot
left t o t h e fr eedom of h is own a ct ion s , bu t is s u b;ect t o a n a bomin a ble
bon da ge ca u s ed by t h e con du ct of ot h er s . Th e s t r en gt h a n d s kill of Her cu les
cou ld n ot en a ble t h e cit y a r t is a n of Gla s gow t o live in pu r it y; a n d if
legis la t ion clea n s es t h e Au gea n s t a ble, it is n ot doin g for h im wh a t h e s h ou ld
h a ve been left t o do for h ims elf, bu t on ly s a vin g h im fr om by t h e s elfis h n es s
of t h ir d pa r t ies beyon d h is r ea ch ."
1291

In t h e r es t r ict ion s wh ich pr even t ever y ma n fr om h is own pr ofit or
gr a t ifica t ion t h a t wh ich in flict s on n eigh bor a dea dly in ju r y, t h er e is n o
h a r ds h ip;-it is s imple ju s t ice. Ou r la w r equ ir es t h a t t h e r a ilwa y compa n y,
t h e ma s t er of s t eamboa t , a n d t h e ma n u fa ct u r er of gu n powder , s h ou ld
r es pect ively con du ct t h eir oper a t ion s s o a s n ot t o en dan ger t h e of t h e
commu n it y; a n d t h er e ca n be n o r ea s on wh y t h e s a me r es pon s ibilit y s h ou ld
n ot be a t t a ch ed t o t h os e wh os e pr ofit a ble occu pa t ion is bu ildin g or s pin n in g.
Su ch in t er ven t ion beh a lf of t h e pu blic is n ot t o be con fou n ded wit h t h e old
s u mpt u a r y la ws ,-for it in t er fer es wit h t h in gs , n ot wit h per s on s ; n or ca n it be
compa r ed t o a t t empt s t o r egu la t e la bor an d wa ges , or t o r es t ra in t s on t r a de,-
for it is n ot don e t o pr ocu r e, a r t ificia l a dju s t men t of s omet h in g wh ich men
ca n bes t for t h ems elves , s ome s pecu la t ive a dva n t a ge, bu t , on t h e pr in ciple of
s a lu s popu li s u pr ema lex, t o pr ot ect on e s et of h u ma n bein gs fr om bein g t h e

128
Liverpool Health of Towns Advocate, p. 87.
129
Edinburgh Review, January , 1850, p.213.
193
vict ims of dis ea s e a n d dea t h t h ou gh t h e s elfis h cu pidit y of ot h er s . Th e own er
of t h e s oil is t h e per s on wh o ma in ly pr ofit s by t h e a ccu mu la t ion of a cit y -
h is , a t a ll even t s , a r e a dva n t a ges for wh ich h e n or s pin s ; a n d ma n y of t h e
pr in cely for t u n es of ou r been cr ea t ed by t h e r a pid r is e,-oft en s o fa r a s t he
own er h ims elf ma y kn ow, of cit y popu la t ion s . It does n ot s eem t h en t o be a
ver y h a r d r u le eit h er of mor a lit y or la w, t h a t a pr opr iet or wh o a ccu mu la t es
wea lt h by mea n s , s h a ll be compelled t o s u bmit t o r egu la t ion s s h ou ld t h ey
even in s ome degr ee r edu ce t h e ga in s , ma y be a s ecu r it y, a gain s t t h e lives of
t h os e W h o n eces s it ies of t h eir pos it ion a r e en r ich in g h im, fr om bein g
s a cr ificed t o h is a va r ice or h is r eckles s n es s . Wh ile h e der ives a pr ofit by
let t in g ou t h is s qu a r e ya r ds of t h e ea r t h 's s u r ely is n ot u n fa ir t h a t h e s h ou ld
become bou n d n ot t o it t o t h e occu pa n t per for a t ed t h r ou gh ou t wit h pit -fa lls
in wh ich h ea lt h a n d life ma y be los t ."
1302

"It is t h e common r igh t of t h e n eigh bor h ood," s a ys Dr . Simon , "t o
br ea t h e a n u n con t a min a t ed a t mos ph er e; a n d wit h t h is common r igh t
n u is a n ces mu s t be con s ider ed t o cla s h . It migh t be a ll in fr a ct ion of per s on a l
liber t y t o in t er fer e wit h a pr opr iet or 's r igh t t o ma ke offen s ive s mells wit h in
t h e limit s of h is own t en emen t , a n d for h is own s epa r a t e in h a la t ion ; bu t
s u r ely it is a s t ill grea t er in fr a ct ion of per s on a l liber t y, wh en t h e pr opr iet or ,
en t it led a s h e is t o bu t a join t u s e of an a t mos ph er e wh ich is t h e common
pr oper t y of h is n eigh bor h ood, a s s u mes wh a t is equ iva len t t o a s ole
pos s es s ion of it , a n d cla ims t h e r igh t of diffu s in g t h r ou gh it s ome eva n es cen t
effu viu m wh ich ot h er s , equ a lly wit h h ims elf, a r e t h u s obliged t o in h a le."
Su ch a r e t h e opin ion s of s ome of t h e mos t emin en t a u t h or it ies in
En gla n d on t h is ma t t er ; a n d t h ey a r e s a n ct ion ed by t h e h igh es t ju dicial
t r ibu n a l in ou r own St a t e. Th er e h a ve been few decis ion s in ou r cou r t s , in
ca s es for viola t ion s of t h e s a n it a r y la ws of t h e Common wealt h ; bu t s u ch as
h a ve been ma de a r e in oppos it ion t o t h e pr in ciple of t h is object ion , a n d in
a ccor da n ce wit h t h e views h er e pr es en t ed.
l131

6. It may be s aid ,-"You r mea s u r e will cr ea t e a n u n n eces s a r y expen s e;
t h e St a t e a lr ea dy s pen ds t oo mu ch mon ey; we ca n n ot a ffor d it ."
Ever yon e s h ou ld r eflect t h a t t h is is n ot a n expen s e, bu t a n in ves t men t ,-
a s a vin g,-a " s t it ch in t ime," wh ich is des ign ed t o a dd t o t h e wea lt h a n d n ot
t o t h e pover t y of t h e Common wea lt h ; a n d s u ch we h a ve pr oved will be t h e
r es u lt . Expen dit u r es for celebr a t ion s , a n d for va r iou s t empor a r y or ot h er
pu r pos es , a n d of dou bt fu l expedien cy, mor e t h a n s u fficien t for t h is pu r pos e,
a r e oft en ma de wit hin t h is St a t e, wit h ou t oppos it ion a n d wit h ou t cou n t in g
t h e cos t ; a n d wh y s h ou ld t h e t r iflin g ou t la y for t h is mos t ' u s efu l mea s u r e be
u r ged t o defea t it ? we h a ve a lr ea dy demon s t r a t ed t h e econ omy of t h e
mea s u r e (es pecia lly in pa ges 250 t o 260,) a n d we deem it u s eles s t o r eply
fu r t h er t o s u ch a s ma y s t ill per s is t in t h is ma kin g.

130
Ibid. 214, 215.

131
See Pick ering's Reports , VoI. VII; p. 76; and VoI. XII, p. 184. We extract one of thes e decis ions . It is not only the rlg1lt
but the duty of the city government of Bos ton, s o as they may be able, to remove every mtis ance which may endanger the
health of the citiz ens . And they have neces s arily the };ower of decid ing ll. what manner this s hall be done, and their
decis ion is conclus ive, lmles s they tral1SCena the powers conlerred on them by the city charter. Police regulations to
direct the us e of private property s o as to prevent its being pernicious to t\ ,e citiz ens allarge, are not void, aitnough they
may in s ome meas ure interf ere with private rights without provid ing f or compens ation. The property of a private
ind ividual may be appropriated to public us es in connectiou with meas ures of municipal regulations , and in s uch cas e
compens ation mus t be provided f or, or the appropriation wIll be uncons titutional and void
194
7. It may be s aid, -"If you diffu s e in for ma t ion on ma t t er s gen er a lly
a mon g t h e people, will you n ot ma ke per s on h is own ph ys icia n ? will you n ot
in cr ea s e, a n d pr es s qu a cker y; a n d t h u s ma gn ify a n d n ot dimin is h t h e
s a n it a r y evils wh ich it is you r pu r pos e t o pr even t ?
It s eems t o u s t h a t t h is mea s u r e will h a ve a n effect oppos it e t o t h e on e
h er e s u ppos ed. It is n ot in t en ded, in t h e lea s t degr ee, t o u s u rp or t o in t er fer e
wit h t h e du t ies of t he ph ys icia n , in t h e cu r e of dis ea s e, bu t t o a id h im in h is
effor t s , a n d t o dign ify t h e impor t a n ce of t h os e effor t s . It is , h owever ,
in t en ded t o t ea ch t h e people s o mu ch of t h eir ph ys ica l or ga n iza t ion , a n d s o
mu ch of t h e in flu en ces t h a t a ct u pon t h em, t h a t t h ey ma y kn ow, a n d be led
t o a void, t h e dis ea s e, a n d t h u s es ca pe t h e in fir mit ies , t h e con s equ en ces of
s ickn es s . Th is mea s u r e will t ea ch t o obt a in pr oper medica l a dvice wh en t h ey
a r e s ick, a n d t a mper wit h t h ems elves or wit h t h eir dis ea s es , by da n ger ou s
r emedies , n os t r u ms or ign or a n t of t h eir a pplica bilit y t o t h eir own pa r t icu la r
ca s es . It will lea d t h em t o u n der s t a n d w h en or in wh a t s t a ge of t h e dis ea s e,
it is bes t t o obt a in pr ofes s ion a l a dvice; from wh om t o obt a in it ; dis cr imin a t e
bet ween t h e good a n d t h e ba d. Ign or an ce per mit s a ca u s e of dis ea s e t o
oper a t e u n ch ecked u n t il t h e it s elf a ct u a lly in va des t h e s ys t em; a n d t h e s a me
per mit s t h e dis ea s e t o ma ke s u ch a dva n ces befor e obt a in ed, t h a t it is oft en
impos s ible t o a r r es t it . on t h e ot h er h a n d, u n der s t a n ds a n d a voids t he
ca u s es dis ea s e; or if dis ea s e s h ou ld h a ppen t o h a ve ma de it s a t t a ck, t he
s a me in t elligen ce will r equ ir e medica l a dvice of t h e kin d a t t h e
commen cemen t of t h e dis ea s e, wh en a dvice is mos t u s efu l, a n d w h en t he
power of medica l r emedies is mos t decis ive. An d t h is in t elligen ce will pr es ide
over a ll t h e ma n a gemen t of t h e s ick r oom; a n d t h u s s econ d a ll of t h e medica l
a dvis er , a n d give a ll pos s ible effect t o t h e r emedies u s ed for t h e expu ls ion of
t h e dis ea s e. Ign or a n ce a n d a s s u mpt ion con s t it u t e t h e es s en ce of qu a cker y;
in t elligen ce a n d a des ir e t o do r igh t , con t emn it ; a n d t h is mea s u r e is
des ign ed t o pr even t t h e for mer , a n d pr omot e t h e la t t er .
8. It may be s aid, -" If you s a y s o mu ch a bou t h ea lt h a n d dis ea s e you
will excit e t h e a la r m of t h e people, a n d cr ea t e mor e dis ea s e t h a n you
pr even t . It is bet t er t o let a pla ce t h a t is u n h ea lt h y r ema in s o, u n impr oved,
t h a n t o a la r m t h e people a bou t it ."
If a pla ce is u n h ea lt h y, a n d on t h a t a ccou n t a n impr oper pla ce of
r es iden ce, does n ot a feelin g of common h u ma n it y r equ ir e t h a t it s h ou ld be
kn own ? If people a r e on t h e br in k of a da n ger ou s pr ecipice, s h a ll t h ey n ot be
t old of t h eir da n ger ?-s h a ll t h ey be per mit t ed t o pu r s u e t h eir cou r s e t o
des t r u ct ion , for fea r of excit in g t h eir a la r m ? Is n ot a kn owledge of t h eir
con dit ion t h eir on ly s a fet y ? Th e object ion , in ou r ju dgmen t , in s t ea d of bein g
a r ea s on for t h e r eject ion of t h is mea s u r e, is a power fu l on e for it s a ppr ova l.
To be for ewa r n ed is t o be for ea r med. It is on ly t h os e wh o kn ow t h eir
ca pa bilit ies a n d. t h eir lia bilit ies ,-wh o kn ow t h eir da n ger s a n d mea n s of
r emova l or es ca pe, t h a t a r e con fiden t a n d u n a la r med. Th e ign or a n t ,
u n con s ciou s of t h e mea n s of mit iga t ion , a r e mor e likely t o be t imid, a la r med,
a n d t o be over power ed wit h gr ou n dles s fea r s , on t h e a ppr oa ch of da n ger .
Su ppos e t h a t it s h ou ld be a s cer t a in ed, a ft er ca r efu l a n d pa r t icu la r
in ves t iga t ion , t h a t a cer t a in loca lit y in t h e St a t e is u n h ea lt h y ,-t h a t in t h a t
pla ce cer t a in in flu en ces exis t , a n d cer t a in dis ea s es pr eva il, t h a t des t r oy,
u n n eces s a r ily, a gr ea t a mou n t of life, a n d pr odu ce a gr ea t a mou n t of
ph ys ica l debilit y, a n d in ca pa cit y for la bor . Wh a t is du t y in s u ch a ca s e? t o
195
per mit t h e evil t o r ema in u n expos ed, a n d t h e des t r u ct ion of life a n d
h a ppin es s t o con t in u e u n ch ecked? or t o ma ke. kn own t o t h e people t h e
exa ct . cir cu ms t a n ces in wh ich t h ey a r e pla ced, t h e ca u s es of t h e s a n it a r y
evils wh ich t h ey s u ffer , a n d t h e mea n s of r emova l? Wou ld n ot t h is kn owledge
lea d t h em t o a dopt t h os e pr eca u t ion a r y mea n s wh ich wou ld r edu ce t h e
a mou n t of t h e; evil, a s t h eir on ly s a fet y? or , if t h is wer e impos s ible, in du ce
t h em t o s eek s ome ot h er pla ce of a bode ? a n d u n der s u ch cir cu ms t a n ces
wou ld n ot s u ch a r emova l be a du t y ? Self-pr es er va t ion on t h eir pa r t , a n d
ph ila n t h r opy on ou r s , s a y s o; a n d s o in ou r ju dgmen t t h is object ion is
r emoved a n d r en der ed power les s .
9. It may be s aid, -" It will in t er fer e wit h Divin e Pr oviden ce."-" It wa s t o
be s o."-" It wa s s o or der ed."-" If we a r e t o die of ch oler a , t yph u s ,
con s u mpt ion , or a n y ot h er dis ea s e, it mu s t be s o,-it is u s eles s a n d impr oper
for u s t o in t er fer e."
Th is is a n old s en t imen t . It h a s for med a pa r t of r eligiou s belief in
differ en t n a t ion s , fr om r emot e a n t iqu it y t o t h e pr es en t t ime. Dea t h , wh et h er
it come in t h e s h ape of a pla gu e, mowin g down it s t h ou s a n ds , or a s a
s olit a r y mes s en ger , s lowly wa s t in g or s u dden ly des t r oyin g t h e in dividu a l,
h a s been con s ider ed by ma n y a s t h e s pecia l Pr oviden ce of God, wit h wh ich
we ou gh t n ot a n d ca n n ot in t er fer e. As la t e a s 1720, wh en in ocu la t ion for t h e
s ma ll-pox, a s a pr ot ect ion a ga in s t t h e dis ea s e in t h e n a t u r a l wa y, "wa s
in t r odu ced in t o Bos t on , it wa s s t r on gly oppos ed; a n d on e r ea s on given wa s ,
t h a t it wou ld in t er fer e wit h t h is Pr oviden ce. An d even in ou r da y s ome
con s ider it a dis obedien ce t o a Divin e comma n d,-" in s or r ow t h ou s h a ll br in g
for t h ,"-t o in h a le et h er or a n y ot h er a gen t t o mit iga t e pa in , or t o a lt er t h e
ch a r a ct er of la bor !
We s h a ll n ot a t t empt a dis cu s s ion of a n y t h eologica l or ph ilos oph ica l
qu es t ion , r ela t in g t o t h e pr oviden t ia l a gen cy ma n ifes t ed by t h e Su pr eme
Gover n or of a ll t h in gs , in pr es idin g over a n d gover n in g t h e u n iver s e wh ich h e
h a s ma de; bu t we wou ld view t h is gr ea t ma t t er of life a n d h ea lt h in t h e s a me
ligh t t h a t "we view a ll ot h er ma t t er s wit h wh ich t h ey a r e con n ect ed, a n d over
wh ich t h is pr ovident ia l a gen cy is ext en ded. We s ee clea r ly t h e oper a t ion of
ca u s e a n d effect , we s h ou ld s ee wis e la ws wis ely a dmin is t er ed in ever y event
t h a t t a kes pla ce in t h e u n iver s e. Th e h u s ba n dma n does n ot s it down by t h e
s ide of h is field, a nd wa it u n t il t h e t ime of t h e h a r ves t ; a n d if h e does n ot
r eceive a cr op, wh en h e did n ot s ow h is s eed; or if h e did s ow, wh en h e
n eglect s t h e pr oper ca r e of t h e gr owin g pla n t t o pr ot ect it from in ju r y ,-fr om
weeds , n oxiou s a gen t s , or " filt h " of a n y kin d,-s a y " it wa s t o be s o." His
a gen cy, h is ca r e, h is la bor , is n eces s a r y t o s u cces s . So in a lmos t ever y even t
of pr a ct ica l life, we a ct in dir ect oppos it ion t o t h e ver y s en t imen t of t h is
object ion . If " it wa s t o be s o" is t o be wr it t en u pon ever y effect , wh y do we
s en d for a ph ys icia n wh en we a r e s ick? Wh y do we t a ke food t o pr es er ve life,
or u s e mea n s t o cu r e dis ea s e? Wh y do we n ot let ca u s es t a ke ca r e of
t h ems elves ? Ever yon e, in a pplyin g t h e object ion t o pr a ct ica l life, mu s t s ee it s
fa lla cy. We believe t h a t " God h elps t h os e wh o h elp t h ems elves ," a n d n on e
ot h er s . It wa s a ma xim of Dr . Ch a lmer s , t h a t " ma n s h ou ld t r u s t in God a s if
God did a ll, a n d la bor t h ems elves a s if ma n did a ll."
Pa in , s u ffer in g, a n d t h e va r iou s ph ys ica l evils t o wh ich a r e expos ed,
ma y n ot s eem t o be a n eces s a r y pa r t of t h e s ch eme of n a t u r e, bu t on ly a s
in ciden t a l t o it . Th ey r es u lt fr om t h e viola t ion s of h er la ws ; a n d a r e
196
per mit t ed for wis e pu r pos es , per h a ps for t h e dis ciplin e a n d developmen t of
ou r ph ys ica l a n d mor a l power s . In t h e oper a t ion of epidemic dis ea s es s ome
in n ocen t ma y s u ffer ; bu t t h ey a r e in dividu a l except ion s t o t h e gen er a l r ole ;
a n d t h ey come like dr ou gh t or bligh t u pon t h e la bor s of t h e h on es t
h u s ba n dma n . It is ea s y t o per ceive t h at t h e s ou r ces of man y, even a va s t
ma jor it y of t h es e evils , ma y be r emoved by t h os e wh o s u ffer fr om t h em ; a n d
t h a t t h ey do n ot lie s o deep t h a t h u ma n a gen cy ca n n ot dis cover a n d des t r oy
t h em. Ma n h a s a power t o wield over a n d t o expel dis ea s e. It h a s been
a s s er t ed, by h igh a u t h or it y, t h a t " it wou ld be pos s ible t o ba n is h n ea r ly a ll
dis ea s e fr om t h e ear t h , a n d t o r es t or e ma n t o h is pr is t in e vigor . If s u ch a
belief be t r u e, t h a t a fflict in g con t r a s t bet ween . t h e s u ffer in gs of ma n kin d,
a n d t h e bea u t y a n d ben eficen t or der in g of t h e u n iver s e, dis a ppea r s . Th e
s ou r ce of t h e con t r a s t is fou n d t o be wit h in u s ,-t h e fou n t a in of t h e evil is in :
ou r s elves . We a r e ou r own t or men t or s , a n d a r e n ot ; mer ely t h e pr ey a n d
u n r es is t in g vict ims of power s h igh er t h a n ou r s elves ."
132
10. It may be s aid, -" We a ckn owledge t h a t a ll you s a y is r ea s on a ble a n d
ca n n ot well be ga in s a yed ; bu t we a r e a bu s in es s -like, a mon ey-ma kin g, a n d
mon ey-lovin g people. We a r e t oo mu ch occu pied t o con s ider t h es e ma t t er s .
So ma n y ot h er t h in gs t a ke u p ou r a t t en t ion t h a t we h a ven 't t ime t o exa min e,
mu ch les s t o ca r r y ou t you r mea s u r e ; ou r people a r e n ot u p t o it yet ."
We a r e fu lly a wa r e of t h e pr eva ilin g t en den cies of t h e pu blic min d, a n d
of t h e in differ en ce a n d a pa t h y wit h wh ich s u bject s r ela t in g t o h ea lt h a r e
gen er a lly r ega r ded. It is t imes wh en epidemic dis ea s es pr eva il, or wh en we
a r e r emin ded of t h eir effect s by ou r own s u ffer in gs or los s es ,we a r e excit ed
a n d in t er es t ed. We a r e t oo mu ch in clin ed t o con s ider h ea lt h a s a ma t t er "
belon gin g t o t h e doct or s a n d n ot t o u s ," a n d t o depen d u pon t h em for a
s u pply ; t h a t mon ey is bes t obt a in ed a n d t ime is bes t employed, wh en t h e
dolla r is s ou gh t , an d des ir e is gr a t ified, wit h ou t r ega r d t o t h e s a n it a r y
con s equ en ces of a n y pa r t icu la r mode of doin g it . Some s t r a n ge a n oma 1ies
a n d in con s is t en cies a r e fou n d in s ociet y a s a t pr es en t con s t it u t ed.
Money -loving! An d is t h is t h e on ly object of life Ar e t h er e n on e t h a t
over lie it ? An d even if it be u pper mos t , a r e we pu r s u in g t h e bes t mea n s t o
obt a in it ? It is t r u e t h a t mos t of u s , wh en s elect in g a n occu pa t ion , a pla ce of

132
So ind is pens able an element is health in all f orms of human welf are, that whoever, invigorates hi health has alread y
obtained one of the great guaranties of mental s uperiority of us efulnes s , and of virtue. Health, s trength, and longevity ,
depend upon immutable laws . Ther is no chance about them. There is no arbitrary unterf erence of highter powers with
them. Primarily our paren, and s econdarily ours elves , are res pons ible f or them.The providence of God is no more
res pons ible, becaus e the virulence of dis eas e ris es above the power of all therapeutics , or becaus e one quarter part of the
human race d ie bef ore completing the age of one y ear,-d ie bef ore completing one s eventieth part of the term of exis tence
allotted to them by the Ps almis t ;-1 s ay the providence of God is no more res pons ible f or thes e things , than it is f or pick ing
pock ets or s tealing hors es ."
" Health is earned,-as literally s o as any commod ity in the mark et. Health can be accumulated , inves ted, made to y ield its
interes t and its compound interes t, and thus be doubled and redoubled. The eapital of health, iIIdeed, may all be f urf~ited
by olle phy s ica! mis demeauor, as a rich man may s illk all his property in one bad s peculation; but it is as eapable of
being iIIcreas ed as any other k ind or eapilal ; and it ean be s afely iIIs ured on pay mellt of the reas onable premium of
temperance and f orethought. This , too, is a s pecies of wealth, which is not only capable of a lif e-long enjoy ment by its
pos s es s or, but it may be trans mitted to children by a will and tes tament that no human jud icature can s et as ide.
" Let the y oung man, then, rememher, that, f or every offence which he commits agains t the laws of health, nature will
bring him into judgment. However gracious ly God may deal with the heart, all our experience proves that He never
pardons s tomach, mus cles , legs , or brain. Thes e mus t expiate their offences un-vicarious ly . Nay , there are nume. lIS and
obvious ,,as ,,s of violated phy s ical law", where Nature, with all her diligence and s everity , s eems uuable to s courge the
offeuder enough during his lif e-time, and s o s he goes on ply ing her s courge upon hill children aud his childreu's children
af ter him, even to the third and fourth generation. The puni.hment is entailed on pos terity ; uor human law, nor human
device, can break the elltailment. And ill thes e hered itary iIItlictions , nature abhors alik e the primogeniture laws of
England and the Salic laws of France. All the s ons and all the daughter" are made inherilors ; Dol in aliquot parIs ; hut, by
a k i,ld of malignalll mulliplication in Ihe dis temper, each inherits the whole."-Mann's Thoughts for a Young man, pp. 14,
23, 19.
197
bu s in es s , a pla ce of r es iden ce, do n ot in qu ir e in t o it s s a n it a r y in flu en ces , a s
we s h ou ld do if we a ct ed wis ely : if it pr omis es mon ey we en t er in t o it
gen er a lly wit h ch a r a ct er is t ic zea l, r ega r dles s of t h e con s equ en ces . Bu t h ow
oft en do we h a ve t o lea r n t h a t we commit t ed a n er r or ! In s t ea d of gr a du a lly
a ccu mu la t in g ca pit a l, wh ile pr es er vin g a n d in vigor a t in g ou r h ea lt h : in a wa y
wh ich wou ld give u s a mor e pr os per ou s , a h a ppier a n d lon ger life, we ma ke a
h a za r dou s s pecu la t ion a n d los e t h e wh ole. Th is is t h e r es u lt of ;gu or a n ce. It
is wor s e t h a n t h a t . It is folly a n d cr ime t h u s t o r u s h r eckles s ly in t o a s ea of
u n cer t a in t y, wh en s a fet y a n d compet en ce a r e cer t a in ly a t t a in a ble ot h er wis e.
Ou r t h ou gh t s r eceive a s ign ifica n t illu s t r a t ion in a n ext r a ct of a r ecen t let t er
fr om Ca lifor n ia . Ou r pa r t y ," s a ys t h is wr it er , " fou r mon t h s a go, con s is t e'd
of s ix per s on s , of wh om t wo on ly a r e n ow a live. Two died of a dis ea s e
occa s ion ed by over -exer t ion a n d impr oper expos u r e a t t h e diggin gs , on t h e El
Dor a do; on e of a violen t fever , occu r r in g a ft er a s cen e of fr olic Ir in g a n d
dis s ipa t ion in t h e villa ge; a n d a n ot h er wa s mu r der ed a n d r obbed in h is
lodgin gs , of t h e few t h ou s a n ds of gold du s t , wh ich h e h a d ga t h er ed by h a r d
la bor , a n d wa s a bou t t o ca r r y ba ck t o h is n a t ive New En gla n d. We, wh o a r e
a live, a r e doin g t oler a bly well, bu t wor k a t gr ea t r is k of pr oper t y, h ea lt h a n d
life." If t h es e s ix per s on s h a d kn own exa ct ly t h eir s a n it a r y ca pa biliiy a n d
lia bilit y, a n d "w h a t t o do a n d h ow t o do it , t h ey migh t h a ve pr es er ved t h eir
lives . Th ey migh t h a ve wr ou gh t a n d a ct ed s o a s t o h a ve a voided t h e ca u s es
of dis ea s e; or , if t h is h a d been impos s ible, t h ey migh t h a ve h a d dis cr et ion
en ou gh t o a ba n don t h eir s u icida l r es iden ce or employmen t . We wou ld n ot
dis cou r a ge, bu t en cou r a ge, en er gy a n d per s ever a n ce in ever y ca llin g, bu t
on ly in s u bor din a t ion t o h igh er obliga t ion s , a n d in s t r ict r ega r d t o t h e h igh er
du t ies of s elf-pr es er va t ion a n d s elf-in vigor a t ion .
"We hav'n't time!" In deed! bu t we h a ve t ime for ot h er t h in gs ,-for la bor ,
for leis u r e, for dis s ipa t ion , for a lmos t an yt h in g we des ir e t o pu r s u e. An d t o
wh a t pu r pos e mor e u s efu l t h a n t h e pr es er va t ion of ou r lives a n d h ea lt h ca n
we devot e a por t ion of ou r t ime ? If t ime is n ot t a ken by u s , a n d u s ed by u s ,
for t h is ob;ect , it will be t a ken by a n ot h er a gen t ; a n d we s h a ll be pr ema t u r ely
depr ived of a n oppor t u n it y of u s in g it ou r s elves for a n y pu r pos e wh a t ever . A
s h or t en ed life a n d a debilit a t ed fr a me, .will be t h e con s equ en ce of ign or a n ce
in a t t en t ion ; a len gt h en ed life a n d a n ! of kn owledge a n d a pplica t ion . In pla in
En glis h , 'Ice h a ve t ime mea n s we h a ve n o DISPOSITION. If we h a ve t o
exa min e a n d ca r r y ou t t h is mea s u r e we s h a ll fin d t ime a n d a bilit y t o do it ,
a n d s t ill h a ve en ollgh for ot h er pu r pos es . " Wh er e t h er e is a will t h er e is a
wa y ;" wh er et h er e pos it ion t h er e is a t ime,-" a t ime for a ll t h in gs ."
Th e you n ger por t ion of s ociet y ma y be t a u gh t t h e les s on s of exper ien ce
wh ich t h e elder por t ion s h a ve lea r n ed du r in g a lon g life,-t h e ph ys ica l
ca la mit ies t o wh ich t h ey h a ve been expos ed, t h e mis t a kes t h ey h a ve ma de,
a n d t h e r emedies r epa r a t ion t h ey h a ve u s ed. Th ey ma y be t old t h e bes t
cou r s e t o pu r s u e t o in vigor a t e a n d pr olon g t h eir own exis t en ce. Bu t h ow few
a pply t h is in s t r u ct ion a s a gu ide t o t h eir own in ph ys ica l impr ovemen t ! How
gr ea t a pr opor t ion s a y,IT will do well en ou gh for old people t o t a lk s o, bu t we
a r e en ou gh a s we a r e, we live in a n ot h er a ge ;" a n d t h ey n eglect a n d r efu s e t o
a pply t h e u s efu l in s t r u ct ion of ot h er s a n d wa it u n t il t a u gh t by t h eir own s a d
exper ien ce. Th ey a r e t h en oft en t oo old t o pr ofit by it Th ey did n ot lea r n h ow
t o live, u n t il t h eir life-t ime h a d n ea r ly expir ed.
198
Ou r people s pen d a n in defin it e a mou n t of mon ey in t h e pu r ch a s e, a n d
of t ime in t h e per u s a l, of t h e mis cella n eou s lit er a t u r e of t h e a ge; bu t a book,
wr it t en wit h ever s o mu ch t a len t a n d a u t h en t icit y, wh ich con t a in s fa ct s
r ela t in g t o t h e in -comin gs a n d ou t -goin gs of h u ma n exis t en ce, a n d t o t h e
r is e a n d fa ll in t h e t ide of h u ma n welfa r e,-ma t t er s wh ich con cer n a n d a ffect
ever y member of s ociet y ,-is t oo dr y a n d s t a t is t ica l ; it will n ot in t er es t ; we
h a v'n 't t ime t o exa min e it !" An in dividu a l ca u a n n ou n ce t h a t h e s ells a
pa t en t medicin e, wh ich is a lleged t o be a cu r e for a ll dis ea s es , a n d even
t h os e s u ppos ed t o be in cu r a ble; a n d, by a s ys t ema t ic pu ffin g, h e will
comma n d t h e pu blic ea r a n d a ma s s a for t u n e by dr a ft s u pon pu blic
cr edu lit y; bu t t h e ma n wh o a n n ou n ces , in pla in a n d s imple t er ms , a wis e
a n d t r u t h fu l pla n for a voidin g dis ea s e, for livin g wit h ou t s ickn es s a n d
wit h ou t medicin es , will be r ega r ded wit h in differ en ce, a n d in for med t h a t II
t h e people a r e n ot u p t o it yet ." A lect u r er ca n a n n ou n ce a n ew s ys t em of
medicin e, " elect r o-biologica l" or ot h er wis e, a n d a t t r a ct cr owds of a t t en t ive
lis t en er s , n igh t a ft er n igh t ; bu t if a n ea r n es t , t h ou gh t fu l, h on es t ma n ,
pr es en t s t h e s imple, ever yda y, u n va r n is h ed pr in ciples , by wh ich dis ea s e ma y
be a voided a n d t h e ca u s es of dis ea s e r emoved, a n d t h e fa ct s by wh ich t h es e
pr in ciples a r e demon s t r a t ed, h e will fin d few lis t en er s , a n d even t h os e wh om
h e is for t u n a t e en ou gh t o obt a in , ma y pr on ou n ce h im u n wor t h y of
con fiden ce,-a vis ion a r y dr ea mer .
Th e u ps et t in g of a plea s u r e-boa t , dr own in g s ever a l per s on s ; a
s h ipwr eck, con s ign in g h u ma n life t o a wa t er y gr a ve; t h e bu r s t in g of a s t ea m-
boiler , s ca ldin g a nd s ca t t er in g t h os e wit h in . it s r ea ch ; a collis ion on a
r a ilr oa d, ma n glin g or des t r oyin g t h e pa s s en ger s ; a fir e, mu r der , s u icide, or
ot h er s u dden a n d s a d ca la mit y, will s omet imes occu r a n d pr odu ce a gen er al
pu blic excit emen t . All t h e fa ct s a r e ga t h er ed t oget h er a n d min u t ely det a iled
in t h e n ews pa per s ; people collect in t h e s t r eet s , a n d in pu blic a n d pr iva t e
cot er ies , t o t a lk t h e ma t t er over ; a s t r on g s ympa t h y is ma n ifes t ed for t h e
s u ffer er s ; ju dgmen t is immedia t ely pr on ou n ced u pon t h e gu ilt y; a n d a lou d
ca ll is ma de for s u ch a pu n is h men t a s s h a ll be a wa r n in g a ga in s t a
r epet it ion of t h e offen ce. Bu t t h e da r k s t r ea m of dis ea s e a n d dea t h , is ever y
da y a n d ever y h ou r cr owded wit h vict ims , ca r r ied down u pon it s ever flowin g
cu r r en t beyon d t h e limit s of t ime, a n d a ll a r e u n moved a n d wit h ou t emot ion
or excit emen t . Th e people " h a ven t t ime t o con s ider it ;" a n d ma ke n o
a t t empt t o a r r es t or les s en t h e a mou n t of dis ea s e a n d dea t h t h a t con s t a n t ly
floa t , in t h eir on wa r d cou r s e, on t h es e da r k wa t er s . Th ey n ever a s k t h e
qu es t ion , Ca n t h is mor t a l cu r r en t be s t a yed, t h e n u mber of t h es e vict ims
les s en ed, t h e a mou n t of t h is h u ma n wr et ch edn es s a n d h u ma n woe mit iga t ed
or pr even t ed ? An d even wh en in for med, in a demon s t r a t ion a s clea r a s
mer idia li ligh t , t h a t it ma y be dolt e, t h ey ma ke n o effor t t o do it , a n d r eply, "
We a r e n ot u p t o it yet ; you a r e befor e you r t ime; you wer e bor n in a n a ge t oo
s oon !"

Her e we migh t r es t ou r la bor s ; bu t we can n ot clos e ou r r epor t wit h ou t a
few wor ds of a ppea l wh ich ou r s u bject s u gges t s .
1. It a ppea ls t o Phy s icians . Th e member s of ou r pr ofes s ion ," s a ys a n
emin en t medica l a u t h or it y, wh o h a ve a lr ea dy emba r ked in t h is mos t
r igh t eou s cr u s a de a ga in s t ph ys ica l cor r u pt ion , ca n n ot bu t feel t h ems elves
en cou r a ged by t h e s ympa t h y a n d cooper a t ion of t h e cler gy; a n d wh o h a ve
199
n ot yet t a ken a n y pa r t in fu r t h er a n ce of t h e ca u s e, ma y per h a ps fin d a
mot ive t o exer t ion in t h e in t er es t wit h wh ich it is r ega r ded by t h e member s of
ot h er pr ofes s ion s , a n d by s ociet y a t la r ge. Bu t a s en s e of du t y ,fa r mor e t h a n
t h e mer e for ce of exa mple, ou gh t t o en lis t t h e medica l ma n in t h is h oly
wa r fa r e. No member of s ociet y is t o cogn iza n t a s h e is of t h e fa ct s of t h e ca s e,
or bet t er pr epa r ed t o in t er pr et a n d en for ce t h em; n o on e is les s open t o t h e
s u s picion of mea n or u n wor t h y mot ives ; a n d n o on e h a s s u ch fr equ en t
oppor t u n it ies of con ver s e wit h men of ever y degr ee. If h e, wh o kn ows s o
mu ch s h ou ld a ppear in differ en t or , wh a t is wor s e,-fr om t h e ba d h a bit of
lookin g a t t in e pr a ct ice of h is pr ofes s ion a s t h e on ly h on or a ble occu pa t ion of
a medica l ma n , a n d t h e wor k of pa llit a t ion a s h is on ly du t y ,-s h ou ld s pea k
s ligh t in gly of t h is h igh er wor k pr even t ion , a n d ca r p a t t h e effor t s of ot h er s on
t h e pr et en ce t h a t t h ey a r e given t o exa gger a t ion ; s ociet y wou ld s oon ca t ch
h is t on e of t h ou gh t a n d feelin g; a n d a ca u s e wh ich , on r eflect ion a n d ca r efu l
exa min a t ion , h e wou ld be con s t r a in ed t o s u ppor t , mu s t s t iffer ir r epa r a ble
in ju r y. If, on t h e ot h er h a n d h e cou ld be in du ced t o exer t h ims elf h ea r t ily,
bu t dis cr eet ely in fa vor of s a n it a r y mea s u r es , a n d t o br in g h is in flu en ce t o
bea r on t h os e wit h wh om h is pr ofes s ion a l a voca t ion s pla ce h im in
commu n ica t ion , it is impos s ible t o over -es t ima t e t h e good h e ma y be t h e
mea n s of effect in g."
133

2. It a ppea ls t o Clergy men. Th eir officia l du t ies lea d t o vis it t h e s ick a n d
t h e dyin g; a n d t h ey s h ou ld be for cibly impr es s ed wit h t h e t r u t h t h a t t h e
a r ch it ect a n d t h e s ca ven ger ,- t h a t s a n it a r y r efor ms in t h eir va r iou s modes of
oper a t ion , ; a r e t heir bes t collea gu es . Th ey s h ou ld s ee a n d feel, t h a t
r emovin g ph ys ica l s u ffer in g a n d r a is in g t h e s ocia l a n d per s on a l con dit ion of
t h e s u ffer er , is t h e s u r es t W a y of ga in in g a cces s t o t h e h ea r t , a n d of ma kin g
t h eir wa r n in gs , t h eir in s t r u ct ion s , a n d t h eir con s ola t ion s effect u a l ; t h a t t h e
ea s ies t a n d mos t per ma n en t impr es s ion s a r e t h os e ma de befor e t h e body
a n d t h e min d become degr a ded in filt h , s t u pefied by dis ea s e, or h a r den ed
a n d s ea r ed in gu ilt . In t h eir per s on a l in t er cou r s e a n d in t h eir pr ea ch in g, t h ey
s h ou ld diffu s e s a n it a r y in for ma t ion , a n d u r ge t h e impor t a n ce of s a n it a r y
mea s u r es . A weigh t y r es pon s ibilit y r es t s u pon s u ch men , a n d it becomes
t h em t o feel it , a n d t o ma ke t h ems elves per fect ma s t er s of t h e s u bject , t h a t
t h ey ma y u s e t h e in for ma t ion wis ely a n d u s efu lly in h elpin g for wa r d on e of
t h e gr ea t es t r efor ms of t h e a ge.
3. It a ppea ls t o Educated men of all clas s es . As a ma t t er of in t en s e
in t er es t , a s R .ma t t er r equ ir in g pr ofou n d in ves t iga t ion , a s a ma t t er of u s efu l
s cien ce, few s u bject s ca n be pr es en t ed t o a n in t elligen t min d wh ich pr omis es
mor e s a t is fa ct or y r es u lt s t h a n t h e s a n it a r y movemen t . For t h es e object s
a lon e it is wor t h y of bein g s t u died. Bu t wh en it is viewed, in it s per s on a l a n d
s ocia l r ela t ion s t o ma n a n d min d, it , in ma n y r es pect s , t r a n s cen ds a ll ot h er
ma t t er s . To t h os e, wh o, by edu ca t ion , a r e qu a lified for t h e la bor , few object s
pr es en t a gr ea t er or mor e ext en ded field of u s efu ln es s . Edu ca t ed men a n d
edu ca t ed women t oo, wh o ma ke t h ems elves ma s t er s of s a n it a r y s cien ce,
ma y, by t h eir pen s , by t h eir or a t or y, a n d by t h eir per s on a l in flu en ce, do a n
a mou n t of good of wh ich few or a n y or u s h a ve a s yet a n a dequ a t e
con cept ion . Su ch la bor s , ju diciou s ly con du ct ed, wou ld exer t a migh t y
in flu en ce of t h e r a ce a n d it s u n bor n million s . On s u ch per s on s a ls o r es t s a

133
Britis h and Foreign Medieo-Chirurgical Review, Vol. I, f or 1848, p32.
200
gr ea t r es pon s ibilit y. I wou ld beg you t o con s ider ," s a ys Dr . Simon , II t h e
in ca lcu la ble good wh ich ma y be con fer r ed on t h e poor er cla s s es of s ociet y by
t h e dir ect edu ca t ion a l in flu en ce of t h os e in bet t er a n d mor e en ligh t en ed
cir cu ms t a n ces . Wh en I s a y t h a t t h e s ocia l s a n it a r y er r or s , t o wh ich I h a ve
pa r t icu la r ly r efer r ed, wou ld gr a du a lly bu t s wift ly va n is h u n der t h e in flu en ce
of edu ca t ion , I do n ot mea n t h a t t h e cu r e wou ld be in lea r n in g t o r ea d a n d t o
wr it e, t h ou gh t h es e a t t a in men t s , of cou r s e, wou ld la r gely in cr ea s e t h e
pr es en t u s efu ln es s a n d ma r ket va lu e of t h eir pos s es s or . Th e edu ca t ion t o
wh ich I r efer , a s a n a ll-impor t a n t in flu en ce for s l1n it a r y pr ogr es s , is t h a t
wh ich wou ld con s is t in exh ibit in g t o t h e lowes t cla s s es of s ociet y fr equ en t
pr a ct ica l eviden ces of t h e a t t a in a bilit y a n d of t h e a dva n t a ges of h igh er
civiliza t ion ; a n edu ca t ion wh ich , by models a n d exa mples , wou ld lea d t h em
t o kn ow clea n lin es s fr om dir t , decen cy fr om gr os s n es s , h u ma n pr opr iet y
fr om br u t is h s elf-a ba n don men t ; a n edu ca t ion wh ich , by s en s ible exper ien ce,
wou ld t ea ch t h em t o feel t h e comfor t a n d t h e pr ofit of s a n it a r y obs er va n ces ,
a n d wou ld a pply t h eir in s t in ct of s elf pr es er va t ion t o t h e deliber a t e a voida n ce
of dis ea s e." Lor d Mor pet h u t t er ed t h is n oble la n gu a ge in a n a ddr es s t o h is
con s t it u en t s , wh ile t h e bill for pr omot in g t h e pu blic h ea lt h wa s pen din g in
pa r lia men t :-" Let my cou n t r ymen con demn me a s t h ey ma y, on ly do n ot let
t h em h old me; do n ot h old t h e n ew pa r lia men t ; do n ot let t h em h old
t h ems elves a bs olved, if t h ey do n ot , eit h er in t h eir pla ces a s member s of
pa r lia men t , or a s con s t it u en t s keepin g t h eir r epr es en t a t ives of t h eir du t y,
in s is t u pon ea r ly a n d efficien t legis la t ion on s u bject ."-" No on e's con s cien ce,
be t h ey min is t er s of s t a t e be t h ey member s of pa r lia men t , be t h ey member s
of cor por a t ion s , or be t h ey cit izen s of a n y cla s s , ou gh t t o h old t h ems elves
h a r mles s , if in t ime comin g t h ey offer a n y obs t r u ct ion , or s u ffer a ny
obs t r u ct ion t o be offer ed, t o t h e immedia t e a dopt ion of s a n it a r y r efor m."
134

4. It a ppea ls t o t h e Wealthy and Philanthropic. Th e mu n ificen t ch a r it ies
of t h e people of Ma s s a ch u s et t s a r e well kn own . Ma n y a on e h a s given livin g
or t es t a men t a r y eviden ce t h a t t h er e r u n s t h r ou gh ou r s ociet y a s t r on g
cu r r en t s ocia l s ympa t h y, a n d a willin gn es s a n d even a des ir e t o dis pos e of
por t ion s of t h e wea lt h , wh ich h a s been bes t owed u pon u s , for t h e r elief a n d
eleva t ion of s u ffer ing h u ma n it y. Amon g t h e differ en t object s wh ich pr es en t
t h ems elves for t h es e n oble s ympa t h ics , we s olicit for t h e s a n it a r y movemen t
a ca r efu l exa min a t ion . In ou r ju dgmen t n o object is of mor e pa r a mou n t
in t er es t a n d impor t a n ce. Mon ey u s ed in collect in g a n d diffu s in g s a n it a r y
in for ma t ion ; in t h e es t a blis h men t a n d ma in t en a n ce of is t it u t ion s des ign ed t o
pr even t s a u it a r y evils ; a n d in t h e va r iou s modes of oper a t ion wh ich ma y be
devis ed a n d ca r r ied for wa r d by en er get ic a n d wis e men , wou ld pr even t a n
a mou n t of evil, a n d wou ld a ccomplis h a n a mou n t of good, pr omis ed by few
or n o ot h er mea n s .
5. It a ppea ls t o t h e People. Th is mea s u r e is , u n like ma n y ot h er s , limit ed
in it s des ign a n d loca l or pa r t ia l in it s a pplica t ion . It r ea ch es , a n d is in t en ded
t o r ea ch , ever y per s on in ever y pa r t of t h e St a t e. If a dopt ed a n d pr oper ly
ca r r ied in t o oper a t ion it will be u n iver s a lly felt ,-by t h e pr ofes s ion a l ma n , t h e
a r t iza n a n d t h e la bor er , by t h e r ich a n d t h e poor ; a n d t h e gen er a l s a lu t a r y
effect s will be gr a du a l bu t per cept ible a n d gr ea t , u pon t h e collect ive in t er es t s
of t h e wh ole St a t e, a n d u pon t h e s ocia l a n d per s on a l in t er es t s of ea ch

134
Journal of Public Health, Vol.l, p. 23.
201
in dividu a l. Ever y ma n in ever y s t a t ion h a s a dir ect in t er es t in it s s u cces s ;
a n d ever y on e s h ou ld do a ll in h is power t o es t a blis h a n d ma ke it s u cces s fu l.
Ever yon e s h ou ld, a s fa r a s pos s ible, en dea vor t o u n der s t a n d t h e ch a r a ct er
a n d des ign of t h e mea s u r e, a n d s h ou ld commen d it s pr in ciples t o ot h er s ; h e
s h ou ld u n it e in for min g loca l s a n it a r y a s s ocia t ion s ; a n d in obt a in in g t h e
pa s s a ge of wis e s a n it a r y la ws a n d r egu la t ion s , a n d h e s h ou ld a s s is t t h e
pu blic a u t h or it ies in ca r r yin g t h em in t o oper a t ion . Ever y per s on s h ou ld
en dea vor t o r efor m wh a t ever s a n it a r y evils ma y exis t in h is own per s on a n d
h a bit s , a n d t h os e of h is fa mily a n d n eigh bor h ood. An d by t h es e mea n s t h e
s a n it a r y movemen t will be a cceler a t ed, a n d s oon er a ccomplis h t h e h igh a n d
n oble pu r pos es for wh ich it is des t in ed.
Th e s a n it a r y r efor m we a dvoca t e is n ot like s ome of t h e popu la r r efor ms
of t h e a ge. It r es t s u pon n o vis ion a r y t h eor ies , con ceived a lon e in t h e clos et ,
or by s ome impr a ct ica ble en t h u s ia s t . It a ims a t t h e es t a blis h men t of n o
a bs t r a ct pr in ciple, wit h n o defin it e, pr a ct ica l bea r in g or a pplica t ion . It is n ot
r a dica l in it s ch a r a ct er or t en den cy ; does n ot s eek t o over t u r n n or u pt u r n
a n y s ocia l, polit ica l or r eligiou s s en t imen t or in s t it u t ion ; n or a br oga t e a n y
con s t it u t ion a l or s t a t u t e la w. It in t er fer es wit h n o ma n 's r igh t s ,-pecu n ia r y,
s ocia l, polit ica l or r eligiou s . Bu t it t a kes t h in gs a s t h ey a r e ; looks u pon ma n
a s it fin ds h im ; a llows h im t o en joy t h e in s t it u t ion s wit h wh ich h e is fa vor ed
; a n d gives h im t h e mea n s of livin g lon ger , a n d of en joyin g mor e wh ile h e
does live. Th er e is in t h is n o t r a n s cen den t a lis m, or ot h er is m or ology, t o
wh ich a n y r ea s on a ble object ion ca n be ma de; t h ou gh it t r a n s cen ds , in it s
s implicit y, in it s pr a ct ica l u t ilit y, a n d it s s u bs t a n t ia l, ever yda y, u n iver s a l
ben efit s , a ll ot h er r efor ms . Ever y per s on , in ever y s it u a t ion can do s omet h ing
t o pr omot e t h is r efor m ; a n d ever y s u ch effor t wis ely dir ect ed, will in cr ea s e
t h e a mou n t of h is own , in dividu a l en joymen t , a n d a dd t o t h e a ggr ega t e
en joymen t of t h e people of t h e wh ole Common wea lt h .
6. It a ppea ls t o t h e Periodical Pres s . In t h is cou n t r y a lmos t ever y a du lt
r ea ds . In du lgen ce in t h e lu xu r y of a n ews pa per is a u n iver s a l ch a r a ct er is t ic
of ou r people; a n d by t h e power of s t ea m t h e pr es s is a ble t o fu r n is h t h is
lu xu r y in a n u n pr eceden t ed ma n n er a n d in a n y des ir a ble qu a n t it y. We h a ve
wa t ch ed wit h a dmir a t ion , bu t n ot wit h ou t fea r , t h e gr owt h a n d in flu en ce of
t h e migh t y power of t h e fr ee per iodica l pr es s . It edu ca t es , s wa ys , s h a pes ,
a n d ca r r ies ba ckwa r d or for wa r d, ma n y a n in dividu a l, a n d oft en t h e pu blic,
t oo, in a ca r eer of in fa my or in a ca r eer of glor y. It a s s u mes a n immen s e
r es pon s ibilit y; a n d ever y pr es s s h ou ld feel' , a n d wield it s in flu en ce for good
a n d n ot for evil.
We h a ve s t a t ed ( p. 46) t h a t t h e per iodica l pr es s gen er a lly in En gla n d,
h a s been in fa vor of s a n it a r y r efor m. Th e " Times ," t h e " Mor n in g Ch r on icle,"
t h e " Da ily n ews t h e lea din g pa per s of Gr ea t Br it a in , a n d t h e expon en t s a n d
gu ides of pu blic opin ion in t h eir r es pect ive s ph er es , a n d t h e ot h er les s
pr omin en t pu blica t ion s of t h e da ily pr es s , a s well a s per iodica ls of a differ ent
cla s s , h a ve a dvoca t ed t h e ca u s e wit h a t a len t , dis cr et ion a n d per s ever a n ce,
wh ich r eflect u pon t h em t h e h igh es t h on or . Th e combin ed in flu en ce of t h e
excellen ce of t h e cau s e, a n d of t h e for ce of pu blic opin ion , h a s s ilen ced a ll
oppos it ion ; a n d s a n it a r y r efor m h a s n ow t a ken it s pla ce a mon g t h e mos t
pr omin en t s u bject s of in t er es t a mon g a ll cla s s es of people t h r ou gh ou t t h e
kin gdom.
202
Th e s u bject a ppea ls t o t h e per iodica l pr es s in t h is cou n t r y t o imit a t e s o
n oble a n exa mple. It is a s u bject bou n ded by n o s ect ion a l in t er es t s a n d n o
pa r t y lin es , bu t is of u n iver s a l con cer n a n d of u n bou n ded a pplica t ion ; a n d
on e in wh ich pr es s , of a n y ch a r a ct er , ma y s a fely a n d pr oper ly emba r k. Ever y
on e t h a t a ids in it s pr omot ion a dvoca t es a mea s u r e wh ich cer t a in ly ca n do
n o h a r m, a r id ma y , -ju dgin g fr om a ll pa s t exper ien ce,-do immea s u r a ble good
; a n d ever yon e t h at oppos es it , or t h r ows obs t a cles in t h e wa y of it s
a dva n cemen t , len ds it s a id, n ot on ly t o defea t a h a r mles s mea s u r e, bu t on e
des ign ed t o pr omot e t h e pr ogr es s a n d eleva t ion of s ociet y a n d t h e bes t
in t er es t s a n d weIl bein g of t h e h u ma n r a ce. It will be a n ea r n es t of s u cces s if
t h e per iodica l pr es s s h a ll zea lou s ly en ga ge in t h is en t er pr is e, a s it will
cer t a in ly fin d it for it s in t er es t t o do, an d s u ppor t a n d defen d t h e s a n it a r y
movemen t wit h t h e s a me t a len t a n d en er gy t h a t is devot ed t o ma t t er s
con s ider ed of t h e h igh es t impor t a n ce. Edit or s will t h er e h a ve dis ch a r ged
s ome wh a t of t h e res pon s ibilit y , wh ich devolves u pon t h em a s gu ides of
pu blic opin ion a n d well wis h er s t o h u ma n it y.
7. It a ppea ls t o Towns and Cities . On t h e mu n icipa l a u t h or it ies of t own s
a n d cit ies , depen ds t h e immedia t e execu t ion of a ll s a n it a r y la ws a n d
r egu la t ion s . Th ey a r e r equ ir ed t o per for m a n impor t a n t du t y. Th or ou gh
kn owledge of t h e con dit ion of t h e people, a n d wis e ada pt a t ion a n d
a dmin is t r a t ion of s a n it a r y mea s u r es , will ben efit a n d bles s t h em. Bu t
blu n der in g ign or a n ce, or in con s ider a t e mea s u r es , or u n wis e a dmin is t r a t ion ,
will n ot do it . Iife, hea lt h , ph ys ica l h a ppin es s , a n d even t h e mor a l con dit ion
of a t own , ma y depen d, in s ome degr ee, u pon t h e a dopt ion or r eject ion of
pr oper s a n it a r y r egu la t ion s . An immen s e r es pon s ibilit y t h en r es t s u pon
t h es e loca l a u t h or it ies . An d t h is impr es s ion s h ou ld a bide u pon t h em, a n d
t h ey s h ou ld be led t o a ct a ccor din gly. If t h ey do n ot it will be kn own .
Ch oler a in on e dis t r ict s la ys it s t h ou s a n ds or it s t en s of t h ou s a n ds , a n d yet
in a n ot h er ca n n ot fin d a s in gle vict im ; a n d t h e ca u s e of t h is differ en ce is
a t t r ibu t a ble t o cer t a in s a n it a r y con dit ion s pr es en t in on e ca s e,-a bs en t in t h e
ot h er . Ch oler a , t yph u s , con s u mpt ion , a n d ot h er dis ea s es , a r e " h ea lt h
in s pect or s , t h a t s pea k in la n gu a ge wh ich n on e ca n mis u n der s t a n d ; t h ey
vis it per s on s on pollu t ed r iver s , t h e n eglect ed lu n a t ic in h is cell, t h e cr owded
wor ks h op, t h e es t a blis h men t s for pa u per ch ildr en , t h e s ides of s t a gn a n t
s ewer s , t h e u n dr a in ed cit y, t h e u n clea n ed s t r eet , t h e cella r a n d t h e a t t ic, a s
well a s t h e fa ir open qu a r t er s wh ich s t r a n ger s fr equ en t a n d a dmir e. Th e
over s igh t s , t h e er r or s , t h e cr imes of per s on s ,wh o in r es pon s ible offices h a ve
ch a r ge of t h e h ea lt h a n d life of men , a r e pr ocla imed a lou d by t h eir
in exor a ble voices ."
1
135
8. It a ppea ls t o t he S tate. Un der ou r con s t it u t ion a n d la ws ea ch
in dividu a l in s ociet y h a s a r igh t t o be pr ot ect ed in t h e en joymen t of h is life."
Th is ma y be con s ider ed in a s a n it a r y a s well a s a mu r der ou s s en s e. An d it is
t h e du t y of t h e s t a t es t o ext en d over t h e people it s gu a r dia n ca r e, t h a t t h os e
wh o ca n n ot or will n ot pr ot ect t h ems elves , ma y n ever t h eles s be pr ot ect ed ;
a n d t h a t t h os e wh o ca n a n d des ir e t o do s o t h e mea n s of doin g it mor e
ea s ily. Th is r igh t a n d a u t h or it y s h ou ld be exer cis ed by wis e la ws , wis ely
a dmin is t er ed ; a n d wh en t h is is n eglect ed t h e St a t e s h ou ld be h eld

135
Niles 's Regis ter, Vol. XXXVIII, for July 31, 1B30,p. 399. American Almanac, Vol I, p. 187 ; Vol. II, p. 112.

203
a n s wer a ble for t h e con s equ en ces of t h is n eglect . If liges liat or s a n d pu blic
officer s kn ew t h e n u mber of lives u n n eces s a r ily des t r oyed, a n d t h e s u ffer in g
u n n eces s a r ily occa s ion ed by a wr on g movemen t , or by n o movemen t a t a ll,
t h is gr ea t ma t t er ma t t er wou ld be mor e ca r efu lly s t u died, an d er r or s wou ld
n ot be s o fr equ en t ly commit t ed.
Ma s s a ch u s et t s h a s a lwa ys been emin en t a mon g t h e Amer ica n s t a t es .
Her met r opolis h a s ever been t h e met r opolis of New En glan d. Her exa mple
h a s been imit a t ed an d h a s been felt , wh er ever t h e s on s of New En gla n d a r e
fou n d or t h e n a me of New En gla n d is kn own . Her deeds a r e s u ch a s t o
J u s t ify even h er own s on s for a n a llu s ion t o t h em.
Her pu r it a n for efa t h er s es t a blis h ed t h e fir s t s ys t em of s elf gover n men t ,
combin in g la w a n d or der wit h wit h liber t y a n d equ a lit y a n d ba s ed u pon pu r e
mor a lit y, u n iver s a l edu ca t ion a n d fr eedom in r eligiou s opin ion , a s t h e on ly
fou n da t ion wh ich ca n in s u r e it s per ma n en cy a n d pr os per it y. An d in h er
cr a dle wa s r ocked t h e fir s t ch ild t h a t dr ew it s fir s t br ea t h u n der it s ben ign
in flu en ce.
Sh e h a s h er Con cord, h er Lexin gt on , a n d h er BUNKER h ill, a ll ma r ked ;
a s t h e fir s t ba t t le-fields in t h a t gr ea t s t r u ggle wh ich s ever ed t h e ch ildr en
fr om t h eir s oil wa s pou r ed t h e blood of t h e mos t wor t h y a n d t h e mos t n oble
pa t r iot s t h e wor ld h a s ever kn own ; a n d t h e bon es of h er s on s , fa llin g in t h e
gr ea t s t r u ggle for indepen den ce, n ow lie min gled wit h t h e s oil of ever y s t a t e
fr om New En gla n d t o Geor gia , a n d t h er e t h ey will lie for ever ."
Th e t h ir t een u n it ed colon ies fu r n is h ed for t h e r egu la r s ervice of t h e
r evolu t ion a r y a r my, bes ides milit ia , 231,779 men , -a n a ver a ge of 17,830
ea ch . Of t h es e, Ma s s a ch u s et t s fu r n is h ed 67,907, or 29 per cen t . of t h e
wh ole, 35,968 mor e t h a n a n y ot h er s t a t e, a n d 50,077 men mor e t h a n , or
n ea r ly fou r t imes , h er equ a l pr opor t ion .
1
An d s h e pou r ed ou t h er t r ea s u r e for
t h e ou t fit a n d s u ppor t of h er s on s in t h e r egu la r or milit ia s er vice, a n d for
t h e s u ppor t of t h eir fa milies , wh om t h ey left beh in d, a n d for ot h er pu blic
pu r pos es , in n ea r ly t h e s a me pr opor t ion
1
, a n d wit h t h e s a me liber a l h a n d, as
s h e did h er ph ys ica l for ce a n d h er blood.
Sh e es t a blis h ed, mor e t h a n t wo h u n dr ed yea r s a go, a n d n ea r t h e
begin n in g of h er exis t en ce, fr ee s ch ools , open a like t o a ll; a n d t h ey h a ve been
ch er is h ed a n d s u ppor t ed, fr om t h a t t ime t o t h e pr es en t , by mon ey dr a wn
fr om t h e t r ea s u r ies of t own s , r eplen is h ed by t a xes on t h e in h a bit a n t s . Sh e
expen ded in t h is wa y, la s t yea r , for t h es e fr ee s ch ools , $830,577 33,-a s u m
equ a l t o $3 87 for ever y ch ild in t h e St a t e bet ween t h e a ges of fou r a n d
s ixt een . Th e wh ole St a t e h a s been dot t ed over wit h s ch oolh ou s es like "
s pa r klin g dia mon ds in t h e h ea ven s ," givin g in t ellect u a l ligh t t o a ll t h a t come
wit h in t h eir s ph er e.
Sh e es t a blis h ed ill t h e Un it ed St a t es t h e fir s t s ys t em for t h e pu blic
r egis t r a t ion of bir t h s , ma r r ia ges a n d dea t h s , by wh ich t h e per s on a l h is t or y
a n d iden t it y, a n d t h e s a n it a r y con dit ion of t h e in h a bit a n t s , ma y be
a s cer t a in ed. Sh e fou n ded t h e fir s t Blin d As ylu m; t h e firs t St a t e Refor m
Sch ool; a n d a ided in fou n din g t h e fir s t Dea f a n d Du mb As ylu m; a n d h er
mon ey, pu blic a n d pr iva t e, h a s flowed fr eely in t h e s u ppor t of a ll t h e n oble
ch a r it ies a n d r eligiou s en t er pr is es of t h e a ge.
On e of h er s on s fir s t in t r odu ced in t o t h e Un it ed St a t es t h e r emedy of
va ccin a t ion for t h e pr even t ion of s ma ll-pox, wh ich h a s depr ived t h a t t er r ific
dis ea s e of it s power , wh en ever u s ed, a n d r en der ed it s a ppr oa ch gen er a lly
204
h a r mles s . An ot h er of h er s on s h a s t h e h on or of ma kin g t h e gr ea t dis cover y of
et h er iza t ion , by mea n s of wh os e won der fu l ca pa bilit ies t h e s u r geon s
in s t r u men t is depr ived of it s s t in g, a n d la bor of it s s or r ow; t h e oper a t or is
per mit t ed t o pu r s u e h is wor k u n dis t u r bed, wh ile t h e pa t ien t r ema in s
pa s s ive, u n con s ciou s , a n d u n moved by t h e h or r or s wh ich , wit h ou t it , migh t
be in flict ed. Th e bles s in gs of t h is gr ea t pr even t ion of h u ma n s u ffer in g a r e
kn owledged a n d felt t h e wor ld over .
For t h es e a n d ver y ma n y ot h er u s efu l a n d h on or a ble deeds wh ich migh t
be s pecified, s h e h a s been n a med, by dis t in gu is h ed men of ot h er s t a t es a n d
cou n t r ies , " t h e for efa t h er s la n d " t h e mor a l s t a t e," " t h e en ligh t en ed s t a t e," "
t h e s t a t e," " t h e ph ila n t h r opic s t a t e," " t h e lea din g s t a t e, t h e pa t t er n s t a t e,"
" t h e n oble s t a t e," " t h e glor iou s old Ba y s t a t e. An d ma n y a n eja cu la t ion h a s
gon e u p in a ll s in cer it y, God bles s h er ;" " God s a ve t h e Common wea lt h of
Ma s s a ch u s et t s !
Th er e s h e s t a n ds ;" a br igh t mor n in g s t a r in t h e s ys t em of t h e Un ion .
On t h e pa ges of h er h is t or y a r e r ecor ded t h e n oble deeds wh ich h a ve given
h er a good glor iou s . Bu t h er people dema n d a t h er h a n ds a mor e fu ll
en joymen t of life, a n d a mor e a bu n da n t diffu s ion of it s bles s in gs ; a n d n o
mor e n oble a n d h on or a ble a n d glor iou s pa ge ca n a n ywh er e be fou n d, t h a n
t h a t wh ich s h a ll r ecor d t h e a dopt ion of s ome s imple bu t efficien t a n d
compr eh en s ive pla n of Sa n it a r y Refor m; by wh ich t h e gr ea t es t pos s ible
a mou n t of ph ys ica l power ma y be pr odu ced, of ph ys ica l s u ffer in g ma y be
pr even t ed, a n d t h e gr ea t es t pos s ible a mou n t of ph ys ica l, s ocia l a n d mor a l
employmen t , ma y be a t t a in ed. " Th is is t h e t r u e glor y wh ich ou t lives a ll
ot h er ; a n d s h in es wit h u n dyin g lu s t r e, fr om gen er a t ion t o impa r t in g t o it s
wor ks s omet h in g of it s own immor t a lit y.

All wh ich is r es pect fu lly s u bmit t ed.

LEMUEL SHATTUCK,
N. P. BANKS, J r ., COMMISSIONERS
J EHIEL ABBOTT ,

BOSTON, Apr il 25, 1850.

BILL DRAWN BY THE COMMISSION, AND RECOMMENDED TO THE
LEGISLATURE FOR ENACTMENT.
[See t h is . Repor t , pp. 48-55,109-119, 138, 242, a n d 284.]

An Act for t h e Pr omot ion of Pu blic a n d Per s on a l Hea lt h .

BE it enacted by the Senate and Hous e of Repres entatives , in General
Court as s embled, and by the authority of the s ame, as f ollows :
SECT. 1. His Excellen cy t h e Gover n or , wit h t h e a dvice a n d con s en t of
t h e Cou n cil, s h a ll appoin t s even per s on s , wh o, t oget h er wit h t h e Gover n or ,
a n d t h e Secr et a r y of t h e Boa r d of Edu ca t ion , ex off iciis , s h a ll con s t it u t e a n d
be den omin a t ed t h e Gen er a l Boa r d of Hea lt h ; a n d t h e per s on s s o a ppoin t ed
s h a ll h old t h eir offices for t h e t er m of s even yea r s : provided, t h a t t h e per s on
fir s t n a med in s a id Boa r d s h a ll go ou t of office a t t h e en d of on e yea r , t h e
205
per s on n ext n a med s h a ll go ou t of office a t t h e en d of t wo yea r s , a n d s o of
t h e r ema in in g member s , on e r et ir in g ea ch yea r , a n d in t h e or der in wh ich
t h ey a r e n a med, u n t il t h e wh ole Boa r d be ch a n ged. An d t h e Gover n or , wit h
t h e a dvice a n d con s en t of t h e cou n cil a s a for es a id, s h a ll fill a ll va ca n cies in
s a id Boa r d, wh ich ma y occu r fr om dea t h , r es ign a t ion or ot h er wis e. An y
member wh o r es ign s , or wh os e t er m of office h a s expir ed, ma y, if du ly
qu a lified, be r ea ppoin t ed.
SECT. 2. Th e s a id Boa r d s h a ll meet in J a n u a r y, Apr il, J u ly, a n d
Oct ober , in ea ch year , a n d a t s u ch ot h er t imes a s t h ey ma y deem n eces s a r y
or expedien t .
SECT. 3. Th ey s h a ll a ppoin t a compet en t per s on t o be t h e Secr et a r y of
t h e Boa r d, a n d s ha ll a ls o a ppoin t s u ch ot h er per s on s , or employ s u ch
t empor a r y a s s is t a n ce, a s ma y be n eces s a r y t o ca r r y in t o execu t ion t h e
s a n it a r y la ws of t he St a t e, u n der t h eir s u per in t en den ce; a n d ever y s u ch
per s on s o a ppoin t ed or employed s h a ll h old h is office-du r in g t h e plea s u r e of
t h e Boa r d. Th e Boa r d s h a ll fix t h e compen s a t ion of a ll per s on s s o a ppoin t ed
or employed: pr ovided, t h a t t h e member s of s a id Boa r d s h a ll r eceive n o
compen s a t ion for t h eir own s er vices . Th e s a la r y of t h e Secr et a r y s h a ll be
h u n dr ed dolla r s per a n n u m, wh ich , t oget h er wit h h is in ciden t a l expen s es
a n d t h os e of t h e Boa r d, wh ile in t h e dis ch a r ge of t h eir officia l du t ies , s h a ll be
pa id by t h e St a t e, on cer t ifica t es s ign ed by t h e ch a ir ma n a n d Secr et a r y.
SECT. 4. Th e s a id Boa r d s h a ll per for m t h e followin g du t ies :-
1. Th ey s h a ll h a ve t h e gen er a l s u per in t en den ce of t h e execu t ion of t h e
s a n it a r y la ws of t h e St a t e.
2. Th ey s h a ll dir ect t h e Secr et a r y of t h e Boa r d in t h e dis ch a r ge of h is du t ies .
3. Th ey s h a ll con s ider a n d decide u pon s a n it a r y qu es t ion s , s u bmit t ed t o
t h em by t h e St a t e, by cit ies , by t own s , a n d by t h e Loca l Boa r ds of Hea lt h .
4. Th ey s h a ll a dvis e t h e St a t e a s t o t h e loca t ion a n d er ect ion of pu blic
bu ildin gs , a n d a s t o t h e s a n it a r y r egu la t ion s of pu blic in s t it u t ion s .
5. Th ey s h a ll, a t lea s t on ce in ea ch yea r , vis it a n d a s cer t a in t h e s a n it a ry
con dit ion of t h e s ever a l pu blic ch a r it a ble in s t it u t ion s of t h e St a t e.
6. Th ey s h a ll pr epa r e a n d fu r n is h , a t t h e expen s e of t h e St a t e, t o t h e s ever a l
Loca l Boa r ds of Hea lt h , a ll n eces s a r y bla n ks for t h e pu r pos es of t h is a ct .
7. Th ey s h a ll, fr om t ime t o t ime, is s u e in s t r u ct ion s t o t h e s ever a l Loca l
Boa r ds , a s t o t h eir power s a n d du t ies ,a n d s h a ll s u gges t a n d r ecommen d
loca l s a n it a r y r u les a n d r egu la t ion s .
8. Th ey s h a ll s u per in t en d ea ch en u mer a t ion of t h e in h a bit a n t s of t h e St a t e,
a n d t h e pr epa r a t ion of t h e a bs t r a ct s of t h e s a me, a u t h or ized by t h e
con s t it u t ion a n d la ws .
9. Th ey s h a ll la y befor e t h e Legis la t u r e, a n n u a lly, in a pr in t ed for m, a
r epor t , con t a in in g a n a bs t r a ct of t h eir pr oceedin gs , a n d of t h eir r eceipt s
a n d expen dit u r es , t oget h er wit h t h e Repor t of t h e Secr et a r y of s a id Boa r d;
a n d s h a ll a ccompa n y t h e s a me wit h s u ch r ema r ks , a s t h eir obs er va t ion ,
exper ien ce, a n d r eflect ion ma y s u gges t , a s t o t h e s a n it a r y con dit ion of t h e
St a t e, it s in s t it u t ion s , a n d it s in h a bit a n t s ; a n d r ecommen d t h e a dopt ion
of s u ch u s efu l s a n it a r y mea s u r es , a s in t h en . ju dgmen t ma y lea d t o
impr ovemen t .

SECT. 5. Th ey ma y expen d fift y dolla rs , a n n u a lly, in t h e pu r ch a s e of
books a n d wor ks , r ela t in g t o pu blic h ea lt h a n d t o t h e ca u s es a n d pr even t ion
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of dis ea s e ; wh ich books a n d wor ks , t oget h er wit h s u ch ot h er books , wor ks ,
a n d docu men t s , a s ma y be obt a in ed in exch a n ge or by don a t ion , s h a ll be
kept in t h e office of t h e Secr et a r y of t h e Boa r d, a n d be t h e pr oper t y of t h e
St a t e.
SECT. 6. Th e Secr et a r y, u n der t h e gen er a l dir ect ion of t h e Boa r d, s h a ll
per for m t h e followin g du t ies :-
1. He s h a ll keep fu ll a n d a ccu r a t e a ccou n t s of t h e r eceipt s a n d expen dit u r es
of t h e Boa r d.
2. He s h a ll, wh en dir ect ed by t h e Boa r d, ma ke a s a n it ar y s u r vey of a
pa r t icu la r t own , or pa r t of t h e St a t e; a n d collect in for ma t ion a s t o it s
s a n it a r y con dit ion .
3. He s h a ll h a ve a ll t h e a u t h or it y by la w given t o, a n d per for m a ll t h e du t ies
impos ed u pon , t h e Secr et a r y of St a t e, r ela t in g t o t h e r egis t r a t ion a n d r et u r n
of bir t h s , ma r r ia ges , a n d dea t h s .
4. He s h a ll s u per in t en d ea ch en u mer a t ion of t h e in h a bit a n t s of t h e St a t e,
a n d t h e pr epa r a t ion of t h e a bs t r a ct s of t h e s a me, a u t h or ized by t h e
con s t it u t ion a n d la ws .
5. He s h a ll a r r a n ge t h e officia l wr it t en a n d pr in t ed r epor t s a n d docu men t s ,
obt a in ed fr om Loca l Boa r ds of Hea lt h a n d ot h er pu blic a s s ocia t ion s , a n d
fr om pr iva t e in dividu a ls ; a n d ca u s e t h em t o be bou n d a n d in dexed for
con ven ien t r efer en ce. An d h e is a u t h or ized t o exch a n ge t h e pr in t ed
docu men t s of t h e. Boa r d for ot h er s a n it a r y wor ks , pr in t ed in t h is a n d in
for eign cou n t r ies .
6. He s h a ll per for m s u ch ot h er du t ies a pper t a in in g t o h is office, a s ma y be
r equ ir ed by t h e Boa r d.
7. He s h a ll pr epa r e a n d la y befor e t h e Boa r d, a n n u a lly, in a pr in t ed for m, a
r epor t con t a in in g a n a bs t r a ct of t h e in for ma t ion obt a in ed.
8. He s h a ll diffu s e, a s fa r a s pr a ct ica ble, t h e Common wea lt h , in for ma t ion
r ela t in g t o t h e s a n it a r y con dit ion of t h e St a t e a n d it s in h a bit a n t s ; t o t h e en d
t h a t t h e la ws of h ea lt h a n d life ma y be bet t er u n der s t ood, t h e ca u s es of
dis ea s e a s cer t a in ed a n d r emoved, t h e len gt h of h u ma n life ext en ded, t h e
vit a l for ce a n d pr odu ct ive power in cr ea s ed, a n d t h e gr ea t es t a mou n t of
ph ys ica l impr ovemen t a n d h a ppin es s a t t a in ed a n d en joyed.
SECT .7. Th e s a id Secr et a r y is a u t h or ized a n d ma y, wit h t h e a ppr ova l of
t h e Boa r d, employ s u ch a s s is t a n ce a s s h a ll be n eces s a r y t o en a ble h im t o
dis ch a r ge t h e du t ies of h is office.
SECT. 8. Th e ma yor a n d a lder men of ea ch cit y, a n d t h e s elect men of
ea ch t own , s h a ll appoin t t h r ee :five, or s even per s on s , r es iden t cit izen s
t h er eof, wh o s h a ll con s t it u t e a n d be den omin a t ed t h e Boa rd of Hea lt h of t h e
Town , or t h e Loca l Boa r d of Hea lt h . Th e ma yor of t h e cit y, t h e ch a ir ma n of
t h e s elect men of t h e t own , a n d t h e r egis t r a r of bir t h s , ma r r ia ges a n d dea t h s ,
or t h e t own cler k wh er e n o s u ch r egis t r a r exis t s , s h a ll be, ex officiis ,
member s of s a id Boa r d. An d t h e per s on s s o a ppoin t ed s h a ll t a ke a n oa t h
fa it h fu lly t o per for m t h e du t ies of t h eir office; a n d t h ey s h a ll h old t h eir s a id
offices for t h r ee year s , if t h e s a id Boa rd is fixed a t a n d con s is t s of t h r ee
member s , a s a for es a id; or for five yea r s , if it is fixed a t a n d con s is t s of five
member s ; or for s even yea r s , if it is fixed a t a n d con s is t s of s even member s :
pr ovided, t h a t t h e per s on fir s t n a med in s a id Boa r d s h a ll go ou t of office a t
t h e en d of on e yea r , t h e per s on n ext n a med s h a ll go ou t of office a t t h e en d
of t wo yea r s , a n d s o of t h e r ema in in g member s , on e r et ir in g ea ch yea r a n d in
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t h e or der in wh ich t h ey a r e n a med, u n t il t h e wh ole Boa r d be ch a n ged. An d
t h e ma yor a n d a lder men , or t h e s elect men a s a for es a id, s h a ll fill a ll
va ca n cies in s a id Boa r d, wh ich ma y occu r fr om dea t h , r es ign a t ion or
ot h er wis e. An y member wh o r es ign s , or wh os e t er m of office h a s expir ed,
ma y, if du ly qu a lified, be r ea ppoin t ed.
SECT. 9. Th e s a id Loca l Boa r ds s h a ll ca r r y in t o execu t ion , wit h in t h eir
r es pect ive ju r is dict ion s , t h e s a n it a r y la ws of t h e St a t e, a n d t h e or der s of t h e
Gen er a l Boa r d of Hea lt h ; a n d ma y, if n eed be, in t h e dis ch a r ge of t h eir du t y,
exa min e per s on s u n der oa t h , wh ich oa t h t h ey a r e a u t h or ized t o a dmin is t er .
Th ey s h a ll en dea vor , a s fa r a s pr a ct ica ble, t o pr even t dis ea s e a n d s a ve life,
by r emovin g t h e cau s es of dis ea s e a n d mor t a lit y; a n d pr omot e h ea lt h a n d
pr olon g life, by adopt in g a n d ca r r yin g in t o execu t ion u s efu l s a n it a r y
mea s u r es , r u les a n d r egu la t ion s .
SECT. 10. Th e s a id Loca l Boa r ds s h a ll meet in J a n u a r y, Apr il, J u ly; a n d
Oct ober , in ea ch year , a n d a t s u ch ot h er t imes a s t h ey ma y deem n eces s a r y
or expedien t .
SECT. 11. Th e Boa r d of Hea lt h of a n y t own of mor e t h a n t en t h ou s a n d
in h a bit a n t s , ma y expen d for t y dolla r s a n n u a lly, a n d of a n y t own of les s t h a n
t en t h ou s a n d in h a bit a n t s , t wen t y dolla r s , a n n u a lly, in t h e pu r ch a s e of books
or wor ks r ela t in g t o pu blic h ea lt h , a n d t o t h e ca u s es a n d pr even t ion of
dis ea s e; wh ich books a n d wor ks , t oget h er wit h s u ch ot h er books , wor ks , a n d
docu men t s a s ma y be obt a in ed in exch a n ge or by don a t ion , s h a ll be kept in
t h e office of t h e Secr et a r y of t h e Boa r d, a n d be t h e pr oper t y of t h e t own ;
pr ovided, t h a t in es t ima t in g t h e n u mber of in h a bit a n t s for t h e pu r pos es of
t h is a ct , t h e la s t cen s u s , n a t ion a l or s t a t e, s h a ll be t h e ba s is of compu t a t ion .
SECT. 12. Th e s a id Boa r d s h a ll, fr om t ime t o t ime, a ppoin t on e of t h eir
n u mber t o be Secr et a r y; a n d a ls o s h a ll, if n eed be, a ppoin t a n ot h er
compet en t member t o be Medica l Hea lt h Officer ; a n d a n ot h er t o be Su r veyor .
An d t h ey s h a ll a ppoin t s u ch ot h er officer s , n ot of t h e Boa r d, a n d employ
s u ch ot h er per s on s a s ma y be n eces s a r y t o ca r r y in t o execu t ion t h e s a n it a r y
la ws of t h e St a t e, a n d t h e s a n it a r y or din a n ces a n d r egu la t ion s of t h e t own .
Th ey s h a ll fix t h e compen s a t ion of ea ch per s on s o a ppoin t ed a n d employed,
s u bject t o t h e a ppr ova l of t h e ma yor a n d a lder men of t h e cit y, or t h e
s elect men of t h e t own : pr ovided, t h a t s a id compen s a t ion s h a ll n ot exceed t h e
a mou n t u s u a lly pa id for s imila r s er vices in t h e t own . An d ever y s u ch officer
a n d per s on s o a ppoin t ed a n d employed s h a ll h old h is office du r in g t h e
plea s u r e of t h e Boa r d.
SECT. 13. It s h a ll be t h e du t y of t h e Secr et a r y t o keep a r ecor d of t h e
pr oceedin gs of t h e Boa r d, a n d a n a ccu r a t e a ccou n t of t h eir r eceipt s a n d
expen dit u r es , a n d t o per for m s u ch ot h er s er vices a s u s u a lly per t a in t o t h e
office; a n d t o pr es erve a n d t r a n s mit t o h is s u cces s or in office, a ll r ecor ds ,
wr it t en a n d pr in t ed docu men t s , pa per s a n d books , belon gin g t o t h e office or
t o t h e Boa r d.
SECT. 14. It s h a ll be t h e du t y of t h e Medica l Hea lt h Officer t o a s cer t a in
t h e exis t en ce a n d preva len ce of s ickn es s a n d dis ea s es of differ en t kin ds , a n d
pa r t icu la r ly of zymot ic, or epidemic, en demic a n d con t a giou s dis ea s es ; t o
obs er ve t h eir pr eva len ce a n d mor t a lit y in ea ch yea r , a n d ea ch s ea s on of t h e
yea r , a s compa r ed wit h ot h er yea r s a n d .s ea s on s ; in ea ch dis t r ict of t he
t own , a s compa r ed wit h ot h er dis t r ict s or wit h ot h er pla ces ; a n d in ea ch
cla s s of per s on s , as compa r ed wit h ot h er cla s s es ; a n d t o en dea vor t o
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a s cer t a in a n y a t mos ph er ic, loca l, or per s on a l ca u s es of t h e t empor a r y
in cr ea s e or decr ea s e of dis ea s e a n d mor t a lit y. He s h a ll poin t ou t loca l
n u is a n ces or per s on a l ca u s es likely t o pr odu ce dis ea s e, or ot h er wis e t o
in ju r e t h e h ea lt h of t h e in h a bit a n t s ; s u gges t r emedies ; per for m s u ch ot h er
s er vices , of a like n at u r e, a s t h e Boa r d ma y r equ ir e; a n d ma ke r epor t s on a ll
t h es e ma t t er s t o t h e s a id Boa r d.
SECT. 15. It s h a ll be t h e du t y of t h e Su r veyor t o pr epa r e, u n der t h e
dir ect ion a n d for t h e u s e of t h e Boa r d, a n d for pu blic in s pect ion , a ma p of
t h e t own , or a n y s ect ion of t h e t own , on wh ich s h a ll be ma r ked, a s fa r a s
pr a ct ica ble, t h e loca t ion , level, a n d gr a de, of r oa ds , s t r eet s , la n es , a n d
cou r t s ; pla n s for dr a in a ge a n d s ewer a ge; t h e n a t u r a l a n d a r t ificia l mill a n d
ot h er pon ds ; a n d a n y loca lit ies in wh ich u n fa vor a ble s a n it a r y in flu en ces a r e
kn own t o exis t ; a n d per for m s u ch ot h er s er vices of a s imila r n a t u r e, a s ma y
be r equ ir ed by t h e Boa r d; a n d h e s h a ll r epor t t o t h e s a id Boa r d on a ll t h es e
ma t t er s .
SECT. 16. Th e s a id Loca l Boa r ds of Hea lt h a r e a u t h or ized t o ma ke, a n d
wh en ever in t h eir ju dgmen t t h e pu blic h ea lt h a n d s a fet y or t h e pu blic good
will be pr omot ed t h er eby, t h ey s h a ll ma ke r u les a n d r egu la t ion s , n ot
in con s is t en t wit h t h e con s t it u t ion a n d la ws of t h e St a t e, for eit h er or a n y of
t h e followin g pu r pos es :

1. For a s cer t a in in g t h e ca u s e or ca u s es of t h e dea t h of ever y per s on wh o dies
in t h e t own .
2. For a s cer t a in in g, fr om t ime t o t ime, t h e pr eva ilin g dis ea s es of t h e t own ;
a n d t h eir a t mos ph er ic, loca l, a n d per s on a l ca u s es .
3. For a s cer t a in in g t h e pr eva len ce a n d a mou n t of s ickn es s , a mon g per s on s
of differ en t cla s s es a n d occu pa t ion s , a n d a mon g s ch ola r 's a t t en din g t h e
pu blic s ch ools .
4. For pr even t in g or mit iga t in g dis ea s es , es pecia lly zymot ic, or epidemic,
en demic, a n d con t a giou s dis ea s es .
5, For a ffor din g medica l r elief t o per s on s a fflict ed or t h r ea t en ed wit h dis ea s e,
a n d es pecia lly wit h epidemic, en demic or con t a giou s dis ea s es .
6. For t h e per iodica l or s pecia l va ccin a t ion of t h e in h a bit a n t s .
7. For r emovin g, des t r oyin g, a n d pr even t in g n u is a n ces , dan ger ou s t o t h e
pu blic h ea lt h .
8. For r es t r a in in g a n d r emovin g per s on s a n d a r t icles , in fect ed wit h t h e
s ma ll-pox or ot h er con t a giou s dis ea s e.
9. For t h e es t a blis hmen t , loca t ion , a n d ma n a gemen t of h os pit a ls , for t h e
a ccommoda t ion of per s on s s ick wit h con t a giou s or ma lign a n t dis ea s es .
10. For t h e con s t r u ct ion a n d ma n a gemen t of s in ks , a s h -pit s , pr ivies ,
ces s pools , dr a in s , a n d common s ewer s ; a n d for t h e r emova l of h ou s e-dir t ,
offa l, n igh t s oil, s t r eet dir t , a n d ot h er filt h .
11. For clea n s in g a n d pu r ifyin g a n y ves s el, bu ildin g, lot , or ot h er pla ce; or
a n y a r t icle in a con dit ion en da n ger in g t h e pu blic h ea lt h .
12. For t h e loca t ion , a n d for pr even t in g t h e loca t ion , of pigs t ies , s la u gh t er -
h ou s es , ch emica l wor ks , a n d a n y t r a de or employmen t , offen s ive t o t h e
in h a bit a n t or da n ger ou s t o t h e pu blic h ea lt h .
13. For t h e wa r min g a n d ven t ila t ion of s ch oolh ou s es an d ot h er pu blic
bu ildin gs ; a n d for pr even t in g t h e s a n it a r y evils wh ich a r is e fr om over -
cr owded boa r din g or lodgin g-h ou s es , a n d fr om cella r -dwellin gs .
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14. For pr even t in g t h e s a le of a n y a r t icle of food or dr in k, u n wh oles ome or
da n ger ou s t o t h e pu blic h ea lt h .
15. For pr even t in g or mit iga t in g t h e s a n it a r y evils , a r is in g fr om t h e s a le of
in t oxica t in g liqu or s ; a n d fr om h a u n t s of dis s ipa t ion .
16. For pr even t in g t h e s a le of a du lt er at ed medicin es , dr u gs a n d liqu or s ,
da n ger ou s t o t h e pu blic h ea lt h .
17. For t h e s a n it a r y ma n a gemen t .of cemet er ies , a n d ot h er bu r ia l-pla ces ;
a n d for t h e in t er men t of t h e dea d.
18. For t h e pu blic r egis t r a t ion of bir t h s , ma r r ia ges a n d dea t h s in t h e t own ,
r equ ir ed by t h e la ws of t h e St a t e.
19. For execu t in g an y s a n it a r y or der of t h e Gen er a l Boa r d of Hea lt h r ela t in g
t o t h e t own or it s in h a bit a n t s .
SEC. 17. Th e Boa r d of Hea lt h of a n y s ea por t t own ma y es t a blis h t h e
qu a r a n t in e t o be per for med by a n y ves s el a r r ivin g wit h in t h e h a r bor of t h e
t own ; a n d ma y ma ke s u ch qu a r a n t in e r egu la t ion s , r ela t in g t o a n y ves s el,
a n d t o t h e pa s s en ger s or a r t icles on boar d of t h e s a me, a s t h ey s h a ll ju dge
n eces s a r y for t h e h ea lt h a n d s a fet y of t h e in h a bit a n t s ;-or t wo or mor e t own s
ma y, a t t h eir join t expen s e, a n d for t h e common ben efit , ma ke a n d es t a blis h
s u ch r egu la t ion s . An d a n y Boa r d of Hea lt h ma y exa min e, u n der oa t h , t h e
ma s t er or a n y s ea ma n or per s on on boa r d a n y ves s el, s u s pect ed of comin g
fr om a s ickly por t , or of h a vin g s ickn es s on boa r d du r in g t h e voya ge, or of
h a vin g goods or a r t icles on boa r d wh ich ma y occa s ion s ickn es s . An d a ll
expen s es in cu r r ed on a ccou n t of a n y per s on , ves s el, or goods , u n der a n y
qu a r a n t in e r egu la t ion s , s h a ll be pa id by s u ch per s on , or t h e own er of s u ch
ves s el or goods , r es pect ively.
SECT. 18. Wh en a n y h ou s eh older s h a ll kn ow t h a t a n y per s on wit h in h is
fa mily a n d wh en a n y ph ys icia n s h a ll kn ow t h a t a n y per s on wh om h e vis it s .
is s ick wit h t h e s ma ll-pox, or a n y ot h er con t a giou s or ma lign a n t dis ea s e,
da n ger ou s t o t h e pu blic h ea lt h , s u ch h ou s eh older a n d s u ch ph ys icia n s h a ll
immedia t ely give n ot ice t h er eof t o t h e Boa r d of Hea lt h of t h e t own , in s u ch
ma n n er a s t h ey s h a ll pr es cr ibe.
SECT. 19. Not ice s h a ll be given by t h e Loca l Boa r ds of Hea lt h of a ll
r egu la t ion s ma de by t h em, by pu blis h in g t h e s a me in s ome n ews pa per of t h e
t own , or wh er e t h er e is n o s u ch n ews pa per , by pos t in g t h em u p in s ome
pu blic pla ce or pla ces of t h e t own ; a n d s u ch n ot ice of s u ch r egu la t ion s s h a ll
be deemed lega l n ot ice t o a ll per s on s .
SECT. 20. It s h a ll be t h e du t y of ever y ma gis t r a t e a n d ot h er civil officer ,
a n d of ever y in h a bit a n t of t h e St a t e, t o obs er ve a n d a s s is t in ca r r yin g in t o
execu t ion t h e or der s , r u les a n d r egu la t ion s of t h e Gen er a l a n d Loca l Boa r ds
of Hea lt h , a n d t o a id t h e s a id Boa r ds a n d t h eir a u t h or ized a gen t s , in t h e
per for ma n ce of t h eir r es pect ive du t ies .
SECT. 21. Th e s a id Boa r ds . of Hea lt h , if it s h a ll a ppea r t o t h em
n eces s a r y or expedien t , a r e a u t h or ized t o r equ ir e t h e s h er iff of t h e cou n t y or
h is depu t y, t h e ma r s h a l of t h e cit y, or a n y con s t a ble of t h e t own , t o per for m
a n y of t h e followin g du t ies :
1. To r emove or des t r oy a n y a r t icle, deca yed, pu t r id, or ot h er wis e da n ger ou s
t o t h e pu blic h ea lt h ; or a n y ot h er n u is a n ce or ca u s e of dis ea s e.
2. To r emove a n y per s on or a r t icle in fect ed wit h con t a giou s or ma lign a n t
dis ea s e, fr om on e pla ce t o a n ot h er .
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3. To br ea k open a n d en t er in t h e da y t ime a n y h ou s e, s h op, or ot h er
bu ildin g, or pla ce, con t a in in g a per s on or a r t icle in fect ed wit h s ma Il-pox or
ot h er con t a giou s dis ea s e; or con t a in in g a n y n u is a n ce da n ger ou s t o t h e
pu blic h ea lt h .
4. To impr es s a n d t a ke u p con ven ien t h ou s es , lodgin g, n u r s es , a t t en da n t s
a n d ot h er n eces s a r ies for t h e a ccommoda t ion , s a fet y, a n d r elief of t h e s ick.
SECT. 22. Th e ch a r ges for r emovin g a n d clea n s in g a n y a r t icles , a n d of
s ecu r in g t h e s a me, a n d of clea n s in g a n y h ou s e or ot h er pla ce, s h a ll be pa id
by t h e own er s t h er eof, a t s u ch r a t es a n d pr ices a s s h a ll be fixed by t h e
Boa r d of Hea lt h , u n der wh os e dir ect ion t h e s a me wa s don e.
SECT. 23. Wh en ever t h e s h er iff of t h e cou n t y or h is depu t y, t h e
ma r s h a l of t h e cit y, a n y con s t a ble of t h e t own , or ot h er officer , s h a ll impr es s
a n y men , or s h a ll u s e a n y h ou s e, s t or e or ot h er pla ce, or a n y pr oper t y, for
t h e a ccommoda t ion or ben efit of t h e s ick, or for t h e s t or a ge of in fect ed
a r t icles , a s pr ovided for in t h is a ct , t h e s ever a l pa r t ies in t er es t ed s h a ll be
en t it led t o a ju s t compen s a t ion t h er efor e, t o be pa id by t h e t own for wh ich
s u ch per s on s h a ve been employed, or for wh ich s u ch pr oper t y h a s been
u s ed.
SECT. 24. All n eces s a r y expen dit u r es in cu r r ed by a n y Loca l Boa r d of
Hea lt h , in t h e dis cha r ge of t h eir officia l du t ies , s h a ll be pa id by t h eir t own or
cit y, a ft er bein g a u dit ed by t h e Secr et a r y of t h e Boa r d, a n d cer t ified t o be
cor r ect by a ma jor it y of t h e ot h er member s : pr ovided, t h a t in ma kin g a n y
s u ch expen dit u r e of mor e t h a n fift y dolla r s , in t own s of les s t h a n t wo
t h ou s a n d in h a bit a n t s .; a n d of mor e t h a n on e h u n dr ed dolla r s , in t own s of
mor e t h a n t wo t h ou s a n d a n d les s t h a n five t h ou s a n d in h a bit a n t s ; a n d of
mor e t h a n five h u n dr ed dolla r s , in t own s of mor e t h an five t h ou s a nd
in h a bit a n t s , t h e s a id Boa r d s h a ll fir s t obt a in t h e a ppr ova l of t h e s elect men of
t h e t own , or t h e ma yor a n d a lder men of t h e cit y.
SECT. 25. Wh en ever a n y ma lign a n t or con t a giou s dis ea s e s h a ll pr eva il
a s a n epidemic in a n y t own , t h e Loca l Boa r d of Hea lt h s h a ll n ot ify t h e
Gen er a l Boa r d of Hea lt h of t h e s a me; a n d t h e s a id Gen er a l Boa r d of Hea lt h
s h a ll a dopt , r ecommen d, or ca r r y in t o execu t ion ,s u ch mea s u r es of
pr even t ion or mit iga t ion , a s t h ey s h a ll deem n eces s a r y or expedien t .
SECT. 26. An y per s on wh o s h a ll viola t e a n y or der or r egu la t ion ,
pr es cr ibed in t h e s ixt een t h a n d eigh t een t h s ect ion s of t h is act , or wh o s h a ll
obs t r u ct a n y member of a n y Loca l Boa r d of Hea lt h , or a n y per s on a ct in g
u n der t h eir a u t h or it y, in t h e dis ch a r ge of h is du t y, s h a ll be lia ble t o a
pen a lt y n ot exceedin g on e h u n dr ed dolla r s for ea ch offen ce; a n d a n y per s on ,
wh o s h a ll viola t e a n y of t h e pr ovis ion s of t h e s even t een t h a n d t wen t y-fir s t
s ect ion s , s h a ll be lia ble t o a pen a lt y n ot exceedin g five h u n dr ed dolla r s for
ea ch offen ce.
SECT. 27. Ea ch of t h e s a id Loca l Boa r ds of Hea lt h s h a ll, in t h e mon t h
of J a n u a r y, a n n u a lly, pr epa r e a n d s u bmit t o t h e t own , or t o t h e cit y cou n cil,
a t t h e n ext meet in g t h er ea ft er , a wr it t en repor t , con t a in in g a n a bs t r a ct of t h e
pr oceedin gs a n d of t h e r eceipt s a n d expen dit u r es of t h e Boa r d, du r in g t h e
n ext pr ecedin g yea r en din g December t h ir t y-fir s t ; a n d s h a ll a ccompa n y t h e
s a me wit h a s t a t emen t of s u ch fa ct s a n d obs er va t ion s , a s will exh ibit t h e
s a n it a r y con dit ion of t h e t own a n d it s in h a bit a n t s ; a n d s h a ll r ecommen d
s u ch mea s u r es of impr ovemen t , a s t h ey ma y deem n eces s a r y or expedien t ;
a n d t h ey s h a ll t r a n s mit a copy of t h eir repor t , in wr it t en or pr in t ed for m, t o
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t h e Gen er a l Boa r d of Hea lt h . An d a ll r epor t s pr in t ed by or der of t own s s h a ll
be in oct a vo for m, on pa per a n d pa ge of u n ifor m s ize, s imila r t o t h e ,pu blic
docu men t s of t h e St a t e, a n d con ven ien t for bin din g ; a n d a ll wr it t en r epor t s
s h a ll be on let t er pa per of common s ize a n d con ven ien t for bin din g.
SECT. 28. An y t own , wh ich s h a ll n eglect t o a ppoin t a Boa r d of Hea lt h
a n n u a lly, a s r equ ir ed by t h is a ct , s h a ll be lia ble t o a pen a lt y n ot exceedin g
on e h u n dr ed dolla r s for ea ch n eglect ; an d t h e Boa r d of Hea lt h of a n y t own
wh ich s h a ll n eglect t o ma ke a n d t r a n s mit t h e r epor t r equ ir ed by t h e t wen t y-
s even t h s ect ion h er eof, s h a ll be lia ble t o a like pen a lt y.
SECT. 29. All pet it ion s a n d compla in t s con cer n in g s a n it a r y ma t t er s ,
s h a ll be ma de a n d pr es en t ed, in a wr it t en or pr in t ed fon t , t o t h e Loca l Boa r d
of Hea lt h , or t h eir a u t h or ized a gen t ; a n d t h e object of a ll s u ch pet it ion s s h a ll
be immedia t ely con s ider ed a n d a ct ed u pon ; a n d it s h a ll be t h e du t y of every
per s on wh o kn ows of t h e exis t en ce of a n y ca u s e of dis ea s e, or of a n y ma t t er
wh ich ma y pr oper ly come u n der t h e cogn iza n ce of t h e Boa r d, t o ma ke it
kn own .
SECT. 30. Wh en ever a n y n u is a n ce, filt h , or ca u s e of dis ea s e s h a ll be
fou n d on Pr iva t e proper t y, t h e Boa r d of Hea lt h s h a ll or der t h e own er , or
occu pa n t t h er eof, t o r emove t h e s a me a t h is own expen s e, wit h in t wen t y-fou r
h ou r s , or s u ch ot h er t ime a s t h ey s h a ll deem r ea s on a ble, a ft er n ot ice s er ved,
a s pr ovided in t h e s u cceedin g s ect ion ; a n d if t h e own er or occu pa n t s h a ll
n eglect s o t o do, h e s h a ll for feit a s u m n ot exceedin g t wen t y dolla r s , for ever y
da y du r in g wh ich h e s h a ll kn owin gly per mit s u ch n u is an ce or ca u s e of
dis ea s e t o r ema in a ft er t h e t ime pr es cr ibed, a s a for es a id, for t h e r emova l
t h er eof.
SECT. 31. Th e or der men t ion ed in t h e pr ecedin g s ect ion s h a ll be
commu n ica t ed by a wr it t en n ot ice, s er ved per s on a lly u pon t h e own er or
occu pa n t , or h is or h er a u t h or ized a gen t , by a n y per s on compet en t t o s er ve a
n ot ice in a civil s u it ; or s u ch n ot ice ma y be left a t t h e own er 's , occu pa n t 's , or
a gen t 's la s t a n d u s u a l pla ce of a bode, if t h e s a me be kn own , a n d is wit h in
t h e St a t e ;a n d if t h e own er 's , or a gen t 's res iden ce is u n kn own , or wit h ou t t h e
St a t e, t h e pr emis es bein g u n occu pied, t h en s u ch n ot ice ma y be s er ved by
pos t in g u p t h e s a me on t h e pr emis es , or by pu blis h in g t h e s a me in s u ch
ma n n er , a n d for s u ch len gt h of t ime, a s t h e Loca l Boa r d of Hea lt h s h a ll deem
expedien t .
SECT. 32. If t h e own er or occu pa n t s h a ll n ot comply wit h t h e or der
a bove men t ion ed, t h e Boa r d of Hea lt h ma y ca u s e ,t h e s a id n u is a n ce, filt h , or
ca u s e of dis ea s e, t o be r emoved or des t r oyed, a n d a ll expen s es in cu r r ed
t h er eby s h a ll be pa id, by t h e s a id own er or occu pa n t , or by s u ch ot h er
per s on a s s h a ll h a ve ca u s ed or per mit t ed t h e s a me, if s u ch own er or
occu pa n t , or s u ch ot h er per s on s h a ll h a ve h a d a ct u a l n ot ice fr om t h e Boa r d
of Hea lt h , of t h e exis t en ce of s a id n u is a n ce, filt h , or ca u s e of dis ea s e.
SECT. 33. All expen s es in cu r r ed by a n y t own or cit y in t h e r emova l of
n u is a n ces , or for t h e pr es er va t ion of t h e pu blic h ea lt h , a n d wh ich a r e
r ecover a ble of a n y pr iva t e per s on or cor por a t ion , by vir t u e of a n y pr ovis ion s
of la w, ma y be s u ed for a n d r ecover ed in a n a ct ion of debt , befor e a n y cou r t
h a vin g ju r is dict ion .
SECT. 34. An y fin es a n d for feit u r es r ecover ed u n der t h e t wen t y-eigh t h
s ect ion of t h is a ct , s h a ll en s u r e t o t h e u s e of t h e St a t e; a n d a ll ot h er fin es
a n d for feit u r es in cu r r ed u n der t h e gen er a l la ws , or t h e s pecia l la ws
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a pplica ble t o a n y t own or cit y, or t h e ordin a n ces , by-la ws , an d r egu la t ion s of
a n y t own , or of t h e Boa r d of Hea lt h of a n y t own , r ela t in g t o h ea lt h , s h a ll
en s u r e t o t h e u s e of s u ch t own ; a n d a ll s u ch fin es ma y be r ecover ed by
compla in t in t h e n a me of t h e t r ea s u r er , befor e a n y ju s t ice of t h e pea ce of t h e
cou n t y, or police cou r t of t h e t own or cit y, in wh ich t h e offen ce ma y h a ve
been commit t ed.
SECT. 35. An y a ct ion on t h e ca s e, for per s on in ju r ed, eit h er in h is
comfor t or t h e employmen t of h is es t a t e, by a n y n u is a n ce, ma y h a ve a n t h e
da ma ge s u s t a in ed t h er eby; in wh ich act ion t h e defen da n t ma y plea d t h e
gen er a l is s u e a n d give a n y s pecia l ma t t er in eviden ce.
SECT. 36. Th e cou r t of common plea s , or a n yon e of t h e ju s t ices t h er eof,
in t er m t ime or va ca t ion , ma y, in a ll ca s es , eit h er befor e or pen din g a
pr os ecu t ion , for a common n u is a n ce, a ffect in g t h e pu blic h ea lt h , is s u e a n
in ju n ct ion t o s t a y or pr even t t h e s a me, u n t il t h e ma t t er s h a ll be decided by a
ju r y or ot h er wis e; an d ma y is s u e a ll s u ch ot h er wr it s a n d pr oces s es , a nd
ma ke a ll s u ch or der s a n d decr ees a ccor din g t o t h e cou r s e of pr oceedin gs in
ch a n cer y, a s ma y be n eces s a r y or pr oper t o en for ce s u ch in ju n ct ion ; a n d
ma y dis s olve t h e s ame wh en t h e cou r t or a n yon e of t h e s a id ju s t ices s h a ll
t h in k it pr oper .
SECT. 37. Per s on s ma y be compla in ed of, a n d in dict ed by t h e gr a n d
ju r y h a vin g ju r is dict ion , for a common n u is a n ce, in ju r iou s t o t h e pu blic
h ea lt h ; a n d wh en a n y per s on s s h a ll be con vict ed on s u ch in dict men t t o be
r emoved, or des t r oyed, a t des t r oyed t h e expen s e of t h e defen da n t , u n der t h e
dir ect ion of t h e Boa r d of Hea lt h of t h e t own wh er e t h e n u is a n ce is fou n d;
a n d t h e for m of t h e wa r r a n t t o t h e s h er iff, or ot h er officer , ma y be va r ied
a ccor din gly.
SECT. 38. Th e Loca l Boa r ds of Hea lt h s h a ll h a ve a ll t h e a u t h or it y, a n d
ma y per for m a ll t h e du t ies impos ed by la w u pon ju s t ices of t h e pea ce, by "
a n a ct in a ddit ion t o a n a ct t o pr ovide for t h e con fin emen t of idiot s a n d
in s a n e per s on s ," pa s s ed Apr il s ixt h , eigh t een h u n dr ed a n d t h ir t y-eigh t .
SECT. 39. Th e wor d " t own ," in t h is a ct , ma y be con s t r u ed t o in clu de a ll
cit ies except in ca s es in wh ich s u ch con s t r u ct ion wou ld be r epu gn a n t t o a n y
pr ovis ion h er ein con t a in ed.
SECT. 40. All a ct s a n d pa r t s of a ct s in con s is t en t wit h t h e pr ovis ion s of
t h is a ct , a r e h er eby r epea led.