this province of the human mind, to concur in bearing testimony that the sense of the ludicrous and the sense of the pathetic have their sources not far from each other in the very highest parts of our nature, and on this ground to endeavour to procure for the poor and wearied, for the thoughtless and even for the erring, an occasional enjoyment of this special kind. If the theatre cannot be made to coincide with their views of morality, there are substitutes for it that may be easily found. Henderson, the actor, went up and down England setting large rooms of people in a roar, at that wonderful production of the most melancholy of men, the diverting history of John Gilpin, then just published anonymously, and among his audiences was to be seen the great Mrs. Siddons herself, who shook her sublime sides and clapped her majestic hands in ecstacy at the exhibition. I venture to think that such an entertainment might be allowed to alternate with more serious subjects, and that an hour so employed was as well spent as if it had been devoted to the feudal system, or the solar system, or any other system that comes less home to our business and bosoms than the successless efforts of the London citizen to keep his wedding day with his wife and children at the Bell at Edmonton. Plenty of materials for such amusement may be found if they are carefully sought and judiciously selected. And we need

not leave the selection merely to the unaided taste of uneducated men. In popular productions of a comic kind there will often be something of the freedom, or even the coarseness of the popular spirit. But such flaws are merely incidental to the ludicrous, not essential to it, and the guidance of a more refined spirit will keep it all right. A good laugh thus periodically administered would save a great quantity of alcohol, while it would excite those very sympathetic feelings and genial dispositions which are most wanted for regenerating our moral system and knitting together the different classes of society. The men whom we could thus send laughing to their beds would have experienced an hour's happiness without sensuality, an evening's pleasure without any fear or misgiving at the time, and without any remorse afterwards.

I now conclude these observations, feeling how partially and imperfectly I have handled the various topics that lay before me, and I sit down entreating your indulgence for these defects, and for any errors into which I may have fallen in speaking of those matters on which I have touched. The whole subject after all is, if not in its infancy, yet barely in its adolescence, and it is only after many failures and many mistakes, that we can hope to arrive at right conclusions.

90

Address

BY

PROFESSOR CHRISTISON,

ON PUBLIC HEALTH.

THE

HE office whose duties I have had the honour of being appointed to discharge at these meetings has been filled in turn, since the birth of our Association in 1857, by men of no less mark than the Right Hon. Mr. Cowper, Lord Shaftesbury, Lord Ebrington, Lord Stanley, Lord Talbot de Malahide, and Mr. Fairbairn. When I made this discovery, I first became sensible that, in undertaking to deliver this address as their successor, I had incurred a greater responsibility than I was aware of in accepting it. As your President, I thought I could not repeat those general considerations, which have been put before you so often and so ably by my predecessors, and which would, I feel, lead in my hands to little else than weariness on your part and unprofitableness on mine. Turning next, among other suitable subjects, to the readiest which lay within my reach, the advancement made in our knowledge of public health since this Association last met a year ago, it appeared to me that the progress made in that time had not been in any way so remarkable, that the retrospect was likely to prove either a large enough or a pleasant enough theme. I have therefore been led to look for materials to the very opposite quarter. For some time past we have been told a good deal of what has been latterly done in this field. I propose rather to say something of what is still undone. An inquiry of that kind will be less flattering to our vanity. But it may turn out more serviceable, if we should succeed in discovering some well-defined "desiderata" for a better knowledge, and a better condition, of the public health and more especially if we can thus point out blanks in our knowledge which may be filled up through means of encouragement held out by the Social Science Association.

I propose to look at my subject from a physician's point of view. I am inclined to think it is well that we should all some

times look at public health from this direction. The branch of knowledge called public health is not essentially medical in all its details. It is far from indispensable that every inquiry concerning it be carried on by the physician alone. On the contrary much has been done in this line, and well done too, by members of the Association, as well as by others not belonging to the medical profession. But there are inquiries of great consequence to public health which no one can fitly undertake without a wide acquaintance with medicine. Others, which may be carried on independently, may, nevertheless, require to be tested by reference to medical principles and medical experience. And, on the whole, the closer the bond of union. is drawn between medicine and public health, the better will it be for the stability of the latter branch of knowledge. This truth seems to have been sometimes lost sight of lately; and perhaps it is on this account that some non-medical inquirers have arrived at conclusions which medical observation refuses to confirm.

Public Health, in the simple acceptation of the term, means nothing more than the aggregate health of each individual in a community. But as a branch of Social Science, Public Health deals as little as possible with individuals. Its principles rest on observations made on bodies of men. Inquiries into public health are carried on with reference to bodies of men, because in that way we escape the disturbing effect of collateral circumstances. For a reason somewhat analogous, such inquiries are best carried on, not by individuals, but rather by bodies of men, or by individuals acting under their authority, or liable to their check; because we are thus more likely to escape the bias arising from the prepossessions of individual minds. And further, when measures for raising the standard of public health are based on such inquiries, it is not left to individuals to carry them through. They generally require aid from the municipal powers, or the general government itself of a country. Hence the importance of attaching the study of the Public Health to this Association, as a department of Social Science. For inquiry will thus be encouraged; its conclusions will be tested by discussion in the hands of many well-qualified persons; and the resulting measures will go forth to the nation with the sanction of a public body, and with the aid of many who have either a share, or an influence, in legislation.

Public health, as a branch of Social Science, treats of the agents which influence, for better or for worse, the average bodily vigour, mental energy, healthiness, and length of life of the community. The main agents of this kind are the

earth and its covering, the air, water, and heat, food, drink, and exercise, occupation and habits, education, whether bodily or mental, and moral discipline. They act by favouring or engendering diseases, or, on the contrary, by circumscribing or extinguishing them. Very few diseases are exempt from the influence of one or more of these agents. But hitherto the researches of the inquirer into public health have been necessarily confined to certain great classes of diseases, and some special diseases of frequent occurrence.

The study of public health may be taken up from the basis of the agents that influence it. The study may be undertaken also from the basis of the diseases, whose sway is ruled by these influences. The physician naturally prefers the latter order of inquiry. The relations of diseases and groups of diseases to the various agents I have enumerated is a very large subject; much too large to be exhausted on such an occasion as the present. I may be supposed, therefore, to have been inconsiderate in choosing such a topic for this address. But I have thought it might interest you more, and be more in keeping with my own pursuits, if, instead of the eloquent general views usually dealt with by those in my position, I should endeavour to offer you a sketch of the mode in which the principal diseases, or groups of diseases are influenced by the agents which affect the public health, and attempt to illustrate by a few apposite instances what has been already done, and what remains to be done, for lessening the prevalence of such diseases, and the mortality, ill-health, and pecuniary loss arising from them.

In carrying out this design, I shall take for my guide, wherever I can, the Government Register of Deaths, which ought to be our main text-book in all inquiries relative to public health on the large scale. I must deviate, however, from the register in its classification of diseases, which will not suit my purpose altogether; for diseases are by no means always so grouped there as to bear relation to the agents which cause or favour them. Keeping that relation in view, we might comprise at least five-sixths of the deaths in the register in the nine following groups: 1. Epidemic diseases; 2. Inflammatory diseases; 3. Diseases of the brain and spine; 4. Diseases of the heart and blood-vessels; 5. Diseases of the digestive organs, not included in the inflammatory groups; 6. Diseases of the uterine organs; 7. Diseases of the urinary organs; 8. Diseases of depraved constitution; 9. Death from violence. The remaining sixth of the register consists mainly of deaths whose causes are so vaguely given in the returns that they are incapable of being arranged with any defined group.

I propose to take the Scottish register for my guide. I suppose it is generally as exact as the English register, and though on a less scale, yet quite large enough; and it has the advantage of supplying facts from large populations the most different we could well find in civilised society as to situation and manner of life.

When the Medical Registrar of Scotland, Dr. Stark, drew up in 1861 the "First Detailed Annual Report of the Registrar-General for Scotland" for the year 1855, he found the average mortality to be lower than in any other kingdom in Europe-viz., one in forty-eight annually. He therefore properly added a caveat, that this particular year might not yield a true average. I am happy to say that ulterior experience exactly confirms the original result, the average for seven years ending with 1861 being also one in forty-eight. It would be most interesting to trace the diseases which occasion that relatively low mortality, compared with those which cause the higher rates of less favoured lands-Lower Austria, for example, where the deaths actually reach one in 27.4-and thus to see whether in this way the agents which produce, and the influences which extend disease, can be discovered, and then possibly mitigated or removed. But there is an insuperable difficulty in the constitution of the register itself. It may surprise you to learn that even in Scotland, which is supplied with medical men not inferior in professional skill to those of any other country, more than a fourth part of the deaths are returned to the registrar in a shape which renders them useless for such an inquiry as that now referred to. A tenth part of the deaths in 1855 are returned without a cause being stated at all. Of the remainder, about a fifth are returned in a nomenclature which admits of being interpreted in two or more ways, or in any way one likes. The deaths in 1855 were 62,000. Of these, 5,732 were returned without any cause being assigned; 5,725 were referred to such vague causes as lung disease, asthma, atrophy, sudden death, teething, and diseases of unascertained seat; and 5,685 were referred to the gradual decay of old age. The English register is not quite so defective as this. Nevertheless, the deaths unreturned, or faultily returned, amount to a fifth of the whole.

Let it be understood, however, that no blame attaches to the registrars. But there was an error on the part of those who organised the list of names of diseases to be used by the certifiers of death. Lung disease is a term which positively invites a man to carelessness. It should be extinguished. I suspect most returns under it should be transferred to the category of pulmonary consumption; but it may correctly