George Vivian Poore

“ The soil, if properly tilled, provides health as well as wealth, and be it remembered that in proportion to its productiveness so is the need of labour; and further, be it remembered that long after the eye is too dim and the hand too slow to keep time with steam machinery, the physical powers are amply sufficient for the cultivation of the land.
Many of our pressing social problems are inextricably linked with our duty to the soil, and any country in which the fertility of the soil does not increase cannot be rightly regarded as really in the van of civilisation and scientific progress. ”

“ Each branch of knowledge which is necessary for a medical man is provided for and controlled by a separate professor; and it is a remarkable fact, and redounds greatly to the foresight and wisdom of our founders, that the number of professorial chairs remains the same, the only addition being the all-important one of Public Health and Hygiene, in the establishment of which we were again the pioneers among medical schools. If imitation be the sincerest form of flattery, we ought to feel proud, for every school in London is now formed more or less perfectly on the model established here in 1828. ”

“ This table, therefore, seems to me to conclusively demonstrate that the sewage of water-closet towns is far more bulky and far more filthy and dangerous than the sewage of midden towns.
Sewage is not to be regarded too absolutely from its chemical side. We must use our senses, inclusive of our common sense, in coming to a conclusion, and we must not pin our faith on analyses alone. When I am told that it is of little use to deal with solid excreta, because the liquid household slops alone are as foul and difficult to treat as the complete mixture, I confess I am incredulous. ”

“ Under such conditions as these the sewage problem may well be insoluble. The first and main duty of any sanitary authority should be to exercise a wise control over building. If every house were compelled in the future to have a curtilage bearing a definite proportion to the cubic contents, there would be an end of these towers of Babel, which shut out from us the light and air of heaven; the price of building land would fall; it would be possible to make some calculations as to sewage; and the excessive overcrowding of a city would be prevented. ”

“ It is the top of the soil which can break up and assimilate organic matter; the subsoil has no such power. It is a common mistake to bury deeply any organic matter which seems to us to be particularly offensive. In this way we ensure its preservation and endanger the wells. The safety of our wells is directly proportionate to the thickness of the humus, and to place organic matter below the humus is like throwing the dog's bone beneath the kennel instead of into it. ”

“ It is impossible not to regret the fine old College, with its spacious courtyard and physic garden and its historic associations. But it would seem as if no purely educational establishment81 can flourish in the City of London. The Royal Society, the College of Physicians, and the College of Surgeons have all moved away, and Gresham College alone is left, as if to show the impossibility of flourishing in the richest city of the day. ”

“ I have for years combated the oft-repeated statements as to the 'healthiness' of London, not because I expect that London will alter its way, but because rural places and the Colonies should not blindly follow the lead of London, in the belief that they are following a good sanitary model, and that disastrous consequences will not inevitably follow upon a reckless overcrowding of houses. ”

“ London is very largely a city of wealthy and well-to-do people, most of whom must be looked upon as sojourners rather than dwellers in the city. Among such as these, who can command every luxury and necessary of life, including change of air, death-rates ought to be low. It is manifestly unfair to contrast the death-rate of St. George’s, Hanover Square, or Kensington, with the death-rate of a town packed with the wage-earning class.
3. The mobility of the London population is so great that it must vitiate any statistics bearing on the health of the inhabitants. ”

“ Sims Woodhead [7] says that 'the deeper layers of the earth are frequently almost entirely free from micro-organisms, just as is the ground water.' Of course if the soil of a city be porous, and if there be a subterranean network of sewers interspersed with cesspools, this would (in the high probability that an average proportion of these contrivances leak) constitute a very great danger, but we must not blame the earth because we mismanage it. The earth, be it remembered, is our sole permanent source of wealth, and we must not needlessly quarrel with our bread-and-butter. ”

“ In this way medicine and surgery became divorced, and this forcible and arbitrary separation of two branches of the same subject served undoubtedly to hinder the progress of medical knowledge to an enormous extent. Medicine was thus left mainly in the hands of scholars, of men who at that time stood alone in the possession of scholastic learning, while surgery was handed over to men who had little or no scholarship, but who amassed a considerable amount of practical wisdom in the daily struggle with the difficulties of their craft. ”

“ The final question is, What can be done to prevent overcrowding of houses and of persons in the house?
I freely admit that very little can be done in big towns, and people must be left to judge for themselves as to whether they will allow their children to run the extra risk of death, crippling disease, or defective development, inseparable from life in a crowded city. ”

“ The moral of all that I have been saying is to the effect that to nourish the humus and to till it are the inexorable duty of the sanitarian. This simple duty is the key to plentiful food and a good supply of wholesome water. Nature is relentless, and will sooner or later destroy those who neglect to follow her inexorable laws. ”

“ If the evil effects of free trade are to be counteracted, it will be by returning the refuse of our towns free of cost to the impoverished agriculturist. If we in England go on as we are going, and if our brethren in the Colonies follow our example, as they are doing, I believe our race must become extinct, and it will be a Chinaman rather than a New Zealander who will sit in contemplation on the ruins of London Bridge. ”

“ If a man spend money in making his house more wholesome without increasing its size, and thereby increases its value, it is clearly not in the interests of the public health that he should be fined by the sanitary authority for so doing. ”

“ If such a ticket were issued, and qualified men anxious to prolong their studies might, in return for a payment, feel themselves free to visit any or all of the great London hospitals, there can be no doubt that we should have a great afflux of students. I very much doubt the wisdom of the policy of trying to attract numbers of students by lowering the examination tests for a degree. This is an educational age, and we must not forget that some of the boys at the Board Schools have possibly a juster notion of physiology than had many of our professional ancestors. ”

“ On board ship space is economised to the utmost, and it is a matter of interest and wonder to observe how many luxuries one can have on board a well-planned ship, mainly by reason of the cleverly-designed fittings which economise space; and it is, further, a matter of interest to observe how the principle of 'a place for everything and everything in its place' lends itself to cleanliness and wholesomeness. The besetting sin of modern hospital architects is the giving of an extravagant excess of space [21] in places where it is not needed. ”

“ This assertion is too ridiculous to require an answer, for it is notorious that the London medical graduates have had more than their fair share in all the practical advances made by medicine in the last half century; and in medicine, surgery, midwifery, and public health they have more than held their own. It is very possible that a scientific training makes it rather difficult for a conscientious man to be dogmatic, and until the public is more highly educated than at present, the dogmatic practitioner is sure to have a large clientèle and will pass for a practical man. ”

“ But is there no danger in using organic refuse, which may be infective and dangerous, as an application to the land? To this I should say emphatically 'No,' provided it be put in the upper layers of the soil, and the soil be tilled. Our organic refuse, when allowed to putrefy in water, and to trickle under pressure to our wells, or run direct into our sources of drinking-water, has turned millions of pounds into the pockets of members of my profession, but when rationally used as a top-dressing for the well-tilled soil it has never, that I am aware of, produced any harm. ”

“ Another cause of the high death-rate was superstition, which regarded disease as a “visitation” which had to be borne without question or inquiry.
With such an attitude towards epidemics, which by some were regarded as due to an unfortunate conjunction of certain planets, it is not to be wondered at that the epidemics were mismanaged; and it is certainly difficult to imagine any measure better calculated to cause the spread of the plague than that of forbidding those affected to leave their houses, and compelling them to stay indoors and infect the rest of the household. ”

“ This world would not be habitable were it not for the humus with which its bare rocks are clothed. The humus is the living covering of the skeleton, and its formation has taken ages. The primitive bare rock which has been 'weathered' by the changing seasons gets clothed with a growth of lichen. ”

“ On this account I ventured some years ago to speak of the humus as the 'Living Earth,' and I take it that no more important addition has ever been made to the stock of human knowledge than the recognition that the humus teems with life, and that its fertility and healthiness depend entirely upon biological processes. ”

“ We must therefore conclude that the death-rate and the disease-rate bear no fixed ratio to each other, especially when we consider that between 2,000 and 3,000 medical men found sufficient work among the population to furnish them with an income. If deaths be few in London, it is clear that second-rate health is by no means exceptional. ”

“ We may now profitably turn to the consideration of Malaria, a disease which is undoubtedly connected with the soil and which has its habitat in the soil of certain places. Malaria requires for its development decaying organic matter, a high or moderately high temperature, and usually an excess of moisture. Tropical marshes are the elected seats of malaria, but not the exclusive seats, for it is known that certain rocks and arid plains, as well as the sandy estuaries of rivers, are liable to be malarious. ”

“ Although we have to make many allowances, and take many things into consideration before we can estimate the true value of the London death-rate, it is, of course, undeniable that an enormous improvement in the health of the City has taken place since the beginning of the present century. ”

“ While I am not slow to admit that water under pressure is a great advantage if it be wisely used, I have pointed out persistently for some years that our present system of water-carried sewage gives a 'fatal facility' to the overcrowding of houses, and has made life, of a sort, physically possible under conditions of overcrowding which have never been equalled in the history of the world. ”

“ Now a dry catch may in country places be used with the addition of dry earth, and where the householder has a garden he can have no difficulty in managing everything for himself, and must be little better than an idiot if he allows any sanitary authority to rob him of the finest manure the world produces, the excreta of the 'paragon of animals,' and withal the most highly fed. ”

“ The construction of the furnace involves an outlay of capital, which steadily diminishes as the furnace wears out by frequent use. If we burn organic matter merely to be rid of it, we spend our money for the sole purpose of dissipating our capital. The function of fire is to destroy and sterilise.
If we mix organic matter with large quantities of water, we have to encounter all the evils and annoyance of putrefaction, and if, when so mixed, we send it to the sea, we have no material gain of any kind. We spend our money for the purpose of dissipating our capital. ”