Remediation

“ This Principle of Prevention may take the form, on the one hand, of altering the environment, on the other, of treating the individual. But if the cost of curative treatment, or even of altering the environment, is to be borne by the community, it is essential, on grounds of economy, that there should be a searching out of all incipient cases and such a disciplinary supervision as will prevent persons from becoming destitute through neglected infancy, neglected childhood, preventable illness, and voluntary unemployment. ”

“ I would submit that it is shown by the evidence collected in the present inquiry, that the great preventives—drainage, street and house cleansing by means of supplies of water and improved sewerage, and especially the introduction of cheaper and more efficient modes of removing all noxious refuse from the towns—are operations for which aid must be sought from the science of the civil engineer, not from the physician, who has done his work when he has pointed out the disease that results from the neglect of proper administrative measures, and has alleviated the sufferings of the victims. ”

“ To open out avenues through our cul-de-sac courts, to promote the sanitary condition of every house, to arrest by thorough drainage and removal of refuse the elimination of aerial poison, are the great duties that we have day by day to do. Though the task before us be great, the objects in view are immeasurably greater—to exalt the standard of life, to economise rates, and above all to decrease the sum of misery, disease, and death.... ”

“ For the remedies; there may be some general preservatives, whereof we will speak: as for the just cure, it must answer to the particular disease; and so be left to counsel, rather than rule.
The first remedy or prevention is to remove, by all means possible, that material cause of sedition whereof we spake; which is, want and poverty in the estate. To which purpose serveth the opening, and well-balancing of trade; the cherishing of manufactures; the banishing of idleness; the repressing of waste, and excess, by sumptuary laws; the improvement and husbanding of the soil ”

“ The Medical Officer of Health for the Strand wrote (1856) :—
“To pave streets, and to water roads, to drain houses or even to construct sewers, however necessary these works may be, are among the least important of the duties which devolve upon you. But to improve the social condition of the poorer classes, to check the spread of disease, and to prolong the term of human life, while they are works of a high and ennobling character, are yet duties involving the gravest responsibility. Should less care be bestowed upon our fellow creatures than is daily afforded the lower animals? ”

“ Social Hygiene, as it will be here understood, may be said to be a development, and even a transformation, of what was formerly known as Social Reform. In that transformation it has undergone two fundamental changes. In the first place, it is no longer merely an attempt to deal with the conditions under which life is lived, seeking to treat bad conditions [2] as they occur, without going to their source, but it aims at prevention. It ceases to be simply a reforming of forms, and approaches in a comprehensive manner not only the conditions of life, but life itself. ”

“ It is the object of the present Report to direct attention to the nature and extent of this evil, and to show how important it is that its mitigation, and, as far as may be found practicable, its entire removal, should form a part of every exertion that is made for improving the physical condition of the poor. ”

“ The results of all sanitary investigation indicate clearly the vital necessity for the complete and speedy removal from human habitations of all matters which, by their decomposition, may tend to the production of disease, and early measures should be taken by the authorities of all towns, especially those which are at all compactly built, to secure this removal. ”

“ Now, it becomes more and more apparent that it is a useless extravagance to adopt the policy of curative and restorative treatment, unless we are prepared to "search out" the cases [288] that need dealing with,—the infants and children who are just beginning to be neglected by their parents and guardians, the persons of all ages who are just beginning to suffer from disease, the feeble-minded lacking ameliorating care, the man just smitten with unemployment—at the stage in their complaint at which the application of our treatment has, at any rate, some chance of yielding effective results. ”

“ We think nowadays quite serenely of schemes for the treatment of the nation's health as one whole, where our fathers considered illness as a blend of accident with special providences; we have systematised the community's water supply, education, and all sorts of once chaotic services, and Germany and our own infinite higgledy-piggledy discomfort and ugliness have brought home to us at last even the possibility of planning the extension of our towns and cities. ”

“ We consider that it is proved, by the experience of the several specialised and preventive Authorities that have been established for this purpose, that the arrest of the causes of destitution, and the necessary changes in the social environment, can be effected only by making each such Authority responsible for its own special part of the work of prevention, and for providing the appropriate treatment for the particular section of persons in whom it may have failed to prevent destitution. ”

“ The subjects, to be discussed by experts, include water supply and sewage disposal, health and death rates in cities, public health problems of municipalities, state and nation, milk supply and infant mortality, school hygiene, street cleaning, tenement house sanitation, personal and industrial hygiene and diseases of animals transmissible to man. ”

“ Science has taught us that the removal of the ordure of towns to the fields is a question that concerns not only our health, but, what is a far more important consideration with us, our breeches pockets. ”

“ Now, if to drain the system of its impurities, to cleanse and purify the blood of the animal economy, three grand systems of drainage are required, the inference is plain, that one would not be enough—that two might perform the office, but with a strain upon the machinery. But to be perfect, to perform the office completely and efficiently, to be, in fact, in health, to constitute health, all are needful. ”

“ At one time the legal and punitive point of view, directing itself mainly to individual cases, or the philanthropic, palliating sufferings, dispute the foremost places; and now in their turn hygienic or educational endeavours arise, towards treating causes instead of waiting for consequences. Such endeavours are still undeniably too vague in thought, too crude in practice, and the enthusiast of hygiene or education or temperance may have much to answer for. ”

“ VILLAGE SANITARY WORK.
It is a recently recognized but an old and universal truth, that human life involves the production of refuse matters, which, unless proper safeguards are taken, are sure to become a source of disease and death. The danger is not confined alone nor chiefly to that element of household waste which is most manifestly offensive, but in almost equal degree to all manner of organic refuse. ”

“ Whilst such neglects are visited by the scourge of a regularly recurring pestilence and ravages of death more severe than a war, it may be confidently stated that the exercise of attention, care, and industry, directed by science in their removal, will not only be attended by exemptions from the pains of the visitation, but with exemptions from pecuniary burdens, and with promise even of the profits of increased production to the community. ”

“ This form of deterrence it is that lies at the base of all our Public Health and Factory Legislation; a deterrence that leads the owners and occupiers to bestir themselves to keep their dwellings up to the current local standard of healthiness, the occupiers of factories to maintain these in accordance with the requirements of the law, and the operatives in unhealthy trades to observe the precautions prescribed against disease. ”

“ Or you might build a splendid marble palace of a hospital or asylum, and herd together vast numbers of little boys or fallen women or cripples, and try in some big, mechanical, institutional way to do with your pound of cure what an ounce of prevention would have accomplished a thousand times better, if it could have come in the way of justice, not charity. ”

“ Some of recent growth have been allowed, for the same reason, to spring up and develop without any regard to sanitary principles or the requirements of public health. There is therefore abundant scope for further reform and in not a few cases urgent need of it. ”

“ Clean streets and houses, clean milk and pure water, sanitary housing, and careful medical inspection all do their part in maintaining a low rate of illness and death, thus reacting upon the health of the citizens of the future. ”

“ Its appearance marks the first stage of social reform, which was mainly a sanitary effort to clear away the gross filth from our cities, to look after the cleansing, lighting, and policing of the streets, to create a drainage system, to improve dwellings, and in these ways to combat disease and to lower the very high death-rate. ”

“ The labourers in the work of sanitary reform have been many; and it is by the united efforts of some of the most enlightened, disinterested, and learned men that shed lustre on this century, that this great work has been placed in its present position. ”

“ That it is important for the sake of economy, as well as for the health of the population, that the practice of the removal of refuse in suspension in water, and by combined works, should be applied to all houses, especially those occupied by the poorer classes. ”

“ Such refuse invariably suffers destruction by fire or by some other so-called sanitary method involving either the total or almost complete loss of valuable materials. We satisfy our consciences, however, by reflecting that the pursuance of such drastic methods satisfies the faith of hygiene, although the community suffers very pronouncedly in pocket in the long run. ”

“ All progress in civilization is attended with injury to some individuals. Trained nurses have deprived some unskilled labour of employment; hospitals have injured the business of some physicians; pure-water supplies, good sewers, food inspection, vaccination,—in short, all effective measures in public hygiene,—interfere with the trade side of medical practice ”

“ The Local Authorities do not apply the Principle of Curative Treatment wholly, or even mainly, for the pleasure or the advantage of the individual sufferer; what they have in view is the prevention of future evils to the community from the spread or recurrence of the disease, or the continuance of the disability. ”

“ The most expensive and wisely constructed building and the best modern equipment will not long remain in a sanitary condition unless watchful care is exercised, and intelligence and energy applied to the eradication of dirt, and conditions that favor the multiplication of the enemies to life and health that are ever present. ”

“ To break up the Poor Law, and to transfer its several services to the Local Education, Health, Lunacy, and Pension Authorities, and to a national authority for the able-bodied, is to hand over the task of treating curatively the several sections of the destitute to authorities charged with the prevention of the several causes of destitution from which those sections are suffering. ”

“ It was, in fact, this deep sympathy, joined to his remarkable insight into the relations between effects and their causes, which led him to devote his life to the promotion of sanitary reform, when once it had become obvious to him that all effort to improve the condition of the people would be impossible until its principles were known and acted upon. ”

“ It must not be supposed that these matters are dealt with from the standpoint of a vigilance society for combating vice. The demand throughout is for the regulation of life, for reform, but for reform quite as much in the direction of expansion as of restraint. ”

“ In places where infection has actually prevailed, the necessary precautions are immediately taken to prevent its return; and the society has, therefore, appropriated a certain sum of money for purifying the tainted habitations of the poor. ”

“ There are plenty of specific cases of ill-treatment and niggardly treatment against which no inspection can guard: of poor food and monotonous food, overcrowding in bedroom, squalor of accommodation, lack of suitable sanitary and washing arrangements, and the like. But the emphasis of those who resist is not upon specific complaints. ”

“ The process of destruction is not sudden, it is gradual. It is a long-drawn-out process. It involves the multiplication of the diseased, the maimed, the feeble-minded, of paupers and lunatics and criminals. Even natural selection thus includes the need for protecting the feeble, and so renders urgent the task of social reform, while the more thoroughly this task is carried out with the [15] growth of civilization, the more stupendous and overwhelming the task becomes. ”

“ So long as the phenomena of waste and repair are in harmony—so long, in other words, as the builder follows the scavenger—so long man exists in integrity and repair—just, indeed, as houses exist. Derange nutrition, and at once degeneration, or rather let us say, alteration begins. ”

“ The waste of life, limb, property and financial resources can be sharply reduced if rural people take a decisive stand for better safety and health. Accidents and jobrelated illnesses can be averted by safe and proper methods, control of hazards, and use of protective equipment when appropriate. ”

“ It is a case in which prevention is much wiser than cure, and while economy and convenience may indicate such a polluted stream to be a desirable source of supply, a proper regard for health conditions will rule it out absolutely. ”