“With such a system, can there be a wonder that the sanitary condition of the city is not improved? * * * Nor must the consideration be kept from view, that the members of the common council, the board of health, and commissioners of health are all, from the manner of their appointment, subject to partisan influence. To expect a perfect sanitary system, under such a condition of things, is to expect an impossibility.”
The medical officer of health for the City of London, a gentleman of large experience, thus defines a health organization capable of answering the demands of a large and growing town: “The object of this organization lies in a word: inspection, inspection of the most constant, most searching, most intelligent, and most trustworthy kind, is that in which the provisional management of our sanitary affairs must essentially consist.” The results of this work of voluntary sanitary inspection which I have before me prove on every page the truth of the above statement. No health organization without daily inspection would have any efficiency.
Of the value of such thorough inspection in the suppression of epidemics, and in the prevention of disease, there are abundant examples. The people of a populous town of England, becoming alarmed at the approach of cholera in 1849, organized a corps of inspectors, whose duty it was to visit from house to house, and inquire for cases of premonitory diarrhoea, and when found to apply the remedy at once. The result was that cholera did not visit that town. The same systematic house-to-house visitation was adopted in some poor districts of London in 1854, and there was an almost complete exemption of those parts of the city, while some quarters of the wealthy, which were not under such surveillance, suffered severely.
But it is essential that this inspection should be by thoroughly qualified medical men, and it must consist in a house-to-house visitation. Disease must be sought for, found, its incipient history completely made out, the causes upon which it depends reported, and its remedy suggested. Every case of death should be visited, and all the circumstances attending the development of the disease, if it belong to the preventable class, should be rigidly investigated and reported, in order that the central bureau may apply the proper remedy.