Better drainage, better dwellings, better sanitary arrangements, especially in towns, and better knowledge of the laws of health,—and in this category I would especially place the breaking down of the idea that sir was one of the principal carriers of disease, and that night air was partic-ularly noxious, and ought to be excluded in every possible way, an idea which probably had its origin in the difficulty of keeping up the tem-perature of dwellings when wood was chiefly used as fuel, and steam power had not yet made coal comparatively cheap—all these taken together have no doubt rendered epidemics of contagious and infectious diseases, such as scarlet-fever, measles, diphtheria, and perhaps typhoid (though this is usually water-borne) of less magnitude than formerly; and though the first onset of an epidemic is usually sufficiently sharp, we do not witness those terribly fatal outbreaks which we used to see.
To these causes also we must attribute the great diminution of phthisis and other tubercular troubles, and also of stone in the bladder which was formerly so very common in children. Val-vular disease of the heart also seems less frequent, perhaps owing to the better treatment of rheumatic fever; as well as cirrhosis of the liver from drink; and those cases of hideous deformity where the palate, nose and parts of the face were destroyed, and the bones of the skull and other large bones necrosed, as the result of specific disease.
Much has been said and written about change of type of disease, but is it not the people who are changed with their habits and surroundings, rather than disease and its laws?
In the former times men lived simpler and less exciting lives than they do at present : their desires and ambitions were more limited, the aim of the middle-aged being to secure a competency for old age, and of the young to obtain such a position as would enable them to marry and have a home of their own; and for this they were willing to work patiently and steadily. "I don't mind a little work if I can get what I want," was a common expression. Their houses were far less convenient, colder, and more draughty; clothing was less warm, but little flannel and woollen material being used, indeed, flannel was looked upon as almost effeminate. There being no railroads and few covered conveyances, people were much more exposed to wet and cold and other hardships. Their intellects were sound and good, but perhaps scarcely so acute as those of men of the present day, but they certainly had more endurance and more vigour both of body and mind, as well as a higher sense of justice and duty. They cared less for the comforts and conveniences of life, and this was seen even in their pleasures. I well recollect one incident. The foxhounds met at Toddington, a place lying under the hill about three miles west of the Dyke. It was February or March, and the day was damp and cold, with an occasional drizzling shower; there was no scent, and we remained hanging about the covert all the morning. Later on a fox was found, and after a slow and short run was lost just under the Dyke, at about four or five o'clock in the afternoon. Horses and men were standing all close together, while the hounds were casting for a scent, when I noticed the late Earl of Sheffield and his son, Mr. Douglas Holroyd, leave the rest and start to ride home to Sheffield Park, a distance of about twenty miles. Their horses were tired, and, as they must have started quite by eight o'clock in the morning, to be in time for the meet at eleven, and could not have reached home till eight or nine o'clock at night, they would have been almost constantly in the saddle for twelve hours, and for the latter part of the time in damp clothes. Would this be considered pleasure in the present day?
Diseases at that time were such as might be expected from the manner of life of the people. Having been accustomed to less luxury and com-fort, their perception of pain and discomfort was less acute, and minor ailments received but little attention. They suffered, however, much from rheumatoid arthritis (rheumatic gout, as it was then called) and from rheumatic fever and its conse-quences; pulmonary troubles were also common, especially chronic bronchitis and emphysema; phthisis, arterial degeneration (sclerosis) and its consequences were frequently met with. Calculous affections of the kidneys and bladder were also prevalent; and, if the memory can be trusted, crippled and infirm old people were more frequently seen, and as there was not the same amount of warmth in the houses and none of the modern means and appliances for alleviating their weakness and infirmity, they died at an earlier age.
Macaulay has pointed out that the natural combativeness of man is always carried on with the weapons in which he most excels, and that, as in ruder times muscular power and physical endurance were in the ascendant, so with the greater cultivation of the intellect, the conflict is now carries on by mental power and acuteness. We can therefore understand how the intro-duction and development of that great revolu-tionist, the railway, and of steam, and machinery generally, together with the increase of wealth in the country, have produced a great change in the ideas, aims, habits and surroundings of the people. It can scarcely be said that civilisation has increased—if by civilisation is meant the cultivation of the best instincts of our nature, such as patriotism, independence, manliness, considera-tion for others, the desire to be useful citizens, and a sense of duty. Nelson's last signal, "England expects every man to do his duty," and Wellington's constant appeals to duty in his addresses, would perhaps, not stir the hearts of men now as they stirred the hearts of the sailors and soldiers of those days; the desire of too many now seems to be to attain their ends, not by steady work, but at the cost of as little labour as possible; and there seems, also to have sprung up a restless desire to acquire wealth in the shortest possible time, wealth being now, more than ever, looked on as the stepping-stone to position, influence and luxury. Competition has consequently become extremely sharp, speculation has increased, men have become more unscrupulous in their dealings with each other, and mercantile morality, as shown by our daily papers, is less to be relied on. I well recollect a remark of an old uncle of mine : "Men are very much altered since I was a boy; they swear less and lie more."
Pleasure and relaxation, if it can be called relaxa-tion, are taken in the same hurried manner. How often do we get the same history : "I was quite fit till I took a holiday and went abroad, and I have not been well since; but then think what a distance we went and what a lot we did in the time."
In a pleasure place like Brighton we often come across cases in which the nervous system is dis-ordered from almost opposite causes. We see people, often well educated, whose one idea it seems to be to get as much of what they call enjoyment out of life as they can, and to avoid everything which can possibly interfere with their ease and comfort. These are, perhaps, more to be pitied and more unhappy than any others. Selfish and indolent, they have none of the higher and better aims and desires, such as the wish to live a useful life, and to hold a position command-ing respect; nor have they any object before them, the attainment of which would entail a little work and perseverance, and would provide that moderate competition and intercourse with others, and that exercise and occupation which are necessary to give tone and vigour to the mind. At an early age, possibly at 40, they begin to find that society does not want drones, that they are, to use a colloquial expression, "somewhat out of it;" they have very few friends, and frequently none of the comforts of home and domestic life (for they have probably been too selfish and too much afraid of responsibility to marry); and, having nothing to look back on with satisfaction, and nothing to look forward to with pleasure or hope, they become dissatisfied and unhappy, and their nervous system gets into a worse condition that that on their more ambitious and energetic neighbours.
Constant excitement and high pressure cannot fail, sooner or later, to produce their effects, and disease or break-down of the nervous system consequently frequently follows.
As might be expected, the powers of perception having been more cultivated, and people having become more accustomed to luxury and comfort, pain and the other inconveniences incidental to illness, in spite of better nursing and modern appliances, are more acutely felt. Insanity is said to be on the increase, and this may be true, if we may judge by the number of new asylums. Cases of nervous prostration in its various forms (all included under the name of neurasthenia) have become exceedingly common, as well as the different varieties of neuritis and neuralgia, and all sorts of imaginary diseases. Added to these is that terrible form of insomnia, with its attendant restlessness and sense of discomfort, which leads to a craving for sedatives of all sorts, especially sedative drugs, which are now supplied to the public to their very great injury in the elegant form of tabloids, for the craving soon becomes a habit which generally ends in misery, disease, and sometimes death to the patients, and trouble and distress to their friends.
Diseases of the alimentary canal and accessory organs of digestion also seem more common. There can scarcely be any doubt that the material and structure of the teeth are less strong and durable than they were formerly. May there not be a corresponding imperfection of structure in the stomach or other organs, and may we not therefore start life with weaker powers of digestion?
Every nurse knows that worry and anxiety in the mother will so affect the secretion of milk as to cause it seriously to disagree with the infant, and most of us know from personal experience that these same causes will produce loss of appetite or sickness or diarrhœa. When we remember how liberally the various organs of digestion are supplied with nerves, through the two pneumo-gastrics, the sympathetic, and the vaso-motor nerves, we can scarcely wonder that when the brain, which governs digestion, is enfeebled by high pressure and exhaustion, the secretions necessary for that process should be inefficient and that the function itself should be imperfectly performed. People now frequently take their meals in a hurried and irregular manner, and their food is not of the best or most wholesome quality, consisting as it frequently does of meat and vegetables adulterated with deleterious and perhaps poisonous preservatives and colouring matter, and other impurities; besides which ordinary food is often badly prepared. We can hardly therefore be surprised that the digestive organs, already enfeebled, should fail in their duty, and that a state of irritation, or perhaps a low form of inflammation, should be set up in the whole tract of the alimentary canal, and that we should be constantly hearing of post-nasal catarrh, adenoids, gastric and duodenal catarrh, catarrh of the small intestines and colon, and appendicitis; and that these should be frequently followed by cancer or some form of malignant disease. Medicine and Surgery have done much to relieve this state of things as shown by the very large number of abdominal operations now done, but perhaps a stricter application of the laws against the adulteration of food, and a better knowledge of the laws of health might be more efficient remedies. "Messorum ilia dura" con-veys the same meaning now as it did in the days of Horace.
There can scarcely be a doubt that much more is heard of diseases in women that formerly, and, though in many instances these are neurotic or imaginary, in many they are a very stern reality. Darwin has stated that the organs of generation in animals are peculiarly sensitive to external influences, to some so minute as to be scarcely traceable; and every breeder of domestic animals knows that if he wished to be successful he must select good animals, and animals of the proper age, and keep them in the best conditions for health. In the present state of society and manner of living, such conditions rarely exist, everything being sacrificed to the attainment of luxury and ease.
Marriage is consequently postponed to an age later than nature intended, large families are not considered desirable and are therefore avoided; women often do not nurse their infants, some because they cannot, other because they will not, on account of the trouble and restraint it entails, a course which not only endangers the health of the child, but that of the mother also. These and many other causes now in operation sow the seeds of disease which is frequently followed by the Nemesis of severe suffering and the life of a chronic invalid.
The state of society in England at the present time has been frequently compared with that of Rome and Greece before their decline, and much has been said and written about the deterioration of the English race. Can it be that the greatness of England culminated in the Victorian era, and that we are even now on the downward path?
This last paragraph was written in 1906. In 1914 War was declared and the greatest struggle the world has known commenced, accompanied by the greatest convulsions in our whole social life. Future history will record that the men and women of England faced the situation quietly, calmly, and in accordance with Nelson's words, "England expects that every man will do his duty." And I would fain believe that this terrible upheaval and test has removed, in its few years, much of that disintegration of character and softening of manly fibre which one could but observe and deplore in the pre-war days. I trust it may be that we have learnt in this fiery ordeal the lessons which Greece and Rome, to their undoing, failed to learn; and that henceforward the men and women of our race may show. along with the in-creased science and subtlety that modern life has brought them, a staunch survival of those simple and more Spartan virtues which I had feared were becoming lost to us.
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