The improvement of hygienic conditions in the towns began in England soon after the middle of the 18th century. West minster obtained an Improvement Act in 1762, Birmingham in 1765, the City of London in 1766, Manchester in 1776, and most of the other provincial towns soon followed. As a result of such acts noisome streams, which were but open drains, were covered in, streets were paved and lighted, and sewers improved. There were still many glaring defects of sanitation, including much which would horrify us now.
The improvement of such conditions as these could only be made by state action. This was clearly perceived by the social philosopher, Jeremy Bentham (1748-1832) (q.v.). The efficient agents in convincing the public that factors which influence the health of the country must be the concern of the legislature were two disciples of Bentham, the 19th-century reformers, Thomas Southwood Smith (1788-1861) (q.v.) and Edwin Chadwick (1800-90) (q.v.).
Rise of Hospitals.—An important hospital and dispensary movement arose about the middle of the i8th century. Many great hospitals both in England and in Continental countries were then either founded or rebuilt. The London hospital was rebuilt in 1752; St. Bartholomew's in 1730-53. Between 1700 and 1825 no fewer than 154 hospitals and dispensaries were founded in the British Isles. Though defective from the modern point of view, yet under the influence of the sanitarians, such as Hales, Pringle and Lind, these were far better equipped and better ventilated than institutions constructed at the beginning of the i8th century. The industrious Howard gives a very complete picture of them, and one that is more favourable than might have been expected. The main defect was the nursing. This was better in the lying-in hospitals, where the services of a higher type of woman were available, and where ladies served on the management. The gen eral state of the hospitals remained almost stationary from the mid-18th century until transformed by the changes in surgery and nursing in the second half of the 19th century.
Inoculation and Vaccination.—During the i8th century smallpox was never absent from Britain, and from time to time the disease became epidemic. The outbreaks, often grave and fatal, varied greatly in virulence. Infection with a mild form would lead to protection from a graver. In the East a method of direct inoculation of the disease from a patient suffering from a slight attack was widely in vogue from an early date. The practice attracted little attention in Europe until Lady Mary Wortley Montagu (1689-1762) studied it at Constantinople. It was then
soon taken up in England, and became recognized on the Con tinent.
The efforts of Lady Mary were reflected on the other side of the Atlantic. The Puritan leaders, Increase Mather (1639-1723) (q.v.) and Cotton Mather (1663-1728) (q.v.), turning from their exploits against witches, ardently urged the operation. In Eng land the learned Dr. Richard Mead (1673-1754) (q.v.), who ex ercised very great influence on the medical world in his day, pub lished in 1747 a work in which he supported the practice. It spread widely and rapidly. The operation was largely in the hands of specialists who were not always medical men.
Such was the state of affairs when the country practitioner, Edward Jenner (1749-1823) (q.v.), came upon the scene. In 1796 he demonstrated that the condition known as cowpox or vaccinia gave immunity to smallpox. From that time "vaccina tion" with cowpox has taken the place of the old method of inoculating with smallpox.
The discovery of vaccination is a mere trifle compared to the train of new work and new thought that was ultimately opened by the study of immunity to disease of which that established by vac cination is a special instance. The work of Pasteur, Lister and Koch, and the main part of the modern therapeutical movement, are based on the study of the type of phenomena to which Jenner drew attention.