In short, political economy regards health as anterior and essential to the prosperity of a people. Popular education, social advancement, national greatness, are attainable only upon this condition. Whatever achievement or excellence may exist or be possible beyond, if not primarily and solely due to it, is nevertheless largely dependant. Physical efficiency involves more or less of moral power, the will to originate and the energy to accomplish, which render alike the man and commonwealth the realized ideal.

PHYSIOLOGICAL AND HYGIENIC INSTRUCTION OF PATIENTS.

By C. E. MILES, M. D., Boston, Mass.

The time has gone by when the office of the physician is thought to consist solely in aiding nature in her effort to achieve a triumph over the actual attacks of disease. The present expects of him so to instruct those under his professional watch and care that they shall in a great degree escape its assaults. It is not entirely by the administration of drugs that the thoughtful expect or choose to be relieved of their mental or physical maladies; but they hope to be so directed, in many instances, that nature shall be enabled to rally her powers, and health become restored without resorting to the more active forms of medication; and, if we mistake not, all indications for the future point in the same direction.

Hence the demand and the necessity that the medical profession fully consider, in all their bearings, those topics pertaining to preventive medicine, hygiene, and sanitary laws, and that they impart to the community the results of their investigations, thereby lessening the ills and enhancing the value of human life.

It shall be the purpose of this paper, as assigned, to discuss the importance of Physiological and Hygienic Instruction of Patients. At a time like the present it will be impossible to

give a broad range to the subject, or to more than hint at the topics considered. We shall, therefore, confine our attention chiefly to certain instructions in regard to the air we breathe, the food we eat, our drinks, the clothing we wear, the Tobacco habit, Sexual Physiology and Hygiene, and the laws of Labor and Rest.

One of the elements absolutely essential to human life, is the air we breathe. Perfect health cannot be maintained for a moment except in a pure atmosphere, however favorable all other conditions may be; although it is possible that existence may be prolonged, so tenacious is the body to life, even when it is in a most vitiated state. Partly because of this resistance of the body, and partly because of the lack of knowledge, the masses to a great extent live in an atmosphere pregnant with the germs of disease and death. The important facts relating to the elements of pure air; the quantity consumed by the individual, and the purposes it serves in the vital economy; the vitiation to which it is liable; the method by which it occurs, and the results which follow, are but little understood by the community, and in too many instances practically ignored by the profession.

Let the community fully comprehend that the oxygen in the air is nature's great disinfectant; that the blood is the carrier of the larger part of the waste material of the body, and that the average adult presents nine pounds of this fluid every minute to be purified by the air we breathe; that without this process the most virulent poisons are retained in the system, and we have gone far to lead men to be interested for themselves, and to cultivate a sentiment that will compel the enactment of sanitary laws and their execution.

When the general attention shall be awakened, and the importance of this question clearly presented, the whole subject involved in this matter of pure air, as ventilation, drainage, cleanliness and disinfection, will become a matter of anxious interest to the public. But now the average individual, family, town, and city, fail to take due thought and care in this most important matter except as aroused to it by the medical profession. Line upon line and precept upon precept are not

more necessary in morals than they are in regard to the commonest facts pertaining to the health and physical habits of a community; so thoughtless and neglectful are men of the physiological and hygienic conditions of their being.

The attempt to practice medicine without keeping this whole subject in view, indicates either gross ignorance or indifference on the part of the physician. To treat a patient immersed in a noxious atmosphere and expect favorable results is preposterous. To permit a patient to live under such conditions unwarned is the height of selfishness. A single illustration gives point to this subject: a prominent merchant suggested to a friend that he had suffered and been drugged for twenty years for a violent morning headache that had never been relieved. He was advised to leave all drugs alone and to sleep with his chamber window lowered four inches. He had no occasion for further drugging. Hygienic law obeyed prevented pain and rendered medication needless.

Without food we die as well as without air; but as a feeble existence may be continued for a period in a noxious atmosphere, so an enfeebled body can for a time be maintained when imperfectly nourished. But wholesome food in proper· quantities is as essential as pure air to the maintenance of health. On this point the demand for both physiological and hygienic instruction on the part of the profession as a means of the preservation of health and cure of disease is everywhere and always apparent.

The period of infancy is largely vegetative, and is designed chiefly for the growth of the body. In proportion as it is properly or badly nourished, so will be its future develop

As the twig is bent so the tree will grow is no more true than that the human body will be fashioned in accordance with the methods of training it shall receive. In times that are now quite remote the mothers generally nourished their children, and less attention was given to the subject of infantile feeding than is demanded in our own time. Now, with the birth of the child, the question arises as to what it shall eat; and in answer to it, there is too often a fearful barrier placed to the infant's existence; or if not absolutely

to existence, it is to all comfort or healthful development. And it is a patent fact that multitudes in infant life, that cannot be numbered, are annually swept from the earth from improper diet and faulty methods of feeding.

It is not the province of this paper to suggest the proper diets for infancy, nor the times and methods of feeding them; but rather to present the duty and the necessity of the profession to be informed on these subjects, and that they properly teach those who come under their charge in regard to these matters. But we cannot forbear the remark that no course of procedure can be less scientific than to prescribe tonics, pepsins, alkalies and tincture Rhei when the cause of the infantile disease has its rise in an improper diet, whatever it may be, unless that be first corrected. Then, indeed, in most instances, all need for medicine will have ceased.

Every physician is aware that chronic diseases, a very large proportion of them, have their rise, their progress, and fatality in a faulty nutrition. This occurs too frequently, not from necessity, but on account of the ignorance of the masses, or their failure to obey the dietetic laws. Too little food, too much food, too many kinds of food, improper food, badly-prepared food, and so on, have their part in laying the foundation of functional and structural diseases innumerable. The attacks of acute disease arising from the same causes are the commonest occurrences.

Prevention of disease in these instances will largely come by the constant instruction and advice of the profession in this direction. The cure of disease thus induced will never be accomplished by medication alone. As a rule the sufferer will not object to the doses prescribed, and the physician will usually have at hand the "best known remedial agent" for the difficulty, and with a flourish will prescribe for his patient; but far too often will he forget to lay before him the diets, and methods of preparing and taking them, that are absolutely essential to his recovery.

The endless question: "What shall we drink?" must also be met by the physician; to answer which will often tax his skill, good judgment and conscience. The physiological

and hygienic bearings involved are often of the greatest importance to the patron in health and the patient in disease, and frequently to the physical, social and moral well-being of society.

Those drinks which are simply nutritious are not to be taken inordinately in health even, and much less in disease. It is well known that nature's most abundant and delicious drink may be abused to the extent of fatal results; and when administered as a therapeutic agent, as great care and skill is often requisite as in the use of the more heroic remedies, so called.

It is, however, in regard to the physiological value of the alcoholic stimulants as a beverage, and as remedial agents, that the physician will most frequently be called on to advise his patients and the public. In no other direction is the possibility of his advice and instruction of greater importance to them; and on this point, too, the most diverse opinions are held by those equally eminent in the profession. That opinions so diametrically opposite should obtain is no more marvellous than that in regard to the use of various foods and other drinks and medicinal agents.

But in those instances where there is no question in the mind of the practitioner as to the utility, primarily, of the use of the alcoholic stimulants as a beverage or remedially for the sick, much conscientious care and good judgment must be exercised in recommending them, lest ulterior results may follow that will prove ill to those proposed to be benefited. Temerity, prejudice and false sentimentalism should be put aside by the true physician, and courage, cool judgment and well-defined opinions and conscientious motives should inspire him and guide his movements; calmly leaving final results, as often he must, to that favorable termination which will reasonably occur in the nature of things.

We utterly disagree with those who decline to prescribe the narcotics because their use has been abused, or to prescribe the alcoholic stimulants, because, forsooth, some have taken them inordinately, and others have thereby made themselves beastly and demoniac. Yet we must earnestly protest against