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blessings, viz. : the extirpation of the plague which had previously so often ravaged the inhabitants.
Intermittent fever has ceased in certain parts of Great Britain and of this country under the influence of tillage and drainage of the soil. Till innoculation was brought from the East and taught to modern Europe, the physician could not. mitigate small-pox.
Jenner, led by Nature's teachings, substituted the milder disease of vaccination for the fatal scourge of small-pox.
Private investigations in Europe and America have, in these later days, proved that residence on a damp soil brings consumption ; and, second, that drainage of wet soil of towns tends to lessen the ravages of that disease.
We have been taught by Murchison and others that fevers are often propagated by contaminated drinking-water or milk. Our own Board investigations have proved that contaminated air may also cause it.
Still more recently cholera has been brought, in its origin and progress, under law, and we know how we could probably prevent it if proper precautions against its origin were taken. A neglect of proper sanitary regulations tends to propagate this scourge, year after year, over Europe.
These monitions given by Nature and individuals as to our power of checking or preventing disease, have at last culminated in the fact that the State decides to use its moral power and material resources in aid of State or Preventive Medicine. England, in this respect, outranks all other countries. America, I think, stands next. This
appears to me the general course of events hitherto in regard to public health. I do not mean to assert, however, that nothing has ever been done before by the state. On the contrary, the Parliament of Great Britain and other European states and the legislatures of our various States have at times spasmodically and tentatively, for centuries past, given powers to local town boards of health. They have, moreover, at times, devised important plans for the health of the people and for the prevention of the spread of certain discases. But all these were trivial compared with the present
• 68,596 died of it in London, 1664-5.
position of England and of some States of this Union where state boards of health have been established.
Again, physicians have heretofore devoted themselves chiefly not to the prevention, but to the "cure” of disease. How utterly impotent have commonly been their efforts to cope with great epidemics ! The giving of medicine during a disease, not the prevention of it, bas been their chief aim, and the community now generally believes that the physician is simply an administrator of drugs. How rarely is a physician called upon to mark out the course a man should pursue to prevent their use. Nevertheless, modern times will bear ample witness to the zeal with which some of the most distinguished of our number have protested against the too free use of medicine, and have declared that our art must be pursued more in accordance with Nature's laws, and not in total neglect of them, as was too frequently the case in former days. Some few even, though I would protest against it, have carried their skepticism so far as to lead one to believe that they think the practice of Physic hitherto has been an unmitigated evil.
With one accord I believe it may be said that the whole profession has cordially greeted the advent of State or Preventive Medicine. What, it may now be asked, will be the effect upon the public and the profession after two or three centuries of growth of the principles of Preventive Medicine? I look forward with high hopes for the future of this young idea, founded as it is on the duty of the state to investigate the laws of all diseases so that, as far as possible, all shall hereafter be prevented. I think that idea cannot fail of making a stalwart growth. It may make many errors, but it must make yearly progress in the knowledge of the more hidden causes of disease. At least three good results will arise from it:
1st. The profession will learn that a system of therapeutics dependent on materia medica simply, is much less valuable than that which seeks to defend its patients from the insidious approaches of the causes of disease.
2d. The people will themselves learn to avoid many evils into which they now fall, because of their ignorance of the laws of health. They will have less faith in drugs, more in na
ture; more in anticipating and preventing evil than in curing it after it has begun.
3d. The knowledge of the precise effects of special drugs, and of their various compounds one with another, will become more and more accurate under the teaching of modern experimental physiology, and still more under clinical experience. Though it may take centuries to develop, even to a small extent, the future materia medica, the future physician will use each article with a finer knowledge of the precise effects of each drug and of its combinations, than it is possible for us now to have. We can scarcely foresee the time that will be required for this materia medica to become even tolerably perfect. In fact, the knowledge of the special action of drugs at the present day, compared with what we have yet to learn upon this important subject, is a mere trifle.
Meanwhile, as the profession of medicine becomes more thoroughly scientific, the people will also gradually learn that all filth (physical, moral or intellectual) is absolute poison; that no violation of physical, moral or intellectual law can be made, even momentarily, without injury to human comfort and life, and possibly without causing premature death. It will learn that it is not only worse than useless, but a vile wrong to one's self, to use various articles as incautiously as they are generally now used.
But it may be asked, What is to become of the physician and his practice, when the public takes care of its own health more than it does at present? Will the profession be useless? Far from it. It will stand higher than ever. It will be the prophet of the future, and will direct men how to govern their own bodies in order to get the full amount of work and of joy that is possible out of each body that appears in life. I feel sure that more than at the present day will the wise adviser and practitioner of medicine be then needed, whenever misfortune or wilfulness or carelessness, folly or crime shall have brought disease and perhaps a tendency to early death into a family. It will be the physician's duty to show the way out of such impending evil. He will take the child at its birth, and will cast its horoscope from the past and present of its family tendencies, and its actual surroundings. Having well considered these data he will lay down the rules of life which should rigidly be pursued by parents and by himself in order to gain possession of as much of perfect health as he is capable of having. As the dentist now undertakes to modify and to guide the various processes of dentition from earliest childhood to old age, so the physician will be the monitor and guide for the entire body from birth to death. The dentist is, philosophically speaking, in advance of the physician of the present day, inasmuch as in his own specialty he oftener acts on the principle of Preventive Medicine. It must be admitted, moreover, that however wise a prophet the physician may be, and however skilled in hygienic law the people may become, there will always be a very wide margin of ignorance, folly and of adverse circumstances on the part of the public, which must be met, and, if possible, remedied by the professors of our art.
To be able to aid in inaugurating such a future state of professional and lay knowledge is surely an object worthy of our highest effort. It is satisfactory to me, and I hope also to you, to think that we are allowed to advocate this noble cause in Massachusetts. It is my hope that by the efforts of the Board the State will annually become more alive to its best interests, and to its duties towards the people. Hygienic laws will be enacted and they will be obeyed by the many, if from no other motive, from self-interest. May we not hope that our country homes will be more carefully guarded from the many causes of disease that now, through ignorance, beset them. I trust that in our cities large tenements for the poor, in which there are common corridors and water-closets or privies for two or three hundred people, and in which the comforts of home and all the amenities of human life are set at naught, in which it is impossible to educate a family in decency, and where disease and crime prevail, will be declared public nuisances and pest-houses. I look forward to the time when a city government will be considered criminal which, like the city of Boston, allows, year after year, sewers to be introduced as unwisely as they are at present, and its sewage to be thrown broadcast about its borders, thereby at times overwhelming its inhabitants with a tainted atmosphere. The same govern
ment will, I trust, feel the importance of having proper administration of the laws about drunkenness, guarding itself alike against the futile waste of time of attempting to enforce a general prohibition, or the allowing, as at present, of unbridled license in the sale of liquor. When Preventive Medicine has full sway, men will not be allowed day after day to disturb the public peace or the comfort of their own families by beastly drunkenness. The authorities of that day will promptly decide whether it be the result of disease or of crime, and will seclude the wrong-doer either in a drunkard's sanitarium or a prison. I feel sure, moreover, that the time will come when the selling of rum to an avowed and wellknown drunkard will be deemed one of the most dreadful of crimes, inasmuch as drunkenness strikes at the root of the physical, moral and intellectual health of the people. These are only a few of the blessings that will arise when Preventive Medicine shall have its full sway over our people, and when individuals and laws shall have been gradually moulded by it.
As an example, imperfect though it must be, of what I think will be the relations of physicians and the community compared with those which they respectively hold at present, let me imagine the following: Suppose two parents have hereditary tendencies to consumption, and they are desirous of knowing how best to manage their child that has just been born. They wish that it may have the best chance of arriving at a good old age after a life of health.
after a life of health. Let us suppose that both parents have this ancestral tendency to that disease of the lungs which is known as consumption. According to some modern writers, it has many antecedents or causes, but we shall probably know it for centuries to come, as it has been known in the past, as the one disease of the lungs that slays a large percentage of all who die in New England. There are certainly some general topics, even with our present knowledge of its antecedents, which would naturally and physiologically come under discussion in replying to the inquiries. Among them are some which are generally applicable to all human beings, whether in health or disease, viz. : residence, nutrition, clothing, care of the skin, bathing, &c.,