recreations, education, profession, exercise, walking, running, dancing, horseback exercise, driving, gymnastics, bowling, rowing, swimming. Let me try to give most briefly some general ideas on each of these topics.

RESIDENCE.

The physician must look well to the homestead,—its situation, its surroundings, its construction. He must declare that the house should be in the country rather than on the sea-coast, and placed on a dry soil, or if situated on a wet soil, that it must be immediately and effectually subdrained in all the immediate vicinity, and the cellar must be cemented so as to be always dry. All draining, in fact, around and from the house must be arranged with the greatest care; for manifold evils may fall on a family when little attention is paid to this important matter. Especially should all refusematter from the kitchen and other sinks, from water-closet or privies, be effectually carried away, and at the same time be so far removed from the source of water-supply which is to be used for culinary purposes, that it will be impossible, by any percolation through the soil, that the one should mingle with the other. To avoid this contingency, closely cemented stone, brick or vitrified tile-drains should be used for the refuse-water, and the supply for culinary purposes should be drawn, if possible, from some distant spring or pond, and be conveyed to the house in wooden, iron or brass, and if possible, not lead pipes. In future times, when Preventive Medicine has gained its full and legitimate influence over the community, no city, town or large village will dare to carry on its government without taking immediate measures to procure an abundance of good, pure, soft water, and the same authority will carefully* watch to prevent all possible contaminations from houses or mills or other impurities. Having chosen a proper site for the house, and having carefully drained it and supplied it with pure drinking-water, arrangements should be made for an equally abundant supply at all

In this connection I would refer the reader to the Report by W. R. Nichols, in another part of this volume, on the "Present Condition of Certain Rivers of Massachusetts."

times, day and night, of pure air. For this purpose it will be well to have the house situated on an elevated knoll, and open to the south and west winds, though shielded, perhaps, somewhat from the north and east. It should not be too much shaded by trees or creeping vines, for these cause a dampness about it. The sun, which modern science would prove is the source of all vegetable and animal life and activity, and whose beneficial rays are daily felt when they are present, or sighed for when absent, should be allowed to have free access, if possible, to every room and chamber in the house. The atmosphere of the family dwelling should never be allowed to be too cold in some parts, or too hot in others. It should be slightly tempered with warmth in the dead of winter all over the house. In the sitting-room the heat should not be above 72 Fahrenheit, nor below 68; 70, the medium, is the best. Most people, at the present day, seek to gain this by means of furnaces or radiating steam-pipes in each room. Often not the least arrangement for a proper change of air is made. Nothing can be more deleterious or more absurd than the very common method, much employed now, of building houses without any open fire-places. Some, even, have only small flues, utterly inadequate for the purpose of ventilation. It is the duty of Preventive Medicine to protest against all these, and to endeavor to bring back our builders and the community to common sense in this respect. One general rule should be laid down. Let open fire-places, connected with well-constructed chimneys, be made in every apartment, so that they can be used, if needed, for proper ventilation. In this respect, at least, our fathers were wiser than we, with all our vaunted knowledge. They established their broad hearthstones, and threw up their wide-throated chimneys. Gathered around these the children inhaled healthy, continually renewed, air, and during the long winter evenings, as they watched the blazing log-fire, or listened to the crackling embers, they gained health as well as joy; whereas our children scarcely gain either, while huddling around the black hole of a furnace register. The youth of those days obtained a more genial warmth, as well as this constant change of air, and which cannot possibly be obtained by the modern furnace, or

by that still more pestilent apparatus, born of modern parsimony in the use of pure air, the air-tight stove. This latter contrivance, whether it be constructed to burn wood or coal, or whether made of wrought-iron or cast-iron, must be wholly condemned by Preventive Medicine. It is an instrument of torture at times for an invalid, and if continually used it is fraught with the worst consequences to a growing family. It wholly prevents ventilation, and heats too much. I have a decided belief that a consumptively inclined family may have its whole fate decided adversely by the exclusive use of the furnace, or air-tight, or steam apparatus to warm all the homestead. Patients have told me that my orders for the removal of an air-tight stove, and for the use of an open fire have relieved them more than any drugs which I gave them. They felt grateful because I refused to prescribe unless my orders in this respect were immediately obeyed, as the first and most important measure to be adopted.

Open fire-places, or the admirable substitute for that, the old-fashioned but philosophical Franklin fire-place, or opengrated stove or grate should therefore be in every room of the modern dwelling, and thus we should imitate in a degree at least our ancestral homes, and gain all the advantages without the few disadvantages of their ampler chimneys; for these old homes, I think (although I am not quite sure upon this point), failed in one respect, and in which we moderns have probably improved upon ancient modes. They made no arrangement for tempering the atmosphere all over the house. This certainly is a great comfort in modern days, and I cannot think it a detriment if we use small furnaces communicating with the open air, or if we place simply entry stoves so to slightly warm the corridors and chambers during the coldest of the winter weather. Great caution, however, should always be taken when using furnace or entry stoves to provide thorough ventilation by opening the windows daily. Unless the weather be intensely cold, a small crevice may be advantageously left open during the entire night. On this latter point so much depends on individual power and conditions that no general rule can be laid down save this, viz. : that many more die from the want of pure air than from a superabundance of it, even if it be cool.

NUTRITION.

Upon a proper nutrition of the body depends the present and future health of any being. It becomes therefore a very important element in our attempt to prevent consumption. It varies much with the age and individual tendencies, each of which will have to be considered by the future physician. In babyhood the mother's milk is usually most fitted for a child, and should always be used unless, according to our hypothesis, any hereditary taint exist. But under the supposition that the mother is born of consumptive parents, what should be done? Shall she nurse her child? If before and after its birth she is in perfect health, and has always been so, and is anxiously desirous of nourishing her babe, I should not feel at liberty to prevent her. I would allow her to continue to do so during the usual period of nursing, provided she and her babe continue well. But if the health of either should, fail, I should feel compelled to advise the mother to give up this duty to a healthy wet-nurse. I should require this for the sake of both mother and child. For the unfortunate parent who continues nursing may be undermining her own health, at the same time that she brings perhaps death to her child. Some, I know, are willing to forego in such cases the employment of wet-nurses, and substitute instead cow's milk. That this substitute will be often apparently sufficient for the present health of the babe cannot be denied, but I have no belief that we can ever improve upon a healthy woman's milk as the nutriment for a babe. Therefore, when the milk of a healthy nurse can be procured, that is at least tolerably near the age of the child, it will usually prove better than any artificial substitute. When a wet-nurse cannot be got, then condensed milk may be used, largely diluted. But a long time before the mother's milk or its artificial substitute be given up as the main article of diet, other things may be advantageously added. A little stale white-bread or milkbiscuits may be crumbed into the milk. As dentition progresses, the child will relish and will get nourishment, if allowed to suck, and thereby ease his gums, with a small bone or bit of tender beef. If he be of a costive habit, a little simple molasses gingerbread may be allowed. It will

usually be well borne, and will tend to keep the bowels open. The child should not be weaned, but should be kept to such simple food as this till sixteen or eighteen months old. From that period till puberty the simplest and most nourishing diet should be continued. Of meats I have thought that it would be well if he were more closely confined than is usually done; to beef and mutton, fish or fowl; and one or two vegetables, and the simplest of puddings. But pork, salted meats, hams, pickles, various kinds of pies and cakes should be avoided.

I am acquainted with two families, in each of which the consumptive tendencies were VERY STRONG, and both have escaped hitherto the scourge. They both followed this generally named very simple diet, and both had air in abundance. All the children are now beyond middle life, and some are old, and have as yet shown no tendency to consumption. In contrast to these I have known of two other families not hereditarily predisposed to consumption. They both had pork as their principal article of diet. Both have been cut down by consumption. I have no right to make a definite inference from such a small array of facts; but until the contrary be proved I think it well not to neglect even these few, embracing, as they do now, over fifty individuals. No harm can arise from using the simplest food, and possibly a great good may be derived from so doing.

From puberty till adult life a similar simplicity of food would be advisable; but more varieties may be used. In fact, this would be inevitable in the struggles and changes of life. But this is just the period when a fickle, weak judgment, and still more, perhaps, an unbridled will, tend to carry the youth of both sexes into excesses. It is the period of joyousness, and it revels in the sense of freedom. It needs to be gently led, sometimes with infinite kindness and caution, but at the same time with decision; and, as a physician, I know of nothing more important therefore upon this most important subject. At this period the two sexes show different tendencies. The maiden is apt to have a capricious appetite, or perhaps has little or no appetite. At times she arrives at the most false conclusion that she should not eat