utes to this result. I have now in my mind a case of confirmed consumption where, previous to an accidental but a severe blow upon the chest, the patient was perfectly well. But he had been ill from the moment of this blow. Hence I cannot recommend this exercise of boxing to any consumptively inclined.

Bowling.

This may be used unless hemorrhage has occurred. But at all times it should be cautiously allowed to the consumptively inclined, and wholly avoided by those who have once bled.

Rowing.

This tends to expand the chest, and if no racing be undertaken, may prove of great value. The combination which one gets of rowing, walking and camping-out in perfect mountain-air in the Adirondacks may be recommended as one of the best methods of spending in our northern climate a long vacation in the summer.

Before the Pacific Railroad was built, I occasionally advised patients to try a trapping expedition to the western coast. One of my earliest patients wholly recovered his health while with Fremont in one of his earlier pioneer expeditions to the Rocky Mountains and the Pacific. During this trip all kinds of exercise were necessary, and, among others, rowing; and all was done with not only great advantage, but a complete recovery of my patient.

Swimming.

I will not condemn this exercise, but it must be used with great caution. Too long a stay in the water I have known to actually cause phthisis. I have already alluded to the case (page 48). The patient attempted to swim a stream. He was very much chilled and terribly fatigued. He was well, when he undressed on one side of the river. He felt very ill on his arrival at the other bank, as if he had taken a severe cold, was livid, etc. Cough set in immediately, and he was in advanced consumption when months afterwards I saw him.

Bathing in the surf has usually a tonic effect, but should never be continued too long; and to those consumptively inclined the sea-shore is rarely, if ever, to be recommended. In fact, mere residence on the sea-shore, where he meets the conflict between the land and ocean climate is unfavorable for the consumptive, compared with being in the interior (i. e. in a land climate), or quite off from the coast on an island (in an ocean climate).

I have thus given you my views of the grand scope of Preventive Medicine, and, as a most imperfect illustration of its future usefulness, I have run through a series of recommendations that I think any experienced physician might even now give, according to the principles and rules of action that will weigh with the physician of the future. And I believe that if these recommendations, with others that might be added by any family physician, should be thoroughly carried out by the parent during childhood, and by the man or woman when arrived at adult life, many that will die of consumption would escape that calamity.

In saying this I do not mean to intimate that during the whole period no other remedies, strictly so called, might not be necessary. Doubtless they would be; and of the exact mode of application of those remedies physiological experiment and clinical experience of physicians are teaching us more and more every day. I contend, therefore, that the physician of the future will stand higher than ever, as Preventive Medicine advances. In this statement I take a position exactly the reverse of that assumed by President Barnard in his late address before the Health Association at its recent meeting in New York. That gentleman quietly informed his medical hearers that their doom was sealed under the steady advance of modern science. Their services would become less and less necessary, and would finally be no longer needed by the laity. I think he is wrong and that my views are correct, because, while human free agency and human imperfection exist, while accidents, moral and physical, occur, there will always be some occurrences tending to injure health which no skill in prophecy can foresee. The

wise physician will therefore be summoned to act immediately on important cases of disease or threatened death. These he will meet not only by wise preventive regulations for the future health of his patient, but likewise by a careful administration of medicine, properly so called, during the actual attack.

I remain, gentlemen,

Your sincere friend and colleague,

HENRY I. BOWDITCH.

ON THE PRESENT CONDITION

OF CERTAIN RIVERS OF MASSACHUSETTS,

TOGETHER WITH

CONSIDERATIONS TOUCHING THE WATER-SUPPLY OF TOWNS.

A REPORT

TO THE

STATE BOARD OF HEALTH OF MASSACHUSETTS,

BY WM. RIPLEY NICHOLS,

PROFESSOR OF GENERAL CHEMISTRY IN THE MASSACHUSETTS INSTITUTE OF TECHNOLOGY.