observation and experiment, a flood of light has been shed upon the nature and causes of disease. Amid all these discoveries and improvements, the main inquiry has hitherto been, how to cure disease. Scarcely any thing can be found in medical books and journals till within half a century, on the subject of preventing disease. The first two writers (living in advance of their times) who started some important inquiries in this direction were Dr. John Forbes in Great Britain, and Dr. Elisha Bartlett in the United States, men distinguished for their independence and originality of thought. While attending medical lectures in Philadelphia, in 1840, the writer became particularly interested in hygiene; and, from the first day of entering upon the practice of medicine, his interest has constantly increased in all matters pertaining to the preservation of health, and especially the prevention of disease. All writings on the subject, like those of Dr. John Forbes, Dr. Andrew Combe, and others, attracted his attention; and a personal acquaintance with Dr. Elisha Bartlett served to increase this interest.

In "The British and Foreign Medical Review" for January, 1846, Dr. John Forbes, in his celebrated article on "Young Physic," speaking of the importance and results of certain changes in medical practice, said, "Redoubled attention should be directed to hygiene, public and private, with the view of preventing diseases on a large scale, and individually in our sphere of practice. Here the surest and most glorious triumphs of medicine are to be achieved."

About the same time, Dr. Elisha Bartlett published a work in this country, on "The Philosophy of Medicine;" and, in urging upon the profession a more thorough knowledge of the causes and nature of disease, said, "The next thing to be done is to find out the best methods of modifying and preventing disease. This is the great mission which now lies immediately before us; this is to constitute the great work of the next and succeeding generations."

Both of these writers were fully impressed with the truth and importance of the sentiments contained in these paragraphs. They predicted with much positiveness that a great reform was soon to take place in the treatment of diseases, and their predictions have proved true. At no period in the history of medicine. have there been such discoveries and improvements as within the last thirty years.

Great advances have been made in ascertaining the primary

causes of disease, as originating in filth, bad air, impure water, foul gases, poison from decaying animal and vegetable matter, &c. It has been found, moreover, that the spread and fatality of infectious and contagious diseases can be very much controlled by isolation, by disinfectants, and by a resort to sanitary laws. To carry out these measures in a community, or extensively among a people, it becomes necessary to employ some public agency, and enlist legislation for enacting laws and establishing boards of health. In this way has arisen what is called "sanitary legislation," or "state medicine," the chief object of which is to prevent disease. The leading agency in carrying on this work in Great Britain has been the Register General's department, requiring regular returns of births and deaths from every part of the kingdom, with a bureau of health connected with government. For thirty years or more, sanitary interests have been frequently discussed in Parliament; stringent laws on health have been enacted; cities and counties have been divided into districts, and an officer of health appointed to each. Instructions and reports on the subject have multiplied, together with discussions in journals and newspapers. The object of all this legislation and labor is to prevent disease, not to cure it.

The inquiry naturally arises, What is the result or fruit of these sanitary operations? It is not time yet to obtain the full benefits of such means; for, while the advantages of observing some sanitary laws may be seen very soon, it will take many years to reap the complete benefits of others. In certain localities in Great Britain, where these laws have been only partially applied for a few years, there has been witnessed a marked decrease in the amount of sickness and rate of mortality. From careful investigations, it is estimated that this diminution will already range from one-fourth to one-third; but it is the opinion of the best judges on the subject, that, when sanitary science is faithfully applied, there will be a decrease of more than one-third of the sickness and mortality which formerly occurred. The immense advantage, or value, which will be gained by this prevention of disease, in the saving of time and expense, in the prevention of pain and distress, in the general improvement of health and prolongation of life, cannot be estimated in figures or described in language. The more extensively and thoroughly these principles are applied, the greater good will they accomplish, and the more perfectly we shall find the laws of the external world adapted to the human system,

showing that man has a far greater control of those laws than has generally been supposed.

Another important consideration is, that the more thoroughly sanitary agencies are applied, on a large scale, they not only serve directly to prevent disease, but furnish essential aids in curing it. Thus, the more you improve ventilation and the quality of water, drainage, and sewerage, and have regard to dietary habits. and physical exercise, &c., the more successful will be the operation of all therapeutical agencies.

Again the general application of sanitary science must tend to diffuse among all classes a more thorough knowledge of the principles of physiology, so that they will possess better and more correct views of the laws of health and life. Thus every individual will be able to take far better care of himself, to understand his own peculiar weaknesses and predispositions to disease, so that in process of time, by care and watchfulness, the constitution itself will become very much strengthened. Let this course be continued through two or three generations, and one of the most fruitful sources of disease, by means of heredity, will be diminished. Heredity is a powerful agency in the production of disease, which has been too much overlooked, and should receive greater attention than it has hitherto.

In the inheritance of morbid tendencies we have one of the most fruitful sources of disease. This will become more patent in proportion as the principles of physiology shall become better understood in their connection with hereditary influences. Without attempting to describe the various ways in which the seeds of disease are transmitted from parent to child, we may say they are manifold, in organization and function; in defective and abnormal structure; in the weak or excessive development of this or that organ; in the general want of balance in the organs, and of harmony of function; in the quality of the blood, and the marked predisposition to certain diseases, like scrofula and consumption.

If it be said that sanitary agencies do not reach directly this class of diseases, yet their influence will gradually help to prevent them by improving the general health and constitution of people. Besides, they will direct attention to certain sources of disease in heredity, and show that these should be avoided in forming matrimonial alliances. If legislation cannot be brought to bear directly upon this point, self-interest and public opinion can. The time will come when good health and a sound constitution will be better

appreciated, when the duties and responsibilities of matrimony will be regarded in altogether a different light from what they have been. This change may be slow in progress, but when it comes a great amount of disease from hereditary sources will be prevented.

This sanitary movement has certain advantages over all other reforms. Its success does not depend upon the medical profession alone, nor upon government support, nor upon any one body of men, but upon all classes, both men and women. In carrying on this reform the parties become at once partakers in its rewards, in improved health and strength; and its benefits become everywhere so manifest that the work must go on with accumulated power. What is the testimony of one of the best judges in the country on the subject? Says Dr. H. I. Bowditch, in his work just published upon "Public Hygiene in America: ""We stand now at the very dawn of the grandest epoch yet seen in the progress of medicine. While philosophically, accurately, and with the most minute skill, studying by means of physiology, pathological anatomy, chemistry, the microscope, and above all by careful clinical observation, the natural history of disease and the effects of remedies, our art at the present day looks still higher; viz., to the prevention of as well as to the cure of disease. And this is to be done by sanitary organizations throughout each State, the nation, the laity, and the profession heartily joining hands in this most noble cause.'

If by such means one-third or more of the sickness and the suffering consequent thereto can be averted; if the rate of mortality can be very sensibly diminished, public health everywhere greatly improved, and human life prolonged, "the glorious triumphs predicted by Dr. John Forbes, it may truly be said, "are being achieved."

2.- Prevention of Insanity.

The idea that insanity can be prevented may surprise some persons. The impression entertained among people generally has been, that it arises from causes obscure and mysterious, or is the visitation of evil and supernatural spirits, so that it cannot be fully comprehended or easily cured. It is certain that no intelligent and systematic attempts have ever been made for its general prevention. But, on the other hand, there has been an immense expenditure of time, labor, and means, to cure the insane.

What are the facts in the case? In all civilized and Christian countries, this unfortunate class in large numbers have been gath

ered into asylums, with two objects in view, viz., safety and cure. Once it was thought, if the treatment of insanity was commenced in its first stages, from eighty to ninety per cent of all such cases could be cured; but now the cures are less than half that per cent. If the great majority of the insane say nine out of ten cured, their number would surely be diminished. But if only from thirty to forty out of every hundred new cases are cured, and eight to ten annually die, we have certainly one-half of all the persons becoming insane to add every year to the chronic insane.

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The question, whether insanity is increasing faster than population, is one upon which there is difference of opinion; but the evidences, we believe, lean strongest in favor of the relative increase. For a long time it has been apparent that the number of the insane was everywhere rapidly increasing, that lunatic-hospitals were crowded, and large new establishments were frequently being erected. It has come to this, that the support of this class, and the management of such institutions, are becoming very burdensome, and to all appearance are likely to be still more so. The impression is becoming general, that the multiplication of lunatichospitals is doing but little to check insanity, and that, if this evil is ever to be checked, some different means must be provided. The fact that these hospitals do not cure more of the insane, nor serve to check insanity, suggests the question whether the fault is in the nature and treatment of the disease, or in the management of these institutions. The explanation generally given is, that proper treatment was not received in its first stages. What is the testimony of experts upon the subject? Says the superintendent of the McLean Asylum- the oldest institution in New England, and admitted to be one of the best-managed in the United States

in a late report, "For the treatment of insane persons, we could wish some practice more encouraging in its remedial effects might be devised. As now administered, asylums for such unfortunates afford little more than a place where they may be isolated from. society, kindly treated, and a watchful oversight maintained to prevent them from committing injury upon themselves or their attendants."

Says another expert, who was superintendent for many years over the next oldest hospital in Massachusetts, "Lunatic-hospitals do not prevent insanity, because they do not by the intercourse of their officers with society at large, by their published reports, and by their general relations to the public, seek to en