Even with existing circumstances, the medical charities can do much to prevent the growth of pauperism. A large number of acute cases of disease would, but for their intervention, become chronic and permanently disabling. Many families on the verge of pauperism, when even temporarily relieved of the expense incident to the care of the sick, are enabled to regain independence, and the prompt and efficient surgical aid given to the injured has many a time saved not only the limb but the character; for in a large proportion of cases, to be a cripple means to be a pauper.

The preventive value of the hospitals would be much greater, if the ordinary therapeutic treatment were supplemented by some such provision for convalescents, as has been popularized in England during the past few years. In London patients discharged from the nospitals, but not yet strong enough to labor, are sent to healthful localities in the country, where they remain under medical supervision, until fully restored. The expenses incurred are met wholly by private charity. Another very important means by which the medical charities may contribute to the prevention of pauperism, is by the dissemination of information upon sanitary subjects, particularly the care of infants. A liberal distribution of printed matter conveying, in the plainest and simplest words, the more important principles of personal and domestic hygiene, supplemented by personal instruction to those applying at the dispensaries, has been found to accomplish much in the direction of preserving health, and improving the habits of the classes most exposed to disease.

Finally, if the best results are to be attained, there must be among those who conduct medical charities careful study and frequent conference. No one institution has arrived at such perfection, that it may not improve its methods, by comparing them with the work of others, in the same field. It is coming to be recognized, that there is a science of charity, and when that science takes its place among the studies to which the best minds devote their noblest powers, we may hope to see as great and beneficent a revolution in our treatment of poverty, as physical science has wrought in our relation to inanimate nature.

Jas. W,. Walk, M. D., 28 Chairman.

The following paper, by John B. Pine, of New York, was read in his absence by Judge E. C. Kincaid.

FIRST AID TO THE INJURED, *

BY JOHN B. PINE.

Upon the battlefields of the Franco-Prussian war, the red cross gained for itself a significance possessed by no other emblem. To all, friend and foe alike, it indicated the power which saves. Whether borne by the Sister of Charity, coming like an angel with healing in his wings, or the surgeon, or the trained ambulance assistant, it carried hope to the wounded and dying, and the conviction that compassionate assistance was near. Of that heroic army of men and women whd gained for the red cross its glorious distinction, no corps rendered more faithful service, nor did any do more to save life and to mitigate suffering than the St. John's Ambulance Association of England. The lineal descendant, as it may be called, of the Knights of St. John of Jerusalem, it nobly sustained the traditions oi its order, once so famous for deeds of mercy as well as of chivalry; and the spirit of the old knights was revived in many a healing touch upon the fields of Sedan and beneath the walls of Metz. With the capitulation of Paris the exigency which necessitated the formation of the Association ceased, and the services of its members were no longer required abroad; but, returning to England, they found an ample field for work at home, which at once enlisted their energies. Among the results which they have accomplished are the establishment of the ambulance system in cities, and the founding of cottage hospitals in the smaller towns. The knowledge gained by the members of the association in caring lor the wounded during the continuance of the war was found, in times of peace, to be so frequently available in cases of accident, as to suggest the idea of giving instruction to all classes in the* preliminary treatment of the sick and injured.

In l5?7the Association, with the co-operation of some of the most eminent physicians and surgeons, established courses of lectures. The same ignorance as to how d fractured limb should be handled, how bleeding from a dangerous wound should be stopped, how an apparently drowned person should be treated, prevailed at tnat time in England, as it does in America at present. It was to essen this ignorance and to replace it with an elementary knowledge of surgical treatment that the Association's lectures were devised. A syllabus of instruction was prepared, and classes were formed. The" immediate and general response with which the Association's offer was met, proved how thoroughly the need for instruction in "First Aid" was appreciated; and the very large number of pupils who have since then attended the lectures is the best evidence of the eagerness with which the opportunity for gaining such instruction was received. The classes have been so numerous and of so varied a character as to include all ranks, from the princess Christian, who has attended the Association's lectures and obtained a certificate after passing the prescribed examination, to colliers and working women. Classes have been formed among the London policemen and firemen, in the war office, the Indian office, the admiralty, the post office, the custom house, among the county .constabulary, borough police and fire brigades; in the East and the West India and the Surrey docks; among the militia, and among many other organizations. The extent of the Association's work is demonstrated by the fact that upwards of forty thousand pupils have obtained the " First Aid" certificates after passing the requisite examination. At a public meeting held at the GuildHall in London, on the 30th of June last, certificates were presented to some six hundred men and women, pupils in a single district, by his Royal Highness, the Duke of Connaught, who commented in eulogistic terms upon the great practical value of the instruction given by the Association. It is a legitimate inference that the good resulting from such general dissemination Of the principles of "First Aid to the Injured," must necessarily be enormous; and that such is actually the fact is more than proved by the Association's records showing the relief rendered by its pupils. These records abound in instances of "First Aid," such as the placing of a broken leg in extemporized splints, made of an umbrella or cane, and bandaged with a handkerchief; of a hemorrhage stopped by the pressure of a finger, or a pebble and a twisted handkerchief; of an apparently drowned child resuscitated. In many cases the relief has been rendered by fellow workmen, or by a policeman or fireman, or by others who, before receiving the Association's instructions were absolutely incompetent to give such assistance. The feasibility of the scheme being thus demonstrated in England, it is not remarkable that it should have been taken up in other countries. It was introduced into Germany by Dr. Friedrich E&march, an eminent surgeon, who prepared a hand book on "First Aid to the Injured/' and was instrumental in organizing the first "S&mariter-Verein," or Samaritan Society,which has an object similar to that of the St. John's Ambulance Association. Since the formation of this society at Kiel in 1882, others of a like character have been formed in various parts of Germany, and valuable services have already been rendered by "First Aid" pupils. The idea has also been introduced in France and India, and during the last year the hand-book of "First Aid" has been translated into the Eussian language.

A beneficent undertaking, so signally successful abroad, could not long escape the notice of philanthropists in this country. A paper on " First Aid," prepared by Mr. John Paton, who had made himself familiar with the workings of the English Association, brought the subject to the attention of the State Charities Aid Association of New York; and in January, 1882, a committee, under the chairmanship of General George B. McClellan was appointed by that body ta establish a course of instruction in "First Aid," and to form classes in New York. The project, from its very inception, was enthusiastically received, and was the subject of frequent and extended mention in the newspapers. So numerous were the applicants for instruction, and so rapidly were classes formed, that had it not been for the cordial and active assistance of the medical profession it would have been impossible to meet the demand for lectures. During the first six months after the movement was begun in New York, thirty-two classes, composed of five hundred and forty men and women, received instruction. In addition, several classes which were formed at Orange and at New Brunswick were largely attended. In some of these classes which were attended by ladies and gentlemen a fee was charged; but the majority were free, and were made up of working-men and working-women.

During the winter of 1882-1883 instruction was given on a still more extended scale in New York; thirty-seven classes, composed of nine hundred and eighty-nine pupils, being formed. About one-fourth of these were paying classes, the remainder being free. Nineteen were made up of women, ladies, working-women, teachers and students; eighteen were composed of men, the great majority of these being working-men. Two classes of policemen received the instruction which is to be given to the whole force; while all the employes of the New York Central & Hudson River Railroad in the Grand Central Depot, as well as the,men employed in the Hoe Printing Press Works, the DeLamater Iron Works and other factories, were trained to render prompt relief to the injuries incident to their several occupations. Outside of New York, also, a lively interest in "First Aid" was manifested from the very first; and during the past winter this interest has taken the shape of "Emergency Lectures " in Boston and of a movement, in Philadelphia, to establish courses of "First Aid" instruction by the Society for Organizing Charity in that city. The Boston lectures have been largely attended, and have taken so strong a hold as to place their continuance beyond all doubt; and a meeting called by the Philadelphia Society in April last, for the purpose of making "First Aid " more generally understood, resulted in the most emphatic expression of public approval which "First Aid" has yet received in this country. The meeting, which was held at the Academy of Music, was attended by the heads of the police department, by the directors and physicians of five hospitals, and by many prominent citizens. The practical value of "First Aid" instruction was forcibly presented to the meeting by the records of the police, who for a few months previously had been attending the lectures of Dr. J. William White, of the University of Pennsylvania. Extracts from these records were published in the daily papers, and regarded as the result of a course of instruction covering but a brief period, they present an astounding mass of testimony as.to the amount of suffering which may be averted and the number of lives which may be saved by a knowledge of a few of the simplest and most elementary principles of surgical treatment.

In February, 1883, the Committee of the State Charities Aid Association for the better carrying on of its work, and particularly with a view to the wider dissemination of "First Aid/' organized "The Society for Instruction in First Aid to the Injured/' which is composed of a central body in New York City and of branches thrpughout the country, each branch being represented in the General Center. It is the business of the General Center to organize branch centers in the larger towns and cities, and detached clashes in smaller places, to provide a syllabus of instruction, a code of rules for lectures, to issue certificates and to exercise a general supervision and control over the affairs of the Society. Each Branch provides its own lecturers, and the means for its support, and conducts its own management, subject