The Relations between Sanitary Science and 
the Medical Profession, 
Then, in all matters pertaining to mental 
improvement, to the progress of society, 
to every phase in civilization and the 
various developments of Christianity, the 
sanitation of the body and of the mind 
must be paramount to everything else. 
In fact, the province of sanitary science 
covers the entire life; not only of every 
individual, but of the whole human race. 
No other subject or science is of such 
transcendent importance. It is in its 
infancy, and no comparison can be made 
between what it now is and the magnifi- 
cent proportions it is destined to attain. 
Taking this view of physiology, and 
that health is its normal condition, it will 
be seen that all deviations from this state, 
or violations of the laws that govern it, 
furnish the causes or entrance of weak- 
nesses, imperfections and diseases which 
afflict the human system. These changes 
may occur from internal, predisposing 
causes, or from agents operating ex- 
ternally to the body. Just at this point, 
in these changes of organization from a 
normal to an abnormal state, we are 
taught most important lessons. On one 
side, we have sanitation and sanitary 
science; on the other, disease and its 
superstructure, medicine. Just here start 
the most powerful and destructive evils 
that ever befell the human family. These 
evils may be trifling in their origin, but 
increase—sometimes slowly, sometimes 
rapidly—and become terrible in their 
results. They include the whole cat- 
alogue of diseases; their name is legion. 
We dwell on this point, for it is very 
important to have clear and definite ideas 
of disease, its nature and cause. It is 
simply the penalty of violated law. There 
is no mystery in it; no visitation of 
Divine Providence; no curse inflicted by 
some evil spirit. It is no less important 
for sanitarians than for physicians to 
have a clear and definite knowledge of 
disease as well as its cause. 
tion of mortality, especially in cities. 
Numerous acts of parliament have been 
passed in favor of sanitary science. The 
medical profession and journals generally 
commend it; and never were its pros- 
pects brighter in Great Britain than at 
the present time. 
Perhaps the science has not created sjo 
general interest, nor taken so strong'a- 
hold, in the United States as it has in 
Great Britain ; but still its history is one 
of marked interest. Let us notice a 
few of its salient points. From 1830 to 
1840 Dr. John Bell conducted the Journal 
of Health, in Philadelphia, which very 
ably advocated the principles of hy- 
giene. In 1835 Dr. Jacob Bigelow, 
in the annual address before the Mas- 
sachusetts Medical Society, pronounced 
a certain class of diseases “self-limited” 
in their character, and urged that they 
should be treated accordingly. This was 
a marked step in the way of medical re- 
form, which, with other influences, led tb 
what was called the “expectant treai- 
ment of disease.” 
In 1842 was issued the first registra- 
tion-report of births, marriages and 
deaths in Massachusetts, and has been 
continued annually, till we have now the 
forty-fourth report. Sanitary science 
has been greatly advanced by facts and 
arguments derived from these reports. 
Several other states have followed the 
course of Massachusetts, in establishing 
registration-departments. No one agency 
can do so much to advance the cause of 
vital statistics as such registration-re- 
ports. The application and progress of 
sanitary science depend much upon yt 
knowledge of vital statistics; and tne 
more thoroughly these are understood, 
the betterfor the cause of sanitation. 
In 1844 Dr. Elisha Bartlett published 
in Philadelphia a work on the “ Phil- 
osophy of Medical Science,” and, in urging 
upon the profession a better knowledge 
of the cause 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 be- 
fore us : this is to constitute the great work 
of the next and succeeding generations.’' 
This statement was made two years be- 
fore that of Dr. Forbes, already quoted. 
Both these men, living in advance of the 
times, were distinguished for 
thought and independence of expression;! 
they have proved themselves true proph- 
ets. 
In 1860 one of the most brilliant ad- 
dresses ever given in this country was 
delivered before the Massachusetts Med- 
ical Society by Dr. Oliver Wendell 
Holmes. As this had a direct tendency 
to promote sanitary science, the address 
and its reception deserve special notice. 
At this time the importance of a more 
thorough study of Nature in medical 
practice had been urged on the profession 
in previous addresses and other medical 
papers published. In pursuing this line 
of thought, Dr. Holmes expressed very 
positive opinions, accompanied with 
reasons and illustrations, that too much 
medicine altogether was given by the 
profession,and thatihere were great evils 
arising from over-medication. For this , 
opinion, Dr Holmes was not only severe- 
ly criticised by prominent physicians, 
but denounced and abused, if hnrsli lan- 
guage could do it. But reaction soon 
followed this violent attack. The dis- 
cussion led many physicians to a new 
and more careful study of the natural 
laws of disease and the true effects of 
drugs. Great gold came out of this 
controversy. Dr. Holmes, instead of 
being injured, gathered new laurels. 
Many young physicians, seeing the pro- 
priety and force of his strictures, struck * 
out a new course in their practice. 
The most efficient agents of all, for 
establishing and applying the principles 
of sanitary science, are boards of health. 
The first state board of health in this 
country was formed in Massachusetts in 
1869, since which time boards have been 
started in nearly all the states of the 
Union. In 1872 the American Health 
Association was organized in New York. 
This is the most extensive and power- 
ful agency of the kind in this country, 
and we think we may safely say in the 
world. It has published eleven large 
volumes, which contain a greater and 
more valuable collection of papers on 
sanitation than can anywhere else be 
found. The primary object of the asso- 
ciation, as stated in its constitution, is 
the “advancement of sanitary science.” 
A careful examination of the contents of 
these volumes affords the strongest pos- 
sible evidence, that the association has 
done a grand work. Here almost every 
question connected with the science, in 
all its diversified applications, is found 
discussed. Some of the papers show 
great research and an originality of 
thought which might be elaborated into 
a volume. Besides its published works, 
the association has greatly advanced the 
interests of sanitary science in all the 
cities where it has held its annual meet- 
ings. 
treatment and cure fo disease,—not, as 
we may say, its prevention. Add to this 
the most implicit faith that all classes 
generally have in drugs, together with 
the crowded state of the profession, it 
will be seen that the physician is virtually 
constrained to have an eye constantly on 
his business. It is true that in medical 
studies, lectures and books, a great deal 
is said about the charitable aspects of 
the profession, and that it is always ex- 
pected to give a large amount of service 
to the poor. 
It is just to state here that the 
claims of the sick poor have been most 
liberally responded to by physicians, 
and that no other profession or class of 
men do so much for the poor as the med- 
ical profession. But this work of charity 
has its equivalents;—it secures to the 
physician a stronger hold in the affection 
and confidence of the people, and, in dif- 
ferent ways, tends to increase his busi- 
ness. But to engage actively in means to 
prevent disease, not simply in one in- 
stance, but in case of great numbers, this 
is very different,—it cuts off directly the 
support of the physician. Such action is 
based upon a love of humanity—of phil- 
anthropy—a higher range of motive than 
that of giving services to the sick poor. 
It appeals to the very highest class of 
motives,— not simply to save expense 
and relieve suffering, or improve health 
and prolong life, but to elevate mankind 
and increase, physically, mentally and 
morally, the sum of human happiness. 
Such are the legitimate fruits of sanitary 
science. 
Considering the powerful pecuniary in- 
terests of the profession, and the disin- 
terested motives requisite to engage in 
sanitation-work, it is rather surprising 
that so many members of the profession 
have from time to time engaged heartily 
in advancing sanitary science. The main 
object must have been the promotion of 
health, the diffusion of useful knowledge, 
and the enlightenment of mankind gen- 
erally in respect to the laws of health and 
life. In some few instances, it might 
have been prompted by pecuniary consid- 
erations,— the individual holding some 
official position, or seeking one. But 
these are exceptional cases. Our state 
and municipal authorities have made 
such small appropriations for public 
health, that the salaries offered to medi- 
cal men are not numerous or large enough 
to be very attractive. In this respect 
Great Britain is far ahead of us. The 
promotion of the public health has be- 
come there a part of her government 
machinery. The whole kingdom is di- 
vided into some fifteen hundred dis- 
tricts, over each of which a medical offi- 
cer of health is appointed, with salary 
graded according to the services rendered. 
Besides this provision, and showing 
the interest of the government in sani- 
tary matters, there are over one thousand 
inspectors of nuisance appointed, in 
charge cf as many districts. This in- 
spection proves of great advantage, not 
only directly in preventing disease, but 
by dispersing information among the peo- 
ple, they become helpers in the work. 
The medical appointments in Great Brit- 
ain are made on the ground of special 
training and qualifications for this kind 
of work, and the same persons are con- 
tinued in office for years. Thus there is 
a wide difference between the interest in 
• sanitary science in Great Britain and in 
the United States. In the former the 
science receives a powerful support from 
the government, and a large amount of 
means is annually distributed among its 
advocates. Besides, there is on the part 
of the people more general intelli- 
gence on the subject,—a higher apprecia- 
tion of the benefits of the science, and a 
more ready disposition to co-operate in 
carrying on the reform. Though the sci- 
ence has been making advances in these 
respects in the United States, there is 
much room for improvement. Our na- 
tional government is not doing what it 
ought for public health; neither are the 
state or municipal authorities making the 
appropriations for it which they should. 
Most of the contributions to sanitary 
science here have been voluntary. This 
reform has been carried forward by men 
heartily interested in the work,—very few 
seeking or expecting any remuneration. 
The reward for such services does not 
consist in dollars and cents, nor in the 
plaudits of the multitude, but in “ the 
consciousness of duty done and noble 
deeds performed.” A distinguished med- 
ical writer lately made this remark : “The 
most important work that sanitarians are 
doing at the present day is ‘ sowing seed 
which in time will yield abundant har- 
vest.’ ” And never in the history of med- 
icine was there such a combination of 
circumstances so favorable to improve- 
ment in the practice of medicine. Never 
before has there been such earnest in- 
quiry made on the part of the profes- 
sion to ascertain the true causes of dis- 
ease. It has been found in the moral 
world, that in order to eradicate great 
evils, their primary causes must be first 
removed. So in the prevention of dis- 
ease, the same course must be taken. 
This accords with the teachings of sani- 
tary science. Leading members of the 
medical profession have here been doing 
noble work. 
could discuss this subject with greater 
propriety and force than Dr. Flint, and, 
inasmuch as he was to voice the medical 
profession in this country before the 
highest medical body in Great Britain, it 
shows the importance he attached to this 
topic in its selection. At the same time, 
in presenting these views, he must have 
been pretty well assured that they would 
be cordially received by the leading mem- 
bers of that association. After recount- 
ing in the forepart of this address the 
changes that had taken place in his own 
experience in medical practice, he says: 
“We are entering upon a revolution in 
medicine. It is bewildering to project 
the thoughts into the future in order to 
foresee the changes which will be brought 
about in the coming half-century in our 
knowledge of the correction of diseases 
and the results as regards their preven- 
tion and treatment.” 
He expresses the opinion that' hy- 
gienic agencies will be employed here- 
after far more than they have been ; that 
the normal conditions of health and the re- 
cuperative powers of nature will receive 
greater attention, and less dependence 
will be placed upon drugs and other arti- 
ficial means. In referring to bacterial 
etiology, he says : “ Here open to the im- 
agination the future triumphs of preven- 
tive medicine in respect to all classes of 
diseases.” When the medical profession, 
says he, “shall employ all the preventive 
measures possible and the best remedial 
medicines, disease will be more success- 
fully treated,and the profession will have 
reached a high ideal position.” Alongside 
of this testimony, we will quote the 
opinions of three distinguished English 
physicians who have given special atten- 
tion for many years to sanitary science. 
Says Dr. B. W. Richardson': “ The in- 
fluence which sanitation will exert in the 
future over the science and art of medi- 
cine, promises to be momentous. It 
promises nothing less than the develop- 
ment of a new era; nor is it at all wide 
of the mark to say that such new era has 
fairly commenced. With the progress of 
sanitary science we must expect to see 
preventive medicine taking the ascend- 
ency. With true nobleness of purpose, 
true medicine has been the first to strip 
herself of all mere pretences to cure, and 
has stood boldly forward to declare as a 
higher philosophy the prevention of dis- 
ease. The doctrine of absolute faith in 
the principle of prevention indicates the 
existence of a high order of thought, of 
broad views on life and health, on dis- 
eases and their external origin, on death 
and its correct place in nature.” 
Says Dr. Alfred Carpenter; “The sci- 
ence of disease-prevention Is destined to 
alter the whole field of medical practice; 
to render obsolete much of our present 
knowledge as to the history of diseases 
and the measures which are now required 
for their treatment. The inquiry must 
come as to how the increase of disease is 
to be prevented, rather than, having 
arisen, how is it to be cured. This will 
apply to every kind of complaint, and 
will not be limited to any one class.” 
Says Sir Henry Acland : “In addition 
to treatment and cure of disease, what- 
ever be the duty of individuals, medical 
science and art collectively must aim as 
a whole Ist, At the preservation of 
health; 2d, At the everting of disease 
from individuals and the public generally; 
3d, At rearing healthy progeny for the 
family and the state by probing the laws 
of inheritance; and, 4th, At procuring 
legislation effectual to these ends. It 
claims, therefore, a voice in moral educa- 
tion as well as physical training. It 
holds a duty in relation to the diminution 
of vice, for the sake not only of self-de- 
stroying victims, but more for the sake 
of the innocents whom they ignorantly 
slay.” 
It would seem that in the opinion of 
Dr. Acland sanitary science covers very 
important ground. This opinion may be 
accounted for in part, from the fact that 
he has long been a professor at the Ox- 
ford University,—has had large experi- 
ence in educational matters, and under- 
stands the full import of physiological 
laws. If the preservation of health or 
prevention of disease is accomplished by 
improving the organization, a multitude 
of other improvements follow, and the 
more perfect the former, the greater will 
be the latter. 
There is one method of preventing dis- 
ease, referred to by Dr. Acland and other 
writers, which has never received the at- 
tention it deserves—that is by the observ- 
ance of the laws of inheritance. Within 
a few years, this subject has been consid- 
erably discussed in the United States and 
Great Britain, but few seem to appreciate 
fully the magnitude of its bearings on 
sanitation. The diseases considered pre- 
ventable,—of which there are nine or ten 
—come under the zymotic class, but there 
are two other classes, called constitution- 
al and local, each larger than the zymotic. 
Thus far, sanitary science has expended 
its principal force upon this class; but 
supposing its agencies could be brought 
to bear equally upon the prevention of 
diseases, is these two classes, what 
a vast amount of good it would 
accomplish! Let us explain. For 
many years there has been a class of dis- 
eases called “ Hereditary,” because the 
predisposing causes were inherited,—be- 
cause they are transmitted from genera- 
tion to generation, and thus run in fami- 
lies. Now, if those ancestors were free 
from any taint, or in other words, had 
perfectly sound and healthy constitutions, 
the seeds, the germs, the predisposing 
tendencies of disease would not be trans- 
mitted. Let us carry out a little farther 
this line of argument. 
The same kind of evidence which 
proves that the germs of, or predisposi- 
tion to disease, are transmitted in a 
single instance, applies to all others of a 
similar character; and the legitimate in- 
ference is that there must exist in nature 
a great general law. Such a law, we be- 
lieve, exists and is based upon a normal 
standard of physiology,—a standard for 
the government of the human body, 
wherein all its parts are perfect in struc- 
ture, and its organs harmonious in their 
functions. This standard of organization 
constitutes the highest measure of health; 
is free from all kinds of weakness, as 
well as predisposition to disease. But, 
unfortunately, we do not find such or- 
ganized standards in the present state of 
society only approximations; and the 
nearer individuals or families approach 
this standard, the sounder the constitu- 
tion, the less disease; whereas, the 
further the deviations diverge from this 
standard, the greater are the weaknesses 
and liabilities to disease. Here come in 
the laws of inheritance,—starting not in 
a perfect, healthy organization, but in 
conditions of the body where changes of 
some kind have taken place in the vital 
forces of the system. To understand 
and utilize these laws, they must be re- 
duced to some system ; the distinct rela- 
tions between the causes and the effects 
must be traced out, till we find a great 
general law serving as a standard of ap- 
peal, or a regulator to all the minor ones. 
There can be no question but that in 
the inheritance of morbid tendencies we 
have one of the most fruitful sources ot 
disease. This will become more patent 
in proportion as the principles of physi- 
ology shall become better understood in 
their connection with hereditary influ- 
ences. Without attempting to describe 
the various ways in which the seeds of 
disease, or the predisposing causes, are 
transmitted from parent to child, we may 
say they are manifold,—in organization 
or function; in defective or abnormal 
structure; in the weak or excessive de- 
velopment of this or that organ ; in the 
general want of balance in the organs, 
and of harmony of function; in the qual- 
ity of the blood, and the marked predis- 
position to certain diseases, like scrofula 
and consumption. 
A clasp of diseases called “hereditary” 
have existed since the days of Hippo- 
crates, and have always been considered 
difficult to treat, and much less to cure. 
Very little attention has been paid to 
these complaints by sanitarians, as it 
was supposed they could not be easily 
prevented. But this is a mistake; they 
originate from the violation of law by 
human agency: they can, then, certainly 
be prevented. 
It is admitted by physiologists that all 
parts of the body can be changed by 
proper exercise and the law of nutrition, 
some parts increased in size and 
strength more than others,—so that in 
this way a far greater measure of health 
can be secured. It is found that decided 
improvements can be made in the physi- 
cal system during the lifetime of an in- 
dividual, and that in three or four gen- 
erations the human constitution may 
reach a higher state of perfection. If 
nature has, therefore, established a phy- 
siological standard of health,—which is 
seldom, if ever, liable to disease,—and 
at the same time it is well understood 
this standard is attainable, should not 
the greatest possible efforts be put forth 
to secure and maintain this standard? 
It is here in this field where the germs 
(the seeds), the primary causes, of a vast 
amount of disease, are to be forestalled. 
In this warfare with disease we have 
been content to lop off a few branches, 
leaving intact the trunk and roots. We 
have been battling the enemy in the out- 
skirts, without attempting to take the 
citadel. Here is a great work for sani- 
tary science; here this science is destined 
to reap its richest harvests. It may take 
time; but reforms in which the highest 
welfare of mankind are involved never 
remain stationary. 
By NATHAN ALLEN, M. B. 
[Read at the Fourteenth Annual Meeting of the 
American Health Association, Oct. 5, 1886, 
at Toronto, Canada. 
SANITARY SCIENCE. 
What is sanitary science? This phrase 
is comparatively new, but is full of mean- 
ing. The word “sanitary,” in its deriva- 
tion and uses, signifies health or healthy, 
but when combined with science, is far 
more expressive. It means the applica- 
tion of laws or principles for the preser- 
vation of health in whatever way they 
may be employed. As to the use of the 
term science here, the claim can not 
justly be called in question. To such an 
extent have these principles been dis- 
covered and applied, and so uniformly 
and certainly have the same results fol- 
lowed, that they may be said to consti- 
tute a science—the science of health. 
It is not necessary that these laws 
should be understood by everybody, and 
admitted as true, that they be considered 
a science; but if they have been exten- 
sively applied by a large number of good 
judges, and the same results never fail, 
they constitute, when combined, to all 
intents and purpose, a science,—as much 
so as physiology or biology. As both 
these are comparatively modern sciences, 
so is that of sanitation, certainly in name 
and application. 
It is only about forty years since this 
subject began to attract general attention. 
It started with the establishment of the 
registration of births, deaths and mar- 
riages, in Great Britain, by Dr. William 
Earr. While investigating upon a large 
scale the causes of death, the inquiry nat- 
urally arose, What can be done to prevent 
as well as to cure disease? This inquiry, 
from a small beginning, has resulted 
in the most surprising advance in a 
knowledge of the laws of health and life. 
So rapid and extensive have been these 
changes, that one living during this 
period can hardly credit them; and never 
were these improvements taking place 
faster than at the present day. But the 
advantages already secured, though great 
and invaluable, are mere harbingers of 
richer and more permanent blessings in 
store. In the progress of this science, 
every year has signalized the past, that 
it had a deeper and broader scope, not so 
much in improving the old methods of 
work, but in entering into new fields and 
enlisting new agencies. Its aim is not 
merely to remove the existing causes 
of diseases, but to destroy the germs or 
seeds of disease. It does not stop with 
preventing this or that contagious dis- 
ease, or reduce to the minimum the 
zymotic class of diseases; but when the 
principles of this science are applied to 
the fullest extent, they will present the 
human body so sound and healthy in all 
its parts as in a great measure to forestall 
disease. 
There is, we believe, a normal standard 
of physiology, where all the organs are so 
sound and well-balanced, and where all 
perform respectively their functions so 
thoroughly, as to afford small chances for 
disease. This organization represents 
the highest standard of health, and the 
nearer the human body in all its parts 
approximates to this standard, the better 
or higher degree of health shall every such 
person possess. With this view of phy- 
siology, it will be seen that all disease is 
a violation of law,whether it arises from 
internal or external cause. As there 
must be some change in the structure or 
functions of certain organs in the body, 
for the introduction of disease, is it not 
clearly the province of sanitary science 
to take cognizance of such changes? If 
the violations of law can be arrested or 
modified in the very first stages, may it 
not serve to prevent a vast amount of 
disease? 
There is a sphere higher and broader, 
where the principles of this science 
should be brought to bear—that is, in 
perfecting the human body. It is well 
known that there is naturally a most sur- 
prising difference between one individual, 
or one family, and another, as to good 
health and the liabilities to disease. 
Why should not sanitary science recog- 
nize this difference more, and point out 
the way whereby great improvements 
can be made in the physical system, and 
then eradicate, upon a large scale, the 
first, the primary causes of disease? 
By commencing early, and with the use 
of proper means, the organization of 
every individual can be greatly improved 
and made more healthy; and by a proper 
application of the laws of inheritance for 
three or four generations, human organi- 
zation may become so perfected as to 
diminish a large proportion of the sick- 
ness and disease that exist at the 
present day. This is not mere theory 
nor speculation, but a doctrine based 
upon the laws of physiology—laws which 
should be better understood. Inasmuch 
as such a change would be productive of 
sanitation in the highest degree, is it not 
the province of sanitary science to enter 
and cultivate this field? Would it not 
improve health and prolong life upon the 
largest scale and to the greatest number? 
What other science or agency can do 
this work so well? That human organi- 
zation can be improved, by the laws of 
exercise, nutrition and inheritance, there 
can be no question. If the highest state 
of health depends on a normal standard 
of physiology, in which all parts of the 
body are perfect in structure, combined 
with a harmonious development of every 
organ, it is certainly the province of 
sanitary science to use all its appliances 
to obtain that standard. It is no more 
nor less than the same form or image in 
which man was created; and the same 
Almighty power has established laws by 
the use of which man, in the process of 
time, can attain to that of his original 
creation. The more thoroughly physi 
ology is studied, wth reference to sanita- 
tion, the stronger is the evidence that 
man is the artificer of his own physical 
well-being. The laws of inheritance 
must become the agents of sanitary 
science; and healthy offspring must be- 
come an object of primary importance. 
When the principles of physiology and 
sanitary science are both brought to 
bear in renovating human organization, 
we shall find that a wise provision is 
made for the redemption of the body as 
well as the soul. We can not expect 
this change will be brought about by 
divine interference, nor is it left for ac- 
cident or chance, but the means and re- 
sponsibility are wisely placed in the 
hands and power of human agency. 
In case the body is thus reconstructed, 
—made sound and healthy in every part, 
—the germs or seeds of disease will not 
be found in the system. Here is work 
for sanitary science on the largest possi- 
ble scale. In making these changes, in 
order to secure the highest standard of 
health and to the greatest number, it will 
be seen that sanitary science has a great 
work to do. The whole system of edu- 
cation, especially in early life, must be 
based more and more upon the systematic 
training and development of the body. 
There are a multitude of evils in the 
present state of society that conflict with 
the laws of health and life, which san- 
itary science would remove or regulate. 
HISTORY OF SANITARY SCIENCE AS CON- 
NECTED WITH THE MEDICAL 
PROFESSION. 
Formerly the great object of the medi- 
cal profession was the cure of disease. 
The program of studies and lectures 
in the medical schools was confined al- 
most exclusively to this one idea. The 
term “hygiene” was scarcely to be found 
in books, or referred to in lectures. Phy- 
siology was comparatively a new science, 
and some of its most important applica- 
tions have not been discovered, till with- 
in a few years. In fact, this science can 
not be fully understood in all its bearings 
without combining with it the principles 
of hygiene. 
The study of physiology was formerly 
superficial, rather than profound; as the 
laws of health and life are based on this 
science, these of course were not very 
well understood. Hence there was great 
difficulty in ascertaining the real causes 
of disease and the natural laws that gov- 
erned it. Health and its normal conditions 
must be first understood, and disease— 
its causes and treatment—come after- 
ward. Very little thought or attention 
was given to the object paramount to all 
others: health and its requirements. 
The whole burden of medical studies and 
lectures was pursued with special refer- 
ence to disease and its treatment. Thus 
in the preparation for the practice of 
medicine, the treatment of disease has 
so completely absorbed attention that 
normal physiology and the recuperating 
powers of nature have, in a measure, 
been overlooked. “ Vis medicatrix” was a 
favorite phrase of some writers, but very 
little use has been made of its practical 
application. Two great evils have grown 
out of this defective mode of education : 
Ist, a lack of clear apd definite ideas of 
diseases and their causes; and 2d, a 
tendency, in the treatment of disease, 
to resort mainly to artificial means. But 
within thirty or forty years there has 
been decided improvement in respect to 
both these evils. 
From 1840-50 several leading physi- 
cians in Great Britain, from careful ob- 
servation and reflection, began to make 
some changes in their practice : Ist, to 
dispense less medicine; 2d, to study 
more carefully into the natural laws of 
disease; and 3d, to summon to their aid 
the powerful resources of nature. Among 
these physicians were John Forbes, John 
Connolly, Andrew Combe and others. 
The British and Foreign Medical Beview 
was their organ of publication, which 
attracted much attention. Several works 
explaining the views of these men were 
published at that lime, and had a large 
circulation. 
From 1840 to 1850 the Registrar-Gen- 
eral’s office for collecting and publishing 
reports of the births, marriages and 
deaths in Great Britain became fairly 
established. This agency has been more 
influential than any other, for creating 
an interest in sanitary matters. In ex- 
amining into the causes of death, in dif- 
ferent localities, and comparing the 
mortality of one place with another, 
started many inquiries on public health. 
The annual reports, also from this office, 
prepared by Dr. William Farr, added 
greatly to the interest on this subject. 
About the same period Dr. Andrew 
Combe of Edinburgh, published several 
works on the application of physiology 
to education and health. These works 
had a very large circulation, and exerted 
great influence in directing public atten- 
tion to the laws of health and life. The 
writings of Dr. A. Combe were pecul- 
iarly calculated to show the advantages 
of a practical knowledge of physiology 
for developing healthy bodies, and there- 
by preventing disease. While the writ- 
ings of Dr. Combe were based strictly on 
scientific principles, they were remark- 
ably well adapted, both in style and 
matter, to instruct the masses. 
One of the most distinguished physicians 
at this time in Great Britain, advocating 
reform in medical practice, was Dr. John 
Forbes. In his celebrated paper called 
“Young Physic,” which was published in 
the British and Foreign Medical Beview, 
he made this significant statement: “Re- 
doubled attention should be directed to 
hygiene, public and private, with a view 
of preventing diseases on a large scale, 
and individually in our sphere of practice. 
Here the surest and most glorious tri- 
umphs of medical practice are to be 
achieved.” If this prophecy has not 
already been fulfilled, it is very evident 
that, in progress of time, it will be still 
more abundantly. 
As a result of the interest on this sub- 
ject, a royal commission was appointed 
in 1857, to inquire into the sanitary con- 
dition of the army in England. This 
commission recommended that not only 
some regulations should be adopted for 
protecting the health of the army, but 
that a school be established for educating 
army-surgeons, in which “hygiene and 
sanitary science” should be taught. This 
was the nucleus or starting-point of that 
celebrated work on practical hygiene, 
by Dr. Edmund A. Parks. This “ Man- 
ual of Practical Hygiene,” constituting 
a treasury of knowledge on sanitation, 
has had a large circulation, and passed 
through several editions. 
The interest in sanitary matters has been 
steadily increasing in Great Britain among 
all classes. Its fruits are becoming every 
year more and more manifest by im- 
proved health generally, and by a reduc- 
In drawing this discussi m to a close, 
a few suggestions may seem appropriate. 
While quoting from Dr. Flint’s address 
on “Medicine of the Future,” the inquiry 
arises, Is not sanitary science also to 
have a “future”? Most assuredly. Its 
past history is very brief and different 
from that of medicine. This extends back 
thousands of years, and its whole history 
is made up of a succession of changes. 
It is not so with sanitary science. A 
half-century covers its whole existence. 
Its only change has been the constant 
unfolding and applying of Nature’s laws 
to the improvement of health and preven- 
tion of disease. It has not been found 
necessary in its progress to try experi- 
ments or apply any new medicine. As 
sanitation is based upon the laws of na- 
ture, its course can not change or go 
backward. Excelsior is its motto. 
This sanitary movement has certain 
advantages over other reforms. Its suc- 
cess does not depend upon the medical 
profession alone, nor upon the patron- 
age of government, nor upon any one 
body of men, but upon all classes,—men 
and women. The more people become 
enlightened on the subject, the more 
earnestly will they engage in the work, 
and become at once partakers In its 
benefits. 
The history of sanitary science is full 
of promise for the future. It is really 
only about twenty-five years since it 
could be said to have had a fair start. 
Its doctrines have become deeply rooted, 
not only in the medical profession, but 
among large numbers of the laity scat- 
tered throughout this country and Eu- 
rope. The press is committed decidedly 
in its favor. Its teachings are found 
broadcast in books, journals, pamphlets, 
reports and newspapers. Its principles 
are being taught and applied both in our 
common schools and in higher institu- 
tions of learning. Boards of health have 
been organized in all large cities and in 
nearly every one of the United States. 
The benefits already derived from this 
science can not be estimated in figures, 
or described in language. The pestilence 
in this country has been stayed ; epidem- 
ics have been checked; a vast amount of 
sickness prevented, and a great multi- 
tude of lives saved. In Great Britain, 
where the science has made greater 
progress, and more exact accounts kept, 
upon Mr. Edwin Chadwick’s authority, 
based on the registrar-general’s report, 
it is asserted that the lives of 30,000 per- 
sons are annually saved, and 300,000 
cases of sickness, every year, prevented 
by means of this science! 
The two following statements, though 
once quoted, are so prophetic that they 
will bear repeating. 
Forty-two years ago Dr. Elisha Bart- 
lett said, in Philadelphia, while urging 
upon the profession a more thorough 
knowledge of the causes and nature of 
disease: “The next thing to be done is 
to find out the best method of modifying 
and preventing disease. This is the great 
mission that lies immediately before us; 
this is to constitute the great work of the 
next and succeeding generations.” Forty 
years ago Dr. John Forbes, in an address 
to his brethren, said in London : “Re- 
doubled attention should be directed to 
hygiene, public and private, with a view 
of preventing diseases on a large scale, 
and individually in our sphere of practice. 
Here the surest and most glorious tri- 
umphs of medicine are to be achieved.” 
Ten years ago Dr. Henry I. Bowditch 
of Boston, who has given more thought 
to this subject than any other man in 
this country, said, near the close of his 
work on “Public Hygiene in America”: 
“We stand now at the very dawn of the 
grandest epoch yet seen in the progress 
of medicine. While philosophically, ac- 
curately, and with the most minute skill, 
studying by means of physiology, patho- 
logical anatomy, chemistry, the micro- 
scope, and above all, by careful clinical 
observation, the natural history of dis- 
ease 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.” 
These testimonials speak for them- 
selves. They need no comment. The 
predictions here uttered are certain to be 
fulfilled. The glorious triumphs spoken 
of will surely be achieved. Individuals, 
organizations and institutions may perish, 
but these principles will live and advance 
step by step, from one triumph to an- 
other, from one glory to another. 
It is related of a distinguished states- 
man, that, in the immediate prospect of 
death, he expressed the desire, that if pos- 
sible, he might live fifty years more to 
see certain reforms in government car- 
ried out. So, the sanitarian, in forecast- 
ing the future, might well wish to live 
another half-century, in order to see the 
great changes and improvements in so- 
ciety, brought about by the principles of 
sanitary science. 
SANITATION OF THE FUTURE. 
RELATIONS OF SANITARY SCIENCE TO THE 
PROFESSION. 
While the success of this science de- 
pends mainly upon physicians, there is a 
wide difference in the interest which they 
take in it, as well as the sacrifices which 
they are willing to make for it. Let us 
inquire who, and how many, of our phy- 
sicians have been actively engaged in 
this reformatory work ? The number, 
compared with the whole profession, is 
not large,—in fact, is very small. Those 
engaged in this work are widely scatter- 
ed both in city and country, and are gen- 
erally active with the pen and tongue, so 
that they seem more numerous than they 
really are. There are, it is true, great 
numbers in the medical profession who 
are kindly disposed to sanitary reform, 
and speak highly of it in their practice, 
but, at the same time, are unwilling to 
make much sacrifice to advance its inter- 
ests. 
Unlike many other reforms and 
good works, there is a direct antagonism 
between the interests of this profession 
and sanitation. The support of this pro- 
fession depends mainly on the cure of dis- 
ease, not its prevention. Every step in 
this reform diminishes more or less 
professional income. There is no trade 
or speculation in this reform. When a 
person has spent years in study, and 
made large investments to secure a live- 
lihood, how can we expect he will sacri- 
fice these interests? There is probably no 
of men, engaged in professional or 
other kinds of business, to whom appeals 
of so complex and antagonistic charac- 
ter are made for services. The success de- 
pends much upon the education and the 
moral training of parties. On the one 
side stands out the highest welfare of 
the individual, and society in respect to 
health, while on the other side the phy- 
sician is tempted to make his own inter- 
ests paramount to all others. 
Let us for a moment consider his posi- 
tion. In choosing this profession, the 
pecuniary considerations were undoubt- 
edly most powerful; and, then, in his 
early preparations and through his whole 
course of study, compensation for pro- 
fessional services has been constantly 
kept in mind. The whole drift of medi- 
cal study, and teaching by sickness or 
from books, has express reference to the 
SANITARY IMPROVEMENTS IN MEDICINE. 
Some twenty-five years ago Sir Joseph 
Lister, of Edinburgh, made a great dis- 
covery for the prevention of disease by 
introducing what has been called “Anti- 
septic Surgery ” It had been found, 
prior to that time, that wounds and sur- 
gical operations were frequently followed 
by an inflammation which proved fatal. 
Surgeon Lister discovered that by an ap- 
plication of antiseptic dressings patients 
were more sure to recover from the 
most dangerous operations. It is, more- 
over, found that antiseptics can be applied 
to many diseases, as well as to surgical 
cases, which checks their progress and 
aids essentially in the recovery. It is 
now admitted that a great amount of dis- 
ease is thus prevented, and a multitude 
of lives may be saved. 
Again : in this same line of prevention, 
there has been made, within a few years, 
one of the greatest discoveries ever made 
in the history of medicine—that some of 
the most dangerous diseases are produced 
by infinitely small animalcules called 
bacteria and other micro-organisms. 
This subject is now undergoing most 
thorough Investigations in Germany, 
France and Great Britain. If means 
can be devised whereby these bacteria can 
be destroyed, or their existence eradicated 
from the system, it will prevent a vast 
amount of disease. 
Again : There seems to be a prevailing 
impression in the medical profess ion, that 
important changes are about to take 
place in the treatment of diseases. This 
sentiment is foreshadowed in a variety 
of ways, and many facts and illustrations 
might be cited in proof of the same. The 
most noticeable instance is the following: 
Dr. Austin Flint, of New York, was in- 
vited last year by the British Medical 
Association to give an address this year 
before that body. Dr. Flint died sudden- 
ly in March, but his address, by singular 
forethought, was found prepared for this 
occasion, which has since been published. 
The very title of the paper is significant 
—“ Medicine of the Future.” 
No physician in the United States