But the greatest foes of existence are those that do their work unseen and in silence, and that nothing less powerful than a microscope can render visible to human sight. Yet the devotees of science assure us that in these microscopic organisms are traced the elementary sources of all disease; and they assure us, also, that it is to counteract or prevent their ravages that the best energies of medical science can be most effectually applied.

Such, then, appears to be the status of medicine, as these first years of the century begin. We note many improvements, we recognize many and great advances in the administration of medicines, but we cast our gaze outward over a world of sickness and suffering yet. The normal condition of existence should be one of perfect health. The perfect type of life on this earth is a sane mind in a sound body, from the earliest moment of existence, through the intermediate stages of development and maturity, until it shall terminate finally in the processes of natural decay. Yet a condition of perfect health in any large community is nowhere to be found. Some allowance may perhaps be charged to the inherent imperfections of our nature. But if we attempt to account for the universal prevalence of disease upon any such theory, we deceive ourselves.

Do we find encouragement and comfort in comparing our own times with the past? We search through its annals, as guided by the light of history, to find that in the sixteenth century the average duration of human life was from eighteen to twenty years. At the beginning of the nineteenth it had reached to thirty years. And now, as the twentieth century opens, it is said to have been extended beyond forty years. But why tell of that? Why count that as a victory for therapeutics which possibly may have been accomplished in other ways? Are we certain that the administration of medicine has produced the change?

Running parallel with all this increasing longevity, and

precisely corresponding with it, both in regard to times and localities, are better modes of living, fewer unseemly and unwholesome practices, wider streets, purer air, and the introduction of sewerage systems and unpolluted water supply — all advances in sanitary and hygienic conditions, with which therapeutic agencies have nothing to do.

And what of the future now? Signs are not wanting that indicate along what lines the advances of the twentieth century shall come. And prevention seems, in the light of history, more promising in its results than attempts, at cure. Probably hygienic measures will never supersede the use of therapeutic remedies in the treatment of disease. But we well may anticipate with satisfaction the approach of that season when they shall be blended together in a closer and more beneficent union than the world has ever yet known.

Preventive medicine is no new thing. Nor is it one whose importance or influence upon the public health need be urged upon a body of physicians for the novelty of the subject or for the originality of the thought. Its importance has long been recognized. Boards of health have been appointed specially to enforce its requirements. Volumes have been written upon public hygiene. Preventive medicine and the discussions that have followed its recommendations have long occupied a prominent position in the medical literature of the times. Discourses have been read to us that have placed the subject before us in a manner as convincing and as truthful as can find expression in language, and in terms that admit of no reply.

Boards of health, both state and local, have urged upon us the need of improvement in sanitary conditions, with force of statement and cogency of reasoning that no argument can refute. Public health associations make sanitary science their chief purpose and study. National conferences of state and provincial boards of health seek to secure cooperation and uniformity of methods of doing their work.

The American Medical Association organizes a section to discuss state medicine and public hygiene. The American Climatological Association wrestles with the problems that our ever varying and always trying climate presents. They all tell the same story. They all say: Pure air, pure food, comfortable clothing, freedom from exposure to pathogenic

germs.

We have been told also, until the repetition induces a sense of weariness, that wherever putrefactive processes are going on; wherever there are accumulations of that material which we call filth in contradistinction from dirt; wherever stagnant pools or swamps abound; wherever marshes exhale their deleterious vapors; wherever tenements are overcrowded, and wherever lack of proper ventilation exists; wherever food products of every kind are placed upon the markets, and so upon the tables of the hungry, in improper condition; wherever agricultural processes are carried on, especially such as relate to milk production and meat supply, without proper regard to sanitary requirements and purity and cleanliness; wherever the effiuvia from sink drains and house offal mingle with and vitiate the air that is breathed; wherever noxious weeds or plants contaminate the atmosphere with their infectious exhalations; wherever drinking water is polluted from any cause; wherever streams and rivers are made foul by waste from manufactories, or from being used as receptacles of decaying matter of every description, all along their courses; wherever the smoke nuisance envelops us like a cloud; wherever these things exist, we have been told sufficiently often that danger exists also. There the microbe revels; there the bacillus watches for his prey. And there preventive medicine and preventive measures are needed always, to destroy their power of doing harm.

It is true that the work of the medical profession appears in all this. It is true that it is science medical science

that makes these matters plain. It is true that it was medical science that first discovered the microbe, and it was medical science also that first suggested the measures that should terminate his work. It is true that the guiding hand of medical science has given direction to all these proposed or actual measures of sanitary improvement and reform. It is true that it is because of medical science that the rivers of waters that take their rise among the unpolluted springs and streams of the highlands and the mountains are rushing onward with impetuous speed through their conduits and channels, in haste to allay the thirst of the famishing millions that crowd the cities' contracted areas. It is true that because it is the best method for its disposal that medical science can devise at present, that so much of the waste of the earth that is concomitant with existence is drained through miles of impervious conductors and buried in the

It is true that whatever improvement is to be noted in these, and in other particulars, has resulted from medical science and the facts that medical science has made known. It is true that they who have been instrumental in inaugurating all these reformatory enterprises, whose benefits are already so great, as well as in projecting others which it must rest with the future to complete, have been chiefly medical men. It is true that it has been the voice of medical science that has set forth so clearly the dangers that still are threatening, and it is the voice of medical science also that is yet busy in calling for measures of relief. It is true that it has been the trumpet blasts of medical science that have brought these topics to our attention, and have thundered their ominous warnings so often and so loudly in

our ears.

But repetition does not stimulate to activity. Argument does not renovate a broken constitution. Discussion does not destroy the industrious germ. And so, in defiance of all that medical science or common knowledge has taught

us, these dangers yet remain a constant menace to life and health. Our rivers are too often streams of pollution; our tenements are overcrowded; our food products are not always above suspicion; our milk supply is not always free from danger; our drinking water is not always pure. And so there is work yet for medical science to do.

The intense activities that have marked the nineteenth century have gone far in many beneficent directions, but they have left to the twentieth an inheritance of labor and of duty that must not be postponed.

Dr. Salmon, veterinary of the Bureau of Animal Industry in the Department of Agriculture at Washington, makes this remark: "Without doubt there should be greater efforts than have yet been put forth in this country to secure a pure and wholesome food supply. Those who are working in this direction need the encouragement and aid of the general practitioner of medicine, I might say of the whole medical profession. They need even more than this - the experience and knowledge which are gained by the men in the active practice of medicine."

Thus does the representative of our government at Washington recognize the agency and influence of the medical profession in the prosecution of this department of its work, thereby practically making the acknowledgment that the work is not yet thoroughly nor satisfactorily done. And so, because it is not, our strong men perish, and so our children die. When sixteen children in every hundred born in Massachusetts have died before they were one year old, through twenty successive years - twenty-five in every hundred, according to high authority, is the ratio in all large American cities; when 11,500 of the little ones die in a single year, as happened in Massachusetts, in 1900; when 47,266 persons, or very nearly one in every fifty, of the total population of the State, exclusive of those who die by violent death and also those who are reported as dying