theria, fifty-nine per cent; and deaths from tubucular disease, forty-six per cent. The mortality from surgical operations has been reduced twenty per cent. One surgical procedure alone, ovariotomy, has added forty thousand years of useful life to the women of England, with a like proportion for other countries. Has humanity then no debt of gratitude to the medicl profession?

Mr. Chadwick tells us that the death rate in the English army forty years ago was twenty per thousand; it is now less than six; in Germany it is six; in France, ten; in Italy, eleven, and in Russia, eighteen. In the Indian army, in 1858, the death rate was sixty-nine per thousand; in 1888, it was reduced to fourteen.

In the cholera epidemic in 1831-3, in Europe and America, deaths were numbered by the millions. In 1893, the nature of the disease was understood; medical science had robbed it of its terrors. In Europe, the deaths resulting were comparatively few, and in our country it was completely shut out, not even getting a foothold in our seaboard cities. Smallpox, which a hundred years ago claimed hundreds of thousands annually, is now almost entirely under control, and would be completely eradicated were it not for the opposition and indifference to preventive measures by members of our own profession.

An eminent sanitary authority has said, we can perhaps find no better evidence of the efficacy of preventive measures than in the history of yellow fever in our southern states. Fifty years there was throughout the South a most appalling condition prevailing. The city of New Orleans was in great danger of being depopulated. In thirty days there were over five thousand deaths from yellow fever alone. The enforcement of sanitary regulations, inaugurated in 1863, was a most fortunate circumstance in that fair city. It not only checked the ravages of yellow fever, but it did much to prevent other epidemics, and to awaken the people to the establishment of a magnificient system of sewerage and the adoption of other sanitary regulations.

Contrast the condition of the present magnificent city of Memphis with that of 1878, when, out of a population of 19,500 persons, unable to get away, there were 17,600 cases of yellow fever, with a death rate of over thirty-three per cent. No such awful example of filth inviting disease has ever before occurred on our continent, nor will it ever occur again. Through the influence of preventive medicine these scourges have all but disappeared, and no longer terrorize our people, and in the growing light we feel the dawning of a better day, when not only they, but tuberculosis, and our common forms of fever, all of which are preventable, will have disappeared. "Every day sees the sentiment growing stronger among all classes of our people. Every day is marked by a distinct advance in public interest. The stagnant cess-pool has given way to ventilated drain; the reeking well and foul cistern to a well regulated public water supply."

Preventive medicine is steadily gaining ground; medical men everywhere are awakening to the realization of their own responsibility. Governor Shaw has very forcibly illustrated the thought by a comparison between the great engines which move our modern trains and the locomotive engines of fifty years ago. In a word, as our opportunities increase, so do our responsibilities.

It is plain, the medicine in the future will be in the main, preventive,

and there is a great responsibility resting upon us as a profession, for as we become acquainted with the conditions which produce disease, our responsibility increases in directing our efforts toward their eradication, and fortifying against the encroachments of disease by building up resistance.

A distinguished authority has said this is a problem involving a campaign of popular education; certain unfortunates must have the help of the State in providing treatment in sanitoria.

Private philanthropy is by no means adequate to so great a problem, but efforts in this direction must be supplemented by municipal, state. and national support.

One of our great dailies recently said: "Our country is becoming enormously wealthy; public resources are unstinted, and there is no apology for distress or want anywhere. Out of the various methods which are proposed for a more even distribution of material blessings, may it not be expected that a system may be evolved by which decent and kindly care will be bestowed upon those requiring it without the thought that they are receiving anything to which they are not justly entitled."

But sentiment and humanitarian considerations should not alone influence the state in dealing with this question. A broader view of the subject must be taken. We must regard it as a matter of the wisest and best policy on the part of the state or community, acting in and for its own best interests. Perhaps no field at the present time is so inviting and ripe for the harvest" as the question of tuberculosis. Its insiduous beginning, its slow and weary course, under ordinary conditions, its sad termination, present a picture only too familiar to us all. Specific after specific, "cure" after 'cure' have been proposed, and have vanished in an elixir dream. Climate, which at one time gave such bright promise, has been disappointing, and we find it has but a mild influence on the disease. Patients compelled to live out-of-doors show as large per cent of recoveries in low as is claimed in high altitudes. Two factors, and only two factors, seem to govern its control. Its inception depends on the passage of a living microorganism from one body to another, and then finding favorable conditions for growth and multiplication.

Hygienic-dietetic treatment in sanitoria, both in Europe and America, emphasizes the fact that tubercular disease is both preventable and curable. In treating it let us keep these facts in mind-that it is both preventable and curable no longer admits of doubt.-The concensus of opinion from every quarter accentuates the fact.

Dr. Stewart, in an admirable paper on this subject, says: "In place of despair and the calm resignation of helplessness with which the consumptive has heretofore been treated, we observe growing confidence on the part of the physician in his ability to do something. We hear him speaking words of encouragement and hope inspiring courage and gladness."

Let us glance at practical results in cases so treated. Knopt's statistics show absolute cures, fourteen per cent; relative cures fourteen per cent; amelioration, forty-two per cent. The chances of the disease to heal without being discovered are between twenty and twenty-five per cent. Nine per cent of those dying of non-tubercular disease are shown to have had phthisis at some time in their lives. Four thousand consecutive autopsies, conducted by Birch-Hershfeld, show tubercular lessons in forty per cent. Turban's

statistics show that patients treated in the early stages of consumption are relieved, if not cured, in as high as eighty-four per cent.

In view of these encouragihg facts, is it not our duty to lessen as far as possible the spread of this disease which annually causes more deaths in Iowa, than all other contagious diseases combined? It is not an extravagant estimate to say that two thousand lives in our state have been sacrificed to the fell destroyer since last we met. What are we doing to limit its spread, to protect or cure those who, through somebody's neglect, have fallen victims to this terrible malady? That it is a legitimate function of government to protect its citizens no one will question.

In Iowa we care for our criminals and for our insane, for our feebleminded and for our incorrigibles, for our destitute and for our afflicted at an enormous cost to the state, and we thank God we can do these things, for surely no one who loves his fellow man could wish it otherwise. And these yet, unfortunate persons whose kindly care is prompted by such noble sentiments of humanity, are not a source of danger to the lives and health of the community in which they live, while the poor victim of tubercular disease is a sower of contagion in every community, and a menace to the lives and health of all with whom he comes in contact.

With a more thorough knowledge by the people of the nature and infectiousness of this disease, and a more active interest by the members of our own profession, who are or ought to be, conservators of health and priests in the temples of Hygiea, the present condition of things cannot long endure. Other commonwealths have taken the step, and the time is ripe in Iowa to inagurate a movement for the establishment of a state hospital for the care of our tuberculosus poor. It is our prerogative as well as our duty, and I want to suggest, if it meets the approval in the society, that a committee composed of one member from each county of the state be appointed on reorganization, to present this matter to the next general assembly and if possible, secure an appropriation for the establishment and maintenance of such an institution.

If this society will but set to work in earnest, I cannot but believe that so noble and philanthropic an enterprise will appeal to the sound judgment, philanthropy and justice of our legislators, and that Iowa will be classed with the states which are endeavoring to throw about their citizens protection from tubercular disease, and to promote health and prosperity within their borders.

Our modern civilization has brought us many new problems to be solved. We are living in closer touch with sections and people in remote parts of the world. New conditions and questions are constantly arising, and we must give them attention, but not to the extent of neglecting the more important and helpful work at our very doors.

The new century "shall proclaim the nobler aim of thought and action," and it perhaps goes without saying, that the medicine of the future will be in the main, preventive. Our attitude along well established lines will remain unchanged. Research in pathological and bacteriological laboratories will continue. Physiology and hygiene will engage the thought of the profession; soundness of body, the importance of local tissue health as a means of resisting the invasion of pathogenic micro-organisms, will receive greater

attention, until every infectious disease, the great death producers of the world, will be eradicated.

The nature and conditions giving rise to malignant disease will probably be understood, and its preventive treatment established as the result of greater pathologic knowledge. Greater perfection in diagnosis, technique and treatment of all pathologic conditions will follow along the lines already mapped out. The serum treatment of all disease will play an important role in the medicine of the future. Means will be devised and stringent laws enacted for the protection of the race against the curse of inherited disease and those physically and mentally unfitted for the marriage relation will not be permitted to propagate their kind.

What the achievements of the new century will be, no man can prophesy. Marvelous things will be accomplished along lines we little dream of now. It is perhaps safe to predict that the great forces of nature will be utilized to serve man's purpose. A broader and deeper culture will be required of the physician. Some things now taught in our schools of medicine will have to be unlearned, and instruction given along lines which have never yet found place in a college curriculum. "More attention will be paid to the quality,

not the quantity of the output."

A closer relation between sanitary authorities national, state and local, will be found necessary and desirable, and will greatly facilitate the work of stamping out infectious disease, and improving sanitary conditions.

"The future of science is not in doubt." Medical men will "hew close to the line." ever ready to seek after and to accept truth, no matter how it may disarrange our preconceived ideas of things, nor how many idols we may tumble down in the pursuit.

Many things were accomplished in medicine during the last century which were undreamed of a hundred years ago.

"The new

Shall do

The unknown things, the wondrous deeds

Earth's future needs

Demand;

Its hand

Shall shape the course

Its brain devise

The plan

To win the richest prize that man can win—

The betterment of man."

XII

SANITATION FOR THE FARM *

In presenting this paper I have to say that the title ''Sanitation for the Farm" was selected by your secretary.

To go into any detailed consideration of this important subject, at all, would require at least two or three octavo volumes of many pages each.

There are so many things that affect the health of the home, whether in the country or town, and so many things that are peculiar to the country, and that influence for weal or woe the physical condition of the farmer and his family that I shall have to content myself with but the merest suggestions as to desirable sanitary measures, leaving to your discriminating judgment such after consideration and reflection as their seeming importance may warrant.

The ideal of the sanitarian, for a healthy home, is one where there is the nearest approach to pure air, pure water, and pure food. In city life these requisites are difficult, if not impossible to be obtained. Just in proportion as they are denied, in that proportion are those subject to such denial called upon to battle for health.

Health is a normal, physiological condition, and the life forces that the All Wise Creator has planted in every animal and vegetable are ever vigilant to detect and militant to remove whatever tends to impair health or destroy life.

In country life, and in farming as an occupation, we should have, and could have the essentials for healthful living above referred to, viz., pure air, pure water, and pure food. To have the first two there must be pure soil. Soil pollution is the greatest factor, perhaps, in air and water pollution.

One would naturally expect to find in the abodes of our farmers the noblest specimens of robust health-little sickness and long and vigorous life on the part of their inmates. And yet is this so to the extent that might reasonably be expected?

Is it not rather a fact that sickness and insanity are as prevalent in the country as in the city? There are many who deal in statistics and who seem to be careful and conscientious observers who tell us that proportionate to the population there is a much larger per cent. of both sickness and insanity in the country than in the city.

From my own observation as a physician in Iowa extending over forty years I am compelled to state that sickness and accident in the country were far beyond what it should have been had proper sanitary precautions been

*Read before the Iowa State Agricultural Society December 10, 1900, by J. F. Kennedy, A. M. M. D., Secretary State Board of Health.