tality per cent. be applied to obtain the rate of sickness, it will appear that 5.06 per cent. of the population, or 5,787 persons of both sexes, have on the average been constantly sick, in Boston, for the last nine years. By the same rule, in a country town of an average healthy standard, containing 2,000 inhabitants, 60 will constantly be sick. This seems a large proportion or amount of sickness, but it may nevertheless be true, where those in infancy and old age are included.

This subject is of vast consequence. It would be extremely interesting and useful to know the amount of sickness in the families, and among persons of the various professions and occupations, the farmers, the mechanics, the manufacturers, and others, and how far it differs in different places and under different circumstances. All the facts and arguments generally used in favor of a sanitary survey, may be applied to show the utility and importance of this branch of the subject. To obtain the facts, some simple plan is needed, which may easily and without much labor be carried into operation; and such a plan we have given in the appendix.

XXVI. WE RECOMMEND that measures be taken to ascertain the amount of sickness suffered, among the scholars who attend the public schools and other seminaries of learning in the Commonwealth.

It has recently been recommended that the science of physiology be taught in the public schools; and the recommendation should be universally approved and carried into effect as soon as persons can be found capable of teaching it. Sanitary science is intimately connected with physiology, and deserves equal and even greater commendation as a branch of education. Every child should be taught, early in life, that, to preserve his own life and his own health and the lives and health of others, is one of his most important and constantly abiding duties. By obeying certain laws, or performing certain

The following are the provisions of an act relating to public hygiene, passed April 24, 1850:

SECT. 1. Physiology and hygiene shall hereafter be taught in all the public schools of this Commonwealth, in all cases in which the school committee shall deem it expedient.

SECT. 2. All school teachers shall hereafter be examined in their knowledge of the elementary principles of physiology and hygiene, and their ability to give instructions in the

same.

SECT. 3. This act shall take effect on and after the first day of October, one thousand eight hundred fifty-one.

acts, his life and health may be preserved; by disobedience, or performing certain other acts, they will both be destroyed. By knowing and avoiding the causes of disease, disease itself will be avoided, and he may enjoy health and live; by ignorance of these causes and exposure to them, he may contract disease, ruin his health, and die. Every thing connected with wealth, happiness and long life depend upon health; and even the great duties of morals and religion are performed more acceptably in a healthy than in a sickly condition.

This matter has been too little regarded in the education of the young. Intellectual culture has received too much and physical training too little attention. Some measure is needed which shall impel children to make a sanitary examination of themselves and their associates, and thus elicit a practical application of the lessons of sanitary science in the every-day duties of life. The recommendation now under consideration is designed to furnish this measure. It is to be carried into operation in the use of a blank schedule, which is to be printed on a letter sheet, in the form prescribed in the appendix, and furnished to the teacher of each school. He is to appoint a sanitary committee of the scholars, at the commencement of the school, and, on the first day of each month, to fill it out, under his superintendence, according to the accompanying directions. Such a measure is simple, would take but a few minutes each day, and cannot operate otherwise than usefully upon the children, in forming habits of exact observation, and in making a personal application of the laws of health and life to themselves. This is education of an eminently practical character, and of the highest imporAll the reasons in favor of our twenty-fifth recommendation apply also to this. By adopting it, many and many a life would annually be saved in this Commonwealth, and the general health of the rising generation would be greatly improved.

tance.

XXVII. WE RECOMMEND that every city and town in the State be REQUIRED to provide means for the periodical vaccination of the inhabitants.

The small-pox is a terrific disease; but it is almost entirely

shorn of its terrors by the preventive remedy of vaccination. If a person is not vaccinated, there is more than two chances to one, that, if exposed, he will take the disease; but, if properly vaccinated, there is scarcely one chance in five hundred. Hence the importance of this preventive measure, and the guilt of neglecting it.

Dr. Waterhouse, of Cambridge, vaccinated his son in July, 1800; and this was the first person ever vaccinated in America. In 1810, an act was passed in this State, providing "that it shall be the duty of every town to choose persons to superintend the inoculation of the inhabitants with the cow-pox." This law was repealed in 1836; and the Revised Statutes provide "that each town may make provision for the inoculation of the inhabitants." This substitution of the word may for shall left it optional with towns to do or not to do it; and it has probably caused the loss of many lives. Under the operation of the old law many towns were accustomed, once in five or more years, to have a general vaccination of the inhabitants; but this custom, as far as our knowledge extends, has been generally discontinued, and the inhabitants have thus been left liable to the disease from every new exposure. Boston has provided that no child shall be admitted into the public schools without a certificate from some physician that it has been vaccinated. It has also provided for the gratuitous vaccination of the poor who may choose to go to the office of the city physician for that purpose. These excellent regulations should be adopted in every place. And local Boards of Health should be required to provide for a general vaccination of the inhabitants at least as often as once in five years.

Since the repeal, in 1837, of the salutary laws of the State relating to small-pox, no more restraint has been laid upon persons sick with this than with any other disease, and it has consequently seldom been absent from the large cities. During more than 30 years, prior to 1837, the disease caused the death, in Boston, of 37 persons only; and most of these were at Rainsford's Island. It seldom occurred in the city proper. During the 12 years ending December 31, 1849, since the repeal, it caused the death of 533 persons! and in the first six

months of 1850, one hundred and forty-six have died! These were unnecessary deaths, they might and ought to have been prevented! and so should the thousands of cases of sickness by the same disease which did not terminate fatally. The plan of house-to-house visitation, described in our twentyfourth recommendation, might have been adopted. The city might have been divided into small districts, to each of which a physician might have been assigned, who should have been required to visit every family, whether invited or not, and to vaccinate, or to revaccinate, every person, if necessary or expedient. By this plan the disease would soon have been deprived of subjects to feed upon, and must have been starved out. It might thus have been expelled from the city in less than one month; and the lives of more than one hundred persons which now have been lost, in less than six months might have been saved. The public expense, too, of such a measure would have been far less than that of the small-pox widows, and the small-pox orphans which have been thrown upon the city for support, to say nothing of other expenses; and the various other marked effects and calamities of the disease, suffered more privately, might have been avoided.

Under existing circumstances, it becomes the special duty of every person to protect himself against this disease. Any one who permits himself to be sick with it, is as justly chargeable with ignorance, negligence or guilt, as he who leaves his house open to be entered and pillaged by robbers, known to be in the neighborhood. And upon that state, city, or town, which does not interpose its legal authority to exterminate the disease, should rest the responsibility, as must rest the consequences, of permitting the destruction of the lives and the health of its citizens.

XXVIII. WE RECOMMEND that the causes of consumption, and the circumstances under which it occurs, be made the subject of particular observation and investigation.

We have given some facts, (pp. 94-99,) to illustrate the operation of consumption, and stated that if that disease is ever to be eradicated or ameliorated, it can only be done by preventive means and not by cure. Dr. Fisher, late of Boston,

in the circular to which we have alluded, (page 166,) states, that "the disease, when once excited and seated in the system, is necessarily fatal. No remedial agent has ever yet been, and probably never will be, discovered, which will cure the malady when once developed in the lungs. It becomes, therefore, the duty of those who are aware of this fact and of the mortality which consumption occasions, to ascertain the causes of the disease, and to inform the public how these causes may be avoided. If the mortality produced by this disease is ever to be lessened, it is to be effected by preventive means. These means, when known and fully appreciated by the community, will be adopted, to a greater or less extent, and by their adoption a vast amount of human suffering and human life will be saved.” This is the opinion of an eminent professional man, who had made this disease the subject of particular investigation, and his views are entitled to the highest regard.

The causes of this disease, and the means of removal, are the great objects of investigation; and they can be accurately ascertained only by an extensive series of systematic, uniform and exact observations of the external circumstances,-atmospheric, local and personal,-occurring in each case. And we cannot too strongly impress upon local Boards of Health, upon the members of the medical profession, and upon all others interested, the importance of making a united and energetic effort to obtain such observations concerning every case which occurs in every part of the Commonwealth. Near 3,000 cases, in this State, annually terminate in death; and if they were properly observed, for a series of five, ten, or more years, it is impossible to anticipate the good results which might follow. Possibly, and even probably,-discoveries might be made which would reduce the annual number of cases, certainly by hundreds, and perhaps by thousands. We shall hereafter suggest a form of a Register of Cases adapted to this object; and the great importance of the disease, and the confident hope that some discovery can be made which will materially abate its melancholy ravages, should arouse us all to action.