vented the further spread of the disease. What would not Dr. Southwood Smith or Mr. Chadwick give for a few dozen of such hard-working, zealous, intelligent ministers, in the field of sanitary reform ?" 1

We commend this matter earnestly to public attention. In what way it could be best carried into effect, we will not attempt to specify. We would, however, suggest that arrangements be made in the Massachusetts General Hospital, and in other similar institutions, to admit females of a proper character to be educated for these special objects.

Preliminary proceedings have taken place for erecting a new hospital in Boston, for the accommodation of the laboring classes and the poor. If such an institution should be established, this should be one of its purposes. It might be made a kind of normal school, of the highest character and usefulness, at which females and males might be educated and prepared to be intelligent nurses in and out of the city; and thus confer the double benefit of relieving its own patients and contributing to the relief of others. There are many females among us who wish for employment and support; and we know of no way better than this in which they might obtain their desires, and at the same time make themselves honored and eminently useful to others.2

XLV. WE RECOMMEND that persons be specially educated in sanitary science, as preventive advisers as well as curative advisers.

The great object of sanitary science is to teach people the causes of disease,-how to remove or avoid these causes,-how to prevent disease,-how to live without being sick,-how to increase the vital force,-how to avoid premature decay. And one of the most useful reforms which could be introduced into the present constitution of society would be, that the advice of the physician should be sought for and paid for while in health, to keep the patient well; and not, as now, while in sickness, to cure disease, which might in most cases have been avoided or prevented. And this practice, we understand, exists to some

Edinburgh Review, Vol. LXXXVII, for 1848, p. 442.

For further information, see article" Deaconesses and Protestant Sisterhoods," Edinburgh Review, Vol. LXXXVII, for 1848, pp. 430-451, and the works there reviewed.

extent in some civilized countries. Three existing reasons, however, now occur to us, which we fear will prevent or obstruct, at least for a considerable period, the introduction into our country of this useful reform. One reason is, that persons who are well generally think that they have no need of a physician; another, that if advice is sought for or given at such times, it is not generally considered worth paying for;—and a third, that there are few persons educated in sanitary science, and capable of giving good sanitary advice. These are fatal errors, and should be corrected, for they have cost thousands of lives. Sanitary professorships should be established in all our colleges and medical schools, and filled by competent teachers. The science of preserving health and preventing disease should be taught as one of the most important sciences. It would be useful to all, and to the student in curative medicine as well as to others. To the young man who is educating himself for the great purposes of life, whatever profession he may select, it cannot be inferior, in interest and importance, to any other branch of education. An illustration of our ideas on this matter is contained in the following extract from the Weekly Summary of the Public Health in London, issued by the Registrar-General, Sept. 19, 1849:

"No city, perhaps, ever possessed such an efficient body of medical men as are now practising in London. During this epidemic they have performed services which in any other field must have won the highest honors; combating the disease night and day in the most pestilential quarters, and that on much more settled principles than the public might be led to suspect from certain discussions at the medical societies. And their office has been discharged with so much kindness as to deserve the gratitude of the poor, instead of drawing down on their heads the charges with which the physicians of other countries have often been assailed by the populace. Nearly all the sick have been seen by these practitioners, yet 14,500 persons have already died of cholera in London. How is this? The medical force will be found to have been employed at an immense disadvantage. It is called into action at the wrong end of the malady. Inquiries prove, that while medical advice

is generally sought in the characteristic stage, it is seldom obtained in the premonitory stage, when the power of medicine is decisive; and to that earlier and still more important period preceding the premonitory stage, which is prevented as easily as cured, medical practice has had little or nothing to say. Cholera here, also, only shows in high relief what exists in ordinary circumstances. Medical men rarely if ever treat the beginnings of diseases, and are scarcely ever consulted professionally on the preservation of the health of cities or families. The art of preserving health is taught in no regular course of lectures at any of the great schools of medicine in the United Kingdom. Yet the classical sanitary works of Pringle, Lind, Blane, Jackson, Johnson, and Martin, have been framed from observation in the British navy and army. In the science of health there are more exact, demonstrable truths than in the science of disease; and the advantage of 'prevention' over 'cure' requires no proof. In the Cyropædia of Xenophon, physicians who only treat the sick are compared to 'menders of torn clothes,' while the preservation of health is declared a noble art, worthy of Cyrus himself. Vegetius speaks in similar, Jackson in stronger terms, but perhaps unjustly for if it is godlike to save many from suffering, and to carry them in healthy life up to the natural term of existence, it is a worthy occupation to rescue a few from the arms of death or incurable infirmity.

"But the preservation and restoration of health are parts of one science; and if, as has been done by London and Liverpool, health officers be appointed in all the districts of the kingdom, the art of preserving health will be studied by a high order of men, well paid by the public; and ultimately, with an increase of their remuneration,-the diminution of sickness, the disappearance of epidemics, immense advantage to the public, the whole medical profession may devote themselves to the preservation and development of the vigor of the human faculties, instead of being tied down to the treatment of the sick and dying. And this,' Lord Bacon says, after his great survey of learning, we hope might redound to a general good, if physicians would but exert themselves, and raise their minds

above the sordid considerations of cure; not deriving their honor from the necessities of mankind, but becoming ministers of the divine power and goodness, both in prolonging and restoring the life of man; especially as this may be effected by safe, commodious, and not illiberal means, though hitherto unattempted. And certainly it would be an earnest of divine favor if, whilst we are journeying to the land of promise, our garments, those frail bodies of ours, were not greatly to wear out in the wilderness of this world.""

In connection with these sentiments, in which we fully concur, there is another matter deserving investigation, which has as great if not greater influence on the sanitary condition of the people. We allude to the numerous incompetent, uneducated medical advisers, who are employed as curative physicians. We boast of living in an enlightened era of the world, and perhaps, when compared with many others, our boasting may be well founded. This age is indeed remarkable in many respects, and unlike any that have preceded it. The elements of progress that exist in its very constitution, hold out, for the future destinies of society and for the elevation of man, higher hopes than have ever before been entertained. Notwithstanding this general characteristic, there was never a period when ignorant pretension was more bold, or seemed to have greater patronage. We have, besides physicians educated according to the rules of some state medical organization, or some medical school, the homoopathic, the hydropathic, the analytical, the Thomsonian, the botanical, the eclectic and electrical, the mesmeric, the pathetistic, the electro-biologic, the chrono-thermal, the Indian, and very many other denominations of physicians, each putting forth their own system as the only sure one for the cure of all diseases. Looking superficially at all these classes, it would seem that at no period has medical practice been more unsettled. There are men of integrity and skill in these different denominations; but there undoubtedly exists in most, if not all of them, a vast amount of practice which is injurious, or does violence to health and life.

"An immense extent of suffering, of abridgment of human life, is regularly bought and paid for, among us. A market of

imposition is opened to supply the demands of ignorance; and this must continue to be so, until the people are more enlightened. Did the pretenders to medical science, who infest the country in such formidable numbers, confine themselves to the barbarians' practice of charms and incantations, the mischief wrought by their art would be far less deplorable; but accustomed as they are to more potent prescriptions, they commit wider havoc of human health and life, than the medicine-men of the savages themselves."1

It is not our intention here to discuss the causes which produce this characteristic of society, but to call public attention to it, that it may be examined, and its effects made known among all classes of the people. If the fatal consequences which result from the practice of those who deal in the human constitution and its diseases, and in the credulity and confidence of its possessors, as a trade merely, were truly exhibited, the disclosure would be startling. Men to whom human life and human health are intrusted, should know something of the natural constitution of the body, the operation of disease upon it, and the nature and effect of remedies; and they should possess common sense and experience sufficient to apply this knowledge skilfully to the almost infinite variety of forms and circumstances under which disease appears. Neither a blacksmith from his anvil, an hostler from his stable, a barber from his shop, or a woman from her wash-tub, can be supposed, without previous education or experience, even if " acquired from the Indians," to possess this knowledge, or to be qualified to act as a curative physician.

XLVI. WE RECOMMEND that physicians keep records of cases professionally attended.

The science of medicine, like most other sciences, is founded upon facts. Many of these facts are stated in the recorded observation and experience of the profession, gathered up and handed down to us in the accumulated medical literature of the age. In anatomy and physiology, (and in surgery, too, to some extent,) branches of this science, truth and demonstration may be found; but in the practice of medicine more uncertainty

1 Mann's Sixth Report of the Board of Education, p. 74.