must beware of inhaling the germ-laden air or drinking infected

water.

In every house there should be a room so situated that it may be perfectly isolated-preferably on the upper floor-to be used as an infirmary when sickness invades the habitation, thus giving the opportunity to separate the sick from the well, and thus diminish the chances of spreading disease. Evidently prophylaxis in its broadest sense means revolution, or evolution. It means a higher education for the masses, and a much wider diffusion of what is called "common sense" than we find common now. It means earnestness in acquiring and applying to the art of living the scientific knowledge of cause and effect; and it also means amid the mass of the people the virtue to live in obedience to the sanitary laws that such knowledge teaches.

The epidemic of typhoid fever that decimated the mining town of Plymouth, Pa., a few months ago, was an object-lesson in hygiene not to be forgotten. The excreta of one person in typhoid fever was deposited on the frozen bank of a mountain stream. When the thaw came this excrement was washed into the stream, and was conveyed to the reservoirs from which Plymouth drew its chief supply of water. Typhoid soon appeared, and in an incredibly short time became epidemic.

An epidemic could hardly have found a place less prepared to combat it. I do not know of a sanitary law that was not habitually and openly set at defiance by the Plymouth inhabitants, and when their day of trial came they were compelled, as we know, to pay a fearful penalty. The most efficient service by competent physicians was almost powerless to check the ravages of a dread disease occurring in a community so utterly regardless of the most ordinary conditions of health.

The epidemic of small-pox which has been, and still is, devastating Montreal, emphasizes the great need of intelligent Common Councils and efficient Boards of Health in cities whose inhabitants are not all educated in hygiene. It also emphasizes the virtues of vaccination as prophylactic of small-pox-a proceeding which has awakened such determined opposition among

a large class in the stricken city, to the great disadvantage of the whole population.

As expressing my own views on the question of vaccination, I will quote a few lines written by Dr. Derby, of Massachusetts, some four years ago:

"We may speculate about the possibility of the potency of vaccine being exhausted in the human family; we may find that people with good vaccine scars sometimes have small-pox; we may dispute as much as we please about the average period when revaccination may be considered a prudent safeguard; we may even conjecture that other diseases than that of the cow may be communicated by humanized vaccine; we may turn the vaccination question with ingenious skill so that its many facts shall reflect a multitude of curious lights, and after all we find that in vaccination we rest in a security against the horrid pestilence, unknown to former generations."

That disease may be modified by the qualities of race there is very little doubt, but I will only detain the Fellows while I allude to one race-the Jewish. Their great hygienic lawgiver, Moses, laid the foundation of a sturdy, long-lived race, when he promulgated his famous health laws, which were many centuries in advance of his time. Statistics show us that no other race so long resists the tendency to death as the Jewish, and probably no other race requires so little drug-medication, or so few services from the physician, except in the single item of obstetrics.

DISCUSSION.

DR. SMITH BAKER, of Oneida County.-It seems to me that it is not so much the fact of prophylaxis as it is the how of prophylaxis. Why is it we have so repeatedly brought before us the general statement of the fact that we need prophylaxis of disease? How is it that we have so little brought before us concerning the methods of prevention? It would seem, with all our general statement, there is also a general apathy on the subject. It has

been said that if we tell the masses that a certain well is saturated with poison they will point to it and say "No, indeed; it is a well of clear, pure water, used by us for these forty years, more or less, and we can not believe it." And thus it is with all the particulars needful for carrying on prophylaxis. The question arises, How is this, and why is this? The paper has well and timely emphasized the fact that there should be a general and popular education on this very subject. It seems to me equally proper for the profession to take hold of the matter with greater firmness than it ever has done before; at least that they should be leaders in this direction, and face the enemy with commendable courage.

DR. KNEELAND, of Onondaga County.-As well here as anywhere else, I wish to direct the attention of the Fellows present to the epidemic of typhoid fever which prevailed at Plymouth, Pa., and which was said to have been traceable to the contamination of the water-supply by one case occurring away up on the mountain, above the town. If there is any gentleman present willing to make such an incredible statement as that I would like him to defend his position.

DR. Wм. H. THORNTON, of Erie County.-I am just the man the doctor is looking for, and, since this matter is one pertinent to the subject of prophylaxis, I shall crave the indulgence of my auditors while I make a few remarks upon the subject. During the prevalence of this terrible plague the Buffalo Board of Health delegated Dr. A. H. Briggs, the health physician, Dr. J. W. Putnam and myself, to visit Plymouth. Our object was to study the epidemic in all its bearings, hoping to discover some things useful for application to home surroundings in the way of prevention of disease. A very brief summary of our findings is as follows: At the time of our visit there were about eight hundred persons sick with typhoid fever. We visited many of the sick and confirmed this diagnosis. We made a careful inspection of many of the places where the epidemic prevailed, and could find no local cause which in our opinion would account for such an extensive epidemic. We were led, however, to believe that the trouble originated in contamination of the water-supply. The town receives its water from three sources; namely, from the river, from wells, and from reservoirs supplied by a mountain stream. So far as we were able to learn by careful investigation, all of the first

cases, and in fact nearly all of the patients then ill, were in families supplied with water from this mountain stream. This stream we followed upward as far as the fourth or upper reservoir. During January there had been one case of typhoid fever in the person of a man who, having contracted the disease in Philadelphia, came to reside in a cottage close by this stream and just below the upper reservoir. This place we visited. The attendants of this sick man told us that on some stormy nights some of the stools from the patient, instead of being taken to the privy, were thrown into the snow bank which lay on a steep slope descending directly to the creek. During the winter and up to the last week of March this creek was frozen up, and in consequence the town was temporarily supplied with water from the river. When the warm weather came, during the latter part of March, the melting snow carried these typhoid germs into the stream. Just at this time also the Water Works Company began to draw their supply from the reservoir fed by this creek. Now then, during the early part of April cases of typhoid fever began to break out in the town, and on one day, about the 8th of April, two hundred people were stricken with the disease.

We found two families residing on the banks of the creek, near the lower reservoir. One family drew their supply of water from the stream. During the first week in April one member of the family was taken with typhoid fever, and subsequently the entire family, eight in number, had the disease. The other family, residing not fifty yards distant, drew their water from a spring in their yard-none of this family had the disease.

From these facts, and some others of a similar nature, the Commission were forced to the conclusion that the entire outbreak of the disease was directly traceable to the contamination of the water-supply by the stools of the typhoid fever patient up the side of the mountain. I think this should teach us that, for the sake of prophylaxis, all typhoid stools should be disinfected, and that they should be prevented from entering a source of watersupply in any way or in any form. It would seem also to be a reasonable inference that the typhoid germs are able to multiply themselves in a suitable soil outside of the human body.

ADDRESS ON PATHOLOGY.

By EDWARD G. JANEWAY, M. D., of New York County.

Read November 19, 1885.

THE request for an address upon the subject for which I have been announced would have been a source of pleasure had it not been for the embarrassments imposed upon me by sickness and convalescence. Your committee, however, should be held responsible for my short-comings, inasmuch as they declined to grant my wish for a release from my engagement. Craving your indulgence, therefore, I shall aim to draw your attention briefly to some of the advances made by pathology. These are all the more manifest because of the stationary character of some of our sister professions, notably that of the law, which, with its adherence to precedents, is so content with the usages of the past, and is so afraid of innovations. We are more fortunate in our profession, for, while not eager for change, we are still always seeking for newer information. We are consequently ever and anon changing our belief and practice.

To any observant mind it has long been apparent that we are in the midst of a revolution in medicine, and in no department is this more apparent than in pathology. The older explanations no longer satisfy the demands of the inquirer. Formerly, a large part of the study of the nature of disease was done in the library, and, in consequence, the result was mostly of a theoretical character. Metaphysics has not helped and will not help us in these searches, though, on the contrary, physics has proved of marked service. Need I say that more correct views of pathology must necessarily produce advance in therapeutics? In no part of the field is this more evident than in the effect of the newer views as regards the etiology of inflamma