in this way from the remainder of the ward. In this room it was the practice to isolate any patients suspected of yellow fever. No mosquito could get into it, or if by any chance one did, it was not allowed to get out alive ; and this was all the protection that was deemed necessary; whereas but a few weeks before isolation was accomplished by removal to a distant building across a ravine with many attending inconveniences and hardships. The change in the attitude toward malaria was illustrated by two large wards standing side by side, one built a year later than the other. Both were some three feet above the ground. Beneath the one built first, when malaria was supposed to arise as an exhalation from the damp ground, there was a concrete floor which cost the government $2000. The theory was that this would keep the malaria down and incidentally would permit a more complete disinfection after the flushing of the floor of the ward. Beneath the second ward there was the natural gravel which cost nothing. It is needless to say that the recoveries were as numerous in the one ward as in the other, and that cases of malaria did not develop in either.
Under a military government, action may instantly follow scientific discovery. All that is necessary is that there shall be an intelligent chief and efficient subordi nates ; but in a republic appropriate action on the part of health boards, state or local, and on the part of physi cians themselves, is likely to be taken only when there is cooperation on the part of other leaders of public opinion. The treatment of disease, and especially sanitary measures for the prevention of disease, must be discussed elsewhere than in medical journals and at the meetings of medical societies. Physicians and investigators, as soon as the demonstration is complete, must be ready to take steps to create public opinion, and then must summon as allies in the new crusade all those who come into contact with disease, distress, and bad social conditions from other standpoints than that of the medical profession. It is generally understood that physicians must be leaders, but they cannot lead effectively unless they are in constant and intimate relations with all these other groups—relations which must be established gradually, and which should be a constant asset immediately available when new situations of this kind arise.
Defective eyesight, decayed teeth, an imperfect carriage, are, from a social point of view, not merely causes of individual suffering and occasions for the exercise of pro fessional skill. They are also causes of poverty; causes of irregular employment ; causes of undue restriction in the field of possible industrial opportunity ; causes which may lead to physical deterioration in offspring. Such defects
as these can be remedied, if the public sentiment of the community is alert to remedy them. Knowledge which individual parent's may scarcely be expected to possess exists, nevertheless, in the community, and should find expression through the health board, through the school board, or through some other recognized agency. It may indeed be that the remedy would be found to lie chiefly in the education of parents and in the education of future generations; but whether thus indirectly or by more direct means, the prevention of disease, for which the combined efforts of physicians and of others are requisite, remains a fundamental and a most neglected public duty.
The most striking illustration is a movement which has but recently been inaugurated, but which is making rapid headway, and will for some time to come give the greatest scope for effective cooperation. This is the concerted movement for the prevention of tuberculosis. There has been a rapid transition in the public mind from submissive despair to eager hopefulness, from pessimism to impatient demand for fruits of the new knowledge which has been gained. There has been a slow dawning of public conviction that if, as physicians say, tuberculosis is curable, it must be cured oftener ; that if, as bacteriolo gists have demonstrated, it is preventable, it must be pre vented ; that if it is communicable, then there is a moral responsibility to stay the infectious plague. The problem is how to utilize for the good of mankind the knowledge that we have ; how to extend that knowledge where it will have potent influence in the prevention of needless disease and death ; how to bridge over the gap between what is written in medical books and what is written in the sunken cheeks of the consumptives, of whom one may easily see a thousand or more in a single day if he will merely visit the hospitals of the city of New York, where less than one in twenty of the entire number is to be found. Personal interest in this subject does not often need to rest upon an altruistic basis. Nearly every family has lost a member or close friend, or looks forward with apprehension to an im pending loss. It is this catholic impartiality that makes almost inevitable a concerted movement against the dis ease; yet the impartiality is not complete, for consumption feeds upon overcrowding and alcoholism and undernutri tion, so that again it is found that from him that hath not is taken away even that which he h'ath, and that the destruction of the poor is their poverty.