"The sink water ran within five feet of the well, on the surface of the ground. The privy, with surface disposal of waste, was within ten feet upon the other side. The barn and large barnyard were twenty feet distant. The slope of the land from all these was toward the well. By the way, this was a milk farm,— probably it would be safe to say a milk-and-water farm,—so that the public shared the benefit of these arrangements. A case of malignant diphtheria developed here, and was followed in rapid succession by six others. Three of the patients died; four recovered. When told that the water from the well was probably the direct source of the trouble, the owner turned contemptuously away, drank of the water, smacked his lips, and said, "No better water than this can be found anywhere." He then accused the doctor of trying to excuse his "want of skill" by maligning the premises. Later some of the water was sent to Professor Hill, of Harvard, who found it highly charged with organic matter, and pronounced it dangerous. Dr. Palmer says, "A frequent unhygienic condition in this region is for the pump to be placed in the sink, and for the sink-spout to empty upon the ground within a very few feet of the well. My experience leads me to the conclusion that the average farm-house is more unwholesome than the average village or city house"; and he piously adds, "Nothing but the loving kindness and forbearance of an overruling Providence permits the inmates to live out half their days,"— surely, a more Christian and sensible doctrine than the one which charges this same merciful Deity with the wholesale destruction and misery which result from ignorance and disregard of sanitary law.

The very harmonious relations which existed between rheumatism and damp cellars is worthy of notice. Many of the cellars were rendered additionally unwholesome from the presence of decaying vegetables and various accumulations, the removal of which had been neglected, and, again, by the roof water being. allowed to discharge where it penetrated the cellar wall, rendering it damp and mouldy.

The degree of knowledge with regard to sanitary matters which was found to prevail may be inferred from the data given. It was not uncommon to find people of considerable intelligence unacquainted with even the crudest principles of hygiene. Perhaps the most extreme instances were found in the two housewives, one of whom poured her kitchen waste through a square hole cut for the purpose in the floor, and the other who caused her drain-spout to

be turned so as to discharge its contents under the kitchen. Both these women were regarded as remarkably neat housewives.

I think I am safe in asserting that in the West I found more interest in, and consequently a somewhat better acquaintance with, sanitary subjects than in the same grade of persons in the East. In a pretty Western village, I was told that a regulation had been in force for some time which limited the shade trees both as to numbers and nearness to dwellings, and also that no branches were allowed to grow below a prescribed distance from the ground. Great improvement in the health of a once malarious district had been the result. I could mention more than one New England town which would be benefited by such an ordinance; and how many of our delightful places along the Hudson, think you, might find such a decree the greatest of boons! or who shall say to what extent we might thus be able to exorcise that hateful scourge, malaria, which more and more finds a lurking-place in the shaded recesses of our homes, filling our veins alternately with ice and fire, and making the grasshopper to seem a burden?

The proportion of unwholesome bedrooms, shut-up parlors, outhouses attached to dwellings, and back-yard abominations was somewhat larger in New England than elsewhere. The house of which the poet sings, the artist raves, and which the novelist weaves into his romances, is, in real life, the most unhygienic of abodes. Pass beyond the "noble old elms, the vine-covered porches, and the mossy door-stone," and fill in the further details of damp cellar, mouldy little bedrooms, and the complicated horrors which go to make up the rear premises, and the picture seems to have lost its attractiveness. Not long ago I had occasion to step into just such a dwelling, and this was what presented itself to enliven the background of the picture already upon the easel: a woman with a moth-patched complexion, who groaned audibly at every step,poor thing, her rheumatism had come back, she said; a second woman lying upon a lounge, pale as Banquo's ghost, apparently just crawling back to life after a severe illness; a third enormously fleshy woman, who sat wheezing in a rocking-chair; and a limp young girl, with a face like curd, who brought me a glass of water.

Contrast this "Poet's Corner" with the ideal home of the sanitarian, the home which should and so easily could be. The house standing upon dry and, if need be, well-drained soil, over a clean, dry, well-cemented cellar; turned at a slight angle, so that there shall be no absolutely north rooms; family bedrooms large, on

second floor, and these, as well as living-rooms, on the sunniest side of the house; all windows opening from top as well as bottom; shutters closed or shades drawn only in the hottest days. A cheery fireplace in every room, if possible; if not possible, then one in the large family bedroom and in the living-room, to brighten the winter evenings and to aid in ventilation (no fireboards nor other devices to cover these in warm weather). A bathroom, with hot and cold water supply. Shade trees in moderate numbers, and standing at a respectful distance from the house. Well, out of doors, deep, secured against surface water. Out-buildings standing widely apart from house and well, properly constructed and kept scrupulously clean. Roof water all conveyed into a cistern or carried a suitable distance from the house. Laundry and larger part of kitchen waste utilized by being poured upon the garden or carried well away by a good drain.*

A bright young wife once said of her new house, “It has an upstairs, a downstairs and an out-doors to it." Now, this out-doors part is just what every house needs, in order to be a perfect dwelling-place; but, as with the proverb of the unshod wife of the shoemaker, so no house is so conspicuously destitute of this out-ofdoors space as your true farm-house. Our sanitary home must therefore have for summer, first, a temporary awning to serve instead of a roofed piazza (which latter shuts out the sun from the rooms behind it all the year round); then hammocks hung here and there, as convenience will permit; a tent or two on the lawn, where the children can play or take naps, and where mother can bring her sewing or father his newspaper; a few rustic seats here and there in the shady nooks; and, best of all, a table under a tree or tent, where tea can be served in fine weather. Such a dwelling-place is neither chimerical nor extravagant. Indeed, it would be in most cases a paying investment, returning its cost ten times over in health and happiness. By it the musty and wormeaten dreariness of the picturesque old house is thrown farther in the shade than by its own dismal surroundings. Such a sanitary abode I found in a bright little Western town, and to enliven this picture were a mother and five daughters, all absolutely well. Think of it! Six rosy, healthy, happy women all in one house. I could hardly believe it; but no amount of cross questioning revealed a flaw in the evidence. The men of the household were absent, but I was assured that they also were in excellent health.

* See Prof. Victor C. Vaughan's article, entitled "Building a Home."

Granting that most country homes are defective in their sanitary arrangements, and that much mischief is the result, where and to whom are we to look for the remedy? How prevent a repetition of old blunders in the location and erection of new homes, how improve or eradicate the evils existing in homes already established, how insure the more rapid dissemination of that knowledge of sanitation which shall help every man to be both his own and his brother's keeper?

That even an architect cannot always be trusted in these matters can be proved by the fact that a fine new hospital, not many miles from here, is so constructed that every one of its rooms or wards for the sick has only a northern exposure; and thus no bed-ridden patient can ever, within those walls, enjoy the gladdening and healing influence of a sunbeam. Also, I have seen a house, built in connection with a great State enterprise, where the kitchen drain, composed of loose tiles, was laid within two feet of the cistern (there was no well on the place) on one side, and a privy, with a shallow box for a vault, placed twelve feet distant upon the other. If we see such faults as these in buildings planned by those who should be authorities in such matters, what must we expect from the haphazard manner in which most country houses are planned and erected? A sanitary engineer is, of course, a being quite unknown in these localities.

Clearly, the one person possessing the requisite scientific knowledge, and who can be easily reached, is the physician; and, fortunately, no place is so remote and no household so wretched as to be beyond the reach of his advice and assistance. Indeed, the man who is going to build a house should first send for the doctor. With an attack of diphtheria upon him, he would be more excusable, did he neglect this duty. And woe betide the medical man or woman who is not prepared to render sound and efficient advice in a matter so important both to client and community! Already in some of the best medical colleges, both for men and women, chairs of preventive medicine are being established; and soon we hope that no respectably equipped institution of the kind will be without such a department. No doctor who is not alive to his finger-tips to every question which involves the health of the community of which he, by the very nature of his profession, is the self-constituted guardian, is deserving either of confidence or support.

We are told that, if the physician were to set about righting all the sources of illness which he sees, he would soon reduce himself

to a state of poverty and idleness, and consequently he holds himself in an attitude of indifference toward these dangers. This view is as untrue as it is ungenerous and repulsive. The hollow cough which sounds the death-knell of a trusting patient, a little child pinched and wan with suffering, a strong man stricken down prostrate and helpless with disease, are things at which no man rejoices, even though a fee be to him the price of the suffering which he strives to alleviate. There is no profession which develops unselfishness, patience, and heroism as does that of medicine; and there is no field of its practice which so calls out the above qualities as that which is furnished by the country. And yet the seeming indifference, the neglect to guard and warn and instruct, which is the negative quality in the ministrations of many of the medical profession, has often surprised and puzzled me.

Not long since, in a house in New England, there occurred within the space of three weeks one case of severe inflammatory rheumatism, three of acute enteritis, and one of acute pleurisy, all in adults (the children had died long ago). Here the family doctor came and went, carefully attentive, noting every symptom of his patients and prescribing cautiously and wisely. Yet, from first to last, he apparently took no note of the fact that at the rear of the house, beginning at the very door-step, was a perfect frog-pond, the result of the almost constant pouring and dashing of every variety of unclean waters out among the rank weeds which flourished there. And, further, he apparently failed to note that each person attacked as above stated had slept in a room the windows of which opened upon this filthy pool. I regret to add that at this house summer boarders were received; and soon after these occurrences it was literally swarming with the men, women, and children who had gone there in the quest of health.

66

One more,- - an old farm-house. Unhealthy" seems to be written all over it, from musty cellar, tree, vine, veranda, and blind shaded rooms, to the inevitable abominations behind. The history harmonizes perfectly with the suggestions of the place,- a history of more than forty years of affliction to two people, now old, the husband almost an imbecile from some kind of nervous affection, the wife crippled by rheumatism and enfeebled by bodily and mental suffering. The children had died many years ago, "of malignant sore throat," so the mother said; and, as she spoke of that terrible time, her lips quivered, the hard, stiff old hands were raised to the worn and wrinkled face, and the tears trickled through the gnarled