(number of medical men increased 100 per cent.,) and yet within a stone's-throw of my own residence there are a half dozen cellars in which water stands during some portion of the year, and as many houses whose drains have no connection with the main sewer. Go where you will into the farming districts, and you will find the most lamentable ignorance as to the necessity of sewerage and protection of the water supply from surface drainage. Eventually in our own, as in other States where the law has been in force for a considerable period, all our larger towns and villages will have organized local Boards, and through their agency, aided by the Central Board, some form of modified organization will be effected among all the outlying agricultural districts, until the beneficent results of the law shall be extended throughout the entire State. But in the meantime, there is a very important and extensive work to be done preparatory to the accomplishment of these results. Public sentiment must be enlightened as to the urgent necessity of obedience to the laws of health, and the people made to understand that a large percentage of the sickness, suffering and mortality prevalent in the community is due solely to the violation of sanitary laws; and the common people will hear us gladly No class in the community will be so open to conviction as to the reasonableness of the observance of sanitary laws as that which constitutes the great majority-the agriculturists. They have only to apply the same reasoning to the laws of their own physical being, as they are daily using with reference to the products of the soil. What sort of success ought to be expected by a nurseryman who is denied all opportunity to prune his trees till they are already misshapen and deformed beyond remedy; who has no means or opportunity of destroying the infesting parasite, until the vital powers are well-nigh exhausted; no supply of water till the foliage is withered; no fertilizing of the soil till there is complete impoverishment? And is not this about the precise relation doctors sustain oftimes to the bodies of their patients under the present system? Cobbling and tinkering is pretty much all we are permitted to do for the vital mechanisms of our patrons. The distinguished English sanitarian, Chadwick, says: "I will build a city which shall have any required death rate, from 3 per thousand upward" (the present average being 18 per thousand); and our own immortal Holmes says "the white plague" of the north, as he aptly calls consumption, which is responsible for the lion's share of our death rate, is more than analagous to the familiar spindling of plants deprived of air and sunlight. That distinguished layman, Lord Palmerston, years since declared that for every death from typhoid fever

some one ought to hang, and that an unfailing specific for malaria, diphtheria and cholera was contained in a 6-inch drain-tile. Add to these the indisputable fact that nearly one-half of our existing diseases are preventable, and who shall deny that the present relation of medical men to the public does not require readjustment?

The very practical and important question now comes: Who shall bring about the needed readjustment, and who shall be the educators of the community in this important work? I answer, our own medical. profession; the very men who are the daily witnesses of the dire evils of the violated physical laws; men whose education, whose character for benevolent and humane work, whose constant observation and experience, and whose position in society pre-eminently fit them for this noble and self-sacrificing work. I know that just here it will be alleged that this work of preventing disease strikes at the very foundation of our means of support. It must be admitted that the allegation is true so far as the present avocation of the physician is restricted within the narrow limit of alleviation of human suffering and the so-called cure of disease. But it needs no prophetic vision to see the radical change already begun, which will enlarge its circle of power and influence in the legitimate service which our profession is to render the human race; and just as surely as there is to be a revolution in the character of the service, so will there be in the compensation rendered for that service. The present system of making a physician's income from a family or community depend solely upon the amount of sickness occurring in it, is not worthy of the reforms and advancing civilization of the 19th century. Its philosophy, which, condensed is, millions for cure but not a dime for prevention, is radically false. The much abused John Chinaman, who, it is said, was discusing and practicing civil service reform long before our ancestors were building their rude huts, was wiser in his generation when he adopted the motto "an ounce of prevention etc." and remunerated his medical attendants only so long as he was kept in good health, but promptly discontinued their services when sick. This system, which may very aptly be called a scheme of health insurance, is rapidly growing in favor, both in the profession and in communities. Not a few of the profession in England, France, Germany, and to some extent already in our own enlightened country, are paid a stipulated annual salary, in consideration of which the family physician agrees on his part to render all professional service required, excepting operations and manipulations requiring the skill and training of specialists; to make careful sanitary inspection of the house and premises of

his client, and whenever in his judgment it is deemed necessary in order to satisfy him that all is in accord with sanitary laws; to offer any suggestions needed in regard to diet or habits of life;-in short, the family physician becomes responsible as the adviser of the family in all matters pertaining to hygiene and medical treatment. The practicability of this system is assured from the fact, already stated, of its successful adoption in our own and foreign countries, and also the favorable results where it has been tried in various lodges and benevolent associations, manufactories and mines, all over our own country. The advantages of such a system of preventive treatment, both to the medical profession and the public, are manifold, and time will only admit of a brief summary. At least 40 per cent. of disease which is preventable would be avoided.

Acute disease would come under observation and treatment earlier, and the attack be greatly modified, our patients not delaying to have medical advice until, as at present, every conceivable remedy which household experience, patent quackery, or superstition can suggest, had been tried, under the false impression that "they are not ill enough to call a doctor." In truth, this phrase has almost become the popular synonym for at least a serious indisposition, and "alas, too often a full, doubtful stage of a possibly fatal disease." Chronic diseases would be much less frequent. Under the present system there is a temptation to shorten the medical attendance, sometimes because the physician desires to guard himself against any suspicion of prolonging his visits with a view of making all out of the case pecuniarily that is possible, and oftener perhaps because the patient considers himself so far convalescent as to dispense safely with further medical supervision. The consequence is a large number of serious and obstinate chronic ailments, the sequence of a half-removed result of some acute attack and "germs of evil which will curse generations yet unborn, are left lurking in the system."

Welcome then, we say, to the day when the prevention of disease shall be the chief avocation of our profession, and that this period may be hastened, let every member exert himself to the utmost, for the faithful enforcement of the wise and beneficent laws affecting the sanitary condition of our country. Give circulars from the Secretary of the Board a careful, thoughtful reply; co-operate heartily with those whose official duties require them to devote themselves to this important work; educate the community in which Providence has placed you, to obedience of the laws which govern their physical being, and if perchance you are not rewarded pecuniarily, the consciousness of noble work ac

complished for the benefit of humanity will be a greater and more enduring compensation.

The question of expert testimony in our Courts is gradually occupying a more prominent place in the minds of medical men, authors of medical jurisprudence, and the legal profession. During the past two years, so far as I can learn, there have been no new decisions by Supreme Courts with reference to the right of expert witnesses to extra compensation or their duty to answer the summons as expert witnesses without promise of reasonable compensation. It will be remembered that all the decisions in our own country up to 1884, with one exception, that of exparte Dement, in the State of Alabama, were favorable to the claim of the expert witness to extra or reasonable compensation. In States where this matter is not regulated by law, an increasingly large number of cases is being reported in the inferior county and district Courts, where an attempt has been made to reduce the medical expert witness to the level of the ordinary witness, whose testimony has reference only to simple facts. One of the most recent and interesting of these was that of Dr. F. H. Darby, a prominent physician of Warren, Ohio. In a case of manslaughter, having answered all questions of fact as to post-mortem conditions, etc., he was asked his opinion as to what the appearance of the external wound indicated? Refusing to answer unless he was guaranteed a certain fee, he was sent to jail for contempt, and, having been confined behind the bars several days, was fined $25 and costs. The reply of Dr. Darby when asked to give his reason for refusing an answer, was so clear and logical that I give it in his own words, to which all lovers of justice will say Amen. "Because," said he, "it is expert testimony, and to render such requires a very liberal expenditure of time, labor, and capital to acquire the knowledge necessary to give it. This knowledge is the physician's stock-in-trade; it is what he has to sell. For the State or any one else to extort this from him without reasonable compensation, is unjust, and in direct violation of every principle of law and equity. The duties of common witnesses, physicians, like the good citizens that they are, have ever been willing to assume. To matters of fact we are willing to testify at any sacrifice. We feel that we owe it to the State, that the ends of justice may be meted out to evil-doers; just as a juryman in civil life makes a sacrifice of time, or the soldier in times of war must take up arms in defence of his country, so, too, we feel under a like obligation to abandon our respective fields of labor, and, if need be, spend day after day in courts to elucidate any facts that may have come under our own observation. But here we draw the line,

and I for one take the position, that questions of opinion, the correct answers to which depend on previous and special education, professional knowledge and skill, is our private property, and instead of the State being a party to our robbery, it should extend to us the strong arm of protection, as it does to other property owners." The Doctor was very warmly sustained in his position, and received numerous resolutions from medical societies and leading physicians throughout the State, expressive of sympathy, and material aid to appeal from the decision of the Lower to the Supreme Court of the State. This appeal has been made, and the Doctor writes:-"We are now at the door of the Supreme Court. It will take us three years, however, to get a hearing, i. e. unless taken up out of its regular order; a thing unlikely, unless the doctors go on a strike, and create a dearth of experts."

Recently, also, Judge C. C. Fuller, of Mecosta county, Michigan, on an occasion where a physician refused to give expert testimony without extra compensation, decided: "After many years study and observation, I decide that a physician's knowledge is his stock-in-trade, his capital, and we have no more right to take it without extra compensation than we have to take provisions from a grocery without pay, to feed a jury." It is evident, I think, that this just and sensible view of the question of remuneration of the expert is conceded by our highest authorities upon medical jurisprudence, and most eminent jurists; and yet it is equally evident that expert testimony is gradually declining in favor. The conflict of opinion between men of science and distinction in the profession, is so frequent and decided as to bring all expert testimony into unmerited disrepute. Redfield makes this sweeping statement:"When we consider the conflicting character of testimony coming from experts, and often its one-sided and partisan character, and above all the tendency of the most mature and well-balanced minds, to run into the most incomprehensible theorizing, we cannot wonder that some of the wisest and most prudent men of the age are beginning to feel that the testimony of experts is too often becoming, in practice, but an ingenious device in the hands of unscrupulous men, to stifle justice and vindicate the most high-handed crime." We must admit that there is too much truth in this statement, and no question affecting the dignity and honorable character of the profession demands a more thoughtful inquiry than the remedy for this evil. This, in my opinion, is only to be reached by wise state legislation. Says Dr. John J. Reese in his able work on medical jurisprudence, in commenting on this subject:-"The only true andproper system is for each State to appoint one or more experts who shall be State Officers, phy