BOOK 060. IN8 v.6 c. 1 INTERNATIONAL CONGRESS OF ARTS AND SCIENCES # INTERNATIONAL CONG 3 T153 00D577flt, A THIS FIRST EDITION DE LUXE, printed from type, is limited to five hundred sets, of which this is copy No r:..^. m INTERNATIONAL CONGRESS OF ARTS AND SCIENCE #1 Digitized by the Internet Archive in 2010 with funding from Boston Library Consortium Member Libraries http://www.archive.org/details/internationalcon06cong ^«9 ! ABELARD AND HIS SCHOOL Hand-painted Photogravure from the Painting by F. Flameng Abelard, the famous French scholar, was born at Palais near Nantes in 1079. He became so celebrated for his learning and genius that he was induced to open a school in Paris in 1103, where he lectured on Philosophy, Theology, and Logic with great success. He was the first who applied philoso- phical criticism to theology. His romantic love affair with Heloise has contributed largely, however, in making his name famous in modern literature. Abelard died under charge of heresy in 1142, and was buried in the Paraclete, which he had made a convent with Heloise as the Abbess. Heloise survived till 1164,and was also laid to rest in the Paraclete. In 1817 the ashes of Abelard and Heloise were removed to the cemetery of Pere la Chaise. INTERNATIONAL CONGRESS OF ARTS AND SCIENCE EDITED BY Howard J. Rogers, A.M., LL.D. DIRECTOR OF CONGRESSES VOLUME VI MEDICINE TECHNOLOGY V UNIVERSITY ALLIANCE LONDON NEW YORK Copyright 1906 by Hougicton, Mifflin & Co. all rights reserved Copyright 1908 by University Alliance ILLUSTRATIONS VOLUME VI FACING PAGE Abelard and His School Frontispiece Photogravure from the painting by F. Flameng Portrait Group of Scientific Lecturers .1 Photogravure from a photograph Dr. Pean Operating Before His Class 20 Photogravure from the painting by H. Gervex Trinity College, Cambridge 186 Photogravure from a photograph Virgil, Horace and Varius at the House of Maecenas . . .712 Photogravure from the painting by Charles F. Jalabert in ORGANIZATION OF THE CONGRESS PRESIDENT OF THE EXPOSITION: HON. DAVID R. FRANCIS, A.M., LL.D. DIRECTOR OF CONGRESSES: HOWARD J. ROGERS, A.M., LL.D. Universal Exposition, 1904. ADMINISTRATIVE BOARD NICHOLAS MURRAY BUTLER, Ph.D., LL.D. President of Columbia University, Chairman. WILLIAM R. HARPER, Ph.D., LL.D. President of the University of Chicago. R. H. JESSE, Ph.D., LL.D. President of the University of Missouri. HENRY S. PRITCHETT, Ph.D., LL.D. President of the Massachusetts Institute of Technology. HERBERT PUTNAM, Litt.D., LL.D. Librarian of Congress. FREDERICK J. V. SKIFF, A.M. Director of the Field Columbian Museum. OFFICERS OF THE CONGRESS PRESIDENT: SIMON NEWCOMB, Ph.D., LL.D. Retired Professor U. S. N. VICE-PRESIDENTS: HUGO MUNSTERBERG, Ph.D., LL.D. Professor of Psychology in Harvard University. ALBION W. SMALL, Ph.D., LL.D. Professor of Sociology in the University of Chicago. TABLE OF CONTENTS DIVISION E — UTILITARIAN SCIENCES Utilitarian Science 3 David Starr Jordan DEPARTMENT XVII — MEDICINE The Modern Conceptions and Methods of Medical Science ... 23 William Thomas Councilman The Development of Modern Medicine 41 Frank Billings Section A — Public Health. The Relations of Public Health Science to Other Sciences .... 55 William Thompson Sedgwick Public Health: Its Present Problems \ . 68 Ernst J. Lederle Short Papers .86 Section B — Preventive Medicine. The Logical Basis of the Sanitary Policy of Mosquito-Reduction . . 89 Ronald Ross Section C — Pathology. The Relations of Pathology . 1&5 Ludvig Hektoen The Relation of Pathology to Other Sciences . . . . • .123 Johannes Orth The Behavior of Native Japanese Cattle in regard to Tuberculosis (Perlsucht) 137 Shibasaburo Kitasato Short Papers 149 Section D — Therapeutics and Pharmacology. The Relation of Therapeutics to Other Sciences in the Nineteenth Century . 153 Oscar Liebreich The Problems of Therapeutics 17 Sir Lauder Brunton viii TABLE OF CONTENTS Short Paper 185 Section E — Internal Medicine. The Historical Relations of Medicine and Surgery ._ . . . .189 Thomas Clifford Allbutt The Problems of Internal Medicine 210 William Sydney Thayer Section F — Neurology. The Value of the Physiological Principle in the Study of Neurology . . 225 James Jackson Putnam Section G — Psychiatry. \ Psychiatry in its Relation to Other Sciences 243 Charles Loomis Dana The Problem of Psychiatry in the Functional Psychoses .... 262 Edward Cowles Section H — Surgery. The History and Development of Surgery during the Past Century . . 307 Frederic S. Dennis Short Papers .382 Section I — Gynecology. ' Some Fundamental Problems in Obstetrics and Gynecology . . . 389 John Clarence Webster Short Paper . . .408 Section J ■ — Ophthalmology. The Relations of Ophthalmology to Other Departments of Science . .411 Edward Jackson The New Ophthalmology and its Relation to General Medicine, Biology, and Sociology 422 George Milbry Gould Section K — Otology and Laryngology. Relations of Laryngology, Rhinology, and Otology with Other Arts and Sciences 449 SfR Felix Semon Section L — Pediatrics. The Foundations and Aims of Modern Pediatrics . . . . . 477 Theodore von Escherich The History of Pediatrics and its Relation to Other Sciences and Arts . . 498 Abraham Jacobi Works of Reference for the Department of Medicine 527 Works of Reference for the Section of Psychiatry . . . . . 529 Works of Reference for the Section of Surgery . .... 530 TABLE OF CONTENTS ix DEPARTMENT XVIII — TECHNOLOGY The Fundamental Conceptions which enter into Technology . . . 535 Henry Taylor Bovey Section A — Civil Engineering. The Relations of Civil Engineering to Other Branches of Science . . . 555 John Alexander Low Waddell The Present Problems of Technology 571 Lewis Muhlenberg Haupt Short Paper 590 Section B — Mechanical Engineering. The Relations of Mechanical Engineering to Other Branches of Engineering 593 Albert William Smith Short Papers 602 Section C — Electrical Engineering. The Relations of Electrical Engineering to Other Branches of Engineering 605 Arthur Edwin Kennelly Electrical Engineering Problems of the Present Time 617 Michael Idvorsky Pupin Section D — Mining Engineering. The Relation of Mining Engineering to Other Fields .... 633 Robert Hallowell Richards Present Problems in the Training of Mining Engineers . . . 644 Samuel Benedict Christy Section E — Technical Chemistry. The Relations of Technical Chemistry to Other Sciences .... 671 Charles Edward Munroe Some Present Problems in Technical Chemistry 686 William Hultz Walker Short Papers 700 Section F — Agriculture. The Relations of Agriculture to Other Sciences 715 Charles William Dabney Some Present Problems in Agriculture 727 Liberty Hyde Bailey Works of Reference for the Department of Technology .... 739 Works of Reference relating to the Section of Agriculture .... 741 CONTENTS OF THE SERIES . ...... 742 GROUP OF SCIENTIFIC LECTURERS. The International Congress of Arts and Science presents men renowned in almost every branch of Science, leading professors of the greatest institutions of learning, astronomers, surgeons, technologists, economists, pathologists, anal- ogists, physicists — famous specialists and scientists from all quarters of the globe. The present group includes a number of these celebrities. In the front row, from left to right, we have the full-length portraits of Prof. J. G. Hagen, S. J., of the Georgetown University, which was founded by the Jesuits in 1788 ; Dr. Carl Beck, Professor of Surgery in the New York Post-Graduate Medical School; Dr. Wilhelm Waldeyer, Professor of Anatomy, University of Berlin; Dr. Simon Newcomb, President of the Congress and Dean of American Scien- tists; Dr. Oscar Backhand, Astronomer of the Imperial Academy of Science, St. Petersburg; Dr. Ormond Stone, Professor of Astronomy, University of Vir- ginia; and Dr. David Starr Jordan, President of Leland Stanford, Jr., Univer- sity, in California. In the second row on the extreme left, we have the portrait of Dr. Benjamin Ide Wheeler, President of the University of California, and oh the extreme right stands Dr. Eugen von Philippovich, Professor of Political Economy, University of Vienna. DIVISION E — UTILITARIAN SCIENCES DIVISION E — UTILITARIAN SCIENCES {Hall 1, September 20, 10 a. m.) Speaker: President David Starr Jordan, Leland Stanford, Jr., University. UTILITARIAN SCIENCE BY DAVID STARR JORDAN [David Starr Jordan, President of Leland Stanford, Jr., University since 1891. b. January 19, 1851, Gainesville, Wyoming County, New York. M.S. Cornell, 1872; LL.D. ibid. 1886; Ph.D. Butler University, 1880; M.D. University of Indiana, 1875; Post-Graduate, Harvard University, London, Paris. Professor of Biology, Butler University, 1875-79; Professor of Zoology, University of Indiana, 1879-85; President of Indiana University, 1885-91; Associate of the U. S. Fish Commission since 1878; Head of Bering Sea Commission, 1896-98; President of California Academy of Sciences; Fellow of A. O. U; Member of American Philosophical Society, etc. Author of many books, including Fishes of Northern and Middle America ; Science Sketches ; Manual of the Vertebrates ; Guide to Study of Fishes; The Innumerable Company, Care and Culture of Men; The Voice of the Scholar, etc.] It falls to my lot to-day, to discuss very briefly, in accordance with the Programme of this Congress, some of the common features of utilitarian science, with a word as to present and future lines of investigation or instruction in some of those branches of the applications of knowledge which have been assigned to the present division. Applied science cannot be separated from pure science; for pure science may develop at any quarter the greatest and most unexpected economic values; while on the other hand, the application of know- ledge must await the acquisition of knowledge before any high achievement can be reached. For these reasons, the classification adopted in the present Congress, or any other classification of sciences into utilitarian science and other forms of science, must be incom- plete and even misleading. Whatever is true is likely some time to prove useful, and all error is likely to prove some time disastrous. From the point of view of the development of the human mind, all truth is alike useful, and all error is alike mischievous. In point of development, pure science must precede utilitarian science. Historically, this seems to be not true; for the beginnings of science in general, as alchemy, astrology, and therapeutics, seem to have their origin in the desire for the practical results of know- ledge. Men wanted to acquire gold, to save life, to forecast the future, not for knowledge's sake, but for the immediate results of 4 UTILITARIAN SCIENCES success in these directions. But even here accurate knowledge must precede any success in its application, and accuracy of knowledge is all that we mean by pure science. Moreover, as through the ages the representatives of the philosophies of the day, the a priori ex- planations of the universe, were bitterly and personally hostile to all inductive conclusions based on the study of base matter, men of science were forced to disguise their work under a utilitarian cloak. This is more or less true even to this day, and the greatest need of utilitarian science is still, as a thousand years ago, that this cloak should be thrown off, and that a larger and stronger body of workers in pure science should be developed to give the advance in real knowledge on which the thousands of ingenious and noble applica- tions to utilitarian ends must constantly depend. • It is a fundamental law of psychology that thought tends to pass over into action. Applied science is knowledge in action. It is the flower of that highest philanthropy of the ages by which not even thought exists for itself alone, but must find its end in the enlarge- ment of human control over matter and force or the amelioration of the conditions of human life. The development of all science has been a constant struggle, a struggle of fact against philosophy, of instant impressions against traditional interpretations, of truth against " make-believe." For men are prone to trust a theory rather than a fact ; a fact is a single point of contact; a theory is a circle made of an infinite number of points, none of them, however, it may be, real points of contact. The history of the progress of science is written in human psycho- logy rather than in human records. It is the struggle of the few realities or present sense-impressions against the multitude of past impressions, suggestions, and explanations. I have elsewhere said that the one great discovery of the nineteenth century — forestalled many ages before — was that of the reality of external things. Men have learned to trust a present fact or group of facts, however con- tradictory its teachings, as opposed to tradition and philosophy. From this trust in the reality of the environment of matter and force, whatever these may be, the great fabric of modern science has been built up. Science is human experience of contact with environment tested, set in order, and expressed in terms of other human expe- rience. Utilitarian science is that part of all this knowledge which we can use in our lives, in our business. What is pure science to one is applied science to another. The investigation of the laws of hered- ity may be strictly academic to us of the university, but they are utilitarian as related to the preservation of the nation or to the breeding of pigs. In the warfare of science the real in act and motive has been persistently substituted for the unreal. Men have slowly learned that the true glory of life lies in its wise conduct, in the UTILITARIAN SCIENCE 5 daily act of love and helpfulness, not in the vagaries fostered by the priest or in the spasms of madness which are the culmination of war. To live here and now as a man should live constitutes the ethics of science, and this ideal has been in constant antithesis to the ethics of ecclesiasticism, of asceticism, and of militarism. The physical history of the progress of science has been a struggle of thinkers, observers, and experimenters against the dominant forces of society. It has been a continuous battle, in which the weaker side, in the long run, is winner, having the strength of the earth behind. It has been incidentally a conflict of earth-born knowledge with opinions of men sanctioned by religion; of present fact with preestablished system, visibly a warfare between inductive thought and dogmatic theology. The real struggle, as already indicated, lies deeper than this. It is the effort of the human mind to relate itself to realities in the midst of traditions and superstitions, to realize that nature never contradicts herself, is always complex, but never mysterious. As a final result all past systems of philosophy, perhaps all possible sys- tems, have been thrown back into the realm of literature, of poetry, no longer controlling the life of action, which rests on fact. This conflict of tendencies in the individual has become a con- flict among individuals as each is governed by a dominant impulse. The cause of tradition becomes that of theology ; — for men have always claimed a religious sanction for their own individual bit of cosmic philosophy. Just as each man in his secret heart, the centre of his own universe, feels himself in some degree the subject of the favor of the mysterious unseen powers, so does society in all ages find a mystic or divine warrant for its own attitude towards life and action, whatever that may be. The nervous system of man, inherited from that of the lower animals, may be regarded as primarily a means of making locomo- tion safe. The reflex action of the nerve centre is the type of all mental processes. The sensorium, or central ganglion, receives impressions from the external world representing, in a way, various phases of reality. The brain has no source of knowledge other than sensation. All human knowledge comes through human experience. The brain, sitting in darkness, has the primary function of con- verting sensory impressions into impulses to action. To this end the motor nerves carry impulses outward to the muscles. The higher function of nerve-action, which we call the intellect, as distinguished from simple reflex action and from instinct, is the choice among different responses to the stimulus of external realities. As con- ditions of life become more complex, the demands of external realities become more exacting. It is the function of the intellect to consider and of the mind to choose. The development of the mind 6 UTILITARIAN SCIENCES causes and permits complexity in external relations. Safety in life depends on choosing the right response to external stimulus. Wrong choice leads to failure or to death. From the demands of natural selection results the intense prac- ticality of the mental processes. Our senses tell us the truth as to external nature, in so far as such phases of reality have been essen- tial to the life of our ancestors. To a degree, they must have seen "things as they really are," else they should not have lived to con- tinue the generation. Our own individual ancestors through all the ages have been creatures of adequate accuracy of sensation and of adequate power of thought. Were it not so they could not have coped with their environment. The sensations which their brains translated into action contained enough of absolute reality to make action safe. That our own ordinary sensations and our own induc- tions from them are truthful in their essentials, is proved by the fact that we have thus far safely trusted them. Science differs from common sense mainly in the perfection of its tools. That the instruments of precision used in science give us further phases of reality is shown by the fact that we can trust our lives to them. We find it safer to do so than to trust our unaided senses. While our senses tell us the truth as to familiar things, as rocks and trees, foods and shelter, friends and enemies, they do not tell us the whole truth: they go only so far as the demands of ancestral environment have forced them to go. Chemical composition our senses do not show. Objects too small to handle are too small to be seen. Bodies too distant to be reached are never correctly appre- hended. Accuracy of sense decreases as the square of the distance increases. Sun and stars, clouds and sky, are in fact very different from what they seem to the senses. In matters not vital to action, exactness of knowledge loses its importance. Any kind of belief may be safe, if it is not to be carried over into action. It is perfectly safe, in the ordinary affairs of life, for one who does not propose to act on his convictions to believe in witches and lucky stones, imps and elves, astral bodies and odic forces. It is quite as consistent with ordinary living to accept these as objective realities as it is to have the vague faith in microbes and molecules, mahatmas and protoplasm, protective tariffs and mani- fest destiny, which forms part of the mental outfit of the average American citizen to-day. Unless these conceptions are to be brought into terms of personal experience, unless in some degree we are to trust our lives to them, unless they are to be wrought into action, they are irrelevant to the conduct of life. As they are tested by action, the truth is separated from the falsehood, and the error involved in vague or silly ideas becomes manifest. As one comes to handle microbes, they become as real as bullets or oranges and as UTILITARIAN SCIENCE 7 susceptible of being manipulated. But the astral body covers only- ignorance and ghosts vanish before the electric light. Memory-pictures likewise arise to produce confusion in the mind. The record of past realities blends readily with the present. Men are gregarious creatures and their speech gives them the power to add to their own individual experiences the concepts and experiences of others. Suggestion and conventionality play a large part in the mental equipment of the individual man. About the sense-impressions formed in his own brain each man builds up his own subjective universe. Each accretion of knowledge must be cast more or less directly in terms of previous experience. By processes of suggestion and conventionality the ideas of the individual become assimilated to those of the multitude. Thus myths arise to account for phenomena not clearly within the ordin- ary experiences of life. And in all mythology the unknown is ascribed not to natural forces, but to the action of the powers that transcend nature, that lie outside the domain of the familiar and the real. It has been plain to man in all ages that he is surrounded by forces stronger than himself, invisible and intangible, inscrutable in their real nature, but terribly potent to produce results. He cannot easily trace cause and effect in dealing with these forces; hence it is natural that he should doubt the existence of relations of cause and effect. As the human will seems capricious because the springs of volition are hidden from observation, so to the unknown will that limits our own we ascribe an infinite caprice. All races of men capable of abstract thought have believed in the existence of something outside themselves whose power is without human limitations. Through the imagination of poets the forces of nature become per- sonified. The existence of power demands corresponding will. The power is infinitely greater than ours; the sources of its action in- scrutable: hence man has conceived the unknown first cause as an infinite and unconditioned man. Anthropomorphism in some degree is inevitable, because each man must think in terms of his own experience. • Into his own personal universe, all that he knows must come. Recognition of the hidden but gigantic forces in nature leads men to fear and to worship them. To think of them either in fear or in worship is to give them human forms. The social instincts of man tend to crystallize in institutions even his common hopes and fears. An institution implies a division of labor. Hence, in each age and in each race men have been set apart as representatives of these hidden forces and devoted to their pro- pitiation. These men are commissioned to speak in the name of each god that the people worship or each demon the people dread. 8 UTILITARIAN SCIENCES The existence of each cult of priests is bound up in the perpetua- tions of the mysteries and traditions assigned to their ca-re. These traditions are linked with other traditions and with other mystic ex- planations of uncomprehended phenomena. While human theories of the sun, the stars, the clouds, of earthquakes, storms, comets, and disease, have no direct relation to the feeling of worship, they can- not be disentangled from it. The uncomprehended, the unfamiliar, and the supernatural are one and the same in the untrained human mind; and one set of prejudices cannot be dissociated from the others. To the ideas acquired in youth we attach a sort of sacredness. To the course of action we follow we are prone to claim some kind of mystic sanction; and this mystic sanction applies not only to acts of virtue and devotion, but to the most unimportant rites and cere- monies; and in these we resent changes with the full force of such conservatism as we possess. It is against limited and preconceived notions that the warfare of science has been directed. It is the struggle for the realities on the part of the individual man. Ignorance, prejudice, and intolerance, in the long run, are one and the same thing. In some one line, at least, every lofty mind throughout the ages has demanded objective reality. This struggle has been one between science and theology only because theological misconceptions were entangled with crude notions of other sorts. In the experience of a single human life there is little to correct even the crudest of theological conceptions. From the supposed greater importance of religious opinions in determining the fate of men and nations, theological ideas have dominated all others throughout the ages; and in the nature of things, the great religious bodies have formed the stronghold of conservatism against which the separated bands of science have hurled themselves, seemingly in vain. But the real essence of conservatism lies not in theology. The whole conflict, as I have already said, is a struggle in the mind of man. From some phase of the warfare of science no individual is exempt. It exists in human psychology before it is wrought in human history. There is no better antidote to bigotry than the study of the growth of knowledge. There is no chapter in history more encouraging than that which treats of the growth of open-mindedness. The study of this history leads religious men to avoid intolerance in the present, through a knowledge of the evils intolerance has wrought in the past. Men of science are spurred to more earnest work by the record that through the ages objective truth has been the final test of all theories and conceptions. All men will work more sanely and more effectively as they realize that no good to religion or science comes from " wishing to please God with a lie." UTILITARIAN SCIENCE 9 It is the mission of science to disclose — so far as it goes — the real nature of the universe. Its function is to eliminate, wherever it be found, the human equation. By methods of precision of thought and instruments of precision of observation and experiment, science seeks to make our knowledge of the small, the distant, the invisible, the mysterious, as accurate, as practical, as our knowledge of com- mon things. Moreover, it seeks to make our knowledge of common things accurate and precise, that this accuracy and precision may be translated into action. For the ultimate end of science as well as its initial impulse is the regulation of human conduct. Seeing true means thinking right. Right thinking means right action. Greater precision in action makes higher civilization possible. Lack of pre- cision in action is the great cause of human misery ; for misery is the inevitable result of wrong conduct. " Still men and nations reap as they have strewn." A classic thought in the history of applied science is expressed in these words of Huxley: " There can be no alleviation of the sufferings of man except in absolute veracity of thought and action and a re- solute facing of the world as it is." " The world as it is " is the pro- vince of science. " The God of the things as they are is the God of the highest heaven." And as to the sane man, the world as it is is glori- ous, beautiful, harmonious, and divine, so will science, our tested and ordered knowledge of it, be the inspiration of art, poetry, and religion. Pure science and utilitarian science merge into each other at every point. They are one and the same thing. Every new truth can be used to enlarge human power or to alleviate human suffering. There is no fact so remote as to have no possible bearing on human utility. Every new conception falls into the grasp of that higher philan- thropy which rests on the comprehension of the truths of science. For science is the flower of human altruism. No worker in science can stand alone. None counts for much who tries to do so. He must enter into the work of others. He must fit his thought to theirs. He must stand on the shoulders of the past, and must crave the help of the future. The past has granted its assistance to the fullest degree of the most perfect altruism. The future will not refuse; and, in return, whatever knowledge it can take for human uses, it will choose in untrammeled freedom. The sole line which sets off utili- tarian science lies in the limitation of human strength and of human life. The single life must be given to a narrow field, to a single strand of truth, following it wherever it may lead. Some must teach, some must investigate, some must adapt to human uses. It is not often that these functions can be united in the same individual. It is not necessary that they should be united; for art is long, though life is short, and for the next thousand years science will be still in its 10 UTILITARIAN SCIENCES infancy. We stand on the threshold of a new century; a century of science; a century whose discoveries of reality shall far outweigh those of all centuries which have preceded it; a century whose glories even the most conservative of scientific men dare not try to forecast. And this twentieth century is but one — the least, most likely — of the many centuries crowding to take their place in the line of human development. In each century we shall see a great widening of the horizon of human thought, a great increase of precision in each branch of human knowledge, a great improvement in the conditions of human life, as enlightenment and precision come to be controlling factors in human action. In the remaining part of this address I shall discuss very briefly some salient features of practice, investigation, and instruction in those sciences which in the scheme of classification of this Congress have been assigned to this division. In this discussion I have received the invaluable aid of a large number of my colleagues in scientific work, and from their letters of kindly interest I have felt free to make some very interesting quotations. To all these gentlemen (a list too long to be given here) from whom I have received aid of this kind, I offer a most grateful acknowledgment. Engineering The development of the profession of engineering in America has been the most remarkable feature of our recent industrial as well as educational progress. In this branch of applied science our country has come to the very front, and this in a relatively short time. To this progress a number of distinct forces have contributed. One lies in the temperament of our people, their native force, and their tendency to apply knowledge to action. In practical life the Amer- ican makes the most of all he knows. Favoring this is the absence of caste feeling. There is no prejudice in favor of the idle man. Only idlers take the members of the leisure class seriously. There is, again, no social discrimination against the engineer as compared with other learned professions. The best of our students become working engineers without loss of social prestige of any sort. Another reason is found in the great variety of industrial openings in America, and still another in the sudden growth of American colleges into universities, and universities in which both pure and applied sciences find a generous welcome. For this the Morrill Act, under which each state has developed a technical school, under federal aid, is largely responsible. In the change from the small college of thirty years ago, a weak copy of English models, to the American university of to-day, many elements have contributed. Among these is the current of enlightenment from Germany, and at the same time the UTILITARIAN SCIENCE 11 influence of far-seeing leaders in education. Notable among these have been Tappan, Eliot, Agassiz, and White. To widen the range of university instruction so as to meet all the intellectual, esthetic, and industrial needs of the ablest men is the work of the modern university. To do this work is to give a great impetus to pure and to applied science. Two classes of men come to the front in the development of en- gineering: the one, men of deep scientific knowledge, to whom advance of knowledge is due, the other the great constructive engi- neers; men who can work in the large and can manage great enter- prises with scientific accuracy and practical success. Everywhere the tendency in training is away from mere craftsmanship and towards power of administration. The demands of the laboratory leave less and less time for the shop. "Two classes of students," says a correspondent, " should be encouraged in our universities: First, the man whose scientific attainments are such that he will be able to develop new and important processes, the details of which may be directly applied. This type of man is the scientific engineer. The other is the so-called practical man, who will not only actually carry on engineering work, but may be called on to manage large enterprises. If his temperament and ability are such as to give him a thorough command of business methods and details, while he is in addition a good engineer, he will find a field of great usefulness before him on leaving the university. The university should en- courage young men to undertake the general executive work nec- essary to handling men and in the many details of large enterprises. The successful man of this character is necessarily a leader, and the university should recognize that such a man can be of great influ- ence in the world, if he is thoroughly and broadly educated." "We need," says another correspondent, "men possessing a better general training than most of those now entering and leaving our engineering schools. We need more thoroughly trained teachers of engineering, men who combine theoretical training with a wide and constantly increasing experience, men who can handle the factors of theory, practice, and economics." "Technical education," says another correspondent, "should look beyond the individual to the aggregate, and should aim to shape its activities so as to develop at the maximum number of points sympathetic and helpful relations with the industrial and engineering interests of the state. This means careful and steady effort towards the coordination of the activities of the technical school with the general condition of industry and engineering as regards its raw materials, its constructive and productive operations, its needs and demands with regard to personnel, and its actual or potential trend of progress." 12 UTILITARIAN SCIENCES The coming era in engineering is less a period of discovery and invention than of application on a large scale of principles already known. Greater enterprises, higher potentialities, freer use of forces of nature, all these are in the line of engineering progress. "The realm of physical science," says a correspondent, "has become to the practical man a highly improved agricultural land, whereas in earlier days it was a virgin country possessing great possibilities and exacting but little in the way of economic treat- ment." In all forms of engineering, practice is changing from day to day; the principles remain fixed. In electricity, for example, the field of knowledge " extends far beyond the direct limits or needs of electrical engineers." "The best criticism as to engineering education came formerly almost entirely from professors of science and engineering. To-day the greatest and most wholesome source of such criticism comes from those engaged in practical affairs. We have begun a regime wherein coordinated theory and practice will enter into the engineering training of j^oung men to a far greater and more profitable extent than ever before." "The marvelous results in the industrial world of to-day," says a correspondent, "are due largely to the spirit of 'usefulness, activity, and cooperation' that exists in each community of interests and which actuates men employing the means which applied science has so bountifully accorded. I know of no greater need of engineer- ing education in our country to-day than that its conduct in each institution should be characterized by the same spirit of useful- ness, activity, and cooperation." In mining, as in other departments of engineering, we find in the schools the same growing appreciation of the value of training at once broad, thorough, and practical, and the same preference for the university-trained engineer over the untrained craftsman. The head of a great mining firm in London writes me that " for our business, what we desire are young men of good natural quali- fications, thoroughly trained theoretically without any so-called practical knowledge unless this knowledge has been gained by employment in actual works." On the pay-roll of this English firm I find that five men receive salaries of more than $20,000. All these are graduates of technical departments of American universities. Seventeen receive from $6000 to $20,000. Nine of these were trained in American univer- sities, one in Australia, and two in England, while five have risen from the ranks. In the lower positions, most have been trained in Australia, a UTILITARIAN SCIENCE 13 few in England, while in positions bearing a salary of less than $2500 most have risen from the ranks. "Given men of equal qualifications/' says the director of this firm, "the man of technical training is bound to rise to the higher position because of his greater value to his employer. As a rule, also, men who have been technically trained are, by virtue of their education, men who are endowed with a professional feeling which does not to the same extent exist among those men who have risen from the rank and file. They are therefore more trustworthy, and especially in mining work, where premium for dishonesty exists, for this qualification alone they are bound to have precedence. We do not by any means wish to disparage the qualifications of many men who have risen from the ranks to eminent positions, but our opinion may be concentrated in the statement that even these men would be better men had they received a thorough technical training." The progress of chemical engineering is parallel with that in other departments of technology. Yet the appreciation of the value of theoretical training is somewhat less marked, and in this regard our manufacturers seem distinctly behind those of Germany. "The development of chemical industries in the past history of the United States," says a correspondent, "was seriously delayed by the usually superficial and narrow training of the chemist in the colleges. Thus managers and proprietors came to undervalue the importance of chemical knowledge. The greatest need at present in the development of chemical industries is an adequate supply of chemists of thorough training to teach manufacturers the impor- tance in their business of adequate chemical knowledge. Epoch- making advances in chemical industry will spring from the brain of great chemists, and to insure the production of a few of these, the country must expect to seed lavishly and to fertilize gener- ously the soil from which they spring. Germany has learned the lesson well: other nations cannot long delay." Agriculture In the vast range of the applications of science to agriculture, the same general statements hold good. There is, however, no such general appreciation of the value of training as appears in relation to the various branches of training, and the men of scientific education are mostly absorbed in the many ramifications of the Department of Agriculture and in the state agricultural colleges and experiment stations. There are few illustrations of the power of national cooperation more striking than those shown in the achieve- ments of the Department of Agriculture. I have no time to touch 14 UTILITARIAN SCIENCES on the varied branches of agricultural research, the study of the chemistry of foods and soils, the practice of irrigation, the fight against adulterations, the fight against noxious insects, and all the other channels of agricultural art and practice. I can only com- mend the skill and the zeal with which all these lines of effort have been followed. The art of agriculture is the application of all the sciences. Yet " agricultural education," writes a correspondent, "has not yet reached the dignity of other forms of technical education." "The endowment of the science of agricultural research in the United States is greater than in any other country. The chief fault to be found is in striving too rapidly for practical applications and in not giving time enough for the fundamental research on which these applications must rest. The proportion of applied agricul- tural science in agriculture is too great in this country. While we do not need fewer workers in applied agricultural science, we do need more workers who would devote themselves to fundamental research." Two branches of applied science not specifically noticed in our scheme of classification seem to me to demand a word of notice. One is selective breeding of plants and animals; the other, the artificial hatching of fishes. By the crossing of animals or plants not closely related, a great range of variety appears in the progeny. Some of these may have one or more of the desirable qualities of either parent. By selection of those possessing such qualities a new race may be formed in a few generations. The practical value of the results of such experiments cannot be over-estimated. Although by no means a modern process, the art of selective breed- ing is still in its infancy. Its practice promises to take a leading place among the economically valuable applications of science. At the same time, the formation of species of organisms under the hand of man throws constant floods of light on the great ques- tions of heredity, variation, and selection in nature, the problem of the origin of species. In this connection I may refer to artificial hatching and accli- matization of fishes, the work of the United States Bureau of Fish- eries and of the fish commissions of the different states. There are many species of fish, notably those of the salmon family, in which the eggs can be taken and fertilized by artificial processes. These eggs can be hatched in protected waters so that the young will escape many of the vicissitudes of the brook and river, and a thou- sand young fishes can be sent forth where only a dozen grew before. UTILITARIAN SCIENCE 15 Medicine In the vast field of medicine I can only indicate in a few words certain salient features of medical research, of medical practice, and of medical instruction in America. In matters of research, the most fruitful line of investigation has been along the line of the mechanism of immunity from con- tagious diseases. To know the nature of microorganisms and their effect on the tissues is to furnish the means of fighting them. " The first place in experimental medicine to-day," says Dr. W. H. Welch, "is occupied by the problem of immunity." That medicine is be- coming a scientific profession and not a trade is the basis of the growing interest of our physicians in scientific problems, and this again leads to increased success in dealing with matters of health and disease. The discovery of the part played by mosquitoes in the dissemination of malaria, yellow fever, dengue, elephantiasis, and other diseases caused by microorganisms marks an epoch in the study of these diseases. The conquest of diphtheria is another of the features of advance in modern medicine, and another is shown in the great development of surgical skill characteristic of American medical science. But the discoveries of the last decades have been rarely startling or epoch-making. They have rather tended to fill the gaps in our knowledge, and there remain many more gaps to fill, before medical practice can reach the highest point of adequacy. The great need of the profession is still in the direction of research, and research of the character which takes the whole life and energy of the ablest men demands money for its maintenance. We need no more medical colleges for the teach- ing of the elements. We need schools or laboratories of research for the training of the masters. In the development of medicine there has been a steady move- ment away from universal systems and a 'priori principles, on the one hand, and, on the other hand, from blind empiricism, with the giving of drugs with sole reference to their apparent results. The applications of sciences — all sciences which deal with life, with force, and with chemical composition — must enter into the basis of medicine. Hence the insistent demand for better prelim- inary training before entering on the study of medicine. "Only the genius of the first order," says a correspondent, "can get on without proper schooling in his youth. What our medical inves- tigators in this country most need is a thorough grounding in the sciences, especially physics and chemistry." The instruction in medicine, a few years ago almost a farce in America, has steadily grown more serious. Laboratory work and clinical experience have taken the place of lectures, the courses 16 UTILITARIAN SCIENCES have been lengthened, higher preparation for entrance has been exacted, though in almost all our schools these requirements are still far too low, and a more active and original type of teacher has been in demand. Even yet, so far as medical instruction is concerned, the hopeful sign is to be found in progress rather than in achievement. A college course, having as its major subjects the sciences fundamental to medicine, is not too much to exact of a student who aspires to be a physician worthy of our times and of the degree of our universities. First-hand knowledge of real things should be the keynote of all scientific instruction. "Far more effort is now made," writes a correspondent, "in both the prepara- tory and the clinical branches to give the student a first-hand know- ledge of his subject. This tendency has still a long way to travel before it is in danger of being overdone. The practical result of this tendency is that the cost of education per student is greatly in- creased and the profits of purely commercial schools are thereby threatened. This forms, doubtless, the main source of the objec- tion made by the weaker and less worthy schools to better methods of instruction. We need well-endowed schools of medicine that may carry on their work unhampered by the necessities of a commercial venture. Medical schools now exist in great numbers, — many ,of them cannot keep up with modern requirements, and necessa- rily their salvation lies in antagonizing everything in the nature of more ample and more expensive training." Another correspondent writes, emphasizing the value of biologic studies: "The final comprehension of bodily activity in health and disease depends on knowledge of living things from ovum to birth, from birth to maturity, and from maturity to old age and death. Anything less than such fundamental knowledge requires constant guessing to fill up the gaps, and guesses are nearly always wrong." In many regards, even our best schools of medicine seem to show serious deficiencies. The teaching of anatomy is still one of the most costly, as well as least satisfactory, of our lines of work. A correspondent calls attention to the fact that in making anatomy "practical" in our medical schools, " we expended last year $750,000 in the United States, twice the amount expended in Germany, with as a result neither practical anatomy nor scientific achieve- ment." "Anatomy," he continues, "should be made distinctly a university department, on a basis similar to that of physics and chemistry. Unfortunately, university presidents still stand much in the way of the development of anatomy, for many of them seem to think that almost any one who wears the gown is good enough to become a professor of anatomy. Repeatedly have I witnessed the appointment of a know-nothing when a recognized young man might have been had for half the money." Our forces are dissipated, UTILITARIAN SCIENCE 17 the fear of things scientific has destroyed even the practical in this noble old mother science which is still giving birth to new sciences and to brilliant discoveries. Among other matters too much neglected are personal hygiene, a matter to which the physician of the past has been notoriously and joyously, indifferent. Especially is this true as regards the hygiene of exercise and the misuse of nerve-affecting drugs. Public sanitation as well deserves more attention. "The demand for adequately trained officers of public health is not what it should be, and our public service as a whole is far below that of European countries. Both public opinion and university authorities are responsible for this condition." The hygiene of childhood, in which line great advances are made, is still not adequately represented in most of our medical colleges, and the study of psychiatry and nervous disturbances in general is not sufficiently lifted from the realm of quackery. "Not only," says a correspondent, "should psychiatry be taught in every med- ical school, but it should be taught from a clinical standpoint. Every city in which there are medical schools should have a psych- opathic hospital for the reception of all cases of alleged insanity and for their study, treatment, and cure. Such a hospital should contain, also, a laboratory for the study of normal and of patho- logical psychology. I am convinced that progress in normal psych- ology will be made chiefly through the study of abnormal condi- tions, just as physiology has profited so enormously through the work of the pathologist." A word should be said for veterinary medicine and its achieve- ments of enormous economic value in the control of the contagious diseases of animals. The recent achievements of vaccination against the Southern cattle fever and against tuberculosis, the eradication of the foot and mouth disease among other matters, have demanded the highest scientific knowledge and the greatest skill in its practi- cal application. Unfortunately, veterinary science lacks in this country adequate facilities for research and instruction. "Practically," says a cor- respondent, "the veterinary sciences in the United States are lead- ing a parasitic existence. We are dependent almost wholly upon the results of investigation and teaching of European countries, not- ably Germany and Denmark. The value of the live-stock industry here is so tremendous that almost every state in the Union should have a well-equipped veterinary school supported by public funds. There is but one veterinary school in the United States that has anything like adequate support." That this is true shows that our farmers and stock-raisers are very far from having an adequate idea of one of the most important of their economic needs. 18 UTILITARIAN SCIENCES Economics We may justify the inclusion of economics among the utilitarian sciences on grounds which would equally include the sciences of ethics and hygiene. It is extremely wise as well as financially profit- able to take care of one's health, and still more so to take thought of one's conduct. The science of economics in some degree touches the ethics of nations and the " wealth of nations," a large factor in the happiness of the individuals contained within them, depends on the nation's attitude towards economic truths. Another justi- fication of this inclusion is found in the growing tendency in our country to call on professional economists to direct national opera- tions. On the other hand, our economists themselves are becoming more and more worthy of such trusts. The inductive study of their science brings them into closer contact with men and with enter- prises. By this means they become students of administration as well as of economics. They realize the value of individual effort as well as the limitations which bound all sorts of executive work, in a republic. "Only a few years ago," writes a correspondent, "the teachers of economics were far more generally unfavorable critics of government work which interested them. They have become more and more disposed to cooperate at the beginning rather than to condemn at the end. Just as economics has taken a more kindly and hospitable attitude towards politics, so similarly has it towards business, as illustrated in the rapid rise of courses in commerce." The demand for trained economists in public affairs is " compelling the teachers of economics more and more to seek contact with the men who are grappling face to face with economic problems." The relation of economic theory to administration is a subject on which there is much diversity of opinion. It is claimed by able authority that "economic science, by becoming ultra-theoretical, has come into far closer touch with practical life than it ever attained before. Laws, the statement of which seems like a refinement of theory, determine the kind of legislation required on the most practical of subjects." On another hand, it is claimed by high au- thority that our country must have its own political economy. "The generalizations arising solely from the uniformity of human nature are so few that they cannot constitute a science. The classical or orthodox political economy of England was conditioned from start to finish by the political problems it had to face. We are only beginning to acquire our national independence." Still another view is that "all that has been achieved in the field of economics that is of any value, has been the result of logical analysis applied to the phenomena and experiences of every-day UTILITARIAN SCIENCE 19 industrial life. The stages of past development can be determined and interpreted only in the light of this analysis. The lesson which the historical economist has never learned, is the importance of that principle, which lies at the bottom of the whole modern theory of evolution, and which was made use of by Lyell and Darwin, namely, the principle that historical changes of the past are to be accounted for by the long continued action of causes which are at this present moment in operation and can be observed and measured at the present day." "This," says my correspondent, "needs saying and re-saying, until it is burned into the minds of all students of economics." The recent progress of economics in America has lain in part in the development of economic theory by critical and by construct- ive methods. An important reason for welcoming the exact and critical study of economic theory is this: In the promulgation of imaginary economic principles the social and political charlatan finds his choice field of operation, just as the medical charlatan deals with some universal law of disease and its universal cure. The progress of science in every field discredits these universal principles with their mystical panaceas. There is all the more reason why in politics, as in medicine, those generalizations which deal with necessary laws or actually observed sequence of events should be critically and constructively studied. In general, however, the progress of economics has followed the same lines as progress in other sciences, through a " minute investi- gation and the application of principles already discovered or out- lined by painstaking inquiry as to facts." This method of work has been especially fruitful in the study of monetary problems, of finance, taxation, and insurance, in the study of labor problems and conditions, in the study of commerce, and in the study of crime and pauperism. In its development economics is, however, many years behind the natural sciences, a condition due to reliance on metaphysical methods and to the inherent difficulty in the use of any other: "Economics," says a correspondent, "has been less successful than the material sciences in getting rid of the apparatus of meta- physical presumptions. The economist is still too eager to formu- late laws that shall disclose the ultimate spiritual meaning of things instead of trying to explain how these things came to pass. He has profited in small degree by those lessons which the progressive evolutionary sciences have driven home in the past in the methods of thinking of workers in other fields. Our science is still sadly behind the times in its way of handling its subject-matter. The greatest and most important work of economic investigations is to make students see things as they are, to fit young men for the more highly 20 UTILITARIAN SCIENCES organized business new conditions are ushering in, and give a better appreciation of the problems of government and a better training for participation in them." Says another correspondent: " Training in research is in fact essential to every technical man. The young technologist will be confronted by new problems not covered by anything in literature or in his past experience. Training in research is training in the art of solving unsolved problems, and the practical man who has had discipline of that kind has a great advantage over his more conven- tional competitors. The Germans recognize this principle, and behold their marvelous industrial growth. The student in every department of science should be taught to think as well as to do." The time must come when a man who has no training and no experience in research will not be called educated, whatever may be the range of his erudition. To unfold the secret of power is the true purpose of education. : QilS I DR. DEAN OPERATING BEFORE HIS GLASS Hand-painted Photogravure from the Painting by H. Gervex The fascinating gruesomeness of a serious surgical operation incorporated, so to speak, with the scientific aspect, is the subject of Gervex's ambitious effort, shown at the Paris Exposition, 1889. The operator is Dr. Jules Dean, author of several works on Surgery, Officer of the Legion and Member of the Institute, France. The painting represents a handsome young girl pre- pared to undergo an operation for an affection of the throat. Dr. Dean is ex- plaining the case to his class before using the knife, and the countenances of his auditors indicate the gravity of his words, a treatment that evidences the genius of the artist. DEPARTMENT XVII — MEDICINE DEPARTMENT XVII — MEDICINE {Hall 1, September 20, 4.15 p. m.) Chairman: Dr. William Osler, Johns Hopkins University. Speakers: Dr. William T. Councilman, Harvard University. Dr. Frank Billings, University of Chicago. THE MODERN CONCEPTIONS AND METHODS OF MEDICAL SCIENCE BY WILLIAM THOMAS COUNCILMAN [William Thomas Councilman, Shattuck Professor of Pathological Anatomy, Har- vard University Medical School, b. Maryland, 1854. M.D. Maryland Univer- sity; A.M. (Hon.) Harvard and Johns Hopkins University. Graduate student of Johns Hopkins University; special course, Vienna, Leipzig, Prague, Strass- burg. Assistant in Physiology and Anatomy, Associate Professor, Johns Hopkins University. Member of Association of American Physicians, National Academy of Science. Author of medical works on Diphtheria; Small-Pox; and Cerebro-Spinal Meningitis.] An acquaintance with present conditions in medicine and with the literature of the past makes us aware of a great change both in the conceptions of medicine and in the methods by which the con- ceptions are reached. There has been a great increase of knowledge brought about by investigation and experiment, a realization of the value of knowledge and its acceptance and utilization. Medi- cine has severed all connection with speculative philosophy and taken its true place among the natural sciences. It has been brought into closer accord with other sciences than ever before and has accepted the methods of science. There are no systems, no schools, no paramount authority; no hypothesis is so firmly held that it is not instantly rejected when it fails to accord with new knowledge. Progress in medicine has gone hand in hand with progress in all departments of knowledge. Medicine has for its problems the cause, the nature, the preven- tion, the cure of disease. It is a branch of biology in that in all of its relations it has to do with living things. The ontologic concep- tion of disease as a thing differing from and entering into the organ- ism is no longer held, but disease is regarded as a condition of living things in which there is disharmony of function. The phenomena of life depend upon actions exerted upon living tissue by its sur- roundings. When the action exerted leads to forms of activity which differ from and fail to come into accord with the usual activ- ities, whatever produces such an action is a cause of disease. These 24 MEDICINE causative agencies acting on the tissue, produce structural alter- ations, in consequence of which even the action exerted by the or- dinary surroundings may result in disharmony. The terms health and disease both carry with them the conception of activity. Al- though the abnormality of function is always associated with and depends upon structural alteration, there may be extensive struc- tural alteration which is so repaired or compensated for that it does not result in disease. In the history of the advance of knowledge in medicine we find two methods by which knowledge has been sought. In one, the endeavor has been made to form conceptions of the objects studied by means of impressions conveyed by the senses. Great advances have always followed the discovery of methods and instruments by means of which the territory of investigation has been extended. The inquiry does not stop with the mere description of the concep- tions derived from the sense-impressions, but an effort is made to correlate them, to ascertain preceding conditions, and the meaning or idea involved. When the inquiry passes beyond the immediate investigation, an ideal conception of the nature, the interrelation, the cause or the result of the conditions studied, an hypothesis, may be formed, based on experience and analogy. The hypothesis must be tested by further observation under natural conditions and by the experiment which involves observation under known and controlled conditions. When the hypothesis has been so tested and found to hold good in all cases under the same conditions, it can be used as a basis from which new questions may arise. The other method is by speculation. By a wide and illegitimate use of analogy conceptions are formed and projected into the objects, instead of being derived from the sense-impressions. A tendency to speculation is inherent in the nature of man. Confronted al- ways with the unknown, which has such enormous proportions compared with the known, and so much of which seems to be re- moved from the possibility of actual investigation, man is led to attempt to answer the questions which the unknown thrust upon him by means of the imagination. As knowledge becomes deeper and more extended, speculation tends to become more confined. True philosophy aims at a complete understanding of the causal relation of all processes in nature and of man's relation to these processes. Disease, as one of the most important conditions in nature affecting man in all of his relations, has always had an im- portant place in philosophy. All the systems of philosophy in the past, from Plato down, have embraced speculations concerning disease. The true ends of philosophy cannot be reached by specu- lation, but by the use of all the material for observation given by the natural sciences, and a philosophic system will contain just so MODERN METHODS OF MEDICAL SCIENCE 25 much truth as there is natural science in it. Nature seems to de- light in refuting all conceptions of her processes which are not based on sense-impressions. The progress of knowledge by these two methods has been the same in all sciences as in medicine, but it is more easily followed in medicine, because of the important place which its subject disease has always held in the thoughts of man. It is possible to trace the past in the conditions of the present. In the earliest period of medi- cine, before there were any records of the study of the phenomena of disease and any differentiation of disease, disease was regarded as the visitation of the wrath of offended deities, and the surest mode of its relief the propitiation of the deity by supplications and offerings. Such beliefs are still held, or at least practices which were based on such beliefs are continued. In almost all countries at the present time it is the custom to offer supplications that the disease of an important individual may be removed by divine inter- position. It is true that such prayers may be a part of past tradi- tion or a part of the discipline of a religious system, but undoubt- edly their efficacy is believed in by many. Disease has played an important role in systems of religions, and the teachers of the sys- tem who had most fully embraced its tenets were supposed to be the most efficacious in removing disease. Christian Science is only one of a great number of religious systems held to-day in which treatment of disease forms an important part of the cult. In the past there have been systems of medicine which gave explanations of all phenomena, and the system being perfect the phenomena were removed from further investigation. Homeopathy is the most important survivor of such speculative systems. Speculation has undoubtedly been fostered by systems of religion founded on what was accepted as supernatural revelation. Reve- lation which sufficed for the explanation of phenomena at the time when it was given becomes firmly and inseparably blended with speculation when it must be expanded to meet a wider range of phenomena. Knowledge cannot be diffused, accepted, or utilized beyond the general development of culture. Any general influence which can be exerted on the people, turning thought into new directions, giving new subjects and proper methods, is of great importance. Darwin, by substituting a rational and easily com- prehended hypothesis, based on observation and experiment, with a clear statement of the method by which the hypothesis was formed, for a revelation which did not suffice and which could not be twisted to conform to what was of general and accepted know- ledge, exerted probably the greatest influence on general scientific progress in the last century. Medicine, like all other sciences, has felt its vivifying influence. 26 MEDICINE One of the greatest changes which has taken place in the last century is the general acceptance of the idea that medicine is a natural science, in which knowledge must be sought by the methods of science, namely, observation and experiment, and that disease is the result of injurious conditions acting upon the tissues. A great part of the mystery surrounding disease has been removed b}' know- ledge of the conditions which give rise to it, with the further know- ledge that it is possible to prevent disease by removing such con- ditions. Even though some may still believe that an epidemic of typhoid fever is an act of God, they must see that the action is exerted by means of a defective water-supply, and the surest way of removing the epidemic is not by supplication, but by purifying the water. At no time in the world's history has the importance of knowledge been so fully recognized as at present. People see the application of knowledge in the arts, and that improvement in the processes involved is directly dependent upon increased knowledge of the processes. There is a closer union between science and art than has ever been before. We see the influence of the appreciation of knowledge in medicine in the general acceptance of the idea that the hospital, in addition to taking care of the sick, shall furnish facilities for the investigation of disease; in the creation of institutes devoted to the furtherance of medical knowledge, and in endow- ments of universities to the same end. A brief glance at some of the more important periods in medical history will enable us to trace the influence and the results of the two methods by which knowledge has been sought. The history of medicine begins with Hippocrates. Before him there were only superstition and tradition without systematic observation and description. He described accurately the results of his stud}' of the phenomena of disease, classified the phenomena, and based his methods of treatment on his observations. The influence of Greek philosophy made him attempt to explain the phenomena, by the assumption of a force residing in and presiding over the body. The contemporaries and successors of Hippocrates who regarded him as a god, and his conclusions as unfailing axioms, entirely neglected the methods by which he arrived at them. It must ever remain a source of wonder that the light which burst upon medicine with the advent of Hippocrates should so soon have passed into darkness. The Greeks chose rather to speculate on the meaning of phenomena than to investigate them. Galen, next to Hippocrates, had the greatest influence on medicine, an influence which was dominant for more than 1300 years. Galen mastered all the knowledge and traditions of medicine at his time and made important contributions to anatomy and pl^siology. He was the first to introduce the experimental method into medicine, and gave a firm foundation MODERN METHODS OF MEDICAL SCIENCE 27 to nerve physiology by observing the paratysis of certain muscles after section of the nerves. A voluminous writer as well as investi- gator, Galen created a complete system of medicine which remained as authority until men became bold enough to throw over authority when it did not conform with what could be learned from investi- gation. The stagnation and decline in medicine which followed Galen and continued during the Middle Ages was due to the dom- inance of a dogmatic religion in lands in which the general culture of the people should have given the conditions for knowledge to increase. The Church regarded its dogma as sufficient, and all inquiry, all free activity of men's minds were prohibited. Dogma based on supposed revelation sufficed. There was some attempt at progress made by the Arabians, but their most important contri- bution was the preservation of the old learning. Even the period of the Renaissance passed with little or no influence on medicine, for mental activity was turned exclusively into channels in which dogma could not be disturbed. Three circumstances served to bring about a new era in the pro- gress of knowledge in which medicine shared. The discovery of the art of printing by which knowledge became more diffused and more exact by the substitution of record for tradition, the discovery of America, with the stimulation which this gave to thought and imagination, and the Reformation, which gave freedom to thought, removed the weight of authority, and allowed investigation. The reform in medicine was introduced in Europe by Paracelsus, whose work was chiefly the overthrow of the Galen system, which had sufficed and under which investigation was not possible. Progress in the new reform was more active in England than in the land of its birth. This was due to the freedom from war, the greater freedom of the people in all ways, and to the work of Francis Bacon, who for the first time showed clearly the methods by which knowledge must be sought. With few exceptions, English medicine has remained true to the precept of Bacon, that knowledge increases by the observations of things with the proper utilization of past observa- tions. There has been an almost continuous line of great physicians in England who have enriched medical knowledge by investigation and who remained free from speculation. The contributions which such men as Harvey, Sydenham, Hunter, and Bright have made, remain and have served as bases from which knowledge has grown. The theories which were founded upon their work have passed with- out influence. That there came a time in England when medical investigation was greatly surpassed in other countries, is to be attri- buted to the introduction of methods of investigation which could not be utilized in England. It was the introduction of the labora- tory with the facilities for and the systematization of medical investi- 28 MEDICINE gation which gave medicine in Europe its ascendency. Young men at an age when authority has the least weight, and before there was opportunity given them for the investigation of the clinical phe- nomena of disease, found in the laboratory opportunity for inves- tigation, and had small questions placed before them which could be solved. The laboratory gave the workers scientific methods which formed the basis, and gave the direction of further work in the clinic. With the laboratory came also a division of labor, which allowed certain men to devote their time to investigation and teaching. Ambition was stimulated, for advance and the further career was made dependent upon the ability for investigation. It is interesting to follow a wave of speculation in medicine which reached its acme in Germany in the early part of the nineteenth century. In the period following the Reformation the most striking figure in medicine was Albrecht v. Haller, a man who as investigator and clear thinker has been equaled by few. Haller recognized the important fact that life was a property inherent in the tissues and manifested itself by sensation and movement. On the work of Haller is founded the system of Brown, who though a Scotchman can be regarded as the forerunner of the German Natur-philosophie in medicine. The system of Brown is founded on the principle, which he states clearly, that the living animal body is distinguished from the dead and from all lifeless matter by the capacity for excitation by external influences. The difference between health and disease lies in the degree of irritability of the tissues. He divided disease into the sthenic and asthenic types, according to the degree of irritability developed by the excitant, and the treatment of disease was based on this. In the hands of Brown's pupils and successors treatment of disease was productive of great harm. The theory of Brown found ready acceptance in Germany, not only by physicians but by a group of men who sought to explain nature by the creation of laws. The law once made was regarded as more correct than the observa- tion. Schelling, who was the foremost figure in this philosophy, sought to give a representation of all the phenomena in nature, to develop the interrelation of the phenomena, to show the action of natural laws in all bodies, and believed that these laws originated in a common point and were characterized as an advancing series of higher phases of development of matter. Not only was it impossible to construct a system of the world from the knowledge of nature at that time, and it probably never will be possible, but Schelling very imperfectly utilized what knowledge there was. This Natur- philosophie dominated medicine in Germany during the first quarter of the nineteenth century. It is expressed to a greater or less extent in all medical writing. The most gifted men could not entirely withdraw from its influence. Medicine was not a science following MODERN METHODS OF MEDICAL SCIENCE 29 the methods of observation and experiment, investigation was banished from the clinic and laboratory and found its place at the writing-desk. Hartmann says that one reason why the Natur-philoso- phie found such ready acceptance was the ease with which it was possible by its aid to become famous as a writer. The young phy- sician found it no longer necessary to become acquainted with the material for study by toilsome investigation; he only needed the philosophic forms of expression and could apply these to what he knew or did not know of medicine. Many systems of medicine were founded which purported to give a complete explanation of all the phenomena of disease. Of all these systems, the one which has endured the longest was almost the most fantastic in its structure. The success of the system of Hahnemann or homeopathy is, in the first place, due to the fact that under it the treatment of disease represented a great advance as compared with treatment under the systems of Brown and Rasori. However zealous the exponents of a system may be, it will find its condemnation from those who suffer most from it. The system as presented by Hahnemann was com- plete; it offered names and seeming explanations for all conditions. The practice of the medical art under the system was easy and involved no toilsome investigations. It was put forth at an early period of the Natur-philosophie and was carried upward on the tidal wave which swept through Germany. It at once found great favor with the people and was taken up by great numbers of phy- sicians. In the course of time the adherents of the system have become divided into three camps. In one its principles have been extended far beyond the conception of Hahnemann, in that the products of disease have been used as remedial agents; a second have remained true to the principles of the founder; and a third, comprising a large number of intelligent physicians, hold only to the name. Under the Natur-philosophie, combinations between religion and medicine arose and a system, which represented a return to medieval mysticism, was formed by Windischmann and Ringseis. In this it was taught that the causes of disease are immaterial and not to be sought for, since disease merely represents discord between body and soul. Such a remarkable phenomenon as the dominance of the specula- tion which was5 a part of the Natur-philosophie must be regarded as a part of the romantic movement which swept through Germany and found its chief expression in poetry. All barriers to idealism and speculation were cast aside. The movement was a part of the awakening of Germany to a new national life. The great questions of the time involving political liberty and even national existence were absorbing. Under such circumstances only a few could turn from the pressure of such large questions to the narrow field of 30 MEDICINE scientific investigation. It is remarkable that the great awakening in France which preceded it should have been characterized by the opposite tendencies. During this period of speculation in Germany valuable contributions to knowledge were continually being made in anatomy and physiology. The chief exponents of the Natur- philosophie were physicians who had to do with the clinical phe- nomena of disease. Speculation was fostered because the methods of gaining information from the study of disease were at the time so meager that observation was restricted. So confirmed was the habit of speculation that each new discovery in anatomy and physi- ology, instead of serving as a basis for investigation, became food for new speculation. It is possible to see the influence of the Natur-philosophie on its greatest opponent, Rudolf Virchow. No one more clearly laid down the methods of scientific investigation than did Virchow in the opening articles of his Archivs. He was a born investigator and made valuable contributions to knowledge in every department of medicine. The protocols of his autopsies are models of full and accurate descriptions of observations. He made important additions to the technic and methods of work by the use of which new know- ledge was gained. He was a great teacher as well as investigator, and men trained in his methods are among the most famous in medicine. It is difficult to find in the history of modern medicine any one who can be compared with Virchow in the contributions made to medical knowledge and the influence which he exerted. He sub- stituted for the ontologic conception of disease, which was prevalent in Germany at that time, the conception which we adopt to-day, that it consists in life under altered conditions. This is not an explanation, but a simple way of stating the summation of the most obvious phenomena. He created the cell theory of disease, which, though it represented an enormous advance over prevalent theories and has been most stimulating to investigation, can no more be held in its entirety as Virchow gave it than any of the systems it supplanted. Unlike the other systems, it did not pretend to be all-satisfying and all-explaining. The cell theory of disease should be regarded as an hypothesis fully justified in being formed from the knowledge at that time available. In Virchow's theory of inflammation we see the great value of an hypothesis which, though gradually proved incorrect by continued observations, has been most stimulating to investigation. It is interesting to see the con- tention which has been excited by theory. No one contends for the acceptance of an observation, but is content to leave this for time, but the contention is for the conception based on the observation and the theory formed from the conceptions. Virchow properly MODERN METHODS OF MEDICAL SCIENCE 31 opposed the ontologic conception of disease, but this led him also to oppose the proof given that certain diseases which he regarded as due to the action of general causes, were due to parasites. Virchow appeared in medicine at the time when Natur-philosophie, though seemingly dominant in Germany, was really far advanced in decline, and his mighty blows were delivered against a feeble body. It was the knowledge of French and English medicine, wmere the advance had been by investigation, the increase in knowledge in all the nat- ural sciences giving too much to be covered by any system, which gave the death-blow to this period of speculation in medicine. It is possible now to see the effect of this period of unrestricted imagination on medicine. It is true that it inhibited progress, by restricting observation and experiment, that it substituted theory for knowledge, and found satisfaction in empty phrases and jug- gling with terms. But it gave birth to fruitful stimulation, and opened wdde and distant vistas which science has utilized. The excitation of the imagination, provided the imagination be con- trolled and theories be recognized as theories, is most useful in science. Without the imagination, without the tendency to seek for explanations of phenomena, there would be no progress. There is only danger in the failure to recognize the true relation of the hypothesis and in attempting to progress by adding hypotheses. There was but little progress in the period, but progress resulted from the stimulation which the period gave, and from the reaction which followed it. Although as playing a great part and affecting an entire people, such a movement has passed and will probably not return, we constantly see the same tendencies. The medical systems, often connected with religion, which are constantly arising in all countries, and especially in this, the attempt to form theories in explanation of the unknown, are due to the same mental states which produced the Natur-philosophie. They arise, have a ready following composed of birds of passage resting temporarily on any bough provided, and disappear without making any real impression. How completely the period of the Natur-philosophie has passed in the country of the creation is seen in the history of medicine in Germany for the last fifty years. By the adoption of scientific methods, by the fostering influence of the government, which pro- vided facilities for research, and by a system which gave reward for investigation, Germany has become the leader of the world. At no time in the world's history was there such rapid advance, such a complete transformation in methods, such an array of great men in all the departments of medicine as in France, following the Revolution. The foremost of the men in this school in France was Bichat. He undertook the gigantic task of creating for medicine a solid foundation derived from the study of objects and from ex- 32 MEDICINE periments. He carried the anatomic study of disease further than ever before, endeavoring to ascertain not only the lesions in the organs, but in the tissues which compose them. The relation be- tween the anatomic lesions and disorders of function he says must be studied by experiment. The work of Magendie in physiology was hardly less important than that of Bichat in pathology. Phy- siology had suffered from the theory of vital force which as a seeming explanation weighed upon it as an incubus, opposing investigation. He claimed for physiology the same methods as in physics and chemistry, saying that the carefully conducted experiment is alone decisive in testing the conclusions formed from observation of phe- nomena. The work of Magendie had full recognition in France, and he was followed by Claude Bernard and Brown-Sequard, who further developed his methods. Corvisart, Andral, Louis, Rayer, and Cruvilhier were among the most brilliant men in the new school which was founded by Bichat and Magendie. Corvisart and Laennec deserve especial mention in that the former brought to general knowledge the method of percussion of Auenbrugger, which had been forgotten, and the latter introduced and further developed the method of auscultation. In the advance of science new technical methods of investigation play a most important role. The technical method enables the observation to extend further and more deeply. Virchow has said that the introduction of the microscope into medical research en- abled us to approach several hundred times nearer disease than before. The microscope introduced a new era in the study of disease; it came into general use when the study of gross pathology in the absence of new questions had almost reached its limit. It gave more correct ideas of disease by increasing the powers of observation; it overthrew at once many theories and gave new points of view and new questions, . from which further observation could proceed. Every improvement in the microscope by which its efficiency is increased has the same influence. The knowledge of the influence of bacteria in disease is due, in the first instance, to the improve- ment of the microscope, and in the second, to the discovery by Koch of methods of cultivation, by means of which the individual species can be studied. Until this was possible our knowledge of bacteria was inexact and their causative relation to disease only an hypothesis. The development of knowledge of the minute struc- ture of cells and tissues is principally due to the use of methods of staining, which started with the simple carmin stain of Gerlach. In clinical medicine the introduction of the microscope, the thermo- meter, the methods of chemic investigation, the blood-counter, the Rontgen ray, have all led to a closer insight into disease and the substitution of knowledge for conjecture. There is a further indirect MODERN METHODS OF MEDICAL SCIENCE 33 advantage which comes from the use of instruments of precision in investigating phenomena, in that the continued use of the methods, the constant seeking for exact knowledge of conditions removes the tendency toward speculation. The brilliant results which have been reached in surgery, changing this from the most despised to the leading branch of medicine, show the advantage of methods which are founded on knowledge. Surgery was despised in the period in medicine in which speculation was in the ascendency, when the answers to its problems were sought in the study rather than at the bedside and in the laboratory. The art of surgery has been dependent upon direct observation of disease, and its remedial measures were applied to the disease as revealed by sense-impressions. Theories and systems in medicine have come rather from internal medicine, in which field the diseased conditions were not so susceptible to study as things. The broken leg, however, is revealed by sight and touch, the tumor is an object. Moreover, the training in the anatomic and other laboratories so essential for a surgeon, gave the knowledge and the methods, and the manual skill to make them effective. At an early period surgery had re- course to animal experimentation, for the animal body offered the readiest means for testing new devices. In surgery new knowledge has been readily accepted and utilized. The demonstration of anesthesia came first from the surgeon, and the surgeon was the first to accept and apply the knowledge that infection is due to the action of living organisms. By the use of anesthesia and of measures of preventing infection, surgery has been extended into fields for- merly supposed not to be open to the exercise of its art. Medicine owes a debt to surgery for not only what it has accomplished, but for holding to proper methods and demonstrating their importance. The less advance in modes of treating disease which internal medi- cine has made, compared with that made in surgery, is to be attri- buted to the difficulty of obtaining definite knowledge of the con- ditions of disease in internal organs. That the lack of power is due primarily to lack of knowledge is shown by the fact that for diphtheria, formerly one of the most dreaded, now probably the best-known of diseases, there is a remedy which leaves little to be desired. The production of antitoxin is the greatest triumph of scientific medicine and is due to knowledge obtained by the application of scientific methods to the study of a disease which gave unusual opportunities for investigation. It points out what may be accomplished in the future by not seeking for analogies between other diseases and diphtheria, but by pursuing the same methods. Modern therapeutics is guided by two principles in each- of which efficiency is dependent upon knowledge of disease. In the most important, the remedial agent has a specific action on 34 MEDICINE the cause of disease, either destroying it or opposing its action. In the second, the remedial agents are used not with the view of exert- ing any specific action against the cause of disease, nor even in assist- ing in the restoration of the tissue which has been injured, but with the view of restoring function. Any agent acting as a cause of disease produces injury of the tissue, and the effect of this is altera- tion, or diminution, or destruction of function. There is a close in- terrelation of function, that of one organ depending upon the others. The effect of the alteration of function is seen in the supervention of phenomena, which differ from the ordinary. The effect of impaired function may be remedied by supplying the body with some sub- stance which was formed by the impaired organ. Substances directly derived from glands in the animal body, such as thyroid and pancre- atic extract, may be supplied. Or the functional activity of an organ may be increased by direct stimulation or increasing its blood supply. Or the function of some other organ nearly related to the organ affected may, by increased function, be caused to supply the deficienc}^. Therapeutics acts either as a guard against, or as a caretaker of the body in disease. Its greatest triumphs are in prevention. When the injury has once been produced, its effects are minimized by the capacity of the body to adapt itself to new conditions. There is a third use of therapeutics in the case in which the disease pro- duces so much pain and discomfort that the remedial agent is used for the purpose of diminishing the effect of sense-impression on the central nervous system. It is clear how complicated the questions are, and how much greater is the task presented to the physician than to the surgeon. The surgeon acts directly, either adjusting parts which are deranged or by removing tissue which is diseased. The study of medical literature shows the mistakes and follies which have been and are being perpetrated in therapeutics. The more obscure the disease, the greater the number of remedies; the more ignorant the practitioner the more confidence that certain drugs will act as remedies in all diseases. Each year has served to discard some remedy considered infallible and to substitute for it another equally infallible. The discontent of the general public with such therapeutics is shown in the success of charlatans who advertise nostrums for the cure of all diseases. It is just as easy for them to obtain certificates of cures by the nostrums as it is for the practitioner to become convinced of cures effected by certain favorite drugs. The greater knowledge of the infectious diseases which has come with their experimental study has especially served to place thera- peutics upon a proper basis. It has become apparent that many diseases are self-limited and tend to recover under any treatment, MODERN METHODS OF MEDICAL SCIENCE 35 provided this be not too injurious, and that the medical art can be more successfully exerted in preventing disease than in its cure. The first effect of increased knowledge of disease was to produce a feeling of powerlessness in the face of it, followed by a nihilism in therapeutics which was as much to be deplored as overconfidence, for it acted as a bar to progress. This nihilism was a prominent feature of the Vienna school in the sixth decade of the past century. The science of therapeutics as we find it to-day is founded on ex- perimental pharmacology and pathology. In experimental pharma- cology the action of drugs on the healthy animal is investigated. It is sought to discover the mode of entry of the drug into the tissues, the mode of excretion, the changes the drug undergoes while in the body, and the changes in structure and function it produces. The action of the drug may differ in different animal species. Know- ledge of the pathology of disease shows in what part changes are produced by the causative agent, the nature of the changes, and the effect of these changes on function. The determination of what is taking place in the body in disease is the most important ques- tion in medicine to-day. For its answer all the resources of science must be brought to bear. The subject is rendered more compli- cated by the fact that we are not dealing with a fixed but with a variable quantity. Age, heredity, temperament, and social en- vironment must all be considered. We cannot say, except with wide limitations, what changes and variation in function will be produced by the action of certain conditions. With the knowedge of the effect of the drug on the healthy body, and the knowledge of what changes are being produced in disease, and the effect of which we wish to minimize, an intelligent experiment may be made. Previous experimentation on animals should deprive the experi- ment of all danger. Another change which has become apparent is the greater spe- cialization not only in the exercise of the medical art, but in in- vestigation. All increase of knowledge must bring with it special- ization, for with the enlargement of the field comes the impossi- bility of its control by one individual. Specialization has both advantages and disadvantages. The advantages are, that inves- tigations are more easily carried out by the simplification of the questions and the familiarity with technical methods. Methods of investigation have become so complicated that the necessary skill can only be attained by the constant exercise of methods only applicable in a very narrow field, and an investigator of ex- ceptional ability in one line of work may be powerless in another. A man may profitably devote his entire energies to the study of the changes in nerve cells in disease, or may confine himself to the study of a single species of bacteria. With the enormous increase 36 MEDICINE in medical literature there has come specialization in this, and certain journals are devoted to special subjects and are only read by those working in the field covered. The first differentiation came in the separation of anatomy, physiology, and pathology from prac- tical medicine, that is, the medicine concerned with the exercise of the art. The separation was a natural one, for not only could progress be more rapid, but the subjects could be better taught by one who had the knowledge which came from his own investi- gations. It is no longer possible for a single individual to control the knowledge in any of these primary subdivisions. The most obvious disadvantage in specialization is the loss of the more gen- eral aspects of questions. The large questions become broken up into smaller, and the smaller questions become leading questions to be again broken up. It is also felt that the knowledge gained in such special investigations may not be of a character which can be utilized in the treatment of disease. But few of the questions which arise and form the basis for investigation come from the clinic, and they apparently have only the most remote relation to the problems of disease. The investigator very properly feels that his investigations are justified, in that they form contributions to general knowledge, and whether or not the results are directly applicable to the treatment of disease does not disturb him. There was an error perpetrated in not giving to those devoted to the study of the clinical aspect of disease the same opportunity to devote themselves to research, to answer the question which came from the phenomena of disease, which was given to anatomy, physiology, and pathology. Clinical medicine, the study of the problems of disease coming from the bedside, must have the same opportunity and must advance by the use of the same methods as physiology and anatomy. Clinical medicine is behind the special departments in the contributions it has made to knowledge, in the methods by which it seeks to advance, and in the efficiency of teaching. Provision must be made in the universities which will enable men in the clinical departments to devote themselves to research and teaching, and laboratories must be provided for such research. Only one who is himself an investigator can direct in- vestigation by recognizing and properly stating the questions. There need be no fear that the knowledge which comes from investigation will not be utilized. In what way may not be apparent at the time. Often knowledge which seemed furthest removed from utility has become the most important. That knowledge is power, and that it is the only power is an accepted axiom. Anatomy and physiology, originally arising from human medi- cine for the furtherance of knowledge which could be applied to the treatment of disease in man, have long outgrown such limita- MODERN METHODS OF MEDICAL SCIENCE 37 tions. Both have become comparative. Physiology undertakes the study of the processes taking place in living things, anatomy their form and structure. The comparative view has more slowly entered into pathology, for this has been more closely in contact with clinical medicine, and mostof the questions for investigation have arisen in connection with the diseases of man. Disease is found in every living thing, in all animal and plant life. The phenomena of disease must differ according to the conditions peculiar to the organism. Strictly speaking there can be little similarity between the phenomena of disease in a plant and in an animal. The functions that are destroyed or altered by disease are too dissimilar. But this is not true when we study the closer details of disease. In both, changes are pro- duced and the changes affect function. We can study unicellular organisms directly under the microscope, see the changes which are being produced by injurious conditions and the effects of the changes. Knowledge derived from such study may be said to be the basis of our conception of inflammation. The studies of plant diseases have been almost entirely directed from the economic side. The economic results which have come from this study by enabling the prevention of disease are almost incalculable. General medicine has gained by this study a greater knowledge of para- sites, their mode of action and the means by which the organism is protected against them. That the knowledge has been so rapidly gained is due to the facilities for investigation and experimenta- tion. Plant experimentation has never given offense. It should be regarded on the whole as very much better that the study of plant disease has been directed from the economic side, for progress has been more rapid, but there would be advantage in the closer association of plant and animal pathology and the extension to plant diseases of questions coming from disease in man. Careful study of diseases in animals has been chiefly directed to the infectious diseases and especially to those artificially pro- duced. The questions have been chiefly those concerned Avith the parasitic cause of disease and the mode of action of the parasites. The more obscure diseases of animals have attracted but little attention and only from the economic side. The phenomena of disease in the higher animals have much similarity to the phenom- ena of disease in man, and in certain aspects the diseases of animals are more capable of investigation. Diseases are found in ani- mals which are similar to the most obscure diseases in man. Our ignorance of these diseases in man is due to their complexity and the difficulties of investigation. To their understanding chemical and physical methods are necessary, and some of these methods cannot be carried out, for they may be harmful to the individual. In animals we have the advantage that the disease can be inter- 38 MEDICINE rupted at any stage and the conditions studied at this stage. We know the infectious diseases of animals chiefly by their experi- mental production. There has been but little study of these dis- eases under natural conditions and much knowledge can be gained by the mode of, and conditions predisposing to, infection. Ques- tions of heredity have an important bearing on disease. The sus- ceptibility of animals to disease varies. Common experience has shown in man also that, under circumstances apparently the same, certain individuals will acquire diseases, others remain exempt. There is also foundation for the belief that susceptibility for cer- tain infectious diseases is inherited and in other diseases inherited susceptibility is beyond doubt. The most striking recent discovery in medicine is that the blood-serum contains many complex sub- stances. Some of them play an important role in the animal econ- omy, for others we can as yet discern no purpose, and our know- ledge of these substances is chiefly confined to their effects, but it has recently been found possible to isolate one substance in pure form with a known chemic composition. While these substances may serve an important role in protecting the body against disease they may act in the opposite way by providing a means by which injurious substances are brought in contact with cells. Whether chemic variation may not arise, be inherited, and play an important part in disease susceptibilit}'- is an important question to be answered by comparative medicine. For the purpose of such investigation an animal clinic is necessary, which should be provided with thorough facilities for the study of disease. The questions for solution should come both from comparative medicine and from the clinic of human disease. Comparative medicine is intimately associated with experimental medicine. There can be no contention as to the relative advan- tages of observation and experiment. The experiment is only obser- vation under simple and known conditions and supplements obser- vation under the more complicated natural conditions. In the experiment it is possible to divide questions into their simpler com- ponents and make each the subject of experiment. In experimental medicine just as in the animal clinic, the questions for solution should come from both comparative medicine and the human clinic. The most brilliant results in experimental medicine have come from the study of the infectious diseases. Knowledge of these diseases stands in direct relation to the possibility of their experimental production. It is true that we have not been able to produce in animals man}' of the diseases which are found in man. Experimental medicine is comparatively new and the number of animal species experi- mented upon has not been large. It has recently been found possible to produce syphilis in the chimpanzee and there is every reason to MODERN METHODS OF MEDICAL SCIENCE 39 hope that this will lead to knowledge of the nature of this most obscure disease. Questions concerning the circulation and respira- tion in disease which are closely related to physics will find their answer in experimental medicine. The opponents of animal ex- perimentation should remember that the greater our knowledge of disease which comes in this way, the further will disease in man be removed from experiment. Before our present knowledge of diphtheria, tuberculosis, tetanus, and anthrax, all treatment of these diseases was experimental. In certain cases experiments must be carried out in human beings and even when the experiments may have a fatal termination. Such experiments will only be resorted to when this forms the only method of obtaining knowledge of the highest importance, and the subjects of the experiment must be adults who submit with full knowledge of the possible consequences. Let us give all honor to the men who devised and the brave men who submitted to an experiment, the knowledge obtained from which has placed yellow fever in the list of pre- ventable diseases. There has been in the past too wide a separation between the public and the medical profession. The public has derived its medical information chiefly through the newspapers and the information so given has been sensational and unreliable. Without correct infor- mation of the problems which face the medical profession and of the methods by which these problems are being solved, neither the sym- pathy nor cooperation of the public may be secured. Active or passive opposition may be encountered. There is evidence that this is being slowly changed. The medicine of the romance is not so fantastic as it was formerly. The general information in biology, human anatomy, and physiology necessary for any appreciation of medi- cine is being imparted by the schools. Many of the popular maga- zines contain admirable articles on disease. The stories of such diseases as malaria and yellow fever have actual fascination. The medical education of the public is also furthered by the work of boards of health in the control of infectious diseases. The public is slowly but none the less surely learning that disease is not a mysteri- ous entity, dwelling like a devil in the body, to be driven out by the use of some equally mysterious agent, but a condition of life which can be guarded against. The public is not slow in the ap- preciation of the results of the work of boards of health, and is willing to make provision for their work. Medical education, the training of men to exercise the art of medicine, has been revolutionized in the past twenty-five years. The most marked change has been in the substitution of object-study for the didactic lecture. The didactic lecture is still used, though not with the idea of imparting knowledge, but of showing the in- 40 MEDICINE terrelation of knowledge coming from objective teaching. The suc- cessful practice of medicine depends more than ever before upon the use of methods which give accurate knowledge of the con- dition of the sick individual, and training in the exercise of these methods is the most important part of medical education. It is certainly of importance that the student should learn the structure of the body, the functions of the different organs, and the changes which organs and functions undergo in disease. The knowledge acquired will be constantly used in solving the problems presented in the practice of medicine. While this is true, a great part of the value of these studies consists in the discipline which laboratory study enforces. In the laboratory the student learns to acquire conceptions of objects and of the activities taking place in them, by means of sense impressions, and to use and appreciate methods by means of which the field of investigation is extended. He learns to approach pro- blems from the scientific point of view. Progress and success in medi- cine is directly dependent upon the habit of investigation. Medi- cine is not and probably will not be an exact science with definite laws, by the application of which the exact sequence of phenomena can be foretold. Every case of disease is a problem, and on the knowledge acquired from investigation successful treatment of the individual depends. Science demands to know, and methods by which knowledge can be obtained are of supreme importance. Methods of obtaining knowledge have been widely extended in clinical investigation. Every year sees the discovery of new methods. There should be, and with the foremost men there is, no distinction between the clinic and the laboratory. In both knowledge is sought by the use of the senses, and methods of investigation have a su- preme importance. The laboratory discipline can be given just as well in the clinic as in the other laboratories, with the advan- tage that the methods of the clinic are the methods which are used in the practice of medicine, and facility in methods can only be acquired by continual exercise. It is evident, however, that the laboratories and clinics should only be conducted by men who themselves know and fully appreciate the importance of methods. It is probable that in the medical education of the future there will be a restriction of the laboratory training in anatomy, physiology, and pathology, and an extension of the training in the methods of the clinical laboratory. THE DEVELOPMENT OF MODERN MEDICINE BY FRANK BILLINGS [Frank Billings, Professor of Medicine, University of Chicago, and Professor of Medicine and Dean of Faculty, Rush Medical College, b. April 2, 1854, High- land, Wisconsin. M.D. Northwestern University Medical School, 1881; M.S. ibid. 1890; Demonstrator of Anatomy, ibid. 1882-85; Lecturer on Physical Dia- gnosis, ibid. 1883-87; Professor of Physical Diagnosis, ibid. 1887-91; Professor of Medicine, ibid. 1891-98; Professor of Medicine, Rush Medical College, 1898; Dean of Faculty, ibid. 1900. Member of Association of American Physicians; Association of American Pathologists; American Medical Association; Illinois State Medical Society; Chicago Medical Society; Chicago Pathological Society; Chicago Academy of Science; Chicago Neurological Society; Chicago Literary Club. Editor of Year-Book of Medicine.] Modern medicine is a composite of the knowledge of many sci- ences. The last twenty-five years mark the period of the greatest evolution of medicine in its history. The foundation of modern medi- cine was laid by the labors of hundreds of earnest workers in the field of science during the last three centuries. As a rule the value to modern medicine of these pioneer investigators was in an in- verse ratio to the length of the period which separated them from modern times. Exceptions to this rule are found, however, even in the seventeenth and eighteenth centuries. Indeed, at that period when one considers the superstition, prejudice, mystic belief, magic, astrology, dogma after dogma, and system after system which pre- vailed, the inheritance of the dark ages, our admiration is excited by the really great results of the work of some of the scientists. Until the seventeenth century, Hippocrates, Galen, and Aristotle were the authorities in medicine. There was practically no ad- vancement in medicine in that period of time. Anatomy and patho- logy were not understood; dissection was forbidden by the clergy of the Middle Ages, because it was considered impious to muti- late a form made in the image of God. Dissections of the human body were practiced to a limited degree during the fourteenth and fifteenth centuries, but the sixteenth century was marked by the birth of Vesalius, a naturalist, whose investigations in human ana- tomy marked the beginning of scientific medicine. The seventeenth century marked the birth of realism. Galileo was a reformer in physics, and other scientific men broke away from the superstitions and dogmas of the day and searched for light along self-chosen paths. During the century, Harvey dis- covered the circulation of the blood. Zoology and botany were cultivated. Romer calculated the velocity of light. Lord Bacon's brilliant mind shone resplendent. Sir Isaac Newton discovered the law of gravity. Malpighi, Steno, Bartholin, De Graf, Wharton, 42 MEDICINE Nuck, Brunner, Wirsung, Peyer, Havers, Cowper, Schneider, Hew- son, Vieussens, and Merkel, and many others, dissected out ever- lasting monuments of their genius and skill. Hooke introduced the term "cell," and the cell-doctrine was founded by Malpighi and Grew. Linnaeus, Kant, Richelieu, Mazarin, Moliere, Bach, Hayden, Beethoven, and Goethe were contemporaries of these other great men. Peruvian bark was introduced into Spain during this period. The eighteenth century, called the golden age of medicine, wit- nessed a continuation of the constructive and realistic work of the previous century. Pathologic anatomy was born, and in the person of Morgagni received an impetus which gave it everlasting life. John Hunter, Baillie and Home in England, and Bichat in France were worthy successors of Morgagni. In this century Leopold Aven- brugger, the discoverer of percussion as a means of diagnosis of the diseases of large organs of the body, introduced the method in clin- ical investigation. Haller originated experimental physiology. An ambulatory clinic was inaugurated at Prague in 1745, and the first clinical institute was founded at Vienna in 1754 by Van Swieten. Preventive inoculation against small-pox was performed, a method of protection against variola which was practiced by the Chinese a thousand years before Christ. The most notable event of that period occurred at the close of the century with the discovery, by Edward Jenner, of vaccination as a protection against small-pox. The period marked by the first seventy-five years of the nineteenth century was but a continuation of the tendencies of the preceding period. The watchword of medicine was pathological anatomy and diagnosis — the so-called scientific or exact medicine. This tendency to realism was modified to some degree by the philosophic teaching of Schelling, Hartman, Spencer, Haeckel, Hagel, and others. Pathologic anatomy found brilliant exponents in Bretonneau, Corvisart, Bright, Rokitansky, Louis Magendie, and many others. The practical salutary effect of pathology upon practical medi- cine was evinced by the epoch-making clinical observations of Addison, Graves, Cheyne, William Stokes, Trousseau, Wunderlich, Ziemmsen, Corrigan, and others. Notable was the advancement made in physical exploration in diagnosis. Avenbrugger's inven- tion of percussion was extended by the translation of his book and the adoption and improvement of the method of percussion by Corvisart. In 1815, Laennec invented the stethoscope. Skoda developed both percussion and auscultation and published his famous work on these subjects in 1839. Thus in medicine we find that, even in that early day, the pathologist and the clinician taught that by the aid of its special senses and by the microscope and instruments DEVELOPMENT OF MODERN MEDICINE 43 of precision the diagnosis could be made with a definiteness, im- possible by the use of the symptoms alone. The epoch-making work of Johannes Mueller in embryology and physiology marked the beginning of modern physiology, and this, with the unparalelled activity of Virchow in pathology, resulted in an enormous development of scientific observation and product- iveness. Corresponding activity marked the work in the sciences of chem- istry, zoology, comparative and human anatomy, physics, botany, and general biology. The development of the microscope gave impetus to the study of the lower forms of life. In 1838, Ehren- berg regarded infusoria as animals. In 1852, Perty claimed that most infusoria should be assigned to the vegetable world. Cohn proved the correctness of this conclusion and perfected a classi- fication. In 1837, Bassi discovered the parasitic nature of silk-worm disease. The parasitic form of favus and thrush was proved by Schoenlein and Nagel respectively. Dovaine recognized the anthrax bacillus in 1850. In 1857, Pasteur demonstrated that fermenta- tion and putrefaction were caused by lower organisms and at the same time forever set at rest the superstition of spontaneous gener- ation. Obermayer recognized the spirillum of relapsing fever in 1873. Bacteriology became an exact science with the discovery by Robert Koch of cultural methods which made the differentiation of germs possible. The causative relations of bacteria and microorganisms to all infective processes has been proved by the laws promulgated by Koch. The discovery by Brieger, Panum and others of the poisons produced by bacteria was another important step in the progress of bacteriology as related to medicine. From the discovery and development of bacteriology, and especially through the brilliant researches of Pasteur and Koch and of their students, has resulted a knowledge which has revolutionized and marked the birth of modern medicine. Parasites The discovery of the hematozoon of malaria by Laveran; the recognition of the ameba of dysentery by Loesch ; of the ray fungi and especially the actinomyces as infective agents in the lower animals and in man and the more exact knowledge of other ani- mal parasites infecting man and animals, which the microscope has made clear, have been as epoch-making in parasitology as the discoveries of Pasteur and Koch in bacteriology. The recognition of the relation of bacteria, protozoa, and ani- mal parasites to infective disease has been the means of a more 44 MEDICINE exact knowledge of the clinical phenomena of disease, of morbid anatomy, of physiology, and of physiologic chemistry than would have been possible without it. Transmission of Infection The knowledge of the cause of disease has led to a study of the life-history of infective organisms outside of as well as in the animal body. The mode of propagation, the means of transmission of in- fective microorganism, by fomites and other agents, has become known. The r61e of insects which infect animals play, as defin- itive or intermediate hosts, has been studied and proved. The discovery of Manson of the transmission of Filaria sanguinis hominis by the mosquito was of vast importance as a suggestion of the mosquito as a definitive host in malaria. The investigations of Manson, Ross, Celli, Grassi, Dionise, Marchiafava, Bignami, Koch, and others have made our knowledge of malaria exact. With the microscope we may now not only recognize malaria and differentiate it from the other infective fevers, but we may also at the same time recognize by an examination of the blood the type of malarial in- fection and foretell its course. Not only may we recognize the dis- ease definitely and apply the drug treatment more rationally, but the knowledge of the means of its transmission from man to man enables us to apply preventive measures which are of the greatest importance from a commercial as well as from a humanitarian point of view. The recognition of the role of the mosquito in malaria has been, furthermore, a stimulus to the study of the same insect in relation to other infections. The brilliant research work of Reed and Carroll in 1900 in Cuba, by which they proved that the mosquito of the genus stegomya is the sole means of the transmission of yellow fever from man to man, is of great importance as a scientific fact. The influence of this discovery upon mankind, as a prophylactic against a disease which has killed multitudes, is wonderful. Hardly less important is the fact that the Bacillus pestis may infect fleas and these in turn infect rats, mice, and man. It is im- portant, too, to know that pests like the house-fly may be carriers of infective bacteria from refuse filth to kitchens and tables and con- taminate food, and thus infect u swith typhoid fever, cholera, and perhaps other diseases which are propagated by filth. The study of bacteria in the laboratory and in the blood tissues of infected animals has led to the discovery of the means by which bacteria disturb the animal economy and produce phenomena expressive of disease. The fact that the blood and tissues of infected animals contained a toxin which could also be isolated from pure DEVELOPMENT OF MODERN MEDICINE 45 bacterial cultures in the laboratory and that this toxin when in- troduced into an animal was capable of exciting the same phenom- ena of disease as the bacteria themselves, was positive proof that bacteria excite disease phenomena at least in some instances by means of a toxin which they form. The elaboration of antitoxins in the body of the infected animal was also promptly recognized, and served to explain not only the self-limitation of many of the infective diseases, but it also helped us to understand the immunity which one attack affords in some of the bacterial diseases. Protective Inoculation Long before bacterial toxins were recognized as the cause of disease phenomena, Pasteur established the principle of protect- ive inoculation with bacteria of lessened virulence, which was brought about by attenuation of the bacteria by a modification of cultural methods and also by serial inoculation of certain lower animals. This he successfully applied to charbon in sheep and cattle and to chicken cholera. In both of these diseases the bacteria were known and the problems of attenuation could be carried on in the laboratory by direct study of the bacteria before inoculation and afterward when they were recovered from the body of the animals experimented upon. His final life-work was no less important in firmly fixing the im- munizing influence in rabies. Here the discovery was made that the infecting bacterium escaped every known means of recognition by microscopical and cultural examination of the tissues and blood of the infected animals. Apparently there are pathogenic germs which we do not know because we have not yet recognized the proper culture material for the successful artificial cultivation of them, nor have we discovered the tinctorial reaction which they may possess; and, finally, it is not improbable that they may be infinitely smaller than other germs and, therefore, more difficult to recognize. Pasteur recognized the fact that in hydrophobia the brain and other nervous tissues of an infected animal are capable, when in- oculated into another animal's brain, of producing the disease. That the infected brain used for infecting animals contained the germs which caused the disease was proved by the fact that a stage of incubation occurred in the inoculated animal and that a series of animals were successfully inoculated consecutively from the first. Pasteur then successfully attenuated the unknown micro- organism present in the nervous tissues of an inoculated animal by dessication of the nervous tissue in a sterile apparatus by methods too well known to repeat. Nor is it necessary to occupy time in re- 46 MEDICINE peating the well-known methods pursued by Pasteur and his pupils in the use of the graduated doses of attenuated toxin contained in the nerve tissues in the prophylactic treatment of rabies. To Pasteur, therefore, we owe the scientific recognition of the principle of protective inoculation. It is now a well-known fact, however, that inoculation against disease was practiced by the Chinese a thousand years ago. They inoculated the healthy with small-pox as a protection against the disease. Variolization was also practiced in Europe in the seventeenth and eighteenth centuries. We read that in 1718, Lady Montague caused a son to be inoculated with variola in Italy, and that two years later her daughter was inoculated in England. The practice was followed in Ireland long after the successful establishment of vaccine as a protection against variola. Inoculation against syphilis, or syphilization, was practiced in Europe during the nine- teenth century. We owe to Jenner, however, the first example of the protective inoculation by means of an attenuated virus. This attenuation we now know was established by the accidental inoculation of milch cows with small-pox, producing a modified disease, vaccinia. That vaccinia, produced in man by inoculation, would protect against small-pox was proved when, in 1798, Jenner successfully vaccinated direct from the cow, the five-year-old lad William Summers. The thousands of successful vaccinations which have since been performed and the thousands of lives which have been saved by vaccination are proof of its validity and utility. The immunity established by protective inoculation is apparently the same as that induced by an unmodified attack of variola. Serum Therapy When chemistry had revealed the nature of bacterial poisons and experiments established their relation to the phenomena of disease, it was proved that substances were formed in artificial culture media and in the blood and tissues of infected animals which had the power to neutralize the effect of the bacterial poison in other animals infected with the same organism. Further investigation showed that an animal inoculated with the laboratory preparation of anti- toxin was protected against the disease. Furthermore, it was found that the blood serum of an animal inoculated with bacteria in a non-fatal and repeated dose contained an antitoxin. When the blood serum of an infected animal was injected into a healthy animal, the latter was protected against the original disease. Antitoxin was, therefore, proved to be formed in artificial media DEVELOPMENT OF MODERN MEDICINE 47 of bacterial cultures and in the bodies of infected animals. When the antitoxin thus formed was injected into an animal, it had the power to protect that animal against the particular bacterial infec- tion, or, if given subsequent to the infection of the animal, to miti- gate the severity of the disease or entirely to check it. Thus Koch and his students established the principle of serum therapy. Upon this principle there has been developed and given to the world the anti-diphtheritic serum of Behring and of Roux, and also an immunizing serum for Asiatic cholera, tetanus, ery- sipelas, plague, epidemic dysentery, streptococcus infection, and other diseases. While the serum treatment has not proved successful in all of the diseases in which it has been used, it has been so success- ful in some — diphtheria, for instance — as firmly to establish the principle of serum therapy. The study of prophylactic sera by Paul Erlich led to our present knowledge of immunity. His side chain theory has established a working basis which affords superb fields of research in physiologic chemistry which have already yielded rich returns. Bacteriology made possible the comprehension of perfect cleanli- ness and enables the surgeon to invade every part of the body without fear of infection and has saved thousands of lives which twenty-five years ago would have perished miserably as the result of disease at that time inoperable, or as the result of infection from contact with the surgeon. By means of cleanliness and skill, in- duced by a broader experience, the surgeon has been able to add to our knowledge information of great value which could have been obtained probably in no other way. He has been able to study dis- ease in the living body and show the relation of a disease process to infection. He has thus been able to clear away many of the misconceptions of symptomatology and diagnosis, especially in dis- ease of the abdominal organs. Bacteriology has stimulated laboratory clinical diagnosis. Bac- terial reaction to sera and blood cultural tests are of the greatest aid to diagnosis. Clinical research work has command of an arma- mentarium consisting of a knowledge of pathologic anatomy, of physiology, of bacteriology, of chemic physiology, and of physics, which allows of a precision in diagnosis never before at the command of the physician. The evolution of bacteriology has afforded a stimulus and aid in the advancement of parasitology, physiology, physio-chemistry, and of other fundamental sciences. This knowledge has been more directly applied to practical medicine than ever before. Indeed modern medicine is now so comprehensive that the student must be thoroughly conversant with chemistry, inorganic, organic, and physical, with physiology, with general biology, with human 48 MEDICINE and comparative anatomy, with bacteriology, and parasitology, to understand and appreciate it. Slowly but surely the secrets of the cause of disease which baffled the search of centuries have yielded to the brilliant light of modern methods. The causative agents of most of the infective diseases of man and of the lower animals are now known. The unknown causative germs of the few remaining infectious diseases will soon be discovered, and then the principles of immunity and cure by inoculation or by the application of antitoxins will find wider application. Prevention of Infection The recognition of the germ-cause of the infectious diseases enables modern medicine not only to combat disease more rationally and successfully, but it enables us to prevent them. In most of the infective diseases due to germs, protozoa, parasites, and fungi, the causative agents have been so fully investigated that we know the life-history, and what conditions are best suited for the propagation and multiplication of each, and also what will remove and annihilate these dangerous enemies. So the diseases of domestic animals which may also infest man, for example, actinomy- cosis of cattle, trichina of swine, tuberculosis of animals, chicken cholera, foot and mouth disease, charbon, etc., may be entirely eradicated. The experience of one hundred years proves that small- pox may be prevented by proper vaccination. If universally applied and repeated at proper intervals the disease would probably disap- pear. Our knowledge of the living agents which provoke malaria, typhoid fever, cholera, the plague, and the means by which they propagate, develop, and the manner in which they infest man, enables us, if we may command the situation irrespective of the financial cost, not only to prevent but also in many localities to abolish them altogether. The discoveries of Reed, Carroll, and Agramonti of the relation of the mosquito (Stegomyia fasciata) to yellow fever has been practically applied with notable success in Cuba and elsewhere. The study of bacteriology has developed general hygiene to a high plane. The value of sunlight, pure air, and pure food are fully recognized as preventives and also as rational curative measures in many infective diseases. Unfortunately there are a few of the scourges of mankind which science has not yet conquered. Pneumonia, the bacterial cause of which is known, is still a "captain of death." Cancer remains uncon- quered. So, too, do many of the chronic diseases, namely, the primary DEVELOPMENT OF MODERN MEDICINE 49 blood diseases, diabetes, the various degenerative processes, etc., which, though frequently easily recognized during life, are at best only modified by our efforts to check or remove them. Physio-chemistry, experimental medicine, physiology, and patho- logic anatomy have given us much information of these processes, and there can be no question that many of these problems will be solved by the present methods of investigation. The present knowledge of the cause of disease, of the evolution of disease processes, of the natural expression of disease as recog- nized by clinical investigation, has resulted in a rational mode of treatment. Drug treatment is no longer looked upon as specific, but as a helpful agent to modify and palliate disease processes, in conjunction with proper dietary, hydratic, and hygienic measures. Polypharmacy and indiscriminate drugging and drug nihilism are recognized as equally irrational. It requires a nice judgment of when to give, as much as when to withhold, drugs. To enable a diseased or crippled organ more nearly to perform its function; to fortify and prolong life, with the hope of a favorable termination of a self-limited disease; to palliate suffering, are some of the measures which drugs afford modern medicine. Pharmaco- logy and pharmacy have developed equally with the other parts of medicine and enable us to command drugs and active principles with accuracy and comfort. The discovery of the X-ray was a boon tosurgical diagnosis and it has proved of wonderful therapeutic value in many of the disease processes of the skin and superficial tissues. When the X-ray shall be better understood its appreciation will be undoubtedly much more extensive. The rapid development of modern medicine has attracted wide attention and excited the interest of students and investigators over the whole world. A larger percentage than ever before of the best-educated students of the world have sought medicine as the most attractive field of study and research. At this time there are hundreds of earnest, thoughtful, patient, and energetic workers after truth who fre- quently sacrifice home, friends, comfort, health, and even life for the advancement of the science of medicine. The advancement of modern medicine has also attracted the attention of the philanthropic rich as never before. In recent years institutes of research have been erected or are in the course of con- struction and equipment which have rich endowment. Modern medi- cine is therefore better prepared to develop now than ever before. The development of medical literature has been in keeping with the advancement of other sciences. Large and valuable libraries are found in every land. Medical journalism is a science of itself and 50 MEDICINE enables the physician at small cost to be in touch with all that is new and progressive. Modern medicine requires of its students an education which shall fit them to take part as research workers or as practitioners to apply th> . and Year. CD 03 .9 SI a u IS 3 M -D 0) ^ a Eh w 9-2 "S CD l-H 3 3 5* P o "SI Ho — * r2 e3 3 Eh o> fi O QJ CO 4^ OJ © ^ , • S 1899 Tokio . -j 19Q0 1,468,953 29,274 4,238 343 499 37 5,117 2,812 1,497,675 27,869 4,254 336 458 56 5,104 3,767 T.. . /1899 Kioto . 1 1900 356,956 7,905 1,132 99 168 14 1,413 918 364,673 7,703 1,204 159 176 25 1,564 803 rv i /1899 Osaka . \ 1900 835,203 16,407 2,257 175 316 9 2,757 2,002 865,021 15,991 2,431 221 337 17 3,006 2,036 Yoko- /1899 hama. \ 1900 195,364 2,829 278 40 44 00 362 353 201,036 2,487 401 32 34 3 470 305 K°MS9o 225,970 5,360 711 36 88 1 836 590 240,917 4,808 719 27 74 5 825 642 Naga- /1899 saki . \l900 114,144 1,489 196 12 15 1 224 192 125,231 1,804 234 22 34 4 295 189 Nagoya{^99 243,767 252,068 4,622 4,675 543 597 29 19 84 65 3 1 659 682 591 627 Hiro- / 1899 shima . \ 1900 126,039 1,937 207 3 24 4 238 305 133,732 2,179 256 16 20 2 294 289 Total of the Eight Cities. 1899. 1900. 3,566,394 3,680,351 69,823 9,562 737 1,238 69 11,606 67,516 10,097 832 1,198 113 12,240 7,663 8,658 JAPANESE CATTLE AND TUBERCULOSIS All Other Places. 139 1899 1900 40,393,614 40,777,622 862,264 843,228 46,376 49,428 2,014 2,344 7,178 7,228 435 531 56,003 59,531 105,792 116,613 Sum Total of Entire Japan. 1899 1900 43,960,008 44,457,973 932,087 910,744 55,938 | 2,751 59,525 3,176 8,416 494 8,426 644 67,609 71,771 113,455 125,271 The Relation op the Total Mortality and Mortality prom Tuberculosis to the Number op Inhabitants (Calculated to 1000 Inhabitants). Place Total mortality. Pulmonary tuberculo- sis. Total tuberculo- sis. Other respiratory diseases. Tokio Kioto Osaka Yokohama 19.23 21.63 19.06 13.41 21.78 13.76 18.75 15.64 18.95 21.01 2.86 3.24 2.76 1.71 3.06 1.80 2.30 1.78 2.71 1.18 3.45 4.13 3.39 2.10 3.56 2.17 2.70 2.05 3.29 1.42 2.22 2.38 2.37 1 41 Kobe Nagasaki 2.64 1.59 Nagoya Hiroshima Average of 8 cities . . . 2.46 2.29 2.25 2.74 20.84 1.31 1.58 2.71 The Percentage op the Tuberculosis Mortality to the Total Mortality Place Pulmonary tuberculosis. Total tuberculosis. Other respiratory diseases. Tokio 14.86 14.97 14.47 12.77 14.06 13.09 12.26 11.25 14.31 5.62 17.89 19.07 17.79 15.65 16.34 15.76 14.42 12.93 17.36 6.77 11.51 Kioto 11.03 Osaka 12.46 Yokohama Kobe 10.50 12.12 11.57 Naeova 13.10 Hiroshima 14.43 Average of 8 cities . Other towns 11.88 13.04 Average figure 6.27 7.56 12.95 A valuable paper on the statistics of tuberculosis has been written by Tamaye Ogiya, under the directorship of Professor Sata, from the pathologic institute at Osaka. This authoress states that dur- ing a period of three and a half years she has found among 250 140 PATHOLOGY Table III. Place and year. Population. Total number of deaths. Deaths from tuberculosis. Total number of cattle. Number of diseased cattle. +3 o m P-i 1896{q ■• 43,815 807 23 ( 2.85%) 5,188 36 l897{o :: 1898{q •• 1899 {q ■• 1900 { o " 1901 {o :: 1902 |q •• 1903{q ■• 44,029 768 18 ( 2.34%) 5,585 16 43,357 35,026 43,370 35,104 43,821 35,346 44,093 35,526 45,043 35,607 936 697 805 704 778 673 701 642 762 684 766 678 32 ( 3.41%) 60 ( 8.60%) 31 ( 3.85%) 80 (11.30%) 33 ( 4.24%) 51 ( 7.55%) 48 ( 6.85%) 39 ( 6.07%) 58 ( 7.61%) 42 ( 6.14%) 62 ( 8.09%) 88 (13.00%) 5,389 1,964 5,870 1,952 5.491 2,257 5,473 2,214 5,109 2,245 5,352 21 37 25 115 20 75 32 67 37 31 25 46 M., Mikato; O., Osaka. Table IV. — Similar Table from the District Abu in Yama-Guchi-Ken for the Years 1901 to 1903. Town- ship. Sammi Udago Fukuga Susa . . . Akiraki Nako Ogawa Tama- saki i* 1901 1902 1903 1901 1902 1903 1901 1902 1903 1901 1902 1903 1901 1902 1903 1901 1902 1903 1901 1902 1903 1901 1902 1903 >> ■+» oj a += O O ■s a 3 ft -+j o o Ph H 3,246 51 3,333 48 3,262 73 2,022 33 2,058 29 2,015 43 2,839 79 2,892 47 2,901 71 5,223 98 5,225 91 5,292 106 2,924 49 2,547 40 2,603 39 3,957 78 3,932 79 4,058 54 4,180 106 4,205 87 4,247 86 3,952 89 3,994 83 3,851 95 <& o o -^ 1.96%) 14.58%) 4.10%) 3.00%) 3.44%) 4.25%) 2.81%) 5.10%) 4.40%) 3.77%) 6.10%) 2.50%) 2.56%) 5.12%) 5.06%) 1.85%) 8.49%) 2.30%) 6.97%) 5.61%) 4-81%). 4-21 %) Total number of cattle. 426 436 418 202 203 203 581 511 521 418 414 404 278 257 268 262 262 257 825 734 593 309 267 257 1 12 9 25 Number of diseased cattle. Ph JAPANESE CATTLE AND TUBERCULOSIS 141 autopsies 116 cases of tuberculosis, amounting to 46.4% of the total. Of the tuberculosis patients, 20 (17.3%) were under 18 years, 96 (82.2%) were more than 18 years; among these patients she found 90 (77.6%) who presented lesions showing primary pulmonary tuberculosis, 12 (10.34%) who had primary intestinal tuberculosis. Among the latter 6 were more and 6 less than 18 years. Basing the statement upon this paper, it may be said that the occurrence of primary intestinal tuberculosis is not rare in Japan either among adults or children, although cow's milk is employed but little by us for the nourishment of children. The table on the preceding page refers to districts in which man suffered from tuberculosis, but his cattle were free from it (the years considered are from 1896 and 1903); they are the districts Mikata and Osaka at Tasima in Hiyogo-Ken; these districts possess only native cattle. The following table shows the number of cases of tuberculosis (perlsucht) among the slaughtered cattle found during the years 1901 to 1903 in five large cities : Table V. Native cattle. Mixed races. Imported. Place. O CD U If* ■43 o u CO CM O CD H M o3 FH oa o to CD O CD Li U . 3 3 « fc-3 ■+3 o CO *3