THE story so far has been of men and of movements--of men who have,
consciously or unconsciously, initiated great movements, and of
movements by which, nolens volens, the men of the time were moulded and
controlled. Hippocrates, in the tractate on "Ancient Medicine," has a
splendid paragraph on the attitude of mind towards the men of the past.
My attention was called to it one day in the Roman Forum by Commendatore
Boni, who quoted it as one of the great sayings of antiquity. Here it
is: "But on that account, I say, we ought not to reject the ancient Art,
as if it were not, and had not been properly founded, because it did
not attain accuracy in all things, but rather, since it is capable of
reaching to the greatest exactitude by reasoning, to receive it and
admire its discoveries, made from a state of great ignorance, and as
having been well and properly made, and not from chance."(1)
(1) The Works of Hippocrates, Adams, Vol. I, p. 168, London, 1849
(Sydenham Society).
I have tried to tell you what the best of these men in successive ages
knew, to show you their point of outlook on the things that interest
us. To understand the old writers one must see as they saw, feel as they
felt, believe as they believed--and this is hard, indeed impossible! We
may get near them by asking the Spirit of the Age in which they lived
to enter in and dwell with us, but it does not always come. Literary
criticism is not literary history--we have no use here for the former,
but to analyze his writings is to get as far as we can behind the
doors of a man's mind, to know and appraise his knowledge, not from our
standpoint, but from that of his contemporaries, his predecessors and
his immediate successors. Each generation has its own problems to face,
looks at truth from a special focus and does not see quite the same
outlines as any other. For example, men of the present generation
grow up under influences very different from those which surrounded my
generation in the seventies of the last century, when Virchow and
his great contemporaries laid the sure and deep foundations of modern
pathology. Which of you now knows the "Cellular Pathology" as we did? To
many of you it is a closed book,--to many more Virchow may be thought a
spent force. But no, he has only taken his place in a great galaxy. We
do not forget the magnitude of his labors, but a new generation has new
problems--his message was not for you--but that medicine today runs in
larger moulds and turns out finer castings is due to his life and work.
It is one of the values of lectures on the history of medicine to
keep alive the good influences of great men even after their positive
teaching is antiquated. Let no man be so foolish as to think that he has
exhausted any subject for his generation. Virchow was not happy when he
saw the young men pour into the old bottle of cellular pathology the new
wine of bacteriology. Lister could never understand how aseptic surgery
arose out of his work. Ehrlich would not recognize his epoch-making
views on immunity when this generation has finished with them. I believe
it was Hegel who said that progress is a series of negations--the
denial today of what was accepted yesterday, the contradiction by each
generation of some part at least of the philosophy of the last; but all
is not lost, the germ plasm remains, a nucleus of truth to be fertilized
by men often ignorant even of the body from which it has come. Knowledge
evolves, but in such a way that its possessors are never in sure
possession. "It is because science is sure of nothing that it is always
advancing" (Duclaux).
History is the biography of the mind of man, and its educational
value is in direct proportion to the completeness of our study of the
individuals through whom this mind has been manifested. I have tried
to take you back to the beginnings of science, and to trace its gradual
development, which is conditioned by three laws. In the first place,
like a living organism, truth grows, and its gradual evolution may
be traced from the tiny germ to the mature product. Never springing,
Minerva-like, to full stature at once, truth may suffer all the hazards
incident to generation and gestation. Much of history is a record of the
mishaps of truths which have struggled to the birth, only to die or else
to wither in premature decay. Or the germ may be dormant for centuries,
awaiting the fullness of time.
Secondly, all scientific truth is conditioned by the state of knowledge
at the time of its announcement. Thus, at the beginning of the
seventeenth century, the science of optics and mechanical appliances had
not made possible (so far as the human mind was concerned) the existence
of blood capillaries and blood corpuscles. Jenner could not have
added to his "Inquiry" a study on immunity; Sir William Perkin and the
chemists made Koch technique possible; Pasteur gave the conditions that
produced Lister; Davy and others furnished the preliminaries necessary
for anaesthesia. Everywhere we find this filiation, one event following
the other in orderly sequence--"Mind begets mind," as Harvey (De
Generatione) says; "opinion is the source of opinion. Democritus with
his atoms, and Eudoxus with his chief good which he placed in pleasure,
impregnated Epicurus; the four elements of Empedocles, Aristotle;
the doctrines of the ancient Thebans, Pythagoras and Plato; geometry,
Euclid."(2)
(2) Works of William Harvey, translated by Robert Willis, London,
1847, p. 532.
And, thirdly, to scientific truth alone may the homo mensura principle
be applied, since of all mental treasures of the race it alone compels
general acquiescence. That this general acquiescence, this aspect of
certainty, is not reached per saltum, but is of slow, often of difficult
growth,--marked by failures and frailties, but crowned at last with
an acceptance accorded to no other product of mental activity,--is
illustrated by every important discovery from Copernicus to Darwin.
The difficulty is to get men to the thinking level which compels the
application of scientific truths. Protagoras, that "mighty-wise man,"
as Socrates called him, who was responsible for the aphorism that man
is the measure of all things, would have been the first to recognize the
folly of this standard for the people at large. But we have gradually
reached a stage in which knowledge is translated into action, made
helpful for suffering humanity, just as the great discoveries in physics
and chemistry have been made useful in the advance of civilization.
We have traced medicine through a series of upward steps--a primitive
stage, in which it emerged from magic and religion into an empirical
art, as seen among the Egyptians and Babylonians; a stage in which the
natural character of disease was recognized and the importance of its
study as a phenomenon of nature was announced; a stage in which the
structure and functions of the human body were worked out; a stage in
which the clinical and anatomical features of disease were determined;
a stage in which the causes of disorders were profitably studied, and
a final stage, into which we have just entered, the application of the
knowledge for their prevention. Science has completely changed man's
attitude towards disease.
Take a recent concrete illustration. A couple of years ago in
Philadelphia and in some other parts of the United States, a very
peculiar disease appeared, characterized by a rash upon the skin and
moderate fever, and a constitutional disturbance proportionate to the
extent and severity of the eruption. The malady first broke out in the
members of a crew of a private yacht; then in the crews of other boats,
and among persons living in the boarding-houses along the docks. It was
the cause of a great deal of suffering and disability.
There were three courses open: to accept the disease as a visitation
of God, a chastening affliction sent from above, and to call to aid the
spiritual arm of the church. Except the "Peculiar People" few now take
this view or adopt this practice. The Christian Scientist would probably
deny the existence of the rash and of the fever, refuse to recognize
the itching and get himself into harmony with the Infinite. Thirdly, the
method of experimental medicine.
First, the conditions were studied under which the individual cases
occurred. The only common factor seemed to be certain straw mattresses
manufactured by four different firms, all of which obtained the straw
from the same source.
The second point was to determine the relation of the straw to the rash.
One of the investigators exposed a bare arm and shoulder for an hour
between two mattresses. Three people voluntarily slept on the mattresses
for one night. Siftings from the straw were applied to the arm,
under all of which circumstances the rash quickly developed, showing
conclusively the relation of the straw to the disease.
Thirdly, siftings from the straw and mattresses which had been
thoroughly disinfected failed to produce the rash.
And fourthly, careful inspection of the siftings of the straw disclosed
living parasites, small mites, which when applied to the skin quickly
produced the characteristic eruption.
SANITATION
WHEN the thoughtful historian gets far enough away from the nineteenth
century to see it as a whole, no single feature will stand out with
greater distinctness than the fulfilment of the prophecy of Descartes
that we could be freed from an infinity of maladies both of body and
mind if we had sufficient knowledge of their causes and of all the
remedies with which nature has provided us. Sanitation takes its place
among the great modern revolutions--political, social and intellectual.
Great Britain deserves the credit for the first practical recognition of
the maxim salus populi suprema lex. In the middle and latter part of
the century a remarkable group of men, Southwood Smith, Chadwick, Budd,
Murchison, Simon, Acland, Buchanan, J.W. Russell and Benjamin Ward
Richardson, put practical sanitation on a scientific basis. Even
before the full demonstration of the germ theory, they had grasped the
conception that the battle had to be fought against a living contagion
which found in poverty, filth and wretched homes the conditions for its
existence. One terrible disease was practically wiped out in twenty-five
years of hard work. It is difficult to realize that within the memory of
men now living, typhus fever was one of the great scourges of our large
cities, and broke out in terrible epidemics--the most fatal of all to
the medical profession. In the severe epidemic in Ireland in the forties
of the last century, one fifth of all the doctors in the island died
of typhus. A better idea of the new crusade, made possible by new
knowledge, is to be had from a consideration of certain diseases against
which the fight is in active progress.
Nothing illustrates more clearly the interdependence of the sciences
than the reciprocal impulse given to new researches in pathology
and entomology by the discovery of the part played by insects in the
transmission of disease. The flea, the louse, the bedbug, the house fly,
the mosquito, the tick, have all within a few years taken their places
as important transmitters of disease. The fly population may be taken
as the sanitary index of a place. The discovery, too, that insects are
porters of disease has led to a great extension of our knowledge of
their life history. Early in the nineties, when Dr. Thayer and I were
busy with the study of malaria in Baltimore, we began experiments on
the possible transmission of the parasites, and a tramp, who had been
a medical student, offered himself as a subject. Before we began, Dr.
Thayer sought information as to the varieties of mosquitoes known in
America, but sought in vain: there had at that time been no systematic
study. The fundamental study which set us on the track was a
demonstration by Patrick Manson,(3) in 1879, of the association of
filarian disease with the mosquito. Many observations had already
been made, and were made subsequently, on the importance of insects as
intermediary hosts in the animal parasites, but the first really great
scientific demonstration of a widespread infection through insects was
by Theobald Smith, now of Harvard University, in 1889, in a study of
Texas fever of cattle.(4) I well remember the deep impression made upon
me by his original communication, which in completeness, in accuracy of
detail, in Harveian precision and in practical results remains one of
the most brilliant pieces of experimental work ever undertaken. It is
difficult to draw comparisons in pathology; but I think, if a census
were taken among the world's workers on disease, the judgment to be
based on the damage to health and direct mortality, the votes would be
given to malaria as the greatest single destroyer of the human race.
Cholera kills its thousands, plague, in its bad years, its hundreds of
thousands, yellow fever, hookworm disease, pneumonia, tuberculosis,
are all terribly destructive, some only in the tropics, others in more
temperate regions: but malaria is today, as it ever was, a disease to
which the word pandemic is specially applicable. In this country and in
Europe, its ravages have lessened enormously during the past century,
but in the tropics it is everywhere and always present, the greatest
single foe of the white man, and at times and places it assumes the
proportions of a terrible epidemic. In one district of India alone,
during the last four months of 1908, one quarter of the total population
suffered from the disease and there were 400,000 deaths--practically
all from malaria. Today, the control of this terrible scourge is in our
hands, and, as I shall tell you in a few minutes, largely because of
this control, the Panama Canal is being built. No disease illustrates
better the progressive evolution of scientific medicine. It is one of
the oldest of known diseases. The Greeks and Graeco-Romans knew it well.
It seems highly probable, as brought out by the studies of W.H.S. Jones
of Cambridge, that, in part at least, the physical degeneration in
Greece and Rome may have been due to the great increase of this disease.
Its clinical manifestations were well known and admirably described by
the older writers. In the seventeenth century, as I have already told
you, the remarkable discovery was made that the bark of the cinchona
tree was a specific. Between the date of the Countess's recovery in Lima
and the year 1880 a colossal literature on the disease had accumulated.
Literally thousands of workers had studied the various aspects of its
many problems; the literature of this country, particularly of the
Southern States, in the first half of the last century may be said to
be predominantly malarial. Ordinary observation carried on for long
centuries had done as much as was possible. In 1880, a young French army
surgeon, Laveran by name, working in Algiers, found in the microscopic
examination of the blood that there were little bodies in the red blood
corpuscles, amoeboid in character, which he believed to be the germs of
the disease. Very little attention at first was paid to his work, and it
is not surprising. It was the old story of "Wolf, wolf"; there had been
so many supposed "germs" that the profession had become suspicious.
Several years elapsed before Surgeon-General Sternberg called the
attention of the English-speaking world to Laveran's work: it was taken
up actively in Italy, and in America by Councilman, Abbott and by others
among us in Baltimore. The result of these widespread observations
was the confirmation in every respect of Laveran's discovery of the
association with malaria of a protozoan parasite. This was step
number three. Clinical observation, empirical discovery of the cure,
determination of the presence of a parasite. Two other steps followed
rapidly. Another army surgeon, Ronald Ross, working in India, influenced
by the work of Manson, proved that the disease was transmitted by
certain varieties of mosquitoes. Experiments came in to support the
studies in etiology; two of those may be quoted. Mosquitoes which had
bitten malarial patients in Italy were sent to London and there allowed
to bite Mr. Manson, son of Dr. Manson. This gentleman had not lived out
of England, where there is now no acute malaria. He had been a perfectly
healthy, strong man. In a few days following the bites of the infected
mosquitoes, he had a typical attack of malarial fever.
(3) Journal Linnaean Society, London, 1879, XIV, 304-311.
(4) Medical News, Philadelphia, 1889, LV, 689-693, and monograph
with Kilborne, Washington, 1893.
The other experiment, though of a different character, is quite as
convincing. In certain regions about Rome, in the Campania, malaria is
so prevalent that, in the autumn, almost everyone in the district is
attacked, particularly if he is a newcomer. Dr. Sambon and a friend
lived in this district from June 1 to September 1, 1900. The test was
whether they could live in this exceedingly dangerous climate for
the three months without catching malaria, if they used stringent
precautions against the bites of mosquitoes. For this purpose the hut
in which they lived was thoroughly wired, and they slept under netting.
Both of these gentlemen, at the end of the period, had escaped the
disease.
Then came the fifth and final triumph--the prevention of the disease.
The anti-malarial crusade which has been preached by Sir Ronald Ross and
has been carried out successfully on a wholesale scale in Italy and in
parts of India and Africa, has reduced enormously the incidence of
the disease. Professor Celli of Rome, in his lecture room, has an
interesting chart which shows the reduction in the mortality from
malaria in Italy since the preventive measures have been adopted--the
deaths have fallen from above 28,000 in 1888 to below 2000 in 1910.
There is needed a stirring campaign against the disease throughout the
Southern States of this country.
The story of yellow fever illustrates one of the greatest practical
triumphs of scientific medicine; indeed, in view of its far-reaching
commercial consequences, it may range as one of the first achievements
of the race. Ever since the discovery of America, the disease has been
one of its great scourges, permanently endemic in the Spanish Main,
often extending to the Southern States, occasionally into the North, and
not infrequently it has crossed the Atlantic. The records of the British
Army in the West Indies show an appalling death rate, chiefly from this
disease. At Jamaica, for the twenty years ending in 1836, the average
mortality was 101 per thousand, and in certain instances as high as 178.
One of the most dreaded of all infections, the periods of epidemics in
the Southern States have been the occasions of a widespread panic with
complete paralysis of commerce. How appalling the mortality is may be
judged from the outbreak in Philadelphia in 1793, when ten thousand
people died in three months.(5) The epidemics in Spain in the early part
of the nineteenth century were of great severity. A glance through
La Roche's great book(6) on the subject soon gives one an idea of
the enormous importance of the disease in the history of the Southern
States. Havana, ever since its foundation, had been a hotbed of yellow
fever. The best minds of the profession had been attracted to a solution
of the problem, but all in vain. Commission after commission had been
appointed, with negative results; various organisms had been described
as the cause, and there were sad illustrations of the tragedy associated
with investigations undertaken without proper training or proper
technique. By the year 1900, not only had the ground been cleared,
but the work on insect-borne disease by Manson and by Ross had given
observers an important clue. It had repeatedly been suggested that
some relation existed between the bites of mosquitoes and the tropical
fevers, particularly by that remarkable student, Nott of Mobile, and
the French physician, Beauperthuy. But the first to announce clearly the
mosquito theory of the disease was Carlos Finlay of Havana. Early in the
spring of 1900, during the occupation of Cuba by the United States, a
commission appointed by Surgeon-General Sternberg (himself one of the
most energetic students of the disease) undertook fresh investigations.
Dr. Walter Reed, Professor of Bacteriology in the Army Medical School,
was placed in charge: Dr. Carroll of the United States Army, Dr.
Agramonte of Havana and Dr. Jesse W. Lazear were the other members. At
the Johns Hopkins Hospital, we were deeply interested in the work, as
Dr. Walter Reed was a favorite pupil of Professor Welch, a warm friend
of all of us, and a frequent visitor to our laboratories. Dr. Jesse
Lazear, who had been my house physician, had worked with Dr. Thayer and
myself at malaria, and gave up the charge of my clinical laboratory to
join the commission.
(5) Matthew Carey: A Short Account of the Malignant Fever,
Philadelphia, 1793.
(6) R. La Roche: Yellow Fever, 2 vols., Philadelphia, 1855.
Many scientific discoveries have afforded brilliant illustrations of
method in research, but in the work of these men one is at a loss to
know which to admire more--the remarkable accuracy and precision of the
experiments, or the heroism of the men--officers and rank and file of
the United States Army; they knew all the time that they were playing
with death, and some of them had to pay the penalty! The demonstration
was successful--beyond peradventure--that yellow fever could be
transmitted by mosquitoes, and equally the negative proposition--that it
could not be transmitted by fomites. An interval of twelve or more days
was found to be necessary after the mosquito has bitten a yellow fever
patient before it is capable of transmitting the infection. Lazear
permitted himself to be bitten by a stray mosquito while conducting his
experiments in the yellow fever hospital. Bitten on the thirteenth, he
sickened on the eighteenth and died on the twenty-fifth of September,
but not until he had succeeded in showing in two instances that
mosquitoes could convey the infection. He added another to the long list
of members of the profession who have laid down their lives in search
of the causes of disease. Of such men as Lazear and of Myers of the
Liverpool Yellow-Fever Commission, Dutton and young Manson, may fitly be
sung from the noblest of American poems the tribute which Lowell paid to
Harvard's sons who fell in the War of Secession:
Many in sad faith sought for her,
Many with crossed hands sighed for her;
But these, our brothers, fought for her,
At life's dear peril wrought for her,
So loved her that they died for her.
Fortunately, the commander-in-chief at the time in Cuba was General
Leonard Wood, who had been an army surgeon, and he was the first to
appreciate the importance of the discovery. The sanitation of Havana was
placed in the hands of Dr. Gorgas, and within nine months the city was
cleared of yellow fever, and, with the exception of a slight outbreak
after the withdrawal of the American troops, has since remained free
from a disease which had been its scourge for centuries. As General Wood
remarked, "Reed's discovery has resulted in the saving of more lives
annually than were lost in the Cuban War, and saves the commercial
interest of the world a greater financial loss each year than the
cost of the Cuban War. He came to Cuba at a time when one third of the
officers of my staff died of yellow fever, and we were discouraged at
the failure of our efforts to control it." Following the example of
Havana other centres were attacked, at Vera Cruz and in Brazil, with the
same success, and it is safe to say that now, thanks to the researches
of Reed and his colleagues, with proper measures, no country need fear a
paralyzing outbreak of this once dreaded disease.
The scientific researches in the last two decades of the nineteenth
century made possible the completion of the Panama Canal. The narrow
isthmus separating the two great oceans and joining the two great
continents, has borne for four centuries an evil repute as the White
Man's Grave. Silent upon a peak of Darien, stout Cortez with eagle eye
had gazed on the Pacific. As early as 1520, Saavedra proposed to cut
a canal through the Isthmus. There the first city was founded by the
conquerors of the new world, which still bears the name of Panama.
Spaniards, English and French fought along its coasts; to it the founder
of the Bank of England took his ill-fated colony; Raleigh, Drake, Morgan
the buccaneer, and scores of adventurers seeking gold, found in fever an
enemy stronger than the Spaniard. For years the plague-stricken Isthmus
was abandoned to the negroes and the half-breeds, until in 1849,
stimulated by the gold fever of California, a railway was begun by
the American engineers, Totten and Trautwine, and completed in 1855,
a railway every tie of which cost the life of a man. The dream of
navigators and practical engineers was taken in hand by Ferdinand de
Lesseps in January, 1881. The story of the French Canal Company is a
tragedy unparalleled in the history of finance, and, one may add, in the
ravages of tropical disease. Yellow fever, malaria, dysentery, typhus,
carried off in nine years nearly twenty thousand employees. The
mortality frequently rose above 100, sometimes to 130, 140 and in
September, 1885, it reached the appalling figure of 176.97 per thousand
work people. This was about the maximum death rate of the British Army
in the West Indies in the nineteenth century.
When, in 1904, the United States undertook to complete the Canal,
everyone felt that the success or failure was largely a matter of
sanitary control. The necessary knowledge existed, but under the
circumstances could it be made effective? Many were doubtful.
Fortunately, there was at the time in the United States Army a man who
had already served an apprenticeship in Cuba, and to whom more than to
anyone else was due the disappearance of yellow fever from that island.
To a man, the profession in the United States felt that could Dr. Gorgas
be given full control of the sanitary affairs of the Panama Zone, the
health problem, which meant the Canal problem, could be solved.
There was at first a serious difficulty relating to the necessary
administrative control by a sanitary officer. In an interview which Dr.
Welch and I had with President Roosevelt, he keenly felt this difficulty
and promised to do his best to have it rectified. It is an open secret
that at first, as was perhaps only natural, matters did not go very
smoothly, and it took a year or more to get properly organized. Yellow
fever recurred on the Isthmus in 1904 and in the early part of 1905. It
was really a colossal task in itself to undertake the cleaning of the
city of Panama, which had been for centuries a pest-house, the mortality
in which, even after the American occupation, reached during one
month the rate of 71 per thousand living. There have been a great many
brilliant illustrations of the practical application of science in
preserving the health of a community and in saving life, but it is safe
to say that, considering the circumstances, the past history, and the
extraordinary difficulties to be overcome, the work accomplished by
the Isthmian Canal Commission is unique. The year 1905 was devoted to
organization; yellow fever was got rid of, and at the end of the year
the total mortality among the whites had fallen to 8 per thousand,
but among the blacks it was still high, 44. For three years, with a
progressively increasing staff which had risen to above 40,000, of whom
more than 12,000 were white, the death rate progressively fell.
Of the six important tropical diseases, plague, which reached the
Isthmus one year, was quickly held in check. Yellow fever, the most
dreaded of them all, never recurred. Beri-beri, which in 1906 caused
sixty-eight deaths, has gradually disappeared. The hookworm disease,
ankylostomiasis, has steadily decreased. From the very outset, malaria
has been taken as the measure of sanitary efficiency. Throughout the
French occupation it was the chief enemy to be considered, not only
because of its fatality, but on account of the prolonged incapacity
following infection. In 1906, out of every 1000 employees there were
admitted to the hospital from malaria 821; in 1907, 424; in 1908, 282;
in 1912, 110; in 1915, 51; in 1917, 14. The fatalities from the disease
have fallen from 233 in 1906 to 154 in 1907, to 73 in 1908 and to 7 in
1914. The death rate for malarial fever per 1000 population sank from
8.49 in 1906 to 0.11 in 1918. Dysentery, next to malaria the most
serious of the tropical diseases in the Zone, caused 69 deaths in 1906;
48 in 1907; in 1908, with nearly 44,000, only 16 deaths, and in 1914,
4.(*) But it is when the general figures are taken that we see the
extraordinary reduction that has taken place. Out of every 1000 engaged
in 1908 only a third of the number died that died in 1906, and half the
number that died in 1907.
(*) Figures for recent years supplied by editors.
In 1914, the death rate from disease among white males had fallen to
3.13 per thousand. The rate among the 2674 American women and children
connected with the Commission was only 9.72 per thousand. But by far the
most gratifying reduction is among the blacks, among whom the rate from
disease had fallen to the surprisingly low figure in 1912 of 8.77 per
thousand; in 1906 it was 47 per thousand. A remarkable result is that
in 1908 the combined tropical diseases--malaria, dysentery and
beri-beri--killed fewer than the two great killing diseases of the
temperate zone, pneumonia and tuberculosis--127 in one group and 137
in the other. The whole story is expressed in two words, EFFECTIVE
ORGANIZATION, and the special value of this experiment in sanitation is
that it has been made, and made successfully, in one of the great plague
spots of the world.
Month by month a little, gray-covered pamphlet was published by Colonel
Gorgas, a "Report of the Department of Sanitation of the Isthmian Canal
Commission." I have been one of the favored to whom it has been sent
year by year, and, keenly interested as I have always been in infectious
diseases, and particularly in malaria and dysentery, I doubt if anyone
has read it more faithfully. In evidence of the extraordinary advance
made in sanitation by Gorgas, I give a random example from one of his
monthly reports (1912): In a population of more than 52,000, the death
rate from disease had fallen to 7.31 per thousand; among the whites it
was 2.80 and among the colored people 8.77. Not only is the profession
indebted to Colonel Gorgas and his staff for this remarkable
demonstration, but they have offered an example of thoroughness and
efficiency which has won the admiration of the whole world. As J. B.
Bishop, secretary of the Isthmian Canal Commission, has recently said:
"The Americans arrived on the Isthmus in the full light of these two
invaluable discoveries (the insect transmission of yellow fever and
malaria). Scarcely had they begun active work when an outbreak of yellow
fever occurred which caused such a panic throughout their force that
nothing except the lack of steamship accommodation prevented the flight
of the entire body from the Isthmus. Prompt, intelligent and vigorous
application of the remedies shown to be effective by the mosquito
discoveries not only checked the progress of the pest, but banished
it forever from the Isthmus. In this way, and in this alone, was
the building of the canal made possible. The supreme credit for its
construction therefore belongs to the brave men, surgeons of the United
States Army, who by their high devotion to duty and to humanity risked
their lives in Havana in 1900-1901 to demonstrate the truth of the
mosquito theory."(7)
(7) Bishop: The French at Panama, Scribner's Magazine, January,
1913, p. 42.
One disease has still a special claim upon the public in this country.
Some fourteen or fifteen years ago, in an address on the problem of
typhoid fever in the United States, I contended that the question was
no longer in the hands of the profession. In season and out of season
we had preached salvation from it in volumes which fill state reports,
public health journals and the medical periodicals. Though much has been
done, typhoid fever remains a question of grave national concern. You
lost in this state(7a) in 1911 from typhoid fever 154 lives, every one
sacrificed needlessly, every one a victim of neglect and incapacity.
Between 1200 and 1500 persons had a slow, lingering illness. A nation of
contradictions and paradoxes--a clean people, by whom personal hygiene
is carefully cultivated, but it has displayed in matters of public
sanitation a carelessness simply criminal: a sensible people, among whom
education is more widely diffused than in any other country, supinely
acquiesces in conditions often shameful beyond expression. The solution
of the problem is not very difficult. What has been done elsewhere can
be done here. It is not so much in the cities, though here too the death
rate is still high, but in the smaller towns and rural districts, in
many of which the sanitary conditions are still those of the Middle
Ages. How Galen would have turned up his nose with contempt at the
water supply of the capital of the Dominion of Canada, scourged so
disgracefully by typhoid fever of late! There is no question that the
public is awakening, but many State Boards of Health need more efficient
organization, and larger appropriations. Others are models, and it is
not for lack of example that many lag behind. The health officers should
have special training in sanitary science and special courses leading to
diplomas in public health should be given in the medical schools. Were
the health of the people made a question of public and not of party
policy, only a skilled expert could possibly be appointed as a public
health officer, not, as is now so often the case, the man with the
political pull.
(7a) Connecticut.
It is a long and tragic story in the annals of this country. That
distinguished man, the first professor of physic in this University
in the early years of last century, Dr. Nathan Smith, in that notable
monograph on "Typhus Fever" (1824), tells how the disease had followed
him in his various migrations, from 1787, when he began to practice, all
through his career, and could he return this year, in some hundred and
forty or one hundred and fifty families of the state he would find
the same miserable tragedy which he had witnessed so often in the
same heedless sacrifice of the young on the altar of ignorance and
incapacity.
TUBERCULOSIS
IN a population of about one million, seventeen hundred persons died of
tuberculosis in this state in the year 1911--a reduction in thirty years
of nearly 50 per cent. A generation has changed completely our outlook
on one of the most terrible scourges of the race. It is simply appalling
to think of the ravages of this disease in civilized communities. Before
the discovery by Robert Koch of the bacillus, we were helpless and
hopeless; in an Oriental fatalism we accepted with folded hands a state
of affairs which use and wont had made bearable. Today, look at the
contrast! We are both helpful and hopeful. Knowing the cause of the
disease, knowing how it is distributed, better able to recognize the
early symptoms, better able to cure a very considerable portion of all
early cases, we have gradually organized an enthusiastic campaign which
is certain to lead to victory. The figures I have quoted indicate
how progressively the mortality is falling. Only, do not let us be
disappointed if this comparatively rapid fall is not steadily maintained
in the country at large. It is a long fight against a strong enemy,
and at the lowest estimate it will take several generations before
tuberculosis is placed at last, with leprosy and typhus, among the
vanquished diseases. Education, organization, cooperation--these are the
weapons of our warfare. Into details I need not enter. The work done by
the National Association under the strong guidance of its secretary, Mr.
Farrand, the pioneer studies of Trudeau and the optimism which he has
brought into the campaign, the splendid demonstration by the New York
Board of Health of what organization can do, have helped immensely in
this world-wide conflict.
SOME years ago, in an address at Edinburgh, I spoke of the triple gospel
which man has published--of his soul, of his goods, of his body. This
third gospel, the gospel of his body, which brings man into relation
with nature, has been a true evangelion, the glad tidings of the final
conquest of nature by which man has redeemed thousands of his fellow men
from sickness and from death.
If, in the memorable phrase of the Greek philosopher, Prodicus, "That
which benefits human life is God," we may see in this new gospel a link
betwixt us and the crowning race of those who eye to eye shall look on
knowledge, and in whose hand nature shall be an open book--an approach
to the glorious day of which Shelley sings so gloriously:
Happiness
And Science dawn though late upon the earth;
Peace cheers the mind, health renovates the frame;
Disease and pleasure cease to mingle here,
Reason and passion cease to combat there,
Whilst mind unfettered o'er the earth extends
Its all-subduing energies, and wields
The sceptre of a vast dominion there.
(Daemon of the World, Pt. II.)
End of Project Gutenberg's The Evolution of Modern Medicine, by William Osler