The President's Address Register (Adelaide, SA : 1901 - 1929), Tuesday 5 September 1905, page 7
THE PRESIDENTS ADDRESS.
Tho President (Professor E. C. Stirling, C.M.G., M..D.. F.ltS.. F.R.C-S., Consulting Surgeon to the Adelaide Hospital, and Proessor of Phvsiokxrv in the Universitvt rie
ivercd the inaugural addrefe, and took for his subject 'Medical science and social problems.' He said:— —Welcome and Thanks.— The first and wry pleasant duty that falls to my lot as President of this consress U to welcome, in the name of the medical profession of South Australia; our brethren from beyond our borders. If these to some extent stall divide m poli'iBillv. yet they form no barrier^ to the confraternization of the members of the groat irmy of medical fcfcncc. whose common object it the relief of suffering, and abolition of disease. On our visitors do we. in this numerically small Stato, very greatly rdy or the success of this* meeting, .which they inve honoured by their presence. Though South Australia cannot, indeed, offer the scenic attractions and advantages of some of the other States, yet we, it* citizens, like to. think that we arc not inferior to our nctighlxuin in the warmth of the personal and social welcome we endeavour to extend tb those who favour us with their too infrequent visits. On such nn occasion as the present we may be relied upon to do our be*t to uphold what- reputation for hospitality we may be thought to possess. May ] also be the month piece of tlie congreaj in welcoming to this meeting all those who, thouch not belonging to the medical profession, yet have shown their interest in our proceedinfH'and in the cuiw we represent by behiK present at a gathering which can scarcely have appealed to them as a recreaHonmry attraction. For my second duty
tlie more aiuicnit ta-K presents meu of tcknowledflinK in an adequate manner the XMnpliment which has been conferred upon me by my election to a presidential chair Lhat has been occupied l-y some of the most) dwtingaishod members of the profession in Australasia. I 'lake this carutBt opportunity of expressing my deep appreciation of Lhc highest honour which lie* in the power -f my medical colleague* to bestow on one af their number. May I be found as worthy if their confidence as were those wlio have preceded me in the dignities of 'the position, in tt* dutfo*, and wilj not till my predccesMtrs agree with me if I add in ite greati anxieties and responsibilities? In this particular instance this acknowledgment ahnoMt requires the infusion of an Apology, seeing that I, standing for some vear-- outride the active practice of our |.rofe--*ion, feel myself in some respects unqualified to addrcM my experienced colleagues en many matters which lie nearest to their UwugbU and work. Instruction or inspiration is not in my power to offer, but 1 console myself with the thought that there may perhaps lie some propriety, or even advantage, in an arrangement whereby every now and then the opportunity of speaking ex catbedra should be given to tltofce whose daily work consists in the consideration of the healing art, rather from the point of view of its underlying principles than from that of their adaptation to tl-e requirements of actual practice. —Predecessors in Office.— Thi% your Excellency, ladies, am) gentlemen, is not an ordinary anniversary; I aia glad to think by the faeos I sec before me that thvre are many here this evening wbo need no rcmindimr that the Institution of Intercolonial Medical Congresses, to givo them their original name, was founded in South Australia, and tliat in Adclatdo in' 1SS7 was held the first of the series of meeting! that have continued uninterruptedly ever since to the great benefit of ourselves and, I woukl fain think, of our chIIing. Now, after these evcntfnl years, it returns to as for the second time!. It is pleasant to sec here, older by those eighteen years that have passed siikc he held office, but still in the prime of intellectual life, the first President of the lint congress. So also do we welcome those other past Presidents— Dr. Batcbeior, President of the New Zealand Congress in 1S90; Dr. John Thomson. President of the Queensland Congress in 1800; and Dr. Butler. President of the Tasmanian. and last, meeting in 1002, who in jtheir fwpectwe State* have so worthily upheld the dignity of Iheir country and their profession as to make their example difficult of emulation for their successors. Still with uk aho is the real originator of the system of congresses. Dr. Poulton, the secretary of the first meeting, as he is again of this. Neither has be lost bis superabundant energies of 18 years ago, which, to our f*rent advantage, he now once moro places at our. disposal. And other distincumhed participator!! of the first congress 1 see, now become the Nestors of their profewn'on. whom we gladly welcome to Adelaide for the second time. —Advances of Surgery and Medicine.— How, then, shall I use this, an opportunity that comes once only in a man's lifetime, when be may address not only his oftcembled colleagues, but those now numerous members of the public to whom the widespread dissemination of scientific information has brought some knowledge of the romance of medicine and surgery. On occasions such or these, which serve as milestones in our lives and in our profession, it w a time-honoured custom for him who stands in the position which I liavc the honour to occupy toniglit to review the progress of tliat particular branch of the profession with which bis life's work has been identified. For one whose special interests were for more than a quarter of a century centred in the prac
tice and principles of surgery it is a tempting theme to exalt the bom of bJb- calling by dwelling on its phenomenal advance daring a period of which bis own student . day« Jxt the beginning. But that has! been an oft-told dde; it has been told !-y some of those who themselves were in the forefront of that triumphant march which ha* brought tsurgery to * pitch of suoos-jj undreamt of even only half a century iv-'O, and 1 need not repeat H. The thaumaturge proceedings of the operating room iiavc, indeed, ulwuyg ap(icaled to the popular imagination, and their results have become perfectly familiar lo the intelligent public, cither as the outcome of their own personal experiences or of the general spread of information which is one of the characteristics of this age of publicity. Indeed, we know how. cadi remarkable discovery is served uo to us by the daily press on tlie morning following its announcement in tlie country of its origin. The brilliancy of the results of surgery not unfrcqucntly gives rise lo disparaging comparisons between it* progress and t bat of its less spectacular sister— Uic science of medicine. Bat this disparagement is not wholly justified; for medicine, if it has been later than surgery to respond to the vivifying influences of the ancillary sciences, has now at last entered upon an era of remarkable discovery preguant with infinite possibilities for the future. If surgery as a craft has in the period in which ? we hve reached its golden age, it is pos. sible to predict with great assurance that the present century will witness an cqoal if not greater advance on the part ol medicine and its collateral branches. In. deed, as we can plainly see. that advance has now begun. Already the new therepcobcs and tlie new science of preventive medicine have accomplished unexpected results while offering boundless pro-i mue of achievements in the future. About 30 years ago a distinguished Eng.i lish surgeon, a leader of the profession, pave it as bis opinion that operative surgery had nearly, if not quite, reached its ultimate limits, and that certain regions of the body most perforce remain sacred from interference. But a great deal of water has flowed under the bridge since that tune. Surgery has extended its scope Jar beyond what then appeared possible. Almost every organ of the body, including such important structures as the spleen, kidneys, longs, Mver and its appendages, the brain and spinal cord, are now success- 1 fully invaded by the surgeon's knife; some of them arc even entirely removed. I The heart itself, the centre of the circulation, the slightest wound of which was not so long ago thought to be a fatal injury ia not exempt i from interference, for there have been cases in which wounds of this organ have been successfully sewn up. The feasibility has even been seriously considered of reraoving tlie obstruction to the circulation caused by the disease of its valves which, as experimental physiology has shown, need not lie regarded as impracticable. Long lengths, to be measured in feet, are with impunity cut out of the intestines and tlie continuity of tho remainder restored. The stomach— that long-suffering organ than which, as has been well said by a surgical cynic, no ass is more heavy laden— has. by its successful removal, been proved to be one of those usclcs* superfluities of vhich not a few encumber our far from structurally perfect bodies. But it roust be dear that in a finite body there must be some limit to our interference with organs on the adequate integrity of which the maintenance of life depends; nnd. if we have not quite reached those limitations, we can hardly doubt that, so far as actual removal of parts are concerned, there cannot in this respect be many more worlds to conquer for the surgical Alexander. Hut even if this be the case, it is quite possible tliat surgery may be considerably extended on the constructive Ride, so that we may be able to engraft, wholly or in part, complex organs as we do now in our transplantations of skin, l«ne, teeth, and nerve. And, of course, there w still abundant room for improvement in our methods of operation and means of diagnosis. —Importance of Anatomical Knowledge.— May I venture in this connection to enipliasize- the importance of the too-ol'ten neglected minutiae of human anatomy. Now that sumcal interference is piiKncd to the utmost limits of corporeal endurance, and almost every doctor considers himself capable of undertaking the most intricate operations, a refined knowledge of tho smallest structural details of the human body is more than ever imperative. A due regard to those methods of operation which will ensure the least possible distutbancc of parts and the least interference of normal functions may moke all the difference between success and failure. Bat it is astonishing what the human body will endure. On! the little more, snd how much it is. Awl the little tag, «nd what worlds away I' To whom shall this appeal with greater and more painful force than those to whose ''little lew' of knowledge or. of skill, that might, have been the 'little more,' -has cost a human life. But, after all, though I speak as a surgeon proud of my calling, our craft i'm, we must admit, in many of ils proceedings, a rough-andrready sort of business seeking to cut the gordion knot of disease rather than to untie it. Though the surgeon's knife will probably remain the ultima ratio of treatment of many of those injuries, deformities, and accidents to which our body w subject, partly on account of its own inherent ini|-erfections. yet the discoveries of recent years render it permissible, and by. no means visionary, to conceive of more rational and less violent therapeutics than the cutting off or cutting out of diseased organs or taaiuci. Indeed we are, even now, some times alilu to achieve this object by appropriate medication. Better still, tue council of perfection would be to substitute prevention for our cores, for, indeed, there is no reason whv the pruraipjes of the new ocience of preventive medicine diouki not equally be applicable to the suqpcal manifestations of disease. —The Old and the New Medicine.— After king epochs of slow and gradual growth, interrupted by dark ages of stagnation and superstition, both medicine and surgery have, in our own times, witnessed a remarkable and, relatively to post epochs, Midden expansion not only in their methods but in their underlying principles. Between the old and the new medicine there in a difference not merely of degree but, in a great measure, of kind. Wtuit then, we may ask, is the nature of the now influences which, to so. conspicuous a degree and with a potency exceeding that of p-u-t 'forces, have served both as a stimulus to, and as the Iwjbs of, this midden bound of progress. It may not be without some interest even to those outside the profession if we see what answer can be given to this question. In ancient Greece, some time dm/ins the three centuries lhat prc ceded the Christian era. there arose among the physicians of the day a sect who, because they based their practice on experience .done, to the exclusion of genera listlion, reasoning, ami analog}-, termed thempelves .the Empirics, this word being the Anglkwed form of the (.reek word, meaning 'one who is guided by experience.' Another sect, which flourished nt tine wme time, held experience to be \-alnetoss, ami founded it* doctrine exclusively npon reasoning and theory. These styled themselves Methodists, because they bused their practice on a simple method, which we intent call a 'rule of thumb.' To this wet Galen, one of tho greatest names in the early history of medicine, belonged. A third sect availed themselves of both experience and renwrninR. and were called the Dogmatists. Thus, even in these early days, there were schinm in the profession, and it is not surprising to lenrn that hei tween them there was much and bitter controversy. Truly our medical forefather* ; were very human. The Empirics were con. I trovcrmally defeated; the sect died out, '. and lhc name Emoiric, no doubt from its association with what was considered to he a defunct medical heresy, became a term of opprobrium.' which connoted (inackcry. nnd. as applied to medicine, it still rcteins much of its sinister meaains. But if the Empirics as a distinct medical sect died out,, their basic doctrine of practice has survived. For long ages empiricism— wing the term now in its literal and proper sense— bos been one of the principal foundations of our medical practice; to the wfa empiricism of our medical forefathers it has owed much, and we mart admit tliat on a method of sound empiricism successful clinical treatment greatly rests, and must continue to rest, as, indeed, do most of the judgments of our daily lives* And here let me observe that, -when we are apt to decry the manner of practice of our forefathers io the exaltation of our own method*, we should remember tliat it is Iqucstionablo'whcther we of the present day are in all respects the equals, in powers of .assiduous and attentive observation, of ' those (treat masters of the profession who f-r- lone ago preceded, us. Without the multitudinous mcchanica] and other aids to diagnosis that we now possess and that to come extent are substitute* for natural wits, yet these men. by their unaitied power* of observation, were often aide lo form an extraordinarily correct- conception ?of the conditions and course or a disease. Their methods of treatment, indeed, purely empirical though they were, had. in many cases a succees that we have not been abl«: grcatlr to improve upon. So then let u* ever remember when we boast of our modern progress that our prodeeesw* of old were not all ignorant not always wrong in their methods and judgments, and that they have left us a rich legacy of recorded
shscrvatious und clinical insight into diskwc tliat stand as on example of bow much ? may lie achieved by the unaided senses and by natural intelligence wisely applied, in I many ways we might well ask for 'the old , paths is the pood way and walk therein.' i Hut .«o long as our practice continued to bo ba-«d only upon empirical methods to the exclusion of rea.--.nud processes which could enable us to recognise the underlying priuriplcs of which the observed £acUj were but i scattered cxprcssionx, fo lone could medi-j cine lay no legitimate claim to come within tin; category of the science*. To the dignity of tluit |KM-ition both medicine and surgery nuiy now, with some justice, lay claim. No longer docs medical practice rest upon a chaotf— an incoherent and unrelated aggregate of observed facts: Xo longer are we satisfied to know that such ami such things are, bjit we have begun to ask the questions why and how they ore, and when we are able to give even, a partial answer to these questions our knowledge ceases to be empirical, and becomes ratiqnal or . scientific, and it is this just in so far as our answers are complete. In other words, medicine no longer content* itself with ibe knowledge, however accurately determined or however often recorded, tliat a disease has such and such a set of symptoms, and that for some unexplained reason guchandsncha treatment is beneficial or detrimental, but it socks to know what are the intimate causes of the perturbed action; why does it arise; why does it run the* definite and constant course which has been observed to characterize it or which distinguishes it from other kinds of perturbed action; and why should a particular kind of treatment be beneficial or the reverse? When we arc able to give the answers to questions of this kind iu a sufficient number of correlated cases we arc able to establish certain laws of disease that embody principles which guide us in our practice, and give to medicine not only rational methods but extend infinitely its scope of action. A koinuI principle, or even a wrong hypothesis that has been rightly; wed, is worth any number of unrelated /acts. 'Felix qui |x-toit rerom cogiioecere' causas' is just ox true for the phynctan as for the phjloaopher; nay, twice lumpy u the former, who can by his knowledge project his own felicity into the bodies and minds of. those unto 'whom he ministers. It is part of the aims of this address to bring before the notice of those to whom the facts may be unfamiliar some conspicuous illustrations of the wide influence that scientific principles have exerted upon medical science; to show that the phenomenal progress' which the last balfccntury has witnessed in various departments of our profession lias been due to the application of these principles, and that what already has been achieved in this direction is only an earnest of further and perhaps greater triumphs in the future. Here, then, is the difference between tlie old and the new medicine. The old based its methods, often we must admit with, great practical success, upon empiricism and irrational hypotheses. The new, while retaining what is good of the old methods, seeks for tlie deeper and the truer insight into tlie bow and the wherefore. —The Germ Theory.— ?. In these days, when- every one is familiar with the extensive rob played by the microscopic organisms which we collectively call germs in the causation and manifestations of disease, it almost requires an apology for alluding (o so well-known a story. But as no more striking example can be mentioned of the fur-reaching influence that may follow the application of a scientific conception, may I be pardoned if I make some brief alluaon to the subject. Nowadays everybody, even that muchtalked-of individual tlie 'man in the street,' is familiar with the fact that the pront successes of surgery have been due to the co-operation of two factors— the use of anaesthetics and the adoption of aseptic and antiseptic procedures. Everybody knows that the object of these latter methods is. in the former case, to exclude from entrance into open wounds and aufe ceptiWc surfaces those noxious vegetable organisms generally found in the neighbourhood of man. which, when they do cuter, ore the ennsea of these local putrefactions and dangerous infections of the system commonly called blood- poisonings. Antiwptis has the less favourable design of destroying the germs if, unfortunately, they should have -.already gained entrance. Not only have these aseptic methods permitted a vastly extended scope of surgical procedures, especially in the abdominal region, but they have alto ted to the practical abolition of those. former scourges of surgical practice, hospital gangrene, pyaemia, septicaemia,., erysipelas, and other forms .of ,.' blood poisoning, secondary hemorrhage, und suchlike nirgical calamities. ..itAnd if puerperal fever and* its allies still, exist moro frequently than they should do it is principally because of the ignorance and want of surgical deanliness,.of those obstetrio anachronisms-rthe amateur. Mrs. Gamps, who so confidently and. so gleefully preside over ibe occasion* whidi ore liable to give rise to this class of complaints. —A Far-reaching Discovery.— Now, for the purposes' of my argument, the point is that all these great results from the me of aseptic methods may, with much truth, be said to have sprung from a single biochemical ' discovery, which, when it was made, liad no connection whatever with medicine or surgery; indeed, it bod reference to tlie very prosaic and apparently remote question of the mnkiiijr of beer. Nevertheless, it. was undoubtedly Pasteur's classical investigations into the causes and conditions of fcrinentatiou which formed tlie immediate starting point, and, indeed, the foundation of the aseptic methods of treatment with which the name of Lister will ever be honourably associated. For, applying the itfintinlm of Pasteur's uiscoverv to sur
gery. Lister showed tlpt just as fermentation is caused by the presence and action of certain definite, living, vegetable organisms, so putrefaction in wounds, which is only a special variety of fermentation, is similarly caused by certain other minnte organisms: and ho proved also that the fame land of methods which would prevent the pne process would prevent tho other. Thus the practical question in respect to surgery resolved itself, as we have laid, virtually into methods for the exclusion from wounds of these organisms, or for their destruction should they, hovo gained entrance. No better example could be given of the world of difference that lies between the knowledge of a fact and the knowledge of its cause. Our forefathers were perfectly cognisant, indeed they had disastrous experience, of the broad fact that putrefactive processes were ant to bo 'set up in wounds, but, being ignorant of the cause, they were powerless to avert tlie fatal results. Tlie principles involved in Pasteur's discoveries in the field of fermeutut ion were soon destined to receive a still wider application .for they led to the discovery that many of tne diseases we term infectious were due -to the entrance into, ami operation within, the body -of other orpicisnw of a nature allied to those whieh cause the infection of wounds. And if, still, there are some infectious complaints 1n which the specific germ ha« not yet with certainty been detected -we may be absolutely sure ihat -for every such
disease there exists an organic generator; and, further, there even is much to justify the view that other diseases than those now generally classed with the infectious group— such, for instance, as rheumatwm— may be due to similar causation: and need 1 say that we arc ever on the alert to discover a possible {rerm of cunccr? Nor is the knowledge gained from this gcneraluation limited in its application lo man nnd his diseases. It lias been extended to those pestilence* wiiich at times, in certain places and with such fatality, infest the domestic aiuniab; it has been successfully, applied to the improvement of ecoltomic and manufacturing processes; and, in the light of the same knowledge, we have learned the nature of those chemical changes taking place in the soil by whidi it becomes better litU.il for the nutrition of vegetable crops. Tlie formation of nitrates, whidi arc ro valuable as fertilir zcrs, we now know to be due to the action of vegetable organii-ms similar to those which produce disease, and when these arc nLseiit or deficient we can supply them by duett inoculation. How wide then and fur-reaching has been the influence of this oue biochemical discovery of the organic causes of fermentation; and I Ita-ve but I merely touched upon the fringe of an imnicnse subject. Truly the value of a new principle, however limited its application may at firsti appear to be. is incalculable, and the direction which its influence may take unlimited. It is, however, clear tliat these discoveries, great as thev.are, form, hut the introductions of fresh problems. Una great step to liave traced the causation of disease to specific organisms,! which arc tangible entities that may bo seen, isolated, and used as we wiO for the experimental confirmation of our theories. But our canon requires that causation should be -pushed still further back, for there arises the next question— Ii©w and why dp these gams produce their effects? Into this domain of enquiry we have now begun io penetrate. But as these considerations involve questions of somewhat greater complexity I shall most' conveniently bring them under your notice. in a concrete form. And in so doing may 1 seek once more the indulgence of my medical brethren for dealing with matters which to them are so familiar? —Toxins, Antitoxins, and Immunity.— Diphtheria, one of tho oldest known of infectious disorders, is caused by specific b'ving organisms, which, as a rule, gain entrance into the body through the nose or throat. Settling on some part of these regions, they rapidly multiply, and at tho sauie time sccrens a poisonous substance, or toxin. This, entering the circulation, is distributed throughout the body, and poisons the tissues by interfering with the normal processeH by which they maintain their vitality. In short, a contagiitm anima turn frobi without produces a virus Inaniura— a lifeless poison— which docs the mischief within. Now, it is found that if some of this diphtheria toxin, which, up to a certain degree of purity, can be obtained separately by growing the diphtheria germ in suitable culture mediums outside the body, be repeatedly and in successively increasing doses injected into the blood of a horse, this animal becomes so affected that it acquires at length the capacity .of withstanding, without symptoms, a dose of the toxin tliat would, without preliminary treatment, inevitably have killed iU In other words, using the terminolofrv of the day. we ray that the horse has been made immune to this special diphtheria poison. In fchis condition the serujn, or fluid part of the horse's blood, is found tb contain a sulistancc whidi, because it is antidotal to, or capable of neutralizing, diphtheria toxin, is called anti-toxin. And when a suitable dose of this serum, is injected into the blood of a human being it may act either by preventing an attack of diphtheria— that is, it confers immunity in this respect—or, if the disease has not advanced too far. it nets as a curative agent: From this method of treatment arises the term so much in evidence at the present time —scrum therapy— and speaking of this one disease, diphtheria, it may safely lie said tliet by its timely application thousands of lives liavc been raved. Now, It must be umlcnftood that this conclusion as to the antagonism of toxin and antitoxin does not merely rest on the results of triab on the living bodies of man or other animals, but its main, facts are* based securely on experiments in the laboratory, where it can be shown that if the proper proportions of the two. substances are added together in a test tube the mature is harnucss when injected; the poisonous toxin has. in fact, been neur trained by tho antitoxin. The cose of diphtheria presents us with one of ths most satisfactory examples of the remedial application of the antidotal action of antitoxin on a toxin produced by bacterial action. In some other diseases— of which the now comparatively rare disease, tetanus, or lockjaw, may be token as an example— though laboratory experiments justify similar conditions as to the manner of formation and interaction of these antagonistic substances, yet the. application of this kind, of treatment lias not so far yielded such satisfactory results as in the case of diphtheria. For this relative failure we can recognise. reasons which in no way invalidate the general conclusions, but these it. is not necessary to discuss. We find also that the toxins arising from bacterial action are not alone in their power of generating antitoxins, for eadi land of snake powon will similarly produce its antitoxin, which, if it can be applied in time, act« as an efficient antidote; and so will ricin (the poisonous clement of the castor oil bean) and abrin (the active principle of those bright red-and-Wack seeds called crabs' eyes, or jequirity), both these latfbnamed poisons being far more powerful than strychnine. In all these coses the reaction may be demonstrated in the most certain manner in a laboratory experiment, — Ehrlich's Theory.— Considered merely in the light of a sysfa-m nnnlicnble tn the treatment of nar
ticular diseases, these facts concerning toxins and antitoxins are of great imporunnce; but of still greater value arc certain underlying' principles which have emerged From some recent investigations on this subject, with which the name of Ehrlidi will ever honourably be associated; although, as in matt other great discoveries, the whole result is not the work of a single mind. The great merit, in this respect, of this distinguished pathologist is that he Iras reduced the interactions of toxins and anti-toxins, both intra vitam and in vitro, to principles of molecular chemistry and of chemical physics. Be has shown that tlie interactions in question are subject,. both qualitatively and quantitatively, to the known laws tliat govern chemical action. We hre not able, it is true, with our pro-, tent knowledge, to symbolize the reactions involved in the form of an equation, for we do not know tbe exact chemical nature of the substances concerned; and, indeed, both toxins and antitoxins have, not yet been isolated, in a pure condition, but wo have evidence that the former,- at least, nnpeara to he related to substances closely resembling products formed in the course of ordinary digestion. Consequently it is not improbable that, notwithstanding their poisonous character, the toxins are subEtanctiK not far removed from those which form the normal food' of the body tissues. Antitoxins arc believed to bdongtoadofcly allied group, tihrlieh's theory further refers the chemical actions involved to tiiosc cells of the bedy on which toxins exert their influence; he shows us how, on grounds finite in harmony with known physiological Liws. tbe formation of antitoxins., depends nn the power possessed by the molecules of. certain susceptible body cells to seize hold of and anchor to themselves tbe circulating toxins, and in so doing tliey arc ittiraulated to an increased activity which causes them to liberate into ? the blood- j btream certain substances which arc, in fact, the antitoxins, and these, meeting the j toxins, combine with them and neutralize; their effects in much the same way. as an alkali can unite with and neutralize an* add. i Thus in the laboratory ' of tbe body are produced the same effects as when two rhcttucal antagonists ore mixed together in n tax tube. —A Central Problem of Physiology.— Great as is the importance of this theory From a therapeutic point of view it has a Ktill wider significance, for it throws light upon one of the central problems of physio. log-% viz., the nature of the cbemkal roc- j chitninm of those normal physiological proL-CHse* by which the living cells of the body, regenerate their substance by incorporating the nutritive materials which form their food, and then ognin. by their activities, break down into watfe material. And the conception has still wider application*, which will be mentioned directly. We have seen that in diphtheria and tetanus Ihe deleterious inlliienec of their organic Eencralor* depends upon the production of toxins, which, indeed, may produce their pffecti quite independently of the actual presence of the germs themselves; bot we ilso know that there is another dass nf diseases in which the effects arc due to ' the actual bodUy presence of the bacteria ' ;md not to toxins, which may be isolated From them. Of such a das are typhoid fever, cholera, plaque, pneumonia, eeptiraemia, and other forms of blood poisoning in which diseases scrum therapy is still on its trial, but so far with lew certain and ntccessful results than in the ewe of djph- 1 thma. In immunMnR an animal against this clan of disenccs ihe object is to de- : velop in it not a serum capable of neutra- 1 liring the toxic product, but one capable of destroying the actual, bring bacterial organmns. 'torn is done by wing for nrawtDuatioo cultures containing the bodies of
tbe bacteria themselves, not merely their separated toxins. To toe reactions which take place when these bactericidal sera, as they arc called, are used Ehrlich applies a clicmko-pbvsiological explanation similar to, but more complicated than, that which he given for the relatively simpler affair ;-f toxins and antitoxins, but this again it is not necessary to discuss. By pursuing ihiK line of research it has been found possible to produce iu animal scrums a variety rf thc*e anti-bodies, as they may be called collectively, each oi which bis some specifically destructive action, not unly on such organic cells as ore represented by bacteria but upon other lands of cellular units of complex fluids or organs, well as the red corpusdes of the blood, the cells of the liver, nervous system, and so on; and here can bo seen the ground for the hope, so often expressed but as yet unfulfilled, that by an application of this principle, we may be able to develop a scrum which shall have the property of destroying those cells of which a cancer or other malignant growth is composed, while leaving untouched tbe healthy cells; or if cancer should be proved to be due to a. germ, wo would eeek for a, scrum wliich would destroy either it or its poison. Koch's tuberculin treatment of consumption, the tragedy of the failure of which we so well remember, was one of the many attempts that have been made to treat this disease on the principles we have been discusnnc. Nevertheless, now that we know so well that in this and many other complaints we have to deal, not with a nameless and unknown something, but with definite and s|iecific organisms with whose conditions of existence we are perfectly familiar the hope remains that the defeat in these cases may not be final Indeed, we have good grounds for believing that the organic generator, of every disease once it is known may. be. made to produce its own antidote. This surely is a magnificent conception.—Other —Other Applications of Ehrlich's Theory.— Nor even do the results; of these investigations stop here, {or out of them have. arisen new methods more precise than any others available for the identification of various bacterial species; means more delicate than any other test for detecting the presence of toxins; . a means of diagnosis for typhoid fever: a method for the determination, with extraordinary accuracy, of tbe resemblances ana differences between the blood of various species of animals which is capable of being applied in. Courts of law for the identification of bloodstains. The same methods can be applied also for the purpose of determining the relationships of species and group* of animals by demonstrating tho Fact that 'there has persisted a common ]iroperty in the blood of various groups through tlic countless ages that have elapsed since their evolution from a common auccstor, and tiiiujn. spite of differences of food and habits of life.' lost)}, from an exhaustive study of the phenomena of old age, to which an increasing amount of attention has been paid of recent years, the distinguished physiologist Metchnikoff, wljoee name is o guarantee that lie doe* not speak as a visionary enthusiast and who. himself, lias borne a conspicuous part in the investigations tliat we have just lieen discussing, has 'suggested that it miy be possible to apply the principles of serum therapy to. the arra.t of those senile changes whidi we have been accustomed to believe form tbe inevitable and distressing concomitants .of old age, to the end that we may prolong tbe usual span of life. Bo this as it may, the increasing study do voted to the conditions of old age make it abundantly dear that many of its painful incidents arc of our own making, and, above all others, the deleterious euects of alcoholic excess in bringing about premature senility and decay stand, out in malignant relief.—Vaccination.— —Vaccination.— In these days when tbe questions of serum therapy and immunity loom so large iu the foreground of medical science we may, in tlic light of recent discoveries, recall the epoch-making discovery of vaccination. \ little more than a hundred years ago the Englishman Jeocer recognised, what seems at that time to have been common knowledge on the dairy farms of Gloucestershire, tliat persons who had contracted cowpox— a mild disease— from their, charges did not as a rule afterwards contract the virulent disease small|iox, and vaccination *u the methodised application of these observations. It rests on the basis thai by the introduction of a weakened poison such as thut of cowpox, which is in effect smallppx modified and mitigated by iu inssage through the cow, it. is possible to establish in tbe body of man a certain insusceptibility to,. or tolerance of, the poison of smallpox, so that tlie latter disease .is cither., not coptracted at all, or, tf contracted, it assumes, a milder form. Thus vaccination is but a special application of what we now know to be .a general principle. I. need not dwell on tbe fact that by. the general adoption of vacciuation smallpox, which from the thirteenth century ranked as the most destructive of pestilences, has been, if not completely eradicated, at least greatly mitigated in its prevalence and effects wherever communities have hern willing to avail themselves of tbe protection afforded by the practice. On the other hand, we have had frequently manifested tlie power of mischief that may arise from iu- nesrleet and from a policy of indulgence towards that type of person who calk himself a conscientious objector. You will sea why I have recalled this episode of medical history. It is, of course, because the basic principle of Jcnncr's discovery lias. received such ample confirmation by the recent investigations in serum therapy and immunity. But. we may ask, why did vaccination remnin more than a century as tlie single example of an immunization conferred by this method? The broad idea of establishing artificially an immunity for poisons is itself very old. for. as we learnt in our school days, MiUiridates, King of Ppnlus, in the fear of attempts upon his life by poisons, produced in himself a tolerance of their effects by the habitual and continued taking of them in small dote*. The term Mithridatism, still applied to the tolerance to poisons thus produced, perpctintes the mme of an early practical exponent of artificial immunization. —A Remarkable Conception.— We may, I think, safely say Ibat the reason why vnecinaUon remained for so long as the «ole example of protective inoculation was because it was an empirical discovery in - the sense that no underlying principle Was discerned which would admit of its explanation or its extension to other awes. 1 tie fact of its protective influence mis known, and. indeed, -was so obvious that the practice of vaccination was adopted by most civilized communities, though, let us regretfully admit, with greater thorougbiness by others than by tin countrymen of 'the great Englishman who delised it. but no rational explanation of the cause of- the fact was forthcoming, and this is just what Khrlich's theory attempts to supply. Even if. as L« very probable, it will ultimately be found out not to be correct in all it* details, it may safdy be said that iU fundamental principles will never die, and nothing can' minimise the stimulating influence of this very remarkable conception that Iras radiated in so many diverse direction*. It i». then, not a little remarkable that in these days, when tbe. principle of ?Icnncr's discovery has been so amply vindicated and extended, and when some of its undoubted original dangers have been removed by better method* of application, that we witness a marked tendency to neglect the protection which the world's cxjiericncc tew shown it so conspicuously affords. With, this wide and everwidening, scope : of the prindplcs involved in- the recent theories of immunity .' it is no wonder lhat they ocenpy «o prominent a place Sn modern medidne. Nor, as we have seen, is tlicir application limited to the proccntes of disordered function' with which medical science has to deal, but it extends towards a better understanding of the normal physiological mechanisms of. all living tissues. The-' Illustrate the ..conception that is being to surely borne in upon im (hat medical edence, like biology, of which, indeed, it is but a branch, requires for its duddation the convergence upon it and application to it of fundamental physical and chemical conceptions. No bolter example' could be given of tbe value to sriencc of a. well-ordered imagination and of a good working hypothesis, of how investigations in one field may open up unexpected discoveries in many direction*. Tlic dreams of to-dav become the rcali'fos of tomorrow, and in these theories we have a germinating idea which » destined to grow into a tree of knowledge whose manifold branches will bear abundant fruit. | —Tbe Animal Kingdom in BebiUon to Disease large & the role played in disease by' those minnte vegetable organisms that we collectively call hactcrial germs that we ire apt -to forget that the animal kingdom ulso provides its contingent of dnr.dly enemies to the human body. Putrinc aside those grosser forms of parasitism such as hydaituls, tapeworms, tuid the lik--. whidi ore not as a nde fatal, it is now well krown that in another cla«s of diseases-- infectious but not contagious— fitch m the various forms of malaria, yellow fever, ami oilier*, the exciting -auce is the |-rofcncc in the body of minute organisms wMch belong to the lowest class of animals; and. further, that the transmitters to man of these low organisms are to be sought among otiirr nnd higher orders ot annaaU. lo Ihe diseases particuhrJy
mentioned it is now well established that mosquitoes of certain sorts are both tho agents in the transference as well as the necessary hosts in which a part of tbe parasiteV liie's cydc of development taken place Thus the problem of the abolition of these diseases resolves itself into u question of the destruction of the breeding placet of mosquitoes, which task. ap|»arently at first sight so impracticable, bits met with a gratifying success wherever it has been intelligently and persistently undertaken. That terrible complaint, deeping sickness, which devastates a large belt of tropical Africa,. is similarly caused by a minute animal parasite transmitted to man by a tsetse fly: sleeping uckncsj is, m fact, the human form of that deadly complaint known as naqana or fectse fly disease, which* renders large parts of South Africa uninhabitable for the introduced domestic animals. Other forms of the same fatal animal disease ore those known in India as surra, and in North Africa as dourine. The ' agency of animals in respect to the. causation of infectious disease is alto shown in plague,, where there is good reason to believe that raU. and |ierha'ps mice acd fleas, act as carriers to man. We strongly suspect bouse Hies to be agents whereby typhoid fever, cholera, and forms of blood poisoning may be distributed; anthrax and glanders come to us from tlic horse, sheep, and ox; our common tapeworms through the pig and bovine cattle, and tlie familiar friend of man— the don— is. as we liave long known practically the sole source of hydrophobia and hydatidi. From tlie knowledge of these and many other similar facts it has followed, as part of our recent views, tliat medical science refutes more and more to be bound by the rigid limits formerly prescribed for it^ viz, tluit the human body and' its diseases are to be regarded as isolated factors to be considered apart from their organic environment. It has been compelled to recognise, what the zoologist has long recognised, that man is only a unit m the work! of living things interrelated, not only in structure, but in disease, with bis animal and vegetable surroundings. . —A Warning to Australia.— While I speak of this subject perhaps it m not out of place if I litter a word- of senous warning in respect to the danger that now confronts. Australia from tlic caw with which some of these fatal diseases of stock, from which we have hitherto been free, may be introduced into this country. .Occurring all around us—in Soutn America, Africa, Mauritius. India, Manila, and New Guinca-ibcy ore, witii the frequcnt and increasing means of communication, knocking, so to speak, at our very doors. And if ever they or any of them should, through carelessness or misadventure, gain a footing in this land you may depend upon it ihat the result will be a destruction of our flocks and herds that is inconceivable to those unfamiliar with their deadly effects in other countries. Ask of Africa what it has lost from nagana. dounne. rinderpest, and lurse sickness, India, Manntius, and the Philippines from surra South America from mat de caderas, and from the answers let Australia take warning before it is too hie. A few hundreds a year spent now, with intelligent and prudent foresight, in securing the scr» vices of some competent and scientific expert, who lias had large and practical ex. penence of the highly complex and difficult problems which attend the investigation and management of this class of pestilence, might be the means of saving millions of money and untold trouble in the future. —Result; of British Apathy.— All these discoveries then whidi I have mentioned, with their extensive ramifications, constitute great and important advances not only in the wealth of added faefs. but abo, what is dill more important, in the widening of our ideas concerning the nature' of living activities, and those departures Irom the normal we call disease. Ahcady they have profoundly influenced our medical and suiuical theory and practice, while they are full of i»|ic for the future. Together they have led lo the establishment of what is practically a new science— that oi preventive medicine, which, in its turn, lias led io the virtual suppression of some diseases and the mitigation of the effects of others. Were it not for ignorance, apathy, and that selfcomplacency which is so essentially a diaraoteristie of our own British race, tbe results would be still more marked. Indeed, success in this direction has led a cyme to observe that medidne has made prodigious progress in all things except in the treatment of disease, and there is some truth in ihe sarcasm; but if we are not much better ablo to cure diseases, in the full sense of the term, than were onr forefathers we are certainly much better aide to prevent them, and wo may regard tui« as the higher and better function. —Rational Therapeutics.— We have, however, abo learnt that there are other and wiser methods ol treatment than by a multitudinous and often haphazard ppiypharmacy, for we have a much deeper knowledge, to whieh the recent investigations into tbe conditions of immunity bare largely contributed, of bow great, how manifold, ami bow cfTectirc are the natural ' recuperative powers of tbe healthy body, which were long ago recognised in .the. Hippocratic aphorism, vis medieatrix naturae, We have discovered, or, at all events, we better appreciate, tho facts that fresh air, abundant sunlight change of scene and climate, ocd more suitable, dietaries arc in themselves potent Ibsiapeutie agents; and not the least important discovery is the realization that the doctor s best function often is to he nraply the homo minister naturae We have rocccsrfully a|iplicd the actinic ravs of light to obstinate and disfiguring complaints of tbe skin, and we have invoked, with as yet uncertain success, as therapeutic ajients some of those mysterious and potent electrical and radio-active emanations placed at our disposal by the recni extraordinary developments of physical ptiencc, which bid fair io exhaust the Greek alphabet in their provisional no-nen clature. By the reseandies of ths rvnihttic chemitt we are able to tue medicvuents of absolute purity and known chemical composition, instead of crude drugs of vnry:«K ind uncertain content*: while a more cxfer.ded knowledge of molecular ttruclnr.' las directed attention to a possible connection between chemical constitution and physiological action, which must eventually lead to a more accurate and scientific fhtrapeusis. That conunrathely n-ctut development of physico-chemical science known as tbe ionic, dissociation tkcoiy, ivhieh gives us a rational explication, np Lo a certain p tint,' of such intricate li\ ing actions an tlie contwtir n or ordinary muscles and of the rhythmic and ceaseless beat of tbe heart, the traneudations of phy* ; tiol'igkal fluids, snd has i-ven 'oecti applied j to the explanation of that mystery of mys- 1 tcries, the fertilization of the egg cell, in similarly applicable to Uic chemical mechanisms involved in the action of I drugs, ftcrmtcides, and disinfectant*, as! well as to many of the normal activities of the living body. Again we come back to
tbe fact that tbe more we loam of living actions the more do we find that they it*/ be referred to the same law-i of physics w chemistry which govern vhc rvmtiou^ oc iuert matter. —Medical Science in Relation to the Community — But whijc we may contemplate with much' Kaiisfuctiou these great advances in modi*, cal science let us not forget tliat the ledger of national life has its other side, which is not so flattering to our pride of progress. The gaunt spectre cancer, with lU allied, molignaut maladies— the opprobrium medidnac— the da-ad of wliich is an added terror to Uic frailties of old «©s, still stalks the land claiming in thousands its victims of unutterable jmin and misery- In spito of all our boasted progress we have not even learned their cause; we do uot know the remedy, save, in m far that all cx|-c-nence tells us, more and more, that early; and complete removal— and the earlier tho tatter— offers a good bone of recovery. 'J o this let all take heed, and they may taka the comfort tlxsy may so sorely need. On this problem of malignant dwease is now, being concentrated, in an organized system, *otnc of the best minds of 4Jte incdicul profession tlmmchout the civilized world, und it, may wdl be hoped-nay, it may be cx-liccted— that its solution, will not long be delayed, U, the glory of medidne and (ho infinite relief of human suffering. Tho great white plague, umsuni|Aion, in spito of our knowledge of its cause and of thu conditions which will bring about it* prevention aud cure, still slay* its myriads, far exceeding those of battle and all otlicc pestilences combined iu tlic most iutcrcst-ng, joyoui, and useful quells of their lives, but it may also be Aid that ir UilierculosM is still pnniagatcd it is not because of tlie failure of science but because of ignorance, apathy, wilful neglect, or, it may be, genuine poverty on the jiort of tiiosc who xtill continue habits and practices rliich are rcspou*ib!c for iu prevalence and xpread. We go into hysterics at the thought of the advent among im of some rare visitant disease nidi as bubonic plague, wnall|-ox, or leprosy; but we complacently tolcrau the continuance in our midst of typho*! fever and diphtheria, which are perfectly prevcntibJe, and whose talo of victims i* for greater than tlitt of the former. We fail to have our diihlren vaednated or to lie oursdves rcvaccinated, by whidi means we might render the community securo against a severe tmiolliiox epidemic, while our UovcrumenU, with all thdr love of compulsory measure*, tolerate Uic neglect, preferring rather, or at leant finding it KoiuetiuivH ncccKKiry. to spend Uiousand* in Uic effort to eradicate what might bo prevented. — niysical Deterioration of Uic llacc.— We sec unmistakable evidence of Uic physical deterioration of tiro race, due, no doubt, it, many co-operative factors into which 1 may not enter except to My that or* contributory cause is the tendency lor . jicuple (o flock to the towuH. where tho mothers of the future jiass the most important periodtof their lives— that of curly, udo]c«ccncu— under the unfavourable or even injurious ruiidiliuiu of crowded ami ill-ventilated working rooms. The cry 'bailc to the land' may have a wider and a deeper significance than the mere desire to fill up Uie blank spaccR on Uie map witU profitable industries. It is rare to mm even a child wiih a sound set of teeth— a defect most frequently due to their neglect, from whk-li arise* many an ailment, Ixiili 4 hen and afterwards; aud Uiere is much truth in Uie observation tliat toolln,K-wd-T may serve as a better national protection, tluin Riinimwdpr. — Survival of Uie RUest.— It cannot aUo be doiuited that Uic propress of medical science lilts beeu a contributory factor in this degeneracy by bringing about thu mving and tlie prolongation of Uic lives of those who are physically or mentally unfitted to lie Uic jiarents of a, hcnlUiy race. This brings us within sight of the eternal disharmony between the tendency of the work of our social, political, and ethical systems of our hospitals, asylums, and Uie like, wliidi arc directed towards a similar end, aiui Uia efforts of unaided Nature 'red in tooth and daw/' whidi. by. Uic diminalion of tin unfit, strives with unceasing purpose only for the improvement of the tarn and the survival and perpetuation oi its lxst. And if lime jiormiltcd it would bo an interesting study to see what an imiwrtanl part hit been played by disrobe in Uie evolution of the human species, and how dvilizeil man -by his migration*, his discuses, and his meddling has dwlurlnil existing harmonies nnd altered, often for Uie worn, tho organic face of the earth. And that the degeneration of whidi 1 have *pokcu in nut merely physical, but cxteud5 nlso to the mental organization, in iJiowii by the striking and progrcmive increase both in the nnmber of tho actually insane, and. in Uie increase of Uiooc nervous complaints of which neurasthenia and the like may be taken uh the tvi**— this phenomenon being apparently characteristic of all highly civilized communities and for which the mental strains and Htre»o* of modern life and ititcm|ierance are bcld to be chiefly responsible. —The Dcdinins Birth Rate.—
Correlative with the question of physical deterioration is the uidy fact, for Mme time suspected and recently confirmed by tbe report of a royal ooinmisiou in a neighbouring colrny, tluit tbe decline in tbn birth rate, wl«ch we have lwen accustomed to Uiiiik of as a feature only of tho*! older countries which have had to face the )*vblenis of over-population, lias extended to these sparsely peopled States, and Uiat all classes arc affected, even those who hjta not the burden of want to offer as an excuse. Thus one of Uic conspicuous signs of national decadence is beginning to affect us while we are still a nation in lhc making. And the causes at work, clear and distinct, and for Uic most part disreputable, bring with them the uncomfortable idea of a concomitant general loosening ot' moral fibre which will inevitably radiate its ' maiign influence In other directions. Here at leant is a field in which that derabcratto panacea, compulsory enactment, is~ powers ?? leas. .*,...... -, -OU«* Evils.- ,-£*? ' Closely -connected.' in respect to cause, with the question of physical degeneration is the ? ercessifc mortality ^b£; itofant- fife, for which,; as m the former case, inadequate,and improper fceaing ure more largely rcsnonabie than any other single causi, and t bw, when not due to genuine poverty is attributable^ the lamentable PfcS-£ on *he part cf those who arc moUiers which our vaunted system of education does little to remove. If w« are powerfew to counteract those evil and otherinUuenon- whith underlie the reduction of the rfrth rate it ought, at least not to Ik- an insuperable problem- ami indeed it is our obvious duty to find means for prcscrrinir nwre of 4hose infani* we have, 'llii; hydra-headed monster alcoholic excess still dwcljs with «s briiigirig in his train poverty, crime, cndlcs* social ami domestic misery, and physical nnd mental suffering predisposing to disease, and second only to another cause, abo begotten of human
frailty, in bringing about those degenerative changes Vnich Jead to senile decaf and premature old age The solution of the alcohol question would be tbe solution of many an 31 to which weak flesh has made itself tbe heir. We still show little msdom in out dietnrien either in yuaubty or quality. We still continue to 'dig 'our graves with our teeth,' nnd to lav the foundations of disease, among which may be mentioned the prevalent complaint appendicttu. In this rexpect we in Australia should pay more lived to the evin of our exccKdreJy carnivorous diet, to which many -of our ilk may be traced. —The Duty of the People.— Reviewing thcs-c and oilier physical disabiuV .tic* which it is the lot of man to suffer and endure it must in fairness be aunub* ied that the nsponsibility for the existence and continuance °f most of them cannot be laid at the door of medical science. Where this baa been able tb intervene ft ha* done *o with *-me succchs, as witness the nsmlts of preventive medicine. If wo except from the category cancer and some otber dL*ca*e« in which we must regretfully confaw tbe |»rwcnt importsnec of our pn»fewion Hie majority of thews physical ills have now. for the most part, largely become social qticstfoiiJ1. and their solution vfcen the doctor, upealdnjr in the name of science, has pointed out the cause and cure, lies in the individual and collective cf. forts of the people. Tf, owing to ignorance, apathy, or self-indulgence, they still con.Irene to exist, n. is the community, not the * doctor, who is responsible. And it would ?he better if mclcty, instead of blaming -rcience. a* it frequently does, that ?c ian»ot find ways o£ curing disease, set its houso in. order, and, by abstaining from hurtful wave, automatically abolished a vast '.amount of coffering. Sometime* the advice and precepts of science arc wilfully ilLornsurdcd, as in the case of vaccination, ?wlien* the effective remedy is deUlferateiy thrust aside with the approval, or even the insriizntion. of politicians who cure inure fur the votes than for the bodies of their constituents. — How Suffering May be Relieved.— Then think of the enormous smni of human improvement, pbyskal, mental, and moral, ilia'i would accrue to a great mass of the i«oT-k-. if only tlutil one factor in the lire? «tispo'it»on to and causation of disease, in?UiniteraJDce. wore eliminated from tbcftr lives by deliberate voluntary restraint, for I have no belief whatever in the permanent otficacv or benefit of three prohibitive smwurw which are f=o often ndvocated as the only possible (Kinacca. It U stated that iu.-o-Uiir.ii of the Immense national dnnk I.ill is incurred by the working .cLu-ses. Ifow surely, Ilicn, would the 'diversion into healthier channels of money -awd iu this direction bring an automatic xelk'f to tbore who arc most concerned— a iriicf from an uutoM amount of grinding l-ovcrty, flckmsy, and mental and tnoml tKrttrusM. And to a degree much greater than w realized, how very much longer and Jicalthicr Jives we should lend if we refrained from catins so much, so often, and so unwisely. What might be dune towards rthe relief, or even the abolition, of that ecanrgo of homo lite, consumption, if only people would cease from doing those tiling* Avhieh promote its propagation and continuance, and would do tlion; which, tlicy .can be to!d in all honesty, will with ccrtwity prevent iu spread and bring aljoot its cure, itiit how shall we blame the cicncml puWk- for their errors of commission and nmiicion when those who cannot daim the excuse of ignorance, in defiance of rinks that arc not so imaginary as they seem to think, persist in continuing the reprehensible and imanitnry practice of the rtronriovtioas transference t'com mouth to month of an uncleansed communion cup? 1 £n, too. any betterment in respect to the unsatisfactory and unwholesome condition* ?which prevail in councctiqn with physieal 'dcterkimtion. decline of birth rate, infant mortality, and the like, is only to be expected from a rode awakening of the |Hiblie . conscience and the adoption of a sane and rational system of training in those hygienic and physiologic matters which though of fuvh great importance for the varna mind and the sound body, yet arc so inadequately treated or even entirely neglected in our M-stenis of education. The suppression of malaria and yellow fever has become, as we have seen, a question of ' the destruction of the right sorts of mos' qiritor*: plague, largely, of the extermination of rats and of the filth which usually invites their pretence: cholera and typhoid, of pure water and uncontaminnted food. , Hydrophobia was soecdily eradicated in GrcHt Britain by the niudi-nbuscd order for tutitrliniz dopt, and in it hundred different ways the fact is obvious that what .were once considered mcdknl qucsi-tinnx have mnv to a a large extent re.'solved tlicnMclvcit into social problems.
— Revival of Quackery and Occultism.— (Whether it is to be considered ns a social failing, or only an amiable foible, it is nevertlieless tn* tluit the boundless cmlulity of mankind u|mn subjoctg connected -ivith morlieine luts from curliest times been & conspicuoas feature in his life, and it is not a little reuuirkable that an age which hus witnessed *o great n growth of scientific precision in our medical methods and concepliouii should lie aLso characterized by .yrevrval of superstition, a belief in occultism and quackery of nil dc.-rintkirid tluit ,woold be worthy of mcdiucvnl times. It is particularly remarkable tliat these liehciu and the luiliits nnd practices begotten of tlicm arc not confined to the ignorant, but prevail notoriously among those u-ho belong to the educated classes. We sec the columns of the press filled with the announccmenti) of clainoyants, iirofessorrt of scunnd sight, pitimists, herbalists of various xwtiooalitns*, ami the more outlandish tbe more sought after, hypnotists, vr-*stal gazer*, faith ocalcrs. and a whole tribe ot a Hfmflar sort, ninny of the dcsignaUoUA being merely cloaks for practices much mxrm than is indicated by tlieir names. We are told that imperfect noses can be ?corrected by absolutely |iainlc*- methods, that double chins, drooping checks, and wrinkles can be removed, and that ruptures cam be cured without operation. There arc ; infallible remedies for cancer, consumption, obesity, baldness, alcoholism, nnrcotnania, and numerous other disease*. Column* are filled with the marvellous and unfailing virtue* of somebody's pills, potions, syrups, and other nostrums, the same article pro.fearing to cure a whole group -of the most diverse complaints, while flamboyant posters portray the features of the eminent tnccialwts who deal in tlicm. There is an abiding faith, chiefly among the more educated, in various routine 'systems of trentanent,' as they arc called, which pom under the names of their exploiters. And have ?we not seen in recent times worthy and oihcrwwc blameless citizens pinning their faith to thccfficucy of au iron riug as a cure for rbcuntathzn, — Christian ScienceOne of the most recent devdopmenU of this revival of superstition is the pscudoTeUgious movement which pones under tbe name of Christian Science, with the ltcv. Jlary Baker Eddy as the chief exponent and apostle. As an example of the fatuous twaddle which passes for Mrs. Eddy's gosjiellct me give you the foUo\rin^ extract, .which is port of on invocation for the cure of cancer of the stomach— one of the most zeal, most objective, and moot distrexring .of comnlaiata:— 'Lord, help us to believe 'that AU Evil is Utterly Unreal; that it is .silly to be side, absurd to be oiling, wicket _to be wailing, atheism and denial of Ijod 'to say I'm sick. Help us to stoutly aJb'rra 'with our hand in \our Hand, with our Eyes fixed upon Thee, that we have no Dy*pcpwn, that we never hail Ujvpepsia, ;tbat we will never have Dyspepsia, that -there is no such thing, that there never xua any Mich thing, there never will be any such thing. Amen.' Surely no liinmbo-iianbo of Haitian Obi-man could be more ridicnlonsly inept; and yet this is the sort of tiling that hog gained the concur; T«nce and approval of many educated people. XcverthclcM, however rc|»eUant we may find the mcUiods and practices of these charlatans, and however silly we may Uiink tiicm, in an age which profcswM to ?k! one of reason and enlightenment, it is Tcr-- evident that they must find their tnn'e profitable, for they continually increase in number, in the voluminoutoiess of ?then- announcements, and, we may add, in the impndencc of their pretensions. True of all times and of all sorts and conditions of men and women, nnd never more true than in this connection the Ifudibrastic distich— rvmhtkss the nleasun; Is as great Of being cheated as to cheat embodies a profound knowledge of human nature, and condenses a practical wisdom which explain* the facile success of many a rogue and charlatan with their confiding dunes. ? —Influence of tbe Mind on the Body.— To our sorrow and discomfiture it. must, liowtvcr. be admitted that we doctors have nil of us. at some time or another, met with cases in which so-and-so's patent pills have cured our patient when precisely the Mine ingredients (for the composition of all of these remedies is no secret) have failed, and do we rot know, all of us at Ica&t who have served our time iu a large hospital, the marvellous efficacy of the local brew of mistura diabolic* concocted .?with quite other object* in view than that of scientific medication? There can be no doubt of the reason of many of these successes, which w. in fact, the principal foundation on which all kinds of quackery is based. It is that the confident assertions and brazen effrontery of the purveyor of the patent medicine has produced an expecteticn of. and a profound belief in. its #nt i.
cacy, -which contributory factor* often fail to accompany. the orthodox ?prescription. Tlus statement brings m within1 sight- of the great question of the influence of the mind on the body, a factor curiously enough more recognised by tlic laity than by the incdical profession, not only as manifested in one and the same person, but also as between two different individuals. The potency of this influence everybody freely admits, but few of us :actually take it into serious consideration in our practice. We were never taught anything about it in our medical course, nor do we teach it now, and but little attempt has been made to organize and systematize our scattered hut yet considerable imoss of kuowledgc of the subject. Yet there is no doubt but that the power to utilize, consciously or unconsciously, this mental factor in medicine u tbe real secret of Uk success of many a physician who, except iu this respect, has no better medical equipment than his less successful compeers. Though we ridicule the quality, yet really we all envy the possession of a good bedside manner, which is only one mode of expression for a pleasant and reassuring comportment, and it is just faculties belonging to the same category which account for much of the success of the advertising fraternity. 'Two mighty powers,' says tin: writer of a recent book, 'work for pood in every physician worthy of the name, what he knows, and what he is; but alas, as a role, we only value the former.' This well suggests the too often neglected powers that may lie behind tbe personality of tiie physician. Gradually we arc learning that the abundant faitfi which inspires to noble deeds nnd to the enduring of great sulf-.'ring is a form of mental energy, which may lie diverted into the swelling -therapeutic stream, hut it is a pity thnt the chief exploitation of this |-otcnt force should liave so chiefly fallen into the hands of unscrupulous impostors and charlatans ignorant of all things except the illimitable credulity of human nature. Here tiien is a wide held of investigation for til;- physician of the future from which a rich harvest may lie expected. —Conclusion.— It tins been my endeavour in this address, in which you may well say thnt I liavc vamlcrcd 'from tlic Dan to Dcersheba of medical and »ocioJ science, to present to tip*: who do nut belong to our protessiou t-onie ticcount of its niius and methods, of iU triumphs over physical ills, of its hojieK aiid aspirations for the future, nnd of the vivifyiiig influence of ramc principles of science which have *o gtcatly cotitririutcd to iU ndvnncc. 1 have endeavoured to show that man must be considered only as a unit, in the world of living tilings, closely inter-related by his diseases with his atiinuil and vegetable surroundings, and tluit medical knowledge consequently slaiuls not a|Kirt from, but part of. the great body of urgatiixed sc-iencc; inilted, more and more is it borne iu upon us tint nut only every science, hut also every system of truth, is intimately counectcd with every other. From tuc*c facts _ it arises thai the investigation of an everincreasing number of diseases have virtually rewired themselves iuto problems of notany, zoology, or of physical chemistryWe mh: how wide bus ixH-orae the w»|ie of preventive medicine, aud by a sli$!tt stretch of the imagination we may ahcuv. foresee a hygienic millennium in which alt i&hmhx sluill be abolished, leaving only accidents and tl«c inevitable inciilciiU of old age. Tlic*.? latter, we are ou the one hand, assured by ore of the moil eminent ot living patiioIogisW. might, by appropriate treatment and a better living. l-c pesqwuod (o a (tcriul conJdcrably be-*ond liiut at which we now accept them with what resignation we may command; while, on the other linnd. to those of us who have iwsswl the incridiiin of days it comes as an uncomfortable suggestion from a man ot MNcncc of equal eminence in . another branch of medicine, Lhat an anaesthetic cutinnasia is the most fitting treatment for the sexagenarian. .rur nir part 1 prefer ' to pin my faith to the optimistic new ratlwr than tn the homicidal treatment, and I fancy there arc nwny. similarly conditioned in |Kiint of years, who will liavc tlic same prefercm-e. Then it bun been indicated, very perfunctorily, as 1 am too well aware, that' many of the medical questions relative to disease have ims^cd out of the doninin of medicine and entered that of social nnd r-oliticnl science, in which, again, they arc dqicndeiil upon individual, collective, mid organised elTorts iwientificnlly directed nnd pcrsUtcntiy carrictl out. Had I not outraged your lutienl indulgence by the length of my remarks it would have been interesting and |ioesibly profitable' to examine the extent to which these efforts invc been smtefcsfnl nr. alas, too often
nclhcicnt cr even unattcmptcil. Science hnx, I think, shown by its adiievemeiiU and by On enerpies Uiat it may be trusted to continue to do its share in the world's work, but how shall we, in an age distinsni»hc-l by its shams, slioddy, nnd superficialities, inculcate and foster that spirit of jofty imlriotism, self-reliance, wlfrestrnint, supreme dc\otion to duty, and imceasing striving for excellence in aU things undertaken wliich arc the real foundations upon which a nation's greatness rests? It i* well thnt we «houkl realize, before it is too kite, that a nation's pre-eminence deliendrt not alone on tlic extent to which its collective intelligence i* organized and coordinated along the nmny -livcrse |ioths that lend to sucoem. Uut nlso on tlic high sense of duly and Kolf-Kicrilice of iU citizens. And the doctor may perhaps lie forgiven if, in his capacity of a social unit of tlic community, he ventures to my that it i* iiii|MMrsiblc to view without anxiety the prevailing tendency of the day towards the pursuit of pleasure and the decline of high enthusiasms nnd beliefs in ideals. Tn this we mnv see the sacrifice of many thing) (liat hsive nMiic.our countrj' preiit and the presence of iminy that have contributed to the downfall of great nations in the |Ktst. It ix tciiil of n.- with much 'trutli that we arc apt to be in earnest about trifles and to trifle about earnest things, nnd this in day* when, with uncx|icctcd Huddcnnes. our national patrimony— nay, our wry existence as a great nation, may become the stake for wliich we shall contend with, others less self-complacent than ourselves. Mniiy Ic-snns have been taught to a wondering and startled world by the great Manchurian drtma. hut they may all be summed up in the one singularly happy nnd comprehensive appreciation, which we who deal with the lives of men may well take o heart— 'Nothing but tlic best will do.' This, after all. is hut the most modern variant of that venerable exhortation of the Preacher applicable to all men and for all time— 'Whatsoever thy hand findech to do, do it with thy might.'' The delivery of the address was punctuated by approving cheers, and at the close n iicrfect storm of applause broke from all parts of the hall Dr. John Thomson (Brisbane, one of the Vice-PrpsklenU) in moving a vote of thanks to the President, said they had expected an intellectual treat, and their expectations had lieen realized. (Loud cheers.) l*rofciM-r Stirling, in the feast he had put before them, had given them many- dishes of the very highest quality to provide food for their mental digestion and dissimilation. The address had been worthv of the man— the man wiioni the medicnlnrofcwion of Australasia had unanimously selected as .their President; the man who wrote after his name the mystic letters V.RS., which only two other men in Australia conki do, a title which England bestowed upon only her most scientific sons. (Cheers.) The address was worthy of the profession to which it was delivered, and equally worthy of the men of Adelaide, among whom was Dr. Poulton. who, to commemorate the jubilee of the Queen, inauiniratcd the rongrcmes. (Cheers.) His Excellency the Governor, in putting tin: motion, asked that it should be carried with acclamation. The vote of thanks was carried with the audience standing, and Professor Stirling bowed his acknowledgments. On the motion of Dr. Butler, M.L.C. (flobart). a vote of thank* was accorded to His Excellency the Governor. The proceedings d«wd with the National Anthem on the Cousorvatoriuiu organ by Dr. Knnis.
The Professor's Experiment A professor has retrieved the body of a recently deceased street dweller and, with the help of his concerned medical friend, carefully place wires attached to batteries around the heart of the unfortunate, describing the exact placement to correctly stimulate the heart in the hope of restarting it. Just as the man begins to recover, and success looked likely, the laboratory is blown up by a freak lightning strike, destroying all occupants and evidence.