place, particularly during the last thirty years, made specialization inevitable. In the last century medical and surgical cases were mingled together in the same hospital wards, and surgeons like John Hunter and Abernethy treated diseases of the heart and stomach as well as wounds and fractures. Nowadays it would be simply impossible for any man, however gifted, to take all medical learning to be his province. Hence one practitioner gives himself to the study of diseases of the nerves, others to that of the affections of the eye, the throat, the skin, and so on. Moreover, there are few physicians or surgeons who are not more or less acknowledged specialists in some particular class of diseases. Twenty-five years ago there was a strong feeling in the profession, not only in this country, but almost everywhere, against specialism. This feeling had a retarding influence on the general progress of medicine, contributions from special fields of practice being received with suspicion, like to that of those who asked "Can any good come out of Nazareth?" This distrust hindered the development of abdominal surgery; and had not Spencer Wells been made of stern stuff, morally as well as intellectually, he would have given up the battle against the public opinion of his profession in despair, and a vast amount of human suffering would have gone unrelieved.

The prejudice has not even yet entirely

died out, but it is no longer active.

Another direction in which medicine has undergone very great expansion during the last half-century is in the knowledge of the nature and causes of disease. To the growth of this knowledge the development of physiology has most powerfully contributed. The experimental study of the healthy organism naturally led to the application of similar methods in the investigation of disease. Pathology, in the strict sense of the term, did not exist in 1837, and for many years after that date it was little more than an inventory of the dilapidations caused by disease. Such investigations, though useful in their way, could not have influenced medical practice to any appreciable extent.

Now not only medicine but hygiene is built on the knowledge that has been gained of the processes of disease and the causes which set them in operation,

and the circumstances which modify the intensity of their action and the nature of their effects. The foundation of a scientific pathology was laid by Virchow, who looked for the starting point of disease in a perverted activity of the living cells of which the organs and tissues of the body are composed. The most fruitful, as it is the most striking, development of our knowledge of the causes of disease has been the discovery of the infinitesimal organisms which go up and down the world seeking whom they may devour.

The "germ theory" of disease is no longer a theory, but a body of established truths. Bacteriology in its application to the healing art is the creation of Pasteur, though Davaine was the first to prove the causal relation of a particular micro-organism to a specific infectious disease (anthrax or woolsorter's disease). Davaine's experiments were not, however, accepted as conclusive, and it was not till 1877 that Pasteur proved beyond all doubt that the tiny rod-like bodies which Davaine had found in the blood of animals dying of anthrax were the exciting cause of the disease. Since then bacteriology has revealed to us the

This was in 1863.

pneumonia,

organisms which cause relapsing fever, leprosy, typhoid fever, glanders, tuberculosis, cholera, diphtheria, tetanus, and bubonic plague, the microbe responsible for the production of the last-mentioned scourge having been discovered so recently as 1894 by a Japanese pathologist, Dr. Kitasato. The elucidation of the origin of tuberculosis and cholera is the chief among Robert Koch's many services to science. A micro-organism of animal nature has been shown by Laveran to be the cause of malarial fever. The agents which cause other infectious and suppurative processes, and certain kinds of skin disease, have also been positively identi fied; others are with confidence assumed to exist, though they have so far eluded the search of our scientific detectives;

others are with more or less reason suspected. Indeed, the doctrine that every disease is a kind of fermentation caused by a specific micro-organism is so fascinating in its simplicity that it is in danger of being treated by some enthusiasts as if it were the master-key which unlocks all the secret chambers of pathology. It is becoming clear, however, that if microbes are necessary causes of a large number of diseases, they are sufficient causes of very few. The living body itself and its environment must be taken into account. Hence there are signs in various quarters of a reaction against the exaggerated cult of the microbe, and the minds of some of the most advanced investigators are turning once more to the cellular pathology, which till quite recently was spoken of as a creed outworn. It is recognized that the living cell itself is an organism varying in form and in function, and thus presenting an analogy with the different species of microbes. Like these, the cell secretes products that have a decided influence on the economy of which they form part. It has been shown by MM. Armand Gautier, Charrin, and Bouchard that the organism in its normal state manufactures poisonous substances, and that those products may under certain conditions be hurtful to itself, causing an “auto-intoxication," which may manifest itself in various forms of disease.

The change in our conception of disease is naturally bringing about a change in our notions of treatment. The fact that a specific disease is produced by a specific poison-for the poison is the morbific agent, whether it be manufactured by a microbe or secreted by a cell-inevitably suggest the idea of an antidote. Such antidotes or "antitoxins" have been discovered for tetanus, diphtheria, and some forms of blood-poisoning. The exact nature of these antitoxins is still obscure, but they are extracted from the blood of animals into which cultures of the microbe of the disease which it is desired to neutralize have been injected till they have ceased to have any effect.

Artificial immunity having thus been established, the neutralizing substance in the animal's blood is expected to be an antidote to the same poison when at work in the human system. Theoretically the method appears to be rational; but practically it must be admitted that it has not yet fulfilled the hopes that were excited by the first reports of its effects. Still, there is already ample evidence that in diphtheria it is of very real service, and on this ground alone Drs. Behring and Roux must be numbered among the benefactors of the human race. Again, Dr. Yersin's success in the treatment of plague with antitoxic serum in China was little short of marvellous. The cases, however, were few in number, and the results of the method when tried on a large scale at Bombay are awaited with the greatest interest by the medical profession. Although the results in the treatment of tetanus and other diseases have not been particularly brilliant, there can be little doubt that as our knowledge of antitoxins grows their field of usefulness will increase.

Another new method of medication, which has come into use in the last few years, is the introduction into the system of certain animal Juices and extracts of various organs to supply the want of similar substances, the manufacture of which is suppressed or diminished by disease. The pioneer in this therapeutic advance was Dr. George Murray of Newcastle, who has proved that myxedema and cretinism, diseases dependent on atrophy or imperfect development of the thyroid gland, can be cured by supplying the economy with extract of the corre sponding organ of a sheep. The success of this treatment has led to what the profane might be disposed to call a "boom" in animal extracts; the brain, the heart, the lung, the kidney, the spleen, the pancreas, and every gland and nearly every tissue in the body are used in the treatment of disorders supposed to be in any way connected with improper working of these organs. In spite of present extravagance it is possible that we are on a track that

may lead to the transformation of medicine.

We are very far now from the blue pill and black draught which-with the lancet--were the chief weapons in the therapeutic arsenal of the practitioners who bled and purged and physicked her Majesty's lieges in 1837. Sir William Gun is reported to have said: "One thing I am thankful Jenner and I have together succeeded in doing. We have disabused the public of the belief that doctoring consists in drenching them with nauseous drugs." Nevertheless, a good deal of faith in drugs still survives, not only in the public, but in the profession, as is shown by the ceaseless introduction of new remedies. Several hundreds were introduced in 1896. It

is true, however, that there is much less drugging than there used to be; more over it is better directed.

Pharma

cology is now a science, and is able to place in the hands of the doctor the active principles of drugs, which can thus be administered in forms at once more convenient and more effective.

Among the principal additions to the resources of the physician in dealing with disease may be mentioned the use of salicin and salicylate of soda in rheumatism as suggested by Dr. Maclagan, who has by this means robbed that terrible disease of its worst terrors; the use of nitrite of amyl in angina pectoris, which we owe to Dr. Lauder Brunton; the use of digitalis in heart disease, which was established on a scientific basis by Dr. Wilks; the cold bath treatment of fever; the treatment of heart disease by graduated exercises and by baths; the open-air treatment of consumption; the manifold applications of electricity; and the great and ever growing number of chemical products having power to lower the temperature, to deaden pain, to prevent decomposition, and to antagonize poisons generated in the alimentary canal and elsewhere. Reference may also be made of improvements in the manner of administering remedies, as by injection under the skin. into the veins, etc.

The greatest triumphs of all, however, in the realm of medicine in the Victorian age have been achieved in the prevention of disease and the maintenance of a high standard of public health. This subject would require an article to itself, even if handled only in the most general way. To those interested in it, I would earnestly recommend a study of Sir John Simon's standard work on "English Sanitary Institutions," a record which in itself will remain as one of the noblest monuments of Queen Victoria's glorious reign. There may be read the history of a long struggle against the powers of insanitary darkness, with the result that typhus fever, which used to be a scourge of large towns, is now practically unknown; that the mortality from “fevers" in general has been very greatly reduced; that cholera, which several times invaded these realms in the earlier years of her Majesty's reign, has for a long time been prevented from gaining a footing on our shores; that consumption is being brought more and more under control; that several years have been added to the average of human life, and that it is not only longer, but more comfortable and more effective.

Further possibilities of checking the ravages of communicable diseases appear to be opening out before us. Haffkine's inoculations for the prevention of cholera in India are founded on a rational principle, which is that of vaccination—namely, the protection of susceptible individuals by the injection of an attenuated virus, which gives the organism the power of resisting the effects of the poison in its natural state. This method of prophylaxis has also been used in regard to typhoid fever. and will doubtless find further application in other directions.

Time and experience alone can decide whether these means of protection against disease are efficient. It is certain, however, that medicine, which had wandered for SO many centuries through quagmires of speculation after ignes fatui of one kind or another, is now at last on the right path which leads through the discovery of the cause