since 1879, yet, 'tis not profitable to do more than give to imagination a free rein in this ideal realm of ever increasing triumph of Dr. Ephraim McDowell. What a boundless sphere for tender sentiment, in which the poet's ecstatic fancies may ever find ennobling and enduring thought as beautiful as are the thoughts that nourish a mother's love.

Not all paths, my friends, leading to success and renown are of co-equal importance in the affairs of man. Yet the products of each play a more or less material part in human concerns, and perhaps contribute a mole hill or a mountain, to the grand total of human experience and wisdom. In my judgment, Dr. Ephraim McDowell's contribution to the comfort and the security of the most sacred and enduring part of the family circle is of priceless value in the broadest sense. For, happy and contented homes make for orderly and law-abiding communities, characterized by mutual thrift and broad, sound, sympathetic spirit. A country thus established and maintained withstands all assaults and prospers in testimony of the wisdom, in God's most sacred gift to man.

DOCTORS AND THE PEOPLE.* BY J. C. WILSON, M. D.,

PHILADELPHIA.

Mr. President, Ladies and Gentlemen: It is a great honor to have the privilege of addressing the Medical Association of the Mississippi Valley upon the occasion of its Thirty-seventh Annual Meeting, and I beg to express to you my high appreciation of the distinction which your President has conferred upon me. The very name of your association impresses me with a sense of responsibility. We all know that the Mississippi is the long

*Address in medicine, Mississippi Valley Medical Association, Nashville, Tenn., October 17-19, 1911.

est river in the world; that it is the main stream of the river system that drains the greater part of the United States of America lying between the Appalachian Mountains on the east and the Rocky Mountains on the west-an empire within an empire. We know that your great river extends through the heart of the continent and affords a water way from the temperate regions of the north to the subtropical climate of the Gulf, and that its great tributaries bring to it the riches of a world less glittering but of far greater annual value than the East poured into Europe through Venice in her palmiest days. We know that this great valley from the earliest days of its settlement, both in the north and in the south, has a most interesting and romantic history, but that no chapter in human history can. compare with the story of its magnificent development in recent years, indeed, within the span of a long human life. In that period its wildernesses have become teeming hives of industry, its waste places fertile gardens, its hamlets towering cities, and its whole extent the home of a great and powerful population in which learning and science and every gracious art of modern civilization flourish; and those of us who still linger on the eastern slopes of the Alleghanies and the Atlantic seaboard are proud to know that in the veins of the leaders of this great movement and their descendants flows the restless, resolute, liberty-loving and Godfearing blood of those who uttered the Declaration of Independence and made. thirteen feeble Colonies the foundation of a mighty nation.

But my task to-night is not to tell you of your greatness. It is rather to discuss a homely theme which deeply touches us all. It is very practical and will, I trust, meet the requirement of your President, that it should interest alike those of my

profession who have honored us with. their presence and those of other interests and training. My theme is the relation of the medical profession to the people.

The three professions called learned, that is, divinity, the law and medicine, have in modern times been curiously separated from the people at large. Even the individual members of these professional bodies, while appearing to be in many respects very close to their fellow members, show upon critical study a certain curious aloofness which becomes very conspicuous in the aggregate. Manifest to some extent in superficial and external things, this difference between professional and non-professional members of a community becomes impressive and significant when we investigate its actual causes. The clergyman in his robes or in everyday raiment of a slightly severe cut, with a manner at once dignified and responsible, shows forth his saintly calling. The judge in his gown, the advocate hastening to court with his green bag, the notary with his seal of office, outwardly manifest the majesty of the law. The snuff box and gold-headed cane are no longer the vogue for doctors, but the most recent member of our guild, fresh from his two years in the hospital, has unconsciously acquired an air and deportment as distinctive as the linen suit and the caduceus which he wore upon his arm while in service. But there are differences that are deeper and essential. They are the result of the prolonged and more severe training preparatory to professional life, of studious and bookish habits, of the realization of higher uses for human energy than making things and barter and gain, of lofty ideals, of closer touch with the spiritual nature of man. Not only are the professions thus separated from others, but they also differ among themselves and especially in their

relation to non-professional persons. Divinity has to do with the religious life of the people and is brought into close and constant contact with all classes of society in the attempt to realize its lofty aims, and the influence and discipline of the Church find a ready response on the part of the people to the means by which they are aroused. The law has in a certain sense perhaps a greater hold, even a closer relation with the whole people than the Church. Without the law no contract is valid, no property can be conveyed, no guilty man punished, no innocent citizen absolved of imputed crime-thus the law and those who have made it their profession are in close and constant relation with the people, and the latter fully realize that there is an impassable boundary between law and anarchy.

With medicine, however, the conditions are wholly different. The organization. of the medical profession but lightly touches the people and the discipline reaches them not at all. They only most remotely comprehend its aims and are incapable of a dispassionate consideration of the means by which it is striving to realize them. They are in no sense bound to it and so long as they are in good health regard themselves as altogether above and independent of it. So far are they from being influenced by its powers to restore health to the individual and avert pestilence from the community. which must appear in every sense mysterious to them, that they form organizations to undermine the results of scientific investigations concerning the causation and course of diseases and to prevent such investigations. Hence anti-vaccination societies and anti-vivisection societies. It is thus seen that there are many people who are wholly indifferent to the medical profession; some that are actively hostile to it. Those who are indifferent so long

as they are well and who at once demand the services of the most experienced and skillful physicians when they are injured or ill, afford material for an unpleasant psychological study. Those who are hostile are influenced by the most transparent motives. They comprise two general groups-the first of which is made up of fanatics and persons of unsound reason and subject to delusions, persons who profess to be healers without any real knowledge and those who are pure charlatans and scamps, but the lines of separation between these subgroups are not at all-sharply drawn. The second group is composed of the dupes and victims of those who constitute the first group. These last, alas, too often have the courage of their convictions and not only pour out money freely but also sometimes let their children die of curable diseases rather than accept the services of a qualified medical practitioner. It is creditable to the general common sense of mankind that with so many temptations to practice it, quackery is on the wane.

The history of medicine sheds an instructive light upon the relations between the medical profession and the people. From the time of Hippocrates until the eighteenth century medicine concerned itself chiefly with results. It knew sickness and death, but it had no means of knowing the causes of these portentous calamities. The teachings of the Hippocratic school were preserved by the Saracens, who added little to the knowledge previously acquired. During the Dark Ages of European history such healing as was practiced was in the hands of the clergy, who united the functions of the physician with those of the priest. With the Renaissance medicine became again a learned profession and its study was resumed with great activity. The discovery of the circulation by Harvey and

his demonstration of the correlation between structure and function toward the close of the sixteenth century signalized the dawn of scientific medicine. During all this long period we find a slowly developing knowledge of anatomy, physiology, pathological anatomy, of the symptoms of disease, of epidemiology, of the relations and sequences of morbid phenomena which we know as the natural history of diseases; but of the causes of disease not an inkling. Demoniacal possession, occultations of the stars, comets, spells and witchcraft, an offended deity were invoked in vain. Hence in the healing art, in therapeutics, nothing but a blundering empiricism. Drugs there were of all kinds, many of them very potent, drastic or sleep-inducing, as the case might require, but none of them could touch the cause of the malady. And there were charms and amulets and incantations and pilgrimages and votive offerings and ings and the laying-on-of-hands and prayers, but no calamity of plague or pestilence was stayed and no man who was really sick was cured. The conception of disease as a mysterious unknown something that had entered the body of the patient and mostly held possession for a time against all dislodging agencies however potent and occult, has not yet wholly lost its influence with people of a certain turn of mind and some ignorance and is largely responsible for much of the hostility to scientific medicine that exists to-day. To such persons plain, straightforward methods of dealing with disease are an offense and any plan of treatment or any remedy without mystery or occultism confusion worse confounded. These are the people among whom a catchy name may form a mighty cult altogether without science and with but a travesty of Christianity, or among whom the effort to reunite in one person

the mediaeval functions of priest and physician has found a favor which appears to be as short lived as it is powerless for lasting good. These are the people who become the ready dupes of organized and unorganized claimants of special gifts and powers of healing based upon absurd and fantastic pseudo-scientific or spiritual endowments. And these are they who remain in happy ignorance that the transient benefit they experience is the result of the well known and most useful agency in certain disordered psychical states which is daily used in the scientific management of appropriate cases and which physicians call suggestion.

The history of medicine would be but a series of disconnected episodes were it not that it teaches us that here as in other fields of human endeavor knowledge ripens slowly and that failures are the stepping stones to success. It teaches us another lesson well worth the knowing, and that is that knowledge advances by indirection. There is no reason for medicine except to prevent and cure disease. yet most of the actual workers who made this history in its earlier periods appear to have been more concerned with other matters. The physicians of the Hippocratic school were prolific writers upon philosophical subjects. The Arabian physicians contributed voluminously to the knowledge of astronomy, geometry, logic and metaphysics, while the great anatomists of the Renaissance were more interested in the dissection of the cadaver than in getting sick men well. This fascinating history has a third and even greater lesson, and that is that the control of effects can only be compassed by a knowledge of their causes. Thus failure upon failure, the accumulation of knowledge by indirection, investigation of facts for the mere sake of the truth, made the

way clear for a new departure in medicine the study of causes, and, at the beginning of the last third of the nineteenth century, bacteriology, the youngest of the biological sciences, daughter of the genius of Pasteur and Koch, came into being. This event, of transcendent importance, dwarfing all other divisions into insignificance, separates the history of medicine into two great periods--the era of empiricism and the era of science. The boundary between these periods, like that between all great historical movements, is not abrupt. Many great achievements, as, for example, Harvey's discovery of the circulation of the blood and the discovery and perfection of the microscope, heralded the coming of the era of science; and the day is not far distant in which medicine shall be wholly free from the benumbing influence of the ignorance and superstition which hampered its long prescientific period. But fifty years have not yet elapsed and medicine is revolutionized. As of old it occupies itself with the individual because the sick man must be succored and cured; but the single patient is no longer its chief concern. To his interests are added the larger and more important requirements of the community. Medicine has thus become not only curative but also protective. No possible knowledge of effects could have. given us preventive medicine. We owe this to the study of causes, and the means by which they have been and are being studied are bacteriology and animal experimentation. By the scientific and humane methods of laboratory research the nature of infection and immunity has been clearly established, the methods by which particular diseases are transmitted have been revealed, the part played by various insects as direct carriers and intermediate hosts of disease producing microorganisms has become known and

The

the natural defences of the body against infection investigated. This knowledge has been used in the cure and prevention of the infections with remarkable results in preventing suffering and saving life. There are many examples, but the results. of the work of our army surgeons in Cuba, the insular possessions and the Canal zone in dealing with so-called tropical diseases are most impressive. work of the Yellow Fever Commission, carried on by Walter Reed and his associates in Cuba, established the fact that the germ of this disease was conveyed from the infected human being to others by means of a certain species of mosquito and led to the practical eradication of that disease in Havana and other cities of the Island and from the Canal zone. Ashford's investigations into the causation of tropical anaemia in Porto Rico revealed. the hookworm as the active agent and led to an enormous reduction of the disease. By systematic and general measures of sanitation in the Philippines, based upon scientific knowledge of the causes of diseases, the prevalence of cholera has been greatly reduced; smallpox has been almost stamped out, the plague brought under control, malaria robbed of its terrors, leprosy greatly diminished, and beriberi, the scourge of the Orient, placed clearly upon the list of preventable diseases. This achievement in regard to beri-beri is a notable result of one of the scientific methods in medicine and illustrates the spirit of modern medical research. This disease was long regarded as a neuritis due to an unknown infection; then as a food disease arising in some way from rice that had undergone some sort of decomposition; later as caused by a fish diet. Finally, as a result of a prolonged and unremitting search for its cause, conducted by our army medical officers, it has been demonstrated

to be the result of the use of polished rice, that is, rice from which the whole pericarp has been removed, as an almost exclusive diet.

We all know what the study of causes has accomplished in the zone of the Panama Canal under the system of sanitary engineering organized and maintained by Colonel Gorgas. One of the worst pest infected districts of the world was converted into a healthful region. Yellow fever was annihilated and malaria reduced to a comparatively insignificant disease as regards its prevalence and malignancy. Not less inspiring are the official reports concerning the mobilization of 18,000 men in Texas and California in the spring of the current year in the rainy season. The percentage of sick was less than in the posts from which these troops were assembled. Enteric fever was practically unknown. Compare this record with the awful reports of sickness and death in Chickamauga and other practice camps in the Spanish-American War. The President of the United States has well said that the expenditure of lives and money in that war and in the discharge of the responsibilities that followed it are as nothing compared with the benefits, to the human race that have accrued from

it, and he has congratulated the Medical Corps of the Army and the medical profession at large in having been in so conspicuous a way the benefactors of mankind. These are striking examples of the work being done by scientific medicine. There are many others equally important. and far-reaching, but I have briefly alluded to them because they show what has been accomplished in tropical sanitation, under highly unfavorable conditions, because the facts are embodied in the official reports and records of the Government and finally because they cover the