THE OUTLOOK FOR HUMAN HEALTH 157 



parasitic disease as "Puffing Billy" from a modern express 

 locomotive. The technique in vogue still depends largely on 

 the empirical use of drugs and relies for improvement on the 

 primitive method of progress by trial and failure. Thus the 

 therapeutics of plague consists mainly in the treatment of the 

 symptoms as they occur, in contrast with the more scientific 

 methods of prophylaxis by the elimination of the rat flea or 

 through the injection of Haffkine's serum. But there already 

 exist some commencements at least of treatment on scientific 

 lines that promise important results ; witness the discovery of 

 the opsonic index, the new vaccine therapy, or the treatment of 

 phthisis by formalin inhalations. And even on the purely 

 empirical administration of drugs some light has been thrown 

 by recent developments of bacteriology. For instance, whilst it 

 was previously known by experience that the proper time to 

 exhibit quinine in an attack of ague was during the sweating 

 stage, we now know that at this time new crops of malarial 

 bacilli are born and that the occasion is therefore appropriate 

 for a massacre of these innocents. 



If the therapeutics of parasitic disease still leaves so much to 

 be desired, what shall we say of the next division of our subject, 

 the prophylaxis of metabolic disease ? Progress, if any there 

 be, resembles closely that strategic movement to the rear so 

 dear to unsuccessful military commanders. Anaemia, rheumatism, 

 gout, dyspepsia, diseases of the heart and kidneys, neurasthenia 

 and the whole Mas malorum due to faults of metabolism still 

 flourish amongst us with the vigour of the proverbial bay- 

 tree. According to recent statistics, the incidence of some of 

 them at least, such as the circulatory diseases, so far from 

 exhibiting any sign of check, seems on the whole to show a 

 distinct upward tendency. Others, like appendicitis, threaten 

 to be numbered amongst the accomplishments essential in polite 

 society. People are patched up more effectually and, let us add, 

 more often than seemed the case formerly — else why the large 

 increase in the number of their medical advisers — but as for 

 winning free or partly free from this large group of diseases, 

 that, it would seem, is a consummation so hardly obtainable as 

 to be a mere crying for the moon. With the exception of the 

 prophylaxis by Bulgarian bacilli, the discovery, be it noted, not 

 of a doctor but of a Professor of Bacteriology, no real attempt 

 appears to have been made by the orthodox to avert those ills 



