THE MARCH OF MEDICINE—WINTROBE 389 
sulfonamides. There is good reason to hope that certain other infec- 
tions, hitherto unaffected by any measures, may be cured by penicillin. 
The lack of toxicity of penicillin is all the more appreciated because 
we have learned that the sulfonamides sometimes produce harmful 
effects which may even prove fatal. 
MEDICAL SCIENCE AND THE WAR 
During our own Civil War four times as many men died from disease 
as from the wounds of battle. During World War I the mortality from 
battle casualties for the first time exceeded the deaths from communi- 
cable diseases. ‘This was brought about by a combination of factors 
such as camp sanitation, prophylactic vaccination, personal hygiene, 
the isolation of disease carriers, contacts and suspects, and the practice 
of vigorous delousing. Modern warfare, thanks to the advances which 
have been described and to others which must still be mentioned, should 
have a much better record in spite of the fact that it 1s far more wide- 
spread than ever before and in spite of the new lethal agents that have 
been devised. 
At Pearl Harbor not a single patient with a gunshot wound of the 
abdomen who reached the operating table alive and in whom the vis- 
ceral wounds could be repaired, subsequently died. This can be attrib- 
uted largely to the sulfonamide that was used. There never has been 
such a record in military surgery before. Penicillin, no doubt, will 
make the record even better. 
The management of shock is just as important in the handling of 
the wounded as the control of infection. Shock is the state of general 
collapse that follows any severe injury or wound. It is often fatal 
and to avoid death immediate treatment is necessary. This war has 
brought the development of dried blood plasma, still the most valuable 
agent, other than whole blood, for the treatment of shock. Such 
plasma can be transported easily and after addition of water can be 
given the wounded even on the battlefield. This procedure, as well 
as the present highly developed system of field and hospital care and 
the use of transportation for the wounded, represent steps of enormous 
value. 
The chief medical problem of the war probably is malaria. This is 
because our troops must operate in the regions where the bulk of the 
3,500,000 deaths from malaria recorded annually occur. Never before 
have millions of men engaged in tropical warfare and thus this great 
disease predator has an unsurpassed opportunity to exert its influence. 
The capture of Java deprived us of the chief source of quinine but 
fortunately atabrine, a drug synthesized by the Germans following 
the First World War, is equally good if not better than quinine. Thou- 
sands of men have been given small doses of atabrine regularly for 
many months to hold in check malarial infection which could other- 
