PROGEESS OF MEDICINE IN THE NINETEENTH CENTURY. 643 



United States diphtheria and typhoid fever each causes from 20,000 to 

 30,000 deaths a year, while more than 100,000 deaths are an'nually 

 due to consumption. Yet for each of these diseases we know the spe- 

 cific o-erm, the channels through which it is usually conveyed, and the 

 means by which this conveyance can be to a great extent prevented. 

 The ravages of these diseases are therefore largely due to the fact 

 that the great mass of the people are still ignorant on these subjects. 

 Antitoxin is not yet used for either prevention or treatment in diph- 

 theria to anything' like the extent which our knowledge of its powers 

 demands. 



Our better knowledge of the causes of certain infectious and con- 

 tagious diseases and of the mode of their spread has been of great 

 importance to the world from a purely comniercial point of view, 

 since it has led to the doing away with many unnecessary obstructions 

 to traffic and travel, which were connected with the old systems of 

 quarantine, while the security which has been gained from the modern 

 method of cleansing and disinfection is decidedly greater than that 

 secured by the old methods. A striking illustration of the effect of 

 these improvements is seen in the manner in which the news of the 

 recent outbreak of plague in Glasgow was received in England and 

 throughout Europe. One hundred years ago the city would have 

 been almost deserted, and terror would have reigned in all England. 

 To-day it is well understood that the disease spreads by a Ixicillus 

 which is not conveyed through the air. No one fears a repetition of 

 the ghastly scenes of the Black Death in the fourteenth century. In 

 like manner and for the same reasons Asiatic cholera has lost most of 

 its terrors. 



The benefits to the public of modern progress in medicine have been 

 greatly enlarged by the establishment of many small hospitals and by 

 the steady increase in the employment of specially trained nurses in 

 private practice, even in rural districts. The result of a case of 

 typhoid or of pneumonia often depends as much upon the nurse as 

 upon the doctor, and affection can not take the place of skill in either. 

 For the great mass of the p(H>ple cases of severe illness or injury, or 

 those requiring major surgical operations, can be treated more suc- 

 cessfully in well-appointed hospitals than in private houses, and as 

 this is becoming generally understood the old feeling against entering 

 a hospital for treatment is rapidly disappearing. Improvement in 

 hospital construction and management has kept pace with progress in 

 medical knowledge, and in future such institutions seem destined to 

 play an increasinglv important part in municipal and village life. 



All progress in civilization is attended with injury to some mdivid- 

 uals Trained nurses have deprived some unskilled labor of employ- 

 ment, hospitals have injured the Imsiness of some physicians, pure 

 water supplies, good sewers, food inspection, vaccination— m short, 



