18 INTRODUCTION 



so little has been accomplished during the many centuries that have 

 passed, and at the same time that so much has been achieved in 

 the brief period that has really been available for productive work. 



The days of therapeutic empiricism are fortunately coming to an 

 end. From the standpoint of curative therapy they have brought 

 us but little that is worth retaining cinchona bark, the gift of the 

 Peruvian Indian, for the treatment of malaria, and mercury, a remedy 

 of the Talmists, as a problematical cure for syphilis. As regards the 

 curative treatment of the remainder, not one of the hundreds and 

 thousands of pharmaceutical preparations that have been intro- 

 duced since the days of the Vedas, has been shown to be of value, 

 if as evidence of a curative effect we demand a shortening of that 

 period of time which the animal body itself requires to accomplish 

 a cure. We have learned to prevent many diseases by the elimina- 

 tion of the corresponding infecting agents from our midst; cholera, 

 plague, typhus fever, typhoid fever, yellow fever, smallpox, malaria, 

 and diphtheria are diseases which if they still exist among civilized 

 people do so with the consent of the people in the face of a full 

 knowledge of the manner of their prevention. 



Wonderful progress also has been made in surgery. By its means 

 countless lives have been saved which otherwise would have been 

 doomed. But after all surgical treatment cannot be regarded as 

 curative treatment in the proper sense of the word; the surgeon may 

 amputate a badly crushed limb or he may remove a diseased appen- 

 dix, or a cancerous breast, but he does not cure the limb, nor the 

 appendix, nor does he restore the breast to its original condition. 

 The final repair, the healing of the wound, is accomplished by the 

 animal body itself. The surgeon, however, is frequently placed in a 

 condition where he can assist nature materially to accomplish 

 a cure, and in this respect he is certainly more favorably placed 

 than the internist. 



The latter may be a most skilful diagnostician, an excellent 

 pathologist perhaps, but he does not cure the diseases with which he 

 is brought into contact. He may in a measure influence some diseases 

 by his directions for the general care of the patient, but, as a rule, the 

 patient dies or recovers irrespective of his therapeutic efforts, in 

 so far at least as these efforts are based upon ancient empiricism. 

 Typhoid fever patients still pursue the same course which was so well 

 described by the physicians of the medieval ages; our pneumonia 



