554 



NATURE 



[August 8, 1895 



knowledge of remedies, and the ideas which govern the employ- 

 ment of remedies in the treatment of disease? 



" The ba.sis iif thcr.iiieutics is iliagnosis, the grasp of the actual 

 condition underhiny the >yniptonts or phenomena, and the 

 ijreater our command of i>«\vcrful remctlies and the more precise 

 our know letige of their cft'ects and of the mode in which these 

 ert'ects are produced, the more important does accuracy in diag- 

 nosis become. 



'■ A diagnosis, to Ik: real, implies not only the recognition of 

 the disease which may be present and an accuntle appreciation 

 of the nuirbid changes w hich may have taken place in various 

 organs. It enihraces a knowletlge of the nature and intensity 

 of the pathological processes w hich have lieen and are in opera- 

 tion, and of the causes which set them going, and also of the 

 results to which they tend. A further element, moreover, enters 

 into the consideration ; an estimate, by the aspect of the [Mtient, 

 by the pulse and temi>erature, and by other subjective and ob- 

 jective indications, of the impression made on the system, and of 

 the resistance which it is capable of to the lethal tendencies of the 

 disease. 



" Near by year we see improvement in this respect : not only 

 that hospital physicians and teachers endeavour to carry di;»gnosis 

 to a greater pitch of accuracy and a higher point of refinement 

 than ever l)efore, but that the entire iMxiy of medical men are 

 trained by improvetl education and systematic clinical teaching 

 to appreciate and to practise careful di;ignosisin their daily work. 



" Diagnosis, we may say, has reached an extraordinary degree 

 of advancement. There are, no doubt, still new fields to 

 conquer, but in the recognition of diseases, local and general, 

 there is not much which seriously concerns the human race 

 which remains to lie done. The same degree of knowletlge, 

 however, docs not extend to morl>id processes. Our compre- 

 hension of the significance and essential character of inflam- 

 mation is by no means complete and satisfactor)'. The part 

 which fever ])lays and the place which it holds among the 

 phenomena of <li-sc.ase is far from l>eing fully understfxxl. It 

 cannot have lieen intended by nature for the destruction of 

 the subject, and we can see distinctly that in some ca,ses it 

 forms [art of the defensive oiieralions ; |)ossibly, indeed, its 

 general tendency is defensive, by promoting the |)roduction 

 of phagfK'ytes. or |xjssibly a certain elevation of the tem- 

 l>eraiure may be fatal to maleficent organisms which have taken 

 l)ossesaiiin of the blo<Kl or tissues. We are not certain, indeed, 

 whether in pyrexia the heat-producing oxidation in the structures 

 receives its stimulus from, or lakes place at the bidding of, 

 the nervous centres, or, on the other hand, is due to enfeeble- 

 ment of the restraint which they normally exercise over it, or 

 whether it defies control by the thermo-taxic nervous centres."' 



An address in surgery was delivered by Mr. Jonathan 

 Hutchinson, who gave a brief rctros|)ect of the surgery of the 

 (lasi. interspersed with a few comments as to what may be hoped 

 for the future. 



I'rof. Schafer delivered an address in I'hysiology, taking for 



his subject " Internal Secretions.' After describing various 



glands and secretions and their method of interaction, he said : 



The general results to which we are led |K)int very stnmgly in 



favour of the notion that internal secretions are yielded Uith by 



the ductless glands and by what are usually known as the true 



secreting glands, and it is obvious that such internal secretions 



may In: of no less imixirtancethan the lM;ller-rccognised fimrtions 



of the external secreting glands. Thai a failure ol one or other 



' f iliise internal secretions has to \k definitely reckoned with 



•Ih (ihysician there can be no doubt whatever, while at the 



11,,. idt thera|ieutist will lie able to avail himself of the 



iples which the intenially .secreting organs aflord, and 



i~es to use Iheir extracts in place of ihe hitherto more 



(.xiiiiiiuiily employed vegetable medicaments. 



The work of the different sections covered a wide range, and 

 nnidi of it relates purely to medical practice. It will l>e 

 Millie Fini. therefore, for iisto indicate by the following summary 

 Ihe general character of a few of ihe more imiKirlant papers 

 and discuvsions re|K>rtcd in Ihe British Mcdiial /oiiriia/. 



SKCnON OF MP.DlrlNF. 



The I'resiilcnl, Dr. J'avy. o|K-ned Ihe proceedings in this 



Section by an .iddress. in which he deM;ril)ed the progress in 



'' ' ' " '' f\of the c.xsiial relationshi]> existing 



rid certain diseases, enlarging upon 



liail had ujKin Ihe <|ueslion of treat- 



NO. 1345, VOL, 52] 



ment, and U|X>n the control that could be exercised upon the 

 spread of infectious disea.ses. He briefly touched ujion the serum 

 treatment of diphtheria. Dr. Sidney Martin then intrmluced 

 the discussion on diphtheria and its treatment by the antitoxin. 

 Dr. .Martin commenced by staling that there hat! always been 

 two schools of therapeutists with regard to the treatment of 

 di])htheria, the one trying to discover .some local application 

 which would loosen or remove membrane in the throat, and the 

 other to provide a remedy that would act upon the general 

 symptoms of the disease. The want of success in the past made 

 it essential, in his opinion, to examine most carefully into any 

 new method of treatment suggested, anil to submit it to a most 

 rigid scientific inquiry before accepting it. The antitoxin treat- 

 ment, he stated, had been studied with the greatest care, and 

 its recommendation was l>aseil upon the results of a considera- 

 tion of the pathology of the disease. 



I'rof. von Kanke (Munich) slated that whilst in 1S92 he had in 

 his hos|iilal a mortality of 562 per cent., in 1893 of 46 percent., 

 and in 1894 up to .September 24, when he had commenced the 

 serum treatment, one of 57 per cent., since thai time his death- 

 rate had been reduced to 177 per cent. Me further considered 

 that not only w.as the reduced death-rate due to the injection of 

 antitoxin, but that the course of the disease was favourably 

 influenced in the most striking manner. I'rof Baginsky. of the 

 Kmpress I'lederick Hospital, Kerlin. though not speaking witli 

 the high enthusiasm of Dr. Kanke, yet ga\e equally slailling 

 figures, stating that whilst the mortality in the four years previous 

 to 1895 had been on the average 41 per cent, under the old 

 system of trealmenl, during ihe last year, umler the seium treat- 

 ment, it hiid been reduced to 15 "6 percent. Dr. Sims Woodhead 

 spoke briefly upon Ihe importance of using large doses of serum, 

 and concluded by quoting some Paris statistics which were 

 highly favourable. Dr. Hermann ISiggs (New York) then gave 

 a most interesting account of the immunising efl'ect of the serum, 

 quoting figures to show that in almost all cases the immunising 

 )X)wer of the serum extends to a period of thirty days. He 

 further slated that out of Soo healthy children who had received 

 injections, he had not setn a single case in which any harm had 

 resulted from the treatment. 



Section ^>^■ StRCKRV. 



Sir William .MacCormac, President of the Section of Surgery, 

 took for the subject of his address " Some I'oinls of Interest in 

 Connection with the Surgery of War." He came to the following 

 conclusion : — 



" It would ajipear probable that in a future war many of the 

 wounds produced by the new projectile will be surgically less 

 .severe, and i^rove amenable to eft'ective smgical treatment. 

 Probably also the number of severe injuries will be very great 

 when we consider the enormous range of the new weapon anil 

 the penetrating power of Ihe projectile, which enables il lo 

 traverse the Imdies of two or three individuals in line, inchiiling 

 Ixmes, and to inflict serious or fatal wounds ai a distance of 

 3000 or 4000 yards. It is imixissible to say what ihe (iroporlion 

 between these two is likely to lie. At near ranges the explosive 

 etTects will be much the same as before ; but at long range ihe 

 narrow bullet track, the small eMcrnal wounds, which olien 

 apprinich the suliculaneous in cliaraclei, and the moderate tie- 

 gree of comminution and Assuring of the iione will be surgically 

 a<lvantageous. These will form the bulk of Ihe gunshot injuries- 

 of the future, for it would seem impossible with magazine quick- 

 firing rifles lo maintain a contest at close quarters without speeily 

 mutual annihilation. 



" We may lake It for granted that the number of wounded, in 

 priiporlion lo the numbers engage*! and arlually under Inc. "ill 

 be greater than before. The supply of aininunilion will \te 

 larger, the facility for its ilischarge greater, and smokeless powder 

 will increase accuracy of aim. 



" I think we are ju.stified in believing, although there is high 

 authf)rity for a conlrarj' opinion, that Ihe next great war will lie 

 more destructive to human life, ' bloodier,' in fail, than any "f 

 its predccesst)rs : and that the number of injuries, and in many 

 ca.scs the severity of the injury, will be largely increasecl. Hut 

 very many ca.ses will remain less severe in character, more 

 capable of successful trealmenl, and less likely lo entail future 

 disablement, while improved sanitation and antiseplic methods 

 will enormously increase Ihe proporticm of recoveries. 



*' It is ihe unceasing efliirl of nuHlern surger)' lo prox'ide anll- 

 seplic protection in an elfeclive form in lime of war : ami I may 

 lie |x-rmilled lo recall that the medical organisation during our 



