July 6, 1906.] 



SCIENCE. 



9 



dustrial life and the whole fabric of 

 modern society. Not medicine only, but 

 all the forces of society are needed to com- 

 bat these dangers, and the agencies which 

 furnish the knowledge and the weapons 

 for this warfare, are among the most 

 powerful for the improvement of human 

 society. 



Great as was the material, intellectual 

 and social progress of the world during 

 the past century, there is no advance which 

 compares in its influence upon the happi- 

 ness of mankind with the increased power 

 to lessen physical suffering from disease 

 and accident, and to control the spread of 

 pestilential diseases. Were we to-day as 

 helpless as the physicians of past centuries 

 in the face of plague, smallpox, typhus 

 fever, cholera, yellow fever and other 

 epidemic diseases, even if the existence of 

 our modern crowded cities were possible, 

 which may be doubted, the people would sit 

 continually in the shadow of death. Great 

 industrial activities of modern times, ef- 

 forts to colonize and to reclaim for civil- 

 ization vast tropical regions, the immense 

 undertaking to construct the Panama 

 Canal, are all in the first instance de- 

 pendent upon the successful application to 

 sanitary problems of knowledge, much of it 

 gained in recent years, concerning the 

 causation and propagation of epidemic and 

 endemic diseases. 



And yet probably a fair measure of the 

 general realization of these facts is the 

 provision by Congress that of the seven 

 members of the Isthmian Canal Conunis- 

 sion, four shall be engineers without a word 

 concerning a sanitarian on the commission. 

 There could hardly be a more impressive 

 opportunity to demonstrate to the world the 

 practical value of our new knowledge con- 

 cerning the mode of conveyance of malaria 

 and yellow fever, the two great scourges 

 of Panama, than that afforded by the dig- 

 ging of the Isthmian Canal. The sanitary 



problem is not surpassed in difficulty by 

 the engineering problem, but we may feel 

 reasonable assurance that with the sanitary 

 control in hands as trained and capable as 

 those of Colonel Gorgas, the ghastly experi- 

 ences of the old French Panama Canal 

 Company and in the construction of the 

 railway will not be repeated. 



To comprehend fully the degree and the 

 character of the progress of modern medi- 

 cine requires a kind of knowledge and a 

 breadth of vision not possessed by the aver- 

 age man. He is concerned mainly with 

 the prompt relief of his own ailments or 

 those of his family. Of the triumphs of 

 preventive medicine he knows little or 

 nothing. With such dull matters as the 

 decline in the death rate by one half, and 

 the increase in the expectation of life by 

 ten or twelve years during the last cen- 

 tury, he does not concern himself. He 

 takes no account of the many perils which 

 have been removed from his pathway since 

 his birth, and indeed at the time of his 

 birth, nor does he know that had he lived 

 a little over a century ago and survived 

 these perils, he would probably be marked 

 with smallpox. 



While it is true that in the relief of phys- 

 ical suffering and in the treatment of dis- 

 ease and accident the progress has been 

 great and the physician and the surgeon 

 can do more, far more to-day than was pos- 

 sible to his predecessors, and while im- 

 provement in this direction must always be 

 a chief aim of medicine, still it is in the 

 prevention of disease that the most bril- 

 liant advances have been made. The one 

 line of progress, that with which the daily 

 work of the physician is concerned, affects 

 the individual, the unit; the other, like all 

 the greater movements in evolution, affects 

 the race. It has been argued, with a cer- 

 tain measure of plausibility, that the inter- 

 ference with the law of the survival of 

 the fittest, assumed to be a result of the 



