500 



SCIENCE 



[N. S. Vol. XXXIV. No. 877 



tined to a dwarfish, toad-like existence, 

 into a nearly or quite normal individual 

 when fed on the extract of thyroid glands 

 of the sheep. 



Modern surgery is an outgrowth of 

 physiological medicine, although many of 

 its triumphs are due to asepsis, and this in 

 turn is a product of the stage of medicine 

 next to be considered, the etiologic. 



Btiologic medicine seeks to determine the 

 causes of disease and to deal directly with 

 these. It is a direct outgrowth of physio- 

 logic medicine and has really been the aim 

 of the foremost students of the physiology 

 of disease. "While the causes of some dis- 

 eases have been fairly well understood for 

 many years, etiologic medicine was first 

 really placed on a firm basis by the genius 

 of Pasteur and Koch about fifty years ago. 

 In infectious and contagious diseases the 

 specific organisms and their mode of trans- 

 mission have been discovered in a large 

 number of cases, and in others much has 

 been learned even where the specific organ- 

 ism has not yet been discovered. Thus one 

 species of mosquito is known to transmit 

 malaria, another to transmit yellow fever. 

 The malarial organism is knoAvn, that of 

 yellow fever is not. Malaria can be fairly 

 successfully treated with quinine. There 

 is no specific for yellow fever. Both dis- 

 eases can be abolished by getting rid of 

 the mosquito. Typhoid fever, for which 

 there is no specific, can be gotten rid of by 

 guarding water and food supplies and for 

 a time, at least, guarding the public against 

 typhoid carriers, people who harbor the 

 germ without themselves being sick. Such 

 carriers, however, would probably not ex- 

 ist where the water and food supplies have 

 been kept pure for years, except, of 

 course, as they might come in from outside. 

 Tuberculosis is a more difficult problem, 

 but by guarding the air and food supply 

 and by teaching consumptives how to keep 



themselves from infecting others great ad- 

 vances can be made toward getting rid of 

 this disease. 



Tuberculosis offers perhaps the best ex- 

 ample of advance from the physiologic to 

 the etiologic attitude toward disease. The 

 history of recent advance in the study and 

 treatment of tuberculosis has recently been 

 well summarized by R. W. Phillip ("Pro- 

 gressive Medicine and the Outlook on 

 Tuberculosis," British Medical Journal, 

 1909). 



The remarkable advance in the medical 

 sciences during the last half century has 

 been due chiefly to the development of re- 

 search laboratories in universities, in spe- 

 cial research institutions and in the gov- 

 ernment service. In spite of relatively 

 meager funds these institutions have pro- 

 vided instruments and inspiration for 

 search for the truth; the work has been 

 led by men of genius, and has been organ- 

 ized so as to promote cooperation without 

 destroying initiative. For the most part 

 these research laboratories have been con- 

 nected with laboratories of medical schools, 

 although in this country such connection 

 has been unfortunately too rare. Where 

 such a connection exists, as at Chicago and 

 Rush, the investigator is stimulated by the 

 youth about him while the younger men 

 are inspired with ambition for that real 

 power which comes from scientific knowl- 

 edge. 



In the application of medical science to 

 human needs America has been much more 

 backward than in the advance of medical 

 science. This is due probably chiefly to 

 the fact that a very few men can advance 

 medical science enormously if they be of 

 the caliber to discover essential truths and 

 have the right environment. One or two 

 research institutions or a government in- 

 clined to give even meager support to 

 medical investigation makes possible the 



