July 25, 1913] 



SCIENCE 



107 



presentation the obligation seems to rest 

 heavily on the physician, for he is urged to 

 welcome and incite the activities of those 

 vrho are bound as a result of these to ask 

 him continually to replace older by newer 

 knowledge. But it must be remembered 

 that the interests of the community enter 

 as a factor here, and since the com m unity 

 is better served by this, the equation is well 

 balanced. 



Sometimes it would appear that the 

 thought of service had departed from its 

 ancient place of honor — but in truth, it has 

 merely changed the form of its expression. 

 In the olden time the long cross country 

 drives of the friendly doctor to a distant 

 patient were justly presented to us as part 

 of the hardships of a devoted life. Now 

 the scene has shifted a bit, long .iourneys 

 over the literature, some of it often rather 

 rocky and uneven, or hours devoted to tests 

 and exact determinations in his office lab- 

 oratory, or even to experiments which 

 hazard life, take the place of the earlier 

 expressions of devotion and accomplish the 

 same end — they make the doctor a better 

 man. 



Thus far it has been my purpose to indi- 

 cate the relation of the progress of medi- 

 cine, either by laboratory work in the strict 

 sense, or through careful and systematic 

 clinical studies, to your own mental atti- 

 tude and growth. 



This, however, is but the first part of the 

 story; the second part deals with quite 

 another matter. The laboratory has al- 

 tered the practical and economic situation 

 of the physician in the last few years to an 

 unprecedented degree, and it is concerning 

 this alteration that I wish to say a word. 

 . To-day no physician would remove to the 

 Canal Zone with the idea of making his 

 main practise among those suffering from 

 yellow fever; nor would he to-day expect 

 as an army surgeon to have a great experi- 



ence with typhoid. In both these instances 

 steps have been taken which lead to the 

 elimination of the diseases named — they 

 simply are not there. I use these instances 

 merely as an illustration of the fact that 

 the health of the community has been pro- 

 tected and bettered in various ways. Thus 

 we recognize that there are mechanical de- 

 vices sometimes directed against the patho- 

 genic organisms themselves or sometimes 

 against their hosts. Pure milk and pure 

 water mean fewer typhoid organisms — ^the 

 draining of marshes, fewer places in which 

 pestiferous mosquitoes can breed. The me- 

 chanical protection of screens and traps 

 keeps from us disease-bearing flies, and 

 shoes go a long way toward blocking the 

 entrance of the hookworm. 



Moreover you have vaccines for smallpox 

 and for typhoid, to name but two, the ef- 

 fect of which is to render the body inhos- 

 pitable to the organisms against which they 

 are directed. Even when the disease-bear- 

 ing organism has established itself, it is 

 possible in some instances to kill it within 

 the host, as in the case of the malaria 

 organism and the Spirocheta pallida. 



When this can not be done and the patho- 

 genic organism is not only active but en- 

 trenched — there are antitoxins available, 

 as in the case of diphtheria, by which the 

 poisons that are doing damage can be neu- 

 tralized, and finally protection of the body 

 in the widest sense can be accomplished by 

 general hygienic measures, so that the in- 

 roads of such persistent but unapproach- 

 able organisms as the tubercle bacillus may 

 be blocked and prevented. 



It is, however, not my object to give a dis- 

 course on preventive medicine or public 

 hygiene, but merely to point out that a 

 great deal has been accomplished in bring- 

 ing under control a number of diseases 

 which heretofore have been treated by the 

 phj'sician single-handed. 



