August 13, Ib'SG ] 



SCIENCE. 



151 



knowledge as to the relations between micro- 

 organisms and certain diseases, and the strong 

 stimulus which this has given to preventive medi- 

 cine. Sanitation is becoming fashionable, and 

 if we may believe some of its votaries, it is a very 

 simple matter to prolong the average life-time to 

 the scriptural, 'three score years and ten.' All 

 that is necessary is that everything shall be clean, 

 and every person virtuous. Having learned to 

 distinguish those diseases which can be prevented 

 much more easily and certainly than they can be 

 cured, we may turn them over to the sanitarian, 

 who has his own battles to fight with ignorance 

 and prejudice. If he succeeds, and so far as he 

 succeeds, he will change, in certain respects, the 

 work of the practitioner. 



I come now to the consideration of the second 

 part of my subject, namely, the dii'ection or man- 

 ner in which we have reason to hope that medi- 

 cine will be developed in the United States, and 

 the kind of co-operation which you may reason- 

 ably expect to receive from the medical profession 

 of that country. 



In one sense medicine, as we have it to-day, is 

 the result of co-operation ; not of deliberate, cen- 

 trally planned, and direct co-operation, but of 

 natural selection from results produced by many 

 men, often working at cross-purposes, and, there- 

 fore, wasting much energs', but nevertheless work- 

 ing, though blindly, to a common end. And it is 

 safe to predict that in the future much of the best 

 work will be done in the same way, by individual 

 effort inspired by the love of science, by personal 

 ambition, etc. But the results obtained in this 

 way come slowly, and some things that we want 

 can hardly be obtained by individual effort, even 

 if we were willing to wait, hence we must look to 

 organization for help. 



In this broader view of co-operation it is inter- 

 esting to consider those fields of labor to which 

 comparatively few physicians can devote them- 

 selves, because of want of time and opportunity, 

 but whose proper working is, nevertheless, of the 

 greatest importance to the practitioner. 



One of these is experimental laboratory work, 

 and in this direction the prospect of valuable con- 

 tributions from America is now exceedingly good . 

 Some of the wisest of our most wealthy men have 

 shown their appreciation of the responsibilities 

 which riches entail on their possessors by seeking 

 new channels through which to benefit theii" fellow- 

 men. While the old and well-known methods of 

 endowing hospitals and charitable institutions are 

 not neglected, there is aj)i)arent an increasing ten- 

 dency to endeavor to promote the advancement 

 of knowledge, and especially of such knowledge 

 as tends to the mitigation of suffering and the im- 



provement of the race, to furnish means for the 

 investigation of disease, to provide laboratories, 

 and to endow medical schools, and thus place 

 them beyond the reach of the temptations and 

 difficulties which must always exist when such 

 schools are dependent upon the fees of students, 

 and are, therefore, practically commercial manu- 

 facturing establishments. 



As illustrations of this tendency, I may mention 

 the bequest of £1,400,000 by Johns Hopkins to 

 endow, in the city of Baltimore, a university and 

 a hospital of which the medical department is to 

 be a special feature, to be provided with the best 

 laboratory and other facilities for original investi- 

 gation as well as for teaching ; the gift of Mr. 

 Carnegie to the Bellevue hospital medical school 

 of New York in the shape of a well-equipped 

 pathological laboratory ; the presentation by Mr. 

 Vanderbilt and niembers of his family, to the 

 College of physicians of New York, of £200,000, to 

 provide for that school new buildings and clinics 

 having the best means of teaching and research, 

 and the endowment by an unknown donor, of a 

 laboratory for the University medical college of 

 New York, with the sum of £20,000. 



As the class of men who have vvealth, leisure, 

 and knowledge becomes greater, there comes an 

 ever increasing demand, not only for the best 

 medical skill, for the most expert practitioner, 

 but also for exhaustive research in every direc- 

 tion which promises to furnish new^ means for the 

 prevention or relief of suffering, and for warding 

 off, as long as possible, the inevitable end ; and 

 hence there is little reason to doubt that the exam- 

 ples I have named will be followed by others in 

 the near future. With such opportunities, and 

 under such conditions and influences, the stimulus 

 to the young and ambitious woiker is strong ; we 

 have abundance of material of this kind upon 

 which the process of natural selection can operate, 

 and there is little reason to doubt that the result 

 will be substantial and valuable contributions to 

 physiology, fathology, and therapeutics. 



There is another most important means of ad- 

 vancing medical and sanitary science which only 

 a government can furnish, and in which field of 

 work England now stands pre-eminent— I refer to 

 vital statistics. In this field, the United States 

 government has thus far done but little, yet enough 

 to show the great interest and value of what we 

 have a right to hope will be done in the future by 

 combining the work of the several states. This is 

 one of the fields in which international co-opera- 

 tion is most desirable ; it alone can furnish data 

 suflSciently complete and reliable for a scientific 

 consideration of the relations of disease to geo- 

 graphical and race distinctions. 



