November 25, 1904.] 



SCIENCE. 



711 



and Nuttall were followed with rapidity 

 by the epoch-making work of Behring and 

 Kitasato and Roux with rega^'d to tetanus 

 and diphtheria. The diphtheria and te- 

 tanus antitoxines were not chance discov- 

 eries of empirically determined virtue, but 

 true specific, therapeutic agents, the results 

 of experiment scientifically planned and 

 carefully prosecuted. Widespread investi- 

 gations of the various phases of immunity, 

 bacterial and cytotoxic, have given us in a 

 few short years a mass of physiological 

 knowledge, the full import of which is 

 scarcely yet to be comprehended. Few 

 things in modern medicine are more im- 

 pressive than a survey of the work of the 

 last twelve years done under the inspira- 

 tion of Ehrlich. 



Beside the antitoxines of diphtheria and 

 tetanus and the power of producing a 

 greater or less degree of immunity, as has 

 already been mentioned, by preventive in- 

 oculations against cholera, plague and ty- 

 phoid fever, we have come to possess a 

 bactericidal serum of a certain value in 

 combating the actual disease, plague, while 

 the favorable influence of Shiga's anti- 

 dysenteric ser.um seems to be undoubted. 

 There is much reason to hope that the re- 

 cently promised anti-crotalus serum of No- 

 guchi as well as the anti-cobra serum of 

 Calmette may prove to be real boons to 

 humanity. But it is not alone in the pro- 

 duction of specific anti-sera, that the thera- 

 peutic value of the modern studies of im- 

 munity lies. There are signs which justify 

 us in looking forward to the possible dis- 

 covery of an explanation of the mode of 

 action of substances long empirically used, 

 knowledge the value of which may be 

 readily appreciated. 



"When we consider these facts it is, in- 

 deed, easy to appreciate to what an extent 

 the exact has driven the conjectural from 

 this last field of medicine. A hundred 

 years ago we were depleting and purging 



and sweating and bleeding according to 

 theories often strangely lacking in founda- 

 tion, the prevalence of which depended 

 rather upon the individual force and vigor 

 of the expounder than upon their intrinsic 

 merit. To-day from the study of the pa- 

 thological physiology of bacterial and cyto- 

 toxic intoxications, we are rapidly evolving 

 scientific preventive and curative measures, 

 while searching out the rationale and mode 

 of action of our older therapeutic agents. 



But a few days ago, I happened to open 

 a copy of Littre* bearing, by a curious 

 chance, the date of 1889, and read "Mede- 

 cine. (me-de-si-n') 1° Art qui a pour but 

 la conservation de la sante et la guerison 

 des maladies, et qui repose sur la science 

 cles maladies ou pathologic"— an essential 

 modification of the definition of one hun- 

 dred years before and indicative of the 

 changes of a century. 



To meet the manifold problems of to-day 

 the training of the physician must, of neces- 

 sity, be very different from what it was a 

 hundred years ago. The strong reaction 

 which set in in the earlier part of the nine- 

 teenth century against philosophical gen- 

 eralization in medicine, the insistence upon 

 a strict objectivity, all the more emphatic 

 because of the prevalence of anatomical 

 methods of research, have held very gen- 

 eral sway. Medicine, no longer resting 

 upon a basis of philosophical speculation, 

 stands upon the firmer foundation of the 

 exact natural sciences. Almost from the 

 beginning the student of to-day is taught 

 methods, where a hundred years ago he 

 was taught theories. The enormous ex- 

 pansion of the field which must be covered 

 has led, naturally, not only to an ever-in- 

 creasing specialism, but to the fact that the 

 course of study which is regarded as prop- 

 erly fitting the physician for practise is 

 reaching backward farther and farther into 

 the earlier years of his school training. 



* Dictionaire de la langue Frangaise. 



