Fripay, Juuy 6, 1906.



The Formal Opening of the Laboratory of the Rockefeller Institute for Medical Re- search :—

A Sketch of the Development of the Rocke- feller Institute for Medical Research: Dr.

a GF EP Tere e er Tees 1 The Endowment of Research: Dr. WILLIAM WM b6id 66 os eo RRR Ane ve ccs nc ct benes 6 Address by President Nicholas Murray BUEN iki tt odin cbetoke pte snap en he a$iins 12 Address by President Charles W. Eliot.... 13

Scientific Books :— Fine’s College Algebra: Proressor J. Ep- WU EE, “Ac bseuwhes dees ccnes aren és 18

Societies and Academies :— The New York Section of the American Chemical Society: Dr. F. H. Poucu. The Torrey Botanical Club: C. Stuart GaGerR.. 19

Discussion and Correspondence :— Intercollegiate Athletics and Scholarship: PROFESSOR WILLIAM TRUFANT FOSTER. Note on the Ypsiloid Apparatus of Crypto- branchus: B. G. SmitH. A Newly-found Stony Meteorite: Dr. G. P. MERRILL...... 21

Special Articles :—

The Great Catalogue and Scientific Investi- gation of the Heber R. Bishop Collection of Jade: Dr. GEORGE FREDERICK Kunz. The Rock of the Pelée Obelisk and the Condition of the Volcano in February, 1906: Dr.

ANGELO HIEILPRIN ...... 22. cece wcteeee 23 The Commission for Brain Investigation.... 26 William T. Bedgwick...........cccecccsees 27 Scientific Notes and News..............++: 28 University and Educational News.......... 31

MSS. intended for publication and books, etc., intended for review should be sent to the Editor of SctzNcE, Garrison-on- Hudson, N. Y.



FIvE years ago there were in France, Germany, England, Russia and Japan well- equipped and endowed institutions for re-

_search in medicine. In this country not

one existed. For pure and applied science, all our higher institutions of learning had their laboratories, their corps of instructors and fellowships, and both opportunity and encouragement were given to students to take up original work. But how great the contrast when we turn to medicine, whose problems are related not only to the health but even the life of the race. The poverty of the resources of the medical institutions was truly pitiful. Their laboratories were for the instruction of students and pos- sessed but little equipment beyond what was necessary for this end.

It was at this time that a group of five

_ men met in the Arlington Hotel at Wash-

ington just five years ago last week, at the request of the founder of this institute, to consider the question of the establishment of an institution to promote research in medicine. There could be but one opinion, and, at the conference only one was ex- pressed, viz., That the most urgent need existed and that the time was ripe for the foundation of such an institution in tais country.

May 11, 1906.

A hats. tre ake ae

ea ee


Never was a suggestion more warmly welcomed nor an offer more heartily appre- ciated by the profession and the medical press from one end of the country to the other.

To this group of five, two others were added a few weeks later, and on June 14, 1901, the institution was formally inecor- porated as The Rockefeller Institute for Medical Research, with the seven men re- ferred to as its board of directors. They were William H. Welch, T. Mitchell Prud- den, Christian A. Herter, Theobald Smith, Hermann M. Biggs, Simon Flexner and L. Emmett Holt. The same board has been continued up to the present time. At this first meeting a pledge of $200,000 was made to the board to be drawn upon at their dis- eretion during a period of ten years, it being understood that this was for prelim- inary work.

In considering what use should be made of the funds placed at its disposal to make them immediately productive of some sci- entific results, and at the same time to get a general view of the field, the board de- cided not to centralize work in a single place, but to create a number of scholar- ships or fellowships to be distributed in existing laboratories throughout the coun- try. In this way it was hoped several ends might be attained: first, to enlist the coop- eration of various investigators in different places; secondly, to aid some promising lines of research which could not be con- tinued for lack of funds; and, finally, to discover who and where were the persons who desired to undertake research work and what were their qualifications.

From a large number of applications re- ceived, twenty-three grants were made to eighteen different laboratories in this coun- try, and three men were sent abroad to pursue special investigations, two in Ehr- lich’s laboratory in Frankfurt and one in Koch’s Institute in Berlin.


[N.S. Von. XXIV. No. 601.

At the end of the first year’s work, it was evident to the directors that while much could be accomplished by individual workers carrying on their investigations in separate laboratories, widely scattered, the highest results in research could not be secured in this manner. Existing institu- tions did not afford adequate facilities for many phases of investigation which were of the greatest importance. Again, the heads of these institutions, although in many instances men of great ability, were so taken up with their duties as teachers as to leave comparatively little of either time or energy to devote to research work. It was gratifying to find that there were a large number of earnest men and women in America anxious to devote themselves to this branch of science; but it was quite clear that very few possessed the breadth of education combined with the technical training requisite for independent work. The directors, therefore, were united in the conviction that, although many important investigations might be fostered by contin- uing the plan of foreign grants, great prog- ress was not possible in this way, and that this could be secured only by centralizing the most important lines of work in a fixed place, under a competent head or series of heads, and with special equipment. In other words, the institute must have a lab- oratory of its own with its own staff of workers who should devote their entire time to research.

These conclusions and the considerations upon which they were based were, there- fore, placed before the founder, who at the second annual meeting, in June, 1902, made another and larger gift to the institute, to enable the board of directors to acquire land and erect a laboratory building in which to begin the work of organization along the broader lines contemplated.

The first question to be decided was where such an institute should be located.

Jury 6, 1906.]

After due consideration of the advantages offered in other cities, New York was unani- mously selected as possessing greater ad- vantages than were elsewhere to be found in America. The next step was to find a suitable site; one which should be ade- quate, not only to present needs, but for future expansion; near enough to the cen- ter of the city to be accessible, and yet sufficiently removed to secure for its work- ers the freedom from needless interrup- tions and the quiet necessary for scientific pursuits.

After a prolonged search, the committee on site reported in October, 1902, in favor of the Schermerhorn property, fronting East River at East 66th and 67th Streets, as meeting to a remarkable degree all the requirements. This entire property was purchased by Mr. Rockefeller a few months later, and a plot comprising twenty-six and a half city lots, upon which the present building stands, was deeded to the insti- tute. Work was immediately begun upon plans for a laboratory building.

The next great question was the cheice of a scientific director. After looking over the entire field in America and Europe, the board could find no one possessing the qualifications to so high a degree as one of its own members, Dr. Simon Flexner, who was prevailed upon to resign his position as professor of pathology in the University of Pennsylvania, and assume the director- ship of the scientific work in the new lab- oratory. Dr. Flexner began his work July 1, 1903, and spent the following year in Europe, studying various questions con- nected with institutions for research, espe- cially those of organization, construction and equipment. He also acquired the nucleus of a library for the institute.

Eighteen months and much careful thought were spent in completing the plans for the present laboratory building. Dur- ing this time five of the directors visited


Europe, in order to profit by the experi- ence of other institutions of a similar char- acter. Final plans were adopted June 13, 1904; and a few weeks later contracts were let, ground was broken for the new build- ing and December 3 of the same year the cornerstone was laid.

It was quite clear to the directors that it was unwise to delay commencing work until the new laboratory was completed. It was decided to take steps at once to get together a nucleus of a future laboratory staff; that it was best that a beginning should be made with a small program, a few problems, in a small building, so that the institute should be in a position for a natural organic growth and development and avoid the dangers incident to rapid expansion. A building at the corner of Lexington Avenue and 50th Street was leased and fitted up for temporary use. In that place, in October, 1904, work was be- gun and continued for eighteen months until the completion of the new building a few weeks ago.

The staff at first consisted only of the director and four other workers. It has, however, been gradually increased until, at the time of removal, it numbered nine persons.

One of the most difficult problems pre- sented to the board has been to secure a staff of scientific workers. Heads of lab- oratories and their assistants in this coun- try are, almost without exception, men trained for the work of instruction rather than that of investigation. Many applica- tions for positions in the institute have been received from England, France and Germany, but the feeling of the directors has been that it was the American type of mind, with its genius for practical results, that was wanted, and this has made the board doubtful as to the wisdom of choos- ing European heads for any of its de- partments. Many young men and women


were found in this country with evident capacity, yet few possessed necessary train- ing which should fit them to work inde- pendently. With each year’s experience the conviction has steadily grown that the institute must in large measure train its own staff, selecting from the promising young applicants such as gave evidence of a special fitness and giving them subse- quently such training both here and abroad as would fit them for their special work.

To get in close touch with such a class, a number of resident scholarships and fel- lowships have been created. For these thirty-one applications were received dur- ing the present year and five have been awarded. This plan, if suecessful, will be continued and from this corps, from time to time, will be reeruited the future work- ers of the institute.

The present organization provides for the following departments: pathology, bac- teriology, physiological and pathological chemistry, physiology, comparative zool- ogy. To these it is expected that a depart- ment of pharmacology and experimental therapeuties will soon be added.

The fully organized staff will consist of a chief director and a head for each of the different departments. Each head will have his associate and corps of assistants. The heads of departments, associates and first assistants, it is expected, will constitute the permanent staff of the institute. The other workers will be less closely attached. Besides, there are contemplated scholar- ships and fellowships for workers who may come for a limited period; and finally, it is expected to provide for a limited number of voluntary workers who will be given the facilities of the institute for working out, under supervision, their own problems.

While the purpose of the institute will be research, not instruction, it can not fail to exert a considerable influence in medical education, since many of those who will

[N.S. Vor. XXIV. No. 601.

receive their training within its walls will, doubtless, go elsewhere to assume positions of responsibility in teaching institutions.

The present scientific staff consists of fourteen persons; the laboratory building, when fully equipped, will furnish facili- ties for about fifty workers.

Much work must always be done in the fundamental subjects of chemistry, biology, physiology and pathology, for upon these basie sciences future discoveries in medical science must largely rest. While fully realizing the importance of these and lib- erally providing for them in its laboratory, the institute aims at the same time to keep close to the practical side, and will en- deavor to apply the latest discoveries in science to problems connected with the pre- vention and eure of disease. In order that the greatest good can be accomplished along these lines, the board realizes that a hospital closely affiliated with the institute is indispensable. Only in this way is it possible for those who work in the labora- tory to appreciate the relation of their re- sults to the problems of practical medicine. The hospital need not be large, but should be fully equipped. Such a hospital it is hoped may soon be added to the institute, in which the closest kind of scientific study may be given to obseure diseased condi- tions.

From the very beginning, the institute has sought not to monopolize the field, but to cooperate in all possible ways with exist- ing agencies for medical research in this country. It has cooperated with the Health Department of New York in the study of the conditions surrounding the production and distribution of the milk supply of the city, and the effects of milk upon the health of the children in the tenements; also with the commission appointed by the city in 1904, to study the prevalence of the acute respiratory diseases, and with that appoint- ed in 1905 to investigate cerebro-spinal

Jury 6, 1906.]

meningitis. It has united with Harvard University in sending a man to Manila to study certain phases of smallpox. With the same end in view, also, it has made grants each year to assist important in- vestigations which were being carried on in various places.

While it has been impossible to aid more than a small proportion of the even suit- able ones asking for assistance, still an average of twenty grants has been made each year, and much excellent work done which otherwise could not have been under- taken.

With the opening of a central laboratory for research in New York, these foreign grants will necessarily become a less impor- tant part of the work. It is not, however, the intention of the institute to discontinue them altogether. The board hopes always to be ready, with a grant of money or by sending a trained man, to assist in the solu- tion of any important emergency problem which may arise in connection with the public health in any part of the country.

The work done entirely or in part under the auspices of the institute and published in various scientific journals has been col- lected in volumes of reprints; four such volumes of about five hundred pages each having already been issued, two in 1904 and two in 1905; a fifth volume is now in press. The need of a special organ of pub- lication was early felt by the board and in 1904 negotiations were opened with the editor of the Journal of Experimental Medicine with a view to transferring its control to the institute. This has been accomplished.

In February, 1905, the institute took charge of the publication of this journal, under whose auspices it has since been is- sued. In it are published not only the work of the institute, but also other scien- tifie contributions of a similar nature.

In the five volumes of reprints appear


137 original papers; they may be classified under the following heads: There were 50 papers relating to etiology, or the causation of disease; 28 relating to pathology; 12 to bacteriology ; 22 to physiology; 8 to chem- istry; 9 to toxicology; 7 to experimental therapeutics, and 1 to pathological anat- omy.

Among the most important researches in point of the attention which has been given to them may be mentioned: 21 papers upon dysentery and diarrhceal diseases; 5 papers upon milk; 4 papers upon small- pox; 12 upon various pathological condi- tions of the blood; 3 upon diabetes; 5 upon trypanosomiasis, and 6 upon snake venom. The other topics are widely distributed over the field of scientific medicine.

To many, five years may seem a long time to be taken up with the work of prelimi- nary organization. Many difficulties have been encountered and many perplexing questions have come up for decision. It has been the policy of the board of direct- ors to proceed deliberately, and no step has been taken until a conviction regarding the wisdom of it was practically unan- imous.

To outline the development of an insti- tution which should secure the highest pos- sible efficiency has been no easy task. European models have aided greatly, but it was believed that what was needed in America was an institution different in many important respects from those of Europe. While many years will be re- quired for the full development of the institute, the board has felt that the general policy should be reflected from the outset. Throughout it has striven to keep con- stantly in mind the intention of the founder, expressed in his letter of gift, that the trust was to be administered in such a way as ‘to accomplish the most for humanity and science.’


The present staff of the institute is com- posed of the following persons:

Department of Pathology and Bacteriology— Dr. Simon Flexner, Dr. E. L. Opie, Dr. H. Noguchi, Dr. J. E. Sweet, Dr. H. S. Houghton.

Department of Physiology—Dr. 8S. J. Meltzer,

Dr. John Auer. Department of Chemistry—Dr. P. A. Levene,

Dr. W. Beatty.

Resident Fellows and Scholars—B. F. Terry, zoology; R. D. MacLaurin, chemistry; Chas. A. Rouiller, chemistry; E. H. Schorer, bacteriology; Bertha I. Barker, bacteriology.


THE support of hospitals has always made a strong appeal to the philanthropy of the state and of individual citizens, and the importance to the community of educated physicians has been appreciated, although in this country until recent years most in- adequately, but the recognition of medical science as a rewarding object of publie and private endowment is almost wholly the re- sult of discoveries in this department of knowledge made during the last quarter of a century. An eloquent witness to the awakening of this enlightened and _ bene- ficent sentiment is the establishment, in 1901, of the Rockefeller Institute for Med- ical Research with its laboratories formally opened to-day.

While the scientific study of infectious diseases is, of course, not of recent origin and had been pursued as a part of the functions of health departments and of university laboratories of hygiene and of pathology, the first provision of a special laboratory for this purpose was made by the German government in 1880, in the Imperial Health Office in Berlin, and to the directorship of this laboratory was called from his country practise Robert Koch, who four years before had startled the scientific world by his memorable investiga- tions of anthrax.

[N.S. Von. XXIV. No. 601.

The supremacy of Germany in science is due above all to its laboratories, and no more fruitful record of scientific diseov- eries within the same space of time can be found than that afforded by this laboratory during Koch’s connection with it, from 1880 to 1885. Thence issued in rapid suc- cession, the description of those technical procedures which constitute the foundation of practical bacteriology and have been the chief instruments of all subsequent discov- eries in this field, the determination of cor- rect principles and methods of disinfection, and the announcement of such epochal dis- coveries as the causative germs of tubercu- losis—doubtless the greatest discovery in this domain—of typhoid fever, diphtheria, cholera, with careful study of their prop- erties.

The leading representative, however, of the independent laboratory devoted to medical science is the Pasteur Institute in Paris, founded in 1886, and opened in 1888. The cireumstances which led to the foundation of this institute made probably a stronger appeal to popular sympathy and support than any others which have ever occurred in the history of medicine.

There stood in the first place, the per- sonality and the work of that great genius, Louis Pasteur, of noble and lovable char- acter, one of the greatest benefactors of his kind the world has known, who for forty years had been engaged, often under adverse conditions, in investigations which combined the highest scientific interest with important industrial and humanitarian ap- plications. Pasteur’s revelation of the world of microscopic organisms in our en- vironment—the air, the water and the soil —and his demonstration of their relation to the processes of fermentation and putre- faction, had led Lister in the late sixties, even before anything was definitely known of the causative agency of bacteria in hu- man diseases, to make the first and most

Jury 6, 1906.]

important application of bacteriology to the prevention of disease by the introduc- tion of the principles of antiseptic surgery, whereby untold thousands of human lives have been saved.

In 1880, came the most momentous of Pasteur’s contributions to medical science and art in the introduction of the method of active immunization by the use of the living parasites of the disease attenuated in virulence, a method which until this date had remained without further appli- cation since its employment by Edward Jenner in 1796 in vaccinating against smallpox. Pasteur’s researches in this field of immunity, marvelous in their orig- inality, ingenuity and fertility of resource, culminated in 1885 in the announcement of his successful method of protective in- oculation against that dread disease, rabies, and most of those here present will recall the enthusiasm with which this great triumph of experimental medicine was hailed throughout the civilized world.

It was under the immediate impression and the incentive of this discovery, and as a mark of gratitude to Pasteur, that over two and one half million franes were raised within a short time by international subseription for the construction and en- dowment of an institute to bear his name, where the Pasteur treatment was to be carried out and ample facilities afforded for investigations of microorganisms and the problems of infectious diseases. This model institute, much enlarged since its foundation and after the death of Pasteur under the directorship, first of Duclaux, and now of Roux, and in one of its most important divisions, of Metchnikoff, has been a fruitful center of productive research and through its contributions to knowledge affords a signal illustration of the benefits to science and to humanity of the endow- ment of laboratories for the advancement of medical science.


It was under much the same influences that the important Imperial Institute for Experimental Medicine in St. Petersburg, with even wider scope than the Pasteur In- stitute, was founded and munificently en- dowed by Prince Alexander of Oldenburg in 1890.

In the following year the Prussian gov- ernment established in Berlin, under the directorship of Professor Koch, the ad- mirably organized and equipped Institute for Infectious Diseases, to which is at- tached, as to the Pasteur Institute, a hos- pital for infectious diseases. This and the excellent Institute for Experimental Thera- peutics, in Frankfort, under Professor Ehrlich’s direction, founded also by the Prussian government in 1896, are unsur- passed in their scientific activities and in the number and value of their contribu- tions to our knowledge of infection and immunity.

In 1891, was founded in London the British, later the Jenner, and now the Lister, Institute of Preventive Medicine, designed to be a national institute similar in character and purpose to the Institut Pasteur, in Paris. The funds were con- tributed by the public, and subsequently increased by Lord Iveagh’s generous gift of two hundred and fifty thousand pounds.

Within less than a year after the founda- tion of the Rockefeller Institute for Med- ical Research, the Memorial Institute for Infectious Diseases was founded in Chi- eago, by Mr. and Mrs. Harold F. MeCor- mick, and placed under the capable direc- tion of Professor Hektoen.

The Institute for the Study, Treatment and Prevention of Tuberculosis, which bears the name of its beneficent founder, Henry Phipps, was incorporated in Phila- delphia in 1903, and, while devoted to a single disease, it must be ranked among those of wide scope, when we consider the magnitude and surpassing importance of


the problems pertaining to this disease.

It may also be noted that the Carnegie Institution in Washington, with its un- equaled endowment of ten million dollars, includes within its seope the support of biological and chemical investigations of great importance to medical science, so that our country now stands in line with Germany, France and Great Britain in the opportunities afforded for research in medical and other sciences.

These various institutions have been men- tioned as typifying the general aims and character of the Rockefeller Institute for Medical Research, rather than to afford any complete picture of the material aid now available for the advancement of scientific medicine. If the latter were the purpose, it would be necessary to travel far afield

~so as to inelude independent medical labo-

ratories of more restricted scope, such as those for the study of cancer, the labora- tories connected with departments of health, so well exemplified in our own country by those of the state board of health of Massachusetts, and of the de- partment of health of the city of New York, hospitals and the laboratories con- nected with them, the medical laboratories of the universities and medical schools, such as the Thompson Yates and Johnston laboratories in Liverpool, and the splendid new laboratories of the Harvard Medical School, laboratories established in recent vears for the study of tropical diseases, such as our government laboratories in Manila, and funds available for special grants to investigators. ; Impressive and encouraging as is this 1emarkable growth within recent years of laboratories devoted to the medical sciences, no one who has any knowledge of the vast field to be covered, of the difficulty and complexity of the problems, of the expendi- ture of money required, and of the returns in inereased knowledge and benefits to

[N.S. Von. XXIV. No. 601.

mankind which have been attained and which may be expected in increasing meas- ure, can for a moment suppose that the existing opportunities, considerable as they are, are adequate to meet the present and the future needs of scientific medicine.

As I have already stated, the wider rec- ognition of medical science as a rewarding object of endowment is a result of dis- coveries made during the last quarter of a century, and it is of interest to inquire why this increased knowledge should have borne such abundant fruit. The result is not due to any change in the ultimate aims of medicine, which have always been what they are to-day and will remain, the pre- vention and the cure of disease, nor to the application to the solution of medical prob- lems of any higher intellectual ability and skill, than were possessed by physicians of past generations, nor to the growth of the scientific spirit, nor to the mere fact of a great scientific advance in medicine, for the most important contribution ever made to our understanding of the processes of disease was the discovery by Virchow, in the middle of the last century, of the prin- ciples and facts of cellular pathology, the foundation of modern pathology.

The awakening of this wider public in- terest in scientific medicine is attributable mainly to the opening of new paths of in- vestigation which have led to a deeper and more helpful insight into the nature and the modes of prevention of a group of dis- eases—the infectious diseases—which stand in a more definite and intimate relation to the social, moral and physical well-being of mankind than any other class of dis- eases. The problems of infection which have been solved, and kindred ones which give promise of solution, are among the most important relating to human society. The dangers arising from the spread of contagious and other infectious diseases, threaten, not the individual only, but in-

Juty 6, 1906.)

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 Commis- 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 ean 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


suecess of preventive medicine, will bring about deterioration of the race. I believe the argument to be fallacious, and that we already have sufficient experience to show that there need be no serious apprehension of such a result.

Before some accurate knowledge of the causation of infectious diseases was se- eured, preventive medicine was a blunder- ing science, not, however, without its one great victory of vaccination against small- pox, whereby one of the greatest scourges of mankind ean be controlled and could be eradicated, if the measure were universally and efficiently applied. The establishment upon a firm foundation of the germ doc- trine of infectious diseases, the discovery of the parasitic organisms of many of these diseases, the determination by experi- ment of the mode of spread of certain others, and the experimental studies of in- fection and immunity, have transformed the face of modern medicine. The recogni- tion, the forecasting, the comprehension of the symptoms and lesions, the treatment of a large number of infectious diseases, have all been illuminated and furthered, but the boon of supreme import to the human race ‘has been the lesson that these diseases are preventable.

Typhus fever, once wide-spread, and of all diseases the most dependent upon filth and overerowding, has fled to obscure, un- sanitary corners of the world before the face of modern sanitation.

In consequence of the knowledge gained by Robert Koch and his coworkers, Asiatic cholera, to the modern world the great rep- resentative of a devastating epidemic, will never again pursue its periodical, pandemic journey around the world, even should it make a start.

Of bubonie plague, the most dreaded of all pestilences, which disappeared mysteri- ously from the civilized world over two centuries ago, we know the germ and the

[N.S. Vor. XXIV. No. 601.

manner of propagation, and, although it has ravaged India for the last ten years with appalling severity, it can be and has been arrested in its spread when suitable measures of prevention are promptly ap- plied.

Typhoid fever, the most important in- dex of the general sanitary conditions of towns and cities, has been made practically to disappear from a number of cities where it formerly prevailed. That this disease is still so prevalent in many rural and urban districts of this country, is due to a disgraceful neglect of well-known meas- ures of sanitation.

To Major Walter Reed and his colleagues of the army commission, this country and our neighbors to the south owe an inesti- mable debt of gratitude for the discovery of the mode of conveyance of yellow fever by a species of mosquito. On the basis of this knowledge, the disease, which has been long such a menace to lives and commercial interests in our southern states, has been eradicated from Cuba, and can be con- trolled elsewhere.

Another army surgeon, Major Ross, act- ing upon the suggestion of Sir Patrick Manson, had previously demonstrated a similar mode of ineubation and transporta- tion of the parasite of malaria, discovered by Laveran, and it is now possible to at- tack intelligently and in many localities, as has already been proven, with good promise of success, the serious problem of checking or even eradicating a disease which renders many parts of the world al- most uninhabitable by the Caucasian race and, even where less severe, hinders, as does no other disease, intellectual and industrial activities of the inhabitants. It is gratify- ing that one of our countrymen and a mem- ber of the board of directors of this insti- tute, Dr. Theobald Smith, by his investiga- tions of Texas cattle fever, led the way in

Juty 6, 1906.]

the discovery of the propagation of this class of disease through an insect host.

The deepest impress which has been made upon the average death rate of cities has been in the reduction of infant mortal- ity through a better understanding of its eauses. The Rockefeller Institute, by the investigations which it has supported of the questions of clean milk and of the causes of the summer diarrheas of infants, has already made important contributions to this subject, which have borne good fruit in this city and elsewhere.

No outcome of the modern science of bacteriology has made a more profound im- pression upon the medical profession and the public, or comes into closer relation to medical practise than Behring’s discovery of the treatment of diphtheria by antitoxic serum, whereby in the last twelve years the mortality from this disease has been re- duced to nearly one fifth of the former rate.

The most stupendous task to which the medical profession has ever put its hands is the crusade against tuberculosis, whose preeminence as the leading cause of death in all communities is already threatened. Sufficient knowledge of the causation and mode of spread of this disease has been gained within the last quarter of a century, to bring within the possible bounds of real- ization the hopes of even the most en- thusiastic, but it will require a long time, much patience and a combination of all the forees of society, medical, legislative, educational, philanthropic, sociological, to attain this goal.

Time forbids further rehearsal, even in this meager and fragmentary fashion, of the victories of preventive medicine. Enough has been said to make clear that man’s power over disease has been greatly increased in these latter days. But great and rapid as the progress has been, it is small in comparison with what remains to


be done. The new fields which have been opened have been explored only in rela- tively small part. There still remain im- portant infectious diseases whose secrets have not been unlocked. Even with some whose causative agents are known, notably pneumonia and other acute respiratory affections, and epidemic meningitis, very little has yet been achieved by way of pre- vention. The domain of artificial im- munity and of the treatment of infections by specific sera and vaccines, so auspi- ciously opened by Pasteur and by Behring, is still full of difficult problems, the solu- tion of which may be of immense service in the warfare against disease. Of the cause of cancer and other malignant tu- mors nothing is known, although many workers with considerable resources at their disposal are engaged in its study. With the change in the incidence of disease, due at least in large part to the repression of the infections of early life, increased im- portance attaches to the study of the cireu- latory, renal and nervous diseases of later life, of whose underlying causes we are very imperfectly informed. There are and will arise medical problems enough of supreme importance to inspire workers for generations to come and to make demands upon all available resources.

In directing attention, as I have done, to some of the practical results of scientific discovery in medicine, and in indicating certain of the important problems awaiting solution, there is always the danger of giv- ing to those unfamiliar with the methods and history of such discovery a false im- pression of the way in which progress in scientific knowledge has been secured and is to be expected. The final victory is rarely the result of an immediate and direct onslaught upon the position ultimately se- eured. The advance has been by many and devious and gradual steps, leading often, it might appear, in quite different

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directions, and mounted more frequently than not to secure