have earned retirement. The society especially fosters and encourages younger members to read essays and to present unusual cases, and they are always certain of an appreciative audience. This is a keen incentive to study and research work.

Since it is true that history repeats itself, is it not well to pause now and then to take a glance at the achievements of the past in order to gain new encouragement for the accomplishment of the future?

A survey of its history shows that medicine has had a far greater development in the past century than in all previous time. The changes that have taken place have been truly stupendous. The current of medical progress is still in rapid and vigorous flow, with no sign of slowing. A multitude of keen investigators are eagerly and industriously hunting out and developing new knowledge and new methods. Every year or two yields new facts of fundamental value. These discoveries are rapidly assimilated into the body of diagnostic and therapeutic methods and practise; the novelty of one year becomes the routine of the next.

Of the great body of science, medicine is an integral part. In no department of knowledge is scientific method more rigorously pursued, or with more productive results than in medicine. It is the use of the scientific method alone that has brought about the vast development of medicine within the past century, with all the resultant benefit to mankind. In no field of human activity is there a greater exercise of humanitarian spirit than in medicine. In the difficulties that confront mankind to-day, the course and the duty of the medical profession are clear-to continue the vigorous employment of those scientific principles and the exercise of the altruistic spirit that elevated medicine out of the empirical and stagnant inefficiency that characterized it for a thousand years. Furthermore, medicine is in a position to offer the application of those same principles and spirit to the solution of the grave difficulties that confront mankind to-day. Medicine can proudly present its record before the world as a con

spicuous example of the attainment of substantial efficiency and social service; the methods and the spirit that have brought success to medicine ought to help in bringing equal efficiency and achievement in industrial, economic and civic institutions.

The great achievement of medicine not only affords us inspiration and pride, but impose upon us serious responsibilities and obligations. It is our duty, individually and collectively, to keep ourselves worthy of our great profession, assiduously to cultivate our art, to maintain unimpaired the great heritage of the past, and, as opportunity offers, to add to the store of medical knowledge. We should cherish the principles and the spirit that have brought us to our proud position. We should keep aglow the light that has dispelled so much of the darkness and obscurity of the peculiar problems that confront us, and let that light shine into the gloom of a disordered world. In the consciousness of the great achievements and usefulness that have been attained, and in our own assiduous efforts to live up to the spirit of our great profession, rest the greatest satisfactions and the greatest rewards that can come to us.

Will you not turn with me for a brief glance at some of the developments in medicine during the last half century. In the short time which I have at my disposal it will be possible to touch only the high lights of this subject.

Fifty years ago the use of the microscope was in the hands of a few men who devoted their lives exclusively to research work, whereas to-day, it is one of the instruments at the right hand of every busy practitioner, who would feel as much at sea without it as without his stethescope or test tube.

Among the broader developments of the last half century when medical science branched out and its progress depended upon highly specialized study and research, the practise of medicine evolved the specialist. These have increased to enormous numbers, and surely for the most part are justifiable, but it must be confessed that some are needless and immature. It will require a decade or more to

drop to the mean level in this regard. There can be little doubt but that the pendulum is swinging from the extreme degree in specialized medicine so that in a few years the normal balance between the specialist and the general practitioner will be established.

Along with the growth of specialized medicine has come the laboratory, which at the present time is the brain of practical scientific medicine. It is to the laboratory that we are chiefly indebted for all of the great discoveries in medicine and the allied sciences. The beginning of this era of laboratory work was the establishing of Von Ziemssen's laboratory in Munich in 1885.

Among the great discoveries which we owe to the laboratory are Pasteur's work on pathogenic microbes, in which he brought out the theory of protective inoculation against certain infectious diseases. Later on he gave to the medical world the results of his studies on rabies and anthrax, which have been of immeasurable service to mankind throughout the civilized world.

About the same time Koch introduced a new method for the isolation and pure culture of bacteria which is essentially the same as is now in use. In 1874 Ehrlich improved the method of staining smears which had been worked out by Weigert three or four years previously. This opened the door to the study of a great number of microorganisms and has proven one of the most important diagnostic criteria in the practise of medicine. As a result of Weigert's and Ehrlich's laboratory technique the spirillum of relapsing fever was discovered in 1873 by Obermeier and the parasitic amoeba in dysenteric stools by Loesch in 1875. Koch was able to grow anthrax bacilli for the first time in artificial media in 1875. In 1879 Neisser announced the discovery of the gonococcus. In 1880 Pasteur presented his monograph on the study of the streptococcus and the staphylococcus which had been isolated for the first time by him two years previously. About the same time Eberth described the typhoid bacillus as the cause of the continued fever known as typhoid. Laveran discovered and described

the plasmodium of malarial fever, November 6, 1880.

Perhaps the most important of these discoveries and the one which attracted instantly the most wide-spread attention among the laity as well as the medical profession was that of the tubercle bacillus by Koch in 1882. Tuberculosis had been known and observed for centuries, but the microorganism which produced it had eluded all of the keenest observers up to that time. Another almost equally important discovery made by Klebs in 1883 was the diphtheria bacillus; its causal relation to diphtheria was demonstrated by Loeffler in the same year. Along about this time came the discovery of the tetanus bacillus, the colon bacillus, the meningococcus, the bacillus of Malta fever and a number of others. Still another contribution along this line was that of Smith and Kilbourne, who discovered that Texas fever was transmitted by the cattle tick. However, some years antedating the announcement of Smith and Kilbourne, Dr. A. F. A. King, of this city, read a paper before this society in which he expressed the belief that malaria was transmitted by the mosquito. This may, and probably did, give a hint as to the transmission of certain infectious diseases, which led to valuable discoveries, chief of which was that of Reed and Carroll of this city, who demonstrated that yellow fever was transmitted by a certain species of mosquito; thus corroborating Dr. King's theory. As a result of this discovery Cuba was made safe to the traveler and the completion of the Panama Canal was made possible.

Another notable contribution to practical bacteriology was the discovery in 1896 by Widal of the agglutination test for typhoid fever, upon which the present-day differential diagnosis between typhoid and other continued fevers rests.

With the mention of one additional important discovery I will pass on to developments in other fields. Perhaps none of these mentioned heretofore have arrived at a more prominent place in the history of valuable discoveries than Wassermann's serodiagnosis

of syphilis in 1907 and Schaudinn's discovery of the Treponema pallidum, two years earlier, in 1905.

Medical science is indebted to the pathologists for many important and valuable contributions during the past fifty years. As a result of their investigations the pathology of many of the diseases to which human flesh is heir has come to be more or less understood. The progress of physiology has kept pace with pathology along allied lines, but its scope is much more comprehensive than the latter, as it invades the domain of chemistry to some extent. This field of medical research has contributed more of practical value than any other, with the exception of bacteriology, with which it is also closely linked. In this field has been developed the knowledge of the ductless glands which at the present time is attracting so much attention. It was BrownSequard who, in 1891, called attention to this domain of the body.

Charcot laid the foundation for the later developments in psychoanalysis by his studies on hysteria a half a century ago. Freud in the present generation has carried this branch of medicine to the point of practical application. To Golgi's method of staining, which was given to the medical profession in 1873, the knowledge of the histology of the nervous system is attributable.

The place which Lister occupies in relation to the developments of surgery is recognized by the entire scientific world. Not infrequently he is alluded to as the father of modern surgery. As he antedates the period covered by this paper I will not dwell further upon his achievements, although to him may be attributed the foundation of aseptic surgery.

The advancements in this branch of medicine are so many and spectacular as to well nigh overwhelm the chronicler of a brief history of medical progress.

One of the earliest important steps in the progress of surgery was the introduction of steam sterilization of dressings and instruments in 1886 by von Bergmann. This super

seded corrosive sublimate antisepsis then in

use.

Esmarch, in the early seventies, called attention to his method of controlling hemorrhage at operations by bandaging the limb above the site of operation, thereby giving the operator an almost bloodless field and greater freedom for exact work, and at the same time saving the patient from unnecessary loss of blood.

Sir Spencer Wells went a step farther and devised the clip or hemostatic forcep to pick up the individual bleeding points at the site of operation, this doing away with Esmarch's method.

Local anesthesia by ether spray was introduced by Richardson in 1886 and cocaine by Anrep and Kohler about the same time. Dr. Corning, in 1885, described the results of his experiments in spinal anesthesia, although the claim for this new and important discovery has been made in Germany on behalf of Bier in the same year. Six years later Quincke called attention to the importance of a study of cerebro-spinal fluid in certain local and system diseases.

As a result of the work of Corning, and later Quincke, Crile developed his method of anocia-association, which for a brief time was widely used.

The strides in abdominal surgery during the past twenty-five years have been so rapid, varied and extensive as to make it impossible to select any high points for mention, since they all come well within that category.

It may not be inappropriate to call attention in passing to the fact that much of the recent progress in field surgery has been due to the great surgical clinics which have been developed during the past twenty years, both here and abroad.

The care of the mother at child-birth is the oldest branch of the practise of medicine and, without doubt, the most important to the future of the world. Whereas, there have been no startling developments in this branch of medicine yet the obstetrician has kept pace with the surgeon in modern methods and asepsis.

The progress in the field of diagnosis rests

upon the developments in bacteriology, physiology, histology and chemistry. A history of any one of these necessarily describes diagnostic progress.

In therapeutics the most noteworthy advance was the gradual transition from the oldtime so-called gunshot prescription to the simple single drug prescription devoted to the specific need for which it is to be used. Some of the more beneficial additions to modern therapeutics are chloral as a hypnotic and the salicylates for the relief of so-called rheumatic affections.

The discovery of the hemostatic effects of certain drugs by means of which hemorrhage beyond the reach of the hemostatic instruments may be controlled has been a great boon to the physician and to the surgeon.

In the eighties the antipyretic drugs were given to the profession and were soon eagerly appropriated by the laity for the relief of vague and distressing pains in one part of the body or another.

A very important contribution to therapeutics was the introduction of von Behring's anti-diphtheritic serum in 1893. Another was the introduction of anti-typhoid inoculation.

The modern synthetic sleep-producing drugs, of which trional and sulphonal are examples, were introduced in 1893. Novocain, which is widely used, was discovered by Einhorn in 1905. No more important remedial agent has been given to the medical profession than Ehrlich's salvarsan in 1909, which has done much to rob syphilis of its terrors both to the community and to the individual.

The multiplicity of pharmaceutical and biological products is bewildering and a large percentage of them are useless and serve merely to enrich the manufacturers and to deceive for a time the credulous public.

The most spectacular of all the discoveries in modern medicine is that of the X-ray, which Roentgen announced in 1895. Not only has it proven a useful therapeutic agent but it holds a commanding position among diagnostic methods. Another therapeutic agent which aroused a great deal of attention was the introduction of radium for

the treatment of cancer and indolent ulcer, the exact value of which has not, as yet, been definitely determined. The trend of to-day in therapeutics is to limit the amount and number of drugs used, and to employ hygienic and dietetic measures in the treatment of disease, and to reach out after prophylactic methods.

In passing from a consideration of therapeutics I may be pardoned for calling attention to the fact that the medical profession differs from all others in being the only one which, in its practise, is self-destructive, by teaching the public laws of social hygiene and of preventive measures.

A necessary development in the scientific care of the sick was the advent of the trained nurse, who came to be recognized as a necessity in the latter part of the nineteenth century. Nursing as a profession was suggested by Dr. Samuel Gross about fifty years ago, and shortly thereafter, on August 1, 1875, the first training school for nurses was formally opened at Bellevue Hospital, N. Y. Soon, other training schools were established, until at the present time training schools for nurses are to be found in great numbers throughout the civilized world.

It would be difficult to conceive the possibility of carrying out the modern methods of caring for the sick without the invaluable aid of that great body of earnest and intelligent women who go to make up the nursing profession. One has only to mention the Red Cross to realize the deep root the nursing profession has taken in the social fabric of the world.

Of necessity the scheme of medical education and the development of medical libraries have grown with the needs arising out of the progress of the profession during the past half century.

Having considered briefly a few of the more important epoch-making discoveries which have marked the progress of the medical profession during the past half century, may we not draw therefrom encouragement to look at the future, rich in the promise of developments which will progressively lessen