cialization that individuals have reached. It has been characteristic of the larger institutions rather generally in this country during the past that whenever any department or line of work was suggested by one institution, every other one has desired at once to introduce a similar department. Now, funds are and in future will be even more lacking for duplication of new departments and our universities must face the problem of teaching subjects for which they are naturally adapted by their location and the funds at their command. It is very likely also that new topics which are taken up by any institution will have in many cases a genetic relation to the history and previous program of the institution as well as to its geographic location and natural advantages. Other limiting and directing influences will readily suggest themselves without further discussion of this point. But however the matter is determined, there is sure to be in future university development a clear recognition of the fact that it is neither possible nor desirable for each institution to cover all fields of developing knowledge. And this principle applies clearly to the special question under consideration.

Courses in aquiculture must be established to train technical workers and those institutions should embark upon the work which are advantageously located to undertake it, all factors being considered. It is also important to note that such work may follow either one of two distinct lines. There will be courses of a general character to train the routine worker, and those of advanced character to train the research worker. There is evident need in both directions in order to prepare men for general purposes and also to carry on research and direct the work of the former group. The general training will naturally be given in special undergraduate courses, whereas the special work must be provided in courses for graduate students.

I should like to emphasize here the necessity of having the specific cooperation of the Bureau of Fisheries in order to make this work successful in either phase. A certain amount of technical practise is inseparable from

proper training in this field. It already exists under the control of the bureau, and the proper type of organization will bring these two things together so that the student getting training along theoretical and laboratory lines will be able to secure practical work under the Bureau of Fisheries. This practical training might well be given during the summer months. There are opportunities for this practise in connection with the operation of egg taking and other work of the fish hatchery and with the problems of fish foods to be worked out in the new laboratory of the bureau. There are opportunities of this sort at many points already controlled by the bureau, which might be very appropriately utilized for training men registered in these special courses. The bureau already provides in part for taking in college students, associating them with this work and giving them manual training in those processes essential for work in practical fisheries problems.

May I point out one feature known to the bureau which has proved thus far difficult to handle well and which is conspicuous to the outsider as a weakness in the present organization. The helpers drawn into this summer work are often only casually interested in the problem or concerned merely in getting a pleasant summer vacation. They are not men who are so directly interested in fish culture problems as to desire to make this summer training a part of their general education for service in fisheries work. If these summer positions could be filled first of all by men who are seeking to secure thorough training for work as fishery experts and hence directly interested in the problems of the fisheries, the students would be advantaged in their work and the training given would not be incidental but would form part of a general program that would ultimately serve to advance the work of the bureau and fisheries interests in general.

Organization of Science.-I touch upon this theme with some hesitation. The National Research Council has given intensive study to the problem, and the opinions of an outsider are likely to be premature or to appear of little value in comparison with Dr. Merriam's.

Some work has already been done to bring into closer touch the research worker and the bureau. Many of the men before me have enjoyed from time to time opportunities for carrying out investigations at various laboratories and have gained immensely, not only in their own work but in the possibilities for training younger men to meet the needs of the service. There is a demand for a more definitely organized program, one calculated to bring the university laboratory with its pure science and the bureau with its applied science into definite and intimate contact. Two lines of attack are possible:

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First, the end desired might be reached under the direction of the research council or some branch of it through discussion or correspondence. The gain would be very great. I merely suggest one of the evident disadvantages in such a plan. It throws a heavy burden of labor on some central committee. success depends upon the existence of a machinery functioning actively enough to carry out all the processes of conveying the information and coordinating the plans. Furthermore, it suffers the disadvantage of being at times subject to the difficulties due to imperfect understanding. Men express themselves so differently that what is found on the written page is sometimes interpreted in a different way than was intended. This may be followed by a further waste of time spent in explanations. Extensive discussions in modern science have arisen from this very cause and the result is evident loss of energy.

The second method, which looks more likely to be successful, is a plan for having a divisional board of ten, fifteen or twenty members, which should be representative of different parts of the country, different institutions, different lines of work, and different regions that come in contact with different phases of existence a board to have meetings as a general body and able to have personal conferences with representatives of the Bureau of Fisheries. The advantages of personal contact seem to make this a more profitable line of attack than the other, though I am not blind to the difficulties in both suggestions.

Personal discussion brings up new points of view and yields keener analyses of any situation; it provides, I believe, means for meeting difficulties more readily than methods of conference by letter.

I want to indicate clearly, however, that if such a plan is to be tried this board must be directly subject to the Bureau of Fisheries. I am confident that the history of the past shows that no undesirable connotation can be attached to the words "subject to." The bureau has responsibility for these problems given it by the people and should have the final authority in such an arrangement. It should have freedom to suggest where in its experience certain plans do not seem to be feasible.

It would be possible for such a body to hold sectional or topical conferences for the discussion of problems important in a particular region or for the solution by joint action of a question of serious import at a particular time. The membership of such conferences could be specifically determined with reference to the special need and the definite questions that demanded experimental investigation or laboratory study to be taken back to the universities for research and report at some later date. Other advantages will evidently accrue from this association of technical experts and scientific investigators in a board which could outline a plan of active and direct procedure with a view to securing the necessary knowledge whether it was already in existence or had to be worked out by investigators properly equipped with library and laboratory facilities.

Such a board would exert a powerful influence outside of that which it might have in developing a program; it would possess power to push those lines of activity which are seen on analysis to be not only right but essential. Important items often appeal to men in legislative halls or to the general public as being quite unnecessary or even foolish. A board representing the public at large would give a weight to its views that could not be imparted to them in any other way.

Of course, one has to consider also another aspect of the question. It is inevitable that

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attempts be made from time to time to force the introduction of unwise policies and the modification of well-planned organization; these influences may emanate from political centers and sources that are unfortunate. best such influences delay the progress of scientific investigation and the application of scientific methods, in this instance to the Bureau of Fisheries; at worst they destroy work built up by laborious efforts in the past. We must be awake to the need not only for building an organization and for securing the best so that it can weather the shifting of political results but also for directing the organization parties and of public opinion in politics. HENRY B. WARD

MEDICINE, A DETERMINING FACTOR IN WAR1

THE death rate in our Civil War of killed and dying of wounds is given as thirty-three per thousand, the disease death rate as sixtyfive. In the Spanish War the death rate from battle is five and the death rate from disease 30.4 per thousand. In the present war, taking the statistics up to March 28, 1919, we find the rate of death from wounds received in action is 14.191 and that of death from disease is 14.797 per thousand. This includes the army on both sides of the ocean. The statistics of the American Expeditionary Forces, with an average strength of 975,716, reveal a rate of death from wounds in action of 31.256 per thousand and a death rate from disease of 11.233. Of those who died of disease, pneumonia claimed 9.146 per thousand.

Studying comparatively the diseases of the American armies during the Civil War, Spanish-American War and the recent war, we find that malaria was one of the chief causes of disability in both the Civil War and the Spanish-American War, though it caused but 6 per cent. of the deaths in the Civil War and but 10 per cent. in the Spanish-American War. But in the recent war malaria has caused such

1 From the presidential address of Dr. Alexander Lambert given at the Atlantic City Meeting of the American Medical Association and printed in the Journal of the association.

a small number of deaths that it is not given in detail, but is put into the aggregate term of "other diseases." Typhoid fever, with typhomalaria, so called, was one of the chief causes of death from disease in both the Civil War and the Spanish-American War, causing 22.4 per cent. of the deaths of the Civil War, and being the one great uncontrolled epidemic of the Spanish-American War, causing in the fighting period of the latter war 60.5 per cent. of all deaths. But in the recent war only 0.4 per cent. of the deaths are chargeable to this scourge. Pneumonia, on the other hand, causing only 13 per cent. of the deaths during the four years of the Civil War and only 3 per cent. in five months of the Spanish-American War, has become the dreaded epidemic of the recent war, causing in the American army 85 per cent. of all deaths from disease. In the Civil War, meningitis caused 2 per cent. of the deaths, and 2 per cent. of the deaths in the Spanish-American War, and it caused 4 per cent. of the deaths in this war. Smallpox caused 4 per cent. of the deaths in the Civil War; in the Spanish-American War, one man died of this disease; in this war, one man died from smallpox in the United States and five in France. In 1918 and in the first months of 1919, there were 102 patients with smallpox admitted to the hospitals in the United States. These patients came into the various camps from civil life, for the disease developed among the recruits before they could be vaccinated and thus protected, but it has not developed at all among the vaccinated troops in the United States. Dysentery caused 28 per cent. of the deaths in the Civil War, and nearly 30 per cent. (29.3 per cent.) of the 5,600,000 cases of disease reported in that war. In the Spanish-American War it caused 5.6 per cent. of the deaths. But it caused only forty-one deaths out of 48,000 cases, or 0.08 per cent. of the deaths in the recent war. The transmission of yellow fever by mosquitoes does not come into consideration in the recent war, though there were small epidemics of this disease in both the former wars, there being about 1,300 cases in the Civil War and about 1,100 in the Spanish-American War. There is one achievement by the Medical

Department of the United States Army after the Civil War which stands as a lasting monument to the industry and genius of the surgeons of that time; it is the "Medical and Surgical History of the War of the Rebellion." This was the first great medical history ever published of any war, and remains still the standard to be attained.

As a result of the scientific medical work during and after the Spanish-American War, the investigations of three American army surgeons, Jesse Lazear, James Carroll and Walter Reed, gave to the world the solution of the problem of the transmission of yellow fever by mosquitoes. With this knowledge, came simultaneously the power to control this dread disease, which for centuries had been the scourge of the West Indies, and had time and again spread in devastating epidemics to this country and even to southern Europe. Lazear and Carroll laid down their lives to gain this knowledge, and paid the ultimate sacrifice in order that thousands, through their work, might be protected and live. The sanitary control of mosquitoes, and thus of tropical malaria and yellow fever, and the wise administration of this knowledge, made possible the building of the Panama Canal. It was an American army surgeon, William C. Gorgas, who seized this great opportunity and transformed a pesthole of tropical diseases into a healthy and safe terrain, that the engineering genius of the United States Army might be free to construct the canal. The French under De Lesseps had failed because of the epidemic and tropical diseases which were at that time uncontrollable. Disease had defied and overcome engineering skill and genius. Preventive medicine controlled and conquered.

Ten years ago the practical application of the knowledge gained from the study of the epidemic of typhoid fever of the SpanishAmerican War brought about the compulsory inoculation against typhoid in the United States Army. It had been shown by the Vaughan and Shakespeare Board that nearly 65 per cent. of the typhoid fever of that war was transmitted by contact of man with man,

and was not water borne. Hence sanitation could only reduce typhoid to a certain level and not eradicate it. The introduction of compulsory typhoid inoculation in the army has practically eradicated the disease. Following the work of the English medical corps in the Boer War, a United States Army surgeon, F. F. Russell, made possible the practical application of this method in the U. S. Army and proved conclusively that typhoid fever could be completely controlled. The American Army Medical Corps has, in the recent war, discovered the transmissibility of trench fever by body lice, and thus has shown the means of prevention of this new disease which, while killing no one, rendered thousands of men useless for weeks and ineffective for fighting. This discovery came to save thousands of men for the fighting lines at a time when they were urgently needed.

Medical science has to-day, therefore, within its grasp the power to control the diseases which, in former times, decimated warring armies and spread out from these armies among the non-combatant populations. Formerly, when war broke out, it was almost inevitably followed by some dread pestilence among the civil populations of the countries in which the war was waged. By proper sanitation and preventive inoculation, dysentery and cholera can be abolished; by vaccination armies can be protected against smallpox. Body lice disseminate typhus, recurrent fever, and trench fever, and by proper disinfection of these vermin these diseases cease to occur. Through sanitation and preventive inoculation, typhoid fever, the scourge of the two previous wars, is absolutely controlled, and this includes also paratyphoid, which has been recognized as a separate entity only since the Spanish-American War. In the SpanishAmerican War, 60.5 per cent. of all deaths were caused by typhoid, and in the present war 85 per cent. were caused by pneumonia. The typhoid of the Spanish-American War was due to local causes and local epidemics. The pneumonia of this war was beyond control, and was part of a world-wide epidemic that swept over both hemispheres, and the morbidity and mortality of some of the cities

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of this country exceeded those of the camps. Subtracting the death rate caused by pneumonia from the total death rate by disease in the recent war we have 2.2 per thousand for the entire army on both sides of the water, which is practically a peace-time death rate. Meningitis has caused, in this war, ten times as many deaths as typhoid fever; pneumonia has caused two hundred times as Mumps and scarlet fever, of the infectious diseases of the young men, remain as yet to be controlled, but they are not of great import in the armies in war. The disabling type of disease coming under the head of venereal disease has, in this war, been so controlled that the number of cases brought from civil life was greater than the number occurring in the American Expeditionary Forces in France, which was reduced to twenty-two per thousand per year, a rate only one eighth as high as the incidence among recruits coming from civil life, and only one third as high as the best that ever had been accomplished in the army before.

Influenza, measles and pneumonia, in the respiratory group, still stand as baffling problems, and their control has not been accomplished. Measles appeared and spread until it no longer had material on which to spread, as one attack confers immunity to a second. Pneumonia, following influenza or originating as a primary disease, still eludes control. But the knowledge which we have gained in this war of the methods of its spread, of the various infectious organisms which produce it, and their various types and varying virulence, of its occurrence as a secondary complication to measles and influenza, has enormously increased. The value of the facts thus learned are incalculable, and belief is justified that the problem is better understood than ever before, and that we soon shall see the solution of these problems.

The occurrence in the camps of meningitis, another disease of the respiratory group, as far as its portal of infection is concerned, has been forty-five times as frequent in the army as its occurrence in civil life among the same age group. This has been due to overcrowding and the diminution of air space allowed

the individual soldier in badly ventilated barracks. The responsibility for these sanitary sins rests on the General Staff and not on the Medical Corps.

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What then are the lessons that we can draw for future action? There is no question but that the salvage of human beings, the protection of troops from disease in an army, renews and saves the fighting forces. Until recently, until medical science could control disease during war time, armies had been more decimated and injured by disease than through battle casualties. Now that, except for epidemic spread of respiratory diseases, the communicable and epidemic spreading diseases can practically be controlled, the medical corps of an army has become an essential part of the fighting organization. Whole nations must now go to war. longer can they mobilize a selected portion of volunteers and send them to fight the war and defend the nation. Since all the youth of the nation must mobilize and turn to war, it becomes the duty of a general staff to save its man power and to salvage it to the greatest extent possible. The history of the Crimean War, of our Spanish-American War, and our experience in the recent war have clearly shown that only through proper representation on the general staff by those men trained in such salvage, and by experts in such knowledge of sanitation, can this duty be performed. When the General Staff of the United States Army comes to realize this fully, one can not conceive that it will fail to give proper representation in its councils and organization to the Medical Department. The practical necessity for this was finally recognized in the A. E. F. by General Pershing and three medical officers were detailed at General Headquarters as substantive members of the General Staff. Responsibility and authority can not be separated, and only by such organization can adequate authority equal the inevitable responsibilities.

In the mobilization of the industrial forces of the nation by the Council of National Defense, the health of the nation and the protection of both nation and its armies was regarded of such importance that it demanded