MEDICINE TO-DAY.*
NOT long ago an eminent physician in the course of the opening lecture of one of the great medical schools remarked : "Medicine has of late made great progress in every direction except, perhaps, in the curing of disease." There was, it may be, something of playful exaggeration in the dictum ; it may certainly be replied that vast progress has been made in what sane of the wisest of proverbs declares to be better than cure— prevention. Dr. Evans begins with a brief chapter on the " Medicine of the Past." We recognize that it has to be 'brief, so large is the subject which he has made it his business 'to treat, the " Medicine of the Present," and he proceeds at 'once to an inquiry which is distinctive of the new science, " The Causes of Disease." These causes are mechanical (injuries 'from outside), physical (heat, cold, electricity, &c.), and chemical (things absorbed, either noxious in themselves or becoming noxious in the body). So far we have not progressed very much beyond the medicine of the past. Then comes the group of causes the knowledge of which is essentially modern, the Parasitic. This part of the subject is dealt with in the next chapter on "Germs," and is still further developed in the two which follow on "The Microscope in Medicine." Without the microscope, indeed, we should be helpless. The largest germ known to exist is that of anthrax, and yet eight thousand of these placed end to end would cover only an inch ; what is the smallest no one can say ; the limit of our vision, Dr. Evans tells us, is reached in the influenza bacillus, which is about the eighth of the size of that of anthrax. Doubtless there are yet more minute varieties. But it may be asked, What is the good of knowing about these things if we cannot protect ourselves against them ? But that we can do. Vaccination is the best known example of this prevention ; but there are many others, all brought about in the same way, the weakening of the germ, turning it from an enemy into a protector. This may be done by passing it through the body of another animal. The smallpox germ is weakened by passing through the cow, and being applied when so weakened to the human body makes it immune. Then, again, the anthrax bacillus is weakened by being grown at a high temperature ; the harmless product thus -reached is introduced into the animal and effectually protects it. A case more immediately interesting is the treatment of diphtheria. Here the horse is the beneficent animal through which the bacillus is passed to make it harmless. The results .are remarkable. " It is estimated that in London alone the lives of more than a thousand children are saved every year by the use of diphtheria antitoxin serum." Probably we are only on the threshold of achievement in this direction. Some day we may reach the ideal stage of immunity from every ail- anent—except old age. Not unlike to the injurious bacillus is the injurious insect. It is one of the achievements of modern 'medicine that it has discovered this mischievous agency. We know now that sleeping-sickness results from the bite of the tsetse fly (Glossinapalpalis). The bite introduces an organism known as a trypanosoma. Similarly yellow fever is caused by -a kind of mosquito known as the Stegomyid fascinate, while various kinds of malaria are communicated by different varieties -of the same insect. Elephantiasis has a similar origin. These are troubles commonly found in tropical or sub-tropical countries, and our knowledge of them is definite. We have less certainty with regard to the mischief caused by the common house-fly ; but we have strong suspicions that it exists. The mention of this creature suggests a doubt whether Dr. Evans's maxim that " the best method to prevent any of these diseases is to get rid of the insects which are its promoters " is of universal .application. If we could get rid of the house-fly would it be well ? The balance of nature is not to be lightly upset. The gamekeeper, we know, gets rid of hawks, stoats, and weasels, -and suffers from swarms of rats. In another province of the science we have the discovery of anaesthetics, valuable not -only because they diminish the aggregate of pain, but because they render possible operations which could not otherwise have been attempted. In yet another comes the clinical thermometer. "It was not till 1860," says Dr. Evans, "that its use became at all common." This refers, of course, to its • Medical Science of To-Day. By Wilmott Evans. London : Seeley, Service Auld Co. 1-5& net.]
professional use. Its use in lay hands is much more recent. Yet what could be more valuable ? It is as necessary as are danger signals on a railway. We recommend Dr. Evans's book as full both of interest and of practically valuable sug- gestions.
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