of any value in the prevention of disease. The chief difficulty is that we have no class of skilled legislators -men, who by special study, experience, training and legal insight, are qualified to construct proper sanitary laws based on scientific principles, for the protection of the health of the people. When such men shall be put forward by the united efforts of the medical profession, to take the place in our legislative health committees of our political agriculturists, unscrupulous pettifoggers and decayed rural practitioners, who now formulate our health laws-then, and not till then, will the triumph of preventive medicine become complete. AVAILABILITY OF BACTERIOLOGY IN DIAGNOSIS. The ability to establish an early and definite diagnosis of contagious disease is of too evident practical importance to the physician to require any extended remark. The skillful diagnostician of former times often found it impossible to make such a prompt and positive diagnosis as the interests of his patients and those who might be exposed to infection required. In tuberculosis, diphtheria, typhoid and relapsing fever, malaria and other parasitic diseases, the early differential diagnosis from other and milder affections was frequently found to be difficult or impossible. The We have now, however, within our reach the means of making the diagnosis of these diseases certain. scientific physician by the aid of his microscope and staining methods, can establish at once the presence or absence of the causal micro-organism and thus set all doubt at rest. The importance of this method to the public has been recognized by many municipal boards of health, who have equipped bacteriological laboratories in which diag nostic tests may be made for busy practitioners who are liable to encounter obscure cases of infectious diseases. But the microscopic detection of the pathogenic germ is not the only aid to diagnosis that bacteriologic science has afforded. In those definite and well-marked changes, called "reactions," set up in the tissues by the subcutaneous injection of the toxic products of certain disease germs, we have another diagnostic method of world-wide fame. I refer to the use of tuberculin and mallein, now well known as tests for tuberculosis and glanders in animals-diseases that may be transmitted to The value of these and other similar infection tests is generally recognized, and their use is extensively gaining ground both in this country and in Europe. man. Still another improved method of diagnosis has been made available to the clinician by the recent researches of biologists. It is known as the serum diagnosis of typhoid fever; and as it illustrates the practical nature of all biologic work, it merits a passing notice here. The discovery of this serum-test seems to have been the outcome of studies in immunity made by many observers, among whom we may mention the names of Metchnikoff, Issaeff, Pfeiffer, Bordet, Durham and Gruber. The last step in this series of observations was made by Widal of Paris, who read a paper June 26th, 1896, before the Société Médicale des Hopitaux announcing his discovery. It consists of adding a few drops of the patient's blood to a fresh culture of typhoid bacilli with a dilution of one to ten. If the bacilli begin to lose their motility and to clump together in various agglutinative masses, the diagnosis of typhoid fever is assured. Dr. Wyatt Johnson of Canada has shown that this test can be made with dried blood and has thus opened the way for its introduction into municipal laboratories as a practical, working test. IMPORTANT PRACTICAL RESULTS IN THERAPEUTICS. But it is not alone in pathology, in preventive medi cine, or in diagnosis, that the chief utility of bacteriology may be found. It has also been greatly utilized in therapeutics. Although it is of much interest to our profession to know the cause and nature of a disease, yet if we cannot cure it, our art is vain and our science is only a reproach unto us. Following the lead of surgery our therapeutists, naturally, at first, attempted to prevent the spread of disease germs throughout the fluids and tissues of the body by destroying them at the foci of initial infection. This could be done perhaps in such diseases as erysipelas and diphtheria, but it was a procedure of not very wide application, and of many manifest limitations. Attempts have also been made by means of germicidal and other remedies, to place the entire organism of the infected individual in a condition so far as possible unfavorable to the multiplication and growth of the virulent germs. But towards such plans of treatment, named generally after their inventors, the attitude of the profession in general has been one of quiet indifference rather than of enthusiastic advocacy. Fortunately, however, far more remarkable and brilliant practical results in therapeutics have been obtained by another and more ingenious method which is the immediate outcome of bacteriological research. refer to serum therapeutics, or the treatment by antitoxins, which have been found to be powerful curative agents in diphtheria and in tetanus. It is probable that in the future, this treatment will be extended to other diseases, and that it will be a long time before we shall hear the last word about serum therapy. It has been ascertained, by experimental inquiry, that the animal organism possesses the marvelous power of neutralizing the poisons or toxins, secreted by microbes within the body, by the secretion of counter-poisons or antitoxins. Serum therapeutics makes this principle available in the cure of disease. It consists in injecting into the patient's body the antitoxins from the blood of an immune animal to combat the toxins of the parasite in the patient's blood. This treatment has been used with phenomenal success in diphtheria. I will not abuse your patience by presenting to you in detail the incontestible proofs of its efficacy in this disease. It will suffice if I quote to you the words of Prof. Welch of Baltimore, a distinguished and acute observer whom we all delight to honor and to claim as a native of our own State. Dr. Welch in a recent paper says: "The discovery of the healing serum is entirely the result of laboratory work. It is an outcome of the studies of immunity. In no sense was the discovery an accidental one. Every step leading to it can be traced, and every step was taken with a definite purpose and to solve a definite problem." After presenting statistics which show the greatly decreased mortality of diphtheria due to this treatment, the Doctor concludes by saying: "My study of the results of the treatment of over seven thousand cases of diphtheria by antitoxin, demonstrates beyond all reasonable doubt that anti-diphtheretic serum is a specific, curative agent for diphtheria, surpassing in its efficacy all other known methods of treatment for this disease. It is the duty of the physician to use it." Other statements of equal authoritative value, which to be brief I must omit, establish on a firm basis the immense practical value of antitoxin. And yet it must be confessed that there are a few members of our profession who refuse to try it, or to acknowledge its efficacy. Others, under the pressure of public opinion, use the antitoxic serum in a half-hearted way, in small unconcentrated doses, or late in the disease after all other measures have failed. All this must certainly bring the new treatment into needless disrepute. It can be no rash inference for me to make, that a man with a mind hermetically sealed against proven truth, and in a state of invincible ignorance in such a matter, whatever else he may be, can never be a great physician. Who would suppose that such an actually successful remedy would ever need to be strenuously advocated-that the medical profession, or any part of it, would have to be urged into the habit of using it? So fully has its practical therapeutic value been shown, that its use stands no longer on the basis of doubtful expediency, but rather on that of imperative duty. Finally, gentlemen, I need not ask you to put yourselves abreast of the latest progress in bacteriology— the science which has done so much for practical medicine; for I feel sure that you are there already. I need not urge you to utilize to the utmost, every possible aid that this science affords in the brave fight which you are waging against the myriad invisible foes of human life; for that, surely, is your highest hope and strongest desire. To you, the toil-won conquests of your brothers, the bacteriologists, working in constant, indissoluble communion-devising, searching, discovering are not all as if they had not been. It is for them to originate, to revolutionize, to experiment, to suggest. It is for you to consider, to judge, to adapt, to apply-both striving together for the same end, the highest welfare of a common humanity. Like the brave followers of the immortal Ulysses as described by Tennyson, may we all forever prove to be "One equal temper of heroic hearts. Made weak by time and fate; but strong in will, |