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as if the success of the undertaking depended entirely upon his own efforts; let every one contribute his share in the good work by an essay, by discussion and legitimate criticism of the topics introduced by others, or by committee or other work, and our Association will soon realize in the highest degree the ends to which we aspire.



By HENRY D. DIDAMA, M. D., of Onondaga County.

November 18, 1884.

The advance of science is hindered not more by obstinacy than by fickleness. The skepticism which uses an honest crucible is a blessing ; the skepticism which wields a club and smashes old things indiscriminately merely because they are ancient, is a curse. Underneath its destructive malice is often a credulous and craven tenderness for anything which is new. One face of Janus was emblematic of Memory and looked benignly upon the past with its garnered treasures; the other represented Hope and peered eagerly into the rich possibilities and promises of the future. These faces were not mutually inimical; they were complemental; they were unity in diversity. In medicine, bigotry and laziness sometimes call themselves conservative; opposed to these are discontent and love of novelty, which may assume the label, progress; but genuine progress and enlightened conservatism work harmoniously together to perfect medical science: the one patiently tests all things; the other holds fast that which is good. In medicine much is worthy of conservation; not a little is still moot; research is very active and confident; vast fields await exploration. Your attention is invited now to a few illustrations and suggestions.

In pathology, the predisposing causes of disease are fairly well known by long and careful observation; but in the dazzling field of the microscope they are apt to be forgotten. Inheritance, acquired vices, insufficient, improper, or excessive food and drink, vitiated air, deficient sunlight, exposures, indo

lence, overwork, worry, these are predisponents which act by so impairing the resisting power, that attacking foes of feeble potency are able to gain an easy victory.

Many diseases, such as eruptive, contagious, and malarial fevers, pneumonia, consumption, erysipelas, septicæmia, pyæmia, and even suppuration, are now quite generally regarded as the work of micro-organisms, the contagium vivum.

The doctrine of germs is essentially modern, although Harvey is thought to have had glimpses of its truth more than two hundred years ago. But Harvey never regarded germs as living particles, capable of prolific multiplication ; he considered the emanations from a certain disease able, by what he called a seminal influence, to propagate the same disease in a healthy person.

The witty Jonathan Swift, in the early part of the last century, described a specialist in microscopy whose enthusiasm is hardly eclipsed by the zeal of any modern observer. This enthusiast had discovered worms in the flesh of certain diseased animals, and he published an account of his observations. His paper attracted some attention and received favorable comment. Inflated with vanity, the now famous discoverer continued to use his lens and forthwith published the startling announcement that worms were the fountain and origin of all diseases.

In the present germ excitement, which is analogous to the gold fever of 1848 and the petroleum craze of later years, we are not to ignore other and well-established causes of disease. We encourage the search for new microzymes, as we do prospecting for gold and oil; we watch intently each promising indication ; but we prudently reserve our credence and wait for verifications of alleged discoveries, knowing that some observers have that keen vision pointed out in the couplet :

“Optics sharp it needs, I ween,
To see what is not to be seen."

We not only twine fadeless chaplets for the modest brows of those who unearth a new bacillus whose pedigree can be established beyond question, but we bestow our admiration upon those ingenious philological microscopists who, if they can not

diagnosticate hereditary diseases by the physiognomy of the blood-corpuscle, are yet able to invent some magnificent name for the minutest pest which infests the human organism.

We urge that investigation can not be too extensive and thorough; but we counsel that there be no premature rushing into print with generalizations, lest the observations on which they are based shall turn out illusory, lest alleged causes shall prove to be but animportant coincidences.

The reward for patient work may be slow in coming, like the flour from the mills of the gods, but it will be of excellent quality at last.

If he be worthy of national gratitude who makes two blades of unnecessary grass grow where but one had a feeble struggle for existence before, how much more deserving of temporary immortality is he who establishes his claim to a new cacozyme, be it bacillus, or micrococcus, or spirillum, especially if he can tell us what to do with it!

The specific micro-organisms of tuberculosis and splenic fever and, perhaps, of cholera have been differentiated; those of miasmatic diseases, seen in Ohio as the palmella by a genius of sharp optics, and as a micrococcus by Italian observers, remain to be verified. There should be little doubt of their existence, notwithstanding the incredulity recently expressed by an eminent writer who still pins his faith to the ancient notion that a poison is generated by decomposing vegetation. For, while a living and developing organism will account for all the facts of origin, incubation, and behavior of miasmatic fevers, a dead poison is quite unsatisfactory and insufficient. But the germs which cause scarlatina, measles, pertussis, etc., have thus far eluded search; and it is still an undecided question whether or not croupous pneumonitis be a germ-fever with a local expression. The suggestions of our eminent friend and associate who called attention to this point several years ago are entitled to, and are receiving consideration throughout the world. Continued observations are still needed to confirm or overthrow the proposition.

In therapeutics, conservative progress finds an ample field.

To prevent; to guide to a favorable termination, when prevention has been neglected; to alleviate, when recovery is impossible; to delay the inevitable escape of the soul from its weary prison; these are the important duties of the physician. A thorough knowledge of the composition and structure of the body, and of the relation of parts, is indeed of great importance. The action of organs in health and their perverted action in disease rightly demand the most careful study. The foes which boldly attack the citadel of life, and the occult influences which insidiously undermine and sap the vital forces, these may well engage our earnest attention. The analysis of our secretions and excretions, of our foods and medicines and poisons, deserves all the consideration which it receives.

The innumerable instruments of precision, which promise to substitute mathematical accuracy for vague guesses and which are too often used, not to supplement but to supplant other and valuable methods of investigation, these, like the tribe of Abou Ben Adhem, will continue to increase till they become multitudinous, if not perplexing, like the grasshoppers of the West. These rightfully challenge recognition and study, while with unappeasable appetite they devour our substance if we attempt to add them all to our armamentarium. But anatomy and histology, physiology, pathology and chemistry, ætiology, diagnosis, and prognosis, the possession of all the “scopes,” all the “graphs,” and all the “meters,” and the familiar and dexterons use of them, all these, interesting as they may be to the scientist, important and indispensable as they may be as preliminaries, foundations, and aids to medical skill, all these are practically worthless except as they contribute to the relief of human suffering.

“The real physician,” says Broussais, “is the one who cures; the observation which does not teach the art of healing is not that of a physician, it is that of a naturalist.”

And, paraphrasing Sacred Writ, it may be added: There remaineth therefore Pathology, Diagnosis, Therapeutics, these three; but the greatest of these is Therapeutics.

Therapeutics, then, which includes all means to prevent

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