standard. De Haen, of Vienna, was among the first who taught that the hand could not be trusted to determine the heat of the body, and that the thermometer must be called to our aid. He had wonderfully correct conceptions of the value of exact knowledge of the varying temperature of various diseases, We know what problems he strove to solve. We know what results he saw would follow their solution, but the mechanical skill of his day was unable to furnish an instrument adequate to the purposes of his thoughtful mind. The realization of the splendid conceptions which filled his brain was reserved for our times. The pathological lessons which he vaguely hinted at have now passed into the daily teachings of the schools.

The physician of every age has counted the pulse and the respirations of the sick; he now, with the thermometer, measures their temperature as well. The stethoscope and the thermometer alone have placed the science of modern medicine far above the medical science of all the preceding ages. The illustrious Chomel, one of the greatest of French physicians, and among my earlier teachers, devoted himself with singular assiduity to the study of the elementary features of typhoid fever, whereby to determine positively its existence. After years of survey of the various phenomena, he reached this conclusion: If certain conditions show themselves in a certain order of occurrence, and persist through a period of time comprised within from three to four weeks, we may conclude that the disease is typhoid fever. Such were the teachings of one who was esteemed a consummate master of his art-of one over whom the grave has but recently closed. In 1855, Dr. Parkes, in his lectures on the "Proximate Cause of Fever," said: "I shall have to allude to inexplicable phenomena, to vast spaces still unfilled by solid facts, to spots unknown to observation, and to regions lighted only by the dim and treacherous ray of speculation." We ofted had, in typhoid fever, worse than these perplexities. But the evils which beset the illustrious Chomel have been wholly removed from our path. We are no longer misled by the treacherous lights which confused him. We are able to avoid the quagmires in which he sank, and through the aid of the thermometer, advance with certainty to the goal of positive diagnosis. Nor is it in typhoid fever alone that the thermometer is of such decided value. The discovery abounds in valuable fruits in nearly every field of pathology, indeed in all pathological tissue-changes. The variation of a single degree above, or a single degree below, the healthy standard of the body, if it but persist for a time, invariably denotes mischief. If the mercury

rises above, it indicates one form of diseased action. If it falls below, it points to another and a very different character of disease. Each pathological state has its determinate temperature. On this law all the rest hinges. This is our point of departure. From it we proceed to ascertain the typical temperature. The thermometer, while thus enabling us to recognize the special disease before us, is equally waluable in determining what progress the disease is making-whether it is stationary, or moving toward health, or toward death.

Another important element of modern progress, at which I can only glance, is the recognition of the existence of certain diseased actions which are self-limited. A conspicuous example of this class. of affections is furnished by intermittent fever. Each of the three stages has a determinate set of phenomena, consuming a definite amount of time. They run their course. The cold stage is succeeded by the fever-this is followed by the sweat, and with its termination the paroxysm is over. This paroxysm of intermittent is typical of the self-limitations of a variety of diseased actions. Typhoid fever is another example. Before the discovery of this law of self-limitation, the practice in typhoid fever was active. The physician labored to cut it short, and the mortality was one in three cases. Under the guidance of modern research the mortality has been reduced to one in twenty-two cases.

The results of the modern methods of studying both physiological and pathological phenomena are not limited to the mere enlargement of the domain of knowledge in these departments of life. There is a precision and accuracy of our facts in vast territories of human interest, where in former times men groped in darkness or wandered in doubt.

When the microscope made possible the Cellular Pathology, as expounded by Virchow, it added another to the long catalogue of obligations under which it has placed the science of medicine. But a little over a generation ago, the whole doctrine of inflammation was in a most loose and confused condition. The term was applied to diverse and incongruous phenomena. The entity, which it was held to represent, was regarded as an evil, as an enemy, which must be subdued at all hazards; against which a relentless war must be waged. We have now come to look upon it as often the best ally that nature has in her service to prevent what would otherwise be irreparable. We now regard it as an elevation of the two processes of nutrition-growth and disintegration. And on these in their normal state all healthful life

depends. When their elevation is in exact parallelism, the processes of inflammation are benign. Their proper management enables us to avert disaster and prevent wide-spread evils. The suffering connected with the reparation of a fractured bone, for example, may make a severe draft on our comfort; but it is small indeed compared with the evils of an ununited fracture. This American discovery of the true relations of inflammation and of the processes of the movement by which nature "educes good from evil," constitutes one of the most important developments ever made in this department of science. For instance: Under the most skillful management of the best practitioners, when the object and the method were to fight pneumonia as though it were a tiger to be destroyed only by successive blows, the recorded loss was one in every three cases. Under the beneficent methods inaugurated by the present enlightened views of inflammation, the loss is not over one in twenty-five or thirty cases.

The question naturally arises here, what are the signs of these improvements in medical science? Has the general tenure of life been increased? Has life, when compared with former epochs, been lengthened among human beings? If neither of these events has accompanied the march of medical science, it may be a march but it is not progress. Our boasted advance is as nothing if it does not show an improvement in the health of communities, an increase of the general hold on life. Such, however, is the fact. The improvements in medical art and medical science have done both these things. Men live now in better health and for more years on the earth than they did in former times.

There are those of our brethren who, shutting their eyes to the dazzling achievements of the present, point to some remote past as the golden age of medicine. They seem to forget that their very work is a standing refutation of the truth of the picture they would draw "There is constant improvement because there is constant discontent. If we were perfectly satisfied with the present, we should cease to contrive, to labor, and to save with a view to the future." Had not Louis been discontented with what Broussais called "Medical Science," we should not now be enjoying the rich fruits of Louis' philosophical methods. If Bright and his co-laborers had been satisfied with the confused and unsafe tenets of what was called renal pathology, the world might not yet have been enriched with a contribution which is Justly esteemed among the most inestimable in medical science.

I might continue this branch of my subject very much longer, and

still leave it unexhausted, but time admonishes me that I must pass on. I have said nothing of what sanitary science has done to increase the comfort of living and add to the length of human life. And yet sanitary science has been created in the half century in which we live. Nor have I time to do more than allude to statistical medicine, a field of never-failing interest, in which the laborers are bringing out most important results; and can only stop to mention Life Insurance, the creation of vital statistics, itself a vast science-productive of incalculable benefits to society. Many other contributions made to medical science in recent times I must, for the want of time, pass by unnoticed. Enough has been said to show to you something of that gratifying progress which it has made in the memory of physicians still in their prime.

But this great increase of our knowledge concerning the nature and results of disease is by no means necessarily attended, as I have already had occasion to remark, by augmented power over disease. The character of the morbid processes may be accurately defined, and yet we may be wholly unable to correct them. Nay, the very perfection of our knowledge may only render us more hopeless as to the result of all remedial efforts. That which our fathers treated as a disorder of function, we often, under the clear light of modern pathology, recognize as a disease of structure. Diseases of the liver and of the brain in which they bled and purged with great hopes of success, we regard as cases of disorganization, which afford no ground of hope. Nor in the utmost improvement of our therapeutics can we ever expect to find a cure for all the morbid conditions which may be revealed by pathology. A boundary has been set to the operations of the human body. Its machinery must wear out and run down. Age obstructs and deranges its organization. The days of our lives have been limited to three-score years and ten, and though by reason of uncommon vigor they may be occasionally extended beyond four score years, still, from the very nature of the frame, it must at last experience decay; and alchemy there is none by which it can recover its healthful action. But apart from this natural decay of the organs of our bodies, we are servile still to those "skyey influences," as they have been termed, which have long waged so successful a warfare against our race. Through them intractable diseases continue to find their way into our systems. Unwise marriages, too, aid in maintaining the list of incurable disorders. The unhealthy organization of parents is entailed upon their offspring, and the free-will of fathers

and mothers becomes the fixed fate of their children. Cancer, consumption, insanity, and mental imbecility are among the diseases thus transmitted from one generation to another. Added to the rest, sensual indulgence comes in still further to swell the catalogue of hopeless maladies, developing cirrhosis of the liver, degeneration of the kidneys, induration or softening of the brain, and other perversions of structure as irremediable as the changes of organization wrought by age. By all these causes morbid states of the organism are induced, which, in the present condition of our art, we have no power of correcting, and which, to the end of time, must remain incurable.

But, while we are obliged to admit that the practice has not kept pace with the science of medicine, and can easily see that from the nature of the case it can never attain to that state of completeness of which the science is capable, still it is flagrant injustice to our therapeutics to affirm, as some are known to do, that they have not advanced at all. Concede to ancient medicine all that is claimed for it by the most ardent admirers of antiquity. Grant that the physicians of the age of Homer, the earliest of whom we have any report, were men of real skill, and made great cures among the soldiers of Agamemnon. I do admit it freely, for the reverence, approaching idolatry, in which they were held, proves them benefactors of their people. I grant, also, that Hippocrates was a great physician, as well as a true philosopher. I admit the claims of Galen and Dioscorides to having administered medicines wisely and well. I give full credit to Paracelsus, who was not content to sit patiently by the bedside of the sick and trust their cure to the vis medicatrix naturæ, but insisted on coming in with his heroic chemicals and dispelling disease by their force. I can believe that Basil Valentine, mounted on his currus triumphalis antimonii, though he may sometimes have driven it tog fast, and not always safely, yet made important cures by his active remedies. I heartily admit the practical skill of the learned Boerhaave, and that the observant Sydenham was a safe, a judicious and a successful practitioner. All this is conceded to the art of former times. Medicine, in a word, I believe, has been in all its stages a boon to mankind.

Further than all this, I concede to the skeptics, who call in question the value of curative medicine, that many diseases which were formerly thought to be amenable to treatment are self-limited, and run a determinate course, uninfluenced by drugs. I agree that medicines have been many times given injudiciously, and that they may be still sometimes abused. I readily grant that, in many cases, the only ra