THE DEBT OF THE PUBLIC TO THE MEDI

CAL PROFESSION.*

IT

T is a graceful courtesy, which I very highly appreciate, that you should ask a stranger, instead of one of your own members, to address you on this festal occasion. The fact that you have completed an existence of a century as a medical society naturally suggests that the address should be somewhat of a review of the past.

I have, therefore, chosen as my subject "The Debt of the Public to the Medical Profession." I shall endeavor to indicate, in a brief outline, how much the profession has done for the community. The conclusion, therefore, is inevitable that there is an obligation on the part of the public to recognize this debt by affording enlarged facilities to a profession which has given of its time and labor so unselfishly for the good of the public.

In one respect the medical profession differs from all others, in that it is the only profession which is self-destructive. While we live by ministering to the wants of those who are suffering by accident and disease, I glory in the fact that the medical profession is foremost in the endeavor to abate disease and to prevent accident. The profession could not have attained this end by its own efforts alone, but it has been pendent very largely upon the general intelligent co-operation of the public, and of sanitary engineers, and also of legis

*The Oration delivered before the Medical and Chirurgical Faculty of the State of Maryland, at the Celebration of the Centennial Anniversary of their Foundation, April 26, 1899. Reprinted from the Philadelphia Medical Journal, April 29, 1899.

lators, for the legal means to make effective the measures which the profession has shown to be needful for the public health.

Public hygiene or sanitation has been a very large element in arresting the ravages of disease, which, in former times, swept over entire nations, and even continents; and it is a source of pride to us that among the foremost sanitarians in every community are the doctors. It is a very striking fact that diseases which once assumed the form of veritable pestilences are now, at least in civilized countries, almost unheard of, and others, though they have not yet disappeared, have had their fangs drawn, so that the public suffers far less than it formerly did. If the voice of the profession were heeded, even the diseases which have been only abated would almost, if not entirely, disappear.

Let us briefly consider a few of these diseases:

1. The Plague.-Among the most fearful epidemics which have devastated the world, perhaps the worst has been what is known as the plague. It is represented now by the bubonic plague, of which we have had a memorable instance within the last two years in India, when over 250,000 lives have been lost. But, bad as it has been there, its recent devastation is as nothing compared with its former ravages. Those of you who have read James's novel, entitled "The Fire and the Plague," will recall the vivid and frightful picture of the plague in 1665, during which 70,000 persons perished in the then relatively small city of London alone. Still earlier, in the fourteenth century, the Black Death, as was then its horrible name, swept over Europe, and carried off 25,000,000 people, one-fourth of the entire population of that continent! This frightful destruction, it will be observed, took place in the then most civilized countries of the world. By contrast, the bubonic plague of the nineteenth century is limited. wholly to peoples who are only semicivilized, among whom sanitary laws are not understood, and the grossest violation

But this terrible

of them is a common everyday occurrence. mortality, it would seem, is never to be repeated. As a result of laboratory researches the bacillus of the plague has been discovered, and Haffkine has recently introduced a preventive inoculation with sterilized bouillon-cultures of its bacillus. In India, which is now the home of the plague, Haffkine has shown extraordinarily good results, both in experimental inoculations of animals and of man. For example, of 20 rats from a ship, newly arrived from Europe, 10 were inoculated with the protective serum and 10 were not. Into the cage in which the whole 20 were kept, a rat suffering from the plague was introduced. Of the 10 uninoculated rats, 9 died. Of the 10 rats rendered immune by inoculation, only 1 contracted the disease. Following upon this and many other experiments, it was deemed right to inoculate human beings, and there are thousands now who owe their lives to this preventive inoculation.

To take but a single instance, in the town of Lower Daumaun, 2197 persons were inoculated, 6033 remaining unprotected. Of the latter 1482 died, almost twenty-five per cent., whereas only 36 of those who were inoculated succumbed to the disease, less than one and two-fifths per cent.*

Would it be an impertinent question were I to ask whether there could be mentioned a single lawyer who has thus cut off the means of livelihood of his brothers-in-law, or a single merchant who would so destroy his own business and that of his fellow-merchants by pointing out a means by which the community could dispense with his wares?

II. Cholera. Another scourge which has been almost throttled in civilized countries is cholera. It first appeared in Europe in 1832, and in France alone 120,000 people died. In the single city of New York there were 3500 deaths. Its ravages have been conspicuous very recently in the * Osler's Practice, 3d edition, p. 193.

city of Hamburg, when in three months, in the summer of 1892, there were 18,000 victims, with 7614 deaths. Engineers and physicians can proudly point to their achievements in this epidemic. The city of Altona, which is physically continuous with Hamburg, drank the water of the Elbe, but, being located nearer the mouth, drank the water with all the added contamination of Hamburg; yet in Altona there were only 516 cases as against 18,000 in Hamburg, and many of the 516 were refugees from Hamburg itself. The explanation is a very simple one. Hamburg drank the unfiltered water of the Elbe, whereas the inhabitants of Altona had a filtration plant, which was their efficient bulwark against the disease.

This is taking into account only the question of life, which is, of course, by far the most important. But looking at it also from a commercial point of view, we all remember how the business of Hamburg was for the time ruined. The few millions which would have properly filtered the water of the same river for Hamburg were lost five or ten times over by the merchants of Hamburg as a result of their fatal delay. The voice of the physicians and sanitarians of Hamburg was but a voice crying in the wilderness until emphasized by the hoarse diapason of disease. This is an object-lesson which our own country and many of our own cities would do well to heed.

III. Yellow Fever.-Another scourge, similar in its extent and its violence to the plague and to cholera, and one which appeals to the people of this country even more than those two, is the yellow fever. The fearful epidemic of 1797 is well known to every intelligent American. Not limited to the southern portion of our country, its pathway was strewn with corpses in all the larger cities of the North as well as of the South. Our own immortal Rush has left a monument to his name in his efforts to stem the tide of the disease. By his unselfish bravery and his devo

tion to duty in the midst of pestilence he has set us an example which the whole country admires, and which, fortunately, will never again be needed. The later freedom of this country from similar widespread and fatal epidemics of yellow fever is due chiefly to intelligent plans for sanitary reform and to our vigilant quarantine regulations, which, as a rule, during the present century have kept it at bay.

We are now about to do better, for having driven the indolent and ignorant Spaniard from Cuba, we shall be able to attack the disease at its fountain head. The efforts of our officers, especially of General Wood, whom we gladly recognize both as doctor, diplomat, and warrior, will bear the richest harvest of good by exterminating the disease in Cuba itself. Before this we could only erect a defensive wall against the disease; now we can prevent it in its very home.*

How much such prevention of disease means commercially is shown by a statement in the newspapers only ten days ago, that capitalists had $40,000,000 ready to invest in New Orleans if the sewage question could be solved and epidemics of small-pox and yellow fever prevented.

IV. Scurvy. Prior to the present century, scurvy was one of the most dreaded diseases, especially on shipboard. Armies were decimated by it and navies rendered useless; sometimes half a ship's crew would be disabled by scurvy. Until the researches of physicians showed that it owed its origin to the lack of fresh vegetables, its ravages were fre

*Through the efforts of the commission of which the late lamented Major Walter Reed was a member, the mosquito has been discovered to be the only means of propagating yellow fever. By preventing the access of the mosquito to yellow fever patients the disease has been banished from Cuba for the first time in one hundred and seventy years! This means also that it has been banished from the United States as well. Colonel William C. Gorgas Chief Sanitary Officer of the Panama Canal zone will do for that region the same splendid life-saving work he did in Havana.-(W. W. K., 1905.)