ences producing an increase of secretion, excretion and metabolic process. Twenty-five years daily experience with cold water, tonic hydrotherapy, has not only taught me the value of this agent as a bodily and nerve tonic, but has enabled me by carefully adapting the temperature, pressure, duration, etc., to the invalid, to increase appetite and hunger, and stimulate the metabolic and organic processes which have resulted in gains of flesh as well as blood, strength and nervous equilibrium. Cold water's influence is coextensive with the functions of the human body. The prize-fighter and wrestler takes his cold spray and rub down before the grilling contact, not because he is aware of Mosso's and others studies showing 33 1-3 per cent increase of muscular power, but because he knows from experience that he is stronger, can stand more pain and last longer than if he omitted it. How often do we notice hunger after swimming or a surf bath; time after time. This value of water as a therapeutic agent has been known since the adumbrations of antiquity. but no amount of persuasive eioquence can wean some of the profession from powder and pill. We should break away from the fetish of medicinal measures and realize the advantages to be derived from treatments other than chemical. Carlson's experiments are but another scientific confirmation of the well understood but little appreciated value of tonic hydrotherapy, of physiotherapeutic methods. These methods have stood the test of time, of physiological experiment and are not mere "psychological" and suggestive remedies. time before the generally accepted manifestation of this disease; unfortunately, primary lesions are so small and insignificant that they have hitherto been overlooked. This primary lesion usually takes the form of a patch of anesthesia, a smail blister, or the two combined, and occurs most frequently in those parts of the body which ore mos exposed to injury. A definite period of time elapses between its appearance and any secondary manifestation, varying with the type of the disease. In many cases there are distinct rigors, not accompanied by rise in temperature, between the primary and secondary manifestations appear either rapidly, or slowly and gradually, according to the type of the disease.-New York Medical Journal. ORATION IN MEDICINE TO-DAY AND YESTERDAY IN MEDICINE.* By O. P. NUсKOLS, Pineville. It gives me great pleasure to meet you and greet you to-day, and I should feel guilty of scant appreciation if I did not extend to you my sincere thanks and gratitude for the courtesy you have shown me in electing me to deliver this address to you to-day, however far I may fall short of coming up to your expectations. And, since I have no new message to bring to you, or to elaborate on any special subject, I have chosen to entertain you for a few minutes by passing in review, briefly, some of the work of the past history of our profession, as well as that of the present. To the student of medical history the mind may at once turn to ancient mythology, and enquire of that patron saint, Aesculapius, to find a foundation for rational medicine, but in vain. He might take his quest to that ancient city of learning named for the goddess of Science, Art and Arms" and find that in the dim ages of the past there lived among those classic hills, a follower of Aesculapius, who was distinguished for his great learning, who traveled much, studied the epidemic diseases of his day, assembled the literature then extant. and handed down to the medical truths of that day and time which medical profession the only fundamental have in part lived throughout the ages. Some of the writings of Hippocrates have come down to us to-day, as the focal point of all real medical literature of the past. Like many other ancient philosophers, he traveled over many countries, sojourning at many places where epidemic diseases were raging. and observing their progress and characteristics. He was at Athens at one time during the prevalence of a great plague, which he is said to have arrested, indicating that he possessed many of the good qualities of a first class health officer of to-day. While it goes without question that he was a physician far ahead of his time, one of his chief distinctions was that he created for medicine a literature which has rendered his name immortal. As the trend of emigration and civilization have ever moved westward, we next find the city of Rome with its immortal Galen, the most famous physician and anatomist of his time. He regarded the structure of the human body as the foundation of the healing art, and in his works, almost every bone, every process of bone, twig or nerve, ramification of *Read before the Kentucky State Medical Association, Louisville, September 21-23, 1915. blood vessel, every viscus, muscle and gland are described with great minuteness. He described the function of the blood vessels, and explained endosmosis and exosmosis as the attractive and expulsive forces. He considered stagnation and putridity as causing every morbid change which took place in the fluids of the body. All fevers were attributed to this cause, and instead of fresh air and cooling draughts, the curtains were drawn, the fires were kept up, and all food and medicines were of the most heat producing kind. was With the decline and fall of the Roman Empire, the science and study of medicine also declined, to such an extent that there was no practical advance until the beginning of the Fifteenth Century. This century truly a period of transition; "the darkness just before the dawn" was beginning to be dispelled by gleams of new light. It was during and subsequent to this period of medical Rennaisance that many prominent figures appear upon the medical horizon, but time forbids my mention of other than a few who have had special influence in marking the way for future progress. Just as the pioneer, through great privation and hardship, has waded into the unexplored forest and blazed the way for the onward march of progress and civilization, so have our medical forbears, with a courage undaunted, led the way through untrodden paths, and gradually unfolded the wonderful truths of medicine that we enjoy to-day. It was not by sheer chance of fortune that Dr. William Harvey was enabled to stand before the College of Physicians in London, on April 17, 18 and 19, in the year 1616 and deliver his memorable lectures, in which he fully expounded his original and complete views of the true circulation of the blood, but it was by patient and painstaking toil, that he was enabled to lay one of the chief foundation stones for all future medical progress. Jenner, by his close observation of human events, and patient study, was enabled to give to the world a means of saving the lives of millions then unborn, and almost completely eradicating one of the most loathsome epidemic diseases by his simple and practical vaccination for smallpox. Semmelweis, after a thorough and patient investigation, startled the medical world, by his theory of puerperal septicemia, and sent the old doctrine of childbed fever to a well deserved and everlasting desuetude, but was scoffed and ridiculed into insanity, dying a miserable wreck, not knowing that soon after the sod had fallen over his lifeless form, his theory would be accepted by the entire medical world and render incalculable service to humanity. Thus all along the pathway of medicine, we find the history of medical martyrs, and while the pages of history are replete with the names of great military heroes, who have conquered by the sword, and even to-day on the blood-stained battle fields of Europe. history is being made, and when the scroll of the future historian is unrolled, there will be emblazoned on its records the names of the great heroes of battle who have gone forth to destroy their fellow men, but back of that gory field of human carnage, we see another army, assisted as they are by the white capped angels of mercy, whose mission is not to destroy human life but to save it. Future generations may not find their names written in the Halls of Fame but, their names names will be written in the hearts of those to whom they have administered, and it is far better to administer to humanity's cause and die in obscurity, than wade through fields of blood and erect a monument uponthe wreckage of human misery and human woe. So it has ever been with the heroes in the ranks of medicine, whose great deeds have been done in th laboratory and the sick room or upon the battlefield without the blare of trumpet or the beat of drum, and oft having to tread the unknown paths alone, amid the hurling darts of ignorance and jealous criticism, and reap as their reward for honest service and patient sacrifice, ah! indeed, too oft, ingratitude. but let us remember that, "The web of life is of a tangled yarn, With its good and its ill together." So, the history of medicine as it stretches into the long shadows of yesterday, has been that of a slowly advancing and steadily agu menting army of earnest and workers, seeking no other goal than that of a higher medical attainment and a greater service to humanity. We might pause for a moment to mention the names of a few such men as Virchow, Rockitansky, Pasteur, Koch. Laennec and Lister, with many other great leaders who stood in the front rank of this magnificent host, and gave to the science of medicine a great impetus, and opened up the laboratory of natural phenomena, which placed medicine on a more solid foundation. But these great leaders, brilliant as they were, were followed and sustained by that mighty host of general practitioners, who constitute the court of last resort, to pass upon any new medical theory, fad or fancy. But the leaf of time has slowly been turned, and the last quarter century has been a period of great world progress, during which all the collateral sciences have made most marvelous advance, until to-day by means of the tele graph and telephone the world has been brought together upon a common speaking gallery. The great vessel in mid-ocean is within speaking distance of the shore; the stars in the heavens are brought down to be interviewed by man, while man himself rises into mid-space between heaven and earth and claims it as his highway of travel. So, to-day we stand in awe, and ask in fear and trembling the question: Has medicine and surgery kept step with this world progress? Let's see: SURGERY. Archaeology has made claim to a high state. of surgical development as far back as the days of ancient Egypt, but there is no positive proof of such a development. However, whatever may have been true, it is well known that before the discovery of anesthesia, all surgical procedures of any magnitude were akin to death itself, but since Morton discovered the use of anesthesia, and especially since the use of antisepsis and asepsis, surgry has gone forth with a bold hand, and invaded almost every tissue and structure of the human body. The abdominal cavity had been as sacred as the domain of the Most Holy of Holies. with its significant sign board "keep out" scattered all along its "linea alba," but the surgeon with the boldness and courage of the immortal MacDowell, whom all Kentuckians are pleased to honor, invaded this sacred domain, and to-day every organ within its bounds are dealt with according to its needs, and hundreds, yea, thousands of lives have been saved that would have otherwise perished. The cranial cavity, the cavity of the chest, and cavity of the spinal column, have all been made to yield to the deft hand of surgery, and the intrepid Crile, like Joshua of old, even commands the heart to stand still for repairs, while Lane finding the alimentary canal too long and circuitous, puts in a short circuit, cuts out part of the distance, and, if nature deals unkindly with some poor unfortunate in not furnishing an outlet, surgery is prompt at hand with an artificial anus. So to-day, when we review the marvelous records of surgery during the past quarter century, we are made to wonder if not ere long, surgery like the great military hero, Alexander, will not “weep for other worlds to conquer" and other feats to perform. INTERNAL MEDICINE, While surgery has thus advanced, her more quiet and less spectacular handmaiden, internal medicine, has also made most marvelous progress, and been of inestimable value to her advancement. pleasure the old time family physician of a half century ago, equipped as he was with clinical thermometer and stethoscope as his principal diagnostic aids, with few remedies compared with those to to-day, he went about his work with a zeal, with a touch of humanity, full worthy of emulation. Without the multiplicity of diagnostic and therapeutic helps and conveniences of to-day; without modern means of communication or travel, his task was truly an arduous one. He and his malarial fever patient often hobnobbed with the mosquito, not then so well acquainted with his newfangled name, regarding him as only an incidental pest. The common house fly after visiting all the cesspools and deposits of excreta in the neighborhood, was admitted to the typhoid fever patient, family and friends alike. The family pets were al lowed to visit among the sick, and the well alike, without let or hindrance, while the trusted physician sits by the bedside of the patient, meditating upon the probable cause and transmission of his disease, surrounded as they were, unconsciously, by the invisible multitude of bacteria, ready to give battle to the defending phagocytes, in every system. But while thus hedges about by many limitations in point of etiology and pathology of disease, his shortcomings were largely compensated by his devotion to duty and to his patient, and with the information then at his hand, no truer type of genuine manhood, or true physician, has ever graced the pages of medical history, or upheld the dignity of physician, friend and adviser in the sick room. But in the light of to-day bacteriology has made known the cause of many diseases at that time unknown, and bacterial vaccines and antitoxines furnish an antidote and enre for many diseases of hitherto high mortality. Medical and physical diagnosis have undergone a process of evolution in the last half century that would compare favorably with the Darwinian theory of man. The diagnostician of to-day is no longer content with a simple glance at the tongue, and a few other perfunctory performances, but after a most thorough and rigid investigation and physical examination, brings to his aid the microscope and the test tube, the Widal and the Wasserman, the X-ray, the blood pressure and the blood count, all of which when boiled lown in the retort of common sense, and strained through the sieve of mental analysis, should yield a finished product of a correct diagnosis. followed by a rational and scientific treatment. In the field of therapeutics there has been an equally marked advance, but time forbids my going into details. Within the last few years Professor Paul Erlich has given to We shall always recall with much pride and the profession a remedy for the treatment of one of the most loathsome, subtle, and far reaching diseases that we have to treat, which has proven to be almost a specific in the majority of cases. Sir Almond Wright has peered into the labyrinths of nature, and brought forth his opsonin theory, which has stimulated a great study into the subject of serology with much resultant benefit to suffering humanity. Metchnikoff drew a lesson from the sturdy Bulgarian, and gave to the profession a bacillary remedy, which may not stay the hand of time, or postpone the final day, as he once dreamed, but has been of great benefit in the treatment of many gastro-intestinal diseases. Abderhalden has added another link to the chain of cancer diagnosis by his blood studies, which promises us a means of early diagnosis and early treatment in this very fatal disease before the deeper tissues and lymphatics are invaded. The bite of the rabid dog no longer sounds the death knell to the beautiful daughter of wealth, or to the ragged son of poverty, thanks be to the work of M. Louis Pasteur, supplemented when need be by the State Board of Health. There has recently been wafted over the seas from Frieburg what purports to be something new in the treatment of obstetric cases, which has been given extensive advertising in some of the lay periodicals as if to attract the popular mind to its use. In the well equipped hospital, beneath the shadows of the tinted ray, amid the quiet tread of the trained nurse, where all the conditions are propitious, by the administration of certain active and very potent drugs, the patient may be gently wrapped in a state of amnesia, and the pangs of labor buried in quiet forgetful ness, but not without danger, and we fear when it goes before the great court of general practitioners, it will be tenderly shroud ed, and laid away to take a prolonged and never waking "twilight sleep." There has possibly been no single advance in medicine, that has attracted wider attention and yielded greater results for good, than that of the study and elaboration of the influence of the internal secretions on the various processes of body metabolism. It seems that the dream of youth has ever run pari passu with advancing years, and it was its promptings that led Ponce de Leon to seek its fountain, and likewise stirred the fertile brain of the distinguished Brown-Sequard, the father of organotherapy, to point out its uses and possibilities. And to-day there are no more firmly established facts in the whole realm of medicine and therapeutics, than the part played by the ductless glands in many pathologie conditions, or the therapeutic activity of their glandular extracts. It would be useless for me to recall to your mind the many advances daily put into practice by the up-to-date physician of to-day in the diagnosis and treatment of the more common ailments with which he comes in contact. Hydrotherapy, electricity, massage, vibration, dry hot air, and a lengthy list of very useful modern day helps, have added wonderfully to the sum total of medical efficiency. So it seems when we make even a partial and cursory review of the many achievements and wonderful discoveries of the past quarter century, we are convinced that this is truly a scientific age, and the spirit of inquiry dominates all regions of thought; and especially is this true in medicine. PREVENTIVE MEDICINE. Important as it may be to discover disease processes and apply scientific and rational treatment, there is no part of the physician's work so important and so far reaching for good as in the field of preventive medicine. In this department of medical work the advance in the last two decades has surpassed the most sanguine hope or visionary dream. The most gigantic engineering feat within the world's history, was made possible by and through the development of sanitary science, and its pestilential region transformed into one of healthfulness and happiness. Havana and the Cuban Island before the advent of American sanitation was a veritable dead house, but to-day is beautiful, clean and healthful. It seems as but yesterday when our southern coast was visited annually by yellow fever, which sent a thrill of terror yellow fever, which through all our southern states, attended by great loss of life and money, but to-day the guilty transmitter of the disease, the stegomyia, has been discovered, and yellow fever numbered with the things of the past. Bacterial epidemics, and endemic diseases of all kind, are fast being controlled and eliminated. Hookworm disease has recently fallen in the wake of sanitary science, and thousands of its pale, anemic and listless victims, restored again to health and happiness, and taught the lessons of prevention. It has been said that in the past, disease has caused far greater loss of life on the battle field than all the casualties of war, but to-day sanitary science has followed your son and mine to the military camp and rendered life as safe from disease as at home. A little more than a year ago our country felt a shudder when it was reported that New Orleans was invaded by Bubonic plague, but by the prompt action under the splendid leadership of Dr. Rupert Blue and the local health authorities, it was speedily arrested, with a saving of human life and suffering that might have been appalling. So, I might enumerate indefinitely the list of preventable diseases and preventive measures, that have been and are being put forth to-day, both by the Government, the State and the Community, with such far reaching and almost incalculable saving of human life and human suffering, to say nothing of the monetary saving, but this movement is too well known by the medical profession in Kentucky to call for any further comment upon my part. TO-DAY. Thus to-day we stand on this high eminence of medical attainment, we must not become flushed by the success of the past, or soothed into inertia by the achievements of the present, and forget the work that lies before us. Milton has well said that "To know that which before us lies is the prime wisdom," and it comes down to us from ancient India that every "to-day well lived, makes every yesterday a dream of happiness, and every tomorrow a vision of hope. So we, as physicians, must profit by the past, live in the present, and hope for the morrow, that many things that at present exist may be corrected. It has been stated upon good authority that almost all blindness comes at or after birth, hereditary blindness being very rare. Out of 70,000 cases in the United States, 35,000 were from ophthalmia neonatorium, 21,000 from neglect and abuse; almost too cruel to mention. Let us interpose a question: Has preventive medicine a work for the morrow? Seven thousand wonen die annually from cancer of the breast alone, breast alone, largely from neglect and delay. Should not women-kind be better informed by the profession? Tuberculosis, like a mighty avalanche, sweeps into eternity its 250,000 annually, while all the other preventable diseases claim their full quota, making a sum total that staggers comprehension. In recent years our southern coast has been visited by a new enemy, that has spread with startling rapidity, and has fastened its deadly fangs into the body of almost every one of our southern states. Its etiology is shrouded in mystery, its end results speak from the scattered tombstones all over our beautiful southland. It has been studied from every angle and by the most scientific men in the profession from many lands. Every insect, bacteria, bee or beetle has been shadowed with: guilt, yet has proven a perfect alibi. Almost every article of diet has been snatched before the court of inquiry, but without conviction, but let us hope, that the ever patient and painstaking hand of science, will in time dis cover the true cause of pellagra, and then, and not until then, will we be enabled to eradicate this latest and most virulent scourge from our land. The unspeakable diseases of vice that have stalked down through all the ages and scattered misery and woe in their wake, still linger to fling back into the face of our vaunted civilization the true saying of Pope, "Oh! Vice. thou art a monster of so frightful mien, As to be hated, needs but to be seen; May we who live and labor in this beautiful morn of preventive medicine, at least indulge a hope that ere we reach the full noon-day these things may be corrected. ORGANIZATION. In concluding my address to you to-day, I do not feel that I would do justice to my subject or to my hearers if I failed to mention the splendid organization which has meant so much to the progress of the medical profession, and to which we lend our allegiance and support. It fills us with pride and patriotism, when we view the trained soldier, as he steps in unison with his every comrade down the line, and marches forth in solid phalanx to battle against a common enemy. But, touched by the higher impulse of humanity's call, no grander sight has ever been viewed by man or angel, than that of a united profession, going forth shoulder to shoulder, as one man, to battle against disease and death. So, let us still march forward against our common foe, with the Kentucky Medical Association as always well up in front rank, carrying afloat our banner, bearing upon it, our insignia of state "United we stand, divided we fall.” Renal Infections.--Dr. W. H. Robey (Boston Medical and Surgical Journal, Feb. 11, 1915) justly remarks that renal infections are first seen by practitioners, and upon their promptness in making a diagnosis, based on a careful etiological survey, depends the outcome. Cases of pyelitis of tuberculous origin should not be allowed to continue until the bladder is involved Renal infection must be considered in the differential diagnosis of every febrile affection. The urine may show much or little, according to the degree of intrarenal pressure and drainage and the condition of the ureter, so that frequent and thorough examinations of the sediment are necessary. The two most constant signs are pus in the urine and some degree of tenderness in the kidney by bimanual palpation.--International Journal of Surgery, New York. |