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31st of December, 1896, there were auscultation. The pulse and the heart 2,392 confinements, with three deaths. beats are made visible by the sphygmoall of them from causes absolutely un- graph and cardiograph. The clinical connected with blood-poisoning. The thermometer has given definiteness to conclusion is irresistible that, as

conception of fever, and the eminent authority has put it, "the changes in the body temperature which hygiene of a maternity depends less it registers supply most useful indicaupon its construction and its age than tions for treatment; not in medicine upon the hygienic principles upon alone, but in surgery and obstetrics, the which it is directed, and upon the perse. thermometer is the doctor's most trustverance with which these principles are worthy danger signal. The interior of carried out in daily practice.”

the stomach, the bladder, and other Passing to medicine proper, or what hollow organs have been explored with used to be called distinctively suitable varieties of electric search“physick," the advance in knowledge, if light. The spectroscope and the hæmaless striking than in surgery, has been tocytometer-an instrument by means not less real. Unfortunately in this par- of which blood corpuscles be ticular department of the aling art, counted-enable the condition of the knowledge is not power to the same ex

blood to be exactly appreciated. The tent as in those which deal with out- microscope has revealed the secret of ward and visible disease. Hence the many diseases of which our happier improvement in medicine, which deals forefathers knew nothing.

For years mainly with internal diseases, has been after the queen came to the throne this chiefly in the direction of increase of instrument was looked upon by the bulk precision in diagnosis. This has been of the medical profession as a toy; now largely promoted by the invention of a physician without a microscope would numerous instruments for the examina- be a more incongruous figure than the tion of parts beyond the ken of the un- captain of an Atlantic liner without a aided eye and for recording movements telescope. The analysis of the various and changes in the size and position of secretions of the body furnishes infororgans by graphic methods. The mation of the most valuable character ophthalmoscope, invented by Helm

as to the functional imperfection of the holtz in 1851, not only revolutionized several organs, and as to forms of conthe study of eye disease, but gave phy- stitutional unsoundness which may be sicians a valuable means of diagnosis in quite unsuspected by the patient. relation to affections of the brain and Now both the hospital ward and the other parts of the nervous system and private consulting-room are in constant the kidney. The laryngoscope, which touch with the laboratory. This applithe medical profession owes to the cation of chemistry to medical diagnosis celebrated maestro Manuel Garcia, who has been found of the greatest use in in 1855 solved a problem which had life insurance business, particularly in baffled Babington and several others. regard to the detection of Bright's disnot only made effective treatment of

ease and diabetes. The Röntgen rays, the upper part of the windpipe

though, as far as the healing art is conpossible, but enabled physicians to cerned, they have hitherto found their recognize certain serious affections principal field of usefulness in surgery. of the chest

have been employed with some success and

centres, and sometimes to detect signs of and other internal organs.

in the diagnosis of diseases of the lungs

Of many impending tuberculosis. The stetho- other aids to diagnosis which are being scope, though introduced by Laennec introduced every year, and indeed alsome years before the accession of her most every day, this is not the place to Majesty, has been greatly perfected speak. during the last sixty years; and the Another powerful factor in the addiagnosis of diseases of the heart and vancement of medicine has been the delungs has reached a degree of refine- velopment of specialism. ment undreamed of by the inventor of growth of knowledge which has taken

The rapid

nerve

place, particularly during the last Now not only medicine but hygiene is

built on the knowledge that has been thirty years, made specialization inevitable. In the last century medical gained of the processes of disease and and surgical cases were mingled to the causes which set them in operation, gether in the same hospital wards, and and the circumstances which modify surgeons like John Hunter and Aber- the intensity of their action and the nethy treated diseases of the heart and nature of their effects. The foundation stomach as well as wounds and frac- of a scientific pathology was laid by tures. Nowadays it would be simply Virchow, who looked for the starting impossible for any man, however gifted, point of disease in a perverted activity to take all medical learning to be his of the living cells of which the organs province. Hence one practitioner gives and tissues of the body are composed. himself to the study of diseases of the The most fruitful, as it is the most nerves, others to that of the affections of striking, development of our knowledge the eye, the throat, the skin, and so on. of the causes of disease has been the Moreover, there are few physicians or discovery of the infinitesimal organisms surgeons who are not more or less which go up and down the world seekacknowledged specialists in some partic. ing whom they may devour. ular class of diseases. Twenty-five The "germ theory" of disease is no years ago there was a strong feeling in longer a theory, but a body of estabthe profession, not only in this country, lished truths. Bacteriology in its applibut almost everywhere, against special- cation to the healing art is the creation ism. This feeling had a retarding in- of Pasteur, though Davaine was the fluence on the general progress of medi- first to prove the causal relation of a cine, contributions from special fields particular micro-organism to a specific of practice being received with suspi- infectious disease (anthrax or woolcion, like to that of those who asked sorter's disease). This was in 1863. "Can any good come out of Nazareth ?” Davaine's experiments were not, howThis distrust hindered the development ever, accepted as conclusive, and it was of abdominal surgery; and had not not till 1877 that Pasteur proved beyond Spencer Wells been made of stern stuff, all doubt that the tiny rod-like bodies morally as well as intellectually, he which Davaine had found in the blood would have given up the battle against of animals dying of anthrax were the the public opinion of his profession in exciting cause of the disease. despair, and a vast amount of human then bacteriology has revealed to us the

Since suffering would have gone unrelieved. The prejudice has not even yet entirely organisms which cause relapsing ferer,

leprosy, typhoid fever, pneumonia, died out, but it is no longer active.

Another direction in which medicine glanders, tuberculosis, cholera, diphthehas undergone very great expansion ria, tetanus, and bubonic plague, the during the last half-century is in the microbe responsible for the production knowledge of the nature and causes of the last-mentioned scourge having of disease. To the growth of this been discovered so recently as 1894 by knowledge the development of physi- a Japanese pathologist, Dr. Kitasato. ology has most powerfully contributed. The elucidation of the origin of tuberThe experimental study of the healthy culosis and cholera is the chief among organism naturally led to the applica- Robert Koch's many services to science. tion of similar methods in the investiga- A micro-organism of animal nature has tion of disease. Pathology, in the strict been shown by Laveran to be the cause sense of the term, did not exist in 1837, of malarial fever. The agents which and for many years after that date it cause other infectious and suppurative was little more than an inventory of the processes, and certain kinds of skin disdilapidations caused by disease. Such ease, have also been positively identiinvestigations, though useful in their fied; others are with confidence assumed way, could not have influenced medical to exist, though they have so far eluded practice to any appreciable extent. the search of our scientific detectives; others are with more or less reason sus- Artificial immunity having thus been pected. Indeed, the doctrine that every established, the neutralizing substance disease is a kind of fermentation caused in the animal's blood is expected to be by a specific micro-organism is so fas- an antidote to the same poison when at cinating in its simplicity that it is in work in the human system. Theoretidanger of being treated by some cally the method appears to be rational; enthusiasts as if it were the master-key but practically it must be admitted that which unlocks all the secret chambers it has not yet fulfilled the hopes that of pathology. It is becoming clear, were excited by the first reports of its however, that if microbes are necessary effects. Still, there is already ample causes of a large number of diseases, evidence that in diphtheria it is of very they are sufficient causes of very few. real service, and on this ground alone The living body itself and its environ- Drs. Behring and Roux must be numment must be taken into account. bered among the benefactors of the Hence there are signs in various quar- human race. Again, Dr. Yersin's sucters of a reaction against the exagger- cess in the treatment of plague with ated cult of the microbe, and the minds antitoxic serum in China was little of some of the most advanced investi- short of marvellous. The cases, howgators are turning once more to the ever, were few in number, and the recellular pathology, which till quite re- sults of the method when tried on a cently was spoken of as a creed out- large scale at Bombay are awaited with worn. It is recognized that the living the greatest interest by the medical cell itself is an organism varying in profession. Although the results in the form and in function, and thus present treatment of tetanus and other diseases ing an analogy with the different have not been particularly brilliant, species of microbes. Like these, the there can be little doubt that as our cell secretes products that have a de- knowledge of antitoxins grows their cided influence on the economy of field of usefulness will increase. which they form part. It has been Another new method of medication, shown by MM. Armand Gautier, Char- which has come into use in the last few rin, and Bouchard that the organism in years, is the introduction into the sysits normal state manufactures poison- tem of certain animal Juices and exous substances, and that those products tracts of various organs to supply the may under certain conditions be hurtful want of similar substances, the manuto itself, causing an "auto-intoxication," facture of which is suppressed or diwhich may manifest itself in various minished by disease. The pioneer in forms of disease.

this therapeutic advance

Dr. The change in our conception of dis- George Murray of Newcastle, who has ease is naturally bringing about a proved that myxædema and cretinism, change in our notions of treatment. diseases dependent on atrophy or imThe fact that a specific disease is pro- perfect development of the thyroid duced by a specific poison-for the gland, can be cured by supplying the poison is the morbific agent, whether economy with extract of the correit be manufactured by a microbe or se- sponding organ of a sheep. The succreted by a cell-inevitably suggest the cess of this treatment has led to what idea of an antidote. Such antidotes or the profane might be disposed to call a “antitoxins" have been discovered for "boom" in animal extracts; the brain, tetanus, diphtheria, and some forms of the heart, the lung, the kidney, the biood-poisoning. The exact nature of spleen, the pancreas, and every gland these antitoxins is still obscure, but and nearly every tissue in the body are they are extracted from the blood of used in the treatment of disorders suranimals into which cultures of the posed to be in any way connected with microbe of the disease which it is de- improper working of these organs. sired to neutralize have been injected In spite of present extravagance it is till they have ceased to have any effect. possible that we are on a track that

was

may lead to the transformation of medi- The greatest triumphs of all, however, cine.

in the realm of medicine in the VictoWe are very far now from the blue rian age have been achieved in the prepill and black draught which-with the vention of disease and the maintenance lancet--were the chief weapons in the of a high standard of public health. therapeutic arsenal of the practitioners This subject would require an article to who bled and purged and physicked her itself, even if handled only in the most Majesty's lieges in 1837. Sir William general way. To those interested in it, Guu is reported to have said: “One I would earnestly recommend a study thing I am thankful Jenner and I have of Sir John Simon's standard work on together succeeded in doing. We have "English Sanitary Institutions," a recdisabused the public of the belief that ord which in itself will remain as one of doctoring consists in drenching them the noblest monuments of Queen Vicwith nauseous drugs." Nevertheless, toria's glorious reign. There may be a good deal of faith in drugs still sur- read the history of a long struggle vives, not only in the public, but in the against the powers of insanitary darkprofession, as is shown by the ceaseless ness, with the result that typhus fever, introduction of new remedies. Several which used to be a scourge of large hundreds were introduced in 1896. It towns, is now practically unknown; is true, however, that there is much less that the mortality from “fevers" in gendrugging than there used to be; more eral has been very greatly reduced; that over it is better directed. Pharma- cholera, which several times invaded cology is now a science, and is able to these realms in the earlier years of her place in the hands of the doctor the Majesty's reign, has for a long time active principles of drugs, which can been prevented from gaining a footing thus be administered in forms at on our shores; that consumption is beonce more convenient and more effec- ing brought more and more under contive.

trol; that several years have been added Among the principal additions to the to the average of human life, and that resources of the physician in dealing it is not only longer, but more comfortwith disease may be mentioned the use able and more effective. of salicin and salicylate of soda in Further possibilities of checking the rheumatism suggested by Dr. ravages of communicable diseases apMaclagan, who has by this means pear to be opening out before us. robbed that terrible disease of its worst Haffkine's inoculations for the preventerrors; the use of nitrite of amyl in tion of cholera in India are founded on angina pectoris, which we owe to Dr. a rational principle. which is that of Lauder Brunton; the use of aigitalis in vaccination-namely, the protection of heart disease, which was established on susceptible individuals by the injection a scientific basis by Dr. Wilks; the cold of an attenuated virus, which gives the bath treatment of fever; the treatment organism the power of resisting the of heart disease by graduated exer- effects of the poison in its natural state. cises and by baths; the open-air treat. This method of prophylaxis has also ment of consumption; the manifold ap- been used in regard to typhoid fever, plications of electricity; and the great and will doubtless find further applicaand ever growing number of chemical tion in other directions. products having power to lower the Time and experience alone can decide temperature, to deaden pain, to prevent whether these means of protection decomposition, and antagonize against disease are efficient. It is cerpoisons generated in the alimentary tain, however, that medicine, which had canal and elsewhere. Reference may wandered for so many centuries also be made of improvements in the through quagmires of speculation after manner of administering remedies, as ignes fatui of one kind or another, is by injection under the skin. into the now at last on the right path which veins, etc.

leads through the discovery of the cause

as

to

some

to its removal or to the prevention of known to the world almost solely the effect.

through his contributions to literature, MALCOLM MORRIS. was yet not a “man of letters.” That

there is a particular interest attaching to his life and his individuality there can be no question; for while we have one of the most accomplished of living

critics denying him a place in the From The National Review.

pantheon sacred to "men of letters," ARTHUR HUGH CLOUGH.

we have another accomplished critic, What is a “man of letters"? Tne who was living till a few years agoquestion is not an inappropriate one to Matthew Arnold-regarding him with put in connection with the subject of an affectionate reverence hardly less this essay. For when,

fifteen striking than that which the author of years ago and more, it was suggested to “In Memoriam” felt towards the friend the distinguished editor of a certain who inspired that noblest of elegies. series of volumes dealing with "English Arthur Hugh Clough was in no reMen of Letters” that Arthur Hugh spect a “man of letters." Literature Clough might well find a place in that was not his business. It does not fall series, the reply was substantially neg to the lot of those who may have to ative. “I know," the editor remarked, deal with his life and his work to be "that some of my friends think Clough compelled to trace out a perhaps sordid ought to be included, but I have never and coarse personality beneath the been able to agree with them or to re- robes of an almost regal success in the gard Clough as belonging to the family world of letters. There is little that of ‘men of letters.'

Clougb has left us that is not transAn opinion of this kind, proceeding parent and natural. But within this from so authoritative a source,

we find so attractive personality that mands attention. What is a “man of we may perhaps be in some danger of letters"? And if Clough did not be exaggerating the merely literary imlong to the fraternity of “men of let- portance of the forms through which ters," why did he not belong to it? If that personality expressed itself. We we might regard the expression, "a find that personality ever most sensiman of letters," as indicating one to tively alive to everything in nature that whom literature is his business-and is gentle and beautiful, ever tenderly the definition seems to have good tolerant towards every kind of human deal to recommend it-then certainly defect or shortcoming, but at the same Clough did not fall within this cate- time severely and inexorably just gory. To him literature was anything towards itself. It is this mixing of ienbut a business. It might be said that derness and severity, coupled as it is very little indeed that came from his with the utmost sensitiveness to every pen was written for the sake of writ- beautiful and ennobling impression, ing it, and that whatever he wrote for that gives the distinctive charm to one the sake of writing it was, as a rule, of the very few men of the present lacking in the charm that breathes century who can claim to be studied, from so much of his work.

not for what they did, but for what It may be accepted, then, without they were. It is recorded of Clough much difficulty, that a “man of letters” that when at Oxford he was noted for Arthur Hugh Clough was not, and that the Spartan simplicity of his manner of his exclusion from the series of vol- living-a simplicity that led him to disumes alluded to above was a proper ex- pense with fires in his rooms during clusion. That point being disposed of, even the severest weather. This Sparthe question arises as to what it is that tan simplicity in respect of physical gives particular interest to the life and surroundings was in exact keeping individuality of a man who, though with his mental treatment of himself.

VOL. XIV. 742

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LIVING AGE.

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