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<h1>EXPERIMENTS<br />
ON ANIMALS</h1>

<p class="center p6">BY</p>

<p class="center xlarge"><b>STEPHEN PAGET</b></p>

<p class="center p6">WITH AN INTRODUCTION BY<br />
<span class="large"><b>LORD LISTER</b></span></p>

<p class="center p4">THIRD AND REVISED EDITION</p>

<p class="p4 blockquote2">"<i>Perhaps it is wrong to compare sin with sin, but I
declare to you, the more I think of it, the more intimately
does this Prejudice seem to me to corrupt the soul, even
beyond those sins which are commonly called more
deadly.</i>"&mdash;<span class="smcap">Cardinal Newman.</span></p>

<p class="center p6 large"><b>NEW YORK<br />
WILLIAM WOOD AND COMPANY<br />
MDCCCCVII</b><span class="pagenum"><a name="Page_iv" id="Page_iv">iv</a></span></p>

<p><span class="pagenum"><a name="Page_v" id="Page_v">v</a></span></p>

<p class="center p6">TO<br />

<span class="large">CHARLES ALFRED BALLANCE</span><br />
M.S., F.R.C.S.</p>

<p class="center">AND</p>

<p class="center"><span class="large">WILLIAM HUNTER</span><br />
M.D., F.R.C.P.<span class="pagenum"><a name="Page_vi" id="Page_vi">vi</a></span></p>

<hr class="c30" />

<p><span class="pagenum"><a name="Page_vii" id="Page_vii">vii</a></span></p>

<p class="center p4 large"><b>PREFACE</b></p>

<p>The first edition of this book was published in 1900.
For twelve years it had been my business, as Secretary
to the Association for the Advancement of Medicine by
Research, to know something about experiments on
animals, and to follow the working of the Act of 1876;
and to give facts and references to a very large number
of applicants. Believing that an account of these experiments,
and of the conditions imposed on them by
the Act, might serve a useful purpose, I proposed to
the Council of the Association that I should write a
book on the subject. The Council accepted this proposal;
and decided that the book should be written for
general reading, that it should not be anonymous, and
that it should be published without reserve.</p>

<p>It was, of course, a doubtful and embarrassing task.
But, from twelve years' experience of the things said by
the chief opponents of all experiments on animals, I
knew that there was only one way of doing it&mdash;to give
the original authorities, the plain facts, the very words,
chapter and verse for everything.</p>

<p>Among those who kindly revised the proofs were
Prof. Rose Bradford and Prof. Starling, who revised
Part I.; Mr. Shattock, who revised Part II.; and Prof.
Schäfer. Valuable help was given by Mr. R. H. Clarke,
Sir Victor Horsley, Dr. Beevor, Prof. Ronald Ross,
and the late Dr. Washbourn; and I was allowed to
<span class="pagenum"><a name="Page_viii" id="Page_viii">viii</a></span>
make free use of Mr. George Pernet's careful researches
into the history of the subject. Lord Lister himself
did me the honour to read and correct, with the utmost
patience, Parts I. and II.</p>

<p>In the second edition (1904) some mistakes were
corrected, and some facts were added.</p>

<p>The present edition has been thoroughly revised;
and I have included in it a reprint, with some changes
and omissions, of a pamphlet, <i>The Case against Anti-vivisection</i>,
which I wrote in 1904.</p>

<p class="i2">1906.</p>

<hr class="c30" />

<p><span class="pagenum"><a name="Page_ix" id="Page_ix">ix</a></span></p>

<p class="center p4 large"><b>INTRODUCTION TO THE FIRST<br />
EDITION</b></p>

<p>This work by Mr. Paget is entirely a labour of love.
Not being himself engaged in researches involving experiments
upon the lower animals, he is not directly
interested in the subject. But, in his official capacity
as Secretary (1887-1899) to the Association for the
Advancement of Medicine by Research, he has become
widely conversant with such investigations, and has
been deeply impressed with the greatness of the
benefits which they have conferred upon mankind,
and the grievous mistake that is made by those who
desire to suppress them.</p>

<p>The action of these well-meaning persons is based
upon ignorance. They allow that man is permitted to
inflict pain upon the lower animals when some substantial
advantage is to be gained; but they deny that
any good has ever resulted from the researches which
they condemn.</p>

<p>How far such statements are from the truth will be
evident to those who peruse this book. Its earlier
pages deal with Physiology, the main basis of all sound
medicine and surgery. The examples given in this
department are not numerous; they are, however, sufficiently
striking, as indications that, from the discovery
of the circulation of the blood onwards, our knowledge
of healthy animal function has been mainly derived from
experiments on animals.<span class="pagenum"><a name="Page_x" id="Page_x">x</a></span></p>

<p>The chief bulk of the work is devoted to the class of
investigations which are most frequent at the present
day; and it shows what a flood of light has been already
thrown by Bacteriology upon the nature of human
disease and the means of combating it.</p>

<p>The chapter on the Action of Drugs will be to many
a startling disclosure of the gross ignorance that prevailed
among physicians even in the earlier part of last
century. The great revolution that has since taken
place is no doubt largely due to advances in sciences
other than Biology, especially Chemistry. But it could
not have attained its present proportions without the
ever-increasing knowledge of Physiology, based on experiments
on animals; and Mr. Paget shows how large
a share these have had in the direct investigation of
articles of the Materia Medica.</p>

<p>The concluding part of the volume discusses the
restrictions which have been placed by the legislature
in this country on those engaged in these researches,
with the view of obviating possible abuse. Whether
the Act in question has been really useful, whether it
has not done more harm than good, by hampering and
sometimes entirely preventing legitimate and beneficent
investigation, I will not now discuss.</p>

<p>Meanwhile I commend Mr. Paget's book to the careful
consideration of the reader.</p>

<p class="right">LISTER.</p>

<hr class="c30" />

<p><span class="pagenum"><a name="Page_xi" id="Page_xi">xi</a></span></p>

<h2>CONTENTS</h2>

<table border="0" cellpadding="1" cellspacing="3" summary="toc">
<tr>
  <th colspan="3">PART I<br />
  EXPERIMENTS IN PHYSIOLOGY</th>
</tr>
<tr>
  <td>&nbsp;</td>
  <td>&nbsp;</td>
  <td class="tdr">PAGE</td>
</tr>
<tr>
  <td class="tdr">I.</td>
  <td class="tdl smcap">The Blood</td>
  <td class="tdr"><a href="#Page_3">3</a></td>
</tr>
<tr>
  <td class="tdr">II.</td>
  <td class="tdl smcap">The Lacteals</td>
  <td class="tdr"><a href="#Page_19">19</a></td>
</tr>
<tr>
  <td class="tdr">III.</td>
  <td class="tdl smcap">The Gastric Juice</td>
  <td class="tdr"><a href="#Page_24">24</a></td>
</tr>
<tr>
  <td class="tdr">IV.</td>
  <td class="tdl smcap">Glycogen</td>
  <td class="tdr"><a href="#Page_30">30</a></td>
</tr>
<tr>
  <td class="tdr">V.</td>
  <td class="tdl smcap">The Pancreas</td>
  <td class="tdr"><a href="#Page_36">36</a></td>
</tr>
<tr>
  <td class="tdr">VI.</td>
  <td class="tdl smcap">The Growth of Bone</td>
  <td class="tdr"><a href="#Page_40">40</a></td>
</tr>
<tr>
  <td class="tdr">VII.</td>
  <td class="tdl smcap">The Nervous System</td>
  <td class="tdr"><a href="#Page_44">44</a></td>
</tr>
<tr>
  <td colspan="3">&nbsp;</td>
</tr>
<tr>
  <th colspan="3">PART II<br />
  EXPERIMENTS IN PATHOLOGY, MATERIA<br />
  MEDICA, AND THERAPEUTICS</th>
</tr>
<tr>
  <td class="tdr2">I.</td>
  <td class="tdl smcap">Inflammation, Suppuration,<br />
  and Blood-Poisoning</td>
  <td class="tdrt"><a href="#Page_75">75</a></td>
</tr>
<tr>
  <td class="tdr">II.</td>
  <td class="tdl smcap">Anthrax</td>
  <td class="tdr"><a href="#Page_87">87</a></td>
</tr>
<tr>
  <td class="tdr">III.</td>
  <td class="tdl smcap">Tubercle</td>
  <td class="tdr"><a href="#Page_96">96</a></td>
</tr>
<tr>
  <td class="tdr">IV.</td>
  <td class="tdl smcap">Diphtheria</td>
  <td class="tdr"><a href="#Page_102">102</a></td>
</tr>
<tr>
  <td class="tdr">V.</td>
  <td class="tdl smcap">Tetanus</td>
  <td class="tdr"><a href="#Page_128">128</a></td>
</tr>
<tr>
  <td class="tdr">VI.</td>
  <td class="tdl smcap">Rabies</td>
  <td class="tdr"><a href="#Page_137">137</a></td>
</tr>
<tr>
  <td class="tdr">VII.</td>
  <td class="tdl smcap">Cholera</td>
  <td class="tdr"><a href="#Page_152">152</a></td>
</tr>
<tr>
  <td class="tdr">VIII.</td>
  <td class="tdl smcap">Plague</td>
  <td class="tdr"><a href="#Page_168">168</a></td>
</tr>
<tr>
  <td class="tdr">IX.</td>
  <td class="tdl smcap">Typhoid Fever; Malta Fever</td>
  <td class="tdr"><a href="#Page_196">196</a></td>
</tr>
<tr>
  <td class="tdr2">X.</td>
  <td class="tdl smcap">The Mosquito: Malaria,<br />
  Yellow Fever, Filariasis</td>
  <td class="tdrt"><a href="#Page_214">214</a></td>
</tr>
<tr>
  <td class="tdr">XI.</td>
  <td class="tdl smcap">Parasitic Diseases</td>
  <td class="tdr"><a href="#Page_243">243</a></td>
</tr>
<tr>
  <td class="tdr">XII.</td>
  <td class="tdl smcap">Myx&oelig;dema</td>
  <td class="tdr"><a href="#Page_247">247</a></td>
</tr>
<tr>
  <td class="tdr">XIII.</td>
  <td class="tdl smcap">The Action of Drugs</td>
  <td class="tdr"><a href="#Page_251">251</a></td>
</tr>
<tr>
  <td class="tdr">XIV.</td>
  <td class="tdl smcap">Snake-Venom</td>
  <td class="tdr"><a href="#Page_259">259</a>
  <span class="pagenum"><a name="Page_xii" id="Page_xii">xii</a></span></td>
</tr>
<tr>
  <td colspan="3">&nbsp;</td>
</tr>
<tr>
  <th colspan="3">PART III<br />
  THE ACT RELATING TO EXPERIMENTS ON ANIMALS<br />
  IN GREAT BRITAIN AND IRELAND</th>
</tr>
<tr>
  <td class="tdr">I.</td>
  <td class="tdl smcap">Text of the Act</td>
  <td class="tdr"><a href="#Page_271">271</a></td>
</tr>
<tr>
  <td class="tdr">II.</td>
  <td class="tdl smcap">Anæsthetics under the Act</td>
  <td class="tdr"><a href="#Page_281">281</a></td>
</tr>
<tr>
  <td class="tdr">III.</td>
  <td class="tdl smcap">Inspectors' Report, 1905</td>
  <td class="tdr"><a href="#Page_283">283</a></td>
</tr>
<tr>
  <td colspan="3">&nbsp;</td>
</tr>
<tr>
  <th colspan="3">PART IV<br />
  THE CASE AGAINST ANTI-VIVISECTION</th>
</tr>
<tr>
  <td class="tdr">I.</td>
  <td class="tdl smcap">Anti-Vivisection Societies</td>
  <td class="tdr"><a href="#Page_297">297</a></td>
</tr>
<tr>
  <td class="tdr">II.</td>
  <td class="tdl smcap">Literature</td>
  <td class="tdr"><a href="#Page_313">313</a></td>
</tr>
<tr>
  <td class="tdr">III.</td>
  <td class="tdl smcap">Arguments</td>
  <td class="tdr"><a href="#Page_325">325</a></td>
</tr>
<tr>
  <td class="tdr">IV.</td>
  <td class="tdl smcap">"Our Cause in Parliament"</td>
  <td class="tdr"><a href="#Page_367">367</a></td>
</tr>
<tr>
  <td class="tdr">V.</td>
  <td class="tdl smcap">A Historical Parallel</td>
  <td class="tdr"><a href="#Page_371">371</a></td>
</tr>
<tr>
  <td colspan="3">&nbsp;</td>
</tr>
<tr>
  <td colspan="2"><b>INDEX</b></td>
  <td class="tdr"><a href="#Page_377">377</a>
  <span class="pagenum"><a name="Page_1" id="Page_1">1</a></span></td>
</tr>
</table>

<h2>PART I<br />
EXPERIMENTS IN PHYSIOLOGY</h2>

<p><span class="pagenum"><a name="Page_2" id="Page_2">2</a></span></p>

<p><span class="pagenum"><a name="Page_3" id="Page_3">3</a></span></p>

<p class="center xlarge"><b>EXPERIMENTS ON ANIMALS</b></p>

<h3>I<br />
THE BLOOD</h3>

<h4>I.&mdash;<span class="smcap">Before Harvey</span></h4>

<p>Galen, born at Pergamos, 131 <span class="smcap">A.D.</span>, proved by experiments
on animals that the brain is as warm as the
heart, against the Aristotelian doctrine that the office
of the brain is to keep the heart cool. He also proved
that the arteries during life contain blood, not &#960;&#957;&#949;&#8166;&#956;&#945; (Greek: pneuma),
or the breath of life:&mdash;</p>

<p class="blockquote">"Ourselves, having tied the exposed arteries above
and below, opened them between the ligatures, and
showed that they were indeed full of blood."</p>

<p>Though all vessels bleed when they are wounded,
yet this experiment was necessary to refute the fanciful
teaching of Erasistratus and his followers, of whom
Galen says:&mdash;</p>

<p class="blockquote">"Erasistratus is pleased to believe that an artery is a
vessel containing the breath of life, and a vein is a vessel
containing blood; and that the vessels, dividing again
and again, come at last to be so small that they can close
their ultimate pores, and keep the blood controlled within
them; yea, though the pores of the vein and of the artery
<span class="pagenum"><a name="Page_4" id="Page_4">4</a></span>
lie side by side, yet the blood remains within its proper
bounds, nowhere passing into the vessels of the breath of
life. But when the blood is driven with violence from
the veins into the arteries, forthwith there is disease; and
the blood is poured the wrong way into the arteries, and
there withstands and dashes itself against the breath of
life coming from the heart, and turns the course of it&mdash;and
this forsooth is fever."</p>

<p>For many centuries after Galen, men were content to
worship his name and his doctrines, and forsook his
method. They did not follow the way of experiment,
and invented theories that were no help either in
science or in practice. Here, in Galen's observation of
living arteries, was a great opportunity for physiology;
but the example that he set to those who came after
him was forgotten by them, and, from the time of Galen
to the time of the Renaissance, physiology remained
almost where he had left it. Of the men of the Renaissance,
Servetus, Cæsalpinus, Ruinius, and others,
Harvey's near predecessors, this much only need be
said here, that they did not discover the circulation of
the blood; and that the claim made a few years ago to
this discovery, on behalf of Cæsalpinus, by his countrymen,
was not successful. But it is probable that
Realdus (1516-1557) did understand the passage of
blood through the lungs, but not the general circulation.
He says:&mdash;</p>

<p class="blockquote">"The blood is carried through the pulmonary artery
to the lung, and there is attenuated; thence, mixed with
air, it is carried through the pulmonary vein to the left
ventricle of the heart: which thing no man hitherto has
noted or left on record, though it is most worthy of the
observation of all men.... And this is as true as truth
itself; for if you will look, not only in the dead body but
also in the living animal, you will always find this pulmonary
<span class="pagenum"><a name="Page_5" id="Page_5">5</a></span>
vein full of blood, which assuredly it would not
be if it were designed only for air and vapours....
Verily, I pray you, O candid reader, studious of authority,
but more studious of truth, to make experiment on
animals. You will find the pulmonary vein full of blood,
not air or <i lang="la" xml:lang="la">fuligo</i>, as these men call it, God help them.
Only there is no pulsation in the vein." (<cite>De Re
Anatomicâ</cite>, Venice, 1559.)</p>

<p>Fabricius ab Aquapendente, Harvey's master at
Padua, published his work on the valves of the veins&mdash;<cite>De
Venarum Ostiolis</cite>&mdash;in 1603. He did not discover
them. Sylvius speaks of them in his <cite>Isagoge</cite> (Venice,
1555), and they were known to Amatus (1552), and
even to Theodoretus, Bishop of Syria, who lived, as
John Hunter said of Sennertus, "the Lord knows how
long ago." But Fabricius studied them most carefully;
and in anatomy he left nothing more to be said about
them. In physiology, his work was of little value;
for he held that they were designed "to retard the
blood in some measure, lest it should run pell-mell into
the feet, hands, and fingers, there to be impacted": they
were to prevent distension of the veins, and to ensure
the due nourishment of all parts of the body. It is true
that he compared them to the locks or weirs of a river,
but he understood neither the course nor the force of
the blood: as Harvey said of him, "The man who discovered
these valves did not understand their right
use; neither did they who came after him"&mdash;<i lang="la" xml:lang="la">Harum
valvularum usum rectum inventor non est assecutus, nec
alii addiderunt; non est enim ne pondere deorsum sanguis
in inferiora totus ruat; sunt namque in jugularibus deorsum
spectantes, et sanguinem sursum ferri prohibentes.</i> Men
had no idea of the rapidity and volume of the circulation;
they thought of a sort of Stygian tide, oozing this way
<span class="pagenum"><a name="Page_6" id="Page_6">6</a></span>
or that way in the vessels&mdash;Cæsalpinus was of opinion
that it went one way in the daytime and another at
night&mdash;nor did they see that the pulmonary circulation
and the general circulation are one system, the same
blood covering the whole course. The work that they
did in anatomy was magnificent; Vesalius, and the
other great anatomists of his time, are unsurpassed.
But physiology had been hindered for ages by fantastic
imaginings, and the facts of the circulation of the blood
were almost as far from their interpretation in the sixteenth
century as they had been in the time of Galen.</p>


<h4>II.&mdash;<span class="smcap">Harvey</span> (1578-1657)</h4>

<p>The <i lang="la" xml:lang="la">De Motu Cordis et Sanguinis in Animalibus</i> was
published at Frankfurt in 1628. And it begins with
these words: <i lang="la" xml:lang="la">Cum multis vivorum dissectionibus, uti ad
manum dabantur</i>:&mdash;</p>

<div class="blockquote">
<p>"When by many dissections of living animals, as they
came to hand, I first gave myself to observing how I
might discover with my own eyes, and not from books
and the writings of other men, the use and purpose of
the movement of the heart in animals, forthwith I found
the matter hard indeed, and full of difficulty: so that I
began to think, with Frascatorius, that the movement of
the heart was known to God alone. For I could not
distinguish aright either the nature of its systole and
diastole, or when or where dilatation and contraction took
place; and this because of the swiftness of the movement,
which in many animals in the twinkling of an eye,
like a flash of lightning, revealed itself to sight and then
was gone; so that I came to believe that I saw systole
and diastole now this way now the other, and movements
now apart and now together. Wherefore my mind
wavered; I had nothing assured to me, whether decided
by me or taken from other men: and I did not wonder
<span class="pagenum"><a name="Page_7" id="Page_7">7</a></span>
that Andreas Laurentius had written that the movement
of the heart was what the ebb and flow of the Euripus
had been to Aristotle.</p>

<p>"At last, having daily used greater disquisition and
diligence, by frequent examination of many and various
living animals&mdash;<i lang="la" xml:lang="la">multa frequenter et varia animalia viva
introspiciendo</i>&mdash;and many observations put together, I
came to believe that I had succeeded, and had escaped
and got out of this labyrinth, and therewith had discovered
what I desired, the movement and use of the
heart and the arteries. And from that time, not only
to my friends, but also in public in my anatomical
lectures, after the manner of the Academy, I did not
fear to set forth my opinion in this matter."</p>
</div>

<p>It is plain, from Harvey's own words, that he gives
to experiments on animals a foremost place among his
methods of work. Take only the headings of his first
four chapters:&mdash;</p>

<p class="blockquote">i. <i lang="la" xml:lang="la">Causæ, quibus ad scribendum auctor permotus fuerit.</i><br />

ii. <i lang="la" xml:lang="la">Ex vivorum dissectione, qualis fit cordis motus.</i><br />

iii. <i lang="la" xml:lang="la">Arteriarum motus qualis, ex vivorum dissectione.</i><br />

iv. <i lang="la" xml:lang="la">Motus cordis et auricularum qualis, ex vivorum
dissectione.</i></p>

<p>He thrusts it on us, he puts it in the foreground.
Read the end of his Preface:&mdash;</p>

<p class="blockquote">"Therefore, from these and many more things of the
kind, it is plain (since what has been said by men before
me, of the movement and use of the heart and arteries,
appears inconsistent or obscure or impossible when one
carefully considers it) that we shall do well to look deeper
into the matter; to observe the movements of the arteries
and the heart, not only in man, but in all animals that
have hearts; and by frequent dissection of living animals,
and much use of our own eyes, to discern and investigate
the truth&mdash;<i lang="la" xml:lang="la">vivorum dissectione frequenti, multâque
autopsiâ, veritatem discernere et investigare</i>."<span class="pagenum"><a name="Page_8" id="Page_8">8</a></span></p>

<p>Finally, take the famous passage in the eighth chapter,
<i lang="la" xml:lang="la">De copiâ sanguinis transeuntis per cor e venis in arterias,
et de circulari motu sanguinis</i>:&mdash;</p>

<p class="blockquote">"And now, as for the great quantity and forward
movement of this blood on its way, when I shall have
said what things remain to be said&mdash;though they are well
worth considering, yet they are so new and strange that
I not only fear harm from the envy of certain men, but
am afraid lest I make all men my enemies; so does
custom, or a doctrine once imbibed and fixed down by
deep roots, like second nature, hold good among all men,
and reverence for antiquity constrains them. Be that as
it may, the die is cast now: my hope is in the love of
truth, and the candour of learned minds. I bethought
me how great was the quantity of this blood. Both from
the dissection of living animals for the sake of experiment,
with opening of the arteries, with observations
manifold; and from the symmetry of the size of the
ventricles, and of the vessels entering and leaving the
heart&mdash;because Nature, doing nothing in vain, cannot in
vain have given such size to these vessels above the rest&mdash;and
from the harmonious and happy device of the
valves and fibres, and all other fabric of the heart; and
from many other things&mdash;when I had again and again
carefully considered it all, and had turned it over in my
mind many times&mdash;I mean the great quantity of the blood
passing through, and the swiftness of its passage&mdash;and
I did not see how the juices of the food in the stomach
could help the veins from being emptied and drained dry,
and the arteries contrariwise from being ruptured by the
excessive flow of blood into them, unless blood were
always getting round from the arteries into the veins,
and so back to the right ventricle&mdash;I began to think to
myself whether the blood had a certain movement, as in
a circle&mdash;<i lang="la" xml:lang="la">c&oelig;pi egomet mecum cogitare, an motionem quandam
quasi in circulo haberet</i>&mdash;which afterward I found
was true."<span class="pagenum"><a name="Page_9" id="Page_9">9</a></span></p>

<p>This vehement passage, which goes with a rush like
that of the blood itself, is a good example of the width
and depth of Harvey's work&mdash;how he used all methods
that were open to him. He lived to fourscore years;
"an old man," he says, "far advanced in years, and
occupied with other cares": and, near the end of his
life, he told the Hon. Robert Boyle that the arrangement
of the valves of the veins had given him his first
idea of the circulation of the blood:&mdash;</p>

<p class="blockquote">"I remember that when I asked our famous Harvey,
in the only discourse I had with him, which was but a
while before he died, what were the things which induced
him to think of the circulation of the blood, he answered
me that when he took notice that the valves in the veins
of so many parts of the body were so placed that they
gave free passage of the blood towards the heart, but
opposed the passage of the venal blood the contrary way,
he was invited to imagine that so provident a cause as
Nature had not so placed so many valves without design;
and no design seemed more probable than that, since the
blood could not well, because of the interposing valves,
be sent by the veins to the limbs, it should be sent by the
arteries, and return through the veins, whose valves did
not oppose its course that way."</p>

<p>But between this observation, which "invited him
to imagine" a theory, and his final proofs of the
circulation, lay a host of difficulties; and it is certain,
from his own account of his work, that experiments
on animals were of the utmost help to him in leading
him "out of the labyrinth."</p>


<h4>III.&mdash;<span class="smcap">After Harvey</span></h4>

<p class="title2">1. <i>The Capillaries</i></p>

<p>The capillary vessels were not known in Harvey's
time: the <i lang="la" xml:lang="la">capillamenta</i> of Cæsalpinus were not the
<span class="pagenum"><a name="Page_10" id="Page_10">10</a></span>
capillaries, but the &#957;&#949;&#965;&#770;&#961;&#945; (Greek: neura) of Aristotle. It was believed
that the blood, between the smallest arteries and the
smallest veins, made its way through "blind porosities"
in the tissues, as water percolates through earth
or through a sponge. The first account of the capillaries
is in two letters (<i lang="la" xml:lang="la">De Pulmonibus</i>, 1661) from
Malpighi, professor of medicine at Bologna, to Borelli,
professor of mathematics at Pisa. In his first letter,
Malpighi writes that he has tried in vain, by injecting
the dead body, to discover how the blood passes from
the arteries into the veins:&mdash;</p>

<p class="blockquote">"This enigma hitherto distracts my mind, though for
its solution I have made many and many attempts, all
in vain, with air and various coloured fluids. Having
injected ink with a syringe into the pulmonary artery, I
have again and again seen it escape (become extravasated
into the tissues) at several points. The same thing
happens with an injection of mercury. These experiments
do not give us the natural pathway of the blood."</p>

<p>But, in his second letter, he describes how he has
examined, with a microscope of two lenses, the lung
and the mesentery of a frog, and has seen the capillaries,
and the blood in them:&mdash;</p>

<p class="blockquote">"Such is the divarication of these little vessels, coming
off from the vein and the artery, that the order in which
the vessel ramifies is no longer preserved, but it looks
like a network woven from the offshoots of both vessels."</p>

<p>He was able, in a dead frog, to see the capillaries;
and then, in a living frog, to see the blood moving in
them. But, in spite of this work, it took nearly half
a century before Harvey's teaching was believed by all
men&mdash;<i lang="la" xml:lang="la">Tantum consuetudo apud omnes valet</i>.
<span class="pagenum"><a name="Page_11" id="Page_11">11</a></span></p>

<p class="title2">2. <i>The Blood-pressure</i></p>

<p>Harvey had seen the facts of blood-pressure&mdash;<i>the
great quantity of blood passing through, and the swiftness
of its passage</i>&mdash;but he had not measured it. Keill's
experiments on the blood-pressure (1718) were inexact,
and of no value; and the first exact measurements
were made by Stephen Hales, who was rector of
Farringdon, Hampshire, and minister of Teddington,
Middlesex; a Doctor of Divinity, and a Fellow of the
Royal Society. His experiments, in their width and
diversity, were not surpassed even by those of John
Hunter, and were extended far over physiology, vegetable
physiology, organic and inorganic chemistry, and
physics; they ranged from the invention of a sea-gauge
to the study of solvents for the stone, and he seems
to have experimented on every force in Nature. The
titles of his two volumes of <cite>Statical Essays</cite> (1726-1733)
show the great extent of his non-clerical work:&mdash;</p>

<div class="blockquote">
<p>Volume I. <i>Statical Essays, containing Vegetable Statics,
or an Account of some Statical Experiments on the Sap in
Vegetables, being an Essay towards a Natural History of
Vegetation; also, a Specimen of an Attempt to Analyse the
Air, by a great Variety of Chymio-Statical Experiments.</i></p>

<p>Volume II. <i>Statical Essays, containing Hæmostatics, or
an Account of some Hydraulic and Hydrostatical Experiments
made on the Blood and Blood-vessels of Animals;
also, an Account of some Experiments on Stones in the
Kidneys and Bladder, with an Enquiry into the Nature of
those anomalous Concretions.</i></p>

<p>"We can never want matter for new experiments,"
he says in his preface. "We are as yet got little further
than to the surface of things: we must be content, in
<span class="pagenum"><a name="Page_12" id="Page_12">12</a></span>
this our infant state of knowledge, while we know in part
only, to imitate children, who, for want of better skill
and abilities, and of more proper materials, amuse themselves
with slight buildings. The farther advances we
make in the knowledge of Nature, the more probable and
the nearer to truth will our conjectures approach: so that
succeeding generations, who shall have the benefit and
advantage both of their own observations and those of
preceding generations, may then make considerable advances,
when <i>many shall run to and fro, and knowledge
shall be increased</i>."</p>
</div>

<p>His account of his plan of measuring the blood-pressure,
and of one of many experiments that he made
on it, is as follows:&mdash;</p>

<div class="blockquote">
<p>"Finding but little satisfaction in what had been
attempted on this subject by Borellus and others, I
endeavoured, about twenty-five years since, by proper
experiments, to find what was the real force of the blood
in the crural arteries of dogs, and about six years afterwards
I repeated the like experiments on two horses, and
a fallow doe; but did not then pursue the matter any
further, being discouraged by the disagreeableness of
anatomical dissections. But having of late years found
by experience the advantage of making use of the statical
way of investigation, not only in our researches into the
nature of vegetables, but also in the chymical analysis
of the air, I was induced to hope for some success, if
the same method of enquiry were applied to animal
bodies....</p>

<p>"Having laid open the left crural artery (of a mare),
I inserted into it a brass pipe whose bore was 1/6 of an
inch in diameter; and to that, by means of another brass
pipe which was fitly adapted to it, I fixed a glass tube of
nearly the same diameter, which was 9 feet in length;
then, untying the ligature on the artery, the blood rose
in the tube 8 feet 3 inches perpendicular above the level
of the left ventricle of the heart, but it did not attain
<span class="pagenum"><a name="Page_13" id="Page_13">13</a></span>
to its full height at once: it rushed up gradually at each
pulse 12, 8, 6, 4, 2, and sometimes 1 inch. When it was
at its full height, it would rise and fall at and after each
pulse 2, 3, or 4 inches, and sometimes it would fall 12 or
14 inches, and have there for a time the same vibrations
up and down, at and after each pulse, as it had when
it was at its full height, to which it would rise again,
after forty or fifty pulses."</p>
</div>

<p class="title2">3. <i>The Collateral Circulation</i></p>

<p>After Hales, came John Hunter, who was five years
old when the <i>Statical Essays</i> were published. His experiments
on the blood were mostly concerned with its
properties, not with its course; but one great experiment
must be noted here that puts him in line with
Harvey, Malpighi, and Hales. He got from it his
knowledge of the collateral circulation; he learned how
the obstruction of an artery is followed by enlargement
of the vessels in its neighbourhood, so that the parts
beyond the obstruction do not suffer from want of
blood: and the facts of collateral circulation were fresh
in his mind when, a few months later, he conceived and
performed his operation for aneurysm (December 1785).
The "old operation" gave him no help here; and
"Anel's operation" was but a single instance, and no
sure guide for Hunter, because Anel's patient had a
different sort of aneurysm. Hunter knew that the
collateral circulation could be trusted to nourish the
limb, if the femoral artery were ligatured in "Hunter's
canal" for the cure of popliteal aneurysm; and he
got this knowledge from the experiment that he had
made on one of the deer in Richmond Park, to see
the influence of ligature of the carotid artery on the
growth of the antler. The following account of this
<span class="pagenum"><a name="Page_14" id="Page_14">14</a></span>
experiment was given by Sir Richard Owen, who had it
from Mr. Clift, Hunter's devoted pupil and friend:&mdash;</p>

<p class="blockquote">"In the month of July, when the bucks' antlers were
half-grown, he caused one of them to be caught and
thrown; and, knowing the arterial supply to the hot
'velvet,' as the keepers call it, Hunter cut down upon and
tied the external carotid; upon which, laying his hand
upon the antler, he found that the pulsations of the
arterial channels stopped, and the surface soon grew
cold. The buck was released, and Hunter speculated on
the result&mdash;whether the antler, arrested at mid-growth,
would be shed like the full-grown one, or be longer
retained. A week or so afterward he drove down again
to the park, and caused the buck to be caught and thrown.
The wound was healed about the ligature; but on laying
his hand on the antler, he found to his surprise that the
warmth had returned, and the channels of supply to the
velvety formative covering were again pulsating. His
first impression was that his operation had been defective.
To test this, he had the buck killed and sent to Leicester
Square. The arterial system was injected. Hunter
found that the external carotid had been duly tied. But
certain small branches, coming off on the proximal or
heart's side of the ligature, had enlarged; and, tracing-on
these, he found that they had anastomosed with other
small branches from the distal continuation of the carotid,
and these new channels had restored the supply to the
growing antler.... Here was a consequence of his
experiment he had not at all foreseen or expected. A
new property of the living arteries was unfolded to
him."</p>

<p>All the anatomists had overlooked this physiological
change in the living body, brought about by disease.
And the surgeons, since anatomy could not help them,
had been driven by the mortality of the "old operation"
to the practice of amputation.
<span class="pagenum"><a name="Page_15" id="Page_15">15</a></span></p>

<p class="title2">4. <i>The Mercurial Manometer</i></p>

<p>Hale's experiments on the blood-pressure were admirable
in their time; but neither he nor his successors
could take into account all the physiological and mathematical
facts of the case. But a great advance was
made in 1828, when Poiseuille published his thesis,
<i lang="fr" xml:lang="fr">Sur la Force du C&oelig;ur Aortique</i>, with a description of
the mercurial manometer. Poiseuille had begun with the
received idea that the blood-pressure in the arteries
would vary according to the distance from the heart,
but he found by experiment that this doctrine was
wrong:&mdash;</p>

<p class="blockquote">"At my first experiments, wishing to make sure
whether the opinions, given <i lang="la" xml:lang="la">à priori</i>, were true, I observed
to my great astonishment that two tubes, applied
at the same time to two arteries at different distances
from the heart, gave columns of exactly the same height,
and not, as I had expected, of different heights. This
made the work very much simpler, because, to whatever
artery I applied the instrument, I obtained the same
results that I should have got by placing it on the
ascending aorta itself."</p>

<p>He found also, by experiments, that the coagulation
of the blood in the tube could be prevented by filling
one part of the tube with a saturated solution of
sodium carbonate. The tube, thus prepared, was connected
with the artery by a fine cannula, exactly fitting
the artery. With this instrument, Poiseuille was able
to obtain results far more accurate than those of Hales,
and to observe the diverse influences of the respiratory
movements on the blood-pressure. He sums up his
results in these words:&mdash;</p>

<p class="blockquote">"I come to this irrevocable conclusion, that the force
with which a molecule of blood moves, whether in the
<span class="pagenum"><a name="Page_16" id="Page_16">16</a></span>
carotid, or in the aorta, etc., is exactly equal to the force
which moves a molecule in the smallest arterial branch;
or, in other words, that a molecule of blood moves with
the same force over the whole course of the arterial
system&mdash;which, <i lang="la" xml:lang="la">à priori</i>, with all the physiologists, I was
far from thinking."</p>

<p>And he adds, in a footnote:&mdash;</p>

<p class="blockquote">"When I say that this force is the same over the
whole course of the arterial system, I do not mean to
deny that it must needs be modified at certain points of
this system, which present a special arrangement, such as
the anastomosing arches of the mesentery, the arterial
circle of Willis, etc."</p>

<p>Later, in 1835, he published a very valuable memoir
on the movement of the blood in the capillaries under
different conditions of heat, cold, and atmospheric
pressure.</p>

<p class="title2">5. <i>The Registration of the Blood-pressure</i></p>

<p>Poiseuille's work, in its turn, was left behind as
physiology went forward: especially, the discovery of
the vaso-motor nerves compelled physiologists to reconsider
the whole subject of the blood-pressure. If
Poiseuille's thesis (1828) be compared with Marey's
book (1863), <i lang="fr" xml:lang="fr">Physiologie Médicale de la Circulation du
Sang</i>, it will be evident at once how much wider and
deeper the problem had become. Poiseuille's thesis is
chiefly concerned with mathematics and hydrostatics;
it suggests no method of immediate permanent registration
of the pulse, and is of no great value to practical
medicine: Marey's book, by its very title, shows what
a long advance had been made between 1828 and
1863&mdash;<i lang="fr" xml:lang="fr">Physiologie Médicale de la Circulation du Sang,
basée sur l'étude graphique des mouvements du c&oelig;ur et du
<span class="pagenum"><a name="Page_17" id="Page_17">17</a></span>
pouls artériel, avec application aux maladies de l'appareil
circulatoire</i>. Though the contrast is great between
Hales' may-pole and Poiseuille's manometer, there is
even a greater contrast between Poiseuille's mathematical
calculations and Marey's practical use of the
sphygmograph for the study of the blood-pressure in
health and disease. Marey had the happiness of seeing
medicine, physiology, and physics, all three of them
working to one end:&mdash;</p>

<p class="blockquote">"La circulation du sang est un des sujets pour lesquels
la médecine a le plus besoin de s'éclairer de la physiologie,
et où celle-ci à son tour tire le plus de lumière des sciences
physiques. Ces dernières années sont marquées par deux
grands progrès qui ouvrent aux recherches à venir des
horizons nouveaux: en Allemagne, l'introduction des procédés
graphiques dans l'étude du mouvement du sang;
en France, la démonstration de l'influence du système
nerveux sur la circulation périphérique. Cette dernière
découverte, que nous devons à M. Cl. Bernard, et qui
depuis dix ans a donné tant d'impulsion à la science,
montre mieux que toute autre combien la physiologie est
indispensable à la médecine, tandis que les travaux
allemands ont bien fait ressortir l'importance des connaissances
physiques dans les études médicales."</p>

<p>Marey's sphygmograph was not the first instrument
of its kind. There had been, before it, Hérisson's
sphygmometer, Ludwig's kymographion, and the
sphygmographs of Volckmann, King, and Vierordt.
But, if one compares a Vierordt tracing with a Marey
tracing, it will be plain that Marey's results were far
advanced beyond the useless "oscillations isochrones"
recorded by Vierordt's instrument.</p>

<p>Beside this improved sphygmograph, Chauveau and
Marey also invented the cardiograph, for the observation
of the blood-pressure within the cavities of the
<span class="pagenum"><a name="Page_18" id="Page_18">18</a></span>
heart. Their cardiograph was a set of very delicate
elastic tambours, resting on the heart, or passed through
fine tubes into the cavities of the heart,<a name="FNanchor_1" id="FNanchor_1" href="#Footnote_1" class="fnanchor">[1]</a>  and communicating
impulses to levers with writing-points.
These writing-points, touching a revolving cylinder,
recorded the variations of the endocardial pressure,
and the duration of the auricular and ventricular contractions.</p>

<hr class="c15" />

<p>It is impossible here to describe the subsequent
study of those more abstruse problems that the older
physiologists had not so much as thought of: the
minutest variations of the blood-pressure, the multiple
influences of the nervous system on the heart and
blood-vessels, the relations between blood-pressure and
secretion, the automatism of the heart-beat, the influence
of gravitation, and other finer and more complex issues
of physiology. But, even if one stops at Marey's book,
now more than forty years old, there is an abundant
record of good work, from the discovery of the circulation
to the invention of the sphygmograph.
<span class="pagenum"><a name="Page_19" id="Page_19">19</a></span></p>

<h3>II<br />
THE LACTEALS</h3>

<p>Asellius, in his account of his discovery of the lacteal
vessels (1622), is of opinion that certain of "the
ancients" had seen these vessels, but had not recognised
them. He has a great reverence for authority: Hippocrates,
Plato, Aristotle, the Stoics, Herophilus, Galen,
Pollux, Rhases, and a host of other names, he quotes
them all, and all with profound respect; and comes to
this conclusion: "It did not escape the ancients, that
certain vessels must needs be concerned with containing
and carrying the chyle, and certain other vessels
with the blood: but the true and very vessels of the
chyle, that is, my 'veins,' though they were seen by
some of the ancients, yet they were recognised by
none of them." He can forgive them all, except
Galen, <i lang="la" xml:lang="la">qui videtur nosse omnino debuisse</i>&mdash;"but, as for
Galen, I know not at all what I am to think. For
he, who made more than six hundred sections of living
animals, as he boasts himself, and so often opened
many animals when they were lately fed, are we to
think it possible that these veins never showed themselves
to him, that he never had them under his eyes,
that he never investigated them&mdash;he to whom Erasistratus
had given so great cause for searching out the
whole matter?" Probably, the milk-white threads had
been taken for nerves by those who had seen them:
<span class="pagenum"><a name="Page_20" id="Page_20">20</a></span>
and those who had never seen them, but believed in
their existence, rested their belief on a general idea
that the chyle must, somehow, have vessels of its own
apart from the blood-vessels. What Galen and Erasistratus
must have seen, Asellius and Pecquet discovered:
and Harvey gives a careful review of the discovery
in his letters to Nardi (May 1652) and to Morison
(November 1653). He does not accept it; but the
point is that he recognises it as a new thing altogether.</p>

<p>A year or two after he had made the discovery,
Asellius died; and his work was published in 1627
by two Milanese physicians, and was dedicated by
them to the senate of the Academy of Milan, where
Asellius had been professor of anatomy. The full
title of his book is, <i lang="la" xml:lang="la">De Lactibus sive Lacteis Venis,
quarto Vasorum Mesaraicorum genere novo invento,
Gasparis Asellii Cremonensis, Anatomici Ticinensis,
Dissertatio. Quâ sententiæ anatomicæ multæ vel perperam
receptæ convelluntur vel partim perceptæ illustrantur.</i>
He gives the following account of the discovery, in
the chapter entitled <i lang="la" xml:lang="la">Historia primæ vasorum istorum
inventionis cum fide narrata</i>. On 23rd July 1622,
demonstrating the movement of the diaphragm in a
dog, he observed suddenly, "as it were, many threads,
very thin and very white, dispersed through the whole
mesentery and through the intestines, with ramifications
almost endless"&mdash;<i lang="la" xml:lang="la">plurimos, eosque tenuissimos candido-sissimosque
ceu funiculos per omne mesenterium et per
intestina infinitis propemodum propaginibus dispersos</i>:&mdash;</p>

<p class="blockquote">"Thinking at first sight that they were nerves, I did
not greatly heed them. But soon I saw that I was
wrong, for I bethought me that the nerves, which belong
to the intestines, are distinct from these threads, and
<span class="pagenum"><a name="Page_21" id="Page_21">21</a></span>
very different from them, and have a separate course.
Wherefore, struck by the newness of the matter, I
stopped for a time silent, while one way and another
there came to my mind the controversies that occupy
anatomists, as to the mesenteric veins and their use;
which controversies are as full of quarrels as of words.
When I had pulled myself together, to make experiment,
taking a very sharp scalpel, I pierce one of the larger
threads. Scarcely had I hit it off, when I see a white
fluid running out, like milk or cream. At which sight,
when I could not hold my joy, turning to those who
were there, first to Alexander Tadinus and Senator
Septalius, both of them members of the most honourable
College of Physicians, and, at the time of this
writing, officers of the public health, '<em>I have found it</em>,'
I say like Archimedes; and therewith invite them to
the so pleasant sight of a thing so unwonted; they being
agitated, like myself, by the newness of it."</p>

<p>He then describes the collapse and disappearance
of the vessels at death, and the many experiments
which he made for further study of them; and the
failure, when he tried to find them in animals not lately
fed. He did not trace them beyond the mesentery,
and believed that they emptied themselves into the liver.
The discovery of their connection with the receptaculum
chyli and the thoracic duct was made by Jehan
Pecquet of Dieppe, Madame de Sévigné's doctor, her
"good little Pecquet." The full title of his book (2nd
ed., 1654) is, <i lang="la" xml:lang="la">Expérimenta Nova Anatomica, quibus incognitum
hactenus Receptaculum, et ab eo per Thoracem
in ramos usque subclavios Vasa Lactea deteguntur</i>. He
has not the academical learning of Asellius, nor his
obsequious regard for the ancients; and the discovery
of the thoracic duct came, as it were by chance, out
of an experiment that was of itself wholly useless. He
<span class="pagenum"><a name="Page_22" id="Page_22">22</a></span>
had killed an animal by removing its heart, and then
saw a small quantity of milky fluid coming from the
cut end of the vena cava&mdash;<i lang="la" xml:lang="la">Albicantem subinde Lactei
liquoris, nec certe parum fluidi scaturiginem, intra Venæ
Cavæ fistulam, circ[=a] dextri sedem Ventriculi, miror
effluere</i>&mdash;and found that this fluid was identical with
the chyle in the lacteals. In another experiment, he
succeeded in finding the thoracic duct&mdash;"At last, by
careful examination deep down along the sides of the
dorsal vertebræ, a sort of whiteness, as of a lacteal
vessel, catches my eyes. It lay in a sinuous course,
close up against the spine. I was in doubt, for all
my scrutiny, whether I had to do with a nerve or
with a vessel. Therefore, I put a ligature a little
below the clavicular veins; and then the flaccidity
above the ligature, and the swelling of the distended
duct below the ligature, broke down my doubt&mdash;<i lang="la" xml:lang="la">Ergo
subducto paulo infra Claviculas vinculo, cum a ligaturâ
sursum flaccesceret, superstite deorsum turgentis alveoli
tumore, dubium meum penitus enervavit.... Laxatis
vinculis, lacteus utrinque rivulus in Cavam affatim Chylum
profudit.</i>"</p>

<p>It is to be noted that Asellius and Pecquet, both
of them, made their discoveries as it were by chance.
Unless digestion were going on, the lacteals would
be empty and invisible; and, on the dead body,
lacteals, receptaculum, and thoracic duct would all
be empty. For these reasons, it cost a vast number
of experiments to prove the existence, and to discover
the course, of these vessels. Once found in
living animals, they could be injected and dissected
in the dead body; but they had been overlooked by
Vesalius and the men of his time.
<span class="pagenum"><a name="Page_23" id="Page_23">23</a></span></p>

<p>From the discovery of the lacteals came the discovery
of the whole lymphatic system. Daremberg,
in his <i lang="fr" xml:lang="fr">Histoire des Sciences Médicales</i> (Paris, 1870),
after an account of Pecquet's work, says:&mdash;</p>

<p class="blockquote">"Up to this point, we have seen English, Italians,
and French working together, with more or less success
and genius, to trace the true ways of blood and chyle:
there is yet one field of work to open up, the lymphatics
of the body. The chief honour here belongs, without
doubt, to the Swede Rudbeck, though the Dane Bartholin
has disputed it with him, with equal acrimony and
injustice."</p>

<p>Rudbeck's work (1651-54) coincides exactly, in
point of time, with the first and second editions,
1651 and 1654, of Pecquet's <i lang="la" xml:lang="la">De Lactibus</i>. It may
be said, therefore, that the whole doctrine of the
lymphatic system was roughed out half-way through
the seventeenth century.
<span class="pagenum"><a name="Page_24" id="Page_24">24</a></span></p>

<h3>III<br />
THE GASTRIC JUICE</h3>

<p>From many causes, the experimental study of the
digestive processes came later than the study of the
circulation. As an object of speculative thought,
digestion was a lower phase of life, the work of
crass spirits, less noble than the blood; from the
point of view of science, it could not be studied
ahead of organic chemistry, and got no help from
any other sort of knowledge; and, from the medical
point of view, it was the final result of many unknown
internal forces that could not be observed
or estimated either in life or after death. It did
not, like the circulation, centre itself round one
problem; it could not be focussed by the work of
one man. For these reasons, and especially because
of its absolute dependence on chemistry for the
interpretation of its facts, it had to bide its time;
and Réaumur's experiments are separated from the
publication of Harvey's <i lang="la" xml:lang="la">De Motu Cordis et Sanguinis</i>
by a hundred and thirty years.</p>

<p>The following account of the first experiments
on digestion is taken from Claude Bernard's <i lang="fr" xml:lang="fr">Physiologie
Opératoire</i>, 1879:&mdash;</p>

<div class="blockquote">
<p>"The true experimental study of digestion is of comparatively
recent date; the ancients were content to
find comparisons, more or less happy, with common
<span class="pagenum"><a name="Page_25" id="Page_25">25</a></span>
facts. Thus, for Hippocrates, digestion was a 'coction':
for Galen, a 'fermentation,' as of wine in a vat. In
later times, van Helmont started this comparison again:
for him, digestion was a fermentation like that of bread:
as the baker, having kneaded the bread, keeps a little
of the dough to leaven the next lot kneaded, so, said
van Helmont, the intestinal canal never completely
empties itself, and the residue that it keeps after each
digestion becomes the leaven that shall serve for the
next digestion.</p>

<p>"The first experimental studies on the digestion
date from the end of the seventeenth century, when
the Academy of Florence was the scene of a famous
and long controversy between Borelli and Valisnieri.
The former saw nothing more in digestion than a
purely mechanical act, a work of attrition whereby the
ingesta were finely divided and as it were pulverised:
and in support of this opinion Borelli invoked the facts
that he had observed relating to the gizzard of birds.
We know that this sac, with its very thick muscular
walls, can exercise on its contents pressure enough
to break the hardest bodies. Identifying the human
stomach with the bird's gizzard, Borelli was led to
attribute to the walls of the stomach an enormous
force, estimated at more than a thousand pounds;
whose action, he said, was the very essence of digestion.
Valisnieri, on the contrary, having had occasion to open
the stomach of an ostrich, had found there a fluid
which seemed to act on bodies immersed in it; this
fluid, he said, was the active agent of digestion, a kind
of <i lang="la" xml:lang="la">aqua fortis</i> that dissolved food.</p>

<p>"These two opposed views, resulting rather from
observations than from regularly instituted experiments,
were the starting-point of the experimental researches
undertaken by Réaumur in 1752. To resolve the
problem set by Borelli and Valisnieri, Réaumur made
birds swallow food enclosed in fenestrated tubes, so
that the food, protected from the mechanical action
of the walls of the stomach, was yet exposed to
<span class="pagenum"><a name="Page_26" id="Page_26">26</a></span>
the action of the gastric fluid. The first tubes
used (glass, tin, etc.) were crushed, bent, or
flattened by the action of the walls of the gizzard;
and Réaumur failed to oppose to this force a
sufficient resistance, till he employed leaden tubes
thick enough not to be flattened by a pressure of
484 pounds: which was, in fact, the force exercised
by the contractile walls of the gizzard in turkeys, ducks,
and fowls under observation. These leaden tubes&mdash;filled
with ordinary grain, and closed only by a netting
that let pass the gastric juices&mdash;these tubes, after a
long stay in the stomach, still enclosed grain wholly
intact, unless it had been crushed before the experiment.
When they were filled with meat, it was found changed,
but not digested. Réaumur was thus led at first to
consider digestion, in the gallinaceæ, as pure and simple
trituration. But, repeating these experiments on birds
of prey, he observed that digestion in them consists
essentially in dissolution, without any especial mechanical
action, and that it is the same with the digestion of
meat in all animals with membranous stomachs. To
procure this dissolving fluid, Réaumur made the birds
swallow sponges with threads attached: withdrawing
these sponges after a definite period, he squeezed the
fluid into a glass, and tested its action on meat. That
was the first attempt at artificial digestion <i lang="la" xml:lang="la">in vitro</i>.
He did not carry these last investigations very far,
and did not obtain very decisive results; nevertheless
he must be considered as the discoverer of artificial
digestion."</p>
</div>

<p>After Réaumur, the Abbé Spallanzani (1783) made
similar observations on many other animals, including
carnivora. He showed that even in the gallinaceæ
there was dissolution of food, not mere trituration: and
observed how after death the gastric fluid may under
certain conditions act on the walls of the stomach
itself.
<span class="pagenum"><a name="Page_27" id="Page_27">27</a></span></p>

<div class="blockquote">
<p>"Henceforth the experimental method had cut the
knot of the question raised by the theories of Borelli and
Valisnieri: digestion could no longer be accounted anything
but a dissolution of food by the fluid of the stomach,
the gastric juice. But men had still to understand this
gastric juice, and to determine its nature and mode of
action. Nothing could be more contradictory than the
views on this matter. Chaussier and Dumas, of Montpellier,
regarded the gastric juice as of very variable
composition, one time alkaline, another acid, according to
the food ingested. Side by side with these wholly theoretical
opinions, certain results of experiments had led to
ideas just as erroneous, for want of rigorous criticism of
methods; it was thus that Montègre denied the existence
of the gastric juice as a special fluid; what men took for
gastric juice, he said, was nothing but the saliva turned
acid in the stomach. To prove his point, he made the
following experiment:&mdash;He masticated a bit of bread,
then put it out on a plate; it was at first alkaline, then
at the end of some time it became acid. In those days
(1813) this experiment was a real embarrassment to the
men who believed in the existence of a special gastric
juice: we have now no need to refute it.</p>

<p>"These few instances suffice to show how the physiologists
were unsettled as to the nature and properties of
the gastric juice. Then (1823) the Academy had the
happy idea of proposing digestion as a subject for a
prize. Tiedemann and Gmelin in Germany, Leuret and
Lassaigne in France, submitted works of equal merit, and
the Academy divided the prize between them. The work
of Tiedemann and Gmelin is of especial interest to us on
account of the great number of their experiments, from
which came not only the absolute proof of the existence
of the gastric juice, but also the study of the transformation
of starch into glucose. Thus the theory of digestion
entered a new phase: it was finally recognised, at least
for certain substances, that digestion is not simply dissolution,
but a true chemical transformation." (Cl.
Bernard, <i lang="la" xml:lang="la">loc. cit.</i>)
<span class="pagenum"><a name="Page_28" id="Page_28">28</a></span></p>
</div>

<p>In 1825 Dr. William Beaumont, a surgeon in the
United States Army, began his famous experiments on
Alexis St. Martin, a young Canadian travelling for the
American Fur Company, who was shot in the abdomen
on 6th June 1822, and recovered, but was left with
a permanent opening in his stomach. Since the surgery
of those days did not favour an operation to close this
fistula, Dr. Beaumont took St. Martin into his service,
and between 1825 and 1833 made a vast number of
experiments on him. These he published,<a name="FNanchor_2" id="FNanchor_2" href="#Footnote_2" class="fnanchor">[2]</a>  and they
were of great value. But it is to be noted that the
ground had been cleared already, fifty years before, by
Réaumur and Spallanzani:&mdash;</p>

<p class="blockquote">"<em>I make no claim to originality in my opinions</em>, as it
respects the existence and operation of the gastric juice.
My experiments confirm the doctrines (with some modifications)
taught by Spallanzani, and many of the most
enlightened physiological writers." (Preface to Dr. Beaumont's
book.)</p>

<p>Further, it is to be noted that Alexis St. Martin's
case proves that a gastric fistula is not painful. Scores
of experiments were made on him, off and on, for nine
years:&mdash;</p>

<div class="blockquote">
<p>"During the whole of these periods, from the spring of
1824 to the present time (1833), he has enjoyed general
good health, and perhaps suffered much less predisposition
to disease than is common to men of his age and circumstances
in life. He has been active, athletic, and vigorous;
exercising, eating, and drinking like other healthy
and active people. For the last four months he has been
unusually plethoric and robust, though constantly subjected
<span class="pagenum"><a name="Page_29" id="Page_29">29</a></span>
to a continuous series of experiments on the interior
of the stomach; allowing to be introduced or taken out
at the aperture different kinds of food, drinks, elastic
catheters, thermometer tubes, gastric juice, chyme, etc.,
almost daily, and sometimes hourly.</p>

<p>"Such have been this man's condition and circumstances
for several years past; and he now enjoys the
most perfect health and constitutional soundness, with
every function of the system in full force and vigour."
(Dr. Beaumont, <i lang="la" xml:lang="la">loc. cit</i>. p. 20.)</p>
</div>

<p>In 1834 Eberlé published a series of observations on
the extraction of gastric juice from the mucous membrane
of the stomach after death; in 1842 Blondlot of
Nancy studied the gastric juice of animals by the method
of a fistula, such as Alexis St. Martin had offered
for Dr. Beaumont's observation. After Blondlot, came
experiments on the movements of the stomach, and
on the manifold influences of the nervous system on
digestion.</p>

<p>It has been said, times past number, that an animal
with a fistula is in pain. It is not true. The case of
St. Martin is but one out of a multitude of these cases:
an artificial orifice of this kind is not painful.
<span class="pagenum"><a name="Page_30" id="Page_30">30</a></span></p>

<h3>IV<br />
GLYCOGEN</h3>

<p>Claude Bernard's discovery of glycogen in the liver
had a profound influence both on physiology and on
pathology. Take first its influence on pathology.
Diabetes was known to Celsus, Aretæus, and Galen;
Willis, in 1674, and Morton, in 1675, noted the
distinctive sweetness of the urine; and their successors
proved the presence of sugar in it. Rollo, in
1787, observed that vegetable food was bad for
diabetic patients, and introduced the strict use of a
meat diet. But Galen had believed that diabetes was
a disease of the kidneys, and most men still followed
him: nor did Rollo greatly advance pathology by
following not Galen, but Aretæus. Later, with the
development of organic chemistry, came the work of
Chevreuil (1815), Tiedemann and Gmelin (1823), and
other illustrious chemists: and the pathology of diabetes
grew more and more difficult:&mdash;</p>

<p class="blockquote">"These observations gave rise to two theories: the
one, that sugar is formed with abnormal rapidity in the
intestine, absorbed into the blood, and excreted in the
urine; the other, that diabetes is due to imperfect destruction
of the sugar, either in the intestine or in the blood.
Some held that it underwent conversion into lactic acid
as it was passing through the intestinal walls, while
others believed it to be destroyed in the blood by means
of the alkali therein contained."<a name="FNanchor_3" id="FNanchor_3" href="#Footnote_3" class="fnanchor">[3]</a> </p>

<p>Thus, before Claude Bernard (1813-1878), the pathology
of diabetes was almost worthless. And, in
physiology, his work was hardly less important than
the work of Harvey. A full account of it, in all its
bearings, is given in Sir Michael Foster's <cite>Life of Claude
Bernard</cite> (Fisher Unwin, 1899).
<span class="pagenum"><a name="Page_31" id="Page_31">31</a></span></p>

<p>In Bernard's <i lang="fr" xml:lang="fr">Leçons sur le Diabète et la Glycogenèse
Animale</i> (Paris, 1877), there is a sentence that has
been misquoted many times:&mdash;</p>

<p class="blockquote"><i lang="fr" xml:lang="fr">Sans doute, nos mains sont vides aujourd'hui, mais notre
bouche peut être pleine de légitimes promesses pour l'avenir.</i></p>

<p>This sentence has been worked so hard that some of
the words have got rubbed off it: and the statement
generally made is of this kind:&mdash;</p>

<p class="blockquote"><i>Claude Bernard himself confessed that his hands were
empty, but his mouth was full of promises.</i></p>

<p>Of course, he did not mean that he was wrong in his
facts. But, in this particular lecture, he is speaking
of the want of more science in practice, looking forward
to a time when treatment should be based on science,
not on tradition. Medicine, he says, is neither science
nor art. Not science&mdash;<i lang="fr" xml:lang="fr">Trouverait-on aujourd'hui un seul
médecin raisonnable et instruit osant dire qu'il prévoit d'une
manière certaine la marche et l'issue d'une maladie ou
l'effet d'une remède?</i> Not art, because art has always
something to show for its trouble: a statue, a picture,
a poem&mdash;<i lang="fr" xml:lang="fr">Le médecin artiste ne crée rien, et ne laisse aucune
&oelig;uvre d'art, à moins d'appliquer ce titre à la guérison du
malade. Mais quand le malade meurt, est-ce également
son &oelig;uvre? Et quand il guérit, peut-il distinguer sa part
de celle de la nature?</i></p>

<p>To Claude Bernard, experiments on animals for the
<span class="pagenum"><a name="Page_32" id="Page_32">32</a></span>
direct advancement of medicine seemed a new thing:
new, at all events, in comparison with the methods of
some men of his time. He was only saying what Sir
John Burdon Sanderson said in 1875 to the Royal
Commission:&mdash;</p>

<p><i>It is my profound conviction that a future will come, it
may be a somewhat distant future, in which the treatment
of disease will be really guided by science. Just as completely
as mechanical science has come to be the guide of
the mechanical arts, do I believe, and I feel confident, that
physiological science will eventually come to be the guide of
medicine and surgery.</i></p>

<p>Anyhow, lecturing a quarter of a century ago on
diabetes, his special subject, Claude Bernard spoke out
his longing to compel men into the ways of science,
to give them some immediate sign which they could not
refuse to see:&mdash;</p>

<p class="blockquote">"At this present time, medicine is passing from one
period to another. The old traditions are losing ground,
and scientific medicine (<i lang="fr" xml:lang="fr">la médecine expérimentale</i>) has
got hold of all our younger men: every day it gains
ground, and will establish itself against all its critics, and
in spite of the excesses of those who are over-zealous
for its honour.... And when men ask us what are the
results of scientific medicine, we are driven to answer
that it is scarcely born, that it is still in the making.
Those who care for nothing but an immediate practical
application must remember Franklin's words, <em>What is
the use of a new-born child, but to become a man?</em> If
you deliberately reject scientific medicine, you fail to see
the natural development of man's mind in all the sciences.
Without doubt, our hands are empty to-day, but our
mouth may well be filled with legitimate promises for
the future."<span class="pagenum"><a name="Page_33" id="Page_33">33</a></span></p>

<p>He died in 1878. The following account of the
discovery of glycogen is taken from his <cite>Nouvelle Fonction
du Foie</cite> (Paris, 1853):&mdash;</p>

<p class="blockquote">"My first researches into the assimilation and destruction
of sugar in the living organism were made in 1843:
and in my inaugural thesis (Dec. 1843) I published my
first experiments on the subject. I succeeded in demonstrating
a fact hitherto unknown, that cane-sugar cannot
be directly destroyed in the blood. If you inject even a
very small quantity of cane-sugar, dissolved in water,
into the blood or under the skin of a rabbit, you find
it again in the urine unchanged, with all its chemical
properties the same.... I had soon to give up my first
point of view, because this question of the existence of
a sugar-producing organ, that I had thought such a hard
problem of physiology, was really the first thing revealed
to me, as it were of itself, at once."</p>

<p>He kept two dogs on different diets, one with sugar,
the other without it; then killed them during digestion,
and tested the blood in the hepatic veins:&mdash;</p>

<div class="blockquote">
<p>"What was my surprise, when I found a considerable
quantity of sugar in the hepatic veins of the dog that
had been fed on meat only, and had been kept for eight
days without sugar: just as I found it in the other dog
that had been fed for the same time on food rich in
sugar....</p>

<p>"Finally, after many attempts&mdash;<i lang="fr" xml:lang="fr">après beaucoup d'essais
et plusieurs illusions que je fus obligé de rectifier par des
tâtonnements</i>&mdash;I succeeded in showing, that in dogs fed
on meat the blood passing through the portal vein does
not contain sugar before it reaches the liver; but when it
leaves the liver, and comes by the hepatic veins into the
inferior vena cava, this same blood contains a considerable
quantity of a sugary substance (glucose)."</p>
</div>

<p>His further discovery, that this formation of sugar is
increased by puncture of the floor of the fourth ventricle,
<span class="pagenum"><a name="Page_34" id="Page_34">34</a></span>
was published in 1849. It is impossible to exaggerate
the importance of Claude Bernard's single-handed work
in this field of physiology and pathology:&mdash;</p>

<div class="blockquote">
<p>"As a mere contribution to the history of sugar within
the animal body, as a link in the chain of special problems
connected with digestion and nutrition, its value was very
great. Even greater, perhaps, was its effect as a contribution
to general views. The view that the animal body,
in contrast to the plant, could not construct, could only
destroy, was, as we have seen, already being shaken.
But evidence, however strong, offered in the form of
numerical comparisons between income and output,
failed to produce anything like the conviction which was
brought home to every one by the demonstration that a
substance was actually formed within the animal body,
and by the exhibition of the substance so formed.</p>

<p>"No less revolutionary was the demonstration that the
liver had other things to do in the animal economy besides
secreting bile. This, at one blow, destroyed the then
dominant conception that the animal body was to be
regarded as a bundle of organs, each with its appropriate
function, a conception which did much to narrow inquiry,
since when a suitable function had once been assigned
to an organ there seemed no need for further investigations....</p>

<p>"No less pregnant of future discoveries was the idea
suggested by this newly-found-out action of the hepatic
tissue, the idea happily formulated by Bernard as
'internal secretion.' No part of physiology is at the
present day being more fruitfully studied than that which
deals with the changes which the blood undergoes as it
sweeps through the several tissues, changes by the careful
adaptation of which what we call the health of the body
is secured, changes the failure or discordance of which
entails disease. The study of these internal secretions
constitutes a path of inquiry which has already been trod
with conspicuous success, and which promises to lead to
<span class="pagenum"><a name="Page_35" id="Page_35">35</a></span>
untold discoveries of the greatest moment; the gate to
this path was opened by Bernard's work." (Sir M.
Foster, <i lang="la" xml:lang="la">loc. cit.</i>)</p>
</div>

<p>But the work to be done, before all the clinical facts
of the disease can be stated in terms of physiology, is
not yet finished. In England, especial honour is due
to Dr. Pavy for his life-long study of this most complex
problem.
<span class="pagenum"><a name="Page_36" id="Page_36">36</a></span></p>

<h3>V<br />
THE PANCREAS</h3>

<p>Here again Claude Bernard's name must be put first.
Before him, the diverse actions of the pancreatic juice
had hardly been studied. Vesalius, greatest of all
anatomists, makes no mention of the duct of the pancreas,
and speaks of the gland itself as though its purpose were
just to support the parts in its neighbourhood&mdash;<i lang="la" xml:lang="la">ut
ventriculo instar substerniculi ac pulvinaris subjiciatur</i>.
The duct was discovered by Wirsung, in 1642: but
anatomy could not see the things that belong to physiology.
Lindanus (1653) said, <i>I cannot doubt that the
pancreas expurgates, in the ordinary course of Nature, those
impurities of the blood that are too crass and inept to
be tamed by the spleen: and, in the extraordinary course,
all black bile, begotten of disease or intemperate living</i>.
Wharton (1656) said, <i>It ministers to the nerves, taking up
certain of their superfluities, and remitting them through its
duct into the intestines</i>. And Tommaso Bartholini (1666)
called it the <i>biliary vesicle of the spleen</i>.</p>

<p>This chaos of ideas was brought into some sort of
order by Regnier de Graaf, pupil of François de Bois
(Sylvius). De Bois had guessed that the pancreas must
be considered not according to its position in the body,
but according to its structure: that it was analogous to
the salivary glands. He urged his pupil to make experiments
on it: and de Graaf says:&mdash;
<span class="pagenum"><a name="Page_37" id="Page_37">37</a></span></p>

<p class="blockquote">"I put my hand to the work: and though many
times I despaired of success, yet at last, by the
blessing of God on my work and prayers, in the
year 1660 I discovered a way of collecting the pancreatic
juice."</p>

<p>And, by further experiment, he refuted Bartholini's
theory that the pancreas was dependent on the
spleen.</p>

<p>Sylvius had supposed that the pancreatic juice
was slightly acid, and de Graaf failed to note this
mistake; but it was corrected by Bohn's experiments
in 1710.</p>

<p>Nearly two hundred years come between Regnier
de Graaf and Claude Bernard: it is no wonder that
Sir Michael Foster says that de Graaf's work was
"very imperfect and fruitless." So late as 1840,
there was yet no clear understanding of the action
of the pancreas. Physiology could not advance without
organic chemistry; de Graaf could no more
discover the amylolytic action of the pancreatic juice
than Galvani could invent wireless telegraphy. The
physiologists had to wait till chemistry was ready
to help them:&mdash;</p>

<p class="blockquote">"Of course, while physical and chemical laws were
still lost in a chaos of undetermined facts, it was
impossible that men should analyse the phenomena
of life: first, because these phenomena go back to
the laws of chemistry and physics; and next, because
they cannot be studied without the apparatus, instruments,
and all other methods of analysis that we owe
to the laboratories of the chemists and the physicists."
(Cl. Bernard, <cite>Phys. Opér.</cite>, p. 61.)</p>

<p>Therefore de Graaf failed, because he got no help
from other sciences. But it cannot be called failure;
<span class="pagenum"><a name="Page_38" id="Page_38">38</a></span>
he must be contrasted with the men of his time,
Lindanus and Bartholini, facts against theories, not
with men of this century. And Claude Bernard went
back to de Graaf's method of the fistula, having to
guide him the facts of chemistry observed by Valentin,
Tiedemann and Gmelin, and Eberlé. His work began
in 1846, and the Académie des Sciences awarded a
prize to it in 1850:&mdash;</p>

<p class="blockquote">"Let this vague conception (the account of the
pancreas given in Johannes Müller's Text-book of
Physiology) be compared with the knowledge which
we at present have of the several distinct actions of
the pancreatic juice, and of the predominant importance
of this fluid not only in intestinal digestion but in
digestion as a whole, and it will be at once seen what
a great advance has taken place in this matter since
the early forties. That advance we owe in the main
to Bernard. Valentin, it is true, had in 1844 not only
inferred that the pancreatic juice had an action on
starch, but confirmed his view by actual experiment
with the juice expressed from the gland; and Eberlé
had suggested that the juice had some action on fat;
but Bernard at one stroke made clear its threefold action.
He showed that it on the one hand emulsified, and on
the other hand split up, into fatty acids and glycerine,
the neutral fats; he clearly proved that it had a powerful
action on starch, converting it into sugar; and lastly,
he laid bare its remarkable action on proteid matters."
(Sir Michael Foster, <i lang="la" xml:lang="la">loc. cit.</i>)</p>

<p>Finally came the discovery that the pancreas&mdash;apart
from its influences on digestion&mdash;contributes its share,
like the ductless glands, to the general chemistry of
the body:&mdash;</p>

<p class="blockquote">"It was discovered, a few years ago, by von Mering
and Minkowski, that if, instead of merely diverting its
<span class="pagenum"><a name="Page_39" id="Page_39">39</a></span>
secretion, the pancreas is bodily removed, the metabolic
processes of the organism, and especially the metabolism
of carbo-hydrates, are entirely deranged, the result being
the production of permanent diabetes. But if even a
very small part of the gland is left within the body, the
carbo-hydrate metabolism remains unaltered, and there
is no diabetes. The small portion of the organ which
has been allowed to remain (and which need not even
be left in its proper place, but may be transplanted under
the skin or elsewhere) is sufficient, by the exchanges
which go on between it and the blood generally, to
prevent those serious consequences to the composition
of the blood, and the general constitution of the body,
which result from the complete removal of this organ."
(Prof. Schäfer, 1894.)</p>

<p>Here, in this present study of "pancreatic diabetes,"
by Dr. Vaughan Harley and others, are facts as
important as any that Bernard made out: in no way
contradicting his work, but adding to it. The pancreas
is no longer taken to be only a sort of salivary gland
out of place: over and above the secretion that it
pours into the intestines, it has an "internal secretion,"
a constituent of the blood: it belongs not only to the
digestive system, but also, like the thyroid gland and
the suprarenal capsules, to the whole chemistry of
the blood and the tissues. So far has physiology come,
unaided by anatomy, from the fantastic notions of
Lindanus and the men of his time: and has come
every inch of the way by the help of experiments
on animals. Professor Starling's observations, on the
chemical influence of the duodenal mucous membrane
on the flow of pancreatic fluid, have advanced the
subject still further.
<span class="pagenum"><a name="Page_40" id="Page_40">40</a></span></p>

<h3>VI<br />
THE GROWTH OF BONE</h3>

<p>The work of du Hamel proved that the periosteum is
one chief agent in the growth of bone. Before him,
this great fact of physiology was unknown; for the
experiments made by Anthony de Heide (1684), who
studied the production of callus in the bones of frogs,
were wholly useless, and serve only to show that men
in his time had no clear understanding of the natural
growth of bone. De Heide says of his experiments:&mdash;</p>

<p class="blockquote">"From these experiments it appears&mdash;<i lang="la" xml:lang="la">forsan probatur</i>&mdash;that
callus is generated by extravasated blood, whose
fluid particles being slowly exhaled, the residue takes the
form of the bone: which process may be further advanced
by deciduous halitus from the ends of the broken
bone."</p>

<p>And Clopton Havers, in his <cite>Osteologia Nova</cite> (London,
1691), goes so far the wrong way that he attributes to
the periosteum not the production of bone, but the prevention
of over-production; the periosteum, he says, is
put round the shaft of a bone to compress it, lest it
grow too large.</p>

<p>Du Hamel's discovery (1739-1743) came out of a
chance observation, made by John Belchier,<a name="FNanchor_4" id="FNanchor_4" href="#Footnote_4" class="fnanchor">[4]</a>  that the
<span class="pagenum"><a name="Page_41" id="Page_41">41</a></span>
bones of animals fed near dye-works were stained with
the dye. Belchier therefore put a bird on food mixed
with madder, and found that its bones had taken up
the stain. Then du Hamel studied the whole subject
by a series of experiments. To estimate the advance
that he gave to physiology, contrast de Heide's fanciful
language with the title of one of du Hamel's papers&mdash;<i lang="fr" xml:lang="fr">Quatrième
Mémoire sur les Os, dans lequel on se propose
de rapporter de nouvelles preuves qui établissent que les os
croissent en grosseur par l'addition de couches osseuses qui
tirent leur origine du périoste, comme le corps ligneux des
Arbres augmente en grosseur par l'addition de couches
ligneuses qui se forment dans l'écorce.</i> Or take an example
of du Hamel's method:&mdash;</p>

<p class="blockquote">"Three pigs were destined to clear up my doubts.
The first, six weeks old, was fed for a month on ordinary
food, with an ounce daily of madder-juice&mdash;<i lang="fr" xml:lang="fr">garance grappe</i>&mdash;put
in it. At the end of the month, we stopped the
juice, and fed the pig in the ordinary way for six weeks,
and then killed it. The marrow of the bones was surrounded
by a fairly thick layer of white bone: this was
the formation of bone during the first six weeks of life,
without madder. This ring of white bone was surrounded
by another zone of red bone: this was the formation of
bone during the administration of the madder. Finally,
this red zone was covered with a fairly thick layer of
<span class="pagenum"><a name="Page_42" id="Page_42">42</a></span>
white bone: this was the layer formed after the madder
had been left off.... We shall have no further difficulty
in understanding whence transudes the osseous juice
that was thought necessary for the formation of callus
and the filling-up of the wounds of the bones, now we
see that it is the periosteum that fills up the wounds, or
is made thick round the fractures, and afterward becomes
of the consistence of cartilage, and at last acquires the
hardness of bones."</p>

<p>These results, confirmed by Bazan (1746) and
Boehmer (1751), were far beyond anything that had
yet been known about the periosteum. But the growth
of bone is a very complex process: the naked eye sees
only the grosser changes that come with it; and du
Hamel's ingenious comparison between the periosteum
and the bark of trees was too simple to be exact.
Therefore his work was opposed by Haller, and by
Dethleef, Haller's pupil: and the great authority of
Haller's name, and the difficulties lying beyond du
Hamel's plain facts, brought about a long period of
uncertainty. Bordenave (1756) found reasons for supporting
Haller; and Fougeroux (1760) supported du
Hamel. Thus men came to study the whole subject
with more accuracy&mdash;the growth in length, as well as
the growth in thickness; the medullary cavity, the
development of bone, the nutrition and absorption of
bone. Among those who took up the work were Bichat,
Hunter, Troja, and Cruveilhier; and they recognised the
surgical aspect of these researches in physiology. After
them, the periosteal growth of bone became, as it were,
a part of the principles of surgery. From this point of
view of practice, issued the experiments made by Syme
(1837) and Stanley (1849): which proved the importance
of the epiphysial cartilages for the growth of the
<span class="pagenum"><a name="Page_43" id="Page_43">43</a></span>
bones in length, and the risk of interfering with these
cartilages in operations on the joints of children.
Finally, with the rise of anæsthetics and of the antiseptic
method, came the work of Ollier, of Lyon, whose
good influence on the treatment of these cases can
hardly be over-estimated.
<span class="pagenum"><a name="Page_44" id="Page_44">44</a></span></p>

<h3>VII<br />
THE NERVOUS SYSTEM</h3>

<p>As with the circulatory system, so with the nervous
system, the work of Galen was centuries ahead of its
time. Before him, Aristotle, who twice refers to experiments
on animals, had observed the brain during
life: for he says, "In no animal has the blood any
feeling when it is touched, any more than the excretions;
nor has the brain, or the marrow, any feeling, when it is
touched": but there is reason for believing that he neither
recognised the purpose of the brain, nor understood the
distribution of the nerves. Galen, by the help of the experimental
method, founded the physiology of the nervous
system:&mdash;</p>

<p class="blockquote">"Galen's method of procedure was totally different to
that of an anatomist alone. He first reviewed the anatomical
position, and by dissection showed the continuity
of the nervous system, both central and peripheral, and
also that some bundles of nerve fibres were distributed to
the skin, others to the muscles. Later, by process of the
physiological experiment of dividing such bundles of
fibres, he showed that the former were sensory fibres
and the latter motor fibres. He further traced the nerves
to their origins in the spinal cord, and their terminations
as aforesaid. From these observations and experiments
he was able to deduce the all-important fact that different
nerve-roots supplied different groups of muscles and
different areas of the skin.... An excellent illustration
of his method, and of the fact that we ought not to treat
symptoms, but the causes of symptoms, is shown very
<span class="pagenum"><a name="Page_45" id="Page_45">45</a></span>
clearly in one of the cases which Galen records as having
come under his care. He tells us that he was consulted
by a certain sophist called Pausanias, who had a severe
degree of anæsthesia of the little and ring fingers. For
this loss of sensation, etc., the medical men who attended
him applied ointments of various kinds to the affected
fingers; but Galen, considering that that was a wrong
principle, inquired into the history, and found that while
the patient was driving in his chariot he had accidentally
fallen out and struck his spine at the junction of the
cervical and dorsal regions. Galen recognised that he
had to do with a traumatism affecting the eighth cervical
and first dorsal nerve; therefore, he says, he ordered
that the ointments should be taken off the hand and
placed over the spinal column, so as to treat the really
affected part, and not apply remedies to merely the
referred seat of pain."<a name="FNanchor_5" id="FNanchor_5" href="#Footnote_5" class="fnanchor">[5]</a> </p>

<p>Galen, by this sort of work, laid the foundations of
physiology; but the men who came after him let his
facts be overwhelmed by fantastic doctrines: all through
the ages, from Galen to the Renaissance, no great
advance was made toward the interpretation of the
nervous system. Long after the Renaissance, his
authority still held good; his ghost was not laid even
by Paracelsus and Vesalius, it haunted the medical
profession so late as the middle of the seventeenth
century; but the men who worshipped his name missed
the whole meaning of his work. This long neglect of
the experimental method left such a gap in the history
of physiology, that Sir Charles Bell seems to take up
the experimental study of the nervous system at the
point where Galen had stopped short; we go from the
<span class="pagenum"><a name="Page_46" id="Page_46">46</a></span>
time of Commodus to the time of George the Third, and
there is Bell, as it were, putting the finishing touch to
Galen's facts. It is true that experiments had been
made on the nervous system by many men; but a dead
weight of theories kept down the whole subject. For a
good instance, how imagination hindered science, there
is the following list, made by Dr. Risien Russell, of
theories about the cerebellum:&mdash;</p>

<p class="blockquote">"Galen was of opinion that the cerebellum must be the
originator of a large amount of vital force. After him,
and up to the time of Willis, the prevalent idea seems
to have been that it was the seat of memory; while
Bourillon considered it the seat of instinct and intelligence.
Willis supposed that it presided over involuntary
movements and organic functions; and this view, though
refuted by Haller, continued in the ascendency for some
time. Some believed strongly in its influence on the
functions of organic life; and according to some, diseases
of the cerebellum appeared to tell on the movements of
the heart.... Haller believed it to be the seat of
sensations, as well as the source of voluntary power;
and there were many supporters of the theory that the
cerebellum was the seat of the sensory centres. Renzi
considered this organ the nervous centre by which we
perceive the reality of the external world, and direct and
fix our senses on the things round us. Gall, and later
Broussais, and others, held that this organ presided over
the instinct of reproduction, or the propensity to love;
while Carus regarded it as the seat of the will also.
Rolando looked on it as the source of origin of all
movements. Jessen adduced arguments in favour of its
being the central organ of feeling, or of the soul, and the
principal seat of the sensations."</p>

<p>It is plain, from this list, that physiology had become
obscured by fanciful notions of no practical value. If a
better understanding of the nervous system could have
<span class="pagenum"><a name="Page_47" id="Page_47">47</a></span>
been got without experiments on animals, why had men
to wait so long for it? The Italian anatomists had
long ago given them all the anatomy that was needed
to make a beginning; the hospitals, and practice, had
given them many hundred years of clinical facts;
nervous diseases and head injuries were common
enough in the Middle Ages; and by the time of
Ambroise Paré, if not before, <i lang="la" xml:lang="la">post-mortem</i> examinations
were allowed. The one thing wanted was the experimental
method; and, for want of it, the science of the
nervous system stood still. Experiments had been
made; but the steady, general, unbiassed use of this
method had been lost sight of, and men were more
occupied with logic and with philosophy.</p>

<p>Then, in 1811, came Sir Charles Bell's work. If
any one would see how great was the need of experiments
on animals for the interpretation of the nervous
system, let him contrast the physiology of the
eighteenth century with that one experiment by Bell
which enabled him to say, "I now saw the meaning
of the double connection of the nerves with the spinal
marrow." It is true that this method is but a part
of the science of medicine; that experiment and experience
ought to go together like the convexity and
the concavity of a curve. But it is true also that men
owe their deliverance from ignorance about the nervous
system more to experiments on animals than to any
other method of observing facts.</p>

<h4>1. <i>Sir Charles Bell</i> (1778-1842)</h4>

<p>The great authority of Sir Charles Bell has been
quoted a thousand times against all experiments on
animals:&mdash;
<span class="pagenum"><a name="Page_48" id="Page_48">48</a></span></p>

<p class="blockquote">"Experiments have never been the means of discovery;
and a survey of what has been attempted of
late years in physiology, will prove that the opening of
living animals has done more to perpetuate error than
to confirm the just views taken from the study of
anatomy and natural motions."</p>

<p>He wrote, of course, in the days before bacteriology,
before anæsthetics; he had in his mind neither inoculations,
nor any observations made under chloroform or
ether, but just "the opening of living animals." He
had also in his mind, and always in it, a great dislike
against the school of Magendie. Let all that pass;
our only concern here is to know whether these words
are true of his own work.</p>

<p>They occur in a paper, <i>On the Motions of the Eye,
in Illustration of the Uses of the Muscles and Nerves of
the Orbit</i>; communicated by Sir Humphry Davy to the
Royal Society, and read March 20, 1823.<a name="FNanchor_6" id="FNanchor_6" href="#Footnote_6" class="fnanchor">[6]</a>  This
essay was one of a series of papers on the nervous
system, presented to the Royal Society during the
years 1821-1829. In 1830, having already published
four of these papers under the title, <i>The Exposition of
the Nervous System</i>, Bell published all six of them, under
the title, <i>The Nervous System of the Human Body</i>.</p>

<p>In his Preface to this book (1830) he quotes the
earliest of all his printed writings on the nervous
system, a pamphlet, printed in 1811, under the title,
<i>An Idea of a New Anatomy of the Brain, Submitted for
the Observation of the Authors Friends</i>. We have
therefore two statements of his work, one in 1811,
the other in 1823 and 1830. The first of them was
written when his work was still new before his eyes.
<span class="pagenum"><a name="Page_49" id="Page_49">49</a></span></p>

<p>Those who say that experiments did not help Bell
in his great discovery&mdash;the difference between the
anterior and the posterior nerve-roots&mdash;appeal to certain
passages in the 1830 volume:&mdash;</p>

<div class="blockquote">
<p>"In a foreign review of my former papers, the results
have been considered as a further proof in favour of
experiments. They are, on the contrary, deductions
from anatomy; and I have had recourse to experiments,
not to form my own opinions, but to impress them upon
others. It must be my apology that my utmost efforts
of persuasion were lost, while I urged my statements on
the grounds of anatomy alone. I have made few experiments;
they have been simple and easily performed, and
I hope are decisive....</p>

<p>"My conceptions of this matter arose by inference
from the anatomical structure; so that the few experiments
which have been made were directed only to the
verification of the fundamental principles on which the
system is established."</p>
</div>

<p>If it were not for the 1811 pamphlet, the opponents
of all experiments on animals might claim Sir Charles
Bell on their side. But while his work was still a new
thing, he spoke in another way of it:&mdash;</p>

<div class="blockquote">
<p>"I found that injury done to the anterior portion of
the spinal marrow convulsed the animal more certainly
than injury to the posterior portion; but I found it
difficult to make the experiment without injuring both
portions.</p>

<p>"Next, considering that the spinal nerves have a
double root, and being of opinion that the properties of
the nerves are derived from their connections with the
parts of the brain, <i>I thought that I had an opportunity of
putting my opinion to the test of experiment, and of proving
at the same time</i> that nerves of different endowments
were in the same cord (nerve-trunk) and held together
by the same sheath.
<span class="pagenum"><a name="Page_50" id="Page_50">50</a></span></p>

<p>"On laying bare the roots of the spinal nerves, I
found that I could cut across the posterior fasciculus of
nerves, which took its origin from the posterior portion
of the spinal marrow, without convulsing the muscles
of the back; but that on touching the anterior fasciculus
with the point of the knife, the muscles of the back were
immediately convulsed.</p>

<p>"<i>Such were my reasons for concluding</i> that the cerebrum
and cerebellum were parts distinct in function,
and that every nerve possessing a double function
obtained that by having a double root. <em>I now saw the
meaning</em> of the double connection of the nerves with
the spinal marrow; and also the cause of that seeming
intricacy in the connections of nerves throughout their
course, which were not double at their origins."</p>
</div>

<p>It is impossible to reconcile the 1830 sentences
with this vivid personal account of himself; <i>I had an
opportunity of putting my opinion to the test of experiment
... an opportunity of proving ... Such were my
reasons for concluding ... I now saw....</i> It is just
what all men of science say of their experiments: the
very phrase of Archimedes, and Asellius, and de Graaf.
If Sir Charles Bell had been working at the facts of
chemistry or of botany, who would have doubted the
meaning of these words?</p>

<p>This same inconsistency of sentences occurs elsewhere
in his <i>Nervous System of the Human Body</i>. In
one place he says that he has made few experiments:
<i>They have been simple, and easily performed, and I hope
are decisive.</i> In another he says: "<i>After making several
experiments on the cerebrum and cerebellum, I laid the
question of their functions entirely aside</i>, and confined
myself to the investigation of the spinal marrow and the
nerves; <i>a subject which I found more within my power</i>,
and which forms the substance of the present volume."
<span class="pagenum"><a name="Page_51" id="Page_51">51</a></span></p>

<p>Next, take his account of the cranial nerves:&mdash;</p>

<div class="blockquote">
<p>"It was necessary to know, in the first place,
whether the phenomena exhibited on injuring the
separate roots corresponded with what was suggested
by their anatomy....</p>

<p>"Here a difficulty arose. An opinion prevailed that
ganglions were intended to cut off sensation; and every
one of these nerves, which I supposed were the instruments
of sensation, have ganglions on their roots. Some
very decided experiment was necessary to overturn this
dogma. (Account of the experiment.) By pursuing the
inquiry, it was found that a ganglionic nerve is the sole
organ of sensation in the head and face: ganglions were
therefore no hindrance to sensation; and thus my
opinion was confirmed.... <em>It now became obvious</em> why
the third, sixth, and ninth nerves of the encephalon were
single nerves in their roots....</p>

<p>"Observing that there was a portion of the fifth nerve
which did not enter the ganglion of that nerve, and
being assured of the fact by the concurring testimony of
anatomists, I conceived that the fifth nerve was in fact
the uppermost nerve of the spine.... This opinion was
confirmed by experiment.... (Account of an experiment
on the dead body.) On dividing the root of the
nerve in a living animal, the jaw fell relaxed. Thus its
functions are no longer matter of doubt: it is at once a
muscular nerve and a nerve of sensibility. And thus the
opinion is confirmed, that the fifth nerve is to the head
what the spinal nerves are to the other parts of the body,
in respect to sensation and volition."</p>
</div>

<p>The value of the experimental method could hardly
be stated in more emphatic words. He supposed something,
conceived it, had an opinion about it. Anatomy
had suggested something to him. He put his opinion
to the test of phenomena, that is to say, to the test of
visible facts; and then his opinion was confirmed. As
<span class="pagenum"><a name="Page_52" id="Page_52">52</a></span>
with the spinal nerve-roots, so with the fifth cranial
nerve&mdash;his work was successful, because he followed
the way of experiment.</p>

<p>He was by nature of a most complex and sensitive
temperament, full of contrary forces&mdash;one man in 1811,
another in 1830. In 1811 he wrote, <em>I now saw the
meaning of the double connection of the nerves</em>; in 1830
he had come to hate the <i>stupid sterile materialism</i> of
the French school: he beheld anatomy falling behind
physiology, and his Windmill Street school perishing
to make way for the Hospital schools and for the
University of London. He was before everything else
a great anatomist: he stood up for the honour of
anatomy against the new physiology, and for the
honour of the Monroes and the Hunters against
Magendie: he hated the notion that any man should
proceed to experiments on function till the very last
secrets had been got out of structure. He died a few
years afterward. The 1830 writings are his last stand
for the defence of his country, his school, and his
beloved anatomy, against the methods of Magendie;
who said of himself, "I am a mere street scavenger,
<i lang="fr" xml:lang="fr">chiffonier</i>, of science. With my hook in my hand and
my basket on my back, I go about the streets of
science, collecting what I find."</p>

<p>This open conflict between Bell's first and last
thoughts is a part of his character: he was brilliant,
impulsive, changeable, inconsistent; and, what is more
important, his honour kept him from trying to evade
this trumpery charge of inconsistency; and he reprinted
the 1811 Preface in the book that he published in
1830. Doubtless he would have picked his words
more carefully if he had foreseen that one of the 1830
sentences would be wrested out of its place in his life's
<span class="pagenum"><a name="Page_53" id="Page_53">53</a></span>
work, and used as false evidence against the very
method that he followed.</p>

<p>His observations on the cranial nerves brought about
an immediate change in the practice of surgery:&mdash;</p>

<div class="blockquote">
<p>"Up to the time that Sir Charles Bell made his experiments
on the nerves of the face, it was the common
custom of surgeons to divide the facial nerve for the
relief of neuralgia, <i lang="fr" xml:lang="fr">tic douleureux</i>; whereas it exercises,
and was proved by Sir Charles Bell to exercise, no influence
over sensation, and its division consequently for
the relief of pain was a useless operation." (Sir J.
Erichsen.)</p>

<p>The relation of Magendie's work on the nerve-roots to
Bell's work need not be considered here. The exact
dates of Bell's observations are given by one of his pupils
in the Preface to the 1830 volume. Magendie finally
proved the sensory nature of the posterior nerve-roots:
"The exact and full proof which he brought forward of
the truth which Charles Bell had divined rather than
demonstrated, that the anterior and posterior roots of
spinal nerves have essentially different functions&mdash;a
truth which is the very foundation of the physiology of
the nervous system&mdash;is enough by itself to mark him as
a great physiologist." (Sir M. Foster, <i lang="la" xml:lang="la">loc. cit.</i>)</p>
</div>

<h4>2. <i>Marshall Hall</i> (1790-1857)</h4>

<p>Reflex action had been studied long before the time
of Marshall Hall. The Hon. Robert Boyle (1663) had
observed the movements and actions of decapitated
vipers, flies, silkworms, and butterflies. Similar observations
were made on frogs, eels, and other lower animals,
by Redi, Woodward, Stuart, Le Gallois, and Sir Gilbert
Blane. According to Richet, it was Willis who first
gave the name <i>reflex</i> to these movements.
<span class="pagenum"><a name="Page_54" id="Page_54">54</a></span></p>

<p>It cannot be said that these first studies of reflex
action did much for physiology. But the following
translation from Prochaska (1800) shows how they
cleared the way for Marshall Hall's work, by the proof
that they gave of the liberation of nervous energy in
the spinal cord:&mdash;</p>

<p class="blockquote">"These movements of animals after decapitation must
needs be by consent and commerce betwixt the spinal
nerves. For a decapitated frog, if it be pricked, not
only draws away the part that is pricked, but also creeps
and jumps; which cannot happen but by consent betwixt
the sensory nerves and the motor nerves. The seat of
which consent must needs be in the spinal cord, the only
remaining portion of the sensorium. <i>And this reflexion
of sensory impressions into motor impressions is not
accomplished in obedience to physical laws alone&mdash;wherein
the angle of reflexion is equal to the angle of incidence,
and reaction to action&mdash;but it follows special laws as it
were written by Nature on the spinal cord, which we
can know only by their effects, but cannot fathom with
the understanding.</i> But the general law, whereby the
sensorium reflects sensory impressions into motor impressions,
is the preservation of ourselves."</p>

<p>It was not possible, in 1800, to go further, or to
put the facts of reflex action more clearly: but this
fine sentence gives no hint of the truth that guided
Marshall Hall&mdash;that the "consent and commerce" of
reflex action are to be found at definite points or levels
in the spinal cord; that the cord no more "works as
a whole" than the brain. The greatness of Marshall
Hall's work lies in his recognition of the divisional
action of the cord: he proved the existence of definite
centres in it, he discovered the facts of spinal localisation,
and thus foreshadowed the discovery of cerebral
localisation. In his earlier writings (1823-33) he
showed how the movements of the trunk and of the
<span class="pagenum"><a name="Page_55" id="Page_55">55</a></span>
limbs are only one sort of reflex action; how the
larynx, the pharynx, and the sphincter muscles, all act
by the "consent and commerce" of the spinal cord.
Later, in 1837, he demonstrated the course of nerve-impulses
along the cord from one level to another, the
results of direct stimulation of the cord, and other
facts of spinal localisation. He noted the different
effects of opium and of strychnine on reflex action;
and he extended the doctrines of reflex action beyond
physiology to the convulsive movements of the body
in certain diseases.</p>

<h4>3. <i>Flourens</i> (1794-1867)</h4>

<p>Beside his work on the nervous system, Flourens
studied the periosteal growth of bone, and the action
of chloroform;<a name="FNanchor_7" id="FNanchor_7" href="#Footnote_7" class="fnanchor">[7]</a>  but he is best known by his experiments
on the respiratory centre and the cerebellum.
The men who interpreted the nervous system followed
the anatomical course of that system: first the nerve-roots,
then the cord, then the medulla oblongata and
the cerebellum, and last the cerebral hemispheres; a
steady upward advance, from the observation of decapitated
insects to the localisation of centres in the human
brain. Flourens, by his work on the medulla oblongata,
localised the respiratory centre, the nerve-cells for the
reflex movements of respiration:&mdash;</p>

<p class="blockquote">"M. Flourens a circonscrit ce centre avec une scrupuleuse
précision, et lui a donné le nom de n&oelig;ud vital"
(Cl. Bernard.)
<span class="pagenum"><a name="Page_56" id="Page_56">56</a></span></p>

<p>Afterward came the discovery of cardiac and other
centres in the same portion of the nervous system.
Flourens also showed that the cerebellum is concerned
with the equilibration of the body, and with the coordination
of muscular movements; that an animal, a
few days old, deprived of sensation and consciousness
by removal of the cerebral hemispheres, was yet able
to stand and move forward, but, when the cerebellum
was removed, its muscles lost all co-ordinate action.
(<cite>Recherches Expérimentales</cite>, Paris, 1842.) And from
his work, and the work of those who followed him,
on the semicircular canals of the internal ear, came
the evidence that these minute structures are the terminal
organs of equilibration: that as the special senses
have their terminal apparatus and their central apparatus,
so the semicircular canals and the cerebellum are the
terminal apparatus and the central apparatus of the
sense of equilibrium.</p>

<h4>4. <i>Claude Bernard</i> (1813-1878)</h4>

<p>The discovery of the vaso-motor nerves, and of the
control of the nervous system over the calibre of the
arteries, was made by Claude Bernard at the outset of
his work on the influence of the nervous system on the
temperature.<a name="FNanchor_8" id="FNanchor_8" href="#Footnote_8" class="fnanchor">[8]</a>  The evidence of Professor Sharpey before
the Royal Commission of 1875 shows how things had
<span class="pagenum"><a name="Page_57" id="Page_57">57</a></span>
been misjudged, before Bernard's time, in the light of
"views taken from the Study of Anatomy and Natural
Motions":&mdash;</p>

<p class="blockquote">"I remember that Sir Charles Bell gave the increased
size of the vessels in blushing, and their fulness of blood,
as an example of the increased action of the arteries in
driving on the blood. It turns out to be just the reverse,
inasmuch as it is owing to a paralysis of the nerves
governing the muscular coats of the arteries."</p>

<p>Claude Bernard's first account of his work was
communicated to the Société de Biologie in December
1851. The following description is taken from his
<cite>Leçons de Physiologie Opératoire</cite>:&mdash;</p>

<div class="blockquote">
<p>"I will remind you how I was led to the discovery
of the vaso-motor nerves. Starting from the clinical
observation, made long ago, that in paralysed limbs you
find at one time an increase of cold, and at another an
increase of heat, I thought this contradiction might be
explained by supposing that, side by side with the general
action of the nervous system, the sympathetic nerve might
have the function of presiding over the production of
heat; that is to say, that in the case where the paralysed
limb was chilled, I supposed the sympathetic nerve to
be paralysed, as well as the motor nerves; while in the
paralysed limbs that were not chilled, the sympathetic
nerve had retained its function, the systemic nerves alone
having been attacked.</p>

<p>"This was a theory, that is to say, an idea leading
me to make experiments; and for these experiments I
must find a sympathetic nerve-trunk of sufficient size,
going to some organ that was easy to observe, and must
divide this trunk to see what would happen to the heat-supply
of the organ. You know that the rabbit's ear,
and the cervical sympathetic nerve of this animal, offered
us the required conditions. So I divided the nerve; and
immediately my experiment gave the lie direct to my
<span class="pagenum"><a name="Page_58" id="Page_58">58</a></span>
theory&mdash;<i lang="fr" xml:lang="fr">Je coupai donc ce filet et aussitôt l'expérience
donna à mon hypothèse le plus éclatant démenti</i>. I had
thought that the section of the nerve would suppress the
function of nutrition, of calorification, over which the
sympathetic system had been supposed to preside, and
would cause the hollow of the ear to become chilled; and
here was just the opposite, a very warm ear, with great
dilatation of its vessels.</p>

<p>"I need not remind you how I made haste to abandon
my first theory, and gave myself to the study of this new
state of things. And you know that here was the starting-point
of all my researches into the vaso-motor and
thermic system; and the study of this subject is become
one of the richest fields of experimental physiology."</p>
</div>

<p>Waller, in 1853, studied the vaso-motor centre in
the spinal cord; and Schiff, in 1856, found evidence of
the existence of two kinds of vaso-motor nerves&mdash;those
that constrict the vessels, and those that dilate them.
This view was finally established in 1858 by Claude
Bernard's experiments on the chorda tympani and the
submaxillary gland.</p>

<p>The <i lang="fr" xml:lang="fr">Leçons de Physiologie Opératoire</i> were published
in 1879. Twenty years later, Sir Michael Foster says
of Bernard's work:&mdash;</p>

<p class="blockquote">"It is almost impossible to exaggerate the importance
of these labours of Bernard on the vaso-motor nerves,
since it is almost impossible to exaggerate the influence
which our knowledge of the vaso-motor system, springing
as it does from Bernard's researches as from its fount
and origin, has exerted, is exerting, and in widening
measure will continue to exert, on all our physiological
and pathological conceptions, on medical practice, and on
the conduct of human life. There is hardly a physiological
discussion of any width in which we do not
sooner or later come on vaso-motor questions. Whatever
part of physiology we touch, be it the work done by
<span class="pagenum"><a name="Page_59" id="Page_59">59</a></span>
a muscle, be it the various kinds of secretive labour, be
it the insurance of the brain's well-being in the midst of
the hydrostatic vicissitudes to which the changes of daily
life subject it, be it that maintenance of bodily temperature
which is a condition of the body's activity; in all
these, as in many other things, we find vaso-motor
factors intervening. And if, passing the insecure and
wavering line which parts health from illness, we find
ourselves dealing with inflammation, or with fever, or
with any of the disordered physiological processes
which constitute disease, we shall find, whatever be the
tissue specially affected by the morbid conditions, that
vaso-motor influences have to be taken into account.
The idea of vaso-motor action is woven as a dominant
thread into all the physiological and pathological doctrines
of to-day; attempt to draw out that thread, and
all that would be left would appear as a tangled heap."</p>

<h4>5. <i>Cerebral Localisation</i></h4>

<p>Finally, moving upward along the anatomy of the
nervous system, physiology came to study the motor-centres
and special sense-centres of the cerebral hemispheres.
The year 1861 may fairly be said to mark
the beginning of the discovery of these centres, when
Broca, at a meeting of the Anthropological Society of
Paris, heard Aubertin's paper on the connection between
the frontal convolutions and the faculty of speech.
But, of course, some sort of belief in cerebral localisation
had been in the air long before Broca's time.
Willis (1621-1675), who was contemporary with Sir
Isaac Newton, had written of the brain as though
its convolutions, or "cranklings" as he called them,
showed that its work was departmental:&mdash;</p>

<p class="blockquote">"As the animal spirits for the various acts of imagination
and memory ought to be moved within certain and
<span class="pagenum"><a name="Page_60" id="Page_60">60</a></span>
distinct limits, or bounded places, and these motions
to be often iterated or repeated through the same tracts
or paths, for that reason these manifold convolutions and
infoldings of the brain are required for these divers
manners of ordinations of the animal spirits&mdash;to wit,
that in these cells or storehouses, severally placed, might
be kept the species of sensitive things, and as occasion
serves, may be taken from thence."<a name="FNanchor_9" id="FNanchor_9" href="#Footnote_9" class="fnanchor">[9]</a> </p>

<p>And Gall, a century after Willis, had collected and
published, in support of his system of phrenology,
many cases and <i lang="la" xml:lang="la">post-mortem</i> examinations showing the
differentiation of the work of the brain. Gall is a
warning for all time against the dangers of deduction;
he had but one idea, and he drove it to death; but the
clinical and pathological facts which he amassed, in the
hope of establishing a set of doctrines out of all relation
to facts, are as true now as ever; and, if he had been
content to go the way of induction, and to set himself
to the accumulation of facts, he might have become
a great physiologist. In his knowledge of the anatomy
of the brain, and in the dissection of the brain, he was
far ahead of the men of his time; but he followed his
own imaginings, and left nothing that could last, except
those cases and pathological instances that are buried
in the ruins of his system. But there they are, and
are still of value. For example, Gall's case of loss
of speech, after an injury involving the speech-centres,
ought to have commanded the attention of all physiologists:
but it came to nothing, because he used it to
support his doctrine of organs and bumps, and it
shared the fate of that doctrine. Phrenology is gone
<span class="pagenum"><a name="Page_61" id="Page_61">61</a></span>
past recall; it died of that congenital disease, the
deductive fallacy; but there was a time when it might
have been turned to the service of science.</p>

<p>The excitement that Gall aroused by the spread of
his ideas shows that some belief in cerebral centres
was waiting for development. All men are by nature
phrenologists; the commonplace excuses that are offered
for lapses of memory, venial offences, and inherited
weaknesses, all appeal to the comfortable notion that
the offender is not wholly perverted, and that some very
small and strictly localised group of cells is at fault.
And it is probable that the physiology of the central
nervous system, with its present strong tendency
toward psychology, will some day be back, at a far
higher level, above the point where phrenology went
wrong. As Mme. de Staël said, <i lang="fr" xml:lang="fr">L'esprit humain fait
progrès toujours, mais c'est progrès en spirale</i>. But
the question, whether the general desire for a
rational system of psychology will ever commend
itself to physiology, belongs to the future. All that
is of present concern is the steady, continuous, and
successful advance, by the way of induction, and by
the help of experiments on animals, toward a clear
and accurate statement of the departmental work of
the brain.</p>

<p>It is one of many instances how science and practice
work together, that the modern study of these centres
began not in experiment but in experience. The first
centres that were thus studied were the speech-centres;
and the observation of them arose out of the cases
recorded by Bouillard in 1825, and Dax in 1836.
Clinical observation, and <i lang="la" xml:lang="la">post-mortem</i> examination,
found the speech-centres; physiological experiments
had nothing to do with it; and phrenology had, as
<span class="pagenum"><a name="Page_62" id="Page_62">62</a></span>
it were, found them, and then lost them. But at
once, so soon as practice gave the word to science,
physiology set to work. These clinical facts had been
there all the time; loss of speech had gone with
disease or injury of "Broca's convolution" ever since
man had been on the earth, and nobody had seen
the significance of this sequence. Then, after 1861,
everything was changed; and in a few years physiology
had mapped out a large part of the surface of
the brain, and had charted the motor-centres.</p>

<p>The story of Broca's convolution is told in Hamilton's
<cite>Text-Book of Pathology</cite>:&mdash;</p>

<p class="blockquote">"In 1825, Bouillard collected a series of cases to show
that the faculty of speech resided in the frontal lobes.
In the year 1836 M. Dax, in a paper read to the Medical
Congress of Montpellier, stated as a result of his researches
that, where speech was lost from cerebral causes,
he believed the lesion was invariably found in the left
cerebral hemisphere, and that the accompanying paralysis
of the right side of the body is consequent upon this.
This paper for long lay buried in the annals of medical
literature, but was unearthed years afterwards by his
son, and presented to the French Academy. Bouillard's
views were also disinterred by Aubertin, and in the
year 1861 were brought by him before the notice of
the Anthropological Society of Paris. Broca, who was
present at the meeting, had a patient under his care
at the time who had been aphasic (without power of
speech) for twenty-one years, and who was in an almost
moribund state. The autopsy proved of great interest,
as it was found that the lesion was confined to the left
side of the brain, and to what we now call the third
frontal convolution. Broca was struck with the coincidence;
and when a similar case came under his care
afterwards, unaware of what had been done by Dax, he
postulated the conclusion that the integrity of the third
<span class="pagenum"><a name="Page_63" id="Page_63">63</a></span>
frontal convolution, and perhaps also part of the second,
is essential to speech. In a subsequent series of fifteen
typical cases examined, it was found that the lesion had
destroyed, among other parts, the posterior part of the
third frontal in fourteen. In the fifteenth case the
destruction had taken place in the island of Reil and
the temporal lobe."</p>

<p>After 1861, physiology took the lead, and kept it.
But, through all the work, science and practice have
been held together; the facts of experimental physiology
have been and are tested, every inch of the
way, by the facts of medicine, surgery, and pathology.
The infinite minuteness and complexity of the investigation,
and its innumerable side-issues, are past all
telling. They who are doing the work, in science
and in practice, have always had in their thoughts the
fear of fallacies in the interpretation of these highest
forms of life. Sir William Gowers, fourteen years ago,
wrote as follows of the earlier workers:&mdash;</p>

<p class="blockquote">"Doubt was formerly entertained as to the existence of
differentiation of function in different parts of the cortex,
but recent researches have established the existence of a
differentiation which has almost revolutionised cerebral
physiology, and has vastly extended the range of cerebral
diagnosis. The first step of the new discovery was constituted
by the clinical and pathological observations of
Hughlings Jackson, which suggested the existence, on
each side of the fissure of Rolando, of special centres for
the movements of the leg, arm, and face. These observations
led to the experiments of Ferner, which resulted
in the demonstration of the existence in the cortex of the
lower animals of well-defined regions, stimulation of
which caused separate movements, or evidence of special
sense excitation, while the destruction of the same parts
caused indications of a loss of the corresponding function.
<span class="pagenum"><a name="Page_64" id="Page_64">64</a></span>
Hence he came to the conclusion that these regions constitute
actual motor and sensory centres. Ferrier had,
however, been anticipated in many of these results by
two German experimenters, Fritsch and Hitzig, whose
results, differing a little in detail, correspond closely
in their general significance. Many other investigations
of the same character have since been made,
of which those of Munk are especially important. The
original observations of Hughlings Jackson left little
doubt that the general facts, learned from experiments
on animals, are true of man; and this conclusion has
been to a large extent confirmed by pathological and
clinical observations directed to the verification on man
of the pathological results. To this verification the
labours of Charcot and his coadjutors have largely contributed.
But the verification has already made it
probable that some differences exist between the brain
of man and that of higher animals (even of monkeys),
and that the conclusions from the latter cannot be simply
transferred to the former."</p>

<p>Many and great difficulties, beyond this danger of
the fallacy of "simple transference," beset every step
of the work: it required the right use of the most
delicate and susceptible instruments and tests, and the
right understanding of anatomy, microscopic anatomy,
comparative anatomy, organic chemistry, electricity, and
physics: every moment of advance must be guarded,
every word must be weighed. Among the earlier difficulties,
was the failure of almost all the physiologists,
before Hitzig, to produce muscular action by excitation
of the cerebral cortex. Longet, Magendie, Flourens,
Matteuci, Van Deen, Weber, Budge, and Schiff, had all
failed. Hitzig (<cite>Untersuchungen über das Gehirn</cite>, Berlin,
1874) had observed, in man, that it was easy to produce
movements of the eyes by the passage of the
<span class="pagenum"><a name="Page_65" id="Page_65">65</a></span>
constant current through the occipital region.<a name="FNanchor_10" id="FNanchor_10" href="#Footnote_10" class="fnanchor">[10]</a>  Taking
this fact for a starting-point, he used a very low current,
and thereby succeeded in producing certain definite
muscular movements by stimulation of the cortex in
animals. Of Hitzig's work, Sir Victor Horsley says:&mdash;</p>

<p class="blockquote">"It was not till 1870 that the next absolute proof
(after Bell's work in 1813) was obtained of the localisation
of function, so far as the highest centres of the
nervous system were concerned. In that year Fritsch
and Hitzig discovered that electrical excitation, with
minimal stimuli, of various points of the cortex, caused
those storehouses, of which Willis spoke, to discharge,
and to reveal their function by the precise limitation of
the groups of muscles which they were able to throw
into action. These researches were abundantly confirmed
and greatly extended by Professor Ferrier, and
thus has been constructed in the history of this subject
the most recent great platform or stage of permanent
advance."<a name="FNanchor_11" id="FNanchor_11" href="#Footnote_11" class="fnanchor">[11]</a> </p>

<p>The thirty years since Hitzig's work cannot be put
here, for they would take a volume to themselves.
There have been differences of interpretation of this
or that fact, diversities of results, and problems too
hard to solve, and other difficulties, such as befall all
the natural sciences; but these imperfections amount to
very little, when the whole result comes to be reckoned.
The marvel is that the work is so nearly perfect, seeing
its immeasurable complexity.
<span class="pagenum"><a name="Page_66" id="Page_66">66</a></span></p>

<p>Let any man, who has but touched the study of
physiology, consider what is involved in even the most
superficial observation of the simplest facts of the
nervous system: for instance, the ordinary nerve-muscle
preparation that is taught to every medical
student, or the microscopic structure of the spinal cord,
or the Wallerian method. Or let him consider how the
physiology of the nervous system has been founded on
the lower forms of life: the work of Romanes and
others on the Medusa and the Echinodermata, and
Huxley's work in biology, and the endless chain of
forces that are alike in man and in jelly-fishes. Then
let him try to estimate the output of hard thinking, for
the advance from lower to higher structures, and up to
man; the vigilant criticism of all theories and foregone
conclusions, the incessant self-judgment and wearisome
doubts and disputes all the way, elusiveness of facts, and
vagueness of words. And the results thus wrung out
of science had still to be stated in terms of practice, and
tested by the facts of medicine, surgery, and pathology,
and used in every hospital in the civilised world, not
only for the saving of life, but also for the diagnosis and
medical or surgical treatment of innumerable varieties
of disease or injury of the brain, the cord, or the nerves.
Sir Michael Foster, in a short summary of the problems
of physiology, puts clearly these consummate difficulties
of the physiology of the nervous system:&mdash;</p>

<div class="blockquote">
<p>"In the first place there are what may be called
general problems, such as, How the food, after its
preparation and elaboration into blood, is built up into
the living substance of the several tissues? How the
living substance breaks down into the dead waste?
How the building up and breaking down differ in the
different tissues in such a way that energy is set free
<span class="pagenum"><a name="Page_67" id="Page_67">67</a></span>
in different modes, the muscular tissue contracting, the
nervous tissue thrilling with a nervous impulse, the
secreting tissue doing chemical work, and the like? To
these general questions the answers which we can at
present give can hardly be called answers at all.</p>

<p>"In the second place there are what may be called
special problems, such as, What are the various steps
by which the blood is kept replenished with food and
oxygen, and kept free from an accumulation of water; and
how is the activity of the digestive, respiratory, and
excretory organs, which effect this, regulated and adapted
to the stress of circumstances? What are the details of
the vascular mechanism by which each and every tissue
is for ever bathed with fresh blood, and how is that
working delicately adapted to all the varied changes of
the body? And, <i>compared with which all other problems
are insignificant and preparatory only</i>, how do nervous
impulses so flit to and fro within the nervous system as
to issue in the movements which make up what we
sometimes call the life of man?"</p>
</div>

<p>The physiology of the nervous system is wrought
to finer issues now than in the time of Bell and
Magendie; and this generation of students may live
to see the present facts and methods of cerebral
localisation as the mere rudiments or elements of
science. Happily for mankind, science has already
so far elucidated them that they have done good
service for the diagnosis and treatment of disease,
and for the saving of lives.</p>

<hr class="c15" />

<p>Some examples have been given, in the foregoing
chapters, of the value of physiological experiments on
animals. It would be easy to lengthen the list, for
there is no general subject in all physiology that does
not owe something to this method: as Mr. Darwin
<span class="pagenum"><a name="Page_68" id="Page_68">68</a></span>
said, in his evidence before the Royal Commission of
1875, "I am fully convinced that physiology can progress
only by the aid of experiments on living animals.
I cannot think of any one step which has been made
in physiology without that aid." Many examples have
been left out altogether&mdash;the work of Boyle, Hunter,
Lavoisier, Haldane, Despretz, and Regnault, on animal
heat and on respiration; of Petit, Dupuy, Breschet,
and Reid, on the sympathetic system; of Galvani,
Volta, Haller, du Bois-Reymond, and Pflüger, on
muscular contractility: nothing has been said of the
work lately done on the suprarenal glands and
"adrenalin," and on the blood-pressure in its relation
to secretion. For the most part, only those examples
have been taken that occur far back in the history of
physiology: more has been said about the past than
about the present. First, because it was necessary
to put an end to the false statements that are made,
by those who are opposed to all experiments on
animals, about the work done in the past. Next,
because the abstruse details of physiology, in the
present, are not intelligible for general reading. Next,
because it is impossible now to isolate physiology, or
to say what belongs to physiology alone, to have back
the simpler problems of the past, to discover the circulation
of the blood twice. But the experimental
method, alike in the past and in the present, has been
the chief way of advance. And if a forecast may be
made without offence, it is certain that the work of
physiology, as in the past and the present, so in the
near future, will exercise a profound influence for good
on medical and surgical treatment. Among the subjects
that especially occupy physiologists now are, the
more exact localisation and interpretation of the special
<span class="pagenum"><a name="Page_69" id="Page_69">69</a></span>
sense-centres, and the better knowledge of the internal
secretions and chemical influences of the glands and
tissues of the body. It would be hard to find two
fields of work more sure to favour the growth of the
<i lang="la" xml:lang="la">arbor vitæ</i> side by side with the <i lang="la" xml:lang="la">arbor scientiæ</i>.</p>

<p>But the last word here must be said by a physiologist
of the very highest authority, Professor Starling. He
has kindly given me, for this edition, the following
note:&mdash;</p>

<div class="blockquote">
<p>"Among the researches of the last thirty years, those
bearing on the <i>Circulation of the Blood</i> must take an
important place, both for their physiological interest
and for the weighty influence they have exerted on
our knowledge and treatment of disorders of the
vascular system, such as heart disease. We have
learned to measure accurately the work done by the
great heart-pump; and by studying the manner in which
this work is affected by different conditions, we are
enabled to increase or diminish it, according to the
needs of the organ. Experiments in what is often
regarded as the most transcendental department of
physiology&mdash;<i lang="la" xml:lang="la">i.e.</i> that which treats of muscle and nerve&mdash;have
thrown light on the wonderful process of 'compensation,'
by which a diseased heart is able to keep up a
normal circulation.</p>

<p>"<i>Vaso-motor System.</i>&mdash;Largely by the labours of
British physiologists, the exquisite control exercised by
the nervous system over every blood-vessel in the body
has been brought to light, the paths tracked out, and
the mechanisms elucidated, by means of which the
circulation through each part of the body is subordinated
to the needs of the whole. Since the chief vaso-motor
nerves take their course through the sympathetic system,
the researches on their distribution have led to the
mapping out of the whole of this system, and to an
accurate knowledge of its functions. We are now
acquainted with the course, to all parts of the body,
<span class="pagenum"><a name="Page_70" id="Page_70">70</a></span>
of the nerves which not only determine the changes
in the calibre of the blood-vessels, but affect also the
secretion of sweat and the erection of the hairs.
Incidentally, the mapping out of these nerves, in the
hands of Mackenzie, Head, and others, has led to
more power of localising the seat of visceral disease.</p>

<p>"<i>Digestion.</i>&mdash;Our knowledge of the processes of digestion
has of late years received a great accession by the
work of Professor Pawlow, of St. Petersburg. His
success is largely due to his recognition of the importance
of keeping his experimental animals under the
most normal conditions possible, and of studying the
different parts of the alimentary tract in animals which
were not anæsthetised, but which were free from any
pain or even discomfort, either of which conditions
materially interferes with the activity of the digestive
glands. He therefore established in dogs fistulæ in
chosen portions of the alimentary canal, analogous to
the fistula which accident rendered so valuable in the
case of Alexis St. Martin. Not only has the knowledge
thus gained enabled the physician to understand the
sequel of events in disordered digestion, but the success
of the operative measures undertaken by physiologists
for the elucidation of their science has emboldened
surgeons to attack disease in the most various parts
of the alimentary canal.</p>

<p>"Renewed study of the secretion of pancreatic juice
evoked by the passage of the acid digestive products
from the stomach into the small intestine, which had
been described by Pawlow, has resulted in the discovery
of a new class of chemical agents, which act as special
messengers from one part of the body to another, and
exercise an important function in determining the action
of all parts to one common end.</p>

<p>"<i>Respiration.</i>&mdash;The investigation of the chemical properties
of the colouring matter of blood, and of its
compound with carbon monoxide, has resulted, in the
hands of Dr. Haldane, in the laying down of measures
for the prevention of accidents from choke-damp or
<span class="pagenum"><a name="Page_71" id="Page_71">71</a></span>
after-damp in mines. The same investigation has
resulted in the discovery of a method of determining
the total amount of blood circulating in the body of
a living man. The application of this method has
already added largely to our knowledge of the pathology
of different forms of anæmia, as well as of the conditions
obtaining in heart disease. Experiments by Hill and
others on the physiological effects of compressed air
have shown the precautions which should be observed
in all diving operations. A proper appreciation of these
results by diving-engineers would not only entirely
obviate the cases of 'caisson disease,' but would enable
diving to be carried on safely to a greater depth than has
hitherto been attempted.</p>

<p>"It is impossible, however, to enumerate all the physiological
gains of the last twenty or thirty years,
or to point out their manifold applications in the cure
and prevention of disease. The full control of the processes
of disease, which is the goal of the physician
and the surgeon, can only be attained through an
accurate knowledge of the conditions governing the
functions of the healthy body. The foundation of
medicine and surgery is physiology: and it is only on
living animals that the processes of life can be investigated."
<span class="pagenum"><a name="Page_72" id="Page_72">72</a></span></p>
</div>

<hr class="c30" />

<p><span class="pagenum"><a name="Page_73" id="Page_73">73</a></span></p>

<h2>PART II<br />
EXPERIMENTS IN PATHOLOGY,<br />
MATERIA MEDICA, AND<br />
THERAPEUTICS</h2>

<p><span class="pagenum"><a name="Page_74" id="Page_74">74</a></span></p>

<p><span class="pagenum"><a name="Page_75" id="Page_75">75</a></span></p>

<h3>I<br />
INFLAMMATION, SUPPURATION, AND<br />
BLOOD-POISONING</h3>

<p>Pathology, the study of the causes and products of
diseases, is a younger science than physiology: the use
of the microscope was the beginning of pathology; and
the microscope, even so late as sixty years ago, was
very different to the microscope now. The great
pathologists of that time had not the lenses, microtomes,
and reagents that are now in daily employment;
they knew nothing of the present methods of
section-cutting and differential staining. But the
publication in 1839 of Schwann's cell-theory marks
the rise of modern pathology. In 1843, Darwin wrote
his first draft of the doctrine of the origin of species;
and Pasteur, that year, was in for his examination at
the École Normale. The work of Schwann, Virchow,
and Pasteur had such profound influences on science
that the span of sixty years seems to cover the modern
development of pathology: and this span of years is
marked, half-way, by the rise of bacteriology. In
1875, when the Royal Commission on Experiments
on Animals was held in London, the evidence was
concerned practically with physiology alone: very little
was said about pathology, and of bacteriology hardly
a word. The witnesses say that they "believe they
are beginning to get an idea" of the true nature of
<span class="pagenum"><a name="Page_76" id="Page_76">76</a></span>
tubercle: and the evidence as to the nature of anthrax,
given by Sir John Simon, reads now like a very old
prophecy:&mdash;</p>

<p class="blockquote">"We are going through a progressive work that has
many stages, and are now getting more precise knowledge
of the contagium. By these experiments on sheep
it has been made quite clear that the contagium of sheep-pox
is <i>something of which the habits can be studied: as the
habits of a fern or a moss can be studied: and we look
forward to opportunities of thus studying the contagium
outside the body which it infects. This is not a thing to
be done in a day, or perhaps in ten years, but must
extend over a long period of time.</i> Dr. Klein's present
paper represents one very important stage of a vast
special study. He gives the identification of the contagium
as <i>something which he has studied to the end in
the infected body, and which can now in a future stage
be studied outside the body</i>."</p>

<p>Thirty years ago, there was no bacteriology, in the
present sense of the word: and now the "habits" of
these "contagia" have been studied, outside and inside
the body, with amazing accuracy. It has been proved,
past all possibility of doubt, that the pathogenic bacteria
are the cause of infective diseases; they have
fulfilled Koch's postulates&mdash;that they should be found
in the diseased tissues, be cultivated outside the body,
reproduce the same disease in animals, and be found
again in the tissues of those animals. By an immeasurable
amount of hard work crowded into a few
years, this New World of bacteriology has been subdued.
The Royal Commissioners of 1875, speaking
of physiological experiments only, said, "It would
require a voluminous treatise to exhibit in a consecutive
statement the benefits that medicine and surgery
<span class="pagenum"><a name="Page_77" id="Page_77">77</a></span>
have derived from these discoveries." If physiology in
1875 required a treatise, bacteriology in 1906 requires
a library: and it is impossible here to give more than
the faintest outline of some of the work that has been
done.</p>

<p>But all pathology is not bacteriology; and it would
take a treatise of prodigious length to set forth the
work of modern pathology in the years before anything
was known of bacteria. The microscopic structure of
tumours and of all forms of malignant disease, the
nature of amyloid, fatty, and other degenerative
changes, and the chief facts of general pathology&mdash;hypertrophy
and atrophy, necrosis, gangrene, embolism,
and many more&mdash;all these subjects were
studied to good purpose, before bacteriology. Above
all, men were occupied in the study of inflammation
under the microscope. It was this use of the microscope
that revolutionised pathology; especially, it made
visible the whole process of inflammation, the most
minute changes in the affected tissues, the slowing and
arrest of the blood in the capillaries, the choking-up
of the stream, and the escape of blood-cells out of the
capillaries into the tissues. Everything had been made
ready for the fuller interpretation that was coming
from bacteriology: the old naked-eye descriptions of
inflammation were left behind; men set aside the
definition of Celsus, that it was <i lang="la" xml:lang="la">rubor et tumor cum
colore et dolore</i>&mdash;words that sound like Molière's jest
about the <i lang="la" xml:lang="la">vis dormitiva</i> of opium&mdash;they watched inflammation
under the microscope, in such transparent
structures as the frog's web and mesentery, the bat's
wing, and the tadpole's tail. It was thus that Wharton
Jones discovered the rhythmical contraction of the
veins in the bat's wing. The discovery of the escape
<span class="pagenum"><a name="Page_78" id="Page_78">78</a></span>
of the white blood-cells, <i lang="la" xml:lang="la">diapedesis</i>, through the walls
of the capillaries, was made by Waller and Cohnheim.
To those who are opposed to all experiments on
animals, it may seem a very small thing that a blood-cell
should be on one side or the other of a microscopic
film in a tadpole's tail; but this <i lang="la" xml:lang="la">diapedesis</i>, the
first move of the blood in its fight against disease, is
now seen, in the light of Metschnikoff's work, as a fact
of very great importance.</p>

<p>The history of this transitional period, from the
study of inflammation in transparent living tissues to
the use, in surgery, of the facts of bacteriology, is told
in Lord Lister's Huxley Lecture, October 1900. He
describes how the foundations were laid in surgical
pathology, by microscopical and experimental work on
inflammation, coagulation, suppuration, and pyæmia,
for bacteriology to build on: how his own share of the
work began when he was house-surgeon to Sir John
Erichsen at University College Hospital, and afterward
to Mr. Syme in Edinburgh, and how it was continued
through all his Edinburgh and Glasgow life:&mdash;</p>

<div class="blockquote">
<p>"After being appointed to the Chair of Surgery in the
University of Glasgow, I became one of the surgeons to
the Royal Infirmary of that city. Here I had, too, ample
opportunities for studying hospital diseases, of which the
most fearful was pyæmia. About this time I saw the
opinion expressed by a high authority in pathology that
the pus in a pyæmic vein was probably a collection of
leucocytes. Facts such as those which I mentioned as
having aroused my interest in my student days in a case
of pyæmia, made such a view to me incredible; and I
determined to ascertain, if possible, the real state of things
by experiment....</p>

<p>"While these investigations into the nature of pyæmia
were proceeding, I was doing my utmost against that
<span class="pagenum"><a name="Page_79" id="Page_79">79</a></span>
deadly scourge. Professor Polli, of Milan, having recommended
the internal administration of sulphite of potash
on account of its antiputrescent properties, I gave that
drug a very full trial as a prophylactic.... At the same
time, I did my best, by local measures, to diminish the
risk of communicating contagion from one wound to
another. I freely employed antiseptic washes, and I had
on the tables of my wards piles of clean towels to be used
for drying my hands and those of my assistants after
washing them, as I insisted should invariably be done in
passing from one dressing to another. But all my efforts
proved abortive; as I could hardly wonder when I believed,
with chemists generally, that putrefaction was
caused by the oxygen of the air.</p>

<p>"It will thus be seen that I was prepared to welcome
Pasteur's demonstration that putrefaction, like other true
fermentations, is caused by microbes growing in the
putrescible substance. Thus was presented a new problem:
not to exclude oxygen from the wounds, which was
impossible, but to protect them from the living causes of
decomposition by means which should act with as little
disturbance of the tissues as is consistent with the attainment
of the essential object.... To apply that principle,
so as to ensure the greatest safety with the least attendant
disadvantage, has been my chief life-work."<a name="FNanchor_12" id="FNanchor_12" href="#Footnote_12" class="fnanchor">[12]</a> </p>
</div>

<p>And, of course, the application of that principle is
not limited to the performance of the major operations
of surgery. It is in daily use in every hospital, and in
every practice all the world over, for the safe and quick
healing of whole legions of injuries, "casualties," and
minor operations.</p>

<p>But what of Semmelweis, and his study of puerperal
fever? Did he not, before Lord Lister, and without
the help of experiments on animals, discover antiseptic
<span class="pagenum"><a name="Page_80" id="Page_80">80</a></span>
surgery? His claim is urged by those who are opposed
to all such experiments. And the answer is, that his
work was lost just for want of experiments on animals.
If he could have demonstrated, as Pasteur did, the living
organism, the thing itself, there in the tissues of an
infected rabbit, and in a test-tube, and under a microscope,
he might have stopped the mouths of his adversaries.
He could not. He could only demonstrate to
them the fact that their patients died, and his patients
lived: and that some sort of direct infection was the
cause of the deaths. The tragedy of his life cannot be
told too often, and may be told again here.<a name="FNanchor_13" id="FNanchor_13" href="#Footnote_13" class="fnanchor">[13]</a>  For want
of the final proof that bacteriology, and the inoculation
of animals, alone could give, he was unable to hold out
against his enemies till Pasteur could rescue him.</p>

<p>In 1846, when he was twenty-three years old, Ignaz
Semmelweis was appointed assistant-professor in the
maternity department of the huge general hospital of
Vienna. For many years, the mortality in the lying-in
wards had been about 1.25 per cent., and no more.
Then, under a new professor, it had risen; and, for
some years before Semmelweis came on the scene, it
had been 5 per cent., or even 7 per cent. In October
1841, there had been an epidemic that had lasted till
May 1843. In these twenty months, out of 5139
women delivered, 829 had died; that is to say, 16
per cent.</p>

<p>There were two sets of wards in the maternity department.
The one set may be called Clinique A, and
the other Clinique B. For many years, the mortality
had been the same in each. In 1841 a change was
<span class="pagenum"><a name="Page_81" id="Page_81">81</a></span>
made: Clinique A was assigned to the teaching of
students, and Clinique B to the teaching of midwives:
and, so soon as this change had been made, the mortality
in Clinique B became less, but the mortality in Clinique A
did not. Commissions of inquiry were held, and in
vain. It was suggested that the foreign students were
somehow to blame, nobody knew why; and many of
them were sent away. Still the deaths went on.
Women admitted to Clinique A would go down on their
knees and pray to be allowed to go home; almost every
day the bell was heard ringing in the wards, for the administration
of the Sacrament to a dying woman. People
talked about atmospheric influences, and overcrowding,
and the tainted air of old wards, and the power of the
mind over the body: and Semmelweis set to work.</p>

<p>He observed that cases of protracted labour in Clinique
A died, almost all of them; but not in Clinique B.
He observed also that cases of premature labour, nearly
all of them, did well, whichever Clinique they were
in; so did those women who were delivered before
they came to the hospital, and were admitted after delivery.
He observed also that a row of patients, lying
side by side, would all be attacked at once in Clinique
A; which never happened in Clinique B. He tried
everything: he altered the details of treatment; he used
various subterfuges to prevent one of the professors
from examining serious cases; he enforced this or that
rule in Clinique A, because it was the custom in Clinique
B; he slaved away at the notes of the cases&mdash;and
at last the truth came to him, by the death of one of
his friends from a dissection-wound. He says, "My
friend's fatal symptoms unveiled to my mind an identity
with those which I had so often noticed at the
deathbeds of puerperal cases." He saw now that the
<span class="pagenum"><a name="Page_82" id="Page_82">82</a></span>
students, coming straight from the dissecting-rooms, had
infected the patients during examination.</p>

<p>In May 1847 he gave orders that every student,
before examining, should thoroughly disinfect his hands.
But, though he had reckoned with dissecting-room
poisons, he had forgotten to reckon with other sources
of infection. In October of that year, a woman was
admitted who had malignant disease; of twelve women
examined after her, eleven got puerperal fever, and died.
In November, a woman was admitted who had a suppurating
knee-joint, with sinuses; and eight women
were infected from her, and died. Therefore Semmelweis
said, "Not only can the particles from dead bodies
generate puerperal fever, but any decomposed material
from the living body can also generate it, and so can
air contaminated by such materials." Henceforth he
isolated all infected cases, he enforced the strict use of
disinfectants: and the mortality in Clinique A, which in
May 1847 had stood at 12.24 per cent., fell in December
to 3.04, and in 1848 was 1.27.</p>

<p>His work was taken up with enthusiasm by Hebra,
Skoda, and Haller; the news of it was sent to every
capital in Europe. In February 1849 Haller read a
paper on it before the Medical Society of Vienna, and
said, "The importance of these observations is above all
calculation, <i>both for the maternity department and for the
hospitals in general, but particularly for the surgical wards</i>."
A committee was nominated to report on the whole
matter; but it was opposed by the professor in charge
of Clinique A, and nothing came of it. In May 1850,
Semmelweis opened a great debate on puerperal fever,
which occupied three sittings of the Vienna Medical
Society. His opponents were there in full force, all the
Scribes and Pharisees of the profession. They brought
<span class="pagenum"><a name="Page_83" id="Page_83">83</a></span>
about a vague distrust of his figures and his facts; they
got people to believe that there must be "something
else" in puerperal fever, as well as the local infection.
Semmelweis began to be discouraged. The University
authorities made a dead set against him&mdash;they refused
to renew his appointment, they got him out of the
hospital, and out of Vienna. He went to Pesth, and
was Professor of Midwifery there; but the same opposition
and hostility were at Pesth as at Vienna. Slowly
he began to lose his hold over himself, went down hill,
became excitable and odd. The end came in July 1865.
At a meeting of University professors, he suddenly took
a paper from his pocket and read aloud to them a solemn
oath, to be enforced on every midwife and every doctor.
His mind had given way: he was moved to an asylum
at Vienna, and died there a few weeks later. He was
only forty-two when he died&mdash;<i>What a wounded name,
Things standing thus unknown, shall live behind me.</i></p>

<p>The contrast between the work of Semmelweis and
the work of Pasteur cuts like a knife here. The failure
of Semmelweis' teaching may be estimated by the fact
that it had all to be done over again. The year of his
success at Vienna was 1848. Eight years later, in the
Paris Maternity Hospital, between 1st April and 10th
May 1856, came such an outbreak of puerperal fever
that out of 347 patients 64 died. In 1864, out of
1350 cases, 310 deaths. In Jan.-Feb. 1866, out of
103 cases, 28 deaths: "Women of the lower classes
looked upon the Maternité as the vestibule of death."
In 1877-78, came the use of carbolic acid and perchloride
of mercury at the hospital, thirty years after Semmelweis'
work: and, about the same time, Pasteur's discovery
of the streptococcus in puerperal fever.<a name="FNanchor_14" id="FNanchor_14" href="#Footnote_14" class="fnanchor">[14]</a>  Pasteur
<span class="pagenum"><a name="Page_84" id="Page_84">84</a></span>
could demonstrate to his opponents the visible cause of
the infection, the thing itself. Roux tells the story:&mdash;</p>

<div class="blockquote">
<p>"Dans le pus des abcès chauds et dans celui des
furoncles on constate un petit organisme arrondi, disposé
en amas, qu'on cultive facilement dans le bouillon. On
le retrouve dans l'ostéomyélite infectieuse des enfants.
Pasteur affirme que l'ostéomyélite et le furoncle sont deux
formes d'une même maladie, et que l'ostéomyélite est le
furoncle de l'os. En 1878, cette assertion a fait rire bien
les chirurgiens.</p>

<p>"Dans les infections puerpérales, les caillots renferment
un microbe à grains arrondis se disposant en files. Cet
aspect en chapelet est surtout manifesté dans les cultures.
Pasteur n'hésite pas à déclarer que cet organisme microscopique
est la cause la plus fréquente des infections chez
les femmes accouchées. Un jour, dans une discussion
sur la fièvre puerpérale à l'Académie de Médicine, un de
ses collégues le plus écoutés dissertait éloquemment sur
les causes des épidémies dans les maternités. Pasteur
l'interrompt de sa place: <i lang="fr" xml:lang="fr">Ce qui cause l'épidémie, ce n'est
rien de tout cela: c'est le médecin et son personnel qui
transportent le microbe d'une femme malade à une femme
saine.</i> Et comme l'orateur répondit qu'il craignait fort
qu'on ne trouve jamais ce microbe, Pasteur s'élance
vers le tableau noir, dessine l'organisme en chapelet
de grains, en disant, <i lang="fr" xml:lang="fr">Tenez, voici sa figure</i>." (Roux,
<cite>L'&OElig;uvre Médicale de Pasteur</cite>. <cite>Agenda du Chimiste</cite>,
1896, p. 528.)</p>
</div>

<p>All suppuration, and all forms of "blood-poisoning"&mdash;abscesses,
boils, carbuncles, erysipelas, puerperal
fever, septicæmia, pyæmia&mdash;are due to minute organisms,
various kinds of <i lang="la" xml:lang="la">micrococcus</i>. It has indeed
been shown that suppuration may, in exceptional
conditions, occur without micro-organisms: but practically
every case of suppuration is a case of infection
either from without or from within the body. There
<span class="pagenum"><a name="Page_85" id="Page_85">85</a></span>
is no room here for any account of the work spent on
these micrococci: on their identification, isolation, culture,
and inoculation. It is the same with all the
pathogenic bacteria&mdash;each kind has its own habits,
phases and idiosyncrasies, antagonisms and preferences:
nothing is left unstudied&mdash;the influences of air, light,
heat, and chemistry; all the facts of their growth,
division, range of variation, grades of virulence, vitality,
and products; the entire life and death of each species,
and everything that it is, and does, and can be made to
do. The difficulties of bacteriology are written across
every page of the text-books: above all, the difficulties
of attenuating or intensifying the virulence of bacteria,
and of immunising animals, and of procuring from them
an immunising serum of exact and constant strength.
Every antitoxin is the outcome of an immeasurable
expenditure of hard international work, unsurpassed
in all science for the fineness of its methods and the
closeness of its arguments.</p>

<p>The older theories of disease had attributed infection
to the intemperature of the weather, the powers of the
air, or the work of the devil; later, men recognised that
there must be a <i lang="la" xml:lang="la">materies morbi</i>, something particulate,
transmissible, and perhaps alive, but it was still a
"nameless something." Therefore, they over-estimated
the constitutional, personal aspect of a case of infective
disease, against the plain evidence of case-to-case infection
or inoculation: they studied with infinite care and
minuteness the weather, the environment, the family
history, the previous illnesses of the patient&mdash;everything,
except the immediate cause of the trouble. But
modern pathology, like Pasteur, says, <i lang="fr" xml:lang="fr">Tenez, voici sa
figure</i>.</p>

<p>The antiseptic method was based on bacteriology,
<span class="pagenum"><a name="Page_86" id="Page_86">86</a></span>
resting as it did on the proof afforded by Pasteur that
putrefaction was caused by bacteria, and not by the
oxygen of the air, as had been previously believed. If
any man would measure one very small part of the lives
that are saved by this method, let him contrast the
treatment of empyema fifty years ago with its treatment
now. If he would measure the saving, not of lives but
of limbs, let him take the treatment of compound fractures.
If he would measure the saving of patients from
pain, fever, and long confinement to bed, let him take
the ordinary run of surgical cases, not only the major
operations but all abscesses, lacerated wounds, foul
sores, and so forth.</p>

<p>A serum has also been used of late years for the
treatment of micrococcus-infection, and has given good
results in many cases. It has been used, also, to
avert the risk of such infection in certain operations
where the antiseptic method cannot be strictly carried
out. For the use of a "polyvalent" serum, reference
may be made to the recent paper by Dr. W. S. Fenwick
and Dr. Parkinson. (<cite>Trans. Roy. Med. Chir. Soc.</cite>, 1906.)
<span class="pagenum"><a name="Page_87" id="Page_87">87</a></span>
</p>


<h3>II<br />
ANTHRAX</h3>


<p>In animals, anthrax is also called <i lang="fr" xml:lang="fr">charbon</i>, splenic fever,
or splenic apoplexy: in man, the name of <i>malignant
pustule</i> is given to the sore at the point of accidental
inoculation, and the name of <i>woolsorter's disease</i> is
given to those cases of anthrax where the lungs are
infected by inhalation of the spores of the <i lang="la" xml:lang="la">bacillus
anthracis</i>. The disease occurs among hide-dressers,
woolsorters, brushmakers, and rag-pickers: among
animals, it occurs in sheep, cattle, horses, and
swine:&mdash;</p>

<p class="blockquote">"Many of the outbreaks of anthrax in England have
been in the neighbourhood of Bradford, and have been
traced to the use of infected wool-refuse as manure. A
map published by the Board of Agriculture shows that
the outbreaks of anthrax are most frequent in those
counties of Great Britain where dry foreign wools, hairs,
hides, and skins are manufactured into goods. In 1892,
there were forty-two outbreaks of anthrax in the West
Riding of Yorkshire, as against two in the North Riding,
and one in the East Riding. An undoubted fact in connection
with anthrax is its tendency to recur on certain
farms. During 1895, the disease reappeared on twenty-three
farms or other premises in England, and six in
Scotland, where it had been reported in the previous
year." (Dr. Poore's Milroy Lectures, <cite>On the Earth
in relation to Contagia</cite>, 1899.)
<span class="pagenum"><a name="Page_88" id="Page_88">88</a></span></p>

<p>An admirable account of the disease, as it occurs in
man, is given by Dr. Hamer and Dr. Bell, in the
valuable series of monographs edited by Dr. Oliver
of Newcastle, under the title <cite>Dangerous Trades</cite> (London,
John Murray, 1902). Happily, the disease is very
rare among men, even among those most exposed to
it. For its treatment in man, an antitoxin has been
used with some success: but the cases are too few
to be of much importance.<a name="FNanchor_15" id="FNanchor_15" href="#Footnote_15" class="fnanchor">[15]</a> </p>

<p>The <i lang="la" xml:lang="la">bacillus anthracis</i> was first seen more than fifty
years ago: "Anthrax has the distinction of being the
first infectious disease the bacterial nature of which
was definitely proven."<a name="FNanchor_16" id="FNanchor_16" href="#Footnote_16" class="fnanchor">[16]</a>  Pollender in 1844, Roger
and Davaine in 1850, noted the <i lang="fr" xml:lang="fr">petits bâtonnets</i> in the
blood of sheep dead of the disease, and thought they
were some sort of microscopic blood-crystals: it was
not till 1863, after Pasteur's study of lactic-acid fermentation,
that Davaine realised they were living
organisms. Afterward, Koch succeeded in making
cultures of them, and reproduced the disease by inoculating
animals with these cultures; yet it was
said, so late as 1876, that the <i lang="la" xml:lang="la">bacillus anthracis</i>
was not the cause of anthrax, but only the sign of
it: "Along with the bacilli, there are blood-cells and
blood-plasma, and these contain the true amorphous
virus of anthrax." Then came Pasteur's work, and
reached its end in the experiments at Chartres, and
the famous test-inoculations (1881) at Pouilly-le-Fort.
<span class="pagenum"><a name="Page_89" id="Page_89">89</a></span></p>

<p>In the <cite>Agenda du Chimiste</cite> (1896) M. Roux gives
the following account of this work, which he watched
from first to last:&mdash;</p>

<div class="blockquote">
<p>"Vaccination against <i lang="fr" xml:lang="fr">charbon</i> has now been put to
the test of practice for fourteen years. Wherever it
is adopted, there the losses from <i lang="fr" xml:lang="fr">charbon</i> have become
insignificant. It was followed by vaccination against
swine-measles, <i lang="fr" xml:lang="fr">rouget des porcs</i>, the special study of
our poor friend Thuillier. But the immediate result
of Pasteur's vaccinations is their least merit: they
have given men absolute faith in a science that could
show such good works, they have started a movement
that is irresistible; above all, they have set going the
whole study of immunity, which is bringing us at last
to a right way of treating infective diseases.</p>

<p>"Virulence is a quality that microbes can lose, or can
acquire. Suppose we came across the anthrax-bacillus
so far attenuated, in the way of Nature, that it had
lost all power to kill&mdash;of course we should fail to recognise
it; we should take it for an ordinary bacillus of
putrefaction: you must watch it through each phase of
its attenuation, to know that the harmless organism is
the descendant of the fatal virus. But you can give
back to it the virulence that it has lost, if you put it, to
begin with, under the skin of a very delicate subject, a
mouse only one day old. With the blood of this mouse
inoculate another, a little older, and it will die. Passing
by this method from younger to older mice, we come to
kill adult mice, guinea-pigs, then rabbits, then sheep, etc.
Thus, by transmission, the virus gains strength as it goes.
Doubtless this increase of virulence, that we bring about
by experiment, occurs also in Nature; and it is easy to
see how a microbe, usually harmless to this or that
species of animals, might become deadly to it. Is not
this the way that infective diseases have appeared on the
earth from age to age?</p>

<p>"<i>See how far we have come, from the old metaphysical
<span class="pagenum"><a name="Page_90" id="Page_90">90</a></span>
ideas about virulence, to these microbes that we can turn
this way or that way&mdash;stuff so plastic that a man can
work on it, and fashion it as he likes.</i>"</p>
</div>

<p>Pasteur's note on the attenuation of anthrax was
presented to the Académie des Sciences on 28th
February 1881; and the test-inoculations at Pouilly-le-Fort
were made in May of that year. It was hardly
to be expected that every country, in every year, should
obtain such results as France now takes as a matter of
course; and at one time, about twenty-one years ago,
there was in Hungary a "conscientious objection" to
the inoculation of herds against the disease. But in
Italy, from 1st May 1897 to 30th April 1898, the
issue of anti-charbon vaccine from one institute alone,
the Sero-Therapeutic Institute at Milan, was 165,000
tubes, enough to inoculate 33,734 cattle and 98,792
sheep. And in France, between 1882 and 1893, more
than three million sheep, and nearly half a million
cattle, were inoculated.</p>

<p>The work done in France was published by M.
Chamberland, in the <cite>Annales de L'Institut Pasteur</cite>,
March 1894. The following translation of his memoir&mdash;<i lang="fr" xml:lang="fr">Résultats
pratiques des Vaccinations contre le Charbon
et le Rouget en France</i>&mdash;shows something of the
national influence of the Pasteur Institute:&mdash;</p>


<h4>1. <i lang="fr" xml:lang="fr">Charbon</i></h4>

<p>"After the famous experiments at Pouilly-le-Fort,
MM. Pasteur and Roux entrusted to me the whole
method and practice of the vaccinations against <i lang="fr" xml:lang="fr">charbon</i>.
Twelve years have passed, and it is now time to put
<span class="pagenum"><a name="Page_91" id="Page_91">91</a></span>
together the results, and to make a final estimate of
the value of these preventive inoculations.</p>

<p>"Every year we ask the veterinary surgeons to
report&mdash;</p>

<p>1. The number of animals they have vaccinated.</p>

<p>2. The number that have died after the first vaccination.</p>

<p>3. The number that have died after the second vaccination,
within the twelve days following it.</p>

<p>4. The number that have died during the rest of
the year.</p>

<p>5. The average annual mortality before the practice
of vaccination.</p>

<p>"The sum total of all the reports is given in the
following tables:&mdash;</p>

<p class="title2"><span class="smcap">Vaccination against Charbon (France).</span><br />
<i>Sheep.</i></p>

<table class="fsize70" border="0" cellpadding="0" cellspacing="2" summary="vaccination charbon sheep">
<tr>
  <th rowspan="2" class="bbox">Years.</th>
  <th rowspan="2" class="bh2">Total<br />Number of<br />Animals<br />Vaccinated.</th>
  <th rowspan="2" class="bh2">Number<br />of<br />Reports.</th>
  <th rowspan="2" class="bh2">Animals<br />Vaccinated<br />according<br />to Reports<br />received.</th>
  <th colspan="3" class="bh2">Mortality.</th>
  <th rowspan="2" class="bh2">Total.</th>
  <th rowspan="2" class="bh2">Total<br />loss<br />per<br />100.</th>
  <th rowspan="2" class="bh2">Average<br />loss<br />before<br />Vacci-<br />nation.</th>
</tr>
<tr>
  <th class="bmc">After<br />First<br />Vacci-<br />nation.</th>
  <th class="bmc">After<br />Second<br />Vacci-<br />nation.</th>
  <th class="bmc">During<br />the rest<br />of the<br />Year.</th>
</tr>
<tr>
  <td class="bvert tdc">1882</td>
  <td class="bright tdc">270,040</td>
  <td class="bright tdc">112</td>
  <td class="bright tdc">243,199</td>
  <td class="bright tdc">756</td>
  <td class="bright tdc">847</td>
  <td class="bright tdc">1,037</td>
  <td class="bright tdc">2,640</td>
  <td class="bright tdc">1.08</td>
  <td class="bright tdc">10%</td>
</tr>
<tr>
  <td class="bvert tdc">1883</td>
  <td class="bright tdc">268,505</td>
  <td class="bright tdc">103</td>
  <td class="bright tdc">193,119</td>
  <td class="bright tdc">436</td>
  <td class="bright tdc">272</td>
  <td class="bright i1">&nbsp;784</td>
  <td class="bright tdc">1,492</td>
  <td class="bright tdc">0.77</td>
  <td class="bright tdc">"</td>
</tr>
<tr>
  <td class="bvert tdc">1884</td>
  <td class="bright tdc">316,553</td>
  <td class="bright tdc">109</td>
  <td class="bright tdc">231,693</td>
  <td class="bright tdc">770</td>
  <td class="bright tdc">444</td>
  <td class="bright tdc">1,033</td>
  <td class="bright tdc">2,247</td>
  <td class="bright tdc">0.97</td>
  <td class="bright tdc">"</td>
</tr>
<tr>
  <td class="bvert tdc">1885</td>
  <td class="bright tdc">342,040</td>
  <td class="bright tdc">144</td>
  <td class="bright tdc">280,107</td>
  <td class="bright tdc">884</td>
  <td class="bright tdc">735</td>
  <td class="bright i1">&nbsp;990</td>
  <td class="bright tdc">2,609</td>
  <td class="bright tdc">0.93</td>
  <td class="bright tdc">"</td>
</tr>
<tr>
  <td class="bvert tdc">1886</td>
  <td class="bright tdc">313,288</td>
  <td class="bright i2">88</td>
  <td class="bright tdc">202,064</td>
  <td class="bright tdc">652</td>
  <td class="bright tdc">303</td>
  <td class="bright i1">&nbsp;514</td>
  <td class="bright tdc">1,469</td>
  <td class="bright tdc">0.72</td>
  <td class="bright tdc">"</td>
</tr>
<tr>
  <td class="bvert tdc">1887</td>
  <td class="bright tdc">293,572</td>
  <td class="bright tdc">107</td>
  <td class="bright tdc">187,811</td>
  <td class="bright tdc">718</td>
  <td class="bright tdc">737</td>
  <td class="bright i1">&nbsp;968</td>
  <td class="bright tdc">2,423</td>
  <td class="bright tdc">1.29</td>
  <td class="bright tdc">"</td>
</tr>
<tr>
  <td class="bvert tdc">1888</td>
  <td class="bright tdc">269,574</td>
  <td class="bright tdc">&nbsp;50</td>
  <td class="bright tdc">101,834</td>
  <td class="bright tdc">149</td>
  <td class="bright tdc">181</td>
  <td class="bright i1">&nbsp;300</td>
  <td class="bright i1h">&nbsp;630</td>
  <td class="bright tdc">0.62</td>
  <td class="bright tdc">"</td>
</tr>
<tr>
  <td class="bvert tdc">1889</td>
  <td class="bright tdc">239,974</td>
  <td class="bright i2">43</td>
  <td class="bright tdc">88,483</td>
  <td class="bright tdc">238</td>
  <td class="bright tdc">285</td>
  <td class="bright i1">&nbsp;501</td>
  <td class="bright tdc">1,024</td>
  <td class="bright tdc">1.16</td>
  <td class="bright tdc">"</td>
</tr>
<tr>
  <td class="bvert tdc">1890</td>
  <td class="bright tdc">223,611</td>
  <td class="bright i2">69</td>
  <td class="bright tdc">69,865</td>
  <td class="bright tdc">331</td>
  <td class="bright tdc">261</td>
  <td class="bright i1">&nbsp;244</td>
  <td class="bright i1h">&nbsp;836</td>
  <td class="bright tdc">1.20</td>
  <td class="bright tdc">"</td>
</tr>
<tr>
  <td class="bvert tdc">1891</td>
  <td class="bright tdc">218,629</td>
  <td class="bright i2">65</td>
  <td class="bright tdc">53,640</td>
  <td class="bright tdc">181</td>
  <td class="bright tdc">102</td>
  <td class="bright i1h">&nbsp;77</td>
  <td class="bright i1h">&nbsp;360</td>
  <td class="bright tdc">0.67</td>
  <td class="bright tdc">"</td>
</tr>
<tr>
  <td class="bvert tdc">1892</td>
  <td class="bright tdc">259,696</td>
  <td class="bright i2">70</td>
  <td class="bright tdc">63,125</td>
  <td class="bright tdc">319</td>
  <td class="bright tdc">183</td>
  <td class="bright i1">&nbsp;126</td>
  <td class="bright i1h">&nbsp;628</td>
  <td class="bright tdc">0.99</td>
  <td class="bright tdc">"</td>
</tr>
<tr>
  <td class="bvert tdc">1893</td>
  <td class="bright tdc">281,333</td>
  <td class="bright i2">30</td>
  <td class="bright tdc">73,939</td>
  <td class="bright tdc">234</td>
  <td class="bright i1h">56</td>
  <td class="bright i1">&nbsp;224</td>
  <td class="bright i1h">&nbsp;514</td>
  <td class="bright tdc">0.69</td>
  <td class="bright tdc">"</td>
</tr>
<tr>
  <td class="bbox">&nbsp;Total</td>
  <td class="bh2">3,296,815&ensp;&nbsp;</td>
  <td class="bh2 i1">990</td>
  <td class="bh2">1,788,879&emsp;</td>
  <td class="bh2">5,668&ensp;</td>
  <td class="bh2">4,406&ensp;</td>
  <td class="bh2">6,798&nbsp;</td>
  <td class="bh2">16,872&ensp;</td>
  <td class="bh2">&nbsp;0.94</td>
  <td class="bh2 i1">10%<span class="pagenum"><a name="Page_92" id="Page_92">92</a></span></td>
</tr>
</table>

<p class="title2"><span class="smcap">Vaccination against Charbon (France).</span><br />
<i>Cattle.</i></p>

<table class="fsize70" border="0" cellpadding="0" cellspacing="2" summary="vaccination charbon cattle">
<tr>
  <th rowspan="2" class="bbox">Years.</th>
  <th rowspan="2" class="bh2">Total<br />Number of<br />Animals<br />Vaccinated.</th>
  <th rowspan="2" class="bh2">Number<br />of<br />Reports.</th>
  <th rowspan="2" class="bh2">Animals<br />Vaccinated<br />according<br />to Reports<br />received.</th>
  <th colspan="3" class="bh2">Mortality.</th>
  <th rowspan="2" class="bh2">Total.</th>
  <th rowspan="2" class="bh2">Total<br />loss<br />per<br />100.</th>
  <th rowspan="2" class="bh2">Average<br />loss<br />before<br />Vacci-<br />nation.</th>
</tr>
<tr>
  <th class="bmc">After<br />First<br />Vacci-<br />nation.</th>
  <th class="bmc">After<br />Second<br />Vacci-<br />nation.</th>
  <th class="bmc">During<br />the rest<br />of the<br />Year.</th>
</tr>
<tr>
  <td class="bvert tdc">1882</td>
  <td class="bright tdc">35,564</td>
  <td class="bright tdc">127</td>
  <td class="bright tdc">22,916</td>
  <td class="bright tdc">22</td>
  <td class="bright tdc">12</td>
  <td class="bright tdc">48</td>
  <td class="bright tdc i0h">82</td>
  <td class="bright tdc">0.35</td>
  <td class="bright tdc">5%</td>
</tr>
<tr>
  <td class="bvert tdc">1883</td>
  <td class="bright tdc">26,453</td>
  <td class="bright tdc">130</td>
  <td class="bright tdc">20,501</td>
  <td class="bright tdc">17</td>
  <td class="bright tdc i0h">1</td>
  <td class="bright tdc">46</td>
  <td class="bright tdc i0h">64</td>
  <td class="bright tdc">0.31</td>
  <td class="bright tdc">"</td>
</tr>
<tr>
  <td class="bvert tdc">1884</td>
  <td class="bright tdc">33,900</td>
  <td class="bright tdc">139</td>
  <td class="bright tdc">22,616</td>
  <td class="bright tdc">20</td>
  <td class="bright tdc">13</td>
  <td class="bright tdc">52</td>
  <td class="bright tdc i0h">85</td>
  <td class="bright tdc">0.37</td>
  <td class="bright tdc">"</td>
</tr>
<tr>
  <td class="bvert tdc">1885</td>
  <td class="bright tdc">34,000</td>
  <td class="bright tdc">192</td>
  <td class="bright tdc">21,073</td>
  <td class="bright tdc">32</td>
  <td class="bright tdc i0h">8</td>
  <td class="bright tdc">67</td>
  <td class="bright tdc">107</td>
  <td class="bright tdc">0.50</td>
  <td class="bright tdc">"</td>
</tr>
<tr>
  <td class="bvert tdc">1886</td>
  <td class="bright tdc">39,154</td>
  <td class="bright tdc">135</td>
  <td class="bright tdc">22,113</td>
  <td class="bright tdc">18</td>
  <td class="bright tdc i0h">7</td>
  <td class="bright tdc">39</td>
  <td class="bright tdc i0h">64</td>
  <td class="bright tdc">0.29</td>
  <td class="bright tdc">"</td>
</tr>
<tr>
  <td class="bvert tdc">1887</td>
  <td class="bright tdc">48,484</td>
  <td class="bright tdc">148</td>
  <td class="bright tdc">28,083</td>
  <td class="bright tdc">23</td>
  <td class="bright tdc">18</td>
  <td class="bright tdc">68</td>
  <td class="bright tdc">109</td>
  <td class="bright tdc">0.39</td>
  <td class="bright tdc">"</td>
</tr>
<tr>
  <td class="bvert tdc">1888</td>
  <td class="bright tdc">34,464</td>
  <td class="bright tdc i0h">61</td>
  <td class="bright tdc">10,920</td>
  <td class="bright tdc i0h">8</td>
  <td class="bright tdc i0h">4</td>
  <td class="bright tdc">35</td>
  <td class="bright tdc i0h">47</td>
  <td class="bright tdc">0.43</td>
  <td class="bright tdc">"</td>
</tr>
<tr>
  <td class="bvert tdc">1889</td>
  <td class="bright tdc">32,251</td>
  <td class="bright tdc i0h">68</td>
  <td class="bright tdc">11,610</td>
  <td class="bright tdc">14</td>
  <td class="bright tdc i0h">7</td>
  <td class="bright tdc">31</td>
  <td class="bright tdc i0h">52</td>
  <td class="bright tdc">0.45</td>
  <td class="bright tdc">"</td>
</tr>
<tr>
  <td class="bvert tdc">1890</td>
  <td class="bright tdc">33,965</td>
  <td class="bright tdc i0h">71</td>
  <td class="bright tdc">11,057</td>
  <td class="bright tdc i0h">5</td>
  <td class="bright tdc i0h">4</td>
  <td class="bright tdc">14</td>
  <td class="bright tdc i0h">23</td>
  <td class="bright tdc">0.21</td>
  <td class="bright tdc">"</td>
</tr>
<tr>
  <td class="bvert tdc">1891</td>
  <td class="bright tdc">40,736</td>
  <td class="bright tdc i0h">68</td>
  <td class="bright tdc">10,476</td>
  <td class="bright tdc i0h">6</td>
  <td class="bright tdc i0h">4</td>
  <td class="bright tdc i0h">4</td>
  <td class="bright tdc i0h">14</td>
  <td class="bright tdc">0.13</td>
  <td class="bright tdc">"</td>
</tr>
<tr>
  <td class="bvert tdc">1892</td>
  <td class="bright tdc">41,609</td>
  <td class="bright tdc i0h">71</td>
  <td class="bright tdc">9,757</td>
  <td class="bright tdc i0h">8</td>
  <td class="bright tdc i0h">3</td>
  <td class="bright tdc">15</td>
  <td class="bright tdc i0h">26</td>
  <td class="bright tdc">0.26</td>
  <td class="bright tdc">"</td>
</tr>
<tr>
  <td class="bvert tdc">1893</td>
  <td class="bright tdc">38,154</td>
  <td class="bright tdc i0h">45</td>
  <td class="bright tdc">9,840</td>
  <td class="bright tdc i0h">4</td>
  <td class="bright tdc i0h">1</td>
  <td class="bright tdc">13</td>
  <td class="bright tdc i0h">18</td>
  <td class="bright tdc">0.18</td>
  <td class="bright tdc">"</td>
</tr>
<tr>
  <td class="bbox">&nbsp;Total</td>
  <td class="bh2 i0h">438,824</td>
  <td class="bh2 i0h">1,255&nbsp;</td>
  <td class="bh2">&nbsp;200,962</td>
  <td class="bh2">177</td>
  <td class="bh2 i0h">82</td>
  <td class="bh2">&nbsp;432</td>
  <td class="bh2 i0h">691</td>
  <td class="bh2">&nbsp;0.34</td>
  <td class="bh2 i1">5%</td>
</tr>
</table>

<p>"Comparing the figures in the fourth column with
those in the second, we see that a certain number of
veterinary surgeons neglect to send their reports at the
end of the year. The number of reports that come to
us even tends to get less each year. The fact is, that
many veterinary surgeons who do vaccinations every
year content themselves with writing, 'The results are
always very good; it is useless to send you reports
that are always the same.'</p>

<p>"We have every reason to believe, as a matter of
fact, that those who send no reports are satisfied; for
if anything goes wrong with the herds, they do not fail
to let us know it at once by special letters.</p>

<p>"Anyhow, thanks chiefly to new veterinary surgeons
who do send reports, we see that in the twelve years,
<span class="pagenum"><a name="Page_93" id="Page_93">93</a></span>
up to 1st January of this year, we have had exact returns
as to 1,788,879 sheep and 200,962 cattle&mdash;about
half of all those that were vaccinated.</p>

<p>"The mortality among sheep and cattle is slightly
higher after the first vaccination than after the second.
This fact seems to us easy to explain. The animals
reported dead include both those that died as the result
of the vaccinations, and those that, being already infected
at the time, died of the actual disease. But, at the
time of second vaccination, the animals are already more
or less protected: hence a lower mortality from the
actual disease, and a lower sum total.</p>

<p>"The whole loss of sheep is about 1 per cent.: the
average for the twelve years is 0.94. So we may say
that <i>the whole average loss of vaccinated sheep, whether
from vaccination or from the disease itself is about 1 per
cent</i>. The loss of vaccinated cattle is still less: for
the period of twelve years, it is 0.34, or about 1/3 per
cent.</p>

<p>"These results are extremely satisfactory. It is to
be noted especially that the average annual death-rate
from <i lang="fr" xml:lang="fr">charbon</i>, before vaccination&mdash;the average given in
these reports&mdash;is estimated at 10 per cent. among
sheep, and 5 per cent. among cattle. But even if we
put it at 6 per cent. for sheep, and 3-1/3 per cent. for
cattle, and say that the worth of a sheep is 30 francs,
and of an ox or a cow 150 francs&mdash;which is well below
their real value&mdash;even then it is obvious that the advantage
of these vaccinations to French agriculture is
about five million francs in sheep, and two million in
cattle. And these figures are rather too low than too
high.
<span class="pagenum"><a name="Page_94" id="Page_94">94</a></span></p>

<h4>2. <i lang="fr" xml:lang="fr">Rouget</i></h4>

<p>"Some years after the discovery of vaccination
against <i lang="fr" xml:lang="fr">charbon</i>, M. Pasteur discovered the vaccine for
a disease of swine known under the name of <i lang="fr" xml:lang="fr">rouget</i>.
From 1886, these vaccines were prepared and sent out
under the same conditions as the vaccines against <i lang="fr" xml:lang="fr">charbon</i>.
The following table gives the reports that have
come to us of this disease:<a name="FNanchor_17" id="FNanchor_17" href="#Footnote_17" class="fnanchor">[17]</a> &mdash;</p>

<p class="title2"><span class="smcap">Vaccination against Rouget (France).</span></p>

<table class="fsize73" border="0" cellpadding="0" cellspacing="2" summary="vaccination rouget">
<tr>
  <th rowspan="2" class="bbox">Years.</th>
  <th rowspan="2" colspan="2" class="bh2">Total<br />Number of<br />Animals<br />Vaccinated.</th>
  <th rowspan="2" class="bh2">Number<br />of<br />Reports.</th>
  <th rowspan="2" class="bh2">Animals<br />Vaccinated<br />according<br />to Reports<br />received.</th>
  <th colspan="3" class="bh2">Mortality.</th>
  <th rowspan="2" class="bh2">Total.</th>
  <th rowspan="2" class="bh2">Total<br />loss<br />per<br />100.</th>
  <th rowspan="2" class="bh2">Average<br />loss<br />before<br />Vacci-<br />nation.</th>
</tr>
<tr>
  <th class="bmc">After<br />First<br />Vacci-<br />nation.</th>
  <th class="bmc">After<br />Second<br />Vacci-<br />nation.</th>
  <th class="bmc">During<br />the rest<br />of the<br />Year.</th>
</tr>
<tr>
  <td class="bvert">&nbsp;</td>
  <td rowspan="6" class="cbrace">{</td>
  <td class="bright">&nbsp;</td>
  <td class="bright">&nbsp;</td>
  <td class="bright">&nbsp;</td>
  <td class="bright">&nbsp;</td>
  <td class="bright">&nbsp;</td>
  <td class="bright">&nbsp;</td>
  <td class="bright">&nbsp;</td>
  <td class="bright">&nbsp;</td>
  <td class="bright">&nbsp;</td>
</tr>
<tr>
  <td class="bvert">&nbsp;</td>
  <td class="bright tdc">For these<br />two years</td>
  <td class="bright">&nbsp;</td>
  <td class="bright">&nbsp;</td>
  <td class="bright">&nbsp;</td>
  <td class="bright">&nbsp;</td>
  <td class="bright">&nbsp;</td>
  <td class="bright">&nbsp;</td>
  <td class="bright">&nbsp;</td>
  <td class="bright">&nbsp;</td>
</tr>
<tr>
  <td class="bvert tdc">1886</td>
  <td class="bright tdc">France</td>
  <td class="bright tdc">49</td>
  <td class="bright tdc">7,087</td>
  <td class="bright tdc  i0h">91</td>
  <td class="bright tdc">24</td>
  <td class="bright tdc">56</td>
  <td class="bright tdc">171</td>
  <td class="bright tdc">2.41</td>
  <td class="bright tdc">20%</td>
</tr>
<tr>
  <td class="bvert">&nbsp;</td>
  <td class="bright tdc">and other<br />countries</td>
  <td class="bright">&nbsp;</td>
  <td class="bright">&nbsp;</td>
  <td class="bright">&nbsp;</td>
  <td class="bright">&nbsp;</td>
  <td class="bright">&nbsp;</td>
  <td class="bright">&nbsp;</td>
  <td class="bright">&nbsp;</td>
  <td class="bright">&nbsp;</td>
</tr>
<tr>
  <td class="bvert tdc">1887</td>
  <td class="bright tdc">are put</td>
  <td class="bright tdc">49</td>
  <td class="bright tdc">7,467</td>
  <td class="bright tdc i0h">57</td>
  <td class="bright tdc">10</td>
  <td class="bright tdc">23</td>
  <td class="bright tdc i0h">90</td>
  <td class="bright tdc">1.21</td>
  <td class="bright tdc">"</td>
</tr>
<tr>
  <td class="bvert">&nbsp;</td>
  <td  class="bright tdc">together.</td>
  <td  class="bright">&nbsp;</td>
  <td  class="bright">&nbsp;</td>
  <td  class="bright">&nbsp;</td>
  <td  class="bright">&nbsp;</td>
  <td  class="bright">&nbsp;</td>
  <td  class="bright">&nbsp;</td>
  <td  class="bright">&nbsp;</td>
  <td  class="bright">&nbsp;</td>
</tr>
<tr>
  <td class="bvert tdc">1888</td>
  <td>&nbsp;</td>
  <td  class="bright tdc">15,958</td>
  <td  class="bright tdc">31</td>
  <td  class="bright tdc">6,968</td>
  <td  class="bright tdc i0h">31</td>
  <td  class="bright tdc">25</td>
  <td  class="bright tdc">38</td>
  <td  class="bright tdc i0h">94</td>
  <td  class="bright tdc">1.35</td>
  <td  class="bright tdc">"</td>
</tr>
<tr>
  <td class="bvert tdc">1889</td>
  <td>&nbsp;</td>
  <td  class="bright tdc">19,338</td>
  <td  class="bright tdc">41</td>
  <td  class="bright tdc">11,257</td>
  <td  class="bright tdc">92</td>
  <td  class="bright tdc">12</td>
  <td  class="bright tdc">40</td>
  <td  class="bright tdc">144</td>
  <td  class="bright tdc">1.28</td>
  <td  class="bright tdc">"</td>
</tr>
<tr>
  <td class="bvert tdc">1890</td>
  <td>&nbsp;</td>
  <td  class="bright tdc">17,658</td>
  <td  class="bright tdc">41</td>
  <td  class="bright tdc">14,992</td>
  <td  class="bright tdc">118</td>
  <td  class="bright tdc">64</td>
  <td  class="bright tdc">73</td>
  <td  class="bright tdc">254</td>
  <td  class="bright tdc">1.70</td>
  <td  class="bright tdc">"</td>
</tr>
<tr>
  <td class="bvert tdc">1891</td>
  <td>&nbsp;</td>
  <td  class="bright tdc">20,583</td>
  <td  class="bright tdc">47</td>
  <td  class="bright tdc">17,556</td>
  <td  class="bright tdc">102</td>
  <td  class="bright tdc">34</td>
  <td  class="bright tdc">70</td>
  <td  class="bright tdc">206</td>
  <td  class="bright tdc">1.17</td>
  <td  class="bright tdc">"</td>
</tr>
<tr>
  <td class="bvert tdc">1892</td>
  <td>&nbsp;</td>
  <td  class="bright tdc">37,900</td>
  <td  class="bright tdc">38</td>
  <td  class="bright tdc">10,128</td>
  <td  class="bright tdc i0h">43</td>
  <td  class="bright tdc">19</td>
  <td  class="bright tdc">46</td>
  <td  class="bright tdc">108</td>
  <td  class="bright tdc">1.07</td>
  <td  class="bright tdc">"</td>
</tr>
<tr>
  <td class="bbox tdc">Total</td>
  <td class="bhort">&nbsp;</td>
  <td class="bh2">111,437&ensp;</td>
  <td class="bh2 i0h">&nbsp;&nbsp;296</td>
  <td class="bh2 i1">75,455</td>
  <td class="bh2 i0f">534</td>
  <td class="bh2">188</td>
  <td class="bh2">345</td>
  <td class="bh2">1,067&ensp;</td>
  <td class="bh2 i0f">1.45</td>
  <td class="bh2 tdc">20%</td>
</tr>
</table>

<p>"<i>The total average of losses during the past seven years
is 1.45 per cent., or about 1-1/2 per cent.</i></p>

<p>"This average is appreciably higher than the average
for <i lang="fr" xml:lang="fr">charbon</i>. But it must be noted that the mortality
<span class="pagenum"><a name="Page_95" id="Page_95">95</a></span>
from <i lang="fr" xml:lang="fr">rouget</i> among swine, before vaccination, was much
higher than that from <i lang="fr" xml:lang="fr">charbon</i> among sheep. It was
about 20 per cent.; a certain number of reports speak
of losses of 60 and even 80 per cent.: so that almost
all the veterinary surgeons are loud in their praises of
the new vaccination."</p>

<p>The rest of M. Chamberland's paper is concerned
with the defects, such as they are, of the vaccinations,
and the need of absolute cleanliness in the making of
them: which is somewhat difficult for this vast number
of vaccinations of animals all over France, and in other
parts of the world. The whole story of the discovery
is told in M. Valléry-Radot's Life of Pasteur: and the
whole story of <i lang="fr" xml:lang="fr">rouget</i>, in the same most fascinating book,
vol. ii., p. 180.
<span class="pagenum"><a name="Page_96" id="Page_96">96</a></span></p>

<h3>III<br />
TUBERCLE</h3>

<p>Before Laennec, tubercle had been taken for a
degenerative change of the tissues, much like other
forms of degeneration. It was Laennec who brought
men to see that it is a disease of itself, different from
anything else; and this great discovery of the specific
nature of tubercle, and his invention of the stethoscope,
place him almost level with Harvey. He founded the
facts of tubercle, and on that foundation Villemin built.
In 1865, Villemin communicated to the Académie des
Sciences his discovery that tubercle is an infective
disease; that he had produced it in rabbits, by inoculating
them with tuberculous matter. <i lang="fr" xml:lang="fr">En voici les
preuves</i>, he said. He appealed to these inoculations to
prove his teaching:&mdash;</p>

<p class="blockquote"><i lang="fr" xml:lang="fr">La tuberculose est une affection spécifique.
Sa cause réside dans un agent inoculable.
L'inoculation se fait très-bien de l'homme au lapin.
La tuberculose appartient donc à la classe des maladies
virulentes.</i></p>

<p>It was no new thing to say, or to guess, that phthisis
was or might be infective. So far back as 1500,
Frascatorius had said that phthisis came "by the gliding
of the corrupt and noisome humours of the patient
into the lungs of a healthy man." Surely, if clinical
<span class="pagenum"><a name="Page_97" id="Page_97">97</a></span>
experience could suffice, men would have made something
out of this wisdom of Frascatorius. They made
nothing of it; they waited three hundred years for
Villemin to inoculate the rabbits, and then the thing was
done&mdash;<i lang="fr" xml:lang="fr">En voici les preuves</i>. Three years later, Chauveau
produced the disease in animals, not by inoculation, but
by the admixture of tuberculous matter with their food.
Then, as the work grew, there came a short period of
uncertainty: different species of animals are so widely
different in their susceptibility to the disease that the
results of further inoculations seemed to go against
Villemin; and it was not till 1880 that Cohnheim finally
established Villemin's teaching, and even went beyond it,
making inoculation the very proof of tubercle:&mdash;</p>

<p class="blockquote">"Everything is tuberculous, that can produce tuberculous
disease by inoculation in animals that are susceptible
to that disease: and nothing is tuberculous, that cannot
do this."</p>

<p>Then, in 1881, came the welcome news that Koch
had discovered the bacillus of tubercle. In his first
published account of it (24th March 1882) he says:&mdash;</p>

<p class="blockquote">"Henceforth, in our warfare against this fearful scourge
of our race, we have to reckon not with a nameless
something, but with a definite parasite, whose conditions
of life are for the most part already known, and can be
further studied.... Before all things, we must shut off
the sources of the infection, so far as it is in the power of
man to do this."<a name="FNanchor_18" id="FNanchor_18" href="#Footnote_18" class="fnanchor">[18]</a>
<span class="pagenum"><a name="Page_98" id="Page_98">98</a></span></p>

<p>In November 1890 he announced, in the <cite>Deutsche
Medizinische Wochenschrift</cite>, the discovery of tuberculin.
Its failure was one of the world's tragedies. The
defeat may not be final, and we may live to see phthisis
fought and beaten with its own weapons: but, for the
present, it is more to the purpose to consider what
other benefits have been gained, from the discovery of
the tubercle-bacillus in 1881, in every civilised country
in the world.</p>

<p>1. It has given to everybody a more reasonable and
hopeful view of phthisis and the diseases allied to it.
The older doctrine of heredity, that the child inherits
the disease itself, has given way to the doctrine that
the inheritance, in the vast majority of cases, is not
that of the disease itself, but that of a tendency or
increased susceptibility to the disease.</p>

<p>2. It has brought about an immense improvement in
the early and accurate diagnosis of all cases. The
bacillus found in the sputa, or in the discharges, or in a
particle of tissue, is evidence that the case is tuberculous.</p>

<p>3. It has given evidence, which till 1901 was hardly
called in question,<a name="FNanchor_19" id="FNanchor_19" href="#Footnote_19" class="fnanchor">[19]</a>  that <i lang="la" xml:lang="la">tabes mesenterica</i>, a tuberculous
disease which kills thousands of children every year, is
due in many cases to infection from the milk of tuberculous
cows. In England alone, in 1895, the number
of children who died of this disease was 7389, of
whom 3855 were under one year old.</p>

<p>4. It has proved, and has taught everybody to see
<span class="pagenum"><a name="Page_99" id="Page_99">99</a></span>
the proof, that the sputa of phthisical patients are the
chief cause of the dissemination of the disease. By
insisting on this fact, it has profoundly influenced the
nursing and the home-care of phthisical patients; and
it has begun to influence public opinion in favour of
some sort of notification of the disease, and in favour
of enforcing a law against spitting in public places and
conveyances. In some of the principal cities of the
United States, laws on this subject have already been
enacted.</p>

<p>5. It has greatly helped to bring about the present
rigorous control of the meat and milk trades. The
following paragraph, taken almost at random, will
suffice here:&mdash;</p>

<p class="blockquote">"Bacteriological examinations during the past year
have shown that more milks are tuberculosis-infected
than is generally supposed, and the importance of
carefully supervising milk supplies is becoming more and
more acknowledged. Veterinary surgeons are practically
agreed that tuberculin is a reliable and safe test for
diagnosing the presence of tuberculosis in animals, but
affords no index of the extent or degree of the disease.
The test, however, will not produce tuberculosis in
healthy animals, and has no deleterious effect upon the
general health of the animals. The London County
Council have decided that all cows in London cowsheds
shall be inspected by a veterinary surgeon regularly once
in every three months, and that a systematic bacteriological
examination shall be conducted of milks collected
from purveyors." (<cite>Medical Annual</cite>, 1901.)</p>

<p>6. Tuberculin has come into general use for the
detection of tuberculosis in cattle, to "shut off the
sources of the infection." A full account of this method
in different countries was given by Professor Bang, of
Copenhagen, at the Fourth Congress on Tuberculosis,
<span class="pagenum"><a name="Page_100" id="Page_100">100</a></span>
Paris, 1898. The injection of tuberculin is followed in
eight to twelve hours by a well-marked rise of temperature,
if the animal be tuberculous. Of this test,
Professor McFadyean, Principal of the Royal Veterinary
College, London, says:&mdash;</p>

<p class="blockquote">"I have no hesitation in saying that, taking full account
of its imperfection, tuberculin is the most valuable means
of diagnosis in tuberculosis that we possess.... I have
most implicit faith in it, when it is used on animals standing
in their own premises and undisturbed. It is not
reliable when used on animals in a market or slaughter-house.
A considerable number of errors at first were
found when I examined animals in slaughter-houses after
they had been conveyed there by rail, etc. Since that,
using it on animals in their own premises, I have
found that it is practically infallible. I have notes
of one particular case, where twenty-five animals in
one dairy were tested, and afterwards all were killed.
There was only one animal which did not react, and it
was the only animal not found to be tuberculous when
killed."</p>

<p>Two instances of the validity of this test will suffice.
In 1899, it was applied to 270 cows on some farms in
Lancashire. Of these cows, 180 reacted to the test,
85 did not react, and 5 were doubtful. Tuberculous
disease was actually found, when they were killed, in
175 out of the 180 = 97.2 per cent. (<cite>Lancet</cite>, 5th
August 1899.) In 1901, Arloing and Courmont
published a critical account of the whole subject, and
gave the following facts. In 80 calves, which on
examination after death were found not tuberculous,
the test was negative: in 70 older cattle, which were
tuberculous, the test was positive in every case but one,
<span class="pagenum"><a name="Page_101" id="Page_101">101</a></span>
though the dilution of the serum was 1 in 10.<a name="FNanchor_20" id="FNanchor_20" href="#Footnote_20" class="fnanchor">[20]</a>  It
would be easy to add instances of the value of this
test, for it is practised far and wide over the world.</p>

<p>7. More recently, the discovery of the "opsonic
index," and its use by Sir Almroth Wright and others,
has given a great advance to the observation and
treatment of cases of tuberculosis. The administration
of the "new tuberculin" is now timed and measured
with an accuracy which was absolutely impossible a
few years ago.</p>

<p>It is a far cry, from the present method of counting
how many tubercle-bacilli are taken up by a single
blood-cell, back to Villemin's rabbits. Every inch of
the way, from 1881 onward, the pathological study of
every form of tuberculosis, medical or surgical, human
or bovine, has been dependent on bacteriology; that is
to say, on experiments on animals.
<span class="pagenum"><a name="Page_102" id="Page_102">102</a></span></p>

<h3>IV<br />
DIPHTHERIA</h3>

<p>The bacillus of diphtheria, the Klebs-Loeffler bacillus,
was first described by Klebs in 1875, and was first
obtained in pure culture by Loeffler in 1884. Its
isolation was a matter of great difficulty, and the work
of many years, because of its association in the mouth
with other species of bacteria. The following table,
from Hewlett's <cite>Manual of Bacteriology</cite>, is a good instance
of one of many practical difficulties. Out of 353 cases
of diphtheria, bacteriological examination found the
diphtheria-bacillus alone in 216 cases. In the remaining
137 it was associated with the following organisms:&mdash;</p>

<table border="0" cellpadding="0" cellspacing="2" summary="diptheria associated organisms">
<tr>
  <td class="tdl">Streptococci</td>
  <td class="tdr">6</td>
</tr>
<tr>
  <td class="tdl">Staphylococci</td>
  <td class="tdr">55</td>
</tr>
<tr>
  <td class="tdl">Bacilli</td>
  <td class="tdr">19</td>
</tr>
<tr>
  <td class="tdl">Torulæ</td>
  <td class="tdr">9</td>
</tr>
<tr>
  <td class="tdl">Sarcinæ</td>
  <td class="tdr">6</td>
</tr>
<tr>
  <td class="tdl">Streptococci and micrococci</td>
  <td class="tdr">2</td>
</tr>
<tr>
  <td class="tdl">Micrococci and bacilli</td>
  <td class="tdr">9</td>
</tr>
<tr>
  <td class="tdl">Streptococci and bacilli</td>
  <td class="tdr">1</td>
</tr>
<tr>
  <td class="tdl">Torulæ and bacilli</td>
  <td class="tdr">1</td>
</tr>
<tr>
  <td class="tdl">Micrococci and sarcinæ</td>
  <td class="tdr">6</td>
</tr>
<tr>
  <td class="tdl">Micrococci and torulæ</td>
  <td class="tdr">4</td>
</tr>
<tr>
  <td class="tdl">Many forms present together</td>
  <td class="tdr">19</td>
</tr>
<tr>
  <td class="tdl">&nbsp;</td>
  <td class="tdr">&mdash;</td>
</tr>
<tr>
  <td class="tdl">&nbsp;</td>
  <td class="tdr">137</td>
</tr>
<tr>
  <td class="tdl">&nbsp;</td>
  <td class="tdr">&mdash;</td>
</tr>
</table>

<p>In December 1890 came the news that Behring and
Kitasato had at last cleared the way for the use of an
antitoxin:&mdash;
<span class="pagenum"><a name="Page_103" id="Page_103">103</a></span></p>

<p class="blockquote">"Our researches on diphtheria and on tetanus have led
us to the question of immunity and cure of these two
diseases; and we succeeded in curing infected animals,
and in immunising healthy animals, so that they have
become incapable of contracting diphtheria or tetanus."</p>

<p>Aronsen, Sidney Martin, Escherich, Klemensiewicz,
and many more, were working on the same lines; and
in 1893, Behring and Kossel and Heubner published
the first cases treated with antitoxin. Then, in 1894,
came the Congress of Hygiene and Demography at
Budapest, and Roux's triumphant account of the good
results already obtained. Thus the treatment is not
many years old; but, if the whole world could tabulate
its results, the total number of lives saved would
already be somewhere above a quarter of a million.
Men found it hard at first to believe the full wonder of
the discovery: the medical journals of 1895 and 1896
still contain the fossils of criticism&mdash;all the <em>may be</em>
and <em>must be</em> of the earlier debates on the new treatment.
The finest of all these fossils is embedded in the
<cite>Saturday Review</cite> of 2nd Feb. 1895&mdash;<i>It is a pity that the
English Press should continue to be made the cat's-paw of
a gang of foreign medical adventurers.</i> To get at the
truth, we must reckon in thousands: take, out of a
whole mass of evidence, all just alike, the reports from
London, Berlin, Munich, Vienna, Strasbourg, Cairo,
Boston, and New York; these to begin with. Or the
following facts, cut almost at random out of the medical
journals:&mdash;</p>

<p class="blockquote">"The medical report of the French army states that
since the introduction of the serum-treatment of diphtheria,
the mortality among cases of that disease had
fallen from 11 per cent. to 6 per cent." (<cite>Brit. Med.
Journ.</cite>, 3rd September 1898.)
<span class="pagenum"><a name="Page_104" id="Page_104">104</a></span></p>

<p>"Professor Krönlein (Zürich) exhibited statistical
tables, showing that the prevalence of diphtheria in
the canton of Zürich had been nearly uniform during
the past fifteen years; and that the mortality rapidly
decreased as soon as antitoxic serum was used on a
somewhat larger scale. In his clinic, all the patients
were examined bacteriologically, and serum was administered
in every case of diphtheria without exception.
Of 1336 cases treated before the serum-period, 554 = 39.4
per cent. died; whilst during the serum-period there
were 55 deaths among 437 cases = 12 per cent. In
cases of tracheotomy, the death-rates before and during
the serum-period were 66 and 38.8 per cent. respectively."
(<cite>Lancet</cite>, 7th May 1898, Report of German Surgical
Congress at Berlin.)</p>

<p>"Dr. Kármán was entrusted by the Hungarian
Government with the task of instituting measures for
preventing the spread of diphtheria in a village and
its neighbourhood. As general hygienic regulations
accomplished nothing, he tried preventive inoculation....
Among 114 children thus treated, there was during
the next two months no case of diphtheria, although
the disease was prevalent in the village up to the date
at which inoculation commenced, and continued to rage
in the surrounding villages afterwards. During those
two months, only one case of diphtheria appeared in the
village, and that was in an uninoculated child; while, in
the previous five months, 18.3 per cent. of the village
children had been attacked, of whom eight died, six
not having been treated with serum. Considering the
wretched hygienic condition of the village, the harmlessness
of preventive inoculations, and the continuance
of the disease in the neighbouring villages, where
diphtheria-vaccination was not carried out, the extraordinary
value of the inoculations, in the prophylaxis
of diphtheria, can hardly be denied." (<cite>Brit. Med.
Journ.</cite>, 16th January 1897.)</p>

<div class="blockquote">
<p>"The most striking confirmation of the value of antitoxin
has been afforded where the supply ran short during
<span class="pagenum"><a name="Page_105" id="Page_105">105</a></span>
an epidemic. In Baginsky's clinic, the interruption of the
serum-treatment promptly raised the mortality from 15.6
to 48.4 per cent." (<cite>Brit. Med. Journ.</cite>, 20th October
1895.)</p>

<p>"In an analysis of the ratio of mortality in 266 German
cities of about 15,000 inhabitants, it was found that the
ratio of mortality per 100,000 of the living, before antitoxin
was used, varied from 130 to 84 from 1886 to 1893,
while the ratio from 1894 to 1897 varied from 101 to 35.
It is a significant fact that during 1894, when, although
antitoxin was used to a certain extent, it was not in
general use, the ratio was 101; that when antitoxin was
used more extensively, in 1895, the ratio was 53; that
in 1896 it was 43; that in 1897, when antitoxin was
very generally used, the rate fell to 35." (<cite>Trans. Massachusetts
Med. Soc.</cite>, 1898.)</p>

<p>"Dr. Gabritchefski points out that in recent years the
number of persons (in Russia) attacked by the disease has
increased, the figures for the whole of Russia rising from
about 100,000 or 120,000, ten years ago, to considerably
over 200,000 in 1897. The introduction of the serum
treatment has, however, had a marked effect on the mortality
of the disease; and the actual number of deaths
from diphtheria has either not increased at all, or has
slightly diminished." (<cite>Lancet</cite>, 5th Aug. 1899.)</p>
</div>

<p>Of course there will still be bad diphtheria years and
good diphtheria years: for example, the death-rate of
the population of England, from diphtheria, was higher
during the years 1893-1899 than during the years
1889-1892. Antitoxin can no more prevent a bad
diphtheria year than an umbrella can prevent a wet day.
But in limited outbreaks of diphtheria, such as occur in
a village, an asylum, a school, or a large family of young
children, it can be used, and is used, as a prophylactic,
and with admirable results. The example of Dr. Kármán,
just quoted, is one of the earliest instances of this
<span class="pagenum"><a name="Page_106" id="Page_106">106</a></span>
preventive use of antitoxin: other instances, of equal
importance, are given in the <cite>Boston Medical and Surgical
Journal</cite>, December 1897 and March 1898; and in the
<cite>Lancet</cite>, 2nd April 1898, and 28th January 1899. A
summary of later experiences of this preventive use of
antitoxin in different countries is given by Dr. Wilcox
of New York, and Dr. Stevens of Philadelphia, in Gould's
<cite>Year-Book</cite> for 1902:&mdash;</p>

<p class="blockquote">"At a meeting of the Société de Pédiatrie (Paris),
held June 1901, a resolution was adopted affirming that
preventive inoculations present no serious dangers, and
confer immunity in the great majority of cases for some
weeks, and recommending their employment in children's
institutions and in families in which scientific surveillance
cannot be exercised. Netter stated that he had collected
32,484 observations (cases) of prophylactic injections, and
after eliminating cases in which the disease developed in
less than twenty-four hours after injection, or more than
thirty days after, there were 6 per cent. of failures. On
the other hand, the author stated that he had recently
made ninety preventive injections with but 2.17 per cent.
of failures. Potter reports a series of twenty-four families
in which preventive injections were used. Only one case
of diphtheria occurred. In another series of cases, in
which no prophylactic injections were given, the disease
occurred secondarily in one-third of the houses, and one-sixth
of the inmates contracted the disease, in spite of the
fact that a large number of the primary cases were removed
to the hospital. Blake reports a series of thirty-five
prophylactic injections. The treatment was instituted
after three cases of diphtheria had developed in a children's
home. No secondary cases developed. Voisin and
Guinon describe an epidemic of diphtheria in the Salpetrière
Hospital among idiots and epileptics. Prophylactic
injections were given to all those exposed to the contagion.
After that, but four cases appeared, all mild in character.
One severe case developed, however, two weeks later,
<span class="pagenum"><a name="Page_107" id="Page_107">107</a></span>
ending fatally in twenty-four hours, showing that the
prophylactic action of the antitoxin, while efficacious, is
not of very long duration."</p>

<p>It would be easy to prolong <i lang="la" xml:lang="la">ad infinitum</i> the proofs of
the curative and preventive efficacy of the antitoxin: it
would be impossible to find any evidence to be weighed
for one moment against these proofs. There are three
early records that ought to be quoted more fully: the
1894 report from the Hospital for Sick Children, Paris;
the 1896 report of the American Pædiatric Society;
and the 1898 report of the Clinical Society of London.</p>

<h4>I</h4>

<p>The report from the Hospital for Sick Children,
Paris, is contained in a memoir, <cite>Sérum-Thérapie de la
Diphtérie</cite>, the joint work of MM. Roux, Martin, and
Chaillon (<cite>Annales de l'Institut Pasteur</cite>, September 1894).
It gives the results of the serum-treatment during February
to July 1894. The cases were not selected: the
antitoxin was given in every case that was proved, by
bacteriological examination, to be diphtheria&mdash;with the
exception of 20 cases where the children were just
dying when they were brought to the hospital. No
change was made either in the general treatment or in
the local applications to the throat; these were the same
that had been used in former years: <i lang="fr" xml:lang="fr">le sérum est le seul
élément nouveau introduit</i>.</p>

<p>In 1890-1893, before the serum-treatment, 3971
children were admitted to the diphtheria wards, and 2029
of them died. The percentage of these deaths was&mdash;</p>

<table border="0" cellpadding="0" cellspacing="2" summary="diptheria deaths Paris">
<tr>
  <td>In 1890 <span class="i2">55.88</span><br />
  <span class="i0h">"</span> 1891 <span class="i2">52.45</span><br />
  <span class="i0h">"</span> 1892 <span class="i2">47.64</span><br />
  <span class="i0h">"</span> 1893 <span class="i2">48.47</span></td>
  <td class="cbrace2">}</td>
  <td>Average = 51.71.<span class="pagenum"><a name="Page_108" id="Page_108">108</a></span></td>
</tr>
</table>

<p>The serum was used from 1st February to 24th July
1894. During this period 448 children were admitted,
of whom 109 died = 24.5.</p>

<p>During the same period (February to June) the
Trousseau Hospital, where the serum was not used,
had 520 cases, with 316 deaths = 60.0.</p>

<p>The cases at the Hospital for Sick Children must be
divided into those that required tracheotomy and those
that did not require it:&mdash;</p>

<p class="title2"><span class="smcap">Mortality among Cases not requiring Tracheotomy.</span></p>

<table border="0" cellpadding="0" cellspacing="2" summary="diptheria deaths w/o tracheotomy">
<tr>
  <td>In 1890 <span class="i2">47.30</span><br />
  <span class="i0h">"</span> 1891 <span class="i2">46.64</span><br />
  <span class="i0h">"</span> 1892 <span class="i2">38.8</span><br />
  <span class="i0h">"</span> 1893 <span class="i2">32.02</span></td>
  <td class="cbrace2">}</td>
  <td>Average = 33.94.</td>
</tr>
</table>

<p>During the serum-period, the mortality of these cases
was 12.0. At the Trousseau Hospital, without the
serum, the mortality of these cases during the same
period was 32.0.</p>

<p class="title2"><span class="smcap">Mortality among Cases requiring Tracheotomy.</span></p>

<table border="0" cellpadding="0" cellspacing="2" summary="diptheria deaths w tracheotomy">
<tr>
  <td>In 1890 <span class="i2">76.35</span><br />
  <span class="i0h">"</span> 1891 <span class="i2">68.36</span><br />
  <span class="i0h">"</span> 1892 <span class="i2">74.6</span><br />
  <span class="i0h">"</span> 1893 <span class="i2">73.45</span></td>
  <td class="cbrace2">}</td>
  <td>Average = 73.49.</td>
</tr>
</table>

<p>During the serum-period, the mortality of these cases
was 49.0. At the Trousseau Hospital, without the
serum, the mortality of these cases during the same
period was 86.0.</p>

<p>Setting aside, out of the 448 children, those cases
of "membranous sore throat" or "pseudo-diphtheria,"
in which the Klebs-Loeffler bacillus was not found, there
remain 320 cases where it was found. Of these 320
children, 20 were just dying on admission, and did not
<span class="pagenum"><a name="Page_109" id="Page_109">109</a></span>
receive the serum. Of the 300 who received it, 78
died = 26.0. Before the serum-period, the mortality of
these cases at the same hospital was about 50.0. The
complications of diphtheria, such as paralysis, were
much less frequent during the serum-period than they
had been before it.</p>


<h4>II</h4>

<p>Report of the American Pædiatric Society's Collective
Investigation into the use of Antitoxin in the treatment
of diphtheria in private practice. (Eighth Annual
Meeting, Montreal, May 1896.) From the <cite>New York
Medical Record</cite>, 4th July 1896.</p>

<p>This vast collection of cases is of special interest,
because they occurred in private practice. In most of
them the nature of the disease was proved by bacteriological
examination; in the rest, the clinical evidence
was decisive: "It is possible that among the latter we
have admitted some streptococcus cases, but the number
of such is certainly very small." All other doubtful
cases, 244 in number, were excluded.</p>

<p>Three thousand three hundred and eighty-four cases
were reported by 613 physicians from 114 cities and
towns, in 15 different States, the District of Columbia,
and the Dominion of Canada. To these 3384 cases
were added 942 cases from tenement-houses in New
York, and 1468 cases from tenement-houses in Chicago.
The New York and Chicago cases were, most of them,
treated by a corps of inspectors of the Health Board of
the city; and the municipal surveillance was very strict
at Chicago:&mdash;</p>

<p class="blockquote">"There are very few hospitals in America that receive
diphtheria patients.... It was the custom in Chicago to
<span class="pagenum"><a name="Page_110" id="Page_110">110</a></span>
send an inspector to every tenement-house case reported,
and to administer the serum unless it was refused by the
parents. These cases were therefore treated much earlier,
and the results were correspondingly better than were
obtained in New York, although the serum used was the
same in both cities, viz., that of the New York Health
Board."</p>

<p>The sum total of results was 5794 cases, with 713
deaths = 12.3 per cent., including every case returned;
but 218 were moribund at the time of injection, or
died within twenty-four hours of the first injection.
"Should these be excluded, there would remain 5576
cases in which the serum may be said to have had a
chance, with a mortality of 8.8 per cent.</p>

<table class="fsize90" border="0" cellpadding="0" cellspacing="2" summary="diptheria serum administered">
<tr>
  <td>Of</td>
  <td class="tdr">996</td>
  <td>cases injected</td>
  <td class="tdl">on the first day of the disease,</td>
  <td class="tdr">49</td>
  <td class="tdr">died</td>
  <td>=</td>
  <td class="tdr">4.9</td>
  <td>%</td>
</tr>
<tr>
  <td class="i0h">"</td>
  <td class="tdr">1616</td>
  <td class="i3">"</td>
  <td class="tdl">on the second <span class="i3">"</span></td>
  <td class="tdr">120</td>
  <td class="i1h">"</td>
  <td>=</td>
  <td class="tdr">7.4</td>
  <td>"</td>
</tr>
<tr>
  <td class="i0h">"</td>
  <td class="tdr">1508</td>
  <td class="i3">"</td>
  <td class="tdl">on the third <span class="i4">"</span></td>
  <td class="tdr">134</td>
  <td class="i1h">"</td>
  <td>=</td>
  <td class="tdr">8.8</td>
  <td>"</td>
</tr>
<tr>
  <td class="i0h">"</td>
  <td class="tdr">758</td>
  <td class="i3">"</td>
  <td class="tdl">on the fourth <span class="i3h">"</span></td>
  <td class="tdr">147</td>
  <td class="i1h">"</td>
  <td>=</td>
  <td class="tdr">20.7</td>
  <td>"</td>
</tr>
<tr>
  <td class="i0h">"</td>
  <td class="tdr">690</td>
  <td class="i3">"</td>
  <td class="tdl">on or after the fifth <span class="i1">"</span></td>
  <td class="tdr">244</td>
  <td class="i1h">"</td>
  <td>=</td>
  <td class="tdr">35.3</td>
  <td>"</td>
</tr>
</table>

<p>And in 232 cases, where the day of injection was unknown,
there were 19 deaths = 8.2 per cent.</p>

<p>"No one feature of the cases of diphtheria treated
by antitoxin has excited more surprise among the
physicians who have reported them than the prompt
arrest, by the timely administration of the serum,
of membrane which was rapidly spreading downward
below the larynx. Such expressions abound in the
reports as 'wonderful,' 'marvellous,' 'in all my experience
with diphtheria, have never seen anything like
it before,' etc.</p>

<p>"Turning now to the operative cases, we find the
same remarkable effects of the antitoxin noticeable.
Operations were done in 565 cases, or in 16.7 per
cent. of the entire number reported. Intubation was
<span class="pagenum"><a name="Page_111" id="Page_111">111</a></span>
performed 533 times, with 138 deaths, or a mortality
of 25.9 per cent. In the above are included 9 cases
in which a secondary tracheotomy was done, with
7 deaths. In 32, tracheotomy only was done, with
12 deaths, a mortality of 37.4 per cent. Of the 565
operative cases, 66 were either moribund at the time
of operation or died within twenty-four hours after
injection. Should these be deducted, there remain
499 cases operated upon, by intubation or tracheotomy,
with 84 deaths, a mortality of 16.9 per cent.</p>

<p>"Let us compare the results of intubation, in cases
in which the serum was used, with those obtained with
this operation before the serum was introduced. Of
5546 intubation cases in the practice of 242 physicians,
collected by M'Naughton and Maddren (1892), the
mortality was 69.5 per cent. Since that time, statistics
have improved materially by the general use (in and
about New York, at least) of calomel fumigations.
With this addition, the best results published (those of
Brown) showed in 279 cases a mortality of 51.6 per cent.</p>

<p>"But even these figures do not adequately express
the benefit of antitoxin in laryngeal cases. Witness
the fact that over one-half the laryngeal cases did not
require operation at all. Formerly, 10 per cent. of recoveries
was the record for laryngeal cases not operated
upon. Surely, if it does nothing else, the serum saves
at least double the number of cases of laryngeal diphtheria
that has been saved by any other method of
treatment."</p>

<h4>III</h4>

<p>In 1898, the Clinical Society published the Report
of their Special Committee, based on 633 cases (<cite>Trans.
Clin. Soc.</cite>, xxxi., 1898, pp. 1-50). The whole report
<span class="pagenum"><a name="Page_112" id="Page_112">112</a></span>
should be read carefully; but there is room here for
nothing more than the latter part of it. This is given
at length.</p>

<p class="title2">A<br />
<i>Table showing the General Mortality of cases treated, on the same<br />
day of the disease, with and without Antitoxin.</i></p>

<table class="fsize90" border="0" cellpadding="0" cellspacing="2" summary="diptheria deaths w and w/o serum">
<tr>
  <th colspan="4" class="bh1"><span class="smcap">Antitoxin Committee</span>:<br />633 Cases treated<br />with Antitoxin.</th>
  <th colspan="4" class="bh3"><span class="smcap">Metropolitan Asylums Board</span><br/>1894:<br />3042 Cases treated without<br />Antitoxin.</th>
  <th class="bh2">Difference<br />of<br />Percentage.</th>
</tr>
<tr>
  <th class="tdc bvert">Day of the</th>
  <th class="tdc bright">C</th>
  <th class="tdc bright">D</th>
  <th class="tdc bright2">M</th>
  <th class="tdc bright">Day of</th>
  <th  class="tdc bright">C</th>
  <th  class="tdc bright">D</th>
  <th  class="tdc bright2">M</th>
  <th  class="bright">&nbsp;</th>
</tr>
<tr>
  <th class="tdc bvert">Disease on</th>
  <th  class="tdc bright">a</th>
  <th  class="tdc bright">e</th>
  <th  class="tdc bright2">o</th>
  <th  class="tdc bright">Admission</th>
  <th  class="tdc bright">a</th>
  <th  class="tdc bright">e</th>
  <th  class="tdc bright2">o</th>
  <th  class="bright">&nbsp;</th>
</tr>
<tr>
  <th class="tdc bvert">which</th>
  <th  class="tdc bright">s</th>
  <th  class="tdc bright">a</th>
  <th  class="tdc bright2">r</th>
  <th  class="tdc bright">to</th>
  <th  class="tdc bright">s</th>
  <th  class="tdc bright">a</th>
  <th  class="tdc bright2">r</th>
  <th  class="bright">&nbsp;</th>
</tr>
<tr>
  <th class="tdc bvert">Treatment</th>
  <th  class="tdc bright">e</th>
  <th  class="tdc bright">t</th>
  <th  class="tdc bright2">t</th>
  <th  class="tdc bright">Hospital</th>
  <th  class="tdc bright">e</th>
  <th  class="tdc bright">t</th>
  <th  class="tdc bright2">t</th>
  <th  class="tdc bright">&nbsp;</th>
</tr>
<tr>
  <th class="tdc bvert">was begun.</th>
  <th  class="tdc bright">&nbsp;s.</th>
  <th  class="tdc bright">h</th>
  <th  class="tdc bright2">i</th>
  <th  class="tdc bright">&nbsp;</th>
  <th  class="tdc bright">&nbsp;s.</th>
  <th  class="tdc bright">h</th>
  <th  class="tdc bright2">a</th>
  <th  class="tdc bright">&nbsp;</th>
</tr>
<tr>
  <th class="tdc bvert">&nbsp;</th>
  <th  class="tdc bright">&nbsp;</th>
  <th  class="tdc bright">&nbsp;s.</th>
  <th  class="tdc bright2">l</th>
  <th  class="tdc bright">&nbsp;</th>
  <th  class="tdc bright">&nbsp;</th>
  <th  class="tdc bright">&nbsp;s.</th>
  <th  class="tdc bright2">l</th>
  <th  class="tdc bright">&nbsp;</th>
</tr>
<tr>
  <th class="tdc bvert">&nbsp;</th>
  <th  class="tdc bright">&nbsp;</th>
  <th  class="tdc bright">&nbsp;</th>
  <th  class="tdc bright2">i</th>
  <th  class="tdc bright">&nbsp;</th>
  <th  class="tdc bright">&nbsp;</th>
  <th  class="tdc bright">&nbsp;</th>
  <th  class="tdc bright2">i</th>
  <th  class="tdc bright">&nbsp;</th>
</tr>
<tr>
  <th class="tdc bvert">&nbsp;</th>
  <th  class="tdc bright">&nbsp;</th>
  <th  class="tdc bright">&nbsp;</th>
  <th  class="tdc bright2">t</th>
  <th  class="tdc bright">&nbsp;</th>
  <th  class="tdc bright">&nbsp;</th>
  <th  class="tdc bright">&nbsp;</th>
  <th  class="tdc bright2">t</th>
  <th  class="tdc bright">&nbsp;</th>
</tr>
<tr>
  <th class="tdc bvert">&nbsp;</th>
  <th  class="tdc bright">&nbsp;</th>
  <th  class="tdc bright">&nbsp;</th>
  <th  class="tdc bright2">&nbsp;y.</th>
  <th  class="tdc bright">&nbsp;</th>
  <th  class="tdc bright">&nbsp;</th>
  <th  class="tdc bright">&nbsp;</th>
  <th  class="tdc bright2">&nbsp;y.</th>
  <th  class="tdc bright">&nbsp;</th>
</tr>
<tr>
  <th class="tdc bvert">&nbsp;</th>
  <th  class="tdc bright">&nbsp;</th>
  <th  class="tdc bright">&nbsp;</th>
  <th  class="tdc bright2">&nbsp;</th>
  <th  class="tdc bright">&nbsp;</th>
  <th  class="tdc bright">&nbsp;</th>
  <th  class="tdc bright">&nbsp;</th>
  <th  class="tdc bright2">&nbsp;</th>
  <th  class="tdc bright">&nbsp;</th>
</tr>
<tr>
  <th class="blc2">&nbsp;</th>
  <th class="bmc">&nbsp;</th>
  <th class="bmc">&nbsp;</th>
  <th class="tdc bbottom2">%</th>
  <th class="bmc">&nbsp;</th>
  <th class="bmc">&nbsp;</th>
  <th class="bmc">&nbsp;</th>
  <th class="tdc bbottom2">%</th>
  <th class="bmc">&nbsp;</th>
</tr>
<tr>
  <td class="bvert tdc">1st</td>
  <td class="bright tdc i0h">20</td>
  <td class="bright tdc i0h">2</td>
  <td class="bright2 tdc">10.0</td>
  <td class="bright tdc">1st</td>
  <td class="bright tdc i0h">133</td>
  <td class="bright tdc i0h">30</td>
  <td class="bright2 tdc">22.5</td>
  <td class="bright tdc">12.5</td>
</tr>
<tr>
  <td class="bvert tdc">2nd</td>
  <td class="bright tdc i0h">92</td>
  <td class="bright tdc">10</td>
  <td class="bright2 tdc">10.8</td>
  <td class="bright tdc">2nd</td>
  <td class="bright tdc i0h">539</td>
  <td class="bright tdc">146</td>
  <td class="bright2 tdc">27.0</td>
  <td class="bright tdc">16.2</td>
</tr>
<tr>
  <td class="bvert tdc">3rd</td>
  <td class="bright tdc">133</td>
  <td class="bright tdc">20</td>
  <td class="bright2 tdc">15.0</td>
  <td class="bright tdc">3rd</td>
  <td class="bright tdc i0h">652</td>
  <td class="bright tdc">192</td>
  <td class="bright2 tdc">29.4</td>
  <td class="bright tdc">14.4</td>
</tr>
<tr>
  <td class="bvert tdc">4th</td>
  <td class="bright tdc">130</td>
  <td class="bright tdc">26</td>
  <td class="bright2 tdc">20.0</td>
  <td class="bright tdc">4th</td>
  <td class="bright tdc i0h">566</td>
  <td class="bright tdc">179</td>
  <td class="bright2 tdc">31.6</td>
  <td class="bright tdc">11.6</td>
</tr>
<tr>
  <td class="bvert tdc">5th</td>
  <td class="bright tdc">258</td>
  <td class="bright tdc">66</td>
  <td class="bright2 tdc">25.5</td>
  <td class="bright tdc">5th</td>
  <td class="bright tdc">1,152</td>
  <td class="bright tdc">355</td>
  <td class="bright2 tdc">30.8</td>
  <td class="bright tdc i0h">5.3</td>
</tr>
<tr>
  <td class="bvert tdc">and after.</td>
  <td class="bright tdc">&nbsp;</td>
  <td class="bright">&nbsp;</td>
  <td class="bright2">&nbsp;</td>
  <td class="bright">&nbsp;</td>
  <td class="bright">&nbsp;</td>
  <td class="bright">&nbsp;</td>
  <td class="bright2">&nbsp;</td>
  <td class="bright">&nbsp;</td>
</tr>
<tr>
  <td class="bbox tdc">Totals</td>
  <td class="bh2 tdc">633</td>
  <td class="bh2 tdc">124&nbsp;</td>
  <td class="bh3 tdc">19.5</td>
  <td class="bh2 tdc">Totals</td>
  <td class="bh2 tdc">3,042</td>
  <td class="bh2 tdc">902</td>
  <td class="bh3 tdc">29.6</td>
  <td class="bh2 tdc">10.1</td>
</tr>
</table>

<p class="title2">B<br />
<i>Summary and Conclusions of the Committee's Report</i></p>

<div class="blockquote">
<p>"The material for the investigation of the clinical
value of the antitoxin serum in the treatment of
diphtheria was not obtained from selected, but from
consecutive, cases, reported from the general hospitals
and the fever hospitals of the Metropolitan Asylums
Board; all were made use of which fulfilled the requirements
of the Committee.</p>

<p>"The Committee rejected all cases in which satisfactory
proof of the existence of true diphtheria was
not shown, either by the presence of the <i lang="la" xml:lang="la">Bacillus diphtheriæ</i>
<span class="pagenum"><a name="Page_113" id="Page_113">113</a></span>
upon bacteriological examination, or by the occurrence
of paralysis in the course of the illness. All
were also rejected in which the amount of antitoxin
administered was stated in cubic centimetres and not
in normal units, the Committee having no means by
which the strength of the antitoxin could in these cases
be determined.</p>

<p>"Six hundred and thirty-three cases form the basis
on which the report is drawn up; 549 were treated
with antitoxin obtained from the laboratory of the
Royal Colleges of Physicians and Surgeons; the remainder,
84 in number, were injected with antitoxin
obtained from other sources. In nine instances, antitoxin
from two different sources was injected into the
same patient.</p>

<p>"Statistics of the disease before the use of antitoxin
are introduced as control series; these were obtained
from the fever hospitals of the Metropolitan Asylums
Board, and from the general hospitals; and, like the
antitoxin series, are compiled from consecutive and not
from selected cases.</p>

<p>"The general mortality, under the antitoxin treatment,
was 19.5 per cent.; a reduction of 10 on the
percentage mortality of the cases treated in the hospitals
of the Metropolitan Asylums Board in 1894.
If 15 fatal cases, in which death took place within
twenty-four hours of the first injection, be deducted,
the mortality falls to 15.6 per cent.; which is very
little more than half the mortality during 1894 under
other forms of treatment.</p>

<p>"The lessened mortality is especially noticeable in
the earlier years of life, the percentage mortality of
children under five being 26.3, as opposed to 47.4.
In the next period of five years, the percentage of
<span class="pagenum"><a name="Page_114" id="Page_114">114</a></span>
mortality is 16.0, as opposed to 26.0; whilst after
ten years of age the difference in the mortality is
slight.<a name="FNanchor_21" id="FNanchor_21" href="#Footnote_21" class="fnanchor">[21]</a> </p>

<p>"Laryngeal diphtheria is admittedly the most dangerous
form. The laryngeal cases have a percentage
mortality of 23.6 in the antitoxin, as compared with
66.0 in the non-antitoxin series. In the cases in
which laryngeal symptoms are so severe as to necessitate
tracheotomy, the saving of life by the use of
antitoxin is very marked, the mortality being reduced
one-half, to 36.0 as opposed to 71.6 per cent.</p>

<p>"The strongest evidence of the value of the antitoxin
treatment is that, in addition to reducing the
general mortality by one-third, the duration of life in
the fatal cases is decidedly prolonged. These two facts
taken together conclusively prove the beneficial effects
of the antitoxin treatment.</p>

<p>"The incidence of paralysis is greater in the antitoxin
than in the control series. This increased number
is partly explained by the lessened mortality, and partly
by the longer duration of life in the fatal cases affording
time for the development of paralytic symptoms.
The percentage mortality of those who had some form
or other of paralysis is lower in the antitoxin than
in the control series; so that, notwithstanding the
apparent greater risk of paralysis supervening, the
probability of final recovery is greater.</p>

<p>"No definite conclusion can be drawn, for the
reasons stated in the body of the report, as to the
advantage of administering the whole of the antitoxin
within forty-eight hours of the first injection, or continuing
it for a longer period; but evidence is afforded
of the importance of its administration as early as
<span class="pagenum"><a name="Page_115" id="Page_115">115</a></span>
possible in the course of the disease; the percentage
mortality in cases injected on the first and second days
of the disease being 10.7, as compared with 25.5 for
those first receiving the injection on the fifth or some
subsequent day.</p>

<p>"No conclusion can be drawn, from the cases reported
on, as to the amount of antitoxin which should
be used to produce the best effects; but they show that
the administration of very large doses is followed by no
pronounced ill effects.</p>

<p>"The injection of antitoxin is responsible for the
production of rashes, joint-pains, and possibly for the
occurrence of late pyrexia. In 34.7 per cent. the injections
were followed by rashes. Some amount of
fever accompanied the rash in 60 per cent. In only
9.4 per cent. of those in whom rashes were observed
did death ensue.</p>

<p>"Joint-pains were observed in 40, or 6.3 per cent.
of the whole number, and all but five of them had a
rash as well.</p>

<p>"In 26, or 65 per cent. of the joint-pains, some rise
of temperature accompanied the pain. A rise of temperature
during convalescence, accompanied by either
rash or joint-pain, occurred in 27, or 4.2 per cent. of
the whole number.</p>

<p>"No connection could be traced between the amount
of antitoxin administered and the occurrence of rashes
or late pyrexia, but the pain in and about the joints
appears to have a relationship to the amount of antitoxin
used.</p>

<p>"The results of the Committee's investigation tend
to show that by the use of antitoxin&mdash;</p>

<p>1. The general mortality is reduced by one-third.</p>

<p>2. The mortality in tracheotomy falls by one-half.
<span class="pagenum"><a name="Page_116" id="Page_116">116</a></span></p>

<p>3. Extension of membrane to the larynx very rarely
occurs after the administration of antitoxin.</p>

<p>4. The duration of life in the fatal cases is decidedly
prolonged.</p>

<p>5. The number of fatal cases is less when antitoxin
is used early in the illness than in those which do not
receive it until a later period.</p>

<p>6. The frequency of the occurrence of paralysis is not
diminished, but the percentage of recoveries in cases
with paralysis is slightly increased.<a name="FNanchor_22" id="FNanchor_22" href="#Footnote_22" class="fnanchor">[22]</a> </p>

<p>7. Rashes are produced in about one-third of the
cases, and are attributable to the antitoxin.</p>

<p>8. Pain, and occasionally swelling about the joints, are
produced in a number of cases.</p>

<p>9. Even when used in large doses, no serious ill effects
have followed the injection of antitoxin."</p>
</div>

<hr class="c15" />

<p>The foregoing reports belong to ancient history.
Let us leave them, and study the record of the hospitals
of the Metropolitan Asylums Board. They serve a
city of 121 square miles, and 4-1/2 millions of inhabitants.
<span class="pagenum"><a name="Page_117" id="Page_117">117</a></span></p>

<p>The use of the antitoxin in the hospitals of the Metropolitan
Asylums Board began in 1895. It had been
used in 1894 on a few cases only, during the latter
part of the year, and had been procured with much
difficulty from various sources, chiefly from the Institute
of Preventive Medicine. On 9th November 1894,
the Board applied to the Laboratories' Committee of
the Royal Colleges of Physicians and of Surgeons,
asking them to undertake the supply. Arrangements
were made for this purpose; and the sum of £1000
was given by the Goldsmiths' Company. Dr. Sims
Woodhead, then Director of the Laboratories of the
Conjoint Colleges, now Professor of Pathology at Cambridge,
was put in charge of the bacteriological work
and the preparation of the serum, with a host of
expert colleagues: the administration of the treatment
was the work of the medical officers of the hospitals
of the Metropolitan Asylums Board. The experiences
of 1895 are given in the following passages from the
joint report to the Board from the medical superintendents:&mdash;</p>

<div class="blockquote">
<p>"The period covered by the report extends from 1st
January 1895 to 31st December of the same year.
During this time&mdash;with the exception of an interval of
three months at the Eastern Hospital, when its use was
suspended; of three months at the Fountain, and to a
considerable extent throughout the year at the South-Eastern
Hospital, when all cases were consecutively
treated, irrespective of their severity&mdash;the serum was
administered <i>only to cases which at the time of admission
were severe, or which threatened to become so</i>. In a
certain number, the patients being moribund at the time
of their arrival, and beyond the reach of any treatment,
no antitoxin was given. <i>No change has taken place
during the year in the local treatment of the cases, nor
<span class="pagenum"><a name="Page_118" id="Page_118">118</a></span>
has there been any new factor in the treatment other
than the injection of antitoxin</i>.</p>

<p>"It must be clearly understood that, with the exceptions
previously stated, it has been the practice at each
of the hospitals to administer serum to <i>those cases only
in which the symptoms on admission were sufficiently
pronounced to give rise to anxiety, the mild cases not
receiving any</i>.</p>

<p>"<i>No less than 46.4 per cent. of the antitoxin cases were
under five years of age, against 32.5 per cent. in the non-antitoxin
group</i>; and only 16.1 per cent. in the former
class were over ten years of age, against 33.8 per cent.
in the latter. The high fatality of diphtheria in the
earlier years of life is notorious.</p>

<p>"It is obvious, therefore, that to compare the mortality
of those treated with antitoxin with that of those which
during the same period were not so treated, would be to
institute a comparison between the severe cases and
those of which a large proportion were mild. This
would clearly be misleading.</p>

<p>"The only method by which an accurate estimate can
be obtained as to the merits of any particular form of
treatment, is by comparing a series of cases in which the
remedy has been employed with another series not so
treated, but which are similar, so far as can be, in other
respects. This, in the present instance, is impossible;
but, having regard to the fact that 61.8 of the 1895 cases
were treated with serum, an approximately accurate conclusion
can be drawn by contrasting all cases of diphtheria
completed during 1895, the antitoxin period, with
all cases completed during 1894.</p>

<p>"The year 1894 has been selected for the purpose of
comparison, not only because it is the year immediately
preceding the antitoxin period, but because the average
severity of the cases has been, in our opinion, about
equal. Moreover, the death-rate in 1894 was slightly
lower than it had been in any previous year.</p>

<p>" ... Of 3042 patients of all ages treated during 1894,
902 died&mdash;a mortality of 29.6 per cent.; whereas, of 3529
<span class="pagenum"><a name="Page_119" id="Page_119">119</a></span>
cases treated during 1895, 796 died&mdash;a mortality of 22.6
per cent.; the difference in percentage between the two
rates being therefore 7.1. This, assuming that the
former rate would otherwise have been maintained, represents
a saving of 250 lives during the past year.</p>

<p class="title2"><span class="smcap">Influence of Age.</span><br />
<i>Table showing variations in reduction of mortality obtained with<br />
Antitoxin at different ages.</i></p>

<table class="fsize80" border="0" cellpadding="0" cellspacing="2" summary="diptheria influence of age w serum">
<tr>
  <th rowspan="2" class="bbox">Ages.</th>
  <th colspan="3" class="bh2">Antitoxin Cases,<br />1895</th>
  <th colspan="3" class="bh2">All Cases,<br />1895</th>
  <th colspan="3" class="bh2">All Cases,<br />1894</th>
  <th rowspan="2" class="bh2">Diff. in<br />Mortalities,<br />1894<br />and<br />1895.</th>
</tr>
<tr>
  <th class="bmc">Cases.</th>
  <th class="bmc">Deaths.</th>
  <th class="bmc">Mortality<br />per cent.</th>
  <th class="bmc">Cases.</th>
  <th class="bmc">Deaths.</th>
  <th class="bmc">Mortality<br />per cent.</th>
  <th class="bmc">Cases.</th>
  <th class="bmc">Deaths.</th>
  <th class="bmc">Mortality<br />per cent.</th>
</tr>
<tr>
  <td class="bvert tdc">Under 5</td>
  <td class="bright tdc">1013</td>
  <td class="bright tdc">379</td>
  <td class="bright tdc">37.4</td>
  <td class="bright tdc">1453</td>
  <td class="bright tdc">497</td>
  <td class="bright tdc">34.2</td>
  <td class="bright tdc">1171</td>
  <td class="bright tdc">556</td>
  <td class="bright tdc">47.4</td>
  <td class="bright tdc">13.2</td>
</tr>
<tr>
  <td class="bvert tdc i1">"&emsp;10</td>
  <td class="bright tdc">1829</td>
  <td class="bright tdc">575</td>
  <td class="bright tdc">31.4</td>
  <td class="bright tdc">2720</td>
  <td class="bright tdc">744</td>
  <td class="bright tdc">27.3</td>
  <td class="bright tdc">2246</td>
  <td class="bright tdc">836</td>
  <td class="bright tdc">37.2</td>
  <td class="bright i2h">&nbsp;9.9</td>
</tr>
<tr>
  <td class="bvert tdc i1"> "&emsp;15</td>
  <td class="bright tdc">2056</td>
  <td class="bright tdc">606</td>
  <td class="bright tdc">29.4</td>
  <td class="bright tdc">3144</td>
  <td class="bright tdc">779</td>
  <td class="bright tdc">24.7</td>
  <td class="bright tdc">2609</td>
  <td class="bright tdc">877</td>
  <td class="bright tdc">33.6</td>
  <td class="bright i2h">&nbsp;8.9</td>
</tr>
<tr>
  <td class="blc2 tdc">All ages</td>
  <td class="bmc tdc">2182</td>
  <td class="bmc tdc">615</td>
  <td class="bmc tdc">28.1</td>
  <td class="bmc tdc">3529</td>
  <td class="bmc tdc">796</td>
  <td class="bmc tdc">22.5</td>
  <td class="bmc tdc">3042</td>
  <td class="bmc tdc">902</td>
  <td class="bmc tdc">29.6</td>
  <td class="bmc i2h">&nbsp;7.1</td>
</tr>
</table>

<p>For every age-group, with the single exception of that comprising
the years 15 to 20 (the numbers of which are small), the percentage
mortality was less in the 1895 than in the 1894 cases. The
reduction in mortality was greatest in early life.</p>

<p class="title2"><span class="smcap">Influence of Time of coming under Treatment.</span><br />
<i>Table showing percentage mortality in relation to day of disease<br />
on which cases came under treatment.</i></p>

<table border="0" cellpadding="0" cellspacing="2" summary="diptheria influence of time w serum">
<tr>
  <th class="bbox">Day of Disease.</th>
  <th class="bh2">1894.</th>
  <th class="bh2">1895.</th>
  <th class="bh2">Difference.</th>
</tr>
<tr>
  <td class="bvert tdl">1st</td>
  <td class="bright tdc">22.5</td>
  <td class="bright tdc">11.7</td>
  <td class="bright tdc">10.8</td>
</tr>
<tr>
  <td class="bvert tdl">2nd</td>
  <td class="bright tdc">27.0</td>
  <td class="bright tdc">12.5</td>
  <td class="bright tdc">14.5</td>
</tr>
<tr>
  <td class="bvert tdl">3rd</td>
  <td class="bright tdc">29.4</td>
  <td class="bright tdc">22.0</td>
  <td class="bright tdc i0h">7.4</td>
</tr>
<tr>
  <td class="bvert tdl">4th</td>
  <td class="bright tdc">31.6</td>
  <td class="bright tdc">25.1</td>
  <td class="bright tdc i0h">6.5</td>
</tr>
<tr>
  <td class="bvert tdl">5th and over</td>
  <td class="bright tdc">30.8</td>
  <td class="bright tdc">27.1</td>
  <td class="bright tdc i0h">3.7</td>
</tr>
<tr>
  <td class="bbox tdc">Total</td>
  <td class="bh2 tdc">29.6</td>
  <td class="bh2 tdc">22.5</td>
  <td class="bh2 tdc i0h">7.1</td>
</tr>
</table>

<p>"It will be seen that the percentage mortality of cases
admitted on the same day of disease is less in every
<span class="pagenum"><a name="Page_120" id="Page_120">120</a></span>
instance in the year 1895. The difference is most
marked in the case of those patients who were admitted
on the first and second day of illness, viz., 10.8 and 14.5
respectively.</p>

<p>"Both in 1894 and 1895, no less than over 37 per
cent. of the patients were admitted on, or after, the fifth
day of disease. And, moreover, while in 1894 as many
as 59.2 per cent. of the fatal cases were not brought
under treatment until the fourth day, or later, in 1895,
the antitoxin year, the proportion was even higher, viz.,
67.7 per cent.</p>

<p class="title2"><i>Laryngeal Cases</i></p>

<p>"The tracheotomy results at each hospital are more
favourable in the year 1895 than in 1894, the mortality
ranging in the latter year at the different hospitals
between 90 per cent. and 59.4 per cent., whereas in
1895 the range was from 56.2 to 40.5.</p>

<p>"The combined tracheotomy mortality for all the
hospitals, which in 1894 was 70.4 per cent., has fallen
to 49.4 per cent. in 1895. This is a lower death-rate
than has ever been recorded in any single hospital of
the Board for a year's consecutive tracheotomies. In
other words, rather more than 50 per cent. of children
on whom the operation has been performed have been
saved since the employment of antitoxin. In one of the
hospitals no less than a fraction under 60 per cent. survived,
although the recoveries in that hospital in any
previous year did not exceed 25 per cent., and in the
preceding year&mdash;viz., 1894&mdash;were as low as 10 per cent.</p>

<p>"The improved results in the tracheotomy cases of
1895 have also been shared by analogous cases in which
the operation was not performed. The percentage mortality
of all laryngeal cases has fallen from 62 in 1894 to
42.3 in 1895.</p>

<p>"Moreover, the number of laryngeal cases which required
tracheotomy has fallen in 1895 to 45.3 per cent.,
whereas in 1894 it was 56 per cent.<span class="pagenum"><a name="Page_121" id="Page_121">121</a></span></p>

<p>"The following tables briefly summarise the foregoing
results. As no returns for 1894 were furnished by the
Fountain Hospital by reason of the smallness of the
numbers, the Fountain cases have also been omitted
from the 1895 figures, in order that the two series may
be rendered strictly comparable:&mdash;</p>

<p class="title2">1. <i>Comparative Mortality of Laryngeal Cases at all Hospitals,<br />
except the Fountain.</i></p>

<table border="0" cellpadding="0" cellspacing="2" summary="diptheria mortality laryngeal cases">
<tr>
  <th class="bbox">Year.</th>
  <th class="bh2">Cases.</th>
  <th class="bh2">Deaths.</th>
  <th class="bh2">Percentage<br />Mortality.</th>
</tr>
<tr>
  <td class="bvert tdc">1894</td>
  <td class="bright tdc">466</td>
  <td class="bright tdc">289</td>
  <td class="bright tdc">62.0</td>
</tr>
<tr>
  <td class="blc2 tdc">1895</td>
  <td class="bmc tdc">468</td>
  <td class="bmc tdc">196</td>
  <td class="bmc tdc">41.8</td>
</tr>
</table>

<p class="title2">2. <i>Comparative Results in Tracheotomy Cases at all Hospitals,<br />
except the Fountain.</i></p>

<table border="0" cellpadding="0" cellspacing="2" summary="diptheria deaths w tracheotomy">
<tr>
  <th class="bbox">Year.</th>
  <th class="bh2">Cases.</th>
  <th class="bh2">Deaths.</th>
  <th class="bh2">Percentage<br />Mortality.</th>
</tr>
<tr>
  <td class="bvert tdc">1894</td>
  <td class="bright tdc">261</td>
  <td class="bright tdc">184</td>
  <td class="bright tdc">70.4</td>
</tr>
<tr>
  <td class="blc2 tdc">1895</td>
  <td class="bmc tdc">219</td>
  <td class="bmc tdc">108</td>
  <td class="bmc tdc">49.3</td>
</tr>
</table>

<p class="title2">3. <i>Comparative Number of Laryngeal Cases which required<br />
Tracheotomy at all Hospitals, except the Fountain.</i></p>

<table border="0" cellpadding="0" cellspacing="2" summary="diptheria laryngeal cases which required tracheotomy">
<tr>
  <th class="bbox">Year.</th>
  <th class="bh2">Cases.</th>
  <th class="bh2">Tracheotomies.</th>
  <th class="bh2">Percentage of<br />Tracheotomies.</th>
</tr>
<tr>
  <td class="bvert tdc">1894</td>
  <td class="bright tdc">466</td>
  <td class="bright tdc">261</td>
  <td class="bright tdc">56.0</td>
</tr>
<tr>
  <td class="blc2 tdc">1895</td>
  <td class="bmc tdc">468</td>
  <td class="bmc tdc">219</td>
  <td class="bmc tdc">46.8</td>
</tr>
</table>

<p>"On these tables further comment seems unnecessary.
<span class="pagenum"><a name="Page_122" id="Page_122">122</a></span></p>

<p class="title2"><i>Summary</i></p>

<p>"The improved results in the diphtheria cases treated
during the year 1895, which are indicated by the foregoing
statistics and clinical observations, are&mdash;</p>

<p>1. A great reduction in the mortality of cases brought
under treatment on the first and second day of illness.</p>

<p>2. The lowering of the combined general mortality to
a point below that of any former year.</p>

<p>3. The still more remarkable reduction in the mortality
of the laryngeal cases.</p>

<p>4. The uniform improvement in the results of tracheotomy
at each separate hospital.</p>

<p>5. The beneficial effect produced on the clinical course
of the disease.</p>


<p class="title2"><i>Conclusions</i></p>

<p>"A consideration of the foregoing statistical tables
and clinical observations, covering a period of twelve
months, and embracing a large number of cases, in our
opinion sufficiently demonstrates the value of antitoxin
in the treatment of diphtheria.</p>

<p>"It must be clearly understood, however, that to obtain
the largest measure of success with antitoxin it is essential
that the patient be brought under its influence at
a comparatively early date&mdash;if possible, not later than
the second day of disease. From this time onwards, the
chance of a successful issue will diminish in proportion
to the length of time which has elapsed before the treatment
is commenced. This, though doubtless true of
other methods, is of still greater moment in the case of
treatment by antitoxin.</p>

<p>"Certain secondary effects not unfrequently arise as a
direct result of the injection of antitoxin in the form in
which it has at present to be administered, and even
assuming that the incidence of the normal complications
of diphtheria is greater than can be accounted for by the
<span class="pagenum"><a name="Page_123" id="Page_123">123</a></span>
increased number of recoveries, we have no hesitation in
expressing the opinion that these drawbacks are insignificant
when taken in conjunction with the lessened
fatality which has been associated with the use of this
remedy.</p>

<p>"We are further of the opinion that in antitoxic serum
we possess a remedy of distinctly greater value in the
treatment of diphtheria than any other with which we
are acquainted."</p>
</div>

<hr class="c15" />

<p>Now let us take the whole record of all the hospitals
together. The disease was first admitted in 1888; this
year is therefore to be reckoned as incomplete.</p>

<table border="0" cellpadding="0" cellspacing="2" summary="diptheria record all hospitals">
<tr>
  <th class="bbox">Year.</th>
  <th class="bh3 tdc">Percentage<br />Mortality.</th>
  <th class="bh2">Year.</th>
  <th class="bh2 tdc">Percentage<br />Mortality.</th>
</tr>
<tr>
  <td class="bvert">1888</td>
  <td class="bright2 tdc">59.35</td>
  <td class="bright">1897&emsp;&emsp;&emsp;&emsp;&emsp;</td>
  <td class="bright tdc">17.69</td>
</tr>
<tr>
  <td class="bvert">1889</td>
  <td class="bright2 tdc">40.74</td>
  <td class="bright">1898</td>
  <td class="bright tdc">15.37</td>
</tr>
<tr>
  <td class="bvert">1890</td>
  <td class="bright2 tdc">33.55</td>
  <td class="bright">1899</td>
  <td class="bright tdc">13.95</td>
</tr>
<tr>
  <td class="bvert">1891</td>
  <td class="bright2 tdc">30.63</td>
  <td class="bright">1900</td>
  <td class="bright tdc">12.27</td>
</tr>
<tr>
  <td class="bvert">1892</td>
  <td class="bright2 tdc">29.35</td>
  <td class="bright">1901</td>
  <td class="bright tdc">11.15</td>
</tr>
<tr>
  <td class="bvert">1893</td>
  <td class="bright2 tdc">30.42</td>
  <td class="bright">1902</td>
  <td class="bright tdc">11.04</td>
</tr>
<tr>
  <td class="bvert">1894</td>
  <td class="bright2 tdc">29.29</td>
  <td class="bright">1903</td>
  <td class="bright tdc i0h">9.69</td>
</tr>
<tr>
  <td class="bvert">1895, first antitoxin year&nbsp;</td>
  <td class="bright2 tdc">22.85</td>
  <td class="bright">1904</td>
  <td class="bright tdc">10.08</td>
</tr>
<tr>
  <td class="blc2">1896</td>
  <td class="bmc2 tdc">21.20</td>
  <td class="bmc">1905</td>
  <td class="bmc tdc i1">8.3</td>
</tr>
</table>

<p>These results, of course, are but one instance of what
has happened, since 1895, in every country all over
the civilised world. <i lang="la" xml:lang="la">Securus judicat orbis terrarum.</i> We
have Siegert's tables (1900), based on no less than
40,038 cases admitted in nine years to sixty-nine
hospitals in Germany, Austria, Switzerland, and Paris.
He divides these nine years into a "pre-serum period,"
an "introduction year," and a "serum period." In the
pre-serum period the general mortality was 41.5, and
<span class="pagenum"><a name="Page_124" id="Page_124">124</a></span>
the mortality of cases requiring operation was 60; in
the serum period, the general mortality was 16.5, and
the mortality of cases requiring operation was 37.5.</p>

<p>Any bad results that have been recorded from the
use of the antitoxin are so rare, in comparison with the
hundreds of thousands of injections made, that they do
not come to be considered here. And, even though a
few have occurred, we may be sure that some of them
were due, not to the antitoxin, but to the natural course
of the disease.<a name="FNanchor_23" id="FNanchor_23" href="#Footnote_23" class="fnanchor">[23]</a>  The lesser drawbacks, the occurrence
of joint pains and of rashes, are transient and in no
way serious.</p>

<p>It has been supposed, and said, that the use of the
antitoxin increases the complications of the disease.
On this point, the best authority is Professor Woodhead's
monumental Report (1901), dealing with the
Metropolitan Asylums Board cases for 1895 and 1896.
He sums up the matter thus:&mdash;</p>

<div class="blockquote">
<p>"The free use of antitoxin does not raise the percentage
of cases of albuminuria. As regards vomiting,
the statistics give little information, as vomiting is usually
met with only in the very severe cases. This also holds
good of anuria. The number of cases of adenitis appears
to be distinctly reduced by the use of antitoxin, as the
percentage of cases falls as the injections of antitoxin are
pushed. The use of antitoxin has also had a perceptible
effect in diminishing the cases of nephritis, and it certainly
has not aggravated the kidney complications of
diphtheria. There can be no doubt that in cases treated
with antitoxin there is a greater percentage of cases in
which joint-pains occur than in cases not so treated;
these, however, are transitory, and are probably the
<span class="pagenum"><a name="Page_125" id="Page_125">125</a></span>
result of some slight change in the blood set up by the
action of the serum itself, and not by the antitoxic substance
in the serum. The number of primary abscesses
has undoubtedly been reduced by the use of antitoxin.
It may also be accepted that antitoxic serum has some
effect in temporarily raising the temperature, but only
during the periods of joint-pains and serum rashes; all
these, however, are of comparatively slight importance
as compared with the effect the antitoxin has in diminishing
the percentage mortality and alleviating the more
severe symptoms.</p>

<p>"It is of importance to observe that amongst the cases
of paralysis following diphtheria the death-rate (32 per
cent.) was actually higher amongst those not injected
with antitoxin than amongst those where antitoxin was
used (30.5 per cent.), although the former paralyses must
be looked upon as being the result of a comparatively
mild attack of the disease. From this it is evident that,
when once paralysis supervenes in these cases, it is quite
as fatal in its effects as in the cases (usually those of a
more severe type) where antitoxin has been given. Antitoxin
<em>cannot cure</em> the degeneration of the nerve, but it
<em>can neutralise</em> the diphtheria toxin, and so put a stop to
the advance of the degenerative changes due to its action.
In 1896, when, of course, antitoxin was given much more
freely, the percentage of deaths in the non-injected cases
where paralysis had come on fell to 18.4.</p>

<p>"Antitoxin rashes occur at a comparatively late stage
of the disease. They cannot be looked upon as in any
way dangerous, although the secondary rise of temperature,
and the irritation of the skin which usually accompany
their presence are very undesirable complications,
and may retard somewhat the convalescence of nervous
and irritable patients.</p>

<p>"Antitoxin appears to diminish the liability of the lungs
to inflammatory change in severe attacks of diphtheria."
<span class="pagenum"><a name="Page_126" id="Page_126">126</a></span></p>
</div>

<hr class="c15" />

<p>Now let us take another point of view. If anybody
really doubts whether the antitoxin did really save these
lives in the hospitals of the Metropolitan Asylums
Board, what answer has he got to the following table?
It is published in the Board's Report for 1904, and
was drawn up by Dr. MacCombie, Medical Superintendent
of the Brook Hospital. It shows the supreme
importance of giving the antitoxin <em>at the very beginning
of the disease</em>. The figures in brackets are the total
numbers of the cases in the eight years:&mdash;</p>


<p class="title2"><i>Percentage Mortality according to Time of coming under<br />
Treatment.</i></p>

<table class="fsize85" border="0" cellpadding="0" cellspacing="2" summary="diptheria deaths time of treatment">
<tr>
  <th class="bbox">Day of<br /> Disease.</th>
  <th class="bh2">1897.</th>
  <th class="bh2">1898.</th>
  <th class="bh2">1899.</th>
  <th class="bh2">1900.</th>
  <th class="bh2">1901.</th>
  <th class="bh2">1902.</th>
  <th class="bh2">1903.</th>
  <th class="bh2">1904.</th>
</tr>
<tr>
  <td class="bvert">&nbsp;(204) 1st</td>
  <td class="bright tdr">0.0</td>
  <td class="bright tdr">0.0</td>
  <td class="bright tdr">0.0</td>
  <td class="bright tdr">0.0</td>
  <td class="bright tdr">0.0</td>
  <td class="bright tdr">0.0</td>
  <td class="bright tdr">0.0</td>
  <td class="bright tdr">0.0</td>
</tr>
<tr>
  <td class="bvert">&nbsp;(1278) 2nd&nbsp;</td>
  <td class="bright tdr">5.4</td>
  <td class="bright tdr">5.0</td>
  <td class="bright tdr">3.8</td>
  <td class="bright tdr">3.6</td>
  <td class="bright tdr">4.1</td>
  <td class="bright tdr">4.6</td>
  <td class="bright tdr">4.2</td>
  <td class="bright tdr">5.43</td>
</tr>
<tr>
  <td class="bvert">&nbsp;(1374) 3rd</td>
  <td class="bright tdr">11.5</td>
  <td class="bright tdr">14.3</td>
  <td class="bright tdr">12.2</td>
  <td class="bright tdr">6.7</td>
  <td class="bright tdr">11.9</td>
  <td class="bright tdr">10.5</td>
  <td class="bright tdr">17.6</td>
  <td class="bright tdr">10.63</td>
</tr>
<tr>
  <td class="bvert">&nbsp;(1086) 4th</td>
  <td class="bright tdr">19.0</td>
  <td class="bright tdr">18.1</td>
  <td class="bright tdr">20.0</td>
  <td class="bright tdr">14.9</td>
  <td class="bright tdr">12.4</td>
  <td class="bright tdr">19.8</td>
  <td class="bright tdr">16.7</td>
  <td class="bright tdr">19.51</td>
</tr>
<tr>
  <td class="blc2">&nbsp;(1382) 5th<br />&ensp;and after</td>
  <td class="bmc tdcb">21.0</td>
  <td class="bmc tdcb">22.5</td>
  <td class="bmc tdcb">20.4</td>
  <td class="bmc tdcb">21.2</td>
  <td class="bmc tdcb">16.6</td>
  <td class="bmc tdcb">19.4</td>
  <td class="bmc tdcb">17.3</td>
  <td class="bmc tdcb">13.11</td>
</tr>
</table>

<p>Here we see that in 1482 patients, who got the
antitoxin within forty-eight hours of the onset of the
disease, the mortality was 2-1/4 per cent. In 1278
patients, who did not get the antitoxin till the third
day, the mortality was 11-3/4 per cent. That is the
result of one day's delay over sending the child into
hospital.</p>

<p>Again, it is not only lives that are saved, but suffering
that is avoided. Just lately, at a meeting of the
Chelsea Clinical Society (May 1906), reference was
made to this point by Dr. Foord Caiger, Medical Superintendent
of the South-Western Hospital. "The
number of tracheotomies is less than half what it used
<span class="pagenum"><a name="Page_127" id="Page_127">127</a></span>
to be;" and again, "Instead of the spectacle of a
number of patients in great distress, with swollen necks
and stuffed-up noses, fretful and crying, such cases are
now quite the exception, and, in the few one does come
across, the condition lasts for a comparatively short
time." And again, "It was quite unusual (before
1895) for a nurse to care to stay very long in charge
of one of the diphtheria wards, because she found the
work so depressing. But nowadays the diphtheria
wards are perhaps the most popular in the hospital, a
fact which is mainly owing to the change in the general
aspect of the patients and the greatly reduced mortality."
(<cite>Clinical Journal</cite>, May 23, 1906.)
<span class="pagenum"><a name="Page_128" id="Page_128">128</a></span></p>

<h3>V<br />
TETANUS</h3>

<p>Before bacteriology, the cause of tetanus (lock-jaw) was
unknown, and men were free to imagine that it was
due to inflammation travelling up an injured nerve to
the central nervous system. This false and mischievous
theory was abolished by the experimental work of
Sternberg (1880), Carle and Rattone (1884), and
Nicolaier (1884), who proved, once and for all, that the
disease is an infection by a specific flagellate organism.
Their work was of the utmost difficulty, for many
reasons. First, because tetanus, in some tropical
countries, is so common that it may fairly be called
endemic; and many of these tropical cases, there being
no record of any external infection, had been taken as
evidence that the disease can occur "of itself." Of
this frequency of tetanus in tropical countries, Sir
Patrick Manson, in his book on <cite>Tropical Diseases</cite> (1898),
says:&mdash;</p>

<p class="blockquote">"Tetanus is an exceedingly common disease in some
tropical countries. In Western Africa, for example, a
large proportion of wounds, no matter how trifling as
wounds they may be, if they are fouled by earth or dirt,
result in tetanus. The French in Senegambia have
found this to their cost. A gentleman who had travelled
much in Congoland told me that certain tribes poison
their arrows by simply dipping the tips in a particular
kind of mud. A wound from these arrows is nearly sure
<span class="pagenum"><a name="Page_129" id="Page_129">129</a></span>
to cause tetanus. In many countries, so general and so
extensive is the distribution of the tetanus-bacillus that
trismus neonatorum (tetanus of newly-born infants) is a
principal cause of the excessive infant mortality."</p>

<p>Next, because the tetanus-bacillus has its natural
abode in the superficial layers of the soil: here it is
associated with a vast number of other organisms, so
that its identification and isolation were a work of
immeasurable complexity. What mixed company it
keeps, is shown by Houston's estimate of the number
of microbes per gramme in twenty-one samples of
different soils. This number ranged from 8326 in
virgin sand, and 475,282 in virgin peat, to 115,014,492
in the soil from the trench of a sewage-farm. In all rich
and well-manured soil the tetanus-bacillus may possibly
be present; but it was the work of years to dissociate
it from the myriads of organisms outnumbering it.</p>

<p>Next, because it cannot be got to grow in cultures
exposed to the air: its proper place is below the surface
of the soil, away from the air; it is "strictly anaërobic,"
and the attempts to cultivate it by ordinary methods
failed again and again. It had to be cultivated below
the surface of certain nutrient media, or in a special
atmosphere of nitrogen or hydrogen.</p>

<p>These and other difficulties for many years delayed
the final proof of the true pathology of tetanus. The
success of the work was mainly due to Nicolaier. He
started from the well-known fact that tetanus mostly
comes of wounds or scratches contaminated with
particles of earth&mdash;such mischances as the grinding of
dirt or gravel into the skin, or the tearing of it by a
splinter of wood or a rusty nail; as Dr. Poore says, in
his Milroy Lectures (1899), "Every child who falls on
<span class="pagenum"><a name="Page_130" id="Page_130">130</a></span>
the ground and gets an abrasion of the skin, all
tillers of the soil who get accidental wounds in the
course of duty, and every horse which 'breaks its
knees' by falling in the London streets, runs potentially
a risk of inoculation with tetanus." Nicolaier therefore
studied the various microbes of the soil, and made
inoculations of garden-mould under the skin of rabbits.
He was able, by these inoculations, to produce tetanus
in them; and the discharge from the points of inoculation,
put under the skin of other rabbits, produced the
disease again. He also identified the bacillus, and
cultivated it; but in these cultures it was mixed with
other organisms, and he failed to isolate it from them.
Carle and Rattone, and Rosenbach, were able to produce
tetanus in animals by inoculating them with discharge
from the wounds of patients attacked by the disease.
Finally, Kitasato, in 1889, found a way of obtaining
pure cultures of the bacillus. Beginning with impure
cultures such as Nicolaier had made, he kept these at a
temperature of 36° C. till the bacillus had spored; then,
by repeated exposures of the cultures to a temperature
of 80° C. for three-quarters of an hour at a time, he
killed-off all organisms except the spores of the tetanus-bacillus;
then he kept these in an atmosphere of
hydrogen, at a temperature of 20° C., and thus got
pure cultures.</p>

<p>Brieger, Fränkel, Cohen, Sidney Martin, Kanthack,
and others, have studied the chemical products of the
disease, have obtained them from cultures and from
infected tissues, and have been able with these toxins
to produce the disease in animals. As with the other
infective diseases, so with tetanus, there have been
two main lines of researches; the one, toward a fuller
knowledge of the chemical changes in the blood and in
<span class="pagenum"><a name="Page_131" id="Page_131">131</a></span>
the central nervous system; the other, toward a fuller
knowledge of the nature and ways of the bacillus, and
its method of invasion. Before any study of immunity
or immunisation, or of neutralisation of the toxins in
man by an antitoxin, came the study of the toxins
and of the bacillus. It was proved, by an immense
quantity of hard work, that the bacillus does not tend
to invade the blood, or to pass beyond the lymphatic
glands in the immediate neighbourhood of the site of
inoculation; that it stays in and about the wound, and
there multiplies, and from this site pours into the blood
the chemical products which cause the disease; and
that these chemical substances have a selective action
on certain nerve-cells in the brain and the spinal cord.
This is the bare outline of the facts; and no account
can be given here of the intricate problems of bacteriology
and animal chemistry that have been answered,
or are still waiting an answer. At least, it is evident
that the whole pathology of tetanus was found, proved,
and interpreted by the help of experiments on animals;
and that these alone did away with the old false
doctrine that the disease was due to rapid extension of
inflammation up a nerve to the brain.</p>

<p>In 1894 came the use of an antitoxin in cases of the
disease, and, in 1895, 42 cases were reported, with 27
recoveries. It cannot be said that any one of the
diverse preparations of tetanus-antitoxin, up to this
present time, has triumphed over the disease. Tetanus
is of all diseases the hardest to reckon with: the first
sign of it is the last stage of it; there is no warning,
nothing, it may be, but a healed scratch, till the central
nervous system is affected with sudden and rapidly
advancing degeneration of certain cells. These and
other difficulties have stood in the way of an antitoxin
<span class="pagenum"><a name="Page_132" id="Page_132">132</a></span>
treatment; and there is no less difficulty in estimating
the efficacy of that treatment. The recovery, under
antitoxin, of a "chronic" case cannot always or altogether
be attributed to the treatment; and in a very
acute case, antitoxin, like everything else, has but small
chance of success. Various reports on the antitoxin
treatment, published during 1897-1899, give the following
figures:&mdash;</p>

<table border="0" cellpadding="0" cellspacing="2" summary="tetanus w serum">
<tr>
  <td class="tdl">26 cases,</td>
  <td class="tdl">with 12 recoveries.</td>
</tr>
<tr>
  <td class="tdl">98<span class="i2">"</span></td>
  <td class="i2">57<span class="i2">"</span></td>
</tr>
<tr>
  <td class="tdl">36<span class="i2">"</span></td>
  <td class="i2">25<span class="i2">"</span></td>
</tr>
<tr>
  <td class="tdl">22<span class="i2">"</span></td>
  <td class="i2">11<span class="i2">"</span></td>
</tr>
<tr>
  <td class="tdl">51<span class="i2">"</span></td>
  <td class="i2">36<span class="i2">"</span></td>
</tr>
<tr>
  <td class="tdl">10<span class="i2">"</span></td>
  <td class="i2h">7<span class="i2">"</span></td>
</tr>
</table>

<p>Probably the paper by Dr. Lambert of New York,
in the <cite>Medical News</cite>, July 1900, gives fairly the general
opinion of the treatment, so far as the subcutaneous
administration of antitoxin is concerned:&mdash;</p>

<p class="blockquote">"The following cases of tetanus, treated with antitoxin,
comprise published and unpublished cases. We
have a total of 279 cases, with a mortality of 44.08 per
cent.: but of these we must rule out 17 cases&mdash;4 deaths
from intercurrent diseases, 8 deaths in cases in which
the antitoxin was given but a few hours before death,
and 5 recoveries in which antitoxin was not given until
after the twelfth day (as they probably would have recovered
without it). We have left 262 cases, with 151
recoveries, and 111 deaths, a mortality of 42.36 per cent.
Dividing the cases into acute and chronic, we have 124
acute cases, with 35 recoveries and 89 deaths, a mortality
of 71.77 per cent., and 138 chronic cases, with 116 recoveries
and 22 deaths, a mortality of 15.94 per cent. In
interpreting critically these statistics, we see that in acute
cases the mortality is but slightly reduced, being but 72
per cent. instead of 88 per cent. But, in the less acute
cases, there is a decided improvement, from 40 per cent.
to 16 per cent. Taking the statistics as a whole, there
<span class="pagenum"><a name="Page_133" id="Page_133">133</a></span>
is a distinct improvement in the mortality of tetanus since
the introduction of antitoxin."</p>

<p>It would be foreign to the present purpose to pursue
this matter further: for the other treatments, used by
Baccelli and by Krokiewicz, and the sub-dural use of
antitoxin, are also founded on experiments on animals;
and the same will be true of any better method that
shall be developed out of them.</p>

<p>The <i>preventive</i> use of the tetanus-antitoxin, for the
immunisation of human beings or of animals, has given
excellent results. Horses are very apt to be infected
by tetanus; and the antitoxin has been used in veterinary
practice, both for prevention and for cure. The
curative results are not, at present, very good. But, as
regards protection against the disease, there is evidence
that horses can be immunised against tetanus by the
antitoxin with almost mechanical accuracy. In some
parts of the world, the loss of horses by tetanus is
so common that their immunity is a very important
matter; and that the antitoxin does confer immunity
on them is shown by statistics from France and from
the United States:&mdash;</p>

<div class="blockquote">
<p>1. <i>France.</i>&mdash;"The results of Nocard's method of preventive
inoculations in veterinary practice are most
striking. Among 63 veterinarians, there have been inoculated
2737 animals with preventive doses of antitoxin,
and not a single case of tetanus developed; while during
the same period, in the same neighbourhoods, 259 cases
of tetanus developed in non-inoculated animals." (<cite>Med.
News</cite>, 7th July 1900.)</p>

<p>2. <i>United States.</i>&mdash;"Joseph MacFarland and E. M.
Ranck, in addition to a synopsis of the method of manufacture
of tetanus-antitoxin, give some facts of interest
and importance in regard to its use for prophylaxis
and treatment. The studies were made upon several
<span class="pagenum"><a name="Page_134" id="Page_134">134</a></span>
hundred horses used for the production of various immunised
serums in one of the large laboratories of the
United States. The horses, because of the constant
manipulations, frequently became infected with tetanus,
and in 1897 and 1898, when scrupulous cleanliness and
disinfection were the only precautions employed to prevent
the disease, the death-rate varied from 8 to 10 per
cent. During 1899 nearly two hundred horses were subjected
to systematic immunisation with tetanus-antitoxin;
and, in spite of otherwise similar conditions, the death-rate
descended to 1 per cent." (<cite>Medical Annual</cite>, 1901.)</p>
</div>

<p>The preventive use of the antitoxin has, of course, a
very limited range outside veterinary surgery. Tetanus,
thanks to the use of antiseptic or aseptic methods, not
only in hospital surgery but also in amateur and domestic
surgery, has become a very rare disease, except in
tropical countries. It is no longer a "hospital disease";
and, even in war, it no longer has anything like the
frequency that it had, for instance, in the War of the
Rebellion. A student may now go all his time at a
large hospital without seeing more than a very few
cases. But, now and again, attention is called to some
wholly unsuspected risk of the disease. For example,
certain cases of tetanus occurred in Dundee among
workers at the jute-mills there:&mdash;</p>

<p class="blockquote">"The last victim was a female worker in the jute-mill,
who, six days after a crushed and lacerated wound of the
foot, developed tetanus and died within twenty-four hours.
Some of the dust, taken from under the machine in which
the foot was crushed, was found to contain an unusually
large number of tetanus-bacilli. The source of the jute
used is India." (<cite>Medical News</cite>, August 1900.)</p>

<p>Again, at the Gebaer Anstalt at Prague, in 1899, an
outbreak of tetanus occurred, with several deaths; but
<span class="pagenum"><a name="Page_135" id="Page_135">135</a></span>
it was stopped when a preventive dose of the antitoxin
was given to the new patients on admission.</p>

<p>Again, an amazing number of deaths from tetanus,
in the United States, are due to wounds of the hands
with toy-pistols. It is said that after the Fourth of
July festivities in 1899, no less than 83 cases of tetanus
were reported, 26 of them in and around New York.
Almost all of them were due to gunshot wounds of the
hand with toy-pistols: the unclean wad of the cartridge,
made of refuse paper picked up in the streets,
penetrates deep into the tissues of the hand, taking the
germs of the disease with it, out of the reach of surgical
disinfection. These cases of tetanus in the United States
from toy-pistol wounds are so frequent, that immunisation
has been recommended for them. The <cite>Medical
News</cite>, 1st June 1901, has the following note:&mdash;"H. G.
Wells states that tetanus is endemic in Chicago, the
specific organism being present in the dirt of the streets.
Every Fourth of July an epidemic occurs, because these
bacilli are carried deeply into wounds before wads from
blank cartridges.... The writer thinks that such cases
should receive a prophylactic dose, say, 5 c.c. of tetanus-antitoxin,
as soon as possible after the wound is first
seen. It seems certain that if antitoxin prophylaxis
were adopted, there would be no further Fourth of July
epidemics, and this end would justify the means."</p>

<p>Again, a man might receive a lacerated wound under
conditions especially favourable to infection: he might
tear his hand in a stable where horses had died of
tetanus, or he might cut his finger while he was working
at the disease in a pathological laboratory, or he
might receive a poisoned arrow-wound out in Africa.
In any such emergency, he could safeguard his life
with a protective dose of antitoxin.
<span class="pagenum"><a name="Page_136" id="Page_136">136</a></span></p>

<p>It remains to be added, that the modern study of
tetanus has brought into more general use the old rule
that the wounded tissues in a severe case of tetanus
should be at once excised. Before Nicolaier's work,
while the theory still survived that the disease was
due to ascending inflammation of a nerve, this rule was
neither enforced nor explained.</p>

<p>The results published during the last few years
(<cite>Medical Annual</cite>, 1905-1906) seem to show that the
antitoxin has neither gained nor lost ground as a
remedy. It is, of course, used in conjunction with all
other remedies. Perhaps, in a few years more, something
better will be discovered. And that discovery,
when it comes, will be, as it were, Nicolaier's gift. The
whole study of the disease goes back straight to the
rabbits inoculated in 1880-1884: neither is it possible
that the disease should be further studied, without the
help of bacteriology.
<span class="pagenum"><a name="Page_137" id="Page_137">137</a></span></p>

<h3>VI<br />
RABIES</h3>

<p>Pasteur's study of rabies began in 1880; and the date
of the first case treated&mdash;Joseph Meister, a shepherd-boy
of Alsace&mdash;is July 1885. The first part of the
work was spent in a prolonged search for the specific
microbe of rabies. It was not found: its existence is
a matter of inference, but not of observation.<a name="FNanchor_24" id="FNanchor_24" href="#Footnote_24" class="fnanchor">[24]</a>  In his
earlier inoculations, Pasteur made use of the saliva of
rabid animals; and M. Valléry-Radot tells the story,
how Pasteur took him on one of his expeditions:&mdash;</p>

<p class="blockquote">"The rabid beast was in this case a huge bull-dog,
foaming at the mouth and howling in his cage. All
attempts to induce the animal to bite, and so infect one
of the rabbits, failed. 'But we <em>must</em>,' said Pasteur,
'inoculate the rabbits with the saliva.' Accordingly a
noose was made and thrown, the dog secured and
dragged to the edge of the cage, and his jaws tied
together. Choking with rage, the eyes bloodshot, and
the body convulsed by a violent spasm, the animal was
stretched on a table, and kept motionless, while Pasteur,
leaning over his foaming head, sucked up into a narrow
glass tube some drops of the saliva."</p>

<p>But these inoculations of saliva sometimes failed to
produce the disease; and, when they succeeded, the
incubation-period was wholly uncertain: it might be
some months before the disease appeared. Thus
<span class="pagenum"><a name="Page_138" id="Page_138">138</a></span>
Pasteur was led to use, instead of the saliva, an
emulsion of the brain or spinal cord; because, as
Dr. Duboué had suggested, the central nervous system
is the chief seat, the <i lang="la" xml:lang="la">locus electionis</i>, of the virus of
rabies. But these inoculations also were not always successful,
nor did they give a definite incubation-period.</p>

<p>Therefore he followed with rabies the method that
he had followed with anthrax. As he had cultivated
the virus of anthrax, by putting it where its development
could be watched and controlled, so he must put
the virus of rabies in the place of its choice. It has
a selective action on the cells of the central nervous
system, a sort of affinity with them; they are, as it
were, the natural home of rabies, the proper nutrient
medium for the virus: therefore the virus must be
inoculated not under the skin, but under the skull.</p>

<p>These sub-dural inoculations were the turning-point
of Pasteur's discovery. The first inoculation was made
by M. Roux:&mdash;</p>

<p class="blockquote">"Next day, when I informed Pasteur that the intracranial
inoculation offered no difficulty, he was moved
with pity for the dog. 'Poor beast, his brain is doubtless
injured: he must be paralysed.' Without reply I
went down to the basement to fetch it, and let it come
into the laboratory. Pasteur did not like dogs, but when
he saw this one, full of life, inquisitively rummaging
about in all directions, he exhibited the greatest delight,
and lavished most charming words upon it."</p>

<p>Henceforth all uncertainty was at an end, and the
way was clear ahead: Pasteur had now to deal with
a virus that had a definite period of incubation, and a
suitable medium for development. The central nervous
system was to the virus of rabies what the test-tube
was to the virus of fowl-cholera or anthrax. As he
<span class="pagenum"><a name="Page_139" id="Page_139">139</a></span>
had controlled these diseases, had turned them this
way and that, attenuated and intensified them, so he
could control rabies. By transmitting it through a
series of rabbits, by sub-dural inoculation of each rabbit
with a minute quantity of nerve-tissue from the rabbit
that had died before it, he was able to intensify the
virus, to shorten its period of incubation, to fix it at
six days. Thus he obtained a virus of exact strength,
a definite standard of virulence, <i lang="fr" xml:lang="fr">virus fixe</i>: the next
rabbit inoculated would have the disease in six days,
neither more nor less.</p>

<p>As he was able to intensify the virus by transmission,
so he was able to attenuate it by gradual drying
of the tissues that contained it. The spinal cord, taken
from a rabbit that has died of rabies, slowly loses
virulence by simple drying. A cord dried for four days
is less virulent than one that has been dried for three,
and more virulent than one dried for five. A cord dried
for a fortnight has lost all virulence: even a large dose
of it will not produce the disease. By this method
of drying, Pasteur was enabled to obtain the virus in
all degrees of activity: he could always keep going
one or more series of cords, of known and exactly
graduated strengths, according to the length of time
they had been dried&mdash;ranging from absolute non-virulence
through every shade of virulence.</p>

<p>And, as with fowl-cholera and anthrax, so with
rabies; a virus which has been attenuated till it has
been rendered innocuous, can yet confer immunity
against its more virulent forms: just as vaccination can
protect against smallpox. A man, bitten by a rabid
animal, has at least some weeks of respite before the
disease can break out; and, during that time of respite,
he can be immunised against the disease, while it is
<span class="pagenum"><a name="Page_140" id="Page_140">140</a></span>
still dormant: he begins with a dose of virus attenuated
past all power of doing harm, and advances day by day
to more active doses, guarded each day by the dose of
the day before, till he has manufactured within himself
enough antitoxin to make him proof against any outbreak
of the disease.</p>

<p>The cords used for treatment are removed from the
bodies of the rabbits, by an aseptic method, and are cut
into lengths and hung in glass jars, with some chloride
of calcium in them, for drying. The jars are dated,
and then kept in glass cases in a dark room at a
constant temperature. To make sure that the cords
are aseptic, a small portion of each cord is sown on
nutrient jelly in a test-tube, and watched, to see that no
bacteria occur in the tube. For each injection, a
certain small quantity of cord is rubbed-up in sterilised
fluid; and these subcutaneous injections give no pain
or malaise worth considering.</p>

<p>Of course, the treatment is adjusted to the gravity of
the case. A bite through naked skin is more grave
than a bite through clothing; and bites on the head or
face, and wolf-bites, are worst of all. The number and
character of the scars are also taken into account. An
excellent description of the treatment, by a patient, was
published in the <cite>Birmingham Medical Review</cite> of January
1898. It gives the following tables of treatment:&mdash;</p>

<p class="title2">1. <i>Ordinary Treatment.</i></p>

<table border="0" cellpadding="0" cellspacing="1" summary="tetanus treatment">
<tr>
  <td class="tdc">Day of<br />
  Treatment.</td>
  <td>&nbsp;</td>
  <td class="tdc">Days of Drying<br />
  of Cord.</td>
</tr>
<tr>
  <td class="tdc">1</td>
  <td>&nbsp;</td>
  <td class="tdc">14 and 13</td>
</tr>
<tr>
  <td class="tdc">2</td>
  <td>&nbsp;</td>
  <td class="tdc">12 and 11</td>
</tr>
<tr>
  <td class="tdc">3</td>
  <td>&nbsp;</td>
  <td class="tdc">10 and  9</td>
</tr>
<tr>
  <td class="tdc">4</td>
  <td>&nbsp;</td>
  <td class="tdc">8 and  7</td>
</tr>
<tr>
  <td class="tdc">5</td>
  <td>&nbsp;</td>
  <td class="tdc">6</td>
</tr>
<tr>
  <td class="tdc">6</td>
  <td>&nbsp;</td>
  <td class="tdc">6</td>
</tr>
<tr>
  <td class="tdc">7</td>
  <td>&nbsp;</td>
  <td class="tdc">5</td>
</tr>
<tr>
  <td class="tdc">8</td>
  <td>&nbsp;</td>
  <td class="tdc">4</td>
</tr>
<tr>
  <td class="tdc">9</td>
  <td>(1/2 dose)</td>
  <td class="tdc">3</td>
</tr>
<tr>
  <td class="tdc">10</td>
  <td>(full dose)</td>
  <td class="tdc">5</td>
</tr>
<tr>
  <td class="tdc">11</td>
  <td>&nbsp;</td>
  <td class="tdc">5</td>
</tr>
<tr>
  <td class="tdc">12</td>
  <td>&nbsp;</td>
  <td class="tdc">4</td>
</tr>
<tr>
  <td class="tdc">13</td>
  <td>&nbsp;</td>
  <td class="tdc">4</td>
</tr>
<tr>
  <td class="tdc">14</td>
  <td>(1/2 dose)</td>
  <td class="tdc">3</td>
</tr>
<tr>
  <td class="tdc">15</td>
  <td>(full dose)</td>
  <td class="tdc">3<span class="pagenum"><a name="Page_141" id="Page_141">141</a></span></td>
</tr>
</table>

<p class="title2">2. <i>Cases of Moderate Gravity.</i></p>

<p class="center">Same treatment, up to 13th day.</p>

<table border="0" cellpadding="0" cellspacing="2" summary="tetanus treatment">
<tr>
  <td class="tdc">Day of<br /> Treatment.</td>
  <td>&nbsp;</td>
  <td class="tdc">Days of Drying<br /> of Cord.</td>
</tr>
<tr>
  <td class="tdc">14</td>
  <td>&nbsp;</td>
  <td class="tdc">3</td>
</tr>
<tr>
  <td class="tdc">15</td>
  <td>&nbsp;</td>
  <td class="tdc">5</td>
</tr>
<tr>
  <td class="tdc">16</td>
  <td>&nbsp;</td>
  <td class="tdc">4</td>
</tr>
<tr>
  <td class="tdc">17</td>
  <td>(1/2 dose)</td>
  <td class="tdc">3</td>
</tr>
<tr>
  <td class="tdc">18</td>
  <td>(full dose)</td>
  <td class="tdc">3</td>
</tr>
</table>

<p class="title2">3. <i>Grave Cases.</i></p>

<p class="center">Same treatment, up to 10th day.</p>

<table border="0" cellpadding="0" cellspacing="2" summary="tetanus treatment">
<tr>
  <td class="tdc">Day of<br /> Treatment.</td>
  <td>&nbsp;</td>
  <td class="tdc">Days of Drying<br /> of Cord.</td>
</tr>
<tr>
  <td class="tdc">11</td>
  <td>&nbsp;</td>
  <td class="tdc">4</td>
</tr>
<tr>
  <td class="tdc">12</td>
  <td>&nbsp;</td>
  <td class="tdc">3</td>
</tr>
<tr>
  <td class="tdc">13</td>
  <td>&nbsp;</td>
  <td class="tdc">5</td>
</tr>
<tr>
  <td class="tdc">14</td>
  <td>&nbsp;</td>
  <td class="tdc">5</td>
</tr>
<tr>
  <td class="tdc">15</td>
  <td>&nbsp;</td>
  <td class="tdc">4</td>
</tr>
<tr>
  <td class="tdc">16</td>
  <td>&nbsp;</td>
  <td class="tdc">4</td>
</tr>
<tr>
  <td class="tdc">17</td>
  <td>(1/2 dose)</td>
  <td class="tdc">3</td>
</tr>
<tr>
  <td class="tdc">18</td>
  <td>(full dose)</td>
  <td class="tdc">3</td>
</tr>
<tr>
  <td class="tdc">19</td>
  <td>&nbsp;</td>
  <td class="tdc">5</td>
</tr>
<tr>
  <td class="tdc">20</td>
  <td>&nbsp;</td>
  <td class="tdc">3</td>
</tr>
<tr>
  <td class="tdc">21</td>
  <td>&nbsp;</td>
  <td class="tdc">4</td>
</tr>
<tr>
  <td class="tdc">22</td>
  <td>&nbsp;</td>
  <td class="tdc">3</td>
</tr>
</table>

<p class="title2">4. <i>Very Grave Cases.</i></p>

<p class="center">Same treatment as 3, and in addition.</p>

<table border="0" cellpadding="0" cellspacing="2" summary="tetanus treatment">
<tr>
  <td class="tdc">Day of<br /> Treatment.</td>
  <td>&nbsp;</td>
  <td class="tdc">Days of Drying<br /> of Cord.</td>
</tr>
<tr>
  <td class="tdc">23</td>
  <td>&nbsp;</td>
  <td class="tdc">5</td>
</tr>
<tr>
  <td class="tdc">24</td>
  <td>&nbsp;</td>
  <td class="tdc">4</td>
</tr>
<tr>
  <td class="tdc">25</td>
  <td>(1/2 dose)</td>
  <td class="tdc">3</td>
</tr>
<tr>
  <td class="tdc">26</td>
  <td>(full dose)</td>
  <td class="tdc">3</td>
</tr>
</table>

<p>Furious criticism, unbelief, and flagrant misstatement
of facts began at once, and lasted more than two years.
Of Pasteur's opponents, the chief was M. Peter, who
besought the Académie des Sciences, about once a week,
that they should close Pasteur's laboratory, because he
was not preventing hydrophobia but producing it. The
value of M. Peter's judgment may be estimated by what
he had said, a few years earlier, about bacteriology in
general&mdash;"I do not much believe in that invasion of
parasites which threatens us like an eleventh plague of
Egypt. After so many laborious researches, nothing
will be changed in medicine, there will only be a few
more microbes. M. Pasteur's excuse is that he is a
<span class="pagenum"><a name="Page_142" id="Page_142">142</a></span>
chemist, who has tried, out of a wish to be useful, to
reform medicine, to which he is a complete stranger."</p>

<p>But it does not matter what was said twenty years
ago. In England, the Report of the 1886 Committee,
and the Mansion House meeting in July 1889, mark
the decline and fall of all intelligent opposition to the
work. Among so many thousand cases, during so
many years, it would be a miracle indeed if not a single
case had failed or gone amiss; but we are concerned
here with the thousands. Take, to begin with, four
reports from Athens, Palermo, Rio, and Paris. It is to
be noted that the patients, alike at Paris and at other
Institutes, are divided into three classes:&mdash;</p>

<div class="blockquote">
<p>"A. Bitten by animals proved to have been rabid by
the development of rabies in other animals inoculated
from them.</p>

<p>"B. Bitten by animals proved to have been rabid by
dissection of their bodies by veterinary surgeons.</p>

<p>"C. Bitten by animals suspected to have been rabid."</p>
</div>

<p>It is to be noted also, as a fact proved beyond doubt,
that the full benefit of the treatment is not obtained at
once; the highest degree of immunity is reached about
a fortnight after the discontinuance of the treatment.
Those few cases, therefore, where hydrophobia has
occurred, not only in spite of treatment, but within a
fortnight of the last day of treatment, are counted as
cases where the treatment came too late.</p>

<p>Finally, what was the risk from the bite of a rabid
animal, in the days before 1885? It is a matter of
guess-work. One writer, and one only, guessed it at
5 per cent.; another guessed it at 55, and a third came
to the safe conclusion that it was "somewhere between
these limits." Leblanc, who is probably the best
<span class="pagenum"><a name="Page_143" id="Page_143">143</a></span>
guide, put it at 16; and Pasteur himself put it between
15 and 20. But suppose it were only 10; that,
before Pasteur, out of every 100 men bitten by
rabid animals, 90 would escape and only 10 would
die of hydrophobia; then take this fact, that in one
year, at one Institute alone, there were 142 patients in
class A, bitten by animals that were proved, by the
unanswerable test of inoculation, to have been rabid;
and 1 death. And every year the same thing; and in
all the twelve years together, 2872 such cases (A) and
20 deaths&mdash;a mortality not of 10 per cent., but of less
than 1 per cent.</p>

<h4>1. <i>Athens</i></h4>

<p>The <cite>Annales de l'Institut Pasteur</cite>, June 1898, contain
Dr. Pampoukis' report of three years' work at the
Hellenic Institute, from August 1894 to December
1897. During this period 797 cases were treated&mdash;590
male and 207 female. The animals that bit them
were&mdash;dogs, 732; cats, 34; wolf, 1; other animals,
13; and the 17 other patients had been exposed to
infection from the saliva of hydrophobic patients. Of
the 797 cases, 245 were of class A, 112 B, and 440 C.</p>

<p>"Among the 797 persons treated, there are 2
deaths, one in class B and the other in class C. Thus
the mortality has been 0.25 per cent. Besides these 2
who died of rabies there are 5 more, in whom the first
signs of rabies showed themselves in less than fifteen
days after the last inoculation.</p>

<p>"Finally, beside these 797 cases, there is 1 other
case, bitten by a wolf, in which the treatment failed.
If we reckon this last case in the statistics of mortality,
we have 3 deaths in 798 cases = 0.37 per cent.</p>

<p>"Beside these 798 cases treated at the Institute,
<span class="pagenum"><a name="Page_144" id="Page_144">144</a></span>
there have been others that have not undergone the
antirabic treatment, having trusted the assurances of
those who are called in Greece <i lang="el" xml:lang="el">empirics</i>. Among
these non-treated cases there are 40 who have died of
rabies."</p>

<h4>2. <i>Palermo</i></h4>

<p>The <cite>Annales</cite> for April 1896 give the report by
Dr. de Blasi and Dr. Russo-Travali of the work of the
Municipal Institute at Palermo during 8-1/2 years, from
March 1887 to December 1895. The number of cases
was 2221; in 1240 (class A), the animals were proved
to have been rabid by the result of inoculations; in 981,
there was reason to suspect rabies.</p>

<p>"Setting aside 5 patients who died during the course
of the treatment, and 5 others who died less than
fifteen days after the end of the treatment, we have had
to deplore only 9 failures = 0.4 per cent. Even if
we count against ourselves the 10 other cases, the
mortality is still only 0.85."</p>

<h4>3. <i>Rio de Janeiro</i></h4>

<p>The <cite>Annales</cite> for August 1898 give Dr. Ferreira's
report of ten years' work (February 1888 to April
1898) at the Pasteur Institute at Rio. The number of
cases treated was 2647, of whom 1987 were male and
660 female. Beside these 2647 there were 1234 who
were not treated, because it was ascertained that they
were in no danger of rabies; 3 who were brought to
the Institute, already suffering from the disease; and
59 who refused treatment.</p>

<p>Of the 2647 persons treated, 10 had pricked their
hands at work in the laboratory, 3 had exposed chance
scratches on their hands to the saliva of rabid animals,
<span class="pagenum"><a name="Page_145" id="Page_145">145</a></span>
and 1 had been bitten by a rabid patient. Of the rest,
1886 had been bitten on the bare skin, and 747
through clothing.</p>

<p>In 236 cases the rabies of the animal had been
proved by inoculation. In 1173 it had been recognised
by the signs of the disease. In 1238 there was good
reason to suspect that the animal had been rabid.</p>

<p>Of the 2647 patients, in 30 cases the treatment was
stopped, because the animals were at last traced, after
treatment was begun, and were found not to be rabid.
In 65 cases the patients, after treatment was begun,
refused to go on with it, and 3 of them died of rabies.
In 6 cases rabies developed during treatment; 5 of
them had been very badly bitten about the head, and 1
did not come for treatment till the twenty-first day
after the bite, and was attacked by rabies two days
later. And 5 cases died of other maladies that had
nothing to do with rabies. Setting aside these 106
cases, there remain 2541 cases, with 20 deaths = 0.78
per cent. But, of these 20 deaths, 9 occurred within
fifteen days of the end of treatment, before protection
was fully established. If these 9 deaths be excluded,
the figures stand at 2532 cases, with 11 deaths = 0.43
per cent.</p>

<h4>4. <i>Paris</i></h4>

<p>Dr. Pottevin's report on the work of the Pasteur
Institute (Paris) during 1897 (<cite>Annales</cite>, April 1898)
must be given word for word, without abbreviation.</p>

<p class="title2">I</p>

<p>During 1897, 1521 patients received the anti-treatment
at the Pasteur Institute: 8 died of rabies.
<span class="pagenum"><a name="Page_146" id="Page_146">146</a></span>
The notes of their cases will be found at the end of this
paper.</p>

<p>If we exclude 2 of these 8 cases&mdash;the cases of
Heniquet and Morin, where death occurred before it
was possible for the vaccinations to produce their effect&mdash;the
results of the vaccinations in 1897 are</p>

<table border="0" cellpadding="0" cellspacing="2" summary="rabies treatment">
<tr>
  <td class="tdl">Patients treated</td>
  <td class="tdr">1519&ensp;</td>

</tr>
<tr>
  <td class="tdl">Deaths</td>
  <td class="tdr">6&ensp;</td>

</tr>
<tr>
  <td class="tdl">Mortality per cent.</td>
  <td class="i2h">0.39</td>

</tr>
</table>

<p>In the following table these figures are compared
with those of preceding years:&mdash;</p>

<table border="0" cellpadding="0" cellspacing="2" summary="rabies treatment">
<tr>
  <th class="bbox">Year.</th>
  <th class="bh2">Patients<br />treated.</th>
  <th class="bh2">Deaths.</th>
  <th class="bh2">Mortality<br />per cent.</th>
</tr>
<tr>
  <td class="bvert tdc">1886</td>
  <td class="bright tdc">2671</td>
  <td class="bright tdc">25</td>
  <td class="bright tdc">0.94</td>
</tr>
<tr>
  <td class="bvert tdc">1887</td>
  <td class="bright tdc">1770</td>
  <td class="bright tdc">14</td>
  <td class="bright tdc">0.79</td>
</tr>
<tr>
  <td class="bvert tdc">1888</td>
  <td class="bright tdc">1622</td>
  <td class="bright tdc i0h">9</td>
  <td class="bright tdc">0.55</td>
</tr>
<tr>
  <td class="bvert tdc">1889</td>
  <td class="bright tdc">1830</td>
  <td class="bright tdc i0h">7</td>
  <td class="bright tdc">0.38</td>
</tr>
<tr>
  <td class="bvert tdc">1890</td>
  <td class="bright tdc">1540</td>
  <td class="bright tdc i0h">5</td>
  <td class="bright tdc">0.32</td>
</tr>
<tr>
  <td class="bvert tdc">1891</td>
  <td class="bright tdc">1559</td>
  <td class="bright tdc i0h">4</td>
  <td class="bright tdc">0.25</td>
</tr>
<tr>
  <td class="bvert tdc">1892</td>
  <td class="bright tdc">1790</td>
  <td class="bright tdc i0h">4</td>
  <td class="bright tdc">0.22</td>
</tr>
<tr>
  <td class="bvert tdc">1893</td>
  <td class="bright tdc">1648</td>
  <td class="bright tdc i0h">6</td>
  <td class="bright tdc">0.36</td>
</tr>
<tr>
  <td class="bvert tdc">1894</td>
  <td class="bright tdc">1387</td>
  <td class="bright tdc i0h">7</td>
  <td class="bright tdc">0.50</td>
</tr>
<tr>
  <td class="bvert tdc">1895</td>
  <td class="bright tdc">1520</td>
  <td class="bright tdc i0h">5</td>
  <td class="bright tdc">0.33</td>
</tr>
<tr>
  <td class="bvert tdc">1896</td>
  <td class="bright tdc">1308</td>
  <td class="bright tdc i0h">4</td>
  <td class="bright tdc">0.30</td>
</tr>
<tr>
  <td class="blc2 tdc">1897</td>
  <td class="bmc tdc">1521</td>
  <td class="bmc tdc i0h">6</td>
  <td class="bmc tdc">0.39</td>
</tr>
</table>

<p class="title2">II</p>

<p>Patients treated at the Pasteur Institute are divided
into three classes, as follows:&mdash;</p>

<p>A. The rabies of the animal was proved by experiment,
by the development of rabies in animals inoculated
with its bulb (the upper end of the spinal cord).<a name="FNanchor_25" id="FNanchor_25" href="#Footnote_25" class="fnanchor">[25]</a>
<span class="pagenum"><a name="Page_147" id="Page_147">147</a></span></p>

<p>B. The rabies of the animal was proved by veterinary
examination (dissection of its body).</p>

<p>C. The animal was suspected of rabies.</p>

<p>We give here the patients treated in 1897, under
these three classes:&mdash;</p>

<table border="0" cellpadding="0" cellspacing="2" summary="rabies treatment">
<tr>
  <th colspan="4" class="bbox"><span class="smcap">Bites of the</span><br /><span class="smcap">Head.</span></th>
  <th colspan="3" class="bh2"><span class="smcap">Bites on the</span><br /><span class="smcap">Hands.</span></th>
  <th colspan="3" class="bh2"><span class="smcap">Bites of the</span><br /><span class="smcap">Limbs.</span></th>
  <th colspan="3" class="bh2"><span class="smcap">Total.</span></th>
</tr>
<tr>
  <th class="bvert">&nbsp;</th>
  <th class="tdc bright">P</th>
  <th class="tdc bright">D</th>
  <th class="tdc bright">M&nbsp; p</th>
  <th class="tdc bright">P</th>
  <th class="tdc bright">D</th>
  <th class="tdc bright">M&nbsp; p</th>
  <th class="tdc bright">P</th>
  <th class="tdc bright">D</th>
  <th class="tdc bright">M&nbsp; p</th>
  <th class="tdc bright">P</th>
  <th class="tdc bright">D</th>
  <th class="tdc bright">M&nbsp; p</th>
</tr>
<tr>
  <th class="bvert">&nbsp;</th>
  <th class="tdc bright">a</th>
  <th class="tdc bright">e</th>
  <th class="tdc bright">o&nbsp; e</th>
  <th class="tdc bright">a</th>
  <th class="tdc bright">e</th>
  <th class="tdc bright">o&nbsp; e</th>
  <th class="tdc bright">a</th>
  <th class="tdc bright">e</th>
  <th class="tdc bright">o&nbsp; e</th>
  <th class="tdc bright">a</th>
  <th class="tdc bright">e</th>
  <th class="tdc bright">o&nbsp; e</th>
</tr>
<tr>
  <th class="bvert">&nbsp;</th>
  <th class="tdc bright">t</th>
  <th class="tdc bright">a</th>
  <th class="tdc bright">r&ensp; r</th>
  <th class="tdc bright">t</th>
  <th class="tdc bright">a</th>
  <th class="tdc bright">r&ensp; r</th>
  <th class="tdc bright">t</th>
  <th class="tdc bright">a</th>
  <th class="tdc bright">r&ensp; r</th>
  <th class="tdc bright">t</th>
  <th class="tdc bright">a</th>
  <th class="tdc bright">r&ensp; r</th>
</tr>
<tr>
  <th class="bvert">&nbsp;</th>
  <th class="tdc bright">i</th>
  <th class="tdc bright">t</th>
  <th class="tdc bright">t&ensp;&nbsp;&nbsp;&nbsp;</th>
  <th class="tdc bright">i</th>
  <th class="tdc bright">t</th>
  <th class="tdc bright">t&ensp;&nbsp;&nbsp;&nbsp;</th>
  <th class="tdc bright">i</th>
  <th class="tdc bright">t</th>
  <th class="tdc bright">t&ensp;&nbsp;&nbsp;&nbsp;</th>
  <th class="tdc bright">i</th>
  <th class="tdc bright">t</th>
  <th class="tdc bright">t&ensp;&nbsp;&nbsp;&nbsp;</th>
</tr>
<tr>
  <th class="bvert">&nbsp;</th>
  <th class="tdc bright">e</th>
  <th class="tdc bright">h</th>
  <th class="tdc bright">a&ensp; c</th>
  <th class="tdc bright">e</th>
  <th class="tdc bright">h</th>
  <th class="tdc bright">a&ensp; c</th>
  <th class="tdc bright">e</th>
  <th class="tdc bright">h</th>
  <th class="tdc bright">a&ensp; c</th>
  <th class="tdc bright">e</th>
  <th class="tdc bright">h</th>
  <th class="tdc bright">a&ensp; c</th>
</tr>
<tr>
  <th class="bvert">&nbsp;</th>
  <th class="tdc bright">n</th>
  <th class="tdc bright">s</th>
  <th class="tdc bright">l&ensp; e</th>
  <th class="tdc bright">n</th>
  <th class="tdc bright">s</th>
  <th class="tdc bright">l&ensp; e</th>
  <th class="tdc bright">n</th>
  <th class="tdc bright">s</th>
  <th class="tdc bright">l&ensp; e</th>
  <th class="tdc bright">n</th>
  <th class="tdc bright">s</th>
  <th class="tdc bright">l&ensp; e</th>
</tr>
<tr>
  <th class="bvert">&nbsp;</th>
  <th class="tdc bright">t</th>
  <th class="tdc bright">&nbsp;</th>
  <th class="tdc bright">i&ensp; n</th>
  <th class="tdc bright">t</th>
  <th class="tdc bright">&nbsp;&nbsp;</th>
  <th class="tdc bright">i&ensp; n</th>
  <th class="tdc bright">t</th>
  <th class="tdc bright">&nbsp;</th>
  <th class="tdc bright">i&ensp; n</th>
  <th class="tdc bright">t</th>
  <th class="tdc bright">&nbsp;</th>
  <th class="tdc bright">i&ensp; n</th>
</tr>
<tr>
  <th class="bvert">&nbsp;</th>
  <th class="tdc bright">s</th>
  <th class="tdc bright">&nbsp;</th>
  <th class="tdc bright">t&ensp; t</th>
  <th class="tdc bright">s</th>
  <th class="tdc bright">&nbsp;</th>
  <th class="tdc bright">t&ensp; t</th>
  <th class="tdc bright">s</th>
  <th class="tdc bright">&nbsp;</th>
  <th class="tdc bright">t&ensp; t</th>
  <th class="tdc bright">s</th>
  <th class="tdc bright">&nbsp;</th>
  <th class="tdc bright">t&ensp; t</th>
</tr>
<tr>
  <th class="blc2 tdc">&nbsp;</th>
  <th class="tdc bmc">.</th>
  <th class="tdc bmc">&nbsp;</th>
  <th class="tdc bmc">y&ensp; .</th>
  <th class="tdc bmc">.</th>
  <th class="tdc bmc">&nbsp;</th>
  <th class="tdc bmc">y&ensp; .</th>
  <th class="tdc bmc">.</th>
  <th class="tdc bmc">&nbsp;</th>
  <th class="tdc bmc">y&ensp; .</th>
  <th class="tdc bmc">.</th>
  <th class="bmc">&nbsp;</th>
  <th class="tdc bmc">y&ensp; .</th>
</tr>
<tr>
  <td class="bvert tdc">A</td>
  <td class="bright tdc i0h">15</td>
  <td class="bright tdc">0</td>
  <td class="bright tdc">0</td>
  <td class="bright tdc i0h">81</td>
  <td class="bright tdc">0</td>
  <td class="bright tdc">0&emsp;&nbsp;</td>
  <td class="bright tdc i0h">46</td>
  <td class="bright tdc">1</td>
  <td class="bright tdc">2.1</td>
  <td class="bright tdc">142</td>
  <td class="bright tdc">1</td>
  <td class="bright tdc">0.7&ensp;</td>
</tr>
<tr>
  <td class="bvert tdc">B</td>
  <td class="bright tdc">106</td>
  <td class="bright tdc">0</td>
  <td class="bright tdc">0</td>
  <td class="bright tdc">539</td>
  <td class="bright tdc">4</td>
  <td class="bright tdc">0.74</td>
  <td class="bright tdc">273</td>
  <td class="bright tdc">1</td>
  <td class="bright tdc">0.4</td>
  <td class="bright tdc">918</td>
  <td class="bright tdc">5</td>
  <td class="bright tdc">0.65</td>
</tr>
<tr>
  <td class="bvert tdc">C</td>
  <td class="bright tdc i0h">30</td>
  <td class="bright tdc">0</td>
  <td class="bright tdc">0</td>
  <td class="bright tdc">244</td>
  <td class="bright tdc">0</td>
  <td class="bright tdc">0&emsp;&nbsp;</td>
  <td class="bright tdc">187</td>
  <td class="bright tdc">0</td>
  <td class="bright tdc">0&ensp;&nbsp;</td>
  <td class="bright tdc">461</td>
  <td class="bright tdc">0</td>
  <td class="bright tdc">0&emsp;&nbsp;</td>
</tr>
<tr>
  <td class="bbox tdc">&nbsp;</td>
  <td class="bh2 tdc">151</td>
  <td class="bh2 tdc">0</td>
  <td class="bh2 tdc">0</td>
  <td class="bh2 tdc">864</td>
  <td class="bh2 tdc">4</td>
  <td class="bh2 tdc">0.46</td>
  <td class="bh2 tdc">506</td>
  <td class="bh2 tdc">2</td>
  <td class="bh2 tdc">0.4</td>
  <td class="bh2 tdc">1521</td>
  <td class="bh2 tdc">6</td>
  <td class="bh2 tdc">0.39</td>
</tr>
</table>

<p>The following tables, giving the results obtained
since the vaccinations were first used, show that the
gravity of the bites varies with their position on the
body, and that the mortality is always below 1 per
cent. among patients bitten by dogs undoubtedly
rabid:&mdash;</p>

<table class="fsize85" border="0" cellpadding="0" cellspacing="2" summary="rabies type of bites">
<tr>
  <th class="bbox">&nbsp;</th>
  <th class="bh2">Patients.</th>
  <th class="bh2">Deaths.</th>
  <th class="bh3">Mortality.</th>
  <th class="bh2">&nbsp;</th>
  <th class="bh2">Patients.</th>
  <th class="bh2">Deaths.</th>
  <th class="bh2">Mortality.</th>
</tr>
<tr>
  <td class="bvert tdc">Bites of the Head&nbsp;&nbsp;</td>
  <td class="bright tdc i0h">1,759</td>
  <td class="bright tdc">21</td>
  <td class="bright2 tdc">1.1&nbsp;&nbsp;</td>
  <td class="bright tdc">A</td>
  <td class="bright tdc i0h">2,872</td>
  <td class="bright tdc">20</td>
  <td class="bright tdc">0.69</td>
</tr>
<tr>
  <td class="bvert tdc">Bites of the Hands</td>
  <td class="bright tdc">11,118</td>
  <td class="bright tdc">53</td>
  <td class="bright2 tdc">0.47</td>
  <td class="bright tdc">B</td>
  <td class="bright tdc">12,547</td>
  <td class="bright tdc">61</td>
  <td class="bright tdc">0.48</td>
</tr>
<tr>
  <td class="bvert tdc">Bites of the Limbs</td>
  <td class="bright tdc i0h">7,289</td>
  <td class="bright tdc">22</td>
  <td class="bright2 tdc">0.30</td>
  <td class="bright tdc">C</td>
  <td class="bright tdc i0h">4,747</td>
  <td class="bright tdc">15</td>
  <td class="bright tdc">0.31</td>
</tr>
<tr>
  <td class="bbox tdc">&nbsp;</td>
  <td class="bh2 tdc">20,166</td>
  <td class="bh2 tdc">96</td>
  <td class="bh3 tdc">0.46</td>
  <td class="bh2 tdc">&nbsp;</td>
  <td class="bh2 tdc">20,166</td>
  <td class="bh2 tdc">96</td>
  <td class="bh2 tdc">0.46<span class="pagenum"><a name="Page_148" id="Page_148">148</a></span></td>
</tr>

</table>

<p class="title2">III</p>

<p>In regard to their nationality, the 1521 patients
treated at the Pasteur Institute in 1897 were as
follows:&mdash;</p>

<table border="0" cellpadding="0" cellspacing="2" summary="rabies nationality of patients">
<tr>
  <td class="tdl">Germany</td>
  <td class="i2">&nbsp;</td>
  <td class="tdr">8</td>
</tr>
<tr>
  <td class="tdl">England</td>
  <td>&nbsp;</td>
  <td class="tdr">83</td>
</tr>
<tr>
  <td class="tdl">Belgium</td>
  <td>&nbsp;</td>
  <td class="tdr">14</td>
</tr>
<tr>
  <td class="tdl">Egypt</td>
  <td>&nbsp;</td>
  <td class="tdr">2</td>
</tr>
<tr>
  <td class="tdl">United States</td>
  <td>&nbsp;</td>
  <td class="tdr">1</td>
</tr>
<tr>
  <td class="tdl">Greece</td>
  <td>&nbsp;</td>
  <td class="tdr">1</td>
</tr>
<tr>
  <td class="tdl">India</td>
  <td>&nbsp;</td>
  <td class="tdr">33</td>
</tr>
<tr>
  <td class="tdl">Switzerland</td>
  <td>&nbsp;</td>
  <td class="tdr">33</td>
</tr>
</table>

<p>That is, 175 foreigners and 1346 French.</p>

<p class="title2">IV</p>

<p>Notes of the eight cases where the treatment
failed:&mdash;</p>

<p>1. Camille Bourg, 26. Bitten 11th April; treated at the
Pasteur Institute, 13th to 30th April; died of rabies at the
Lariboisière Hospital, 26th May. Six penetrating bites
on the ball of the left thumb. The dog was examined
by M. Grenot, a veterinary surgeon at Paris, and the
dissection gave evidence of rabies. Another person
bitten and treated at the same time as Bourg is now
in good health.</p>

<p>2. Louis Fiquet, 23. Bitten 22nd April; treated at
the Pasteur Institute, 23rd April to 10th May; died of
rabies at the Necker Hospital, 4th June. Five bites,
two of them deep, round the right thumb. They had
been cauterised five hours after infliction. The dog
was examined by M. Caussé, a veterinary surgeon at
Boulogne, and the dissection gave evidence of rabies.
Another person bitten at the same time as Fiquet is now
in good health.</p>

<p>3. Annette Beaufort, 19. Licked on the hands, which
were chapped, on 15th April. The dog was killed next
day, examined, and declared to have been rabid by
M. Lachmann, a veterinary surgeon at Saint-Étienne.
Treated at the Pasteur Institute, 20th April to 7th May.
<span class="pagenum"><a name="Page_149" id="Page_149">149</a></span>
Died of rabies 14th October. Two other persons bitten
by the same dog and treated at the Pasteur Institute are
now in good health.</p>

<p>4. Julien Heniquet, 53. Bitten 11th March, by a dog
that M. Jenvresse, veterinary surgeon at Beaumont-sur-Oise,
declared after dissection to have been rabid. One
bite had torn the lower lip, the wound had been sutured;
three other wounds on the nose. The wounds had not
been cauterised. Treated at the Pasteur Institute, 18th
May to 5th June. First symptoms of rabies showed
themselves 4th June, before the treatment was finished;
died 7th June. As the disease had its onset during the
course of the inoculations, this case should be excluded
from the number of those who died of rabies after treatment.</p>

<p>5. Germain Segond, 7. Penetrating bite on the bare
right fore-arm, 23rd May. Cauterised an hour later
with a red-hot iron. Treated 26th May to 9th June;
died of rabies 22nd July. The dog's bulb had been sent
to the Pasteur Institute. A guinea-pig inoculated in the
eye 26th May was seized with rabies 10th September.</p>

<p>6. Suzanne Richard, 8. Bitten 12th June on the left
leg by a dog, found on dissection to have been rabid
by M. Touret, veterinary surgeon at Sannois. The bite,
penetrating 3 cm. long, had been sutured; it had been
made through a cotton stocking, and had been cauterised
in half-an-hour. Treated 13th to 30th June; died of
rabies 2nd August. (Notes from M. le Dr. Margny, at
Sannois.)</p>

<p>7. Joseph Vaudale, 33. Bitten on the left hand, 8th
August. Six penetrating bites on the back of the hand;
had not been cauterised. The dog was declared rabid by
M. Verraert, veterinary surgeon at Ostend. Treated at
the Pasteur Institute, 11th to 28th August; died of rabies
27th September.</p>

<p>8. Paul Morin, 38. Bitten 24th August on the left
cheek, a single bite, 2 cm. long; no cauterisation. The
dog was sent to the Alfort School, 25th August, and
found to be rabid. Treated at the Pasteur Institute,
<span class="pagenum"><a name="Page_150" id="Page_150">150</a></span>
26th August to 15th September. Died of rabies some
days after the end of treatment (three weeks after the
bite, says a note sent to us). The interval between the
end of the treatment and the onset of the disease being
less than fourteen days, Morin must not be counted in
the number of patients inoculated under conditions which
permit successful inoculation.</p>

<hr class="c15" />

<p>We hardly need follow the work of the remaining
years. The figures are as follows:&mdash;</p>

<table border="0" cellpadding="0" cellspacing="2" summary="rabies mortality">
<tr>
  <th class="bbox">Year.</th>
  <th class="bh2">Patients<br />treated.</th>
  <th class="bh2">Deaths.</th>
  <th class="bh2">Mortality<br />per cent.</th>
</tr>
<tr>
  <td class="bvert tdc">1898</td>
  <td class="bright tdc">1465</td>
  <td class="bright tdc">3</td>
  <td class="bright tdc">0.2&nbsp;</td>
</tr>
<tr>
  <td class="bvert tdc">1899</td>
  <td class="bright tdc">1614</td>
  <td class="bright tdc">4</td>
  <td class="bright tdc">0.25</td>
</tr>
<tr>
  <td class="bvert tdc">1900</td>
  <td class="bright tdc">1420</td>
  <td class="bright tdc">4</td>
  <td class="bright tdc">0.28</td>
</tr>
<tr>
  <td class="bvert tdc">1901</td>
  <td class="bright tdc">1318</td>
  <td class="bright tdc">5</td>
  <td class="bright tdc">0.38</td>
</tr>
<tr>
  <td class="bvert tdc">1902</td>
  <td class="bright tdc">1105</td>
  <td class="bright tdc">2</td>
  <td class="bright tdc">0.18</td>
</tr>
<tr>
  <td class="bvert tdc">1903</td>
  <td class="bright tdc i0h">628</td>
  <td class="bright tdc">2</td>
  <td class="bright tdc">0.32</td>
</tr>
<tr>
  <td class="blc2 tdc">1904</td>
  <td class="bmc tdc i0h">755</td>
  <td class="bmc tdc">3</td>
  <td class="bmc tdc">0.39</td>
</tr>
</table>

<p>The falling off in the number of patients at the Paris
Institute is related to the establishment of similar Institutes
at Lyon, Marseilles, Bordeaux, Lille, and Montpellier.
But is it not possible that a patient, after treatment
at the Paris Institute, should die at home of rabies,
and his death not be notified to the Institute? The
answer is, that the Institute is very careful, so far as
possible, to keep in touch with its old patients. For
instance, in 1903, it recorded the case of a carpenter
in a Welsh village, who had died of rabies nearly
two years after treatment. And, of course, an Institute
patient, wherever he was, would be of interest to his
neighbours: and a death from rabies would excite attention,
and would hardly fail to be reported.
<span class="pagenum"><a name="Page_151" id="Page_151">151</a></span></p>

<p>It is not impossible that some sort of intensive
modification of Pasteur's treatment may be found, not
for the prevention, but for the cure of hydrophobia;
and two successful cases of this kind have been reported
in the <cite>Annales</cite> of the Paris Institute. Apart
from this faint hope, the <i>cure</i> of hydrophobia is where
it was in the days of the "Tonquin medicine" and the
"Tanjore pills."
<span class="pagenum"><a name="Page_152" id="Page_152">152</a></span></p>

<h3>VII<br />
CHOLERA</h3>

<p>The study of cholera was the hardest of all the hard
labours of bacteriology; it took years of work in all
parts of the world, and the difficulty and disappointments
over it are past all telling. Koch's discovery of
the comma-bacillus (1883) raised a thousand questions
that were solved only by infinite patience, international
unity for science, and incessant research; and the
Hamburg epidemic (1892) marks the time when the
comma-bacillus was at last recognised as the cause of
cholera. A mere list of the men who did the work
would fill page after page; it was bacteriology <i lang="la" xml:lang="la">in
excelsis</i>, often dangerous,<a name="FNanchor_26" id="FNanchor_26" href="#Footnote_26" class="fnanchor">[26]</a>  and always laborious.</p>

<p>There is the same heroic note in the story of the
preventive treatment of cholera by Haffkine's method;
one of the men in whom Pasteur seems to live again.
He began in 1889, under Pasteur's guidance, to study
<span class="pagenum"><a name="Page_153" id="Page_153">153</a></span>
the immunisation of animals against the cholera-bacillus.
Other men, of course, were working on the same lines&mdash;Pfeiffer,
Brieger, Metchnikoff, Fischer, Gamaleïa,
Klein, Wassermann, and many more&mdash;and by 1892
the immunisation of animals was proved up to the hilt.
Then came the advance from animals to men, from
laboratories to Indian cities, villages, and cantonments;
and here the honour is Haffkine's, and his
alone. Ferran's inoculations (Spain, 1885) had failed.
Haffkine, having tested his method on himself and his
friends, went to India, with a commendatory letter
from the British Government:&mdash;</p>

<div class="blockquote">
<p>"Researches on cholera, with special reference to inoculation,
were undertaken and carried on in my laboratory,
in the Pasteur Institute in Paris, between 1889
and 1893. The experiments resulted in the elaboration
of the present method, which when tried on animals was
found to render them resistant against every form of
cholera-poisoning otherwise fatal to them.</p>

<p>"The physiological and pathological effect on man was
then studied on some sixty persons, mostly medical and
scientific men interested in the solution of the problem.
The effect was found to be harmless to health. The
next step was to transfer the operations to the East."
(Haffkine's <cite>Report to the Government of India</cite>, 1895.)</p>
</div>

<p>He reached Calcutta in March 1893, and at the
request of Mr. Hankin<a name="FNanchor_27" id="FNanchor_27" href="#Footnote_27" class="fnanchor">[27]</a>  was invited to Agra; here, in
April, he vaccinated over 900 persons, including many
English officers. From Agra to Aligarh; and from
Aligarh he was asked to more places than he could
<span class="pagenum"><a name="Page_154" id="Page_154">154</a></span>
visit. In 1895 his health failed, and no wonder; and
he came back to Europe for a short time:&mdash;</p>

<p class="blockquote">"My actual work in India lasted twenty-nine months,
between the beginning of April 1893 and the end of July
1895. During this period the anti-cholera vaccination
has been applied to 294 British officers, 3206 British
soldiers, 6629 native soldiers, 869 civil Europeans, 125
Eurasians, and 31,056 natives of India. The inoculated
people belonged to 98 localities in the North-West
Provinces and Oudh, in the Punjab, in Lower Bengal
and Behar, in the Brahmaputra Valley, and in Lower
Assam. No official pressure has been brought on the
population, and only those have been vaccinated who
could be induced to do so by free persuasion. In every
locality, efforts were made to apply the operation on
parts of large bodies of people living together under
identical conditions, in order to compare their resistance
in outbreaks of cholera with that of non-inoculated
people belonging to the same unit of population. This
object has been obtained in 64 British and native regiments,
in 9 gaols, in 45 tea-estates, in the fixed agricultural
population of the villages parallel to Hardwâr
pilgrim road, in the <i>bustees</i> of Calcutta, in a certain
number of boarding-schools, where the parents agreed
to the inoculation of their children, in orphanages, etc.
The vast majority of inoculated people lived thus under
direct observation of the sanitary and medical authorities
of India." (Haffkine, Lecture in London. <cite>British
Medical Journal</cite>, 21st Dec. 1895.)</p>

<p>Altogether, upwards of 70,000 injections on 42,179
people&mdash;<i>without having to record a single instance of
mishap or accident of any description produced by our
vaccines</i>. Consider the colossal difficulties of this new
treatment: the frequent running short of the vaccine,
preventing a second injection; the absolute necessity,
at first, of using very small doses of a weak vaccine,
<span class="pagenum"><a name="Page_155" id="Page_155">155</a></span>
lest one disaster should occur; the impossibility of
avoiding, now and again, some loss of strength in the
vaccine; the impossibility of knowing how long the
protection would last. Surely in all science there is
nothing to beat this first voyage of adventure single-handed
to fight the cholera in India.</p>

<p>Later than Haffkine's 1895 report, we have Dr.
Simpson's 1896 report: "<i>Two Years of Anti-choleraic
Inoculations in Calcutta.</i> W. J. Simpson, M.D.,
M.R.C.P., D.P.H., Health Officer, Calcutta." The date
of this report is 8th July 1896; and it gives not only
the Calcutta results, but all that are of any use for
exact judgment:<a name="FNanchor_28" id="FNanchor_28" href="#Footnote_28" class="fnanchor">[28]</a> &mdash;</p>

<div class="blockquote">
<p>"The results of Calcutta are fully confirmed by those
obtained in other parts of India, wherever it was possible
to make all the necessary observations with precision,
and wherever the cases were sufficiently numerous to
show the effect of the inoculation.</p>

<p>"Outside Calcutta, since the commencement of the
inoculations in India in April 1893, opportunities for an
exact comparison of the respective powers of resistance
against cholera of inoculated and non-inoculated persons
presented themselves; (1) in Lucknow, in the East
Lancashire Regiment; (2) in Gaya, in the jail; (3) in
Cachar, among the tea-garden coolies; (4) in Margherita,
among coolies of the Assam-Burmah Railway Survey; (5)
in Durbhanga, in the jail; (6) in the coolie camp at Bilaspur;
(7) in Serampur, among the general population."</p>
</div>

<p>Here, then, in this 1896 report, are all the results
that give an answer to the question, What will happen
<span class="pagenum"><a name="Page_156" id="Page_156">156</a></span>
when cholera breaks out among a number of people
living under the same conditions, of whom some have
received preventive treatment, and the rest have been
left to Nature?</p>

<h4>I. <i>Calcutta</i> (1894-1896)</h4>

<div class="blockquote">
<p>"The number of people inoculated during the period
under review was 7690; of these, 5853 are Hindus, 1476
Mahomedans, and 361 other classes.... Considering
that the system is a new one, that the inoculations are
purely voluntary, and everything connected with them
has to be explained before the confidence of the people
can be obtained, and considering how long new ideas are
in taking root among the general population&mdash;and in this
case it is not merely the acceptance of an idea, but such
faith in it as to consent to submit to an operation&mdash;the
number is certainly satisfactory for a beginning. The
present problem can be compared with the introduction of
vaccination against smallpox into Calcutta. It took 25
years before the number of vaccinations reached an
average of 2000; whereas the inoculations against
cholera have in two years nearly doubled that average.
This is a proof that, in spite of the difficulties which
every new movement naturally has to meet with, there
are large numbers of people anxious to avail themselves
of the protective effect of the inoculations.</p>

<p>"Although all sorts and conditions of individuals,
weak and strong, sickly and healthy, young and old, well
nourished and badly nourished, and often persons suffering
from chronic diseases, have been inoculated, in every
instance, without exception, the inoculations have proved
perfectly harmless.</p>

<p>"The investigations on the effect of the inoculation are
made exclusively in those houses in which cholera has
actually occurred, the object being to ascertain and
compare the incidence of cholera on the inoculated and
not inoculated in those houses in which inoculations
<span class="pagenum"><a name="Page_157" id="Page_157">157</a></span>
had been previously carried out. <i>For this purpose,
affected houses in which inoculations have not been performed,
and inoculated houses in which cholera has not
appeared, are excluded.</i>"</p>
</div>

<p>Nature gave a demonstration in 77 houses. In one
house, and one only, all the household had been inoculated;
in 76, inoculated and non-inoculated were living
together; but of these 76 houses, 6 are excluded from
the table of results, because the inoculated in them were
so few&mdash;less than one-tenth of the household&mdash;that
their escape from cholera might be called chance. The
cholera came, and left behind it this fact:&mdash;</p>

<div class="blockquote">
<p>654 uninoculated individuals had 71 deaths
= 10.86 per cent.</p>

<p>402 inoculated in the same households had
12 deaths = 2.99 per cent.</p>
</div>

<p>If we add the 6 houses which Dr. Simpson excludes,
we find that in 77 houses there were 89 deaths from
cholera, 77 being among the uninoculated and 12
among the inoculated.</p>

<p>Moreover, of these 12 deaths, 5 occurred during
the first five days after inoculation&mdash;that is to say,
during the period in which the protective influence of
the vaccine was still incomplete. <i>Then came a period of
more than a year, during which the uninoculated had 42
deaths, and the inoculated had one death.</i> The remaining
6 of the 12 deaths occurred more than a year after
inoculation, and 5 of these 6 had received only one
inoculation of the weak vaccine that was used early in
1894.</p>

<p>Take a good instance that came at the very beginning
of the work:&mdash;</p>

<p class="blockquote">"A local epidemic took place around two tanks in
<span class="pagenum"><a name="Page_158" id="Page_158">158</a></span>
Kattal Began <i>bustee</i>, ward 19, occupied by about 200
people. In this <i>bustee</i>, about the end of March, 2 fatal
cases of cholera and 2 cases of choleraic diarrh&oelig;a
occurred. The outbreak led to the inoculation of 116
persons in the <i>bustee</i> out of the 200. Since then, 9 cases
of cholera, of which 7 were fatal, and 1 case of choleraic
diarrh&oelig;a have appeared in the <i>bustee</i>, and it is a very
extraordinary fact that all these 10 cases of cholera have
occurred exclusively among the uninoculated portion of
the inhabitants, which, as stated, forms the minority
in the <i>bustee</i>; while none of the inoculated have been
affected." (<cite>Cholera in Calcutta in 1894.</cite> W. J.
Simpson.)</p>

<h4>2. <i>Lucknow</i> (1893)</h4>

<p>The story of the outbreak of cholera in the East
Lancashire Regiment must be read carefully:&mdash;</p>

<p class="blockquote">"Rumour magnified the events connected with this
outbreak, and distorted the facts connected with the
inoculations; and as a result, the current of public
opinion, which had previously been in favour of inoculation,
set in strongly in the opposite direction. The
advocates of anti-choleraic inoculations were abused in
no particularly measured terms, and the inoculations
were held up to be the source of every possible evil
and danger ... of the most loathsome diseases, and of
every ill which man is heir to. The distrust engendered
by these misrepresentations and fulminations was, however,
only of a temporary nature; and when the exact
circumstances came to be known and understood, the
confidence created by the Calcutta experience began to be
considerably restored. Inoculations were performed in
May 1893, in the East Lancashire, Royal Irish, 16th
Lancers, 7th Bengal Infantry, 7th Bengal Cavalry, and
general populations in the Civil Lines. In 1894, cholera
appeared among the native population of Lucknow, in the
form of an epidemic distinguished by its extreme virulence,
<span class="pagenum"><a name="Page_159" id="Page_159">159</a></span>
patients succumbing in the course of a few hours.
It is stated that the epidemic was of a most malignant
type. In the latter part of July it entered the cantonments,
and attacked the East Lancashire, almost
exclusively confining its ravages to that regiment."</p>

<p>In the East Lancashire, 185 men were inoculated in
May 1893. From the statistical returns obtained from
the military authorities at Lucknow, it appears that at
the time of the outbreak, in July 1894, the strength of
the men, including those in hospital, was 773; and
of these, 133 had been inoculated, as recorded in the
inoculation register, and 640 had not been inoculated.</p>

<p>The following table shows the total number of attacks
and deaths in not inoculated and inoculated:&mdash;</p>

<table border="0" cellpadding="0" cellspacing="2" summary="cholera w and w/o serum">
<tr>
  <th class="bbox">&nbsp;</th>
  <th class="bh2">Attacks.</th>
  <th class="bh2">Deaths.</th>
</tr>
<tr>
  <td class="bvert i0h">&nbsp;</td>
  <td class="bright i0h">Per cent.&nbsp;</td>
  <td class="bright i0h">Per cent.&nbsp;</td>
</tr>
<tr>
  <td class="bvert i0h">Non-inoculated, 640&nbsp;</td>
  <td class="bright i0h">120 = 18.75&nbsp;</td>
  <td class="bright i0h">79 = 12.34&nbsp;</td>
</tr>
<tr>
  <td class="blc2 i0h">Inoculated, 133&nbsp;</td>
  <td class="bmc i1">18 = 13.53&nbsp;</td>
  <td class="bmc i0h">13 =&nbsp;&nbsp; 9.7</td>
</tr>
</table>

<p>The men were moved into camp; but this movement
seemed only to make things worse: "the epidemic in
the camp appears to have been twice as severe as in
the cantonment."<a name="FNanchor_29" id="FNanchor_29" href="#Footnote_29" class="fnanchor">[29]</a> </p>

<p>Lucknow came so early in the work of inoculation,
that weak vaccines were used in small doses. The
cholera, when it broke out, was "of a most malignant
type, senior medical officers of long experience in the
country stating that such a virulent cholera had not
been seen by them for very many years past." More
<span class="pagenum"><a name="Page_160" id="Page_160">160</a></span>
than a year had elapsed between the inoculations and
the outbreak of the cholera. It is no wonder that the
regiment was not well protected:&mdash;</p>

<p class="blockquote">"The small amount of protection which the inoculations
afforded in this case may have depended on the mild
effects which the injections produced on the men at the
time of the operation in 1893, in comparison with the
severity of the epidemic which attacked the regiment. It
is recorded in the Lucknow Inoculation Registers that
only in two men, out of the 185 inoculated in 1893, a
marked febrile reaction was obtained; in 77 individuals
the vaccinal fever was only slight, while in 66 there was
no reaction: an effect which was due to the weakness of
the vaccines procurable at that period of work, and to
the small doses used. The influence of the vaccines was
possibly further reduced, at the time of the epidemic,
by a lapse of fourteen to fifteen months." (Haffkine,
1895 Report.)</p>

<h4>3. <i>Gaya Jail</i></h4>

<p>On 9th July 1894, an outbreak of cholera occurred
in the Gaya jail, and by 18th June there had been
6 cases and 5 deaths. On that day and the next day,
215 prisoners were inoculated. The average number
of the prisoners during the outbreak was 207 inoculated,
and 202 not inoculated. Surgeon-Major Macrae, superintendent
of the jail, reports:&mdash;</p>

<p class="blockquote">"The inoculations being purely voluntary, no selection
of prisoners was possible, but all classes of the jail
were represented&mdash;male and female, old and young,
habituals and less frequent offenders, strong and weakly,
convalescent and even hospital patients sent their representatives;
no difference of any kind was made between
inoculated and non-inoculated; they were under
<span class="pagenum"><a name="Page_161" id="Page_161">161</a></span>
absolutely identical conditions as regards food, water,
accommodation, etc., in fact in every possible respect."</p>

<p>Of course, the best results could hardly be obtained,
because the cholera was already at work: it took about
ten days for the 1894 vaccine to produce its full effect;
and two inoculations were generally made, one five days
after the other. This gradual action of the vaccine is
well shown in Dr. Simpson's table:&mdash;</p>

<table border="0" cellpadding="0" cellspacing="2" summary="cholera w and w/o serum">
<tr>
  <th rowspan="2" class="bbox">&nbsp;</th>
  <th colspan="2" class="bh2"><span class="smcap">Non-Inoculated</span>,<br />202</th>
  <th colspan="2" class="bh2"><span class="smcap">Inoculated</span>,<br />207</th>
</tr>
<tr>
  <th class="bmc">Cases.</th>
  <th class="bmc">Deaths.</th>
  <th class="bmc">Cases.</th>
  <th class="bmc">Deaths.</th>
</tr>
<tr>
  <td class="bvert tdc">&nbsp;During 5 days after 1st&nbsp;</td>
  <td class="bright tdc">7</td>
  <td class="bright tdc">5</td>
  <td class="bright tdc">5</td>
  <td class="bright tdc">4</td>
</tr>
<tr>
  <td class="bvert tdc">inoculation</td>
  <td class="bright">&nbsp;</td>
  <td class="bright">&nbsp;</td>
  <td class="bright">&nbsp;</td>
  <td class="bright">&nbsp;</td>
</tr>
<tr>
  <td class="bvert tdc">&nbsp;During 3 days after 2nd&nbsp;</td>
  <td class="bright tdc">5</td>
  <td class="bright tdc">3</td>
  <td class="bright tdc">3</td>
  <td class="bright tdc">1</td>
</tr>
<tr>
  <td class="bvert tdc">inoculation</td>
  <td class="bright">&nbsp;</td>
  <td class="bright">&nbsp;</td>
  <td class="bright">&nbsp;</td>
  <td class="bright">&nbsp;</td>
</tr>
<tr>
  <td class="bvert tdc">&nbsp;After 3 days after 2nd&nbsp;</td>
  <td class="bright tdc">8</td>
  <td class="bright tdc">2</td>
  <td class="bright tdc">0</td>
  <td class="bright tdc">0</td>
</tr>
<tr>
  <td class="blc2 tdc">inoculation</td>
  <td class="bmc">&nbsp;</td>
  <td class="bmc">&nbsp;</td>
  <td class="bmc">&nbsp;</td>
  <td class="bmc">&nbsp;</td>
</tr>
</table>

<p>Haffkine's comment on these figures must be noted
here:&mdash;</p>

<p class="blockquote">"In the Gaya jail, the inoculations were <i>for the first
time</i> applied <i>in a prevalent epidemic</i>, and <i>very weak doses</i>
of a relatively weak vaccine were used.... Far higher
results have been obtained by an application of stronger
doses. In the <i>bustees</i> situated round the tanks in Calcutta,
where cholera exists in a permanent state, the
disease occurred in 36 houses with inoculated people.
In each of these houses there was one part of the family
inoculated and another not. The observations were
continued for 459 days, with the following results:&mdash;</p>

<p>During the first period of 5 days, subsequent to the
<span class="pagenum"><a name="Page_162" id="Page_162">162</a></span>
inoculation with first vaccine, cholera occurred in 8
houses.</p>

<p class="blockquote">75 non-inoculated had 5 cases, with 3 deaths.
52 inoculated had 3 cases, with 3 deaths.</p>

<p>During the second period of 5 days, subsequent to the
second inoculation, cholera occurred in 2 houses.</p>

<p class="blockquote">8 non-inoculated had 2 cases, with 2 deaths.
17 inoculated had no cases.</p>

<p><i>After the 10 days necessary for the preventive treatment
had expired, and up to the 459th day, the disease visited
26 houses.</i></p>

<div class="blockquote">
<p><i>263 non-inoculated had 38 cases, with 34 deaths.</i></p>

<p><i>137 inoculated had 1 case, with 1 death, in a child
  that had not been brought up for the second
  inoculation."</i></p>
</div>

<h4>4. <i>Assam-Burmah Railway</i></h4>

<p>For a good instance of lives saved even during an
outbreak, take the Assam-Burmah Railway coolies:&mdash;</p>

<p class="blockquote">"Three hundred and fifty
<a name="FNanchor_30" id="FNanchor_30" href="#Footnote_30" class="fnanchor">[30]</a>  Khassia Hill coolies had
been collected for the survey party of the Assam-Burmah
Railway, and put under the escort of a detachment of
Goorkhas, when cholera broke out amongst them. The
largest part of the coolies immediately submitted to the
preventive inoculation, the rest remained uninoculated.
The result was that <i>among the not-inoculated minority
there were 34 cases, with 30 deaths; whereas the inoculated
had 4 fatal cases</i>." (Haffkine, 1895, Lecture in
London.)</p>

<h4>5. <i>Durbhanga Jail</i> (1896)</h4>

<p>The figures in this instance are small: but Surgeon-Captain
E. Harold Brown's report is very pleasant
<span class="pagenum"><a name="Page_163" id="Page_163">163</a></span>
reading. Cholera broke out in the jail on 31st March
1896, and by 9th April there had been 8 cases. Next
day, 172 prisoners were moved into camp 12 miles
away; and 53 were left behind, the sick in the jail
hospital, the patients in the cholera huts, with their
attendants, the old and infirm, and a few cooks and
sweepers. That day, 3 cases occurred in the camp,
and 1 in the jail; and on the 11th, at 2 and 4 <span class="smcap">a.m.</span>,
2 more cases were reported in camp. At 7.30 <span class="smcap">a.m.</span>,
Haffkine and Dr. Green came to the camp:&mdash;</p>

<p class="blockquote">"The prisoners were spoken to on the subject, and
seemed to be pleased with the idea, the word <i lang="hi" xml:lang="hi">tika</i> (inoculation),
which was familiar to them from its association
with smallpox, appearing to appeal to them. They were
accordingly arranged in four rows facing the tent, in front
of which Dr. Haffkine was about to commence operations.
I was the first subject to be inoculated; and after me the
jailor, assistant jailor, hospital assistant, and three warders.
The first prisoner in the front rank was next brought up
and submitted cheerfully; after which, every alternate
man was taken, so that no selection of cases was made,
until one-half of the total number were inoculated. Those
who had not been inoculated were far from pleased at
having been passed over; and, to our surprise, they rose
almost to a man, and begged to be inoculated; nor
were they satisfied when told that the medicine was
exhausted."</p>

<p>The dose administered on this occasion (11th April
1896) was stronger than the Gaya jail dose (18th July
1894): it acted in a few hours, and the reaction was
well marked.</p>

<p class="blockquote">"There were fresh cases of cholera that day at 12
(noon), 6, 7, and 7.30 <span class="smcap">p.m.</span>, and at midnight, all in
those who had not been inoculated, and all terminating
<span class="pagenum"><a name="Page_164" id="Page_164">164</a></span>
fatally, despite the greatest care and the most prompt
and assiduous treatment. On the 12th two further cases
occurred, both among the uninoculated, and both died;
there being thus eight cases in succession, all from the
men who were not inoculated, and all proving fatal."</p>

<p>The inoculations were made at 7.30 <span class="smcap">A.M.</span> Surgeon-Captain
Brown had pain within half-an-hour, and fever
in three hours, with temperature 104°, <i>but this was
probably due to the fact that I was not able to rest</i>. The
prisoners, of course, went to bed: they all reacted
before 4 <span class="smcap">P.M.</span>, but did not have so much trouble over
it. The last case was on the 15th. The outbreak
was a bad type of cholera; out of 30 cases 24 died,
some of them in 1-1/2 to 4 hours. "To summarise the
combined results of the camp and the jail, we find that
of a daily average of 99 non-inoculated there were 11
cases, all fatal = 11.11 per cent.; of 110 inoculated there
were 5 cases, with 3 deaths = 2.73 per cent."</p>

<h4>6. <i>Bilaspur and Serampur</i></h4>

<p>Here again the figures are small, but worth noting.
In a coolie camp at Bilaspur (Central Provinces) 100
non-inoculated had 5 deaths, and 150 inoculated had
1 death. In Serampur, among the general population,
51 non-inoculated had 5 cases and 3 deaths, and 42
inoculated had 2 cases and 1 death.</p>

<h4>7. <i>The Cachar Tea-Gardens</i> (1895)</h4>

<p>This series of inoculations was begun in February
1895, for the protection of the coolies on various tea-estates.
The results are excellent, and deal with large
<span class="pagenum"><a name="Page_165" id="Page_165">165</a></span>
numbers.<a name="FNanchor_31" id="FNanchor_31" href="#Footnote_31" class="fnanchor">[31]</a>  The latest report from Dr. Arthur Powell,
the Medical Officer, is quoted in Dr. Simpson's 1896
report:&mdash;</p>

<div class="hanging indent">
<p><i>At Kalain</i>&mdash;<br />
  1079 not inoculated had 50 cases, with 30 deaths.<br />
  1250 inoculated&mdash;3 cases, with 2 deaths.<a name="FNanchor_32" id="FNanchor_32" href="#Footnote_32" class="fnanchor">[32]</a></p>

<p><i>At Kalaincherra</i>&mdash;<br />
  685 not inoculated had 10 cases, with 7 deaths.<br />
  155 inoculated&mdash;no cases.</p>

<p><i>At Degubber</i>&mdash;<br />
  254 not inoculated had 12 cases, with 10 deaths.<br />
  407 inoculated&mdash;5 cases, all recovered.</p>

<p><i>At Duna</i>&mdash;<br />
  121 not inoculated had 4 cases, with 2 deaths.<br />
  <span class="i0h">29 inoculated&mdash;no cases.</span></p>

<p><i>At Sandura</i>&mdash;<br />
  454 not inoculated had 2 cases, with 1 death.<br />
  <span class="i0h">51 inoculated&mdash;2 cases, with 1 death.</span></p>

<p><i>At Karkuri</i>&mdash;<br />
  198 not inoculated had 15 cases, with 9 deaths.<br />
  443 inoculated&mdash;3 cases, with 1 death.</p>

<p><i>At Craig Park</i>&mdash;<br />
  185 not inoculated had 1 fatal case.<br />
  <span class="i0h">46 inoculated&mdash;no cases.</span></p>
</div>

<div class="blockquote">
<p class="title2"><span class="smcap">Total.</span></p>

<p>Not inoculated, 2976, with 94 cases and 60 deaths.
Inoculated, 2381, with 13 cases and 4 deaths.
<span class="pagenum"><a name="Page_166" id="Page_166">166</a></span></p>
</div>

<p>To the preceding instances, which are rather old
now, must be added the following more recent report,
from the <cite>Indian Medical Gazette</cite>, September 1901:&mdash;</p>

<p class="blockquote">"We are glad to see, from a paragraph in the Report
of the Sanitary Commissioner for Bengal (Major H. J.
Dyson, I.M.S., F.R.C.S.), that an increased number of
anti-cholera inoculations were performed during the year
1900. Assistant-Surgeon G. C. Mukerjee, who was in
charge of this work, reports that in the Puralia Coolie
Depot no less than 13,291 persons were inoculated
against cholera, including over 1000 children. All these
cases of inoculation were among labour emigrants proceeding
to the tea-gardens of Assam and Cachar. The
employers of labour are beginning to realise the value
of cholera inoculation. It is unfortunately not always
easy, or even possible, to follow up the after-history of
persons inoculated; but Major Dyson has quoted a table,
received from the Superintendent of Emigration, which
shows the number of cases among the inoculated and the
non-inoculated at Goalundo. From this table, it is seen
that out of 1527 non-inoculated coolies, who passed
through Goalundo, 33, or 2.09 per cent., got cholera;
whereas of 873 inoculated coolies, only 2, or 0.2 per
cent., were attacked by the disease; that is, the unprotected
suffered about ten times as much as the inoculated.
Assistant-Surgeon Mukerjee also reports that during his
cold-weather tour he passed through some villages in the
Manbhum district, in which he had practised inoculation
the previous year: and, though there had been epidemics
of cholera in them, the inoculated persons escaped. They
came to him in numbers, stating that they owed their
safety to the inoculation."</p>

<p>Of course, the preventive treatment touches points
only here and there on the map of India, with its
300,000,000 people. Probably it will never become
so general in India as vaccination. Cholera in India
<span class="pagenum"><a name="Page_167" id="Page_167">167</a></span>
recalls what Ambroise Paré, more than 400 years ago,
wrote of the plague, "Here in Paris it is always with
us." But, wherever preventive inoculation has been
done, there it has done good.</p>

<p>The <cite>Medical Annual</cite> for 1905 contains an account of
some preventive inoculations recently made during an
epidemic in Japan. Among the inoculated, the attack-rate
was much lower than among the uninoculated;
and the mortality was 45.5 per cent., as against 75
per cent.</p>

<p>Another most important result of the discovery of
the cholera bacillus is its use in diagnosis. For
example, if a case of suspected cholera is landed at a
British port, the sanitary authority at once takes steps
to ascertain whether the specific microbe is present;
and, according to the answer given by bacteriology,
either allows the patient to proceed on his journey, or
adopts measures of isolation to prevent the spread of
the disease to others. Thus, thanks to the insular
position of Great Britain, this dreadful disease has
for many years been prevented from invading her
population.
<span class="pagenum"><a name="Page_168" id="Page_168">168</a></span></p>

<h3>VIII<br />
PLAGUE</h3>

<p>The <i lang="la" xml:lang="la">bacillus pestis</i> was discovered by Kitasato and
Yersin, working independently, in 1894. Yersin's discovery
was made at Hong Kong, whither the French
Government had sent him to study plague: an excellent
account of his work is given in the <cite>Annales de
l'Institut Pasteur</cite>, September 1894. The first experiments
in preventive inoculation, in animals, were made
by Yersin, Calmette, and Borrel, working conjointly, in
1895. They found that it was possible to confer on
animals a certain degree of immunity, by the hypodermic
injection of dead cultures of the bacillus. These
experiments were made on rabbits and guinea-pigs.</p>

<p>Haffkine's fluid was first used on man in January
1897. It is a <i lang="fr" xml:lang="fr">bouillon</i> containing no living bacilli, and
nothing offensive to the religious beliefs of India.<a name="FNanchor_33" id="FNanchor_33" href="#Footnote_33" class="fnanchor">[33]</a>  He
proved its efficacy on rabbits; and then, on 10th
January 1897, inoculated himself with a large dose,
four times as strong as the subsequent standard dose.
<span class="pagenum"><a name="Page_169" id="Page_169">169</a></span>
A few days later, Lieut.-Col. Hatch, Principal of the
Grant Medical College, Bombay, and other members of
the College Staff, were inoculated. These first inoculations
were described by Haffkine in a lecture (1901) at
Poona:&mdash;</p>

<p class="blockquote">"In a short time, a number of the most authoritative
physicians in Bombay, European and native, official
medical officers and private practitioners, submitted
themselves for inoculation. It is a matter of gratification
to me to be able to quote, among these authorities,
the Head of the Medical Service of the Presidency,
Surgeon-General Bainbridge, who not only got himself
inoculated, but inoculated also the members of his family.
Previous to that, Surgeon-General Harvey, the able
Director-General of the Indian Medical Service, submitted
himself to inoculation in 1893 against cholera;
and, in 1898, against plague. It was the example of
these gentlemen, whose competence in the matter of
health could not be disputed, that encouraged thousands
of people, rich and poor, in Bombay and elsewhere, to
come forward for inoculation. Thus his Excellency the
Viceroy thought it right to tell you here, in Poona, that
previous to his starting for the plague-stricken districts
he and his staff had also undergone the prophylactic
inoculation. In due course, mothers brought their children
to be protected by the new 'vaccination.'"</p>

<p>Within a few months, 8142 persons in or near
Bombay were inoculated. It was not possible, in
Bombay, during the rush of plague-work, to follow
up every one of these 8142 persons. But there is
reason to believe, making some allowance for oversights,
that only 18 = 0.2 per cent. of them, were attacked
during the epidemic; that, of these 18, only 2 died:
and that these 2 died within twenty-four hours of inoculation,
<i lang="la" xml:lang="la">i.e.</i>, had the plague in them already at the
time of inoculation.
<span class="pagenum"><a name="Page_170" id="Page_170">170</a></span></p>

<p>And, with regard to a small group of the inoculated,
there are the following more definite facts. This group
lived outside Bombay, across the harbour, in a village
called Mora. The population of Mora, at the time of
the epidemic, was estimated at less than 1000. Out
of this number 429 were inoculated; which, if the
population be reckoned at 1000 exactly, left 571 uninoculated.
Among the 429 inoculated, there were 7
cases of plague, with no deaths: among the uninoculated
there were 26 cases, with 24 deaths.</p>

<p>Just a week after Haffkine had informed the Indian
Government that he had tested his fluid on himself,
plague broke out in the Byculla House of Correction,
Bombay, on 23rd January 1897. Between the 23rd
and the afternoon of the 30th, there were 14 cases,
with 7 deaths. On the afternoon of the 30th, 152
prisoners were inoculated, and 172 were left uninoculated.
The outbreak ceased on 7th February. The
figures, as corrected by the Plague Commission, are,
among the inoculated, 1 case, which recovered; among
the uninoculated, 7 cases, with 2 deaths.</p>

<p>For a full and severe examination of the reports,
statistics, and other evidence concerning this and other
outbreaks in which preventive inoculations were made,
the Report (1901) of the Indian Plague Commission must
be studied. The Commissioners, Professor T. R. Fraser,
Mr. J. P. Hewett, Professor (now Sir) A. E. Wright,
Mr. A. Cumine, Dr. Ruffer, and Mr. C. J. Hallifax,
Secretary, travelled and took evidence in India from
November 1898 to March 1899: during which time
they held 70 sittings and examined 260 witnesses,
some at great length. The evidence and the report
are published in five large volumes. The report, 540
pages in all, deals exhaustively with the whole subject.
<span class="pagenum"><a name="Page_171" id="Page_171">171</a></span>
It represents the very least&mdash;what might almost be
called the very worst&mdash;that can be said of Haffkine's
fluid: and, of course, it reads rather differently from
the reports of the men who, with their lives in their
hands, and worked almost past endurance, fought
plague themselves. The following paragraphs give,
so far as possible, the bare facts of various outbreaks
of the disease in 1897-99, in which Haffkine's fluid
was used.</p>

<h4>1. <i>Daman</i></h4>

<p>Plague broke out in Daman, a town in Portuguese
territory, north of Bombay, and in constant communication
with Bombay by sea, in March 1897. By the
end of the month, when a Government cordon was
placed round the town, about 2000 out of 10,900 had
fled. The outbreak reached its height in mid-April,
and was practically over by the end of May. Inoculations
were begun on 26th March. The total
population on that day (2000 having gone out, and
670 having died of plague) is estimated at 8230.
Of these, 2197 were inoculated, and 6033 were left
uninoculated. Among the inoculated there were 36
deaths = 1.6 per cent.; among the uninoculated 1482
deaths = 24.6 per cent.</p>

<p>The Commissioners criticise these figures severely,
and do not accept them as exact. But they admit the
evidence as to the results of inoculation among the
Parsee community of Daman. Of this community, 306
in number, 277 were inoculated, and only 29 were
left uninoculated. Among the inoculated there was 1
death = 0.36 per cent.: among the uninoculated there
were 4 deaths = 13.8 per cent.</p>

<p>They admit, also, the house-to-house investigations
<span class="pagenum"><a name="Page_172" id="Page_172">172</a></span>
made by Major Lyons, I.M.S., President of the Bombay
Government Plague Committee. At the end of May,
he visited 89 houses, in 62 of which both inoculated
and uninoculated were living together. He found that
out of 382 inoculated, 36 had died = 9.4 per cent.;
out of 123 uninoculated, 38 had died = 30.9 per cent.</p>

<h4>2. <i>Lanauli</i></h4>

<p>Plague attacked Lanauli, a small hill-station and
railway depot, during April to September 1897. The
entire population was estimated at about 2000. Inoculations
were begun on 24th July in two wards of
the town, and a daily house-to-house inspection was
instituted. The figures reported, on the basis of
the average daily strength of the two groups, are as
follows:&mdash;</p>

<div class="blockquote">
<p>Inoculated, 323, with 14 cases, of which 7 died
= 2 per cent.</p>

<p>Uninoculated, 377, with 78 cases, of which 57 died
= 15 per cent.</p>
</div>

<p>The Commissioners criticise the method on which
these figures are based, and do not accept them as
accurate. But they agree that inoculation "exerted
a distinct preventive effect"; and they admit Major
Baker's evidence&mdash;"In the place where inoculation
had been made use of, the town was thriving and
full of people; and the other part of the town was absolutely
empty. One side had plague, and the other
had none."</p>

<h4>3. <i>Kirki</i></h4>

<p>The figures here were obtained under especially
favourable circumstances; and the Commissioners have,
<span class="pagenum"><a name="Page_173" id="Page_173">173</a></span>
practically, no fault to find with their accuracy. The
following account is by Surgeon-Major Bannerman,
Superintendent of the Plague Research Laboratory,
Bombay:&mdash;</p>

<div class="blockquote">
<p>"Plague broke out in Kirki, in the artillery cantonment,
situated four miles from Poona; and the followers of the
four batteries stationed there suffered severely. These
men were living with their families in lines on a sloping
plain, under military discipline, and in circumstances
far superior in a sanitary sense to those of the average
villager. When the disease appeared, the lines were
isolated, so that none could enter or leave without the
knowledge of the military. A special hospital was erected
close by, where all sick persons were sent as they were
discovered by the search parties of European artillerymen,
who visited each house thrice daily. It is therefore probable
that all cases of plague were promptly discovered
and removed to hospital: and in each case the usual disinfection
was thoroughly and systematically carried out.
Yet, in spite of all this, it was found that, in those not
protected by inoculation, 1 out of every 6 of the population
was attacked, and 2 out of every 3 attacked died.
The epidemic was, therefore, a severe one. The population
of the lines numbered 1530; and, out of these, 671
volunteered for inoculation. At the close of the epidemic,
the plague-hospital admission and discharge book was
examined, and compared with the register of those inoculated,
when the following result was got. The population
operated on being under military discipline, and
confined to their lines, makes the accuracy of the figures
undoubted:&mdash;</p>

<p>Inoculated, 671, with 32 cases, of which 17 died
= 2.5 per cent.</p>

<p>Uninoculated, 859, with 143 cases, of which 98 died
= 11.4 per cent.</p>

<p>"Here, then, is seen a body of people divided into
<span class="pagenum"><a name="Page_174" id="Page_174">174</a></span>
two groups by the fact that one had undergone inoculation
and the other not, <i>but differing in no other way</i>,
reacting towards plague in such a markedly different
manner that the conclusion is forced on one, that the
inoculation must be the cause. Seeing the absolute
similarity of conditions, <i>the 671 inoculated should have
had proportionately 112 cases and 77 deaths, if they had
remained as susceptible to the disease as their uninoculated
brothers, sisters, parents, wives, husbands, children; but,
instead of that, they had only 32 cases and 17 deaths</i>.
This death-rate would doubtless have been still further
reduced, but for the fact that a very much weakened
vaccine had to be used, owing to the demand having got
beyond the resources of the laboratory at that time."</p>
</div>

<h4>4. <i>Belgaum</i></h4>

<p>In Belgaum, a town of Southern India with a normal
population of about 30,700, two outbreaks of plague
occurred in quick succession. The first outbreak lasted
from November 1897 to May 1898; the second,
from July 1898 to January 1899. During the two
epidemics, 2466 persons were inoculated. Of these,
it was reported that only 61 (or 62) had been attacked,
of whom 33 died = 1.34 per cent. But these figures,
in the judgment of the Commission, cannot be accepted
as even approximately correct. There are, however,
two groups of these Belgaum cases, one of which the
Commission admits as substantially accurate, and the
other as absolutely accurate. These groups are,
(1) the Army cases; (2) the cases reported by Major
Forman, R.A.M.C., Senior Medical Officer of the
Station.</p>

<p>(1) <i>The Army Cases.</i>-These cases occurred in the
26th Madras Infantry, which was living in lines close
to the cantonment and the city. The first case of
<span class="pagenum"><a name="Page_175" id="Page_175">175</a></span>
plague in the regiment was on 12th November 1897.
Ten days later, the regiment was moved out into camp.
Inoculation was begun, by Surgeon-Major Bannerman,
on 23rd December, up to which time there had been,
among the regiment and its families and followers, 78
cases, with 49 deaths. The following account of the
inoculations is given by Surgeon-Major Bannerman:&mdash;</p>

<p class="blockquote">"No difficulty was experienced in persuading the men
to consent to inoculation, when it was explained to them
that they would be free to return to their houses in the
lines after being operated on. General Rolland was the
first to be operated on, and his example, combined with
that of the officer commanding, and their medical officer,
who were all operated on in front of the men, sufficed to
convince the Sepoys of the harmlessness of the operation:
and the only difficulty that then remained was to perform
the operation fast enough.... The community was,
practically, completely inoculated by the end of the year.
The total operated on was 1665, out of a population of
1746 living in the lines at that date. The 81 not operated
on were infants, women far advanced in pregnancy, and
the sick in hospital chiefly, though one solitary Sepoy
has, up to the present time, refused to submit to
operation."</p>

<p>From this time onward to the end of the first
epidemic, though the disease was at its height in
January in the neighbouring city and cantonment,
and though the men were allowed to go freely to
these places after inoculation, <i>only 2 out of the 1665
were attacked, and both recovered</i>.</p>

<p>When the second epidemic came, in July 1898, the
troops, families, and followers, were reinoculated at their
own request, 1801 in all. "Practically no one was left
in the lines unprotected by inoculation." From this
time onward to the end of the second epidemic, though
<span class="pagenum"><a name="Page_176" id="Page_176">176</a></span>
it was much more severe than the first, only 12 cases
occurred. <i>In the first epidemic, before inoculation, 78
cases occurred, and 2 after it: in the second, and much
more severe, epidemic, though the sanitary measures adopted
in both epidemics were similar, only 12 cases occurred.</i>
"It would hardly appear to be open to doubt," says
the Commission, "that the practical immunity of
the regiment, during the second outbreak, was due
to inoculation."</p>

<p>(2) Major Forman's evidence before the Commission
is very striking, though the figures are small. The
following abstract of it is given in the Report of the
Commission:&mdash;</p>

<div class="blockquote">
<p>"The groups of persons, concerning whom Major
Forman gave us evidence, were his private servants, and
the hospital attendants of the Belgaum Station Hospital
with their wives and children. He inoculated these
groups when plague first broke out in the town, and
was able to keep in touch with them continuously after
that time. Regarding the first group, he says, bringing
down their history to 3rd March 1899, 'Of my private
servants there were in all, including their wives and
children, 28 people inoculated. There have been no
cases of plague, and no deaths up to date. There were
3 uninoculated. One was a child of 9 years of age,
whose father refused to allow it to be inoculated. It died
of plague 12 days after the other people were inoculated.
The other 2 cases that were not inoculated were not so
distinctly under my own observation. One was a sweeper
employed in the cantonment, and sleeping in my compound:
he, I am told, died of plague some months afterwards.
The other was my water-carrier: he threw
himself into a well: I was informed that he had buboes
and fever, and ran away to escape segregation. Of the
28 inoculated, none died of plague: and of 3 uninoculated,
<span class="pagenum"><a name="Page_177" id="Page_177">177</a></span>
2 are said to have died of plague, and 1 undoubtedly
died of plague.'"</p>

<p>"Regarding the second group of which he gave us
particulars, Major Forman said that, out of 90 hospital
servants, 87 were inoculated. Of the inoculated persons,
1 died from fever and endocarditis, and 1 died of plague.
Excepting these two, the rest of the inoculated were alive
and well in March 1899. Only 3 persons remained
uninoculated. Of these, one was not operated upon,
because she had recently been delivered; another was
not operated upon, because she was pregnant; and the
third was a boy of 16 years of age, whose father refused
to let him be inoculated. The boy died of plague, two
months after the inoculation of the rest of the hospital
servants had been done. One of the two uninoculated
women died of plague two days after the boy, she having
been in attendance upon him. The other uninoculated
woman remained well."</p>
</div>

<h4>5. <i>The Umarkhadi Jail, Bombay</i></h4>

<p>Plague broke out in this jail on the last day of 1897,
and 3 prisoners died. Next day, 1st January 1898,
all the prisoners were paraded, and all were willing to
be inoculated. But it was decided to divide them into
two equal groups, and inoculate one group. There
were 402 altogether: 2, when their turn came, refused
to be inoculated: thus 199 were inoculated, and
203 were left uninoculated. No distinction was made
between the two groups: "They had the same food
and drink, the same hours of work and rest, and the
same accommodation." The plague did not come
wholly to an end till March. The figures, since the
inmates of a jail are a shifting population, are based on
<span class="pagenum"><a name="Page_178" id="Page_178">178</a></span>
the average daily number of each group: this was 147
for the inoculated, and 127 for the uninoculated. The
figures are:&mdash;</p>

<table border="0" cellpadding="0" cellspacing="2" summary="plague w and w/o serum">
<tr class="bbox">
<th colspan="2" class="bbox">Average Daily Number.&nbsp;</th>
<th class="bh2">Cases.&nbsp;</th>
<th class="bh2">Deaths.</th>
</tr>
<tr>
<td class="bleft">Inoculated</td>
<td>147</td>
<td class="tdc bvert">3</td>
<td class="tdc bvert">0</td>
</tr>
<tr>
<td class="blc">Uninoculated</td>
<td class="bmc">127</td>
<td class="tdc bmc">9</td>
<td class="tdc bmc">5</td>
</tr>
</table>

<p>The Commission draw attention to "the important
fact that, during the whole period of the outbreak, the
number of attacks among the inoculated was only one-third
of the number among the uninoculated; and that
the disease among the inoculated was remarkably mild,
resembling mumps more than plague, though the cases
among the uninoculated were of average severity."
According to Surgeon-Major Bannerman, the hospital
authorities were doubtful whether these three cases
among the inoculated were plague at all.</p>

<h4>6. <i>Undhera</i></h4>

<p>The figures for Undhera are very valuable: "The
conditions," says Surgeon-Major Bannerman, "approached
very nearly the strictness of a laboratory
experiment." Even the Commissioners are enthusiastic
here.</p>

<p>Undhera is an agricultural village, 6 miles from
Baroda. Plague broke out in it, in January 1898. A
careful census was taken, and showed a population of
1029. By 12th February there had been 76 deaths.
On that day the village was visited by Mr. Haffkine,
<span class="pagenum"><a name="Page_179" id="Page_179">179</a></span>
Surgeon-Major Bannerman, and other experts, and 513
persons were inoculated:&mdash;<i>By reference to the census
papers, the whole of the inhabitants were called out, house
by house, and the half of each household inoculated. In
this way, an endeavour was made to inoculate half the
men, half the women, and half the children in each family,
and to arrange that a fairly equal proportion of the sickly-looking
should be placed in each division.</i> The plague
lasted 42 days after the inoculations, and affected 28
families. On 4th April a house-to-house investigation
was made by Mr. Haffkine, Surgeon-General Harvey,
Surgeon-Major Bannerman, and Captain Dyson. The
figures are as follows:&mdash;</p>

<table border="0" cellpadding="0" cellspacing="2" summary="plague deaths">
<tr>
  <th class="bbox tdc">Population on<br />
  12th February.</th>
  <th class="bhlt">&nbsp;</th>
  <th class="bh2">&nbsp;</th>
  <th class="bh2 tdc">Cases.</th>
  <th class="bh2 tdc">Deaths.</th>
  <th class="bh2 tdc">Mortality.</th>
</tr>
<tr>
  <td class="bvert tdc">1029-76=953</td>
  <td class="tdl">Inoculated,</td>
  <td class="bright tdc">&ensp;   513&ensp;</td>
  <td class="bright tdc i0h">8</td>
  <td class="bright tdc i0h">3</td>
  <td class="bright tdc">0.6 per cent.</td>
</tr>
<tr>
  <td class="blc2">&nbsp;</td>
  <td class="bbottom tdl">Uninoculated,</td>
  <td class="bmc tdc">&ensp; 440&ensp;</td>
  <td class="bmc tdc">28</td>
  <td class="bmc tdc">27</td>
  <td class="bmc tdc">6.0 per cent.</td>
</tr>
</table>

<p>Thus, out of 28 families, where the protected and
the unprotected lived and ate and slept together, the
protected, 71, had 3 deaths; and the unprotected, 64,
had 27. The percentage of attacks was four times
higher among the unprotected; the percentage of
deaths was ten times higher.</p>

<h4>7. <i>Khoja Community, Bombay</i></h4>

<p>The head of this community, H.H. Sir Sultan Shah,
Aga Khan, K.C.I.E., opened a private station for the
inoculation of the community in March 1897, and again
in December of that year. He was himself inoculated
<span class="pagenum"><a name="Page_180" id="Page_180">180</a></span>
three times, and many of the community so often as
five times. The work of inoculation went on daily, and
by 20th April 1898 the number of persons inoculated
or reinoculated was 5184. The whole community,
according to a careful census taken at the beginning
of 1898, numbered 9350; but, since many families
had fled to avoid the infection, this number is too low.
The Commissioners guess 9770: Haffkine, to the disadvantage
of his own statistics, guesses so high as
13,330. The number of the inoculated or reinoculated
shifted, of course, as the work went on: their
average daily number during the four months of plague,
January to April 1898, was 3814.</p>

<p>During these four months, the number of deaths
<i>from all causes</i> in the whole community was 184.
According to the average mortality of the community
in times of no plague, the deaths <i>from all causes</i> during
four months would be 102. It may fairly be assumed
that the extra deaths, 82, were due to plague: and,
indeed, 64 plague-deaths were either acknowledged by
the relatives, or certified by the burial-books of the
community. <i>Of these 82 deaths, 3 occurred among the
inoculated or reinoculated, and 77 among the uninoculated.</i></p>

<p>The Commissioners find fault with these figures:
"Nevertheless, quite apart from the statistics put before
us, which we think inaccurate, we do not doubt that
inoculations had a good effect, especially as much
weight must be allowed to the opinion of a community
so intelligent as that of the Khojas."
<span class="pagenum"><a name="Page_181" id="Page_181">181</a></span></p>

<h4>8. <i>Hubli</i></h4>

<p>This, the greatest and most amazing of all instances
of preventive plague-work, was done in a town of
50,000 persons. The following report, by Surgeon-Captain
Leumann, was forwarded to the Plague Commissioners
by Mr. E. K. Cappel, Collector of Dhárwár,
with this comment:&mdash;</p>

<div class="blockquote">
<p>"The town of Hubli&mdash;a mercantile town of over 50,000
inhabitants&mdash;was attacked by plague in an epidemic form
at the commencement of the monsoon rains. The average
rainfall between April and October amounts to more than
28 inches. Under these circumstances, although a large
and weather-proof health camp had been prepared for
emergencies, complete evacuation of the infected townsite
was impossible; and the attempt to effect it would
have led to the severest hardships and to the immediate
spread of the disease into surrounding villages and districts.
It was for this reason that the determination was
formed to make a bold and comprehensive experiment
with the prophylactic, and not on any <i lang="la" xml:lang="la">à priori</i> grounds.
If this experiment had failed, the results, judged by the
actual mortality among the uninoculated, would have
been appalling. <i>All possible sanitary measures in the
shape of disinfection, unroofing of houses, and segregation,
were applied concurrently with inoculation, as Government
are already aware; but the rate of mortality among
those who held back from inoculation rose at one time to a
height which, I believe, has never been approached elsewhere....</i></p>

<p>"However, the experiment, in the hands of Dr. Leumann,
did not fail, and it has afforded a demonstration
of success which is of Imperial importance. Many thousands
of lives have undoubtedly been saved, and at the
present moment the plague mortality is merely sporadic,
<span class="pagenum"><a name="Page_182" id="Page_182">182</a></span>
and Hubli is steadily regaining its normal population and
trade, though surrounded by infected villages."</p>
</div>

<p>The Hubli report must be put at full length, for
the vivid picture it gives of plague in India, and of
the difficulties besetting the magnificent work of the
Indian Medical Service. It is a story that Mr. Kipling
ought to write. And it is to be noted that Surgeon-Captain
Leumann, who saved Hubli, recognised the
extreme importance of other methods than inoculation&mdash;disinfection,
isolation of cases, evacuation of infected
districts. He says:&mdash;</p>

<p class="blockquote">"While paying the highest tribute to the value of
Mr. Haffkine's inoculation method, which I claim, here
in Hubli, to have put to perhaps the severest test to
which it has yet been subjected, I am of the opinion that
individual protection is, on however great a scale conducted,
of less importance to that of general protection
and hygiene (considering each method separately, that
is to say), for it seems to me more radical, if not more
rational, to eradicate a disease than to leave it to pursue
its course and only protect people against its ravages."</p>

<p>Sanitation, therefore, was Dr. Leumann's faith. Now
for his works:&mdash;</p>

<div class="blockquote">
<p>"I first started inoculation here on 11th May....
When I began my inoculations, I operated first of all on
some European or native gentlemen in front of a crowd of
poor and low-caste people, whom I had gathered together
in the worst-affected area, and they were thus soon induced
to ask for inoculation themselves.... They have
presented themselves, by the hundred, at all times of
the day, before myself and others, for the purpose of
being inoculated.<a name="FNanchor_34" id="FNanchor_34" href="#Footnote_34" class="fnanchor">[34]</a>  ... I have never experienced the
<span class="pagenum"><a name="Page_183" id="Page_183">183</a></span>
slightest difficulty in inoculating Mussulmanis or any
other purdáh women in Hubli.... The very men who,
in March last, created a disturbance in Hubli, were
not only the first and the most willing to undergo inoculation,
but also to bring their wives and families to
my hospital, or to invite me to their homes to inoculate
them.</p>

<p>"Inoculated persons holding certificates of double
inoculation have, at my special wish and order, been
left in their homes throughout this epidemic; only their
clothes, house, and property being disinfected on the
occurrence of a plague case or death in their house. As
the vast majority of plague cases have never been notified
before death in Hubli (nor, in my experience of nearly
two years, elsewhere, if native supervision be largely
resorted to), it will readily be understood that the majority
of the inoculated have actually been living in the same
house, or even room, with a plague case (often of the
pneumonic type, whose terrible power of spreading the
disease was first shown by Professor Childe, I.M.S.,
of Bombay) during the whole of the time that case was
living, probably attending on the patient, breathing the
same stuffy air, and, perhaps, sharing the same blanket;
and I attach at the end of this report a long series of
cases where such conditions have occurred, <i>the non-inoculated
dying of plague, and the inoculated escaping,
almost to a man</i>.</p>

<p>"Various critics on my work, not knowing what the
actual facts were and are, have at different times asserted
that the inoculated inhabitants of Hubli left the town in
larger numbers than the non-inoculated. Exactly the
reverse was the case. The British officers on plague
duty here, and all the Divisional Superintendents, invariably
replied (officially and in writing when so required)
that the non-inoculated left Hubli in far greater
<span class="pagenum"><a name="Page_184" id="Page_184">184</a></span>
numbers and proportion than the inoculated; and my
own observations entirely bear out this statement.</p>

<p>"It has been urged that those who received inoculation
were of a class or classes better protected than others
against plague by reason of their habits, the food they
eat, the houses they live in, etc. In reply, I unhesitatingly
state that if there be but one town in India where
that line of argument will not hold good, it certainly is
Hubli; for <i>not only were the poorer, dirtier, lower-caste
people the first to be persuaded to receive inoculation, but
I made it my personal and special duty to work amongst
them</i>. My first few thousand inoculations were almost
entirely amongst the lowest and poorest of the people.
The Brahmins are, perhaps, of all castes, supposed to
be the most cleanly in their houses, habits, etc., yet the
Brahmins of Hubli (who at first, imagining themselves
immune, were the foremost and greatest perverters of
the truth concerning its efficacy, and the last to apply for
the protection inoculation affords), simply inundated the
various inoculation centres, as soon as plague began to
spread in their midst, clamouring for the very method of
which they had only lately tried to prevent others from
availing themselves.</p>

<p>"Unfortunately, the average native, educated or not,
appears to have the very greatest aversion to notifying
any case of sickness&mdash;plague or other&mdash;and hence, in my
opinion, it becomes more necessary than ever to protect
the people by inoculation, since they will not help to protect
themselves by the foremost and simplest of sanitary
and hygienic measures.<a name="FNanchor_35" id="FNanchor_35" href="#Footnote_35" class="fnanchor">[35]</a>  With so few police (and those
<span class="pagenum"><a name="Page_185" id="Page_185">185</a></span>
none too good) to help one; an inadequate British Staff;
with so much reliance placed in Native Superintendents
and Supervisors, and a Municipality so bankrupt that it
could not apparently afford to buy enough blankets out
of its own funds for the patients in the Plague Hospitals&mdash;the
work of segregation, house-to-house inspection,
etc., became, from a medical point of view, absurdly insufficient.</p>

<p>"The total number of inoculations performed in Hubli,
both on actual inhabitants and on people from outside
(villages) between 11th May and 27th September, amounts
to some 78,000 altogether."</p>

<p class="title2">I</p>

<table class="fsize90" border="0" cellpadding="0" cellspacing="2" summary="plague w and w/o serum">
<tr>
  <th rowspan="2" class="bbox">Dates.</th>
  <th rowspan="2"  class="bh2">Census of<br />Hubli.</th>
  <th rowspan="2" class="bh2">Non-<br />Inoculated.</th>
  <th rowspan="2" class="bh2">Inoculated.</th>
  <th colspan="2" class="bh2">Plague-deaths<br />among:</th>
</tr>
<tr>
  <th class="bmc">Non-<br />Inoculated.</th>
  <th class="bmc">Inocu-<br />lated.</th>
</tr>
<tr>
  <td class="bvert tdc">Five weeks<br />from May 11</td>
  <td class="bright tdc">Fell from<br />50,000 to</td>
  <td class="bright">&nbsp;</td>
  <td class="bright">&nbsp;</td>
  <td class="bright">&nbsp;</td>
  <td class="bright">&nbsp;</td>
</tr>
<tr>
  <td class="bvert tdc">to June 14</td>
  <td class="bright tdc">47,427</td>
  <td class="bright tdc">44,573</td>
  <td class="bright tdc i0h">2,854</td>
  <td class="bright tdc">47</td>
  <td class="bright tdc i0h">1</td>
</tr>
<tr>
  <td class="bvert tdc">Week ending:</td>
  <td class="bright">&nbsp;</td>
  <td class="bright">&nbsp;</td>
  <td class="bright">&nbsp;</td>
  <td class="bright">&nbsp;</td>
  <td class="bright">&nbsp;</td>
</tr>
<tr>
  <td class="bvert tdc">June 21</td>
  <td class="bright tdc">47,082</td>
  <td class="bright tdc">41,494</td>
  <td class="bright tdc i0h">5,588</td>
  <td class="bright tdc">22</td>
  <td class="bright tdc i0h">3</td>
</tr>
<tr>
  <td class="bvert tdc">June 28</td>
  <td class="bright tdc">47,485</td>
  <td class="bright tdc">39,042</td>
  <td class="bright tdc i0h">8,443</td>
  <td class="bright tdc">29</td>
  <td class="bright tdc i0h">1</td>
</tr>
<tr>
  <td class="bvert tdc">July 5</td>
  <td class="bright tdc">46,537</td>
  <td class="bright tdc">36,020</td>
  <td class="bright tdc">10,517</td>
  <td class="bright tdc">55</td>
  <td class="bright tdc i0h">6</td>
</tr>
<tr>
  <td class="bvert tdc">July 12</td>
  <td class="bright tdc">46,518</td>
  <td class="bright tdc">33,255</td>
  <td class="bright tdc">13,263</td>
  <td class="bright tdc">34</td>
  <td class="bright tdc i0h">6</td>
</tr>
<tr>
  <td class="bvert tdc">July 19</td>
  <td class="bright tdc">45,240</td>
  <td class="bright tdc">29,716</td>
  <td class="bright tdc">15,524</td>
  <td class="bright tdc">82</td>
  <td class="bright tdc i0h">7</td>
</tr>
<tr>
  <td class="bvert tdc">July 26</td>
  <td class="bright tdc">43,809</td>
  <td class="bright tdc">24,112</td>
  <td class="bright tdc">19,697</td>
  <td class="bright tdc">100</td>
  <td class="bright tdc">15</td>
</tr>
<tr>
  <td class="bvert tdc">Aug. 2</td>
  <td class="bright tdc">43,707</td>
  <td class="bright tdc">21,031</td>
  <td class="bright tdc">22,676</td>
  <td class="bright tdc">140</td>
  <td class="bright tdc">16</td>
</tr>
<tr>
  <td class="bvert tdc">Aug. 9</td>
  <td class="bright tdc">42,768</td>
  <td class="bright tdc">15,584</td>
  <td class="bright tdc">27,184</td>
  <td class="bright tdc">272</td>
  <td class="bright tdc">19</td>
</tr>
<tr>
  <td class="bvert tdc">Aug. 16</td>
  <td class="bright tdc">40,441</td>
  <td class="bright tdc">10,685</td>
  <td class="bright tdc">29,756</td>
  <td class="bright tdc">386</td>
  <td class="bright tdc">61</td>
</tr>
<tr>
  <td class="bvert tdc">Aug. 23</td>
  <td class="bright tdc">39,400</td>
  <td class="bright tdc">6,367</td>
  <td class="bright tdc">33,033</td>
  <td class="bright tdc">371</td>
  <td class="bright tdc">41</td>
</tr>
<tr>
  <td class="bvert tdc">Aug. 30</td>
  <td class="bright tdc">38,210</td>
  <td class="bright tdc">4,094</td>
  <td class="bright tdc">34,116</td>
  <td class="bright tdc">328</td>
  <td class="bright tdc">28</td>
</tr>
<tr>
  <td class="bvert tdc">Sept. 6</td>
  <td class="bright tdc">38,382</td>
  <td class="bright tdc">2,731</td>
  <td class="bright tdc">35,469</td>
  <td class="bright tdc">227</td>
  <td class="bright tdc">34</td>
</tr>
<tr>
  <td class="bvert tdc">Sept. 13</td>
  <td class="bright tdc">38,408</td>
  <td class="bright tdc">1,116</td>
  <td class="bright tdc">37,292</td>
  <td class="bright tdc">138</td>
  <td class="bright tdc">47</td>
</tr>
<tr>
  <td class="bvert tdc">Sept. 20</td>
  <td class="bright tdc">39,142</td>
  <td class="bright tdc i0h">937</td>
  <td class="bright tdc">38,205</td>
  <td class="bright tdc">106</td>
  <td class="bright tdc">55</td>
</tr>
<tr>
  <td class="blc2 tdc">Sept. 27</td>
  <td class="bmc tdc">39,315</td>
  <td class="bmc tdc i0h">603</td>
  <td class="bmc tdc">38,712</td>
  <td class="bmc tdc i0h">58</td>
  <td class="bmc tdc">20<span class="pagenum"><a name="Page_186" id="Page_186">186</a></span></td>
</tr>
</table>

<p class="title2">II</p>

<table border="0" cellpadding="0" cellspacing="2" summary="plague w and w/o serum">
<tr>
  <th rowspan="2" class="bbox">Dates.</th>
  <th colspan="2" class="bh2">Plague death-rate.<br />Comparison per 1000<br />between</th>
  <th rowspan="2" colspan="2" class="bh2">Percentage reduction<br />of Plague death-rate<br />in favour of the<br />Inoculated.</th>
</tr>
<tr>
  <th class="bmc">Non-<br />Inoculated.</th>
  <th class="bmc">Inoculated.</th>
</tr>
<tr>
  <td class="bvert tdc">Five weeks<br />from May 11</td>
  <td class="bright">&nbsp;</td>
  <td class="bright">&nbsp;</td>
  <td>&nbsp;</td>
  <td class="bright">&nbsp;</td>
</tr>
<tr>
  <td class="bvert tdc">to June 14</td>
  <td class="bright tdc i0h">1.022</td>
  <td class="bright tdc i0h">.350</td>
  <td class="tdr">Over</td>
  <td class="bright tdc">65 per cent.</td>
</tr>
<tr>
  <td class="bvert">&nbsp;</td>
  <td class="bright">&nbsp;</td>
  <td class="bright">&nbsp;</td>
  <td>&nbsp;</td>
  <td class="bright">&nbsp;</td>
</tr>
<tr>
  <td class="bvert tdc">Week ending:</td>
  <td class="bright">&nbsp;</td>
  <td class="bright">&nbsp;</td>
  <td>&nbsp;</td>
  <td class="bright">&nbsp;</td>
</tr>
<tr>
  <td class="bvert tdl i1">June 21</td>
  <td class="bright tdc i1">.530</td>
  <td class="bright tdc i0h">.527</td>
  <td class="tdr">About</td>
  <td class="bright tdc i0h">1 per cent.</td>
</tr>
<tr>
  <td class="bvert tdl i1">June 28</td>
  <td class="bright tdc i1">.742</td>
  <td class="bright tdc i0h">.118</td>
  <td class="tdr">Nearly</td>
  <td class="bright tdc">85 per cent.</td>
</tr>
<tr>
  <td class="bvert tdl i1">July 5</td>
  <td class="bright tdc i0h">1.524</td>
  <td class="bright tdc i0h">.570</td>
  <td class="tdr">About</td>
  <td class="bright tdc">63 per cent.</td>
</tr>
<tr>
  <td class="bvert tdl i1">July 12</td>
  <td class="bright tdc i0h">1.022</td>
  <td class="bright tdc i0h">.452</td>
  <td class="tdr">Nearly</td>
  <td class="bright tdc">56 per cent.</td>
</tr>
<tr>
  <td class="bvert tdl i1">July 19</td>
  <td class="bright tdc i0h">2.793</td>
  <td class="bright tdc i0h">.450</td>
  <td>&nbsp;</td>
  <td class="bright tdc">84 per cent.</td>
</tr>
<tr>
  <td class="bvert tdl i1">July 26</td>
  <td class="bright tdc i0h">4.147</td>
  <td class="bright tdc i0h">.761</td>
  <td>&nbsp;</td>
  <td class="bright tdc">82 per cent.</td>
</tr>
<tr>
  <td class="bvert tdl i1">Aug. 2</td>
  <td class="bright tdc i0h">6.656</td>
  <td class="bright tdc i0h">.705</td>
  <td>&nbsp;</td>
  <td class="bright tdc">89 per cent.</td>
</tr>
<tr>
  <td class="bvert tdl i1">Aug. 9</td>
  <td class="bright tdc">17.325</td>
  <td class="bright tdc i0h">.698</td>
  <td class="tdr">Over</td>
  <td class="bright tdc">96 per cent.</td>
</tr>
<tr>
  <td class="bvert tdl i1">Aug. 16</td>
  <td class="bright tdc">33.694</td>
  <td class="bright tdc">2.083</td>
  <td>&nbsp;</td>
  <td class="bright tdc">94 per cent.</td>
</tr>
<tr>
  <td class="bvert tdl i1">Aug. 23</td>
  <td class="bright tdc">57.011</td>
  <td class="bright tdc">1.241</td>
  <td>&nbsp;</td>
  <td class="bright tdc">98 per cent.</td>
</tr>
<tr>
  <td class="bvert tdl i1">Aug. 30</td>
  <td class="bright tdc">80.116</td>
  <td class="bright tdc i0h">.820</td>
  <td>&nbsp;</td>
  <td class="bright tdc">98 per cent.</td>
</tr>
<tr>
  <td class="bvert tdl i1">Sept. 6</td>
  <td class="bright tdc">83.112</td>
  <td class="bright tdc i0h">.958</td>
  <td>&nbsp;</td>
  <td class="bright tdc">99 per cent.</td>
</tr>
<tr>
  <td class="bvert tdl i1">Sept. 13</td>
  <td class="bright tdc">112.903</td>
  <td class="bright tdc">1.260</td>
  <td class="tdr">Over</td>
  <td class="bright tdc">99 per cent.</td>
</tr>
<tr>
  <td class="bvert tdl i1">Sept. 20</td>
  <td class="bright tdc">113.127</td>
  <td class="bright tdc">1.439</td>
  <td class="tdr">Over</td>
  <td class="bright tdc">99 per cent.</td>
</tr>
<tr>
  <td class="blc2 tdl i1">Sept. 27</td>
  <td class="bmc tdc">96.185</td>
  <td class="bmc tdc i0h">.517</td>
  <td class="bbottom tdr">Over</td>
  <td class="bmc tdc">99 per cent.</td>
</tr>
</table>

<p>"It appears that if the 47,427 inhabitants had remained, as they
did&mdash;in their town, without running away by rail or otherwise, or
without camping out in a mass&mdash;and if no inoculation had been
resorted to&mdash;they would have lost 24,899 souls, or a little over half
of their number. The official records show that this has actually
occurred, during the present terrible outbreak, in a number of large
villages, of 2000 inhabitants and over, in the Hubli <i lang="hi" xml:lang="hi">taluka</i> and elsewhere
in the Dhárwár District, where no inoculation was done,
and no camping-out was possible on account of the wet weather."
(Haffkine's commentary on Dr. Leumann's report.)</p>
</div>

<p>That is the story of Hubli; and, as it stands, it is
almost incredible. The Commissioners, by very strict
inquiry, reduced it to credibility without robbing it of
glory. The inquiry brought out more instances of the
immeasurable difficulty of the work. Natives who
wished to avoid inoculation would escape through the
back door at the sight of a plague officer: bribery,
<span class="pagenum"><a name="Page_187" id="Page_187">187</a></span>
personation, sale or transfer of certificates of inoculation,
concealment of cases and of deaths, were all
practised by those who wished not to be inoculated,
or to get the privileges of the inoculated without
inoculation, or to save their infected houses from being
disinfected and unroofed. Again, with the people dying
like flies, and many of them bearing no mark of identification,
and with the medical officers overworked past
human endurance, the wonder is, not that the statistics
were faulty, but that there are any statistics at all.
Certainly, the Commission is well within the mark in
saying, "It is quite clear that a very large number of
lives must have been saved in Hubli by inoculations
during the whole course of the epidemic there. <i>Moreover,
we may note that an arithmetical estimate is not the
only criterion by which we can appreciate the value of inoculations.
And in Hubli their value is approved by the consensus
of opinions of officers who have seen probably far
more of this process and its results in practice than any
other persons in India, and who, having every facility
for forming a sound judgment as to its effect where
plague was really virulent, are satisfied as to its great
value.</i>"</p>

<p>Finally, as at Daman so at Hubli, there are lesser
groups of statistics, of that kind which is <i>approved by
the consensus of opinions of officers</i>. These are, (1)
Lieutenant Keelan's house-to-house investigation;
(2) the Southern Mahratta Spinning Mills; (3) the
Southern Mahratta Railway employés.</p>

<p>1. Lieutenant Keelan made a house-to-house visitation
of 200 houses, in each of which there were protected
and unprotected persons living together, and
in each of which there had been one or more cases
of plague. The figures for 69 of these houses are
<span class="pagenum"><a name="Page_188" id="Page_188">188</a></span>
appended to Captain Leumann's report. They are as
follows:&mdash;</p>

<table border="0" cellpadding="0" cellspacing="2" summary="plague w and w/o serum">
<tr>
  <th class="bbox">&nbsp;</th>
  <th class="bh2">Inmates.</th>
  <th class="bh2">Cases.</th>
  <th class="bh2">Deaths.</th>
  <th class="bh2">Mortality.</th>
</tr>
<tr>
  <td class="bvert tdc">Inoculated</td>
  <td class="bvert tdc">336</td>
  <td class="bvert tdc">11</td>
  <td class="bvert tdc">&nbsp;4</td>
  <td class="bvert tdc i2">1.19</td>
</tr>
<tr>
  <td class="blc2 tdc">Uninoculated&nbsp;</td>
  <td class="bmc tdc">144</td>
  <td class="bmc tdc">84</td>
  <td class="bmc tdc">80</td>
  <td class="bmc tdc">55</td>
</tr>
</table>

<p>These 69 houses were selected: there was nothing
unfair in the method of selection, still, they were
"good houses"; they are not, therefore, exact for
statistics; but, as the Commissioners say, they are
"of interest as quite special examples of successful
inoculation."</p>

<p>2. In the Southern Mahratta Spinning and Weaving
Company's Mills, a careful record of inoculation was
kept and checked by the manager. The number of
the workpeople at the time when inoculation was begun,
21st June, was 1173. At the end of the epidemic the
figures were:&mdash;</p>

<table border="0" cellpadding="0" cellspacing="2" summary="plague w and w/o serum">
<tr>
  <th class="bhlt">&nbsp;</th>
  <th class="bh2">&nbsp;</th>
  <th class="bh2">Deaths.</th>
  <th class="bh2">Mortality per<br />cent.</th>
</tr>
<tr>
  <td class="bleft">Inoculated twice</td>
  <td class="bright tdc">&emsp;1040&ensp;</td>
  <td class="bright tdc">22</td>
  <td class="bright tdc i0h">2.11</td>
</tr>
<tr>
  <td class="bleft">Inoculated once</td>
  <td class="bright tdc i1h">58</td>
  <td class="bright tdc i0h">8</td>
  <td class="bright tdc">13.79</td>
</tr>
<tr>
  <td class="blc">Uninoculated</td>
  <td class="bmc tdc i1h">75</td>
  <td class="bmc tdc">20</td>
  <td class="bmc tdc">26.66</td>
</tr>
</table>

<p>Here, again, the figures have not a statistical value:
"We are not informed whether the inoculations were
performed simultaneously; or at what stage of the
outbreak the average strength of the inoculated was
reached." All the same, what Major Bannerman says
of them is true&mdash;<i>The experience in this company's mill at</i>
<span class="pagenum"><a name="Page_189" id="Page_189">189</a></span>
<i>Hubli should be an object lesson to all mill-owners in
plague-stricken towns.</i></p>

<p>3. The figures for the Southern Mahratta Railway
are given by Major Bannerman in his "Statistics"
(1900): they are not mentioned in the Report of the
Plague Commission. They are of great value, because
the daily shifting of the numbers was recorded as the
work of inoculation went on, and the date of each case
of plague was also noted. Major Bannerman gives the
following account:&mdash;</p>

<p class="blockquote">"The railway employés were living in barracks, and
in the railway yard, apart from the general population of
Hubli town. <i>They were under close daily inspection by
English officials</i>, who formed a committee for this purpose,
with Dr. Chenai as their medical adviser. The
results may therefore be regarded as accurate in a high
degree, the numbers dealt with not being excessive, and
the supervision strict."</p>

<p>The figures, based on the average numbers in each
group, are as follows:&mdash;</p>

<table border="0" cellpadding="0" cellspacing="2" summary="plague w and w/o serum">
<tr>
  <th class="bhlt">&nbsp;</th>
  <th class="bh2">&nbsp;</th>
  <th class="bh2">Cases.</th>
  <th class="bh2">Deaths.</th>
  <th class="bh2">Mortality per<br />cent.</th>
</tr>
<tr>
  <td class="bleft">Twice Inoculated&emsp;&emsp;</td>
  <td class="bright tdc">990&emsp;</td>
  <td class="bright tdc i0h">6</td>
  <td class="bright tdc i0h">1</td>
  <td class="bright tdc">0.1</td>
</tr>
<tr>
  <td class="bleft">Once Inoculated</td>
  <td class="bright tdc">270&emsp;</td>
  <td class="bright tdc i0h">5</td>
  <td class="bright tdc i0h">1</td>
  <td class="bright tdc">0.3</td>
</tr>
<tr>
  <td class="blc">Uninoculated</td>
  <td class="bmc tdc">760&emsp;</td>
  <td class="bmc tdc">35</td>
  <td class="bmc tdc">21</td>
  <td class="bmc tdc">2.7</td>
</tr>

</table>

<p>These eight instances must suffice: many must be
left out&mdash;among them, Dhárwár and Gadag, where Miss
Corthorn, M.B., did work as splendid as Leumann's
work at Hubli; and Mr. Anderson's work in the Ahmednagar
villages; and many more. These plague-reports
<span class="pagenum"><a name="Page_190" id="Page_190">190</a></span>
are to be read, not for their record of heroic zeal and
resourcefulness, but only as one more example of many
thousand lives saved by a method learned from experiments
on animals.</p>

<p>But, of course, there is not, and perhaps there never
will be, a national acceptance and adoption of this
method through the length and breadth of India. It
does not work miracles; it is an uncomfortable process
to submit to; privileges must be offered with it, or the
native will often prefer to take his chance; the protection
is of uncertain duration; all sorts of lies are
told about it, partly by anti-vivisectionist writers,
partly by native political agitators, partly by the
<i lang="hi" xml:lang="hi">hakims</i>. For instance, at a meeting of <i lang="hi" xml:lang="hi">hakims</i> at
Masti, Lahore, on 11th April 1898, the following resolutions
were passed:&mdash;</p>

<div class="blockquote">
<p>"That in the opinion of this meeting the bubonic
plague is not a contagious disease. It originates from
poisoned air, and this poison is created in the air on
account of atmospherical germs and the excess of terrestrial
humidities.</p>

<p>"That this meeting, having carefully considered the
Resolution of the Punjab Government (11th January
1898), is of opinion that the rules embodied in that
Resolution (isolation, disinfection, etc.), are unnecessary
under the principles of Unani medical science."</p>
</div>

<p>And among statements to be made to the Plague
Commissioners was the following, from a native practitioner
in Bombay (April 1899):&mdash;</p>

<div class="blockquote">
<p>"I do not think the plague was imported in Bombay
from Hong Kong or anywhere else. I attribute three
sources of causes of outbreaks of plague in Bombay:
<span class="pagenum"><a name="Page_191" id="Page_191">191</a></span></p>

<p>(<i>a</i>) The predisposing cause was the Bombay Municipality;
(<i>b</i>) The exciting cause was the Nature herself;
(<i>c</i>) The aggravating cause was the Plague Committee."</p>
</div>

<p>All these difficulties were well stated by Surgeon-General
Harvey, Director-General of the Indian Medical
Service, at the discussion on Haffkine's discourse before
the Royal Society, June 1899:&mdash;</p>

<p class="blockquote">"The people of England should consider the difficulties
attending the work of a bacteriologist in India.... He
had no doubt as to the value of the inoculations. At
Undhera he carefully examined the results of the experiment,
and, as far as he could judge, there was no
possibility of error. The results in that experiment were
such as to be 90 per cent. in favour of the inoculated
against the uninoculated. The natives of India were,
however, a strange people, and it was difficult to prophesy
how they would act. In Calcutta, the mention of inoculations
had driven in hot haste from the city 300,000
people, many of whom afterwards returned and were
inoculated; while at Hubli he had seen the inhabitants
come in their thousands to be inoculated and pay for
the inoculations. The medical officer in charge at Hubli
had performed about 80,000 inoculations, and had only
observed some 12 abscesses. He thought that 12
abscesses only, in 80,000 inoculations, showed good
results. But, after all, what were the numbers of inoculations
performed to the 300,000,000 inhabitants of
India? He felt that even if every one consented to be
inoculated it was impossible to provide the vaccine or the
medical officers for such a demand. It was accordingly
to sanitary improvements that he looked with the most
confidence to protect India against the plague."</p>

<p>Therefore, now and for many years to come, preventive
inoculation must fall into line with the other
<span class="pagenum"><a name="Page_192" id="Page_192">192</a></span>
world-wide ways of fighting plague&mdash;quarantine, notification,
isolation, all sanitary measures, destruction of rats&mdash;<i lang="fr" xml:lang="fr">le
rat, le génie de la peste</i>&mdash;evacuation of infected
towns, disinfection or unroofing of infected houses.
Happily, this is just what it does. That admirable
paper, the <cite>Indian Medical Gazette</cite> (September 1901),
has put this fact very simply: "No one ever imagined
that inoculation was the <i>only</i> means of fighting plague.
Its great value consists in its immediate application.
To sanitate, ventilate, and practically rebuild a town or
village takes time; and in the meantime thousands
die." For sudden outbursts of plague&mdash;since rats are
one chief source of infection, and notification is fundamentally
abhorrent to native custom, and evacuation
may ruin trade, or spread infection, or be impossible
by reason of the rains&mdash;since "East is East, and West
is West"&mdash;it is not always possible to provide, for an
Indian village smitten by plague, the excellent arrangements
of the Western world. In all such cases, and
in all cases of epidemic plague within narrow limits,
as in jails, barracks, mills, and the like centres of
human life; and in all inner communities, such as the
Parsee community at Daman, or the Jewish community
at Aden&mdash;by every test of this kind, the saving power
of preventive inoculation has been proved, again and
again, past all doubt. As for those larger death-traps,
Hubli, Dhárwár, and the rest of them, here, though
the statistics are inexact, we have the word of the
men and women themselves who stood between the
dead and the living, and the plague was stayed. Such
faults as there were, in 1899, in the treatment&mdash;the
contamination of this or that stock of the fluid,
and the inadequate method of standardisation&mdash;have
been duly noted by the Commission. The rush for
<span class="pagenum"><a name="Page_193" id="Page_193">193</a></span>
the fluid in 1899 may be estimated from the following
paragraphs:&mdash;</p>

<div class="blockquote">
<p>(i.) <i>Paris.</i> "The preparation of anti-plague serum is
being rapidly proceeded with; up to the present time
the Institute has supplied it, in response to all the very
numerous requests which have come from Portugal,
Spain, Italy, and Turkey, without encroaching on the
reserve kept in readiness for Paris and the departments."
(<cite>Lancet</cite>, 16th September 1899.)</p>

<p>(ii.) <i>India.</i> "The spread of plague westward to Spain
and Portugal seems to have excited more or less general
alarm, and I hear that an unprecedented demand has
suddenly arisen for the plague prophylactic fluid. The
Government of India have been asked the cost of supplying
from 50,000 to 100,000 doses, and the earliest date
at which this quantity could be despatched. It is also
desired to know if in case of need 50,000 doses a week
could be sent to London. Russia desires to obtain a
considerable stock for Port Arthur. Italy has been
making inquiries for home use; and also Portugal, in
order to inoculate at Mozambique. The present laboratory
is at Government House, Parel, Bombay, and has
only recently been fitted up by the Government of India.
About 10,000 doses a day can be turned out, but it is
thought that still further enlargements will be required
if the demand should increase beyond this amount."
(<cite>Lancet</cite>, 23rd September 1899.)</p>
</div>

<hr class="c15" />

<p>It would take too long for the present purpose to
consider what has been done, not only for the prevention
of plague, but also for its cure by a serum
treatment. The results obtained by this treatment in
India have not been very good; but Yersin and others
report better results in other countries. Good results
are reported from Amoy (1896), Nhatrang (1898),
Oporto (1899), and Buenos Ayres (1899-1900). In
<span class="pagenum"><a name="Page_194" id="Page_194">194</a></span>
Glasgow, the prophylactic use of Yersin's serum seems
to have done excellent service: the success of its
curative use was not very striking. The curative
results at Nhatrang (Yersin, <cite>Annales de l'Institut
Pasteur</cite>, March 1899) are notable. Nhatrang is an
Annamese fishing-village; and the plague, when it was
left to itself, killed every case that it got:&mdash;</p>

<p class="blockquote">"La peste s'est montrée excessivement meurtrière chez
les Annamites. Sur 72 cas de peste, 39 personnes chez
lesquelles la maladie a évolué normalement, ou qui n'ont
été traités que par des médecins indigènes, sont mortes
sans exception. Les 33 autres cas ont pu être traités
par le sérum, quelquefois dans de bonnes conditions, mais
le plus souvent quelques heures seulement avant la mort.
Malgré cela, nous avons obtenu 19 guérisons et 14 décès,
ce qui fait une mortalité de 42 per cent., chez les traités.
<i lang="fr" xml:lang="fr">Ainsi, d'une part, 100 pour 100 de mortalité chez les non-traités;
de l'autre, 42 per cent. chez les malades qui ont
reçu du sérum.</i> Ces chiffres confirment les résultats que
j'avais obtenu en Chine en 1896."</p>

<p>A long review of this curative treatment, fairly hopeful
but nothing more, is given in the Report of the
Plague Commission, vol. v., pp. 269-320. The Commissioners
are of opinion that it ought not yet to be
extended, as a general measure, over all the districts
affected with plague; and that there is need of more
work in bacteriology before it can be thus extended.
"We desire to record our opinion that, though the
method of serum-therapy, as applied to plague, has not
been crowned with a therapeutic success in any way
comparable to that obtained by the application of the
serum method to the treatment of diphtheria, <i>none the
less the method of serum-therapy is in plague, as in other
<span class="pagenum"><a name="Page_195" id="Page_195">195</a></span>
infectious diseases, the only method which holds forth a
prospect of ultimate success.</i>"</p>

<p>It is a strange contrast, between this opinion and
the statements made by the opponents of all experiments
on animals. Some of these statements will be
found in Part IV. of this book. Happily for the world,
no amount of foul language can hinder the good work;
and, when we talk of <i>Empire-building</i>, and of <i>deeds that
win the Empire</i>, we must reckon bacteriology among
them: as Lord Curzon did, in his speech at Calcutta,
March 3, 1899&mdash;<i>What is this medical science we bring
to you? It is built on the bed-rock of pure irrefutable
science; it is a boon which is offered to all, rich and poor,
Hindu and Mohammedan, woman and man.</i>
<span class="pagenum"><a name="Page_196" id="Page_196">196</a></span></p>

<h3>IX<br />
TYPHOID FEVER. MALTA FEVER</h3>

<h4><span class="smcap">Typhoid Fever</span></h4>

<p>The names of Klebs, Eberth, and Koch, are associated
with the discovery, in 1880-81, of the bacillus of
enteric fever, <i lang="la" xml:lang="la">bacillus typhosus</i>; and it was obtained in
pure culture by Gaffky in 1884. It has been studied
from every point of view, in man and in animals; in
the blood, tissues, and excretions; in earth, air, water,
milk, and food; in its distribution, methods of growth,
and chemical products. Especially, the study of its
chemical products has been directed toward (1) immunisation
against the disease, (2) bacteriological diagnosis
of the disease at an early stage.</p>

<p>The date of the first protective inoculations against
typhoid is July to August 1896: they were made at
Netley Hospital, by Professor Wright and Surgeon-Major
Semple. The first inoculations in Germany,
made by Pfeiffer and Kolle, were published two months
later. The story of these famous Netley inoculations
is told in the <cite>British Medical Journal</cite>, 30th January
1897. Eighteen men offered themselves&mdash;</p>

<p class="blockquote">"A good deal of fever was developed in all cases, and
sleep was a good deal disturbed. These constitutional
symptoms had to a great extent passed away by the
morning, and laboratory work went on without interruption....
With two exceptions, all these vaccinations
<span class="pagenum"><a name="Page_197" id="Page_197">197</a></span>
were performed upon Medical Officers of the Army or
Indian Medical Services, or upon Surgeons on Probation
who were preparing to enter those services."</p>

<p>Good luck attend all eighteen of them, and immunity
against typhoid, wherever they are. The doses
that they received were estimated in proportion to the
dose that would kill a guinea-pig of 350-400 grammes
weight; and the protective fluid contained no living
bacilli:&mdash;</p>

<p class="blockquote">"The advantages which are associated with the use of
such 'dead vaccines' are, first, that there is absolutely
no risk of producing actual typhoid fever by our inoculations;
secondly, that the vaccines may be handled and
distributed through the post without incurring any risk
of disseminating the germs of the disease; thirdly, that
dead vaccines are probably less subject to undergo alterations
in their strength than living vaccines."</p>

<p>The first use of the vaccine during an outbreak of
typhoid was in October 1897, at the Kent County
Lunatic Asylum. The treatment was offered to any of
the working staff who desired it:&mdash;</p>

<p class="blockquote">"All the medical staff, and a number of attendants,
accepted the offer. <i>Not one of those vaccinated&mdash;84 in
number&mdash;contracted typhoid fever: while of those unvaccinated
and living under similar conditions, 16 were
attacked.</i> This is a significant fact, though it should
in fairness be stated that the water was boiled after a
certain date, and other precautions were taken, so that
the vaccination cannot be said to be altogether responsible
for the immunity. Still, the figures are striking."
(<cite>Lancet</cite>, 19th March 1898; see also Dr. Tew's paper, in
<cite>Public Health</cite>, April 1898.)</p>

<p>Certainly, they are striking; so is the story of the
eight young subalterns on the Khartoum expedition, of
<span class="pagenum"><a name="Page_198" id="Page_198">198</a></span>
whom six were vaccinated, and two took their chance.
The six escaped typhoid, the two were attacked by it,
and one died. But these figures are too small to be of
much value.</p>

<p>The first anti-typhoid inoculations on a large scale
were made among British troops in India (Bangalore,
Rawal Pindi, Lucknow), when the Plague Commission,
of which Professor Wright was a member, was in
India, November 1898 to March 1899. These inoculations
were voluntary, at private cost, and without
official sanction; though the original proposal for them,
in 1897, had come from the Indian Government.
Pending official sanction, they were stopped. Then,
on 25th May 1899, the Indian Government made
application to the Secretary of State for India that
they should be sanctioned, and should be made at the
public cost. The application is as follows:&mdash;</p>

<p class="blockquote">"The annual admissions <i lang="la" xml:lang="la">per mille</i> for enteric fever
amongst British troops in India have risen from 18.5 in
1890 to 32.4 in 1897, while the death-rate has increased
from 4.01 to 9.01; and we are of opinion that every
practicable means should be tried to guard against the
ravages made by this disease. The anti-typhoid inoculations
have been, we believe, on a sufficiently large scale
to show the actual value of the treatment, while the
results appear to afford satisfactory proof that the inoculations,
when properly carried out, afford an immunity
equal to or greater than that obtained by a person who
has undergone an attack of the disease; further, the
operation is one which does not cause any risk to health.
In these circumstances, we are very strongly of opinion
that a more extended trial should be made of the treatment;
and we trust that your Lordship will permit us to
approve the inoculation, at the public expense, of all
British officers and soldiers who may voluntarily submit
themselves to the operation."
<span class="pagenum"><a name="Page_199" id="Page_199">199</a></span></p>

<p>On 1st August, the Secretary of State for India
announced in Parliament that this treatment, at the
public expense, had been sanctioned.</p>

<p>On 20th January 1900, Professor Wright published
in the <cite>British Medical Journal</cite> an account of these
1898-99 inoculations in India. "They were undertaken
under conditions which were very far from ideal.
In particular, there is reason to suppose that the results
obtained may have been unfavourably influenced by a
weakening of the vaccine, brought about by repeated
re-sterilisation." In no case was reinoculation done.
The statistics were compiled from information furnished
by officers of the Royal Army Medical Corps actually in
charge of troops in the various stations; and were supplemented
by reports received from the commanding
officers of the various inoculated regiments. They are
as follows:&mdash;</p>

<table border="0" cellpadding="0" cellspacing="2" summary="typoid w and w/o serum">
<tr>
  <th class="bhlt">Numbers under<br />Observation.</th>
  <th class="bh2">&nbsp;</th>
  <th class="bh2">Cases.</th>
  <th class="bh2">Deaths.</th>
  <th class="bh2">Percentage<br />of Cases.</th>
  <th class="bh2">Percentage<br />of Deaths.</th>
</tr>
<tr>
  <td class="bleft">Inoculated</td>
  <td class="bright tdc">2835&emsp;</td>
  <td class="bright tdc i0h">27</td>
  <td class="bright tdc i0h">5</td>
  <td class="bright tdc i0h">0.95</td>
  <td class="bright tdc">0.2</td>
</tr>
<tr>
  <td class="blc">Uninoculated</td>
  <td class="bmc tdc">8460&emsp;</td>
  <td class="bmc tdc">213</td>
  <td class="bmc tdc">23</td>
  <td class="bmc tdc">2.5</td>
  <td class="bmc tdc i0h">0.34</td>
</tr>
</table>

<p>If the inoculated had been attacked equally with the
uninoculated throughout the period of observation, they
would have had 71 cases instead of 27.</p>

<p>These inoculations belong to the early part of 1899.
During the rest of the year, inoculations were made in
India, Egypt, and Malta: the results are given in an
appendix to the Report of the Royal Army Medical
Department, 1899. (See <cite>British Medical Journal</cite>, 21st
September 1901.) The great majority of the troops
tabulated were in India. Of the troops stationed at
<span class="pagenum"><a name="Page_200" id="Page_200">200</a></span>
Malta, 61 were inoculated, 2456 not inoculated; among
the former there were no cases, among the latter there
were 17 cases and 5 deaths. In Egypt, of 4835
troops, 461 were inoculated; among these there were
no cases, among the uninoculated there were 30 cases
and 7 deaths. In India, of 30,353 troops, 4502 were
inoculated, leaving 25,851 not inoculated; among the
inoculated there were 44 cases and 9 deaths, among
the non-inoculated 657 cases and 146 deaths. Taking
the Indian statistics, and estimating percentage to
strength, we find, amongst the inoculated, admissions
0.98, deaths 0.2; amongst the non-inoculated, admissions
2.5, deaths 0.56. The cases which occurred
amongst the inoculated men were in the majority of
instances of a mild character. Taking Malta, Egypt,
and India together, it appears that the inoculated, if
they had suffered equally with the non-inoculated,
would have had 108 cases and 24 deaths, instead of
44 cases and 9 deaths.</p>

<p>At the end of 1899, this treatment, only just out of
the hands of science, was suddenly demanded for the
protection of a huge army at war in a country saturated
with typhoid. Still, the South African results, and
other results during 1899 to 1901, show a good
balance of lives saved. The following paragraphs give
all results published from the beginning of 1900 to
May 1902. They are put in order of publication.
Doubtless a few other reports have been overlooked in
compilation; but the list includes all that were easily
accessible.</p>

<p>1. <i>Manchester, England.</i> The <cite>British Medical Journal</cite>,
28th April 1900, contains a note by Dr. Marsden,
Medical Superintendent of the Monsall Fever Hospital,
Manchester, on the inoculation of 14 out of 22 nurses
<span class="pagenum"><a name="Page_201" id="Page_201">201</a></span>
engaged in nursing typhoid patients. Of the remaining
8, 4 had already had typhoid. The inoculations were
made in October 1899. The following table shows the
subsequent freedom from typhoid of the nursing staff:&mdash;</p>

<table border="0" cellpadding="0" cellspacing="2" summary="typhoid cases">
<tr>
  <th class="bbox">Year.</th>
  <th class="bh2">Number of<br />Typhoid Patients.</th>
  <th class="bh2">Cases among<br />Nursing Staff.</th>
 </tr>
<tr>
  <td class="bvert tdc">1895</td>
  <td class="bright tdc">229</td>
  <td class="bright tdc">3</td>
</tr>
<tr>
  <td class="bvert tdc">1896</td>
  <td class="bright tdc">238</td>
  <td class="bright tdc">3</td>
</tr>
<tr>
  <td class="bvert tdc">1897</td>
  <td class="bright tdc">302</td>
  <td class="bright tdc">4</td>
</tr>
<tr>
  <td class="bvert tdc">1898</td>
  <td class="bright tdc">426</td>
  <td class="bright tdc">8</td>
</tr>
<tr>
  <td class="bvert tdc">To end of September 1899</td>
  <td class="bright tdc">163</td>
  <td class="bright tdc">5</td>
</tr>
<tr>
  <td class="blc2 tdc">From October 1899 to March 1900</td>
  <td class="bmc tdc">146</td>
  <td class="bmc tdc">0</td>
</tr>
</table>

<p>2. <i>Ladysmith, South Africa.</i> The <cite>Lancet</cite>, 14th July
1900, contains a short note by Professor Wright, on
the distribution of typhoid among the officers and men
of the military garrison, during the siege of Ladysmith.
The figures are as follows:&mdash;</p>

<table class="fsize90" border="0" cellpadding="0" cellspacing="2" summary="typhoid deaths">
<tr>
  <th class="bbox">&nbsp;</th>
  <th class="bh2">Number.</th>
  <th class="bh2">No. of<br />Cases.</th>
  <th class="bh2">Proportion<br />of Cases.</th>
  <th class="bh2">No. of<br />Deaths.</th>
  <th class="bh2">Proportion<br />of Deaths.</th>
  <th class="bh2">Case-<br />mortality.</th>
</tr>
<tr>
  <td class="bvert tdc">Not inoculated&ensp;</td>
  <td class="bright tdc">10,529</td>
  <td class="bright tdc">1489</td>
  <td class="bright tdc">1 in 7.07</td>
  <td class="bright tdc">329</td>
  <td class="bright tdc">1 in 32</td>
  <td class="bright tdc i0h">1 in 4.52</td>
</tr>
<tr>
  <td class="blc2">Inoculated</td>
  <td class="bmc tdc i0h">1,705</td>
  <td class="bmc tdc i1">35</td>
  <td class="bmc tdc">1 in 48.7</td>
  <td class="bmc tdc i1">8</td>
  <td class="bmc tdc i0h">1 in 213</td>
  <td class="bmc tdc">1 in 4.4</td>
</tr>
</table>

<p>The wide difference between the two groups, as
regards the incidence of the disease, is well marked;
but the case-mortality is practically the same in each
group. (The statistics of the General Hospital, Ladysmith,
also tell in favour of the preventive treatment:
see Surgeon-Major Westcott's letter, <cite>British Medical
Journal</cite>, 20th July 1901, in answer to Dr. Melville's
letter, <cite>British Medical Journal</cite>, 20th April 1901.)</p>

<p>3. <i>The Portland Hospital: Modder River and Bloemfontein</i>.
<span class="pagenum"><a name="Page_202" id="Page_202">202</a></span>
The <cite>British Medical Journal</cite>, 10th November
1900, contains an account by Dr. Tooth of the cases
of typhoid in this hospital. Concerning the preventive
treatment, he says: "The experience of my colleague
Dr. Calverley and myself may be of interest, though we
fear that the numbers are too few for safe generalisation.</p>

<p>"<i>Personnel of the Portland Hospital.</i> We take first
the relation of disease and inoculation among the
<i>personnel</i> of the hospital. Twenty-four non-commissioned
officers, orderlies, and servants of the Portland
Hospital, and 4 of the medical staff, were inoculated
on the voyage out. All these showed the local symptoms
at the time; that is, pain, stiffness, and local
erythema; 17 also presented well-marked constitutional
symptoms&mdash;general feeling of illness, fever, and headache.
Of the orderlies, 9 had enteric fever subsequently.
Two had refused inoculation, and both of
these had the disease very severely; in fact one died.
Of the inoculated cases, 5 had the disease lightly, and
2 fairly severely. One of the sisters had the disease
rather severely, and she had not been inoculated.</p>

<p>"<i>Officers and men admitted to the Portland Hospital.</i>
We had under treatment at the Portland Hospital 231
cases of enteric fever, most of which came under our
care at Bloemfontein. We have not included in these
figures a number of patients who came in convalescent
for a short time only, and on their way to the base, and
who would therefore appear in the admission and discharge
book of the hospital. If we did so, of course
our percentages would be lower. Of these 231
patients, 53 had been inoculated at home or on the
voyage out, and of them 3 died, making a percentage
of deaths among the inoculated of 5.6 per cent.; 178
had not been inoculated, of whom 25 died; that is, a
<span class="pagenum"><a name="Page_203" id="Page_203">203</a></span>
mortality among the non-inoculated of 14 per cent.
The general mortality in enteric fever with us was 28
deaths out of 231 cases; that is, 12.1 per cent., which
seems to compare favourably with the experience of the
London hospitals.</p>

<p>"It is interesting to record our experience among
the officers taken separately. Thirty-three officers were
admitted with enteric fever; 21 had been inoculated;
that is, 63.6 per cent.; a much larger percentage than
among the men. Only one of these officers died, and
he had not been inoculated.</p>

<p>"These figures are small, but such as they are they
are significant, and they dispose us to look with favour
upon inoculation. So also does our clinical experience
with our patients, for among the inoculated the disease
seemed to run a milder course."</p>

<p>4. <i>No. 9 General Hospital, Bloemfontein.</i> The <cite>Medical
Chronicle</cite> for January 1901 contains an account, by
Dr. J. W. Smith, of the work of this hospital. He says:
"The general impression amongst the medical officers
in our hospital was that a single inoculation probably
did not confer an immunity lasting very long&mdash;the
lapse of time differing in individuals&mdash;and also that
there was a tendency in the cases of enteric in inoculated
patients to abort at the end of ten or fourteen
days. I should say, however, that a very considerable
number of our detachment who had been inoculated
suffered from enteric, of whom 4 at least died. Of the
medical staff, the only member of the junior staff who
had not been inoculated died of enteric."</p>

<p>5. <i>Scottish National Red Cross Hospital, Kroonstadt.</i>
The <cite>British Medical Journal</cite>, 12th January 1901,
contains an account of the work of this hospital by
Surgeon-Colonel Cayley, Officer in Charge. He says:
<span class="pagenum"><a name="Page_204" id="Page_204">204</a></span>
"The first section of the hospital, consisting of 61
persons&mdash;officers, nursing sisters, and establishment&mdash;left
Southampton on 21st April 1900. During the
voyage out, all except 4 were inoculated twice, at an
interval of about ten days; 2 were inoculated once;
and 2 (who had had typhoid) were not inoculated.
Immediately we reached the Cape, the hospital was
sent up to Kroonstadt in the Orange River Colony, and
remained there as a stationary hospital till the middle
of October. During this period there were always
many cases of enteric under treatment in hospital.
Further, some of the medical officers and student
orderlies had charge of the Kroonstadt Hotel temporary
hospital, which was crowded up with enteric cases; and
the nursing sisters, for three weeks, did duty in the
military hospitals at Bloemfontein in May and June,
when enteric fever was at its worst. There was not a
single case of enteric among the <i>personnel</i> of this first
section of the hospital.</p>

<p>"The second section of the hospital&mdash;medical officers,
nurses, and establishment, 82 in all&mdash;left Southampton
in May 1900. On board ship nearly all of them were
inoculated, but many of them only once. The material
for inoculation had been on board for some time, and
was not so fresh as in the first instance. Of this
second section, 1 nurse had enteric at Kroonstadt.
She was the only one, out of a total of 36 nurses, who
suffered from enteric; and she was the only nurse who
was not inoculated, excepting the 2 who were protected
by a previous attack of enteric. A third section of the
hospital, consisting of 4 medical officers and 16 nurses,
went out in July; they were all inoculated, and none of
them had enteric.</p>

<p>"Of the second section, 5 orderlies had enteric fever
<span class="pagenum"><a name="Page_205" id="Page_205">205</a></span>
at Kroonstadt, of whom 2 died. Of these 5, there
were 2 inoculated (once) and 3 non-inoculated. Of the
2 who died, 1 had been once inoculated, the other had
not been inoculated."</p>

<p>6. <i>Meerut, India.</i> The <cite>British Medical Journal</cite>, 9th
February 1901, gives a short note by Professor Wright
on inoculations in the 15th Hussars. He says:
"Through the kindness of Lieutenant-General Sir
George Luck, commanding the Bengal Army, I am
permitted to publish the following officially compiled
statistics, dealing with the effects of anti-typhoid inoculations
in the case of the 15th Hussars:&mdash;</p>

<p class="title2"><i>From 22nd October 1899 to 22nd October 1900.</i></p>

<table class="fsize83" border="0" cellpadding="0" cellspacing="2" summary="typhoid cases">
<tr>
  <th class="bbox">&nbsp;</th>
  <th class="bh2">Strength.</th>
  <th class="bh2">Inoculated.</th>
  <th class="bh2">Cases.</th>
  <th class="bh2">Deaths.</th>
  <th class="bh2">Not<br />Inoculated.</th>
  <th class="bh2">Cases.</th>
  <th class="bh2">Deaths.</th>
</tr>
<tr>
  <td class="bvert">Officers</td>
  <td class="bright tdc i0h">22</td>
  <td class="bright tdc i0h">19</td>
  <td class="bright tdc">0</td>
  <td class="bright tdc">0</td>
  <td class="bright tdc i1">3</td>
  <td class="bright tdc i0h">0</td>
  <td class="bright tdc">0</td>
</tr>
<tr>
  <td class="bvert">N.C.O. and Men&ensp;</td>
  <td class="bright tdc">481</td>
  <td class="bright tdc">317</td>
  <td class="bright tdc">2</td>
  <td class="bright tdc">1</td>
  <td class="bright tdc">164</td>
  <td class="bright tdc">11</td>
  <td class="bright tdc">6</td>
</tr>
<tr>
  <td class="blc2">Women</td>
  <td class="bmc tdc i0h">36</td>
  <td class="bmc tdc i0h">24</td>
  <td class="bmc tdc">0</td>
  <td class="bmc tdc">0</td>
  <td class="bmc tdc i0h">12</td>
  <td class="bmc tdc i0h">0</td>
  <td class="bmc tdc">0</td>
</tr>
</table>

<p>It would thus appear that the incidence of enteric in the
inoculated was represented by 0.55 per cent., and the
mortality by 0.27 per cent.; while the incidence in
the uninoculated was 6.14 per cent., and the death-rate
3.35 per cent."</p>

<p>If the inoculated had suffered equally with the uninoculated,
they would have had 22 cases with 11 deaths,
instead of 2 cases with 1 death.</p>

<p>7. <i>The Edinburgh Hospital, South Africa.</i> The <cite>Scottish
Medical and Surgical Journal</cite>, March 1901, contains
an account of the work of the Edinburgh Hospital, by
Dr. Francis Boyd. Of the staff, 58 were inoculated
(27 once, and 31 twice). Among these 58, there were
<span class="pagenum"><a name="Page_206" id="Page_206">206</a></span>
9 cases of typhoid fever, with I death, in a patient
who had old mitral disease. "Our experience has been
that, while inoculation appears to modify the disease,
completely modified attacks are met with in the uninoculated.
Again, very severe attacks, with complications
and relapse, occur in those who have been
inoculated. One cannot from this conclude that inoculation
has been valueless, for had not the patient
been inoculated, the attack might have been still more
severe."</p>

<p>8. <i>Egypt and Cyprus.</i> The <cite>British Medical Journal</cite>,
4th May 1901, gives a short note by Professor Wright
on inoculations during 1901 in Egypt and Cyprus. He
says: "I am indebted to the kindness of Colonel W. J.
Fawcett, R.A.M.C., Principal Medical Officer in Egypt,
for the following statistics dealing with the incidence
of enteric fever, and the mortality from the disease,
for the year 1900, in the inoculated and uninoculated
among the British troops in Egypt and Cyprus:&mdash;</p>

<table border="0" cellpadding="0" cellspacing="2" summary="enteric fever w and w/o serum">
<tr>
  <th class="bbox">&nbsp;</th>
  <th class="bh2 tdc">Average Annual<br />Strength.</th>
  <th class="bh2 tdc">Cases.</th>
  <th class="bh2 tdc">Deaths.</th>
  <th class="bh2 tdc">Percentage<br />of Cases.</th>
  <th class="bh2 tdc">Percentage<br />of Deaths.</th>
</tr>
<tr>
  <td class="bvert">Uninoculated&ensp;</td>
  <td class="bright tdc">2669</td>
  <td class="bright tdc">68</td>
  <td class="bright tdc">10</td>
  <td class="bright tdc">2.50</td>
  <td class="bright tdc">0.40</td>
</tr>
<tr>
  <td class="blc2">Inoculated</td>
  <td class="bmc tdc i0h">720</td>
  <td class="bmc tdc i0h">1</td>
  <td class="bmc tdc i0h">1</td>
  <td class="bmc tdc">0.14</td>
  <td class="bmc tdc">0.14</td>
</tr>
</table>

<p>These figures testify to a nineteen-fold reduction in the
number of attacks of enteric fever, and to a threefold
reduction in the number of deaths from that disease,
among the inoculated.... The only case which occurred
among the inoculated was that of a patient
admitted to hospital on the thirty-third day after inoculation.
It would seem that the disease was in this
case contracted before anything in the nature of protection
had been established by the inoculation."
<span class="pagenum"><a name="Page_207" id="Page_207">207</a></span></p>

<p>9. <i>Imperial Yeomanry Hospital, Pretoria.</i> Dr. Rolleston,
Consulting Physician to this hospital, writes in
the <cite>British Medical Journal</cite>, 5th October 1901: "Among
the <i>personnel</i> of the hospital (17 medical officers, 50
nursing sisters, 83 orderlies, etc.), total, 150, there
were 22 cases of enteric fever, or an incidence of 14.6
per cent. Of the 150, 35 were inoculated, and of
these, 6, or 17 per cent., suffered from enteric; while,
of 115 non-inoculated members of the <i>personnel</i>, 16, or
13.9 per cent., suffered from enteric fever; the percentage
is therefore higher among the inoculated.
There were 2 deaths, both in non-inoculated patients.
In 100 cases of enteric fever among non-commissioned
officers and men, taken mainly from convalescent
patients, only 8 had been previously inoculated; there
were 3 fatal cases, all among non-inoculated patients.
Among 42 officers who had enteric, no fewer than 19
had been previously inoculated; 6 of these 19 cases
were severe in character, but none were fatal; of the
23 non-inoculated cases, 7 were severe, and of these 7,
3 ended fatally. The interval between inoculation and
the subsequent incidence of enteric fever varied between
one and twenty-one months, but in only four instances
was the interval less than six months. The average
interval between inoculation and the onset of enteric
fever in these 19 cases was thirty-eight weeks.</p>

<p>"As far as these scanty figures go, they point to the
conclusion (1) that anti-typhoid inoculation does not
absolutely protect against a future attack of typhoid
fever; (2) that when enteric occurs in an inoculated
person, there is, as a rule, an interval of about six
months; (3) that inoculation protects against a fatal
termination to the disease."</p>

<p>10. <i>Richmond Asylum, Dublin.</i> The <cite>British Medical</cite>
<span class="pagenum"><a name="Page_208" id="Page_208">208</a></span>
<cite>Journal</cite>, 26th October 1901, contains a note by Professor
Wright on an outbreak of typhoid in this asylum
during August to December 1900. Inoculations were
begun on 6th September, by Dr. Cullinan, and by 30th
November 511 persons were inoculated. After careful
criticism of all doubtful cases, Professor Wright gives
the following figures:&mdash;</p>

<p class="blockquote hang"><i>Comparative Incidence of Typhoid Fever in Inoculated and Non-Inoculated,
calculated upon the average strength of the representative
groups during the period intervening between the
commencement of the inoculations and the termination of the
epidemic.</i></p>

<table border="0" cellpadding="0" cellspacing="2" summary="thyphoid w and w/o serum">
<tr>
  <th class="bbox">&nbsp;</th>
  <th class="bh2">Average<br />Strength.</th>
  <th class="bh2 ">Cases.</th>
  <th class="bh2 ">Deaths.</th>
  <th class="bh2 ">Percentage<br />of Cases.</th>
  <th class="bh2 ">Percentage<br />of Deaths.</th>
</tr>
<tr>
  <td class="bvert">Uninoculated&ensp;</td>
  <td class="bright tdc">298</td>
  <td class="bright tdc">30(-1?)</td>
  <td class="bright tdc">4</td>
  <td class="bright tdc">10.1</td>
  <td class="bright tdc">1.3</td>
</tr>
<tr>
  <td class="blc2">Inoculated</td>
  <td class="bmc tdc">339</td>
  <td class="bmc tdc i0h">5(+1?)</td>
  <td class="bmc tdc">1</td>
  <td class="bmc tdc i0h">1.3</td>
  <td class="bmc tdc">0.3</td>
</tr>
</table>

<p>"It may be noted," he says, "that the result is in
conformity with that of all the statistical returns of
anti-typhoid inoculation which have reached me."</p>

<p>11. <i>Deelfontein.</i> The <cite>Lancet</cite>, 18th January 1902,
contains a paper by Dr. Washbourn and Dr. Andrew
Elliot, on 262 cases of typhoid fever in the Imperial
Yeomanry Hospital at Deelfontein during the year
March 1900 to March 1901. (See Dr. Washbourn's
earlier letter, <cite>Brit. Med. Jour.</cite>, 16th June 1900.) They
say: "In 211 of our cases, it was definitely recorded
whether the patient had been inoculated or not: 186
of these cases had not been inoculated, with 20 deaths,
or a mortality of 10.7 per cent.; 25 had been inoculated,
with 4 deaths, or a mortality of 16 per cent. The
mortality was thus higher among the inoculated than
among the non-inoculated." Of the <i>personnel</i> of the
hospital, there were 59 inoculated, with 4 cases, and
25 not inoculated, with 4 cases.
<span class="pagenum"><a name="Page_209" id="Page_209">209</a></span></p>

<p>12. <i>Winburg.</i> The <cite>Lancet</cite>, 5th April 1902, contains
a short note by Professor Wright, on the 5th
Battalion, Manchester Regiment. He says: "In view
of the dearth of statistics bearing on the incidence of
typhoid fever in South Africa in inoculated and uninoculated
persons respectively, the following, for which
I am indebted to Lieutenant J. W. West, R.A.M.C.,
Winburg, Orange River Colony, may not be entirely
without interest. The statistics here in question give
the results obtained in the case of the 5th Battalion,
Manchester Regiment, for the six months which have
elapsed since their landing in South Africa. The
figures, which relate to a total strength of 747 men
and officers under observation, are as follows:&mdash;</p>

<table border="0" cellpadding="0" cellspacing="2" summary="typhoid w and w/o serum">
<tr>
  <th class="bbox">&nbsp;</th>
  <th class="bh2 ">Number.</th>
  <th class="bh2 ">Cases.</th>
  <th class="bh2 ">Deaths.</th>
  <th class="bh2 ">Percentage<br />of Cases.</th>
  <th class="bh2 ">Percentage<br />of Deaths.</th>
</tr>
<tr>
  <td class="bvert">Uninoculated&ensp;</td>
  <td class="bright tdc">547</td>
  <td class="bright tdc">23</td>
  <td class="bright tdc">7</td>
  <td class="bright tdc">4.2</td>
  <td class="bright tdc">1 in 3.3</td>
</tr>
<tr>
  <td class="blc2">Inoculated</td>
  <td class="bmc tdc">200</td>
  <td class="bmc tdc i0h">3</td>
  <td class="bmc tdc">0</td>
  <td class="bmc tdc">1.5</td>
  <td class="bmc tdc">0</td>
</tr>
</table>

<p>"The three attacks in the inoculated are reported
to have been of exceptionally mild type, contrasting
in a striking manner with the severe attacks which
occurred in the uninoculated. At the time of sending
in the report, some of the uninoculated patients were
'not yet out of danger.'"</p>

<hr class="c15" />

<p>Certainly, these instances show a good balance of
lives saved, not only under the adverse conditions of
the war, but also in Egypt, India, and the United
Kingdom. But the bacteriological work on typhoid
fever has been directed also to the working out of a
<span class="pagenum"><a name="Page_210" id="Page_210">210</a></span>
very different problem: and that is the method of
diagnosis which is called "Widal's reaction." The
practical uses of this reaction are of the utmost importance.
It is the outcome of work in different parts of
the world&mdash;by Wright and Semple and Durham in England,
Chantemesse and Widal in France, Pfeiffer and
Kolle and Grüber in Germany, and many more. The
first systematic study of it was made by Durham and
Pfeiffer; and Widal's name is especially associated
with the application of their work to the uses of practice.
Admirable accounts of the whole subject are
given by Dr. Cabot in his book, <cite>The Serum-Diagnosis
of Disease</cite> (Longmans, 1899), and by Mr. Foulerton
in the <cite>Middlesex Hospital Journal</cite>, October 1899 and
July 1901.</p>

<p>Widal's reaction is surely one of the fairy tales of
science. The bacteriologist works not with anything
so gross as a drop of blood, but with a drop of blood
fifty or more times diluted; one drop of this dilution is
enough for his purpose. Take, for instance, an obscure
case suspected to be typhoid fever: a drop of blood
taken from the finger is diluted fifty or more times, that
the perfect delicacy of the test may be ensured; a drop
of this dilution is mixed with a drop of nutrient fluid
containing living typhoid bacilli, and a drop of this
mixture of blood and bacilli is watched under the
microscope:&mdash;</p>

<p class="blockquote">"The motility of the bacilli is instantaneously or
very quickly arrested, and in a few minutes the bacilli
begin to aggregate together into clumps, and by the end
of the half-hour there will be very few isolated bacilli
visible. In less marked cases, the motility of the bacilli
does not cease for some minutes; while in the least
marked ones the motility of the bacilli may never be
<span class="pagenum"><a name="Page_211" id="Page_211">211</a></span>
completely arrested, but they are always more or less
sluggish, while clumping ought to be quite distinct by
the end of the half-hour."</p>

<p>The result of this clumping is also plainly visible
to the naked eye, by the subsidence of the agglutinated
bacteria to the bottom of the containing vessel: and
thus an easy practical mode of diagnosis is afforded
by it.</p>

<p>As with typhoid, so with Malta fever, cholera, and
some other infective diseases. And the unimaginable
fineness of this reaction goes far beyond the time of
the disease. Months, even years, after recovery from
typhoid, a fiftieth part of a drop of the blood will still
give Widal's reaction: and it has been obtained in an
infant whose mother had typhoid before it was born.
A drop of dried blood, from a case suspected to be
typhoid, may be sent a hundred miles by post to be
tested; and typhoid, like diphtheria, may now be submitted
to the judgment of an expert far away, and the
answer telegraphed back. It would be difficult to exaggerate
the practical importance of this reaction for
the early diagnosis of cases of typhoid fever, especially
those cases that appear, at the onset, not severe.</p>

<h4><span class="smcap">Malta Fever</span></h4>

<p>The specific organism of Malta fever (Mediterranean
fever), the <i lang="la" xml:lang="la">bacillus Melitensis</i>, was discovered in 1887 by
Surgeon-Major David Bruce, of the Army Medical Staff.
Its nature and action were proved by the inoculation of
monkeys. The use of Widal's reaction is of great value
in this disease:&mdash;
<span class="pagenum"><a name="Page_212" id="Page_212">212</a></span></p>

<p class="blockquote">"The diagnosis of Malta fever from typhoid is, of
course, a highly important practical matter. It is exceedingly
difficult in the early stages." (Manson, <i lang="la" xml:lang="la">loc.
cit.</i>)</p>

<p>As with typhoid, so with Malta fever, Netley led the
way to the discovery of an immunising serum. In the
course of the work, one of the discoverers was by accident
infected with the disease:&mdash;</p>

<p class="blockquote">"He was indisposed when he went to Maidstone to
undertake anti-typhoid vaccination, and after fighting
against his illness for some days, he was obliged to
return to Netley on 9th October. Examination of blood-serum
(Widal's reaction) showed that he was suffering
from Malta fever. It appears that he had scratched his
hand with a hypodermic needle on 17th September,
when immunising a horse for the preparation of serum-protective
against Malta fever; and his blood, when
examined, had a typical reaction on the micrococcus of
Malta fever in 1000-fold dilution. The horse, which has
been immunised for Malta fever for the last eight months,
was immediately bled, and we are informed that the
patient has now had two injections, each of 30 cub. cm.
of the serum. He is doing well, and it is hoped that the
attack has been cut short." (<cite>British Medical Journal</cite>,
16th October 1897.)</p>

<p>About fifty cases had up to September 1899 been
treated at Netley "with marked benefit: whereas they
found that all drug-treatment failed, the antitoxin treatment
had been generally successful."<a name="FNanchor_36" id="FNanchor_36" href="#Footnote_36" class="fnanchor">[36]</a>  A good instance
of the value of the serum-treatment of Malta fever is
published in the <cite>Lancet</cite>, 15th April 1899. For a later
<span class="pagenum"><a name="Page_213" id="Page_213">213</a></span>
account of this treatment and of its efficacy, see the
<cite>Philadelphia Medical Journal</cite>, 24th November 1900.</p>

<p>Another point is noted by Sir Patrick Manson, in his
recent Lane Lectures (Constable, 1905). "For some
time back," he says, "a commission of experts, working
under the direction of the Royal Society, has been
studying this disease in Malta. The commission has
accumulated much detailed information; but the most
important observation it has published is the fact that
a large percentage of the goats in Malta are infected
with <i lang="la" xml:lang="la">Micrococcus melitensis</i>, and that the milk of the
infected goats contains the bacterium. May not this
account for the great prevalence of Mediterranean fever
there and in other places having perhaps a similar milk-supply?"
<span class="pagenum"><a name="Page_214" id="Page_214">214</a></span></p>

<h3>X<br />
THE MOSQUITO: MALARIA, YELLOW<br />
FEVER, FILARIASIS</h3>

<p>Within the last few years, it has been proved that the
mosquito is an intermediate host, between man and
man, of malaria, yellow fever, and filariasis (elephantiasis).<a name="FNanchor_37" id="FNanchor_37" href="#Footnote_37" class="fnanchor">[37]</a>
Just as the grosser parasites, the tapeworms,
must alternate between man and certain animals, and
cannot otherwise go through their own life-changes and
reproduce their kind, so the micro-parasites that are the
cause of malaria alternate between man and the mosquito,
having the mosquito as an intermediate host.
These organisms, once they get into the mosquito, pick
out certain structures, and there carry out a definite
cyclical phase of their lives, whereby their progeny
make their way into the stylets of the mosquito, and so
get back to man, who is their "definite host." Thus,
malaria is not, strictly speaking, a disease of man; it is
one phase in man of micro-organisms that have another
phase in mosquitoes. So also with filariasis; the
filariæ in man, their ova, and their embryo-worms, are
one phase of filariasis; and the embryo-worms in certain
structures of the mosquito are another phase. The
<span class="pagenum"><a name="Page_215" id="Page_215">215</a></span>
<i lang="la" xml:lang="la">plasmodium malariæ</i> and the <i lang="la" xml:lang="la">filaria</i> are instances of a law
of animal life that holds good also of plant life:&mdash;</p>

<div class="blockquote">
<p>"All plants and animals possess parasites, and thousands
of different species of parasites have been closely
studied by science; we therefore know much about their
general ways of life. As a rule, a particular species of
parasite can live only in the particular species of animal
in which, by the evolution of ages, it has acquired the
power of living. It is therefore not enough for the parasites
of an individual animal&mdash;say a man&mdash;to be able to
multiply within that individual, but they must also make
arrangements, so to speak, for their progeny to enter into
and infect other individuals of the same species. They
cannot live for ever in one individual; they must spread
in some way or other to other individuals.</p>

<p>"The shifts made by parasites to meet this requirement
of their nature are many and various, and constitute
one of the wonders of nature. Some scatter their spores
and eggs broadcast in the soil, water, or air, as it were
in the hope that some of them will alight by accident on
a plant or animal suitable for their future growth. Many
parasites employ, in various ways, a second species of
animal as a go-between. Thus, some tapeworms, and
the worms which cause trichinosis, spend a part of their
lives in the flesh of swine, and transfer themselves to
human beings when the latter eat this flesh. To complete
the cycle, the parasites return to swine from human
offal; so that they propagate alternately from men to
swine, and from swine to men. The blood-parasites
which cause the deadly tsetse-fly disease among cattle in
South Africa are transferred from one ox to another on
the proboscis of the ox-biting or tsetse-fly. The progeny
of the flukes of sheep enter a kind of snail, which spreads
the parasites upon grass. The progeny of the guinea-worm
of man enter a water-flea. The progeny of the
parasites which cause Texas cattle-fever, and which are
very like the malarial parasites, live in cattle-ticks, and
<span class="pagenum"><a name="Page_216" id="Page_216">216</a></span>
are transferred by the young of these ticks into healthy
cattle." (Ross, <cite>Malarial Fever</cite>, 1902.)</p>
</div>

<h4>1. <span class="smcap">Malaria</span></h4>

<p>The <i lang="la" xml:lang="la">plasmodium malariæ</i> was discovered by Laveran
in 1880, in the blood of malarial patients. For many
years his work stopped there, because it was impossible
to find the <i lang="la" xml:lang="la">plasmodium</i> in animals: "the difficulties
surrounding the subject were so great that this discovery
seemed to be almost hopeless." In 1894, Sir
Patrick Manson&mdash;who had proved mosquitoes to be
the intermediate host in the case of the parasitic nematode
<i lang="la" xml:lang="la">filaria</i>&mdash;suggested, as a working theory of malaria,
that the plasmodium was carried by mosquitoes. This
belief, not itself new, he made current coin. He observed
that there is a flagellate form of the plasmodium,
which only comes into existence after the blood has
left the body: and he suggested that the flagella might
develop in the mosquito as an intermediate host, a
halfway-house between man and man. Then, in 1895,
Ross set to work in India, keeping and feeding vast
numbers of mosquitoes on malarial blood; and for two
years without any conclusive result. About this time
came MacCallum's observations, at the Johns Hopkins
University, on a parasitic organism, <i lang="la" xml:lang="la">halteridium</i>, closely
allied to the plasmodium malariæ; he showed that the
flagella of the halteridium are organs of impregnation,
having observed that the non-flagellated form, which
he regarded as the female, after receiving one of the
flagella, changed shape, and became motile. In August
1897, Ross found bodies, containing pigment like that
of the malarial parasite, in the outer coat of the stomach
of one kind of mosquito, the grey or dapple-winged
<span class="pagenum"><a name="Page_217" id="Page_217">217</a></span>
mosquito, <i lang="la" xml:lang="la">Anopheles maculipennis</i>, that had been fed on
malarial blood. In February 1898, he was put on
special duty under the Sanitary Commissioner with the
Government of India, to study malaria, and started
work again in Calcutta:&mdash;</p>

<p class="blockquote">"Arriving there at a non-fever season, he took up
the study of what may be called 'bird malaria.' In
birds, two parasites have become well known&mdash;(1) the
halteridium, (2) the proteosoma of Labbé. Both have
flagellated forms, and both are closely allied to the plasmodium
malariæ. Using grey mosquitoes and proteosoma-infected
birds, Ross showed by a large number of
observations that it was only from blood containing the
proteosoma that pigmented cells in the grey mosquito
could be got; therefore that this cell is derived from the
proteosoma, and is an evolutionary stage of that parasite.
Next, Ross proceeded to find out its exact location, and
found that it lay among the muscular fibres of the wall
of the mosquito's stomach. It grows large (40-70 micro-millimetres)
and protrudes from the external surface of
the stomach, which under the microscope appears as if
covered with minute warts." (Manson, at Edinburgh
meeting of British Medical Association, 1898.)</p>

<p>These pigmented spherical cells give issue to innumerable
swarms of spindle-shaped bodies, "germinal
rods"; and in infected mosquitoes Ross found these
rods, in the glands that communicate with the proboscis.
Thus the evidence was complete, that the plasmodium
malariæ, like many other parasites, has a special intermediate
host for its intermediate stage of development;
and that this host is the dapple-winged mosquito. It
is impossible to over-estimate the infinite delicacy and
difficulty of Ross's work; for instance, in his "Abstract
of Recent Experiments with Grey Mosquitoes,"
he says that "out of 245 grey mosquitoes fed on birds
<span class="pagenum"><a name="Page_218" id="Page_218">218</a></span>
with proteosoma, 178, or 72 per cent., contained pigmented
cells; out of 249 fed on blood containing
halteridium, immature proteosoma, &amp;c., not one contained
a single pigmented cell." Another time (April
1898) he counted these pigment-cells under the microscope:&mdash;</p>

<p class="blockquote">"Ten mosquitoes fed on the sparrow with numerous
proteosoma contained 1009 pigmented cells, or an average
of 101 each. Ten mosquitoes fed on the sparrow with
moderate proteosoma contained 292 pigmented cells, or
an average of 29 each. The mosquitoes fed on the
sparrow with no proteosoma contained no pigmented
cells."</p>

<p>Finally, he completed the circle of development by
infecting healthy sparrows by causing mosquitoes to
bite them.</p>

<p>In 1899, there went out a German Commission to
German East Africa, a Royal Society's Commission to
British Central Africa, and an expedition from the
Liverpool School of Tropical Medicine; in 1900,
another German Commission, this time to the East
Indies, and another expedition from the Liverpool
School; by July 1901, the Liverpool School was
organising its seventh expedition. Italy, of course, has
given infinite study to the disease:&mdash;</p>

<p class="blockquote">"It has been decided that, in addition to the stations
of observation and experiment in the provinces of Rome,
Milan, Cremona, Mantua, Gercara, Foggia, Lecce, others
shall be established in the provinces of Udine, Verona,
Vicenza, Padua, Ravenna, Pisa, Basilicata, and Syracuse.
Besides epidemiological researches, applications on a
large scale will be made of preventive measures for the
protection of the agricultural population against the
scourge. Another extensive experiment on the prophylaxis
<span class="pagenum"><a name="Page_219" id="Page_219">219</a></span>
of malaria will be made on the Emilian littoral.
Moreover, in all the malarious regions of the Italian
peninsula the provincial and communal administrations
and many private persons will co-operate in the application
of preventive measures. From all this it may be
gathered that during the summer and autumn the war
against malaria will be carried on in Italy with great
vigour and thoroughness." (<cite>British Medical Journal</cite>,
6th July 1901.)</p>

<p>In India, the work started in 1900 by the Royal
Society Commissioners, and by the Nagpur Conference,
has been widely extended; especially by such researches
as those of Major Buchanan, I.M.S., Superintendent of
the Central Jail, Nagpur. The following paragraph,
from the report of the Sanitary Commissioner with the
Government of India, refers to Major Buchanan's
published work, <cite>Malarial Fevers and Malarial Parasites
in India</cite>:&mdash;</p>

<p class="blockquote">"A remarkable note is struck at the outset, in the
acknowledgment made, by the author, of the capable
assistance rendered in these researches by several of his
Burmese prisoners, whom he trained to the use of the
microscope, and who soon became expert in detecting
and distinguishing the various kinds of parasites....
Besides a systematic clinical account of the different
forms of fever and the associated parasites, which is
the first attempt of the kind in India, there are a
summary of the facts showing the relation of the
seasonal prevalence of <i>Anopheles</i> to the incidence of
attacks; experiments exhibiting the protective effects of
mosquito-curtains; inoculation-experiments; researches
on the blood-parasites of birds; and many other
points.... Nor can we pause to notice the many
attempts now being made by health officers and others
to pursue the methods of prophylaxis indicated; these
efforts are necessarily in the tentative stage, but, so far,
<span class="pagenum"><a name="Page_220" id="Page_220">220</a></span>
and especially where carried out in connection with small
communities and institutions, they are giving promise of
gratifying success."</p>

<p>The famous experiment made by Dr. Sambon and
Dr. Low in 1900, must be recalled here:&mdash;</p>

<div class="blockquote">
<p>"Dr. Luigi Sambon and Dr. G. C. Low, both connected
with the London School of Tropical Medicine,
volunteered to live from June till October, that is to say,
through what may be called the height of the malaria
season, in a part of the Campagna near Ostia, which is
so infested by the disease that no one who spends a
night there under ordinary conditions escapes the effect
of the poison. Dr. Sambon, Dr. Low, Signor Terzi, and
their servants, have now exposed themselves to the
pestilential influence of this valley of the shadow of
death for over two months. They live in a mosquito-proof
hut; they take no quinine or other drug which
might be regarded as prophylactic. Not one of the experimenting
party has the least sign of infection.<a name="FNanchor_38" id="FNanchor_38" href="#Footnote_38" class="fnanchor">[38]</a>  ...
<span class="pagenum"><a name="Page_221" id="Page_221">221</a></span></p>

<p>"What for practical purposes may be regarded as an
experiment of the same kind is being conducted in West
Africa. Dr. Elliot, a member of the Liverpool expedition
sent to Nigeria some time ago to investigate the subject
of malarial fever, has recently returned to this country.
He reports that the members of the expedition have been
perfectly well, although they have spent four months in
some of the most malarious spots. They lived practically
amongst marshes and other places hitherto supposed to
be the most deadly. They have not kept the fever off
by the use of quinine, and they attribute their immunity
to the careful use of mosquito-nets at night." (<cite>British
Medical Journal</cite>, 22nd September 1900.)</p>
</div>

<p>A similar "experiment," of the utmost importance,
was made in 1900 by Professor Grassi. It concerned
the workmen and their families along the Battipaglia-Reggio
railway, 104 in all, including 33 children.
The great majority of them had suffered from malaria
in the preceding year; and only 11, including 4
children, had never suffered from it. Pending the
arrival of the malarial season, quinine was given to
all who needed it. The first <i>Anopheles</i> with its
salivary glands infected was found on 14th June.
Twelve days later came a case of malaria outside the
"zone of experiment," in a person who had never had
malaria before. The twelve days correspond to the
incubation-period after infection. <i>Anopheles</i> having
come, and the malarial season with him, the experiment
was begun. The houses were carefully protected
with wire netting, chimneys and all; the <i lang="es" xml:lang="es">siesta</i> was
taken under wire netting; the workmen, if they were
out in the evening or at night, wore veils and gloves;
and <i>Anopheles</i> was to be killed wherever he was found.
Quinine was altogether given up and forbidden, except
for three workmen who had escaped or evaded its use
<span class="pagenum"><a name="Page_222" id="Page_222">222</a></span>
before June, and had, indeed, never before been treated
with quinine; one of them, moreover, had been sleeping
outside the zone of experiment in July. Except these
three, all the 104 and their doctors remained absolutely
free from malaria up to 16th September, the date of
Professor Grassi's report:&mdash;</p>

<p class="blockquote">"Rightly to estimate the value of these facts, it is
necessary briefly to describe the surroundings of the
protected area. Towards the north, coming from Battipaglia,
three railway cottages are situated, at a distance
of 1, 2, and 3 kilometres respectively. The 25 inhabitants
of these cottages, although they were put under the tonic
and quinine treatment in the non-malarial season, all
without exception were taken ill with malarial fevers, in
many cases obstinate."</p>

<p>Experiments of voluntary exposure to bite from an
infected mosquito were made at or about this time, in
London, New York, Italy, and India. The London
"consignment" of mosquitoes had been allowed to bite
a malaria-patient in Rome. The experiment had to be
very carefully planned:&mdash;</p>

<p class="blockquote">"To have sent mosquitoes infected with malignant
tertian parasites might have endangered the life of the
subject of the experiment; and quartan-infected insects
might have conferred a type of disease which, though not
endangering life, is extremely difficult to eradicate. The
cases, therefore, on which the experimental insects were
fed had to be examples of pure benign tertian&mdash;a type of
case not readily met with in Rome during the height of
the malarial season; the absolute purity of the infection
could be ascertained only by repeated and careful microscopic
examination of the blood of the patient." (<cite>British
Medical Journal</cite>, 29th September 1900.)
<span class="pagenum"><a name="Page_223" id="Page_223">223</a></span></p>

<p>The mosquitoes were forwarded, through the British
Embassy in Rome, to the London School of Tropical
Medicine. The two brave gentlemen who let themselves
be bitten by some thirty of the mosquitoes were
in due time attacked by malaria, and the tertian forms
of the parasite were found in their blood. Nine months
later, one of them had a relapse, and the parasite was
again found in his blood.</p>

<p>It is not possible to sum up the wealth of work on
malaria published in 1900-1901. Good accounts of it
are in the Transactions of the Section of Tropical
Diseases, at the Annual Meeting of the British Medical
Association (Cheltenham, 1901), and in the Thompson
Yates Laboratories Reports, vol. iii., pt. 2, 1901.
Everything had to be studied: not only the nature
and action of the <i lang="la" xml:lang="la">plasmodium</i> in all its phases, but also
the whole natural history and habits of the <i>Anopheles</i>
of different countries; and, above all, the incidence of
the disease on natives and on Europeans in China,
India, and Africa. All that can be done here is to try
to indicate the principal lines followed in the present
world-wide campaign against malaria. The following
paragraphs are taken mostly from the accounts given
by Dr. Christophers and Dr. Annett, in the Thompson
Yates Laboratories Report, 1901:&mdash;</p>

<p>1. <i>Elimination of the Infection at its Source.</i> This is
the method employed with success by Professor Koch
in New Guinea, viz., to search out all cases of malaria
(the concealed ones in particular), and to render them
harmless by curing them with quinine. At Stephansort,
by thus hunting up all infected cases, and as it were,
sterilising them by the systematic administration of
quinine, he was able to achieve a great reduction of
the disease in the next malarial season, even under
<span class="pagenum"><a name="Page_224" id="Page_224">224</a></span>
adverse conditions. He says, in his report to the
German Government: "The results of our experiment,
which has lasted nearly six months, have been so uniform
and unequivocal that they cannot be regarded as
accidental. We may assume that it is directly owing
to the measures we have adopted that malaria here has,
in a comparatively short time, almost disappeared."</p>

<p>This method, of course, is applicable only in small
communities; and, within these limits, it may become
one of the most valuable of all methods, being, like
the quality of mercy, a blessing both to him who gives
and to him who taketh. But it cannot be practised
on a vast scale. This difficulty is well put by Sir
William MacGregor, K.C.M.G., Governor of Lagos,
West Africa:&mdash;</p>

<p class="blockquote">"In all probability, the day will come before long,
when newly-appointed officers for places like Lagos will
have to undergo a test as to whether they can tolerate
quinine or not. A man that cannot, or a man that will
not, take quinine, should not be sent to or remain in a
malarial country, as he will be doing so at the risk of his
own life, <i>and to the danger of others</i>.... The great
difficulty is how to extend this treatment beyond the
service, more particularly to the uneducated masses of
the natives. It is simply impossible to protect the whole
population by quinine administered as a prophylactic.
In the first place, the great mass of natives would not
take the medicine; and, in the second place, the Government
could not afford to pay for the 70 tons of quinine
a year that would be required to give even a daily grain
dose to each of 3,000,000 of people."</p>

<p>2. <i>Segregation of Europeans from Natives.</i> This
method is strongly advocated by the members of the
Nigeria Expedition of the Liverpool School (1900).
The distance of removal to half a mile is considered
<span class="pagenum"><a name="Page_225" id="Page_225">225</a></span>
sufficient: "Considerable evidence has now been accumulated
to prove that the distance which is traversed
by a mosquito is never very great, and extremely rarely
reaches so much as half a mile." The arguments in
favour of this method of "segregation" are of so great
interest that they must be put here at some length.
The drawback is that the method cannot be followed
everywhere to its logical issue without some risk of
giving offence, of seeming to abandon the native, of
damaging commerce, and so forth. But, short of this,
much might be done for the protection of Europeans in
Africa:&mdash;</p>

<div class="blockquote">
<p>"This method is a corollary of the discovery that native
children in Africa practically all contain the malaria
parasite, and are the source from which Europeans
derive malaria. Koch showed in New Guinea that in
most places infection was very prevalent in native
children, so much so that in some villages 100 per
cent. of those examined contained parasites. He also
showed that, as the children increased in age, immunity
was produced, so that in the case of adults a marked
immunity was present, and malarial infection was absent.
The Malaria Commission showed, independently, that
a condition of universal infection existed among the
children of tropical Africa, associated with an immunity
of the adults. This infection in children had many remarkable
characteristics. The children were in apparent
health, but often contained large numbers of parasites,
and a small proportion only of the children failed to
show some degree of infection.... The Liverpool
School Expedition found a similar condition of a</p>ffairs in
all parts of Nigeria visited by them.

<p>"With a knowledge of the ubiquity of native malaria,
the method of infection of Europeans becomes abundantly
clear. The reputed unhealthiness or healthiness of
stations is seen at once to be dependent on the proximity
<span class="pagenum"><a name="Page_226" id="Page_226">226</a></span>
or non-proximity of native huts. The attack of malaria
after a tour up-country, the malaria at military stations
like Prah-su, the abundance of malaria on railways, are
all explicable when the extraordinary condition of universal
native infection is appreciated. It is evident that,
could Europeans avoid the close proximity of native huts,
they would do away with a very obvious and great source
of infection.... When it is understood that each of
these huts certainly contains many children with parasites
in their blood, and also scores or hundreds of
<i>Anopheles</i> to carry the infection, then the frequency with
which Europeans suffer from malaria is scarcely to be
wondered at.... The accompanying plan is that of
a new railway settlement on the Sierra Leone Railway.
Miles of land free from huts exist along the line, but the
close neighbourhood of native huts has been selected.
At the time of building of these quarters, it lay in the
power of the engineers to have a malaria-free settlement;
instead of which, by the non-observance of a simple fact,
the station is most malarious: in this particular instance,
much ingenuity has been shown in providing each set of
European quarters with plenty of malarial infection. In
towns only is there any difficulty in carrying out the
principle of segregation. In two instances, however, this
has been carried out in towns, with the result that the
segregated communities of Europeans are notoriously the
most healthy on the West Coast. Even when no scheme
of complete segregation can be carried out, the principle
should always be borne in mind, and, whenever opportunity
offers, huts should be removed, and European
houses built in the open.... It is almost universally
the rule in West Africa to find European houses built
round by native quarters, a practice which long experience
in India has taught Europeans to avoid carefully.
At Old Calabar, many of the factories are almost surrounded,
except in front, by native habitations; similarly,
at Egwanga, the small native town is built by the side and
back of one of the factories. Also at the Niger Company's
factory at Lokoja, the native houses are very close up
<span class="pagenum"><a name="Page_227" id="Page_227">227</a></span>
to the Company's boundary railings. Akassa engineers'
quarters may be, again, mentioned as an example where
the engineering artisans, chiefly natives of Lagos, Accra,
and Sierra Leone, are housed with their families alongside
the European house. A large proportion of these
native children were found by us to contain malarial
parasites. Similarly also at Asaba, the proximity of the
barracks of the Hausa soldiers, who have their wives and
children with them, is a dangerous menace to the officers
at the Force House.</p>

<p>"Examples of the opposite condition of affairs might
also be given. For instance, at Old Calabar, the Government
offices and Consulate, Vice-Consulate, and medical
house, are comparatively free from malarial fever; it
having been established that the natives shall not build
on the European side of the creek separating the two
slopes on which the native town and European quarters
are built. This creek is at a distance of about half a
mile from the houses mentioned."</p>
</div>

<p>It is plain, from these and other instances given by
the members of the Nigeria Expedition, that a modified
sort of "segregation" can be effected in many places,
without any injury either to native feelings, or to
politics, or to commerce; and that by such segregation
the risk of malaria among Europeans in Africa
would be diminished.</p>

<p>3. <i>Protection against Anopheles.</i> Manson, in his
<cite>Tropical Diseases</cite> (1905), says, "The question is often
asked, Is there any other way by which malaria can be
contracted than through a mosquito-bite? For many
reasons, I believe not. It is difficult to prove a negative;
but, so far, there is no observation capable of
bearing investigation that would lead us to suppose
that malaria can be acquired, under natural conditions,
except by mosquito-bite," All authorities are agreed
<span class="pagenum"><a name="Page_228" id="Page_228">228</a></span>
that, practically, the fight against malaria and the fight
against <i>Anopheles</i> are one and the same thing; and the
experiments by Sambon, Low, and Grassi, show what
can be done, in this war against the mosquito, by way
of defence. But what is practicable in Italy might not
be generally practicable on the West African coast; as
Sir William MacGregor says of Lagos:&mdash;</p>

<p class="blockquote">"It is not likely that in a place like Lagos as good
results can be obtained from the use of mosquito-proof
netting as in Italy. One great objection to it here is the
serious and highly disagreeable way it checks ventilation.
This is a difficulty that cannot be fully brought
home to one in a cold climate. But, in a low-lying, hot,
and moist locality like Lagos, it comes to be a choice of
evils, to sit inside the netting stewed and suffocated, or
to be worried and poisoned by mosquitoes outside. The
netting is hardly a feasible remedy as regards native
houses. It is not possible to protect even European
quarters completely by it. Few officers or others are so
occupied that they could spend the day in a mosquito-proof
room. Certain it is that any man that suffers
from the singular delusion that mosquitoes bite only
during the night, would have a speedy cure by spending
a few days, or even a few hours, in Lagos. Operations
here (September 1901) are being limited to supplying
one mosquito-proof room to the quarters of each officer.
In this he will be able to spend the evening free from
mosquitoes if he chooses to do so. The European wards
of the hospital are similarly protected."</p>

<p>The European in Africa, as Ross says, is generally
neglectful of his health; and the "unhealthiness" of
the African coast is to some extent due to the life that
men lead there:&mdash;</p>

<p class="blockquote">"Let us compare the habits of a European in a business-house
in Calcutta with the habits of a European in
<span class="pagenum"><a name="Page_229" id="Page_229">229</a></span>
West Africa. In Calcutta he sleeps under a punkah or
mosquito-net, or both; he dresses and breakfasts under
a punkah; in the evening he takes vigorous exercise,
and he dines under a punkah. He wears the lightest
possible clothing, he lives in a solid, cool, airy house, and
he obtains very good food; once in five or six years, he
returns to Europe for leave.... In Africa, the houses
are frequently very bad; in Freetown, for instance, they
are the same as the houses of natives, and are mingled
with them. The Anglo-African seems to imagine that
he can live in the tropics in the same manner as he
lives in England. He seldom uses a punkah, except
perhaps for an hour at dinner-time, and, not seldom,
he neglects even the mosquito-net. The food is often,
or generally, execrable. Owing to the frequent absence
of gymkhanas and clubs, the exile obtains little suitable
exercise."</p>

<p>But whatever risks the old resident may choose to
take, the newcomer can at least use a proper and
efficient mosquito-net at night, and avoid sleeping in a
native house, and protect himself in these and the like
ways against malaria.</p>

<p>4. <i>The keeping down of Anopheles.</i> The breeding
places of <i>Anopheles</i> are ponds, swamps, and puddles,
roadside ditches, tanks, and cisterns, old disused canoes,
and the like collections of stagnant water: also the
smaller receptacles that are more generally occupied by
<i>Culex</i>, such as broken bottles, old tins, pots, and calabashes,
and barrels, whatever will hold water&mdash;all the
débris and broken rubbish round huts or houses. In
all these places, <i>Anopheles'</i> eggs or larvæ are found;
and, with practice, it is easy to detect them. Of
course, it is not easy to wage war against the adult
mosquito: the work is, <i lang="la" xml:lang="la">Venienti occurrere morbo</i>, to
organise gangs of workmen, or of prison labour, and
<span class="pagenum"><a name="Page_230" id="Page_230">230</a></span>
"mosquito brigades"; to clear the ground of cartloads
of old biscuit-tins, broken gin-bottles, and other dust-heap
things, in and around the place; to cover-in the
cisterns, rain-barrels, and wells; to clean pools and
duck-ponds of weed, and stock them with minnows;
to put a film of kerosene to the puddles, or sweep them
out, or fill them up and turf them over; everywhere,
to drain, and level, and clean-up the surface soil; and
everywhere, by these and the like methods, to break
the cycle of the life of the <i lang="la" xml:lang="la">plasmodium malariæ</i>:&mdash;</p>

<p class="blockquote">"Draining and cultivation where the land will repay the
expenditure, permanent and complete flooding where it
will not, and such flooding is possible; proper paving of
unhealthy towns, and the filling-in of stagnant, swampy
pools; these&mdash;in other words, all measures calculated to
keep down mosquitoes&mdash;are the more important things
to be striven for in attempting the sanitation of malarious
districts. In England, in Holland, in France, in Algeria,
in America, and in many other places, enormous tracts
of country, which formerly were useless and pestilential,
have been rendered healthy and productive by such
means." (Manson.)</p>

<p>And, short of such great enterprises as Government
works of drainage, much has already been done, in
many African towns, and in India, by the work of a
few men and women: not only by practical sanitary
improvements, but by insistent teaching and lecturing.
For the admirable results recently obtained in Ismailia,
Algeria, Formosa, and the Malay States, see the <cite>Medical
Annual</cite>, 1905 and 1906.<a name="FNanchor_39" id="FNanchor_39" href="#Footnote_39" class="fnanchor">[39]</a>
<span class="pagenum"><a name="Page_231" id="Page_231">231</a></span></p>

<p>Before leaving the subject of malaria, it must be
added that the discovery and study of the parasite
which causes it have cleared up the mystery of the
specific action of quinine upon the disease. It operates
simply by its germicidal effect upon the microbe. But,
beyond this, we have now a clue which we never had
before to guide us to the most advantageous manner of
administering the drug.</p>

<h4>2. <span class="smcap">Yellow Fever</span></h4>

<p>The specific organism of malaria may become active
again and again in the blood, causing relapses twenty
years or more after the original infection. The specific
organism of yellow fever expends itself at once, in one
acute attack; and, if the patient recovers, he is thenceforth
more or less immune against infection. That the
inoculation of the disease, by the application of a single
mosquito recently contaminated, is calculated to produce
a mild or abortive attack less dangerous than the average
attack among the non-acclimatised, was known to Finlay,
and was confirmed in 1899 by the Army Commission
of the United States.</p>

<p>Of the mortality of the disease, Sir Patrick Manson,
in 1900, wrote as follows:&mdash;</p>

<p class="blockquote">"It is better for women and children than for men;
better for old residents than for newcomers; worst of all
for the intemperate. According to a table of 293 carefully
observed cases given by Sternberg, the mean mortality
in the whole 293 cases was 27.7 per cent. This may be
taken as a fairly representative mortality in yellow fever
among the unacclimatised, something between 25 and 30
per cent., although in some epidemics it has risen as high
as 50 or even 80 per cent. of those attacked.... Some
<span class="pagenum"><a name="Page_232" id="Page_232">232</a></span>
of these epidemic visitations bring a heavy death-bill;
thus, in New Orleans, in 1853, 7970 people died of
yellow fever; in 1867, 3093; in Rio, in 1850, it claimed
4160 victims; in 1852, 1943; and in 1886, 1397. In
Havana, the annual mortality from this cause ranges
from 500 to 1600 or over."</p>

<p>The earlier attempts to reproduce the disease, by
inoculation with its products, failed altogether:&mdash;</p>

<p class="blockquote">"In 1816, Dr. Chervin, of Point-à-Pitre (Antilles),
drank repeatedly large quantities of black vomit without
feeling the least disturbance. Some years before,
other North American colleagues, Doctors Potter, Firth,
Catteral, and Parker, did everything possible to inoculate
themselves with yellow fever. After having uselessly
attempted experiments on animals, they experimented
on themselves, inoculating the black matter at the very
moment in which the moribund patient rejected it, placing
this matter in their eyes, or in wounds made in their
arms, injecting it more than twenty times in various parts
of their body ... in short, devising every sort of daring
means for experimentally transmitting yellow fever. All
these experiments were without result, and in the United
States during many years it was believed that this terrible
malady was non-contagious." (<cite>British Medical Journal</cite>,
3rd July, 1897.)</p>

<p>The history of the subject, from 1812 to 1880,
is given by Dr. Finlay of Havana, in the <cite>New York
Medical Record</cite> (9th February 1901). In 1880, two
very important reports on the disease were published;
one by a Havana Commission of the National Board of
Health of the United States, the other by the United
States Navy Department. They tended to show that
yellow fever is a "germ-disease"; that it is not wind-borne;
and that there may be some change, outside
the body of the patient, whereby the virulence of the
<span class="pagenum"><a name="Page_233" id="Page_233">233</a></span>
active principle of the disease is heightened. From
these reports, Dr. Finlay advanced his doctrine that
the mosquito receives and transmits the germs of the
disease:&mdash;</p>

<p class="blockquote">"It was upon the above line of reasoning (in these
reports), that I conceived the idea that the yellow-fever
germ must be conveyed from the patient to the non-immunes
by inoculation, a process which could be performed
in nature only through the agency of some stinging
insect whose biological conditions must be identical with
those which were known to favour the transmissibility of
the disease."</p>

<p>In 1881 he inoculated himself and six soldiers with
infected mosquitoes, and obtained, as he had calculated,
mild attacks and subsequent immunity. During the
years 1881-1900 he inoculated by this method 104
persons:&mdash;</p>

<p class="blockquote">"In these inoculations, be it remembered, my principal
object was rather to avoid than to seek the development
of a severe attack; in point of fact, only seventeen showed
any appreciable pathogenic effects after their inoculation.
I felt sure, however, that severe or fatal result
might follow an inoculation either with several mosquitoes
contaminated from severe cases of the disease, or from a
single insect applied several days or weeks after its contamination,
having come to this last conclusion in view
of the facts connected with the <i>Anne Marie</i>, and the
epidemic of Saint Nazaire."</p>

<p>Dr. Finlay's discovery that the mosquito can convey
yellow fever, and that the germ of the disease is more
virulent after a prolonged sojourning in the mosquito,
was proved beyond all question by the work of 1889-1901.
But, so far as immunisation is concerned, few
<span class="pagenum"><a name="Page_234" id="Page_234">234</a></span>
people would submit themselves to be bitten by an infected
mosquito, even with perfect assurance that the
germs contained in it were of a low degree of virulence:
the urgent need, therefore, was for an immunising serum.
In 1896, at Flores, Sanarelli discovered the <i lang="la" xml:lang="la">bacillus
icteroides</i>; and by October 1897, he had prepared an
immunising serum which was able to give a considerable
amount of protection to animals.<a name="FNanchor_40" id="FNanchor_40" href="#Footnote_40" class="fnanchor">[40]</a>  Next year
(<cite>Annales de l'Institut Pasteur</cite>, May 1898) came the
news that he had advanced against yellow fever with
its own weapons&mdash;<i lang="fr" xml:lang="fr">Premières expériences sur l'emploi du
sérum curatif et préventif de la fièvre jaune</i>. Of the first
8 cases (Rio de Janeiro), 4 recovered. Then came the
22 cases at San Carlos do Pinhal, in Saint-Paul au
Brésil (January 1898), with 16 recoveries, and only 6
deaths. And it is to be noted that he submitted his
method of treatment to the utmost test that was possible;
he chose the bad cases, and the country where
the fever was most fatal:&mdash;</p>

<p class="blockquote">"Chaque cas était choisi de commun accord entre
nous, dans le but de mettre bien en évidence l'action
thérapeutique du sérum, <i lang="fr" xml:lang="fr">mettant toujours de côté tous les
cas qui se présentaient avec des symptômes vagues ou
attenuès ou en forme légère ou fruste. On ne conservait
donc que des cas oû, d'après la violence des phénomènes
d'invasion, on devait considérer comme très peu probable
une crise spontanée de la maladie</i>...."</p>

<p>Furthermore, Sanarelli was able to show the preventive
value of the serum. At the end of February
1898, yellow fever broke out in the jail at San
Carlos:&mdash;
<span class="pagenum"><a name="Page_235" id="Page_235">235</a></span></p>

<div class="blockquote">
<p>"La première victime fut un condamné, qui vivait
avec tous les autres dans une salle oû les conditions
hygiéniques étaient assez mauvaises. Le lendemain, la
sentinelle, qui était en rapport continuel avec la salle des
condamnés, tombait malade. Quelques jours après, un
autre condamné suivait le sort du premier, et bientôt un
quatrième cas, mortel aussi, finit par signaler la prison
comme un nouveau foyer d'infection qui venait s'allumer
au centre d'un quartier de la ville encore resté indemne.</p>

<p>"Si on avait abandonné la chose à elle-même, on
aurait vu se produire le même spectacle qu'avaient
fourni, dans les conditions identiques, pendant les dernières
épidémies, les prisons de Rio-Claro, de Limeira,
et d'autres villes de l'État de Saint-Paul."</p>
</div>

<p>Every prisoner, except one who had already had the
fever, was therefore given the preventive treatment.
At once the outbreak stopped; no more cases occurred,
though only a weak serum was used, though the state
of the prison and its occupants was unhealthy, though
the fever, two months later, was still raging round the
prison, in the town.</p>

<p>In October 1900, the United States Commission on
Yellow Fever published a preliminary report on 11
cases of mosquito-inoculation. Of these, the majority
gave a negative result, and were found susceptible to
infection, at a later date, from the blood of a yellow-fever
patient. Two gave a positive result. In the
course of these experiments, Dr. Lazear, a member of
the Commission, died of the disease. In February
1901, and again in July, the Commission published
further reports, emphasising the fact that the mosquito
conveys the disease, and denying that the disease can
be conveyed in clothing, bedding, and so forth:&mdash;</p>

<div class="blockquote">
<p>"Our observations appear to demonstrate that the
parasite of this disease must undergo a definite cycle of
<span class="pagenum"><a name="Page_236" id="Page_236">236</a></span>
development in the body of the mosquito before the latter
is capable of conveying infection. This period would
seem to be not less than twelve days.</p>

<p>"We also consider the question of house infection, and
are able to show that this infection is due to the presence
of mosquitoes that have previously bitten yellow-fever
patients; and that the danger of contracting the disease
may be avoided in the case of non-immune individuals
who sleep in this building, by the use of a wire screen.</p>

<p>"We also demonstrate, by observations made at this
camp (Fort Lazear), that clothes and bedding contaminated
by contact with yellow-fever cases, or by the
excreta of these cases, is absolutely without effect in
conveying the disease."</p>
</div>

<p>In February 1901, Dr. H. E. Durham published an
abstract of an <i>interim</i> report of the Liverpool School
Yellow Fever Commission. He and Dr. Walter Myers,
the two Commissioners, had both of them been attacked
by the disease, and Dr. Myers had died of it. The
report gives evidence that the disease is due to a bacillus
which is not the <i lang="la" xml:lang="la">bacillus icteroides</i>; and it does not
wholly favour the earlier report (1900) of the American
Commission. A later Commission to New Orleans,
September 1901 to January 1902, reported an extensive
series of investigations, which seem rather to
support the belief that the <i lang="la" xml:lang="la">bacillus icteroides</i> is the cause
of the disease. Later still, this belief is again denied;
and, as in rabies, so in yellow fever, the good work has
gone on without waiting for the identity of this or that
micro-organism.</p>

<hr class="c15" />

<p>Immunisation, by the direct use of an infected
mosquito, may be compared with the old custom of
<span class="pagenum"><a name="Page_237" id="Page_237">237</a></span>
inoculation against smallpox. The use of Sanarelli's
serum-treatment has not gone far. There remains for
consideration the method of keeping down infection by
keeping down <i>Culex</i>.</p>

<p>Three reports, in 1901-1902, come from Dr. Guitéras
(Havana), Surgeon-Major Gorgas, chief sanitary officer
(Havana), and the Commission at New Orleans. Dr.
Guitéras reports that 6 cases of yellow fever (inoculation)
were treated in a large "mosquito-proof" building,
which also contained cases of other diseases. No
prophylaxis was enforced, save the exclusion of mosquitoes;
non-immunes visited the yellow fever cases,
non-immunes nursed them, and most of the attendants
and labourers about the place were non-immunes; but
not a single case of infection occurred. The New
Orleans Commission reports that, of 200 cisterns, &amp;c.,
examined in the city for the presence of larvæ, the larva
of <i>Culex</i> (<i lang="la" xml:lang="la">Stegomyia</i>) predominated in more than 60 per
cent.</p>

<p>The report of Surgeon-Major Gorgas is very pleasant
reading. For two centuries, Cuba had been cursed
with yellow fever; then, after the war with Spain,
America took it over:&mdash;</p>

<p class="blockquote">"The army took charge of the health department of
Havana, when deaths (from all causes) were occurring at
the rate of 21,252 per year. It gives it up, with deaths
occurring at the rate of 5720 per year. It took charge,
with smallpox endemic for years. It gives it up, with
not a case having occurred in the city for over eighteen
months. It took charge, with yellow fever endemic for
two centuries&mdash;the relentless foe of every foreigner
who came within Havana's borders, which he could not
escape, and from whose attack he well knew every fourth
man must die. The army has stamped out this disease
in its greatest stronghold."
<span class="pagenum"><a name="Page_238" id="Page_238">238</a></span></p>

<p>Make fair allowance for the wide variation, from year
to year, of the number of yellow fever cases in any
town within the geographical belt of the disease; admit
that a town may, in the course of nature, have many
hundred cases in one year, and only half a dozen in
another year. Again, make fair allowance for all other
good influences of the American occupation of Cuba,
beside those that were concerned with the stamping out
of <i>Culex</i>; admit that the general death-rate of Havana,
in the last February of Spanish rule (1898), was 82.32
per thousand, and in February 1901, was 19.32. Still,
there is an example here, in the 1901 work in Havana,
for the world to follow, wherever yellow fever exists.
The following abstract of Surgeon-Major Gorgas' results
was published in the <cite>Practitioner</cite>, May 1902, by Professor
Hewlett, one of the foremost of English bacteriologists:&mdash;</p>

<p class="blockquote">"Commencing in February 1901, orders were issued
that every suspected case of yellow fever should be
screened with wire gauze at the public expense, so as to
render the room or rooms mosquito-proof. All mosquitoes
in the infected house and in contiguous houses were destroyed.
After the middle of February, 100 men were
employed in carrying out the destruction of the mosquito-larvæ
in their breeding places, putting oil in the cesspools
of all houses, clearing the streams, draining pools, and
oiling the larger bodies of water. Up to June, quarantine
was enforced, together with disinfection of the house and
fomites. After that, however, rigid quarantine of the
patient was stopped, and disinfection of fabrics and
clothing ceased. It was merely required that the patient
should be reported, his house placarded and screened, and
a guard placed over each case to report how general sick-room
sanitation was carried out, to see that the screen-door
communicating with the screened part of the house
was kept properly closed, and to see that communication
<span class="pagenum"><a name="Page_239" id="Page_239">239</a></span>
with the sick-room was not too free, four or five non-immunes
only being allowed in. <i>By the end of September,
the last focus of the disease had been got rid of,
and since then, up to the beginning of January, there has
not been a single case.</i> Whereas, for the years since
1889, from 1st April to 1st December, yellow fever
caused an average of 410.54 deaths, with a maximum of
1175 for 1896, and a minimum of 79 for 1899, <i>it caused
in 1901 5 deaths only. In the months of October and
November, when the disease has hitherto been exceedingly
rife in Havana, there has not been a single case. For the
first time in 150 years, Havana has been free from yellow
fever.</i>"</p>

<p>Sir Patrick Manson, lecturing in America, last year,
on tropical diseases, summed up the work as follows:&mdash;</p>

<div class="blockquote">
<p>"Time will not permit&mdash;what to you is probably quite
unnecessary&mdash;the recapitulation of the story of the
labours of Reed and his coadjutors. I cannot pass on,
however, to what I have to say in connection with this
work without a word of admiration for the insight, the
energy, the skill, the courage, and withal the modesty and
simplicity of the leader of that remarkable band of workers.
If any man deserved a monument to his memory, it was
Reed. If any band of men deserve recognition at the
hands of their countrymen, it is Reed's colleagues.</p>

<p>"The principal outcome of the labours of these men
has been the demonstration, first, that the ultra-microscopic
germ of yellow fever is present in the blood of the
patient during the first three days of the disease. Second,
that the first step in the passage of the germ from the
sick to the sound is made, under natural conditions, in
the stegomyia mosquito. And third, that after about
twelve days and upwards in stegomyia, the yellow fever
germ, when implanted by the said mosquito into another
human host, is capable of reproduction, so that at the end
of a further period of about three days it has established
itself throughout the blood, is causing the violent reaction,
<span class="pagenum"><a name="Page_240" id="Page_240">240</a></span>
the clinical manifestations of which we call yellow
fever, and is once more in a condition to re-enter the
mosquito.</p>

<p>"These are great etiological facts. They are of
supreme practical and scientific value. Acting on them,
the United States sanitary authorities expelled yellow
fever from Havana. Acting on them, they should be
able in the future to protect the United States themselves
from such terrible visitations as in the past have swept
through some of your cities."</p>
</div>

<h4>3. <span class="smcap">Filariasis</span></h4>

<p>These same lectures contain an admirable account of
the life-history of <i>Filaria</i>. It is not necessary here to
describe the loathsome deformities which occur in the
later stages of filariasis. These deformities (<i lang="la" xml:lang="la">elephantiasis</i>,
Barbadoes leg), which may attain colossal size, are
due to the blocking of the lymphatic vessels with filarial
worms. Cases of the disease are hardly ever seen in
this country; but it is very frequent in some parts of
the tropics. <i>In the endemic areas</i>, says Manson, <i>10 per
cent. is not an uncommon proportion of the population to be
found affected with filariasis. Thirty and even 50 per cent.
may be affected. In many of the Pacific Islands&mdash;the
Samoa group for instance&mdash;I believe that even this proportion
is exceeded.</i></p>

<p>That <i>Culex</i> (<i lang="la" xml:lang="la">fatigans</i>) can carry the parasite, has
been proved past all doubt. Neither does anybody
doubt, that the keeping down of this mosquito would
keep down filariasis. A report of great interest, from
Barbadoes, was published in the <cite>British Medical Journal</cite>
for 14th June 1902. It is written by Dr. Low, whose
experiment on himself in the Campagna has already
been noted in this chapter. Dr. Low reports that there
is no indigenous malaria in the island, and that neither
<span class="pagenum"><a name="Page_241" id="Page_241">241</a></span>
he nor Mr. Lefroy could find a single <i>Anopheles</i> larva,
though they hunted diligently in the swamps and other
likely places. But filariasis is terribly common, and so
is <i lang="la" xml:lang="la">Culex fatigans</i>. Dr. Low examined the night-blood
of 600 cases of all kinds in the General Hospital, the
Central Almshouse, and elsewhere, and found the
filaria-embryos in no less than 76 = 12.66 per cent.
He caught and dissected a hundred mosquitoes (<i lang="la" xml:lang="la">Culex
fatigans</i>) from the wards and corridors of the General
Hospital, and found that no less than 23 of them were
infected. If it were not for <i>Culex</i>, and for men's indifference
and apathy, filariasis could be kept down all
over the island:&mdash;</p>

<div class="blockquote">
<p>"There is a perfect water supply, and people can get
their water fresh from the standpipes at their doors.
Old wells ought to be filled up; no water-barrels or tubs
should be allowed, or, if kept, they should be emptied
every week or so. Tanks and collections of water in
gardens should all be periodically treated with kerosene,
or be furnished with closely-fitting covers to prevent
mosquitoes getting in. These methods are simple and
inexpensive, and each householder should see that they
are applied in his garden and grounds. The difficulty
begins when one has to take into account the inability of
the negro to grasp anything of a hygienic nature. The
only way to get over this, would be a system of sanitary
inspection by a few competent men. For individual
prophylaxis, mosquito-nets ought always to be used;
but many, even educated people, still persist in sleeping
without them; of course, nothing in this line can be
expected of the native population.</p>

<p>"If such means were adopted for Barbadoes, the
presence of filarial disease, which at present is quite
alarming, could easily, with little trouble and expense, be
greatly diminished, and thus save much suffering, as well
as loss of time, hideous deformity, and doubtless in not a
few instances loss of life."
<span class="pagenum"><a name="Page_242" id="Page_242">242</a></span></p>
</div>

<p>Thus, in a few years, from experiments on mosquitoes,
sparrows, and men, has come the present plan of campaign
against malaria, yellow fever, and filariasis; that
is, against <i>Anopheles</i> and <i>Culex</i>. He who would know
what is being done to check these diseases in Italy,
India, China, Africa, and America, must read Prof.
Ross' <i>Malarial Fever, its Cause, Prevention, and Treatment</i>
(1902), and <i>Mosquito Brigades, and how to organise them</i>
(1902). There has been nothing like it since Pasteur
died. Far and wide, from Staten Island to Cuba, from
Hong Kong to Lagos, the work of keeping down the
larvæ of <i>Anopheles</i> and <i>Culex</i> is going on. <i>Henceforth
we have to reckon not with a nameless something, but with
a definite parasite, whose conditions of life are known.
Before all things, we must shut off the sources of the infection.</i>
For centuries, men had believed in exhalations
and miasmata lying all over the land: and, behold, the
agents of malaria are in the puddles round a man's
house, and the agents of yellow fever are in the water-butt
and the broken bottles and old sardine-tins.
Science has given the word, and now there are <i>Anopheles</i>
brigades and <i>Culex</i> brigades set going; labourers
with brooms and rubbish-carts, sweeping out the stagnant
pools, draining the surface soil, and carrying off the odd
receptacles that serve to hold mosquito eggs and larvæ.
The job, like all sanitary jobs, must be steady, year in,
year out: it must be limited to infected places, a whole
continent cannot be treated. But there the work is,
and will grow; and saves, by unskilled labour, and at
a trivial expense, those "non-acclimatised" lives that
have hitherto been thrown away as recklessly as the
larvæ that are now swept out of the puddles and ditches
round African settlements.
<span class="pagenum"><a name="Page_243" id="Page_243">243</a></span></p>

<h3>XI<br />
PARASITIC DISEASES</h3>

<p>The foregoing chapters are concerned with bacteriology
alone, and with those curative or preventive methods of
treatment that have come out of inoculation-experiments
on animals. The lives that are saved, or safeguarded,
by these methods, even in one year, must be many
thousands in each country of the civilised world. And,
beside human lives, there is the protection of sheep
and cattle against anthrax, swine against rouget, horses
against tetanus, cattle against rinderpest. In Cape
Colony alone, so far back as 1899, about half a million
cattle had received preventive treatment against rinderpest;
and the sum total of human and animal lives
saved or safeguarded, in all parts of the world, must
be reckoned in millions by this time.</p>

<p>The present chapter, and the next two chapters, are
concerned with methods that have come out of experiments
on animals, but not out of bacteriology.</p>

<p>It is plain that the grosser parasites of the human
body, tapeworms and the like, could not be explained
or understood without the help of feeding-experiments
on animals. By this method, and by this alone, their
life-history was discovered. They were known to
Aristotle and to Hippocrates; but nothing was understood
about them. They were never studied, for this
among other reasons, that men believed in spontaneous
<span class="pagenum"><a name="Page_244" id="Page_244">244</a></span>
generation; and the presence of lower forms of life
inside human bodies was attributed to the fault of the
patient, or the work of the devil. Then, at last, Redi
(1712), and Swammerdam (1752) in his <cite>Bibel der
Natur</cite>, struck at the doctrine of spontaneous generation,
saying that it did not apply to insects; and in 1781
Pallas boldly declared that the internal parasites of
man came out of eggs, like insects, and not "of themselves."
It would be a good theme for an essay&mdash;<i>The
paralysing effect, on medicine and surgery, of the
doctrine of spontaneous generation</i>. Rudolphi (1808)
and Bremser (1819) opposed Pallas; and von Siebold
(1835) and Eschricht (1837) supported him. Then
came the great students of this part of biology&mdash;Cobbold,
Busk, Davaine, van Beneden, Leuckart,
Küchenmeister. In 1842, Steenstrup had discovered,
in certain insects, the alternation of generations; in
1852, Küchenmeister proved that the generations of
internal parasites are similarly alternate. By feeding
carnivorous animals with "measly" meat, he produced
tapeworms in them; and by feeding herbivorous
animals with the ova of tapeworms, he made their
muscles "measly."</p>

<p>The feeding of animals was the only possible way
to understand the bewildering transformations and
transmigrations of the thirty or more entozoa to which
flesh is heir. This chapter of pathology makes up in
tragedy what it lacks in romance; for these animal
parasites have killed whole hosts of people. Take,
for instance, the <i lang="la" xml:lang="la">trichina spiralis</i>, a minute worm discovered
in 1835 encysted in countless numbers in the
muscles of the human body; it was studied by
Virchow, Leuckart, and others, by feeding-experiments
on animals, and was proved to come from infected
<span class="pagenum"><a name="Page_245" id="Page_245">245</a></span>
half-cooked ham and pork, and to make its way from
the alimentary canal all over the body. The name of
trichiniasis or trichina-fever was given to the acute
illness that came of the sudden dissemination of these
myriad parasites into the tissues. Trichiniasis had
killed hundreds of people by a most painful death;
outbreaks of it, in Germany and elsewhere, had swept
through villages like cholera or plague: then Leuckart
and Virchow traced it to its source, and it was stopped
there&mdash;<i>Above all things, we must shut off the sources of
the infection</i>&mdash;the butchers' shops were kept under
sanitary inspection, people were warned against half-cooked
ham and pork, and there was an end of it.</p>

<p>Or take hydatid disease, which occurs in all parts
of the world, and in some countries (Australia, Iceland)
is terribly common. The nature of this disease&mdash;that
it is an animal parasite transmissible between
men and dogs&mdash;was proved by feeding-experiments on
animals. In Iceland, where men and dogs live crowded
together in huts, there is an appalling number of deaths
from hydatid disease; Leuckart, in 1863, of it:&mdash;</p>

<p class="blockquote">"At present, almost the sixth part of all the inhabitants
annually dying in Iceland fall victims to the echinococcus
epidemic."</p>

<p>Before Küchenmeister's experiments in 1852, there
was no general knowledge of the exact pathology of
entozoic disease. The advance was not made by the
experimental method alone; other things helped: but
among them was neither clinical experience, nor what
Sir Charles Bell called "the observation of the just
facts of anatomy and of natural motions."</p>

<hr class="c15" />

<p><span class="pagenum"><a name="Page_246" id="Page_246">246</a></span></p>

<p>Beside the entozoa, there are also vegetable parasites.
Of these, the most important is the <i lang="la" xml:lang="la">streptothrix
actinomyces</i>, the cause of actinomycosis in man and
cattle. Israel, in 1877, gave the first accurate account
of it in man; and Böllinger, the same year, studied
it in cattle. Ponfick, in 1882, recognised the identity
of the disease in man and animals. In 1885, Israel
published the collected records of 37 cases in man,
tabulated according to the site of the primary infection.
Boström, about this time, made cultures of the fungus:
but all the earlier attempts at inoculation failed; and
it was not till 1891 that Wolff and Israel published
their successful inoculations, and thus completed the
evidence that actinomycosis is a parasitic infection, a
growth of vegetable threads and spores, transmissible
between men and animals, and able to keep its vitality
outside its host; so that men who are employed with
cattle, or have the habit of chewing straws or ears of
corn, incur some slight risk of infection. Before 1877,
the disease was hardly suspected in man, and was not
understood in cattle.
<span class="pagenum"><a name="Page_247" id="Page_247">247</a></span></p>

<h3>XII<br />
MYX&OElig;DEMA</h3>

<p>On 4th October 1873, Sir William Gull read a short
paper before the Clinical Society of London, "On a
Cretinoid State supervening in Adult Life in Women."
This famous first account of myx&oelig;dema was based on
five cases: it is less than five pages long, it does not
suggest a name for the disease, and it says nothing
about the thyroid gland. Four years later (23rd
October 1877), Dr. Ord read a paper before the
Medico-Chirurgical Society of London, "On Myx&oelig;dema;
a term proposed to be applied to an essential
condition in the 'Cretinoid' Affection occasionally
observed in Middle-aged Women." His work had
begun so far back as 1861; and in this 1877 paper
he gave not only clinical observations, but also pathological
and chemical facts; and he noted, as one among
many changes, wasting of the thyroid gland. He also
pointed out the close resemblance between cases of
myx&oelig;dema and cases of sporadic cretinism.</p>

<p>In 1882, Reverdin stated before the Medical Society
of Geneva that signs like those of myx&oelig;dema had been
observed in some cases of removal of the thyroid gland
on account of disease (goître). In April 1883, Kocher
of Berne read a paper on this subject, before the
Congress of German Surgeons; but he attributed
this myx&oelig;dema after removal of the gland (cachexia
<span class="pagenum"><a name="Page_248" id="Page_248">248</a></span>
strumipriva) not directly to the loss of thyroid-tissue,
but rather to some sort of interference with free
respiration, due to operation. On 23rd November,
Sir Felix Semon brought the subject again before the
Clinical Society; and on 14th December 1883, the
Society appointed a Committee of Investigation to
study the whole question.</p>

<p>Their report, 215 pages long, with tabulated records
of 119 cases of myx&oelig;dema, was published in 1888. It
is a monument of good work, historical, clinical, pathological,
chemical, and experimental. Twenty years ago,
the purpose of the thyroid gland was unknown: a few
experiments had been made on it, by Sir Astley Cooper
and others, and had failed; and Claude Bernard, in his
<cite>Physiologie Opératoire</cite> (published in 1879, soon after his
death), makes it clear that nothing was known in his
time about it. He is emphasising the fact that anatomy
cannot make the discoveries of physiology:&mdash;</p>

<p class="blockquote">"The descriptive anatomy, and the microscopic characters,
of the thyroid gland, the facts about its blood-vessels
and its lymphatics&mdash;are not all these as well known in
the thyroid gland as in other organs? Is not the same
thing true of the thymus gland, and the suprarenal
capsules? <i>Yet we know absolutely nothing about the
functions of these organs&mdash;we have not so much as an
idea what use and importance they may possess&mdash;because
experiments have told us nothing about them</i>; and anatomy,
left to itself, is absolutely silent on the subject."</p>

<p>Therefore, in 1882-83, things stood at this point&mdash;that
the removal of a diseased thyroid gland had been
followed, in some cases, by a train of symptoms such as
Sir William Gull had recorded in 1873. Would the
same symptoms follow removal of the healthy gland?
The answer was given by Sir Victor Horsley's experiments,
<span class="pagenum"><a name="Page_249" id="Page_249">249</a></span>
begun in 1884. He was able, by removal of
the gland, to produce in monkeys a chronic myx&oelig;dema,
a cretinoid state, the facsimile of the disease in man:
the same symptoms, course, tissue-changes, the same
physical and mental hebetude, the same alterations of
the excretions, the temperature, and the voice. It was
now past doubt that myx&oelig;dema was due to want of
thyroid-tissue, and to that alone; and that "cachexia
strumipriva" was due to the loss, by operation, of such
remnants of the gland as had not been rendered useless
by disease.</p>

<p>The advance had still to be made from pathology to
treatment. Here, so far as England is concerned,
honour is again due to Sir Victor Horsley. On 8th
February 1890, he published the suggestion that
thyroid-tissue, from an animal just killed, should be
transplanted beneath the skin of a myx&oelig;dematous
patient:&mdash;</p>

<p class="blockquote">"The justification of this procedure rested on the remarkable
experiments of Schiff and von Eisselsberg. I
only became aware in April 1890, that this proposal had
been in fact forestalled in 1889 by Dr. Bircher, in Aarau.
(The date of Dr. Bircher's operation was 16th January
1889.) Kocher had tried to do the same thing in 1883,
but the graft was soon absorbed; but early in 1889 he
tried it again, in five cases, and one greatly improved."</p>

<p>The importance of this treatment, by transplantation
of living thyroid-tissue, must be judged by the fact
that in 1888 no practical use had yet been made of
the scientific work that had been done. The Clinical
Society's Report, published that year, gives but half a
page to treatment, of the old-fashioned sort; and not
a word of hope.
<span class="pagenum"><a name="Page_250" id="Page_250">250</a></span></p>

<p>Then, at last, in 1891, came Dr. George Murray's
paper in the <cite>British Medical Journal</cite>, "Note on the
Treatment of Myx&oelig;dema by Hypodermic Injections of
an Extract of the Thyroid Gland of a Sheep." Later,
hypodermic injections of thyroid-extract gave way to
sandwiches, made with thyroid gland (Dr. Hector
Mackenzie, and Dr. Fox of Plymouth), and these in
their turn were eclipsed by tabloids.</p>

<p>It is a strange sequence, from 1873 onward: clinical
observation, <i lang="la" xml:lang="la">post-mortem</i> work, calamities of surgery,
experimental physiology, transplantation, hypodermic injections,
sandwiches, and tabloids. And far more has
been achieved than the cure of myx&oelig;dema. Even if
the discovery stopped here, it would still be a miracle
that little bottles of tabloids should bring men and
women back from myx&oelig;dema to what they were before
they became thick-witted, slow, changed almost past
recognition, drifting toward idiocy. But it does not
stop here. The same treatment has given good results
in countless cases of sporadic cretinism, restoring
growth of body and of mind to children that were
hopelessly imbecile. It is of great value also for
certain diseases of the skin. Moreover, physiology
has gained knowledge of the purpose of the thyroid
gland, and a clearer insight into the facts relating to
internal secretion.
<span class="pagenum"><a name="Page_251" id="Page_251">251</a></span></p>

<h3>XIII<br />
THE ACTION OF DRUGS</h3>

<p>Long after the Renaissance, the practice of medicine
was still under the influence of magic. Whatever
things were rare and precious were held to be good
against disease&mdash;gold, amber, coral, pearls, and the
dust of mummies; whatever took strange forms of
life&mdash;toads, earthworms, and the like; whatever looked
like the disease, after the doctrine of signatures&mdash;pulmonaria
for the lungs, because the spots on its leaves
were like tubercle, a kidney-shaped fruit for the
kidneys, a heart-shaped fruit for the heart, and yellow
carrots for the yellow jaundice. Among the drugs in
the 1618 Pharmacop&oelig;ia are <i lang="la" xml:lang="la">cranium humanum</i>, <i lang="la" xml:lang="la">mandibula
lucii</i>, <i lang="la" xml:lang="la">nidus hirundinum</i>, <i lang="la" xml:lang="la">sericum crudum</i>, <i lang="la" xml:lang="la">linum
vivum</i>, and <i lang="la" xml:lang="la">pilus salamandræ</i>. In the Pharmacop&oelig;ia
of 1667 are <i lang="la" xml:lang="la">exuviæ serpentis</i>, <i lang="la" xml:lang="la">telæ aranearum</i>, <i lang="la" xml:lang="la">saliva
jejuni</i>, <i lang="la" xml:lang="la">cranium hominis violentâ morte extincti</i>, and worse
obscenities.</p>

<p>Soon after the publication of this Pharmacop&oelig;ia, on
14th February 1685, King Charles II. died; and in
the Library of the Society of Antiquaries there is a
manuscript account in Latin, by Dr. Scarbrugh, how
the case was treated. The King had sixteen physicians,
and nine consultations in five days; and to say "everything
was done that was possible" gives no idea of the
vigour of the treatment. Finally, the day he died, they
<span class="pagenum"><a name="Page_252" id="Page_252">252</a></span>
gave him, eleven of them in consultation&mdash;<i lang="la" xml:lang="la">totus medicorum
chorus ab omni spe destitutus</i>&mdash;they gave him, as
<i>more generous cardiacs</i>, the <i>lapis Goæ</i>, and the <i>Bezoar-stone</i>.
The <i>lapis Goæ</i> was a dust of topaz, jacinth,
sapphire, ruby, pearl, emerald, bezoar, coral, musk,
ambergris, and gold, all made into a pill and polished;
and the <i>bezoar</i> is a calculus found in the intestines of
herbivorous animals. Half a century later, the Pharmacop&oelig;ia
of 1721 still included ants' eggs, teeth, <i>lapis
nephriticus</i>, and other horrors; and in the Pharmacop&oelig;ia
of 1746, though the dust of Egyptian mummies
was ruled out, vipers and wood-lice were retained.</p>

<p>Certainly these "last enchantments of the Middle
Ages" were slow to depart. Clinical observation, anatomy,
and pathology, had all failed to bring about a
right understanding of the actions of drugs. It was
the physiologists, not the doctors, who first formulated
the exact use of drugs; it was Bichat, Magendie,
and Claude Bernard. That is the whole meaning of
Magendie's work on the upas-poison and on strychnine,
and Claude Bernard's work on curari and
digitalis. Of these four substances, two only are of
any use in practice; yet Magendie's study of strychnine<a name="FNanchor_41" id="FNanchor_41" href="#Footnote_41" class="fnanchor">[41]</a>
was of immeasurable value, not so much
because it gave the doctors a "more generous
cardiac," though that was a great gift, but because
it revealed the <i>selective</i> action of drugs. Contrast his
account of strychnine with Ambroise Paré's story how
they tested the bezoar-stone on the thief instead of
hanging him; contrast Bernard's chapter on curari
with Dr. Scarbrugh's notes on the King's death, with
<span class="pagenum"><a name="Page_253" id="Page_253">253</a></span>
all the Crown jewels inside him: you are in two
different worlds. The <i>selective</i> action of drugs&mdash;the
affinity between strychnine and the central nerve-cells,
between curari and the terminal filaments of the motor
nerves&mdash;that was the revolutionary teaching of science:
and it came, not by experience, but by experiment.</p>

<p>Take Professor Fraser's address on "The Action
of Remedies, and the Experimental Method" at the
International Medical Congress in London, 1881:&mdash;</p>

<p class="blockquote">"The introduction of this method is due to Bichat;
and, by its subsequent application by Magendie, pharmacology
was originated as the science we now recognise.
Bichat represents a transition state, in which metaphysical
conceptions were mingled with the results of experience.
Magendie more clearly recognised the danger of adopting
theories, in the existing imperfections of knowledge; and
devoted himself to the supplementing of these imperfections
by experiments on living animals. The advantages
of such experiments he early illustrated by his
investigation on the upas-poison; and afterwards by a
research on the then newly-discovered alkaloid, strychnia....
He demonstrated the action of this substance upon
the spinal cord, by experiments upon the lower animals,
so thoroughly, that subsequent investigations have added
but little to his results."</p>

<p>Or take Professor Fraser's account of digitalis:&mdash;</p>

<p class="blockquote">"It was introduced as a remedy for dropsy; and, on
the applications which were made of it for the treatment
of that disease, a slowing action upon the cardiac movements
was observed, which led to its acquiring the reputation
of a cardiac sedative. Numerous observations
were made on man by the originators of its application,
by Dr. Sanders and many other physicians, in which
special attention was paid to its effects upon the circulation;
but no further light was thrown upon its remarkable
<span class="pagenum"><a name="Page_254" id="Page_254">254</a></span>
properties, with the unimportant exception that in
some cases it was found to excite the circulation. It
was not until the experimental method was applied in
its investigation, in the first instance by Claude Bernard,
and subsequently by Dybkowsky, Pelikan, Meyer, Boehm,
and Schmiedeberg, that the true action of digitalis upon the
circulation was discovered. It was shown that the effects
upon the circulation were not in any exact sense sedative,
but, on the contrary, stimulant and tonic, rendering the
action of the heart more powerful, and increasing the
tension in the blood-vessels. The indications for its use
in disease were thereby revolutionised, and at the same
time rendered more exact; and the striking benefits which
are now afforded by the use of this substance in most
(cardiac) diseases were made available to humanity."</p>

<p>Or take Sir T. Lauder Brunton's account of the
action of nitrite of amyl in angina pectoris:&mdash;</p>

<div class="blockquote">
<p>"The action of nitrite of amyl in causing flushing was
first observed by Guthrie, and Sir B. W. Richardson
recommended it as a remedy in spasmodic conditions,
from the power he thought it to possess of paralysing
motor nerves. In the spring of 1867 I had opportunities
of constantly observing a patient who suffered from
angina pectoris, and of obtaining from him numerous
sphygmographic tracings, both during the attack and
during the interval. These showed that during the
attack the pulse became quicker, the blood-pressure
rose, and the arterioles contracted.... It seemed probable
that the great rise in tension was the cause of the
pain, and it occurred to me that if it was possible to
diminish the tension by drugs instead of by bleeding,
the pain would be removed.</p>

<p>"I knew from unpublished experiments on animals by
Dr. A. Gamgee that nitrite of amyl had this power, and
therefore tried it on the patient. My expectations were
perfectly answered. The pain usually disappeared in
three-quarters of a minute after the inhalation began,
<span class="pagenum"><a name="Page_255" id="Page_255">255</a></span>
and at the same time the pulse became slower and much
fuller, and the tension diminished."</p>
</div>

<p>Of course it would be easy to lengthen out the list.
Aconite, adrenalin, belladonna, calcium chloride, colchicum,
cocain, chloral, ergot, morphia, salicylic acid,
strophanthus, the chief diuretics, the chief diaphoretics&mdash;all
these drugs, and many more, have been studied
and learned by experiments on animals. Then comes
the answer, that drugs act differently on animals and
on men. The few instances, that give a wise air to
this foolish answer, were known long ago to everybody:
they do not so much as touch the facts of daily
practice:&mdash;</p>

<div class="blockquote">
<p>"The action of drugs on man differs from that on the
lower animals chiefly in respect to the brain, which is
so much more greatly developed in man. Where the
structure of an organ or tissue is nearly the same in
man and in the lower animals, the action of drugs upon
it is similar. Thus we find that carbonic oxide, and
nitrites, produce similar changes in the blood of frogs,
dogs, and man, that curare paralyses the motor nerves,
alike in them all, and veratria exerts upon the muscles of
each its peculiar stimulant and paralysing action. Where
differences exist in the structure of the various organs,
we find, as we would naturally expect, differences in their
reaction to drugs. Thus the heart of the frog is simpler
than that of dogs or men, and less affected by the central
nervous system; we consequently find that while such a
drug as digitalis has a somewhat similar action upon the
hearts of frogs, dogs, and men, there are certain differences
between its effect upon the heart of a frog and on
that of mammals.</p>

<p>"Belladonna offers another example of apparent difference
in action&mdash;a considerable dose of belladonna will
produce almost no apparent effect upon a rabbit, while a
smaller dose in a dog or a man would cause the rapidity
<span class="pagenum"><a name="Page_256" id="Page_256">256</a></span>
of the pulse to be nearly doubled. Yet in all three&mdash;rabbits,
dogs, and men&mdash;belladonna paralyses the power
of the vagus over the heart. The difference is that in
rabbits the vagus normally exerts but little action on the
heart, and the effect of its paralysis is consequently slight
or hardly appreciable." (Professor Fraser.)</p>
</div>

<p>It would be strange indeed, if experts who work in
micromillimetres and decimal milligrammes, and study
the vanishing-point of microscopic structures, and
measure and ordain infinitesimal changes in invisible
organisms, were blind to such gross and palpable
differences as exist between men and pigeons in their
susceptibility to a dose of opium.</p>

<p>Anæsthetics must be reckoned among the drugs that
have been studied on animals: but, for the discovery of
them, men experimented on themselves. The first use
of nitrous oxide (laughing gas) in surgery was 11th
December 1844, when Horace Wells, of Connecticut,
had it administered to himself for the removal of a
tooth. The first use of ether was made by Dr. Long,
of Athens, Georgia; but he did not publish the case, or
follow up the work: and the honour of the discovery
of ether went to Morton, of Boston, who made repeated
experiments, both on animals and on himself. The
date when he first rendered himself absolutely unconscious
for seven or eight minutes, is 30th September
1846; and the first operation under ether was done on
16th October, in the Massachusetts General Hospital.
The first use of chloroform was 4th November 1847,
that famous evening when Simpson, George Keith, and
Matthews Duncan took it together. The whole history
of anæsthesia is to be found in the <i>Practitioner</i>, Oct. 1896.</p>

<p>It is sometimes said that the men who make experiments
on animals ought to make them on themselves.
<span class="pagenum"><a name="Page_257" id="Page_257">257</a></span>
But they do, hundreds of them, and suffer for it:
Heaven knows the list is long enough&mdash;the discoverers
of anæsthesia, Hunter, Garré, Koch, Klein, Moor, Haffkine,
Grassi, Bochefontaine, Quesada, Sanarelli, Pettenkofer&mdash;these
and hosts more, here or abroad, have done
it, as part of the day's work; and some&mdash;by accidental
infection, like Chabry and Villa, or by deliberate self-inoculation,
like Carrion&mdash;have been killed:&mdash;</p>

<p class="blockquote">"Dr. Angelo Knorr, <i>Privat-docent</i> in the Veterinary
School of Munich, died on 22nd February from acute
glanders, contracted in the course of an experimental
research on mallein. Helmann, the Russian investigator
who discovered mallein, himself fell a victim to accidental
inoculation of the glanders virus. Some time afterwards
another Russian, Protopopow, died of glanders contracted
in a French laboratory. An Austrian physician, Dr.
Koffman-Wellenhof, died of the same disease, contracted
in the Institute of Hygiene at Vienna. On 17th January
of the present year Dr. Guiseppe Bosso, of the University
of Turin, died of infection contracted in the course of
cultivations of tubercle-bacilli made in his laboratory.
Not long before, Dr Lola, assistant in the maternity
department of the Czech University Hospital of Prague,
died of tetanus caused by an experimental inoculation
made on himself. Some fourteen or fifteen years ago, a
medical student of Lima proved that 'verruga Peruana'
is an infectious disease by inoculating himself with it, an
act of scientific devotion which cost him his life.<a name="FNanchor_42" id="FNanchor_42" href="#Footnote_42" class="fnanchor">[42]</a>  Besides
those who have died, there are many who have only
escaped with their lives after long and painful illness.
Professor Kourloff contracted anthrax in a laboratory at
Munich, and was saved only by vigorous surgery. Dr.
Nicolas supplied, in his own person, the first example of
tetanus produced in man by inoculation of the pure toxin
<span class="pagenum"><a name="Page_258" id="Page_258">258</a></span>
of the bacillus of Nicolaier." (<cite>Brit. Med. Journal</cite>, 18th
March 1899.)</p>

<p>This list is seven years old now; it is twice the
length by this time. Typhoid, malaria, yellow fever,
have all taken toll of those who study them. It is a
long record of the men who fell ill, or died, or killed
themselves over their work; and the deaths of Barisch,
Dr. Müller, and Nurse Pecha, from plague at Vienna
(October 1898) are another instance that there is
danger in the constant handling of cultures. But these
deaths at Vienna were due to the great carelessness
of one man. In laboratories in all parts of the world
there are stored cultures of all sorts of organisms, yet
no harm comes of it. "More cases of infection occur
amongst young medical men attending fever cases,
whether in private practice or hospital wards, in a
single month, than have occurred in the whole of the
laboratories in the world since they were established."
(<cite>British Medical Journal</cite>, 29th October 1898.) Outside
the laboratory, outside the fever hospitals, the risk is
something less than a negligible quantity:&mdash;</p>

<p class="blockquote">"Apart from plague and cholera, in all the big laboratories
studies are uninterruptedly pursued, from one end
of the year to the other, upon anthrax, glanders, influenza,
Malta fever, various tropical diseases which do not exist
at all or are rare in the countries where they are being
studied. The laboratories in question are situated in the
largest and most important towns of their respective
countries; and, within those towns, very often in the
most fashionable or most populous centres.... On no
occasion was there even a suspicion aroused of an
epidemic having been produced by any of the above-mentioned
institutes, or by those tens of thousands of
operations against cholera performed in India." (Haffkine,
<cite>Madras Mail</cite>, 8th December 1898.)
<span class="pagenum"><a name="Page_259" id="Page_259">259</a></span></p>

<h3>XIV<br />
SNAKE-VENOM</h3>

<p>The Report of the 1875 Commission said:&mdash;</p>

<p class="blockquote">"It is not possible for us to recommend that the
Indian Government should be prohibited from pursuing
its endeavours to discover an antidote for snake-bites;
or that, without such an effort, your Majesty's Indian
subjects should be left to perish in large numbers annually
from the effects of these poisons."</p>

<p>Certainly it was not possible; and the numbers are
large indeed. During 1897, 4227 persons were killed
by wild animals in India, and 20,959 by snakes.
(<cite>British Medical Journal</cite>, 5th November 1898.)</p>

<p>Sir Joseph Fayrer's name must be put in the highest
place of all those who have studied the venomous snakes
of India.</p>

<p>Sewell, in 1887, showed that animals could be
rendered immune, by repeated inoculation with minute
quantities of rattlesnake-venom, to a dose seven times
as large as would kill an unprotected animal. Kanthack,
in 1891, immunised animals in the same way
against cobra-venom. He also made experiments to
ascertain whether the blood-serum of these animals
acted as an antidote to the venom. Then came the
work of Calmette, Fraser, Phisalix, Bertrand, Martin
(Australia), Stephens, and Meyers. Professor Fraser's
observations on the antidotal properties of the bile are,
<span class="pagenum"><a name="Page_260" id="Page_260">260</a></span>
of course, of the utmost importance; not only in preventive
medicine, but also in physiology. The results
obtained by Calmette are a good instance of the fineness
and accuracy of the experimental method. It is
to be noted that the animals were inoculated with a
fine needle, not thrust into cages with snakes, as at
zoological gardens; and that an animal thus poisoned
has a painless death. The different venoms were
measured in decimal milligrammes, and their potency
was estimated according to the body-weight of the
animal inoculated. As with tetanus, so with snake-venom,
there must be a standard, or "unit of toxicity."</p>

<div class="blockquote">
<p>"The following table gives the relative toxicity, for
1 kilogr. of rabbit, of the different venoms that I have
tested. To denote this toxicity I use terms such as
Behring, Roux, and Vaillard used for the toxin of
tetanus, taking the number of grammes of animal killed
by one gramme of toxin:&mdash;</p>

<table border="0" cellpadding="0" cellspacing="2" summary="snake bite">
<tr>
<td class="tdl">1.</td>
<td class="tdl">Venom of <i lang="la" xml:lang="la">naja</i></td>
<td>0.25 mgr. per kilogr.<br />
  of rabbit.</td>
<td>&nbsp;</td>
</tr>
<tr>
<td>&nbsp;</td>
<td>One gramme of this venom kills 4000 kilogrammes<br />
  of rabbit; it has, therefore, an activity of</td>
<td>&nbsp;</td>
<td class="tdcb">4,000,000</td>
</tr>
<tr>
<td>2.</td>
<td class="tdl">Venom of <i lang="la" xml:lang="la">hoplocephalus</i></td>
<td>0.29 mgr.</td>
<td class="tdr">3,450,000</td>
</tr>
<tr>
<td>3.</td>
<td class="tdl">Venom of <i lang="la" xml:lang="la">pseudechis</i></td>
<td>1.25 mgr</td>
<td class="tdr">800,000</td>
</tr>
<tr>
<td>4.</td>
<td class="tdl">Venom of <i lang="la" xml:lang="la">pelias berus</i></td>
<td>4.00 mgr</td>
<td class="tdr">250,000</td>
</tr>
</table>

<p>"Of course, this estimation of virulence is not absolute;
it varies considerably according to the species of
animal tested. Thus the guinea-pig, and still more the
rat, are extremely sensitive. For instance, 0.15 mgr. of
viper-venom is enough to kill, in less than 12 hours, 500
grammes of guinea-pig; so that the activity of this venom
with a guinea-pig is 3,333,000, but with a rabbit is not
more than 650,000. With more resistant animals, the
opposite result is obtained; about 10 mgr. of cobra-venom
are necessary to kill a dog of 6.50 kilogrm. weight; but
to kill the same weight of rabbit 1.65 mgr. is enough.
Thus the virulence of this venom with the rabbit is
4,000,000; but with the dog not more than 650,000."
<span class="pagenum"><a name="Page_261" id="Page_261">261</a></span></p>
</div>

<p>By experiments in test-tubes, Calmette studied these
venoms under the influences of heat and various chemical
agents. He found how to attenuate their virulence,
and how to diminish the local inflammation round the
point of inoculation; and it was in the course of these
test-tube experiments and inoculations that he discovered
the value of calcium hypochlorite as a local
application. Working, by various methods, with attenuated
venoms, he was able to immunise animals:&mdash;</p>

<div class="blockquote">
<p>"I have come to immunise rabbits against quantities
of venom that are truly colossal. I have got several,
vaccinated more than a year ago, which take, without the
least discomfort, so much as 40 mgr. of venom of <i lang="la" xml:lang="la">naja
tripudians</i> at a single injection; that is to say, enough to
kill 80 rabbits of 2 kilogr. weight, or 5 dogs.</p>

<p>"Five drops of serum from these rabbits wholly neutralise
<i lang="la" xml:lang="la">in vitro</i> (in a glass test-tube) the toxicity of 1 mgr.
of <i lang="la" xml:lang="la">naja</i>-venom."</p>
</div>

<p>By 1894 he had found that the serum of an animal,
thus immunised by graduated doses of one kind of venom,
neutralised other kinds of venom:&mdash;</p>

<p class="blockquote">"If 1 mgr. of cobra-venom, or 4 mgr. of viper-venom,
be mixed, in a test-tube, with a small quantity of serum
from an immunised rabbit, and a fresh rabbit be inoculated
with this mixture, it does not suffer any discomfort.
It is not even necessary that the serum should come from
an animal vaccinated against the same sort of venom as
that in the mixture. <i>The serum of a rabbit immunised
against the venom of the cobra or the viper acts indifferently
on all the venoms that I have tested.</i>"</p>

<p>In 1894 he had prepared enough serum for the
treatment to be tried by his own countrymen practising
in some of the French colonies. In April 1895,
he gave the following account of his work:&mdash;
<span class="pagenum"><a name="Page_262" id="Page_262">262</a></span></p>

<div class="blockquote">
<p>"I have immunised two asses, one having received
220 mgr. of <i lang="la" xml:lang="la">naja</i>-venom from 25th September to 31st
December 1894, and the other 160 mgr. from 15th
October to 31st December. The serum of the first of
these two animals has now reached this point, that
half a cubic centimetre destroys the toxicity of 1 mgr.
of <i lang="la" xml:lang="la">naja</i>-venom. Four cubic centimetres of this serum,
injected four hours before the inoculation of a dose of
venom enough to kill twice over, preserve the animal
in every case. It is also therapeutic, under the conditions
that I have already defined; that is to say, if you
first inoculate a rabbit with such a dose of venom as kills
the control-animals in three hours, and then, an hour after
injecting the venom, inject under the skin of the abdomen
4 to 5 cubic centimetres of serum, recovery is the rule.
When you interfere later than this the results are uncertain;
and in all my experiments the delay of an hour
and a half is the most that I have been able to reach.</p>

<p>"This antivenomous serum of asses has these same
antitoxic properties with all kinds of snake-venom; it is
equally active <i lang="la" xml:lang="la">in vitro</i>, preventive, and therapeutic, with
the venoms of <i lang="la" xml:lang="la">cerastes</i>, of
<i lang="la" xml:lang="la">trigonocephalus</i>, of <i lang="la" xml:lang="la">crotalus</i>, and
of four kinds of Australian snakes that Mr. MacGarvie
Smith has sent to M. Roux. I am still injecting these
two animals with venom, and I hope to give to their
serum at last a much greater antitoxic power."</p>
</div>

<p>In 1896 four successful cases of this treatment in
the human subject were reported in the <cite>British Medical
Journal</cite>. In 1898 Calmette made the following statement
of his results:&mdash;</p>

<p class="blockquote">"It is now nearly two years since the use of my antivenomous
serum was introduced in India, in Algeria, in
Egypt, on the West Coast of Africa, in America, in the
West Indies, Antilles, &amp;c. It has been very often used
for men and domestic animals (dogs, horses, oxen), and
up to now none of those that have received an injection
of serum have succumbed.... A great number of
<span class="pagenum"><a name="Page_263" id="Page_263">263</a></span>
observations have been communicated to me, and not one
of them refers to a case of failure." (<cite>British Medical
Journal</cite>, 14th May 1898.)</p>

<p>Good accounts of Fraser's and Calmette's work are
given by Dr. Stone in the <cite>Boston Medical and Surgical
Journal</cite>, 7th April 1898, and by Staff-Surgeon Andrews,
R.N., in the <cite>British Medical Journal</cite>, 9th September
1899. For other cases see the <cite>Pioneer</cite>, 10th August
1899, the <cite>Lancet</cite>, 25th November 1899, and the <cite>British
Medical Journal</cite>, 23rd December 1899. In one of these
cases, recorded by Dr. Rennie, the patient was, literally,
at the point of death, but recovered after the serum had
been injected. Two cases have also been recorded of
cobra-bite during work in the laboratory: both of them
recovered after injection. "Every Government or
private dispensary," says Surgeon Beveridge, "should
be supplied with antivenene, which is certainly the best
remedy for snake-bite available." The cases are few
at present; but it does not appear that the treatment
has failed in any case; and, with a new remedy of this
kind, it is fairly certain that failures would be published.</p>

<hr class="c15" />

<p>From all these instances in physiology, pathology,
bacteriology, and therapeutics, we come to consider the
Act relating to experiments on animals in the United
Kingdom. Many subjects have been left out; among
them, the work of the last few years on the suprarenal
glands and adrenalin, and Dr. William Hunter's admirable
work on pernicious anæmia. No attempt has been
made to describe the researches of experts in many
countries into the nature of malignant disease, or to
guess what may come of the discovery that mice can
be immunised against that form of cancer which occurs
<span class="pagenum"><a name="Page_264" id="Page_264">264</a></span>
in mice and is inoculable from mouse to mouse. Nothing
has been said of the discovery that the African sleeping-sickness
is due to a blood-parasite carried by flies from
man to man. Nothing has been said about those discoveries
in bacteriology that have not yet been applied
to practice, or of the many inventions of medical and
surgical practice that owe only an indirect debt to experiments
on animals. Artificial respiration, the transfusion
of saline fluid, the hypodermic administration of drugs,
the use of oxygen for inhalation, the torsion of arteries,
the grafting of skin, the transplantation of bone, the
absorbable ligature, the diagnostic and therapeutic uses
of electricity, the rational employment of blood-letting&mdash;all
these good methods have been left out of the list;
only some facts have been presented, those that mark
most clearly the advance of knowledge and of practice,
and stand up even above the rest of the work. There
they will stand, when we are all dead and gone: and
by them, as by landmarks, all further advance will be
guided.</p>

<hr class="c30" />

<p><span class="pagenum"><a name="Page_265" id="Page_265">265</a></span></p>

<h2>PART III<br />
THE ACT RELATING TO EXPERIMENTS<br />
ON ANIMALS IN GREAT BRITAIN<br />
AND IRELAND</h2>

<p><span class="pagenum"><a name="Page_266" id="Page_266">266</a></span></p>

<p><span class="pagenum"><a name="Page_267" id="Page_267">267</a></span></p>

<h4>ACT 39 AND 40 VIC. c. 77</h4>

<p>The Royal Commission "On the Practice of subjecting
Live Animals to Experiments for Scientific Purposes,"
was appointed on 22nd June 1875. Its members were&mdash;Lord
Cardwell (chairman), Lord Winmarleigh, Mr.
W. E. Forster, Sir John Karslake, Mr. Huxley, Mr. (Sir
John) Erichsen, and Mr. Hutton. Between 5th July
and 30th December, 53 witnesses were examined, and
6551 questions were put and answered. The report
of the Commission bears date 8th January 1876, and
in that year the present Act received the Royal Assent.</p>

<p>The evidence before the Commission was all, or
nearly all, concerned with physiology, with the work of
Magendie, Claude Bernard, and Sir Charles Bell, the
action of curare, the <cite>Handbook of the Physiological
Laboratory</cite>, the teaching of physiology, and so forth.
Very little was said of pathology; and of bacteriology
next to nothing. Practically, physiology alone came
before the Commissioners; and such experiments in
physiology as are now, the youngest of them, more
than thirty years old.</p>

<p>Bacteriology, at the time of the passing of the Act,
had hardly made a beginning. Therefore the Act
made no special provision for inoculations, injections,
and the whole study of immunisation of animals and
men against disease. Experiments of this kind have to
be scheduled under one of the existing certificates, to
bring them under an Act that was drafted without foreknowledge
<span class="pagenum"><a name="Page_268" id="Page_268">268</a></span>
of them. Certificate A or Certificate B has
to be used for this purpose:&mdash;</p>

<div class="blockquote">
<p class="title2"><i>Certificate A.</i></p>

<p>"We hereby certify that, in our opinion, insensibility
in the animal on which any such experiment may be
performed cannot be produced by anæsthetics without
necessarily frustrating the object of such experiment."</p>

<p class="title2"><i>Certificate B.</i></p>

<p>"We hereby certify that, in our opinion, the killing of
the animal on which any such experiment is performed
before it recovers from the influence of the anæsthetic
administered to it, would necessarily frustrate the object
of such experiment."</p>
</div>

<p>Under one or other of these certificates must be
scheduled all inoculations, injections, feeding-experiments,
transplantations of particles of disease, immunisations,
and the like. They must be scheduled
somehow; and that is the only way of doing it.
Where the act of inducing the disease would itself
give any pain, if an anæsthetic were not administered&mdash;as
in the subdural inoculation of a rabbit, or the
intra-peritoneal inoculation of an animal with a particle
of cancerous tissue&mdash;there the licensee must hold,
together with the license, Certificate B, because the act
of inducing the disease is itself an operation, done
under an anæsthetic. If the animal be a dog or a cat,
he must hold Certificates B and EE; if it be a horse,
ass, or mule, Certificates B and F.</p>

<p>Where the act of inducing the disease is not itself
painful&mdash;as in ordinary inoculation, and in feeding-experiments&mdash;the
licensee must hold, together with his
<span class="pagenum"><a name="Page_269" id="Page_269">269</a></span>
license, Certificate A, because the animal is not anæsthetised.
It is not a painful operation; the experiment
consists not in the act of putting the hypodermic needle
under the animal's skin, but in the subsequent observation
of the course of the disease. Take, for instance,
the inoculation of a guinea-pig with tubercle-bacilli: the
experiment is the production of tubercle; the experiment
lasts till the animal is killed and found to be
infected; it is therefore scheduled under Certificate A.
Or take the testing, on an animal, of an antitoxin; the
experiment is not the injection, but the observation of
the result; the animal may not suffer, but the injection
must still be done under Certificate A. And, if the
animal be a dog or a cat, the licensee must hold
Certificates A and E; or, if it be a horse, ass, or mule,
Certificates A and F.</p>

<p>This want of a special certificate for inoculations is
an important matter, because it has led to the belief that
painful operations are performed, without anæsthesia, in
cases where the only instrument used is a needle. It
is hardly reasonable, for instance, that the inoculation
of a mouse should be scheduled as a painful operation
performed without anæsthesia. The disease, thus painlessly
induced, may in many cases be called painless;
for instance, snake-venom in the rat, septicæmia in the
mouse, malaria in small birds. In other cases, there
are such pain and fever as are part of the disease.
The form that rabies take in rabbits may fairly be
called painless. Inoculations not under the skin, but
into the anterior chamber of the eye, are very seldom
made; they sound cruel, but cocain renders the surface
of the eye wholly insensitive, and the anterior chamber
is so far insensitive that a man with blood or pus
(<i lang="la" xml:lang="la">hypopyon</i>) in the anterior chamber of the eye may
<span class="pagenum"><a name="Page_270" id="Page_270">270</a></span>
suffer no pain from it. A horse or an ass kept for
the giving of an antitoxic serum has a more comfortable
life than an omnibus horse; and this preparation
of the antitoxins, since it is not an experiment, but a
direct use of animals in the recognised service of man,
does not require a license or certificates under the Act.
But the testing of an antitoxin is an experiment, and
must be made under a license and Certificate A.</p>

<p>It is not the business of this book to consider
whether the sensitiveness of a dog, a rabbit, or a
guinea-pig can fairly be stated in terms of the physical
and mental sensitiveness of men and women. In the
world of animals, as in the world of humanity, there
are differences of sensitiveness. Anyhow, the pain
inflicted on animals may in some cases be measured:&mdash;</p>

<div class="blockquote">
<p>"A guinea-pig that will rest quietly in your hands
before you commence to inject it, will remain perfectly
quiet during the introduction of the needle under the
skin; and the moment it is returned to the cage it
resumes its interrupted feeding.</p>

<p>"Arteries, veins, and most of the parts of the viscera,
are without the sense of touch. We have actual proof of
this in what takes place when a horse is bled for the
purpose of obtaining curative serum. With a sharp
lance a cut may be made in the skin so quickly and
easily that the animal does nothing more than twitch the
skin-muscle of the neck, or give his head a shake, whilst
of the further proceeding of introducing a hollow needle
into the vein the animal takes not the slightest notice.
Some horses, indeed, will stand perfectly quiet during
the whole operation, munching a carrot, nibbling at a wisp
of hay, or playing with a button on the vest of the groom
standing at its head.</p>

<p>"Harrowing details concerning the horrors of trephining
rabbits for Pasteur's antirabic treatment are frequently
supplied for popular consumption, but how little real
<span class="pagenum"><a name="Page_271" id="Page_271">271</a></span>
existence any suffering in connection with the operation
has, may be gathered from the fact that if, as a preliminary
measure, the skin be benumbed with carbolic acid, the
whole operation, from making the incision through the
skin to cutting out the piece of bone with a fine trephine
and passing a needle under the dura mater, may be done
without once causing the animal to withdraw its attention
from the important business of munching a bit of
cabbage-leaf or a scrap of succulent carrot." (Prof.
Woodhead, <cite>Medical Magazine</cite>, June 1898.)</p>
</div>

<p>It may be well to put here&mdash;(1) the full text of the
Act; (2) an account of the anæsthetics used for animals;
(3) the latest Report of Government Inspectors appointed
under the Act.</p>

<h3>1.&mdash;<span class="smcap">An Act to Amend the Law relating to<br />
Cruelty to Animals</span></h3>

<p class="title2"><i>15th August 1876</i></p>

<p>Whereas it is expedient to amend the law relating to
cruelty to animals by extending it to the cases of animals
which for medical, physiological, or other scientific
purposes are subjected when alive to experiments calculated
to inflict pain:</p>

<p>Be it enacted by the Queen's most Excellent Majesty,
by and with the advice and consent of the Lords Spiritual
and Temporal, and Commons, in this present Parliament
assembled, and by the authority of the same, as follows:</p>

<p>1. This Act may be cited for all purposes as "The
Cruelty to Animals Act, 1876."</p>

<p>2. A person shall not perform on a living animal any
experiment calculated to give pain, except subject to the
restrictions imposed by this Act. Any person performing
or taking part in performing any experiment calculated
to give pain, in contravention of this Act, shall be
<span class="pagenum"><a name="Page_272" id="Page_272">272</a></span>
guilty of an offence against this Act, and shall, if it be
the first offence, be liable to a penalty not exceeding fifty
pounds, and if it be the second or any subsequent offence,
be liable, at the discretion of the court by which he is
tried, to a penalty not exceeding one hundred pounds, or
to imprisonment for a period not exceeding three months.</p>

<p>3. The following restrictions are imposed by this Act
with respect to the performance on any living animal of
an experiment calculated to give pain; that is to say,</p>

<div class="blockquote">
<p>(1.) The experiment must be performed with a view to
the advancement by new discovery of physiological
knowledge or of knowledge which will
be useful for saving or prolonging life or alleviating
suffering; and</p>

<p>(2.) The experiment must be performed by a person
holding such license from one of Her Majesty's
Principal Secretaries of State, in this Act
referred to as the Secretary of State, as is in
this Act mentioned, and in the case of a person
holding such conditional license as is hereinafter
mentioned, or of experiments performed
for the purpose of instruction in a registered
place; and</p>

<p>(3.) The animal must, during the whole of the experiment,
be under the influence of some anæsthetic
of sufficient power to prevent the animal feeling
pain; and</p>

<p>(4.) The animal must, if the pain is likely to continue
after the effect of the anæsthetic has ceased, or
if any serious injury has been inflicted on the
animal, be killed before it recovers from the
influence of the anæsthetic which has been
administered; and</p>

<p>(5.) The experiment shall not be performed as an illustration
of lectures in medical schools, hospitals,
colleges, or elsewhere; and</p>

<p>(6.) The experiment shall not be performed for the
purpose of attaining manual skill.
<span class="pagenum"><a name="Page_273" id="Page_273">273</a></span></p>
</div>

<p>Provided as follows; that is to say,</p>

<div class="blockquote">
<p>(1.) Experiments may be performed under the foregoing
provisions as to the use of anæsthetics
by a person giving illustrations of lectures in
medical schools, hospitals, or colleges, or elsewhere,
on such certificate being given as in this
Act mentioned, that the proposed experiments
are absolutely necessary for the due instruction
of the persons to whom such lectures are given
with a view to their acquiring physiological
knowledge, or knowledge which will be useful
to them for saving or prolonging life, or alleviating
suffering; and</p>

<p>(2.) Experiments may be performed without anæsthetics
on such certificate being given as in this Act
mentioned, that insensibility cannot be produced
without necessarily frustrating the object of such
experiments; and</p>

<p>(3.) Experiments may be performed without the person
who performed such experiments being under
an obligation to cause the animal, on which any
such experiment is performed, to be killed
before it recovers from the influence of the
anæsthetic, on such certificate being given as
in this Act mentioned, that the so killing the
animal would necessarily frustrate the object of
the experiment, and provided that the animal
be killed as soon as such object has been
attained; and</p>

<p>(4.) Experiments may be performed not directly for
the advancement by new discovery of physiological
knowledge, or of knowledge which will
be useful for saving or prolonging life, or
alleviating suffering, but for the purpose of
testing a particular former discovery alleged to
have been made for the advancement of such
knowledge as last aforesaid, on such certificate
being given as is in this Act mentioned that such
<span class="pagenum"><a name="Page_274" id="Page_274">274</a></span>
testing is absolutely necessary for the effectual
advancement of such knowledge.</p>
</div>

<p>4. The substance known as urari or curare shall not for
the purposes of this Act be deemed to be an anæsthetic.</p>

<p>5. Notwithstanding anything in this Act contained, an
experiment calculated to give pain shall not be performed
without anæsthetics on a dog or cat, except on such certificate
being given as in this Act mentioned, stating, in
addition to the statements hereinbefore required to be
made in such certificate, that for reasons specified in the
certificate the object of the experiment will be necessarily
frustrated unless it is performed on an animal similar in
constitution and habits to a cat or dog, and no other
animal is available for such experiment; and an experiment
calculated to give pain shall not be performed on
any horse, ass, or mule except on such certificate being
given as in this Act mentioned that the object of the experiment
will be necessarily frustrated unless it is performed
on a horse, ass, or mule, and that no other animal
is available for such experiment.</p>

<p>6. Any exhibition to the general public, whether admitted
on payment of money or gratuitously, of experiments
on living animals calculated to give pain shall be
illegal.</p>

<p>Any person performing or aiding in performing such
experiments shall be deemed to be guilty of an offence
against this Act, and shall, if it be the first offence, be
liable to a penalty not exceeding fifty pounds, and if it
be the second or any subsequent offence, be liable, at the
discretion of the court by which he is tried, to a penalty
not exceeding one hundred pounds, or to imprisonment
for a period not exceeding three months.</p>

<p>And any person publishing any notice of any such
intended exhibition by advertisement in a newspaper,
placard, or otherwise shall be liable to a penalty not
exceeding one pound.
<span class="pagenum"><a name="Page_275" id="Page_275">275</a></span></p>

<p>A person punished for an offence under this section
shall not for the same offence be punishable under any
other section of this Act.</p>

<h4><i>Administration of Law</i></h4>

<p>7. The Secretary of State may insert, as a condition of
granting any license, a provision in such license that the
place in which any experiment is to be performed by the
licensee is to be registered in such manner as the Secretary
of State may from time to time by any general or
special order direct; provided that every place for the
performance of experiments for the purpose of instruction
under this Act shall be approved by the Secretary
of State, and shall be registered in such manner as he
may from time to time by any general or special order
direct.</p>

<p>8. The Secretary of State may license any person
whom he may think qualified to hold a license to perform
experiments under this Act. A license granted by him
may be for such time as he may think fit, and may be
revoked by him on his being satisfied that such license
ought to be revoked. There may be annexed to such
license any conditions which the Secretary of State may
think expedient for the purpose of better carrying into
effect the objects of this Act, but not inconsistent with
the provisions thereof.</p>

<p>9. The Secretary of State may direct any person performing
experiments under this Act from time to time to
make such reports to him of the result of such experiments,
in such form and with such details as he may
require.</p>

<p>10. The Secretary of State shall cause all registered
places to be from time to time visited by inspectors for
the purpose of securing a compliance with the provisions
of this Act, and the Secretary of State may, with the
assent of the Treasury as to number, appoint any special
inspectors, or may from time to time assign the duties of
<span class="pagenum"><a name="Page_276" id="Page_276">276</a></span>
any such inspectors to such officers in the employment of
the Government, who may be willing to accept the same,
as he may think fit, either permanently or temporarily.</p>

<p>11. Any application for a license under this Act and a
certificate given as in this Act mentioned must be signed
by one or more of the following persons; that is to say,</p>

<div class="blockquote">
<p>The President of the Royal Society;</p>

<p>The President of the Royal Society of Edinburgh;</p>

<p>The President of Royal Irish Academy;</p>

<p>The Presidents of the Royal Colleges of Surgeons in
London, Edinburgh, or Dublin;</p>

<p>The Presidents of the Royal Colleges of Physicians in
London, Edinburgh, or Dublin;</p>

<p>The President of the General Medical Council;</p>

<p>The President of the Faculty of Physicians and Surgeons
of Glasgow;</p>

<p>The President of the Royal College of Veterinary
Surgeons, or the President of the Royal Veterinary
College, London, but in the case only of an
experiment to be performed under anæsthetics
with a view to the advancement by new discovery
of veterinary science;</p>
</div>

<p>and also (unless the applicant be a professor of physiology,
medicine, anatomy, medical jurisprudence, materia
medica, or surgery in a university in Great Britain or
Ireland, or in University College, London, or in a college
in Great Britain or Ireland, incorporated by royal charter)
by a professor of physiology, medicine, anatomy, medical
jurisprudence, materia medica, or surgery in a university
in Great Britain or Ireland, or in University College,
London, or in a college in Great Britain or Ireland, incorporated
by royal charter.</p>

<p>Provided that where any person applying for a certificate
under this Act is himself one of the persons authorised
to sign such certificate, the signature of some other
of such persons shall be substituted for the signature of
the applicant.</p>

<p>A certificate under this section may be given for such
<span class="pagenum"><a name="Page_277" id="Page_277">277</a></span>
time or for such series of experiments as the person or
persons signing the certificate may think expedient.</p>

<p>A copy of any certificate under this section shall be
forwarded by the applicant to the Secretary of State, but
shall not be available until one week after a copy has
been so forwarded.</p>

<p>The Secretary of State may at any time disallow or
suspend any certificate given under this section.</p>

<p>12. The powers conferred by this Act of granting a
license or giving a certificate for the performance of experiments
on living animals may be exercised by an order
in writing under the hand of any judge of the High Court
of Justice in England, of the High Court of Session in
Scotland, or of any of the superior courts in Ireland,
including any court to which the jurisdiction of such last-mentioned
courts may be transferred, in a case where
such judge is satisfied that it is essential for the purposes
of justice in a criminal case to make any such experiment.</p>

<h4><i>Legal Proceedings</i></h4>

<p>13. A justice of the peace, on information on oath that
there is reasonable ground to believe that experiments
in contravention of this Act are being performed by an
unlicensed person in any place not registered under this
Act, may issue his warrant authorising any officer or
constable of police to enter and search such place, and to
take the names and addresses of the persons found therein.</p>

<p>Any person who refuses admission on demand to a
police officer or constable so authorised, or obstructs such
officer or constable in the execution of his duty under
this section, or who refuses on demand to disclose his
name or address, or gives a false name or address, shall
be liable to a penalty not exceeding five pounds.</p>

<p>14. In England, offences against this Act may be prosecuted
and penalties under this Act recovered before a
court of summary jurisdiction in manner directed by the
Summary Jurisdiction Act.
<span class="pagenum"><a name="Page_278" id="Page_278">278</a></span></p>

<div class="blockquote">
<p>In England "Summary Jurisdiction Act" means the
Act of the session of the eleventh and twelfth
years of the reign of Her present Majesty, chapter
forty-three, intituled "An Act to facilitate the performance
of the duties of justices of the peace
out of sessions within England and Wales with
respect to summary convictions and orders," and
any Act amending the same.</p>

<p>"Court of summary jurisdiction" means and includes
any justice or justices of the peace, metropolitan
police magistrate, stipendiary or other magistrate,
or officer, by whatever name called, exercising
jurisdiction in pursuance of the Summary Jurisdiction
Act: Provided that the court when hearing
and determining an information under this Act shall
be constituted either of two or more justices of
the peace in petty sessions, sitting at a place
appointed for holding petty sessions, or of some
magistrate or officer sitting alone or with others
at some court or other place appointed for the
administration of justice, and for the time being
empowered by law to do alone any act authorised
to be done by more than one justice of the peace.</p>
</div>

<p>15. In England, where a person is accused before a
court of summary jurisdiction of any offence against this
Act in respect of which a penalty of more than five
pounds can be imposed, the accused may, on appearing
before the court of summary jurisdiction, declare that he
objects to being tried for such offence by a court of
summary jurisdiction, and thereupon the court of
summary jurisdiction may deal with the case in all respects
as if the accused were charged with an indictable
offence and not an offence punishable on summary conviction,
and the offence may be prosecuted on indictment
accordingly.</p>

<p>16. In England, if any party thinks himself aggrieved
by any conviction made by a court of summary jurisdiction
<span class="pagenum"><a name="Page_279" id="Page_279">279</a></span>
on determining any information under this Act, the
party so aggrieved may appeal therefrom, subject to the
conditions and regulations following:&mdash;</p>

<div class="blockquote">
<p>(1.) The appeal shall be made to the next court of
general or quarter sessions for the county or
place in which the cause of appeal has arisen,
holden not less than twenty-one days after the
decision of the court from which the appeal is
made; and</p>

<p>(2.) The appellant shall, within ten days after the
cause of appeal has arisen, give notice to the
other party and to the court of summary jurisdiction
of his intention to appeal, and of the
ground thereof; and</p>

<p>(3.) The appellant shall, within three days after such
notice, enter into a recognizance before a
justice of the peace, with two sufficient sureties,
conditioned personally to try such appeal, and
to abide the judgment of the court thereon,
and to pay such costs as may be awarded by
the court, or give such other security by
deposit of money or otherwise as the justice
may allow; and</p>

<p>(4.) Where the appellant is in custody the justice may,
if he think fit, on the appellant entering into
such recognizance or giving such other security
as aforesaid, release him from custody; and</p>

<p>(5.) The court of appeal may adjourn the appeal, and
upon the hearing thereof they may confirm,
reverse, or modify the decision of the court of
summary jurisdiction, or remit the matter to the
court of summary jurisdiction with the opinion
of the court of appeal thereon, or make such
other order in the matter as the court thinks
just, and if the matter be remitted to the court
of summary jurisdiction the said last-mentioned
court shall thereupon re-hear and decide the
information in accordance with the order of the
<span class="pagenum"><a name="Page_280" id="Page_280">280</a></span>
said court of appeal. The court of appeal may
also make such order as to costs to be paid by
either party as the court thinks just.</p>
</div>

<p>17. In Scotland, offences against this Act may be
prosecuted and penalties under this Act recovered under
the provisions of the Summary Procedure Act, 1864, or
if a person accused of any offence against this Act in
respect of which a penalty of more than five pounds
can be imposed, on appearing before a court of summary
jurisdiction, declare that he objects to being tried for
such offence in the court of summary jurisdiction, proceedings
may be taken against him on indictment in the
Court of Justiciary in Edinburgh or on circuit.</p>

<p>Every person found liable in any penalty or costs
shall be liable in default of immediate payment to imprisonment
for a term not exceeding three months, or
until such penalty or costs are sooner paid.</p>

<p>18. In Ireland, offences against this Act may be
prosecuted and penalties under this Act recovered in a
summary manner, subject and according to the provisions
with respect to the prosecution of offences, the
recovery of penalties, and to appeal of the Petty Sessions
(Ireland) Act, 1851, and any Act amending the same,
and in Dublin of the Acts regulating the powers of
justices of the peace or of the police of Dublin
metropolis. All penalties recovered under this Act shall
be applied in manner directed by the Fines (Ireland)
Act, 1871, and any Act amending the same.</p>

<p>19. In Ireland, where a person is accused before a
court of summary jurisdiction of any offence against
this Act in respect of which a penalty of more than five
pounds can be imposed, the accused may, on appearing
before the court of summary jurisdiction, declare that
he objects to being tried for such offence by a court
of summary jurisdiction, and thereupon the court of
summary jurisdiction may deal with the case in all
respects as if the accused were charged with an indictable
<span class="pagenum"><a name="Page_281" id="Page_281">281</a></span>
offence and not an offence punishable on
summary conviction, and the offence may be prosecuted
on indictment accordingly.</p>

<p>20. In the application of this Act to Ireland the term
"the Secretary of State" shall be construed to mean the
Chief Secretary to the Lord Lieutenant of Ireland for the
time being.</p>

<p>21. A prosecution under this Act against a licensed
person shall not be instituted except with the assent in
writing of the Secretary of State.</p>

<p>22. This Act shall not apply to invertebrate animals.</p>

<h3>II.&mdash;<span class="smcap">Anæsthetics under the Act</span></h3>

<p>In almost every case, the anæsthetic used is chloroform
or ether; sometimes it is combined with or
followed by morphia or chloral. The nature of the
anæsthetic used in each case must, of course, be stated
in the returns sent to the Home Office.</p>

<p>Of the use of ether, it need only be said that animals
take it well, and that there is no difficulty in rendering
them unconscious with it. With some animals, chloroform
is equally good. Professor Hobday, of the Royal
Veterinary College, published in 1898 an account of
500 administrations of chloroform to dogs, for operations,
with only one death. Still, for dogs and cats,
ether is used in preference to chloroform. Other
animals take chloroform well.</p>

<p>Morphia is seldom used alone; but, in some cases, it
is used after chloroform or ether. That morphia is a
"real anæsthetic" is certain, for there are deaths every
year from an over-dose of it. Again, it is certain that
an animal, so far under the influence of morphia that it
lies still, cannot be suffering, for the drug does not act
<span class="pagenum"><a name="Page_282" id="Page_282">282</a></span>
directly on the muscles but on the higher nervous
centres.</p>

<p>Very rarely a dog may fail to come readily under the
influence of morphia, may be excited by it, not narcotized.
But this is altogether exceptional. An animal
in such a condition would not be suited for experiment,
and another anæsthetic would be given. Except in
these rare cases, animals take morphia well and are
profoundly influenced by it.</p>

<p>Curare is not an anæsthetic under the Act. It is
illegal to use it as an anæsthetic. In this country it is
seldom used at all, and it is never used alone in any
experiment involving any sort or kind of painful operation.
In every such case a recognised anæsthetic must
be given, and is given.<a name="FNanchor_43" id="FNanchor_43" href="#Footnote_43" class="fnanchor">[43]</a> </p>

<p>A good account of curare was published in the <cite>Edinburgh
Review</cite>, July 1899.</p>

<p class="blockquote">"The Act of 1876 expressly forbids its use as an
anæsthetic. When it is used, it must be supplemented
with some other drug to relieve pain. A good deal of
misconception exists as to the actual physiological effect
of curare. Claude Bernard believed that it did not in
any way affect the sensory nerves, and he described in
theatrical terms the animal as being unable to stir, but
suffering horrible torture. It is pretty certainly known
now that Claude Bernard was wrong, and that, though
curare acts first upon the motor nerves, it also, though
less rapidly, paralyses the sensory nerves.... Probably
the truth is, that, like all other nerve-poisons, the effect
of curare varies with the dose. The muscular nerves
are the first affected, then the sensory, and finally the
central nervous system. As a matter of fact, however,
morphia or some other narcotic is always given in addition
to curare when it is used in laboratory work in
England."
<span class="pagenum"><a name="Page_283" id="Page_283">283</a></span></p>

<h3>III.&mdash;<span class="smcap">Latest Report (1905) of Inspectors<br />
under the Act</span></h3>

<p>(The various tables of names, places, &amp;c., and the
references to them, which are contained in this Report,
need not be reprinted here. The Report, and other
papers relating to the Act, may be bought for a few
pence from Wyman &amp; Sons, Ltd., Fetter Lane, E.C.)</p>

<hr class="c15" />

<h4>ENGLAND AND SCOTLAND</h4>

<p class="right"><i>April 17th, 1906.</i></p>

<p><span class="smcap">Sir</span>,&mdash;I have the honour to submit the following
Report on Experiments performed in England and Scotland
during the Year 1905, under the Act 39 &amp; 40 Vict.
c. 77.... Six new places were registered for the performance
of experiments, and one place was removed
from the register during the year. All licensees were
restricted to the registered place or places specified on
their licenses, with the exception of those who were permitted
to perform inoculation experiments in places other
than a "registered place," with the object of studying
outbreaks of disease occurring in remote districts or
under circumstances which render it impracticable to
perform the experiment in a "registered place."</p>

<p>The total number of licensees was 381. Reports have
been furnished by (or, in a few exceptional cases, on
behalf of) these licensees in the form required by the
Secretary for State. The reports show that 122 licensees
performed no experiments. The numbers given above
include 22 licensees whose licences expired on February
28, 1905, and who returned no experiments in
1905.</p>

<p>Tables I., II., and III. afford evidence,&mdash;</p>

<div class="blockquote">
<p>1. That licences and certificates have been granted
and allowed only upon the recommendation of persons
of high scientific standing;
<span class="pagenum"><a name="Page_284" id="Page_284">284</a></span></p>

<p>2. That the licensees are persons who, by their
training and education, are fitted to undertake experimental
work and to profit by it;</p>

<p>3. That all experimental work has been conducted
in suitable places.</p>
</div>

<p>Table IV. shows the number and the nature of the
experiments returned by each licensee mentioned in
Table II., specifying whether these experiments were
done under the licence alone or under any special certificate.</p>

<p>Table IV. is divided into two parts, A. and B., for the
purpose of separating experiments which were performed
without anæsthetics from experiments in which anæsthetics
were used.</p>

<p>The total number of experiments included in Table IV.
(A.) is 2506.</p>

<p>Of these there were performed,&mdash;</p>

<table border="0" cellpadding="0" cellspacing="2" summary="experiments">
<tr>
  <td>Under</td>
  <td class="tdl">Licence alone<a name="FNanchor_44" id="FNanchor_44" href="#Footnote_44" class="fnanchor">[44]</a> </td>
  <td class="tdr"><span class="i2">1348</span></td>
</tr>
<tr>
  <td><span class="i1">"</span></td>
  <td class="tdl">Certificate C.</td>
  <td class="tdr">145</td>
</tr>
<tr>
  <td><span class="i1">"</span></td>
  <td class="tdl">Certificate B.</td>
  <td class="tdr">665</td>
</tr>
<tr>
  <td><span class="i1">"</span></td>
  <td class="tdl">Certificate B. + EE</td>
  <td class="tdr">346</td>
</tr>
<tr>
  <td><span class="i1">"</span></td>
  <td class="tdl">Certificate B. + F.</td>
  <td class="tdr">2<span class="pagenum"><a name="Page_285" id="Page_285">285</a></span></td>
</tr>
</table>

<p>Table IV. (B.) is devoted entirely to inoculations,
hypodermic injections, and some few other proceedings,
performed without anæsthetics. It includes 35,429 experiments,
whereof there were performed,&mdash;</p>

<table border="0" cellpadding="0" cellspacing="2" summary="experiments">
<tr>
  <td>Under</td>
  <td class="tdl">Certificate A.</td>
  <td class="tdr">34,778</td>
</tr>
<tr>
  <td class="tdc">"</td>
  <td class="tdl">Certificate A. + E.</td>
  <td class="tdr">549</td>
</tr>
<tr>
  <td class="tdc">"</td>
  <td class="tdl">Certificate A. + F.</td>
  <td class="tdr">102</td>
</tr>
</table>

<p>The total number of experiments is 37,935, being 5373
more than in 1904; the increase in the number of experiments
included in Table IV. (A.) is 290, and in Table IV.
(B.), 5083.</p>

<p>All experiments involving a serious operation are
placed in Table IV. (A.). The larger part of the experiments
included in this Table, viz., all performed under
licence alone, and under Certificate C., 1493 in number,
come under the provision of the Act that the animal must
be kept under an anæsthetic during the whole of the
experiment, and must, if the pain is likely to continue
after the effect of the anæsthetic has ceased, or if any
serious injury has been inflicted on the animal, be killed
before it recovers from the influence of the anæsthetic.</p>

<p>In the experiments performed under Certificate B., or
B. linked with EE. or with F., 1013 in number, the
initial operations are performed under anæsthetics, from
the influence of which the animals are allowed to recover.
The operations are required to be performed antiseptically,
so that the healing of the wounds shall, as far as
possible, take place without pain. If the antiseptic precautions
fail, and suppuration occurs, the animal is
required to be killed. It is generally essential for the
success of these experiments that the wounds should
heal cleanly, and the surrounding parts remain in a
healthy condition. After the healing of the wounds the
animals are not necessarily, or even generally, in pain,
since experiments involving the removal of important
organs, including portions of the brain, may be performed
without giving rise to pain after the recovery
<span class="pagenum"><a name="Page_286" id="Page_286">286</a></span>
from the operation; and after the section of a part of the
nervous system, the resulting degenerative changes are
painless.</p>

<p>In the event of a subsequent operation being necessary
in an experiment performed under Certificate B., or B.
linked with EE. or with F., a condition is attached to the
licence requiring all operative procedures to be carried
out under anæsthetics of sufficient power to prevent the
animal feeling pain; and no observations or stimulations
of a character to cause pain are allowed to be made without
the animals being anæsthetised.</p>

<p>In no case has a cutting operation more severe than
a superficial venesection been allowed to be performed
without anæsthetics.</p>

<p>The experiments included in Table IV. (B.), 35,429 in
number, are all performed without anæsthetics. They
are mostly inoculations, but a few are feeding experiments,
or the administration of various substances by the
mouth, or the abstraction of a minute quantity of blood
for examination. In no instance has a certificate dispensing
with the use of anæsthetics been allowed for an
experiment involving a serious operation. Inoculations
into deep parts, involving a preliminary incision in order
to expose the part into which the inoculation is to be
made, are required to be performed under anæsthetics,
and are therefore placed in Table IV. (A.).</p>

<p>It will be seen that the operative procedures in experiments
performed under Certificate A., without anæsthetics,
are only such as are attended by no considerable, if
appreciable, pain. The Certificate is, in fact, not required
to cover these proceedings, but to allow of the subsequent
course of the experiment. The experiment lasts during
the whole period from the administration of the drug, or
injection, until the animal recovers from the effects, if
any, or dies, or is killed, possibly extending over several
days, or even weeks. The substance administered may
give rise to poisoning, or set up a condition of disease,
either of which may lead to a fatal termination. To
administer to an animal such a poison as diphtheria toxin,
<span class="pagenum"><a name="Page_287" id="Page_287">287</a></span>
for example, or to induce such a disease as tuberculosis,
although it may not be accompanied by acute suffering,
is held to be a proceeding "calculated to give pain," and
therefore experiments of the kind referred to come within
the scope of the Act 39 &amp; 40 Vict., c. 77. The Act
provides that, unless a special certificate be obtained,
the animal must be kept under an anæsthetic during the
whole of the experiment; and it is to allow the animal to
be kept without an anæsthetic during the time required
for the development of the results of the administration
that Certificate A. is given and allowed in these cases.</p>

<p>It must not be assumed that the animal is in pain
during the whole of this time. In cases of prolonged
action of an injected substance, even when ending fatally,
the animal is generally apparently well, and takes its
food as usual, until a short time before death. The state
of illness may last only a very few hours, and in some
cases it is not observed at all.</p>

<p>In a very large number of the experiments included in
Table IV. (B.), the results are negative, and the animals
suffer no inconvenience whatever from the inoculation.
These experiments are therefore entirely painless.</p>

<p>In the event of pain ensuing as the result of an inoculation,
a condition attached to the licence requires that the
animal shall be killed under anæsthetics as soon as the
main result of the experiment has been attained.</p>

<p>The number of inoculations and similar proceedings
recorded in Table IV. (B.) continues to increase in accordance
with the progressive importance attached to biological
tests generally in practical medicine for the
diagnosis, treatment and prevention of disease, and to the
more widely recognised need for such experiments on the
part of those responsible for the care of the public health.
Several County Councils and Municipal Corporations
have their own laboratories in which bacteriological investigations
are carried on, including the necessary tests
on living animals; and many others have arrangements
by which similar observations are made on their behalf in
the laboratories of Universities, Colleges, and other Institutions.
<span class="pagenum"><a name="Page_288" id="Page_288">288</a></span>
A sewage farm is registered as a place in
which experiments on living animals may be performed
in order that the character of the effluent may be tested by
its effects on the health of fish. The Board of Agriculture
has two laboratories which are registered for the performance
of experiments having for their object the
detection and study of the diseases of animals. In other
places experiments have been made on behalf of the
Home Office, the War Office, the India Office, the Local
Government Board, the Office of Works, the Board of
Agriculture and Fisheries, and the Metropolitan Asylums
Board. A very large proportion of the experiments in
Table IV. (B.) have thus been performed either on
behalf of Official Bodies with a view to the preservation
of the public health, or directly for the diagnosis and
treatment of disease. Forty-one licensees return over
8000 experiments which were performed for Government
Departments, County Councils, or Municipal Corporations;
2187 experiments were made by four licensees
for the Royal Commission on Tuberculosis; twelve
licensees performed 6265 experiments, almost all inoculations,
for testing antitoxic sera and vaccines and
standardising drugs; and 12,187 experiments, mostly
inoculations into mice, were performed on behalf of the
Imperial Cancer Research Fund.</p>

<p>The number of injections made during the year 1905
for the diagnosis of rabies in dogs is 27; these are
placed in Table IV. (A.).</p>

<p>During the year the usual inspections of registered
places have been made by Sir James Russell, by myself,
and by Mr. W. B. L. Trotter, who was appointed
temporary Assistant Inspector during my absence for
three months. We have found the animals suitably
lodged and well cared for, and the licensees attentive
to the requirements of the Act, as well as to the conditions
appended to their licences by the Secretary of
State.</p>

<p>The irregularities recorded during the year have been
few, and not of a serious character.
<span class="pagenum"><a name="Page_289" id="Page_289">289</a></span></p>

<p>Two licensees, holding certificates (A.) entitling them
to perform inoculations without anæsthetics, administered
an anæsthetic during some of their experiments, whereas
the Act prescribes another form of certificate (B.) when
an animal is anæsthetised during an experiment and
allowed to recover from the anæsthetic.</p>

<p>A licensee, through inadvertence, performed 54 inoculation
experiments in excess of the number allowed by his
certificate.</p>

<p>Another licensee, not understanding that joint experiments
are reckoned to both of the licensees, took part in
the performance of eight experiments in excess of the
number allowed by his certificate.</p>

<p>By direction of the Secretary of State a suitable
admonition was addressed to the licensee in each of the
above cases.</p>

<p>In the month of April 1905 the attention of the
Secretary of State was directed to certain experiments
which were performed in 1903 and the early part of
1904 by persons not holding a licence under the Act 39
&amp; 40 Vict. c. 77. The experiments consisted in vaccinating
dogs against distemper and then exposing them to
infection, the object being to test the efficacy of a method
of vaccination as a safeguard against this disease. The
Secretary of State thereupon caused inquiries to be
made, and from these it appeared that the experiments,
in some instances at least, had been accompanied by
pain, and were, therefore, illegal. The persons, who
were not aware that their experiments were of such a
kind as to come within the provisions of the Act, were
suitably admonished and warned against any similar
illegal action in the future. The matter was not brought
to the knowledge of the Secretary of State until it was
too late for further proceedings to be taken if such had
been considered necessary. It is as well to point out
here that to expose an animal to an infectious and painful
disease like distemper is a proceeding calculated to
cause pain within the meaning of the Act, and that such
experiments can only be legally performed by a person
<span class="pagenum"><a name="Page_290" id="Page_290">290</a></span>
holding a licence and appropriate certificates.&mdash;I have
the honour to be, Sir, your obedient servant,</p>

<p class="right">G. D. THANE, <i>Inspector</i>.</p>

<p>The Right Hon. <span class="smcap">HerbertJohn Gladstone</span>,<br />
<span class="i2"><i>Secretary of State for the Home Department</i>.</span></p>

<h4>IRELAND</h4>

<p class="right"><span class="smcap">8 Ely Place, Dublin</span>,<span class="i1">&nbsp;</span><br />
<span class="right"><i>April 26th, 1906</i>.</span></p>

<p><span class="smcap">Sir</span>,&mdash;I beg to submit Tables showing the experiments
performed in Ireland during the year 1905, under
the Act 39 &amp; 40 Vict. c. 77, together with a list of
the Registered Places in Ireland.</p>

<p>Twelve licences were in force during the year; of
these four expired, and two were renewed. One new
license was granted.</p>

<p>The certificates in existence or allowed were:&mdash;</p>

<table border="0" cellpadding="2" cellspacing="1" summary="certificates">
<tr>
  <td class="tdl">A.</td>
  <td class="tdl">to</td>
  <td>4</td>
  <td>&nbsp;licensees.</td>
</tr>
<tr>
  <td class="tdl">B.</td>
  <td class="tdl">"</td>
  <td>7</td>
  <td class="tdc">"</td>
</tr>
<tr>
  <td class="tdl">C.</td>
  <td class="tdl">"</td>
  <td>3</td>
  <td class="tdc">"</td>
</tr>
<tr>
  <td class="tdl">E.</td>
  <td class="tdl">"</td>
  <td>2</td>
  <td class="tdc">"</td>
</tr>
<tr>
  <td class="tdl">EE.</td>
  <td class="tdl">"</td>
  <td>3</td>
  <td class="tdc">"</td>
</tr>
<tr>
  <td class="tdl">F.</td>
  <td class="tdl">"</td>
  <td>1</td>
  <td>&nbsp;licensee.</td>
</tr>
</table>

<p>One expired during the year, and six new ones were
allowed.</p>

<p>The experiments performed number 218; 106 being
under licence alone, and 112 under certificates. Ten
licensees performed experiments. Twenty certificates
were in force among 12 licensees, of whom 10 performed
experiments, viz.:&mdash;</p>

<table border="0" cellpadding="2" cellspacing="0" summary="experiments w certificates">
<tr>
  <td>Under</td>
  <td>Certificate&nbsp;</td>
  <td>A.</td>
  <td class="tdr">88</td>
</tr>
<tr>
  <td class="tdc">"</td>
  <td class="tdc">"</td>
  <td>B.</td>
  <td class="tdr">14</td>
</tr>
<tr>
  <td class="tdc">"</td>
  <td class="tdc">"</td>
  <td>C.</td>
  <td class="tdr">8</td>
</tr>
<tr>
  <td class="tdc">"</td>
  <td class="tdc">"</td>
  <td>F.</td>
  <td class="tdr">2<span class="pagenum"><a name="Page_291" id="Page_291">291</a></span></td>
</tr>
</table>

<p>The animals experimented on were:&mdash;</p>

<table border="0" cellpadding="2" cellspacing="0" summary="animals experimented on">
<tr>
  <td class="tdl">Guinea pigs&nbsp;</td>
  <td class="tdr">55</td>
</tr>
<tr>
  <td class="tdl">Birds</td>
  <td class="tdr">53</td>
</tr>
<tr>
  <td class="tdl">Rabbits</td>
  <td class="tdr">48</td>
</tr>
<tr>
  <td class="tdl">Cattle</td>
  <td class="tdr">27</td>
</tr>
<tr>
  <td class="tdl">Mice</td>
  <td class="tdr">14</td>
</tr>
<tr>
  <td class="tdl">Dogs</td>
  <td class="tdr">13</td>
</tr>
<tr>
  <td class="tdl">Cats</td>
  <td class="tdr">2</td>
</tr>
<tr>
  <td class="tdl">Horses</td>
  <td class="tdr">2</td>
</tr>
<tr>
  <td class="tdl">Goats</td>
  <td class="tdr">2</td>
</tr>
<tr>
  <td class="tdl">Sheep</td>
  <td class="tdr">2</td>
</tr>
</table>

<p>The experiments were mainly pathological inoculations,
done for the purposes of the investigation or diagnosis
of various diseases, such as canine rabies, tuberculosis,
cancer, glanders, and typhoid fever. A few were
physiological, for the investigation of the functions of
the thymus gland, and of the effects of chloroform and
ether on renal activity. All of these seem to have been
of a reasonable character and intended to serve useful
purposes in the elucidation of the phenomena of disease
or of vital functions. They are reported to have been
free from pain.</p>

<p>Experiments numbering eight were performed in
illustration of lectures, to demonstrate the phenomena
of circulation and respiration and of nervous control.
In these experiments, two dogs, two cats, and four
rabbits were employed.</p>

<p>Some of the investigations were devoted to the study
of diseases in cattle, horses, goats, and sheep, and seem
to be useful and of economic value.</p>

<p>The registered places were inspected and their condition
found satisfactory. The inspectors in Belfast and
Cork report that in those places the provisions of the
Act have been satisfactorily complied with.&mdash;I have, &amp;c.,</p>

<p class="left40">W. THORNLEY STOKER,<br />
<span class="i2"><i>Inspector for Ireland</i></span>.</p>

<p><span class="i0h">To the Right Honourable</span><br />
<span class="i2h">The Chief Secretary to the</span><br />
<span class="i4h">Lord Lieutenant of Ireland.</span>
<span class="pagenum"><a name="Page_292" id="Page_292">292</a></span></p>

<p>This Report gives a clear answer to certain false
statements alleged against experiments on animals. It
shows that more than 90 <i lang="la" xml:lang="la">per cent.</i> of these experiments
are inoculations, with a few feeding experiments, administrations
of substances by the mouth, or abstractions
of a minute quantity of blood for examination.
<i>In no instance has a certificate dispensing with the use
of anæsthetics been allowed for an experiment involving
a serious operation. In no case has a cutting operation
more severe than a superficial venesection been allowed
to be performed without anæsthetics.</i> It shows, also,
that the results, in a very large number of these inoculations,
are negative, painless, not even inconvenient.</p>

<p>The Report shows, also, that the vast majority of
all experiments are inoculations made on the smaller
animals; and that the larger animals (dog, cat, horse,
mule, or ass) are seldom used for inoculation.</p>

<p>It shows, also, that a great proportion of these inoculations
are made in the direct practical service of the
public health and the public purse: to standardise
drugs, to ensure the purity of food and of rivers, to
protect flocks and herds, and to decide quarantine.
Government Departments, County Councils, Municipal
Corporations, and a Royal Commission made more
than one-third of the total number of inoculations;
and the Imperial Cancer Research Fund made more
than one-third, mostly on mice; and a sixth was
made over the testing and standardising of sera and
of drugs.</p>

<p>The operations performed under the License + Certificate
B, or B + EE, or B + F, were 3 per cent. of the
whole number of experiments. The majority of the
<span class="pagenum"><a name="Page_293" id="Page_293">293</a></span>
animals were neither cats nor dogs. They can hardly
be compared to the same number of the larger animals
mutilated by breeders and farmers: for these mutilations
may be inflicted, and are inflicted, without an
anæsthetic. They can hardly be compared to the same
number of pheasants or rabbits wounded, but not killed,
in sport; for the animals wounded in sport get no subsequent
care, and, if they are in pain, nobody need put
them out of it. They may fairly be compared to the same
number of pet animals that have undergone surgical
operations, under anæsthesia, at the hands of a skilled
veterinary surgeon; only with this difference, that many
of them lose health, or suffer disablement or disease,
and so die or are killed; but, if the wound suppurates,
the animal must be killed, and, after the wound has
healed, the animals are not necessarily, or even generally,
in pain. And there must be no <i>further</i> experiment
without anæsthesia. <i>No observations or stimulations
of a character to cause pain are allowed to be made without
the animals being anæsthetised.</i> It is evident that
good care is taken to ensure an irreducible minimum
of pain.
<span class="pagenum"><a name="Page_294" id="Page_294">294</a></span></p>

<hr class="c30" />

<p><span class="pagenum"><a name="Page_295" id="Page_295">295</a></span></p>

<h2>PART IV<br />
THE CASE AGAINST ANTI-VIVISECTION</h2>

<p><span class="pagenum"><a name="Page_296" id="Page_296">296</a></span></p>

<p><span class="pagenum"><a name="Page_297" id="Page_297">297</a></span></p>

<p class="title2">THE CASE AGAINST ANTI-VIVISECTION</p>

<p class="blockquote">[The following pages are taken, with a few changes and
omissions, from a pamphlet which I published in 1904. I am
glad to say that the tone of the Anti-Vivisection Societies is not
quite so bad as it was a few years ago; but I think that what I
wrote in 1904 is still fairly accurate.]</p>

<h3>1. <span class="smcap">Anti-Vivisection Societies</span></h3>

<p>The early history of the anti-vivisection movement is
given in a pamphlet by Dr. Leffingwell, of Brooklyn,
entitled "The Rise of the Vivisection Controversy";
and in a pamphlet published by the National Anti-vivisection
Society, entitled "Dates of the Principal
Events connected with the Anti-vivisection Movement."
Dr. Leffingwell calls attention to a fact not generally
known&mdash;that the movement, in this country, was begun
by the medical journals. The <cite>Medical Times and Gazette</cite>
in 1858, the <cite>Lancet</cite> in 1860, and the <cite>British Medical
Journal</cite> in 1861 condemned in a very outspoken way
certain experiments made on the Continent, and raised
the question whether these or any experiments on
animals could be justified. Later, in 1872, the <cite>Medical
Times and Gazette</cite> declared outright that all experiments,
from the time of Magendie onward, had done nothing
for humanity that could be compared to the discovery
and use of cod-liver oil and bark. In 1874, the Royal
Society for the Prevention of Cruelty to Animals took
proceedings against those who had made certain experiments
<span class="pagenum"><a name="Page_298" id="Page_298">298</a></span>
at Norwich during a meeting of the British
Medical Association. These experiments, and the
publication of the <cite>Handbook of the Physiological Laboratory</cite>,
roused public comment; and during 1875 the
opposition to all experiments on animals took more
definite form. On June 22nd, 1875, the Royal Commission
was appointed; on January 8th, 1876, its
report was dated; and on August 15th, 1876, the
present Act received the Royal assent.</p>

<p>At the time when the Royal Commission was appointed,
the only anti-vivisection society was that which
Mr. Jesse had just started; and if any one will read
Mr. Jesse's cross-examination, by Professor Huxley,
before the Royal Commission, he will not attach much
importance to that society. The National Anti-vivisection
Society was founded in November 1875; the
Irish Society, the London Society, and the International
Association in 1876; the Church Anti-vivisection
League in 1889, the Humanitarian League and the
National Canine Defence League<a name="FNanchor_45" id="FNanchor_45" href="#Footnote_45" class="fnanchor">[45]</a>  in 1891, and the
British Union about 1898. These dates show that the
oldest of these societies came after the Royal Commission,
not before it; the first societies and the Royal
Commission were alike the expression of a widespread
opinion, thirty years ago, that experiments on animals
ought either to be forbidden or to be restricted. This
same opinion had been favoured, fifteen years before
that, by the representative journals of the medical profession.
We have seen something of the work of the
medical profession; let us now see something of the
work of the societies.
<span class="pagenum"><a name="Page_299" id="Page_299">299</a></span></p>

<p>The chief anti-vivisection societies in this country
are the National Society, the London Society, the British
Union, the Church League, and the Canine Defence
League. In February 1898, the National Society
declared itself in favour of restriction; it set before
itself abolition as its ultimate policy, and restriction as
its immediate practical policy. Thus, at the present time,
these societies are divided into two parties: one asks
for restriction, another asks for nothing short of abolition.
This division between them, and the tone of
the National Society toward the smaller Societies,
waste their energy and their funds, and hinder them
from working together. The National Society, in its
official journal (January 1902), speaks as follows of
this schism, in a leader entitled "The Folly of our
Subdivisions":&mdash;</p>

<p class="blockquote">"Nobody seems to know how many Anti-vivisection
Societies there are. A few hundred Anti-vivisectionists
divide themselves up into divisions, subdivisions, coteries,
and cliques, without order, without discipline, without
cohesion. The Anti-vivisectionists between them all
contribute but a few thousands a year, and dribble them
around among multitudinous antagonistic associations....
The pitiful absurdity of the disunion fostered by some
Anti-vivisectionists was illustrated very forcibly last year
by the issue of a prospectus of a Society with a world-embracing
title, in which its promoters declared that
irreparable injury would be inflicted upon our cause if
electoral work were not taken up by <em>them</em>.... The
accounts of this stupendous organisation showed that its
total expenditure for the year was £13, 19s. 4d., out of
which ten shillings was devoted to 'electoral work.' ...
A much graver injury is done to the cause of mercy
by the deplorable waste of money spent in perfectly unnecessary
offices and salaries. We say that one office
would amply suffice for all the work, and that one office
<span class="pagenum"><a name="Page_300" id="Page_300">300</a></span>
would not need half-a-dozen paid Secretaries. The
existence of many quite needless Societies cannot be
justified on any grounds of humanity combined with
common sense."</p>

<p>Nothing need be added to these very grave admissions,
written by Mr. Coleridge himself. He proposes
a very simple remedy for these "quite needless"
societies:&mdash;</p>

<p class="blockquote">"The National Society, as the chief Anti-vivisection
organisation in the world, is always ready to put an end
to this grievous waste by receiving into its corporation
any of the smaller Societies."</p>

<p>But the leaders of smaller societies have two grounds
of complaint against Mr. Coleridge's society: they do
not believe in his policy, and they will not submit to
his "discipline." They call his society "the weak-kneed
brethren," and say that its policy is "miserable,
cowardly, and misleading"; and they take it ill that
he so often accuses them of inaccuracy. He refers
again and again (see the official journal of the National
Society) to this mode of discipline:&mdash;</p>

<div class="blockquote">
<p><i>December 1901.</i>&mdash;"I decline to be made responsible
for the 'anti-vivisection party.' There happen to be
small anti-vivisection associations whose chief occupation
is the dissemination of quite inaccurate pamphlets. I
have nothing to do with them, and cannot prevent anything
they choose to do."</p>

<p><i>January 1902.</i>&mdash;"Time after time has this sacred
cause been undermined and betrayed by its professing
friends by their reckless habit of making erroneous
statements."</p>

<p><i>March 1902.</i>&mdash;"I am quite aware that with many of
my opponents in the exclusive total-abolition coterie, the
motives that actuate them are far removed from the
question of the salvation of the wretched animals, and
<span class="pagenum"><a name="Page_301" id="Page_301">301</a></span>
have their foundation in emotions that seem to me
singularly unworthy and petty."</p>

<p><i>May 1902.</i>&mdash;"As representative of the National
Society, I have again and again written to the representatives
of some of the smaller anti-vivisection societies,
protesting in plain terms against their publication of
inaccurate statements."</p>
</div>

<p>No society could submit to be thus taken to task
four times in six months. The Church League writes
to him, "What the Church League may or may not
think fit to say does not in the very least concern you,
who are not a member of the League. Interference
in such a matter from an outsider is an obvious impertinence."
Such rejoinders are met, in their turn,
by angry leaders, "A Stab in the Back," "Stabs in the
Back," in the National Society's official journal; and
the Hon. Secretary of the London Society, who is a
lady, is accused of want of chivalry for Mr. Coleridge.
The leader, "A Stab in the Back" (April 1902), is a
curious instance of the tone of one anti-vivisection
society toward another:&mdash;</p>

<p class="blockquote">"The time when a man is assailed by a large section
of the press, threatened with violence by laymen, attacked
on points relevant by vivisectors and points irrelevant
by their supporters, is scarcely the moment that a generous
rival would have chosen for hurling a dart; and yet,
incredible as it may appear, the Honorary Secretary of
another Anti-vivisection Society, seizing an opportunity
afforded by an article in the <cite>Globe</cite>, enters the arena, and,
by a letter repudiating any connection with Mr. Coleridge,
appears to sanction the unfriendly criticisms expressed
in that paper. It needed no chivalry to refrain from
writing such a letter. A small amount of good taste
would have amply sufficed.... This letter, which will
convince the public of nothing but the writer's lack of
<span class="pagenum"><a name="Page_302" id="Page_302">302</a></span>
taste, might well be ignored were it not that it is but
one of the many attacks made by members of other
societies, either by open statement or innuendo, against
the Honorary Secretary of the National Society."</p>

<p>But we cannot wonder at these occasional stabs.
For the National Society does not stop at charging
other societies with inaccuracy. It makes yet graver
charges against them. Here are three made by Mr.
Coleridge's society against Miss Cobbe's and Mr. Trist's
societies:&mdash;</p>

<div class="blockquote">
<p><i>March 1901.</i>&mdash;"The February number of the <i>Abolitionist</i>
contains a leading article in which allusions are
made to subjects that are never discussed by decent
people even in private. As the leading organ of the
Anti-vivisection movement, we enter our solemn protest
against the publication of this unspeakable article, which
must inevitably inflict the gravest injury upon our cause."</p>

<p><i>February 1903.</i>&mdash;"It is our duty to inform our readers
that Mr. Trist has published the correspondence, but
that he has mutilated it, omitting some of his own
letters altogether, and excising whole paragraphs of Mr.
Stewart's letters."</p>

<p><i>June 1903.</i>&mdash;"Our amiable contemporary, the <i>Abolitionist</i>,
is good enough, in a long article in its last issue,
to suggest to those preparing the libel action against
Mr. Coleridge what are the most vulnerable points in his
armour."</p>
</div>

<p>Thus divided in policy, and quarrelling among themselves,
these societies are still agreed in appealing to
the public for approval and for money. Here the
London Society's opposition to the National Society
comes out clearly. In its annual report (1903) the
London Society says:&mdash;</p>

<p class="blockquote">"Join a really effective Society with a frank and
straightforward policy&mdash;namely, the London Anti-vivisection
Society, 13 Regent Street, London, S.W. This
<span class="pagenum"><a name="Page_303" id="Page_303">303</a></span>
is a National and International organisation. It has
greater medical support than any other. It is the most
'alive' humane organisation in the world.... Get into
touch with the society. Write to us. We shall be glad
to hear from you and answer any questions."</p>

<p>"If you can provide for the Society's future in your
Will, may we beg of you to do so? If you agree, pray
do it now. Thousands of pounds have been lost to the
Society and the Cause by the fatal procrastination of
well-meaning friends. The pity of it! Legacies should
be left in these <i>exact</i> words: 'To the <i>London</i> Anti-vivisection
Society.' <span class="smcap">Caution.</span> It is of great importance
to describe very accurately the <i>Title of this Society</i>&mdash;namely,
<span class="smcap">The LONDON Anti-vivisection Society</span>&mdash;otherwise
the benevolent intentions of the Donor may
be frustrated. <span class="smcap">Please Note.</span>&mdash;Those charitable persons
who have left money to the Society would do well to
notify the same to the Secretary."</p>

<p>Contrast the tone of this appeal for money with the
tone of the Report:&mdash;&mdash;</p>

<p class="blockquote">"Your Society are glad to note that the Christian
Churches are becoming alarmed at the pretensions of
scientific authority.... The Christian laity has been
largely uninstructed or misinformed on this grave question....
Happily, the signs of the times are propitious;
not all of the leaders of religious thought in this country
have succumbed to the dictation and pretensions of the
professors of vivisection ... a base and blatant materialism,
a practice which owes its inception to barbarism,
and which has developed in materialism of the lowest
possible order."</p>

<p>Surely such eloquence should avail to tear the money
even out of the hands of the dying, lest the National
Society should get it. The National Society, oddly
enough, also says: "<span class="smcap">Caution.</span>&mdash;It is of great importance
to describe very accurately the <i>Title of this Society</i>&mdash;namely,
<span class="pagenum"><a name="Page_304" id="Page_304">304</a></span>
<span class="smcap">The National Anti-vivisection Society</span>&mdash;otherwise
the benevolent intentions of the Donor may be
frustrated." I do not know which of these two societies
is the inventor of this phrase. Still, it is not improbable
that the National Society receives more money than all
the smaller societies together. Of course, we cannot
compare the working expenses of an anti-vivisection
society with the working expenses of the Society for the
Prevention of Cruelty to Animals, or the Society for the
Prevention of Cruelty to Children. The former of these
two societies in one year obtained 8798 convictions;
in one month alone, 689 convictions; and it paid the
full costs of committing 34 of the 689 to prison. The
Society for the Prevention of Cruelty to Children has an
equally good record. But an anti-vivisectionist society
cannot show results of this kind. Nor can we compare
its working expenses to those of a missionary society;
for the missionaries give direct personal service to their
fellow-men. But we can fairly compare an anti-vivisection
society to an anti-vaccination society or a Church
of Christian Science. That is to say, it is a publishing
body. In 1902, the National Society's expenditure, in
round numbers, was £970 on printing and stationery;
£1193 on rent, salaries, and wages; £1255 on books,
newspapers, periodicals, &amp;c., including the <i>Illustrated
Catalogue</i> and the <cite>Hospital Guide</cite>; £1380 on lectures,
meetings, organising new branches, &amp;c.; and about
£500 on all other expenses. Let us take, to illustrate
these figures, what the National Society says from time
to time in its official journal:&mdash;</p>

<div class="blockquote">
<p><i>June 1899.</i>&mdash;(From the Society's Annual Report):
"The whole controversy has been collected and published
in pamphlet form by your Society, and more than
10,000 copies have already been issued to the public.
<span class="pagenum"><a name="Page_305" id="Page_305">305</a></span>
Over 200 people have joined your ranks and become
members of the Society in consequence of it, while two
cheques of £1000 each were received by Mr. Coleridge
in aid of the cause."</p>

<p><i>June 1899.</i>&mdash;"We have received more money within
the past six months than we got in any two years previously."</p>

<p><i>June 1899.</i>&mdash;"We cannot better employ the funds at
our disposal than in securing the constant help of experts
to insure the accuracy of all our statements, and in sending
well-informed lecturers to every city in the kingdom."</p>

<p><i>June 1900.</i>&mdash;(From the Society's Annual Report):
"The receipts of the society from subscriptions and
donations show an increase over those of the previous
year. This increase in itself, however, would hardly
have justified the increase in the expenses which it has
been found necessary to incur in almost every department,
and especially in the distribution of pamphlets and
papers, had it not been for some legacies which fell due,
notably one from&mdash;&mdash;, of £6386."</p>

<p><i>May 1901.</i>&mdash;"With heartfelt gratitude we have once
more to announce that the National Society has received
a gift of a thousand pounds from an anonymous donor.
Nothing could be more opportune for the Cause than this
munificent support, coming as it does just as the issue of
20,000 copies of Mr. Stephen Coleridge's <cite>Hospital Guide</cite>
has been made at so great a cost to the Society."</p>

<p><i>June 1901.</i>&mdash;"Our editorial table is buried deep in
press cuttings from all parts of the kingdom."</p>

<p><i>March 1902.</i>&mdash;"We employ two press-cutting agencies
to send us cuttings from the journals of the whole English-speaking
world."</p>

<p><i>July 1903.</i>&mdash;"We start branches in various towns,
and send lecturers to speak at working men's clubs and
debating societies. All this means a very large expense.
We very often issue a pamphlet likely to do good by the
tens of thousands. Last year we issued 50,000 copies of
the 'Illustrated German Catalogue of Vivisectional Instruments
and Appliances.'"
<span class="pagenum"><a name="Page_306" id="Page_306">306</a></span></p>
</div>

<p>The smaller societies, of course, spend their funds
in the same sort of way. Thus the National Canine
Defence League says that its anti-vivisection work, the
most important of all its works, is earnestly carried
forward by (1) The Writer's League, in a ceaseless flow
of letters to the press; (2) The circulation of lists of
hospitals free from the shameful practice; (3) The publication
of twenty-one strong leaflets on the subject;
(4) The circulation of 300 copies of a book on the
subject. This society in two years sent out 650,000
leaflets and pamphlets; but they were not all of them
about experiments on animals. Another Society, in a
report published in 1902, enumerates the methods
which it employs for "the education of the public at
large." These include (<i>a</i>) the publication of literature;
(<i>b</i>) the holding of public meetings in all parts of the
United Kingdom; (<i>c</i>) the delivery of lectures with or
without limelight illustrations; (<i>d</i>) participation in
debates even with high scientific authorities; (<i>e</i>) inducing
the clergy and ministers of all Churches to
deliver sermons dealing with the subject; (<i>f</i>) organisation
of a press bureau, through which the newspaper
press of the country is watched, and correspondence
and articles contributed. This Society has also a van,
"the only one of its kind in existence. No sooner is
our winter and spring campaign concluded than the
van takes up the thread of the work and carries it
on through the summer, and it may truly be said that
the track of the van across country is white with the
literature which the van circulates on its educational
mission."</p>

<p>It is evident, from these and the like statements,
that these Societies, during the last quarter of a century,
have published a vast quantity of literature. We must
<span class="pagenum"><a name="Page_307" id="Page_307">307</a></span>
examine the style of that literature during some recent
years, and the arguments which it puts forward. But,
before we do this, let us consider what attitude is taken
by these Societies, or by well-known members of this
or that Society, toward certain problems and interests
that closely concern them.</p>

<h4>I</h4>

<p>They do not hesitate to take advantage of all those
improvements of medicine and surgery which have been
made by the help of experiments on animals. They
denounce the work of the present; but they enjoy all
the results of the past, and will enjoy all those of the
near future. "If anything of value to medicine has
been discovered by vivisection, it would be as absurd
to reject it on that account as it would be to abandon
Ireland because centuries ago we took it by force."
And again: "We are no more morally bound to reject
benefits acquired by indefensible means than are the
descendants of slaveholders bound to abandon wealth
originally acquired by the detestable abomination of
slavery." And again, the <cite>Animal's Friend</cite> (November
1903) takes as further instances the benefits derived
from body-snatching, political assassination, and the
French Revolution. But, in the matter of experiments
on animals, it is the very same men and women who
denounce these experiments and who profit by them.
What should we say of an anti-slavery reformer who
was himself drawing a vast income out of the slave
trade?</p>

<p>But there is one gentleman, and, so far as I know,
only one, who did carry his opinions into practice. He
told the story at a debating meeting&mdash;how his little girl
<span class="pagenum"><a name="Page_308" id="Page_308">308</a></span>
had a sore throat, and the doctor wanted to give antitoxin,
and he forbade it, and the child recovered. "Of
course," he says, "it was only an ordinary sore throat."
Truly, a great victory, and a brave deed, to make an
experiment on your own sick child.</p>

<h4>II</h4>

<p>The attitude of these Societies toward sport may
seem at first sight purely negative; but it is worth
study. I have the honour of knowing a very eminent
physiologist who will never shoot, because he thinks it
cruel&mdash;a man much abused by the National Society.
And Lord Llangattock, the President of that Society,
is well known as an a "ardent sportsman."</p>

<p>This contrast is of some interest. Let us see what
the National Society says about sport. Of course, it
is not bound to attack sport. But the reasons which it
gives for remaining neutral are to be noted.</p>

<p>1. It says, very truly, that it is in great part supported
by sportsmen.</p>

<p>2. It says, further, that the cruelties of sport lie
outside its own proper work:&mdash;</p>

<p class="blockquote">"Our opponents frequently ask us why we do not
attack some form of cruelty other than vivisection, which
they consider more heinous. Our Honorary Secretary
recently summarised this argument in his own amusing
manner thus: We must not arrest the man in
Tooting for kicking his wife till we have stopped the
woman in Balham starving her children, and we must
not arrest the woman in Balham for starving her children
until we have stopped the man in Tooting kicking his
wife." (1901.)</p>

<p>Later (1903) the <i lang="la" xml:lang="la">dramatis personæ</i> are a man in East
Islington jumping on his wife, and a woman in West
<span class="pagenum"><a name="Page_309" id="Page_309">309</a></span>
Islington stabbing her husband. But this argument,
of course, will not hold. For it is the same men who
denounce wounds made (under anæsthetics) for physiology,
and who make wounds (without anæsthetics) in
sport.</p>

<p>3. It says that the "object" of the sportsman is
to kill; but the "object" of the experimenter is to
torture:&mdash;</p>

<div class="blockquote">
<p>"There is a vast difference between the killing of
animals and the torturing of them before killing them.
The object of the sportsman is to kill his quarry; the
object of the vivisector is to keep his victim alive while
he dissects it."&mdash;Mr. Wood (1903).</p>

<p>"The object of the sportsman is to kill, and the object
of the vivisector is to keep his victim alive while he cuts
it up."&mdash;Lord Llangattock (1901).</p>

<p>"The vivisector is nothing if not a tormentor; the
sportsman is not a true sportsman if he seeks to inflict
pain on his quarry.... One (the pain of a horse falling on
asphalt) is the result of an accident to be deplored, the
other (the pain from an experiment) is done of devilish
malice prepense."&mdash;Leader in the Society's official journal,
(1899).</p>

<p>"I am not so mentally and ethically confused as to
be unable to distinguish between the entirely different
moral acts of killing and torturing."&mdash;Mr. Coleridge
(1901).</p>
</div>

<p>Here are four statements. One is by Mr. Wood,
the Society's lecturer; one by Lord Llangattock, its
President; one is published in its official journal; and
one is by Mr. Coleridge, its honorary secretary and
treasurer. That is the sort of thing which seems good
enough to the National Society to say to its friends in
Parliament; this childish nonsense about the true sportsman
and his quarry.
<span class="pagenum"><a name="Page_310" id="Page_310">310</a></span></p>

<h4>III</h4>

<p>The attitude of these Societies toward the medical
profession, and toward the Hospitals, must be studied.
Let us look through some numbers of the official
journal of the National Society, and see the attitude
that it sometimes takes toward the medical profession:&mdash;</p>

<div class="blockquote">
<p><i>June 1899.</i>&mdash;"The charm of this sort of thing is that
you are always sure of the <i lang="la" xml:lang="la">post-mortem</i> if of nothing
else."</p>

<p><i>July 1899.</i>&mdash;"There is a disease, well known to the
vestrymen of London, called 'the half-crown diphtheria.'
This is common sore throat, notified as diphtheria because
the vestry pays a fee of half-a-crown to the medical
notifier."</p>

<p><i>December 1899.</i>&mdash;"The patient died, made miserable
by the effect of inoculations which even on bacteriological
grounds gave no promise of success, but the scientific
physician, nowadays, must inject something in the way of
a serum."</p>

<p><i>March 1901.</i>&mdash;"There will always be those who, unable
to think for themselves or exercise their independence
on therapeutic methods, are prone to bow down before
authority which is self-assertive enough to compel the
obedience of weak minds. Such men would inject antitoxin
though every case died. They administer it not
knowing why."</p>

<p><i>April 1901.</i>&mdash;(From "Our Cause in the Press"):
"What effort does the medical profession make to
make clear to its clients what is well known to itself,
that disease is the result of wrong living? Practically
none at all. The medical profession as a whole have
winked at sin, and have merely sought to antidote its
results."</p>

<p><i>September 1901.</i>&mdash;"Some day we shall have our
<span class="pagenum"><a name="Page_311" id="Page_311">311</a></span>
surgeons disembowelling us just to see what daylight and
fresh air will do for the stomach-ache."</p>

<p><i>December 1901.</i>&mdash;"The new medicine demands a mere
laboratory habit; the patient is nothing, the disease
everything. He is a test-tube; such and such reagents
are needed to produce a certain result, and there you are.
The patient's malady, be it what it may, is due to a
microbe, a toxin, or a ptomaine; he must be inoculated
with the serum or antitoxin which counteracts his disease,
and this must be done not <i lang="la" xml:lang="la">secundum artem</i> but
<i lang="la" xml:lang="la">secundum scientiam</i>, and the science means the inoculating
syringe and so many cubic centimetres of filth wherewith
to poison the man's blood and so cure his disease,
though the victims die."</p>

<p><i>December 1903.</i>&mdash;(From "Our Cause in the Press"):
"Not only did we see great callousness in the field
hospitals in South Africa, but conversation with the class
that finds its way into our hospitals in England will reveal
that a great deal of refined cruelty is constantly occurring."</p>
</div>

<p>Why does the official journal of Mr. Coleridge's
society publish these things? For this reason&mdash;that
it must attack those methods that were discovered by
the help of experiments on animals. The medical
profession uses these methods. Therefore, that profession
must be attacked.</p>

<p>The same reason, of course, helps to explain the
National Society's attack on the great Hospitals of
London. It would take too long to tell here the whole
story of that attack. Three charges were made against
the Hospitals: (1) that they maltreat patients; (2) that
they promote the torture of animals; (3) that they
endow this torture at the cost of the patients. They
were accused, to put it plainly, of treachery and fraud;
and of course the Council of the King's Hospital Fund
got its share of abuse. Mr. Coleridge said on this
subject:&mdash;
<span class="pagenum"><a name="Page_312" id="Page_312">312</a></span></p>

<div class="blockquote">
<p>1. (Annual meeting at St. James's Hall, May 1901):
"How have Lord Lister, the vivisector, and his Committee
distributed the Prince of Wales's Hospital Fund?
They have so distributed this fund as to make it clear
to hospital managers that the more they connect their
hospitals with the torture of animals the larger will be
the grant they may expect to get from the Prince of
Wales's Fund. That fund, therefore, has been used as
an insidious but powerful incentive to vivisection."</p>

<p>2. (Annual meeting at St. James's Hall, 1902):
"Sheltering itself now in its most repulsive form behind
those ancient and glorious institutions, founded and
sustained for their Christ-like work of healing the sick,
sapping their foundations and smirching their fair fame,
malignant cruelty has taken up its position in its last
ditch. There it has summoned to its aid vast interests,
ancient prejudices, enormous endowments, and under
illustrious patronage it has pilfered the funds subscribed
for the poor."</p>
</div>

<p>With these statements before us (and it would be
easy to add to them) we cannot doubt that the plan of
campaign against all experiments on animals is also
hostile to the Hospitals, whenever that hostility seems
likely to be of the very least use to the cause.</p>

<hr class="c15" />

<p>Surely there are charities more worthy of subscriptions,
donations, and legacies than these Anti-vivisection
Societies. They quarrel among themselves; they
spend vast sums of money on offices, salaries, press-cuttings,
reprints, lectures and meetings, tons of
pamphlets and leaflets. Their members denounce all
experiments done now, while they enjoy the profit of
all experiments done before now; they say that the
object of the physiologist is to torture his victim out of
<span class="pagenum"><a name="Page_313" id="Page_313">313</a></span>
devilish malice prepense; they accuse doctors of fraud,
and lying, and refined cruelty, and madness, and winking
at sin; they blacklist and boycott the best Hospitals.
And the whole costly business, these thirty years, has
done nothing to stop these experiments; they have
increased rapidly. Surely, if a man wishes to help and
comfort animals, he had better give his money to the
Home for Lost Dogs, or the Home of Rest for Horses.</p>

<h3>II. <span class="smcap">Literature.</span></h3>

<p>We have now to examine the style of the literature
of these societies. But, out of such a vast store of
journals, pamphlets, and leaflets, we can only take one
here or there.</p>

<p>From time to time a book or a pamphlet is, for good
reasons, withdrawn. Thus, in 1902, the London
Society withdrew <i>Dark Deeds</i>. (<i>The Shambles of Science</i>,
now impounded, was published by a chairman of committee
of the National Society, but not by that society.)
In 1900 the National Society withdrew one or more
pamphlets involving acceptance of Dr. Bowie's mistranslation
of Harvey. In 1902 it withdrew and destroyed
a whole store of diverse pamphlets, and appealed to its
supporters to "refrain from circulating any literature
not issued from our office by the present committee";
that is to say, it warned them to distribute no literature
but its own, and not all even of that. But the withdrawal
of a few books and pamphlets makes very little
difference; and most of them are "revised" and brought
out again. Take, for example, the <i>Nine Circles</i>. It
was planned and compiled for Miss Cobbe; Mr. Berdoe
<span class="pagenum"><a name="Page_314" id="Page_314">314</a></span>
was "urgently requested by her to point out to her any
scientific errors or possible inadvertent misrepresentations
of fact, and correct or expunge them"; and he
"carefully read through the proof-sheets." The book
purported to be an exact account, from original sources,
of certain experiments, some made abroad, some in this
country. It was attacked by Sir Victor Horsley at the
Church Congress at Folkestone, October 1892, and was
withdrawn, revised, and brought out again. Our only
concern here is to see what the official journal of the
National Society said of the revised issue. This official
journal, the <cite>Zoophilist and Animal's Defender</cite>, was
started in May 1881, under the shorter title of the
<i>Zoophilist</i>. It speaks of itself as a "scientific journal,"
and as "the recognised organ of the anti-vivisection
movement in England." It is published monthly, and
may be obtained through any bookseller. In 1883 it
was edited by Miss Cobbe; in 1884 by Mr. Benjamin
Bryan; in 1898 by Mr. Berdoe. In 1903, Mr. Coleridge,
apologising for an error made in it in 1898, says:
"At that time I had not the control over its pages that
is at present accorded to me." Thus it is, I believe,
still edited by Mr. Berdoe, and is, or was in 1903, controlled
by Mr. Coleridge. And we are bound to note
here that Mr. Berdoe was in great part responsible for
the <i>Nine Circles</i>; and in 1897 was responsible for
certain statements as to the use of curare, which the
Home Secretary, in the House of Commons, called
"absolutely baseless."</p>

<p>Let us now examine the style of this "official journal."
And, to begin with, what does it say about the
<i>Nine Circles</i>? To make this point clear, let us put in
parallel columns what was said by Sir Victor Horsley
<span class="pagenum"><a name="Page_315" id="Page_315">315</a></span>
of the original edition in 1892, and what was said by
the <i>Zoophilist</i> in 1899 of the revised edition:&mdash;</p>

<div class="blockquote">
<p class="title2"><i>Sir Victor Horsley, Oct. 1892.</i></p>

<p>I have taken the trouble to
collect all the experiments in
which cutting operations are
described as having been performed
by English scientists,
and in which I knew anæsthetics
to have been employed.
These experiments are 26 in
number. In all of them chloroform,
ether, or other anæsthetic
agent was employed. But of
these 26 cases, Miss Cobbe
does not mention this fact at
all in 20, and only states it
without qualification in two out
of the remaining six. When we
inquire into these 20 omissions
in the 26 cases, we find in the
original that again and again
Miss Cobbe has, in making her
extracts, had directly under her
eyes the words "chloroform,"
"ether," "etherised," "chloroformed,"
"anæsthetised," "during
every experiment the animal
has been deeply under the influence
of an anæsthetic," and so
forth.</p>

<p class="title2"><i>The "Zoophilist," July 1899.</i></p>

<p>A revised edition has been
issued, which is a stronger indictment
against the vivisectors
than the original work. There
were some half-dozen omissions
in the first edition concerning
the administration of anæsthetics
in the preliminary operations,
but the cruelty of the
experiments was in no case
modified by the fact that a
whiff of chloroform was possibly
administered, as stated in
the reports, at the beginning of
the operation. Our opponents
may boast of their success in
detecting the omission to dot
the i's and cross the t's in the
first edition of the <i>Nine Circles</i>,
but there are some victories
which are worse than a defeat.
We have replaced the lantern
with which we examined the
dark deeds of the laboratories
by the electric searchlight. The
"researcher" will find it hard to
discover a retreat where its rays
will not follow and expose him.</p>
</div>

<p>For another instance of the inaccuracy of the <i>Zoophilist</i>
we have what it said about Professor Sanarelli's
experiments in South America on five human beings.
Nobody defends him here. But the point is that the
<i>Zoophilist</i> in 1899 said that they had all been killed;
and in 1902 admitted that they had all recovered. Or,
for another instance, we have what it said in 1902
about the case of His Majesty the King. (For these
statements, see <i>Zoophilist</i>, August 1902 and September
<span class="pagenum"><a name="Page_316" id="Page_316">316</a></span>
1903; also its report, October 1902, of Mr. Wood's
speech at Exeter.)</p>

<p>But let us take a wider view. A journal, like a
man, is known by the company that it keeps. Whose
company does the <i>Zoophilist</i> keep? Why does it talk
of <i>Our excellent cotemporary, Humanity</i>&mdash;<i>Our valiant
cotemporary, Le Médecine</i>&mdash;<i>Our excellent cotemporary, The
Herald of the Golden Age</i>? Again, among the journals
that it quotes, some of them very frequently, are the
<cite>Topical Times</cite>, <cite>Broad Views</cite>, <cite>Modern Society</cite>, <cite>Madame</cite>,
the <cite>Humanitarian</cite>, the <cite>Pioneer</cite>, the <cite>Vegetarian</cite>, the <cite>Voice
of India</cite>, the <cite>Herald of Health</cite>, the <cite>Rock</cite>, the <cite>New Age</cite>,
the <cite>Journal of Zoophily</cite>, the <cite>Hom&oelig;opathic World</cite>, <cite>Medical
Liberty</cite>, and the <cite>Honolulu Humane Educator</cite>. This may
be very good company, but it is not all of it the best
company for a "scientific journal." Still, it may be
better company than the American <cite>Medical Brief</cite>, the
<cite>Journal de Médecine de Paris</cite>, and the Belgian <cite>Le Médecine</cite>.
These journals, being veritable "medical journals,"
are quoted in the <cite>Zoophilist</cite> with the most
amazing frequency and at great length; which is a
compliment that they do not receive from other medical
journals. They are, indeed, as vehemently anti-Pasteur
and anti-antitoxin as the <i>Zoophilist</i> itself. Take what
the <i>Medical Brief</i> says:&mdash;</p>

<div class="blockquote">
<p>"Bacteriology originated in Continental Europe, where
the minds of a superstitious race were further unbalanced
by constant delving in pathology, putrefaction, and morbid
anatomy. When it spread to the new world, it also
became blinded with the revolutionary and fanatical tendencies
lying near the surface in such a civilisation."</p>

<p>"They say if you give a calf rope enough, he will hang
himself. Bacteriology is equally clumsy and stupid....
What excuse can be found for the cowardice and ferocious
<span class="pagenum"><a name="Page_317" id="Page_317">317</a></span>
ignorance which, under the shadow of the stars
and stripes, resurrects the sentiment of the Middle Ages
to protect the fraud, seeks to rob the individual physician
of free judgment, and denounces him for failing to use
the nasty stuff?"</p>

<p>"All Continental Europe is suffering from a sort of
leprosy of decadence, mental and moral. The spiritual
darkness of the people affects all the learned professions,
but more especially medicine."</p>
</div>

<p>Such is the <i>Medical Brief</i>, which the official journal
of Mr. Coleridge's society quotes incessantly, calling it
"an American monthly of great ability and without a
trace of the scientific bigotry and narrow-mindedness
which is so prominent a feature in some of our own
organs of medical opinion." Next we come to the
<cite>Journal de Médecine de Paris</cite>. This is anti-Pasteur;
the editor, Dr. Lutaud, came to London in 1899, and
gave a lecture on "the Pasteur superstition" at St.
Martin's Town Hall. From a report of it in the <i>Star</i>
we may take the following sentences:&mdash;</p>

<p class="blockquote">"The result of the serum craze had been that the
hospital was neglected for the laboratory. Microbes of
all the diseases were found in perfectly healthy subjects.
Microbes existed, but as a consequence, not a cause.
Toxins which the seropaths professed to find were only
the results of normal fermentation. The English public
had always supported him in his fifteen years' struggle
against Pasteurism."</p>

<p>Dr. Lutaud, says the National Society, is "the great
authority." The <cite>New England Anti-vivisection Monthly</cite>
in 1900 calls him one of "the brightest scientists of
modern times." His <cite>Journal de Médecine de Paris</cite>
recalls the <cite>Medical Brief</cite>:&mdash;</p>

<p class="blockquote">"To wish to apply the same methods of treatment,
whether preventive or curative, for two morbid conditions
<span class="pagenum"><a name="Page_318" id="Page_318">318</a></span>
(a <i>wound</i> with the point of entry <i>abnormal</i> and an
infectious <i>malady</i>) in essence so different, is to commit a
gross error.... The sick are destroyed by that which
cures their wounds."</p>

<p>These two "medical journals," the <cite>Medical Brief</cite> and
the <cite>Journal de Médecine de Paris</cite>, are upheld by the
National Society as though they were expert witnesses
of irresistible authority, and are quoted with a sort of
ceaseless worship in that Society's official journal. Also
it quotes the <cite>Herald of Health</cite>; and <cite>Medical Liberty</cite>, "a
monthly publication issued by the Colorado Medical
Liberty League, Denver, Colo., whose eloquent editor
seems to be an uncompromising foe to medical bigotry
and monopoly, and humbugs of every description."</p>

<p>Such are the medical journals which support the
<i>Zoophilist</i> as a scientific journal. Now let us take
another point of view. Let us consider whom the
<i>Zoophilist</i> praises, and whom it condemns. That, surely,
is a fair test of an official journal. And we get a clear
result. The late Lord Salisbury and Mr. Arthur Balfour
are "notoriously pro-vivisectionist"; Lord Lister has
"apostatised from the anti-septic faith"; M. Pasteur
is a "remorseless torturer"; the late Mr. Lecky was
"degenerate," because he "performed the <i lang="la" xml:lang="la">volte-face</i> and
went over to our opponents"; and the late Professor
Virchow was subjected to "scathing criticism" by one
Paffrath, and was proved to be absurd. But its praises
are given to a very different set of men.</p>

<p>There is no room here to note the lighter moods of
the <i>Zoophilist</i>; its jokes about cats and catacombs, and
two-legged donkeys and four-legged donkeys, and how
to catch mosquitoes by putting salt on their tails&mdash;and
it will even <i>break its jest on the dead</i>&mdash;but it rebukes
another journal for levity, saying, <i>We regret to see our</i>
<span class="pagenum"><a name="Page_319" id="Page_319">319</a></span>
<i>painful subject treated in this manner.</i> No room, either,
for its description of anti-vivisectionist plays, poems,
novels, and sermons. Let us, to finish with, take a
few statements from its pages, almost at random; some
of them are reprinted there from other sources. The
supply is endless; let us limit ourselves to six of
them:&mdash;</p>

<div class="blockquote">
<p>1. "As other bacteria (beside those of malaria) were
found not to bear sunlight or air, but to habitats in <i lang="la" xml:lang="la">loca
scuta situ</i> (? to inhabit <i lang="la" xml:lang="la">loca senta situ</i>), in filth and
noisomeness, their habits and customs preached again
the old doctrine, 'Let in sun and air and be clean,' as
earnestly as those who thought health was due to sun
and air and water and fire, the four old elements, and act
accordingly, without dissecting hecatombs of animals to
prove a thousand times over that if you boiled or baked
or drowned or freezed living creatures they would die, or
that microscopic parasites did pretty much what visible
parasites have been always known to do." (Loud applause)&mdash;Report
of a speech by the Bishop of Southwell
(1901).</p>

<p>2. "It is just as well that you should have heard what
the clever level-headed lawyer (Mr. Coleridge) thinks
about this abominable conspiracy of cruelty and fraud
and impious inquisitiveness which is called vivisection.
(Cheers.) ... We are sending out on the world in every
direction multitudes of young men who have been trained
as surgeons, and they have lived by cutting (reference
here to the medical students in <i>Pickwick</i>), and we are
sending these young men out with this <i lang="la" xml:lang="la">cacoëthes secandi</i>,
this mania for cutting for the mere sake of cutting. I
should not be surprised if they tackle our noses or our
ears, and set about mutilating us in that way."&mdash;Archdeacon
Wilberforce (1901).</p>

<p>3. "The task of the crusader against vivisection is not
to reason with the so-called scientist, not to truckle to
pedants in the schools, or palter with callous doctrinaires,
<span class="pagenum"><a name="Page_320" id="Page_320">320</a></span>
but to inform and arouse the people; and when John
Bull is prodded from his apathy, and startled from his
stertorous snore, he will rise and bellow out a veto on
the elegant butcheries of pedantic libertines, and rush
full tilt with both his horns against their abattoirs of
cruelty and passion, pharisaically vaunted as research,
until the gates of hell shall not prevail against him."&mdash;The
Rev. Arthur Mursell (1901).<a name="FNanchor_46" id="FNanchor_46" href="#Footnote_46" class="fnanchor">[46]</a> </p>

<p>4. "It has been my experience of anti-vivisection
among Romanists, that nothing suited my purpose better
than taking it for granted that the worshippers of St.
Francis, St. Bernard, &amp;c., must, <i>of course</i>, be on our side."&mdash;(1902.)</p>

<p>5. "Given money, and influential patronage, the vivisector
now expects a time after his own heart, while
professedly engaged in investigating the supposed causes
of cancer, or the transmissibility of tuberculosis. He
can inflict the most horrible and prolonged tortures on
miserable animals, with such a plausible excuse in
reserve, that he is endeavouring all the while to find
cures for the ailments of high personages and millionaires."&mdash;(1902.)</p>

<p>6. "The day of drugging and scientific butchery is
drawing to a close. Already the calm, reassuring voice
of the new Life Science, loud and clear to the few, is
faintly audible to the many. The sharp, crucial knife,
with its dangerous quiver so dear to the heart of the
surgeon, the poisonous drug, will be things of the past.
Wisdom, thy paths are harmony and joy and peace."&mdash;(1902.)</p>
</div>

<hr class="c15" />

<p>Such is the frequent level of the <i>Zoophilist</i>, the official
journal of the National Society, edited by Mr. Berdoe,
controlled by Mr. Coleridge. Let us now take one
<span class="pagenum"><a name="Page_321" id="Page_321">321</a></span>
more of that society's publications, a pamphlet entitled
<cite>Medical Opinions on Vivisection</cite>. Here, if anywhere,
should be the society's stronghold. If it could show
a large and important minority of the medical profession
opposed to all experiments on animals, its power
would be greatly increased. On three occasions,
many years ago, the medical profession did express
its opinion. At two of the annual meetings of the
British Medical Association, and at a meeting of the
London International Medical Congress, resolutions
were passed affirming the value and the necessity of
these experiments. At one of these meetings there
was one dissentient vote; at one, two;<a name="FNanchor_47" id="FNanchor_47" href="#Footnote_47" class="fnanchor">[47]</a>  at one, none.
These three meetings were truly representative; they
were the great meetings of the clans of the profession,
from all parts of the kingdom, for a week of practical
work tempered by festivities. What more could any
profession do than to go out of its way three times
that it might record, in fullest assembly, its belief?
And most certainly it would do the same thing again,
if it thought that any further declaration were needed.</p>

<p>There are in this country about 40,000 medical men.
The National Society's pamphlet quotes 39, or one in
1000. It could quote more; but we must take what
it gives us. Of these 39, we may fairly exclude Professor
Koch, Sir Frederick Treves, and the late Sir
Andrew Clark, who would certainly wish to be thus
excluded. Sir Frederick Treves, who is quoted with
a sort of explanatory note, has told us in the <cite>Times</cite>
what he thinks of the way in which his name has been
used; Sir Andrew Clark is quoted, also with an explanatory
note, for an <i lang="la" xml:lang="la">obiter dictum</i>; and Professor
Koch for no discoverable reason. That leaves 36. Of
<span class="pagenum"><a name="Page_322" id="Page_322">322</a></span>
these 36, at least 11 (probably more) are dead; one
died about 1838, another was born in the eighteenth
century, another died more than twenty years ago. Of
the remaining 25, one is Dr. Lutaud, one is Mr. Berdoe,
one an American doctor, not famous over here, one a
veterinary surgeon, one (I think) opposed to vaccination,
and three inclined to hom&oelig;opathy; one has mistranslated
Harvey to the advantage of the National
Society's cause, one has written <i>Hints to Mothers</i>, and
one has written <i>How to Keep Well</i>. Of these 25
gentlemen, one belongs to a hom&oelig;opathic hospital, two
to provincial hospitals, and one to a hydropathic institute
and a children's sanatorium; the rest of them hold
no hospital or school appointment of any sort or kind.
I may be wrong over one or two of these names; but,
so far as I can see, I have given an exact account of
the value of these <i>Medical Opinions on Vivisection</i>. And,
if we take the dates of these opinions, we find one in
1830, one in 1858, and seven in 1870-1880. Anyhow,
what is the value of an opinion that all experiments
on animals are <i>arrant and horrible Sepoyism
wearing the mask of Art and Science</i>?</p>

<p>Let us leave the National Society, and turn to the
Canine Defence League, and examine that part of its
literature which is concerned with experiments on
animals. Take the following sentences from pamphlets
179 and 204:&mdash;</p>

<div class="blockquote">
<p>"Among the general public the majority are under the
impression that these so-called physiological experiments
are conducted under the influence of anæsthetics, and
that the subjects are rendered insensible to pain; this,
however, is <i>not the case</i>, and I am informed that a large
proportion&mdash;considerably more than half&mdash;of the licenses
<span class="pagenum"><a name="Page_323" id="Page_323">323</a></span>
dispense with anæsthetics entirely. The phenomena of
pain are absolutely essential to any practical issue."</p>

<p>"All diseases have a mental or spiritual origin. Upon
this subject a large treatise might be written. I have
carefully thought this matter over, and can come to no
other conclusion. Can we imagine any wild bird confined
to its nest with rheumatism, or neuralgia, or consumption,
or asthma, or any other affection whatever?
I believe them all to be entirely free from disease; that
is, all which have retained their freedom, and thus have
not come under the baneful influence of man. Take,
again, the fishes, and ask whether any fisherman ever
caught a fish found to be diseased. This subject is an
interesting, though a somewhat melancholy one."</p>
</div>

<p>Next, as an example of the literature of the London
Society, let us take a speech made at St. James's Hall,
May 26, 1903, by Dr. Hadwen, of Gloucester, who is
also vehemently opposed to vaccination. He and Lieutenant-General
Phelps, at the time of the disastrous
smallpox epidemic in Gloucester in 1896, were leaders
of the anti-vaccinationists. It would be easy to give
other instances of the sympathy between anti-vivisection
and anti-vaccination. But our business is not
with Dr. Hadwen at Gloucester, but with him at St.
James's Hall. He says to the London Society:&mdash;</p>

<p class="blockquote">"We are told we must pay attention to what the experts
tell us. My opinion is this: If there is one person in the
whole of God's creation that wants looking after, it is the
expert. (Laughter.)"</p>

<p>Of the House of Commons, he says:&mdash;</p>

<p class="blockquote">"If there is one thing in the world that will move a
member of Parliament, it is to know that any particular
policy will carry votes along with it. (Hear, hear.) You
can bring any member of Parliament to your knees as
<span class="pagenum"><a name="Page_324" id="Page_324">324</a></span>
long as you show him that he has his constituency at
his back; and with all due respect to our noble chairman,
I am bound to say that my experience of members of
Parliament is this&mdash;that their consciences go as far as
votes, and do not extend very much farther." (Laughter
and applause.)</p>

<p>He describes an imaginary experiment under curare,
and is interrupted by a cry of "Demons!" He goes
on:&mdash;</p>

<p class="blockquote">"Yes, madam, they are demons. (Applause.) I know
no other word to describe experimenters who can submit
sentient and sensitive creatures, almost human in intelligence
and faith, to diabolical experiments, whilst their
victims are rendered helpless and voiceless by a hellish
drug. (Applause.) I cannot understand how in a land
like this, that boasts of her Christianity and of her
liberty, men, women, clergy, and politicians can allow
this cowardly science to stand before us, and this
demoniacal work to be carried on. (Loud cheers.)"</p>

<hr class="c15" />

<p>We have now seen something of the style of the
literature of these Societies; and, in the next chapter,
we will consider its arguments. I do not deny that
its style is sometimes at a higher level than the examples
which I have quoted. But I do say that I
could fill a book of 100 pages with quotations from
journals or pamphlets of the last few years, all of
them on the lower level. And in this chapter I
have practically quoted nobody but those who are the
leaders of the opposition to all experiments on animals.
The official journal of this Society, the annual report
of that Society, the leaflets which are sent in answer
to a formal request for literature&mdash;I have quoted these,
as they came to hand, just going through them and
marking those passages which were to my purpose.
<span class="pagenum"><a name="Page_325" id="Page_325">325</a></span></p>

<h3>III. <span class="smcap">Arguments</span></h3>

<p>We have seen that the societies arose out of the Act,
and not the Act out of them; that they are divided or
hostile; and that they have next to nothing to show for
all the vast sums which they have received. Also we
have noted the style of literature which they send broadcast
over the country; and the "medical journals" and
"medical opinions" that are in favour of the cause;
and the general tone and frequent level of the official
journal of the National Society. Still, a good cause
may be ill served; nobody minds, after all, the style of
a thing, so long as it is true. Let us come to the heart
of the matter. What is the nature of the arguments
and evidences of these societies? They desire to bring
about the absolute prohibition, as a criminal offence,
of all experiments on animals. By what facts, what
records, what statistics, do they maintain this attempt
to mend or end the present Act?</p>

<p>Here, at the risk of repetition, let me make quite clear
what they are fighting against. Nine out of ten experiments
are bacteriological. That is to say, 90 or 95
per cent. Of these inoculations, more than a third are
made in the direct service of the national health, and
as it were by the direct orders of Government. A vast
number of them are wholly painless; nothing happens;
the result is negative; the thing does not take. Some
are followed by disease, and the animal is painlessly
killed at the first manifestation of the disease, or recovers,
or dies of the disease. The fate of that animal is the
fate of all of us; it has got to die of something, and it
dies of it. Anyhow, the talk about torture-troughs and
cutting-up has no place here; and the word vivisection,
<span class="pagenum"><a name="Page_326" id="Page_326">326</a></span>
by a gross and palpable abuse, is false nine times out
of every ten. Of the remaining 10 per cent. of all
experiments; in those that are made under the License
alone, or under the License <i>plus</i> Certificate C, the question
of pain does not arise. The animal is anæsthetised,
and is killed under that anæsthetic. The remaining
3 per cent. of all experiments are those that are
made under the License <i>plus</i> Certificate B (or B + EE,
or B + F). The initial operation is done under the
anæsthetic; the animal is allowed to recover; it may
be, practically, none the worse for it. Or it may be
the worse for it, and therefore die, or be killed. But
Certificate B is <i>not</i> allowed for any infliction of pain
on the animal through the operation wound, and never
will be.</p>

<p>Here are two sets of experiments: those under Certificate
A, and those under Certificate B. One is 90
per cent. of all experiments; the other is 3 per cent.
Nine out of ten experiments are inoculations, and the
operation of the tenth is done under an anæsthetic.
That is the first fact, which we must fix in our minds,
before we consider the arguments of the societies.</p>

<p>Next, the dates and the sources of their evidence.
They wish to stop the experiments that are now made
in this country. They are bound, therefore, to produce
"up-to-date" evidence, and from home sources;
not that which is thirty years old, or comes from
sources far away. This present use of animals, here
and now, under the restrictions of the Act, is what
they are fighting; they are bound to draw their instances
from here and now.</p>

<p>But this would not suit them at all: they could not
bear to be thus limited to here and now. Their arguments
and their instances extend over thirty or more
<span class="pagenum"><a name="Page_327" id="Page_327">327</a></span>
years, and are drawn from all parts of the world, from
the United Kingdom, the United States, France, Germany,
Italy, from every country. Journals of Physiology,
text-books, reports, medical journals, British and
foreign, are ransacked to find evidence for the cause;
there is a regular system, year in year out, a sort of
secret service or detective force, a persistent hunting-up
of all scraps and shreds of evidence. One society advertised,
in a daily paper, that it wanted confidential communications,
from medical students, as to the practices
of the laboratory. Another, seeing the chance of a
prosecution, says, "Special inquiries were made on the
subject, and the society's solicitor went to Belfast to
conduct these inquiries on the spot." All this espionage
is sure now and again, in thirty years, to detect something
which it can magnify into a scandal. And when
a fault is found, even a little one, oh the joy in the
ranks of the societies. And, at once, the fault, exaggerated,
and highly coloured, is made a <i lang="la" xml:lang="la">locus classicus</i>,
a commonplace of every drawing-room meeting. What
is the date of it, what was the place of it? Was it
long ago, was it far from here? Still, never let it
drop; what one did then, they are all doing now, all
of them of malice prepense; let us proclaim the blessed
news from every platform; and please remember us in
your Wills.</p>

<p>Among the arguments against all experiments on
animals, is this very common argument, that the truth
about them is too horrible to be told. "We dare not
produce our brief," says the Rev. Nevison Loraine,
at the annual meeting of the London Society in 1901;
"it is only the courage of a lady that dares to produce
tales so harrowing as those that have been briefly
alluded to to-day; and it is part of the weakness of
<span class="pagenum"><a name="Page_328" id="Page_328">328</a></span>
our cause with the public that we cannot tell the whole
story." But, not long ago, the courage of two ladies,
officers of a Swedish Anti-vivisection Society, honorary
members of Mr. Coleridge's society, did produce a book
full of harrowing tales; they told the whole story to
the Lord Chief Justice and a jury. Was not that
producing their brief? <i>I have here in my pocket something
I have not got the nerve to read to you</i>, says Archdeacon
Wilberforce, at the annual meeting of the
National Society in 1901; and the next minute a
lady in the audience is crying out, <em>Do not go on, we
cannot bear it</em>; and he says, <em>You have got to bear it.
Good God, they have got to suffer it.</em> Is not that producing
his brief? Mr. Coleridge, in 1902, sends out
12,000 copies, just to begin with, of an illustrated
German catalogue of laboratory instruments: <i>The
question of thus scattering abroad this fearful document
has been the subject of very grave consideration.... We
have launched upon the world this terrible proof of what
vivisection really is, with a full sense of our responsibility.</i>
Is not that producing his brief? These things in the
pocket, and fearful documents, and briefs that Mr.
Loraine dares not produce, are apt to say little or
nothing about anæsthetics, and to be silent over the
fact that nine out of every ten experiments are
bacteriological, and to over-emphasise experiments made
many years ago or a thousand miles away. You bring
the speaker down to now and here, to the text of the
Act, to the reports to Government, to the Home
Secretary's own words in Parliament; and you are
told that they are all in a conspiracy, all liars more
or less, and that the truth is in the societies, especially
in one of them. Or you bring him down to the good
<span class="pagenum"><a name="Page_329" id="Page_329">329</a></span>
that these experiments have done, the lives that they
have saved; and at once he is off like the wind:&mdash;</p>

<div class="blockquote">
<p>"The society does not concern itself with the results
of vivisection, whether good or bad, and thinks it is
beside the mark to discuss them." (Report of the
Canine Defence League, 1903.)</p>

<p>"When the angel of pity is driven from the heart;
when the fountain of tears is dry, the soul becomes a
serpent crawling in the dust of the desert." (Colonel
Ingersoll.)</p>

<p>"I make no pretence to criticise vivisectional experiments
on the ground of their technical failure or success.
I dogmatically postulate humaneness as a condition of
worthy personal character." (Mr. Bernard Shaw.)</p>

<p>"The vivisector, when he stands over his animal,
whether with anæsthetics or without anæsthetics, is
creating, even if the physical health of the nation is
enhanced by it, a moral shroud not only for himself,
but a moral shroud the edges of which are continually
extending into the thought atmosphere, and so deadening
the national conscience at large." (Mr. Herbert
Burrows.)</p>

<p>"The developed taste for blood and cruelty must
in the end find its full satisfaction in the vivisection of
human beings when they have the misfortune to come
under the power of our future doctors." (Bishop Bagshawe.)</p>
</div>

<p>Here, in these five sentences taken merely out of
the heap, is the ethical argument; so facile, so pleasant
to self, so confident of a good hearing. No wonder
that the societies, now that the facts of science are too
strong for them, are falling back on the facts of ethics.
In the beginning, thirty years ago, they were created
out of ethics; they were born auspiciously. What a
welcome they had! Tennyson and Browning and
Ruskin, Westcott and Martineau, the late Lord Shaftesbury,
<span class="pagenum"><a name="Page_330" id="Page_330">330</a></span>
and her Majesty the late Queen&mdash;these all, and
many more, among whom were some of the best men
and women of the Victorian Age, were their friends.
There never was a cause that enjoyed a better send-off.
Everything was in its favour. Magendie and
Schiff and Mantegazza had made people sick of experiments
on animals. The advocates of the method had
not very much to show on its behalf; no bacteriology,
save as a far-off vision; no great discoveries lately in
physiology or pathology. Thirty years ago, good and
true men fought a way for the Act; and there are few
now who think the worse of them for it, or grudge
them that victory. But, though ethics may be the
same always, yet the arguments from them are not.
The ethical argument now&mdash;we try to find it, and it
takes all shapes, and vanishes in a cloud of foul
language. That text about the sparrows, which is
never quoted in full; that fear about the vivisection
of hospital patients; and all that nonsense about
moral shrouds, and serpents in the desert, and developed
tastes for blood; and Mr. Bernard Shaw, who on
May 22nd, 1900, suggests to the National Society that
"<i>the laceration of living flesh quickens the blood of the
vivisector as the blood of the hunter, the debauchee, or the
beast of prey is undoubtedly quickened in such ways</i>,"<a name="FNanchor_48" id="FNanchor_48" href="#Footnote_48" class="fnanchor">[48]</a>  and
a week later, before the London Society, dogmatically
postulates humaneness as a condition of worthy personal
character; and the lady who says, <em>Oh, Pharisees
and hypocrites! Oh, cruel and ruthless egotists!</em> and the
Falstaff's army of the osteopath, and the fruitarian, and
the <i>anti</i> this, that, and the other, who follow the cause;
<span class="pagenum"><a name="Page_331" id="Page_331">331</a></span>
and all these discordant societies, and the begging for
money&mdash;where, in all this confusion, can we find the
ethical argument? Mercy is admirable, but I will wait
till mercy and truth are met together. Let us leave
the societies to their ethics, and see what they have
to say for themselves in the lower realms of science.</p>

<h4>I</h4>

<p>First, there are the general arguments. That experiments
on animals are useless, or of very little use;
that they contradict each other; that you cannot argue
from animals to men, or from an animal under experiment
to a man not under experiment; that the discoveries
made by the help of experiments on animals
might have been made as well, or better, without that
help; that the way to advance medicine and surgery
has been, and is, and always will be, not by experiments
on animals, but by clinical and <i lang="la" xml:lang="la">post-mortem</i> studies.
These and the like arguments we may call general;
they are the complement of the horrible stories and
magic-lantern slides of the itinerant lecturer.</p>

<p>1. The vague statement that these experiments are
of little use, may be answered in several ways. It
does not come well from those who say that the
question is ethical, not utilitarian; who neither know,
nor care, nor are agreed, what is the real value of
these experiments. "I challenge you," says one, "to
show me what good they have done." Another says,
"I admit that they may perhaps have done a little
good; but so little; they are a bad investment; you
would get a better return from other methods of work."
Another says, "I don't care whether they have or have
<span class="pagenum"><a name="Page_332" id="Page_332">332</a></span>
not done good; this is a matter of conscience; we must
not do evil that good may come; I grant all, or nearly
all, your instances&mdash;malaria, and diphtheria, and cerebral
localisation, and so forth; but the question is a moral
question, and we must not inflict pain on animals, save
for their own good." Probably the best answer is,
that good has indeed come, and is coming, and so far
as we can see will come, out of these experiments;
that the instances given are indeed true; that these
results were won out of many failures, and contradictions,
and fallacies, and harkings-back; and that they
have stood the test of time, and will underlie all better
results, all surer methods, that shall take their place.</p>

<p>2. The statement that "you cannot argue from
animals to man" is not true. Why should it be?
Take tubercle, tetanus, or rabies. The tubercle-bacillus
is the same thing in a man, a test-tube, or a
guinea-pig; the virus of rabies is transmitted from
dogs to men; oysters harbour typhoid, fleas carry the
plague, diverse mosquitoes carry malaria, yellow fever,
filariasis, and dengue. Take the circulation of the
blood, the nature and action of the motor centres of
the brain, the vaso-motor nerves, the excretory organs,
the contractility of muscle, the blood-changes in respiration&mdash;where
are the differences to support this statement
that you cannot argue from animals to men?</p>

<p>3. The twin statements, that all the results got by
the help of experiments might have been got some
other way, and that clinical study and <i lang="la" xml:lang="la">post-mortem</i>
study are infinitely more fruitful than experimental
study, may be taken together. We are told that anybody
could have discovered the circulation by injecting
the vessels of a dead body. Well, Malpighi tried to
discover the capillaries by this method, and failed. We
<span class="pagenum"><a name="Page_333" id="Page_333">333</a></span>
are asked to admit that phrenology, long before physiology,
discovered the truth about the surface of the
brain; <i>I have been told</i>, says Mr. Coleridge at an
annual meeting of his society, <i>that the physiologists can
now triumphantly map out the human brain. I think the
phrenologists have always been able to do that, and whether
they or the vivisectors do it best does not much matter.</i> We
are told that the use of thyroid extract could have been
discovered right away by mere chemistry and thinking.
We hear of a proposal for a bacteriological laboratory
on anti-vivisectionist principles, where no inoculations
shall be made. This argument, that the whole thing
might have been done some other way, must repair its
wit, and find better instances. Then comes the incessant
appeal: "Stick to clinical work; study diseases at
the bedside, in the <i lang="la" xml:lang="la">post-mortem</i> room, in the museum,
anywhere but in the laboratory. The Hospital taught
you to neglect these methods; it made experiments on
its patients, it cheated the public, it sheltered malignant
cruelty in its most repulsive form under illustrious
patronage. Set aside pathology; just sit by your
patients long enough; that is the way of discovery."</p>

<p>Or the appeal takes another tone: "Stick to sanitation.
If only everybody were healthy, everybody
would be well. Diseases are due to dirt, to vice, to
overcrowding, to want of common-sense. Abolish all
slums, disinfect all mankind, body and soul, make every
house clean and wholesome, no bad drainage, or ventilation,
or water, or food. Leave your torture-chambers,
and open your eyes to the blessed truth that, if everybody
were healthy, and everybody were good, everybody
would be well." What is the use of talking in this
way? Suppose that all the physiologists suddenly
rushed into practice, and all the bacteriologists were
<span class="pagenum"><a name="Page_334" id="Page_334">334</a></span>
turned into medical officers of health. What would be
gained? What difference would it make? The physiologists,
of course, would merely vivisect their hospital
patients; and the bacteriologists would hardly feel the
change, for many of them are medical officers of health
already, public servants, appointed by the State.</p>

<p>This argument, that practice is fruitful of discoveries,
and science is barren of them, reaches its highest absurdity
in the National Society's official journal; which
praises extravagantly those methods of practice which
were not discovered by the help of experiments on
animals; praises them without experience, criticism, or
understanding. It finds a statement, in the <i>Medical
Annual</i>, that a year has passed without any great improvement
in practice; and at once it lays the blame
not on practice but on science. It fights hard against
a fact which began in science, though it has been
proved a thousand times over in practice. It accuses
the bacteriologists now of caring nothing for human
suffering, now of rushing after every new method of
treatment and flooding the market with drugs. <i>There
is money in the business</i>&mdash;that is the phrase of the
<i>Zoophilist</i>. But there is money, also, in the anti-vivisection
business. <i>If you can provide for the society's
future in your will, may we beg of you to do so? If you
agree, pray do it now</i>, says the London Society: <i>this is
the most alive humane organisation in the world</i>. But the
National Society says, <i>A grave injury is done to the
cause of mercy by the deplorable waste of money spent in
perfectly unnecessary offices and salaries. We say that
one office would amply suffice for all the work, and that one
office would not need half-a-dozen paid secretaries.</i>
<span class="pagenum"><a name="Page_335" id="Page_335">335</a></span></p>

<h4>II</h4>

<p>Let us leave the general arguments and come to the
special arguments. Some of them are concerned with
the experiments themselves, some with the men who
made them, some with the administration of the Act.
These special arguments must be arranged in some sort
of order; but they cross and recross, and are of diverse
natures, and any attempt at strict arrangement would
fail. That the arrangement may be useful for immediate
reference, and may help anybody to answer statements
made at debates and lectures, a separate heading has
been given to each argument. Those arguments are put
first which are concerned with the experiments themselves,
or with the men who made them; afterward
come those which are concerned with the administration
of the Act.</p>

<p class="title2"><span class="smcap">Harvey</span></p>

<p>"It is perfectly true," says Mr. Berdoe, "that
Harvey again and again, in the plainest terms, declares
that his experiments on living animals aided him in his
discoveries." I agree here with Mr. Berdoe. Then
comes this sentence: <i>But that is not so important as it
appears to be</i>. Why not? What is gained by this
attempt to explain Harvey away? Dr. Bowie mistranslates
him; Dr. Abiathar Wall half-quotes him;
Mr. Adams says that Harvey did not ascribe his discoveries
to experiments on animals; Mr. Berdoe says
that he did; and Mr. Berdoe's society withdraws every
pamphlet that involves acceptance of Dr. Bowie's mistranslation.
Why should we take, on Harvey's work,
any opinion but that of Harvey?
<span class="pagenum"><a name="Page_336" id="Page_336">336</a></span></p>

<p class="title2"><span class="smcap">Sir Charles Bell</span></p>

<p>For the argument from Sir Charles Bell's words, and
for the truth about his work, see Part I., Chap. VII.</p>

<p class="title2"><span class="smcap">Cerebral Localisation</span></p>

<p>Mr. Berdoe says that it is "pure nonsense" to argue
from the motor areas of a monkey's brain to those of
a man's brain. Why is it nonsense? What is the
difference between the movement of a group of muscles
in a monkey's arm and the same movement of the same
group of muscles in a man's arm? With a very weak
current, so weak that it is not diffused beyond the area
where it is applied, the surface of a monkey's brain is
stimulated at one spot; and forthwith its opposite arm
is flexed, or its opposite leg is drawn up, or whatever
the movement may be, according to the spot. A man
has some disease, acute or chronic, of his brain; and,
as the disease advances, twitchings occur in one arm or
one leg, little irrational useless movements, or rigidity,
or loss of power, according to the case. Is it pure
nonsense to believe that the disease has reached a
certain spot on the surface of his brain? There is no
question here of the mental differences between men
and monkeys; no question of consciousness or of will.
But Dr. Holländer, who thinks very highly of Gall's
system of phrenology, says, <i>Is the laboratory-man, the
experimental physiologist, to teach us the mental functions
of the brain from his experiments on frogs, pigeons, rabbits,
dogs, cats, and monkeys?</i> That is the argument; that
we must not compare the monkey's motor areas with
the man's motor areas, for we cannot find the mind of
a man in the brain of a frog.
<span class="pagenum"><a name="Page_337" id="Page_337">337</a></span></p>

<p>But, putting aside phrenology, which is a broken
reed for anti-vivisection to lean on, what other arguments
are urged against the facts of cerebral localisation?
First, that the speech-centres were discovered
without the help of experiments on animals. That is
true; and there, practically, the work of discovery
stopped, till experiments on animals were made. Next,
that the physiologists have not always been agreed as
to the facts of cerebral localisation; that Charcot
doubted them, that Goltz criticised Munk, and so on.
What is the date of these doubts and criticisms?
They are twenty years old. Next, that the surgery of
the brain often fails to save life. That is true; and the
anti-vivisection societies make frequent use of this fact.
But they are unable to suggest any better method.
Mr. Berdoe tells us that he cannot remember hearing,
in his student days, anything about brain-experiments
on animals:&mdash;</p>

<p class="blockquote">"Our work was to observe as closely as possible the
symptoms and physical signs exhibited by patients in the
hospital wards who suffered from any form of nerve or
brain disease, and having carefully noted them in our
case-books, to avail ourselves, when the patient died, of
any opportunity that was offered us in the <i lang="la" xml:lang="la">post-mortem</i>
of correcting our diagnosis."</p>

<p>That is an exact picture of the state of things thirty
years ago; the student taking notes, waiting for the
<i lang="la" xml:lang="la">post-mortem</i> examination, then correcting his notes there,
etc. Every case of brain-tumour in those days died,
but many are saved now; and every case of brain-abscess
in those days died (one or two were saved by a
sort of miracle of surgical audacity); but many are
saved now.
<span class="pagenum"><a name="Page_338" id="Page_338">338</a></span></p>

<p class="title2"><span class="smcap">Antitoxins and Carbolic Acid</span></p>

<p>It is said by opponents of experiments on animals,
that the active principle, in antitoxin, is not the antitoxin,
but the carbolic acid which is added to it. They
take this statement from the <i>Medical Brief</i>; and we
have learned something of the style of that journal.
Here is a sentence from the official journal of the
National Society:&mdash;</p>

<p class="blockquote">"The <i>Medical Brief</i> calls antitoxin 'the fraud of the
age,' and says: <i>Would that physicians could all realise
the hideous horror of using this nasty stuff as a remedial
agent</i>. It would be nothing less than ghoulishness to
inject the matter from an abscess into a child's arm, yet
antitoxin is not much better; it is the decomposing fluid
from a diseased horse, partially neutralised by carbolic
acid."</p>

<p>For a commentary on this sentence, take the following
letter from an eminent bacteriologist:&mdash;</p>

<p class="blockquote">"As regards diphtheria antitoxin, the addition of an
antiseptic is by no means necessary or universal. For
fully two years I added none to the serum which I prepared,
but contented myself with filtration through a Kieselguhr
filter, and bottling under aseptic conditions. At one time
Roux used to put a small piece of camphor in each bottle
as some sort of safeguard against putrefaction. Nowadays
I believe that most makers preserve their sera by
adding a trace of trikresol&mdash;I am not quite sure of the
amount, but it is either .04 per cent. or .004 per cent.!"</p>

<p>But it is probable that the <i>Zoophilist</i> will still accept
the authority of the <i>Medical Brief</i>. Baccelli got good
results, in tetanus, from the administration of carbolic
acid; therefore, in diphtheria, the good results from
<span class="pagenum"><a name="Page_339" id="Page_339">339</a></span>
diphtheria-antitoxin are due to the carbolic acid in it.
That is the argument. But there is no carbolic acid in
it? Oh, then the patient got well of himself, the
treatment didn't kill him, it was not diphtheria after
all, the disease has altered its type lately, he was well
nursed, the back of his throat was painted with something,
the doctor got half-a-crown by calling it diphtheria,
the bacillus diphtheriæ may be found in healthy
mouths, and all bacteriology is <em>base and blatant materialism</em>.</p>

<p class="title2"><span class="smcap">The Argument from the Death-rate</span></p>

<p>There is another argument against diphtheria-antitoxin;
we may call it, for brevity, the death-rate
argument. It is this. <i>The doctors say that the antitoxin
does save lives; they give us statistics from every part of
the world. But, if it saves lives, then the total mortality
ought to go down. But the Registrar-General's returns
do not go down; indeed, they tend to go up. Therefore
diphtheria-antitoxin is useless, or worse than useless.</i> By
this kind of logic, umbrellas are useless. If they were
useful, then the more umbrellas there were, the less
rain there would be. But the increase in umbrellas
coincides with a positive increase of rain. Therefore
umbrellas are useless, or worse than useless.</p>

<p>Despite the absurdity of this argument, Mr. Coleridge
and Mr. Somerville Wood, the National Society's lecturer,
have worked hard with it; Mr. Coleridge in the
press, Mr. Wood on the platform. Surely this confusion
between the total mortality and the case-mortality
of an epidemic disease is a very serious offence. That
there may be no doubt of the confusion, let us consider
a set of quotations, out of a correspondence published
<span class="pagenum"><a name="Page_340" id="Page_340">340</a></span>
in September-October 1902, between G. P., whose
initials we may take to mean general practitioner, and
Mr. Somerville Wood. This correspondence is a good
instance of the argument in its usual form:&mdash;</p>

<div class="blockquote">
<p>G. P.: "The antitoxin treatment of diphtheria has
lessened the mortality from that disease by nearly 50
per cent. In the hospitals of the Metropolitan Asylums
Board the average case-mortality for the last five years
of the pre-antitoxin period, <i lang="la" xml:lang="la">i.e.</i> previous to 1895, was
30.6; that for 1895 and the successive four years was
18.1, the successive figures being 22.8, 21.2, 17.7, 15.4,
and 13.6, the mortality steadily falling with increased
familiarity with the use of the remedy. This has not
been the result of a diminished virulence of the disease,
as similar experience has been gained all over the world.
The figures for Chicago are even more striking, as the
averages are 35.0 and 6.79 for the pre-and the post-antitoxin
periods respectively."</p>

<p>Mr. <span class="smcap">Wood</span>: "Nowadays, almost every sore throat is
called diphtheritic, antitoxin is given, and wonderful
statistics are formulated to bolster up the latest medical
craze. The real test is whether the introduction of antitoxin
has lowered the death-rate generally from diphtheria.
Here are the Registrar-General's figures: In
1887, the death-rate from diphtheria per million persons
in this country was 140. In 1897, after the treatment
had been used several years, the death-rate from this
disease increased to 246 per million."</p>

<p>G. P.: "Mr. Wood's statistics do not vitiate my argument
in the very slightest. His selected figures, using
the lowest rate since 1881, merely show that diphtheria
as a whole was more prevalent in 1897 than in 1887.
He cannot and does not attack the statement that the
case-mortality has been lessened where antitoxin has
been used, and his test is no test at all."</p>

<p>Mr. <span class="smcap">Wood</span>: "Let me give the annual death-rate from
diphtheria to a million living persons from 1881 to 1900,
<span class="pagenum"><a name="Page_341" id="Page_341">341</a></span>
taken from the Registrar-General's returns." (Gives
them.)</p>

<p>G. P.: "One last word in answer to Mr. Wood. I
repeat that his figures show nothing more than the
accepted fact that diphtheria as a whole has been increasing
for the last 30 years. This has no bearing at all on
the also accepted fact that where antitoxin is used the
mortality is lessened, and Mr. Wood has not, in fact,
denied this. His confusion of total mortality and case-mortality
only shows that he does not understand the
elementary principles of statistics."</p>
</div>

<p>A few weeks later, at the <i>Bournbrook and Selly Oak
Social Club</i>, Mr. Wood gives his "thrilling lecture, with
lantern views," <i>Behind the Closed Doors of the Laboratory</i>:
one of his stock lectures. In it, he says:&mdash;</p>

<p class="blockquote">"The proof of the pudding was in the eating. In 1881
the death-rate from diphtheria was 127 per million; in
1900 it was 290 per million. He had but to state that
the antitoxin treatment was introduced about 1894."</p>

<p>Four days later, at an <i>overflowingly-attended Citizen
Social</i> at Birkenhead:&mdash;</p>

<p class="blockquote">"The proof of the pudding lay in the eating. In 1881
in each million of the population 121 persons died from
diphtheria, while in 1900 the mortality from the same disease
was 290 persons in each million of the population,
and the antitoxin treatment was introduced in 1894."</p>

<p>A few weeks later, at Ipswich, the same thing. This
time, he is challenged by letters in the <cite>East Anglian
Daily Times</cite>, and again quotes the Registrar-General.</p>

<p>A few weeks later, at the <i>Hyde Labour Church</i>: the
<i>Closed Doors of the Laboratory</i> again:&mdash;</p>

<p class="blockquote">"He found from the Registrar-General's returns that
the death-rate had gone up in cases in which they were
told that wonderful things had been done by experiments
<span class="pagenum"><a name="Page_342" id="Page_342">342</a></span>
on living animals. If a lower death-rate could be shown,
then the vivisectionists might have something to go upon;
but they could not show a lower death-rate."</p>

<p>That was in January 1903. In December 1903,
Mr. Wood is still using the same argument; this time
it is a lecture at Ashton on <i>Vivisection and the Hospitals</i>:</p>

<p class="blockquote">"Again and again had they defied the so-called scientific
world to put their finger on the Registrar-General's returns,
and show them a single instance where the death-rate had
been lowered by vivisection, and they had not been able
to do it. On the contrary, he found that the death-rate
had gone up in the last 20 years, despite the thousands
of animals that had been experimented upon. The death-rate
in diphtheria was 100 per million more than it was
in 1878."</p>

<p>Mr. Wood in the provinces, and Mr. Coleridge in the
papers, have used this argument hard. Let us look at it
well. It has been refuted again and again. Take a
thousand cases of diphtheria from any civilised part of
the world, in the days before antitoxin; how many of
them died? Take a thousand cases now, treated with
antitoxin; how many of them die? Why do Mr. Wood
and Mr. Coleridge run away from that easy question?
There is nothing unfair in it; they have all the reports
before them; they know the facts well. We do not
find any evidence that they are willing to acknowledge
the truth of those facts. Follow Mr. Somerville Wood,
from place to place, with his magic-lantern and his
stock of lectures. The lantern-pictures are many of
them taken from foreign sources, and some of them are
of great age; but they include a portrait of Mr. Coleridge,
and some comic slides to be shown at the end of
the lecture, rabbits vivisecting a professor, and so forth.
Certainly, he works hard; 95 lectures in one year;
<span class="pagenum"><a name="Page_343" id="Page_343">343</a></span>
<i>we cannot better employ the funds at our disposal than in
sending well-informed lecturers to every city in the kingdom
to rouse the just indignation of the people</i>. The year after
that, 74 lectures; <i>on two occasions he has spoken when unsupported
to over 1000 people, and an audience of several
hundreds is quite the rule</i>. Here he is at Windsor, with
Bishop Barry in the chair, and he says to them:&mdash;</p>

<p class="blockquote">"Unhappily, Pasteur left his microscope and chemicals
and took up the vivisectionist's knife. In that he got
utterly astray and became nothing more than a mere
quack."</p>

<p>Here, with a different audience, at the Mechanics'
Lecture Hall, Nottingham, giving his lantern-lecture on
<i>Pasteurism</i> to a <i>most respectable audience of working men,
their wives, sons, and daughters, and in many cases children</i>.</p>

<p class="blockquote">"The thesis he set out to elaborate and maintain was
that Pasteurism produces hydrophobia rather than cures
it; that vivisection under any circumstances is both cruel
and immoral; and that with special reference to bacterial
toxicology and the treatment by inoculation, the preparation
of toxins by the Pasteur methods was the most
horrible form of repulsive quackery and hideous cruelty."</p>

<p>Here he is at Birmingham, asking for money, and
hinting that, unless all experiments on animals are
stopped, <i>the poor will be the ultimate victims</i>. Here, at
Gloucester, saying that <i>it is silly to experiment at all</i>, and
that he is not going to take his views as to right and
wrong from any man of science, however learned he
may be. Here, at Edinburgh, with the <i>Closed Doors</i>
again, and the picture of the rabbit "roasted alive":
three grains of opium, he tells them, would be enough
to kill the strongest navvy in Edinburgh, but 16 grains
can be administered to a pigeon; and the death-rate
<span class="pagenum"><a name="Page_344" id="Page_344">344</a></span>
has gone up every year in spite of vivisection. Here,
at a drawing-room meeting, asking for money; here, at
a garden party, with a <i>considerable number of persons
ranging themselves on the grass</i>, and he tells them that they
have on their side all that is best in every department
of public life; here, at Blackburn, with the <i>Closed Doors</i>
again, calling the law <i>a sham and a farce</i>; here, at
Cheltenham, with Bishop Mitchinson in the chair, still
quoting the Registrar-General, and saying that <i>he does
not think the outlook was ever more promising than it is
to-day</i>. All over the kingdom, he and his magic-lantern,
year after year, goes Mr. Wood. He is a fluent speaker;
he has things in his pocket; they are brought out, if
you contradict him; or he "challenges" you, or explains
you away, or says that you "are not quite playing
the game." Let him alone; to-morrow he will pack
up his lantern, and be gone.</p>

<p>Mr. Coleridge, in his use of the death-rate argument,
carries it even further than Mr. Wood; for he applies
it over a wider range. "Look at myx&oelig;dema," he says;
"the doctors tell us that they can cure it with thyroid
extract, and that the use of thyroid extract was discovered
by the help of experiments on animals. Very
good. Myx&oelig;dema is due to some fault in the thyroid
gland. Very good. But here are the Registrar-General's
returns of the annual death-rate for all
diseases of that gland. See, the death-rate has gone
up, steadily, during the last 20 years." Was there
ever such an argument? It is only of late years that
myx&oelig;dema has been generally recognised. Till it was
recognised, it was not diagnosed; till it was diagnosed,
it was not returned as a cause of death. Again, there
are many other diseases of the thyroid gland, including
various forms of malignant disease. It is cancer of the
<span class="pagenum"><a name="Page_345" id="Page_345">345</a></span>
thyroid gland that decides the death-rate. The number
of deaths from myx&oelig;dema, especially since the discovery
of thyroid extract, must be small indeed. Moreover,
apart from Mr. Coleridge's fallacy of argument, it is
impossible to see how he can really doubt the efficacy
of the thyroid treatment, both in myx&oelig;dema and in
sporadic cretinism.</p>

<p>Again, "Look at the diseases of the circulation," he
says. "The doctors say that digitalis and nitrite of
amyl act on the heart; and that the action of these
drugs was discovered by the help of experiments on
animals. Very good. The heart is concerned with the
circulation. Very good. But here are the Registrar-General's
returns of the annual death-rate for all
diseases of the circulation. See how it has gone up,
from 1371 per million persons in 1881 to 1709 in
1900. Therefore, either these two drugs are never
used, or they are useless, or the Registrar-General's
returns are false." It is impossible to understand
how Mr. Coleridge could bring himself to write thus.
Digitalis has a certain effect on the heart-beat; nitrite
of amyl diminishes arterial tension. The Registrar-General's
returns for all diseases of the circulation
include every sort and kind of organic disease of
the valves of the heart; include also pericarditis,
aneurism, senile gangrene, embolism, phlebitis, varicose
veins, and 35,499 deaths from "other and undefined
diseases of heart or circulatory system."</p>

<p class="title2"><span class="smcap">Rabies</span></p>

<p>For rabies, Mr. Berdoe praises the "Buisson Bath
Treatment for the Prevention and Cure of Hydrophobia."
The virtues of this treatment are proclaimed
<span class="pagenum"><a name="Page_346" id="Page_346">346</a></span>
by the Chairman of the Canine Defence League, F. E.
Pirkis, Esq., R.N., of Nutfield, Surrey, and it is founded,
we are told, <i>on the simple common-sense principle that if
poison is injected into a person's veins the best thing to do
is to get it out as quickly as possible</i>. This sentence,
and the reference to Mr. Pirkis for further particulars,
and the fact that there is, or was, a Buisson Bath at
the "National Anti-vivisection Hospital," bring us to
the question, What is the value of the evidence in
favour of this treatment?</p>

<p>Mr. Berdoe, in his Catechism of Vivisection (1903),
gives this evidence at considerable length. <i>The treatment</i>,
he says, <i>is simplicity itself. It is merely the use of
the vapour bath, which causes a free action of the skin to
be set up, this draws the blood to the surface of the body,
and so relieves the congestion of the internal organs.</i> Let
us consider this sentence. (1.) Suppose that X&mdash;&mdash;
were bitten by a mad dog, say on March 1st, and on
March 8th he took a course of Buisson Baths, for
safety's sake. There would be no congestion, at that
period, of his internal organs; what would be the good
of drawing the blood to the surface of his body? Mr.
Pirkis says that there would be poison in his veins; it
would be a very subtle poison. How can Mr. Pirkis tell
that it is all in his veins and none of it elsewhere?
Again, X&mdash;&mdash; would be feeling perfectly well. How
would a vapour-bath get this poison out of his veins?
It could not do it by relieving the congestion of his
internal organs, for they would not be congested. How
would it do it? And how would Mr. Pirkis know when
it had done it? (2.) Suppose that X&mdash;&mdash; were bitten
by a mad dog, and, in due time, were seized by hydrophobia.
Has Mr. Pirkis ever seen a case of that disease&mdash;ever
seen a case of hydrophobia? Are they going to
<span class="pagenum"><a name="Page_347" id="Page_347">347</a></span>
tie X&mdash;&mdash; down, or steam him under chloroform, or what?
And how many baths would he want? But there are cases;
there is evidence; a "mass of cures in Asia." Let us look
at them; and let us divide them into cases of prevention
and cases of cure. Let us take, first, the cases of cure.</p>

<p>There are five of these. Five, and no more. One
is Dr. Buisson; cured by one bath, while he was trying
to commit suicide; nothing said about the dog. One
is a case at Kischineff, near Odessa, 18 years ago; no
evidence is given that the dog was rabid. One is a
case at Arlington, New Jersey, 18 years ago; no evidence
is given that the dog was rabid. One is the
case of Pauline Kiehl; no date; no reference to say
where the case is published; no account of her
symptoms. And one is a case at the Jaffna Hospital,
Ceylon; no date; and nothing said about the dog. Of
these five cases, three were a boy, a lad, and a little
girl; but their ages are not given. Five cases in 20
years; they hail from all parts of the world, France,
Russia, the United States, Ceylon, and France again;
three of them happened 18 years ago, or more. And,
we may be certain, not one of them is genuine. Spurious
hydrophobia, the simulation of the disease out of sheer
terror of it, as in Dr. Buisson's case, is well known.</p>

<p>Now we come to the cases of prevention. Over 80
of them, we are told; but seven are especially noted.
Four in 1895, under the care of Dr. Ganguli of Dinajpur;
two in 1896, under the care of Dr. Dass of Narainganj;
and one in 1896, Mr. Kotwal of Bassein. Of this
"mass of cures in Asia," we all know what would have
been said if Pasteur had been in charge of them; that
the dogs were not rabid, that the bites were not infected,
that the wonder is that the poor deluded victims
were not added to Pasteur's hecatomb.
<span class="pagenum"><a name="Page_348" id="Page_348">348</a></span></p>

<p>Next, what does Mr. Berdoe say of the division of
all patients at the Pasteur Institute into classes A, B,
and C? Does he admit that a dog is proved to have
been rabid, if a minute portion of its nervous tissue,
taken from it after death, and put into a rabbit, causes
the rabbit to have paralytic rabies? No; there are
still two things left for him to say:&mdash;</p>

<p>1. He says, on the authority of the <i>Veterinary Record</i>
of ten years ago, that <i>the death of a rabbit with cerebral
symptoms is not a positive indication of death from rabies</i>.</p>

<p>2. He says that Vulpian discovered that healthy
human saliva was poisonous to rabbits, and that it contained
a micro-organism which Pasteur had also found
in the saliva of a rabid patient. What does this statement
prove or disprove? It is twenty-five years old;
but Mr. Somerville Wood, not long ago, used it at a
debating society with great fervour.</p>

<p>Also Mr. Berdoe quotes the late M. Peter, Dr. Lutaud's
forerunner; quotes an <i lang="la" xml:lang="la">obiter dictum</i> of Professor Billroth,
but without any date; tells us that Pasteur himself, in
a letter, referring to one particular case, declared
cauterisation to be a sufficient preventive, but does not
tell us the date of the letter, or the facts of the case;
and quotes a death-rate, but stops at 1890. Of course,
any method of treatment, if you ransack its records
over a sufficient number of years, will show, now and
again, failures or disasters. Take, for instance, those
methods of light-treatment, which Mr. Berdoe praises
so highly. They have had many failures, and one or
two disasters. If they had been discovered by the
help of experiments on animals, we might have had
a pamphlet from the National Society, <i>The Roentgen
"Cure": its list of Victims</i>.
<span class="pagenum"><a name="Page_349" id="Page_349">349</a></span></p>

<p class="title2"><span class="smcap">Certificate A and Certificate B</span></p>

<p>Frequent use has been made of some words spoken
by the Home Secretary in Parliament, on July 24th,
1899. He was asked whether he would state what
rules were laid down with regard to the granting or
signing of certificates dispensing with the use of anæsthetics
in experiments on animals; and whether there
was any limit to the number of such certificates which
one person might sign, or to the number of experiments
upon different animals which might be performed by the
person holding one such certificate. There can be no
doubt as to the meaning of these questions. Certificate
A, which is granted only for inoculation experiments or
similar proceedings, and never for any serious cutting
operation, dispenses wholly with anæsthetics. Certificate
B, which is granted for any kind of operation <i>plus</i>
observation of the animal after operation, dispenses
partly with anæsthetics; that is to say, the operation
is done under an anæsthetic, and the subsequent
observation of the animal, which is counted as part of
the experiment, is made without an anæsthetic. The
questions come to this: When the Home Office grants
Certificate A, or Certificate B, what precautions does it
take against any abuse of these certificates, and what
restrictions does it impose on them?</p>

<p>The Home Secretary answered:</p>

<p class="blockquote">"It is the practice of the Home Office, in addition to
the fact that all certificates expire on December 31st of
the year in which they are granted, to limit the number,
and this is always done in the case of serious experiments
in which the use of anæsthetics is wholly or partly dispensed
with."
<span class="pagenum"><a name="Page_350" id="Page_350">350</a></span></p>

<p>The <i>Times</i> says that the Home Secretary said
"serious experiments." Mr. Coleridge says that
<i>Hansard</i> says that the Home Secretary said "serious
operations." We need not doubt that Mr. Coleridge
is right; but we may doubt whether Hansard underlines
the word <i>wholly</i>, as Mr. Coleridge does. Anyhow,
it does not matter now whether the Home Secretary,
seven years ago, said <i>experiments</i> or <i>operations</i>. His
meaning is clear enough; that, in all serious procedures,
whether they be under Certificate A or under Certificate
B, a limit is put to the number of experiments. Which
is the plain truth, as everybody knows who is concerned
in the administration of the Act; and the limit may be
very strict indeed. After this statement by the Home
Secretary in 1899, we still find Dr. Abiathar Wall, the
Hon. Treasurer of the London Anti-vivisection Society,
saying in 1900 that a <i>vivisector has only to say that he
has a theory whereby he hopes to discover a cure for, say,
neuralgia of the little finger, and the Home Secretary
promptly arms him with a license to torture as diabolically as
he pleases and as many animals as he deems fit</i>. And the
National Society has made constant use of this phrase
about "serious experiments"; declaring that the Home
Secretary himself has said that animals are tortured
under the Act. Here are three statements to that effect,
made by the National Society's Parliamentary Secretary,
by its Lecturer, and by its Hon. Secretary:&mdash;</p>

<div class="blockquote">
<p>1. (Annual Meeting, Queen's Hall, May 1900.)&mdash;"If
you are still unconvinced&mdash;if any one is not thoroughly
satisfied that there is ample cause for the anti-vivisectionist
movement to-day&mdash;it is only necessary for me
to refer you to the words of the Home Secretary, as
spoken in Parliament, in the year 1898.<a name="FNanchor_49" id="FNanchor_49" href="#Footnote_49" class="fnanchor">[49]</a>  He said:
<span class="pagenum"><a name="Page_351" id="Page_351">351</a></span>
'There are serious operations which are performed,
during which the use of anæsthetics is wholly or partially
dispensed with.' Could there be any more sweeping
indictment than that? Is there any need for me to
attempt to convince you that the lower animals are
vivisected painfully, after the words officially spoken by
the Home Secretary in the House of Commons?"</p>

<p>2. "If you want any further proof I will quote from
Hansard, July 24th, 1899, when the then Home Secretary
stated in the House of Commons that serious experiments
take place under the law of England, in which the
use of anæsthetics is wholly or partially dispensed with.
Now, I affirm that serious experiments in which anæsthetics
are wholly or partially dispensed with mean
torture pure and simple."</p>

<p>3. (Annual Meeting, St. James's Hall, May 1901.)&mdash;"If
this were not enough, the late Home Secretary has
told us the facts. I have Hansard here. On July 24th,
1899, the late Home Secretary in his place in Parliament,
and in his official capacity as Home Secretary, told us
that 'serious experiments, in which the use of anæsthetics
have been wholly or partially dispensed with,' do
take place in English laboratories. We know, therefore,
that torture does take place."</p>
</div>

<p>Each of the three speakers uses this phrase as a final
and irresistible argument. <i>If you are still unconvinced.
If you want any further proof. If this were not enough</i>&mdash;they
all of them play the Home Secretary, as a sure
card: at Queen's Hall, at St. James's Hall, they produce
him as though it were indeed unanswerable. Since they
are willing to go back to July, let us take them back to
May. This phrase about "serious experiments" was
spoken on July 24th, 1899. On May 9th of that year,
a question was put and answered in the House. It
was put by the same gentleman who put the question in
July; it was answered by the same Home Secretary;
<span class="pagenum"><a name="Page_352" id="Page_352">352</a></span>
and it was practically the same question. The Home
Secretary, in his answer to it, said:&mdash;</p>

<p class="blockquote">"The sole use of this Certificate (B) is to authorise the
keeping alive of the animal, after the influence of the
anæsthetic has passed off, for the purpose of observation
and study. I should certainly not allow any certificate
involving dissections or painful operations without the
fresh use of anæsthetics."</p>

<p>Here, in May 1899, we have this emphatic statement,
that Certificate B is <i>not</i> allowed for "serious
operations without anæsthetics." Why did the National
Society stop at July? If it had only gone a few weeks
further back, a surprise was in store for it. But at
July it stuck; thus it was still able to say all sorts of
things about "legalised torture." So late as May 6th,
1902, at the great annual meeting at St. James's Hall,
the Rev. Reginald Talbot said:&mdash;</p>

<p class="blockquote">"Certificate B makes it necessary that the operator
should produce complete anæsthesia during the initial
operation, but (please mark this) after the initial operation
is over, after the animal has returned to the state of
semi or complete consciousness, there is then allowed by
this certificate a period of observation upon a semi-sensible
or completely sensible animal. The animal is
opened, is disembowelled, and in that condition his vital
organs can be probed and stimulated. Now that is
something more than pain; it deserves something more
than the name of even severe and prolonged pain. Surely
this comes within the tract and region of what we may
call agony."</p>

<p>As for Certificate A, the inoculations-certificate, which
is used for inoculations only, and therefore is granted
for nine experiments out of every ten, he said:&mdash;</p>

<p class="blockquote">"There is a Certificate A, which, if it were granted,
and when it is granted&mdash;and pray you mark my words,
<span class="pagenum"><a name="Page_353" id="Page_353">353</a></span>
for I know what I am speaking about, and I want you to
know too&mdash;would allow major operations to be performed
upon animals, cats, dogs, or any other animals, without
the use of any anæsthetic at all. I know quite well that
that certificate has not been applied for, or has not been
granted this last year, or, so far as I know, in any previous
year, but I say this," &amp;c.</p>

<p>It is impossible to understand these words. Certificate
A is never granted for major operations. It is
never granted (save in conjunction with another certificate)
for any sort or kind of experiment on a cat or a
dog, or a horse, or an ass, or a mule. It is more in
use than all the other certificates put together; it covers
nine experiments out of every ten. We shall try in
vain to guess how this mistake arose in the speaker's
mind. But, at the great annual meeting of the chief of
all the anti-vivisection societies, it is strange indeed that
nobody seems to have corrected him. This description
of a certificate which does not exist&mdash;<em>I know what I am
speaking about</em>, he says, <em>and I want you to know too</em>&mdash;was
applauded by an audience that filled the whole
hall. Nobody on the platform put him right. And,
in the next number of its official journal, the National
Society reported every word of his speech, and said
that he had <i>analysed the Act and its administration in a
striking and powerful manner</i>.</p>

<p class="title2"><span class="smcap">Curare</span></p>

<p>"Curare," says Mr. Berdoe, "paralyses the peripheral
ends of motor nerves, even when given in very
minute doses." That is to say, it prevents all voluntary
motion. Then comes this frank admission, "Large
doses paralyse the vagus nerve and the ends of sensory
<span class="pagenum"><a name="Page_354" id="Page_354">354</a></span>
nerves." That is to say, it can be pushed, under artificial
respiration, till it paralyses sensation. With small
doses, the ends of the motor nerves lose touch with the
voluntary muscles. With large doses, under artificial
respiration, the ends of the sensory nerves lose touch
with the brain. Let us agree with Mr. Berdoe that
curare does act in this way; that it does not heighten
sensation, and has no effect, save in very large doses,
on sensation, and then abolishes sensation. Only, of
course, to procure this anæsthetic effect, the animal may
have to be subjected to artificial respiration.</p>

<p>(The evidence as to the action of curare on the sensory
nerves rests not on the case of accidental poisoning
recorded by Mr. White, though that case does point that
way, but on Schiff's experiments on the local exclusion
of the poison from one leg of the frog by ligature of an
artery.)</p>

<p>This, surely, is a true definition of curare, that it is
a painless poison, which in small doses prevents the
transmission of motor impulses; and, in large doses,
which may necessitate the use of artificial respiration,
prevents the transmission of sensory impulses. Mr.
Berdoe can hardly refuse to accept this definition;
indeed, it is his own. And, certainly, he would be a
bold man who said that a small dose of curare has any
effect on sensation; or that the exact strength of any
one specimen of curare is standardised as a supply of
antitoxin is standardised.</p>

<p>Now we have a perfect right to take a practical
view of curare. At the present time, and in our own
country, how is it used? The Act forbids its use as
an anæsthetic. What evidence does Mr. Berdoe bring
that it is so used?
<span class="pagenum"><a name="Page_355" id="Page_355">355</a></span></p>

<p>1. He quotes Professor Rutherford's experiments.
These were made at least 16 or 17 years ago.</p>

<p>2. He quotes Dr. Porter's paper, "On the Results
of Ligation of the Coronary Arteries." (<cite>Journal of
Physiology</cite>, vol. xv. 1894, p. 121.) Dr. Porter speaks
of four experiments made under morphia <i>plus</i> curare.
These experiments were made at Berlin, 14 years ago,
by the Professor of Physiology at Harvard, U.S.A.</p>

<p>3. He refers to Professor Stewart's papers, in the
same volume of the <cite>Journal of Physiology</cite>. The one
experiment which he quotes at some length was made
at Strasburg, 14 years ago or more.</p>

<p>But we want to know what is done now and here
under the Act, not what was done at Berlin or Strasburg
14 or more years ago. Still, the experiments by
Professor Stewart have been in constant use, among
the opponents of all experiments on animals. In May
1900, at the great annual meeting of the National
Society, at Queen's Hall, Dr. Reinhardt said:&mdash;</p>

<p class="blockquote">"I will pass on to prove to you, by a few conclusive
evidences, for which I can give you chapter and verse,
that torture is inflicted on animals by British vivisectors
to-day. Now, if you buy the 15th volume of the <cite>Journal
of Physiology</cite>, and look at page 86, you will find there," etc.</p>

<p>To prove that animals are tortured in England to-day,
he quotes one experiment made at Strasburg ever
so long ago. And, in 1901, Mr. Coleridge wrote,
in the <cite>Morning Leader</cite>, saying: <i>It is with curare, which
paralyses motion and leaves sensation intact, that all the
most shocking vivisections are performed.</i> And, the same
year, Mr. Stephen Smith, a "Medical Patron" of the
London Society, wrote: <i>I state emphatically that when
curare is used, proper anæsthesia is out of the question....</i>
<span class="pagenum"><a name="Page_356" id="Page_356">356</a></span>
<i>Curare is used daily throughout England. Mention of an
anæsthetic in a report is no guarantee that the animal was
anæsthetised.</i></p>

<p>I cannot find, in all the anti-vivisection literature
which I have read, any shadow of evidence that any
experiment of any sort or kind has been made in this
country, on any sort or kind of animal, under curare
alone, for the last sixteen or seventeen years. I believe
that I might go further back than that. But surely
that is far enough.</p>

<p>Certainly, so long as any curare is used (not as an
anæsthetic, but in conjunction with an anæsthetic) in
any experiments on animals in this country, the societies
will not trouble to inquire how much of it is used. I
wrote, therefore, to the Professors of Physiology at
Edinburgh, Cambridge, and Oxford, and asked them to
tell me how much curare was used in their laboratories
throughout 1903, and what anæsthetics were given
with it. Some opponents of experiments on animals
seem to think that curare is used very often. One of
them says that it is "used daily throughout England."
So I wrote to these Professors at our Universities, and
they kindly sent the following answers:&mdash;</p>

<div class="blockquote">
<p>1. "Your question <i lang="la" xml:lang="la">re</i> curare is easily answered. We
did <i>no</i> experiments with it during the past year. Indeed,
I have given it up almost entirely for years, chiefly because
it is very difficult to get a preparation which&mdash;I
suppose from impurities&mdash;does not seriously affect the
heart. There might still be occasions during which it is
necessary to use it&mdash;if, <i lang="la" xml:lang="la">e.g.</i> the <i>least</i> muscular movement
would vitiate the results of an experiment. But I find it
possible in nearly all cases to get such absolute quiescence
with morphia or chloral (besides ether and chloroform)
that to all intents and purposes I have long given up the
<span class="pagenum"><a name="Page_357" id="Page_357">357</a></span>
use of curare. Of course, if I had occasion to use it, an
anæsthetic would be administered at the same time."</p>

<p>2. "I have asked those who worked in the physiological
laboratories in 1903 to give me a return of the
number of experiments done and of the number in which
curare was used. Including my own experiments, I find
that 160 in all were made under the License and Certificates
B, EE, C. Curare was given in four cases; in
two of these the A.C.E. mixture was the anæsthetic, in
the other two ether."</p>

<p>3. At the third laboratory, during 1903, curare was
given to seven frogs deprived of their brains before it
was given, and to one rabbit under ether.</p>
</div>

<p>That was the whole use of curare, during a whole
year, in three great Universities: at one, seven inanimate
frogs, and one rabbit under ether; at another, four
animals, under A.C.E. or ether; at another, nothing.</p>

<p class="title2"><span class="smcap">Incomplete Anæsthesia</span></p>

<p>It sometimes happens, at an operation, that the
patient moves. Mostly, this movement is at the
moment of the first incision through the skin; but
it may be at some later period during the operation.
He does not remember, after the operation, that he
moved, or that he felt anything. That is incomplete
anæsthesia, or light anæsthesia. The corneal reflex
may be abolished, and still the patient may move.</p>

<p>Seven years ago some experiments were made in this
country by an American surgeon. In the published
account of them, it was said that one of the animals
was, at one time, under incomplete anæsthesia, and that,
in the case of another animal, the anæsthesia was at
one time overlooked. This latter phrase meant not
<span class="pagenum"><a name="Page_358" id="Page_358">358</a></span>
that the anæsthetic had been left off, but that it had
been given in excess, so that the blood-pressure suddenly
fell. The character of the experiments, and the
occurrence of these two phrases about the anæsthesia,
roused some criticism, and the Home Office instituted
an inquiry into the matter. "That inquiry," it said,
October 11th, 1899, "resulted in showing no evidence
whatever that the animals experimented on by Dr. Crile
felt pain. On the contrary, all the evidence shows they
did not." The Act does not go into questions of
corneal reflex, and unconscious muscular movements,
and all the undefinable shades between incomplete
anæsthesia and complete anæsthesia and profound anæsthesia.
"The only substantial question," says the
Home Office, "is whether or no the animal has been
during the operation under the influence of an anæsthetic
of sufficient power to prevent it feeling pain. This is
the requirement of the law." We cannot refuse to call
morphia and chloral anæsthetics, for there are deaths
every year from an over-dose of them. And we cannot
admit that an animal under an anæsthetic, because it
makes a movement, is in pain or is conscious; for we
know that a patient under operation may move yet feel
nothing. Every hospital surgeon, and every anæsthetist,
who has seen a whole legion of patients go under
chloroform or ether and come out of it, and everybody
who has been under these anæsthetics, they all know
that incomplete anæsthesia is not "sham anæsthesia,"
and that movements, even purposive movements, may
occur without consciousness, without pain, alike in men
and in animals.
<span class="pagenum"><a name="Page_359" id="Page_359">359</a></span></p>

<p class="title2"><span class="smcap">One Animal and One Experiment</span></p>

<p>When the Home Office allows a licensee to make a
certain number of experiments, it means that he may
experiment on that number of animals and no more.
The Home Office, having heard what the experiments
are to be, where they are to be made, on what kind of
animals, and for what purpose, and having taken advice
about them, allows him to make a fixed number, and
adds any restrictions that it likes, <i lang="la" xml:lang="la">e.g.</i> that he must send
in a preliminary report when he has made half that
number. And one thing is certain, that one experiment
= one animal, and that 10 experiments = 10 animals,
and no more. Everybody knows that, who knows anything
at all about the administration of the Act.</p>

<p>Now take a false statement, which has been made
again and again during many years, that one experiment
= any number of animals, and observe how it spread.</p>

<p>1. In the House of Commons, on March 12th, 1897,
Mr. MacNeill asked whether any record were kept of
the number of animals used in experiments during
1895, and said that 200 or 300 animals are sometimes
used in a single experiment, and that 80 or 90 is a
common number. The Home Secretary answered:
"The honourable member is under an entire misapprehension.
The number of animals used does not
exceed the number of experiments given in the return."</p>

<p>2. A year later, May 18th, 1898, at the Annual
Meeting of the National Society, Mr. MacNeill said
again: "Any one casually reading that report (the
Inspector's report to Government) would imagine that
each experiment was on the body of a single animal.
It is nothing of the kind. An experiment is a series of
<span class="pagenum"><a name="Page_360" id="Page_360">360</a></span>
investigations in some particular branch, and sometimes
20, 30, or 40 animals are sacrificed in the one experiment."
The National Society published this speech
in its official journal.</p>

<p>3. A few weeks later, an anonymous letter in the
<cite>Bradford Observer</cite> said, "Any one casually reading the
report would imagine that each experiment was on the
body of a single animal. It is nothing of the kind.
An experiment is a series of investigations in some
particular branch, and sometimes 20, 30, or 40 animals
are sacrificed in the one experiment."</p>

<p>4. On August 1st, 1898, the National Society
published this letter in its official journal, under the
heading, "Our Cause in the Press."</p>

<p>5. On October 21st, 1902, a letter in a provincial
paper said that "one experiment" means "not one
animal, but a series of operations on many animals."</p>

<p>6. In January 1903, the National Society admitted
that its action in 1898 (see 4) was "unfortunate."</p>

<p>7. On June 25, 1903, in Parliament, Mr. MacNeill
again said that "an experiment" did not mean one
operation, but a series of researches, "often performed
by persons who had no more skill than the children
who broke up a watch."</p>

<p>8. About this time, the same false statement was
made by an Anti-vivisection Society at Manchester.</p>

<p>9. A little later, it was made by the National
Canine Defence League, in these words, "Each experiment
may include any number of dogs. There
is no limit fixed by law." On January 11th, 1904,
in the <cite>Times</cite>, the leaflet containing this and other
"grossly false and misleading statements" was vehemently
denounced by the National Society.</p>

<p>It would be hard to find a better instance of the
<span class="pagenum"><a name="Page_361" id="Page_361">361</a></span>
spreading of a false report. An experiment? Oh, it
is any number of animals&mdash;20 of them, 30 of them;
200, 300 of them; hecatombs, and triple hecatombs;
any young doctor can get leave to cut them up.</p>

<p class="title2"><span class="smcap">Certificates E and EE</span></p>

<p>For all inoculations and similar proceedings, Certificate
A is necessary. For all experiments where the
animal is allowed to recover from the anæsthetic,
Certificate B is necessary. But these certificates do
not extend to the dog, the cat, the horse, the mule,
or the ass. The three latter animals are also scheduled
under Certificate F; the dog and the cat under
Certificates E and EE. That is to say, to inoculate
a dog, <i lang="la" xml:lang="la">e.g.</i> for the study of the preventive treatment
against distemper, it is necessary to hold a License,
<i>plus</i> Certificate A, <i>plus</i> Certificate E; to operate on
a dog, and let him recover, it is necessary to hold a
License, <i>plus</i> Certificate B, <i>plus</i> Certificate EE.</p>

<p>And it is certain that the Home Office does enforce
and emphasise here the spirit of the Act; and that
it does guard and restrict and tie up Certificate EE
with its own hands.</p>

<p>Now let us take an instance, which shows in a
very unfavourable light the methods of the National
Canine Defence League. Three years ago, certain
experiments were made on dogs, for the purpose of
finding the best way of resuscitating persons apparently
drowned. The Home Secretary was asked whether he
knew that certain of these experiments were to be made
without anæsthetics; and he answered, "In view of
the great importance of the subject in connection with
<span class="pagenum"><a name="Page_362" id="Page_362">362</a></span>
the saving of human life, and of the strong recommendations
received in support of the experiments, I have not
felt justified in disallowing the certificates."</p>

<p>A great outcry was raised against these experiments
by the National Anti-vivisection Society and
the Canine Defence League. The National Society, in
its official journal, August 1903, said that it was now
proved, "that in England to-day experiments are performed
without anæsthetics which involve inconceivable
agony to dogs, and this with the deliberate
permission of the Home Secretary." Mr. Coleridge
made a public appeal to all humane societies, to go
down with all their strength into Kent, on that not
far distant day when the Home Secretary would have
to face his constituents, and turn him out of Parliament.
The Canine Defence League sent two memorials
to the Home Office, circulated a petition, and issued
leaflets, entitled <i>A National Scandal</i>, <i>Scientific Torture</i>,
<i>A Peep behind the Scenes</i>, and so forth. We must
consider one of these leaflets at some length; but
first let us see what is the truth about these experiments.
They were made by the Professor of
Physiology at Edinburgh; and he has kindly written
to me about them. <i>In every experiment, except two,
the animal was, throughout the whole experiment, under
complete anæsthesia with chloroform or ether. In two
cases, and in two only, a small preliminary operation,
under anæsthesia, having been performed, the animal was
allowed to recover from the anæsthetic, or almost to recover
from it, and was then and there submerged and drowned,
at once and completely, to death; no attempt at resuscitation
was made; it became unconscious in a little more
than a minute.</i></p>

<p>In the face of these facts, what is to be said of
<span class="pagenum"><a name="Page_363" id="Page_363">363</a></span>
the outcry raised by the Canine Defence League?
They presented two memorials to the Home Secretary:
they got up a monster petition with thousands of
signatures; and they issued the following leaflet:&mdash;</p>

<div class="blockquote">

<p class="title2">SIGN THE<br />
NATION'S PETITION<br />
TO PARLIAMENT AGAINST THE<br />
DISSECTION OF LIVE DOGS<br />
<i>In Medical Laboratories</i></p>

<p>1. Dogs, on account of their docility and obedience
to the word of command, are the animals chiefly selected
for torture.</p>

<p>2. Thousands of dogs are tortured yearly by licensed
experimenters.</p>

<p>3. The total number of experiments performed in
1902 was 14,906, 12,776 of which were without
anæsthetics.</p>

<p>4. The Home Secretary stated in Parliament on
July 22nd, 1903, that neither the starving of animals
to death nor the forced over-feeding of animals were
included in these returns.</p>

<p>5. Nor does the number 14,906 give the number of
dogs used, for each experiment may include any number
of dogs&mdash;there is no limit fixed by law.</p>

<p>6. The Home Secretary stated in Parliament on
May 11th, 1903, that at one laboratory alone in
London 232 dogs were used for vivisectional experiments
last year.</p>

<p>7. There are now laboratories scattered over the
whole of the United Kingdom.</p>

<p>8. The Home Secretary stated in Parliament on
10th July 1903, that one dog may be used <i>again</i> and
<i>again</i> for vivisectional experiment or demonstration&mdash;and
this without anæsthetics.
<span class="pagenum"><a name="Page_364" id="Page_364">364</a></span></p>

<p>Think of the condition of the poor dog between each
living-dissection.</p>

<p>Has not the time come for the nation to rise as one
man and say&mdash;</p>

<p class="center">"This shall not be"?</p>
</div>

<p>It is no wonder that even the National Anti-vivisection
Society, in a letter to the <cite>Times</cite>, December
11th, 1903, denounced this leaflet. The wonder is,
that Mr. Pirkis, R.N., the chairman of the Canine
League, tried to defend it. <i>This deplorable leaflet</i>, said
the National Society: <i>It contains a series of grossly false
and misleading statements.</i> Let us take it paragraph by
paragraph. The first two paragraphs are grossly false.
The third suppresses the truth. The fourth is grossly
false; the Home Secretary said that neither the starving
of animals to death nor the forced over-feeding of
animals was included among the experiments <i>authorised
or performed</i>. Paragraph five is grossly false. So is
paragraph six: not one word was said about any experiments,
either by the Home Secretary or by anybody
else. The entire number of all dogs and cats together,
under Certificates A, B, E, and EE, throughout the
whole kingdom, that year, was 344. Paragraph eight
is grossly false.</p>

<hr class="c15" />

<p>For want of space, it is impossible to consider all the
special arguments of the anti-vivisection societies. Of
course, among these special arguments, there are a few
which have something in them. How could they all of
them be utterly false? They go back over thirty
years; they are drawn from all parts of the world. This
incessant rummaging of medical books and journals,
British and foreign; and all this everlasting espionage;
<span class="pagenum"><a name="Page_365" id="Page_365">365</a></span>
the whole elaborate system of a sort of secret service&mdash;these
methods, year in year out, are bound to find, now
and again, a fault somewhere. But I do say, having
read and re-read a vast quantity of the publications of
these societies, that they are, taken as a whole, a standing
disgrace to the cause; that they are tainted through
and through with brutal language, imbecile jokes, and
innumerable falsehoods; that they have neither the
honesty, nor the common decency, which should justify
them. Still, here it is that the money goes. There is
<i>money in the business</i>; there is <i>milk in the cocoa-nut</i>; and
<i>twopence more, and up goes the donkey</i>. These are the
phrases used, by the National Anti-vivisection Society,
of the bacteriologists, and the men who are working
at cancer. But these societies, that spend thousands
every year, what have they got to show for it all?
They have, with much else of the same kind, the <i>Zoophilist</i>.
Truly, a fine result; a high-class official journal,
the <i>recognised organ of the anti-vivisection movement in
England</i>.</p>

<p>Take, for a final instance, one or two of the things
said about anæsthetics. On June 12th, 1897, in the
<i>Echo</i>, Mr. Berdoe said that certain experiments, involving
severe operations, had been made on dogs under
morphia and curare. He based this assertion on the
account of the experiments in the <cite>Journal of Physiology</cite>.
On June 18th, Mr. Weir, in the House of Commons,
called attention to this assertion; and the Home Secretary
promised to inquire into the matter. On July 18th,
Mr. Weir asked whether this inquiry had been made;
and the Home Secretary answered:&mdash;</p>

<p  class="blockquote">"Yes, I have made full inquiry into the allegations contained
in the letter and statement which the honourable
<span class="pagenum"><a name="Page_366" id="Page_366">366</a></span>
member forwarded to me, and find that they are absolutely
baseless. The experiments referred to were performed
on animals under full chloroform anæsthesia; the morphia,
to which alone allusion was made in the published account
of the experiments, being used in addition. Curare was
used, but not as an anæsthetic."</p>

<p>It is simple enough. The gentlemen who made the
experiments did not know that the National Society
buys and ransacks the <i>Journal of Physiology</i>; or did
not care. But the National Society called this answer
a "Fruitless Official Denial"; and Mr. Coleridge sent
an "explanatory letter" to the London daily papers,
accusing all the experimenters of "amending their published
record so as to make it fit in with the Government
report." In 1899, the National Society published
that sentence, which has already been quoted, about the
<i>Nine Circles</i>, and the "whiff of chloroform possibly
administered." In 1900, it said, "The chloroformists
of the physiological laboratories are doubtless common
porters, with no technical knowledge of their work."
In 1901, it said, "Our readers will remember that
Mr. Coleridge has had more than one battle with the
Home Office on the question of complete and incomplete
anæsthesia. We need hardly say that the victory
on each occasion rested with our Honorary Secretary."
And again, "By many turns of the anti-vivisection
screw we have at last extracted (from the Home Office)
the admission that pain is not unknown in the laboratories."
In 1902, it said, "The blessed word anæsthesia
warns off the profane anti-vivisectionist who
would rob the altars of science of their victims." Take
later instances. In 1903, we find Mr. Wood saying
that <i>we may be sure the narcosis becomes profound when
the inspectors knock at the door of the laboratory</i>; Dr.
<span class="pagenum"><a name="Page_367" id="Page_367">367</a></span>
Brand, saying that <i>in all experiments, other than inoculations,
it is probable that only a whiff of chloroform is given,
to satisfy the experimenter's conscience, and to enable him
to make humane statements to the public</i>; and Mr. Berdoe,
saying that <i>vivisectors, where they use anything except curare,
employ sham anæsthetics</i>.</p>

<p>Beside such statements as these, there is the argument
from the very rare action of morphia as a stimulant
(see <cite>British Medical Journal</cite>, January 14th, 1899);
but this argument is not in question. The real argument
is, that a man who makes experiments on animals is
likely enough to tell lies about them. As Mr. Berdoe
says, of a very explicit statement about anæsthetics,
made by the late Professor Roy, <i>It is and must be
absolutely untrue</i>. Read again that sentence about the
"whiff of chloroform." The phrase is thirty years old;
but, like Sir William Fergusson's evidence in 1875, it
is still in use. Or take that one phrase&mdash;<i>where they use
anything but curare</i>. It affords, in six words, a perfect
instance of the anti-vivisectionist at his worst.</p>

<h3>IV. "<span class="smcap">Our Cause in Parliament</span>"</h3>

<p>Under this heading the official journal of the National
Society reports questions asked in Parliament, and the
answers given to them. This aspect of the work of the
anti-vivisection societies, and the part taken by them
in elections, and their plans to amend or abolish the Act,
must be noted here.</p>

<p>In one year, the National Society spent £888, 13s. 2d.
on "purely electoral work." That is a very large sum,
when we think of <i>the grave injury done to the cause of
mercy by the deplorable waste of money spent in perfectly</i>
<span class="pagenum"><a name="Page_368" id="Page_368">368</a></span>
<i>unnecessary offices and salaries</i>. The Society's journal
tells us something of this electoral work:&mdash;</p>

<div class="blockquote">
<p>1899.&mdash;"The Parliamentary League has again been
successful in its work at bye-elections. At&mdash;&mdash; the two
candidates were approached, and both gave more or less
satisfactory answers. Sir&mdash;&mdash; 's reply was thought to
be the more satisfactory one, and consequently our
supporters gave him their votes. As our readers are
aware, he was returned." (In a later number, the
<i>Zoophilist</i> hints that "further pressure" may be applied
to this gentleman in Parliament.)</p>

<p>1900.&mdash;"The efforts of the Society will not be confined
to forwarding the interests of any one candidate
or any one party. As soon as the names of candidates
were announced, Mr. Coleridge issued to all of them a
circular letter demanding their views on the vivisection
question. The numerous replies which have already
arrived, and are still arriving, afford results more gratifying
than we for a moment anticipated, and show clearly
that we are now recognised throughout Great Britain
to be a power that cannot be ignored.... Volunteer
workers are also being despatched from headquarters to
various places. Readers who have votes or who will
help in any way are invited to communicate immediately
to the head office, when information about the views of
their candidates will be at once sent to them."</p>
</div>

<p>The London Society also, like the National Society,
desires to have a representative in Parliament; and
this desire is stated in emphatic words in one of its
reports. The general tone of that report has already
been noted. It loves big black headlines, <span class="smcap">No Surrender</span>,
<span class="smcap">The Awakening Churches</span>, <span class="smcap">A Truculent
Science</span>, <span class="smcap">The Sinews of War</span>, <span class="smcap">The Appeal to the
People</span>. They had better ensure the return of that
opponent of vaccination who says that you can bring
any member of Parliament to your knees.
<span class="pagenum"><a name="Page_369" id="Page_369">369</a></span></p>

<p>And, of course, these societies follow the successful
candidates on their subsequent careers. "In Parliament,"
says the London Society, "the Society's work
is carried on as occasion permits. Members of Parliament
are written to or are personally seen at the House
of Commons. Questions are drafted for them to
submit to the Home Secretary, and one or more
officers of the Society are in constant attendance at
the House of Commons when the question of vivisection
is likely to be raised." And the National
Society says, "In order to stimulate attention (to Mr.
Coleridge's Bill) our lecturer has been assiduous in
his attendance in the lobby of the House during the
present session, and by personal interviews has been
able to arouse a good deal of interest in it on both
sides of the House." It is evident that "Our Cause
in Parliament" is urged with diligence, and is not left
to stand or fall according to the unsolicited conscience
of what the London Society calls the <i>average lay
member</i>. Take, for example, the system of drafting
questions to be put to the Home Secretary. It may
or may not take off the edge of sincerity; anyhow,
the question should be drafted with great care. On
February 26th, 1900, a question was asked as to
certain observations which were alleged to have been
made on living animals, but in fact had been made on
their organs removed after death. The National
Society said of this mistake:&mdash;</p>

<p class="blockquote">"We wish our readers to know that the question was
not prompted by any communication from our Society,
and we think it unfortunate that members of Parliament
should be asked to put questions in the House by persons
who do not realise that questions based on inaccurate
premises can do nothing but harm to our cause. It is
<span class="pagenum"><a name="Page_370" id="Page_370">370</a></span>
hard that the whole anti-vivisection movement should
suffer through the carelessness and indolence of those
who will neither be at the pains to avoid inaccuracy by
their own study and investigation, nor by consulting the
National Society's officers."</p>

<p>These careless, indolent, inaccurate persons, who
think so lightly of the National Society's officers, and
draft a question so silly that the whole cause is damaged,
bring us back to the point whence we started: the want
of unity between the societies, the frequent jarring of
one with another. We have still to see something of
the dealings of the National Society with Government.
It is at its best, doubtless, in the formal letters from
Mr. Coleridge to the Home Office; but these, after all,
are his own work, and the Society cannot take the
credit of them. <i lang="la" xml:lang="la">Per contra</i>, we may credit to the
Society, and not to Mr. Coleridge, certain threats to
Ministers in 1898:&mdash;</p>

<div class="blockquote">
<p>... "Should we be so unfortunate as to be left by
you without such an open assurance, we shall feel it our
duty to employ the strength and resources of this Society
in an endeavour to prevent your return to Parliament at
the next election. We know of a large and increasing
number of your constituents who are ready, in the unfortunate
event of your being unable to reassure them as
to your attitude in the matter of endowing torture, to
place humanity above party politics."</p>

<p>... "This Society will feel it to be its duty to use
every means in its power to prevent your return to
Parliament at the next election."</p>

<p>... "We beg leave to inform you that at the next
election the forces of this Society will be used with the
utmost vigour to prevent your return to Parliament. We
know of many, and shall no doubt soon secure more of
your constituents, pledged to place humanity above party
<span class="pagenum"><a name="Page_371" id="Page_371">371</a></span>
and vote against you on the next occasion that you present
yourself."</p>
</div>

<p>What are we to think of these three letters? The
resources of the Society, given with some vague hope
of keeping animals out of pain, are to be used for keeping
Ministers out of Parliament. Note the bullying
tone of the letters. It is the same thing, two years
later, at the General Election, with the heckling of
candidates: <i>We are now recognised throughout Great
Britain to be a power that cannot be ignored</i>. A Society
that bullies Ministers of State, what will it not do to
the average lay member?</p>

<h3>V. <span class="smcap">A Historical Parallel</span></h3>

<p>It is a long way, from the plain duty to take care of
animals, to the arguments and general behaviour of
these societies. Of course, we have seen them here
from the most unfavourable point of view. From that
point of view, apart from any more favourable aspect,
they have their parallel in history. The two instances
are, in some ways, very unlike: but the parallelism is
worthy of note. The historical instance is more than
fifty years old: we have what was said, in 1851,
against his worst opponents, by a man who had an
unpopular cause to defend. Newman, in 1851, gave a
set of lectures on <i>The Present Position of Catholics in
England</i>: and his sayings, some of them, seem apt to
our present subject. Take the following examples.
Only, here and there, a word is altered, or a phrase
left out, that all offence may be avoided:&mdash;</p>

<div class="blockquote">
<p>... "We should have cause to congratulate ourselves,
though we were able to proceed no further than
to persuade our opponents to argue out one point before
<span class="pagenum"><a name="Page_372" id="Page_372">372</a></span>
going on to another. It would be much even to get them
to give up what they could not defend, and to promise
that they would not return to it. It would be much to
succeed in hindering them from making a great deal of
an objection till it is refuted, and then suddenly considering
it so small that it is not worth withdrawing.
It would be much to hinder them from eluding a defeat
on one point by digressing upon three or four others,
and then presently running back to the first, and then to
and fro, to second, third, and fourth, and treating each in
turn as if quite a fresh subject on which not a word had
yet been said."</p>

<p>... "No evidence against us is too little: no infliction
too great. Statement without proof, though inadmissible
in every other case, is all fair when we are concerned.
An opponent is at liberty to bring a charge against us,
and challenge us to refute, not any proof he brings, for
he brings none, but his simple assumption or assertion.
And perhaps we accept his challenge, and then we find
we have to deal with matters so vague or so minute, so
general or so particular, that we are at our wits' end to
know how to grapple with them."</p>

<p>... "For myself, I never should have been surprised,
if, in the course of the last nine months of persecution,
some scandal in this or that part of our cause had been
brought to light and circulated through the country to
our great prejudice. No such calamity has occurred:
but oh! what would not our enemies have paid for only
one real and live sin to mock us withal. Their fierce and
unblushing effort to fix such charges where they were
impossible, shows how many eyes were fastened on us
all over the country, and how deep and fervent was the
aspiration that some among us might turn out to be a
brute or a villain."</p>

<p>... "We are dressed up like a scarecrow to gratify,
on a large scale, the passions of curiosity, fright, and
hatred. Something or other men must fear, men must
loathe, men must suspect, even if it be to turn away
their minds from their own inward miseries.... A
<span class="pagenum"><a name="Page_373" id="Page_373">373</a></span>
calumny against us first appeared in 1836, it still thrives
and flourishes in 1851. I have made inquiries, and I
am told I may safely say that in the course of the fifteen
years that it has lasted, from 200,000 to 250,000 copies
have been put into circulation in America and England.
A vast number of copies has been sold at a cheap rate,
and given away by persons who ought to have known
that it was a mere fiction. I hear rumours concerning
some of the distributors, which, from the respect which
I wish to entertain towards their names, I do not know
how to credit."</p>

<p>... "The perpetual talk against us does not become
truer because it is incessant; but it continually deepens
the impression, in the minds of those who hear it, that
we are impostors. There is no increase of logical
cogency; a lie is a lie just as much the tenth time it
is told as the first; or rather more, it is ten lies instead
of one; but it gains in rhetorical influence.... Thus
the meetings and preachings which are ever going on
against us on all sides, though they may have no
argumentative force whatever, are still immense factories
for the creation of prejudice."</p>

<p>... "The Prejudiced Man takes it for granted that
we, who differ from him, are universally impostors,
tyrants, hypocrites, cowards, and slaves. If he meets
with any story against us, on any or no authority, which
does but fall in with this notion of us, he eagerly catches
at it. Authority goes for nothing; likelihood, as he
considers it, does instead of testimony; what he is now
told is just what he expected. Perhaps it is a random
report, put into circulation merely because it had a
chance of succeeding, or thrown like a straw to the
wind; perhaps it is a mere publisher's speculation, who
thinks that a narrative of horrors will pay well for the
printing: it matters not, he is equally convinced of its
truth: he knows all about it beforehand; it is just what
he always has said; it is the old tale over again a
hundred times. Accordingly he buys it by the thousand,
and sends it about with all speed in every direction, to
<span class="pagenum"><a name="Page_374" id="Page_374">374</a></span>
his circle of friends and acquaintance, to the newspapers,
to the great speakers at public meetings.... Next
comes an absolute, explicit, total denial or refutation of
the precious calumny, whatever it may be, on unimpeachable
authority. The Prejudiced Man simply discredits
this denial, and puts it aside, not receiving any impression
from it at all, or paying it the slightest attention.
This, if he can: if he cannot, if it is urged upon him
by some friend, or brought up against him by some
opponent, he draws himself up, looks sternly at the
objector, and then says the very same thing as before,
only with a louder voice and more confident manner.
He becomes more intensely and enthusiastically positive,
by way of making up for the interruption, of braving
the confutation, and of showing the world that nothing
whatever in the universe will ever make him think one
hair-breadth more favourably than he does think, than
he ever has thought, and than his family ever thought
before him. About our state of mind, our views of
things, our ends and objects, our doctrines, our defence
of them, he absolutely refuses to be enlightened....
The most overwhelming refutations of the calumnies
brought against us do us no good at all. We were
tempted, perhaps, to say to ourselves, 'What <i>will</i> they
have to say in answer to this? Now at last the falsehood
is put down for ever, it will never show its face
again.' Vain hope! Such is the virtue of prejudice&mdash;it
is ever reproductive; future story-tellers and wonder-mongers,
as yet unknown to fame, are below the horizon,
and will unfold their tale of horror, each in his day, in
long succession."</p>

<p>... "Perhaps it is wrong to compare sin with sin, but
I declare to you, the more I think of it, the more intimately
does this Prejudice seem to me to corrupt the soul, even
beyond those sins which are commonly called more deadly.
And why? because it argues so astonishing a want of
mere natural charity or love of our kind. They can be
considerate in all matters of this life, friendly in social
intercourse, charitable to the poor and outcast, merciful
<span class="pagenum"><a name="Page_375" id="Page_375">375</a></span>
towards criminals, nay, kind towards the inferior creation,
towards their cows, and horses, and swine; yet, as regards
us, who bear the same form, speak the same
tongue, breathe the same air, and walk the same streets,
ruthless, relentless, believing ill of us, and wishing to
believe it. They are tenacious of what they believe, they
are impatient of being argued with, they are angry at
being contradicted, they are disappointed when a point is
cleared up; they had rather that <i>we</i> should be guilty than
<i>they</i> mistaken; they have no wish at all we should not be
unprincipled rogues and bloodthirsty demons. They are
kinder even to their dogs and their cats than to us. Is
it not true? can it be denied? is it not portentous? does
it not argue an incompleteness or hiatus in the very
structure of their moral nature? has not something, in
their case, dropped out of the list of natural qualities
proper to man?"</p>
</div>

<hr class="c15" />

<p>These sentences, many of them, might be used now
to describe Anti-vivisection at its lowest level. It might
keep a higher level: but we have seen that the literature,
arguments, and general methods of the Anti-vivisection
Societies fail to do that. The Parliamentary interviewer,
the itinerant lecturer, and the letter-writer, are not, after
all, of much help to any cause: and surely it is time,
after all this waste of huge sums of money, that a Royal
Commission should inquire, not only into experiments
on animals, but also into Anti-vivisection.
<span class="pagenum"><a name="Page_376" id="Page_376">376</a></span></p>

<hr class="c30" />

<p><span class="pagenum"><a name="Page_377" id="Page_377">377</a></span></p>

<h2>INDEX</h2>

<p class="center"><b>A</b></p>
<div class="left20">

<ul>
  <li>A, Certificate, <a href="#Page_268">268</a>, <a href="#Page_286">286</a></li>
  <li><i>Abolitionist</i>, the, <a href="#Page_302">302</a></li>
  <li>Absorbable ligature, the, <a href="#Page_264">264</a></li>
  <li>Act 39 &amp; 40 Vict. c. 77, <a href="#Page_267">267</a>-<a href="#Page_293">293</a></li>
  <li>Actinomycosis, <a href="#Page_246">246</a></li>
  <li>Adrenalin, <a href="#Page_263">263</a></li>
  <li>Aga Khan, Sir, <a href="#Page_179">179</a></li>
  <li>Air, compressed, <a href="#Page_71">71</a></li>
  <li>Algeria, malaria in, <a href="#Page_230">230</a></li>
  <li>America, diphtheria in, <a href="#Page_109">109</a>;
    tetanus in, <a href="#Page_133">133</a>, <a href="#Page_135">135</a>;
    yellow fever in, <a href="#Page_232">232</a>-<a href="#Page_240">240</a></li>
  <li>Amoy, plague in, <a href="#Page_194">194</a></li>
  <li>Amyl nitrite, <a href="#Page_254">254</a>;
    false argument, <a href="#Page_345">345</a></li>
  <li>Anaemia, <a href="#Page_71">71</a>;
    pernicious, <a href="#Page_263">263</a></li>
  <li>Anæsthesia, grades of, <a href="#Page_357">357</a>;
    false statements, <a href="#Page_366">366</a></li>
  <li>Anæsthetics, discovery and study of, <a href="#Page_55">55</a>, <a href="#Page_256">256</a>;
    use under the Act, <a href="#Page_281">281</a></li>
  <li>Anderson, Mr., <a href="#Page_190">190</a></li>
  <li>Andrews, Staff-Surgeon, <a href="#Page_263">263</a></li>
  <li>Anglo-Indians and Anglo-Africans, <a href="#Page_228">228</a></li>
  <li>Animal heat, <a href="#Page_68">68</a></li>
  <li>Animals, protective inoculation of, <a href="#Page_89">89</a>-<a href="#Page_95">95</a>, <a href="#Page_113">113</a>;
    action of drugs on, <a href="#Page_255">255</a></li>
  <li>Annett, Dr., <a href="#Page_223">223</a></li>
  <li>Anopheles and Culex, <a href="#Page_214">214</a>-<a href="#Page_242">242</a></li>
  <li>Anthrax, <a href="#Page_76">76</a>, <a href="#Page_87">87</a>-<a href="#Page_95">95</a></li>
  <li>Antiseptics, <a href="#Page_78">78</a>-<a href="#Page_86">86</a>;
    use of under the Act, <a href="#Page_285">285</a></li>
  <li>Antitoxins, testing of, <a href="#Page_270">270</a>;
    false arguments against, <a href="#Page_338">338</a>-<a href="#Page_342">342</a>.
    See also Diphtheria, Tetanus, &amp;c.</li>
  <li>Anti-vivisection Societies, <a href="#Page_297">297</a> <i lang="la" xml:lang="la">sqq.</i>;
    dissensions, <a href="#Page_299">299</a>-<a href="#Page_302">302</a>;
    expenditure, <a href="#Page_304">304</a>-<a href="#Page_306">306</a>, <a href="#Page_334">334</a>, <a href="#Page_367">367</a>;
    acceptance of all advantages from past discoveries, <a href="#Page_307">307</a>;
    attitude toward sport, <a href="#Page_308">308</a>;
    toward doctors and hospitals, <a href="#Page_310">310</a>;
    literature, <a href="#Page_313">313</a>-<a href="#Page_324">324</a>;
    method of espionage, <a href="#Page_327">327</a>;
    general arguments, <a href="#Page_326">326</a>-<a href="#Page_334">334</a>;
    special arguments, <a href="#Page_335">335</a>-<a href="#Page_367">367</a>;
    electoral and parliamentary tactics, <a href="#Page_367">367</a>-<a href="#Page_371">371</a></li>
  <li>Aphasia, <a href="#Page_62">62</a></li>
  <li>Arguments, anti-vivisection, <a href="#Page_326">326</a>-<a href="#Page_367">367</a></li>
  <li>Aristotle, <a href="#Page_3">3</a>, <a href="#Page_44">44</a>, <a href="#Page_243">243</a></li>
  <li>Arloing and Courmont, <a href="#Page_100">100</a></li>
  <li>Artificial respiration, <a href="#Page_264">264</a></li>
  <li>Asellius, <a href="#Page_19">19</a></li>
  <li>Assam-Burmah railway, cholera on, <a href="#Page_162">162</a></li>
  <li>Athens, Pasteur Institute at, <a href="#Page_143">143</a></li>
  <li>Aubertin, <a href="#Page_62">62</a></li>
</ul>
</div>

<p class="center"><b>B</b></p>
<div class="left20">
<ul>
  <li>B, Certificate, <a href="#Page_268">268</a>, <a href="#Page_349">349</a>.
    See also Experiments</li>
  <li>Baccelli, Prof., <a href="#Page_133">133</a></li>
  <li>Bacteriology, <a href="#Page_77">77</a> <i lang="la" xml:lang="la">sqq.</i>;
    not before the 1875 Commission,
  <span class="pagenum"><a name="Page_378" id="Page_378">378</a></span>
    <a href="#Page_75">75</a>; the foundation of Lister's work, <a href="#Page_85">85</a>;
    hardly recognised in the wording of the Act, <a href="#Page_267">267</a>;
    the cause of more than <a href="#Page_90">90</a> per cent, of all experiments, <a href="#Page_292">292</a>;
    false statements, <a href="#Page_316">316</a>, <a href="#Page_340">340</a></li>
  <li>Baginsky, Prof., <a href="#Page_105">105</a></li>
  <li>Bagshawe, Bishop, <a href="#Page_329">329</a></li>
  <li>Bainbridge, Surgeon-General, <a href="#Page_169">169</a></li>
  <li>Baker, Major, <a href="#Page_172">172</a></li>
  <li>Bang, Prof., <a href="#Page_99">99</a></li>
  <li>Bannerman, Major, <a href="#Page_173">173</a>, <a href="#Page_175">175</a>, <a href="#Page_178">178</a></li>
  <li>Barbadoes, filariasis in, <a href="#Page_240">240</a></li>
  <li>Barry, Bishop, <a href="#Page_343">343</a></li>
  <li>Battipaglia-Reggio railway, and malaria, <a href="#Page_221">221</a></li>
  <li>Bazan, Dr., <a href="#Page_42">42</a></li>
  <li>Beaumont, Dr. William, <a href="#Page_28">28</a></li>
  <li>Behring, Prof., <a href="#Page_102">102</a></li>
  <li>Belchier, Mr., <a href="#Page_40">40</a></li>
  <li>Belgaum, plague at, <a href="#Page_174">174</a></li>
  <li>Bell, Sir Charles, <a href="#Page_46">46</a>, <a href="#Page_57">57</a>, <a href="#Page_65">65</a></li>
  <li>Bell, Dr., <a href="#Page_88">88</a></li>
  <li>Belladonna, action of, <a href="#Page_255">255</a></li>
  <li>van Beneden, <a href="#Page_244">244</a></li>
  <li>Berdoe, Mr., <a href="#Page_314">314</a> <i lang="la" xml:lang="la">sqq.</i></li>
  <li>Bernard, Claude, <a href="#Page_24">24</a>, <a href="#Page_30">30</a>, <a href="#Page_56">56</a>, <a href="#Page_248">248</a>, <a href="#Page_254">254</a>, <a href="#Page_282">282</a></li>
  <li>Bernard Shaw, Mr., <a href="#Page_330">330</a></li>
  <li>Beveridge, Surgeon, <a href="#Page_263">263</a></li>
  <li>Beyrout, experiments at, <a href="#Page_214">214</a></li>
  <li>Bezoar-stone, the, <a href="#Page_252">252</a></li>
  <li>Bichat, <a href="#Page_253">253</a></li>
  <li>Bilaspur, cholera at, <a href="#Page_164">164</a></li>
  <li>Bircher, Dr., <a href="#Page_249">249</a></li>
  <li>Bird-malaria, <a href="#Page_217">217</a>, <a href="#Page_218">218</a></li>
  <li>Birt, Surgeon-Major, <a href="#Page_212">212</a></li>
  <li>Bloemfontein, typhoid at, <a href="#Page_203">203</a></li>
  <li>Blondlot, <a href="#Page_29">29</a></li>
  <li>Blood, circulation of the, <a href="#Page_3">3</a>-<a href="#Page_10">10</a>;
    blood-pressure, <a href="#Page_11">11</a>-<a href="#Page_16">16</a>, <a href="#Page_70">70</a>;
    collateral circulation, <a href="#Page_13">13</a></li>
  <li>Blood-letting, rational use of, <a href="#Page_264">264</a></li>
  <li>"Blood-poisoning," <a href="#Page_84">84</a></li>
  <li>Board of Agriculture laboratories, <a href="#Page_288">288</a></li>
  <li>Board Hospitals, diphtheria in, <a href="#Page_116">116</a></li>
  <li>Boehmer, <a href="#Page_42">42</a></li>
  <li>Bohn, <a href="#Page_37">37</a></li>
  <li>Böllinger, <a href="#Page_246">246</a></li>
  <li>Bombay, plague in, <a href="#Page_170">170</a></li>
  <li>Bone, growth of, <a href="#Page_40">40</a>, <a href="#Page_55">55</a>;
    transplantation of, <a href="#Page_264">264</a></li>
  <li>Borelli, <a href="#Page_25">25</a></li>
  <li>Borrel, <a href="#Page_168">168</a></li>
  <li>Bouillard, <a href="#Page_62">62</a></li>
  <li>Brain, localisation of functions, <a href="#Page_59">59</a>-<a href="#Page_67">67</a>;
    not sensitive to touch, <a href="#Page_65">65</a>, <a href="#Page_285">285</a>;
    false argument against experiments on, <a href="#Page_336">336</a>;
    surgery of, <a href="#Page_337">337</a></li>
  <li>Brieger, <a href="#Page_153">153</a></li>
  <li>Broca, <a href="#Page_59">59</a></li>
  <li>Brown, Captain Harold, <a href="#Page_162">162</a></li>
  <li>Brown-Séquard, Prof., <a href="#Page_56">56</a></li>
  <li>Bruce, Major, <a href="#Page_211">211</a></li>
  <li>Brunton, Sir T. Lauder, on nitrite of amyl, <a href="#Page_254">254</a></li>
  <li>Buchanan, Major, <a href="#Page_219">219</a></li>
  <li>Buenos Ayres, plague in, <a href="#Page_194">194</a></li>
  <li>Buisson bath, the, <a href="#Page_345">345</a></li>
  <li>Buisson, Dr., <a href="#Page_347">347</a></li>
  <li>Burrows, Mr. Herbert, <a href="#Page_329">329</a></li>
  <li>Busk, Prof., <a href="#Page_244">244</a></li>
  <li>Byculla jail, plague in, <a href="#Page_170">170</a></li>
</ul>
</div>

<p class="center"><b>C</b></p>
<div class="left20">
<ul>
  <li>C, Certificate, <a href="#Page_284">284</a></li>
  <li>Cabot, Dr., <a href="#Page_210">210</a></li>
  <li>Cachar tea-gardens, cholera in, <a href="#Page_164">164</a></li>
  <li>Cachexia strumipriva, <a href="#Page_247">247</a>, <a href="#Page_249">249</a></li>
  <li>Cæsalpinus, <a href="#Page_4">4</a>, <a href="#Page_6">6</a></li>
  <li>Caisson disease, <a href="#Page_71">71</a></li>
  <li>Calcutta, cholera inoculations in, <a href="#Page_156">156</a></li>
  <li>Calmette, on plague, <a href="#Page_168">168</a>;
    on snake venom, <a href="#Page_259">259</a></li>
  <li>Calverley, Dr., <a href="#Page_202">202</a>
  <span class="pagenum"><a name="Page_379" id="Page_379">379</a></span></li>
  <li>Cancer, recent experiments on, <a href="#Page_288">288</a>;
    mice immunised against, <a href="#Page_263">263</a>;
    cancer of thyroid gland, <a href="#Page_344">344</a></li>
  <li>Cancer Research Fund, <a href="#Page_288">288</a></li>
  <li>Capillaries, discovery of the, <a href="#Page_10">10</a></li>
  <li>Cappel, Mr. E. K., <a href="#Page_181">181</a></li>
  <li>Carbolic acid, <a href="#Page_338">338</a></li>
  <li>Cardiograph, the, <a href="#Page_17">17</a></li>
  <li>Cardwell, Lord, <a href="#Page_267">267</a></li>
  <li>Carle and Rattone, <a href="#Page_128">128</a></li>
  <li>Carrion, Daniel, death of, <a href="#Page_257">257</a></li>
  <li>Cayley, Surgeon-Colonel, <a href="#Page_203">203</a></li>
  <li>Celsus, <a href="#Page_77">77</a></li>
  <li>Cerebellum, <a href="#Page_46">46</a></li>
  <li>Cerebral localisation, <a href="#Page_64">64</a>-<a href="#Page_67">67</a>;
    false argument, <a href="#Page_336">336</a></li>
  <li>Chamberland, Dr., <a href="#Page_90">90</a></li>
  <li>Chantemesse, on Widal's reaction, <a href="#Page_210">210</a></li>
  <li>Charbon, <a href="#Page_86">86</a>-<a href="#Page_90">90</a>;
    inoculations against, <a href="#Page_90">90</a>-<a href="#Page_93">93</a></li>
  <li>Charles II., treatment of his case, <a href="#Page_251">251</a></li>
  <li>Chauveau, <a href="#Page_97">97</a></li>
  <li>Chenai, Dr., <a href="#Page_189">189</a></li>
  <li>Chicago, diphtheria in, <a href="#Page_109">109</a>;
    tetanus in, <a href="#Page_135">135</a></li>
  <li>Childe, Prof., <a href="#Page_183">183</a></li>
  <li>Children, malaria in native, <a href="#Page_225">225</a></li>
  <li>Choke-damp, <a href="#Page_70">70</a></li>
  <li>Cholera, study of, <a href="#Page_152">152</a>;
    Haffkine's fluid, <a href="#Page_153">153</a>;
    results obtained in India, <a href="#Page_154">154</a>-<a href="#Page_166">166</a>;
    in Japan, <a href="#Page_167">167</a>;
    bacteriology and quarantine, <a href="#Page_167">167</a></li>
  <li>Church Anti-vivisection League, <a href="#Page_298">298</a>, <a href="#Page_301">301</a></li>
  <li>Clinical Society, report on diphtheria, <a href="#Page_111">111</a>;
    on myx&oelig;dema, <a href="#Page_248">248</a></li>
  <li>Cobbold, Prof., <a href="#Page_244">244</a></li>
  <li>Cocain, <a href="#Page_269">269</a></li>
  <li>Cohnheim on inflammation, <a href="#Page_78">78</a>;
    on tubercle, <a href="#Page_97">97</a></li>
  <li>Coleridge, Mr., <a href="#Page_300">300</a> <i lang="la" xml:lang="la">sqq.</i></li>
  <li>Commission on experiments on animals (1875), <a href="#Page_76">76</a>, <a href="#Page_267">267</a>, <a href="#Page_298">298</a>;
    plague Commission (India), <a href="#Page_170">170</a>;
    Commissions on malaria, <a href="#Page_218">218</a>;
    on yellow fever, <a href="#Page_232">232</a>;
    on tuberculosis, <a href="#Page_288">288</a></li>
  <li>Committee on rabies, <a href="#Page_142">142</a>;
    on myx&oelig;dema, <a href="#Page_248">248</a></li>
  <li>Compensatory action of heart, <a href="#Page_69">69</a></li>
  <li>Congress on tuberculosis, <a href="#Page_98">98</a>, <a href="#Page_99">99</a>;
    International Medical (London), <a href="#Page_253">253</a>, <a href="#Page_321">321</a></li>
  <li>Cooper, Sir Astley, <a href="#Page_248">248</a></li>
  <li>Corthorn, Dr., <a href="#Page_190">190</a></li>
  <li>County Council laboratories, <a href="#Page_287">287</a></li>
  <li>Cretinism, sporadic, treatment with thyroid extract, <a href="#Page_250">250</a></li>
  <li>Crile, Dr., <a href="#Page_358">358</a></li>
  <li>Cuba, yellow fever in, <a href="#Page_237">237</a>-<a href="#Page_240">240</a></li>
  <li>Culex and Anopheles, <a href="#Page_214">214</a>-<a href="#Page_242">242</a></li>
  <li>Cumine, Mr. A., <a href="#Page_170">170</a></li>
  <li>Cunninghame-Graham, Mr. R. B., <a href="#Page_330">330</a></li>
  <li>Curare, action of, <a href="#Page_282">282</a>, <a href="#Page_353">353</a>;
    provision of the Act, <a href="#Page_274">274</a>;
    facts as to its use, <a href="#Page_356">356</a>;
    false argument, <a href="#Page_355">355</a></li>
  <li>Curzon, Lord, <a href="#Page_169">169</a>, <a href="#Page_195">195</a></li>
  <li>Cyprus, typhoid in, <a href="#Page_206">206</a></li>
</ul>
</div>

<p class="center"><b>D</b></p>
<div class="left20">
<ul>
  <li>Daman, plague in, <a href="#Page_171">171</a></li>
  <li><i>Dark Deeds</i>, <a href="#Page_313">313</a></li>
  <li>Darwin, evidence before the 1875 Commission, <a href="#Page_68">68</a></li>
  <li>Davaine on anthrax, <a href="#Page_88">88</a>;
    on entozoa, <a href="#Page_244">244</a></li>
  <li>Dax, <a href="#Page_62">62</a></li>
  <li>"Dead" vaccines, <a href="#Page_197">197</a></li>
  <li>Death-rate argument, the, <a href="#Page_339">339</a></li>
  <li>Deaths from experiment on self, <a href="#Page_257">257</a></li>
  <li>Deelfontein, typhoid in, <a href="#Page_208">208</a></li>
  <li>Diabetes, <a href="#Page_30">30</a>-<a href="#Page_35">35</a>;
    pancreatic diabetes, <a href="#Page_39">39</a></li>
  <li>Diapedesis in inflammation, <a href="#Page_78">78</a></li>
  <li>Digestion, <a href="#Page_24">24</a>-<a href="#Page_29">29</a>;
    Pawlow's experiments, <a href="#Page_70">70</a>
  <span class="pagenum"><a name="Page_380" id="Page_380">380</a></span></li>
  <li>Digitalis, study of, <a href="#Page_253">253</a>;
    false argument, <a href="#Page_345">345</a></li>
  <li>Diphtheria, <a href="#Page_102">102</a>-<a href="#Page_127">127</a>;
    discovery of its antitoxin, <a href="#Page_103">103</a>;
    early results and reports, <a href="#Page_103">103</a>-<a href="#Page_116">116</a>;
    results at the Board Hospitals, <a href="#Page_116">116</a>-<a href="#Page_123">123</a>;
    Siegert's tables, <a href="#Page_123">123</a>;
    Woodhead's 1901 report, <a href="#Page_124">124</a>;
    MacCombie's tables, <a href="#Page_126">126</a>;
    <i>preventive</i> use of the antitoxin, <a href="#Page_105">105</a>-<a href="#Page_106">106</a>;
    tracheotomy statistics, <a href="#Page_104">104</a>-<a href="#Page_126">126</a>;
    false statements and arguments, <a href="#Page_310">310</a>, <a href="#Page_316">316</a>, <a href="#Page_338">338</a>, <a href="#Page_339">339</a>-<a href="#Page_342">342</a></li>
  <li>Distemper, inoculation against, <a href="#Page_289">289</a></li>
  <li>Drafting of questions to be put to the Home Secretary, <a href="#Page_369">369</a></li>
  <li>Drowning, experiments on death by, <a href="#Page_361">361</a></li>
  <li>Drugs, action of, <a href="#Page_251">251</a>-<a href="#Page_258">258</a>;
    lingering influence of magic, <a href="#Page_251">251</a>;
    revolutionary work of Magendie and Claude Bernard, <a href="#Page_252">252</a>;
    discovery of <i>selective</i> action, <a href="#Page_253">253</a>;
    effects of drugs on animals, <a href="#Page_255">255</a></li>
  <li>Duboué, Dr., <a href="#Page_138">138</a></li>
  <li>Dundee, tetanus in mills in, <a href="#Page_134">134</a></li>
  <li>Durbhanga jail, cholera in, <a href="#Page_162">162</a></li>
  <li>Durham, Dr., on Widal's reaction, <a href="#Page_210">210</a>;
    on yellow fever, <a href="#Page_235">235</a></li>
  <li>Dyson, Major, <a href="#Page_166">166</a></li>
</ul>
</div>

<p class="center"><b>E</b></p>
<div class="left20">
<ul>
  <li>E and EE, Certificates, <a href="#Page_284">284</a>-<a href="#Page_286">286</a>, <a href="#Page_361">361</a></li>
  <li>Eberlé, <a href="#Page_38">38</a></li>
  <li>Edinburgh Hospital, South Africa, typhoid in, <a href="#Page_205">205</a></li>
  <li>von Eisselsberg, <a href="#Page_249">249</a></li>
  <li>Egypt, typhoid in, <a href="#Page_199">199</a>, <a href="#Page_206">206</a></li>
  <li>"Electoral Work" of anti-vivisection societies, <a href="#Page_299">299</a>, <a href="#Page_367">367</a></li>
  <li>Electricity in medicine, <a href="#Page_264">264</a></li>
  <li>Elephantiasis, <a href="#Page_240">240</a></li>
  <li>Elimination of infection (malaria), <a href="#Page_223">223</a></li>
  <li>Elliot, Dr. Andrew, <a href="#Page_208">208</a></li>
  <li>England, variability of diphtheria in, <a href="#Page_105">105</a></li>
  <li>Equilibration, <a href="#Page_56">56</a></li>
  <li>Erasistratus, <a href="#Page_3">3</a></li>
  <li>Erichsen, Sir John, <a href="#Page_78">78</a>, <a href="#Page_267">267</a></li>
  <li>Excision of wound in tetanus, <a href="#Page_136">136</a></li>
  <li>Experiments on self, <a href="#Page_152">152</a>, <a href="#Page_153">153</a>, <a href="#Page_169">169</a>, <a href="#Page_220">220</a>, <a href="#Page_222">222</a>, <a href="#Page_233">233</a>, <a href="#Page_257">257</a></li>
  <li>Experiments during 1905, report to Government on, <a href="#Page_283">283</a>-<a href="#Page_293">293</a></li>
  <li>Experiments without anæsthetics, <a href="#Page_268">268</a>-<a href="#Page_271">271</a>, <a href="#Page_286">286</a>, <a href="#Page_292">292</a>, <a href="#Page_352">352</a>;
    false statements, <a href="#Page_322">322</a>, <a href="#Page_352">352</a>, <a href="#Page_363">363</a></li>
  <li>Experiments under Certificate B, or B + EE, or B + F, <a href="#Page_285">285</a>;
    prohibition of <i>subsequent</i> infliction of pain, <a href="#Page_286">286</a>, <a href="#Page_352">352</a>;
    these experiments less than 3 <i lang="la" xml:lang="la">per cent.</i> of all experiments, <a href="#Page_285">285</a>;
    inoculation-experiments about 95 <i lang="la" xml:lang="la">per cent.</i> of all experiments, <a href="#Page_286">286</a></li>
</ul>
</div>

<p class="center"><b>F</b></p>
<div class="left20">
<ul>
  <li>F, Certificate, <a href="#Page_284">284</a></li>
  <li>Fabricius, <a href="#Page_5">5</a></li>
  <li>Fayrer, Sir Joseph, <a href="#Page_259">259</a></li>
  <li>Fenwick, Dr. W. S., <a href="#Page_86">86</a></li>
  <li>Ferran, Dr., <a href="#Page_153">153</a></li>
  <li>Ferrier's work in cerebral localisation, <a href="#Page_63">63</a></li>
  <li>Filariasis, <a href="#Page_240">240</a>;
    Dr. Low's report on, <a href="#Page_241">241</a></li>
  <li>Finlay's work on yellow fever, <a href="#Page_232">232</a></li>
  <li>Fischer, <a href="#Page_153">153</a></li>
  <li>Fistula, artificial, <a href="#Page_28">28</a>, <a href="#Page_29">29</a>, <a href="#Page_70">70</a></li>
  <li>Fleas and plague, <a href="#Page_332">332</a></li>
  <li>Flourens, <a href="#Page_55">55</a></li>
  <li>Forman, Major, evidence before Plague Commission, <a href="#Page_176">176</a></li>
  <li>Forster, Mr. W. E., <a href="#Page_267">267</a>
  <span class="pagenum"><a name="Page_381" id="Page_381">381</a></span></li>
  <li>Foster, Sir Michael, <a href="#Page_58">58</a>, <a href="#Page_66">66</a></li>
  <li>Foulerton, Mr. A., <a href="#Page_210">210</a></li>
  <li>Fox, Dr., <a href="#Page_250">250</a></li>
  <li>France, Pasteur Institutes in, <a href="#Page_150">150</a></li>
  <li>Frascatorius, <a href="#Page_6">6</a>, <a href="#Page_96">96</a></li>
  <li>Fraser, Prof., <a href="#Page_170">170</a>, <a href="#Page_253">253</a>, <a href="#Page_259">259</a></li>
  <li>French army, diphtheria in the, <a href="#Page_103">103</a></li>
  <li>Fritsch and Hitzig on cerebral localisation, <a href="#Page_65">65</a></li>
</ul>
</div>

<p class="center"><b>G</b></p>
<div class="left20">
<ul>
  <li>Gabritchefski, Dr., <a href="#Page_105">105</a></li>
  <li>Gaffky, Dr., <a href="#Page_196">196</a></li>
  <li>Galen, experiment on the arteries, <a href="#Page_3">3</a>;
    quoted by Asellius, <a href="#Page_19">19</a>;
   experiments on the nervous system, <a href="#Page_44">44</a></li>
  <li>Gall and phrenology, <a href="#Page_60">60</a></li>
  <li>Gamaleïa, <a href="#Page_153">153</a></li>
  <li>Gamgee, Dr. A., experiments on amyl nitrite, <a href="#Page_254">254</a></li>
  <li>Gastric juice, <a href="#Page_24">24</a>-<a href="#Page_39">39</a></li>
  <li>Gaya jail, cholera in, <a href="#Page_160">160</a></li>
  <li>Germany, diphtheria in, <a href="#Page_105">105</a></li>
  <li>Glycogen, <a href="#Page_30">30</a>-<a href="#Page_35">35</a></li>
  <li>Gmelin, <a href="#Page_27">27</a></li>
  <li>Goldsmiths' Company, the, <a href="#Page_117">117</a></li>
  <li>Gorgas, Major, on yellow fever, <a href="#Page_237">237</a></li>
  <li>Gowers, Sir William, <a href="#Page_63">63</a></li>
  <li>Graaf, Regnier de, <a href="#Page_36">36</a></li>
  <li>Graham, Dr., <a href="#Page_214">214</a></li>
  <li>Grassi, Prof., experiments on malaria, <a href="#Page_221">221</a>, <a href="#Page_257">257</a></li>
  <li>Greece, rabies in, <a href="#Page_143">143</a></li>
  <li>Gull, Sir William, on myx&oelig;dema, <a href="#Page_247">247</a></li>
</ul>
</div>

<p class="center"><b>H</b></p>
<div class="left20">
<ul>
  <li>Hadwen, Dr., <a href="#Page_323">323</a></li>
  <li>Haffkine, work on cholera, <a href="#Page_153">153</a>;
    on plague, <a href="#Page_168">168</a>;
    experiments on self, <a href="#Page_257">257</a></li>
  <li>Haigh, Rev. H., <a href="#Page_184">184</a></li>
  <li>Haldane, Dr., on respiration, <a href="#Page_70">70</a></li>
  <li>Hales, on blood-pressure, <a href="#Page_11">11</a></li>
  <li>Haller, <a href="#Page_82">82</a></li>
  <li>Hallifax, Mr. C. J., <a href="#Page_170">170</a></li>
  <li>Hamburg, cholera at, <a href="#Page_152">152</a></li>
  <li>du Hamel, on growth of bone, <a href="#Page_40">40</a></li>
  <li>Hamer, Dr., <a href="#Page_88">88</a></li>
  <li>Hankin, Dr., <a href="#Page_153">153</a></li>
  <li>Harley, Dr., on pancreatic diabetes, <a href="#Page_39">39</a></li>
  <li>Harvey, William, <a href="#Page_5">5</a>-<a href="#Page_9">9</a>, <a href="#Page_20">20</a>, <a href="#Page_335">335</a></li>
  <li>Harvey, Director General, I.M.S., <a href="#Page_169">169</a>, <a href="#Page_171">171</a>, <a href="#Page_191">191</a></li>
  <li>Hatch, Lieut.-Col., <a href="#Page_169">169</a></li>
  <li>Havana, yellow fever in, <a href="#Page_238">238</a></li>
  <li>Havers, <a href="#Page_40">40</a></li>
  <li>Head, Dr., work on the nervous system, <a href="#Page_70">70</a></li>
  <li>Hebra, <a href="#Page_82">82</a></li>
  <li>Hewett, Mr. J. P., <a href="#Page_170">170</a></li>
  <li>Hewlett, Prof., <a href="#Page_102">102</a>, <a href="#Page_238">238</a></li>
  <li>Hill, Dr. Leonard, <a href="#Page_71">71</a></li>
  <li>Hippocrates, <a href="#Page_243">243</a></li>
  <li>Historical parallel, <a href="#Page_371">371</a></li>
  <li>Hitzig, work on cerebral localisation, <a href="#Page_64">64</a></li>
  <li>Hobday, Prof., <a href="#Page_281">281</a></li>
  <li>Holländer, Dr., <a href="#Page_336">336</a></li>
  <li>Horses immunised against tetanus, <a href="#Page_133">133</a></li>
  <li>Horsley, Sir Victor, <a href="#Page_315">315</a>;
    on Galen, <a href="#Page_44">44</a>;
    on cerebral localisation, <a href="#Page_65">65</a>;
    his work on myx&oelig;dema, <a href="#Page_248">248</a>, <a href="#Page_249">249</a></li>
  <li>Houston's estimate, <a href="#Page_128">128</a></li>
  <li>Hubli, plague in, <a href="#Page_181">181</a></li>
  <li>Hughlings Jackson, Dr., <a href="#Page_63">63</a></li>
  <li>Hunter, John, <a href="#Page_7">7</a>, <a href="#Page_13">13</a>, <a href="#Page_257">257</a></li>
  <li>Hunter, Dr. William, on pernicious anæmia, <a href="#Page_263">263</a></li>
  <li>Hutton, Mr., <a href="#Page_267">267</a></li>
  <li>Huxley, Prof., <a href="#Page_267">267</a>, <a href="#Page_298">298</a></li>
  <li>Hydatid disease, <a href="#Page_245">245</a></li>
  <li>Hypodermic use of drugs, <a href="#Page_264">264</a>
  <span class="pagenum"><a name="Page_382" id="Page_382">382</a></span></li>
</ul>
</div>

<p class="center"><b>I</b></p>
<div class="left20">
<ul>
  <li>Iceland, echinococcus in, <a href="#Page_245">245</a></li>
  <li>Immunised horses, not in pain, <a href="#Page_270">270</a></li>
  <li>Imperial Yeomanry Hospital, typhoid in, <a href="#Page_207">207</a></li>
  <li>India, cholera in, <a href="#Page_153">153</a>;
    plague in, <a href="#Page_168">168</a>;
    typhoid in, <a href="#Page_198">198</a>;
    malaria in, <a href="#Page_216">216</a></li>
  <li>India Office, experiments made for, <a href="#Page_288">288</a></li>
  <li>Inflammation, study of, <a href="#Page_77">77</a>-<a href="#Page_79">79</a></li>
  <li>Ingersoll, Col., <a href="#Page_329">329</a></li>
  <li>Inoculations, scheduled under Certificate A, <a href="#Page_269">269</a>;
    about 95 <i lang="la" xml:lang="la">per cent.</i> of all experiments, <a href="#Page_292">292</a>, <a href="#Page_325">325</a>;
    presence or absence of pain, <a href="#Page_270">270</a>, <a href="#Page_287">287</a>;
    made by Government and public bodies, <a href="#Page_288">288</a>, <a href="#Page_292">292</a>;
    false arguments and statements, <a href="#Page_338">338</a>, <a href="#Page_352">352</a></li>
  <li>Internal secretion, <a href="#Page_34">34</a>, <a href="#Page_39">39</a>, <a href="#Page_250">250</a></li>
  <li>Irregularities under the Act, <a href="#Page_288">288</a></li>
  <li>Israel, Prof., <a href="#Page_246">246</a></li>
  <li>Italy, malaria in, <a href="#Page_218">218</a> <i lang="la" xml:lang="la">sqq.</i></li>
</ul>
</div>

<p class="center"><b>J</b></p>
<div class="left20">
<ul>
  <li>Jains, the, <a href="#Page_168">168</a></li>
  <li>Japan, cholera in, <a href="#Page_167">167</a></li>
  <li>Jesse, Mr., <a href="#Page_298">298</a></li>
  <li>Jewish community at Aden, plague among, <a href="#Page_192">192</a></li>
  <li>Jute mills, tetanus in, <a href="#Page_134">134</a></li>
</ul>
</div>

<p class="center"><b>K</b></p>
<div class="left20">
<ul>
  <li>Kanthack, Prof., on tetanus, <a href="#Page_130">130</a>;
    on snake venom, <a href="#Page_259">259</a></li>
  <li>Kármán, Dr., <a href="#Page_104">104</a></li>
  <li>Karslake, Sir John, <a href="#Page_267">267</a></li>
  <li>Keelan, Lieut., on plague, <a href="#Page_187">187</a></li>
  <li>Keeping down of the mosquito, <a href="#Page_229">229</a>, <a href="#Page_242">242</a></li>
  <li>Kent County Lunatic Asylum, typhoid at, <a href="#Page_197">197</a></li>
  <li>Khartoum Expedition, typhoid on, <a href="#Page_197">197</a></li>
  <li>Khoja community, plague among, <a href="#Page_179">179</a></li>
  <li>Kirki, plague at, <a href="#Page_172">172</a></li>
  <li>Kitasato, Prof., on diphtheria, <a href="#Page_102">102</a>;
    on plague, <a href="#Page_168">168</a></li>
  <li>Klebs, Prof., on diphtheria, <a href="#Page_102">102</a>;
    on typhoid, <a href="#Page_196">196</a></li>
  <li>Klebs-Loeffler bacillus, the, <a href="#Page_102">102</a> <i lang="la" xml:lang="la">sqq.</i></li>
  <li>Klein, Prof., on anthrax, <a href="#Page_76">76</a>;
    on cholera, <a href="#Page_153">153</a>;
    experiment on self, <a href="#Page_257">257</a></li>
  <li>Koch, Prof., on anthrax, <a href="#Page_88">88</a>;
    on tubercle, <a href="#Page_97">97</a>, <a href="#Page_98">98</a>;
    on cholera, <a href="#Page_152">152</a>;
    on typhoid, <a href="#Page_196">196</a>;
    on elimination of infection (malaria), <a href="#Page_223">223</a>;
    experiment on self, <a href="#Page_257">257</a></li>
  <li>Koch's postulates, <a href="#Page_76">76</a></li>
  <li>Kocher, Prof., on myx&oelig;dema, <a href="#Page_247">247</a>, <a href="#Page_249">249</a></li>
  <li>Krokiewicz, <a href="#Page_133">133</a></li>
  <li>Krönlein, <a href="#Page_104">104</a></li>
  <li>Kroonstadt, typhoid in, <a href="#Page_203">203</a></li>
  <li>Küchenmeister on entozoa, <a href="#Page_244">244</a></li>
</ul>
</div>

<p class="center"><b>L</b></p>
<div class="left20">
<ul>
  <li>Lacteals, the, <a href="#Page_19">19</a>-<a href="#Page_23">23</a></li>
  <li>Labbé's proteosoma, <a href="#Page_217">217</a></li>
  <li>Laboratories, not dangerous to public health, <a href="#Page_258">258</a>;
    used in Government service, <a href="#Page_288">288</a>;
    inspected and approved, <a href="#Page_288">288</a></li>
  <li>Ladysmith, typhoid in, <a href="#Page_201">201</a></li>
  <li>Laennec, on tubercle, <a href="#Page_96">96</a></li>
  <li>Lagos, malaria in, <a href="#Page_224">224</a>, <a href="#Page_228">228</a></li>
  <li>Lamb, Surg.-Capt., <a href="#Page_212">212</a></li>
  <li>Lambert, Dr., on tetanus, <a href="#Page_132">132</a></li>
  <li>Lanauli, plague at, <a href="#Page_172">172</a></li>
  <li><i>Lapis Goæ</i>, given to Charles II., <a href="#Page_252">252</a></li>
  <li>Laryngeal diphtheria, <a href="#Page_114">114</a>, <a href="#Page_120">120</a> <i lang="la" xml:lang="la">sqq.</i></li>
  <li>Laveran, on malaria, <a href="#Page_216">216</a>
  <span class="pagenum"><a name="Page_383" id="Page_383">383</a></span></li>
  <li>Lazear, Dr., death from yellow fever, <a href="#Page_235">235</a></li>
  <li>Leblanc, on risk of rabies, <a href="#Page_142">142</a></li>
  <li>Leffingwell, Dr., on history of anti-vivisection, <a href="#Page_297">297</a></li>
  <li>Lefroy, Mr., <a href="#Page_241">241</a></li>
  <li>Legge, Dr., on industrial anthrax, <a href="#Page_88">88</a></li>
  <li>Leuckart, on trichiniasis, <a href="#Page_244">244</a></li>
  <li>Leumann, Surg.-Capt., his work in Hubli, <a href="#Page_181">181</a>-<a href="#Page_189">189</a></li>
  <li>Licenses under the Act, <a href="#Page_275">275</a>-<a href="#Page_277">277</a>;
    number granted, but not used last year, <a href="#Page_283">283</a></li>
  <li>Lister, Lord, his account of his work, <a href="#Page_78">78</a></li>
  <li>Literature, anti-vivisection, <a href="#Page_313">313</a>-<a href="#Page_324">324</a></li>
  <li>Liverpool School of Tropical Medicine, <a href="#Page_218">218</a>, <a href="#Page_224">224</a></li>
  <li>Llangattock, Lord, <a href="#Page_309">309</a></li>
  <li>Localisation in central nervous system, <a href="#Page_54">54</a>, <a href="#Page_59">59</a>-<a href="#Page_67">67</a></li>
  <li>London Anti-vivisection Society, <a href="#Page_302">302</a>, <a href="#Page_323">323</a>, <a href="#Page_334">334</a></li>
  <li>London School of Tropical Medicine, <a href="#Page_220">220</a></li>
  <li>Loraine, Rev. Nevison, <a href="#Page_327">327</a></li>
  <li>Low, Dr. G. C., on malaria, <a href="#Page_220">220</a>;
    on filariasis, <a href="#Page_240">240</a></li>
  <li>Lucknow, cholera in, <a href="#Page_158">158</a></li>
  <li>Lutaud, Dr., <a href="#Page_317">317</a></li>
  <li>Lymphatic system, the, <a href="#Page_23">23</a></li>
  <li>Lyons, Major, on plague, <a href="#Page_172">172</a></li>
</ul>
</div>

<p class="center"><b>M</b></p>
<div class="left20">
<ul>
  <li>MacCallum, <a href="#Page_216">216</a></li>
  <li>McFadyean, Prof., on tuberculin, <a href="#Page_100">100</a></li>
  <li>MacGarvie Smith, <a href="#Page_262">262</a></li>
  <li>MacGregor, Sir William, on malaria, <a href="#Page_224">224</a>, <a href="#Page_228">228</a></li>
  <li>Mackenzie, Dr. Hector, on myx&oelig;dema, <a href="#Page_250">250</a></li>
  <li>Mackenzie, Dr. James, on nerve distribution, <a href="#Page_70">70</a></li>
  <li>MacNeill, Mr., statements in Parliament, <a href="#Page_359">359</a></li>
  <li>Macrae, Surg.-Major, <a href="#Page_160">160</a></li>
  <li>Magendie, on the nerve roots, <a href="#Page_52">52</a>;
    on selective action of drugs, <a href="#Page_252">252</a></li>
  <li>Magic, lingering late in medicine, <a href="#Page_251">251</a></li>
  <li>Mahratta mills and railway, cholera in, <a href="#Page_188">188</a>, <a href="#Page_189">189</a></li>
  <li>Maidstone, typhoid at, <a href="#Page_197">197</a>, <a href="#Page_212">212</a></li>
  <li>Malaria, <a href="#Page_214">214</a>-<a href="#Page_231">231</a>, <a href="#Page_242">242</a></li>
  <li>Malay States, malaria in, <a href="#Page_230">230</a></li>
  <li>Malpighi on the capillaries, <a href="#Page_10">10</a></li>
  <li>Malta fever, <a href="#Page_211">211</a>;
    possibly milk-borne, <a href="#Page_213">213</a></li>
  <li>Malta, typhoid in, <a href="#Page_199">199</a></li>
  <li>Manometers, <a href="#Page_11">11</a>-<a href="#Page_18">18</a></li>
  <li>Manson, Sir Patrick, <a href="#Page_128">128</a>, <a href="#Page_213">213</a>, <a href="#Page_216">216</a>, <a href="#Page_227">227</a></li>
  <li>Mantegazza, <a href="#Page_330">330</a></li>
  <li>Marey, <a href="#Page_16">16</a></li>
  <li>Marsden, Dr., on typhoid, <a href="#Page_200">200</a></li>
  <li>Marshall Hall, his work on reflex action, <a href="#Page_53">53</a></li>
  <li>Martin, Prof. Sidney, on diphtheria, <a href="#Page_103">103</a>;
    on tetanus, <a href="#Page_130">130</a></li>
  <li>Meat, infection of, <a href="#Page_99">99</a></li>
  <li><i>Medical Brief</i>, the, <a href="#Page_316">316</a>, <a href="#Page_338">338</a></li>
  <li>Medical Journals, the, <a href="#Page_297">297</a></li>
  <li>"Medical Opinions on Vivisection," <a href="#Page_321">321</a></li>
  <li>Meerut, typhoid in, <a href="#Page_205">205</a></li>
  <li>Meister, Joseph, Pasteur's first case, <a href="#Page_137">137</a></li>
  <li>von Mering, <a href="#Page_38">38</a></li>
  <li>Metchnikoff, <a href="#Page_78">78</a>, <a href="#Page_153">153</a></li>
  <li>Mice immunised against cancer, <a href="#Page_263">263</a>, <a href="#Page_288">288</a></li>
  <li>Microscope, before bacteriology, <a href="#Page_77">77</a></li>
  <li>Milk, infection of, <a href="#Page_98">98</a></li>
  <li>Ministers of State, letters to, <a href="#Page_370">370</a></li>
  <li>Minkowski, <a href="#Page_38">38</a></li>
  <li>Monsall Fever Hospital, typhoid in, <a href="#Page_200">200</a></li>
  <li>Mora, plague in, <a href="#Page_170">170</a>
  <span class="pagenum"><a name="Page_384" id="Page_384">384</a></span></li>
  <li>Morphia, a true anæsthetic, <a href="#Page_281">281</a>;
    exceptional action of, <a href="#Page_282">282</a></li>
  <li>Mosquito, the, <a href="#Page_214">214</a>-<a href="#Page_242">242</a></li>
  <li>Mosquito brigades, <a href="#Page_230">230</a></li>
  <li>Mukerji, Surg., <a href="#Page_166">166</a></li>
  <li>Müller, Dr., <a href="#Page_258">258</a></li>
  <li>Municipal laboratories, <a href="#Page_287">287</a></li>
  <li>Murray, Dr. George, on myx&oelig;dema, <a href="#Page_250">250</a></li>
  <li>Mursell, Rev. A., <a href="#Page_320">320</a></li>
  <li>Mutilations by farmers and breeders, <a href="#Page_293">293</a></li>
  <li>Myers, Dr. Walter, death from yellow fever, <a href="#Page_236">236</a></li>
  <li>Myx&oelig;dema, <a href="#Page_247">247</a>-<a href="#Page_250">250</a>;
    false argument, <a href="#Page_344">344</a></li>
</ul>
</div>

<p class="center"><b>N</b></p>
<div class="left20">
<ul>
  <li>Nagpur jail, malaria in, <a href="#Page_219">219</a></li>
  <li>National Anti-vivisection Society, <a href="#Page_299">299</a> <i lang="la" xml:lang="la">sqq.</i></li>
  <li>National Canine Defence League, <a href="#Page_306">306</a>, <a href="#Page_322">322</a>, <a href="#Page_360">360</a>, <a href="#Page_363">363</a></li>
  <li>National Society for Prevention of Cruelty to Animals, <a href="#Page_304">304</a></li>
  <li>Negative results, frequent, of inoculations, <a href="#Page_287">287</a></li>
  <li>Negri, Prof., <a href="#Page_137">137</a></li>
  <li>Nervous system, the, <a href="#Page_44">44</a>-<a href="#Page_67">67</a></li>
  <li>Netley Hospital, work on typhoid, <a href="#Page_196">196</a>;
    on Malta fever, <a href="#Page_212">212</a></li>
  <li>New Guinea, malaria in, <a href="#Page_225">225</a></li>
  <li>Newman, Cardinal, <a href="#Page_371">371</a></li>
  <li>Nhatrang, plague in, <a href="#Page_194">194</a></li>
  <li>Nicolaier, on tetanus, <a href="#Page_129">129</a></li>
  <li>Nigeria, malaria in, <a href="#Page_225">225</a></li>
  <li><i>Nine Circles</i>, the, <a href="#Page_313">313</a></li>
  <li>Nocard, Prof., on tetanus in horses, <a href="#Page_133">133</a></li>
  <li>Nott, Surg.-Capt., <a href="#Page_155">155</a></li>
</ul>
</div>

<p class="center"><b>O</b></p>
<div class="left20">
<ul>
  <li>Official experiments, <a href="#Page_288">288</a></li>
  <li>Oliver, Dr., <a href="#Page_88">88</a></li>
  <li>Ollier, Prof., <a href="#Page_43">43</a></li>
  <li>One experiment = one animal, <a href="#Page_359">359</a></li>
  <li>Oporto, plague at, <a href="#Page_168">168</a>, <a href="#Page_194">194</a></li>
  <li>Opsonic index, the, <a href="#Page_101">101</a></li>
  <li>Ord, Dr., on myx&oelig;dema, <a href="#Page_247">247</a></li>
  <li>"Our Cause in Parliament," <a href="#Page_367">367</a></li>
  <li>"Our Cause in the Press," <a href="#Page_310">310</a>, <a href="#Page_311">311</a>, <a href="#Page_360">360</a></li>
  <li>Owen, Sir Richard, <a href="#Page_14">14</a></li>
  <li>Oxygen, inhalation of, <a href="#Page_264">264</a></li>
</ul>
</div>

<p class="center"><b>P</b></p>
<div class="left20">
<ul>
  <li>Pacific Islands, filariasis in the, <a href="#Page_240">240</a></li>
  <li>Pædiatric Society of America, report on diphtheria-antitoxin, <a href="#Page_109">109</a></li>
  <li>Palermo, Pasteur Institute at, <a href="#Page_144">144</a></li>
  <li>Pallas, on entozoa, <a href="#Page_244">244</a></li>
  <li>Pancreas, the, <a href="#Page_36">36</a>;
    pancreatic diabetes, <a href="#Page_39">39</a></li>
  <li>Paralyses of diphtheria, <a href="#Page_114">114</a>, <a href="#Page_116">116</a>, <a href="#Page_125">125</a></li>
  <li>Paralytic rabies of rabbits, <a href="#Page_146">146</a></li>
  <li>Parasitic diseases, <a href="#Page_243">243</a></li>
  <li>Parasitism, <a href="#Page_215">215</a></li>
  <li>Paré, Ambroise, <a href="#Page_167">167</a>, <a href="#Page_252">252</a></li>
  <li>Paris, diphtheria in, <a href="#Page_107">107</a></li>
  <li>Parkinson, Dr., <a href="#Page_86">86</a></li>
  <li>Parsee community at Daman, plague among, <a href="#Page_171">171</a></li>
  <li>Pasteur, his influence on surgery, <a href="#Page_79">79</a>, <a href="#Page_84">84</a>;
    work on anthrax, <a href="#Page_88">88</a>;
    on rouget, <a href="#Page_94">94</a>;
    on rabies, <a href="#Page_137">137</a></li>
  <li>Pasteur Institutes, <a href="#Page_140">140</a>-<a href="#Page_151">151</a>;
    false argument, <a href="#Page_345">345</a>-<a href="#Page_348">348</a></li>
  <li>Pathology and bacteriology, <a href="#Page_75">75</a>-<a href="#Page_86">86</a></li>
  <li>Pavy, Dr., on diabetes, <a href="#Page_35">35</a></li>
  <li>Pawlow, Prof., on digestion, <a href="#Page_70">70</a></li>
  <li>Pecha, Nurse, <a href="#Page_258">258</a></li>
  <li>Pecquet, Jehan, discovery of the thoracic duct, <a href="#Page_21">21</a>
  <span class="pagenum"><a name="Page_385" id="Page_385">385</a></span></li>
  <li>Pédiatrie, Société de, <a href="#Page_106">106</a></li>
  <li>Pernicious anæmia, <a href="#Page_263">263</a></li>
  <li>Peter, Dr., <a href="#Page_141">141</a></li>
  <li>Pfeiffer, Dr., <a href="#Page_153">153</a></li>
  <li>Phelps, Lieut.-Gen., <a href="#Page_323">323</a></li>
  <li>Phrenology, <a href="#Page_60">60</a>, <a href="#Page_333">333</a></li>
  <li>Phthisis, <a href="#Page_96">96</a></li>
  <li>Physiology, <a href="#Page_3">3</a>-<a href="#Page_71">71</a>, <a href="#Page_267">267</a></li>
  <li>Pirkis, Capt., R.N., <a href="#Page_346">346</a></li>
  <li>Plague, <a href="#Page_168">168</a>-<a href="#Page_195">195</a></li>
  <li>Poiseuille's manometer, <a href="#Page_15">15</a></li>
  <li>Pollender, <a href="#Page_88">88</a></li>
  <li>Polli, Prof., <a href="#Page_79">79</a></li>
  <li>Polyvalent serum, <a href="#Page_86">86</a></li>
  <li>Ponfick, <a href="#Page_246">246</a></li>
  <li>Poore, Dr., on anthrax, <a href="#Page_89">89</a>;
    on tetanus, <a href="#Page_129">129</a></li>
  <li>Portland Hospital, typhoid in, <a href="#Page_202">202</a></li>
  <li>Pottevin, Dr., <a href="#Page_145">145</a></li>
  <li>Powell, Dr. Arthur, <a href="#Page_165">165</a></li>
  <li>Prague, tetanus at, <a href="#Page_134">134</a></li>
  <li><i>Prejudiced Man</i>, the, <a href="#Page_373">373</a></li>
  <li><i>Preventive</i> use of antitoxin in diphtheria, <a href="#Page_104">104</a>, <a href="#Page_106">106</a>;
    in tetanus, <a href="#Page_133">133</a>-<a href="#Page_135">135</a></li>
  <li>Prochaska, <a href="#Page_54">54</a></li>
  <li>Protection against Anopheles and Culex, <a href="#Page_227">227</a>, <a href="#Page_241">241</a></li>
  <li>Puerperal fever, <a href="#Page_79">79</a>-<a href="#Page_84">84</a></li>
  <li>Pyæmia, <a href="#Page_78">78</a></li>
</ul>
</div>

<p class="center"><b>Q</b></p>
<div class="left20">
<ul>
  <li>Quarantine and bacteriology, <a href="#Page_167">167</a></li>
  <li>Quesada, <a href="#Page_257">257</a></li>
  <li>Quinine, action of, <a href="#Page_231">231</a></li>
</ul>
</div>

<p class="center"><b>R</b></p>
<div class="left20">
<ul>
  <li>Rabies, <a href="#Page_137">137</a>-<a href="#Page_151">151</a>;
    tests in 1905, <a href="#Page_288">288</a>, <a href="#Page_291">291</a>;
    false argument, <a href="#Page_345">345</a></li>
  <li>Rats and plague, <a href="#Page_192">192</a>, <a href="#Page_332">332</a></li>
  <li>Realdus, <a href="#Page_4">4</a></li>
  <li>Réaumur, work on digestion, <a href="#Page_25">25</a></li>
  <li>Redi, on entozoa, <a href="#Page_244">244</a></li>
  <li>Reed, on yellow fever, <a href="#Page_239">239</a></li>
  <li>Reflex action, <a href="#Page_53">53</a></li>
  <li>Registered places under the Act, <a href="#Page_283">283</a></li>
  <li>Registrar-General, the, <a href="#Page_339">339</a></li>
  <li>Reinhardt, Dr., <a href="#Page_355">355</a></li>
  <li>Rennie, Dr., on snake venom, <a href="#Page_263">263</a></li>
  <li>Report on experiments on animals, <a href="#Page_283">283</a>-<a href="#Page_293">293</a></li>
  <li>Respiration, <a href="#Page_70">70</a></li>
  <li>Reverdin, Prof., <a href="#Page_247">247</a></li>
  <li>Richardson, Sir Benjamin Ward, <a href="#Page_254">254</a></li>
  <li>Richmond Hospital, Dublin, typhoid in, <a href="#Page_207">207</a></li>
  <li>Rio, Pasteur Institute at, <a href="#Page_144">144</a></li>
  <li>Roger, on anthrax, <a href="#Page_88">88</a></li>
  <li>Rolland, Gen., <a href="#Page_175">175</a></li>
  <li>Rolleston, Dr. Humphry, <a href="#Page_207">207</a></li>
  <li>Romanes, <a href="#Page_66">66</a></li>
  <li>Ross, Prof. Ronald, <a href="#Page_216">216</a>, <a href="#Page_228">228</a>, <a href="#Page_242">242</a></li>
  <li>Rouget, inoculation against, <a href="#Page_94">94</a></li>
  <li>Roux, Prof., <a href="#Page_84">84</a>, <a href="#Page_89">89</a>, <a href="#Page_103">103</a>, <a href="#Page_138">138</a></li>
  <li>Royal Society for Prevention of Cruelty to Animals, <a href="#Page_304">304</a></li>
  <li>Rudbeck, <a href="#Page_23">23</a></li>
  <li>Ruffer, Dr., <a href="#Page_170">170</a></li>
  <li>Rush for plague-serum in 1899, <a href="#Page_193">193</a></li>
  <li>Russia, diphtheria in, <a href="#Page_105">105</a></li>
  <li>Russell, Sir James, <a href="#Page_288">288</a></li>
  <li>Russell, Dr. Risien, <a href="#Page_46">46</a></li>
</ul>
</div>

<p class="center"><b>S</b></p>
<div class="left20">
<ul>
  <li>Salicylic acid, <a href="#Page_255">255</a></li>
  <li>St. Martin, Alexis, <a href="#Page_28">28</a></li>
  <li>Sambon, Dr. G. C., <a href="#Page_220">220</a></li>
  <li>Samoa, filariasis in, <a href="#Page_240">240</a></li>
  <li>Sanarelli, Prof., <a href="#Page_234">234</a>, <a href="#Page_315">315</a></li>
  <li>San Carlos jail, yellow fever in, <a href="#Page_234">234</a></li>
  <li>Sanders, Dr., <a href="#Page_253">253</a></li>
  <li>Sanderson, Sir John Burdon, <a href="#Page_32">32</a></li>
  <li><i>Saturday Review</i>, the, <a href="#Page_103">103</a>
  <span class="pagenum"><a name="Page_386" id="Page_386">386</a></span></li>
  <li>Scarbrugh, Dr., <a href="#Page_251">251</a></li>
  <li>Schiff, Prof., <a href="#Page_58">58</a>, <a href="#Page_249">249</a></li>
  <li><i>Securus judicat</i>, <a href="#Page_123">123</a></li>
  <li>Segregation against malaria, <a href="#Page_224">224</a></li>
  <li><i>Selective</i> action of drugs, <a href="#Page_252">252</a></li>
  <li>Semmelweis, Ignaz, work on puerperal fever, <a href="#Page_79">79</a>-<a href="#Page_82">82</a></li>
  <li>Semon, Sir Felix, <a href="#Page_248">248</a></li>
  <li>Semple, Surg.-Major, <a href="#Page_196">196</a>, <a href="#Page_210">210</a></li>
  <li>Serampur, cholera at, <a href="#Page_164">164</a></li>
  <li>"Serious experiments," <a href="#Page_349">349</a>-<a href="#Page_353">353</a></li>
  <li>Sewage, experiments for testing, <a href="#Page_288">288</a></li>
  <li>Sewell, Dr., <a href="#Page_263">263</a></li>
  <li><i>Shambles of Science</i>, the, <a href="#Page_313">313</a></li>
  <li>Siegert's tables of diphtheria, <a href="#Page_123">123</a></li>
  <li>Sierra Leone, malaria in, <a href="#Page_226">226</a></li>
  <li>Simon, Sir John, evidence before 1875 Commission, <a href="#Page_76">76</a></li>
  <li>Simpson, Dr. W. J., on cholera, <a href="#Page_155">155</a></li>
  <li>Skin, diseases of, <a href="#Page_250">250</a>;
    grafting, <a href="#Page_264">264</a></li>
  <li>Skoda, <a href="#Page_82">82</a></li>
  <li>Sleeping sickness, <a href="#Page_264">264</a></li>
  <li>Smith, Dr. J. W., <a href="#Page_203">203</a></li>
  <li>Smith, Mr. Stephen, <a href="#Page_355">355</a></li>
  <li>Snake venom, <a href="#Page_259">259</a>-<a href="#Page_263">263</a></li>
  <li>Society for Prevention of Cruelty to Children, <a href="#Page_304">304</a></li>
  <li>South Africa, typhoid in, <a href="#Page_200">200</a> <i lang="la" xml:lang="la">sqq.</i></li>
  <li>South America, yellow fever in, <a href="#Page_232">232</a> <i lang="la" xml:lang="la">sqq.</i></li>
  <li>Southwell, Bishop of, <a href="#Page_319">319</a></li>
  <li>Spallanzani, <a href="#Page_26">26</a></li>
  <li>Speech centres, the, <a href="#Page_59">59</a>, <a href="#Page_337">337</a></li>
  <li>Spontaneous generation, <a href="#Page_244">244</a></li>
  <li>Sport, attitude of anti-vivisection societies toward, <a href="#Page_308">308</a></li>
  <li>Sphygmometer, the, <a href="#Page_17">17</a></li>
  <li>Spurious hydrophobia, <a href="#Page_347">347</a></li>
  <li>Stanley, Mr., <a href="#Page_42">42</a></li>
  <li>Starling, Prof., <a href="#Page_39">39</a>, <a href="#Page_69">69</a></li>
  <li>Staten Island, <a href="#Page_242">242</a></li>
  <li>Steenstrup, on entozoa, <a href="#Page_244">244</a></li>
  <li>Sternberg, <a href="#Page_128">128</a>, <a href="#Page_231">231</a></li>
  <li>Stoker, Sir W. T., <a href="#Page_291">291</a></li>
  <li>Stone, Dr., <a href="#Page_263">263</a></li>
  <li>Streptococci, <a href="#Page_83">83</a></li>
  <li>Strophanthus, <a href="#Page_255">255</a></li>
  <li>Strychnine, study of, <a href="#Page_253">253</a></li>
  <li>Subdural inoculations, <a href="#Page_133">133</a>, <a href="#Page_138">138</a>, <a href="#Page_271">271</a></li>
  <li>Suppuration, <a href="#Page_84">84</a></li>
  <li>Swammerdam, <a href="#Page_244">244</a></li>
  <li>Syme, <a href="#Page_42">42</a>, <a href="#Page_78">78</a></li>
  <li>Sympathetic system, <a href="#Page_69">69</a></li>
</ul>
</div>

<p class="center"><b>T</b></p>
<div class="left20">
<ul>
  <li><i>Tabes mesenterica</i>, <a href="#Page_98">98</a></li>
  <li>Talbot, Rev. R., <a href="#Page_352">352</a></li>
  <li>Terzi, Signor, experiment on self, <a href="#Page_220">220</a></li>
  <li>Tetanus, <a href="#Page_128">128</a>-<a href="#Page_136">136</a></li>
  <li>Tew, Dr., on typhoid, <a href="#Page_197">197</a></li>
  <li>Thane, Mr. G. D., <a href="#Page_290">290</a></li>
  <li>Thompson Yates laboratories, <a href="#Page_223">223</a></li>
  <li>Thoracic duct, the, <a href="#Page_21">21</a></li>
  <li>Thuillier, <a href="#Page_89">89</a></li>
  <li>Thyroid extract, use of, <a href="#Page_250">250</a>;
    false argument, <a href="#Page_344">344</a></li>
  <li>Tiedemann, <a href="#Page_27">27</a></li>
  <li>Tooth, Dr., <a href="#Page_202">202</a></li>
  <li>Torsion of arteries, <a href="#Page_264">264</a></li>
  <li>Tracheotomy in diphtheria, <a href="#Page_114">114</a>-<a href="#Page_120">120</a></li>
  <li>Transfusion of saline fluid, <a href="#Page_264">264</a></li>
  <li>Transplantation of bone, <a href="#Page_264">264</a></li>
  <li>Treves, Sir Frederick, <a href="#Page_321">321</a></li>
  <li>Trichiniasis, <a href="#Page_244">244</a></li>
  <li>Trotter, Mr. W. B. L., <a href="#Page_288">288</a></li>
  <li>Tubercle, <a href="#Page_96">96</a>-<a href="#Page_101">101</a></li>
  <li>Tuberculin, <a href="#Page_98">98</a></li>
  <li>Typhoid fever, <a href="#Page_196">196</a>-<a href="#Page_211">211</a></li>
</ul>
</div>

<p class="center"><b>U</b></p>
<div class="left20">
<ul>
  <li>Umarkhadi jail, plague in, <a href="#Page_177">177</a></li>
  <li>Undhera, plague in, <a href="#Page_178">178</a>
  <span class="pagenum"><a name="Page_387" id="Page_387">387</a></span></li>
</ul>
</div>

<p class="center"><b>V</b></p>
<div class="left20">
<ul>
  <li>Valentin, <a href="#Page_38">38</a></li>
  <li>Valisnieri, <a href="#Page_25">25</a></li>
  <li>Valléry Radot, <a href="#Page_137">137</a></li>
  <li>Vaso-motor system, <a href="#Page_56">56</a>, <a href="#Page_69">69</a></li>
  <li>Vaughan, Surg.-Capt., <a href="#Page_155">155</a></li>
  <li>Venesection, <a href="#Page_264">264</a></li>
  <li>Venoms, relative strength of, <a href="#Page_260">260</a></li>
  <li>Veratria, <a href="#Page_255">255</a></li>
  <li>Veterinary operations, <a href="#Page_281">281</a>, <a href="#Page_293">293</a></li>
  <li>Vierordt, <a href="#Page_17">17</a></li>
  <li>Villemin, <a href="#Page_96">96</a></li>
  <li>Virchow, Prof., <a href="#Page_75">75</a>, <a href="#Page_245">245</a></li>
  <li>Virulence, grades of, <a href="#Page_89">89</a>, <a href="#Page_139">139</a>, <a href="#Page_260">260</a></li>
  <li><i>Virus fixe</i>, 139</li>
</ul>
</div>

<p class="center"><b>W</b></p>
<div class="left20">
<ul>
  <li>Wall, Dr. A., <a href="#Page_350">350</a></li>
  <li>Waller, <a href="#Page_78">78</a></li>
  <li>War Office, experiments for, <a href="#Page_288">288</a></li>
  <li>Washbourn, Dr., <a href="#Page_208">208</a></li>
  <li>Wassermann, <a href="#Page_153">153</a></li>
  <li>West, Lieut. J. W., <a href="#Page_209">209</a></li>
  <li>West Africa, malaria in, <a href="#Page_224">224</a>, <a href="#Page_226">226</a></li>
  <li>Wharton Jones, <a href="#Page_77">77</a></li>
  <li>Widal's reaction, <a href="#Page_210">210</a>, <a href="#Page_211">211</a></li>
  <li>Wilberforce, Archdeacon, <a href="#Page_319">319</a>, <a href="#Page_328">328</a></li>
  <li>Willis, <a href="#Page_59">59</a></li>
  <li>Winburg, typhoid in, <a href="#Page_209">209</a></li>
  <li>Winmarleigh, Lord, <a href="#Page_267">267</a></li>
  <li>Wolff, <a href="#Page_246">246</a></li>
  <li>Wood, Mr. Somerville, <a href="#Page_339">339</a>-<a href="#Page_344">344</a></li>
  <li>Woodhead, Prof., <a href="#Page_117">117</a>, <a href="#Page_124">124</a>, <a href="#Page_271">271</a></li>
  <li>Woolsorters' disease, <a href="#Page_87">87</a></li>
  <li>Wright, Sir Almroth, <a href="#Page_101">101</a>, <a href="#Page_170">170</a>, <a href="#Page_196">196</a></li>
</ul>
</div>

<p class="center"><b>Y</b></p>
<div class="left20">
<ul>
  <li>Yellow fever, <a href="#Page_231">231</a>-<a href="#Page_240">240</a></li>
  <li>Yersin, <a href="#Page_169">169</a>, <a href="#Page_194">194</a></li>
</ul>
</div>

<p class="center"><b>Z</b></p>
<div class="left20">
<ul>
  <li><i>Zoophilist</i>, the, <a href="#Page_314">314</a>-<a href="#Page_320">320</a></li>
  <li>Zürich, diphtheria in, <a href="#Page_104">104</a>
  <span class="pagenum"><a name="Page_388" id="Page_388">388</a></span></li>
</ul>
</div>

<hr class="c30" />
<div class="footnotes"><h2>FOOTNOTES:</h2>
<div class="footnote">

<p><a name="Footnote_1" id="Footnote_1" href="#FNanchor_1" class="label">[1]</a>  "On peut s'assurer de l'innocuité de ce premier temps de
l'expérience en examinant l'animal, qui n'est nullement troublé,
qui marche et mange comme de coutume. En comptant le
chiffre du pouls, on trouve quelquefois une légère accéleration,
surtout dans les premiers instants; mais les mouvements du
c&oelig;ur sont toujours réguliers, et donnent, à l'auscultation, des
bruits d'un caractère normal." (Marey, <i lang="la" xml:lang="la">loc. cit.</i> p. 63.)</p>

<p><a name="Footnote_2" id="Footnote_2" href="#FNanchor_2" class="label">[2]</a>  <cite>Experiments and Observations on the Gastric Juice, and the
Physiology of Digestion</cite>, by William Beaumont, M.D.; Edinburgh,
1838.</p>

<p><a name="Footnote_3" id="Footnote_3" href="#FNanchor_3" class="label">[3]</a>  <cite>Reynolds' System of Medicine</cite>, vol. v., art. "Diabetes Mellitus."</p>

<p><a name="Footnote_4" id="Footnote_4" href="#FNanchor_4" class="label">[4]</a>  "An Account of the Bones of Animals being changed to a Red
Colour by Aliment only," by John Belchier, F.R.S., <cite>Phil. Trans.
Roy. Soc.</cite>, 1735-36. There is a letter from Sir Hans Sloane, then
President of the Royal Society, to M. Geoffroy, member of the
French Academy:&mdash;"M. Belchier, chirurgien, membre de cette
Société, dînant un jour chez un Teinturier qui travaille en Toiles
peintes, remarqua que dans un Porc frais qu'on avoit servi sur table,
et dont la chair étoit de bon goût, les os étoient rouges. Il demanda
la cause d'un effet si singulier, et on lui dit que ces sortes
de Teinturiers se servoient de la racine de Rubia Tinctorum, ou
garence, pour fixer les couleurs déjà imprimées sur les Toiles de
coton, qu'on appelle en Angleterre callicoes." This passage of
dye into the bones of animals had been noted so far back as
1573, by Antoine Mizald, a doctor in Paris&mdash;<i lang="la" xml:lang="la">Erythrodanum,
vulgo rubia tinctorum, ossa pecudum rubenti et sandycino colore
imbuit.</i></p>

<p><a name="Footnote_5" id="Footnote_5" href="#FNanchor_5" class="label">[5]</a>  From an address on Galen, given by Sir Victor Horsley before
the Medical Society of the Middlesex Hospital. See <cite>Middlesex
Hospital Journal</cite>, May 1899.</p>

<p><a name="Footnote_6" id="Footnote_6" href="#FNanchor_6" class="label">[6]</a>  This paper includes an <i>Experimental Enquiry into the Action
of these Muscles</i>, giving an account of an experiment on the eye.</p>

<p><a name="Footnote_7" id="Footnote_7" href="#FNanchor_7" class="label">[7]</a>  When Flourens died, Claude Bernard was appointed to his
place in the French Academy; and, in the <cite>Discours de Reception</cite>
(May 27, 1869), said, "It is twenty-two years since the discovery
of anæsthesia by ether came to us from the New World, and
spread rapidly over Europe. M. Flourens was the first man who
showed that chloroform is more active than ether."</p>

<p><a name="Footnote_8" id="Footnote_8" href="#FNanchor_8" class="label">[8]</a>  A full account of this discovery, and of its relation to the
experiments of Brown Séquard, Waller, and Budge, is given by
Sir Michael Foster in his life of Claude Bernard; and the question
of priority between Bernard and Brown Séquard need not be considered
here, for the experimental method was the only way open
to either of them. For an account of the work done, before Bernard,
in this field of physiology, see Prof. Stirling's admirable and learned
monograph, <cite>Some Apostles of Physiology</cite> (Waterlow &amp; Sons,
London, 1902), p. 104.</p>

<p><a name="Footnote_9" id="Footnote_9" href="#FNanchor_9" class="label">[9]</a>  For an account of Willis' work on the nervous system, see Sir
Victor Horsley's <cite>Fullerian Lectures</cite>, 1891. Willis was the first, or
one of the first, to recognise the fact that the cerebral ventricles
are nothing more than lymph-cavities.</p>

<p><a name="Footnote_10" id="Footnote_10" href="#FNanchor_10" class="label">[10]</a>  That the surface of the brain is not sensitive of such stimulation,
that it does not perceive its own substance, was known to
Aristotle. The fact is so familiar that there is no need to quote
evidence of it, beyond that of Sir Charles Bell: "I have had my
finger deep in the anterior lobes of the brain, when the patient,
being at the time acutely sensible, and capable of expressing
himself, complained only of the integument."</p>

<p><a name="Footnote_11" id="Footnote_11" href="#FNanchor_11" class="label">[11]</a>  Horsley, <cite>Fullerian Lectures</cite>, 1891, <i lang="la" xml:lang="la">loc. cit.</i></p>

<p><a name="Footnote_12" id="Footnote_12" href="#FNanchor_12" class="label">[12]</a>  See also the admirable Life of Pasteur, by M. Valléry-Radot.
Translation by Mrs. Devonshire, vol. ii. p. 20.</p>

<p><a name="Footnote_13" id="Footnote_13" href="#FNanchor_13" class="label">[13]</a>  This account of Semmelweis, reprinted by permission from the
<cite>Middlesex Hospital Journal</cite>, is mostly taken from Dr. Theodore
Duka's excellent paper on "Childbed Fever." (<cite>Lancet</cite>, 1886.)</p>

<p><a name="Footnote_14" id="Footnote_14" href="#FNanchor_14" class="label">[14]</a>  See Pasteur's Life, vol. ii. p. 89.</p>

<p><a name="Footnote_15" id="Footnote_15" href="#FNanchor_15" class="label">[15]</a>  Dr. Legge, in his Milroy Lectures, 1905, on Industrial Anthrax
(<cite>Lancet</cite>, March and April 1905), gives a full account of Sobernheim's
work up to March 1904, and a table of seventy-six cases,
treated with Sclavo's serum.</p>

<p><a name="Footnote_16" id="Footnote_16" href="#FNanchor_16" class="label">[16]</a>  See Dr. Flexner's account of the disease, in volume xix. of
Stedman's <cite>Twentieth Century Practice</cite>.</p>

<p><a name="Footnote_17" id="Footnote_17" href="#FNanchor_17" class="label">[17]</a>  "The reports for 1893 are at present too few to be utilised for
this table."</p>

<p><a name="Footnote_18" id="Footnote_18" href="#FNanchor_18" class="label">[18]</a>  "In Zukunft wird man es im Kampf gegen diese schreckliche
Plage des Menschengeschlechtes nicht mehr mit einem unbestimmten
Etwas, sondern mit einem fassbaren Parasiten zu thun
haben, dessen Lebensbedingungen zum grössten Theil bekannt
sind und noch weiter erforscht werden. Es müssen vor allen
Dingen die Quellen, aus denen der Infektionsstoff fliesst, so weit
es in menschlicher Macht liegt, verschlossen werden."</p>

<p><a name="Footnote_19" id="Footnote_19" href="#FNanchor_19" class="label">[19]</a>  At the British Congress on Tuberculosis, London, 1901, Koch
stated that bovine tuberculosis and human tuberculosis are not one
and the same disease, and that the risk of milk-infection is so
small that burdensome restrictions ought not to be enforced. In
the general judgment of men well qualified to study the subject,
he failed to prove his point.</p>

<p><a name="Footnote_20" id="Footnote_20" href="#FNanchor_20" class="label">[20]</a>  For references to this paper, and to evidence put forward
against the validity of the test, and for criticism of such
evidence, see Gould's <cite>Year-Book of Medicine and Surgery</cite>, 1902
(Philadelphia, W. B. Saunders &amp; Company).</p>

<p><a name="Footnote_21" id="Footnote_21" href="#FNanchor_21" class="label">[21]</a>  After childhood, the disease is much less fatal.</p>

<p><a name="Footnote_22" id="Footnote_22" href="#FNanchor_22" class="label">[22]</a>  For an exhaustive and wise study of the diphtheritic paralyses,
see Dr. Woollacott's essay in the <cite>Lancet</cite>, 26th August 1899: "The
use of antitoxic serum in the treatment of diphtheria has, up to the
present time, in the London fever hospitals, had two main results&mdash;the
death-rate has fallen, while the paralysis-rate has risen. In
the hospitals of the Metropolitan Asylums Board, the former has
been reduced from 29 per cent. to 15.3 per cent., while the latter
has risen from 13 per cent. to as high as 21 per cent. in 1896.
This increase of paralysis is chiefly due to the fact that many
more patients now recover from the primary disease, and live long
enough for paralysis to show itself. <i>During the last two years,
however, the occurrence of paralysis has begun to diminish in frequency....
The earlier antitoxin is given in diphtheria, the less
likely is paralysis to follow.</i>" It is to be borne in mind that post-diphtheritic
paralysis, in the great majority of cases, affects only a
very small group of muscles; of Dr. Woollacott's tabulated cases,
377 were of this kind, and 97 were severe. And "the type of
paralysis has, on the whole, become less severe, or at all events
less dangerous to life."</p>

<p><a name="Footnote_23" id="Footnote_23" href="#FNanchor_23" class="label">[23]</a>  This, of course, does not apply to two instances, in 1901, of
accidental contamination of serum. See, for an account of these,
<cite>The British Medical Journal</cite>, November 1901.</p>

<p><a name="Footnote_24" id="Footnote_24" href="#FNanchor_24" class="label">[24]</a>  This sentence was written before the publication of Professor
Negri's observations (see <cite>Medical Annual</cite>, 1906, p. 418).</p>

<p><a name="Footnote_25" id="Footnote_25" href="#FNanchor_25" class="label">[25]</a>  It is satisfactory to know that rabbits affected with rabies do
not suffer in the same way as dogs and some other animals, but
become subject to a painless kind of paralysis.</p>

<p><a name="Footnote_26" id="Footnote_26" href="#FNanchor_26" class="label">[26]</a>  "In order to prove that this <i lang="la" xml:lang="la">vibrio</i> is the cause of Asiatic
cholera, several tests upon themselves have been voluntarily made
by investigators in laboratories. These were carried out in Munich
and in Paris. The results to the experimenters were sufficiently
severe to indicate positively the pathogenic character of the spirillum,
and its capacity to produce cholera-like infections. Such
experimentation is, of course, to be deprecated; indeed, the
occurrence of accidental laboratory infections, one of which
ended fatally, furnished the necessary final proof of the specificity
of the cholera <i lang="la" xml:lang="la">vibrio</i>, and rendered unnecessary any exposure to
the risks belonging to voluntary inoculation." (Dr. Flexner, Stedman's
<cite>Twentieth Century Practice</cite>, vol. xix., 1900.)</p>

<p><a name="Footnote_27" id="Footnote_27" href="#FNanchor_27" class="label">[27]</a>  Mr. Hankin, whose name is had in remembrance by Cambridge
men, is Chemical Examiner and Bacteriologist to the
North-West Provinces and Oudh, and to the Central Provinces.</p>

<p><a name="Footnote_28" id="Footnote_28" href="#FNanchor_28" class="label">[28]</a>  For a summary of this report, see the <cite>Lancet</cite>, 8th August
1896. For more recent results, see Surgeon-Captain Vaughan
and Assistant-Surgeon Mukerji, in the thirtieth annual report of
the Sanitary Commissioner for Bengal (1897). Also the note
published by Surgeon-Captain Nott, in the <cite>Indian Medical Gazette</cite>,
May 1898.</p>

<p><a name="Footnote_29" id="Footnote_29" href="#FNanchor_29" class="label">[29]</a>  "The moving into camp, notwithstanding this example, is all
the same an excellent measure of defence, and would with reason
be adopted in every outbreak." (Simpson, <i lang="la" xml:lang="la">loc. cit.</i>)</p>

<p><a name="Footnote_30" id="Footnote_30" href="#FNanchor_30" class="label">[30]</a>  The exact number is 355, of whom 196 were inoculated; the
coolies numbered 343, and the Goorkhas 12. (See Dr. Simpson's
1896 Report.)</p>

<p><a name="Footnote_31" id="Footnote_31" href="#FNanchor_31" class="label">[31]</a>  "As a field for testing the value of inoculation, the tea-factories
of India possess many advantages. The labourers being
under contract, the after-history of those inoculated is easily followed
up. Each morning the adults are paraded for roll-call;
and all sick must attend hospital, where a record is made of their
disease and treatment." (Dr. Powell, <cite>Lancet</cite>, 13th July 1896.)</p>

<p><a name="Footnote_32" id="Footnote_32" href="#FNanchor_32" class="label">[32]</a>  "It is unfortunate that neither of the fatal cases among the
inoculated was seen by any medical man, not even an unqualified
doctor Babu." Dr. Powell does not think, from what was told
him, that one of them was cholera.</p>

<p><a name="Footnote_33" id="Footnote_33" href="#FNanchor_33" class="label">[33]</a>  It is said that the Jains object to inoculations on the grounds
of religion; and one or two witnesses before the Plague Commission
gave evidence to the same effect. But, at Bombay, the high-priest
of a great religious community addressed a meeting of 5000
in favour of the new treatment; and the rush of suppliants for
inoculation at Hubli and Gaday proves that there is no real religious
difficulty. Doctors have been assaulted, as at Poona, so at
Oporto; in neither case can we say <i lang="la" xml:lang="la">Tantum relligio potuit
suadere malorum</i>.</p>

<p><a name="Footnote_34" id="Footnote_34" href="#FNanchor_34" class="label">[34]</a>  Compare the account of the inoculations at Gaday, in the
<cite>Lancet</cite>, 11th February 1898: "To see the crowd waiting and
struggling to pass the barrier is a strange sight; old men and
women, young children, and mothers with babes in their arms,
form a daily crowd numbered by hundreds, who wait for hours
to get their chance of the day's inoculation."</p>

<p><a name="Footnote_35" id="Footnote_35" href="#FNanchor_35" class="label">[35]</a>  Compare the account given by the Rev. H. Haigh (<cite>Methodist
Recorder</cite>, December 1898), of the plague at Bangalore: "The
native population do all they can to elude the vigilance of the
authorities. In order to escape segregation, the householders in
many instances refrain from reporting plague, and not infrequently
bury the corpse secretly. Not only is any spare piece of ground
used as a burial-place, but the body is at times thrown into a well
or tank, or dropped over the wall of some European compound.
During one week three plague corpses were found, badly decomposed,
in reservoirs commonly resorted to for drinking purposes."</p>

<p><a name="Footnote_36" id="Footnote_36" href="#FNanchor_36" class="label">[36]</a>  For the whole subject, see <cite>Lancet</cite>, 9th September 1899, paper
by Surgeon-Major Birt and Surgeon-Captain Lamb. Two other
cases of accidental inoculation occurred at Netley.</p>

<p><a name="Footnote_37" id="Footnote_37" href="#FNanchor_37" class="label">[37]</a>  For Dr. Graham's experiments at Beyrout, which seem to
prove that the mosquito can also convey dengue or dandy-fever,
see the <cite>New York Medical Record</cite>, 8th February 1902.</p>

<p><a name="Footnote_38" id="Footnote_38" href="#FNanchor_38" class="label">[38]</a>  Sir Patrick Manson, in the <cite>British Medical Journal</cite>, 29th
September 1900, gives the following account of this experiment:&mdash;"A
wooden hut, constructed in England, was shipped to Italy
and erected in the Roman Campagna, at a spot ascertained by
Dr. L. Sambon, after careful inquiry, to be intensely malarial,
where the permanent inhabitants all suffer from malarial cachexia,
and where the field-labourers, who come from healthy parts of Italy
to reap the harvest, after a short time all contract fever. This
fever-haunted spot is in the King of Italy's hunting-ground near
Ostia, at the mouth of the Tiber. It is waterlogged and jungly,
and teems with insect life. The only protection employed against
mosquito-bite and fever by the experimenters who occupied this
hut was mosquito-netting, wire screens in doors and windows,
and, by way of extra precaution, mosquito-nets round their beds.
Not a grain of quinine was taken. They go about the country
quite freely&mdash;always, of course, with an eye on <i>Anopheles</i>&mdash;during
the day, but are careful to be indoors from sunset to sunrise. Up
to 21st September, the date of Dr. Sambon's last letter to me, the
experimenters and their servants had enjoyed perfect health, in
marked contrast to their neighbours, who were all of them either
ill with fever, or had suffered malarial attacks."</p>

<p><a name="Footnote_39" id="Footnote_39" href="#FNanchor_39" class="label">[39]</a>  This paper, by Dr. Stephens, gives also the reasons why
equally good results were not obtained at Mian Mir, Punjab.
The whole paper is of great interest.</p>

<p><a name="Footnote_40" id="Footnote_40" href="#FNanchor_40" class="label">[40]</a>  It is not denied here that he made five experiments on human
beings. See Part IV. chap. ii.</p>

<p><a name="Footnote_41" id="Footnote_41" href="#FNanchor_41" class="label">[41]</a>  For a full statement of the great value of this study of
strychnine, see Cl. Bernard, <cite>Leçons de Physiologie Opératoire</cite>,
1879, p. 89.</p>

<p><a name="Footnote_42" id="Footnote_42" href="#FNanchor_42" class="label">[42]</a>  Daniel Carrion, born 1859 at Cerro de Pasco, proved, by self-inoculation,
the identity of the two forms of the disease, 27th
August 1885; died of the disease, 5th October. See <cite>Ann. de
l'Inst. Past.</cite>, Sept 1898.</p>

<p><a name="Footnote_43" id="Footnote_43" href="#FNanchor_43" class="label">[43]</a>  See Part IV., "Curare."</p>

<p><a name="Footnote_44" id="Footnote_44" href="#FNanchor_44" class="label">[44]</a>  In experiments performed under licence alone, the animal
must during the whole of the experiment be under the influence
of some anæsthetic of sufficient power to prevent the animal
feeling pain; and the animal must, if the pain is likely to continue
after the effect of the anæsthetic has ceased, or if any
serious injury has been inflicted on the animal, be killed before
it recovers from the influence of the anæsthetic which has been
administered.</p>

<p>Certificate C. allows experiments to be performed, under the
foregoing provisions as to the use of anæsthetics, in illustration of
lectures.</p>

<p>Certificate B. exempts the person performing the experiment
from the obligation to cause the animal on which the experiment
is performed to be killed before it recovers from the influence
of the anæsthetic; and when the animal is a dog or a cat,
Certificate EE. is also necessary.</p>

<p>Certificate A. allows experiments to be performed without anæsthetics;
and when the animal on which the experiment is performed
is a dog or a cat, Certificate E. is also necessary.</p>

<p>Certificate F. is required in all cases of experiments on a horse,
ass, or mule.</p>

<p><a name="Footnote_45" id="Footnote_45" href="#FNanchor_45" class="label">[45]</a>  These two societies have other purposes beside that of opposition
to experiments on animals.</p>

<p><a name="Footnote_46" id="Footnote_46" href="#FNanchor_46" class="label">[46]</a>  Even the <i>Zoophilist</i>, which quotes this speech from the <cite>Clapham
Observer</cite>, seems to feel that it might have been put more
simply.</p>

<p><a name="Footnote_47" id="Footnote_47" href="#FNanchor_47" class="label">[47]</a>  I think it was two; it was either one or two.</p>

<p><a name="Footnote_48" id="Footnote_48" href="#FNanchor_48" class="label">[48]</a>  Mr. R. B. Cunninghame-Graham's variant on this theme, in
the <cite>Daily News</cite>, Aug. 27, 1903, is really too filthy to be put here.
Like Mr. Loraine, I dare not produce my brief.</p>

<p><a name="Footnote_49" id="Footnote_49" href="#FNanchor_49" class="label">[49]</a>  This should be 1899.</p>
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