REPORT ON PROGRESS OF MEDICINE.

I.

WALTER R. STEINER, M.D.,

HARTFORD.

No report on the progress of medicine during the past year should be made without a preliminary reference to one of the great names in our art who died September fifth, 1902. For Rudolph Virchow has done more than any one in our profession to put the science of medicine on a rational basis by introducing exact methods of medical research, and establishing the principles of cellular pathology. He has been the stimulus to many to further the advance of medicine and he himself was the author of one hundred and twenty-five large volumes and one thousand pamphlets. Lord Lister has justly called him "Our Beloved Master, The Father of Patology."

The memory of such a man will be ever blessed-a man honored alike for his researches in pathology and anthropology, as well as for his devotion to the public. weal in many official capacities.

It has been well said that the past year has been "characterized by further investigation along many lines. of medical science rather than by the inauguration of new theories." For instance previous labors on the transmission of malaria and yellow fever have been continued and the parasitic theory of their transmission, heretofore advanced, has been substantiated by further researches. As a result of this work yellow fever has been pretty effectively stamped out in Havana and other parts of Cuba, and malaria has become a disease much

less to be dreaded if proper measures are taken to de stroy the offending anopheles and their ova. Koch's theory, that the danger of transmission of tuberculosis from animal to man was practically nil, has been during the past year frequently found to be erroneous. Salmon well states that "tubercle bacilli from bovine sources may infect man and produce a progressive and fatal disease. Ingestion tuberculosis may have its starting point in the glands of the neck or thorax, or even in the lungs, and the number of cases of human tuberculosis showing a primary intestinal lesion is no indication of the number of cases which occur from ingestion. We must depend largely on the clinical evidence for a determination of the relative frequency with which man is infected by tubercular food." 1

No further light has been obtained on the parasitic origin of cancer, but many have turned their attention to this subject and the number of cancer commissions organized is gradually growing larger. Ehrlich's side chain theory of immunity is receiving further and further substantiation and, although the subject grows in its complexity, yet the theory has stood fire so far and may be at present considered a more adequate and convincing theory than any other formerly enunciated.

As we advance in our knowledge of the different diseases, the more likely are we to find their cause and to know the complications and sequelae that can occur dur ing and after their attacks. Let me consequently speak somewhat in detail of some of the progress made during the past year along these and other lines.

SUMMER DIARRHEAS OF INFANTS.

One epoch-making discovery has been made whose significance may have an important bearing on the treatment of the disease in question. I refer to the finding of the Shiga bacillus in summer diarrheas in infants, This was due to the brilliant work of Duval and Bassett 2

who, working under the direction as well as inspiration of Dr. Welch of Baltimore, and Dr. Flexner of Philadel phia, were able to isolate this organism from the stools in forty-two cases of summer diarrheas of infants. 13 was also obtained from scrapings of the intestinal mucosa at autopsy, and in one case from the mesenteric glands and liver. In the stools of acute cases the bacillus was present often in large numbers but in cases of mild severity and in those of long duration they were found with difficulty, "on account of their presence in relatively small numbers and the antagonism of the nor mal intestinal bacteria." The identity of this bacillus with that found in cases of acute dysentery in adults by Shiga in Japan, Flexner and Strong in the Philippines, Kruse in Germany and Vedder and Duval in this country has been most thoroughly established. From the animal experiments of Gay and Shiga's success in treating adult bacillary dysentery with serum, we may look forward with great confidence to the early discovery of an effective serum against this disease.

SMALL-POX.

The past year has been very productive in researches upon the etiology of small-pox. Dr. Councilman's investigations in this line are the most important for he has found, in connection with this disease, an organism belonging to the group of protozoa. It has a definite life cycle without and within the nuclei of the deeper layers of epithelial cells of the skin" and in these two forms is seen in small-pox, while the extra-nuclear form alone causes vaccinia. With the formation of a vesicle the life history of this organism is completed.

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TYPHOID FEVER.

The work done on the occurrence of typhoid bacilli in the blood of typhoid fever patients has been most instructive and has a lesson for those physicians who do not yet realize that "typhoid fever is clinically a general sep

ticemia, of which the intestinal lesions form the more marked local manifestations" and that consequently socalled intestinal antisepsis can neither abort nor influence this disease. Schöttmuller from Lehnhartz's clinic at Hamburg was able to cultivate the typhoid bacilli from the blood eighty-four times out of one hundred and one patients. In thirty-nine out of fifty of them positive results were obtained on the day of the patient's entry into the hospital. He believes the number of bacilli in the blood bears a more or less direct relation to the clinical symptoms and that the estimation of the colonies in plate cultures has a certain prognostic value, the bacilli being more numerous in the severer cases. He obtained positive results much earlier than by the Widal test and declares that a negative bacteriological blood-examination in very ill patients with high fever, where the clinical symptoms do not allow of a positive diagnosis, practically excludes the diagnosis of typhoid. The usual portal of infection is probably the gastro-intestinal tract. Busquet was even more fortunate in isolating the typhoid bacilli for he found them in every case he examined-forty-three in all- and generally at the first examination, although in one case they were only observed at the fourth. In fourteen of the cases there was a mixed infection. Courmont, another French observer, has found them as early as the fifth day and believes with Busquet that they can be recovered from the blood in all cases, at some time during the disease. Cole and Hewlitt 10 in this country have previously obtained this bacillus from the blood—the former in eleven out of fifteen cases and the latter in twenty out of twenty-four. The previous failure to cultivate these organisms was probably due to the small amount of blood withdrawn. The bacteria were consequently killed by the blood's bactericidal action. The present method is to dilute largely the blood so as to destroy its above-mentioned property.

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