mind is superior to the body in its potential reach and, therefore, can be of the highest service in helping to care for the body. In other words, we may be greatly helped or hindered in our efforts in behalf of either personal or public health according as we accept or reject the idea of mind as a more or less distinct and potential force in human welfare.

The Changed Attitude toward Disease.

When Louis XV of France, during his last illness, was told by his physician, La Martiniere, that he had the smallpox, it is said that he made no reply but turned heavily in his bed, threw the coverlet over his face, and a little later said to his attendants, in a heart-broken tone, "I know now the state in which I am, and before long I shall be gathered to my fathers." The news of the nature of his illness soon decimated his court and caused most of his attendants to flee. And a few days later, powerful ruler as he was, he died almost alone from that which was then regarded as one of the most hopeless, as it certainly is one of the most loathsome, of all diseases. This was in 1774, and, although smallpox no longer arouses the terror and hopelessness it did in the days of Louis XV, there are still other diseases which even yet inspire in the minds of the people some of its helpless dread. But important influences have been at work, especially within the last few years, and a changed attitude in regard to disease is being effected. This changed attitude is especially noticeable as it reverses the former belief in the necessity and hopelessness of disease. This change of view is being effected by scientific investigation of the nature of disease, by improved curative measures, but more particularly through a change in the attitude concerning the functions of the physician.

Few realize the resources that are being expended upon the search for the causes of specific diseases, the methods of their transmission, and the means of their prevention, nor the sincere devotion and fearless self-sacrifice of the men who are at work upon these problems. The observation by Jenner in 1798 that most dairy-laborers were immune from smallpox, and his subsequent successful demonstration of

the theory that inoculation with the virus of cowpox is a preventive of this disease, may well be regarded as an accidental though exceedingly fortunate discovery. It was a case, however, in which a keen observer had the intelligence and energy to follow up his observation with persistent and careful demonstration. This was also true of the discovery of anesthetics, first publicly employed to produce unconsciousness to pain in 1846, a discovery which has so greatly enlarged the field of possible relief through surgery. But such random and unorganized effort cannot be relied upon for progress along any line of endeavor. Besides, where reliance must be placed solely upon observation, many erroneous and wholly unreliable conclusions naturally follow. True and economical progress demands investigation and demonstration that have the greater system and surety of science back of them. So generally did suppuration attend the healing of all wounds that observation had practically determined that it was a necessary attendant of all normal wound-healing. But, when Lister attacked the problem in a scientific way, he soon discovered that suppuration was merely the manifestation of the presence of germ poisoning in the wound, and that instead of furthering normal healing it greatly retarded it. Through careful experimentation he found antiseptics which would destroy these germs, cleanse the wound of their poisonous products, and rob surgery of its fevers and frequently fatal results a development which later on was to be followed by the discovery that by perfect cleanliness no germs need enter the wound, so that aseptic surgery has now replaced antiseptic surgery.

Lister's work marked the second great advance in surgery. But it also did more, for his discovery was based on a new method which was destined to revolutionize medical standards and practice everywhere. It was this new method to which Pasteur led the way in his great discovery that many of man's most serious ailments are due to minute invisible bodies which, under conditions favorable to their development, attack the tissues and tend to produce disease and death. Although Pasteur's first discoveries were made while investigating the cause of disease in grape-vines and later on in sheep, he was not long

in determining the similarity of causes in the case of human disease. His scientifically trained mind was also well prepared to seize upon and demonstrate the ways in which these microbes or germs can be transmitted from place to place, as well as the conditions most favorable to their transmission. This opened up a new field to medical research, and since that time many of the efforts for public health have been in the direction of isolating disease, preventing its spread, and of giving it no opportunity for growth. His discoveries also prepared the way for isolating disease germs and for experimenting with them with a view of discovering the best means of counteracting their effects and of preventing their attacks. By artificial cultivation of colonies of an isolated germ it has been possible to inoculate animals and reproduce the disease within them. This has made feasible the scientific observations and experiments that have been the chief means for the past thirty years of discovering the best remedial and preventive measures for some of our most fatal diseases. Although the suffering thus entailed on the animals used in the experimenting is to be deprecated, it has been justified on the ground that the necessities of the case demand it; besides, the saving of even one human life would justify the sacrifice of many animals. At least, it cannot successfully be denied that such experimentation has been the means during the last thirty years of a progress in matters of health greater than during all the preceding centuries. This progress has been particularly marked in the way it is removing the terror and hopelessness of disease. The more we know of the nature of a disease and of its cause, the more hopeful the outlook for its prevention and cure. Much of the old-time terror in regard to disease was inspired by the mystery surrounding it and the resulting feeling of helplessness in attacking it. Curative remedies that are not based upon an exact knowledge of the nature and cause of disease are subject to all the vicissitudes and errors of all other merely observational knowledge.

There is a strong feeling developing among practitioners against giving any medicine for the cure of disease, excepting such as absolute experiment has demonstrated to be a specific against the encroachment or development of the

disease. This has led to far less use of drugs than formerly, and it is claimed that still fewer would be given were it not for the clamor of patients for something to take whenever their physical mechanism is not running smoothly. Besides the injury that may be wrought by the extensive use of drugs, there is the additional danger arising from the incomplete or hasty diagnosis of the physician who feels that a case is not serious enough to warrant careful investigation. Curative measures that will command the confidence of the public will ultimately have to embrace a care and evidence of knowledge in the diagnosis that will inspire confidence, whether the verdict is medicine or no medicine. But whether the ailment be slight or serious, whether it be real or largely imaginative, the patient is probably on the safe side in appealing to his physician at once in regard to a continued ailment; for too often this appeal is made after the disease has gained such headway as to render the result doubtful and the prospect hopeless. The most favorable results, especially in contagious diseases, are always to be secured from early and prompt treatment. And such insidious diseases as tuberculosis are no longer greatly feared if recognized and treated in their early stages. At least such is the evidence of the records and the statements of the medical experts upon whom we must rely.

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But the greatest change in the attitude toward disease is noticeable in the changed view concerning the functions of the physician. The distinguished physician, Earl Mayo, calls attention to this in an article in the Outlook for July 20. Medicine, he says, has heretofore been looked upon as "the healing art," and the business of the physician to be to make us well when we are sick. As our habit has been to give very little heed to our physical state except when we receive unmistakable warning that it is badly deranged, this ideal has been forced upon medical men as a guide of conduct irrespective of any views that they themselves might entertain." But all this is changing. The principal business of the physician of the future will be to keep us well. The evidence of this is to be found in the activity of boards of health in removing sources of disease, in the popular demand for the kind of information and leadership that will promote physical well-being, and in the

emphasis being placed on this phase of medicine by leading physicians, lecturers, magazine articles, etc. This change of attitude toward the function of the physician is manifesting itself especially along the lines of

(a) Emphasizing his duty to be that of leading the people into such a knowledge of the nature, causes, and means of preventing disease as will enable them to avoid its ravages.

(b) Through his researches to gain such a knowledge of the nature of each specific disease as will enable him to detect with surety its presence in its earliest stages, so that the proper remedial measures may be adopted in time.

(c) To do all in his power to remove the alarming mystery that is so often associated with disease and which certain types of medical practitioners are tempted to foster for the sake of magnifying their own services.

(d) Believing that, after all, nature knows best how to combat its own ailments, to seek "to know and to emulate the methods by which nature (meaning in this case the accumulated experience of the bodily organs throughout their entire history) fights disease and tries to overcome it." It is on this side-in the field of experimental medicineDoctor Mayo says, that the most wonderful advance of recent years has been made. "It is the work that has been done in this field that has given us a new outlook, a new hope, a new attitude, and in many cases new methods in facing and treating serious bodily ills."

(e) The corollary of this will naturally be the giving of less medicine and the calling out more and more of the suffering individual's intelligent and persistent efforts in his own behalf. Such a course will have the double advantage of arraying his own will power and intelligence against the further encroachments of the disease, and of fostering physical foresight and practices that will probably do more than anything else to promote progress in matters of health.

(f) To be a student of human nature so that he may be able to call forth a helpful mental attitude not only in the afflicted individual but in the public at large. Professional people have given little consideration to this phase of their work, and, as a result, have missed much of the help that comes from mutual understanding and confidence between