SEVEN DECADES IN MEDICINE- 
By Major W. W. Kee:4 
THE greatest advances in the last sdven decades in medi- 
cine have been four: first, anesthesia; seffoitdrbac- 
teriology and its outgrowths-antiseptic and aseptic surgery 
and obstetrics, and the science of immunology; third, the 
establishment of laboratories- for research; fourth, the 
X-rays. 
On October 16, 1846, in the Massachusetts General Hos- 
pital, Dr. John Collins Warren, Professor of Surgery in the 
Harvard Medical School, operated on a young man in the 
blessed sleep of ether, the anesthetic being administered by 
a dentist, William T. G. Morton. The patient suffered no 
pain. This was the first public administration of ether to 
abolish pain and was the first of the epoch-making discov- 
eries which have revolutionized surgery within my own life- 
time-I was then nearly ten years of age. 
It is perfectly true that Long of Georgia, beginning in 
1842, performed a few minor operations under ether. Yet 
he published nothing, and made no claim to be the dis- 
coverer of anesthesia until three years after its public use 
by Morton and Warren. Utterly lacking that gift of imag- 
ination which marks the genius, he did not appreciate in the 
least what a great thing he had stumbled upon. Had the 
introduction of anesthesia rested with him, it never would 
have been known. The unseemly quarrel of the several men 
who contributed to the discovery of anesthesia and the un- 
fortunate commercialism of Morton were at least relieved 
by the wit of Oliver Wendell Holmes. He it was who named 
the new bantling and gave to the language the terms "anes- 
thesia," "anesthetic," "anesthetist." When it was proposed 
to place a monument to the discoverer of anesthesia in the 
Reprint from The Yale Review, January, 1919. 
Copyright by the Yale Publishing Association, New Haven, Conn. 2 
THE YALE REVIEW 
Public Garden in Boston, a bitter controversy at once arose 
among the advocates of the rival claimants, especially of 
Morton and Jackson. Holmes was asked to solve the knotty 
problem of the inscription for the monument. With his usual 
wit he assured them that nothing was easier: erect a shaft; 
place the bust of Morton on one side and opposite to it that 
of Jackson and between them the legend "To Ether." 
In 1847 Sir James Y. Simpson of Edinburgh discovered 
the anesthetic property of chloroform. Several other anes- 
thetics for prolonged operations have since been introduced, 
but the only serious rival of ether and chloroform is the com- 
bined use of nitrous oxide and oxygen. 
We of the present generation are so familiar with anes- 
thesia during operations that we can hardly appreciate the 
horrors of the pre-anesthetic days. Strong men held the 
patient in their grasp. Strong straps bound each wrist to 
its corresponding ankle. The shrieks of the poor sufferers 
whipped up the surgeons to breathless haste. Operators 
were timed by watches in the hands of the students, and he 
was the best surgeon who could amputate an extremity in 
five seconds less than his rival, for each second seemed an 
age to the writhing patient. Such haste now and then re- 
sulted disastrously. No prolonged, painstaking, accurate, 
artistic surgery was then possible. No operation which re- 
quired absolute quietude of the patient could be attempted. 
Even after the introduction of anesthesia, this cultivation of 
lightning speed did not subside for years. Indeed, in the 
early 'sixties, while I was a student, I saw Gross and Pan- 
coast timed by the watch while extracting a stone from the 
bladder. 
Moreover, the pain was so unbearable that very few op- 
erations were done. Only when the alternative was opera- 
tion or death could one "screw one's courage to the sticking 
point." In the five years preceding the introduction of 
anesthesia in the Massachusetts General Hospital, only 184 
persons submitted themselves to the terrible ordeal; that is, SEVEN DECADES IN MEDICINE 
3 
only 37 operations were performed in a year. At present as 
many operations are done in our large metropolitan hospitals 
in one or two days as in the Massachusetts General Hospital 
in a whole year before 1846. 
No one time can be fixed as the date of the origin of bac- 
teriology. It was the growth of years. The suspicions of 
curious surgeons, pathologists, microscopists, and experi- 
menters gradually assumed definite shape; and finally the 
science of bacteriology received its name in 1884. The words 
"germs," "microbes," and "bacteria" are applied indiffer- 
ently to all sorts of germs, though "bacteria" means lit- 
erally only "little rods." "Bacilli" is another term which 
also means little rods, but it is only applied to those actually 
having that shape. 
As early as 1850 Davaine in France had discovered little 
rods in the blood of animals dead of anthrax. A paper by 
Pasteur awakened him to the probability of their being the 
cause of the disease. Two years later Villemin proved the 
contagiousness of tuberculosis by inoculating animals with 
tuberculous tissue and sputum. Gradually one germ after 
another was discovered in rapid succession. By 1884 a suf- 
ficient number of germs were known to make differentiation 
and orderly classification desirable and possible. At present 
multitudes of various germs have been arranged in scientific 
genera and species. 
Besides these visible and well-known germs, there are 
others which are so small as to pass readily through the pores 
of the finest filters ever constructed. These, on account of 
their excessively small size, have never been seen, and some 
of them may be so small as to be shorter than the violet rays 
of light-the shortest of the visible rays-and if so they can 
never be seen. It is known that they must exist because of 
the effects of inoculating animals with the liquids in which 
they have been practically shown to be present. Among 
these germs as yet undiscovered are those which cause 
smallpox, yellow fever, and infantile paralysis, such diseases 4 
THE YALE REVIEW 
in animals as hog cholera, and certain diseases of children.* 
The idea that there should be any "usual diseases of child- 
hood" is a monstrous and repulsive anachronism. When we 
know the causes of all these diseases we shall then speak of 
the " usual health of childhood." To reach this goal we must 
depend largely upon the bacteriologists. 
When we discover a germ and can grow it in "pure cul- 
ture," unmixed with any other germs, we are then able to 
prepare antidotes. Even now, though we do not know the 
real cause of either, we have the antidote for smallpox- 
vaccination-and have the whip hand of yellow fever-by 
preventing the mosquito from reaching yellow fever patients 
during the first three days of illness. There has not been a 
single case of yellow fever originating in Panama in thirteen 
years. This discovery of how to prevent yellow fever made 
the Panama Canal a possibility. 
To prove that a given bacterium is the definite cause of 
any disease it must fulfil the following conditions: 
First, it must always be found in the blood or tissues in 
every undoubted case of the disease in question. 
Second, a pure culture of the germ must be grown by the 
observer; that is, a growth on bouillon, gelatin, or other ster- 
ile medium, of this one germ and no other. 
Third, on inoculating a rabbit, guinea pig, or other animal 
with this pure culture, the disease in question and no other 
disease must be produced in the inoculated animal. 
Fourth, the same germ must be recovered from the blood 
or tissues of the inoculated animal. 
Fifth, a repetition of the same experiments with this re- 
covered germ must yield identical results. 
To destroy these germs we have developed certain germi- 
cides or antiseptics such as carbolic acid, bichloride of mer- 
cury (corrosive sublimate), tincture of iodine, Dakin's solu- 
tion of the hypochlorite of sodium (made from bleaching 
powder or chloride of lime), and many others. 
In the Civil War, in which I took part as a surgeon, we SEVEN DECADES IN MEDICINE 
5 
dressed wounds with cold water, ointment, and salves. 
Every wound suppurated, that is, reeked with pus and often 
in summer swarmed with maggots as large as chestnut 
worms-disgusting but not harmful. Blood poisoning, hos- 
pital gangrene, erysipelas, and tetanus were rife, and killed 
from seventy-five to over ninety per cent of the patients 
attacked by them! An operation, though painless, thanks 
to anesthesia, always involved great risk even if it were one 
of the simplest character. When Sir Astley Cooper, the 
first surgeon of his day, had to remove a wen from the scalp 
of the King, his anxiety and sleeplessness, as they have 
been pictured by his nephew, seem ridiculous to us. But 
they were quite justified a hundred years ago because of the 
frequency and serious danger of erysipelas, especially after 
even the slightest operation on the scalp. Even at present 
we occasionally see, in the newspapers, accounts of persons 
who die from "blood poisoning" after cutting a corn. No 
antiseptic precautions are taken by these amateur surgeons, 
and infection and death may easily follow. 
Pasteur, the great Frenchman, in studying fermentation 
had discovered that its various forms in yeast, beer, and 
wine were all due to living organisms, which never arose by 
"spontaneous generation" but always from living predeces- 
sors-"omne vivum e vivo." I was a student in Paris in 
1865 when the fight between Pasteur and Pouchet as to 
spontaneous generation was at its height. I was a pupil of 
Pouchet's son and a deeply interested witness of the fight 
and later of the final victory of Pasteur. 
Pasteur's investigations suggested to Lister-who always 
acknowledged his great debt to Pasteur-that putrefaction 
in wounds, whether accidental or intentional (e.g., surgical 
operations), might also be due to living organisms or germs, 
instead of being caused by oxygen as the chemists taught 
and everybody believed at that time. One of his experi- 
ments was a remarkable and positive evidence in favor of 
his view. Lister partially filled four glass flasks with urine, 6 
THE YALE REVIEW 
an easily and quickly putrescible fluid. He heated the necks 
of these flasks and drew them into long tubes only one- 
twelfth of an inch in diameter. He left one flask with its 
slender neck vertical and open to the air. He bent the other 
three long necks downwards at different angles, but also left 
them open to the air. Next he boiled the contents of all four 
flasks sufficiently long to kill any germs that might be pres- 
ent, and placed them on a shelf in his laboratory. The oxy- 
gen of the air could enter all four freely. During the night 
as the temperature fell, the air and its oxygen would be 
drawn into all four flasks. During the day the air with its 
oxygen would be warmed, would expand and be driven 
slowly out of the flasks only to be drawn back again the next 
night. All conditions were entirely similar except that the 
neck of one stood vertically while the other three were bent 
downwards. In a very short time the liquid in the flask 
with a vertical neck underwent putrefaction. The liquid in 
the other three flasks remained clear and undecomposed- 
not for a week or two, nor for a month or two, but for ten 
years, when they were accidentally destroyed by a fire in 
the laboratory. 
This proved conclusively that the oxygen of the air was 
not the cause of decomposition. What then was the cause? 
The explanation was simple. The germs in the air-which 
had not yet been seen and recognized as such by any human 
eye-being heavier than air, were drawn into the flask with 
the upright neck, fell into the urine, and quickly caused 
putrefaction. When the air was slowly drawn into the flasks 
with necks bent downward, the germs could not climb up 
against gravity but settled in the neck, and only germ-free 
air including its oxygen was drawn upwards into the flask. 
Fourteen years later Ogston discovered the first of the two 
commonest causes of suppuration or the formation of "pus." 
This germ was neither a bacterium nor a bacillus (little rod), 
but had a globular form like a coccus (the Greek for " berry"). 
As groups of these germs occurred in clusters like grapes, a SEVEN DECADES IN MEDICINE 
7 
rather strained likeness, he called it the "staphylococcus" or 
"bunch of grapes coccus." Fehleisen then discovered the 
far more deadly form of coccus-the "streptococcus"-so 
called because it occurs in elongated groups resembling a 
"chain." This germ also causes suppuration and especially 
erysipelas. When it once gains access to the blood it is 
almost surely fatal, producing endocarditis or inflammation 
of the lining membrane of the heart itself. 
Lister was a splendid illustration of the "scientific use of 
the imagination" which marks the genius. He saw these 
germs with his mind's eye fourteen years before they were 
definitely recognized. In Sir Clifford Allbutt's fine words, 
Lister saw the importance of Pasteur's work "because he 
was watching on the heights and he was there watching 
alone." In 1867 Lister, then Professor of Surgery in the 
University of Glasgow, published a paper relating his experi- 
ments with carbolic acid in the treatment of compound frac- 
tures-fractures in which the skin as well as the flesh is so 
torn that germs can gain access to the broken bone and 
lacerated muscles. At that time compound fractures killed 
two out of every three patients. Lister's results were aston- 
ishing: of eleven cases, he reported ten recoveries. This re- 
sult was all the more remarkable because conditions in the 
hospital in Glasgow were frightful. Beneath two wards on 
the ground floor, one occupied by Lister's patients and the 
other by those of another surgeon, an investigation showed, 
only a few inches below the surface, a multitude of bodies 
from a previous epidemic of cholera. Adjoining the building 
only a few yards from the windows of the surgical wards, 
was an old church yard in which the paupers were buried in 
pits. These pits emitted a horrible stench from the decom- 
posing bodies. "Five thousand bodies were buried in pits 
holding eighty each, in a stage of decomposition." As if to 
complete the evil picture a large fever hospital was only 
eight feet distant from the surgical wards. As Lister said, 
it would hardly be possible to devise experimental condi- 8 
THE YALE REVIEW 
tions which would more conclusively test his method of 
treatment. His favorable results in compound fractures led 
him to use the method with all his patients. 
What then were the results of this unintentional experi- 
ment? In the ward of the other surgeon, separated from 
Lister's by a passage only twelve feet wide, the mortality 
was so great that it had to be closed. In Lister's ward in 
which his antiseptic treatment by carbolic acid was in use 
in all cases, "in nine months not a single case of pyemia 
[blood poisoning], erysipelas, or hospital gangrene occurred." 
The streptococcus, as we now well know, was the bane of 
maternity, taking a fearful toll of life not only up to five and 
ten in every hundred mothers but in great epidemics up to 
fifty per cent, and even in some epidemics more than every 
other mother. Maternity hospitals might well have had 
over their doors the words of the great Florentine, "Abandon 
hope all ye who enter here." Dr. Holmes in 1843 had de- 
clared that this pestilence was carried by the doctor and the 
nurse from one mother suffering from child-bed fever to the 
next mother. Later Semmelweiss of Vienna inculcated the 
same doctrine. Happily Holmes lived to see his own vindi- 
cation and the victory over child-bed or puerperal fever. 
Pasteur was the first to show that the cause of the fever 
was the deadly streptococcus. Puerperal fever now causes 
death in from only one in three hundred to one in over 
twelve hundred mothers-almost all being neglected cases. 
The revolution in surgery-and in obstetrics-has been 
the most wonderful in all the history of medicine. It far 
excels in practical importance Harvey's discovery of the cir- 
culation of the blood. Millions upon millions of lives have 
been saved by Lister's patient, quiet labors. "Before Lis- 
ter" and "After Lister" in surgical chronology are equiva- 
lents of B.C. and A.D. in Christian chronology. 
Every intelligent person now knows that as anesthesia 
robbed surgical operations of pain, so antiseptic and aseptic 
surgery have robbed it of danger-of course not completely, SEVEN DECADES IN MEDICINE 
9 
but to such a degree that the mortality of most modern 
operations has become almost negligible. Lister's work was 
preventive. By sterilizing with antiseptics the hands of the 
surgeon and all his assistants, the instruments, the dressings, 
and the skin of the patient he destroyed the existing germs; 
and by antiseptic dressing of the wound he prevented the 
entrance of further germs into operation wounds. Wounds 
produced by ordinary accidents and even by gunshots, pro- 
vided the surgeon could reach the patient before the bac- 
teria had time to multiply to any great extent, could be 
made aseptic and would generally heal at once or, as we 
surgeons say, "by first intention." 
Aseptic surgery naturally followed antiseptic surgery. By 
aseptic surgery we mean that chemicals are used as little 
as possible because the chemicals not only kill the bacteria 
but injure the living cells of the tissues. We sterilize instru- 
ments, dressings, sheets, towels, gowns, gloves, everything, 
by boiling or in steam sterilizers. As we cannot boil the 
hands of the surgeon and the skin of the patient, chemical 
disinfectants have to be used for them. When everything is 
once sterile no chemical is used. The germs in the air are 
not a formidable danger. 
But let the sterilization be imperfect so that the bacteria 
are not all destroyed, or, after an accident, let efficient sur- 
gical help be delayed beyond the first few golden hours, and 
infection will spread with all its dangers-chronic exhaust- 
ing suppuration, erysipelas, hospital gangrene, or blood poi- 
soning. Against free, abundant suppuration in wounds of all 
kinds, operative, accidental, and gunshot wounds, antiseptic 
and aseptic surgery contended with great difficulty. For fifty 
years we surgeons have struggled to conquer such infection 
with but little success. It has required the stern school of a 
world war to bring us the victory. 
The suppurative infections of the great war have far ex- 
ceeded anything ever before seen, but by the genius of two 
men they have been in great part robbed of their terrors. THE YALE REVIEW 
10 
Dr. Henry D. Dakin of New York has shown that baking 
soda-the hypochlorite of soda-in a weak solution (less 
than one-half of one per cent strong), will in time sterilize a 
wound without doing any damage to the living cells of the 
tissues. On these cells we must rely for the repair of the 
wound. The solution also dissolves tissues which have been 
devitalized by the terrible shell fragments. Dr. Carrel, so 
well known and admired by us all, has devised a means by 
which this solution is kept in constant contact with the en- 
tire surface of the wound by a series of rubber tubes with 
little holes in the sides. It takes a variable length of time to 
effect sterilization in proportion to the severity of the wound, 
and the length of time between the reception of the wound 
and the beginning of the treatment. 
Every two days a drop of the discharge from the wound 
is examined by the bacteriologist; and when for a few days 
only a single bacterium is found in the two or more areas 
covered by the lens of the microscope, then the wound is 
closed, and almost invariably heals at once. After two or 
three observations, a chart showing the "curve of healing" 
can be made, by which, unless some accidental infection oc- 
curs, M. Lecompte du Nolly (a French physicist, associated 
with Dr. Carrel) can predict even two weeks or more in 
advance when the wound will be healed. 
But this "Carrel-Dakin" method, it must be clearly un- 
derstood, does not consist alone in the application of the 
Dakin solution by Carrel's method. First, the missile and 
especially any pieces of infected clothing, if they have 
lodged in the wound, must be extracted. Then all the devi- 
talized and infected tissue surrounding the track of the 
wound is cut away. This means that the great bulk of the 
infecting bacteria are removed along with the dead and in- 
fected tissues. Splints to immobilize the parts, and suitable 
regimen are also most important. 
The evident advantages of this excision or cutting away 
of the infected tissue en masse especially if done before the SEVEN DECADES IN MEDICINE 
11 
lapse of six to twelve hours-the earlier the better-led to 
trying whether this mechanical removal of the bacteria with 
the dead tissue would not allow the wound to be closed im- 
mediately even without using any germicide. The experi- 
ment has been eminently successful. A very large percentage 
of wounds are now closed at once after removing the missile, 
the dead tissue, and the bacteria; and they heal in a few 
days. When, however, the patient reaches the surgeon only 
after twenty-four hours or longer, then the Carrel-Dakin 
method or some other method must be used. 
I say "or some other method" because there are other 
methods which give such satisfaction in the hands of some 
surgeons that they prefer them to the Carrel-Dakin method, 
though on the whole this seems to give by far the best re- 
sults. Undoubtedly perfection has not been reached by any 
of our present methods, and they will be improved. But 
the basic principles of Lister will still be followed: Get rid 
of all bacteria; destroy all germs on everything, animate or 
inanimate, that is employed about a wound; prevent the 
access of any new germ by a sterile or an antiseptic dressing, 
and the wound will heal unless it has been too deeply in- 
fected. If too deeply infected, the same principles hold good. 
We must get rid of the bacteria as far as possible by cutting 
away the infected tissue as before, and then by chemically 
ridding the wound of the remaining bacteria by the Carrel- 
Dakin method. 
When the great war broke out the surgeons carried over 
into military surgery the usual aseptic methods of civil sur- 
gery. Disaster followed disaster. Then they harked back 
to antiseptic surgery, employing even the strongest antisep- 
tics. Again death crowded upon their heels. The rampant 
infection of war wounds, especially those caused by the ir- 
regular fragments of shells exploding with enormous force 
and tearing and lacerating the flesh beyond belief, was 
colossal and utterly unknown before 1914. 
The virulence of the infection was due in part also to the 12 
THE YALE REVIEW 
soil of Belgium and northern France. These fields had been 
manured from before the days of Julius Caesar for two 
thousand years and were saturated with fecal bacteria espe- 
cially those of tetanus and "gas gangrene" to a degree that 
surgery had never before even imagined and at first was 
wholly unable to cope with. Major Robertson of our army 
has "examined the soil from all parts of the Western Front. 
. . . If only a grain of it [one-sixtieth part of a teaspoon- 
ful] be inoculated into an animal it would invariably cause 
tetanus." The soldier in the trenches and his clothing be- 
come begrimed and bedaubed with this infected mud; when 
a shell fragment strikes him, it often, as it were, "punches 
out" a bit of clothing as large as itself and of almost the same 
shape and carries it deep into the wound, and with it multi- 
tudes of these pus-producing and death-dealing bacteria. 
If, within, say, six hours, the soldier reaches surgical aid, 
unless the wound be so destructive as to ensure his death, 
he has a good chance of recovery; but if he must lie for hours 
or, as sometimes happens, for one or more days beyond the 
reach of help in "No Man's Land," tetanus or gas gangrene 
or other terribly rampant infections develop. Then his 
chances of recovery rapidly fade away. Fortunately, the 
speed with which the wounded as a rule now reach efficient 
surgical aid is such that there is a far smaller mortality than 
early in the war. 
The very first thing given a wounded soldier when he 
reaches the surgeon, even before food or the dressing of his 
wound, is an injection of the antitoxin against tetanus-a 
prophylactic injection-which is repeated three times at 
intervals of a week. The poison elaborated by the tetanus 
bacilli, when it reaches the tissue, combines with the cells 
of the spinal cord and brain; once this combination has been 
effected, the damage has been done, and no amount of the 
antitoxin will neutralize the toxin in the cells and save the 
patient. Hence time is the most precious element in his 
salvation. Every hour, almost every minute counts. SEVEN DECADES IN MEDICINE 
13 
Tetanus at the beginning of the war was very common, 
because the war came so suddenly and the number of troops 
was so enormous that the supply of the antitoxin was wholly 
inadequate. But by November, 1914, the supply was ample, 
and the number of cases of tetanus immediately dropped so 
that by the following April, Major Harvey Cushing at the 
Hotel Dieu Hospital in Paris was shown a case of tetanus as 
a great "rarity." Now it has almost disappeared save in 
the conditions I have mentioned. I wish I could give my 
readers an idea of the horrible torture of the poor sufferers 
from this disease. They would then say instantly that if 
bacteriology and experimental research had never done aught 
else than almost banish this one scourge, this feat would 
have justified their existence. 
Gas-gangrene has nothing to do with the asphyxiating 
gases first used by the brutal Germans in direct contraven- 
tion to their own agreement at the second Hague Conven- 
tion, which is to them only a "scrap of paper." The cause 
of this form of gangrene is a bacillus discovered about twenty- 
five years ago by Professor W. H. Welch of Johns Hopkins. 
When it gets into the tissues, especially the muscles, it pro- 
duces gas so quickly and to such an extent that it may make 
an amputated limb float in water. The poison kills the mus- 
cles, and the germ flourishes best on this dead tissue. It 
grows with great rapidity and may kill its victim within 
thirty-six hours. Therefore, the slogan is again, "Haste, 
haste to the surgeon." Within, say, six hours much can be 
done. After twenty-four hours it is almost hopeless. In 
our Civil War I never saw a case of gas-gangrene. 
Our ordinary surgical resources against this germ are, alas, 
often ineffectual, but a bright ray of hope has recently ap- 
peared. Dr. Bull and Miss Ida W. Pritchett at the Rocke- 
feller Institute have probably discovered how to make an 
antitoxin against gas-gangrene. Dr. Bull went to France to 
test it on the soldiers, as it had succeeded well in animals. 
There is very good reason to believe that it may prove 14 
THE YALE REVIEW 
effectual. If it does, even that dreadful scourge may become 
a rarity. If it should fail, it is our imperative duty instantly 
to search anew for an antitoxin that will be effectual. 
Another equally wonderful achievement in medicine com- 
parable with the victory over tetanus is the conquest of 
typhoid fever. Typhoid fever has been one of the historic 
pestilences of armies. The discovery in 1880 of the germ 
which caused it was one of the very earliest achievements of 
the bacteriologists. Yet even in 1898 when I published a 
book on the "Surgical Complications and Sequels of Typhoid 
Fever," so little was positively known about it that I had to 
assemble proofs that the typhoid bacillus could reach the 
blood stream, that it could cause abscesses in bones and 
muscles, could cause gangrene of the tissues and even of 
whole limbs, infections of the gall bladder, and many other 
surgical disorders. In that same year in the war with Spain 
we learned a fearful lesson of what it could do. Every fifth 
man in our army of 107,000 was attacked with typhoid. It 
caused over eighty-six per cent of all the deaths in that war. 
Had the same ratio held in the British army of over 5,000,000 
in the world war there would have been more than 1,000,000 
cases of typhoid. Instead of that, down to November, 1916, 
there had been only 4,571 cases! In our own army on the 
Mexican border in 1916, among 20,000 troops only one man 
fell ill with typhoid, although it was prevalent in nearby 
towns. 
In our present army, from September 2, 1917, to January 
25, 1918, with a daily average of 742,625 men assembled 
from all over the country, often from places where autumnal 
typhoid was taking its annual toll of lives, only 119 cases of 
typhoid occurred. Had the 1898 rate prevailed there would 
have been 144,568 cases. As soon as all these recruits were 
protected by vaccination, the case rate fell so rapidly that 
in the seventeen weeks from December 7, 1917, to April 5, 
1918-a period longer than our war with Spain-there were 
only ten cases among probably nearly one million men. SEVEN DECADES IN MEDICINE 
15 
How was this marvellous result obtained? In the Boer 
war an attempt was made to control typhoid by a vaccina- 
tion similar to that against diphtheria which is saving so 
many thousands of children every year. These methods were 
perfected by Colonel F. F. Russell of our army, and since 
1911 and 1912 typhoid has practically disappeared from our 
army and navy! This preventive vaccination is the direct 
result-one might almost say solely the result-of experi- 
mental research in bacteriological laboratories. Was it not 
worth while? Are not other such researches to be encouraged 
so that the many diseases still imperfectly understood and 
still causing many, many deaths may be conquered and 
banished? 
Yet in spite of all this multiplied and absolutely convinc- 
ing statement of facts there is a class of people who abso- 
lutely deny the value of this protection. Nay, they assert 
that this "filling the veins with scientific filth called serum 
or vaccine" causes many deaths, and they attempted to 
persuade our soldiers to "resist vaccination." Could they 
have helped Germany better than by trying to cause thou- 
sands to suffer and die from typhoid and other infections? 
Those persons who to-day deny that bacteriology is a 
science and assert that germs of all kinds are not the causes 
of various diseases such as tuberculosis, typhoid, diphtheria, 
tetanus, and gas-gangrene, have minds incapable of under- 
standing any argument addressed to reason or common 
sense. Saving perhaps a half dozen well-known medical 
men, the doctors who support the anti-vivisectionists may be 
eminent in their own little coterie of devotees but they are 
wholly unknown in the large world of science as ever having 
made any valuable contribution to knowledge. 
The science of immunology, dealing with all the means by 
which nature and medical science protects patients-makes 
them immune-is too technical to be discussed here. 
When I was a medical student in the early 'sixties, the only 
existing laboratory was that of anatomy-the dissecting 16 
THE YALE REVIEW 
room. Now every first class medical school lias a dozen or 
more. All of them have made serious contributions to sci- 
ence which it is quite impossible to specify in detail. They 
have added greatly to our knowledge of pharmacology or 
the exact action of drugs, of the respiration, and of the cir- 
culation. Indeed, one may say that almost all our present 
remarkable knowledge of the blood and its functions, except 
Harvey's immortal discovery, is the result of studies within, 
not seven, but five decades. 
Besides these laboratories in the medical schools, other 
privately endowed institutions have arisen which have done 
an enormous amount of good. Of these unquestionably the 
most important and fruitful is the Rockefeller Institute for 
Medical Research. The field of research there has had the 
widest scope-physiology, bacteriology, surgery, medicine, 
even down to specialization in the four different varieties of 
pneumonia. Lately a branch has been established to study 
the diseases of animals, from which animals as well as man 
will benefit. 
Hog cholera, Texas fever or cattle tick, and tuberculosis, 
these three diseases alone cause an economic annual loss of 
$140,000,000 in the United States. How many animals are 
represented by the figures I do not know, but surely hundreds 
of thousands perish every year after serious suffering. To 
arrest these, and other animal diseases which cause still more 
misery and a further annual economic loss of $73,000,000 is 
surely a worthy object. 
In beneficent work in human diseases alone, the work of 
the Rockefeller Institute is without a rival in the United 
States and without a superior anywhere in the world. From 
it has come the serum which has reduced the mortality of 
cerebrospinal meningitis from seventy-five to twenty-five 
and even to seven per cent; the serum against gas-gangrene 
already mentioned; the demonstration that there are four 
different types of pneumonia, against one of which Rocke- 
feller investigators have already discovered a serum; a serum SEVEN DECADES IN MEDICINE 
17 
against infantile paralysis; a new and most useful form of 
anesthesia; the wonderful Carrel-Dakin treatment of infec- 
tions previously described; the many extraordinary surgical 
achievements of Dr. Carrel, and numerous other discoveries. 
One of the most notable of recent contributions to medical 
science was the discovery in 1895 by Professor Roentgen of 
the so-called X-rays. They are so well known that it is need- 
less to do anything more than to refer to their value in physi- 
ology, medicine, and surgery. The whole process of diges- 
tion has been illuminated by these rays. By mixing bismuth, 
which is impervious to them, with the food eaten we can 
see and follow by the X-rays the process of digestion in the 
stomach and intestines. The size and movements of the 
heart, the condition of the lungs, the presence of foreign 
bodies, especially of missiles and even of bullets within the 
heart, the certainty of a fracture or of its absence in bones, 
the existence and size of abscesses, and the presence of cal- 
culi in the kidney, the bladder, or the gall bladder, are 
among the many things that may now be positively deter- 
mined by aid of the X-rays. 
All that I have described and much more besides has 
been accomplished in medical science during my own life- 
time-with ten years to spare. It is a wonderful story. 
I think it is not an exaggeration to say that medicine, 
surgery, obstetrics, and the many medical specialties have 
made more progress in the seventy-two years from 1846 to 
1918 than in as many centuries before. I am also quite 
willing to believe that the next seventy years will be as 
fruitful as the last seventy have been. My only regret is 
that I shall not be here to witness the progress. Yet I ought 
not to say that, for I believe as firmly in my future existence, 
and with powers far superior to the limited powers that are 
given us here, as I do in my present existence. I believe that 
I shall know what is going on in this great though little world.