THE WORLD'S DEBT TO MEDICINE. 
My readers, we are not shut up to such 
an awfulness of desolation as that. There 
is life and we know it; there is sight and 
we know it; there is growth into a Kingdom 
and we know it; and above the voice of the 
baffled seeker after things, who cries, “ I ask, 
and I receive no thing; I seek and find no 
thing; I knock and it is not opened unto 
me,” yet there is the still, small voice that 
whispers, “ Ask and ye shall receive; seek 
and ye shall find; knock and it shall be 
opened unto you.” 
I see two souls go down life’s hillside; 
one with the unanswered question ever held 
like an open book before him, with shaking 
head, with trembling step, with shivering 
heart; down life’s hillside he goes toward 
the valley of the shadow of death. His 
feet touch the brink of the stream yonder. 
“ How? ” is the only word and thought that 
fills his soul. At the touch of the icy 
stream there is a shiver, a struggle, a cry 
“No God!” a leap in the dark! The 
waters gurgle and he is gone. I see 
another walking, in the language of those 
wonderful words, “ Though I walk through 
the valley of the shadow of death, I will 
fear no evil: for Thou art with me; thy 
rod and thy staff they comfort me ”—and 
he comes down to the water of the stream. 
Unshrinking he enters; the chill strikes to 
the center of vitality, but above the tremor 
of nature, “ Then shall my latest breath 
whisper Thy praise,” rises a song of prayer 
to God. Deeper he goes; still calm; deeper 
and deeper, the death wave sweeps upward; 
and yet he sings: “Jesus, Thou Prince of 
Life, Thy chosen cannot die.” And now it 
is almost over him. The wave is icy chill 
to him too, now; and from his lips the cry, 
“ O Christ, my Christ, can this be death ? ” 
And then he sinks from sight; and all is 
over. Over! Oh, no, not over. For there 
comes the rush of angel spirits, and the tri- 
umphant soul is borne away in song of cheru- 
bim and seraphim up to the throne where 
Christ sitteth at the right hand of God. 
—R. S. Holmes, D.D. 
THE WORLD’S DEBT TO MEDICINE* 
JOHN S. BILLINGS, M. D. 
THE word “medicine” in the title of 
this article is used in the broad sense 
of including surgery, obstetrics,1 the 
various specialties relating to diseases of the 
eye, ear, throat, skin, etc., and the so-called 
medical sciences such as anatomy, physi- 
ology, pathology,2 and pharmacology,3 as 
well as the treatment of disease by means 
which do not require the use of instruments, 
or internal medicine as it is sometimes 
termed. Modern sanitary science and prac- 
tical hygiene are not included, because these 
will be treated of in another article. Taken 
in this extended sense medicine has been of 
benefit to the world both directly and indi- 
rectly. Its direct effects have been produced 
by preventing, or by removing or mitigating 
the effects of, disease or injury; by making 
life more comfortable for individuals; its 
indirect benefits have consisted in part of 
the good work which has been done for the 
family and the community by those persons 
whom it has preserved and sustained, and 
who could not have done such work without 
its aid, and, in part, of the results of the 
powerful stimulus which it has given to other 
branches of science and of art, and of the 
effects of the influence which it has exerted 
upon psychology,4 theology, and jurispru- 
dence. 
Medicine holds a high rank among the 
civilizing agencies of the world, and the his- 
tory of its development is, to a great extent, 
the history of human progress. Perhaps 
the simplest way of giving some idea of the 
world’s direct indebtedness to medicine will 
be to contrast the possibilities of relief three 
hundred years ago with those of the present 
day, in some dangerous conditions or dis- 
eases. 
Let us take first the improvements which 
♦Special Course for C. L. S. C. Graduates. THE WORLD'S DEBT TO MEDICINE. 
669 
have been made in the management of 
childbirth, and their results. In 1594, 
for every thousand children born, at least 
fifteen and often forty, mothers died. In 
those days they had no anaesthetics;5 they 
knew very little of the nature of the diffi- 
culties which sometimes involve a fatal re- 
sult both to mother and child if they are not 
removed; and the instruments which the 
physician of to-day uses in such cases with 
excellent results had not yet been devised. 
They knew nothing of the causes or nature 
of puerperal fever, which followed the visit- 
ations of certain physicians, nurses, or mid- 
wives like a pestilence, “ which closed the 
eyes just opened upon a new world of life 
and happiness, bowed the strength of man- 
hood to the dust, and cast the helplessness 
of infancy into the stranger’s arms, or be- 
queathed it, with less cruelty, the death of 
its dying parent,” and they could suggest no 
useful remedy. They saw the eyelids of the 
newborn babe redden and swell, and yellow 
matter exude from between them, and could 
foretell that in a few days or weeks the child 
would be partially or wholly blind ; but they 
knew nothing of the simple and efficacious 
means by which the skilled physician of 
to-day averts such a calamity. To-day more 
than half of the dangers and terrors of child- 
birth are put aside by medical art, puerper- 
al fever is almost unknown in cases where 
the proper precautions have been taken, and 
the death-rate of the mothers is less than 
five per thousand births. 
As the child grew up, three centuries ago, 
one of its greatest dangers was due to small- 
pox, which appeared in epidemic form at 
intervals of about six years. All grown 
people in those days had either had small- 
pox, and were more or less pitted with its 
scars, or had proved themselves insuscep- 
tible to the poison. It became epidemic in 
a community as soon as enough young chil- 
dren had accumulated to furnish fuel for its 
flame, and the mothers and fathers waited 
helplessly to see which of their three or four 
young children was to fall a victim to the 
scourge. Now, thanks to vaccination, this 
danger is almost entirely removed. 
Diphtheria existed in the old days; but it 
was not known by that name; it was the 
malignant sore throat, or the garrotillo, or 
strangling disease, and absolutely nothing 
was known as to its course or proper treat- 
ment. This disease has caused a greater 
mortality within the last fifty years than it 
has ever done before ; but the causes of its 
spread are now becoming understood, and 
there is good reason to hope that the per- 
sistent study and experimentation of a few 
physicians during the last three years has 
resulted in the discovery of a remedy which 
will greatly reduce its mortality. 
In the sixteenth century fevers and dysen- 
teries decimated the villages, the armies, and 
the prisons. No one knew anything definite 
about the differences between various kinds 
of fevers, and the corresponding differences 
of treatment which they demand. Malarial, 
typhoid, typhus, and relapsing fever were 
confounded. They had no quinine or cin- 
chona6 bark. Gradually we have learned to 
distinguish between some of the different 
forms of fever, although there is still some- 
thing to be done in this direction; and we 
have also learned how to treat some of the 
specific forms in such a way as greatly to 
reduce their mortality. The death-rate from 
typhoid fever under modern treatment is 
only about half of what it was fifty years 
ago. 
Little attention was given in the sixteenth 
century to the recording of deaths or to the 
calculation of death-rates; and hence we 
cannot state accurately how much greater 
the expectation of life is in civilized coun- 
tries to-day than it was three hundred, or 
even one hundred years ago; but we do 
know that it has decidedly increased. The 
average duration of life among the better 
class of Roman citizens, according to the 
Pandects7 of Justinian, was 30 years; in 
Geneva during the sixteenth and seventeenth 
centuries it was not more than 20 years; 
fifty years ago it was about 38 years, and 
now it is between 45 and 50 years. This 
great saving in human life is due probably 
much more to better hygiene than to im 
provements in therapeutics,8 but it should be 
remembered that improvements in prevent- 
ive medicine have been largely due to the 670 
THE WORLD'S DEBT TO MEDICINE. 
increase of knowledge by physicians in the 
matter of distinguishing different forms of 
disease, that is to say, to improvements in 
diagnosis. 
Until the physicians had learned to dis- 
tinguish the so-called “ Devonshire colic ” 
from other forms of abdominal pain, and 
had shown that it was due to poisoning 
from lead dissolved in cider, little or nothing 
of value was done in the way of prevention. 
It was not until the differences between 
typhoid and typhus fever had been dis- 
covered, and it had been shown that the 
former was rarely directly contagious, but 
was due to excreta,9 while the latter spread 
by contagion which depended largely upon 
overcrowding and lack of ventilation, that 
rational measures could be taken to prevent, 
or limit the spread of, these diseases. 
The most direct evidence of the prolonga- 
tion of life and relief from suffering for which 
the world is indebted to medicine is to be 
found in the records of surgery and some of 
its special branches. 
Three hundred years ago, when a surgeon 
was bold enough to amputate a crushed or 
gangrenous limb, to remove a large tumor, 
to attempt to relieve a strangulated bowel, 
or to extract a stone from the bladder, he 
had no anaesthetic, and his great dread was 
of the spouting blood from the vessels which 
he was obliged to cut. In 1564 Ambrose 
Pare had described and recommended the 
method of ligating blood vessels divided in 
an operation, instead of using the red hot 
iron to burn the ends, as was the usual 
method; but it was more than a hundred 
years after that before the ligature came 
into general use for this purpose. It is only 
within the present century in fact that we 
have come to understand the importance of 
shedding as little blood as possible in oper- 
ations, and the best methods of doing this. 
The surgical patient in old times deferred 
the torture of an operation as long as possi- 
ble, and when he was at last compelled to 
undergo it, he did so with comparatively 
little hope of surviving its effects; for pyae- 
mia10 was then the rule rather than the 
exception after an operation, especially in 
hospitals. In a large proportion of cases in 
which the surgeon now operates with a fair 
chance of success, such as tumors of various 
kinds, crushes and gangrene in the upper 
part of the thigh, dilatations of the great ar- 
teries in the neck, the armpit, the groin, etc., 
there was then no hope of relief, and the 
unhappy sufferer could only look forward to 
inevitable death. 
If he had a cancer of the lip, or she had 
a cancer of the breast or womb, death was 
prayed for to put an end to the persistent 
pain and horrible sights and odors with 
which they were afflicted, while now such 
persons, if they present themselves in time 
to the surgeon, can be relieved in the ma- 
jority of cases, and thus the bread-winner of 
the family is preserved, the mother remains 
with her children. The patient inhales a 
little sweetish vapor, and sleeps. The sur- 
geon works deliberately and carefully, every 
bleeding vessel is secured at once, everything 
that is allowed to touch the wound has been 
carefully sterilized by heat or chemicals, so 
that none of the bacteria which cause sup- 
puration can gain access to it, and when the 
patient awakes he finds himself in his bed 
looking up vaguely into the face of the 
trained nurse who stands by its side, and 
wondering why the operation has not com 
menced. He does not have to look forward 
to weeks and perhaps months of suppura- 
tion, with daily dressings, before his wound 
has healed—for several days he has nothing 
to do but eat and sleep, his bandages will be 
looked at, but probably not touched before 
the end of the week, when they will be re- 
moved, and instead of an open wound there 
will be seen a thin red line marking the place 
of the future scar. 
The world’s debt to surgery does not con- 
sist merely in the number of lives saved 
by the latter, but it also includes the vast 
shortening of the period of suffering and 
unproductivity which formerly existed after 
an operation. 
It is in what is called abdominal surgery 
that medicine has recently obtained some of 
its greatest triumphs and has conferred 
some of its greatest benefits. The removal 
of ovarian and uterine tumors is now so 
common and successful an operation that THE WORLD'S DEBT TO MEDICINE. 
671 
it is a little difficult to realize that less than 
a hundred years ago the means of relief 
for these affections did not exist. 
In former days many people died of 
painful diseases of the abdominal cavity, 
of the true nature of which little was known, 
and which were vaguely called inflammation 
or obstruction of the bowels. Now it is 
known that many of these are due to in- 
flammation and perforation of a little worm- 
like body attached to the beginning of the 
large intestine in the right side of the lower 
part of the abdomen, and which is known 
as the appendix vermiformis; and hardly a 
day goes by that a successful operation is 
not somewhere performed for the cure of 
disease of this organ. 
Wounds of the abdominal cavity impli- 
cating the intestines were formerly con- 
sidered to be almost necessarily fatal, and 
no attempt was made to put the injured 
organs in a condition to repair the damage 
done; while now in such cases the abdomen 
is opened almost as a matter of course, the 
bleeding is stopped, the effused blood and 
other matters removed, the openings in the 
intestines closed, and in many cases life is 
preserved. 
Turning now from these triumphs of 
general surgery, the list of which it would 
be easy to greatly lengthen, let us consider 
for a moment the great increase to the com- 
fort and producing-ability of man which 
has been brought about by the studies of 
physicians on the mechanism and diseases 
of the eye. The number of men and 
women who have been freed from headaches 
and various obscure forms of nervous 
irritation, and who have been enabled to do 
their daily work with comfort, and to enjoy 
the beauties of nature and the pleasures of 
literature, by means of glasses properly 
fitted to correct the effects of the irregular 
and distorted structure of their eyes, is very 
great, and is becoming greater every day. 
The operations for the removal of cataract, 
and for the making of an artificial pupil 
have literally given sight to the blind in 
thousands of cases. 
The benefits of medicine in diseases of 
the ear are not so marked as they have been 
in diseases of the eye; but the many deaths 
formerly caused by the extension of inflam- 
mation from the internal ear to the mem- 
branes and venous canals of the brain are 
now being prevented by the timely operation 
which physicians urge in cases of chronic 
discharge from the external ear. 
The removal of tumors from the larynx, 
and the passing a silver tube into the organ 
in cases of croup or diphtheria have already 
saved many lives, although they are com- 
paratively recent discoveries. 
The resources of modern medicine for 
the relief of pain are great and manifold. 
With the aid of the hypodermic11 syringe and 
of the alkaloids obtained from narcotic 
plants, such as morphine for example, 
agonizing spasmodic pain like that caused 
by the passage of a calculus12 from the 
kidney can be promptly done away with, 
while such drugs as the bromides, chloral, 
sulfonal, etc., are available to procure rest for 
the weary brain. Besides ether, chloroform, 
and other substances for producing general 
anaesthesia by inhalation, we can produce 
insensibility in a particular part by the use 
of cocaine, or by the intense cold produced 
by the ethyl or rhigolene13 jet, and thus be 
able to perform many painless operations. 
Recently it has been discovered that a 
peculiar disease characterized by a swelling 
of the face and extremities, and by increas- 
ing mental weakness, and which is known 
as myxedema, is dus to a failure of a gland 
situated in the front of the neck, called the 
thyroid gland, to perform its proper work, 
and such cases, which were formerly almost 
surely fatal, are now cured by means of an 
extract from thyroid glands of sheep. 
Many of the disorders of old age 
which make life a burden are now sus- 
ceptible of palliation or relief so as to 
secure comfort to the patient, although the 
degenerations of tissues and organs which 
give rise to them may be beyond the reach 
of art. 
I have space for but one more specimen 
of the direct benefits which medicine has 
conferred upon mankind, and this is the 
improvement which has been made in the 
care and treatment of the insane and feeble- 672 
THE WORLD'S DEBT TO MEDICINE. 
minded. For hundreds of years these un- 
fortunate creatures were supposed to be 
special objects of divine displeasure, to be 
possessed by demons, or to be suffering 
from witchcraft, and exorcisms were almost 
the only remedies applied. If these failed, 
the stake or the gallows was resorted to in 
many cases, and these were quite as fortu- 
nate as most of those who were confined in 
asylums in which all sorts of lunatics were 
huddled together like brutes. As Dr. 
Conolly remarks, it is difficult to account 
for the long neglect, in civilized communi- 
ties, of those afflicted with a malady more 
dreadful than most other maladies in that, 
before it destroys life, it destroys all that 
makes life valuable or desirable. Yet 
nothing is more certain than that this com- 
plicated misery has been, not only the sub- 
ject of neglect, but of the greatest abuse 
and cruelty. Through the investigations 
and efforts of a few physicians all this has 
been changed, and the majority of the 
insane are well housed and fed and receive 
skilled medical treatment, which in many 
cases results in their restoration to their 
families “clothed in their right mind.” 
Great as is the debt which the world owes 
to medicine for the saving of life and the 
relief or mitigation of suffering, this is 
small in comparison with the indirect bene- 
fits to society which it has conferred. Its 
practical utility extends far beyond the 
relief of individuals, for the actions and 
work of kings, of statesmen, and of the 
leaders of human thought and progress are 
at times dependent upon its aid. Medicine 
is the parent of the biological14 sciences, 
including anthropology15 and modern sociol- 
ogy.16 
Educated physicians have led. the way 
in all branches of natural history, and 
have contributed much to chemistry. Medi- 
cine has exerted a powerful influence, not 
merely by the discoveries which it has made 
and announced, but by disseminating the 
modes of observation, of investigation and 
of reasoning, of its votaries. For hundreds 
of years the flickering and feeble flame of 
true scientific thought was kept alight 
mainly by men who had studied medicine, 
and in the organization of great scientific 
societies in the seventeenth and eighteenth 
centuries the physicians took a most promi- 
nent part. 
The physician does not so separate the 
consideration of the psychical part of man 
from that of his physical organization, as is 
commonly done by the theologian or the 
jurist. The more he studies his subject the 
more he is convinced that with every mental 
or spiritual manifestation there is some co- 
ordinate change in bodily structure; that 
body and mind exert a powerful influence 
upon each other, that disorder of the one 
may produce disorder of the 6ther, and 
that both must be taken into considera- 
tion in dealing with ignorance, folly, vice, 
and crime. This view has gradually become 
prevalent among educated men, the modern 
jurisprudence of insanity is based upon it, 
and it is beginning to be accepted by crim- 
inologists and social reformers. 
The influence of the physician in social 
life has always been great, because he be- 
comes the trusted personal friend of many 
persons who seek his advice and opinions in 
matters unconnected with their ailments, 
and it cannot be doubted that this influence 
has been almost invariably exerted for good. 
The example set by him of habitual self- 
sacrifice, of giving up his own comfort, and 
sometimes risking his own health and life for 
the sake of his patients, of punctuality, and 
of precision and accuracy in his work, which 
is often undertaken without the smallest 
prospect of pecuniary reward, is an example 
which has some effect upon those who are 
acquainted with his daily life, all the more 
because these things become habits which 
“ exact no effort, involve no indecision, and, 
above all, no self-praise.”