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Title: Experiments on Animals
Author: Paget, Stephen
Language: English
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    Minor spelling and punctuation inconsistencies been harmonized.
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    marked with _underscores_. Please see the end of this book for
    further notes.



EXPERIMENTS ON ANIMALS



  [Illustration: BRAIN OF AN ANTHROPOID APE, SHOWING THE POSITION OF THE
  MOTOR CENTRES.

  (From a paper by Sir Victor Horsley and Dr. Beevor. _Phil. Trans. Roy.
  Soc._, 1892.)]



    EXPERIMENTS
    ON ANIMALS

    BY

    STEPHEN PAGET

    WITH AN INTRODUCTION BY
    LORD LISTER

    THIRD AND REVISED EDITION

    "_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._"--CARDINAL NEWMAN.

    NEW YORK
    WILLIAM WOOD AND COMPANY
    MDCCCCVII



    TO

    CHARLES ALFRED BALLANCE
    M.S., F.R.C.S.

    AND

    WILLIAM HUNTER
    M.D., F.R.C.P.



PREFACE


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.

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--to give the original authorities, the plain facts, the very words,
chapter and verse for everything.

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 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.

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

The present edition has been thoroughly revised; and I have included
in it a reprint, with some changes and omissions, of a pamphlet, _The
Case against Anti-vivisection_, which I wrote in 1904.

1906.



INTRODUCTION TO THE FIRST EDITION


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.

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.

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.

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.

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.

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.

Meanwhile I commend Mr. Paget's book to the careful consideration of
the reader.

    LISTER.



CONTENTS


    PART I

    EXPERIMENTS IN PHYSIOLOGY

                                          PAGE

        I. THE BLOOD                         3

       II. THE LACTEALS                     19

      III. THE GASTRIC JUICE                24

       IV. GLYCOGEN                         30

        V. THE PANCREAS                     36

       VI. THE GROWTH OF BONE               40

      VII. THE NERVOUS SYSTEM               44


    PART II

    EXPERIMENTS IN PATHOLOGY, MATERIA
        MEDICA, AND THERAPEUTICS

        I. INFLAMMATION, SUPPURATION,
             AND BLOOD-POISONING            75

       II. ANTHRAX                          87

      III. TUBERCLE                         96

       IV. DIPHTHERIA                      102

        V. TETANUS                         128

       VI. RABIES                          137

      VII. CHOLERA                         152

     VIII. PLAGUE                          168

       IX. TYPHOID FEVER; MALTA FEVER      196

        X. THE MOSQUITO: MALARIA,
            YELLOW FEVER, FILARIASIS       214

       XI. PARASITIC DISEASES              243

      XII. MYXOEDEMA                       247

     XIII. THE ACTION OF DRUGS             251

      XIV. SNAKE-VENOM                     259


    PART III

    THE ACT RELATING TO EXPERIMENTS ON ANIMALS
        IN GREAT BRITAIN AND IRELAND

        I. TEXT OF THE ACT                 271

       II. ANÆSTHETICS UNDER THE ACT       281

      III. INSPECTORS' REPORT, 1905        283


    PART IV

    THE CASE AGAINST ANTI-VIVISECTION

        I. ANTI-VIVISECTION SOCIETIES      297

       II. LITERATURE                      313

      III. ARGUMENTS                       325

       IV. "OUR CAUSE IN PARLIAMENT"       367

        V. A HISTORICAL PARALLEL           371

    INDEX                                  377



PART I

EXPERIMENTS IN PHYSIOLOGY

EXPERIMENTS ON ANIMALS


I
THE BLOOD

I.--BEFORE HARVEY

Galen, born at Pergamos, 131 A.D., 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 [Greek:
pneuma], or the breath of life:--

   "Ourselves, having tied the exposed arteries above and below,
   opened them between the ligatures, and showed that they were
   indeed full of blood."

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:--

   "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 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--and this forsooth is fever."

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:--

   "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 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 _fuligo_, as these
   men call it, God help them. Only there is no pulsation in the
   vein." (_De Re Anatomicâ_, Venice, 1559.)

Fabricius ab Aquapendente, Harvey's master at Padua, published his
work on the valves of the veins--_De Venarum Ostiolis_--in 1603. He
did not discover them. Sylvius speaks of them in his _Isagoge_
(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"--_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._ Men had no idea of the rapidity and volume of the
circulation; they thought of a sort of Stygian tide, oozing this way
or that way in the vessels--Cæsalpinus was of opinion that it went one
way in the daytime and another at night--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.

II.--HARVEY (1578-1657)

The _De Motu Cordis et Sanguinis in Animalibus_ was published at
Frankfurt in 1628. And it begins with these words: _Cum multis vivorum
dissectionibus, uti ad manum dabantur_:--

   "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 that Andreas
   Laurentius had written that the movement of the heart was what
   the ebb and flow of the Euripus had been to Aristotle.

   "At last, having daily used greater disquisition and diligence,
   by frequent examination of many and various living
   animals--_multa frequenter et varia animalia viva
   introspiciendo_--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."

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:--

   i. _Causæ, quibus ad scribendum auctor permotus fuerit._

   ii. _Ex vivorum dissectione, qualis fit cordis motus._

   iii. _Arteriarum motus qualis, ex vivorum dissectione._

   iv. _Motus cordis et auricularum qualis, ex vivorum
   dissectione._

He thrusts it on us, he puts it in the foreground. Read the end of his
Preface:--

   "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--_vivorum dissectione frequenti, multâque
   autopsiâ, veritatem discernere et investigare_."

Finally, take the famous passage in the eighth chapter, _De copiâ
sanguinis transeuntis per cor e venis in arterias, et de circulari
motu sanguinis_:--

   "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--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--because Nature, doing nothing in vain, cannot
   in vain have given such size to these vessels above the
   rest--and from the harmonious and happy device of the valves and
   fibres, and all other fabric of the heart; and from many other
   things--when I had again and again carefully considered it all,
   and had turned it over in my mind many times--I mean the great
   quantity of the blood passing through, and the swiftness of its
   passage--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--I began to think to myself whether the
   blood had a certain movement, as in a circle--_coepi egomet
   mecum cogitare, an motionem quandam quasi in circulo
   haberet_--which afterward I found was true."

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--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:--

   "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."

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."

III.--AFTER HARVEY

1. _The Capillaries_

The capillary vessels were not known in Harvey's time: the
_capillamenta_ of Cæsalpinus were not the capillaries, but the
[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 (_De Pulmonibus_, 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:--

   "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."

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:--

   "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."

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--_Tantum consuetudo apud omnes valet_.

2. _The Blood-pressure_

Harvey had seen the facts of blood-pressure--_the great quantity of
blood passing through, and the swiftness of its passage_--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 _Statical Essays_ (1726-1733) show the great extent of his
non-clerical work:--

   Volume 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._

   Volume II. _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._

   "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 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 _many
   shall run to and fro, and knowledge shall be increased_."

His account of his plan of measuring the blood-pressure, and of one of
many experiments that he made on it, is as follows:--

   "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....

   "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 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."

3. _The Collateral Circulation_

After Hales, came John Hunter, who was five years old when the
_Statical Essays_ 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 experiment was given by Sir
Richard Owen, who had it from Mr. Clift, Hunter's devoted pupil and
friend:--

   "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--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."

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.

4. _The Mercurial Manometer_

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, _Sur la Force
du Coeur Aortique_, 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:--

   "At my first experiments, wishing to make sure whether the
   opinions, given _à priori_, 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."

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:--

   "I come to this irrevocable conclusion, that the force with
   which a molecule of blood moves, whether in the 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--which, _à priori_, with all
   the physiologists, I was far from thinking."

And he adds, in a footnote:--

   "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."

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.

5. _The Registration of the Blood-pressure_

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),
_Physiologie Médicale de la Circulation du Sang_, 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--_Physiologie Médicale de la Circulation du Sang, basée sur
l'étude graphique des mouvements du coeur et du pouls artériel, avec
application aux maladies de l'appareil circulatoire_. 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:--

   "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."

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.

Beside this improved sphygmograph, Chauveau and Marey also invented
the cardiograph, for the observation of the blood-pressure within the
cavities of the 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,[1] 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.

  [1] "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 coeur sont toujours
  réguliers, et donnent, à l'auscultation, des bruits d'un caractère
  normal." (Marey, _loc. cit._ p. 63.)

       *       *       *       *       *

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.


II

THE LACTEALS

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,
_qui videtur nosse omnino debuisse_--"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--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: 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.

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,
_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._ He gives the following
account of the discovery, in the chapter entitled _Historia primæ
vasorum istorum inventionis cum fide narrata_. 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"--_plurimos, eosque tenuissimos
candido-sissimosque ceu funiculos per omne mesenterium et per
intestina infinitis propemodum propaginibus dispersos_:--

   "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 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, '_I have found it_,' 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."

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,
_Expérimenta Nova Anatomica, quibus incognitum hactenus Receptaculum,
et ab eo per Thoracem in ramos usque subclavios Vasa Lactea
deteguntur_. 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 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--_Albicantem subinde Lactei liquoris, nec certe parum
fluidi scaturiginem, intra Venæ Cavæ fistulam, circ[=a] dextri sedem
Ventriculi, miror effluere_--and found that this fluid was identical
with the chyle in the lacteals. In another experiment, he succeeded in
finding the thoracic duct--"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--_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._"

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.

From the discovery of the lacteals came the discovery of the whole
lymphatic system. Daremberg, in his _Histoire des Sciences Médicales_
(Paris, 1870), after an account of Pecquet's work, says:--

   "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."

Rudbeck's work (1651-54) coincides exactly, in point of time, with the
first and second editions, 1651 and 1654, of Pecquet's _De Lactibus_.
It may be said, therefore, that the whole doctrine of the lymphatic
system was roughed out half-way through the seventeenth century.


III

THE GASTRIC JUICE

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 _De Motu
Cordis et Sanguinis_ by a hundred and thirty years.

The following account of the first experiments on digestion is taken
from Claude Bernard's _Physiologie Opératoire_, 1879:--

   "The true experimental study of digestion is of comparatively
   recent date; the ancients were content to find comparisons, more
   or less happy, with common 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.

   "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
   _aqua fortis_ that dissolved food.

   "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 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--filled with ordinary
   grain, and closed only by a netting that let pass the gastric
   juices--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 _in vitro_. 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."

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.

   "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:--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.

   "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, _loc. cit._)

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,[2] 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:--

   "_I make no claim to originality in my opinions_, 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.)

  [2] _Experiments and Observations on the Gastric Juice, and the
  Physiology of Digestion_, by William Beaumont, M.D.; Edinburgh,
  1838.

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:--

   "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 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.

   "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, _loc. cit_. p. 20.)

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.

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.


IV

GLYCOGEN

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:--

   "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."[3]

  [3] _Reynolds' System of Medicine_, vol. v., art. "Diabetes
  Mellitus."

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 _Life of Claude Bernard_
(Fisher Unwin, 1899).

In Bernard's _Leçons sur le Diabète et la Glycogenèse Animale_ (Paris,
1877), there is a sentence that has been misquoted many times:--

_Sans doute, nos mains sont vides aujourd'hui, mais notre bouche peut
être pleine de légitimes promesses pour l'avenir._

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:--

_Claude Bernard himself confessed that his hands were empty, but his
mouth was full of promises._

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--_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?_
Not art, because art has always something to show for its trouble: a
statue, a picture, a poem--_Le médecin artiste ne crée rien, et ne
laisse aucune oeuvre d'art, à moins d'appliquer ce titre à la guérison
du malade. Mais quand le malade meurt, est-ce également son oeuvre? Et
quand il guérit, peut-il distinguer sa part de celle de la nature?_

To Claude Bernard, experiments on animals for the 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:--

_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._

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:--

   "At this present time, medicine is passing from one period to
   another. The old traditions are losing ground, and scientific
   medicine (_la médecine expérimentale_) 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, _What is the use of
   a new-born child, but to become a man?_ 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."

He died in 1878. The following account of the discovery of glycogen is
taken from his _Nouvelle Fonction du Foie_ (Paris, 1853):--

   "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."

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:--

   "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....

   "Finally, after many attempts--_après beaucoup d'essais et
   plusieurs illusions que je fus obligé de rectifier par des
   tâtonnements_--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)."

His further discovery, that this formation of sugar is increased by
puncture of the floor of the fourth ventricle, 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:--

   "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.

   "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....

   "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 untold
   discoveries of the greatest moment; the gate to this path was
   opened by Bernard's work." (Sir M. Foster, _loc. cit._)

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.


V

THE PANCREAS

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--_ut ventriculo
instar substerniculi ac pulvinaris subjiciatur_. The duct was
discovered by Wirsung, in 1642: but anatomy could not see the things
that belong to physiology. Lindanus (1653) said, _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_. Wharton (1656) said, _It ministers
to the nerves, taking up certain of their superfluities, and remitting
them through its duct into the intestines_. And Tommaso Bartholini
(1666) called it the _biliary vesicle of the spleen_.

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:--

   "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."

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

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.

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:--

   "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, _Phys. Opér._,
   p. 61.)

Therefore de Graaf failed, because he got no help from other sciences.
But it cannot be called failure; 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:--

   "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, _loc. cit._)

Finally came the discovery that the pancreas--apart from its
influences on digestion--contributes its share, like the ductless
glands, to the general chemistry of the body:--

   "It was discovered, a few years ago, by von Mering and
   Minkowski, that if, instead of merely diverting its 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.)

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.


VI

THE GROWTH OF BONE

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:--

   "From these experiments it appears--_forsan probatur_--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."

And Clopton Havers, in his _Osteologia Nova_ (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.

Du Hamel's discovery (1739-1743) came out of a chance observation,
made by John Belchier,[4] that the 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--_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._ Or take an example of du Hamel's method:--

   "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--_garence grappe_--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 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."

  [4] "An Account of the Bones of Animals being changed to a Red
  Colour by Aliment only," by John Belchier, F.R.S., _Phil. Trans.
  Roy. Soc._, 1735-36. There is a letter from Sir Hans Sloane, then
  President of the Royal Society, to M. Geoffroy, member of the
  French Academy:--"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--_Erythrodanum,
  vulgo rubia tinctorum, ossa pecudum rubenti et sandycino colore
  imbuit._

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--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 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.


VII

THE NERVOUS SYSTEM

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:--

   "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 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."[5]

  [5] From an address on Galen, given by Sir Victor Horsley before
  the Medical Society of the Middlesex Hospital. See _Middlesex
  Hospital Journal_, May 1899.

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 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:--

   "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."

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 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, _post-mortem_ 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.

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.

1. _Sir Charles Bell_ (1778-1842)

The great authority of Sir Charles Bell has been quoted a thousand
times against all experiments on animals:--

   "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."

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.

They occur in a paper, _On the Motions of the Eye, in Illustration of
the Uses of the Muscles and Nerves of the Orbit_; communicated by Sir
Humphry Davy to the Royal Society, and read March 20, 1823.[6] 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, _The
Exposition of the Nervous System_, Bell published all six of them,
under the title, _The Nervous System of the Human Body_.

  [6] This paper includes an _Experimental Enquiry into the Action
  of these Muscles_, giving an account of an experiment on the eye.

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, _An Idea of a New Anatomy of the Brain, Submitted for
the Observation of the Authors Friends_. 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.

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

   "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....

   "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."

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:--

   "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.

   "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
   thought that I had an opportunity of putting my opinion to the
   test of experiment, and of proving at the same time_ that nerves
   of different endowments were in the same cord (nerve-trunk) and
   held together by the same sheath.

   "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.

   "_Such were my reasons for concluding_ 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. _I now saw the meaning_ 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."

It is impossible to reconcile the 1830 sentences with this vivid
personal account of himself; _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...._ 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?

This same inconsistency of sentences occurs elsewhere in his _Nervous
System of the Human Body_. In one place he says that he has made few
experiments: _They have been simple, and easily performed, and I hope
are decisive._ In another he says: "_After making several experiments
on the cerebrum and cerebellum, I laid the question of their functions
entirely aside_, and confined myself to the investigation of the
spinal marrow and the nerves; _a subject which I found more within my
power_, and which forms the substance of the present volume."

Next, take his account of the cranial nerves:--

   "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....

   "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.... _It now became obvious_ why the third, sixth, and
   ninth nerves of the encephalon were single nerves in their
   roots....

   "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."

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 with the spinal
nerve-roots, so with the fifth cranial nerve--his work was successful,
because he followed the way of experiment.

He was by nature of a most complex and sensitive temperament, full of
contrary forces--one man in 1811, another in 1830. In 1811 he wrote,
_I now saw the meaning of the double connection of the nerves_; in
1830 he had come to hate the _stupid sterile materialism_ 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, _chiffonier_, 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."

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 work,
and used as false evidence against the very method that he followed.

His observations on the cranial nerves brought about an immediate
change in the practice of surgery:--

   "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, _tic
   douleureux_; 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.)

   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--a truth
   which is the very foundation of the physiology of the nervous
   system--is enough by itself to mark him as a great
   physiologist." (Sir M. Foster, _loc. cit._)

2. _Marshall Hall_ (1790-1857)

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 _reflex_ to these
movements.

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:--

   "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. _And this reflexion of
   sensory impressions into motor impressions is not accomplished
   in obedience to physical laws alone--wherein the angle of
   reflexion is equal to the angle of incidence, and reaction to
   action--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._ But the general law,
   whereby the sensorium reflects sensory impressions into motor
   impressions, is the preservation of ourselves."

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--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 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.

3. _Flourens_ (1794-1867)

Beside his work on the nervous system, Flourens studied the periosteal
growth of bone, and the action of chloroform;[7] 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:--

   "M. Flourens a circonscrit ce centre avec une scrupuleuse
   précision, et lui a donné le nom de noeud vital" (Cl. Bernard.)

  [7] When Flourens died, Claude Bernard was appointed to his place
  in the French Academy; and, in the _Discours de Reception_ (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."

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. (_Recherches Expérimentales_, 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.

4. _Claude Bernard_ (1813-1878)

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.[8] The evidence of Professor Sharpey before
the Royal Commission of 1875 shows how things had been misjudged,
before Bernard's time, in the light of "views taken from the Study of
Anatomy and Natural Motions":--

   "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."

  [8] 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, _Some Apostles of Physiology_ (Waterlow & Sons, London,
  1902), p. 104.

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 _Leçons de Physiologie Opératoire_:--

   "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.

   "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 theory--_Je
   coupai donc ce filet et aussitôt l'expérience donna à mon
   hypothèse le plus éclatant démenti_. 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.

   "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."

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--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.

The _Leçons de Physiologie Opératoire_ were published in 1879. Twenty
years later, Sir Michael Foster says of Bernard's work:--

   "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 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."

5. _Cerebral Localisation_

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:--

   "As the animal spirits for the various acts of imagination and
   memory ought to be moved within certain and 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--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."[9]

  [9] For an account of Willis' work on the nervous system, see Sir
  Victor Horsley's _Fullerian Lectures_, 1891. Willis was the first,
  or one of the first, to recognise the fact that the cerebral
  ventricles are nothing more than lymph-cavities.

And Gall, a century after Willis, had collected and published, in
support of his system of phrenology, many cases and _post-mortem_
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 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.

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, _L'esprit
humain fait progrès toujours, mais c'est progrès en spirale_. 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.

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 _post-mortem_ examination, found the speech-centres; physiological
experiments had nothing to do with it; and phrenology had, as 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.

The story of Broca's convolution is told in Hamilton's _Text-Book of
Pathology_:--

   "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 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."

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:--

   "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. 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."

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 (_Untersuchungen
über das Gehirn_, Berlin, 1874) had observed, in man, that it
was easy to produce movements of the eyes by the passage of the
 constant current through the occipital region.[10] 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:--

   "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."[11]

  [10] 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."

  [11] Horsley, _Fullerian Lectures_, 1891, _loc. cit._

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.

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:--

   "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 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.

   "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, _compared
   with which all other problems are insignificant and preparatory
   only_, 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?"

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.

       *       *       *       *       *

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 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--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 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 _arbor vitæ_ side by side with the
_arbor scientiæ_.

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:--

   "Among the researches of the last thirty years, those bearing on
   the _Circulation of the Blood_ 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--_i.e._ that which treats of muscle and nerve--have
   thrown light on the wonderful process of 'compensation,' by
   which a diseased heart is able to keep up a normal circulation.

   "_Vaso-motor System._--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, 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.

   "_Digestion._--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.

   "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.

   "_Respiration._--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 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.

   "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."



PART II

EXPERIMENTS IN PATHOLOGY,
MATERIA MEDICA, AND
THERAPEUTICS


I

INFLAMMATION, SUPPURATION, AND BLOOD-POISONING

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 tubercle: and the evidence as to the
nature of anthrax, given by Sir John Simon, reads now like a very old
prophecy:--

   "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 _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._ Dr. Klein's present paper represents one
   very important stage of a vast special study. He gives the
   identification of the contagium as _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_."

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--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 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.

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--hypertrophy and atrophy, necrosis, gangrene,
embolism, and many more--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 _rubor et
tumor cum colore et dolore_--words that sound like Molière's jest
about the _vis dormitiva_ of opium--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 of the white blood-cells,
_diapedesis_, 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
_diapedesis_, 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.

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:--

   "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....

   "While these investigations into the nature of pyæmia were
   proceeding, I was doing my utmost against that 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.

   "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."[12]

  [12] See also the admirable Life of Pasteur, by M. Valléry-Radot.
  Translation by Mrs. Devonshire, vol. ii. p. 20.

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.

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 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.[13] 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.

  [13] This account of Semmelweis, reprinted by permission from the
  _Middlesex Hospital Journal_, is mostly taken from Dr. Theodore
  Duka's excellent paper on "Childbed Fever." (_Lancet_, 1886.)

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.

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 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.

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--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 students, coming
straight from the dissecting-rooms, had infected the patients during
examination.

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.

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,
_both for the maternity department and for the hospitals in general,
but particularly for the surgical wards_." 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 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--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--_What a wounded name, Things standing thus
unknown, shall live behind me._

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.[14] Pasteur could demonstrate to
his opponents the visible cause of the infection, the thing itself.
Roux tells the story:--

   "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.

   "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: _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._ 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, _Tenez, voici sa figure_." (Roux, _L'OEuvre Médicale de
   Pasteur_. _Agenda du Chimiste_, 1896, p. 528.)

  [14] See Pasteur's Life, vol. ii. p. 89.

All suppuration, and all forms of "blood-poisoning"--abscesses, boils,
carbuncles, erysipelas, puerperal fever, septicæmia, pyæmia--are due
to minute organisms, various kinds of _micrococcus_. 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 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--each
kind has its own habits, phases and idiosyncrasies, antagonisms and
preferences: nothing is left unstudied--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.

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 _materies
morbi_, 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--everything, except the immediate cause of the trouble. But
modern pathology, like Pasteur, says, _Tenez, voici sa figure_.

The antiseptic method was based on bacteriology, 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.

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. (_Trans. Roy.
Med. Chir. Soc._, 1906.)


II

ANTHRAX

In animals, anthrax is also called _charbon_, splenic fever, or
splenic apoplexy: in man, the name of _malignant pustule_ is given to
the sore at the point of accidental inoculation, and the name of
_woolsorter's disease_ is given to those cases of anthrax where the
lungs are infected by inhalation of the spores of the _bacillus
anthracis_. The disease occurs among hide-dressers, woolsorters,
brushmakers, and rag-pickers: among animals, it occurs in sheep,
cattle, horses, and swine:--

   "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, _On the Earth in
   relation to Contagia_, 1899.)

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 _Dangerous Trades_ (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.[15]

  [15] Dr. Legge, in his Milroy Lectures, 1905, on Industrial
  Anthrax (_Lancet_, 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.

The _bacillus anthracis_ 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."[16] Pollender in
1844, Roger and Davaine in 1850, noted the _petits bâtonnets_ 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 _bacillus
anthracis_ 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.

  [16] See Dr. Flexner's account of the disease, in volume xix. of
  Stedman's _Twentieth Century Practice_.

In the _Agenda du Chimiste_ (1896) M. Roux gives the following account
of this work, which he watched from first to last:--

   "Vaccination against _charbon_ has now been put to the test of
   practice for fourteen years. Wherever it is adopted, there the
   losses from _charbon_ have become insignificant. It was followed
   by vaccination against swine-measles, _rouget des porcs_, 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.

   "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--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?

   "_See how far we have come, from the old metaphysical ideas
   about virulence, to these microbes that we can turn this way or
   that way--stuff so plastic that a man can work on it, and
   fashion it as he likes._"

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.

The work done in France was published by M. Chamberland, in the
_Annales de L'Institut Pasteur_, March 1894. The following translation
of his memoir--_Résultats pratiques des Vaccinations contre le Charbon
et le Rouget en France_--shows something of the national influence of
the Pasteur Institute:--

1. _Charbon_

"After the famous experiments at Pouilly-le-Fort, MM. Pasteur and Roux
entrusted to me the whole method and practice of the vaccinations
against _charbon_. Twelve years have passed, and it is now time to
put together the results, and to make a final estimate of the value
of these preventive inoculations.

"Every year we ask the veterinary surgeons to report--

1. The number of animals they have vaccinated.

2. The number that have died after the first vaccination.

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

4. The number that have died during the rest of the year.

5. The average annual mortality before the practice of vaccination.

"The sum total of all the reports is given in the following tables:--

VACCINATION AGAINST CHARBON (FRANCE).

_Sheep._

    +------+-----------+--------+----------+------------------------+
    |      |           |        |          |       Mortality.       |
    |      |           |        | Animals  +-------+-------+--------+
    |      |   Total   |        |Vaccinated|After  |After  |During  |
    |      | Number of | Number |according |First  |Second |the rest|
    |      |  Animals  |   of   |to Reports|Vacci- |Vacci- |of the  |
    |Years.|Vaccinated.|Reports.|received. |nation.|nation.| Year.  |
    +------+-----------+--------+----------+-------+-------+--------+
    | 1882 |  270,040  |   112  |  243,199 |  756  |  847  | 1,037  |
    | 1883 |  268,505  |   103  |  193,119 |  436  |  272  |   784  |
    | 1884 |  316,553  |   109  |  231,693 |  770  |  444  | 1,033  |
    | 1885 |  342,040  |   144  |  280,107 |  884  |  735  |   990  |
    | 1886 |  313,288  |    88  |  202,064 |  652  |  303  |   514  |
    | 1887 |  293,572  |   107  |  187,811 |  718  |  737  |   968  |
    | 1888 |  269,574  |    50  |  101,834 |  149  |  181  |   300  |
    | 1889 |  239,974  |    43  |   88,483 |  238  |  285  |   501  |
    | 1890 |  223,611  |    69  |   69,865 |  331  |  261  |   244  |
    | 1891 |  218,629  |    65  |   53,640 |  181  |  102  |    77  |
    | 1892 |  259,696  |    70  |   63,125 |  319  |  183  |   126  |
    | 1893 |  281,333  |    30  |   73,939 |  234  |   56  |   224  |
    +------+-----------+--------+----------+-------+-------+--------+
    | Total|3,296,815  |   990  |1,788,879 | 5,668 |4,406  | 6,798  |
    +------+-----------+--------+----------+-------+-------+--------+

    +------+-------+-----+-------+
    |      |       |     |       |
    |      |       |     |Average|
    |      |       |Total| loss  |
    |      | Total.| loss|before |
    |      |       | per |Vacci- |
    |Years.|       | 100.|nation.|
    +------+-------+-----+-------+
    | 1882 | 2,640 | 1.08|  10%  |
    | 1883 | 1,492 | 0.77|   "   |
    | 1884 | 2,247 | 0.97|   "   |
    | 1885 | 2,609 | 0.93|   "   |
    | 1886 | 1,469 | 0.72|   "   |
    | 1887 | 2,423 | 1.29|   "   |
    | 1888 |   630 | 0.62|   "   |
    | 1889 | 1,024 | 1.16|   "   |
    | 1890 |   836 | 1.20|   "   |
    | 1891 |   360 | 0.67|   "   |
    | 1892 |   628 | 0.99|   "   |
    | 1893 |   514 | 0.69|   "   |
    +------+-------+-----+-------+
    | Total|16,872 | 0.94|   10% |
    +------+-------+-----+-------+

VACCINATION AGAINST CHARBON (FRANCE).

_Cattle._

    +------+-----------+--------+----------+------------------------+
    |      |           |        |          |       Mortality.       |
    |      |           |        | Animals  +-------+-------+--------+
    |      |   Total   |        |Vaccinated| After | After |During  |
    |      | Number of | Number |according | First | Second|the rest|
    |      |  Animals  |   of   |to Reports|Vacci- |Vacci- |of the  |
    |Years.|Vaccinated.|Reports.|received. |nation.|nation.| Year.  |
    +------+-----------+--------+----------+-------+-------+--------+
    | 1882 |   35,654  |   127  |   22,916 |   22  |   12  |   48   |
    | 1883 |   26,453  |   130  |   20,501 |   17  |    1  |   46   |
    | 1884 |   33,900  |   139  |   22,616 |   20  |   13  |   52   |
    | 1885 |   34,000  |   192  |   21,073 |   32  |    8  |   67   |
    | 1886 |   39,154  |   135  |   22,113 |   18  |    7  |   39   |
    | 1887 |   48,484  |   148  |   28,083 |   23  |   18  |   68   |
    | 1888 |   34,464  |    61  |   10,920 |    8  |    4  |   35   |
    | 1889 |   32,251  |    68  |   11,610 |   14  |    7  |   31   |
    | 1890 |   33,965  |    71  |   11,057 |    5  |    4  |   14   |
    | 1891 |   40,736  |    68  |   10,476 |    6  |    4  |    4   |
    | 1892 |   41,609  |    71  |    9,757 |    8  |    3  |   15   |
    | 1893 |   38,154  |    45  |    9,840 |    4  |    1  |   13   |
    +------+-----------+--------+----------+-------+-------+--------+
    |Total |  438,824  | 1,255  |  200,962 |  177  |   82  |  432   |
    +------+-----------+--------+----------+-------+-------+--------+

    +------+-------+-----+-------+
    |      |       |     |       |
    |      |       |     |Average|
    |      |       |Total| loss  |
    |      | Total.| loss|before |
    |      |       | per |Vacci- |
    |Years.|       | 100.|nation.|
    +------+-------+-----+-------+
    | 1882 |   82  | 0.35|   5%  |
    | 1883 |   64  | 0.31|   "   |
    | 1884 |   85  | 0.37|   "   |
    | 1885 |  107  | 0.50|   "   |
    | 1886 |   64  | 0.29|   "   |
    | 1887 |  109  | 0.39|   "   |
    | 1888 |   47  | 0.43|   "   |
    | 1889 |   52  | 0.45|   "   |
    | 1890 |   23  | 0.21|   "   |
    | 1891 |   14  | 0.13|   "   |
    | 1892 |   26  | 0.26|   "   |
    | 1893 |   18  | 0.18|   "   |
    +------+-------+-----+-------+
    |Total |  691  | 0.34|   5%  |
    +------+-------+-----+-------+

"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.'

"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.

"Anyhow, thanks chiefly to new veterinary surgeons who do send
reports, we see that in the twelve years, up to 1st January of this
year, we have had exact returns as to 1,788,879 sheep and 200,962
cattle--about half of all those that were vaccinated.

"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.

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

"These results are extremely satisfactory. It is to be noted
especially that the average annual death-rate from _charbon_, before
vaccination--the average given in these reports--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--which is well below their real value--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.

2. _Rouget_

"Some years after the discovery of vaccination against _charbon_, M.
Pasteur discovered the vaccine for a disease of swine known under the
name of _rouget_. From 1886, these vaccines were prepared and sent out
under the same conditions as the vaccines against _charbon_. The
following table gives the reports that have come to us of this
disease:[17]--

VACCINATION AGAINST ROUGET (FRANCE).

    +------+-----------+--------+----------+------------------------+
    |      |           |        |          |       Mortality.       |
    |      |           |        | Animals  +-------+-------+--------+
    |      |   Total   |        |Vaccinated|After  |After  |During  |
    |      | Number of | Number |according |First  |Second |the rest|
    |      |  Animals  |   of   |to Reports|Vacci- |Vacci- |of the  |
    |Years.|Vaccinated.|Reports.|received. |nation,|nation.| Year.  |
    +------+-----------+--------+----------+-------+-------+--------+
    |      |{ For these|        |          |       |       |        |
    |      |{ two years|        |          |       |       |        |
    | 1886 |{ France   |   49   |   7,087  |   91  |   24  |    56  |
    |      |{ and other|        |          |       |       |        |
    |      |{ countries|        |          |       |       |        |
    | 1887 |{ are put  |   49   |   7,467  |   57  |   10  |    23  |
    |      |{ together.|        |          |       |       |        |
    | 1888 |   15,958  |   31   |   6,968  |   31  |   25  |    38  |
    | 1889 |   19,338  |   41   |  11,257  |   92  |   12  |    40  |
    | 1890 |   17,658  |   41   |  14,992  |  118  |   64  |    73  |
    | 1891 |   20,583  |   47   |  17,556  |  102  |   34  |    70  |
    | 1892 |   37,900  |   38   |  10,128  |   43  |   19  |    46  |
    +------+-----------+--------+----------+-------+-------+--------+
    |Total |  111,437  |  296   |  75,455  |  534  |  188  |   345  |
    +------+-----------+--------+----------+-------+-------+--------+

    +------+-------+-----+-------+
    |      |       |     |       |
    |      |       |     |Average|
    |      |       |Total| loss  |
    |      | Total.| loss|before |
    |      |       | per |Vacci- |
    |Years.|       | 100.|nation.|
    +------+-------+-----+-------+
    |      |       |     |       |
    |      |       |     |       |
    | 1886 |  171  | 2.41|  20%  |
    |      |       |     |       |
    |      |       |     |       |
    | 1887 |   90  | 1.21|   "   |
    |      |       |     |       |
    | 1888 |   94  | 1.35|   "   |
    | 1889 |  144  | 1.28|   "   |
    | 1890 |  254  | 1.70|   "   |
    | 1891 |  206  | 1.17|   "   |
    | 1892 |  108  | 1.07|   "   |
    +------+-------+-----+-------+
    |Total | 1,067 | 1.45|  20%  |
    +------+-------+-----+-------+

  [17] "The reports for 1893 are at present too few to be utilised
  for this table."

"_The total average of losses during the past seven years is 1.45 per
cent., or about 1-1/2 per cent._

"This average is appreciably higher than the average for _charbon_.
But it must be noted that the mortality from _rouget_ among swine,
before vaccination, was much higher than that from _charbon_ 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."

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 _rouget_, in
the same most fascinating book, vol. ii., p. 180.


III

TUBERCLE

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. _En voici les preuves_, he said. He appealed to these
inoculations to prove his teaching:--

   _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._

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 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--_En voici les preuves_. 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:--

   "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."

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:--

   "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."[18]

  [18] "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."

In November 1890 he announced, in the _Deutsche Medizinische
Wochenschrift_, 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.

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.

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.

3. It has given evidence, which till 1901 was hardly called in
question,[19] that _tabes mesenterica_, 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.

  [19] 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.

4. It has proved, and has taught everybody to see 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.

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:--

   "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." (_Medical Annual_, 1901.)

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, 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:--

   "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."

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. (_Lancet_, 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, though the dilution of the serum was
1 in 10.[20] It would be easy to add instances of the value of this
test, for it is practised far and wide over the world.

  [20] 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 _Year-Book of Medicine and Surgery_, 1902
  (Philadelphia, W. B. Saunders & Company).

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.

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.


IV

DIPHTHERIA

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 _Manual
of Bacteriology_, 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:--

    Streptococci                      6
    Staphylococci                    55
    Bacilli                          19
    Torulæ                            9
    Sarcinæ                           6
    Streptococci and micrococci       2
    Micrococci and bacilli            9
    Streptococci and bacilli          1
    Torulæ and bacilli                1
    Micrococci and sarcinæ            6
    Micrococci and torulæ             4
    Many forms present together      19
                                   ----
                                    137
                                   ----

In December 1890 came the news that Behring and Kitasato had at last
cleared the way for the use of an antitoxin:--

   "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."

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--all the _may be_ and
_must be_ of the earlier debates on the new treatment. The finest of
all these fossils is embedded in the _Saturday Review_ of 2nd Feb.
1895--_It is a pity that the English Press should continue to be made
the cat's-paw of a gang of foreign medical adventurers._ 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:--

   "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." (_Brit. Med. Journ._, 3rd September 1898.)

"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." (_Lancet_, 7th
May 1898, Report of German Surgical Congress at Berlin.)

"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." (_Brit. Med. Journ._, 16th January 1897.)

   "The most striking confirmation of the value of antitoxin has
   been afforded where the supply ran short during an epidemic. In
   Baginsky's clinic, the interruption of the serum-treatment
   promptly raised the mortality from 15.6 to 48.4 per cent."
   (_Brit. Med. Journ._, 20th October 1895.)

   "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." (_Trans. Massachusetts
   Med. Soc._, 1898.)

   "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." (_Lancet_, 5th Aug. 1899.)

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 preventive use
of antitoxin: other instances, of equal importance, are given in the
_Boston Medical and Surgical Journal_, December 1897 and March 1898;
and in the _Lancet_, 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 _Year-Book_ for 1902:--

   "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, ending fatally
   in twenty-four hours, showing that the prophylactic action of
   the antitoxin, while efficacious, is not of very long duration."

It would be easy to prolong _ad infinitum_ 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.

I

The report from the Hospital for Sick Children, Paris, is contained in
a memoir, _Sérum-Thérapie de la Diphtérie_, the joint work of MM.
Roux, Martin, and Chaillon (_Annales de l'Institut Pasteur_, 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--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: _le
sérum est le seul élément nouveau introduit_.

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--

    In 1890      55.88 }
     " 1891      52.45 } Average = 51.71.
     " 1892      47.64 }
     " 1893      48.47 }

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

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

The cases at the Hospital for Sick Children must be divided into those
that required tracheotomy and those that did not require it:--

MORTALITY AMONG CASES NOT REQUIRING TRACHEOTOMY.

    In 1890        47.30 }
     " 1891        46.64 } Average = 33.94.
     " 1892        38.8  }
     " 1893        32.02 }

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.

MORTALITY AMONG CASES REQUIRING TRACHEOTOMY.

    In 1890        76.35 }
     " 1891        68.36 } Average = 73.49.
     " 1892        74.6  }
     " 1893        73.45 }

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.

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
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.

II

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 _New
York Medical Record_, 4th July 1896.

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.

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:--

   "There are very few hospitals in America that receive diphtheria
   patients.... It was the custom in Chicago to 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."

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.

    Of  996 cases injected
                   on the first day of the disease,  49 died =  4.9%
     " 1616   "    on the second           "        120   "  =  7.4"
     " 1508   "    on the third            "        134   "  =  8.8"
     "  758   "    on the fourth           "        147   "  = 20.7"
     "  690   "    on or after the fifth   "        244   "  = 35.3"

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

"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.

"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 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.

"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.

"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."

III

In 1898, the Clinical Society published the Report of their Special
Committee, based on 633 cases (_Trans. Clin. Soc._, xxxi., 1898, pp.
1-50). The whole report should be read carefully; but there is room
here for nothing more than the latter part of it. This is given at
length.

A

_Table showing the General Mortality of cases treated, on the same day
of the disease, with and without Antitoxin._

    +----------------------------++---------------------------++----------+
    |                            ||METROPOLITAN ASYLUMS BOARD ||          |
    |    ANTITOXIN COMMITTEE:    ||          1894:            ||Difference|
    |     633 Cases treated      ||3042 Cases treated without ||   of     |
    |      with Antitoxin.       ||        Antitoxin.         ||  Per-    |
    +----------------------------++---------------------------++ centage. |
    |Day of the|  C  |  D  |  M  || Day of  |  C  |  D  |  M  ||          |
    |Disease on|  a  |  e  |  o  ||Admission|  a  |  e  |  o  ||          |
    |which     |  s  |  a  |  r  ||   to    |  s  |  a  |  r  ||          |
    |Treatment |  e  |  t  |  t  ||Hospital.|  e  |  t  |  t  ||          |
    |was begun.|  s. |  h  |  i  ||         |  s. |  h  |  a  ||          |
    |          |     |  s. |  l  ||         |     |  s. |  l  ||          |
    |          |     |     |  i  ||         |     |     |  i  ||          |
    |          |     |     |  t  ||         |     |     |  t  ||          |
    |          |     |     |  y  ||         |     |     |  y  ||          |
    |          |     |     |     ||         |     |     |     ||          |
    |          |     |     |  %. ||         |     |     |  %. ||          |
    +----------+-----+-----+-----++---------+-----+-----+-----++----------+
    |    1st   |  20 |   2 | 10.0||   1st   |  133|  30 | 22.5||   12.5   |
    |    2nd   |  92 |  10 | 10.8||   2nd   |  539| 146 | 27.0||   16.2   |
    |    3rd   | 133 |  20 | 15.0||   3rd   |  652| 192 | 29.4||   14.4   |
    |    4th   | 130 |  26 | 20.0||   4th   |  566| 179 | 31.6||   11.6   |
    |    5th   | 258 |  66 | 25.5||   5th   |1,152| 355 | 30.8||    5.3   |
    |and after.|     |     |     ||         |     |     |     ||          |
    +----------+-----+-----+-----++---------+-----+-----+-----++----------+
    |  Totals  | 633 | 124 | 19.5||  Totals |3,042| 902 | 29.6||   10.1   |
    +----------+-----+-----+-----++---------+-----+-----+-----++----------+

B

_Summary and Conclusions of the Committee's Report_

   "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.

   "The Committee rejected all cases in which satisfactory proof of
   the existence of true diphtheria was not shown, either by the
   presence of the _Bacillus diphtheriæ_ 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.

   "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.

   "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.

   "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.

   "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 mortality is 16.0, as opposed to 26.0;
   whilst after ten years of age the difference in the mortality is
   slight.[21]

  [21] After childhood, the disease is much less fatal.

   "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.

   "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.

   "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.

   "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
   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.

   "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.

   "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.

   "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.

   "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.

   "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.

   "The results of the Committee's investigation tend to show that
   by the use of antitoxin--

   1. The general mortality is reduced by one-third.

   2. The mortality in tracheotomy falls by one-half.

   3. Extension of membrane to the larynx very rarely occurs after
   the administration of antitoxin.

   4. The duration of life in the fatal cases is decidedly
   prolonged.

   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.

   6. The frequency of the occurrence of paralysis is not
   diminished, but the percentage of recoveries in cases with
   paralysis is slightly increased.[22]

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

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

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

  [22] For an exhaustive and wise study of the diphtheritic
  paralyses, see Dr. Woollacott's essay in the _Lancet_, 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--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. _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._" 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."

       *       *       *       *       *

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.

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:--

   "The period covered by the report extends from 1st January 1895
   to 31st December of the same year. During this time--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--the serum was
   administered _only to cases which at the time of admission were
   severe, or which threatened to become so_. 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. _No
   change has taken place during the year in the local treatment of
   the cases, nor has there been any new factor in the treatment
   other than the injection of antitoxin_.

   "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 _those cases only in which the
   symptoms on admission were sufficiently pronounced to give rise
   to anxiety, the mild cases not receiving any_.

   "_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_; 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.

   "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.

   "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.

   "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.

   " ... Of 3042 patients of all ages treated during 1894, 902
   died--a mortality of 29.6 per cent.; whereas, of 3529 cases
   treated during 1895, 796 died--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.

   INFLUENCE OF AGE.

   _Table showing variations in reduction of mortality obtained
   with Antitoxin at different ages._

    +--------+------------------------+------------------------+
    |        |    Antitoxin Cases,    |        All Cases,      |
    |        |          1895.         |          1895.         |
    |  Ages. +------+-------+---------+------+-------+---------+
    |        |Cases.|Deaths.|Mortality|Cases.|Deaths.|Mortality|
    |        |      |       |per cent.|      |       |per cent.|
    +--------+------+-------+---------+------+-------+---------+
    |Under 5 | 1013 |  379  |  37.4   | 1453 |  497  |   34.2  |
    | "   10 | 1829 |  575  |  31.4   | 2720 |  744  |   27.3  |
    | "   15 | 2056 |  606  |  29.4   | 3144 |  779  |   24.7  |
    |All ages| 2182 |  615  |  28.1   | 3529 |  796  |   22.5  |
    +--------+------+-------+---------+------+-------+---------+

    +--------+------------------------+------------+
    |        |        All Cases,      |  Diff. in  |
    |        |           1894.        |Mortalities,|
    |  Ages. +------+-------+---------+    1894    |
    |        |Cases.|Deaths.|Mortality|     and    |
    |        |      |       |per cent.|    1895.   |
    +--------+------+-------+---------+------------+
    |Under 5 | 1171 |  556  |  47.4   |    13.2    |
    | "   10 | 2246 |  836  |  37.2   |     9.9    |
    | "   15 | 2609 |  877  |  33.6   |     8.9    |
    |All ages| 3042 |  902  |  29.6   |     7.1    |
    +--------+------+-------+---------+------------+

   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.

   INFLUENCE OF TIME OF COMING UNDER TREATMENT.

   _Table showing percentage mortality in relation to day of
   disease on which cases came under treatment._

    +---------------+--------+--------+-----------+
    |Day of Disease.|  1894. |  1895. |Difference.|
    +---------------+--------+--------+-----------+
    | 1st           |  22.5  |  11.7  |   10.8    |
    | 2nd           |  27.0  |  12.5  |   14.5    |
    | 3rd           |  29.4  |  22.0  |    7.4    |
    | 4th           |  31.6  |  25.1  |    6.5    |
    | 5th and over  |  30.8  |  27.1  |    3.7    |
    +---------------+--------+--------+-----------+
    |     Total     |  29.6  |  22.5  |    7.1    |
    +---------------+--------+--------+-----------+

   "It will be seen that the percentage mortality of cases admitted
   on the same day of disease is less in every 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.

   "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.

   _Laryngeal Cases_

   "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.

   "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--viz., 1894--were
   as low as 10 per cent.

   "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.

   "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.

   "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:--

   1. _Comparative Mortality of Laryngeal Cases at all Hospitals,
   except the Fountain._

    +-----+------+-------+----------+
    |Year.|Cases.|Deaths.|Percentage|
    |     |      |       |Mortality.|
    +-----+------+-------+----------+
    |1894 | 466  |  289  |   62.0   |
    |1895 | 468  |  196  |   41.8   |
    +-----+------+-------+----------+

   2. _Comparative Results in Tracheotomy Cases at all Hospitals,
   except the Fountain._

    +-----+------+-------+----------+
    |Year.|Cases.|Deaths.|Percentage|
    |     |      |       |Mortality.|
    +-----+------+-------+----------+
    |1894 | 261  |  184  |   70.4   |
    |1895 | 219  |  108  |   49.3   |
    +-----+------+-------+----------+

   3. _Comparative Number of Laryngeal Cases which required
   Tracheotomy at all Hospitals, except the Fountain._

    +-----+------+--------------+--------------+
    |Year.|Cases.|Tracheotomies.|Percentage of |
    |     |      |              |Tracheotomies.|
    +-----+------+--------------+--------------+
    |1894 | 466  |     261      |     56.0     |
    |1895 | 468  |     219      |     46.8     |
    +-----+------+--------------+--------------+

   "On these tables further comment seems unnecessary.

   _Summary_

   "The improved results in the diphtheria cases treated during the
   year 1895, which are indicated by the foregoing statistics and
   clinical observations, are--

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

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

   3. The still more remarkable reduction in the mortality of the
   laryngeal cases.

   4. The uniform improvement in the results of tracheotomy at each
   separate hospital.

   5. The beneficial effect produced on the clinical course of the
   disease.

   _Conclusions_

   "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.

   "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--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.

   "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 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.

   "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."

       *       *       *       *       *

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.

    +--------------------------+----------++--------------+----------+
    |Year.                     |Percentage||Year.         |Percentage|
    |                          |Mortality.||              |Mortality.|
    +--------------------------+----------++--------------+----------+
    |1888                      |  59.35   ||1897          |  17.69   |
    |1889                      |  40.74   ||1898          |  15.37   |
    |1890                      |  33.55   ||1899          |  13.95   |
    |1891                      |  30.63   ||1900          |  12.27   |
    |1892                      |  29.35   ||1901          |  11.15   |
    |1893                      |  30.42   ||1902          |  11.04   |
    |1894                      |  29.29   ||1903          |   9.69   |
    |1895, first antitoxin year|  22.85   ||1904          |  10.08   |
    |1896                      |  21.20   ||1905          |   8.3    |
    +--------------------------+----------++--------------+----------+

These results, of course, are but one instance of what has happened,
since 1895, in every country all over the civilised world. _Securus
judicat orbis terrarum._ 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
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.

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.[23] The lesser drawbacks, the occurrence of joint pains and
of rashes, are transient and in no way serious.

  [23] This, of course, does not apply to two instances, in 1901, of
  accidental contamination of serum. See, for an account of these,
  _The British Medical Journal_, November 1901.

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:--

   "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 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.

   "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 _cannot cure_ the degeneration of the nerve,
   but it _can neutralise_ 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.

   "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.

   "Antitoxin appears to diminish the liability of the lungs to
   inflammatory change in severe attacks of diphtheria."

       *       *       *       *       *

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 _at the very
beginning of the disease_. The figures in brackets are the total
numbers of the cases in the eight years:--

_Percentage Mortality according to Time of coming under Treatment._

    +---------------+-----+-----+-----+-----+-----+-----+-----+-----+
    |Day of Disease.|1897.|1898.|1899.|1900.|1901.|1902.|1903.|1904.|
    +---------------+-----+-----+-----+-----+-----+-----+-----+-----+
    |(204) 1st      |  0.0|  0.0|  0.0|  0.0|  0.0|  0.0|  0.0| 0.0 |
    |(1278) 2nd     |  5.4|  5.0|  3.8|  3.6|  4.1|  4.6|  4.2| 5.43|
    |(1374) 3rd     | 11.5| 14.3| 12.2|  6.7| 11.9| 10.5| 17.6|10.63|
    |(1086) 4th     | 19.0| 18.1| 20.0| 14.9| 12.4| 19.8| 16.7|19.51|
    |(1382) 5th     |     |     |     |     |     |     |     |     |
    | and after     | 21.0| 22.5| 20.4| 21.2| 16.6| 19.4| 17.3|13.11|
    +---------------+-----+-----+-----+-----+-----+-----+-----+-----+

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.

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 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." (_Clinical Journal_, May 23, 1906.)


V

TETANUS

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 _Tropical Diseases_ (1898), says:--

   "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 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."

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.

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.

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--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 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.

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 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.

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 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:--

    26 cases, with 12 recoveries.
    98      "      57     "
    36      "      25     "
    22      "      11     "
    51      "      36     "
    10      "       7     "

Probably the paper by Dr. Lambert of New York, in the _Medical News_,
July 1900, gives fairly the general opinion of the treatment, so far
as the subcutaneous administration of antitoxin is concerned:--

   "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--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 is a distinct improvement in the mortality of
   tetanus since the introduction of antitoxin."

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.

The _preventive_ 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:--

   1. _France._--"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." (_Med. News_, 7th July 1900.)

   2. _United States._--"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 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." (_Medical
   Annual_, 1901.)

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:--

   "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." (_Medical News_, August
   1900.)

Again, at the Gebaer Anstalt at Prague, in 1899, an outbreak of
tetanus occurred, with several deaths; but it was stopped when a
preventive dose of the antitoxin was given to the new patients on
admission.

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 _Medical News_, 1st June 1901, has the
following note:--"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."

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.

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.

The results published during the last few years (_Medical Annual_,
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.


VI

RABIES

Pasteur's study of rabies began in 1880; and the date of the first
case treated--Joseph Meister, a shepherd-boy of Alsace--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.[24] 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:--

   "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 _must_,' 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."

  [24] This sentence was written before the publication of Professor
  Negri's observations (see _Medical Annual_, 1906, p. 418).

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
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 _locus electionis_, of
the virus of rabies. But these inoculations also were not always
successful, nor did they give a definite incubation-period.

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.

These sub-dural inoculations were the turning-point of Pasteur's
discovery. The first inoculation was made by M. Roux:--

   "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."

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 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, _virus fixe_: the next rabbit inoculated would
have the disease in six days, neither more nor less.

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--ranging from absolute
non-virulence through every shade of virulence.

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 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.

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.

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 _Birmingham Medical Review_ of January 1898. It gives the
following tables of treatment:--

1. _Ordinary Treatment._

      Day of            Days of Drying
    Treatment.             of Cord.
        1                 14 and 13
        2                 12 and 11
        3                 10 and  9
        4                  8 and  7
        5                     6
        6                     6
        7                     5
        8                     4
        9     (1/2 dose)      3
       10    (full dose)      5
       11                     5
       12                     4
       13                     4
       14     (1/2 dose)      3
       15    (full dose)      3

2. _Cases of Moderate Gravity._

Same treatment, up to 13th day.

     Day of            Days of Drying
    Treatment.            of Cord.
       14                     3
       15                     5
       16                     4
       17     (1/2 dose)      3
       18    (full dose)      3

3. _Grave Cases._

Same treatment, up to 10th day.

     Day of            Days of Drying
    Treatment.            of Cord.
       11                     4
       12                     3
       13                     5
       14                     5
       15                     4
       16                     4
       17     (1/2 dose)      3
       18    (full dose)      3
       19                     5
       20                     3
       21                     4
       22                     3

4. _Very Grave Cases._

Same treatment as 3, and in addition.

     Day of            Days of Drying
    Treatment.            of Cord.
       23                     5
       24                     4
       25     (1/2 dose)      3
       26    (full dose)      3

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--"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 chemist, who has tried, out of a wish to be useful,
to reform medicine, to which he is a complete stranger."

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:--

   "A. Bitten by animals proved to have been rabid by the
   development of rabies in other animals inoculated from them.

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

   "C. Bitten by animals suspected to have been rabid."

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.

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 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--a mortality not of 10 per cent., but of
less than 1 per cent.

1. _Athens_

The _Annales de l'Institut Pasteur_, 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--590
male and 207 female. The animals that bit them were--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.

"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.

"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.

"Beside these 798 cases treated at the Institute, there have been
others that have not undergone the antirabic treatment, having trusted
the assurances of those who are called in Greece _empirics_. Among
these non-treated cases there are 40 who have died of rabies."

2. _Palermo_

The _Annales_ 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.

"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."

3. _Rio de Janeiro_

The _Annales_ 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.

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, and 1 had been bitten by a rabid patient. Of
the rest, 1886 had been bitten on the bare skin, and 747 through
clothing.

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.

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.

4. _Paris_

Dr. Pottevin's report on the work of the Pasteur Institute (Paris)
during 1897 (_Annales_, April 1898) must be given word for word,
without abbreviation.

I

During 1897, 1521 patients received the anti-treatment at the Pasteur
Institute: 8 died of rabies. The notes of their cases will be found
at the end of this paper.

If we exclude 2 of these 8 cases--the cases of Heniquet and Morin,
where death occurred before it was possible for the vaccinations to
produce their effect--the results of the vaccinations in 1897 are

    Patients treated      1519
    Deaths                   6
    Mortality per cent.      0.39

In the following table these figures are compared with those of
preceding years:--

    +-------+----------+---------+-----------+
    | Year. | Patients | Deaths. | Mortality |
    |       | treated. |         | per cent. |
    +-------+----------+---------+-----------+
    | 1886  |   2671   |   25    |   0.94    |
    | 1887  |   1770   |   14    |   0.79    |
    | 1888  |   1622   |    9    |   0.55    |
    | 1889  |   1830   |    7    |   0.38    |
    | 1890  |   1540   |    5    |   0.32    |
    | 1891  |   1559   |    4    |   0.25    |
    | 1892  |   1790   |    4    |   0.22    |
    | 1893  |   1648   |    6    |   0.36    |
    | 1894  |   1387   |    7    |   0.50    |
    | 1895  |   1520   |    5    |   0.33    |
    | 1896  |   1308   |    4    |   0.30    |
    | 1897  |   1521   |    6    |   0.39    |
    +-------+----------+---------+-----------+

II

Patients treated at the Pasteur Institute are divided into three
classes, as follows:--

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).[25]

  [25] 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.

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

C. The animal was suspected of rabies.

We give here the patients treated in 1897, under these three
classes:--

    +------------------+---------------+---------------+---------------+
    |    BITES OF THE  | BITES ON THE  | BITES OF THE  |    TOTAL.     |
    |        HEAD.     |    HANDS.     |    LIMBS.     |               |
    +--+-----+---+-----+-----+---+-----+-----+---+-----+-----+---+-----+
    |  |  P  |   | M p |  P  |   | M p |  P  |   | M p |  P  |   | M p |
    |  |  a  | D | o e |  a  | D | o e |  a  | D | o e |  a  | D | o e |
    |  |  t  | e | r r |  t  | e | r r |  t  | e | r r |  t  | e | r r |
    |  |  i  | a | t   |  i  | a | t   |  i  | a | t   |  i  | a | t   |
    |  |  e  | t | a c |  e  | t | a c |  e  | t | a c |  e  | t | a c |
    |  |  n  | h | l e |  n  | h | l e |  n  | h | l e |  n  | h | l e |
    |  |  t  | s | i n |  t  | s | i n |  t  | s | i n |  t  | s | i n |
    |  |  s  | . | t t |  s  | . | t t |  s  | . | t t |  s  | . | t t |
    |  |  .  |   | y . |  .  |   | y . |  .  |   | y . |  .  |   | y . |
    +--+-----+---+-----+-----+---+-----+-----+---+-----+-----+---+-----+
    | A|  15 | 0 |  0  |  81 | 0 | 0   |  46 | 1 | 2.1 | 142 | 1 | 0.7 |
    | B| 106 | 0 |  0  | 539 | 4 | 0.74| 273 | 1 | 0.4 | 918 | 5 | 0.65|
    | C|  30 | 0 |  0  | 244 | 0 | 0   | 187 | 0 | 0   | 461 | 0 | 0   |
    +--+-----+---+-----+-----+---+-----+-----+---+-----+-----+---+-----+
    |  | 151 | 0 |  0  | 864 | 4 | 0.46| 506 | 2 | 0.4 |1521 | 6 | 0.39|
    +--+-----+---+-----+-----+---+-----+-----+---+-----+-----+---+-----+

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:--

    +-------------------+---------+-------+----------+
    |                   |Patients.|Deaths.|Mortality.|
    +-------------------+---------+-------+----------+
    |Bites of the Head  |  1,759  |  21   |   1.1    |
    |Bites of the Hands | 11,118  |  53   |   0.47   |
    |Bites of the Limbs |  7,289  |  22   |   0.30   |
    +-------------------+---------+-------+----------+
    |                   | 20,166  |  96   |   0.46   |
    +-------------------+---------+-------+----------+

    +---+---------+-------+----------+
    |   |Patients.|Deaths.|Mortality.|
    +---+---------+-------+----------+
    | A |  2,872  |  20   |   0.69   |
    | B | 12,547  |  61   |   0.48   |
    | C |  4,747  |  15   |   0.31   |
    +---+---------+-------+----------+
    |   | 20,166  |  96   |   0.46   |
    +---+---------+-------+----------+

III

In regard to their nationality, the 1521 patients treated at the
Pasteur Institute in 1897 were as follows:--

    Germany            8
    England           83
    Belgium           14
    Egypt              2
    United States      1
    Greece             1
    India             33
    Switzerland       33

That is, 175 foreigners and 1346 French.

IV

Notes of the eight cases where the treatment failed:--

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.

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.

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. Died of
rabies 14th October. Two other persons bitten by the same dog and
treated at the Pasteur Institute are now in good health.

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.

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.

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.)

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.

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, 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.

       *       *       *       *       *

We hardly need follow the work of the remaining years. The figures are
as follows:--

    +-------+----------+---------+-----------+
    | Year. | Patients | Deaths. | Mortality |
    |       | treated. |         | per cent. |
    +-------+----------+---------+-----------+
    | 1898  |   1465   |    3    |   0.2     |
    | 1899  |   1614   |    4    |   0.25    |
    | 1900  |   1420   |    4    |   0.28    |
    | 1901  |   1318   |    5    |   0.38    |
    | 1902  |   1105   |    2    |   0.18    |
    | 1903  |    628   |    2    |   0.32    |
    | 1904  |    755   |    3    |   0.39    |
    +-------+----------+---------+-----------+

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.

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 _Annales_ of the Paris Institute. Apart from this
faint hope, the _cure_ of hydrophobia is where it was in the days of
the "Tonquin medicine" and the "Tanjore pills."


VII

CHOLERA

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 _in excelsis_, often dangerous,[26]
and always laborious.

  [26] "In order to prove that this _vibrio_ 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 _vibrio_, and rendered unnecessary any exposure to the
  risks belonging to voluntary inoculation." (Dr. Flexner, Stedman's
  _Twentieth Century Practice_, vol. xix., 1900.)

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
the immunisation of animals against the cholera-bacillus. Other men,
of course, were working on the same lines--Pfeiffer, Brieger,
Metchnikoff, Fischer, Gamaleïa, Klein, Wassermann, and many more--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:--

   "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.

   "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 _Report to the Government
   of India_, 1895.)

He reached Calcutta in March 1893, and at the request of Mr.
Hankin[27] 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 visit. In 1895
his health failed, and no wonder; and he came back to Europe for a
short time:--

   "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 _bustees_ 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. _British
   Medical Journal_, 21st Dec. 1895.)

  [27] 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.

Altogether, upwards of 70,000 injections on 42,179 people--_without
having to record a single instance of mishap or accident of any
description produced by our vaccines_. 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, 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.

Later than Haffkine's 1895 report, we have Dr. Simpson's 1896 report:
"_Two Years of Anti-choleraic Inoculations in Calcutta._ 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:[28]--

   "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.

   "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."

  [28] For a summary of this report, see the _Lancet_, 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 _Indian Medical Gazette_, May
  1898.

Here, then, in this 1896 report, are all the results that give an
answer to the question, What will happen 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?

I. _Calcutta_ (1894-1896)

   "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--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--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.

   "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.

   "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 had been previously carried
   out. _For this purpose, affected houses in which inoculations
   have not been performed, and inoculated houses in which cholera
   has not appeared, are excluded._"

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--less than one-tenth of the household--that their escape
from cholera might be called chance. The cholera came, and left behind
it this fact:--

   654 uninoculated individuals had 71 deaths = 10.86 per cent.

   402 inoculated in the same households had 12 deaths = 2.99 per
   cent.

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.

Moreover, of these 12 deaths, 5 occurred during the first five days
after inoculation--that is to say, during the period in which the
protective influence of the vaccine was still incomplete. _Then came a
period of more than a year, during which the uninoculated had 42
deaths, and the inoculated had one death._ 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.

Take a good instance that came at the very beginning of the work:--

   "A local epidemic took place around two tanks in Kattal Began
   _bustee_, ward 19, occupied by about 200 people. In this _bustee_,
   about the end of March, 2 fatal cases of cholera and 2 cases of
   choleraic diarrhoea occurred. The outbreak led to the inoculation
   of 116 persons in the _bustee_ out of the 200. Since then, 9 cases
   of cholera, of which 7 were fatal, and 1 case of choleraic
   diarrhoea have appeared in the _bustee_, 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 _bustee_; while none of
   the inoculated have been affected." (_Cholera in Calcutta in 1894._
   W. J. Simpson.)

2. _Lucknow_ (1893)

The story of the outbreak of cholera in the East Lancashire Regiment
must be read carefully:--

   "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, 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."

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.

The following table shows the total number of attacks and deaths in
not inoculated and inoculated:--

    +---------------------+-------------+------------+
    |                     |   Attacks.  |  Deaths.   |
    +---------------------+-------------+------------+
    |                     | Per cent.   | Per cent.  |
    | Non-inoculated, 640 | 120 = 18.75 | 79 = 12.34 |
    | Inoculated, 133     |  18 = 13.53 | 13 = 9.7   |
    +---------------------+-------------+------------+

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."[29]

  [29] "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, _loc. cit._)

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 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:--

   "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.)

3. _Gaya Jail_

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:--

   "The inoculations being purely voluntary, no selection of
   prisoners was possible, but all classes of the jail were
   represented--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 absolutely identical conditions as regards food,
   water, accommodation, etc., in fact in every possible respect."

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:--

    +-------------------------+------------------+------------------+
    |                         | NON-INOCULATED,  |   INOCULATED,    |
    |                         |        202.      |       207.       |
    +-------------------------+------------------+------------------+
    |                         | Cases. | Deaths. | Cases. | Deaths. |
    +-------------------------+--------+---------+--------+---------+
    | During 5 days after 1st |   7    |    5    |   5    |    4    |
    |     inoculation         |        |         |        |         |
    | During 3 days after 2nd |   5    |    3    |   3    |    1    |
    |     inoculation         |        |         |        |         |
    | After 3 days after 2nd  |   8    |    2    |   0    |    0    |
    |     inoculation         |        |         |        |         |
    +-------------------------+--------+---------+--------+---------+

Haffkine's comment on these figures must be noted here:--

   "In the Gaya jail, the inoculations were _for the first time_
   applied _in a prevalent epidemic_, and _very weak doses_ of a
   relatively weak vaccine were used.... Far higher results have
   been obtained by an application of stronger doses. In the
   _bustees_ 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:--

During the first period of 5 days, subsequent to the inoculation with
first vaccine, cholera occurred in 8 houses.

   75 non-inoculated had 5 cases, with 3 deaths. 52 inoculated had
   3 cases, with 3 deaths.

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

   8 non-inoculated had 2 cases, with 2 deaths. 17 inoculated had
   no cases.

_After the 10 days necessary for the preventive treatment had expired,
and up to the 459th day, the disease visited 26 houses._

   _263 non-inoculated had 38 cases, with 34 deaths._

   _137 inoculated had 1 case, with 1 death, in a child that had
   not been brought up for the second inoculation."_

4. _Assam-Burmah Railway_

For a good instance of lives saved even during an outbreak, take the
Assam-Burmah Railway coolies:--

   _"Three hundred and fifty[30] 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 _among the
   not-inoculated minority there were 34 cases, with 30 deaths;
   whereas the inoculated had 4 fatal cases_." (Haffkine, 1895,
   Lecture in London.)_

  [30] The exact number is 355, of whom 196 were inoculated; the
  coolies numbered 343, and the Goorkhas 12. (See Dr. Simpson's 1896
  Report.)

5. _Durbhanga Jail_ (1896)

The figures in this instance are small: but Surgeon-Captain E. Harold
Brown's report is very pleasant 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 A.M., 2 more cases were reported
in camp. At 7.30 A.M., Haffkine and Dr. Green came to the camp:--

   "The prisoners were spoken to on the subject, and seemed to be
   pleased with the idea, the word _tika_ (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."

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.

   "There were fresh cases of cholera that day at 12 (noon), 6, 7,
   and 7.30 P.M., and at midnight, all in those who had not been
   inoculated, and all terminating 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."

The inoculations were made at 7.30 A.M. Surgeon-Captain Brown had pain
within half-an-hour, and fever in three hours, with temperature 104°,
_but this was probably due to the fact that I was not able to rest_.
The prisoners, of course, went to bed: they all reacted before 4 P.M.,
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."

6. _Bilaspur and Serampur_

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.

7. _The Cachar Tea-Gardens_ (1895)

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 numbers.[31] The latest report from
Dr. Arthur Powell, the Medical Officer, is quoted in Dr. Simpson's
1896 report:--

    _At Kalain_--
      1079 not inoculated had 50 cases, with 30 deaths.
      1250 inoculated--3 cases, with 2 deaths.[32]

    _At Kalaincherra_--
      685 not inoculated had 10 cases, with 7 deaths.
      155 inoculated--no cases.

    _At Degubber_--
      254 not inoculated had 12 cases, with 10 deaths.
      407 inoculated--5 cases, all recovered.

    _At Duna_--
      121 not inoculated had 4 cases, with 2 deaths.
      29 inoculated--no cases.

    _At Sandura_--
      454 not inoculated had 2 cases, with 1 death.
      51 inoculated--2 cases, with 1 death.

    _At Karkuri_--
      198 not inoculated had 15 cases, with 9 deaths.
      443 inoculated--3 cases, with 1 death.

    _At Craig Park_--
      185 not inoculated had 1 fatal case.
      46 inoculated--no cases.

   TOTAL.

   Not inoculated, 2976, with 94 cases and 60 deaths. Inoculated,
   2381, with 13 cases and 4 deaths.

  [31] "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, _Lancet_, 13th
  July 1896.)

  [32] "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.

To the preceding instances, which are rather old now, must be added
the following more recent report, from the _Indian Medical Gazette_,
September 1901:--

   "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."

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
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.

The _Medical Annual_ 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.

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.


VIII

PLAGUE

The _bacillus pestis_ 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 _Annales de l'Institut
Pasteur_, 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.

Haffkine's fluid was first used on man in January 1897. It is a
_bouillon_ containing no living bacilli, and nothing offensive to the
religious beliefs of India.[33] 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. 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:--

   "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.'"

  [33] 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 _Tantum relligio potuit
  suadere malorum_.

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.e._, had the plague in them already at the time of
inoculation.

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.

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.

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.
It represents the very least--what might almost be called the very
worst--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.

1. _Daman_

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.

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.

They admit, also, the house-to-house investigations 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.

2. _Lanauli_

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:--

   Inoculated, 323, with 14 cases, of which 7 died = 2 per cent.

   Uninoculated, 377, with 78 cases, of which 57 died = 15 per
   cent.

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--"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."

3. _Kirki_

The figures here were obtained under especially favourable
circumstances; and the Commissioners have, practically, no fault to
find with their accuracy. The following account is by Surgeon-Major
Bannerman, Superintendent of the Plague Research Laboratory, Bombay:--

   "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:--

   Inoculated, 671, with 32 cases, of which 17 died = 2.5 per cent.

   Uninoculated, 859, with 143 cases, of which 98 died = 11.4 per
   cent.

   "Here, then, is seen a body of people divided into two groups
   by the fact that one had undergone inoculation and the other
   not, _but differing in no other way_, 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, _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_. 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."

4. _Belgaum_

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.

(1) _The Army Cases._-These cases occurred in the 26th Madras
Infantry, which was living in lines close to the cantonment and the
city. The first case of 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:--

   "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."

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, _only 2 out of the 1665 were attacked, and
both recovered_.

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 it
was much more severe than the first, only 12 cases occurred. _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._ "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."

(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:--

   "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,
   2 are said to have died of plague, and 1 undoubtedly died of
   plague.'"

   "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."

5. _The Umarkhadi Jail, Bombay_

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 the
average daily number of each group: this was 147 for the inoculated,
and 127 for the uninoculated. The figures are:--

    +-----------------------+--------+---------+
    | Average Daily Number. | Cases. | Deaths. |
    +-----------------------+--------+---------+
    | Inoculated      147   |   3    |    0    |
    | Uninoculated    127   |   9    |    5    |
    +-----------------------+--------+---------+

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.

6. _Undhera_

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.

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, Surgeon-Major Bannerman,
and other experts, and 513 persons were inoculated:--_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._
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:--

    +---------------+-------------------+------+-------+-------------+
    |Population on  |                   |Cases.|Deaths.| Mortality.  |
    |12th February. |                   |      |       |             |
    +---------------+-------------------+--------------+-------------+
    |1029 - 76 = 953| Inoculated,   513 |  8   |   3   |0.6 per cent.|
    |               | Uninoculated, 440 | 28   |  27   |6.0 per cent.|
    +---------------+-------------------+------+-------+-------------+

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.

7. _Khoja Community, Bombay_

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
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.

During these four months, the number of deaths _from all causes_ in
the whole community was 184. According to the average mortality of the
community in times of no plague, the deaths _from all causes_ 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. _Of these 82 deaths, 3 occurred among the inoculated
or reinoculated, and 77 among the uninoculated._

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."

8. _Hubli_

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:--

   "The town of Hubli--a mercantile town of over 50,000
   inhabitants--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 _à priori_ grounds. If this experiment had failed,
   the results, judged by the actual mortality among the
   uninoculated, would have been appalling. _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...._

   "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, and Hubli is steadily regaining its normal
   population and trade, though surrounded by infected villages."

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--disinfection, isolation of cases, evacuation
of infected districts. He says:--

   "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."

Sanitation, therefore, was Dr. Leumann's faith. Now for his works:--

   "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.[34] ... I have never experienced
   the 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.

  [34] Compare the account of the inoculations at Gaday, in the
  _Lancet_, 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."

   "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, _the non-inoculated
   dying of plague, and the inoculated escaping, almost to a man_.

   "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 numbers and proportion than the inoculated; and my own
   observations entirely bear out this statement.

   "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 _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_. 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.

   "Unfortunately, the average native, educated or not, appears to
   have the very greatest aversion to notifying any case of
   sickness--plague or other--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.[35] With so few
   police (and those 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--the
   work of segregation, house-to-house inspection, etc., became,
   from a medical point of view, absurdly insufficient.

   "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."

  [35] Compare the account given by the Rev. H. Haigh (_Methodist
  Recorder_, 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."

I

    +------------+---------+-----------+-----------+-------------------+
    |            |         |           |           |     Plague-deaths |
    |            |         |           |           |         among:    |
    |  Dates.    |Census of|   Non-    |Inoculated.+-----------+-------+
    |            | Hubli.  |Inoculated.|           |   Non-    |Inocul-|
    |            |         |           |           |Inoculated.| ated. |
    +------------+---------+-----------+-----------+-----------+-------+
    |Five weeks  |Fell from|           |           |           |       |
    | from May 11|50,000 to|           |           |           |       |
    | to June 14 | 47,427  |  44,573   |  2,854    |    47     |   1   |
    |            |         |           |           |           |       |
    |Week ending:|         |           |           |           |       |
    |  June 21   | 47,082  |  41,494   |  5,588    |    22     |   3   |
    |  June 28   | 47,485  |  39,042   |  8,443    |    29     |   1   |
    |  July 5    | 46,537  |  36,020   | 10,517    |    55     |   6   |
    |  July 12   | 46,518  |  33,255   | 13,263    |    34     |   6   |
    |  July 19   | 45,240  |  29,716   | 15,524    |    82     |   7   |
    |  July 26   | 43,809  |  24,112   | 19,697    |   100     |  15   |
    |  Aug. 2    | 43,707  |  21,031   | 22,676    |   140     |  16   |
    |  Aug. 9    | 42,768  |  15,584   | 27,184    |   272     |  19   |
    |  Aug. 16   | 40,441  |  10,685   | 29,756    |   386     |  61   |
    |  Aug. 23   | 39,400  |   6,367   | 33,033    |   371     |  41   |
    |  Aug. 30   | 38,210  |   4,094   | 34,116    |   328     |  28   |
    |  Sept. 6   | 38,382  |   2,731   | 35,469    |   227     |  34   |
    |  Sept. 13  | 38,408  |   1,116   | 37,292    |   138     |  47   |
    |  Sept. 20  | 39,142  |     937   | 38,205    |   106     |  55   |
    |  Sept. 27  | 39,315  |     603   | 38,712    |    58     |  20   |
    +------------+---------+-----------+-----------+-----------+-------+

II

    +---------------+-------------------------+----------------------+
    |               |    Plague death-rate.   |                      |
    |               |   Comparison per 1000   | Percentage reduction |
    |    Dates.     |         between         | of Plague death-rate |
    |               +------------+------------+   in favour of the   |
    |               |    Non-    | Inoculated.|      Inoculated.     |
    |               | Inoculated.|            |                      |
    +---------------+------------+------------+----------------------+
    | Five weeks    |            |            |                      |
    |  from May 11  |            |            |                      |
    |  to June 14   |    1.022   |    .350    | Over   65 per cent.  |
    |               |            |            |                      |
    | Week ending:  |            |            |                      |
    |   June 21     |     .530   |    .527    | About   1 per cent.  |
    |   June 28     |     .742   |    .118    | Nearly 85 per cent.  |
    |   July 5      |    1.524   |    .570    | About  63 per cent.  |
    |   July 12     |    1.022   |    .452    | Nearly 56 per cent.  |
    |   July 19     |    2.793   |    .450    |        84 per cent.  |
    |   July 26     |    4.147   |    .761    |        82 per cent.  |
    |   Aug. 2      |    6.656   |    .705    |        89 per cent.  |
    |   Aug. 9      |   17.325   |    .698    | Over   96 per cent.  |
    |   Aug. 16     |   33.694   |   2.083    |        94 per cent.  |
    |   Aug. 23     |   57.011   |   1.241    |        98 per cent.  |
    |   Aug. 30     |   80.116   |    .820    |        98 per cent.  |
    |   Sept. 6     |   83.112   |    .958    |        99 per cent.  |
    |   Sept. 13    |  112.903   |   1.260    | Over   99 per cent.  |
    |   Sept. 20    |  113.127   |   1.439    | Over   99 per cent.  |
    |   Sept. 27    |   96.185   |    .517    | Over   99 per cent.  |
    +---------------+------------+------------+----------------------+

   "It appears that if the 47,427 inhabitants had remained, as they
   did--in their town, without running away by rail or otherwise,
   or without camping out in a mass--and if no inoculation had been
   resorted to--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 _taluka_ 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.)

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, 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. _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._"

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

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 appended to Captain
Leumann's report. They are as follows:--

    +----------------+----------+--------+---------+------------+
    |                | Inmates. | Cases. | Deaths. | Mortality. |
    +----------------+----------+--------+---------+------------+
    | Inoculated     |   336    |   11   |   4     |    1.19    |
    | Uninoculated   |   144    |   84   |  80     |   55       |
    +----------------+----------+--------+---------+------------+

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."

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:--

    +--------------------------+---------+---------------+
    |                          | Deaths. | Mortality per |
    |                          |         |     cent.     |
    +--------------------------+---------+---------------+
    | Inoculated twice    1040 |   22    |     2.11      |
    | Inoculated once       58 |    8    |    13.79      |
    | Uninoculated          75 |   20    |    26.66      |
    +--------------------------+---------+---------------+

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--_The experience in this company's mill at_ _Hubli should be an
object lesson to all mill-owners in plague-stricken towns._

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:--

   "The railway employés were living in barracks, and in the
   railway yard, apart from the general population of Hubli town.
   _They were under close daily inspection by English officials_,
   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."

The figures, based on the average numbers in each group, are as
follows:--

    +------------------------+--------+---------+---------------+
    |                        | Cases. | Deaths. | Mortality per |
    |                        |        |         |     cent.     |
    +------------------------+--------+---------+---------------+
    | Twice inoculated   990 |    6   |    1    |      0.1      |
    | Once inoculated    270 |    5   |    1    |      0.3      |
    | Uninoculated       760 |   35   |   21    |      2.7      |
    +------------------------+--------+---------+---------------+

These eight instances must suffice: many must be left out--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 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.

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 _hakims_. For instance, at a meeting of _hakims_ at
Masti, Lahore, on 11th April 1898, the following resolutions were
passed:--

   "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.

   "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."

And among statements to be made to the Plague Commissioners was the
following, from a native practitioner in Bombay (April 1899):--

   "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:

   (_a_) The predisposing cause was the Bombay Municipality; (_b_)
   The exciting cause was the Nature herself; (_c_) The aggravating
   cause was the Plague Committee."

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:--

   "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."

Therefore, now and for many years to come, preventive inoculation must
fall into line with the other world-wide ways of fighting
plague--quarantine, notification, isolation, all sanitary measures,
destruction of rats--_le rat, le génie de la peste_--evacuation of
infected towns, disinfection or unroofing of infected houses. Happily,
this is just what it does. That admirable paper, the _Indian Medical
Gazette_ (September 1901), has put this fact very simply: "No one ever
imagined that inoculation was the _only_ 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--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--since "East is East, and West is West"--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--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--the contamination of this or that stock of the
fluid, and the inadequate method of standardisation--have been duly
noted by the Commission. The rush for the fluid in 1899 may be
estimated from the following paragraphs:--

   (i.) _Paris._ "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." (_Lancet_, 16th September 1899.)

   (ii.) _India._ "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." (_Lancet_, 23rd September
   1899.)

       *       *       *       *       *

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 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, _Annales de
l'Institut Pasteur_, 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:--

   "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. _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._ Ces chiffres confirment les
   résultats que j'avais obtenu en Chine en 1896."

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, _none the less the method of serum-therapy is in plague,
as in other infectious diseases, the only method which holds forth a
prospect of ultimate success._"

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 _Empire-building_, and of _deeds that win the Empire_, we
must reckon bacteriology among them: as Lord Curzon did, in his speech
at Calcutta, March 3, 1899--_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._


IX

TYPHOID FEVER. MALTA FEVER

TYPHOID FEVER

The names of Klebs, Eberth, and Koch, are associated with the
discovery, in 1880-81, of the bacillus of enteric fever, _bacillus
typhosus_; 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.

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 _British Medical
Journal_, 30th January 1897. Eighteen men offered themselves--

   "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 were performed upon Medical Officers of the Army
   or Indian Medical Services, or upon Surgeons on Probation who
   were preparing to enter those services."

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:--

   "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."

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:--

   "All the medical staff, and a number of attendants, accepted the
   offer. _Not one of those vaccinated--84 in number--contracted
   typhoid fever: while of those unvaccinated and living under
   similar conditions, 16 were attacked._ 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."
   (_Lancet_, 19th March 1898; see also Dr. Tew's paper, in _Public
   Health_, April 1898.)

Certainly, they are striking; so is the story of the eight young
subalterns on the Khartoum expedition, of 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.

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:--

   "The annual admissions _per mille_ 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."

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

On 20th January 1900, Professor Wright published in the _British
Medical Journal_ 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:--

    +------------------+------+-------+----------+----------+
    |Numbers under     |Cases.|Deaths.|Percentage|Percentage|
    |Observation.      |      |       |of Cases. |of Deaths.|
    +------------------+------+-------+----------+----------+
    |Inoculated    2835|  27  |   5   |   0.95   |   0.2    |
    |Uninoculated  8460| 213  |  23   |   2.5    |   0.34   |
    +------------------+------+-------+----------+----------+

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

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 _British Medical Journal_, 21st
September 1901.) The great majority of the troops tabulated were in
India. Of the troops stationed at 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.

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.

1. _Manchester, England._ The _British Medical Journal_, 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 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:--

    +-------------------------------+-----------------+--------------+
    |             Year.             |    Number of    | Cases among  |
    |                               |Typhoid Patients.|Nursing Staff.|
    +-------------------------------+-----------------+--------------+
    |             1895              |       229       |      3       |
    |             1896              |       238       |      3       |
    |             1897              |       302       |      4       |
    |             1898              |       426       |      8       |
    |   To end of September 1899    |       163       |      5       |
    |From October 1899 to March 1900|       146       |      0       |
    +-------------------------------+-----------------+--------------+

2. _Ladysmith, South Africa._ The _Lancet_, 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:--

    +-------------+-------+------+----------+-------+----------+----------+
    |             |Number.|No. of|Proportion|No. of |Proportion|  Case-   |
    |             |       |Cases.|of Cases. |Deaths.|of Deaths.|mortality.|
    +-------------+-------+------+----------+-------+----------+----------+
    |Not          |       |      |          |       |          |          |
    |  inoculated |10,529 | 1489 |1 in 7.07 |  329  | 1 in 32  |1 in 4.52 |
    |Inoculated   | 1,705 |   35 |1 in 48.7 |    8  | 1 in 213 |1 in 4.4  |
    +-------------+-------+------+----------+-------+----------+----------+

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, _British Medical Journal_, 20th July
1901, in answer to Dr. Melville's letter, _British Medical Journal_,
20th April 1901.)

3. _The Portland Hospital: Modder River and Bloemfontein_. The
_British Medical Journal_, 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.

"_Personnel of the Portland Hospital._ We take first the relation of
disease and inoculation among the _personnel_ 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--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.

"_Officers and men admitted to the Portland Hospital._ 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
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.

"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.

"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."

4. _No. 9 General Hospital, Bloemfontein._ The _Medical Chronicle_ 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--the lapse of time differing
in individuals--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."

5. _Scottish National Red Cross Hospital, Kroonstadt._ The _British
Medical Journal_, 12th January 1901, contains an account of the work
of this hospital by Surgeon-Colonel Cayley, Officer in Charge. He
says: "The first section of the hospital, consisting of 61
persons--officers, nursing sisters, and establishment--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 _personnel_ of this first section of the hospital.

"The second section of the hospital--medical officers, nurses, and
establishment, 82 in all--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.

"Of the second section, 5 orderlies had enteric fever 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."

6. _Meerut, India._ The _British Medical Journal_, 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:--

_From 22nd October 1899 to 22nd October 1900._

    +---------------+---------+-----------+------+-------+
    |               |         |           |      |       |
    |               |Strength.|Inoculated.|Cases.|Deaths.|
    +---------------+---------+-----------+------+-------+
    |Officers       |    22   |    19     |  0   |  0    |
    |N.C.O. and Men |   481   |   317     |  2   |  1    |
    |Women          |    36   |    24     |  0   |  0    |
    +---------------+---------+-----------+------+-------+

    +---------------+-----------+------+-------+
    |               |Not        |      |       |
    |               |Inoculated.|Cases.|Deaths.|
    +---------------+-----------+------+-------+
    |Officers       |     3     |  0   |  0    |
    |N.C.O. and Men |   164     | 11   |  6    |
    |Women          |    12     |  0   |  0    |
    +---------------+-----------+------+-------+

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."

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.

7. _The Edinburgh Hospital, South Africa._ The _Scottish Medical and
Surgical Journal_, 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 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."

8. _Egypt and Cyprus._ The _British Medical Journal_, 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:--

    +------------------------------------------------------------------+
    |             |Average Annual|Cases.|Deaths.|Percentage|Percentage |
    |             |   Strength.  |      |       | of Cases.| of Deaths.|
    |-------------+--------------+------+-------+----------+-----------|
    |Uninoculated |     2669     |  68  |  10   |   2.50   |    0.40   |
    |Inoculated   |      720     |   1  |   1   |   0.14   |    0.14   |
    +------------------------------------------------------------------+

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."

9. _Imperial Yeomanry Hospital, Pretoria._ Dr. Rolleston, Consulting
Physician to this hospital, writes in the _British Medical Journal_,
5th October 1901: "Among the _personnel_ 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
_personnel_, 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.

"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."

10. _Richmond Asylum, Dublin._ The _British Medical_ _Journal_, 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:--

   _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._

    +--------------+---------+-------+-------+----------+----------+
    |              |Average  |Cases. |Deaths.|Percentage|Percentage|
    |              |Strength.|       |       |of Cases. |of Deaths.|
    +--------------+---------+-------+-------+----------+----------+
    |Uninoculated  |   298   |30(-1?)|   4   |   10.1   |   1.3    |
    |Inoculated    |   339   | 5(+1?)|   1   |    1.3   |   0.3    |
    +--------------+---------+-------+-------+----------+----------+

"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."

11. _Deelfontein._ The _Lancet_, 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, _Brit. Med.
Jour._, 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 _personnel_ of the
hospital, there were 59 inoculated, with 4 cases, and 25 not
inoculated, with 4 cases.

12. _Winburg._ The _Lancet_, 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:--

    +--------------+---------+-------+-------+----------+----------+
    |              | Number. |Cases. |Deaths.|Percentage|Percentage|
    |              |         |       |       |of Cases. |of Deaths.|
    +--------------+---------+-------+-------+----------+----------+
    |Uninoculated  |   547   |   23  |   7   |    4.2   | 1 in 3.3 |
    |Inoculated    |   200   |    3  |   0   |    1.5   |     0    |
    +--------------+---------+-------+-------+----------+----------+

"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.'"

       *       *       *       *       *

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 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--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, _The
Serum-Diagnosis of Disease_ (Longmans, 1899), and by Mr. Foulerton in
the _Middlesex Hospital Journal_, October 1899 and July 1901.

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:--

   "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 completely arrested, but they are always more or less
   sluggish, while clumping ought to be quite distinct by the end
   of the half-hour."

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.

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.

MALTA FEVER

The specific organism of Malta fever (Mediterranean fever), the
_bacillus Melitensis_, 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:--

   "The diagnosis of Malta fever from typhoid is, of course, a
   highly important practical matter. It is exceedingly difficult
   in the early stages." (Manson, _loc. cit._)

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:--

   "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." (_British Medical Journal_, 16th
   October 1897.)

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."[36] A
good instance of the value of the serum-treatment of Malta fever is
published in the _Lancet_, 15th April 1899. For a later account of
this treatment and of its efficacy, see the _Philadelphia Medical
Journal_, 24th November 1900.

  [36] For the whole subject, see _Lancet_, 9th September 1899,
  paper by Surgeon-Major Birt and Surgeon-Captain Lamb. Two other
  cases of accidental inoculation occurred at Netley.

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 _Micrococcus melitensis_, 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?"


X

THE MOSQUITO: MALARIA, YELLOW FEVER, FILARIASIS

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).[37] 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 _plasmodium
malariæ_ and the _filaria_ are instances of a law of animal life that
holds good also of plant life:--

   "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--say a
   man--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.

   "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 are transferred by the
   young of these ticks into healthy cattle." (Ross, _Malarial
   Fever_, 1902.)

  [37] For Dr. Graham's experiments at Beyrout, which seem to prove
  that the mosquito can also convey dengue or dandy-fever, see the
  _New York Medical Record_, 8th February 1902.

1. MALARIA

The _plasmodium malariæ_ 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 _plasmodium_ in animals: "the
difficulties surrounding the subject were so great that this discovery
seemed to be almost hopeless." In 1894, Sir Patrick Manson--who had
proved mosquitoes to be the intermediate host in the case of the
parasitic nematode _filaria_--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, _halteridium_, 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 mosquito, _Anopheles maculipennis_, 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:--

   "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--(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.)

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 with proteosoma, 178, or 72 per cent.,
contained pigmented cells; out of 249 fed on blood containing
halteridium, immature proteosoma, &c., not one contained a single
pigmented cell." Another time (April 1898) he counted these
pigment-cells under the microscope:--

   "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."

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

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:--

   "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 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." (_British Medical
   Journal_, 6th July 1901.)

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, _Malarial Fevers and Malarial
Parasites in India_:--

   "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
   _Anopheles_ 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, and especially
   where carried out in connection with small communities and
   institutions, they are giving promise of gratifying success."

The famous experiment made by Dr. Sambon and Dr. Low in 1900, must be
recalled here:--

   "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.[38]...

   "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." (_British Medical Journal_, 22nd
   September 1900.)

  [38] Sir Patrick Manson, in the _British Medical Journal_, 29th
  September 1900, gives the following account of this
  experiment:--"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--always, of course, with an eye on _Anopheles_--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."

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 _Anopheles_ 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. _Anopheles_ having come, and the malarial season with
him, the experiment was begun. The houses were carefully protected
with wire netting, chimneys and all; the _siesta_ was taken under wire
netting; the workmen, if they were out in the evening or at night,
wore veils and gloves; and _Anopheles_ 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 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:--

   "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."

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:--

   "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--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." (_British
   Medical Journal_, 29th September 1900.)

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.

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 _plasmodium_ in all its
phases, but also the whole natural history and habits of the
_Anopheles_ 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:--

1. _Elimination of the Infection at its Source._ 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 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."

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:--

   "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, _and to the danger of
   others_.... 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."

2. _Segregation of Europeans from Natives._ 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
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:--

   "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 affairs in all parts of
   Nigeria visited by them.

   "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 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 _Anopheles_ 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 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.

   "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."

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.

3. _Protection against Anopheles._ Manson, in his _Tropical Diseases_
(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
that, practically, the fight against malaria and the fight against
_Anopheles_ 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:--

   "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."

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:--

   "Let us compare the habits of a European in a business-house in
   Calcutta with the habits of a European in 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."

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.

4. _The keeping down of Anopheles._ The breeding places of _Anopheles_
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 _Culex_,
such as broken bottles, old tins, pots, and calabashes, and barrels,
whatever will hold water--all the débris and broken rubbish round huts
or houses. In all these places, _Anopheles'_ 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, _Venienti
occurrere morbo_, to organise gangs of workmen, or of prison labour,
and "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 _plasmodium malariæ_:--

   "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--in other
   words, all measures calculated to keep down mosquitoes--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.)

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 _Medical Annual_, 1905 and 1906.[39]

  [39] 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.

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.

2. YELLOW FEVER

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.

Of the mortality of the disease, Sir Patrick Manson, in 1900, wrote as
follows:--

   "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 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."

The earlier attempts to reproduce the disease, by inoculation with its
products, failed altogether:--

   "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."
   (_British Medical Journal_, 3rd July, 1897.)

The history of the subject, from 1812 to 1880, is given by Dr. Finlay
of Havana, in the _New York Medical Record_ (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 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:--

   "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."

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:--

   "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 _Anne Marie_,
   and the epidemic of Saint Nazaire."

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 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 _bacillus
icteroides_; and by October 1897, he had prepared an immunising serum
which was able to give a considerable amount of protection to
animals.[40] Next year (_Annales de l'Institut Pasteur_, May 1898)
came the news that he had advanced against yellow fever with its own
weapons--_Premières expériences sur l'emploi du sérum curatif et
préventif de la fièvre jaune_. 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:--

   "Chaque cas était choisi de commun accord entre nous, dans le
   but de mettre bien en évidence l'action thérapeutique du sérum,
   _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_...."

  [40] It is not denied here that he made five experiments on human
  beings. See Part IV. chap. ii.

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:--

   "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.

   "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."

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.

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:--

   "Our observations appear to demonstrate that the parasite of
   this disease must undergo a definite cycle of 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.

   "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.

   "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."

In February 1901, Dr. H. E. Durham published an abstract of an
_interim_ 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
_bacillus icteroides_; 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
_bacillus icteroides_ 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.

       *       *       *       *       *

Immunisation, by the direct use of an infected mosquito, may be
compared with the old custom of 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
_Culex_.

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, &c., examined in the city for the presence of
larvæ, the larva of _Culex_ (_Stegomyia_) predominated in more than 60
per cent.

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:--

   "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--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."

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 _Culex_; 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 _Practitioner_, May 1902, by Professor Hewlett,
one of the foremost of English bacteriologists:--

   "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 with the sick-room was not too free, four or five
   non-immunes only being allowed in. _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._ 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, _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._"

Sir Patrick Manson, lecturing in America, last year, on tropical
diseases, summed up the work as follows:--

   "Time will not permit--what to you is probably quite
   unnecessary--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.

   "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, the
   clinical manifestations of which we call yellow fever, and is
   once more in a condition to re-enter the mosquito.

   "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."

3. FILARIASIS

These same lectures contain an admirable account of the life-history
of _Filaria_. It is not necessary here to describe the loathsome
deformities which occur in the later stages of filariasis. These
deformities (_elephantiasis_, 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. _In the
endemic areas_, says Manson, _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--the Samoa group for instance--I believe that even this
proportion is exceeded._

That _Culex_ (_fatigans_) 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 _British Medical Journal_ 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
he nor Mr. Lefroy could find a single _Anopheles_ larva, though they
hunted diligently in the swamps and other likely places. But
filariasis is terribly common, and so is _Culex fatigans_. 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 (_Culex fatigans_) 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 _Culex_, and for men's
indifference and apathy, filariasis could be kept down all over the
island:--

   "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.

   "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."

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 _Anopheles_ and _Culex_. He
who would know what is being done to check these diseases in Italy,
India, China, Africa, and America, must read Prof. Ross' _Malarial
Fever, its Cause, Prevention, and Treatment_ (1902), and _Mosquito
Brigades, and how to organise them_ (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
_Anopheles_ and _Culex_ is going on. _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._ 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
_Anopheles_ brigades and _Culex_ 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.


XI

PARASITIC DISEASES

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.

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.

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 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 _Bibel der Natur_, 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--_The paralysing effect, on medicine and surgery, of the
doctrine of spontaneous generation_. 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--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."

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 _trichina
spiralis_, 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 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--_Above all things, we must
shut off the sources of the infection_--the butchers' shops were kept
under sanitary inspection, people were warned against half-cooked ham
and pork, and there was an end of it.

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--that it is an animal parasite transmissible between
men and dogs--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:--

   "At present, almost the sixth part of all the inhabitants
   annually dying in Iceland fall victims to the echinococcus
   epidemic."

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."

       *       *       *       *       *

Beside the entozoa, there are also vegetable parasites. Of these, the
most important is the _streptothrix actinomyces_, 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.


XII

MYXOEDEMA

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 myxoedema 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 Myxoedema; 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 myxoedema and cases
of sporadic cretinism.

In 1882, Reverdin stated before the Medical Society of Geneva that
signs like those of myxoedema 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 myxoedema after
removal of the gland (cachexia 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.

Their report, 215 pages long, with tabulated records of 119 cases of
myxoedema, 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 _Physiologie Opératoire_
(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:--

   "The descriptive anatomy, and the microscopic characters, of the
   thyroid gland, the facts about its blood-vessels and its
   lymphatics--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? _Yet we know absolutely
   nothing about the functions of these organs--we have not so much
   as an idea what use and importance they may possess--because
   experiments have told us nothing about them_; and anatomy, left
   to itself, is absolutely silent on the subject."

Therefore, in 1882-83, things stood at this point--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, begun in 1884. He was
able, by removal of the gland, to produce in monkeys a chronic
myxoedema, 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 myxoedema 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.

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 myxoedematous patient:--

   "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."

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.

Then, at last, in 1891, came Dr. George Murray's paper in the _British
Medical Journal_, "Note on the Treatment of Myxoedema 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.

It is a strange sequence, from 1873 onward: clinical observation,
_post-mortem_ work, calamities of surgery, experimental physiology,
transplantation, hypodermic injections, sandwiches, and tabloids. And
far more has been achieved than the cure of myxoedema. Even if the
discovery stopped here, it would still be a miracle that little
bottles of tabloids should bring men and women back from myxoedema 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.


XIII

THE ACTION OF DRUGS

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--gold, amber, coral, pearls, and the
dust of mummies; whatever took strange forms of life--toads,
earthworms, and the like; whatever looked like the disease, after the
doctrine of signatures--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 Pharmacopoeia are _cranium
humanum_, _mandibula lucii_, _nidus hirundinum_, _sericum crudum_,
_linum vivum_, and _pilus salamandræ_. In the Pharmacopoeia of 1667
are _exuviæ serpentis_, _telæ aranearum_, _saliva jejuni_, _cranium
hominis violentâ morte extincti_, and worse obscenities.

Soon after the publication of this Pharmacopoeia, 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 gave him, eleven of them in consultation--_totus
medicorum chorus ab omni spe destitutus_--they gave him, as _more
generous cardiacs_, the _lapis Goæ_, and the _Bezoar-stone_. The
_lapis Goæ_ 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 _bezoar_ is a calculus found in the
intestines of herbivorous animals. Half a century later, the
Pharmacopoeia of 1721 still included ants' eggs, teeth, _lapis
nephriticus_, and other horrors; and in the Pharmacopoeia of 1746,
though the dust of Egyptian mummies was ruled out, vipers and
wood-lice were retained.

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[41] 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 _selective_ 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 all the Crown jewels inside him: you are in two different
worlds. The _selective_ action of drugs--the affinity between
strychnine and the central nerve-cells, between curari and the
terminal filaments of the motor nerves--that was the revolutionary
teaching of science: and it came, not by experience, but by
experiment.

  [41] For a full statement of the great value of this study of
  strychnine, see Cl. Bernard, _Leçons de Physiologie Opératoire_,
  1879, p. 89.

Take Professor Fraser's address on "The Action of Remedies, and the
Experimental Method" at the International Medical Congress in London,
1881:--

   "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."

Or take Professor Fraser's account of digitalis:--

   "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 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."

Or take Sir T. Lauder Brunton's account of the action of nitrite of
amyl in angina pectoris:--

   "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.

   "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, and at the same time the pulse became slower
   and much fuller, and the tension diminished."

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--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:--

   "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.

   "Belladonna offers another example of apparent difference in
   action--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 of the pulse to be nearly
   doubled. Yet in all three--rabbits, dogs, and men--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.)

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.

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 _Practitioner_, Oct. 1896.

It is sometimes said that the men who make experiments on animals
ought to make them on themselves. But they do, hundreds of them, and
suffer for it: Heaven knows the list is long enough--the discoverers
of anæsthesia, Hunter, Garré, Koch, Klein, Moor, Haffkine, Grassi,
Bochefontaine, Quesada, Sanarelli, Pettenkofer--these and hosts more,
here or abroad, have done it, as part of the day's work; and some--by
accidental infection, like Chabry and Villa, or by deliberate
self-inoculation, like Carrion--have been killed:--

   "Dr. Angelo Knorr, _Privat-docent_ 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.[42] 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 of the
   bacillus of Nicolaier." (_Brit. Med. Journal_, 18th March 1899.)

  [42] 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 _Ann. de
  l'Inst. Past._, Sept 1898.

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." (_British Medical Journal_, 29th October 1898.)
Outside the laboratory, outside the fever hospitals, the risk is
something less than a negligible quantity:--

   "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, _Madras Mail_, 8th December
   1898.)


XIV

SNAKE-VENOM

The Report of the 1875 Commission said:--

   "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."

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. (_British Medical Journal_, 5th November 1898.)

Sir Joseph Fayrer's name must be put in the highest place of all those
who have studied the venomous snakes of India.

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, 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."

   "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:--

    1. Venom of _naja_             0.25 mgr. per kilogr. of rabbit.

      One gramme of this venom kills 4000 kilogrammes of
      rabbit; it has, therefore, an activity of           4,000,000

    2. Venom of _hoplocephalus_    0.29 mgr               3,450,000

    3. Venom of _pseudechis_       1.25 mgr                 800,000

    4. Venom of _pelias berus_     4.00 mgr                 250,000

   "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."

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:--

   "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 _naja tripudians_ at a single
   injection; that is to say, enough to kill 80 rabbits of 2
   kilogr. weight, or 5 dogs.

   "Five drops of serum from these rabbits wholly neutralise _in
   vitro_ (in a glass test-tube) the toxicity of 1 mgr. of
   _naja_-venom."

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:--

   "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. _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._"

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:--

   "I have immunised two asses, one having received 220 mgr. of
   _naja_-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
   _naja_-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.

   "This antivenomous serum of asses has these same antitoxic
   properties with all kinds of snake-venom; it is equally active
   _in vitro_, preventive, and therapeutic, with the venoms of
   _cerastes_, of _trigonocephalus_, of _crotalus_, 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."

In 1896 four successful cases of this treatment in the human subject
were reported in the _British Medical Journal_. In 1898 Calmette made
the following statement of his results:--

   "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, &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
   observations have been communicated to me, and not one of them
   refers to a case of failure." (_British Medical Journal_, 14th
   May 1898.)

Good accounts of Fraser's and Calmette's work are given by Dr. Stone
in the _Boston Medical and Surgical Journal_, 7th April 1898, and by
Staff-Surgeon Andrews, R.N., in the _British Medical Journal_, 9th
September 1899. For other cases see the _Pioneer_, 10th August 1899,
the _Lancet_, 25th November 1899, and the _British Medical Journal_,
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.

       *       *       *       *       *

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 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--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.



PART III

THE ACT RELATING TO EXPERIMENTS ON ANIMALS IN GREAT BRITAIN AND
IRELAND


ACT 39 AND 40 VIC. c. 77

The Royal Commission "On the Practice of subjecting Live Animals to
Experiments for Scientific Purposes," was appointed on 22nd June 1875.
Its members were--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.

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 _Handbook of the Physiological
Laboratory_, 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.

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 of them. Certificate A
or Certificate B has to be used for this purpose:--

   _Certificate A._

   "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."

   _Certificate B._

   "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."

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--as in the subdural inoculation of a rabbit, or
the intra-peritoneal inoculation of an animal with a particle of
cancerous tissue--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.

Where the act of inducing the disease is not itself painful--as in
ordinary inoculation, and in feeding-experiments--the licensee must
hold, together with his 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.

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 (_hypopyon_) in the
anterior chamber of the eye may 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.

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:--

   "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.

   "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.

   "Harrowing details concerning the horrors of trephining rabbits
   for Pasteur's antirabic treatment are frequently supplied for
   popular consumption, but how little real 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,
   _Medical Magazine_, June 1898.)

It may be well to put here--(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.

1.--AN ACT TO AMEND THE LAW RELATING TO CRUELTY TO ANIMALS

_15th August 1876_

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:

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:

1. This Act may be cited for all purposes as "The Cruelty to Animals
Act, 1876."

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 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.

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,

   (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

   (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

   (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

   (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

   (5.) The experiment shall not be performed as an illustration of
   lectures in medical schools, hospitals, colleges, or elsewhere;
   and

   (6.) The experiment shall not be performed for the purpose of
   attaining manual skill.

Provided as follows; that is to say,

   (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

   (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

   (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

   (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
   testing is absolutely necessary for the effectual advancement of
   such knowledge.

4. The substance known as urari or curare shall not for the purposes
of this Act be deemed to be an anæsthetic.

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.

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.

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.

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.

A person punished for an offence under this section shall not for the
same offence be punishable under any other section of this Act.

_Administration of Law_

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.

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.

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.

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 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.

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,

   The President of the Royal Society;

   The President of the Royal Society of Edinburgh;

   The President of Royal Irish Academy;

   The Presidents of the Royal Colleges of Surgeons in London,
   Edinburgh, or Dublin;

   The Presidents of the Royal Colleges of Physicians in London,
   Edinburgh, or Dublin;

   The President of the General Medical Council;

   The President of the Faculty of Physicians and Surgeons of
   Glasgow;

   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;

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.

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.

A certificate under this section may be given for such time or for
such series of experiments as the person or persons signing the
certificate may think expedient.

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.

The Secretary of State may at any time disallow or suspend any
certificate given under this section.

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.

_Legal Proceedings_

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.

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.

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.

   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.

   "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.

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.

16. In England, if any party thinks himself aggrieved by any
conviction made by a court of summary jurisdiction on determining any
information under this Act, the party so aggrieved may appeal
therefrom, subject to the conditions and regulations following:---

   (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

   (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

   (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

   (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

   (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 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.

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.

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.

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.

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 offence and not an offence punishable on summary
conviction, and the offence may be prosecuted on indictment
accordingly.

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.

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.

22. This Act shall not apply to invertebrate animals.


II.--ANÆSTHETICS UNDER THE ACT

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.

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.

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 directly
on the muscles but on the higher nervous centres.

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.

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.[43]

  [43] See Part IV., "Curare."

A good account of curare was published in the _Edinburgh Review_, July
1899.

   "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."


III.--LATEST REPORT (1905) OF INSPECTORS UNDER THE ACT

(The various tables of names, places, &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 & Sons, Ltd., Fetter Lane, E.C.)

       *       *       *       *       *

ENGLAND AND SCOTLAND

    _April 17th, 1906._

SIR,--I have the honour to submit the following Report on Experiments
performed in England and Scotland during the Year 1905, under the Act
39 & 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."

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.

Tables I., II., and III. afford evidence,--

   1. That licences and certificates have been granted and allowed
   only upon the recommendation of persons of high scientific
   standing;

   2. That the licensees are persons who, by their training and
   education, are fitted to undertake experimental work and to
   profit by it;

   3. That all experimental work has been conducted in suitable
   places.

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.

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.

The total number of experiments included in Table IV. (A.) is 2506.

Of these there were performed,--

    Under Licence alone[44]      1348
      "   Certificate C.         145
      "   Certificate B.         665
      "   Certificate B. + EE    346
      "   Certificate B. + F.      2

  [44] 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.

  Certificate C. allows experiments to be performed, under the
  foregoing provisions as to the use of anæsthetics, in illustration
  of lectures.

  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.

  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.

  Certificate F. is required in all cases of experiments on a horse,
  ass, or mule.

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,--

    Under Certificate A.         34,778
      "   Certificate A. + E.       549
      "   Certificate A. + F.       102

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.

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.

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 from the
operation; and after the section of a part of the nervous system, the
resulting degenerative changes are painless.

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.

In no case has a cutting operation more severe than a superficial
venesection been allowed to be performed without anæsthetics.

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.).

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, 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 & 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.

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.

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.

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.

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. 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.

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.).

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.

The irregularities recorded during the year have been few, and not of
a serious character.

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.

A licensee, through inadvertence, performed 54 inoculation experiments
in excess of the number allowed by his certificate.

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.

By direction of the Secretary of State a suitable admonition was
addressed to the licensee in each of the above cases.

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 &
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 holding a licence and appropriate
certificates.--I have the honour to be, Sir, your obedient servant,

    G. D. THANE, _Inspector_.

    The Right Hon. HERBERT JOHN GLADSTONE,
    _Secretary of State for the Home Department_.

IRELAND

    8 ELY PLACE, DUBLIN,
    _April 26th, 1906_.

SIR,--I beg to submit Tables showing the experiments performed in
Ireland during the year 1905, under the Act 39 & 40 Vict. c. 77,
together with a list of the Registered Places in Ireland.

Twelve licences were in force during the year; of these four expired,
and two were renewed. One new license was granted.

The certificates in existence or allowed were:--

    A.  to 4 licensees.
    B.  "  7     "
    C.  "  3     "
    E.  "  2     "
    EE. "  3     "
    F.  "  1 licensee.

One expired during the year, and six new ones were allowed.

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.:--

    Under Certificate A.      88
      "       "       B.      14
      "       "       C.       8
      "       "       F.       2

The animals experimented on were:--

    Guinea pigs   55
    Birds         53
    Rabbits       48
    Cattle        27
    Mice          14
    Dogs          13
    Cats           2
    Horses         2
    Goats          2
    Sheep          2

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.

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.

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.

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.--I have, &c.,

    W. THORNLEY STOKER,
    _Inspector for Ireland_.

    To the Right Honourable
    The Chief Secretary to the
    Lord Lieutenant of Ireland.

This Report gives a clear answer to certain false statements alleged
against experiments on animals. It shows that more than 90 _per cent._
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. _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._ It shows, also, that the results,
in a very large number of these inoculations, are negative, painless,
not even inconvenient.

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.

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.

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 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 _further_ experiment without
anæsthesia. _No observations or stimulations of a character to cause
pain are allowed to be made without the animals being anæsthetised._
It is evident that good care is taken to ensure an irreducible minimum
of pain.



PART IV

THE CASE AGAINST ANTI-VIVISECTION

THE CASE AGAINST ANTI-VIVISECTION

   [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.]


1. ANTI-VIVISECTION SOCIETIES

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--that the movement, in this
country, was begun by the medical journals. The _Medical Times and
Gazette_ in 1858, the _Lancet_ in 1860, and the _British Medical
Journal_ 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
_Medical Times and Gazette_ 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 at
Norwich during a meeting of the British Medical Association. These
experiments, and the publication of the _Handbook of the Physiological
Laboratory_, 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.

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[45] 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.

  [45] These two societies have other purposes beside that of
  opposition to experiments on animals.

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":--

   "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 _them_.... 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 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."

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:--

   "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."

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:--

   _December 1901._--"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."

   _January 1902._--"Time after time has this sacred cause been
   undermined and betrayed by its professing friends by their
   reckless habit of making erroneous statements."

   _March 1902._--"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 have their foundation in emotions
   that seem to me singularly unworthy and petty."

   _May 1902._--"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."

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:--

   "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
   _Globe_, 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
   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."

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:--

   _March 1901._--"The February number of the _Abolitionist_
   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."

   _February 1903._--"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."

   _June 1903._--"Our amiable contemporary, the _Abolitionist_, 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."

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:--

   "Join a really effective Society with a frank and
   straightforward policy--namely, the London Anti-vivisection
   Society, 13 Regent Street, London, S.W. This 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."

   "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 _exact_ words: 'To the _London_
   Anti-vivisection Society.' CAUTION. It is of great importance to
   describe very accurately the _Title of this Society_--namely,
   THE LONDON ANTI-VIVISECTION SOCIETY--otherwise the benevolent
   intentions of the Donor may be frustrated. PLEASE NOTE.--Those
   charitable persons who have left money to the Society would do
   well to notify the same to the Secretary."

Contrast the tone of this appeal for money with the tone of the
Report:----

   "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."

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: "CAUTION.--It is of great
importance to describe very accurately the _Title of this
Society_--namely, THE NATIONAL ANTI-VIVISECTION SOCIETY--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, &c., including the _Illustrated Catalogue_ and the
_Hospital Guide_; £1380 on lectures, meetings, organising new
branches, &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:--

   _June 1899._--(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. 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."

   _June 1899._--"We have received more money within the past six
   months than we got in any two years previously."

   _June 1899._--"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."

   _June 1900._--(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----, of £6386."

   _May 1901._--"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 _Hospital Guide_ has been made at so great a cost to
   the Society."

   _June 1901._--"Our editorial table is buried deep in press
   cuttings from all parts of the kingdom."

   _March 1902._--"We employ two press-cutting agencies to send us
   cuttings from the journals of the whole English-speaking world."

   _July 1903._--"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.'"

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 (_a_) the publication of
literature; (_b_) the holding of public meetings in all parts of the
United Kingdom; (_c_) the delivery of lectures with or without
limelight illustrations; (_d_) participation in debates even with high
scientific authorities; (_e_) inducing the clergy and ministers of all
Churches to deliver sermons dealing with the subject; (_f_)
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."

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 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.

I

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 _Animal's Friend_ (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?

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--how his little girl 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.

II

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--a man much abused by the National Society. And Lord
Llangattock, the President of that Society, is well known as an a
"ardent sportsman."

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.

1. It says, very truly, that it is in great part supported by
sportsmen.

2. It says, further, that the cruelties of sport lie outside its own
proper work:--

   "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.)

Later (1903) the _dramatis personæ_ are a man in East Islington
jumping on his wife, and a woman in West 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.

3. It says that the "object" of the sportsman is to kill; but the
"object" of the experimenter is to torture:--

   "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."--Mr. Wood
   (1903).

   "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."--Lord Llangattock (1901).

   "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."--Leader in
   the Society's official journal, (1899).

   "I am not so mentally and ethically confused as to be unable to
   distinguish between the entirely different moral acts of killing
   and torturing."--Mr. Coleridge (1901).

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.

III

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:--

   _June 1899._--"The charm of this sort of thing is that you are
   always sure of the _post-mortem_ if of nothing else."

   _July 1899._--"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."

   _December 1899._--"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."

   _March 1901._--"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."

   _April 1901._--(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."

   _September 1901._--"Some day we shall have our surgeons
   disembowelling us just to see what daylight and fresh air will
   do for the stomach-ache."

   _December 1901._--"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 _secundum artem_ but
   _secundum scientiam_, 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."

   _December 1903._--(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."

Why does the official journal of Mr. Coleridge's society publish these
things? For this reason--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.

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:--

   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."

   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."

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.

       *       *       *       *       *

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 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.


II. LITERATURE.

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.

From time to time a book or a pamphlet is, for good reasons,
withdrawn. Thus, in 1902, the London Society withdrew _Dark Deeds_.
(_The Shambles of Science_, 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 _Nine Circles_. It was planned and
compiled for Miss Cobbe; Mr. Berdoe 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 _Zoophilist and Animal's
Defender_, was started in May 1881, under the shorter title of the
_Zoophilist_. 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 _Nine Circles_; 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."

Let us now examine the style of this "official journal." And, to begin
with, what does it say about the _Nine Circles_? To make this point
clear, let us put in parallel columns what was said by Sir Victor
Horsley of the original edition in 1892, and what was said by the
_Zoophilist_ in 1899 of the revised edition:--

   _Sir Victor Horsley, Oct. 1892._

   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.

   _The "Zoophilist," July 1899._

   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
   _Nine Circles_, 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.

For another instance of the inaccuracy of the _Zoophilist_ 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 _Zoophilist_ 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 _Zoophilist_, August 1902 and September
1903; also its report, October 1902, of Mr. Wood's speech at Exeter.)

But let us take a wider view. A journal, like a man, is known by the
company that it keeps. Whose company does the _Zoophilist_ keep? Why
does it talk of _Our excellent cotemporary, Humanity_--_Our valiant
cotemporary, Le Médecine_--_Our excellent cotemporary, The Herald of
the Golden Age_? Again, among the journals that it quotes, some of
them very frequently, are the _Topical Times_, _Broad Views_, _Modern
Society_, _Madame_, the _Humanitarian_, the _Pioneer_, the
_Vegetarian_, the _Voice of India_, the _Herald of Health_, the
_Rock_, the _New Age_, the _Journal of Zoophily_, the _Homoeopathic
World_, _Medical Liberty_, and the _Honolulu Humane Educator_. 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 _Medical Brief_, the _Journal de Médecine de Paris_, and the
Belgian _Le Médecine_. These journals, being veritable "medical
journals," are quoted in the _Zoophilist_ 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 _Zoophilist_ itself. Take what
the _Medical Brief_ says:--

   "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."

   "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 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?"

   "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."

Such is the _Medical Brief_, 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 _Journal de
Médecine de Paris_. 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 _Star_ we may take
the following sentences:--

   "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."

Dr. Lutaud, says the National Society, is "the great authority." The
_New England Anti-vivisection Monthly_ in 1900 calls him one of "the
brightest scientists of modern times." His _Journal de Médecine de
Paris_ recalls the _Medical Brief_:--

   "To wish to apply the same methods of treatment, whether
   preventive or curative, for two morbid conditions (a _wound_
   with the point of entry _abnormal_ and an infectious _malady_)
   in essence so different, is to commit a gross error.... The sick
   are destroyed by that which cures their wounds."

These two "medical journals," the _Medical Brief_ and the _Journal de
Médecine de Paris_, 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 _Herald of Health_; and _Medical Liberty_, "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."

Such are the medical journals which support the _Zoophilist_ as a
scientific journal. Now let us take another point of view. Let us
consider whom the _Zoophilist_ 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
_volte-face_ 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.

There is no room here to note the lighter moods of the _Zoophilist_;
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--and it will even _break its jest on the dead_--but it
rebukes another journal for levity, saying, _We regret to see our_
_painful subject treated in this manner._ 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:--

   1. "As other bacteria (beside those of malaria) were found not
   to bear sunlight or air, but to habitats in _loca scuta situ_ (?
   to inhabit _loca senta situ_), 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)--Report
   of a speech by the Bishop of Southwell (1901).

   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
   _Pickwick_), and we are sending these young men out with this
   _cacoëthes secandi_, 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."--Archdeacon
   Wilberforce (1901).

   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, 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."--The Rev. Arthur Mursell (1901).[46]

   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,
   &c., must, _of course_, be on our side."--(1902.)

   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."--(1902.)

   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."--(1902.)

  [46] Even the _Zoophilist_, which quotes this speech from the
  _Clapham Observer_, seems to feel that it might have been put more
  simply.

       *       *       *       *       *

Such is the frequent level of the _Zoophilist_, the official journal
of the National Society, edited by Mr. Berdoe, controlled by Mr.
Coleridge. Let us now take one more of that society's publications, a
pamphlet entitled _Medical Opinions on Vivisection_. 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;[47] 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.

  [47] I think it was two; it was either one or two.

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
_Times_ 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 _obiter
dictum_; and Professor Koch for no discoverable reason. That leaves
36. Of 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 homoeopathy; one has mistranslated Harvey to the advantage
of the National Society's cause, one has written _Hints to Mothers_,
and one has written _How to Keep Well_. Of these 25 gentlemen, one
belongs to a homoeopathic 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 _Medical Opinions
on Vivisection_. 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 _arrant and
horrible Sepoyism wearing the mask of Art and Science_?

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:--

   "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 _not the case_,
   and I am informed that a large proportion--considerably more
   than half--of the licenses dispense with anæsthetics entirely.
   The phenomena of pain are absolutely essential to any practical
   issue."

   "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."

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:--

   "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.)"

Of the House of Commons, he says:--

   "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 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--that their consciences go as far as
   votes, and do not extend very much farther." (Laughter and
   applause.)

He describes an imaginary experiment under curare, and is interrupted
by a cry of "Demons!" He goes on:--

   "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.)"

       *       *       *       *       *

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--I have quoted
these, as they came to hand, just going through them and marking those
passages which were to my purpose.


III. ARGUMENTS

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?

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, 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 _plus_ 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 _plus_ 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 _not_ allowed for any infliction of pain on the
animal through the operation wound, and never will be.

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.

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.

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 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 _locus classicus_, 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.

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 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 have here in my pocket something I have not got the nerve to
read to you_, 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, _Do not go on, we cannot bear it_; and he
says, _You have got to bear it. Good God, they have got to suffer it._
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: _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._ 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 that these experiments have done, the lives that they have
saved; and at once he is off like the wind:--

   "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.)

   "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.)

   "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.)

   "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.)

   "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.)

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, and her Majesty the late Queen--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--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 "_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_,"[48] and a week later, before the London Society, dogmatically
postulates humaneness as a condition of worthy personal character; and
the lady who says, _Oh, Pharisees and hypocrites! Oh, cruel and
ruthless egotists!_ and the Falstaff's army of the osteopath, and the
fruitarian, and the _anti_ this, that, and the other, who follow the
cause; and all these discordant societies, and the begging for
money--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.

  [48] Mr. R. B. Cunninghame-Graham's variant on this theme, in the
  _Daily News_, Aug. 27, 1903, is really too filthy to be put here.
  Like Mr. Loraine, I dare not produce my brief.

I

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 _post-mortem_ 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.

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 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--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.

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--where are
the differences to support this statement that you cannot argue from
animals to men?

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 _post-mortem_ 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 are asked to admit that phrenology, long
before physiology, discovered the truth about the surface of the
brain; _I have been told_, says Mr. Coleridge at an annual meeting of
his society, _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._ 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
_post-mortem_ 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."

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 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.

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 _Medical Annual_, 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. _There is money in the
business_--that is the phrase of the _Zoophilist_. But there is money,
also, in the anti-vivisection business. _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_, says the London Society: _this is the most
alive humane organisation in the world_. But the National Society
says, _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._

II

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.

HARVEY

"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: _But that is not so important as it appears to
be_. 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?

SIR CHARLES BELL

For the argument from Sir Charles Bell's words, and for the truth
about his work, see Part I., Chap. VII.

CEREBRAL LOCALISATION

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, _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?_ 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.

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:--

   "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
   _post-mortem_ of correcting our diagnosis."

That is an exact picture of the state of things thirty years ago; the
student taking notes, waiting for the _post-mortem_ 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.

ANTITOXINS AND CARBOLIC ACID

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 _Medical
Brief_; and we have learned something of the style of that journal.
Here is a sentence from the official journal of the National
Society:--

   "The _Medical Brief_ calls antitoxin 'the fraud of the age,' and
   says: _Would that physicians could all realise the hideous
   horror of using this nasty stuff as a remedial agent_. 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."

For a commentary on this sentence, take the following letter from an
eminent bacteriologist:--

   "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--I am not quite sure of the
   amount, but it is either .04 per cent. or .004 per cent.!"

But it is probable that the _Zoophilist_ will still accept the
authority of the _Medical Brief_. Baccelli got good results, in
tetanus, from the administration of carbolic acid; therefore, in
diphtheria, the good results from 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 _base and blatant materialism_.

THE ARGUMENT FROM THE DEATH-RATE

There is another argument against diphtheria-antitoxin; we may call
it, for brevity, the death-rate argument. It is this. _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._ 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.

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 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:--

   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.e._ 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."

   Mr. WOOD: "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."

   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."

   Mr. WOOD: "Let me give the annual death-rate from diphtheria to
   a million living persons from 1881 to 1900, taken from the
   Registrar-General's returns." (Gives them.)

   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."

A few weeks later, at the _Bournbrook and Selly Oak Social Club_, Mr.
Wood gives his "thrilling lecture, with lantern views," _Behind the
Closed Doors of the Laboratory_: one of his stock lectures. In it, he
says:--

   "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."

Four days later, at an _overflowingly-attended Citizen Social_ at
Birkenhead:--

   "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."

A few weeks later, at Ipswich, the same thing. This time, he is
challenged by letters in the _East Anglian Daily Times_, and again
quotes the Registrar-General.

A few weeks later, at the _Hyde Labour Church_: the _Closed Doors of
the Laboratory_ again:--

   "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 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."

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 _Vivisection
and the Hospitals_:

   "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."

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; _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_. The year after that, 74 lectures; _on two occasions he
has spoken when unsupported to over 1000 people, and an audience of
several hundreds is quite the rule_. Here he is at Windsor, with
Bishop Barry in the chair, and he says to them:--

   "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."

Here, with a different audience, at the Mechanics' Lecture Hall,
Nottingham, giving his lantern-lecture on _Pasteurism_ to a _most
respectable audience of working men, their wives, sons, and daughters,
and in many cases children_.

   "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."

Here he is at Birmingham, asking for money, and hinting that, unless
all experiments on animals are stopped, _the poor will be the ultimate
victims_. Here, at Gloucester, saying that _it is silly to experiment
at all_, 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 _Closed Doors_ 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 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 _considerable number of persons
ranging themselves on the grass_, 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 _Closed Doors_ again, calling the law _a sham
and a farce_; here, at Cheltenham, with Bishop Mitchinson in the
chair, still quoting the Registrar-General, and saying that _he does
not think the outlook was ever more promising than it is to-day_. 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.

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
myxoedema," 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. Myxoedema 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 myxoedema 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 thyroid gland that decides the death-rate. The number
of deaths from myxoedema, 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 myxoedema and in
sporadic cretinism.

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."

RABIES

For rabies, Mr. Berdoe praises the "Buisson Bath Treatment for the
Prevention and Cure of Hydrophobia." The virtues of this treatment are
proclaimed by the Chairman of the Canine Defence League, F. E.
Pirkis, Esq., R.N., of Nutfield, Surrey, and it is founded, we are
told, _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_. 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?

Mr. Berdoe, in his Catechism of Vivisection (1903), gives this
evidence at considerable length. _The treatment_, he says, _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._ Let us consider this sentence. (1.) Suppose that
X---- 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---- 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---- were bitten by a mad dog,
and, in due time, were seized by hydrophobia. Has Mr. Pirkis ever seen
a case of that disease--ever seen a case of hydrophobia? Are they
going to tie X---- 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.

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.

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.

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:--

1. He says, on the authority of the _Veterinary Record_ of ten years
ago, that _the death of a rabbit with cerebral symptoms is not a
positive indication of death from rabies_.

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.

Also Mr. Berdoe quotes the late M. Peter, Dr. Lutaud's forerunner;
quotes an _obiter dictum_ 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, _The Roentgen
"Cure": its list of Victims_.

CERTIFICATE A AND CERTIFICATE B

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 _plus_
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?

The Home Secretary answered:

   "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."

The _Times_ says that the Home Secretary said "serious experiments."
Mr. Coleridge says that _Hansard_ 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 _wholly_, as Mr.
Coleridge does. Anyhow, it does not matter now whether the Home
Secretary, seven years ago, said _experiments_ or _operations_. 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 _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_. 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:--

   1. (Annual Meeting, Queen's Hall, May 1900.)--"If you are still
   unconvinced--if any one is not thoroughly satisfied that there
   is ample cause for the anti-vivisectionist movement to-day--it
   is only necessary for me to refer you to the words of the Home
   Secretary, as spoken in Parliament, in the year 1898.[49] He
   said: '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?"

   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."

   3. (Annual Meeting, St. James's Hall, May 1901.)--"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."

  [49] This should be 1899.

Each of the three speakers uses this phrase as a final and
irresistible argument. _If you are still unconvinced. If you want any
further proof. If this were not enough_--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; and it was practically the same question.
The Home Secretary, in his answer to it, said:--

   "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."

Here, in May 1899, we have this emphatic statement, that Certificate B
is _not_ 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:--

   "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."

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:--

   "There is a Certificate A, which, if it were granted, and when
   it is granted--and pray you mark my words, for I know what I am
   speaking about, and I want you to know too--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," &c.

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--_I know what I am speaking about_, he says, _and I want you
to know too_--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 _analysed the Act and its administration
in a striking and powerful manner_.

CURARE

"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 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.

(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.)

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.

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?

1. He quotes Professor Rutherford's experiments. These were made at
least 16 or 17 years ago.

2. He quotes Dr. Porter's paper, "On the Results of Ligation of the
Coronary Arteries." (_Journal of Physiology_, vol. xv. 1894, p. 121.)
Dr. Porter speaks of four experiments made under morphia _plus_
curare. These experiments were made at Berlin, 14 years ago, by the
Professor of Physiology at Harvard, U.S.A.

3. He refers to Professor Stewart's papers, in the same volume of the
_Journal of Physiology_. The one experiment which he quotes at some
length was made at Strasburg, 14 years ago or more.

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:--

   "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 _Journal of Physiology_, and look at
   page 86, you will find there," etc.

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 _Morning Leader_, saying: _It is with curare,
which paralyses motion and leaves sensation intact, that all the most
shocking vivisections are performed._ And, the same year, Mr. Stephen
Smith, a "Medical Patron" of the London Society, wrote: _I state
emphatically that when curare is used, proper anæsthesia is out of the
question...._ _Curare is used daily throughout England. Mention of an
anæsthetic in a report is no guarantee that the animal was
anæsthetised._

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.

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:--

   1. "Your question _re_ curare is easily answered. We did _no_
   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--I suppose from
   impurities--does not seriously affect the heart. There might
   still be occasions during which it is necessary to use it--if,
   _e.g._ the _least_ 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 use of curare. Of course, if I had occasion
   to use it, an anæsthetic would be administered at the same
   time."

   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."

   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.

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.

INCOMPLETE ANÆSTHESIA

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.

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 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.

ONE ANIMAL AND ONE EXPERIMENT

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, _e.g._ 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.

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.

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."

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 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.

3. A few weeks later, an anonymous letter in the _Bradford Observer_
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."

4. On August 1st, 1898, the National Society published this letter in
its official journal, under the heading, "Our Cause in the Press."

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."

6. In January 1903, the National Society admitted that its action in
1898 (see 4) was "unfortunate."

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."

8. About this time, the same false statement was made by an
Anti-vivisection Society at Manchester.

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 _Times_, the
leaflet containing this and other "grossly false and misleading
statements" was vehemently denounced by the National Society.

It would be hard to find a better instance of the spreading of a
false report. An experiment? Oh, it is any number of animals--20 of
them, 30 of them; 200, 300 of them; hecatombs, and triple hecatombs;
any young doctor can get leave to cut them up.

CERTIFICATES E AND EE

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, _e.g._ for the study of the preventive
treatment against distemper, it is necessary to hold a License, _plus_
Certificate A, _plus_ Certificate E; to operate on a dog, and let him
recover, it is necessary to hold a License, _plus_ Certificate B,
_plus_ Certificate EE.

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.

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 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."

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 _A
National Scandal_, _Scientific Torture_, _A Peep behind the Scenes_,
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. _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._

In the face of these facts, what is to be said of 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:---

   SIGN THE NATION'S PETITION TO PARLIAMENT AGAINST THE
   DISSECTION OF LIVE DOGS _In Medical Laboratories_ */

   1. Dogs, on account of their docility and obedience to the word
   of command, are the animals chiefly selected for torture.

   2. Thousands of dogs are tortured yearly by licensed
   experimenters.

   3. The total number of experiments performed in 1902 was 14,906,
   12,776 of which were without anæsthetics.

   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.

   5. Nor does the number 14,906 give the number of dogs used, for
   each experiment may include any number of dogs--there is no
   limit fixed by law.

   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.

   7. There are now laboratories scattered over the whole of the
   United Kingdom.

   8. The Home Secretary stated in Parliament on 10th July 1903,
   that one dog may be used _again_ and _again_ for vivisectional
   experiment or demonstration--and this without anæsthetics.

   Think of the condition of the poor dog between each
   living-dissection.

   Has not the time come for the nation to rise as one man and
   say--

    "This shall not be"?

It is no wonder that even the National Anti-vivisection Society, in a
letter to the _Times_, December 11th, 1903, denounced this leaflet.
The wonder is, that Mr. Pirkis, R.N., the chairman of the Canine
League, tried to defend it. _This deplorable leaflet_, said the
National Society: _It contains a series of grossly false and
misleading statements._ 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 _authorised or
performed_. 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.

       *       *       *       *       *

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; the whole elaborate system of a sort of
secret service--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 _money in the business_; there is _milk
in the cocoa-nut_; and _twopence more, and up goes the donkey_. 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
_Zoophilist_. Truly, a fine result; a high-class official journal, the
_recognised organ of the anti-vivisection movement in England_.

Take, for a final instance, one or two of the things said about
anæsthetics. On June 12th, 1897, in the _Echo_, 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 _Journal of Physiology_. 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:--

   "Yes, I have made full inquiry into the allegations contained in
   the letter and statement which the honourable 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."

It is simple enough. The gentlemen who made the experiments did not
know that the National Society buys and ransacks the _Journal of
Physiology_; 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
_Nine Circles_, 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 _we may be sure the narcosis becomes
profound when the inspectors knock at the door of the laboratory_;
Dr. Brand, saying that _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_; and Mr. Berdoe, saying that _vivisectors,
where they use anything except curare, employ sham anæsthetics_.

Beside such statements as these, there is the argument from the very
rare action of morphia as a stimulant (see _British Medical Journal_,
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, _It is
and must be absolutely untrue_. 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--_where they use anything but curare_. It affords, in six
words, a perfect instance of the anti-vivisectionist at his worst.


IV. "OUR CAUSE IN PARLIAMENT"

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.

In one year, the National Society spent £888, 13s. 2d. on "purely
electoral work." That is a very large sum, when we think of _the grave
injury done to the cause of mercy by the deplorable waste of money
spent in perfectly_ _unnecessary offices and salaries_. The Society's
journal tells us something of this electoral work:--

   1899.--"The Parliamentary League has again been successful in
   its work at bye-elections. At ---- the two candidates were
   approached, and both gave more or less satisfactory answers.
   Sir ----'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
   _Zoophilist_ hints that "further pressure" may be applied to
   this gentleman in Parliament.)

   1900.--"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."

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, NO SURRENDER, THE
AWAKENING CHURCHES, A TRUCULENT SCIENCE, THE SINEWS OF WAR, THE APPEAL
TO THE PEOPLE. They had better ensure the return of that opponent of
vaccination who says that you can bring any member of Parliament to
your knees.

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 _average lay member_. 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:--

   "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 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."

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. _Per contra_, we may credit to the Society, and not to Mr.
Coleridge, certain threats to Ministers in 1898:--

   ... "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."

   ... "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."

   ... "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 and vote against you on the next occasion
   that you present yourself."

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: _We are now
recognised throughout Great Britain to be a power that cannot be
ignored_. A Society that bullies Ministers of State, what will it not
do to the average lay member?


V. A HISTORICAL PARALLEL

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 _The Present Position of
Catholics in England_: 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:--

   ... "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 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."

   ... "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."

   ... "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."

   ... "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 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."

   ... "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."

   ... "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 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 _will_ 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--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."

   ... "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 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 _we_ should be guilty than _they_ 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?"

       *       *       *       *       *

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.



INDEX


    A

    A, Certificate, 268, 286

    _Abolitionist_, the, 302

    Absorbable ligature, the, 264

    Act 39 & 40 Vict. c. 77, 267-293

    Actinomycosis, 246

    Adrenalin, 263

    Aga Khan, Sir, 179

    Air, compressed, 71

    Algeria, malaria in, 230

    America, diphtheria in, 109;
      tetanus in, 133, 135;
      yellow fever in, 232-240

    Amoy, plague in, 194

    Amyl nitrite, 254;
      false argument, 345

    Anaemia, 71;
      pernicious, 263

    Anæsthesia, grades of, 357;
      false statements, 366

    Anæsthetics, discovery and study of, 55, 256;
      use under the Act, 281

    Anderson, Mr., 190

    Andrews, Staff-Surgeon, 263

    Anglo-Indians and Anglo-Africans, 228

    Animal heat, 68

    Animals, protective inoculation of, 89-95, 113;
      action of drugs on, 255

    Annett, Dr., 223

    Anopheles and Culex, 214-242

    Anthrax, 76, 87-95

    Antiseptics, 78-86;
      use of under the Act, 285

    Antitoxins, testing of, 270;
      false arguments against, 338-342.
      See also Diphtheria, Tetanus, &c.

    Anti-vivisection Societies, 297 _sqq._;
      dissensions, 299-302;
      expenditure, 304-306, 334, 367;
      acceptance of all advantages from past discoveries, 307;
      attitude toward sport, 308;
      toward doctors and hospitals, 310;
      literature, 313-324;
      method of espionage, 327;
      general arguments, 326-334;
      special arguments, 335-367;
      electoral and parliamentary tactics, 367-371

    Aphasia, 62

    Arguments, anti-vivisection, 326-367

    Aristotle, 3, 44, 243

    Arloing and Courmont, 100

    Artificial respiration, 264

    Asellius, 19

    Assam-Burmah railway, cholera on, 162

    Athens, Pasteur Institute at, 143

    Aubertin, 62


    B

    B, Certificate, 268, 349.
      See also Experiments

    Baccelli, Prof., 133

    Bacteriology, 77 _sqq._;
      not before the 1875 Commission,
      75; the foundation of Lister's work, 85;
      hardly recognised in the wording of the Act, 267;
      the cause of more than 90 per cent, of all experiments, 292;
      false statements, 316, 340

    Baginsky, Prof., 105

    Bagshawe, Bishop, 329

    Bainbridge, Surgeon-General, 169

    Baker, Major, 172

    Bang, Prof., 99

    Bannerman, Major, 173, 175, 178

    Barbadoes, filariasis in, 240

    Barry, Bishop, 343

    Battipaglia-Reggio railway, and malaria, 221

    Bazan, Dr., 42

    Beaumont, Dr. William, 28

    Behring, Prof., 102

    Belchier, Mr., 40

    Belgaum, plague at, 174

    Bell, Sir Charles, 46, 57, 65

    Bell, Dr., 88

    Belladonna, action of, 255

    van Beneden, 244

    Berdoe, Mr., 314 _sqq._

    Bernard, Claude, 24, 30, 56, 248, 254, 282

    Bernard Shaw, Mr., 330

    Beveridge, Surgeon, 263

    Beyrout, experiments at, 214

    Bezoar-stone, the, 252

    Bichat, 253

    Bilaspur, cholera at, 164

    Bircher, Dr., 249

    Bird-malaria, 217, 218

    Birt, Surgeon-Major, 212

    Bloemfontein, typhoid at, 203

    Blondlot, 29

    Blood, circulation of the, 3-10;
      blood-pressure, 11-16, 70;
      collateral circulation, 13

    Blood-letting, rational use of, 264

    "Blood-poisoning," 84

    Board of Agriculture laboratories, 288

    Board Hospitals, diphtheria in, 116

    Boehmer, 42

    Bohn, 37

    Böllinger, 246

    Bombay, plague in, 170

    Bone, growth of, 40, 55;
      transplantation of, 264

    Borelli, 25

    Borrel, 168

    Bouillard, 62

    Brain, localisation of functions, 59-67;
      not sensitive to touch, 65, 285;
      false argument against experiments on, 336;
      surgery of, 337

    Brieger, 153

    Broca, 59

    Brown, Captain Harold, 162

    Brown-Séquard, Prof., 56

    Bruce, Major, 211

    Brunton, Sir T. Lauder, on nitrite of amyl, 254

    Buchanan, Major, 219

    Buenos Ayres, plague in, 194

    Buisson bath, the, 345

    Buisson, Dr., 347

    Burrows, Mr. Herbert, 329

    Busk, Prof., 244

    Byculla jail, plague in, 170


    C

    C, Certificate, 284

    Cabot, Dr., 210

    Cachar tea-gardens, cholera in, 164

    Cachexia strumipriva, 247, 249

    Cæsalpinus, 4, 6

    Caisson disease, 71

    Calcutta, cholera inoculations in, 156

    Calmette, on plague, 168;
      on snake venom, 259

    Calverley, Dr., 202

    Cancer, recent experiments on, 288;
      mice immunised against, 263;
      cancer of thyroid gland, 344

    Cancer Research Fund, 288

    Capillaries, discovery of the, 10

    Cappel, Mr. E. K., 181

    Carbolic acid, 338

    Cardiograph, the, 17

    Cardwell, Lord, 267

    Carle and Rattone, 128

    Carrion, Daniel, death of, 257

    Cayley, Surgeon-Colonel, 203

    Celsus, 77

    Cerebellum, 46

    Cerebral localisation, 64-67;
      false argument, 336

    Chamberland, Dr., 90

    Chantemesse, on Widal's reaction, 210

    Charbon, 86-90;
      inoculations against, 90-93

    Charles II., treatment of his case, 251

    Chauveau, 97

    Chenai, Dr., 189

    Chicago, diphtheria in, 109;
      tetanus in, 135

    Childe, Prof., 183

    Children, malaria in native, 225

    Choke-damp, 70

    Cholera, study of, 152;
      Haffkine's fluid, 153;
      results obtained in India, 154-166;
      in Japan, 167;
      bacteriology and quarantine, 167

    Church Anti-vivisection League, 298, 301

    Clinical Society, report on diphtheria, 111;
      on myxoedema, 248

    Cobbold, Prof., 244

    Cocain, 269

    Cohnheim on inflammation, 78;
      on tubercle, 97

    Coleridge, Mr., 300 _sqq._

    Commission on experiments on animals (1875), 76, 267, 298;
      plague Commission (India), 170;
      Commissions on malaria, 218;
      on yellow fever, 232;
      on tuberculosis, 288

    Committee on rabies, 142;
      on myxoedema, 248

    Compensatory action of heart, 69

    Congress on tuberculosis, 98, 99;
      International Medical (London), 253, 321

    Cooper, Sir Astley, 248

    Corthorn, Dr., 190

    County Council laboratories, 287

    Cretinism, sporadic, treatment with thyroid extract, 250

    Crile, Dr., 358

    Cuba, yellow fever in, 237-240

    Culex and Anopheles, 214-242

    Cumine, Mr. A., 170

    Cunninghame-Graham, Mr. R. B., 330

    Curare, action of, 282, 353;
      provision of the Act, 274;
      facts as to its use, 356;
      false argument, 355

    Curzon, Lord, 169, 195

    Cyprus, typhoid in, 206


    D

    Daman, plague in, 171

    _Dark Deeds_, 313

    Darwin, evidence before the 1875 Commission, 68

    Davaine on anthrax, 88;
      on entozoa, 244

    Dax, 62

    "Dead" vaccines, 197

    Death-rate argument, the, 339

    Deaths from experiment on self, 257

    Deelfontein, typhoid in, 208

    Diabetes, 30-35;
      pancreatic diabetes, 39

    Diapedesis in inflammation, 78

    Digestion, 24-29;
      Pawlow's experiments, 70

    Digitalis, study of, 253;
      false argument, 345

    Diphtheria, 102-127;
      discovery of its antitoxin, 103;
      early results and reports, 103-116;
      results at the Board Hospitals, 116-123;
      Siegert's tables, 123;
      Woodhead's 1901 report, 124;
      MacCombie's tables, 126;
      _preventive_ use of the antitoxin, 105-106;
      tracheotomy statistics, 104-126;
      false statements and arguments, 310, 316, 338, 339-342

    Distemper, inoculation against, 289

    Drafting of questions to be put to the Home Secretary, 369

    Drowning, experiments on death by, 361

    Drugs, action of, 251-258;
      lingering influence of magic, 251;
      revolutionary work of Magendie and Claude Bernard, 252;
      discovery of _selective_ action, 253;
      effects of drugs on animals, 255

    Duboué, Dr., 138

    Dundee, tetanus in mills in, 134

    Durbhanga jail, cholera in, 162

    Durham, Dr., on Widal's reaction, 210;
      on yellow fever, 235

    Dyson, Major, 166


    E

    E and EE, Certificates, 284-286, 361

    Eberlé, 38

    Edinburgh Hospital, South Africa, typhoid in, 205

    von Eisselsberg, 249

    Egypt, typhoid in, 199, 206

    "Electoral Work" of anti-vivisection societies, 299, 367

    Electricity in medicine, 264

    Elephantiasis, 240

    Elimination of infection (malaria), 223

    Elliot, Dr. Andrew, 208

    England, variability of diphtheria in, 105

    Equilibration, 56

    Erasistratus, 3

    Erichsen, Sir John, 78, 267

    Excision of wound in tetanus, 136

    Experiments on self, 152, 153, 169, 220, 222, 233, 257

    Experiments during 1905, report to Government on, 283-293

    Experiments without anæsthetics, 268-271, 286, 292, 352;
      false statements, 322, 352, 363

    Experiments under Certificate B, or B + EE, or B + F, 285;
      prohibition of _subsequent_ infliction of pain, 286, 352;
      these experiments less than 3 _per cent._ of all experiments, 285;
      inoculation-experiments about 95 _per cent._ of all experiments, 286


    F

    F, Certificate, 284

    Fabricius, 5

    Fayrer, Sir Joseph, 259

    Fenwick, Dr. W. S., 86

    Ferran, Dr., 153

    Ferrier's work in cerebral localisation, 63

    Filariasis, 240;
      Dr. Low's report on, 241

    Finlay's work on yellow fever, 232

    Fischer, 153

    Fistula, artificial, 28, 29, 70

    Fleas and plague, 332

    Flourens, 55

    Forman, Major, evidence before Plague Commission, 176

    Forster, Mr. W. E., 267

    Foster, Sir Michael, 58, 66

    Foulerton, Mr. A., 210

    Fox, Dr., 250

    France, Pasteur Institutes in, 150

    Frascatorius, 6, 96

    Fraser, Prof., 170, 253, 259

    French army, diphtheria in the, 103

    Fritsch and Hitzig on cerebral localisation, 65


    G

    Gabritchefski, Dr., 105

    Gaffky, Dr., 196

    Galen, experiment on the arteries, 3;
      quoted by Asellius, 19;
      experiments on the nervous system, 44

    Gall and phrenology, 60

    Gamaleia, 153

    Gamgee, Dr. A., experiments on amyl nitrite, 254

    Gastric juice, 24-39

    Gaya jail, cholera in, 160

    Germany, diphtheria in, 105

    Glycogen, 30-35

    Gmelin, 27

    Goldsmiths' Company, the, 117

    Gorgas, Major, on yellow fever, 237

    Gowers, Sir William, 63

    Graaf, Regnier de, 36

    Graham, Dr., 214

    Grassi, Prof., experiments on malaria, 221, 257

    Greece, rabies in, 143

    Gull, Sir William, on myxoedema, 247


    H

    Hadwen, Dr., 323

    Haffkine, work on cholera, 153;
      on plague, 168;
      experiments on self, 257

    Haigh, Rev. H., 184

    Haldane, Dr., on respiration, 70

    Hales, on blood-pressure, 11

    Haller, 82

    Hallifax, Mr. C. J., 170

    Hamburg, cholera at, 152

    du Hamel, on growth of bone, 40

    Hamer, Dr., 88

    Hankin, Dr., 153

    Harley, Dr., on pancreatic diabetes, 39

    Harvey, William, 5-9, 20, 335

    Harvey, Director General, I.M.S., 169, 171, 191

    Hatch, Lieut.-Col., 169

    Havana, yellow fever in, 238

    Havers, 40

    Head, Dr., work on the nervous system, 70

    Hebra, 82

    Hewett, Mr. J. P., 170

    Hewlett, Prof., 102, 238

    Hill, Dr. Leonard, 71

    Hippocrates, 243

    Historical parallel, 371

    Hitzig, work on cerebral localisation, 64

    Hobday, Prof., 281

    Holländer, Dr., 336

    Horses immunised against tetanus, 133

    Horsley, Sir Victor, 315;
      on Galen, 44;
      on cerebral localisation, 65;
      his work on myxoedema, 248, 249

    Houston's estimate, 128

    Hubli, plague in, 181

    Hughlings Jackson, Dr., 63

    Hunter, John, 7, 13, 257

    Hunter, Dr. William, on pernicious anæmia, 263

    Hutton, Mr., 267

    Huxley, Prof., 267, 298

    Hydatid disease, 245

    Hypodermic use of drugs, 264


    I

    Iceland, echinococcus in, 245

    Immunised horses, not in pain, 270

    Imperial Yeomanry Hospital, typhoid in, 207

    India, cholera in, 153;
      plague in, 168;
      typhoid in, 198;
      malaria in, 216

    India Office, experiments made for, 288

    Inflammation, study of, 77-79

    Ingersoll, Col., 329

    Inoculations, scheduled under Certificate A, 269;
      about 95 _per cent._ of all experiments, 292, 325;
      presence or absence of pain, 270, 287;
      made by Government and public bodies, 288, 292;
      false arguments and statements, 338, 352

    Internal secretion, 34, 39, 250

    Irregularities under the Act, 288

    Israel, Prof., 246

    Italy, malaria in, 218 _sqq._


    J

    Jains, the, 168

    Japan, cholera in, 167

    Jesse, Mr., 298

    Jewish community at Aden, plague among, 192

    Jute mills, tetanus in, 134


    K

    Kanthack, Prof., on tetanus, 130;
      on snake venom, 259

    Kármán, Dr., 104

    Karslake, Sir John, 267

    Keelan, Lieut., on plague, 187

    Keeping down of the mosquito, 229, 242

    Kent County Lunatic Asylum, typhoid at, 197

    Khartoum Expedition, typhoid on, 197

    Khoja community, plague among, 179

    Kirki, plague at, 172

    Kitasato, Prof., on diphtheria, 102;
      on plague, 168

    Klebs, Prof., on diphtheria, 102;
      on typhoid, 196

    Klebs-Loeffler bacillus, the, 102 _sqq._

    Klein, Prof., on anthrax, 76;
      on cholera, 153;
      experiment on self, 257

    Koch, Prof., on anthrax, 88;
      on tubercle, 97, 98;
      on cholera, 152;
      on typhoid, 196;
      on elimination of infection (malaria), 223;
      experiment on self, 257

    Koch's postulates, 76

    Kocher, Prof., on myxoedema, 247, 249

    Krokiewicz, 133

    Krönlein, 104

    Kroonstadt, typhoid in, 203

    Küchenmeister on entozoa, 244


    L

    Lacteals, the, 19-23

    Labbé's proteosoma, 217

    Laboratories, not dangerous to public health, 258;
      used in Government service, 288;
      inspected and approved, 288

    Ladysmith, typhoid in, 201

    Laennec, on tubercle, 96

    Lagos, malaria in, 224, 228

    Lamb, Surg.-Capt., 212

    Lambert, Dr., on tetanus, 132

    Lanauli, plague at, 172

    _Lapis Goæ_, given to Charles II., 252

    Laryngeal diphtheria, 114, 120 _sqq._

    Laveran, on malaria, 216

    Lazear, Dr., death from yellow fever, 235

    Leblanc, on risk of rabies, 142

    Leffingwell, Dr., on history of anti-vivisection, 297

    Lefroy, Mr., 241

    Legge, Dr., on industrial anthrax, 88

    Leuckart, on trichiniasis, 244

    Leumann, Surg.-Capt., his work in Hubli, 181-189

    Licenses under the Act, 275-277;
      number granted, but not used last year, 283

    Lister, Lord, his account of his work, 78

    Literature, anti-vivisection, 313-324

    Liverpool School of Tropical Medicine, 218, 224

    Llangattock, Lord, 309

    Localisation in central nervous system, 54, 59-67

    London Anti-vivisection Society, 302, 323, 334

    London School of Tropical Medicine, 220

    Loraine, Rev. Nevison, 327

    Low, Dr. G. C., on malaria, 220;
      on filariasis, 240

    Lucknow, cholera in, 158

    Lutaud, Dr., 317

    Lymphatic system, the, 23

    Lyons, Major, on plague, 172


    M

    MacCallum, 216

    McFadyean, Prof., on tuberculin, 100

    MacGarvie Smith, 262

    MacGregor, Sir William, on malaria, 224, 228

    Mackenzie, Dr. Hector, on myxoedema, 250

    Mackenzie, Dr. James, on nerve distribution, 70

    MacNeill, Mr., statements in Parliament, 359

    Macrae, Surg.-Major, 160

    Magendie, on the nerve roots, 52;
      on selective action of drugs, 252

    Magic, lingering late in medicine, 251

    Mahratta mills and railway, cholera in, 188, 189

    Maidstone, typhoid at, 197, 212

    Malaria, 214-231, 242

    Malay States, malaria in, 230

    Malpighi on the capillaries, 10

    Malta fever, 211;
      possibly milk-borne, 213

    Malta, typhoid in, 199

    Manometers, 11-18

    Manson, Sir Patrick, 128, 213, 216, 227

    Mantegazza, 330

    Marey, 16

    Marsden, Dr., on typhoid, 200

    Marshall Hall, his work on reflex action, 53

    Martin, Prof. Sidney, on diphtheria, 103;
      on tetanus, 130

    Meat, infection of, 99

    _Medical Brief_, the, 316, 338

    Medical Journals, the, 297

    "Medical Opinions on Vivisection," 321

    Meerut, typhoid in, 205

    Meister, Joseph, Pasteur's first case, 137

    von Mering, 38

    Metchnikoff, 78, 153

    Mice immunised against cancer, 263, 288

    Microscope, before bacteriology, 77

    Milk, infection of, 98

    Ministers of State, letters to, 370

    Minkowski, 38

    Monsall Fever Hospital, typhoid in, 200

    Mora, plague in, 170

    Morphia, a true anæsthetic, 281;
      exceptional action of, 282

    Mosquito, the, 214-242

    Mosquito brigades, 230

    Mukerji, Surg., 166

    Müller, Dr., 258

    Municipal laboratories, 287

    Murray, Dr. George, on myxoedema, 250

    Mursell, Rev. A., 320

    Mutilations by farmers and breeders, 293

    Myers, Dr. Walter, death from yellow fever, 236

    Myxoedema, 247-250;
      false argument, 344


    N

    Nagpur jail, malaria in, 219

    National Anti-vivisection Society, 299 _sqq._

    National Canine Defence League, 306, 322, 360, 363

    National Society for Prevention of Cruelty to Animals, 304

    Negative results, frequent, of inoculations, 287

    Negri, Prof., 137

    Nervous system, the, 44-67

    Netley Hospital, work on typhoid, 196;
      on Malta fever, 212

    New Guinea, malaria in, 225

    Newman, Cardinal, 371

    Nhatrang, plague in, 194

    Nicolaier, on tetanus, 129

    Nigeria, malaria in, 225

    _Nine Circles_, the, 313

    Nocard, Prof., on tetanus in horses, 133

    Nott, Surg.-Capt., 155


    O

    Official experiments, 288

    Oliver, Dr., 88

    Ollier, Prof., 43

    One experiment = one animal, 359

    Oporto, plague at, 168, 194

    Opsonic index, the, 101

    Ord, Dr., on myxoedema, 247

    "Our Cause in Parliament," 367

    "Our Cause in the Press," 310, 311, 360

    Owen, Sir Richard, 14

    Oxygen, inhalation of, 264


    P

    Pacific Islands, filariasis in the, 240

    Pædiatric Society of America, report on diphtheria-antitoxin, 109

    Palermo, Pasteur Institute at, 144

    Pallas, on entozoa, 244

    Pancreas, the, 36;
      pancreatic diabetes, 39

    Paralyses of diphtheria, 114, 116, 125

    Paralytic rabies of rabbits, 146

    Parasitic diseases, 243

    Parasitism, 215

    Paré, Ambroise, 167, 252

    Paris, diphtheria in, 107

    Parkinson, Dr., 86

    Parsee community at Daman, plague among, 171

    Pasteur, his influence on surgery, 79, 84;
      work on anthrax, 88;
      on rouget, 94;
      on rabies, 137

    Pasteur Institutes, 140-151;
      false argument, 345-348

    Pathology and bacteriology, 75-86

    Pavy, Dr., on diabetes, 35

    Pawlow, Prof., on digestion, 70

    Pecha, Nurse, 258

    Pecquet, Jehan, discovery of the thoracic duct, 21

    Pédiatrie, Société de, 106

    Pernicious anæmia, 263

    Peter, Dr., 141

    Pfeiffer, Dr., 153

    Phelps, Lieut.-Gen., 323

    Phrenology, 60, 333

    Phthisis, 96

    Physiology, 3-71, 267

    Pirkis, Capt., R.N., 346

    Plague, 168-195

    Poiseuille's manometer, 15

    Pollender, 88

    Polli, Prof., 79

    Polyvalent serum, 86

    Ponfick, 246

    Poore, Dr., on anthrax, 89;
      on tetanus, 129

    Portland Hospital, typhoid in, 202

    Pottevin, Dr., 145

    Powell, Dr. Arthur, 165

    Prague, tetanus at, 134

    _Prejudiced Man_, the, 373

    _Preventive_ use of antitoxin in diphtheria, 104, 106;
      in tetanus, 133-135

    Prochaska, 54

    Protection against Anopheles and Culex, 227, 241

    Puerperal fever, 79-84

    Pyæmia, 78


    Q

    Quarantine and bacteriology, 167

    Quesada, 257

    Quinine, action of, 231


    R

    Rabies, 137-151;
      tests in 1905, 288, 291;
      false argument, 345

    Rats and plague, 192, 332

    Realdus, 4

    Réaumur, work on digestion, 25

    Redi, on entozoa, 244

    Reed, on yellow fever, 239

    Reflex action, 53

    Registered places under the Act, 283

    Registrar-General, the, 339

    Reinhardt, Dr., 355

    Rennie, Dr., on snake venom, 263

    Report on experiments on animals, 283-293

    Respiration, 70

    Reverdin, Prof., 247

    Richardson, Sir Benjamin Ward, 254

    Richmond Hospital, Dublin, typhoid in, 207

    Rio, Pasteur Institute at, 144

    Roger, on anthrax, 88

    Rolland, Gen., 175

    Rolleston, Dr. Humphry, 207

    Romanes, 66

    Ross, Prof. Ronald, 216, 228, 242

    Rouget, inoculation against, 94

    Roux, Prof., 84, 89, 103, 138

    Royal Society for Prevention of Cruelty to Animals, 304

    Rudbeck, 23

    Ruffer, Dr., 170

    Rush for plague-serum in 1899, 193

    Russia, diphtheria in, 105

    Russell, Sir James, 288

    Russell, Dr. Risien, 46


    S

    Salicylic acid, 255

    St. Martin, Alexis, 28

    Sambon, Dr. G. C., 220

    Samoa, filariasis in, 240

    Sanarelli, Prof., 234, 315

    San Carlos jail, yellow fever in, 234

    Sanders, Dr., 253

    Sanderson, Sir John Burdon, 32

    _Saturday Review_, the, 103

    Scarbrugh, Dr., 251

    Schiff, Prof., 58, 249

    _Securus judicat_, 123

    Segregation against malaria, 224

    _Selective_ action of drugs, 252

    Semmelweis, Ignaz, work on puerperal fever, 79-82

    Semon, Sir Felix, 248

    Semple, Surg.-Major, 196, 210

    Serampur, cholera at, 164

    "Serious experiments," 349-353

    Sewage, experiments for testing, 288

    Sewell, Dr., 263

    _Shambles of Science_, the, 313

    Siegert's tables of diphtheria, 123

    Sierra Leone, malaria in, 226

    Simon, Sir John, evidence before 1875 Commission, 76

    Simpson, Dr. W. J., on cholera, 155

    Skin, diseases of, 250;
      grafting, 264

    Skoda, 82

    Sleeping sickness, 264

    Smith, Dr. J. W., 203

    Smith, Mr. Stephen, 355

    Snake venom, 259-263

    Society for Prevention of Cruelty to Children, 304

    South Africa, typhoid in, 200 _sqq._

    South America, yellow fever in, 232 _sqq._

    Southwell, Bishop of, 319

    Spallanzani, 26

    Speech centres, the, 59, 337

    Spontaneous generation, 244

    Sport, attitude of anti-vivisection societies toward, 308

    Sphygmometer, the, 17

    Spurious hydrophobia, 347

    Stanley, Mr., 42

    Starling, Prof., 39, 69

    Staten Island, 242

    Steenstrup, on entozoa, 244

    Sternberg, 128, 231

    Stoker, Sir W. T., 291

    Stone, Dr., 263

    Streptococci, 83

    Strophanthus, 255

    Strychnine, study of, 253

    Subdural inoculations, 133, 138, 271

    Suppuration, 84

    Swammerdam, 244

    Syme, 42, 78

    Sympathetic system, 69


    T

    _Tabes mesenterica_, 98

    Talbot, Rev. R., 352

    Terzi, Signor, experiment on self, 220

    Tetanus, 128-136

    Tew, Dr., on typhoid, 197

    Thane, Mr. G. D., 290

    Thompson Yates laboratories, 223

    Thoracic duct, the, 21

    Thuillier, 89

    Thyroid extract, use of, 250;
      false argument, 344

    Tiedemann, 27

    Tooth, Dr., 202

    Torsion of arteries, 264

    Tracheotomy in diphtheria, 114-120

    Transfusion of saline fluid, 264

    Transplantation of bone, 264

    Treves, Sir Frederick, 321

    Trichiniasis, 244

    Trotter, Mr. W. B. L., 288

    Tubercle, 96-101

    Tuberculin, 98

    Typhoid fever, 196-211


    U

    Umarkhadi jail, plague in, 177

    Undhera, plague in, 178


    V

    Valentin, 38

    Valisnieri, 25

    Valléry Radot, 137

    Vaso-motor system, 56, 69

    Vaughan, Surg.-Capt., 155

    Venesection, 264

    Venoms, relative strength of, 260

    Veratria, 255

    Veterinary operations, 281, 293

    Vierordt, 17

    Villemin, 96

    Virchow, Prof., 75, 245

    Virulence, grades of, 89, 139, 260

    _Virus fixe_, 139


    W

    Wall, Dr. A., 350

    Waller, 78

    War Office, experiments for, 288

    Washbourn, Dr., 208

    Wassermann, 153

    West, Lieut. J. W., 209

    West Africa, malaria in, 224, 226

    Wharton Jones, 77

    Widal's reaction, 210, 211

    Wilberforce, Archdeacon, 319, 328

    Willis, 59

    Winburg, typhoid in, 209

    Winmarleigh, Lord, 267

    Wolff, 246

    Wood, Mr. Somerville, 339-344

    Woodhead, Prof., 117, 124, 271

    Woolsorters' disease, 87

    Wright, Sir Almroth, 101, 170, 196


    Y

    Yellow fever, 231-240

    Yersin, 169, 194


    Z

    _Zoophilist_, the, 314-320

    Zürich, diphtheria in, 104



Transcriber's note:
    In footnote 18 the sentence "Es müssen vor allen
    Dingen die Quellen, aus denen der Infections-stoff fliesst, so weit
    es in menschlichen Macht liegt, verschlossen werden.

    was changed to read: Es müssen vor allen
    Dingen die Quellen, aus denen der Infektionsstoff fliesst, so weit
    es in menschlicher Macht liegt, verschlossen werden."

    Three overwide tables have been split into two parts. In each the
    first row of the original table has been repeated in the split off
    table in order to make the table more readable. These three tables
    appear in: PART II-EXPERIMENTS IN PATHOLOGY,
    MATERIA MEDICA, AND THERAPEUTICS.

    VACCINATION AGAINST CHARBON (FRANCE). _Sheep._
    VACCINATION AGAINST CHARBON (FRANCE). _Cattle._
    VACCINATION AGAINST ROUGET (FRANCE).





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