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Disease Germs and Germ Diseases.

Care and cleanliness in and about the house, in short, find a reason, not only in the comfort gained, but also in the intimate connection which the germ theory shows between disease and dirt. Not all disease is from dirt but any dirt may contain the germs of disease.

Recent Progress in Preventive Medicine.

RECENT PROGRESS IN PREVENTIVE MEDICINE.

BY J. L. KAINE, M. D., MILWAUKEE.

66 done?" as you

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Not so much "What have doing?" is the question to be asked the sanitarians, though a large answer may be given to the first question. They have talked a good deal, for one thing. Much of it rather wild talk perhaps, nearly all of it wearisome, a good deal of it the emphatic affirmation of hopeless hypotheses, and some of it vital truth - a mixture of chaff and No. 1 hard wheat; and a busy time there has been and long will be in separating the two. Boundless trivialities, too, have burdened sanitary literature, in the eternal straining of things, and in the raging passion men have to straight-jacket everybody - painful arguments for the legal prohibition of sneezing on the public streets to prevent hay-fever contagion, and the like. But the sanitarians have done more than talk. Beyond all question they have saved tens of thousands of lives even in this country-20,000 lives in the one city of Chicago in five years. This is not a guess, but a proved fact. Science has made astounding progress in recent years. Medicine hasn't stood still, whether in the region of pathology or of new remedies or of audacious surgery; but the emphatic fact in the medical history of the past twenty-five years is the progress of public hygiene. The best remedy is to prevent the need of a remedy.

What the sanitarians have done is to apply the glimmerings of light they had to the practical work of restricting the operations of disease. The work has been mostly empirical, but largely effective. What they are doing is getting more light and putting their work under the enduring

Recent Progress in Preventive Medicine.

conditions of absolute and accurate knowledge. The progress is great, but not always measurable. The sanitarian is almost afraid to look ahead, the promise is so dazzling. As Newton moved toward the completion of his calculations respecting the moon's distance, the consequences of which have been so tremendous; as his figures began to show that the result would correspond with and sustain his great theory, the pencil fell from his nervous hand and he fled, leaving the work to a friend. As the sanitarian gathers up the results of the researches of scores of specialists in certain lines, he is dazed by the possibilities that open up before him in their application. He hasn't the nerve to face them. He hesitates to say, but he doesn't doubt, that zymotic diseases which relentlessly slay their thousands a year, are due to the multiplication of minute organisms within the body; and that it may be possible to destroy them utterly, or to render the human body safe against them by inoculation, or to control the means of their distribution. He refuses to say it, may even deny it, but nevertheless he treasures a growing hope that consumption, which destroys more than a hundred thousand lives a year in the United States, and mostly adult lives, may be entirely eradicated.

The conservatism of the practicing physician respecting the germ-theory of disease, is not to be taken as the attitude of the sanitarian. There is no doubt that attention to this theory may be an obstacle to the empirical treatment of a disease. For the physician there is little help as yet, even in the certain knowledge that a particular disease is due to a microbe. But to the sanitarian the fact is stupendous. However he may counterfeit before the world the sober scrupulousness of the man of science, in the privacy of the laboratory he gloats over the bacterium. In the study of the ways of that minute organism he sees more lives saved to the world than wars have ever destroyed.

There has never been a time in the known history of the world when men haven't known that certain diseases are

Recent Progress in Preventive Medicine.

"catching"; that they may be conveyed from one person to another. When a person has Small Pox, we know to a certainty that he has been exposed to a particular infection; that he has come into contact with something that has come from another person with that particular disease. We know that the persons about him, if they have not been vaccinated, are liable to take this disease and to take it from him. Therefore we know there is a something that may be conveyed from a Small Pox patient to another person, perhaps through a long distance and after a long time, and that it may produce this same disease and no other. Not only Small Pox is communicable, and not only Scarlet Fever, Measles, Whooping Cough, the Itch, but also Diphtheria, Typhoid Fever and perhaps Consumption and a large number of other diseases. What is the nature of this specific poison, this something that is the seed of a particular disease and that is conveyed from one person to another? Speculation has never been idle about this question.

Why does meat decay? asked Schwann. He looked into the matter and found that decay was always accompanied by the multiplication of microscopic creatures. He examined the air and found it full of animal life. He excluded the air and the meat didn't putrefy. Tyndall has since made some beautiful and conclusive experiments in the same line. Lister thought that Gangrene and Erysipelas of wounds might be due to the minute creatures of the air; thereupon he covered the wounds with something that would destroy these creatures and there was no more Gangrene or Erysipelas. These were all steps toward the modern germ-theory-a theory often held before, but without evidence. The old discussion of spontaneous generation has led to something. If bacteria caused putrefaction, why not infection? Observers thought they saw something common to putrefaction and to the morbid processes of Diphtheria, Erysipelas, Splenic Fever, etc. We want to remember that whatever becomes of the germ-theory, it is

Recent Progress in Preventive Medicine.

responsible for the closer study of the manner in which infectious diseases are propagated and that the observations have an immediate and practical value in the limitation of contagion, no matter what the cause.

But the most momentous facts in relation to disease causation were revealed in the study of certain infectious diseases of animals. Here the cause was indeed found to be the multiplication of minute bacteria within the body. We speak now of bacteria, microbes, bacilli and eren disease germs as meaning the micro-organisms of a special character found in the case of different diseases. Cattle and sheep are prone to a malignant contagious or infectious (these words also may be used as meaning the same thing) disease known as anthrax or splenic fever. Pasteur traced the cause to microbes and established the fact. He did more he found he could cultivate the microbes, diminish their virulence, vaccinate animals with the feebler microbe and render them proof against the fatal anthrax. Chickencholera, also, he found to be due to microbes, and here again he cultivated a protecting virus. Hog-cholera, likewise, has its microbe and soon Pasteur's attenuated microbe will save our bacon. Five or six years ago the horses of Paris died by hundreds in a sort of Typhoid Fever epidemic; and here again Pasteur found the deadly microbe. Every body who has the pernicious habit of newspaper reading has heard much of the bacteria of rabies; and hardly anybody is ignorant of the great things that have been done for the French in the discovery of the different microbes of silkworm diseases. There is little doubt that the Pleuro-Pneumonia of cattle has its microscopic bacterium.

These infectious diseases behave in many respects like those to which man is subject, and it was natural to investigate human infectious diseases along the same line. The more so that by accident we had found inoculation for Small Pox as a protection against that disease. The investigation is under terrific headway. What has been discovered?

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