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Pyæmia, at one time a frequent cause of death in our surgical ward, is now a rarity. How far this change is due to the use of germicides and how far it is the result of extra cleanliness— which prevents putrescible matter, the cultivating medium for germs, from accumulating in wounds-is a question upon which I shall not now enter; but all will admit that the recognitionof the germ origin of this disease has brought about the diminution and almost complete extinction of this incurable complication of operation cases.

I would not have you infer from what I have said that I believe any of the vaccination processes for the prevention, mitigation, or cure of any of the infectious diseases, from vaccination, against smallpox to anti-choleraic vaccination, are at present perfected. I do not think they are. The ways of microbes are dark but not past finding out; and the apparent failure of any one method of dealing with a particular infectious disease by a vaccine, through imperfection of detail, must not shake our confidence in bacteriological science generally.

I am free to admit that we are far from home in this matter, but I believe the road is right, and if ever we are to have a definite treatment for the infectious diseases it will be in the direction of vaccines, germicides, or antitoxins, and in respect to these we must look for light from the laboratory.

In the meantime it behoves us to study the modes of dissemination of the germs of infectious diseases and their entrance doors into the body in order that by isolation, disinfection, and other sanitary measures we may prevent and limit outbreaks. There are two diseases, diphtheria and scarlet fever, which, in spite of all our sanitary reforms, are ever rampant in our midst.

Investigation into the distribution of some outbreaks of these diseases have tracked them both to the cow, and the milkman and the pump have both been blamed; but of late a suspicion. has been raised that the milk has been infected before it left the cow, and in some instances suspected milk has been traced to sick cows. This, however, is a problem for the future.

With regard to the ingress of germs into the body, it seems reasonable to think that in some kinds of infectious disease local manifestations mark the spot where the microbes creep into the system. This is undoubtedly the case in inoculated smallpox, vaccinia, syphilis, and erysipelas; and do not the bowel symptoms in cholera and enteric fever, the throat symptoms in diphtheria and scarlet fever, and the conjunctival and nasal symptoms in measles lead us to suspect where, in these cases, the microbes effect an entrance into the system.

It becomes more and more evident, day by day, that there is an unseen world around us, populated by parasites, many of which our present microscopes, with their highest powers, do not enable us to discern. To those who only believe in the existence of objects which they can behold with the unaided eye, such a suggestion might savour of the fantastic and incredible; to them the association of life with the infinitely small and invisible might appear unworthy of credence, but when the difference in size among living organisms in the seen world is contemplated--when the Elephant is compared with the Acarus, the marvel of the gap between the Acarus and the smallest bacterial germ disappears. We are frequently, especially in our large towns, exposed to specific disease-producing germs which are ever ready to make our bodies their home, and yet when so exposed we may escape unarmed, and how do we thus escape? The generally-accepted law, that two factors are necessary for the development of an infectious disease, namely, a specific germ and a suitable soil, is both probable and comforting; and this law applies throughout creation. We know that a hen comes only from a hen's egg; we know also that the egg, to be hatched, must be placed under favourable conditions. There are in this city at the present moment any number of hen's eggs which will never develop into chickens; some for want of favourable conditions only, some-not a few-from having lost their vitality from long keeping. There is reason to think that the human system in a

state of health and vigour is not open to attack by most of the pathogenic micro-organisms, nor finds breeding-ground for them. On some such an assumption as this was doubtless founded the usual and desirable practice of post-prandial visits to infectious cases, when the tissues of the practitioner are at their best, and best able to resist microbes. It seems probable that it is only when the system is run down, and the vitality of the tissues is lowered, that these become vulnerable; that when the blood is fouled by impure atmosphere, the circulation is slack and the nervous system unstrung; then it is that pathogenic microbes effect an entrance and secure a hold. The · bearing of bacteriology on diseases of animals, on commerce, and agriculture is beyond the scope of my undertaking; but I venture to say that the development of bacteriology as a recognised branch of science is every day becoming of more pressing necessity, and calls for state help.

Gentlemen,-At the commencement of my Address I asked your indulgence to the subject I had selected; I now feel that I owe you an apology for the way in which I have dealt with it and the length to which it has run. But if any words of mine should give rein to your thoughts on this subject, my aim will have been gained.

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CASE OF PRIMARY CARCINOMA OF LUNG, WITH SECONDARY DEPOSITS IN LIVER, BRAIN, AND SCAPULA.

ROBERT M. SIMON, M.D.

PHYSICIAN TO THE GENERAL HOSPITAL, BIRMINGHAM,

The extraordinary rapidity of the development of the disease for the patient died within two months of feeling ill for the first time—and the very extensive diffusion of cancer, make it desirable to publish the case. For the very exhaustive and careful pathological report I am indebted to Dr. Stanley, Pathologist to the General Hospital; and the notes of the case I owe to Dr. Brockbank and my Clinical Clerk, Mr. Satchell.

The patient was a man--J. B., aged 44—who had enjoyed good health until five weeks before seeking admission to the hospital. At that time he consulted a doctor on account of abdominal pain, and because his water was thick, scanty, and high coloured. As he did not improve, he attended at the General Hospital as an out-patient, and was admitted on May 31st, 1893. He rapidly got weaker, and died on June 7th.

June 1st. Condition on admission.-Patient is of medium height, sparely developed, and rather emaciated. Has a wellmarked cachectic look, with many venæ stellatæ on the cheeks and nose. The veins on the body also are rather prominent, but not varicose. Some exophthalmos of the left eye and inequality of the pupils, the left being larger than the right, No jaundice, and a slight amount of oedema is present over the sacrum only. The left scapula is enlarged as by a new growth, and there is a small tumour in the fascia of the left arm. Axillary glands not enlarged apparently.

F

Pyæmia, at one time a frequent cause of death in our surgical ward, is now a rarity. How far this change is due to the use of germicides and how far it is the result of extra cleanliness— which prevents putrescible matter, the cultivating medium for germs, from accumulating in wounds—is a question upon which I shall not now enter; but all will admit that the recognition of the germ origin of this disease has brought about the diminution and almost complete extinction of this incurable complication of operation cases.

I would not have you infer from what I have said that I believe any of the vaccination processes for the prevention, mitigation, or cure of any of the infectious diseases, from vaccination, against smallpox to anti-choleraic vaccination, are at present perfected. I do not think they are. The ways of microbes are dark but not past finding out; and the apparent failure of any one method of dealing with a particular infectious disease by a vaccine, through imperfection of detail, must not shake our confidence in bacteriological science generally.

I am free to admit that we are far from home in this matter, but I believe the road is right, and if ever we are to have a definite treatment for the infectious diseases it will be in the direction of vaccines, germicides, or antitoxins, and in respect to these we must look for light from the laboratory.

In the meantime it behoves us to study the modes of dissemination of the germs of infectious diseases and their entrance doors into the body in order that by isolation, disinfection, and. other sanitary measures we may prevent and limit outbreaks. There are two diseases, diphtheria and scarlet fever, which, in spite of all our sanitary reforms, are ever rampant in our midst.

Investigation into the distribution of some outbreaks of these diseases have tracked them both to the cow, and the milkman and the pump have both been blamed; but of late a suspicion. has been raised that the milk has been infected before it left the cow, and in some instances suspected milk has been traced to sick cows. This, however, is a problem for the future.

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