the evolution of modern medicine(现代医药的演变)-第44章
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sent year by year； and； keenly interested as I have always been in
infectious diseases； and particularly in malaria and dysentery； I doubt if
anyone has read it more faithfully。 In evidence of the extraordinary
advance made in sanitation by Gorgas； I give a random example from one
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of his monthly reports （1912）： In a population of more than 52；000； the
death rate from disease had fallen to 7。31 per thousand； among the whites
it was 2。80 and among the colored people 8。77。 Not only is the profession
indebted to Colonel Gorgas and his staff for this remarkable demonstration；
but they have offered an example of thoroughness and efficiency which
has won the admiration of the whole world。 As J。 B。 Bishop； secretary of
the Isthmian Canal Commission； has recently said： 〃The Americans
arrived on the Isthmus in the full light of these two invaluable discoveries
＇the insect transmission of yellow fever and malaria＇。 Scarcely had they
begun active work when an outbreak of yellow fever occurred which
caused such a panic throughout their force that nothing except the lack of
steamship accommodation prevented the flight of the entire body from the
Isthmus。 Prompt； intelligent and vigorous application of the remedies
shown to he effective by the mosquito discoveries not only checked the
progress of the pest； but banished it forever from the Isthmus。 In this way；
and in this alone； was the building of the canal made possible。 The
supreme credit for its construction therefore belongs to the brave men；
surgeons of the United States Army； who by their high devotion to duty
and to humanity risked their lives in Havana in 1900…1901 to demonstrate
the truth of the mosquito theory。〃＇7＇
＇7＇ Bishop： The French at Panama； Scribner's Magazine； January； 1913；
p。 42。
One disease has still a special claim upon the public in this country。
Some fourteen or fifteen years ago； in an address on the problem of
typhoid fever in the United States； I contended that the question was no
longer in the hands of the profession。 In season and out of season we had
preached salvation from it in volumes which fill state reports； public
health journals and the medical periodicals。 Though much has been done；
typhoid fever remains a question of grave national concern。 You lost in
this state＇7a＇ in 1911 from typhoid fever 154 lives； every one sacrificed
needlessly； every one a victim of neglect and incapacity。 Between 1200
and 1500 persons had a slow； lingering illness。 A nation of contradictions
and paradoxesa clean people； by whom personal hygiene is carefully
cultivated； but it has displayed in matters of public sanitation a
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carelessness simply criminal： a sensible people； among whom education is
more widely diffused than in any other country； supinely acquiesces in
conditions often shameful beyond expression。 The solution of the problem
is not very difficult。 What has been done elsewhere can be done here。 It is
not so much in the cities； though here too the death rate is still high； but in
the smaller towns and rural districts； in many of which the sanitary
conditions are still those of the Middle Ages。 How Galen would have
turned up his nose with contempt at the water supply of the capital of the
Dominion of Canada； scourged so disgracefully by typhoid fever of late！
There is no question that the public is awakening； but many State Boards
of Health need more efficient organization； and larger appropriations。
Others are models； and it is not for lack of example that many lag behind。
The health officers should have special training in sanitary science and
special courses leading to diplomas in public health should be given in the
medical schools。 Were the health of the people made a question of public
and not of party policy； only a skilled expert could possibly be appointed
as a public health officer； not； as is now so often the case； the man with the
political pull。
＇7a＇ Connecticut。
It is a long and tragic story in the annals of this country。 That
distinguished man； the first professor of physic in this University in the
early years of last century； Dr。 Nathan Smith； in that notable monograph
on 〃Typhus Fever〃 （1824）； tells how the disease had followed him in his
various migrations； from 1787； when he began to practice； all through his
career； and could he return this year； in some hundred and forty or one
hundred and fifty families of the state he would find the same miserable
tragedy which he had witnessed so often in the same heedless sacrifice of
the young on the altar of ignorance and incapacity。
TUBERCULOSIS
IN a population of about one million； seventeen hundred persons died
of tuberculosis in this state in the year 1911 a reduction in thirty years of
nearly 50 per cent。 A generation has changed completely our outlook on
one of the most terrible scourges of the race。 It is simply appalling to think
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of the ravages of this disease in civilized communities。 Before the
discovery by Robert Koch of the bacillus； we were helpless and hopeless；
in an Oriental fatalism we accepted with folded hands a state of affairs
which use and wont had made bearable。 Today； look at the contrast！ We
are both helpful and hopeful。 Knowing the cause of the disease； knowing
how it is distributed； better able to recognize the early symptoms； better
able to cure a very considerable portion of all early cases； we have
gradually organized an enthusiastic campaign which is certain to lead to
victory。 The figures I have quoted indicate how progressively the mortality
is falling。 Only； do not let us be disappointed if this comparatively rapid
fall is not steadily maintained in the country at large。 It is a long fight
against a strong enemy； and at the lowest estimate it will take several
generations before tuberculosis is placed at last； with leprosy and typhus；
among the vanquished diseases。 Education； organization； cooperation
these are the weapons of our warfare。 Into details I need not enter。 The
work done by the National Association under the strong guidance of its
secretary； Mr。 Farrand； the pioneer studies of Trudeau and the optimism
which he has brought into the campaign； the splendid demonstration by
the New York Board of Health of what organization can do； have helped
immensely in this world…wide conflict。
SOME years ago； in an address at Edinburgh； I spoke of the triple
gospel which man has publishedof his soul； of his goods； of his body。
This third gospel； the gospel of his body； which brings man into relation
with nature； has been a true evangelion； the glad tidings of the final
conquest of nature by which man has redeemed thousands of his fellow
men from sickness and from death。
If； in the memorable phrase of the Greek philosopher； Prodicus； 〃That
which benefits human life is God；〃 we may see in this new gospel a link
betwixt us and the crowning race of those who eye to eye shall look on
knowledge； and in whose hand nature shall be an open bookan approach
to the glorious day of which Shelley sings so gloriously：
Happiness And Science dawn though late upon the earth； Peace
cheers the mind； health renovates the frame； Disease and pleasure cease to
mingle here； Reason and passion cease to combat there； Whilst mind
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unfettered o'er the earth extends Its all…subduing energies； and wields The
sceptre of a vast dominion there。
（Daemon of the World； Pt。 II。）
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