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tend to reduce it, that there is danger. Then the disease germs that are everywhere are ready to take hold of their victim, when the blood agents have not the vitality to overcome and exterminate the intruders.
This, then, is what we know about tuberculosis. It is quite curable; it is not hereditary; it is not developed spontaneously, but directly by infection either by food, or inhalation, or other such means. The communicability of phthisis is coming to be realised in earnest. In New York it is as compulsory to notify a case of consumption as to notify a case of any other infectious disease. And what is true with regard to tuberculosis in man is equally true with regard to tuberculosis in cattle, for it is exactly the same disease, developed in the same kind of organism and amenable to the same treatment. What that treatment is I have endeavoured to show. There could not be produced, I believe, an authoritative cure from tuberculosis by any other means than by those I have indicated. Certainly the usual remedies, such as injection of tuberculin, administering guaiacol carbonate, creasote, &c., produce no satisfactory results. Cod liver oil as a curative agent is not in the question, as it is practically the treatment I speak of in one of its branches-namely, seeking to build up the patient's system by added nourishment. But cod liver oil is not such a good form of nourishment as the more natural fats and foods, such as butter, milk, and fat meats, etc., since it has the tendency to produce nausea.
Take the case of any one who has been cured of tuberculosis by apparently other means-say an invalid who had gone to Australia. The chances were great against his recovering there; but granted that he did recover, it was not by taking medicine that he got better. I contend that his recovery was entirely due to the three remedial agents: plenty of good food, rest, and fresh air. These are just a reversal of the conditions which brought about his illness. When he went to Australia it was either to do no work or to take up some very light employment. He lived in the bush an open-air life, and as a consequence of the change for the better in his surroundings his lost appetite returned, and he soon began to gain in weight. This gave him a start, which he was able to improve upon until he was quite cured, when it is certain he could be no other than a big burly fellow in comparison to his former self.
Perhaps the use of tuberculin, of all the attempted cures, is the raost likely one to prove serviceable. But at present it is valueless,
even Professor McCall Anderson, who writes in the British Medical Journal of October 1 on A Plea for the more General Use of Tuberculin,' has to admit'. . . This improvement,' consequent on the injection of tuberculin, ‘is but too often temporary, the morbid condition relapsing sooner or later after the treatment is stopped. The accuracy of those observations cannot be gainsaid.' He goes on
to say that in, addition to the injection of tuberculin, other means should be resorted to, such as good food, pure air, and other antistrumous remedies.
There is no saying of what use tuberculin may prove to be in the future, when its preparation and proper use have been thoroughly mastered, when used in conjunction with the Nordrach treatment. It is believable that it might prove to be of great utility in arresting the development of the disease, or perhaps in completely eliminating tuberculosis from the system, leaving the rational treatment, under better conditions, to rapidly build up the system and ensure a permanent cure. I think it is probable that, even now, such forms of the disease as lupus would yield to the proper use of tuberculin, if at the same time the patient's system were thoroughly nourished and built up. It has lately been reported that Professor Denys, University of Louvain, has discovered a new serum by which he affirms he can cure tuberculosis, which contention it is said he makes after exhaustive experiments. It is to be hoped that this is so, and that it is not another false hope such as Koch and Verneuil raised. But, even if it be true, it is certain that the injection of a serum could not possibly build up the shattered system. The very best it could do would be to arrest the disease by destroying the bacilli, and therefore in any case the Nordrach system would have to be resorted to in order that the strength might be restored.
Sir Thomas Grainger Stewart says that tuberculosis destroys as many lives as all the zymotic diseases combined, 50,000 to 70,000 dying annually from it in the British Isles. It accounts for at least one-sixth of the total death-rate. At a moderate estimate it affects 30 per cent. of all the cattle in this country. The question is, How are we to make use of the knowledge we now possess in the alleviation or eradication of such a scourge ? Evidently, since it is infectious, the first step towards mastering it is to stop the spread of the disease by keeping healthy subjects from becoming affected. The next step is to cure those who are affected, and at the same time, by periodic compulsory examination of all subjects, to discover at once fresh cases.
These fresh cases would be affected in such a slight degree that they would easily and quickly be restored to perfect health. By these means-preventing the spread of the disease, curing to the utmost extent the existing cases and singling out at once fresh cases for removal and treatment-tuberculosis in man and beast would at no distant date be eradicated, and a death from such a cause would be as rare in this country as a death from leprosy.
JAMES ARTHUR GIBSON.
IMPRESSIONS OF AMERICAN
Every one knows that America is the land of bold experiments, of rapid developments, of sudden adaptation of means to ends. Fewer people are aware how these qualities mark the recent astonishing growth of the higher education in the central and eastern states. Mark Tapley's sarcastic observation, "The soil being very fruitful, public institutions grows spontaneous,' is really scarcely an exaggeration. It may therefore be worth while to record a few of the impressions which I received from a brief visit to a number of American universities in April and May last.
Spoiled children of fate, the Americans are little accustomed to feeling impulses which they are unable to indulge. And so the desire of university education, which is widely spread, and which dominates both sexes, has given rise to a marvellous abundance of colleges. The degree-giving bodies in the United States may be numbered by hundreds. Many of the new universities have arisen from the gifts and bequests of wealthy benefactors, a class abounding in America. Some were instituted by the legislatures of the various states. It is a doubtful point whether the conditions imposed by the benefactor or those created by the not always enlightened members of the legislatures are least onerous. In both ways the natural tendencies of the colleges have been to some degree curbed. Coeducation of men and women, for example, has in some cases been forced on the teachers of universities by the external pressure of those who have had no experience in higher education. Of course many of the new institutions are at a low level. But everywhere the standard is rapidly rising. The University of Chicago, which has arisen since the World's Fair was held in that city, has drawn together a very able teaching staff and thousands of students, and already possesses a series of great buildings which form a very stately whole. Other northern universities, such as that of Wisconsin and that of Evanston, have increased tenfold in a generation. But the older universities of the east, Harvard and Yale and Princeton, still attract the ablest and most ambitious men; and in these the tendency is rather to raise the level of study than merely to increase the number of students.
Within the last twenty years the gradual spread of what is known in America as graduate study has completely changed the character of the universities. The older American colleges imported from England the notion of a course of undergraduate study in certain branches of knowledge, leading up to the bachelor's degree. Until recently the students who desired to go beyond the somewhat narrow limits thus set betook themselves to Germany. At Berlin or Heidelberg or Leipzig they pursued their course, and returned to America with the degree of Doctor of Philosophy, and a certain contempt for all learning that was not German. Within a few years the number of American students at Berlin has fallen to half what it was. The reason is that it is now possible to carry almost all studies much further without leaving America. This is largely the result of the influence of one university, that which is named after Johns Hopkins at Baltimore. The philosophical faculty of this institution was organised in 1876; and from the first it has been ambitious to give the highest teaching in languages, history, and science, rather than to attract numbers. According to the latest statement, there were at the university 520 students, of whom only 144 were undergraduates, the rest mostly graduates reading special subjects for their own progress, or for the degree of Doctor in Philosophy.
The organisation of more advanced study was taken up by other universities. Special libraries and apparatus of all kinds were procured, and the Seminar became a regular part of university organisation. According to recent statements, there are at Yale 1,783 undergraduates, and 729 graduate and professional students ; at Harvard the number of graduate students in the faculty of arts and sciences alone is 287. And as the number of teachers at Harvard, 404, is considerably larger than the number at any English university, as well as more evenly distributed over various studies, graduate students in that university are not likely to suffer for want of special instruction. The new University of Chicago claims to have an even larger number of graduate students than Yale and Harvard, though probably the degree which some of them have taken in the less developed colleges of the west is not of great value.
The sudden rise of graduate study, taken up not merely by young lawyers or students of medicine or divinity, but also in the ordinary course of arts and sciences, shows the immense vitality of learning in America. It can be no common force which makes men in hundreds postpone by three years or so their entrance into active life, and devote themselves to careful investigation of some particular subject in the field of science or history or letters. The individual is driven to this course because he knows that unless he does some good advanced work he will have no chance of appointment to any college post. And the attitude of the university world is determined by the conviction that unless a man has studied his subject seriously and become used to working at first hand, he is not really an educated man, nor fitted to educate others.
The graduate course naturally ends in the production of a dissertation in which some group of facts is thoroughly investigated or some new historical or philosophical view set forth. There is nothing on which the authorities of the Johns Hopkins University more pride themselves than on the dissertations which have been produced by the graduate students. They range over all fields, classical, oriental, historical, physical, biologic, and represent a vast amount of steady work. At Oxford and Cambridge the value of doctoral theses is curiously underrated. Many of them, both in Germany and America, are slight, and many are perverse. But it is most unfair to judge them merely in the light of additions to the sum of knowledge. Their great value is to those who produce them. Until a man has grappled individually with some serious scientific or historic problem, he can have no experience in the use of authorities, in the weighing of evidence, or in the methods of research. And such experience is the basis of higher education in the nineteenth century. Without it a man is quite incapable of judging of the tendencies of modern thought, or of appreciating the intellectual atmosphere which we have to breathe.
Americans are quite ready to recognise that a course of education thus dominated by love of knowledge and the encouragement of research has its drawbacks. Students are seldom sufficiently trained in the use of their own language; their education is far more effective on the scientific than on the literary side. In some cases they acquire the vices of the specialist, and by confining themselves to too narrow a field become myopic as regards the great world. But a perfect system of education has yet to be discovered ; and to Englishmen it should be interesting to study a kind of education of which the faults are diametrically opposed to our own.
It is natural that the great spread of higher education in America should have made the stay at German universities less imperative and less usual. Nevertheless, the newness of everything in America and the abnormality of social conditions there has naturally caused every real student to look beyond his own country to the older civilisation of Europe for many things. The ablest men still make some stay in Germany. France has of late made an effort to attract American students to Paris, by adapting the university curriculum to their needs. Both Oxford and Cambridge have introduced into their scheme new degrees, those of Bachelor of Letters and Bachelor of Science, to be conferred on graduates of foreign universities who pursue some definite course of study in England. This, however, is but a half measure, and is not likely to have much effect.