Theobald Smith

“ We might, on the other hand, spend our whole life in a laboratory without acquiring more than a little manual and optical dexterity. We are in danger of forgetting that the training of the observational powers is simply developing another language made necessary by the expansion of medicine as a biological science. The true investigator may have but imperfectly trained senses, but he may still succeed in discovering and opening up a new country to us. With his intellectual power to grasp and arrange data, largely worked out by others perhaps, he finds his way through the unknown. ”

“ Perhaps, next to the education of physicians of the highest standards, the immediate duty of the university medical school is the development through research of preventive medicine and sanitary science and the education of sanitary officers. This, it seems to me, is the best way in which our debt to society can be discharged; for it is the way through which medicine has moved during the past quarter century to its present commanding position; it is, in fact, the way of least resistance for the human race to evade or mitigate the penalty incidental to advancing civilization. ”

“ Standing between the fortunate inhabitant of a large city whose water-supply and sewerage systems are above reproach and the farmer who bas it within his power to make them so with reference to his own wants, is the half-developed village or town, with its chiefly unsanitary conditions. Here the leaky cesspool still exists, close by the family well, or by the neighbor's well. ”

“ The thousands of city people, who flock every summer to the country and bring to the farming community considerable sums of money, should be properly protected against the dangers of polluted water and infected milk by the adoption of suitable methods of sewage disposal. Too frequently those who left the city for the purpose of gaining strength by breathing pure air, drinking pure water, and eating pure food, only return with the germs of an often fatal disease within them to swell the typhoid statistics of our large cities. ”

“ As I stated before, the knowledge of the world is covered with the froth of research fermentation of several years' depth, and the latter yields about as much genuine knowledge as the froth does actual fluid. The teacher can not well sound its depths unless he has made some independent studies of his own. Then he will be able to say something definite, whether he has been at work in this very field or not. His critical view will enable him to take sides and be positive rather than negative in his teaching. ”

“ The absence of any system of collecting garbage and miscellaneous waste shows itself by the littering of the yards, the alleys, streets, and even stream beds with all kinds of refuse. In some towns the premature introduction of a water-supply system causes the ground to become still more thoroughly saturated with diluted sewage, so that the wells of those households not yet connected with the water-supply are a continual source of danger. In such communities, appreciation of the necessity for a public control of sanitation has not yet made much headway. ”

“ Passing now to the more obvious external conditions which have tended to stimulate medical research, we may single out a few which have been of special importance. Perhaps the most ancient and strongest of all is the desire in the human breast to maintain health and prolong life. From its very beginnings the healing art has been weighed down with the greatest of problems, to save life and to cure disease, often in those of lofty estate, and its status for the time being frequently depended on its success or failure in accomplishing apparently the impossible. ”

“ DISPOSAL OF SEWAGE.
The vital thing which thus presents itself is the disposal of fecal matter and other refuse so that the wells, upon which most rural families depend for their drinking water, may remain pure. To this matter we will first turn our attention.
Every person who tills the soil is acquainted with the remarkable transforming power of the superficial layers of the earth upon manure and excrement. Out of these offensive wastes harmless substances are produced which are essential to the growth of vegetation. ”

“ There the days, months and years of disease processes must be concentrated into minutes and hours. Much of the laboratory work is like the ward visit, a fragment, to be pieced out through the agency of books, lectures and the imagination. ”

“ The spirit of research should be properly tempered by a true insight into the relation of enquiry to the great accumulation of knowledge and the reserve forces stored in the every-day experience of mankind and handed down from generation to generation.
In the meantime the optimism of the world which unknowingly assumes that medical science can rise above natural law and correct any and all excesses of individuals and communities must be met by a better education in natural science rather than abandoned to the manipulations of the charlatans of physical and mental healing. ”

“ Regulations are prescribed and enforced under which the individual household must avoid all conditions which are likely to prove dangerous to the health of the immediate neighborhood and of the entire community. In the country districts, and more particularly in isolated homesteads, the conditions affecting the health of the household are largely in its own hands, and more individual effort is required to maintain healthful surroundings than in cities. The farmer must supply himself with his drinking water and must get rid of the waste of the household as best he can. ”

“ This has not always been the attitude of medicine, for standing as it does under the too near and impending shadow of suffering and death, it was but natural to attack the most difficult and complex problems first.
It is needless to say that the position of the research worker of the immediate future will not be an easy one. The strain to produce something is far more wearing than teaching. The mental play of the teacher's mind to produce something is relaxation compared with that of the investigator to carry out a contract for the delivery of new knowledge. ”

“ It might be claimed that in an isolated homestead the danger is absent because the night soil from the healthy household can not contain the germs of typhoid-fever, and, therefore, the well water can not receive them from leaky cesspools and surface drainage. This would be true if the family lived secluded from other human beings. As the case stands, there is much more communication than is at first thought supposed. There is more or less coming and going of farm hands and other hired help, of tramps, peddlers, etc. The farmer travels more than formerly. ”

“ The physician can not control his patient excepting within a narrow range. Experiment as such, except when of a trivial nature, is forbidden by law and conscience. Statistics is the only court of appeal he has in attempting to prove success, and this method we know is open to serious error. On account of his peculiar and unique life work, the physician must build his education as broadly as possible and carry as much information as is compatible with normal thinking. The research worker, on the other hand, digs and delves and he must leave unnecessary encumbrances behind. ”

“ Though he must procure for himself drinking water, he is, in most cases, able to get a purer water from the ground than the sewage-polluted fluid which is the only water accessible in many cities. While he must get rid of night soil himself rather than have it disposed of by a water-carriage system conveniently located within the house, he may avoid the annoying complications of plumbing, bringing with it the leakages of sewer gas, the plugging up of soil pipes by the roots of trees or by articles carelessly thrown into them. ”

“ When in practice he is disturbed by the confusion of voices, which, like the will-o'-the-wisp, lead neither here nor there, or when he is perplexed by the movement of fads and fashions pointing now in one, now in the diametrically opposite direction, when he comes to realize that much of his professional work is still empiricism and that it moves from precedent to precedent, he will look back upon his best laboratory work with a feeling of relief and recognize in it the germs of the science of medicine where his results came true if he worked accurately, and where he could predict the outcome. ”

“ As a most important and timely contributory force to the advancement of medical research in recent years are the princely gifts of benefactors, with whom we especially associate the names of Johns Hopkins, Garrett, Fabyan, Rockefeller, McCormack, Payne, Morgan, Huntingdon, Sears, Stillman, and many others without whose aid medical research could hardly have commanded a corporal's squad today.
A factor not to be neglected in the advancement of medical science is the feeling of national pride. ”

“ Perhaps the most important acting from within has been the use of animals. The study of the great domain of infectious diseases has revealed such a similarity between the diseases of man and the higher animals that we hesitate now less than before to apply courageously the knowledge gained in our experiments upon the highest mammals to human physiology and pathology. Without this aid from animal life, medicine as a progressive experimental science would dwindle into insignificance. ”

“ Research begets new data and the opposition to these begets new research. Thus the fermentation is kept up and a froth several years deep lies on the surface which few can penetrate.
This haste and hurry is part and parcel of what might be called nature's lavish waste of energy. The volume of our information increases more rapidly than our knowledge of the principles which underlie and support it. The progress actually made is more apparent than real. ”

“ The teacher who is called upon to direct the work of students who are beginning to feel their way into unknown territory or who have already left the beaten path far behind must of necessity be an investigator. Without going ahead of them himself his counsel is apt to be wavering and at times he feels himself wholly helpless to advise. In other words, to direct research the teacher must be playing the chief part while his students, of whatever rank, should take subordinate parts all definitely working toward a given end. ”

“ With the growth of the cost of research it becomes of great importance to exercise care and selection in admitting men to research positions. Fortunately there are not many collateral attractions in a life of research and the process of elimination acts as a rule automatically. Still there is danger just now that some of the flotsam and jetsam caught in an eddy or else afraid of the current of practical life may seek the quiet of the laboratory, because of some imagined taste or capacity which fails to materialize later on. It is far better not to have any research workers than poor ones. ”