447SOME GREAT NAMES IN FRENCH MEDICINE.

of an adequate reserve has been raised. This seemsto be met by a minute by Sir RECINALD CRADDOCKupon certain of the conclusions of the Commission.If sufficient British medical officers are forthcomingfor the proposed Civil Medical Service the problem issettled, " but if not, the Royal Army Medical Corps(India) will either be asked to increase its reserve tomake up the deficiency, or the Secretary of State willhave to make it good by special recruitment and onterms which will ensure the supply." The scheme forthe provision of a Royal Army Medical Corps (India)was proposed and elaborated by Sir CHARLES BURT-CHAELL, late Director of the Medical Services, and fromthe military side this force will practically be theIndian Medical Service in another form without, it

may be hoped, the old jealousies and frictions. SirPATRICK HEHIR, writing in TiiE LANCET (1924, ii.,633), stated that "it may confidently be expectedthat a good number of well-qualified young men of thehome medical scllools desiring an Indian career willjoin this service with a view to obtaining professionalwork in the provinces, and when political opinion hassettled down they will have a full and useful life." Somuch for the military side ; from the civil point ofview it has been strongly urged that all Europeanmembers of the services in India have a right to atten-tion by European doctors. This is met by the LeeCommission, who recommend the grouping of thedistricts of a province so that a British medical officer(civil or military) is posted to one station in each groupwith special arrangements for Europeans at any dis-tance from the station. Any objections to the LeeCommission’s proposals on this point are thereforewithout foundation. Pending any decision on therecommendations a limited number of Europeanofficers are being recruited for the Indian MedicalService on special terms. The dangers of consideringthis service as a permanent career by Europeans areobvious enough, but it does not follow that thesetemporary posts, which are being offered in attractiveterms, will fail to give valuable experience to a manwho is prepared to go abroad for a period at any ratebefore settling in consulting or general practice. Thenew policy in India is directed towards the progressiverealisation of responsible government. The progressis bound to be slow and gradual, and it seems logicalthat the changes in the medical services should also beslow and gradual. If the general standard of medicaleducation in India is to be raised, it will be some yearsbefore there is a body of adequately trained Indianmedical practitioners to take part in the Indianisationof the medical services ; but that this will ultimatelyresult in medical as well as other services is regardedas inevitable by those familiar with the political out-look in that country.

SOME GREAT NAMES IN FRENCHMEDICINE.

IN the history of a nation one finds but a smallplace assigned to medical discoverers and discoveries.Prof. Réne Cruchet, of Bordeaux. in a lecture deliveredto the Institut Français du Royaume Uni on Feb. 20th,commented on this and explained it as being duenot to ingratitude on the part of the historian,but to the fact that a doctor’s skill did not outlivethe body it was practised on, and thus his workhad of necessity an impermanent quality which wasnot shared with the products of the sculptor, thewriter, or the artist. Prof. Cruchet gave an interest-ing summary of the development of the healing artfrom its earliest beginnings in France. It was in 1220that the first French Facultv of Medicine at Montpellier Iwas officially recognised by Cardinal Conrad, and

although, as Prof. Cruchet himself pointed out, Francehas contributed less to medicine itself than she has tothe other arts and sciences, from that time onwardsshe has produced a succession of great medicalmen. The earliest great name in French medicineis that of Guy de Chauliac, the father of Frenchsurgery, who in 1363 published a book on Surgerywhich for four centuries was a bible for his suc-

cessors in that craft. Chauliac operated on hernias,.removed cataracts, and advocated extension in thetreatment of a fractured femur. Under the influ-ence of Guy de Chauliac the Montpellier Faculty ofMedicine remained pre-eminent during the fifteenth

century, a century which was harassed by epidemicsof plague, typhus, " ergot gangrene," and leprosy.From 1376, by royal edict, the professors of that.school were permitted to hold practical demonstra-tions in anatomy on the dead bodies of criminals.It was not until 1498 that the same privilege wasaccorded to the Faculty of Paris.About 1540 Vesalius published his work on ther

Structure of the Human Body after several years"study at Montpellier. There he had as his teacher oneRondelet, who,if he have no other claim to immortality,has been pictured for ever in the character ofRondibilis by Rabelais, who was his pupil. Amongthe friends and pupils of Rondelet was a group ofmen, Platter, Lobel, Delecluse, and Bauhin, whomLinnaeus called the fathers of botany, and who werethe forerunners of the genius of Boerhaave. Thesixteenth century may be called the century ofcontagious diseases, and among the names of thosephysicians of that date are Houllier, Frenel, physicianto Henry II., and William Vaillau, who helped to,differentiate various types of epidemic fever. Vaillau,in particular, separated small-pox from measles,and left a graphic record of the characteristicsymptoms of the onset of the latter disease. He also,gave the first description in 1578 of whooping-cough,which he called Tussis quinta or quintana. But.the outstanding figure of the sixteenth century isAmbroise Paré (11517-1590), of Laval, who laidthe foundation of modern surgery. While accord-ing due homage to the teachers of the old world,he nevertheless was imbued with the new spiritof learning, which so marked the renaissance.The century of Louis XIV., the seventeenth, hadno distinguished name in French medicine, for thewhole art in France was overshadowed by the worksof Harvey and Sydenham in .England, but it wouldnot be fair to take Moliere’s estimate of contemporarymedicine as altogether a just one. In 1651 JeanPecquet discovered the lymphatic circulation, anda little later Mauriceau wrote a treatise on Obstetrics,which may be considered as the first valuable workwhich had appeared on this subject. In theeighteenth century medicine broke away from thedogmatic conceptions which had dominated it in the-preceding 100 years. The great scientific movementhad begun which was going to transform thewhole of man’s outlook towards the body. Twonames stand out, those of Theophile de Borde andDe Barthez, who were forerunners in France of thereturn to the Hippocratic spirit of clinical observation.With the nineteenth century biology became a

science, and in turn was forged into a weapon for thefight against disease. Bichat (1771-1802), inspiredby Borde, first described the different kinds ofanimal tissues, and following him came the period ofexperimental medicine, the discovery of physio-logical functions, the work of Magendie and ClaudeBernard. Claude Bernard studied the action of

poisons on living tissues and concluded that diseasesacted on the body as poisons, but at the time of hisdeath in 1878, Pasteur had already shown by inocula-tion that anthrax was caused by the anthrax bacillus.This was the beginning of the microbic theory ofdisease. Physics and chemistry also paid their tributeto medicine in the hands of Duchenne and Mme. Curie.How many of the great names of nineteenth centurymedicine in France are familiar to us ? *? Baudelocquein obstetrics, Laennec, Trousseau, and Charcot in

448 AN INTERESTING RETROSPECT.

medicine, Dupuytren, Nélaton, and Terrier in surgery,Pinel and Esquirol the pioneers of the humanetreatment of the insane, among others. Of our ownmedical leaders, one doubts if the list of familiar nameswould be much longer. Medicine triumphs in thepresent, for as Dr. Cruchet says, it is a living thing,and cares little about its own ancestry.

Annotations." No quid nimis."

HEXYL RESORCINOL AS A URINARY

ANTISEPTIC.

URINARY infections, particularly pyelitis, provideone of the most trying problems in treatment. Themajority of those who have to deal with them arewilling to acknowledge that this field of therapyadmits of wide improvement. Up to the present nodrug administered by the mouth can be relied onto cure a chronic pyelitis, still less a chronic

pyelonephritis, and the topical application of lavageis admittedly of limited usefulness. For this reasonthe announcement of the discovery of a new urinaryantiseptic of great potency by a worker in JohnsHopkins University, Baltimore, has aroused interestThe drug referred to is " Hexyl Resorcinol," havingthe formula--

OH

An account of the properties of the drug was giventowards the end of last year by Veader Leonard.1The starting-point of Leonard’s investigations wasthe synthesis of certain of the lower homologues ofa series of alkyl resorcinols by Johnson 2 and hisco-workers in 1913. It was found that the successiveaddition of carbon atoms to the alkyl chain wasfollowed by a pronounced increase in bactericidalproperties, and a coincident diminution in toxicityto experimental animals. Hexyl resorcinol isclaimed to fulfil all the experimental qualificationsof the ideal urinary antiseptic-viz., it is chemicallystable, non-toxic, and non-irritating to the urinarytract, it has an antiseptic action in high dilutions inurine of any reaction, and is eliminated in highpercentage by the kidney. In addition it is saidto be actively bactericidal. It is found, however,that in human urine the drug is not infrequentlysecreted as a conjugate, and that this leads to a lossof the bactericidal action in the urine. Nevertheless,even in patients who apparently conjugate hexylresorcinol very completely, the difficulty can begot over by regular administration over several con-secutive days. One other point seems of importance-viz., that the simultaneous exhibition of sodiumbicarbonate also destroys the bactericidal propertiesof the urine, not apparently because it makes theurine alkaline, but perhaps because it in some wayfacilitates the complete conjugation of the drug.It is disappointing, and detracts considerably fromthe interest and value of the paper that no clinicalresults are given by Leonard. He does sum upgenerally results of treatment in human patients,but no detailed account is presented. He claimsthat all the coccal infections of the urinary tract

1 Journal of Urology, 1924, xii., 585-610.2 Johnson and Hodge: Jour. American Chem. Soc., 1913,

xxxv., 529.3 Johnson and Lane : Ibid., 1921, xliii,. 348.

clear up rapidly under hexyl resorcinol and withoutany other treatment. In coliform infections when thebacterial count is low, his drug is efficacious; whenthe count is high, disinfection is not obtained withoutadjuvant local treatment, and even then persistenttreatment is necessary. And when the infection hasspread below the surface of the mucous membranethe treatment is of no avail at all. Frank Kidd4 haspointed out, and none will gainsay him, that of allrenal infections probably about 70 per cent. are

coliform. He reports 140 cases of pyelitis in which117 were infected by Bacillus coli. It is just theinfections by coliforms which Leonard admits are

least influenced by hexyl resorcinol, and his remarkson his results in coli infections might really havebeen written by any other writer about any otherurinary antiseptic. Doubtless in the laboratoryhexyl resorcinol is a powerful bactericide and anadmirable antiseptic, but the human body is not aglass test-tube on a laboratory bench. The usualproblem confronting the surgeon in these cases isthat of a patient who has had a Bacillus coli pyelitisfor a long time ; nothing has so far brought aboutany improvement, and the patient grows tired of thewhole business. Hexyl resorcinol may help here, andit should certainly be tried, for while the author doesnot claim that it is the last word in the treatmentof all urinary infections, he does put forward strongclaims for serious experimental trial.

AN INTERESTING RETROSPECT.5

George Sterling Ryerson, who has just publishedan interesting account of his strenuous life, came ofan old Dutch family which first settled in NewAmsterdam, the New York of to-day, in 1647. Duringthe Revolution of 1775 the family were divided, andon the conclusion of peace the Loyalist membersmigrated to Canada. The writer of the book nowbefore us was born in 1858 (p. 20) or 1855 (p. 32),being the only child of his father’s third wife. Hestudied medicine in Toronto, Edinburgh, and Paris,and later in Austria and Germany, so that when hestarted practice in Toronto in 1880 he had an

unusually cosmopolitan outlook. He served as

a youthful private in the Queen’s Own Riflesin the Fenian Raid, and as a surgeon with theRoyal Grenadiers during the North-West Rebellionof 1885..In 1892 he gained a seat in the OntarioLegislature, and in the same year began his longstruggle for the reform of the Militia MedicalService. In 1895 he organised the St. John AmbulanceAssociation in Canada, and in 1896 established a

branch of the Red Cross in Canada. For all hisservices in ambulance and army medical servicework we must refer readers to the book itself, aswell as for his accounts of the Boer War and thelate war. In this latter struggle he not only gavehis own work, but he also lost his son, killed atSt. Julien, and his wife in the torpedoing of theLusitania. The book is a record of good workunassumingly performed ; but it is marred by errorswhich might easily have been corrected. The authorsays on p. 100 that the Order of St. John of Jerusalemwas founded by Peter the Hermit at Jerusalem in1030, having its origin " in the necessity for medicalaid during the Crusades." Now the first Crusadestarted in 1095. It is true that there was a hospitalin Jerusalem dedicated to St. John the Almoner,Patriarch of Alexandria, founded sometime beforethe recovery of the Holy Land by Godfrey, but Peterthe Hermit did not visit the Holy Land until about1094. After Godfrey had captured Jerusalem thededication of the hospital was changed from St. Johnthe Almoner to St. John Baptist and the societywas organised as an Order in 1118. The curious thingis that Dr. Ryerson gives as his authority for his

4 Kidd, F.: Common Infections of the Kidneys, Oxford Uni-versity Press. P. 14.

5 Looking Backward. By Major-General G. S. Ryerson,M.D., C.M., Canadian Army Medical Services. Toronto: TheRyerson Press. 1924. Pp. 263. $2.50.