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never before were there so many practitioners striving to keepabreast with the rapidly developing knowledge of pathologyand therapeutics ; but the equipment of the modern medicalman is a very elaborate one, and he who falls behind soon

comes to occupy a hopeless position in the race. If it be

admitted, as we think it must be, that the advances of

modern medicine are to be looked for, during the next few

years at least, chiefly in the direction of laboratory work, orof what is commonly understood by I research," we oughtto expect in medical education as it is now con-

ducted, even when academic honours are at its goal, adefinite tendency towards the production of scientific

men. The aim of the curriculum should be to qualify allmembers of the medical profession either to conduct

laboratory investigations for themselves, or fully to appre-ciate their value when conducted by others. The questionnecessarily arises how this condition of things may bereached-how medical education may be so modified as

better to prepare those who undergo it for the class of dutieswhich, at no distant period, they will inevitably be expectedto perform. The range of study is large and the time atthe disposal of the student is all too short. The univer-

sities, old and new alike, are striving to give to science the

practical attention which should ensure the production ofscientific medical practitioners, and the same may be saidof the various corporations, but even so it is difficult to see

how the average man is to find time to master the

chemical, physiological, or pathological investigations uponwhich, in the long run, we must rely for the cure of

individual disease and for the preservation of the healthof communities. Certainly we do not find that those

who have achieved the greatest academic distinctions

necessarily excel as practical men, while it must be admittedthat those who do so may in some instances find it

difficult to appear before the public in their right position,in consequence of not having obtained the label which

carries conviction to the public mind. And all this may

be read as showing that the medical curriculum is over-

loaded.

We have heard it suggested, and argued with considerable

weight, that the medical profession is not likely to be com-

pletely qualified for the discharge of its duties until the

scheme of its education is completely remodelled in a

fashion analogous to that which obtains for the Royal Navy,and until the future medical man, like the future naval

officer, is set apart from his very boyhood, and is compelledto devote himself continuously to studies bearing upon thework of his intended calling. The difficulties in the wayare threefold, the first of them being that the public, as atpresent advised, are not disposed to reward skill in medicinewith sufficient liberality to induce parents to incur heavy costin qualifying their sons to attain it; the second being thatthe suggested isolation from students of other classes mighttend to diminish capacity for dealing with the many personaland private questions with which the life of a medical practi-tioner becomes so inextricably blended. In the third place,who is to pay those who undertake this prolonged and costlyscheme of education ? 7 We doubt whether any one of these

objections is insuperable. It can scarcely be doubted thata definite improvement in the general character of medical

work would be followed by a corresponding elevation of thestandard of remuneration accorded to it; and we do notknow that the naval officer is less conspicuous than his

subordinate, the proverbially handy man," in his powerof mental adjustment to the conditions in which

he is called upon to work. But we have to regardthe idea, at any rate for the present, as visionary. All

that we can yet hope for is the gradual lengthening of

the statutory time of the medical curriculum, and the

introduction of simplifying modifications into the examina.tional schemes, as partial remedies for the existing un.

satisfactory conditions. In particular, any signs of effectiveunion between the universities and the corporations will beof promise, as tending to place all qualified men on a morepractical footing of equality, and so allowing the best ofthem to come to the front by the merits of their professionalwork.

The Position of Plague in India asIllustrated at the Bombay

Medical Congress.IT is now 12t years since plague first appeared in Bombay,

and during this period it has caused approximately six anda half million deaths. So far, in 1909, the death-rate hasbeen low, but too much stress must not be laid upon this, asthe rises in mortality which have occurred from time to time

during the long epidemic have had no distinct causes. The

cynical might say that plague in India has not been withoutits advantages. Before its advent the Government of India

were engaged in discussing what was considered to be oneof the great problems of the future-viz., how to relieve

India of a surplus population through emigration. That

problem has certainly been solved in some districts. Medical

science has also benefited indirectly as well as directly, forthe vast plague mortality stirred public opinion, so that a

Royal Commission was appointed, and to this we owe thebirth of the many fine research laboratories which have come

into; existence recently, the work in which has been the

subject matter of many most valuable papers and dis-

cussions at the Medical Congress recently held at Bombay.But there is, alas, another side to the matter. On the topof the colossal tragedy implied by these millions of deathswe have to remember that in certain districts there was

swept away some of the finest recruiting stock for the

Indian Army, while the persistence of the epidemic, andparticularly the measures which have been taken in some

places to arrest its devastations, have led to acute unrestin the native population. On every ground, humanitarianas well as political, we must all hope that the existingpromises of permanent abatement will be fulfilled.The contributors to the proceedings at the Bombay

Congress,l to which we propose to refer especially, are forthe most part experts employed either in research work inGovernment laboratories or in active plague prevention.The research done has been well carried out by devotedworkers in India who have caught the true spirit of

scientific research. The newly equipped laboratories which

1 A special supplement to the Indian Medical Gazette for Marchcontains a good précis of the proceedings of the Congress.

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provided facilities for earnest work can, therefore, be

intelligently used, and the country is benefiting by the greatfinancial outlay in a corresponding manner. The result of

this organised research is now unfolding a new state of

affairs as regards plague etiology and prevention. The

story is worth recapitulation as a chronicle of advancing know-

ledge. As is generally known, rats have been associated with

plague from time immemorial. The ancient Egyptiansfigured them in their crude drawings and referred to themin their writings. In modern times the facts that rat mor-

tality preceded outbreaks of plague in man and that therewas a disappearance of rats after plague epidemics hadworn themselves out were observed, but they were thoughtto be a coincidence until bacteriological investigation provedthat rat mortality was due to the bacillus pestis. The rat

was then perceived to be a probable source of the spread ofinfection and attempts were made to prove it, but not at firstwith success. Other sources of contagion were examined.

Plague patients were said to spread the disease by contactand by their excreta; and it was argued that, as

rats die from plague, their excreta, which foul human

dwelling places, might aid to infect man ; while rats, whichwill eat their own dead, might keep the infection up.

Then, as was inevitable, the work of those who had

shown that blood-sucking insects were often the causal

agents of the spread of disease, carrying infection fromanimals to man, and vice veIJ’sâ, attracted the notice

of those working on the investigation of plague, and

thus the hint was given that plague might possibly be

propagated by some form of parasitic blood-sucking insectcommon to.man and rats. In India vermin and parasites of all

kinds, especially fleas, are very common; the lower classesof natives and their dwellings are always infested by them,and once attention had been directed to the possibility ofsome such insect as the flea being the medium of infectionthe rest followed. It has now been definitely proved that

any species of flea common to rat and man is capable of

propagating the disease, if it is not also the chief means of

so doing. Major GEORGE LAMB, I.M.S., member of the

Advisory Committee for Plague Investigation, in a paperread before the Bombay Medical Congress, has given a verycomplete résum,é of the epidemiology of plague and comesto the following general conclusions, which he considersof the greatest importance from a prophylactic pointof view (we quote his own words): "1. Bubonic plaguein man is entirely dependent on the disease in the rat.

2. The infection is conveyed from rat to rat, and from rat

to man, solely by means of the rat flea. 3. A case of bubonic

plague in man is not in itself infectious. 4. Insanitaryconditions have no relation to the occurrence of plague,except in so far as they favour infestation by rats. 5. Plagueis usually conveyed from place to place by imported rat fleaswhich are carried by people in their persons or in their

baggage. The human agent not infrequently himself escapesinfection. "

The general subject of the prophylaxis of plague in an in-fected country was treated at the Congress in a paper byCaptain W. GLEN LISTON, I.M.S., of the Plague ResearchLaboratory at Parel. He also pointed out that plague was

essentially a rat disease and compared its spread by animals

to rabies and glanders. He dwelt on the means and

methods best suited for rat extermination and the diffi-

culties of the proceeding owing to the defects in native

houses, the general want of a sanitary environment, and theabundance of food-grain and garbage-available for rats inplaces where natives sleep. Captain LISTON advocates the

systematic setting of large numbers of rat traps in accord-ance with a well-organised plan of campaign, for he has

noted that where the trapping of rats has failed the causeis due to lack of organisation, defective operations, and wantof appreciation of the magnitude of the task by those

engaged on the work. Plague is carried by infected rat

fleas either on the person, in wearing apparel, bedding, orin merchandise, to rats and human beings elsewhere.

Disinfection of all domestic and personal environment is

therefore of the utmost importance, and the comparativesuccess of stopping the spread of plague from India oversea must to a great extent be attributed to this precaution.Rat extermination is therefore the first practical step to betaken. A method of rat extermination formed the sub-

ject of a valuable communication to the Congress byLieutenant-Colonel A. BUCHANAN, I.M.S. His advocacyof the cat as the most obvious method of destroyingrats should appeal to natives of India, especiallyHindus, who from their religious doctrines are for-

bidden to take the life of rats. The cat, if not too well

fed, is the natural enemy of the rat and does not become

infected with true plague. Professor SHIGA of Japan,who was present at the Congress, bore testimony to

the efficacy of cats in plague epidemics in the Far East.The importance of preventing the carriage of plague bysea, emphasising the necessity of disinfection of clothing and

destroying of rats in the docks of infected seaports, was

put forward by Dr. G. J. BLACKMORE, who regarded anyother attempt to hinder rats getting on board ships in wharfas ineffectual.

The good effects of anti-plague inoculation (by vaccine

prepared by the Haffkine method) were ably demon-strated by Major R. F. STANDAGE, I.M.S., based on

work done in Bangalore in house-to-house inoculation.2

Amongst a population of 89,599, including the militarygarrison, 40,573 inoculations were carried out ; of these 33contracted plague, 13 deaths occurring; 13 of the formerand nine of the latter may be discounted as the disease

occurred within ten days of inoculation, thus leaving 20attacks with four deaths. Amongst the 49,026 non-

inoculated 1653 attacks with 1387 deaths occurred. These

figures speak for themselves. Householders popularised themovement by giving Inoculation At Homes." The

debatable question of Recrudescence of Plague was

introduced by Major S. BROWNING SMITH, I.M.S., who hashad charge of the plague preventive measures in the

Punjab for many years. In some of his districts plague hasi

recurred after long intervals, during which no signs of infec-tion reaching the area or existing in it were apparent. He

’

attributes the non-prevalence to the fact that the ratr

population becomes so thinned out or exterminated duringan epidemic as to render their power of spreading the

2 Fully described in THE LANCET of June 6th, 1908, p. 1664.

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disease futile for a considerable period. We may observe

that this appears to support the theory already formed that

plague is kept "going " by its power of affecting some ratswithout fatal results and that these rats (often recognisableby ulcerous conditions of their bodies) act as I carriers," thedisease remaining quiescent until fresh arrivals coming fromthe fields after the harvest become infected. MajorBROWNING SMITH has also noticed that geographical con-

ditions, particularly rivers, aided the prevention of the

spread of plague, and he gave corroboration to rat mortalityoccurring as a forewarning sign to plague recrudescence.

The Defence of Science.IT has probably been the experience of many medical men,

as it has been our own, to be present when some member oja mixed company of intelligent and cultured people haschanced to make mention of experiments upon animals,and perhaps to introduce the topic with the word vivi-

section. At once the smooth interchange of ideas and

opinions has been broken by voices raised in sharpremonstrance, and the man who has innocently provoked thelittle storm is surprised to hear persons, marked generally bytheir liberal outlook upon the world and sympathetic appre-ciation of work done in fields not their own, pouring out vialsof unjust wrath and prejudice upon the heads of men who aredevoting their whole energies to the study of the laws of lifeand to the establishment of sound defences before each of the

many gates by which disease may attack its citadel. And

when a calmer spirit has been restored, in nearly every casea little accurate questioning will prove that the accusers

of science have spoken with such warmth, not out of

malice, but out of ignorance. Ridiculous as it may appear

in the telling, the attack may have been based simply uponan attachment to a dog friend, a feeling which commands

everyone’s respect and one which should not be warped bythe dread that a band of imaginary descendants of BURKEand HARE, practising in canine circles, are lurking roundstreet corners to pounce upon the household pet and bearhim off to the "vivisector’s laboratory," there to suffer a

lingering death of unspeakable torture with the sole reasonof satiating a useless curiosity or a lust for inflicting pain.Suppose that a medical man present on such an occasion

(regardless of the pleasant suggestion, which will be madeif temper is running high, that he is one whose professionnaturally makes him indifferent to suffering owing to his

constant association with it) can gain the ear of the companyand persuade them to listen to a short exposition of themethods of, and the regulations which control, scientific

research and of its claims upon the gratitude of mankind

- suppose this, and the result of the debate will often be

that the denouncer of science will look in the future

with more kindly eyes upon the exponents of experi-mental procedures as applied to the advance of medicine

in this country at the present day.We are re-telling a phase of an old story, but we are

prompted to do so because it is an ever-recurring phase ofa true story, and one in which we are convinced many of

our readers have acted, and will act, a part. And in order

that they may be prepared to do so to the advancement of

their calling and the honour of their science we desire to

bring to their notice a volume of publications of the

Research Defence Society 1 which have been selected by thecommittee from amongst those issued during the first year ofthe society’s campaign. The chief of these papers, which

include Lord CROMER’S presidential address at the publicinauguration of the Society, received our prominent noticeat the time of their first appearance in pamphlet form, butwe are very glad to welcome them again between bookcovers in company with shorter papers, equally able to

uphold the cause of science against the attacks of ignoranceor malevolence. In this book we renew acquaintance withLord Justice FLETCHER MouLTON’s evidence before the

Royal Commission on Vivisection, that impartial and

masterly justification of experimental medicine, in everyword of which there sounds the voice of the judgeand never of the advocate. The reading of it leaves butone regret, that the bench which has claimed the man

who gave that evidence has not been the bench of a

laboratory, for science might have looked for distinguishedservices from Lord Justice FLETCHER MOULTON, thoughin saying so we do not forget that his examination of

the methods of experimental research gains added authorityfrom his detached position and his expert knowledge ofevidence. Sir DAVID BRUCE’S paper on the Extinc.

tion of Malta Fever affords, perhaps, the most completeconcrete instance of the triumph of experimental scienceover a specific and widespread disease for which prolongedobservation had failed to suggest a remedy, although Dr.Louis CORTAULD’S paper on the Antitoxin Treatment of

Diphtheria presses hard on its claims. A paper by ProfessorE. H. STARLING on the Use of Dogs in Experiments containsthis significant assertion : "Though I have been engaged inthe experimental pursuit of pathology for the last 17 years,I can say that on no occasion have I ever seen pain inflictedon a dog or cat in a physiological laboratory in this

country, and my testimony would be borne out byanyoneengaged in experimental work in this country." Re i

remembered that Professor STARLING’S good faith in thismatter has been tested and found whole by the sub.

stantiated verdict of a British jury, a tribunal not too

sympathetic to science in the main and not apt to listen

unmoved to a well-founded cry of cruelty..

Of the remaining excellent papers we will mention onlyProfessor A. R. CUSHNY’S convincing demonstration that

experimental pharmacology affords the one safe guide in

therapeutic practice. Let one quotation suffice. "Digitalisis said, in 1860, to slow and weaken the heart, and theconclusion is drawn that it is useful in aneurism and other

similar vascular enlargements, in apoplexy, and in acutefevers. This was the result of 75 years of clinical

observation. Within a few years TRAUBE and BRUNTO

showed by experimental methods that one effect of digitalisis to raise the blood pressure in a remarkable degree,exactly the worst treatment possible in apoplexy and

aneurism." " This is the sort of stuff needed to convince

1 Publications of the Research Defence Society, March, 1908—March,1909. London: Macmillan and Co. Pp. 216. Price 2s. 6d. (or tomembers at cost price, 1s. 8d. post free, from the secretary, 70, Harley-street, W.). Four pamphlets included in this volume, and which werenot circulated with the set of pamphlets sent to members of thesociety last summer, will be sent shortly to every member.