nd repudiated all British debts, and still reserves its right to repeat these operations as it may think fit.

Some of us do not need the support of party programmes to confirm us in our faith of freedom. Because the principles of free speech, civil liberties, and public finance have been established by a long history of @persistent effort-because these principles are almost like the sky above us, or the air we breathe, we shall not for that reason ignore them, or be stinting in our sympathy for the Russian people, deprived of them at the moment of achievement. And now the names of labour and freedom are used to cover the denial of these late-won blessings. There was a certain kind of snobbery in the days of the Tsars. A traveller, probably an Englishman, would patronise some province with a passing visit, lunch with the Governor, swallow his assurances that he was indeed the father of his province, and come back and write a book about 'my friend, the Governor.' Sometimes actually the same guides, well exercised in this work, are now showing round the docile admirers of the new despotism. And yet, could any greater insult be offered to the splendid traditions of labour achievement in Great Britain, over the long and detailed history of the last seventy years, than to tell us that all this successful spade-work is nothing, as compared with the unsavoury episode which brought the ruin of Russia, and that for us too there is no better way of progress than to pass through the same ghastly catastrophe? If it were indeed so, then British Labour could only have a profound cause for shame. But it is precisely in the fruits of that long spade-work, in the political sense which it has created, in the vital instinct of freedom which the habit of freedom has taught, that we have the guarantee that we shall not in this country 'tacitly accept' the loss of liberty, for any of the 'other benefits' here suggested to us, and this guarantee is more than enough.

BERNARD PARES.

Art. 11.-A CENTURY OF MEDICAL PROGRESS.

On Feb. 22 of this year the medical profession sustained the loss of its recognised leader, Sir Clifford Allbutt, who in his eighty-nine years had lived through changes which it is difficult to imagine will ever be rivalled in the history of medicine. During that time the country has passed through three wars of such considerable dimensions-the Crimean (1854-56), the campaign in South Africa (1899-1902), and the European War (1914-18)-as to give a graphic indication of the efficiency of medicine and surgery in emergencies. The deplorable conditions in the Crimea led to the creation of a nursing profession, the war in South Africa proved that however surgery had advanced-and to this further reference will be made -the control of epidemic diseases had not been mastered, and thus contrasted with the results attained by preventive medicine based on bacteriological research in the Great War.

Of biographies in general there are many, but few there be that are chosen for permanent approval, and in a special branch of activity such as medicine the number of outstanding biographies that will live are necessarily few. Whether or not Sir Clifford Allbutt's life will be written in full is not known, but it so happened that just after his death the Oxford University Press issued biographies of two great leaders in medicine and surgery, both of them by surgeons of great distinction. Dr Harvey Cushing, a leading neurological authority and operator, of Boston, Mass., has written in two volumes the Life of Sir William Osler (1849-1919), Professor of Medicine successively in Philadelphia (1884-89), the Johns Hopkins University, Baltimore (1889-1905), and the University of Oxford (1905-19). Sir William, who was of Cornish descent and Canadian birth, was eminent as a scientific clinical physician, as a leader in the study of medical culture and history, as a pioneer in campaigns against typhoid fever, malaria, tuberculosis, and venereal disease. But perhaps his most signal service was as an educator and reformer of the medical profession, for the extraordinary change that came over the teaching and practice of medicine in the United States of

America during his professional lifetime, owed much to his persuasive leading and influence when Physicianin-chief at the Johns Hopkins Hospital, Baltimore. He and his brother Regius Professor of Physic in Cambridge were ideal occupants of their chairs, combining, as is rare in these days, all the art and modern science of medicine with the instincts of the scholar-physician. Early this year the third edition of the Life of Lord Lister (1827-1912) was brought out by his nephew, Sir Rickman Godlee, Past President of the Royal College of Surgeons of England, who has recently passed beyond the veil. The first edition of Lord Lister's Life appeared in 1917, and, like that of Sir James Paget in 1901, was at once recognised as a really great biography, and the third edition contains a brief survey of surgery in 1924, showing how Lister's advances are utilised by the presentday surgeon's practice. This year has also seen the publication of the first Listerian Lecture delivered on May 14 at the Royal College of Surgeons by Sir W. Watson Cheyne, who accompanied Lister when he migrated from Edinburgh to London in 1877, and, like Sir Rickman Godlee, was his private assistant for many years, and has thus also given a first-hand account of the man and his work. Ambroise Paré (1510-90), John Hunter (1728-93), and Joseph Lister were the outstanding figures in surgery in the 16th, 18th, and 19th centuries respectively, and the last two were inspired, in the words of the great William Harvey (1578-1657), the discoverer of the circulation of the blood, 'to search and study out the secrets of Nature by way of experiment.' Lister by a long series of patient researches elaborated the principles of antiseptic surgery, and thus completely revolutionised the scope of surgical practice throughout the world; Lister's work was the practical application of bacteriology which was then brought into being by the great Frenchman, Louis Pasteur (182296), a chemist, not a medical man, to whom, however, humanity is mainly indebted for making surgery safe, and who has been well described as 'the most perfect man who ever entered the Kingdom of Science.' Two and a half years ago saw the centenaries of Pasteur's birth and of the death of Edward Jenner (1749-1823), the originator of vaccination against small-pox, whose gift to preventive

medicine is not so universally appreciated in this country at the present time as it deserves. The lives and labours of these two benefactors of mankind were practically without a break, for the younger by exact laboratory methods carried on and greatly extended the bearings of his senior's scientific clinical observations, and with the generosity of a really great mind fully acknowledged the significance of his predecessor's work, and did perhaps even more than justice by perpetuating his term ' vaccine' in a much wider sense than its original and etymological application. The difference in method-clinical and laboratory-practised by these two masters has of course continued after their voices are no longer heard; but a survey of the progress of medicine during the Augustan period covered by the lives of Lister, Osler, and Allbutt, which has served as the subject of innumerable introductory addresses and is impossible to treat in detail, would lead to the conclusion that the most epoch-making changes have been due to the sciences started by Pasteur -bacteriology and immunology.

In order to be in a position to attempt the cure or, better, the prevention of disease-and this latter is of course the true ideal of Medicine-it is essential to know the cause, and in a very large number of diseases, for our knowledge is far from complete, this is infection, or, in other words, invasion of our vile bodies by lowly organisms of the vegetable (bacteria) or animal (protozoa) kingdoms. The 'germ theory' of disease, as it was once called rather with a tongue-in-the-cheek attitude, cleared the way for effective action by revealing the cause of disease. Lister, appalled by the preventable deaths following operations in Glasgow, was working at this problem when he found that Pasteur had opened the way for him to apply in practice what became the antiseptic method. Pasteur demonstrated the almost universal distribution of bacteria, the efficacy of thorough sterilisation in preventing their life and malevolent action, and the fallacy of supposed spontaneous generation of micro-organisms. The practical result was that if infection from without was prevented, operations could be safely carried out without blood-poisoning starting from the necessary incision, and thus untold lives were saved and the scope of surgery enormously

his widened. The practical use of anesthesia, which has so nd wonderfully diminished the suffering entailed by operapations, dates from Oct. 16, 1846, when William Morton ar gave ether to a patient in the surgical amphitheatre of be the Massachusetts General Hospital, Boston, and from and Sir James Y. Simpson's discovery of the anaesthetic uses oof chloroform in 1847, which a contemporary clergyman declared was 'a decoy of Satan, apparently offering itself to bless women, but in the end will harden society and rob God of the deep earnest cries which arise in time of trouble, for help.' Anesthesia, however, was known long before the middle of the 19th century, for, in 1799, Sir Humphry Davy wrote, 'As nitrous oxide in its extensive operation seems capable of destroying physical pain, it may probably be used with advantage during surgical operations in which no great effusion of blood takes place.' No advantage, amazing as it now seems, was taken of this hint, and, indeed, surgery advanced but little after the introduction of surgical anesthesia until Lister showed how the more extensive operations thus rendered possible could be freed from the dangers of infection. Antisepsis, and its later development asepsis, and anæsthesia have enabled surgeons to revolutionise their art, the really important factor being the prevention of the entrance of micro-organisms into the wound.

The science of bacteriology or the study of germs, which was so largely due to Pasteur's initiation, led to a wider change even than the surgical transformation, and was responsible for a radical alteration of the conception of medicine as a whole; in the words of Prof. F. Widal, of Paris, 'No science has ever experienced such a revolution as that effected in Medicine by Pasteur's discoveries.' The causation and, therefore, the prevention of many diseases have thus been made logically clear, and the problems of immunity, originated by Edward Jenner, were elucidated and put into more extended practice. Thus the cure of diphtheria by antitoxin, the prevention of enteric fever by anti-typhoid vaccine which in the form of the T.A.B. vaccine (against typhoid, paratyphoid A, and paratyphoid B. fevers) was so remarkably successful during the Great War in obviating this usual scourge of armies in the field, and Vol. 245.-No. 485.

M