ed against the cunning of money sharks and thieves who, vampire like, live at the cost of the lives of their fellowmen.

It is a fact that men who never saw within the walls of a medical college, nor read the preface to a materia medica have put up teas and sold them under a guarantee: "No cure no pay." And our friends the druggists linger long, and tardily learn that they are not licened to practice medicine, but to compound the same;and not only druggists, but every cross-roads merchant has a fantastic array of blended colors showing that he too is an auxiliary to the quack, who gives him fifty per cent of all he can extort from the ignorance of his patronage, and recommneds his medicines as superior to the skill of the licensed physician in the community; also long as he correctly labels his articles and no one is sacrificed by his blunders he goes on unmolested. There are several other subjects that should engage the attention of the law making powers, such as an institution for the care of the idiotic so as to control them and have them taught to work, so that they may not be a burden to the state, and cared for in a state of of celibacy, lest they transmit a like trouble and kindred afflictions to posterity; and this would doubtless save untold misery and affliction could a like application be made to that unfortunate class whose glands have been inoculated by the king of germs (syphilis). It is a subject of great importance that there should be a standard of qualification for the midwives that go to and fro all over the country, oftentimes not only practicing their art but passing as experimental practitioners and surgeons. In conclusion which the time now suggests proper, there is one point that surely should engage the mind of every medical man and that is forensic medicine proper. This is the crucial test by which a man is often measured, yet is not always an impartial judge; but the first thing in every case is to thoroughly acquaint one's self with the subject under consideration, and second is to tell what you know to be true and enough to satisfy the demand and no more. With these credentials no man need shudder because he is made an object of conspicuity, nor need he fear to meet the cross examination that so often contradicts the witness and completely riddles his entire testimony. But David Crocket's maxim: "Know you are right and go ahead" will anchor any young man safe in the harbor of

success.

It was the boast of Augustus that he found Rome of brick and left it of marble. But how much nobler will be the sovereign's boast, when he shall have it to say: That he found forensic medicine dear and left it cheap, found it a sealed book, left it a living letter; found it the patrimony of the rich, left it the inheritance of the poor; found it the two edged sword of craft and oppression, left it the staff of honesty and the shield of innocence.

AN ADDRESS ON MALARIAL FEVER.*

BY WILLIAM SIDNEY THAYER, M. D., Associate Proffessor of Medicine in the Johns Hopkins University.

G

ENTLEMEN: In the few words I wish to speak tonight I shall endeavor to bring together some of the more important points which have been added to our knowledge concerning malarial fever since the discovery of the specific parasite sixteen years ago, and to emphasize their practical significance. I am aware that in Cleveland the disease is relatively rare, and yet its occasional occurrence and its interesting relations from a point of view of diagnosis with various other affections which are common with you here, as well as with us farther south, have suggested to me that a brief discussion of the subject might not be without interest.

Let us first consider the pathogenic agent. From time immemorial the prevalence of fevers in damp and marshy districts has been known. In old times, however, the malarial fevers were not sharply differentiated from various other febrile processes; in particular, typhus, typhoid, relapsing fevers and other septic infections. After the introduction of quinin, Torti, in 1712, differentiated a special class of fevers which yielded to treatment by this drug. These fevers, which occur especially in warm and tropical countries, and in damp, marshy regions, showed frequently an intermittent character, andto them the term "malaria" came to be applied.

*Delivered before the Cleveland Medical Society,

It is very remarkable how early the infections nature of malaria was suspected. Varro (B. C. 118-29) says; "Advertendum etiam si qua erunt loca palustria et propter eaudem causas, et quod arescunt, crescunt animalia quaedam minuta, quae non possunt oculi consequi, et per aera intus in corpus per os, ac nares perveniunt atque effictunt difficiles morbos." Thus, we see that not only was the infectious nature of the process suspected, but further, the infectious agent was believed to be an animal parasite. These views were maintained in 1716 by Lancisi, and later by Rasori and a number of other Italian observers.

The general idea which was held concerning the manner of entrance of the infectious agent into the organism is reflected by the popular term which has since become definitely attached to the disease. The word 'malaria" is nothing more than the Italian expression "mal' aria"-bad air. But these older ideas concerning the animate nature of the virus of malaria gave way gradually, especially during the early part of this century, to the theory that the parasite was of vegetable origin, this view having been especially put foward by Mitchell and Salisbury in this country.

This Their

In 1879 Klebs and Tommasi Crudelli described a bacillus which they believed to be the infectious agent of malaria. they obtained from the earth in malarious districts. observations, though incomplete and soon disproven, gained considerable credence, so much so that fifteen years after the discovery of the true parasite one of the leacing medical journals, published in the Engligh language, referred in an editorial to the opinion of these authors as settled facts.

In 1880 Laveran, a French army surgeon in Algiers, discovered in the blood of patients with malarial fever living organisms, which develope in the red blood-corpuscles of the affected individual, at the expense of which they grow dark pigmentgranules. These organisms are readily demonstrable microscopically, either in the fresh blood or in dried and stained speci

mens.

From the universal presence of these parasites in the blood of patients with malarial fever, their immediate disappearance with recovery, either spontaneous or under treatment by quinin, Laveran believed himself justified in assuming that they

Despite

represent the true pathogenic agent of the malady. the opposition which the discovery of Laveran met with at first, you well know how universal has been its confirmation by all observers who have had opportunity to properly study the disease. The great value of this advance, apart from the light which it has thrown upon the general pathology of malarial fever, is readily appreciated when we consider that it has furnished us with a simple and certain method of diagnosis of the dis

ease.

Now, though the discovery of the presence of a living animal parasite in the blood of all patients with malarial fever-a parasite which disappears with the recovery-is strong presum. tive evidence of the intimate relation between the symptoms and the organism; yet we must acknowledge that only one of Koch's three postulates essential to determine the causal relation between the parasite and the disease has been fulfilled. For the absolute proof of this causal relation we need in addition.

(a) To obtain the organism in pure culture outside the body; (b) To transfer the disease by inoculation from the pure culture into healthy individuals.

The cultivation of the parasite outside the body has never yet been accomplished, but we have in the blood of the infected. individual, which is otherwise sterile, essentially an already prepared pure culture: and repeated experiments by Italian, Russian and German observers have shown that intravenous or hypodermic inoculation of the blood of an infected individual will always transfer the infection.

As has already been said, Laveran's discovery has been almost universally confirmed by all observers who have had opportunity to properly study the disease. And to our credit be it said that our countrymen have been among the foremcst in continuing his work-Councilman and Abbott, Sternberg, Osler, James and Dock having early recognized the importance and value of the discovery.

After Laveran, the next great advance was made by Golgi, who, in 1885, studied the parasites observed in quartan and tertain fever, tracing all the steps in the life-history and reproduction, and noting the remarkable relation which exists between

the devolopment of the parasites and the clinical manifestations of the fever. Further studies by Roman observers and also by Golgi of the more irregular and pernicious fevers occurring in the tropics, and during the later summer and fall in temperate climates, have led us to recognize today three main types of the fever, each of which is associated with a special type of the malarial parasite;

(1) Tertian fever.

(2) Quartan fever. These may be classed as the regular intermittent fever; they occur in temperate climates thoughout the malarial season, forming the only cases in the earlier part of the year.

(3) The more irregular fevers have been termed by the Italians the "estivo-autumnal" fever. This type of the disease occurs commonly in the tropics, but in temperate climates it is observed. ouly during the height of the malarial season;that is, during the later summer and earlier fall.

The Parasite of the Regularly Intermittent Fevers; the Tertian and Quartan Parasites.

We now know that in tertian and quartan fever the parasite exists in the blood in enormous groups, all the members of which are approximately at the same stage of development. The parasite constituting such a group enter the red corpuscles as small, clear, amoeboid, hyalin bodies, which develop within the corpuscles, increasing in size and accumulating dark pigment-granules as a result of the destruction of the hemoglobin of the containing element. When the parasite is fully developed the pigment gathers into a single block or a clump of course granules, and the organism breaks up into a number of small, round hyalin bodies, each of which represents a fresh blood-corpuscle, and pursue again their cycle of development.

The length of the cycle of development of a group of tertian parasites lasts almost exactly 48 hours; so that, if one group be present in the blood, sporulation will occur every other day. On the other hand the cycle of existence of the quartan parasite lasts approximately 72 hours, sporulation occurring every fourth day.