ity. The day when a doctor prescribed a fried toad for jaundice, and the people took it in all faith and gratitude, is gone or fast going, and the same may soon be said of the autocratic sway of the midwife.

The former requirements for a midwife were an age of 50 years or more, a laziness that scorned regular occupation, a disregard of pain and suffering, and ability to stand the sight of blood.

In these days midwives are expected to know something of obstetrics, or, at least, to know their own limitations and enough to call medical assistance when danger threatens in delivery or post-partum. This much would be a great gain, and in this even partial enlightenment of the people we might see some hope of solving the midwife problem.

The question before the profession is, What can we do and what can the State do to correct the present abuse? We, ourselves, can do much to help educate those we have now with us. It is my custom in all cases to explain to my nurses the necessity for and the process of hand sterilization, the methods of cleansing the vulva and perineum, the preparation of bed and dressings, the plainer features of presentation, descent, and delivery. I instruct them as to the signs of hemorrhage and the significance of uterine expansion and bogginess, how to knead the uterus and keep it contracted. Plain rules for diet and infant-feeding are given, and for the care of the baby's eyes and cord. It is needless to say that the instructions given are suited to the intelligence of the nurse. While it is frankly confessed that much of the seed falls on barren ground, the point is that something may always be taught, and that it pays to do it, especially as the instructions are given while the case progresses, and no time is lost.

What now of legislative enactment? It will be difficult to pass a suitable measure for two reasons. In the first place, such a bill, in order to pass, must be absolutely devoid of any suspicion of gain to our profession. In the second place, it will be hard to frame a bill that will improve the situation and still be so simple and practical that its requirements can be met by the class of women who will present themselves as candidates for license. This is the crucial point. If the future midwives were to be drawn from an even fairly-educated class, the problem would present few of its present difficulties.

We all know, however, that for the present and for some time to come our source of supply must be the negro women. We rarely find a young midwife. My experience is that not one in ten is under 50, and few of this race over 50 are capable of any training that requires more than a rudimentary education. We must be content with an humble beginning, and as the people learn to ap

preciate the value of legal supervision the requirements for license should be increased. I am convinced that if we make a start the problem will work itself out. We should begin by enforcing the existing law requiring registration of midwives and those who attend cases of labor for pay. Let the few who refuse to come forward be fined, and all who intend to follow the profession will flock to the clerk's office or else go out of business. I know this to be so, for many former midwives have given up their business rather than go to the small trouble of making monthly returns of births. We should be able to fix a day, say a year later than the act of assembly, after which all who propose to begin the practice of midwifery must obtain license by passing an examination. This examination should be plain and practical, embracing only the knowledge which is practically indispensable. The details should, as is now the case with medical examinations, be left to a board of examiners. The enforcement of the law should be placed in the hands of the executive officer of the State Board of Health. Violations of the law would first come under the notice of the county health officer, and it should be his duty to report the facts to the secretary of the State Board. As possible candidates are in most cases unable to go to the medical centers to attend lectures, the lectures must be brought to them. A combined board of lecturers and examiners should be appointed, say one man for each of three counties for the State at large and a suitable number for Baltimore city, who should meet and formulate a set of examination questions for the whole State. The lectures should be so arranged as to cover the questions for next examination. Each lecturer and examiner should twice a year visit the county-seats of the counties under his charge. Just before each series of lectures an examination should be held covering the ground gone over in the preceding course of lectures. A certificate of proficiency should be given to those who pass, stating that they have attended one course of lectures and are now entitled to attend cases of labor (but not for pay) under the supervision of some physician. The last course of lectures should cover the practical side of obstetrics, and the final examinations should test the ability of the candidate to manage cases of normal labor on her own responsibility.

It is evident that this is a mere summary. The details must be worked out in part by those who are able to draw up a proper bill and in part by those who are entrusted with its enforcement. As I said in beginning, my hope is to arouse sufficient interest to bring about an effort to solve the question. The cry for relief has long gone forth. Can we not answer it at the next session?

WHEN you fret and fume at the petty ills of life, remember that the wheels which go round without creaking last the longest.

DISCOVERIES.

By William Royal Stokes, M.D.,

Professor of Pathology.

INTRODUCTORY ADDRESS BEFORE THE FACULTY AND STUDENTS OF THE COLLEGE OF PHYSICIANS AND SURGEONS, BALTIMORE.

WHEN I first began to consider the subject of this address I was seized by an almost irresistible temptation to trace for you the development of medicine from its beginning to its brilliant present. Is there anything more striking than the contrast between the medicine of the twentieth century and that of the many centuries preceding it? But I must turn my back on this tempting opportunity in deference to my twentieth-century audience.

But strive as I may to ignore the years that are long passed, I cannot entirely avoid them. I must therefore ask you to forget for the present such things as railroads, telephones, printed books, presidential elections, and other similar privileges of civilization, and to transport yourselves in fancy to the island of Cos in the Grecian archipelago, and to the year 460 B. C., when Hippocrates, the greatest of ancient physicians, was born. Hippocrates produced upon medicine an influence which is felt today.

Living successively in Greece, Asia Minor, and Egypt, he both wrote and collected a series of writings which contain many facts still useful in our present medical practice. Passing over his various pathological views concerning the origin of all diseases in the irregular action of the four cardinal fluids-yellow bile, black bile, mucus, and blood-we cannot help but admire his accurate observations in dietetics, the symptoms of disease, diagnosis, and prognosis. His therapeutic skill was remarkable for the period in which he lived, and his knowledge of surgery embraced the proper methods of recognizing and treating fractures and dislocations, hernia, and tumors. He also practiced such operations as trephining, paracentesis, and amputation for gangrene. Many important medical facts were thus known even at this early date, and one could spend much profitable time in studying the lives and writings of the many ancient teachers who developed, handed down, and at times perverted the teachings of Hippocrates. But although we must omit these men from our present consideration, we dare not offend the shade of Aristotle, the teacher of Alexander the Great. We find this great naturalist in Alexandria, about 350 B. C., making profound researches in comparative anatomy and discovering the origin of the nerves from the brain, the optic nerve, the aorta, the ureter, and the pulsation of the heart in the embryo of animals. I shall only mention one more name of ancient times, that of Galen, the Roman physician, who flourished in the second century A. D. Galen studied anatomy at Alexandria, and then went to Rome and practiced as physician to the great moralist, the Emperor Marcus Aurelius. He defended and enlarged upon the writings.

of Hippocrates, and was an author of immense and versatile fertility. Besides writing 98 books on medicine, he published many other volumes on law, grammar, mathematics, and rhetoric. His writings were 389 in all, but he received little or no money for his books. He was paid 75 cents for his book of epigrams, and I suppose in order to make any money on them he had to write 388 more. Galen added no advanced ideas to the crude pathology of his day, but he practically founded experimental physiology by cutting the fifth cervical nerve and thus destroying the motion of the supraspinatus and infraspinatus muscles. He described many of the cranial nerves, located the perception of light in the retina, and his anatomical works contained many correct observations, and lasted as text-books to the sixteenth century. His contributions to surgery and therapeutics again rescued medicine from the grasp of superstition and quackery.

It would certainly be a most pleasant task to linger at this point in our journey in order to investigate the curious mysticism of the medicine of the Middle Ages. The entire universe was said to be filled with demons, and these disagreeable creatures could be managed only by prayers, offerings, exorcisms, and the laying on of hands. All of these measures were employed to cure diseases. The attempts of alchemists to produce gold from baser metals, although, of course, unsuccessful, laid the foundations of chemistry. These interesting things are mentioned in order to prepare for a flying leap through many centuries, passing in our flight the Arabian universities, such as those at Bagdad and Damascus, and the Moorish universities of Toledo and Granada, which preserved the traditions of real medicine during the Middle Ages. We can only mention the great Arabian teacher Rhazes of Bagdad, whose famous account of smallpox was the first correct description of this disease in medicine. We must also hurry on past the many important discoveries in medicine, surgery, physiology, pathology, anatomy, and treatment during the fifteenth and sixteenth ceuturies, and only briefly refer to the epoch-making observation of the circulation of the blood made by William Harvey and published in 1628. Of course, you all must know that until this time the simplest facts in the study of pathology were not understood. Even inflammation, with the migration of the white-blood corpuscles into the tissues, could never have been observed until the circulation of the blood was admitted.

It is most pathetic to observe how Harvey suffered on account of his discovery. Although physician extraordinary to James I and a man with a busy practice, he lost both position and practice when he announced his belief that the blood circulated through the arteries and veins, and regarded by many as a demented old man, he was allowed to end his days peacefully at Oxford. No one in England would publish his book, and it was brought out in Germany. Is it not fortunate that the pleasure obtained in the pursuit of scientific truths made it easier for him to stand the opposition of humanity?

It seems to me that the early growth and development of medicine down to the middle of the nineteenth century simply prepared the way for more important discoveries. While many observations were made, it cannot be claimed that they were of very great direct practical benefit to mankind, and in this particular they differ from our four great Anglo-American medical discoveries. Every one of these has alleviated the sufferings and pain of untold thousands, and will continue to relieve unborn millions of human beings.

The vale of Gloucestershire, I am told, is one of the most beautiful portions of England. Here, in the vicarage at Berkeley, Edward Jenner was born on May 17, 1749. At the age of 21 he went to London and studied under the famous John Hunter. The two men became firm friends, and it was certainly partially due to the careful training in scientific observation which he received from Hunter that his mind was prepared to receive and use the facts which led to his great discovery. After receiving his medical education he insisted upon returning to Gloucestershire, although he received many tempting offers to remain in London.

It is pleasing to learn from Dr. Baron, his faithful biographer, that Edward Jenner was a man of many attainments. He was very fond of the beautiful scenery which surrounded him, and although possessed of a busy practice, he found time for the study of natural history. He made interesting observations on the various fossils found in the rich geological strata of his neighborhood, and collected an extensive paleontological museum. He assisted John Hunter in his celebrated experiments on the hedgehog, showing how the temperature dropped from 97° F. in the summer to 48° F. in winter during hibernation. As a naturalist he explained in true Darwinian style the curious habit of the cuckoo in laying her eggs in the sparrow's nest to hatch, by showing that this bird does not remain in England long enough to both lay eggs and incubate them. The species must therefore be preserved by other birds. He also added much to the knowledge of the migration of birds.

He was said to be a charming companion, and was somewhat of a poet. He also wrote songs and set them to music, and, either with the violin or flute, he took part in many musical parties in his neighborhood. He detested cards and all games of chance.

If vaccination had not overshadowed all of his other work, Jenner would still have remained well known in medicine. His observations concerning the relation between sclerosis of the coronary arteries and angina pectoris, and between rheumatic endocarditis and chronic heart disease, were classical, but we forget, perhaps unjustly, all these things when we consider the discovery of vaccination.

We can almost trace the steps which led to this discovery-his refusal of offered honors in London, his training under Hunter, his residence in the only portion of England where cowpox was endemic, and his instinct as a naturalist.