DEATHS FROM CANCER AT DIFFERENT AGE-PERIODS (ENGLAND): AGE-PERIODS OF MALES

YEAR Under 25-35. 35-45. 45-55. 55-65. 65-75. Above Total. 25. 75. - - 1906 250 322 927 2,454 4,087 3,651 1,566 13,257 1907 305 277 921 2,392 4,041 3,675 1,588 13,199 1908 274 317 925 2,594 4,147 3,957 1,687 13,901 1909 262 296 921 2,581 4,319 4,174 1,710 14,263 1910 283 337 1,001 2,778 4,377 4,315 1,752 14,843 1911 309 317 978 2,901 4,627 4,602 1,855 15,589

Precisely the same phenomenon is to be found in the cancer-mortality of women. Each ten-year period of life exacts its own proportion, with an increasing death-rate out of proportion to the increase of population.

Another fact, attainable only by the study of English statistics, is the singular regularity with which malignant disease selects different parts of the body year after year. If proclivity to this mysterious ailment were a matter of chance, or dependent upon the irregular action of certain forces, we should certainly fail to find such uniformity, or such approach to uniformity, as exists. One year, for instance, there would be, let us say, a preponderance of attacks upon the skin; another year the digestive organs would be the principal sufferers; a third year the joints and muscles would be chiefly involved. The actual experience proves that we are subject here to forces of incalculable stress, which nevertheless press steadily and uniformly upon humanity, where the habits and environment are the same. In the year 1901, for example, of the total number of fatal cases among men, the seat of the disease was the stomach in a little over 21 per cent. of the total number of cases. In 1910 the proportion was also 21 per cent. During the ten years 1901-1910, of the total mortality, the stomach was the organ involved in but a fraction over 21 PER CENT. OF THE TOTAL CASES.

Is cancer increasing? This is a question of vast importance to the human race. That in proportion to total population more die from the disease to-day than twenty or thrity years ago, is a fact about which there can be no doubt. Dr. Stevenson, in the Report of the Registrar- General for the year 1910, tells us that in "all countries from which returns have been received the mortality has shown a general tendency to increase in recent years." Speaking on the "Menace of Cancer," the statistician of the Prudential Insurance Company of America affirmed that "the cancer death-rate in the United States is increasing at the rate of 2.5 per cent. per annum, and a corresponding increase is taking place practically throughout the civilized world." The cancer- rate among men in the United States has increased, according to the same authority, 29 per cent. during the last decade. The steady increase of cancer year after year is strikingly shown by a curve diagram, based upon the English mortality for several years.

A significant illustration of the steady increase in the mortality from cancer is shown by its fatality among women in England between the ages of forty-five and sixty-five. In the year 1875, of all deaths of women at this period of life, one in ten (in round numbers) was due to some form of malignant disease. In 1890 the tribute exacted by the disease had become one in eight. Ten years later—in 1900—of all women dying in England during this period of middle life, the toll of cancer was one in seven; and in 1910 the corresponding proportion was one in five! At this rate of increase it will not be many years before a full third of all the deaths of women at this time of life will be due to malignant disease. There can be little doubt that the same phenomenon would be found to pertain to American experience, were it possible to disentangle the facts from the obscurity in which they are now permitted to lie. It is a curious fact that in England until the year 1900—and, so far as we know, for thousands of years—the death-rate from consumption among women was considerably higher than that of malignant disease; that in 1903, for the first time, the cancer-mortality of women exceeded that of phthisis; and that in 1910 it had so far surpassed it that they are not likely ever again to be equal, unless we shall discover the cause of the more fatal plague.

The theory has been put forth by certain writers that the increased death-rate from cancer is due, not to any increased frequency of the dissease, but rather to improved methods of detection. It is quite certain that fifty years ago, for instance, surgeons were less able and less willing to pronounce judgment regarding obscure cases of internal tumours. But if the better diagnosis of to-day accounts for some part of this increase since 1860, it does not seem probable that it can explain the rising death-rate of the last ten or fifteen years. The medical practitioner of 1900 was certainly as well qualified to pronounce upon the character of the disease as the surgeon or physician of to-day. Nevertheless, the cancer death-rate of England in 1910 had increased 16 per cent. above that of ten years before, and during the fifteen years 1895-1900 it had increased fully 28 per cent. Certainly in these last few years there has been no such increased ability to detect the disease as would account for all this. Yet another fact suggests doubt of this optimistic hypothesis. If the increased cancer death-rate were due merely to the increased ability of the physician or surgeon to recognize the ailment, we should certainly find that the increase of cancer would be seen only in those parts of the system, such as internal organs, where some degree of doubt might perhaps be entertained; while, on the other hand, there would be little or no increase discernible in the mortality of cancers affecting parts of the body where its nature could not be mistaken by any intelligent physician or surgeon. Now, for a number of years, perhaps with this hypothesis in view, the Registrar-General in England has tabulated all deaths from cancer of either sex, not only by different age-periods, but also by the part of the body affected by the fatal disease. A study of the facts thus made known is extremely suggestive. It is true that a marked increase in the death-rate has occurred in cancer affecting internal organs, as we should naturally suppose; but it is also true that malignant disease affecting parts of the body where little or no doubt of the character of the ailment could be entertained by the physician, exhibit in some instances as marked an increase in the death-rate as in some other cases, where doubt of malignancy might be justifiable. For example, cancer of the tongue among men showed a death-rate of 32 per million population in 1897; it went up to 47 per million in 1910— an increase of nearly 50 per cent. Cancer of the female breast showed a death-rate of about 142 per million population in 1897; it had arisen to a rate of 190 per million only thirteen years later; and here, assuredly, the nature of the disease in fatal cases cannot be mistaken.[1] Cancer of the stomach in its final stages does not present insuperable difficulties in way of diagnosis, but the death-rate increased for men about 40 per cent. in fifteen years; and although some of this increase may be due to more careful discrimination between cases of malignant disease affecting the liver, yet this explanation cannot account for the increase when both organs are considered together. The subject is worthy of careful and extended investigation, but even a cursory examination of the facts now available indicate a real increase in the death-rate from cancer in England, and probably in every other civilized country in the world.

[1] "During fourteen years ... the mortality from mammary cancer has increased by about 29 per cent., NOTWITHSTANDING LIVES SAVED BY IMPROVED METHODS OF OPERATION."—Registrar-General's Report for 1910, p. 69.

But all these phenomena are of secondary importance compared with the great problem of medical science—the yet undiscovered cause of malignant disease. During recent years the study of cancer has been conducted with scientific enthusiasm in many laboratories. Vast sums of money have been given, in the hope that these studies may one day lead to the discovery of a cure. One whom I knew in his youth became the heir of great wealth; lived to see one whom he loved perish from the disease; was struck down himself, and dying, left a fortune for the purpose of promoting research concerning cancer. And yet to-day the problem, as attacked in the various laboratories of Europe and America, is apparently as far from solution as it was forty years ago. Sir Henry Butlin, ex-President of the Royal College of Surgeons, England, is said to have operated on as many cases of cancer as any surgeon of his day. Yet, speaking in October, 1911, he said:

"I have been associated with the Imperial Cancer Research and in touch with its staff from the foundation of the Research, and have been a member of the publication committee of all its scientific reports. IT HAS DONE NOTHING ON THE LINES IN WHICH OBSERVATION HAS BEEN SO USEFUL. It has not unfolded the life-history of a single variety of cancer, so that we can base our operations on the information. It has not even discovered whether spontaneous cancer of a particular part of the body in the rat or mouse runs a similar course to spontaneous cancer of the same part of the body in the human subject. These problems are not suited for experimental investigation; they are determined by observation."[1]

[1] Lancet, London, October 7, 1911.

No "serum," no drug, no curative agency of any kind, has thus far been discovered upon which the slightest dependence may be placed. The only measure of relieve which medical science can now suggest is early and complete extirpation. Of what proportion of cases even this insures immunity we cannot tell.

Without decrying what has been done in the laboratory, may it not be that we have gone in that direction as far as there is any hope for success, and that all effort should now be directed TO THE DISCOVERY OF THE CAUSE OF MALIGNANT DISEASE IN HUMAN BEINGS? That great secret still eludes us, but until we can penetrate that mystery, it is difficult to perceive how we may hope to prevent the increasing prevalence of the great destroyer . Yet there is one method of investigation which (speaking from a study of cancer statistics for more than twenty-five years) seems to me to offer, more than all others, a reasonable hope of ultimate success. It is independent of all sacrifice of animal life. It involves, however, an expenditure far greater than is possible for any private investigator, and probably only by the co-operation of the Government can it be undertaken with any chance of success. Yet, if Society can once be aroused to a recognition of the need for the completest possible investigation concerning malignant disease, and particularly the reasons for its differing prevalence among people of different nationalities, habits, and general environment, that inquiry will take place, even though it cost the price of a battleship.

The subject is so vast and involved that it cannot be discussed with any approach to completeness in a single essay. Suppose, however, that we glance at the theory which regards cancer as due to a microbe which in some mysterious ways gains admission into the human body, lying for a time dormant, but liable under appropriate stimulation to be awakened into malignant activity. We know at the outset that if any such germ of disease exists, it has thus far escaped visual recognition. No human eye can be said with certainty to have seen it, even when aided by the most powerful microscope; but this may be due to the fact that, like the germ of certain other diseases, it is so minute that it lies beyond the range of human vision. There are, however, certain facts pertaining to the disease which have significance. We have already seen that in a given country there is a kind of uniformity in the number of those dying from the disease from year to year; but another phenomenon relates to the unequal pressure in difference countries of the causes of the disease.

1. THE DEATH-RATE FROM CANCER APPEARS GREATLY TO VARY ACCORDING TO RACE AND ENVIRONMENT.

CANCER DEATH-RATE IN DIFFERENT COUNTRIES PER 100,000 POPULATION

- Five-Year Periods. Switzerland. England. Italy. 1886-1890 .. .. 114 63 43 1891-1895 .. .. 122 71 44 1896-1900 .. .. 127 80 51 1901-1905 .. .. 128 87 55 -

Here is the record of a period of twenty years. These differences of proclivity to cancer are exceedingly curious. Can the reader perceive why they exist?

The rate in England is quite 50 per cent. higher than that of Italy. If we explain this by the hypothesis of greater skill in detecting the disease, what are we to say of the cancer-rate in Switzerland, which is 50 per cent. higher than that of England?

But here is another curious fact. The United States census of 1900 permits a contrast of the mortality of cancer according to the birthplaces of mothers of those attacked. Here, for instance, is the death-rate from cancer and tumour of persons of different nationality, calculated in three sections of the country—the rural districts of the registration area, the cities of the same section, and the cities outside the registration area.

DEATH-RATES IN THE UNITED STATES FROM CANCER AND TUMOUR PER 100,000 WHITE POPULATION, ACCORDING TO THE BIRTHPLACE OF THE MOTHERS OF PATIENTS

- Registration Area. Other COUNTRIES. Cities. Rural Cities. Districts. - - Italy .. .. .. 20 24 39 Russia and Poland .. 26 30 26 England and Wales .. 79 77 80 Ireland .. .. 90 82 86 -

How are these facts to be explained? What is there about the habits, the environment, the dietetic peculiarities of the Italians in America, which tends to confer upon them a greater immunity from cancer than is possessed by those whose maternal ancestry goes to England or Ireland? Assuredly this immunity is not due to chance. It is governed by some law, even though that law be unrecognized to-day. If the low cancer mortality of Italy made itself manifest only in that country, we might suspect it indicated a lack of skilled diagnosis; but here we find it just as prominent in three different section of the United States. Not only that, but the difference is seen in comparison of parts affected by cancer. For persons whose mothers were born in Ireland the death-rate in cancer of the stomach per million population was 184; the corresponding rate for Italians was 56.

Does the poverty of the people have anything to do with proclivity to cancer? In one way this is a probability. If we could compare the general prosperity of men and women whose parents were born in the United States with the entire population of which the parents were born in other countries, it seems to me that we should find the second class, taken as a whole, to be financially less prosperous than the first. Now, in 1900, the census reveals that in the United States the class to suffer chiefly from malignant diseasewas that which included THE FOREIGN-BORN POPULATION, alike in cities, in rural districts, within or without the registration area. This is certainly a fact of tremendous import. In America the population is a blend of every European nationality. Why, taken as a whole, should the native American suffer from one mysterious disease less than some of those who have come more recently to the United States?

In another work I have ventured to suggest that if we are to discover the cause of cancer, we must study the habits and customs of those still living who have become the victims of some form of this mysterious disease. A theory held by some is that cancer is due to the consumption of meat. If one means that the flesh of perfectly healthy animals is liable to cause cancer, the hypothesis is one for which it seems to me that the evidence is far from being sufficient to justify belief. But if, on the other hand, it is suggested that malignant disease may be due to germs derived from animals which were suffering from som form of cancer when they were killed for the food of human beings, then much that is otherwise obscure becomes plain. We should expect in such cases to find cancer more prevalent among the poor than among the rich, and especially prevalent among those who, from carelessness, or ignorance, or seeming necessity, consume the cheaper kinds of meat. And since, both in their native land and in America, the Italian population consumes less meat than peoples of other nationalities, we should expect them to be less liable to be infected by the germs of malignant disease.

A few years ago a medical writer who has given much attention to this disease published some of his investigations into the cancer death-rate of Chicago. Taking the figures for a single year, he discovered that the "cancer death-rate among the Irish and German residents of Chicago is the highest in the world, being nearly 300 per cent. higher than in their native countries."[1] Of each 10,000 population of each nationality living at the age of forty years and over, he found that the deaths from cancer among the Germans was 76, among the Irish 70, among the Scandinavians 52, and among the natives of Italy 24. It was found that, while the staple diet of Italians in Chicago was macaroni and spaghetti, the people of other nationalities among whom the cancer-rate was exceedingly high, "consume large quantities of canned and preserved meats and sausages, OFTEN EATEN UNCOOKED." He discovered that a large part of the fresh meat prepared at the establishment of a certain slaughtering establishment in Chicago was derived from animals which had been condemned on the ante- mortem inspection, but the flesh of which was perimitted TO BE SOLD AS PURE FOOD AFTER THE DISEASED PARTS HAD BEEN REMOVED. Sold thus at a cheaper price, such meat was chiefly consumed by the poorer classes of the foreign population. And while Dr. Adams does not adopt the hypothesis of the cancer-germ, he does not think there can be "the slightest question but that the increase in cancer among the foreign- born over the prevalence of that disease in their native countries is due to the increased consumption of animal foods, PARTICULARLY THOSE DERIVED FROM DISEASED ANIMALS."

[1] See article by Dr. G. Cooke Adams in Chicago Clinic of August, 1907, pp. 248-251.

A statement like this is calculated to induce serious reflections. The average reader finds it difficult to believe that, according to the present interpretation of the law, the flesh of animals found to be suffering from cancer at the time of their slaughter would be permitted to pass into the world's food-supply. We are int the presence of a great mystery. We do not know how the gret plague originates. But no reflecting man or woman can be insensible to the significance of possibilities when he learns that cancer affects animals which are killed for food; that in the majority of cases the disease affects some part of the digestive tract; that it chiefly prevails among the very poorest classes of the population, excepting only those like Italians, who use but little meat; and that, according to the official regulations of the United States Government in force to-day, THE FLESH DERIVED FROM CANCEROUS ANIMALS NEED NOT ALWAYS BE DESTROYED AS UNFIT FOR HUMAN CONSUMPTION. The cancerous tumour, the affected parts, must indeed be cut away, and carefully condemned. The disposition of the remainder of the meat is left to the decision of the inspector!

The regulation so far as it applies to meat of this kind, is as follows:

"ANY ORGAN OR PART of a carcass, which is badly bruised, or which is affected by tumours, MALIGNANT or benign, ... shall be condemned; but when the lesions are so extensive as to affect the whole carcass, the whole carcass shall be condemned."[1]

[1] Regulations governing Meat Inspection, U.S.A. Regulation No. 13, section 23. See also Appendix VIII., p. 362.

The meaning of this regulation would seem to be perfectly clear. There is no demand by the Government that the entire carcass of an animal affected by malignant disease shall be utterly destroyed for food purposes, unless the disease has involved the entire body,—a condition as rarely found among domesetic animals, as among human beings. Otherwise than this, what is there in the official regulations of the bureau governing meat inspection to prevent such use of the flesh of diseased animals as the inspector may authorize?

It seems to me that if science is ever to discover the cause of malignant disease, there should be a careful study of all the conditions under which the disease now manifests itself. The mortality from cancer in the state of New York, in 1912, amounted to 8,234; in England, the number of those who perished from the disease in 1911 was nearly 36,000. By what figure must we multiply this mortality in order to ascertain the number of persons living who have been affected, or who now are suffering from cancer? Nobody knows. What has been the success of surgery in securing immunity from a recurrence of the disease? So far as the entire country is concerned, we are entirely ignorant. Is it true that among the class of people in such cities as Chicago, where cancerous animals are used for food, cancer is especially prevalent year after year? If true, it should be fully known. Such facts must be ascertained, if ever we are to penetrate the secret of the dissease. Even the number of victims of each sex is not given in the mortality reports of the state of New York at the present day.

Let us suppose that the time comes, when with a realization of peril pertaining to ignorance, public sentiment shall urge the attainment of knowledge concerning cancer as it now affects the general population. In what way is information of this character to be secured? Assuredly not by any of the ordinary census methods, implying publicity. The only practicable enumeration would be one conducted privately, by members of the medical profession. Nor can it be done parsimoniously. In the state of New York, there may be, to-day, 50,000 cases of malignant disease. To have every case, completely reported, might cost the state half a million dollars. Perhaps even the patient should be compensated. Certainly some method could be adopted whereby the reports should be absolutely confidential, the patient being known only by a number. But all this is of minor consequence. When the necessity of the inquiry is everywhere recognized, the details pertaining to accomplishment will be easily arranged.

Assuming the willingness of patients and friends to assist in making a State-wide inquiry concerning the prevalence of malignant disease, let us see in what directions the investigation will be conducted.

FIRST. After securing the name, age, and place of birth of each individual sufferer, and the particulars which would suggest themselves to every physician or surgeon, inquiry should be made concerning the parents; the names, nationality, religious faith, place and date and cause of death. Especially should inquiry be made whether there have been other cases of cancer in the family, and their termination or present state.

SECOND. What is the location of the suspected ailment? When were the first symptoms manifested? To what cause, if any, were they ascribed? Has any surgical operation been performed, and if so, what are the details of time and place? Has recurrence followed operation? For what period was there freedom from symptoms?

Whatis the social position of the patient? Does he belong to that class which is enabled always to select the best food, the most sanitary dwellings, and all the conveniences of well-ordered and comfortable existence; or, on the other hand, to the extremely poor class, which disregards cleanliness, indulges to excess in the use of stimulants, and consumes the poorest and cheapest kinds of meat? I deem it of great importance that the completest possible information be secured concerning the usual diet of every sufferer from this disease. Is he a vegetarian? Are viands invariably well-cooked, or eaten sometimes rare or raw? Is there a liking for the canned products of the packing-house, or for sausage that comes from the same source?[1] What is the water-supply? Within the knowledge of the patient or friends, has there been any other case of malignant disease in the same house? Is residence near any fresh-water lake or stream?

[1] The relation between diseased meat and human ailments is treated at length in my work on "American Meat," New York, 1909.

These are suggestions only. They constitute merely an outline of the information that is necessary, concerning the living sufferers, in whom the disease has made its appearance. Doubtless the average reader will discern no reason for all these inquiiries. Yet each one has some pertinency to the possible discovery of the great secret. Does inquiry concerning family history seem useless? It should have a decided bearing on any theory of heredity. Does the occurrence of near-by cases have no significance? We are not yet in a position to state this as a fact. Does inquiry concerning religion seem especially impertinent? What if some future investigation should prove that cancer everywhere, is more prevalent among the Christians than the Jews? Does the social condition of the sufferer seem to have no relation to cause? What if we discover, that everywhere,—and not among the foreign population of Chicago only,—cancer finds an undue proportion of its victims among the poorest and most poverty-stricken element of every nationality? Does suggestion of inquiry concerning diet induce a smile? It should not, as long as meat derived from cancerous animals is permitted by Government authority, to pass inspection, and to be distributed throughout the world. And no inquiry concerning cancer can be deemed complete which has not fully investigated the extent to which this atrocious practice has been carried on for the past quarter of a century.

But this State-wide inquiry is only a part of the work. Every year, for a period of at least ten years, the record must be revised, the result of surgical operations recorded, the deaths enumerated, the new cases added. The expense of each annual revision would be far less than that of the original inquiry; but the inquiry will be costly, and should be costly, if it is to be accurate and complete. Here, indeed, would be the opportunity for the co-operation of organizations devoted to "cancer research," and particularly of that new foundation, the income of which for a single year is far more than the original investigation would cost.

And when the inquiry is completed; when all attainable information concerning the occurrence of malignant disease shall have been secured not for a single year, but for a period of successive years, not for one community, but for an entire state, and for each of its constitutuent parts, what then? Then I believe a knowledge of the cause of cancer will soon be attained. When we know the cause, then there will be hope for prevention, which is far better than cure. All the various experiments upon mice, for example, whatever they may teach concerning the disease in the lower animals, have not enlightened us concerning the cause of the malady in mankind. The greatest and most promising fields for scientific research, now almost untrodden, awaits the explorers of the future. In a world where now there is comparative unconcern, there may soon be fearful apprehensions of the increasing prevalence of an almost irremediable disease. Within the coming century, the investigation I have here outlined, will sometime be made; and, as a result, the cause of cancer may be as well known to medical science, as the causes of typhoid fever or malaria,—mysteries that seemed insoluble less than a century ago. And I venture with assurance to predict, that some time within the next fifty years, the Governments of England and of the United States, alarmed, it may be, by a continually increasing mortality from cancer, will condemn under severest penalties, the sale for human food of meat deriveed from animals affected by malignant disease,—no matter how great may be the pecuniary loss to every slaughtering establishment and packing-house in either land. The public awakening to danger that must precede legislation cannot yet be discerned; and before the national apprehension is aroused and apathy ceases, probably more than a million lives will be sacrificed to cancer, in England and America alone. ——————————————— Note.—"The deaths ascribed to cancer or malignant disease in England and Wales during 1912, numbered 37,323. The mortality of males was 913 per million living, as compared with 891 in 1911, and that of females, 1,117, as compared with 1,098. IN THE CASE OF EACH SEX, THESE RATES ARE THE HIGHEST ON RECORD."—From 75th Report of Registrar-General, 1914, p. lxxxiii.

CHAPTER XVII

THE FUTURE OF VIVISECTION[1]

[1] Address delivered at Washington, D.C., before the International Humane Congress, December 10, 1913.

Attempts to forecast the future development of Humanity in any direction have always possessed for some minds a peculiar fascination. Plato and Bacon had their visions of a State superior to that in which they lived; Burton foresaw improvements in the administration of justice, and the condition of the poorer classes, which waited for two centuries for some measure of realization; even Defoe had his list of "projects," some of which, laughed at in their day, are the realities of our time. No great reform in any direction was ever effected which had not been the unrealized vision of a dreamer.

And such dreams are the romance of history. For any one to have imagined two centuries ago, that the African slave-trade and negro slavery would some day be condemned by every civilized nation, not because they were pecuniarily unprofitable, but because they contravened the conscience of Society and its sense of righteousness, requierd a faith in the ultimate triumph of justice over greed, that not one man in ten thousand possessed. For Calvin or Torquemada to have imagined the coming of a time when the burning of an unbeliever would not be regarded as pleasing to the Deity, demanded a sublimer vision than either of them possessed. Custom and universal acceptance would sometimes seem to create impregnable barriers against change. But with the slow lapse of years, the venerated custom is attacked by doubt; the superstition is undermined, and the great evil gradually passes from the sight. No great wrong is so securely entrenched, as to be absolutely safe from the ultimate condemnation of mankind.

What is to be the future of vivisection, as conducted in America to- day? Is it to continue, without other limitations against cruelty than those which are self-imposed, without legal restriction or restraint, so long as civilization endures, ever widening its scope, ever increasing the hecatombs of its victims, until uncounted milions shall have been sacrificed? Is protest against excess to grow weaker, until the ideal of humaneness in the laboratory shall become a scoff and a byword? Is approval of any research in the name of Science to become stronger until it shall cover the vivisection of human beings as well as the exploitation of animals? Or are we to expect, as the result of agitation, the legal suppression of all scientific research requiring animal life, within the limits of the next half-century? It is easier to ask questions than to answer them. Yet, as one who for over thirty years, has taken some part in the agitation for reform, you may be willing to permit a forecast of probabilities, vague, it may be, as the vision of a sailor peering through the darkness that environs the ship,—but the best he can do.

No estimate of the future of vivisection in America can be of value which does not recognize the power of the laboratory at the present day. Half a century ago, the vivisection of animals was rarely practised; to-day, in the older states, there are few institutions of higher learning which do not possess ample facilities for animal experimentation. Millionaires, many times over, have been induced to devote some part of their great wealth to the foundation and support of institutions for exsperimentation upon living things. Farms have been established where animals destined to sacrifice, are born and bred. It may safely be estimated that in America, to-day, there are not less than five hundred times as many experiments every year, as took place half a century ago.

One must recognize, too, the change which has taken place in the attitude of a majority of the medical profession towards this reform. During the past thirty years, thousands of young men have entered the profession, who have been carefully educated to regard all criticism of animal experimentation as due to a sentimentalism worthy only of contempt. I greatly doubt whether even one per cent. of the physicians in America, under fifty years of age, have ever heard that half a century ago, the feeling of the medical profession, in the English-speaking world was almost unanimous in disapproval and condemnation of methods and of experiments which now pass without notice, and uncondemned. When men, educated to come into the closest of relations with their fellow-beings, are thus prejudiced and uninformed, should we wonder that their views are so widely accepted? The wonder to me is rather that so large a minority are not to be convinced that everything in a laboratory must be right.

Another element of the forces that to-day are marshalled against reform, is the Press. Political journals, which even twenty-five years ago endeavoured to hold an attitude of impartiality, now present editorials almost every week in ridicule of any legal regulation of vivisection, or of any opposition to laboratory freedom. The intimate knowledge of medical matters sometimes exhibited by the writers, would seem to indicate a closer relation between the physiological laboratory of to-day, and the editorial sanctum, than existed forty years ago. There are journals, so closely related, apparently, to laboratory interests, that they do not permit correction of editorial misstatements or mistake to appear in their columns, even when such blunders are pointed out. The old impartial attitude of the Press seems—except here and there—to have completely disappeared. Any forecast of the future must take into account this vast and ever- increasing influence.

Yet another impediment to the legal repression of any cruelty pertaining to animal experimentation is one which we all deplore, even though no remedy appears in sight. It is not the opposition of enemies, but division among friends that constitutes, in my opinion, the greatest present obstacle to any reform. It is as though against some strong fortress, different armies were engaging in an attack, each with its separate purpose, its own plan of campaign, its own ultimate aim, and now and then crossing and recrossing in each other's way, to the infinite delight of the enemy. Some of us make the demand that ALL such inquiry on the part of Science shall be made a crime; and some of us take the position of the English-speaking medical profession of forty years ago, that ABUSES AND CRUELTY ALONE should be the object of attack. If opposition from the first, had been solely directed against ABUSES of vivisection, could any reform have been achieved? It is not certain. When Mr. Rockefeller opened his purse on the vivisection table, he added immeasurably to the strength of the forces that resist reform. And yet it is difficult to over-estimate the loss to any cause of such men as Sir Benjamin Ward Richardson, as Professor William James and Professor Henry J. Bigelow of Harvard University, or of Dr. Theophilus Parvin of Jefferson Medical College,—to refer only to the dead. Their criticisms of cruelty were outspoken, but they could not join in universal condemnation of all such inquiry into the phenomena of life. Might it not have been better—even at the cost of a lessened demand—to have kept on the side of reform that large element in the medical profession which willingly condemned abuse, but declined to denounce the simplest demonstration, or the most painless investigation? Of course such an inquiry will receive different replies. It is ever the easier task to make condemnation absolute. The thing has been done; the past is beyond recall. But in looking at the future, we cannot but recognize the changed attitude of a majority of the medical profession from that of half a century ago.

The strongest position of the modern physiological laboratory, is its SECRECY. It occupies in the popular mind almost precisely the place which was held for centuries by the Inquisition in Spain. There were men who doubtless objected, then, to the secrecy of the dungeon. "Trust us absolutely," cried the inquisitor. "Ours is the responsibility of preventing errors that lead to eternal death. Can you not leave it to us to decide what shall be done in the torture- chamber, being assured that NO MORE PAIN WILL BE INFLICTED THAN IS ABSOLUTELY NECESSARY FOR THE END IN VIEW?" "Trust us absolutely," demands the vivisector of to-day. "Can you dare to question the purity of our motives, the unselfishness of our aims, the mild and humane methods of our experimentation? Why should any one wish to disturb the silence and secrecy in which we carry on our work? Cannot the public leave it solely to us to determine what pain may be inflicted upon animals, being certain that no more suffering will be caused than we deem to be necessary for success?"

The parallelism is complete. It is a call for implicit confidence. And that confidence has been given by a too credulous public. Three hundred years ago, when the victims were marched in long procession from dungeon to burning-place, they were accompanied by an approving mob, eager to inflict every indignity and to applaud every pang. The men about the burning-place were not intentionally cruel. They had simply given the control of their judgment to the inquisitor. Is it so very different, to-day, in the matter of vivisection? Why should we hesitate to recognize that at the present time, a large section of the general public have made the same act of surrender, justifying whatever the laboratory demands, and defending whatever it defends?

It seems to me probable, therefore, that for many years to come, the laboratory for vivisection, IF ONLY IT CAN MAINTAIN ITS SECRECY, will continue as serenely indifferent to criticsm, as completely master of the confidence of modern society, as supreme in power and position as was the Spanish Inquisition of three centuries ago. New laboratories will be founded upon ill-gotten wealth; new inquisitors, with salaries greater than those of Washington or Lincoln will take the places of those that retire; new theories, now unimagined, will demand their tribute of victims to help prove or disprove some useless hypothesis; even new methods of torment may be invented, and new excuses for their necessity put forth. Nor is this all. If the laboratory of the present day shall continue to maintain its hold upon the intelligence of modern society; if it can keep unimpaired that confidence in its benevolent purpose, that belief in accomplishment, that faith in utility which now so largely obtains; and if, moreover, it can secure for the charity hospital that absolute power and secrecy which it has gained for itself in animal experimentation, then, within the lifetime of men now living, human beings will take their place as "material" for investigation of human ailments. Upon the living bodies of Amerian soldiers, upon lunatics in asylums and babes in institutions and patients in charity hospitals, experiments of this character have already taken place. Is utility to Science to be considered the standard by which human actions are to be judged? Then, even within the present century, experimentation upon human beings may be openly acknowledged as a defensible method of investigation.

Now all this is not a cry of despair, a confession of defeat. It is meant only to be rational recognition of existing conditions, and especially of the forces that now prevent reform. Perhaps if the armies were united, a different forecast could be made; but that union is beyond hope. The enthusiasm that would expect to eliminate a great evil on other terms, and within the space of time occupied by a single generation does not seem to me to be justified by the records of history. Of the ultimate triumph of the reform of vivisection, there can be no more question than of the result of the agitation against human slavery, against the torment of criminals, against the burning of the heretic or the witch. In what way may we anticipate its coming?

We may be certain that a period will yet arrive, when among the more intelligent classes of society, doubts concerning the practical utility of all that is done in the name of Science will take the place of present-day credulity. It is too soon to expect a general spirit of inquiry to arise; the closed laboratory has not been so long in existence but that a request for more time to demonstrate possibility of accomplishment may seem not unreasonable. But some time in the future, long after we have all passed away, the intellectual world may be moved by the spirit of doubt and unrest; it will ask from the laboratory a statement of account; it will demand that the books be balanced; and that against the cost of agony and death, there be made known whatever gains in way of discoveries of clearly demonstrated value to humanity, can be proven to exist.

Like the servant in the parable, the modern laboratory has been given its ten talents. It enjoys a secrecy which is profound, all that wealth can procure, and unrestricted opportunity for ever phase of research. There is no limitation to the torments which it may inflict, without impediment or fear of public criticism, if present secrecy can be maintained. The conscience of modern society—so far as vivisection is concerned,—would seem to have "journeyed into a far country." But some day it may return to its own, and ask for an accounting of its trust.

And fifty years hence, if pressed for the proof of great achievement, of grand discoveries, what evidence will then be produced by the vivisection laboratory? How much of wealth will have been devoted to fruitless explorations in desert regions? What vast fortunes will have been paid out to professional explorers, whose work will have been in vain? What proofs will the laboratory then be able to adduce of "priceless discoveries" made within its walls, proofs resting not upon the heated enthusiasm of the experimenter, but demonstrated by statistical evidence of a decreased mortaility from the scourges of disease? THAT is the test of utility, which may one day be applied not merely to Mr. Rockefeller's creation, but to every laboratory in England and America. Then, perhaps, it may not suffice to set forth discoveries, as useless to mankind, as would be the demosntration of gold and silver in the moon. Before the tribunal of an intelligent public opinion,—not of our day, but of some distant epoch, the justification of secret vivisection will assuredly be demanded. Will it be given? Against the vast cost in money, cost in depravation of the instinct of compassion, cost in the lessened sensitiveness of young men and young women to the infliction of torment, cost in the seeming necessity of defending and justifying cruelty, cost in the temptation to exaggerate facts, cost in the countless hecatombs of victims, non-existent to-day, yet doomed to perish in pain of which no record and no use can be found,—against all this, what profit will be adduced? Something? Undoubtedly. BUT SUFFICIENT TO BALANCE THE COST? When that accounting is made, will the enlightened conscience of humanity then grant condonation, because of great achievement, of all that will have been done in the name of research, and of demonstration of well-known facts? I cannot imagine it.

What can we venture to forecast regarding the future of medical school vivisections, made for the one purpose of fixing facts in memory? No one qualified by any experience in teaching can doubt the value of certain demonstrations. So far as they are performed upon animals made absolutely unconscious to any senstation of pain, it is difficult to suggest a condemnation that does not equally apply to the killing of animals for food or raiment. But the medical school laboratory seems to shrink from the public scrutiny. If there were no need for secrecy, is it likely that every attempt to penetrate the seclusion of the laboratory would be so strenuously opposed? OF WHAT IS THE LABORATORY AFRAID? If the present methods of demonstration or teaching of physiology are such as would meet general approval so far as their painlessness is concerned, why fear to make them known? On the other hand, if animals are subjected to prolonged and extreme torment for the illustration of well-known and accepted facts; if students not only witness, but are sometimes required to perform for themselves experiments as agonizing and as useless as any that ever disgraced the torture-chambers of Magendie, we can well understand why immunity from criticism can only be secured by concealment and secrecy. Opposition to publicity or to investigation by the Government is quite conceivable, if there be something which must be hidden out of sight.

In the long-run, the policy of concealment must fail, and the whole truth be known. Then, indeed, we may hope for the beginning of reform. That fifty or a hundred years hence, all utilization of animals, whether for food or raiment or scientific ends will have absolutely ceased in England and America I am not able to believe. But I am very sure that before this century closes, the subjection of animals to pain for the demonstration of well-known facts will have come to an end; that agonizing experiments will have ceased; that every laboratory wherein animals are ever used for experimental purposes will be open to inspection "from cellar to garret," as Professor Bigelow of Harvard Medical School said they should be; and that except as a shield for crime, the secrecy which now enshrouds the practice will for ever have disappeared.

We are living to-day in a period of unrest and change, such as the world has never known before. A new social consciousness has awakened throughout the civilized world, a feeling that for those who are to come after us, life should be happier and better than it is. Humanity is advancing toward its ideals by leaps and bounds, where once it slowly crept. Every social problem, from the prevention of cruelty, the suppression of vice, the rescue of the submerged, to the abolition of poverty itself, is to-day more in the thought of humanity than ever before in the history of the world. We are but just beginning to learn our duties to human beings of other races; may we not be assured that the more sensitive conscience of the future will define with authority, our duties to the humbler sharers of this mysterious gift of life? Already, Science has told us, that far in the past, we had the same origin; and surely, when some higher ideal than utility to ourselves, shall dominate human conduct, there will be a new conception of JUSTICE toward every sentient being. It may mean extinction of species; but it will notmean their torment. You and I cannot hope for life long enough to see the realization of that dream. And yet, sometimes I have wondered whether it be so far distant as I have feared. But a little while ago, who of us could have imagined that in our day, the Government of the United States would listen to the cries of little birds, starving on their nests in the swamps of Florida, and prohibit the importation of the egret plumes? How much of hopefulness for the final triumph of th eprinciples of humaneness lies in the passage of such a law!

I fancy that one day, all noxious animals, and especially those which prery upon other creatures, will largely, if not entirely, disappear. It is calculated that ever grown lion in South Africa kills for food, every year, between 200 and 300 harmless animals, and each one of which is as much entitled as the lion to the happiness of existence. In great museums to-day, we see the remains of creatures, like the sabre-toothed tiger, that lived probably, over a million years ago. In a century or two, hence, the skeletons of the panther, the tiger, the leopard and the lion, will be found in the same halls of science, with those of other extinct species, that could exist only at the expense of others' lives.

Some day the question of vivisection will be merged in the larger problem, the adjustment of man's relations to animals on the basis of JUSTICE. We who are assembled here to-day, certainly are not forgetful of other cruelties than those which pertain to animal experimentation. In the awful torment endured for days by animals caught in steel traps in order that their death may contribute to the adornment of women and the luxury of men; in the killing of seals, accompanied by the starvation of their young; in the great variety of blood-sports; in the slaughter of animals, destined for human food, in all these, as well as in the cruelties that have pertained to physiological inquiries, we see exemplified man's present indifference to the highest ethical ideals. We do not oppose one phase of cruelty; WE OPPOSE THEM ALL. And we may be assured, that when the day dawns in which humanity shall seek to govern conduct by the ideal of universal justice, then in some more blessed age than ours, the evils of vivisection not only, but all phases of cruelty and injustice will for ever cease.

CHAPTER XVIII

THE FINAL PHASE: EXPERIMENTATION ON MAN

There is one phase of scientific research which cannot be passed in silence. It is experimentation upon human beings. That "no experiments on animals are absolutely satisfactory unless confirmed upon man himself," a well-known vivisector has asserted; and no one acquainted with the trend of events, could doubt the coming of a time when opportunity for such "confirmation" would be given, and when a more precious and a less costly "material" than domestic animals would be used for investigations of this kind. Writing many years ago, a distinguished jurist declared that "to whomsoever in the cause of Science, the agony of a dying rabbit is of no consequence, it is likely that the old or worthless man will soon be a thing which in the cause of learning, may well be sacrificed."

It is necessary at the outset, however, to draw a careful distinction between those phases of experimentation upon man which seem to be legitimate and right, and those other pases of inquiry which are clearly immoral. It is, of course, to be expected that certain experimenters upon human being will endeavour to confound both phases of inquiry in the public estimation; and yet there is no difficulty in drawing clear distinctions between them. Let us see what differences may be perceived between the experimentation upon human beings which is laudable and right, and the other phase of inquiry which Society should condemn.

I. Any intelligently devised experiment upon an adult human being, conscientiously performed by a responsible physician or surgeon solely for the personal benefit of the individual upon whom it is made, and, if practicable, with his consent, would seem to be legitimate and right. In the practice of medicine, there must always be a "first time" when a new method of medical treatment is tested, a new operation performed, a new remedy employed. Whether the procedure pertain to medicine or surgery, so long as the amelioration of the patient is the one purpose kept in view, IT IS LEGITIMATE TREATMENT. The motive determines the morality of the act.

II. Now human vivisection is something quite different. It has been defined as "the practice of subjecting to experimentation human beings—men, women, or children, usually inmates of public institutions—by methods liable to involve pain, distress, injury to health, or even danger to life, without any full, intelligent, personal consent, FOR NO OBJECT RELATING TO THEIR INDIVIDUAL BENEFIT, BUT FOR THE PROSECUTION OF SOME SCIENTIFIC INQUIRY."

The distinction is a perfectly clear one. Under the term "human vivisection" only those experiments are included which have some of these characteristics:

1. THE OBJECT IS SCIENTIFIC INVESTIGATION, AND NOT THE PERSONAL WELFARE OR AMELIORATION OF THE INDIVIDUAL UPON WHOM THE EXPERIMENT IS MADE.

2. The experiment is liable to cause some degree of pain, discomfort, distress, or injury to the health, or danger to the life of the person upon whom it is performed. The defence often made that no real injury resulted from the experiment, cannot palliate the offence against personal rights.

3. The experiment is performed without the intelligent, and full consent of the individual experimented upon. Such legal consent of course is impossible to obtain from children, from the feeble-minded, or from lunatics in public institutions.

It is the purpose of this chapter to demonstratte that such experiments upon human beings have been performed. Naturally, it will be impossible to quote the cases in full. Enough, however, will be given to prove that the charge of human experimentation is not the exaggeration of ignorance or sentimentality; that such methods of research have been practised upon the sick, the friendless, the poor in public institutions, without their knowledge or intelligent consent; that they are in vogue even in our own time; and that hospitals and institutions, founded in many cases, for charitable purposes, have lent their influence and aid in furnishing either victims or experimenters.

Commenting upon certain human vivisections in Germany, the British Medical Journal declared in its editorial columns:

"Gross abuses in any profession should not be hushed up, but should rather bemade public as freely as possible, so as to rouse public opinion against them and thus render their repetition or spread impossible. And therefore we have reason to thank the newspaper Vorw"arts for dragging into light the experiments made by Dr. Strubell on patients.... The whole medical profession must reprobate cruelties such as these perpetrated in the name of Science."[1]

[1] British Medical Journal, July 7, 1900, p. 60.

It is this sentiment which justifies present publicity. The cases to which attention will be directed are not many; but they suffice to illustrate the practice, and to enable the reader to decide whether such experiments should meet approval or condemnation.

I. The Case of Mary Rafferty

An instance of human vivisection which ended by the death of the victim, occurred some years ago in the Good Samaritan Hospital in Cincinnati. It would be difficult to suggest a name for a hospital more suggestive of kindly consideration for the sick and unfortunate: and to this charitable institution, there came one day a poor Irish servant girl by the name of Mary Rafferty.

She was not strong, either mentally or physically. Some years before, when a child, she had fallen into an open fire, and in some way had severely burned her scalp. In the scar tissue an eroding ulcer— possibly of the nature of cancer,—had appeared; and it had progressed so far that the covering of the brain substance had been laid bare. No cure could be expected; but with care and attention she might possibly have lived for several months. We are told that she made no complain of headache or dizziness; that she seemed "cheerful in manner," and that "she smiled easily and frequently,"—doubtless with the confidence of a child who without apprehension of evil, feels it is among friends. The accident, however, had made her good "material"; she offered opportunity for experimentation of a kind hitherto made only upon animals. "It is obvious," says the vivisector, "that it is exceedingly desirable to ascertain how far the results of experiments on the brain of animals may be employed to elucidate the functions of the human brain."[1]

[1] This case, under the significant title, "Experimental Investigations into the Functions off the Human Brain," is related at length in the American Journal of the Medical Sciences, vol. 93 (N.S., 67).

At the outset the experiments seem to have been somewhat cautiously made. Nobody knew exactly what would be the result. The experimenter began by inserting into Mary Rafferty's brain, thus exposed by disease, needle electrodes of various lengths, and connecting them with a battery. As a result, her arm was thrown out, the fingers extended, but in the brain substance no pain was felt. Presently, as the experimenter grew bolder, other phenomena appeared. The vivisector shall tell the story in his own words:

"The needle was now withdrawn from the left lobe, and passed in the same way into the (brain) substance of the right. ... When the needle entered the brain substance, SHE COMPLAINED OF ACUTE PAIN IN THE NECK. IN ORDER TO DEVELOP MORE DECIDED REACTIONS, the strength of the current was increased by drawing out the wooden cylinder one inch. When communication was made with the needles, HER COUNTENANCE EXHIBITED GREAT DISTRESS, and she began to cry. Very soon, the left hand was extended as if in the act of taking hold of some object in front of her; the arm presently was agitated with clonic spasms; her eyes became fixed with pupils widely dilated; lips were blue, and SHE FROTHED AT THE MOUTH; HER BREATHING BECAME STERTOROUS; SHE LOST CONSCIOUSNESS AND WAS VIOLENTLY CONVULSED. The convulsion lasted five minutes, and was succeeded by coma. She returned to consciousness in twenty minutes from the beginning of the attack."

The experiment was a success. Upon the body of the poor servant girl, the distinguished vivisector had produced the "violent epileptiform convulsion" which Fritsch and Hitzig and Ferrier had induced in animals, by the same method of experimentation.

There are those who feel that further vivisecting should have then ceased, and that Mary Rafferty should have been allowed to die in peace. Such views, however, were not permitted by the experimenter to interfere with his zeal for scientific research. Other "observations" were made, and the needles were again passed into the brain, evoking almost the same phenomena. The final experiments were thus described by the vivisector:[1]

"Two days subsequent to observation No. 4, Mary was brought into the electrical room with the intention to subject the posterior lobes (of the brain) to galvanic excitation. The proposed experiment was abandoned. SHE WAS PALE AND DEPRESSED; HER LIPS WERE BLUE, AND SHE HAD EVIDENT DIFFICULTY IN LOCOMOTION. She complained greatly of numbness.... On further examination, there was found to be decided PARESIS and rigidity of the muscles of the right side.... She became very pale; her eyes closed; and she was about to pass into unconsciousness, when we placed her in the recumbent posture, and Dr. S. gave her, at my request, chloroform by inhalation.

"The day after observation No. 5, MARY WAS DECIDEDLY WORSE. She remained in bed, was stupid and incoherent. In the evening she had a convulsive seizure.... AFTER THIS, SHE LAPSED INTO PROFOUND UNCONSCIOUSNESS, AND WAS FOUND TO BE COMPLETELY PARALYZED ON THE RIGHT SIDE.... The pupils were dilated and motionless."

[1] Italics not in original.

When did death come to her release? We do not know; the omission is significant; it may have been within a few moments. The next sentence in the report is headed by the ominous word, "AUTOPSY." The brain was taken out, and the track of the needles traced therein. One needle had penetrated an inch and a half. There was evidence of "INTENSE VASCULAR CONGESTION."

In cases like this, the investigation of a coroner apparently is not required. The experimenter himself was the physician to the hospital. He tells us of course that Mary's death was due to an extension of the disease, for the relief of which she had been led to the "Good Samaritan Hospital." Of the real cause of death, there was apparently but little doubt among scientific men. An English vivisector, Dr. David Ferrier, whose experiments upon monkeys had perhaps first suggested their repitition on a living human brain, questioned somewhath the propriety of the American experiments. In a letter to the London Medical Record, he referred to "the depth of penetration of the needles"; the "occurrence of epileptiform convulsions FROM THE GENERAL DIFFUSION OF THE IRRITATION WHEN THE CURRENTS WERE INTENSIFIED," and declared that the "EPILEPTIC CONVULSIONS AND ULTIMATE PARALYSIS are clearly accounted for by the inflammatory changes" thus induced.

That the experiments had been to some extent injurious to his victim, the vivisector himself, in a letter to the British Medical Journal, very cautiously admitted.[1] He regretted, he said, that the new facts which he had hoped would further the progress of Science were obtained at the expense of SOME injury to the patient. She was, however, "HOPELESSLY DISEASED,"—as if that fact tended to justify her martyrdom! "THE PATIENT CONSENTED TO HAVE THE EXPERIMENTS MADE." Is not this excuse the very height of hypocrisy? Twice, he had stated in his report of the case, that the young woman was "RATHER FEEBLE- MINDED"; he suggests that this poor, ignorant, feeble-minded servant- girl was mentally capable of giving an intelligent consent to repeated experiments upon her brain, the possible result of which even HE could not foresee!

[1] British Medical Journal, May 30, 1874, p. 727.

Who made these experiments? It was Dr. Roberts Bartholow, at that time the physician of the "Good Samaritan Hospital" in Cincinnati. His biographer says that he gained no credit "for his candour in reporting the whole affair,"—a hint, the significance of which for future experimenters, it is not very difficult ot perceive. Yet his treatment of Mary Rafferty was no bar to his professional advancement. Not long after his victim was in her grave, one of the oldest medical schools in the country,—Jefferson Medical College of Philadelphia—offered him a professor's chair; and for several years he was Dean of the medical faculty of that institution.

It might seem impossible that any physician of the present day would care to come forward in defence of this experiment. Yet forty years after the deed was perpetrated, such justification was apparently attempted in an American journal, and republished in a pamphlet issued by the American Medical Association.[1] It would seem at the outset that only by suppression of the worst facts relating to the case, could any defence be essayed. WAS THERE ANY SUCH SUPPRESSION OF MATERIAL FACTS? Let us see.

[1] "The Charge of Human Vivisection," by Richard M. Pearce, M.D., Journal of the American Medical Association, February 28, 1914.

Did any injury to Mary Rafferty result from these experiments upon her brain? Bartholow himself admits some injury; he says that to repeat the experiments "would be in the highest degree criminal." The modern apologist, however will have it otherwise. At the beginning of the experiment, she smiled as if amused; and this, he tells us, "whows that she did not object, that the pain was not severe, AND THAT NO HARM WAS DONE HER." Is this a fair summary of the symptoms elicited during these experiments upon the brain? Why did the apologist mention only the "smile," and neglect altogether to mention the other symptoms reported by Dr. Bartholow? Why does he pass in silence her complain of "ACUTE PAIN IN THE NECK," the "GREAT DISTRESS" EXHIBITED, THE ARM AGITATED WITH CLONIC SPASMS, THE FIXED EYES, THE WIDELY DILATED PUPILS, THE BLUE LIPS, THE FROTHING AT THE MOUTH, THE STERTOROUS BREATHING, THE VIOLENT CONVULSION lasting for five minutes and the succeeding unconsciousness lasting for twenty minutes? Why does the apologist leave unmentioned the symptoms following the subsequent experiments,—the pallor and depression, the blue lips, the difficulty in locomotion, the decided paresis and rigidity of muscles, the profound unconsciousness, THE FINAL PARALYSIS? Do omissions like these suggest an ardent desire to present the whole truth of the matter for the information of the public?

The defender of the experiments tells us:

"It is not an uncommon procedure in neurologic surgery, to stimulate after operation, in conscious patients, certain areas of the brain. This procedure is a familiar one to all neurologists, and it is THEREFORE DIFFICULT to understand why so much has been made of these early observations in Cincinnati."[1]

[1] Italics not in original.

Aside from the astounding confession contained in this admission of familiar procedure, it is difficult to understand what is meant by this paragraph. Is it a suggestion that these experiments upon Mary Rafferty were observations following a remedial surgical operation? It is surely impossible that this can be the meaning; for in the original account of the "Investigations into the function of the human brain," there is not a line in support of such hypothesis. The reader may make his own interpretation of a paragraph which seems exceedingly obscure.

No apology for these experiments could be complete, which did not refer to the alleged "consent." It is thus presented:

"If the patient under these circumstances consented to the observations described, it would appear to be a matter between herself and the physician making the observations."

This is the view of the matter which the apologist invites us to accept. On the one side, stands a poor, ignorant, feeble-minded Irish servant girl, full of faith and implicit trust in the benevolence of those about her; on the other a learned scientist, eager, as he says, "to ascertain how far the results of experiments on the brains of animals may be employed to elucidate the functions of the human brain"; and her "consent" to procedures the purpose and dangers of which she knows nothing,—to experiments involving her life, are suggested as a justification of whatever was done, and as a matter with which Society need have no concern!

Upon such methods of vindication every intelligent reader may form his own judgment. He will doubtless reach the conclusion that such vital omission of essential facts,—no matter whether accidental or intentional,—absolutely nullifies the value of the entire apology. Let us hope that the next defender of these experiments, writing not only for the instruction of the medical profession but also for the general public, will proceed along somewhat different lines; that every symptom which Bartholow mentions, he will mention also; that if he speaks of the "CONSENT" of the victim, he will frankly tell us that it was consent of one whom the experimenter himself called rather "feeble-minded"; and that if he thinks other palliating circumstances exist, he will at least graciously furnish us with references to the evidence presented by the experimenter, upon which he grounds his belief.

II. Experiments with Poison.

Of all experiments upon patients in hospitals, probably one of the boldest was Dr. Sydney Ringer, physician to the University College Hospital in London. His position in this institution gave him a peculiarly favourable opportunity for the utilization of the human "material" under his care. The experiments upon his patients were frankly reported by himself, and were published in his well-known work on Therapeutics.[1] For the most part these experiments were made with poisonous drugs. Are we justified in classing them as human vivisections? If in any case, the drug can be shown to have been administered for the welfare of the patient, it was legitimate medical treatment, to which criticism does not apply. Were the drugs so administered? The experimenter shall describe his work in his own language.

[1] "Handbook of Therapeutics," by Sydney Ringer, M.D. Eighth edition, William Wood and Co., New York.

Poisoning with Salicine

"In conjunction with Mr. Bury, I have made some investigations concerning the action of salicine on the human body, USING HEALTHY CHILDREN FOR OUR EXPERIMENTS, to whom we gave doses sufficient to produce toxic (poisonous) symptoms. We tested the effects of salicine in three sets of experiments ON THREE HEALTHY LADS. To the first two, we gave large doses, and produced decided symptoms.... Under toxic (poisonous) but not dangerous doses, the headache is often very severe, so that the patient buries his head in the pillow. There may be very marked muscular weakness and tremour...."

Another "set of experiments" was made on a boy ten years old, who had been brought to the hospital to be treated for belladonna poisoning. "Our observations," said Dr. Rigner, "were not commnced TILL SOME DAYS AFER HIS COMPLETE RECOVERY." Among effects of the experiment was a severe headache,—"so severe that the lad shut his eyes and buried his head in his arm...became dull and stupid, lying with his eyes closed...."

Other experiments were made upon a boy only nine years old, almost well from an attack of pneumonia, the temperature having become normal over a week before. Dr. Ringer's experiment went so far as to give him apparently considerable apprehension. He speaks of the flushed face, the trembling hand, and lips, the laboured breathing, the spasmodic movements of limbs.

"These symptoms were at their height at midday, and were so marked, and the pulse and respirations so quick, that we must confess we felt a little relief when the toxic (poisonous) symptoms which became FAR MORE MARKED THAN WE EXPECTED, abated; not that at any time the boy was dangerously ill; but as the symptoms progressed, after discontinuing the medicine, WE DID NOT KNOW HOW LONG AND TO WHAT DEGREE THEY MIGHT INCREASE." (!)

What shall be said of experiments like these, made upon children who had almost or quite recovered from ailments for which medical advice was sought?

Poisoning with Ethyl-Atropium.

This drug has no recognized medical use. In order to make experiments with it upon patients under his care, Dr. Ringer was obliged to have it specially manufactured. He refers to "our experiments upon man," and states that the poisonous substance

"produces decided but transient paralysis, THE PATIENT BEING UNABLE TO STAND OR WALK, and the head dropping rather toward the shoulder or chest, and the upper eyelids drooping."[1]

[1] Ringer's "Therapeutics," p. 534.

Experiments with Tartar-Emetic, or Antimony.

Of this poison, an American authority tells us that "the fraction of a grain" may be followed by a fatal result. Dr. Ringer states, nevertheless, that,

"TO A STRONG YOUNG MAN, I gave tartar-emetic in the 1/2-grain doses every ten minutes for nearly seven hours, INDUCING GREAT NAUSEA AND VOMITING with profuse perspiration."[2]

[2] Ibid., p. 273

Twenty-one grains of antimony administered to "a strong young man," though a fatal result may be inducted by a fraction of a single grain!

Poisoning with Alcohol.

With this substance, Dr. Ringer tells us he made a great many observations "every quarter of an hour for several hours ON PERSONS OF ALL AGES.... After poisonous doses, the depression (of temperature) in one instance reached nearly three degrees."

Does this sinister confession mean that even infants were the objects of his scientific zeal? It is certain that some children were subjected to this experiment, for he says:

"In a boy aged ten, who had never in his life before taken alcohol in any form, I found through A LARGE NUMBER OF OBSERVATIONS, a constant and decided reduction of temperature."

Is there any parent who would be willing to have his ten-year-old boy subjected to an experiment like this?

Poisoning with Nitrate of Sodium.

"To eighteen adults, fourteen men and four women, we ordered 10 grains of pure nitrate of sodium in an ounce of water, and of these, seventeen declared they were unable to take it.... One man, a burly strong fellow, suffering from a little rheumatism only, said that after taking the first dose, he felt giddy as if he 'would go off insensible.' His lips, face, and hands turned blue, and he had to lie down an hour and a half before he dared moved. His heart fluttered, and he suffered from throbbing pains in the head. He was urged to try another dose, but declined on the ground THAT HE HAD A WIFE AND FAMILY...."[1]

[1] The London Lancet, November 3, 1883, p. 767

When this account of hospital experimentation first appeared in the Lancet, another medical journal made the following comment:

"In publishing, and indeed, in instituting these reckless experiments on the effect of nitrate of sodium on the human subject, Professor Ringer and Dr. Murrill have made a deplorably false move, which the ever watchful opponenets of vivisection will not be slow to profit by.... It is impossible to read the paper in last week's Lancet without distress. Of eighteen adults to whom Drs. Ringer and Murrill administered the drug in 10-grain doses—all but one avowed they would expect to drop down dead if they ever took another dose. One woman fell to the ground, and lay with throbbing head and nausea for three hours; another said it turned her lips quite black, and upset her so that she was afraid that she would never get over it.... One girl vomited for two hours and thought she was dying. All these observations are recorded with an innocent naivete as though the idea that anyone could possibly take exception to them were far from the writers' minds. But whatever credit may be given to Drs. Ringer and Murrill for scientific enthusiasm, it is impossible to acquit them of grave indiscretion. THERE WILL BE A HOWL THROUGHOUT THE COUNTRY IF IT COMES OUT that officers of a public charity are in the habit of trying SUCH USELESS AND CRUEL EXPERIMENTS on the patients committed to their care...."[1]

[1] Medical Times and Gazette, November 10, 1883.

"CRUEL AND USELESS EXPERIMENTS ON PATIENTS"—that was the judgment of a medical journal of the day. Any stronger condemnation now is hardly necessary.

What is the judgment of the reader upon investigations of this character? Here we have a physician making use of the bodies of his patients for the testing of poisonous drugs, apparently without the slightest regard for the poor and ignorant fellow-beings who had confidently placed themselves under his care. Can such experimentation as this be termed anything but human vivisection? Once we admit that patients in hospitals have no rights superior to scientific demands, and there is hardly a limit to which such experimentation may not be carried on the poor, the ignorant, the feeble-minded and the defenceless.

III. Experiments involving the Eye

Recent experiments with tuberculin, made upon the eyes of children and other patients in public institutions, seem in many cases to have been carried to an extent not easily justified by ordinary ethical ideals. It is impossible to quote all the cases of this phase of human experimentation; but enough can be given to afford any reader the opportunity of judging the morality of the practice.

The experiments in question had one or more of the following characteristics, distinguishing them from ordinary medical treatment:

1. They were made indiscriminately upon large numbers of children or adults, who were under treatment for various ailments. 2. They appear to have been purely experimental in character, and without purpose of individual benefit. 3. They seem to have involved in some cases considerable discomfort or pain and the risk of irreparable injury to the sight. 4. Dying children apparently were not exempt from experimentation.

A recent medical writer, defding the experiments, points out that the tuberculin test could not convey the infection. The test, he says,

"depends on the principle that if a fluid in which tubercle bacilli have grown, and which therefore contains the chemical products of their growth is injected into an animal or person suffering from tuberculosis, a transient increase of temperature occurs, and constitutes the chief sign of a positive reaction.... Later it was found that if the diluted tuberculin was placed on the surface of the eye, there followed in tuberculous persons, a reddening or congestion of the eye, which might go on to the stage of mild conjunctivitis."[1]

[1] Journal of the American Medical Association, February 28, 1914.

Is this a fair summary of the dangers of the eye-test? Let us see what the experimenters tell us.

In the Archives of Internal Medicine for December 15, 1908, two experimenters describe their work. When a drop of turberculin solution is instilled into the eye of certain cases, there occurs, they say, an infetion which varies in intensity in different individuals, "usually attended by lachrimation and moderate fibrinous or fibro-purulent exudation WHICH MAY GO ON TO PROFUSE SUPPURATION." This "profuse suppuration" is something rather more severe than the symptoms described by the apologist just quoted.

The experimenters say:

"Practically, all our patients were under eight years of age, and all but twenty-sex of them were inmates of St. Vincent's Home, an institution with a population of about four hundred, COMPOSED OF FOUNDLINGS, ORPHANS, AND DESTITUTE CHILDREN. The cases in the Home were tested in routine by wards, IRRESPECTIVE OF THE CONDITIONS FROM WHICH THEY WERE SUFFERING, and in the great majority of instances without any knowledge of their physical condition prior to, or at the time that the tests were applied. We purposely deferred the physical examination of these children until after the tests had been applied."

Would any medical practitioner, called to the house of a wealthy man to examine his ailing child, purposely defer its physical examination until after this eye-test had been applied?

Many of the children were suffering from various ailments at the time this test was made. Some had rickets, some typhoid fever, some whooping-cough, pleurisy, pneumonia or heart disease. Some of them were already near their end; in one case we are told that the "tests were applied within eight days of death"; upon another emaciated infant, the test was "applied three days before death." Infancy earned no immunity from experimentation, for the eye-test was said to have been applied "to seventeen infants, ranging in age from four weeks to five months." In this group of cases, one infant was tested within the last twenty-four hours of its pitiful and painful existence.

What were the possible consequences of these tests upon the sight of the orphans and foundlings of St. Vincent's Home? The experimenters frankly confess that at the outset they did not know.

"Before beginning application of the conjunctival test, WE HAD NO KNOWLEDGE OF ANY SERIOUS RESULTS FROM ITS USE.... It has the great disadvantage of producing a decidedly uncomfortable lesion, and it is not infrequently followed by serious inflammations of the eye, which not only produce great physical discomfort and require weeks of active tratment, BUT WHICH MAY PERMANENTLY AFFECT THE VISION, AND EVEN LEAD TO ITS COMPLETE DESTRUCTION.... W ehave had a number of verbal reports of eye complications, some of them relating to very serious conditions; and we are sure they are much commoner than the references we have communicated would indicate.... In fact we are strongly of the opinion that any diagnostic procedure which will so frequently result in serious lesions of the eye has no justification in medicine...."

The conclusions concernng the occasionally disastrous consequences of this eye-test were shortly confirmed by other experimenters. During the following year, two Massachusetts physicians reported a study made in "the out-patient clinic of the Carney Hospital and the Massachusetts Chartiable Eye and Ear Infirmary," and they add: "We are most indebted to the staff of the latter institution for allowing us to make use of their material.... We have discarded the conjunctival test, AS BEING OCCASIONALLY PRODUCTIVE OF DISASTROUS RESULTS."

In May, 1909, two Baltimore physicians reported their trials with two forms of the tuberculin tests, "the result of over a year of experience with patients coming to the Phipps Dispensary of the Johns Hopkins Hospital." A year later they make an additional report.

"In May, 1909, we reported the results of the conjunctival and cutaneous test in 500 patients. The present report deals with 1,000 additional patients to whom these tests were administered, and who formed THE UNSELECTED MATERIAL OF AN AMBULANT CLINIC, the Phipps Dispensary of the Johns Hopkins Hospital."

They, too, suggest the necessity for caution in making this experiment. If a drop of the tuberculin, first in one eye and then in the other, produced no reaction,

"we refrained from further instillations, fearing the possible intensity of a reaction consequent upon a second instillation of tuberculin into an eye. Our fear is based on evidence, gathered accidentally, that a second instillation may give a positive and even a severe reaction in a case in which a similar test gave a negative result.

In January, 1909, one of the professors connected with the College of Physicians and Surgeons, New York, published a "Report upon one thousand Tuberculin tests in young children." He says:

"The observations included in the following report were all made at the Babies' Hospital upon ward patients. Very few of the children were over three years of age, the majority being under two years.... In the early part of the year, unless some positive contra-indication existed, some test, more frequently the eye-test, was used as a routine measure in order to determine whether and under what circumstances reactions were obtained in HEALTHY CHILDREN, or in those at least PRESUMABLY NON-TUBERCULAR."[1]

[1] Archives of Pediatrics, January, 1909.

This is perfectly plain. Healthy children, or children presumably without any symptoms of tuberculosis, were experimented upon in order to see whether a positive reaction could be obtained. Of 555 cases of infants subjected to this test, who were presumably not tubercular, only two gave a positive reaction, although there were seven cases in which the reaction was doubtful.

We are told by this writer that "care was taken not to use tuberculin in an eye which was the seat of any form of disease, tuberculous or otherwise," and to this precaution, he ascribes his freedom "from unpleasant results." He insists that "on account of the kind of observation necessary, and the possible dangers connected with the eye-test, it is not wise to employ it indiscriminately, as among the out-patients of a hospital." Undoubtedly this is true; and he repeats the advice: the ophthalmic test "CANNOT WELL BE USED IN AMBULATORY PATIENTS." Yet we have just seen that the test WAS thus used in the large number of cases "who formed the unselected material of an ambulant clinic" from another well-known hospital dispensary.

The final judgment of the experimenter does not appear to be entirely favourable to the test involving the eye, though he insists that with proper precautions it is safe. Taken apart from the physical signs and general symptoms, the tests may mislead. "Some failures and some unexplained reactions occurred with all the tests." Even though safe, yet

"an intense or prolonged reaction sometimes occurs which is not pleasant to see; besides, in pathological conditions of the eye, DISASTROUS RESULTS MAY FOLLOW. THE EYE IS TOO DELICATE AND IMPORTANT AN ORGAN TO BE USED AS A TEST WHEN ANY OTHER WILL ANSWER QUITE AS WELL."

With this sensible conclusion it is quite impossible to disagree.

Another question is of importance. For these experiments upon the eye, WERE DYING CHILDREN EVER USED AS MATERIAL?

Apparently, there can be no doubt of the fact. The experimenter distinctly states that "DYING CHILDREN, or those who were extremely sick did not as a rule, react to any of the tests." The assertion is repeated: "In no case were positive reactions obtained in DYING CHILDREN."

In one of the tables, there is also a reference to dying children.

We are told that "the hands of the children were confined during the first twelve hours, to prevent any rubbing of the eye."

Can it be that dying children were thus treated? We are not told to the contrary. Yet it would seem that impending death might well have conferred immunity, not merely from such restraint but from the entire experiment. The thought of a dying child with fettered hands, is not a picture upon which the imagination would willingly dwell.

Upon these experiments involving the eye, what judgment is a plain man entitled to make?

In the first place, he should draw a clear distinction between the experiments made upon tuberculous patients, and those made upon healthy children. Among the large number of experiments, it is possible that some were made upon carefully selected cases for the personal benefit of the individuals concerned. Regarding these, opinions may differ as to expediency; but they belong to the rightful province of medical tratment,—wise or otherwise. But if these tests were applied without discrimination, without previous inquiry into their condition; if they were made only upon the eyes of the orphans and foundlings, and the poor in hospital and dispensary, and not upon the children of the wealthier classes; if in large numbers, men, women and children were made "the unselected material" for tests wherein their individual welfare was not sought, in experiments which not only "produced great physical discomfort" but were liable also to "permanently affect the vision, and even lead to its entire destruction," it would seem impossible to regard them with admiration or approval. Would any of us care to have his own dying child, separated from its mother, and with hands confined, made the "material" for any such experiment? Should we care to have anyone dear to us, subjected to the risks which seem to have been so freely imposed upon the unfortunate, the ignorant, the poor? That is the test by which ultimately these experiments will be judged.

IV. The Rockefeller Institute, and Experimentation on Human Beings

In public esteem, the Rockefeller Institute undoubtedly occupies an exceptionally hight position. It would seem to be generally believed, that by reason of experiments made within its walls upon the lower animals, discoveries of the utmost value to the human race are bing added to the resources of medical science. Possibly, a careful analysis of its work might disprove this belief, but that is aside from present inquiry. A more important question confronts us,—the extent to which under the authority of this Institution, human beings as well as animals have been used as "material" from researches altogether unconnected with their personal benefit. If such experiments have in truth been made under the authority of the Rockefeller Institute, it would seem to be of the utmost importance that the exact truth be made known. It is not always easy to state medical facts in popular language, but the attempt shall be made. ———————- When Columbus returned from his discovery of a new world, it is now generally believed that he brought to Europe the germ of one of the most terrible diseases which have ever afflicted the human race. The extent of its malignancy has only been known within the past century. The unborn infant may be touched by it with the possibility of great suffering, and the probability of an early death. There is not an organ of the human body which may not become the seat of its ravages. The majority of other infectious diseases leave their victim after a time; this makes its home within the body and may manifest its malignity after almost a lifetime of quiescence. In its contribution to the sum total of suffering which disease has occasioned the human race, it is probably that with one exception, syphilis stnds above every other human ailment.

On March 3, 1905, a young German biologist by the name of Schaudinn discovered under the microscope what is now generally believed to be the germ of this terrible disease. It is a minute, spiral-shaped organism, with six or eight curves, and capable of movement in space. Its place in the scheme of existence is not wholly certain, but the probability seems that it is a protozoan, belonging to the lowest form of animal life. Its very simplicity makes it appalling; we do not understand how anything so innocent in appearance, can occasion such terrible ravages. In the course of the evolution of life how came it into being? We can only surmise. But once having gained a foothold in the body of a human being, the minute organism begins to multiply: and penetrating to any part of the body, it induces the ravages of a destroyer espite all the opposing defences which Nature may raise against it. The discoverer first called it the "Spirochaete pallidum," but later invented a new name—"Treponema pallidum"—by which it is at present generally known. It is almost ceratin that in this minute organism, invisible to the naked eye, we have the causative agent of one of the great destroyers of the human race.

A Japanese physician, connected with various phases of research work in the Rockefeller Institute (Dr. Hideyo Noguchi), believed it would be possible to device a method for detecting the existence of these germs of syphilis in certain latent and obscure cases, where the disease was merely suspected. He had no though of inventing a cure for the disease; it was a method of detection only. By ingenious procedures which it is unnecessary here to describe, Dr. Noguchi succeeded in cultivating these germs OUTSIDE THE HUMAN BODY; and after grinding them in a sterile mortar, and subjecting them to heat with other manipulations, he found himself finally in possession of an extract or emulsion to which he gave the name of "luetin." It contains the germs of syphilis; but they are intended to be DEAD GERMS. The experimenter himself says:

"I have proposed the name LUETIN for an emulsion or extract of pure culture of Treponema pallidum, which is designed to be employed for obtaining in suitable cases, a specific cutaneous reaction that may become a valuable diagnostic sign in certain stages or forms of syphilitic infection."

Now, if a drop of this luetin be introduced beneath the skin of a child who has inherited the disease, or of a person who has suffered from its obscurer symptoms, there may be produced a "reaction." This may take the form of "a large, indurated, reddish papule" which in a pew days become of a dark, bluish-red colour; or the inflammation may be of a severer type, resulting in a "pustule." A positive result is more frequently obtained when the disease is of long standing, or comparatively inactive. But may not this "reaction" occur in every case, whether or not the individual has ever been affected by the diseas? Anyone can see that if this "reaction" manifests itself in ALL cases, the luetin test has no value whatever. And it was in the prosecution of this phase of research that certain experiments upon human beings were made, which have been criticized. Dr. Noguchi and other physicians injected this luetin emulsion containing the dead germs of syphilis, not only into persons presumed once to have been affected by the loathsome disease, but also into the bodies of 146 other persons, INCLUDING CHILDREN, ENTIRELY FREE FROM THE DISEASE. It would seem that he was advised by an American physician to make his experiments on human beings rather than upon animals. He tells us:

"...In 1910-11, I commenced my experimental work on rabbits.... While I was still working with the animals, PROFESSOR WELCH SUGGESTED THAT I MADE THE TEST ON HUMAN SUBJECTS. Through his encouragement, I commenced the work at once at different dispensaries and hospitals, with the co-operation of the physicians in charge."

Whatever criticism may attach to these experiments, it ought not to fall upon the Japanese investigator, encouraged and supported as he was, by both Christian and Jewish physicians. In appreciation of the assistance afforded him at various charitable institutions, Dr. Noguchi says:

"Through the courtesy and collaboration of—

Dr. Martin Cohen .. Harlem Hospital, Randall's Island Asylum, and New York Ophthalmic and Aural Institute; Dr. Henderson .. State Hospital, Ward's Island, N.Y.; Dr. Lapowski .. Good Samaritan Dispensary; Dr. McDonald .. King's County Hospital; Dr. Orleman-Robinson North-Western Clinic, New York Polyclinic; Dr. Pollitzer .. German Hospital; Dr. Rosenoff .. King's Park State Hospital; Dr. Satenstein .. City Hospital, Blackwell's Island, N.Y.; Dr. Schmitter .. Capt., U.S. Army, Fort Slocum; Dr. Schradieck .. King's County Hospital; Dr. Charles Schwartz California; Dr. Smith .. .. Long Island State Hospital; Dr. Strong .. .. Manhattan Eye, Ear and Throat Hospital; Dr. Swinburn .. Good Samaritan Dispensary; Dr. Windfield .. King's County Hospital; Dr. Wiseman .. King's Park State Hospital;

And the Hospital of the Rockefeller Institute for Medical Research, I was enabled to apply the skin reaction to a number of human cases... The total number of cases was 400."[1]

[1] Journal of Experimental Medicine, vol.xvi. In the original, the names of the hospitals are somewhat obscured by being placed in brackets, and the paragraph made continuous; they are here printed in capitals, to afford the reader a better opportunity of giving these charitable institutions whatever credit is due them.

Four hundred patients in hospitals and dispensaries including the hospital attached to the Rockefeller Institute for Medical Research, were used as "material" for determining the value of a test for latent syphilis. Of these, 146 were healthy individuals, used as "controls."

Dr. Noguchi states that these "controls"

"include 146 normal individuals, chiefly children between the ages of two and eighteen years; and 100 individuals suffering from various diseasess of a non-syphilitic nature.... In none was a positive luetin reaction obtained."

Other experimenters upon human beings have made reports of their investigations in the same direction. A physician of St. Louis in a medical journal, tells us of forty-four cases in which the Noguchi luetin was applied, and he expresses his obligation to eight physicians of that city (naming them), "for the privilege of using THEIR CASES FOR THE WORK."[1] Whether these "CASES" were the private patients of the accomodating physicians, we are not informed. This experimenter had not completed his investigations and announced his intention of "trying it out thoroughly" in a certain St. Louis hospital, which he names.

[1] New York Medical Record, May 25, 1912.

The same experiments appear to have been made in other institutions. In the Bulletin of the Johns Hopkins Hospital for August, 1912, there appears an account of this luetin test, made upon patients suffering from such ailments as rheumatic fever, typhoid fever and consumption. We see that the practice has extended to some of the leading hospitals of the United States.