E-Siddha

TWENTIETH CENTURY

The Twentieth Century is a century of advancement in several sciences, arts, and practical ways in which they could be used towards the welfare of mankind.
The most noticeable things about recent medicine have been the trend toward co-operation and international solidarity, and the fact that nearly every important advance which has been made comes within the scope of preventing the occurence, the recurrence, or the spread of the disease. Listerism; the gifts to mankind of Jenner, Pasteur, Semmelweis, Crede, and O'Dwyer; the chemical and bacteriological examination of air, water, food soils, and drugs; the purification of sewage, cremation; the hygiene of occupations and habitations; the medical inspection and care of school-children and factory children; the Binet-Simon tests: vacation colonies; social surveys and settlement work; town planning; the police surviellance of perverts and criminal characters in great cities; experiments at social control of the use of alcohol: the revival of the ancient ideal of athletics and personal hygiene; the displacement of the medieval ascetic view of suppression of the sexual instinct by the clear-eyed scientific view; social organization against venereal infections; the proposed legal regulation of marriage and sterilization of degenerate stock; the intensive study of alcoholism, the drug habit, syphilis, tuberculosis, and cancer; the use of medical bibliography and statistics to get extensive information as to pathological conditions in space and time; the co-operation of universities, armies, public health services and private endowments in preventing tropical or parasitic diseases; international congresses; the Geneva Convention; even such things as Banting, Bertillionage, Esmarch bandages, or sanitary towels and drinking cups, are all features of preventive medicine or medicine on a grand scale. Misapplication of some of these devices  has   already   led  to  social  slavery  worse  than  that of any kind of slavery we have seen till now. Everything is great, grand, fair, and noble; but men are inconstant, unbelievable, and becoming degraded. In the hands of corrupt politicians concept of a scientific medical policy may become a stalking horse for private vindictiveness. Without going to the social reactions on account of the speedy growth of various medicines and safeguards, we shall have a rapid survey of the development of medicine by way of merely mentioning them and in some cases with some details, which would stimulate Siddha researches.
The tendency in all branches of recent science, even in zoology, sociology, therapeutics, internal medicine and surgery, has been to pass out of the descriptive into the experimental stage. The aim of science is to predict and control phenomena. The researches are going in that direction in the application of the equation in Mendel's lav/ to the experimental study of heredity, in Loeb's proof that the fertilization and development of the embryo is a chemical process, in the consideration of the accessory chromosome as the determinant of sex, in the extravital Cultivation and rejuvenation of tissues, and in the conquest of communicable diseases or in the recent developments of Huntarian or physiological surgery.
Through developments such as these, biology is fast becoming a phase of general physiology. A striking illustration is the almost complete reorganization of anthropology by data drawn from physiology and pathology and the effect of trr's realignment upon recent medicine.
Jacques Loeb (1859-1924) a medical graduate of Strassburg (1884) sometime professor of biology and physiology at Bryn Mawr (1892-1900), the University of Chicago (1900-1902), University of California (1902-1910), and later head of the department of experimental biology in the Rockfeller Institute, devoted most of his life to the dynamic or chemodynamic study of living processes.
In his work on the physiology of the brain, he made original researches on the chain reflexies and overthrew Munk's position that the Rolandic areas is made up of cellular " Sensory spheres", by showing that the particular paralysis occasioned by that certical excision will be abolished as soon as the wound is healed, He was one of the first to settle the question; of what order of magnitude is the smallest particle that can show all the phenomena of life? And the experiments made by himself and pupils upon temperature coefficients have established other important criteria physiological processes. He made extensive investigations of the effects of electrolytic, thermal, and radiant energy upon living matter and founded the theory of "tropisms" (1889) as the basis of the psychology of the lower forms of life, purely mechanical and chemical data displacing the old theory of purposeful instinctive reactions. Even for the higher forms, his main position was that ail actions of fundamental importance are instinctive, have nothing to do with states of consciousness and that even theses may have a chemical basis. In 1889, he caused the unfertilized eggs of the sea-urchin to develop into the swimming larvae by treating them with hypertonic sea water (i.e., in which the concentration has been raised by the addition of salt or sugar) Similar results had been published by Tichomiroff (1886), who claimed to have developed unfertilized silkworm eggs by rubbing them gently with a brush or by temporary immersion in concentrated sulphuric acid. Sataillon got similar effects by needle-punctures. Loeb carried his imitation of normal fertilization further by a preliminary treatment with butryic acid, producing an artificial fertilization membrance with complete development following immersion or the eggs in a hypertonic solution before returning them to normal sea water. The formation of the membrane is supposed to accelerate oxidation, which Loeb regarded as the criterion of a living process. He further showed that the ovum, has a selective, specific activating influence on the permatozoon. In 1916, Loeb stated that he had seven male parthenogenetic (fatherless) frogs, over a year old, produced by the Bataillon method of pricking the unfertilized egg.
As maxwell, Gibbs, or Einstein developed certain phases of mathematics merely to elucidate physical phenomena, so recent advances in anatomy turn almost entirely upon collateral investigations in physiology and some items upon new wrinkles in diagnosis and therapuetics.     In the newer trend anatomy is functional therefore physiological, so much so indeed that it has been falsely dubbed the 'dynamics" of the organism, as if usurping the domain of physiology. In such studies as Gaskell's mapping of the sympathetic-autonomic system, the Asehoff-Maximow map cf the reticuloendothelial system and its extension to the neuraxis, the elucidation of the mechanism of the Magnus reflexes or of the cerebrospinal circulaiion, the physiological anatomy of Leonardo comes into its own. Such structures as the brain-stem, the pallium the dorsal lip of the balstopore, inspire the feeling voiced by Hertz with reference to Maxwell's six equations expressing the electromagnetic theory of Light, viz., that they are "wiser than we are'. In this sense, anatomy is truly the statics of the organism. Rontgenology, intravital staining, microdissection and other devices afford powerful aids at need and even the graphics of Neugebauer and Dickinson on the uncertain structural variations of the female genital tract, with reference to sexual compatibility, contraception, sterility, and lobour, have the inevitable practical tendency of recent medicine.
Through the newer devices of micro-disseciion. micro-injection, and intravital staining experimental cytology and tissue-cultivation have become going sciences.
By such means, the organised structures of the cell have been studied in minute detail, notably the nucleus and chromosomes (Kite and chambers, 1912-25), the invisible reticulum of Golgi (Gatensby 1919, Parat 1926), and the visible Mitochondria by Margaret and Warren Lewis (1914),. E.V. Cowdry (1916) and Guillermond (1919). The recent contention of Heringa (1924) and Boeke (1926) that the cells are bound together by protoplasmic bridges and function as a whole, merely revamps one of the outworn phases of the neuron controversy, confuted by R.G. Harrison (1910) and latterly by Robert Chambers (1925). Harrison, who virtually started extravital cultivation of tissues but his  proof of the  outgrowth  of nerve'-fibers  from  ganglion  cells  (1910) has since demonstrated the origin of the sheath-cells of nerve from the neural (ganglion) crest, the placodes and ultimately the neuroblasts of the meduallary tube (1924). Removal of the ganglion crest results in a series of naked axis-cylinders. In the same way, E. Mulier and S. Ingvar have shown the origin of the spinal ganglia and the sympathetic nervous system from the ganglion crest (1923). These and other experiments on morphogenesis of nerve elements were made possible by the improved technic of M.T. Burrows (1911), who substituted blood plasma for lymph in Harrison's initial experiment. Cells in extravital culture will not grow without an espalier (Lewis). Further improvements were the use of embryonic and ^chicken extract as growth promoters, the trephones of Carrel (1923) and the differential stains (janus green and black) introduced by the Lewises. Pure cultures were first obtained by the methods of A. Fischer (1922) and A.H. Drew. The tedious process of making successive explants is avoided by a special culture flask. By the explanation method, Carrel kept a culture of fibroblasts growing for twelve years, and has observed the transformation of macrophages into cells resembling fibroblasts. Transformation of mononuclears into macrophages and giant cells has been studied in extense by the Lewises (1925-27). In 1915-20 Margaret Lewise made an elaborate study of contraction of smooth and striated muscle-cells, the rapid pendulum movements in heart-muscle and other phenomena, showing that they take place in the protoplasm alone.

Recent embryology illustrates both sides of the shield in the footless controversy about vitalism; seeming triumph of the mechanist in the wonderful advance of genetics; triumph of the totipotency of protoplasm (Driesch) in studies of organization of growth and regulation of form. Here, facing the very beginnings of organized life, the vitalists are on their own ground and justified of their children.
Beginning with the circulation, the immense amount of investigation of the blood alone has created an independent science of hematology, intimately associated with laboratory diagnosis and pathlogy.The pioneer in the graphic study of cardiac arrhythmias was Sir James Mackenzie (1853-1925) of Scone, Perthshire, an Edinburgh graduate of 1878, who first made simultaneous records of the arterial and venous pulses to elucidate the clinical condition of the heart; and by raising the question, " How much work can the heart do?' concentrated future investigation upon the energetics of heart, muscle (1893-94). After practising at Burnley for nearly thirty years (1879-1907), Mackenzie went up to London as consultant (1907) and made his mark by his sincere, earnest attitude toward the sick and his sterling books on the pulse (1902), heart disease (1908), semeiolo-gy (1909), and angina pectoris (1923). He was knighted in 1915, retired from practice in 1918 and started an Institute for Clinical Research at St. Andrews (1919), to which he gave $10,000 in fees received up to his death. He was one of the greatest of modern bedside physicians, attracting patients from all over the world, and by a strange irony of fate, died of angina pectoris on January 26, 1925, Mackenzie first investigated the multiform arrhythmias and differentiated "nodal rhythm" (1902-8) which Sir Thomas Lewis defined as "auricular fibrillation" and identified with "pulsus irregularis perpetiiua" (H.E. Hering (1903), producing the condition experimentally be sewing electrodes into the auricle of an animal (1909). Mackenzie also demonstrated the wonderful efficiency of digitalis in auricular fibrillation and the use of this drug is now interdicted in the sinus arrhythmias. Heart-block paroxysmal tachycardia and the pulsus alternans of Traube (1872.). Lewis has edited heart (1909-27) and also described "auricular flutter" (1912), and the "effort syndrome" of the western front (D.A.H. 1918-19) The study of the mechanism of tissue-oxidation and its automatic activator (glutathione) is of recent vintage.The jumping~off place was the classical paper of Sir Waiter Fletcher and Gowland Hopkins showing the accumulation of lactic acid in the tissues (Muscle) in the absence of oxygen,. This displaced the older theory of storage of available "intramolecular oxygen" in case of need. It was followed by Wintersteins's paper on the quantitative relations of oxygen excess during recovery of tissues from anaerobism and the work of Fletcher and Brown on C02 production during the anerobic period. Oxygen-usage is estimated by the microrespirometers of Thunberg (1905) and Winterstein (1907). The discovery of ozone by C.F. Schonbein (1839) started the search for an activator of oxidation within the cell. Oxygenase and perixidase, the enzymes of autoxidation within *he cell. Oxygenase and Perioxidase. The enzymes of autoxidation in plants, were discovered by Bach and Chodat (1903-4). The next steps were the isolation of glutathione (the philothion or protein hydride of De Rev Pailhade, 1888) in the pure state by Gowland Hopkins (1921), its exact formulation by his pupils (1923), and the synthesis of the recemic and optically active forms by Stewart and Tunnicliffe (1925). The discovery by Hopkins and Dixon of a residual substance in the tissues, which promptly reduces gluththione as fast as it is oxidized (1922), establised its role as a hydrogen acceptor and the probable chemical mechanism of autoxidation in the tissue cells, viz., tissue reduction of glutathione as fast as it is oxidised. The importance of cell-structure in oxidation was stressed by Otto Warburg (1914), and is illustrated by his "charcoal model" of cell respiration (1921-3), which turns upon the oxidation of amino-acid solution when shaken with blood charcoal at room temperatures.Since the nervous mechanism of the automatic regulation of breathing was elucidated by Hering and Breuer (1868), Head (1889),  and  Scott (1908),  recent  study  of respiration  as the convection of oxygen from the air to the tissues from the lungs to the blood, has been transferred from the lungs to the blood and the tissues.
As indicated above, the older views of oxygen storage and 'biogen molecules' have been discarded, for even in such anaerobes as intestinal worms, Spallanzani's snails, or the leech, which can live without oxygen for ten days, C02 is given off by methods all their own. Oxygen consumption has been estimated in all the tissues by Barcroft (1908-14). Rhode (1910-13), Evans (1912) Krogh (1919) and other. Oxygen consumption in the lungs has been found to be only 1/2 the amount taken up the salivary gland. apart from the erythrocytes, that of the Mood is nmimaL The iron in the hemoglobin is the key to Warburg's charcoal model (1923). The Verworn view of narcosis as inhibition of oxidation (1912) is discarded. Mosso's acapnia (C02 deficiency) is discarded* Oxygen hunger does not affect C02 stimulation of the respiratory center until the lowest ebb. Animals may live for weeks with both vagi cut. The view of Bohr that the alveolar epithelium of the lungs may actively secrete oxygen at need as in the swimming bladder of fishes, was put to the test by Douglas, Haldane, Henderson, and Schneider on the summit of Pike's Peak, Colorado and subsequently be Bareroft on Cerro do Pasco. The symptoms of oxygen hunger (mountain sickness) were those of monoxied poisoning and were ascribed by Barcroft to oxygen deficiency in the medulla. Haldane claimed that there is actual oxygen secretion under acclimation, to make the oxygen tension of arterial blood higher than that of alveolar air. Experiments by Krogh, Hartridge, and Barcroft, who lived six days in a glass box at low oxygen tension (84mm), showed no evidence of this point. The regulation of respiration by the C02 concentration in arterial blood (i.e., rise = hyperpnea ; fall = dyspnea- apnea) was shown by Haldane and Preistiey (1805). That this in turn depends upon hydrogen-ion concentration of the blood was shown, bv Winterstein (1911) and Hasselbalch (1912). In the 19th century, the only important contributions to the thermodynamcis of muscular contraction were those of Helmbotz (1847-8) and Fick (1882) on heat production in muscle.
During the last forty years, large number of Russian dissertations bearing upon digestion appeared, mainly by pupils of Pavloff, who did the most important work of his time, both upon digestion and the science of conditional reflexes.
Ivan Petrovich Pavloff the son of Russian priest, of the Ryazan government, was a pupil of Heidenhain and Ludwig, became director of the Institute for Experimental Medicine at Leningrad and 1904 received the Nobel prize for his investigations. The success of Pavloff's early experiments was due to his remarkable skill in operating on laboratory animals. A brilliant, ambidextrous surgeon in his methods of producing gastric and pancreatic fistulae, the ultimate tendency of his work was, at first, not clearly sensed, as he was concerned mainly with the digestive system.
Recent knowledge of postural reflexes started with Sherrington's observations of decrebrate rigidity (1898-1915) and is contained largely in the monumental Korpestelling (Berlin 1924) of Rudolf Magnus (1872-1927) late Professor of Pharmacology at Utrecht. This includes exhaustive experimental consideration of static reflexes (pose and righting of the body and the stato-kinetic reactions to rotation, progressive and partial movements. The effects of unilateral and bilateral labyrinthectomy are found to correspond with the clinical data of otology and neurology as also the behavior in decerebate rigidity with intact labyrinth, medulla or thalamus. Sherrington has showed, the cerebellum plays no part in postural reflexes, which have been allocated to the red nucleus and Dieter's nucleus. The mechanism of tonus was allocated to the sympathetic nerve supply of Boeke (1913) and by Hunter and RoySe (experimental samisectomy (1924-5) but surgical applications of the latter procedure have not been uniformly successful.   ,
The physiology of nutrition and metabolism has attained a going stride in the 20th century.The starting point of recent knowledge of the vitamins or accessory food factors was an experiment of N, Lunin in Bunge's laboratory, showing that a synthetic milk diet lacks an unknown factor necessary for growth in animals, which was confirmed by Gowland Hopkin's proof of the beneficial effect of a minute quantity of fresh milk upon, an artificial growth-inhibiting diet in rats. In 1882-6, Takaki eradicated beriberi from the Japanese Navy by an improved mixed diet which led to the experiments of C. Eijkman and Grijus on the effect of a monotone diet in producing avain beriberi, and their discovery of an antineurotic substance in rice husks and beans (1897-1906). In 1907, Fraser and Stanton treated experimental polineuritis successfully with alcoholic extract of rice polishings. In 1904, Abderhalden and Rona showed that casein predigested by Papsin or H2S04 will inhibit growth in a case in-sugar diet in mice, while Ethel Wilcock and Hopkins showed that inhibition of growth in a zein diet is due to lack lysin and tryptophan, which latter was destroyed by acid digestion of casein in Abderhalden's initial experiment. The experiments of Henriques and Hansen on the illeffects of a gliadin diet were explained in the same way. Similar results were obtained in cattle-fodder by E.V.McCoIlum, Steenbock and others. In 1912, Osborne and Mendel showed that rats can live 530 days on protein-free milk and gliadin, but cannot grow for lack of glycin and lysin. Similar results in stopping growth were obtained by experimental deficiency of tyrosin and phenylanalin, cystin, arginin and histidin, and prolin, Meanwhile, Casimir Funk had introduced the term "vitamin" to denote the missing accessary factor in the polished rice production  of beriberi,  attempted to isolate it from the pericarp and postulated vitamin deficiency for beriberi, scurvy, pellagra, and rickets, In IV13-16 McCollum, Davis and Kennedy located a growth - producing substance in butter-fat and eggs (fat-soluble vitamin A) and a wster-solubale vitamin B as the missing factor In a beriberi producing diet. A water-soluble vitamin C was postulated by Hoist and Froiich for the missing factor in diets producing scurvy. A.f. Hess showed it to be abundant in citrus fruits and tomatoes. Experimental rickets by dietetic deficiency was produced in puppies by Leonard Findlay, in rats by Mc. Collum and Simmonds, with marked improvement on the addition of cod-liver oil ( E. Mellanby, 1919), a phosphorus salt (Sherman and Pappenheimer, 1920) exposure to sunlight or irradiation of food with ultraviolet light. The effect of the cod-liver oil on deposition of calcium on the bones and increase of phosphorus in the blood was shown by Howland and Park (1920), affording an x-ray check on the new treatment. That the missing vitamins was not vitamin A was shown by Hopkins initial experiment of destroying the growth-producing power of a heated fat by passage of oxygen through it (1920) and Zuckers' production of concentrated antirachitic derivative of cod-liver oil, free from vitamin A. Cholesterin, the antirachitic substance extracted from cod-liver by Windaus, was thereof denominated vitamin D. In 1925, Hess and Wienstock simultaneously with Steen bock and Black showed that the substance with acquires antirachitic properties upon irradiation is cholestrol (in animal products) or phytosterol (in plants). In a sense vitamin D is, therefore an effect of irrradiation. A fat-soluble vitamin E allocated to reproductive power and sterility, was postulated in wheat germ and lettuce leaves by Evans and Bishop. The present classification of vitamins is tentative and perhaps artificial for, as Friedrich Mullar observes, deficiency of calcium, magnesium, iron or iodine is as definite in its effects as deficiency of amino-acids or of irradiated cholesteral. Thus as indicated by the remarkable dietetic experiments of Golberger, and those of Chick and Hume on zein feeding in monkeys    pellagra and hunger edema may be due to deficiency of tryptophan and lysin, yet both pellagra and ergotism have been attributed to latent or superimposed infection by Mc. Collum, Crookshank -and others, with the dietetic deficiency as a predisposing factor. The principal gain has been to emphasize the importance of the protective balanced diet of milk, eggs, fresh fruits, citrus and leafy vegetables recommended by Mc. Collum Mc. Carrison, and others. The inhibitory effect of starvation and overfeeding upon the gonads and sexual capacity ^as investigated by H. Stieve. (1922-6)Recent advances in knowledge of the metabolism of proteins are associated with the work of Emil Fischer on the hydrolysis of their amino-acid constituents (1899-1906), Schroder (1882-5), Van slyke and Myer (1913) on conversion of proteins into urea by NH2 uptake in the liver or the tissues and their "specific dynamic action" as energizers and heat-producers. The limited power of the liver to reproduce amino-acid from ingested hydroxy-acids was shown by Embden and Smitz (1910-12), Knoop and Kertess. In 1902 Otto Leowi showed that intact proteins in the food are not requisite for protein synthesis (growth), which disposes of the Voit Pfluger controversy as to their supposed conversion into protoplasm. Nitrogen metabolism, as an expression of wear and  tear in the tissues (nitrogen-increase) from muscular work, implies increase of uric acid (Hamill and Schryer, (1906), purins (M'Leod, 1899, Burian 1905) and creatin (Brown and Cathcart, (1909-21) but this obtains only on excessive exertion as shown by the urine of Marathon runners (Higgins and Benedict. In carbohydrate metabolism to work of Emil Fishcher on the purins (1882-1906) and sugars (1884-1919) again looms large. The changes of substance involved in the ultimate production of C02 and water from sugar were elucidated by Gustav Embden 1912-13 H.D. Dakin (1913) and their co-workers and by Laquer and Myer (1923.) The -role of carbohydrates as protein-sparers and sources of muscular energy was shown even in starvation by Cathcart  1909).    The discovery of insulin by Banting and Best threw new light on metabolism in diabetes. The undecipherable nature of pentose is indicated by some nine different views as to the nature of the pentose in the urine by fifteen observers. Metabolism of fat (synthesis from carbohydrates and storate) was investigated by Lebedev and Ida Semdley (1912-13); the role of lipids h the cell membrane by E. Overton (1899). J. Leob (1909), and Loewe (1912) hydrolysis of ingested fat in the stomach by Volhard (1900) and Willstatter (1924). Katabolism of fats by Knoop (1905) Embden (1906-8) Dakin (1908-23) and Leathes (1923-25); fat systhesis from proteins by Weinland (1908), Athinson Rappaport, and Lusk (1922). The known physiological fats were classified as lipids by Bloor (1925). The reversibility of lipase was demonstrated by Joseph H. Kastle and Arthur S. Loevenhart and confirmed by Armstrong and Gosney (1914-15) Nucleic acid metabolism was investigated by Levene (1912-25) and Jones (1923-25) purin metabolism by Hunter and Givens (1914) S. R. Benedict (Dalmation Coach-dog; 1916) Ackroyd and Hopkins (1916), Rose and Cox (1924-26). The apparatus for gasometry of the blood in common use are those of J.S. Haldene (1892-1918) with the gas-bag of C.J. Douglas (1911) and the portable respiration Calorimenters of F.G. Benedict (1918) and others. The calorimetric methods of blood analysis were divided by Otto Folin and Wu (1919 - 22). Blood sugar is estimated by Calvert's method (1924), blood cholestrol by that of Myers and Wardell (1918) blood-urea by the non-calorimetric methods and Van Slyke and Cullen (1914) and Maclean (1921), who also devised similar ways of estimating blood -sugar and non¬protein nitrogen. Residual nitrogen was estimated by Bang and other; calcium-con" ;nt by Kramer and Tisdall and the phosphat content by Wes: low others, Analysis of Proteins by acid hydrolysis is effected by the methods of Emil Fischer (estrification 1899-1906) Foreman (lime-alcohol) lead-salt method, Dakin (butyl alcohol extraction 1918), Kingston and Schyver (carbonate method, 1924) Analysis by estimation of nitrogen partition  was  perfected  by  Donald  Van  slyke   calorimetric tests for proteins were devised by Miiion, Ehriich, Molisch, Salkowski, Shiff Hopkins and Cole (glyoxyiic reaction 1901) Voisennet (HCL-NQ2 reaction, 1905) Rosenheim, (formaldehyde test, (1906). Ruhemann (nonkydrin test, 1910) and Romieu (Phosphoric acid reaction 1925). Amino-nitrogen is estimated by the methods and apparatus of Donald Van Slyke (1911-15); amino-acids by the methods of Benedict (1909), Denis (1910), Van Slyke (1911). Folia and Co-workers (1912-22)
The new science of Endrocrinlogy although rooted in the prehistoric past, is virtually a creation of the 20th century, In 1902, Sir William Maddock Bayliss (1890-1924) and Ernest H. Starling announced to the Royal society that the secretion of pancreatic juice which is caused by introduction of acid into the duodenum is not a local reflex, but is produced by a substance thrown our from the intestinal mucous membrane under the influence of the acid and carried thence by the blood-stream to the glands, as shown by experiment. Pavloff subsequently discovered enterokinase and Baylias and Starling developed their theory of the chemical control of the body by means of "hormones" or chemical messengers, which pass from the organs and glands by the blood-channels to other parts of the body. This theory had already been adumbrated by Bordue was inherent in Darwins. 'Pangenesis' and seems admirably adapted to explain the many clinical phenomena produced by disturbances of the ductless glands, and the general theory of treatment by animal extracts. In 1903, Charles E. De M. Sajous of Philadelphia, published a system of medicine based upon the internal secretions, in which the suprarenal, pituitary and thyroid bodies are held to control the immunizing mechanism of the body. The old notion of "diathetic diseases" is now yielding to the concept of altered metabolism, much of which may be bound up with some bouleveresement of harmonic equilibrium or some disturbance of function in the ductless glands. Operative surgery has played the most important part in working out the phvsiology and pathology of these glands, a branch of interna! medicine which has, indeed been almost entirely developed by scientific experimentation."
The starting-point of the doctrine of internal secretion was Claude Bernard's work on the giycognic function and Atidfcon's account of disease of the suprarenal capsules. The former was thrown into striking relief through Von Meriag and Minko'4vakiss experimental production of diabetes by excision of the pancreas (1889) and the later studies of E.O, Opie, Ssoboleff, aisd W.G. Maccailum, showing that the presumable sources of this pancreatic glyco-urea is in the Islands of Langerkans. Addison's description of the suprarenal Syndrome led Brown Sequard to excise the adrenals in 1856, reproducing fatal symptoms resembling Addison's disease, and his result was repeatedly confirmed by Tizzoni, Abelous and Langlois Schaffer, and others, In 1894-95, Oliver and Schafer found that injection of the watery extract of the blood-pressure. The active principle was obtained in crystalline form by Jokichi Takamine in 1901. The description of hyperthyoridism or exophthalmic goiter ly Parry, Graves and Basedow and of hypothyroidism or myxedema by Curling, Gull and Ord emphasized the mysterious importance of the thyroid gland, which was excised with fatal results in the dog by the Geneva physiologist Moritz Schiff, in 1856. In 1882, Reverdin of Geneva produced experimental myxedema by total or partial thyroidectomy and, in 1883, Theodor Kocher of Bern reported that 30 out of 100 thyroidectomies were followed by a "cachexia stumipriva". In 1884, Schiff produced 60 cases of fatal excision in dogs., and pointed out that the animals could be saved by a previous graft of part of the glands, which led Murray and Howitz to the treatment of myxedema with thyroid extract, with very successful results, Hor observations on monkeys and the collective investigations of Sir Felix Semon showed that Cretinism, myxedema, and cachexia thyreostrumipriva are one and the same. The part played by the internal secretion was first pointed out by Schiff,  and  the  isolation  iodothynn  by  Baumann,   in   i 896,indicated its relation to iodine metabolism. In 1906, Erwin Payr transplanted a bit of thyroid from a woman to the spleen of her myxedematous daughter, with successful result. Thyroxin, isolated by E.C. Kendall (1914), is a stirring activator of metabolism and probably the hormone of the gland. It was formulated as Cu Hi0 03 NI3 by Kendall and Osterberg. The synthetic product (Harrington, 1925) has no effect on basal metabolism. The parathyroid glands were described by Ivar Sandstrom in 1880 and, in 1891. Eugene Gley showed that negative thyroidectomies in certain animals would be rendered speedily fatal if the four parathyroids were also removed. This was confirmed by Vassale and Generali (1896). Transplantation of the parathyroids was then essayed by von Eiselsberg (1892), Lischner and VY.S. Halsted (1909), and it was shown that tetany will be produced if a transplanted gland is removed and per contra that the tetanic spams will disappear after injecting the saline extract of the gland or after parathyroid feeding or transplatation. Halsted, in 1906, treated tetany successfully by administration of the parathyroids of beeves. In 1908, W.G. MacCallum and C. Voegtlin showed that exhibition of calcium salts will remove tetany, even in man, which seems to connect the parathyroids with calcium metabolism. A parathyroid hormone was isolated by LB. CoIIip in 1926. The function of the thymus gland was first investigated by Friedleben ! (1858) but the effects of its excision or of the injection of its extracts are still obscure. Felix Platter and Kopp described early cases of thymus death in infants. The Status lymphaticus was first sketched out by Richard Bright (1838) and more fully described by Paltauf (1889). Henderson got retarded atrophy of the gland on castration (1904), and Paton found that thymectomy increases the growth of the testes. The first emperiment in physiological surgery upon human beings was made by the gynecologist, Robert Battey who excised the normal healthy ovaries for the relief of neurotic and non-mensturating women (1872).   The rationale of this operation, in relation to a supposed internal secretion from a specialized set of ovarian cells, has since been justified in many remarkable ways, particularly in osteomalacia and by the experiments of Starling and Lane-Claypon, which show that section of the mammary nerves or of the spinal cord in rabbits does not produce the inhibitory effect of Battey's operation upon pregnancy of lactation. The relation of the Leydig cells in the testis to internal secretion is sub judice, the most significant experiments so far being those of Browa« Seuquard (1898-91) and Poehl (1896-7) upon the injection of testicular extracts. In the last thirty years, attention has centered upon the pituitary body. Fatal excisions of the gland in animals had been made by Marinesco (1892), Vassale and Secchi (1834), and others, but Nicholas Paulesco of Bucharest was the ftnt to point out that removal of the anterior lobe is fatal and removal of the posterior lobe negative (1908). Meanwhile Mohr had described obesity with pituitary tumor (1840) Pierre Marie had shown the relation of the pituitary to acromegaly and gigantism (1886), Froblich described pituitary tumor with obesity and sexual infantilism and Harvey Cushing and his associates at the Johns Hopkins Hospital actually produced an experimental pathologic reversion to the Frohlich syndrome by partial excision of the anterior lobe in adult dogs (1908). Simmonds described pitutitary dwarfism (anterior lobe deficiency 1914-18). Hutchinson and Gilford, Progeria (1904), and H.M. Evans showed the effect of anterior lobe extract upon interruption or prevention of the costrus. Cushing has shown that the anterior lobe secretion influences normal growth and sexual development, while the posterior lobe has to do with metabolism of carbohydrates and fats, the high tolerance of sugars in posterior lobe insuffciency yielding to treatment with pituitary extract. Cushing and his pupils have also shown the relation of the hypophysis to diabetes insipidus (1912) and hibernation (1913). Cushing visualizes the pituitary as conductor of the endocrine orchestra and notes that the Roentgen ray and the- rat have done most for it.   That the internal secretions control the configuration of the body and are the activators of emotion is emphasized in the writings oi" W.B. Gannon (1914-16) G.W. Crile (1915) L.F. Barker and others.Popular treatises,, professing to diagnose character in prominent persons from endocrine data after the manner of phrenologist or of fortune-tellers' books, have tended to damage the theory latterly.The doctrine of the correlation of the different internal secretions has been expecially emphasized by the Viennese clinicians, Hand Eppinger W. Falta, and C. Rudinger (1908-9) Eppinger and Leo Hess have also applied the ideas of GaskelL Langley, and Sherrington as to the opposing functions of the iwo "autonomics" of the sympathetic system in the elucidation of the complex mechanism of physiological equilibrium and of isceral neurology (1910). They postuate two opposing diathetic conditions vagotonus and sympthicotonus, described in 1892 by S. Solis Cohen as "vaso-motor ataxia" the semeiology of which can be thrown into relief by certain phramacodynamic tests. These Have been likened to 'tuning keys by means of which we can operate upon the complicated stringed instrument of the body, and voluntarily make on string tighter to increase its vibrations, or another loose to dampen its function'. Eppinger and Hess also assume that the pancreas secretes a hormone, "automomin" which antagonizes adrenalin, the hormone governing the sympathetic autonomic. While much of this is in dispute, it seems probable that the chemical hormones act via the blood upon the central nervous system, while the opposing autonomics of the sympathetic system control the ductless glands and the visceral organs made up of smooth (involuntary) muscle.The most eminent physiogical chemist of recent times was Emil Fischer (1852-1919) of Euskirchen, Rhenish Prussia who was sucessively professor chemistry at Munich (1879), Erlangen (1882) Wurzburg ( 1885), and Berlin (1892) .Fischer discovered, isolated, and formulated a host of new substances, such as Phenylhydrazin (1875), which Abderhalden calls "the pathfinder of carbohydrate chemistry', the aliphatic hydrazins (1875-77) Mannose, isomaliose and the synthetic drugs veronal (1902), proponal (1905) saiodin (1905), and elarson (1913). He made vast resarches in the synthesis of the purin compounds, including caffein xanthin, theobromine (1879-1906); and developed a "family tree" of gout, demonstrating the purin nucleus as a sort of germ-plasm common to all the metabolic products of the disease. He synthetized and supplied structural formulae for most of the sugar groups (1883-1919), including the six hexoses derived from mannitol, hexose from formaldehyde, and fourteen out of the sixteen possible isomeric aldohexoses predicted by Von't Hoff tand Le Bel; and, in his studies of the polypeptides (1899-1906), he linked together great chains of aminoacid substances (eventually 18 in all) to form these compounds, which are essential parts of the different protein molecule.Fisheher oevised quantitative methods for isolating arnino-acids, and demonstrated an amino (NH,) nucleus common to all the proteins. His investigations of the enzymes (1884-1919) show that they are specific in action (1894-5), affecting only certain chemical substances, to which as he puts it, they are related as a key to a lock or a glove to a hand an analogy which Ehrlich cleverly applied in this side-chain theory. A brilliant stroke of genius was Fischer's deliberate attempt to produce a reliable hypnotic, ending in the synthesis of veronal (1904). His last researches covered the depsides and tannin substances. During the war, he displayed phenomenal energy in furthering the manufacture of synthetic subsitutes for nitrogenous products, animal fats and food-stuffs, No chemist of modern times better deserved honor of the Noble prize, which he received in 1902.Emil Abderhalden, of St. Gall, Switzerland, a pupil of Bunge  and  Emil  Fischer and professor of Physiology a Berne  1908) and Halle (1911), is the author of a bibliography of alcoholism (1897) and a text-book of physiological chemistry (1908). He edited a Handbook of Biochemic Technic (1909-10) , to which he added many new procedures, another great Handbook of methods in Biological Investigation (1921-27), of which 24 volumes have been published, Biochemical Dictionary (1911) a book on nutrition (1917) and a text book of physiology (1924). He has made a vast number of investigations of Metabolism and food- stuffs, adopting Carl Ludwig's method of publishing his researches in collaboratioti with his many pupils. His special fields are the integration and disintegration of albuminoids and nucleic acids in the animal body, the protective ferments (1909-12), the metabolism of the cell (1911), the synthesis of its Bausteine (1912), and synthesis of artificial food-stuffs, as tried out experimentally upon animals. In 1916 (with Fodor) he surpassed Emil Fischer by building up a polypeptide containing 19 amino-acids. He holds that the individual cells of animal and vegetable foods are made up a number of chemical or phasic units which, in digestion and metabolism, are split up and transformed into other substances, to be assimilated by the body cells, according to their needs. In studying the protective ferments of the animal body Abderhalden evolved biochemical test for pregnancy and other conditions by a ferment reaction (1912). His contributions to the technic and methodology of biochemistry are of vast extent.The leading spirit of a recent pathology is Ludwig Aschoff Orth and Recklinghausen, stems directly from Virchow, and through   his   own   pupils,   Tawara,   Kiyono,   Suzuki,   Ogata,Kawamura, has carried the Virchow tradition into Japan. A great systematist and philosopher, Aschoff strove to bring order and system into the bewildering complex of pathological reasoning and through his work on pyelonephritis (1893) the different modalities of appendicits (1908) thrombosis (1912), atherosclerosis (1908-14) phthisis (1922), his own treatises (1900-1909) and his other monographs, on ovulation and menstruation, chclesterin gallstones,gastric ulcer, goiter, and fatty degeneration, has done much to stimulate thought and open out new views. His synthesis of the reticulo-endothelial system resembles Waldeyers' summation of the neuron theory (1891) in its orderly tendency, as also his classification of disease-reactions Viz., functional (recreative reaction), deficiency (regenerative reaction), destructive (reparatory reaction), infective (defensive reaction i.e, inflammation). He set the pace and posed the problems for German pathological work on war material of which he has left enduring monuments in the eighth volume of the German medical History of the war (1921) and the gigantic exhibitions of war specimens in the Kaiser Wilhelms Institute and his own Institue at Freiburg. The contributions of his school to Ziegler's Beitrage (1906-28) cover all aspects of pathology.
Among the outstanding pathologists of the newer trend are : Felix archand (1846-1928) of Leipzing, memorable for his work on inflammation and healing of wounds (1890-1921) and clasmatocytes (1901); Paul Grawitz professor at Griefswak (aberrant hypernephroma, (1883-84); infantile jaundice 1883 subcutaneous inflammation, 1887 suppuration, (1887-89); slumbe cells (1891-92); Hans Chiari (1851-1916) of Vienna (post-morten technic, 1894); history of pathology; Pio Foa (1848-1923). the leading pathologist of Italy and Nicolaus Philip Tendeloo o1 Celebes (pulmonary diseases, 1902; tubercolosis (1905-23); James Ewing, of Pitts burgh (Clinical Pathology of blood, 1900-13, neoplastic disease 1919); Frank Burr Mallory (1892) ol Cleveland, Ohio (endothelial Leukocytes, 1898-1926; histopathology, 1914) Eugene Lindsay Opie of Staunton, Virginia pancreatic diabetes, 1899-1902; influenza, pnuemonia, (1917-19) Aldred Scott Warthin, of Greensburg, Indiana (Pathology of hemolymph glands, hematopoietic system, syphilis mustrad gas poisoning); Edward B. Krumbhaar of Philadelphia (heart-block (1910 -17) leucopenia in mustard gas poisoning, 1919; reticulosis 1922; hematopoietic system, 1923 neutrophilic leucocytosis, 1924);
Milton Charles Winternitz, of Baltimore, Professor of Pathology at Yale (influenza 1919); war gas poisoning 1919) Wiliian George Macoallism (1874) of Dunnville, Ontario (Tetany, 1908; pancreatic diabetes, 1909; pneumonia 1918) Simeon Burt Woibach of Grand Island, Nebraska (Rocky mountain fever, typhus fever, influenza) Horat Oertel, Oscar Klotz, of Preston, Ontario (arteriosclerosis, 1912; Yellow fever 1928) Dorothy Reed (Hodgkins' disease 1902), and Maude Eabbott (Malformations of heart, 1908-27), The world War found the medical personnel of armies deficient in pathologists. The foundation of such newer penodoicals as the Bologna Archivio (1922) the Paris Annales (1924) the Copenhagen Acta (1924) Krankheits-Forschung (Tendeloo, Leipzig, 1925) the American Journal of Pathology (F.B. Mallory, 1925), and the Chicago Archives (Ludwig Hektoen 1926) illustrates the recent trend toward orgainsation and system. The collection and preparations of pathological specimens from the world war in the Army Medical Museum (Washington) is due to the stead, fast efforts of Louis B. Wilson and the officers subsequently detailed to this work viz , Majors George R. Callender and James F. Coupal. This renaissance of patholgoy is in striking contrast with its deploarabl;e status during the World War, when few surgeons competent to conduct a postmortem section could be found.
Parasitology and Chemotherapy :- In the last decade of the 19th century as a result of the many improvements in microscopic and bacteriological technic, physicians began to study the animal and vegetable, and particularly the protozone parasites as causes of disease, but the greatest triumphs in this field belong to the 20th century.The first group of parasitic diseases to be investigated was that of protozon dysenteries the pathogens of which had been seen by Lambl (1860) by Lewis (1870) and by Loesch (1875) who made drawings of both innocuous and pathogenic forms, with the latter of which he was able to infect dogs.    The greatest single monograph on dysentery is that of J.J. Woodward (1879), who saw the Loesch amoeba, but did not sense its significance, Koch (1883) and Kartuiis (1886-91) in Egypt, found amoeba to be invariably present in dysenteric postmortems, even of liver abscess and differentiated between endemic dysentery due to amoeba, and epidemic dysentry due to bacteria. Osier confirmed this at the Johns Hopkins Hospital (1890) the term "amoebic dysentary was introduced by W.T. Councilman and U.S. Lafleur at the Johns Hopkins Hospital (1891) two types of parasites being recognized the harmless Amoeba coil, and the pathogenic Ameoba dysenterioe.The symptoms of hook worm infection were vaguely outlined hi the Egyptian Papyri and for centuries the disease was variously known as Egyptian or tropical chlorosis miner's or bricklayer's anemia and St. Gothard tunnel disease. The parasite was described as Anchylostoma duodenale by Angelo Dubini (1843) and its causal relation to the disease was pointed by Wilhelm Griesinger (1866). In 1900 Captain Bailey K. Ashferd, U.S. Army , discovered the great prevalence of the disease in Porto Rico, and it was soon found to be very common among the rural population of the southern States (U.S) by Charles Wardell Stiles, of Spring Valley, New York who discovered that the parasite of the American infections is a new species which he called Uneinaria americana (1902) and later Necatcr Americamis.The trypanosomes discovered by David Gruby (3809-98) in the frog (1843) and by Lewis in the rat (1878) were nonpathogenic, but a new interest in these organisms was awakened when Griffith Evans (1880) discovered in India that surra, a disease of horses, mules camels and cattle, is caused by a variety which was afterward named by Steel and Crook-shank. Trypanosoma evansi (3 885-86). The words "amoebiasis" and "trypanosomiasis" were coined by W.E. Musgrave, Another remarkable organism was found in 1900 by Sir William Boog Leisemen (1865-1926) in a postmortem film from a case of fever at Dum Dum near Caluctta, and afterward described by him (May, 1903) as possibly a trypanosome. In July, 1903, Major C. Donovan found the same bodies in blood taken in life from splenic punctures.Parasitology owes much of its present status to medical etomology.  Sir Ronald  Ross  of the  Indian  Medical  Service (1881-99) located the anopheles Mosquito as the vector of malarial fever, discovered the Laveran plasmodia in the stomach wall of Anopheles which has fed upon the blood of malarial patients (1897), proved that the spores of the parasites are concentrated in the salivary gland of the insect (1898) and devised the culicidal methods (1902) which he employed with success in mosquito reduction is Sierra Leono, Lagos, the Gold Coast and Ismailia (1899-1902). For this work, which led, to effective prevention of malarial fever all over the world, Ross received the Nobel prize in 1902. In mathematics, he has applied the theory of probabilities to the statistical prognosis of epidemics ("a Priori Pathometry", 1916) His plays, poems and autobiography (1923) are the productions of a highly original mind.
Important advances in Protozoology were made by Frit?, Schaudinn (doctor's degree in zoology in Berlin in 1894) and after some studies of the Foraminifera, devoted the rest of his life to the Protozoa.As a descriptive zoologist, he isolated many new species but his first important contribution to medicine was the differentiation between the harmless Entamoeba coli and the Pathogenic Entamoeba histolytica (1903). In addition to his work on amoebic dysentry, which he carried out experimentally upon animals, Schaudinn confirmed the work of Ross and Grassi upon the malarial parasite, identifying Plasmodium vivax (Grassi and Feletti) as the cause of tertian fever (1902) and also confirmed Looss's demonstration of hook-worm infection through the skin (1904).
Paal Ehrlich (1854-1915) of Strehlen, Silesia, a clinical assistant of Frerichs (1878-85) and Gerhardt (1885-89) and professor (1890) at Berlin, where he became an assistant in Koch's Institute, was entrusted (1896) with the director ship of the newly founded Institute fur Serumforschung at Steglitz, which was tranferred, under his direction, to the Institute fur expehmente'le Therapie at Frankfort on the Main (1899).He did the most effective work since Pasteur and Koch in the science of infectious diseases, and added new territory to the domain experimental pharmacology and therapeutics by his genius for research and his wonderful industry.
The trend of recent medicine from the bacterial theory of disease toward the biochemical is strongly marked in Ehrlich's work. The fallibility of the many test for differentiating the psuedo-typhoid, pseudo-tubercle, psuedo-tetanus, and psuedo-diphtheritic bacilli, the variability in pathogenic status of fixed laboratory strains of definite bacilli, the uncertain behaviour of the typhiod bacillus as to fermentation on a sugar slope (Twort 1907) the puzzling mutations and pleomorphisms, such as Neisser (1906), Jacobson (1910) and Penfold (1911) produced in the typhoid and coli germs, the apparent changes of one bacillus into another, the effect of meterological conditions on inulin fermentation, that strange vagaries of agglutination and of Wassermann tests, all show the inadequacy of our present knowledge.
In the face of the bewildering array of laboratory finding which Rudolf Hoeber has assembled in his impressive monograph on the physical chemistry of the cell (1902), we really know very little of intracellular chemistry and metabolism. Nothing daunted, professional bacteriologists have taken comforts in the fact that bacteria, like certain major diseases, have existed and maintained their salient characteristics from remote period of time, when the great dinosaurs and reptiles of the Mesozoic  Era were  infected with very modern specific infections and prehistoric man himself was assailed by arthritis deformans and tubercle Bacteriology is now a highly organised science of immense practical efficiency, and two of its phase, environmental bacteriology and persona? bacteriology, are basic is sanitation. Another phase, the taxonomic, has been a word of ambition among recent workers, who have clearly sensed the necessity of a complete revision of existing schemes of classification (determinative bacteriology).
One of the last and best of the noble line of the Indian Medical Service is Lieut-Col. Robert Mc. Carrison who entered the service in 1901, and was on almost continual duty in India, latterly at the Pastur Institute at Coonoor, In 1906, he described the three day fever endemic in Upper India since 1895, which is probably identical with Dalmatian Pappataci fever. He is further distinguished by his investigations of the infectious endemic gioter of Kashmir the thyroid gland, beriberi and other deficiency diseases particularly the remarkable degenerative changes in the viscera and general lowering of digestive capacity produced by vitamin-B or C deficiency anterior to beriberi or scurvy. This is one of the most significant contributions to the role of nutrition in preventive medicine.
Recent surgery owes much of William Conrad Rontgen,who got by accident some rays passing through most substances; the soft part of the body in particular, revealing the bones of his hand which he modestly called as the "new x-rays", but medical world apprehended their usefulness in medicine and surgery named them as "Rontengen Rays". He was awarded Nobel Prize in the very beginning of the 20th century and became world famous. He was one of the noblest and greatest men of these generation.
There were many great Surgeons* but we are not mentioning them here, except Alezis Carrel, who had revolutionized the surgery of the vascular system and made great advances in physiology and physiological surgery, for which he became a Nobel Prizeman in 1912. In 1902, he published his first paper on vascular anastomoses and visceral transplantation, which he showed that perfect end-to-end anastomosis of blood-vessels can be secured by inserting in the opposing ends a triple-threaded suture, which, when drawn tightly, converts the round iumen of the vessel into an equilateral triangle thus securing closet apposition, without leakage, preserving the continuity of the lumen, and so avoiding thrombosis. Before Carrel's time a wounded artery was treated only be ligation in continuity. From end-to-end anastomosis of arteries, to the substitution of a lost piece of an artery by pieces of artery or vien, and thence to the transplantation of organs from animal to animal. Thus, he has transplanted a kidney with its vascular supply, from cat to cat, secretion of urine beginning before the end of the operation, and this feat not oniy,prdved successful in man, but has been extended to other viscera also. Transplantations in mass of blood-vessels, organs, viscera, and limbs have been also successful.
Carrel's investigations of the latent life of arteries led to the preservation of portions of blood vessles in cold storage for days or weeks before using them in transplantation. Latterly, he has applied the principle of R.G. Harrison's experinem on extra vital cultivation of nervecells (1907-14) to the extravita! cultivation and rejuvenation of tissues, culminating in his remarkable experiment of keeping the excised viscera of an animal alive and functioning physiologically in vitro (1912) He has also succeeded in activating and acclerating the growth of connective tissue by dressings of thyroidal splenic, embryonic and other animal extracts (1913) He has isolated tissue cells in pure cultures and developed technical methods by which these strains can be kept indefinitely in an active condition outside the body.Internal medicine, in its recent phases, harks back to the two main trends of Greek medicine, the Coan and the Cnidian on the one hand, the time-honored Hippocratic reliance on the natural powers on the mind and the five senses in diagnosis (without which the physician is nothing), revision of semeiology (Mackenzie), simple lines of therapy, merging, on the extreme left, into such extravagances of general (Humoral) pathology as the doctrine that there is only one disease, the rest turning upon imbalance" of protective substances in the blood plasma (syzygiology); on the other hand, an almost bewildering array of laboratory tests, instrumentation, specialism, etilogical theorizing, improvisation of sera and vaccines or vagaries of protein of protein theraphy, which tend to merge bedside medicine into the ancillary devices it utilizes to enslave the mind of the physicien by making him dependent upon artificial aids and, in extremes to turn the patient himself into a laboratory animal. Between the two lies the Golden Mean, the via media followed by all practitioners of sound sense, ripe judgement and varied experience. It has been well said that no same man today could read all the current literature on any medical speciality and retain his reason. The actual advances made are those which have stood the acid tests of experience and practical application.
In diagnosis apart from the biochemical methods and blood tests of Folin, Van Slyke and others, the methods of estimating the sedimentation rate of erythrocytes devised by Fahraeus (1918-21), Linzemeier (1920) Westergren (1921), Katz (1922) Zeckwer and Goodell (1925) are of little positive value and most of the functional tests are prognostic. The tests for renal function comprise all phases of urinalysis, including total nitrogen residual nitrogen; provocative polyuria, total urea provocative urea elimination, renal test-meals, methylene-blue indigo-carmine, phenosulphonephthalein, benzoic acid (Kingsbury and Swanson, 1921), blood-cholesterol and bloodchlorides. Cryoscopy and the ambard coefficient are now little used by comparison with these test which afford indices of the functional capacity of the kidney in renal and cardia disease. Pregnancy, and surgical conditions, analogous to the information given by the indicator diagram on a steam-engine. In diabetes and the glycosurias, the tests of Benedict for urinary sugar, of Frommer and Rothera for acetone bodies, of Van Slyke for total acetone bodies, of Sorenson, Sellard Van slyke for acidosis and ketosis, with those of Haldane and Priestley and Fredericia for alveolar C02 tension are commonly employed, while insulin (Banting and Best 1922) as being the main coefficient in sugar metabolism, has thrown much light upon carbohydrate tolerance. The test of pancreatic function include those of Loewi, Wohlgemuth (urinary, diastase) and Cammidge. Hepatic function is estimated by such tests as those of Ehrlich, Schlesinger, Fouchet and Van den Bergh for bile-pigments (Urine and blood), levulose -tolerence (Straues 1901) indican, galactose, coagulation time fibrinogen content fibrinolysis time, blood lipase; hemoclasia are leucocytosis after meals; the phenoltetrachlorphthalein test for global eliminative capacity and duodenal dratinage of bile by the method of Meltzer and Lyon.
In gastroenterology, much is due to Rontgenography, to the Coolidge lube, to W.B. Cannon who introduced the bismuth meal in animals to Holzknecht, Haudek and Groedel, who popularised the use of the fluorescent screen and made the first effective serial plates of the stomach in man to A.F. Hurst who made X-ray studies of defecation and constipation to Biggert who studied the stomach and bowel with bismuth meal and bismuth enema, to Weber, who introduced pneumoperitoneum and to E,A. Graham and W.H. Cole, who devised Rontgenography of the gall bladder. The important studies of Cannon and Washburn on hunger contractions in connection with gastric pain, of Anton J. Carlson on the nature of hunger-contractions, Mann and Whipple on exclusion of the 1 ver and extrahepatic secretion of bile, of Boyden Mann and Higg.ns on the mechanism of evacuation of the gall-bladder the discovery of the sphincter of the common bile-duct and the introduction of non-surgical drainage of the gall¬bladder by S.G. Meltzer and Lyon are among the brilliant achievements  of recent Americans which  include  the  scientists like C. Eggieston and C. Hatcher on the action of emetics and the mechanism of vo iting, of J.T. Case on intestinal stasis of W.C. Alvarez on the mechanism of gastrointestinal peristalsis and of A.C. Ivy on the physiology of gastric secretion. In 1905, W.J. Mayo shewed that duodenal ulcer is ten times more frequent than gastric ulcer, the significance of the pyloric vein in differential diagnosis and perfected the technic of its treatment by gastro-enterostomy, Duodenal intubation with the small tube is associated with the name of Einhorn, fractional intubation of the stomach with that of Rehfuss. The principal diatetic schemes for gastirc ulcer are those of Lcube Lenhartz, Lambert and Sippy. The story of recent developments in gastro-enterology has been effectively conveyed by Walter C. Alvarez.
Tests of gastric function include the test-meals of Iwald (1890) and Rehfuss (1914), X-ray examination (Cannon, 1898) and detection of blood in the faces. The pharmacologic tests for vagotonia and sympathicotonia are still sub judice.
Two main currents of recent therapeutics are purposeful dietetics (nutritional therapy) and protein therapy.The work of the metabolists, Eijkmann (1897), Henriques Hansen (1905), Hopkins (1906-12), Funk (1911), McColIum, Davi et all (1911-18), Osborne and Mendal (1912-15) Goldberger (1915-20) Mccarrison (1921-7) on the deficiency diseases has shown conclusively that a monotone diet, lacking in the proper accessory food factors (vitamins) will produce grave pathological effects in the viscera, the nervous system the sexual apparatus, and other parts of the body which may get beyond control if allowed to go too far.Dietetics, one of the basic principles of Hippocratic therapy, has therefore, come into its own again. In the artificial life of city people, the adjustments of the body to food are as delicate and dubious as those in the new born infant. Forced fasting and "girth control" in persons other-wise "plump and p!easing"tend to toxic urine, constipation, and worse things, McCarrison has recently produced goiter and vesical calculus by an experimental diet in rats (1927). Carlson's fasting Italian (zetti) got naught but constipation and leukemia, Horace Fletcher really cultivated constipation and suffered from chronic toxemia and decayed teeth, while his son-in-law died of colonic stasis and malnutrition. William James said of Fleteherism; "It nearly killed me." The Russian famine brought on amenorrhea, sexual importance and exposure to unusual diseases through lowered resistance. Natural savage man has 3 to 4 stools per diem, while the highly concentrated meat and cereal diet of Americans makes for stasis, acidosis and high blood-pressure, as shown in Chinese put up on this diet. The conclusions of McCarrison, McCoIlum and others are that an ideal normal diet would consist of whole wheat millc and milk products, uncooked vegetables, sprouted legumes, fresh n.eats and fruit, with specific avoidence of white bread, tea, s» ^ar, boiled vegetables, margarine, tinned meats and jams, which injure the system through the boric and sulphurous acids and formaldehyde employed as preservatives. The pecuiair diets of tropical, arcti and other natives are probably natural adjustments of individual metabolism to environment.Salient among the recent triumphs of nutritional therapy is the prevention and arrest of goiter by overcoming iodine deficiency.
In 1909-13, David Marine and C.H. Lenhart demonstrated the effect of iodine on goiter in brook-trout and other animals and foilowing the discovery of thyroxin in the thyroid gland by E.C. Kendal! (1914), reduced the incidence of goiter in over 2,000 schoolgirls of the goiter belt by exhibition of small doses of sodium iodide. Similar results were then obtained in the Swiss Cantons by Jt. Kligiser, with a reduction from 87.6 percent to 13.1   per  ceni,   in  St.  Gail.   The   use  of butter-fat  against
Xerophthalmia, Keralomalacia, and Night-blindness of Unhusked rice against adult beriberi and of tiqui tigqui extract against infantile beriberi of cod-liver oil and food irradiated with ultraviolet light against rickets, the uselessness of cooked vegetables and fruits against scurvy are among the advances in vitamin therapy. In 1925, G.H. Whipple and F.S. Robscheit-Robbins showed the beneficial effect of raw beef liver upon blood regeneration in anemia, which was then applied to the treatment of pernicious anemia in practice by G.R. Minot and W.P. Murphy.
The rationale of protein therapy is, roughly speaking "a hair of the dog that bit you", or one disease cures another; but its scientific locus standi is Weigert's law, Viz., that a local injury or necrosis will be usually start reparative processes in excess of requirements (1871-3), or as Pfluger expressed it in 1877, "Injury is the incentive to removal of injury". It includes anything from acupuncture, the seton the moxa, bloodletting, emesis, of blistering up to the treatment of neurosyphilis by super infection with malaria. The theory of the subject grew up around the treatment of bacterial infections with specific sera and vaccines, which were soon found to have a non-specific therapeutic effect in other diseases.
The Nobel prize in medicine for 1911 was awareded to Allvar Gullstrand, of Landskrona, Sweden, Professor of Ophthalmology in the University of Upsala (1894), for his mathematical investigations of dioptrics or the science of the refraction of light through the transparent media of the living eye. As Willard Gibbs founded the chemical theory of hetrogenous substances, so Gullstrand has founded the diotrics of heterogenous media.Formerly, the image in the eye was regarded as a schematic "co-lmer" or point-for-point arrangement, like that studied on the lenses of optical instruments. The course of the rays in astigmatism,  for instance,  was represented by the  diagrammatic Sturm's conoid. Gullstrand took up the study of the ocular image from the view-point of reality, clearly differentiating its actual formation from its optical projection. He showed that the assemblage of rays in Strum.s conoid has not the slightest resemblance to the actual condition in astigmatism. By applying the methods of mathematical physics, especially those of Sir William Rowan Hamilton, he treated the problem as one concerning a set of widely diffused bundles of rays, refracted through a system of continually curving planes, and showed that, during accommodation, the index of refraction of the lens is augmented by an actual change in its structure. His principle works on this theme are his study of astigmatism his General Theory of Monochromatic Aberrations, and his essays on dioptrics of the crystalline lens and the real optic image. In 1889, he introduced a practical method of estimating corneal astigmatism by a single observation,an advantage possessed by a single instrument, the Sutcliffe ophthalmometer. In 1892, he introduced a photographic method of locating a paralyzed ocular muscle. He also introduced a rnicrometric method of estimating the photographed corneal reflex, as giving the most exact knowledge of the form of the normal and diseased cornea. His work in this field is not unlike Burdon-Sanderson's photographic determinations of reaction time in muscle. In 1907, he showed that the yellow color of the macula in the retina is a cadaveric phenomenon, not existing in life; and, as above stated, he discovered the intracapcular mechanism of accomadation. He also devised the reflexless stationary ophthalmoscope which excludes all light not belonging to the ophthalmoscopic image, and is thus free from all reflections from the mirror or the eye itself, giving a better image, better sterioscopic effect, and a wider filed of vision. He has invented corrective glasses with a spherical lenses for those operated on for cataract, which give cleaner cut and more luminous images, with wider range or vision, than sphercial lenses .
Two prominent innovaiioos in Eye surgery of recent times have been made by officers of the Indian Medical Service. The operation of extraction of cataract within the capsule was introduced by Lint-Colonel Henry Smith in 5900, and his success with it has ben remarkable. As a benefactor of human-kind, he is known all over northern India, where the reflection of the pitiless sunlight from the dusty plains tells with terrific force upon the eyes of the natives. His clinics at Jullundgr and Amritsar in the Punjab, are frequented not only by Stream of blind p#0ples coming by every mode of travel, but by making the pupil perform the operation before him.He averages about 3000 extractions a year, and by 1910, he had 24,000 to his credit, of which 20,000 were done by the intracapsular method. Another new operation, that of sclerocornea! trephining for glaucoma, was introduced by Major Robert Henry EHiot, I.M.S, in August, 1909. The operation of Van Graefe had held the field for half a century, Lagrange and Herbert had emphasized the value of sclerectomy, and even corneal trephining had been essayed by Argyll Robertson, Blanco, Frohlich, and Freeland Fergus, but Elliot has made the operation his own by many improvements and has made it viable. Latterly, diathermy and protein therapy have proved effective weapons in the management of diseases of the eye.
In the field Otology Robert Barany, of Vienna. Privatdocent at the University, has done much to clear up the hazy subject of aural vertigo, or Meniere's disease, especially in differentiating it from allied or adjacent lesions in the cerebellum, from epilepsy, or from ordinary nystagmus.
Labyrinthine vertigo or"Vestibuiar nystagmus" is interpreted by Barany as a disturbance of function of the vestibular nerve or the organs to which it is distributed, and he has traced its origin to a large number of different causes with which it might be confused- He has introduced a number of ingenious differentia! tests, such as production of nystagmus by irrigation of the external meatus with coid or warm water (caloric test) or by having a patient try to point at an object with his eyes shut after having previously touched it (static test), and he has been able to prove his case successful operations on the cerebellum or the internal ear, He has also devised a "noise machine" for testing paracusis Willisii and other diagnostic novelties.
There rise of modern epidemiology is associated with William Farr's article on vital statistics (1837) and his subsequent letters on causes of death in England (1839-70), which stimulated activity in the Statististical Society of London (founded 1834) and led to the foundation of the Epidemiological Society (August 1850), by Babington, Brodie, Simon, Southwood, Smith, Mnrchison and other leading spirits of the time.The most important advances of recent years was the foundation of the institute for Geschichte der Medizin at Leipzing in 1905, under the direction of Karl Sudhoff, for whom a special chair of the subject was created in the University (1905), This Institute and its publications are supported by a special endowment of 500,000 marks left for this purpose by the widow of the late Professor Theodor Puschmann, and in accepting the directorship Professor Sudhoff stipulated that a separate home for the new speciality should be erected. Karl Sudhoff, of Frankfort on the Main, who had practised medicine for many years before this event, and is entirely self-taught in medical history, began his studies with his important investigations of Paracelsus (including a thorough study of the Paracelsus manuscripts), started in 1876, and published 1887-99, which are still authoritative. He has written exhaustive and scholarly monographs on the iatromathematicians of the 15th and 16th centuries .(1902), manuscript and other 15th century medical illustrations (1907), the early history of anatomical illustration German medical incunabula (1908), the Greek papyri of the Alexandrian Period (3909). In addition to these researches, all of the highest order, Sudhoff has published a host of a minor investigations of value, particularly in the Archiv fur Geschichte der medizin, which he founded in 1908. He has made many of the rarer medical texts accessible to German readers through his Klassiker der medizin, a series of inexpensive reprints which, in style and format, are like Ostwald's well-known editions of scientific classics. His method of investigation was a new departure. With the financial resources at his command, he has travelled far and wide in search of rare or unprinted medical manuscripts and illustrations in the European libraries, private and public, and by photographing these and collating them, he has been able to apply the inductive method with signal ability in bringing out may new facts, settling disputed points", ^nd exploding much of the traditional Papierwissenschaft which has been slavishly accepted to date. Thus he has shown, by collation of unprinted manuscripts, that up to Vesalius, the textual illustration of anatomy was for centuries based upon sevile tradition and almost devoid of any sings of original observation. No one has written more effectively upon anotomical illustration since Choulant. Sudhoff has also developed the whole science of the Lasstafelkunst, against which Paracelsus brayed with such obscene vigor in his Liber Paragranum (1859), and, during this research, he discovered the first medical publication to be set in type Gutenberg's purgation calendar of 1457, in the Bibliotheque nationale in Paris. His philological researches on the Alexandrian papyri(1909) throw much light on the status of Egyptian medicine in this period, and his later investigations of the early history of syphilis (1912-26), which we have already described, furnished a formidable argument against the theory of the Amercian origin of the disease. His path-breaking study of medieval surgery was completed in 1918. He had revised Pagal's Einfuhrung, in addition to a beautifully illustrated survey of medical history of his own (with Meyer-Steingg) has published a hisroy of dentistry, an anthology of pediatric incunabula, books on Cos and Cnidos, prehistoric German medicine had has collaborated with Arnold Klebs in a study    of the existing incunabula on plague. He has also added much to our knowledge of the advancement of state medicine during the Middle Ages. His original investigations and reproductions of the medieval writings on leprosy, plague and syphilis including the preventive ordinances, go far beyond the labours of Haeser in this field. To look through his wonderful catalogue of the Dresden Historical Exhibit is to realize how little one knows about the history of hygiene. His vast reading gives him an insight into medieval medicine such as is possessed by no other living man, and his conversation alone is said to be an inspiration to his pupils. Sudhoff believes that classical philogists who have exhausted the possibilities of the secular literature of Greece and Rome, should try their teeth on the older medical writings and help to elucidate them. His exhaustive study of the German medical incunabula supplements and completes the work of choulant, and was a forerunner of the movement, started in Berlin, to get up an international catalogue of all the incunabula in public and private libraries, in order to decide the many unsettled points as to time, place of publication and authorship.
These details, though concise, may look repeating of common knowledge and beyond the limits in this book; it is true. But we have given this as a stimulator for the Siddha medical historians. We have left out some of the important improvements of the modern age In such subjects as "Diversion of mind" "Division of man into body and mind; The materialistic outlook of medicine; The different schools of physiology; Vitalism; the illness of the mind and their treatment; the medical investigation of hypnotism; views the subconscious; the treatment of insanity; reform in treatment of insanity; convulsive therapy,, leucotomy; psycho-somatic medicine: the basic urges of the unconscious mind; the psycho-somatic view of the illness: the popularity of the quack; their treatment in the Middle Ages; Quacks enjoy Royal Patronage; Kinghted Quacks; the Beauty Specialists etc., in 1923, the League of Nations established its Health 16Organization and also made certain arrangements for attacking specified diseases on a world-wide scale. The central governing body of this Organization was the Health Committee, composed of twelve members, plus certain "expert assessors" or individual men and women nominated by the League itself. Under this supervising Health Committee there worked a secretariat, a staff of experts, and a number of sub-committees dealing with special problems, such as malaria, cancer and housing, The second World War brought to an end all of these League of Nation's activities.
The Story of world co-operation in "health problems starts again in the year 1946 when a preliminary International Conference was held in New York at which a constitution for a World Health Organization was drawn up. The Constitution given to this World Health Organization (W.H.O. for short) shows great breadth of vision on the part of those who devised it. Health was defined as "a state of complete physical, mental and sound well-being, and not merely the absence of disease of infirmity". The preamble to the Constitution also stated that "the enjoyment of the highest attainable standard of health, is one of the fundamental rights of every human being, without distinction of race, religion, political belief, economic or social condition".This broad statement was amplified later and the actuai work of the W.H.O. brought to a clearer focus. It function was declared to be to promote maternal and child welfare, and to help to improve mental health, and more especially those aspects of mental health on which harmony between human beings depend. Another part of its aims was "to promote in co-operation with other specilised agencies... the improvement of nutrition, housing, sanitation recreation, economic or working conditions, and other aspects of environmental hygiene... It was also to study and report,Orf. administration and social technique, affecting public health*. and medical care  from preventive  and curative points  of view, including hospital services and social security". The W.H.O. has its headquarters in the Palais des Nations, built to house the former League of Nations on the shores of Lake Leman. It is governed by a World Health Assembly which meets annually and which, theoretically at any rate, includes representatives from seventy-nine nations. Already the W.H.O. has accomplished much for world health. It has sent representatives into the backward countries and has assisted these countries to deal more satisfactorily with their urgent health problems. It has, for example, sent medical commissions into Asia to make frontal attacks on malaria, yaws and venereal diseases. Since the discovery of penicillin and the sulphonamide drugs, the last two of these three diseases can be brought much more quickly under control than was formerly possible and the various commissions not only supply what is required in the way of drugs and equipment but instruct the native inhabitant in their use. Much also has been done for maternal and child welfare by the W.H.O. and this has brought into prominence yet another world problem, that cause by over population. The steep fall in infant mortality which has taken place both in Asia and in Africa has aggravated a problem which has long existed in these continents, that of insufficient food supply for the growing population.
The W.H.O., is a body of immense importance to mankind, and not solely because of the valuable work it is doing in matters of health. The W.H.O. is one of man's earliest attempts to co-operate on a world scale and whether it will succeed or whether it will fail and have to be abandoned is still very uncertain, It was very fortunate in its first Director General, Dr. Brock Chisholm, a man of wide vision. His breadth of view is revealed by the inspiraing message which is handed to each new member of the secretariat as he takes office, a message full of meaning for others besides newcomers to the W.H.O."We must think and act in terms of mankind as a whole. We must be ready to give up old ideas, certainties and in order to place the welfare all people every-where on the same level of values, regardless of where on this little earth one happens to have been born himself. In other words, we must try to attain an equal degree of loyality to all membes of the world community, irrespective of race, religion, and colour, and any other group characteristics,This does not mean that you will be asked to change those political, economic, social, or. religious ideas which you consider the best for yourself or your country. But it does mean that in order to discharge your role in this Organization your must acquire an objective view of the differences between the people of the world. You must realize that the various economic, social, religious systems under which the different nations live are various types of experiments, neither inferior nor superior to each other and all thoroughly explained by the historical conditions which created them ..."
In the past man accusiomed himself to living with abs»~*.~ certainties, absolute orthodoxies, extreme forms of nationalism, ruthlessness and intolerance, but if humanity is to survive we must emerge successfully from this primitive stage of evolution. Already there are faint signs of this emergency beginning and the W.H.O. is the chief of these portent. That is why its survival and its growth is of such incalculable importance to humanity.Now, we shall proceed to Ayurveda System closely related with the Siddha system, which is our main subject.